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.
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| 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.
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| 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.
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| 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!
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| Dr. Rigo's homemade paella |
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
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| 3C Classification |
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| 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!
Warmly,
Kelly Grimes, DPT, OCS
kelly@movementlinks.com
Beautiful and well written! Nora :-)
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