Friday, May 2, 2014

Schroth Method for Scoliosis Management

In February of this year, I traveled to Barcelona, Spain, to attend the Schroth C1 certification course through the Barcelona Scoliosis Physical Therapy School, (BSPTS).
My journey with scoliosis actually started a year and a half prior, in 2011, when my mentor and colleague needed a guest lecturer to pinch hit for an entry level PT program.  I welcomed the opportunity as I had recently learned that I had mild scoliosis myself, and scoliosis was always a clinical presentation that baffled me in school and in my clinical practice. 

In my preparation for that initial lecture, I quickly came across the Schroth method.  I was intrigued from the start, and knew I wanted to learn more.  What struck me was the emphasis on exercise correction specific to the individual’s asymmetry and in 3D, as well as the integration of the corrections into everyday posture and ADLs.

Katharina Schroth
The Schroth method is based on the work of Katharina Schroth, born in Dresden Germany in 1894.  She was diagnosed with scoliosis as an adolescent, underwent brace treatment, and eventually began to develop a method to achieve postural correction on herself. 

            She used the idea of a balloon to envision flattened areas of her ribcage to fill out, and expanded areas to contract.  Mirrors were an integral part of her work, to change her perception of her own posture.  Originally trained in business, Katharina Schroth eventually went back to school to study physiotherapy so that she may begin to treat other patients. 
The method has grown and expanded and is now taught in Germany, Spain, as well as the US, and is expanding to other parts of the world. 

The Schroth- based method as taught by the BSPTS, can be defined as a conservative method aimed at “cognitive, sensory-motor and kinesthetic training to teach the patient to improve his/her scoliosis in 3D posture” and to incorporate this correction into all ADLs.

Muscle cylinder exercise on floor

The 10-day course was taught by Dr. Manuel Rigo, originally trained in the specialties of allergy and clinical immunology, but eventually transitioning to scoliosis, the population he has been managing for the last 30 years.  He is world renowned in the conservative management of scoliosis, and has been teaching the Schroth method since 1989.  Dr. Rigo has a very hands-on approach, working side by side with the physiotherapists who work with him at the Institut Elena Salvá to participate in the exercise instruction and progression.  He fabricates his own braces using the principles of Chêneau and his braces are made in accordance with the Schroth principles of correction.  Dr. Rigo is a brilliant man who is clearly passionate about his craft, yet humble and with a willingness to admit that there is so much still unknown about the etiology and progression of idiopathic scoliosis.

The course was truly an enriching experience for me.  Dr. Rigo launched the course on day 1 with the statement that from that time forward, we were considered family to him.  It is interesting how correct he was, as naturally, spending 10 days of intensive study in a small group away from the additional stresses of family and personal life will create a unique connection among the participants. 
BSPTS C1 Certification Class, February, 2014

We were a group of 12 from 8 different countries (South Africa, Greece, Israel, Bulgaria, Norway, UK, Australia, and the US).  Our experiences with scoliosis leading up to the course were varied as well as our general physiotherapy backgrounds.  I so enjoyed getting to know each person and learn from my classmates and the rich knowledge each brought to the journey we took together.

On the final night, we ate together at Dr. Rigo’s home with his wife, Gloria Quera-Salva, as we indulged in his homemade paella. Delicious!! I can still taste it!

Dr. Rigo's homemade paella

 Major take home messages from the course:
1. The patient with scoliosis has a body schema in the brain that re-enforces the scoliotic posture.  This posture is “correct” for that person.  One of the goals of Schroth treatment is to change the scoliotic body schema in the brain with the postural correction.  Ideally, over time, the correct posture becomes more automaticized and the corrected body schema becomes more dominant in the brain. The problem is not just isolated muscle imbalances but a faulty cortical representation of a particular posture or movement pattern that has become dominant in the individual’s repertoire of movement at some point in life.

2. The 1st principle of correction: Spinal elongation from a stable pelvis in all three planes.  Elongation allows for postural correction in the sagittal, frontal, and transverse plane.

3. The use of body blocks to envision the scoliotic posture is key to the method. It helps classify patients and provides a way to visualize three dimensional nature of the particular individual’s curvature.  From studying the body blocks, appropriate exercises can be developed

3C Classification

Body blocks to visualize 3C Classification
4. Much remains unknown about the etiology and progression of scoliosis. Generalizations can be made, but we must always consider the individual we are managing apart from statistics

5. “Do not create a patient.”, in the words of Dr. Rigo. The clients that we serve with scoliosis are healthy children and adolescents who have an asymmetry in their spine.  Scoliosis does not equal handicap or disability. 

On the last day of the course at one of the breaks, Dr. Rigo came out of his office with a magazine cut out of a women wearing a gorgeous hat with an asymmetry to it’s shape.  He said, “This is how we should view scoliosis.  This hat is asymmetrical, but it is beautiful.”

Thank you to the BSPTS for such an enriching experience! 

Thank you to the many individuals who have given me the courage and support to venture out of my comfort zone and open myself to new experiences!

Kelly Grimes, DPT, OCS