The school adopted the Schroth principles and the original intensive inpatient rehabilitation exercise program of the Katharina Schroth Clinic in Bad Sobernheim, Germany. As can be seen by the therapeutic approach of each school, and the scientific evidence supporting each school’s method of treatment, each of the seven schools promotes a unique technique and unique exercises. Active Correction by Side-Shift: An alternative treatment for early idiopathic scoliosis, Scoliosis prevention. The arrows represent directional breathing used to fill the collapsed lungs with air and reshape the thorax (b), Diagrammatic depiction of the activation of the iliopsoas muscle in a lumbar scoliosis curve. 79). 2002;91:361–4. De Mauroy JC, Journe A, Gagaliano F, Lecante C, Barral F, Pourret S. The new lyon ART brace versus the historical Lyon brace: a prospective case series of 148 consecutive scoliosis with short time results after 1 year compared with a historical retrospective case series of 100 consecutive scoliosis; SOSORT award 2015 winner. The long-term goals of FITS include decreasing scoliosis, stabilizing the scoliosis (stop curve progression), and improving aesthetics and body function in patients who do not undergo surgery or who are post-operative patients. The Lyon approach uses visualization with mirrors and video to help with curve correction (Fig. 2002;91:357–60. They include the Lyon approach from France, the Katharina Schroth Asklepios approach from Germany, the Scientific Exercise Approach to Scoliosis (SEAS) from Italy, the Barcelona Scoliosis Physical Therapy School approach (BSPTS) from Spain, the Dobomed approach from Poland, the Side Shift approach from the United Kingdom, and the Functional Individual Therapy of Scoliosis approach (FITS) from Poland. Light blue arrows represent trunk elongation with cranial and caudal forces. Cochrane Database Syst Rev., DOI: One of the important aspects of exercising in different positions is that the individual trunk areas are being challenged to work against or with gravity in different positions. The arrows show the direction of breathing and the red markings on the patient’s brace showing the convexities, A physical therapist assists a patient with 3D correctional breathing in the sitting position, while a red elastic band facilitates auto-elongation and auto-correction of the scoliosis curves at the same time as providing resistance against the corrective movements. If a JIS patient requires bracing, only rigid bracing is recommended. Muscle activation is done via specific activation of muscles that can improve the correction, such as the iliopsoas, the quadratus lumborum and erector spinae. Allow your lower back to arch. In recent decades, there has been a call for change among all stakeholders involved in scoliosis management. 2008;135:303–19. Fabian KM, Rożek-Piechura K. Exercise tolerance and selected motor skills in young females with idiopathic scoliosis treated with different physiotherapeutic methods. The Schroth classification system gives the direction of the side deviation and rotation of the main important body blocks (major curves) and a clear orientation for the standardized therapy plan which includes the therapy diagram, exercise-program with home-exercises, and necessary mobilizing technique. Diagnosis and patient evaluation are essential in this model aimed at patient-centered decision-making according to clinical experience, external evidence and the patient’s preference. As with the old Lyon brace, the ARTbrace is adjustable, but many new concepts were used to build the brace: The mathematical basis of the detorsion is the circled helicoid with horizontal circle generator. Blue arrows represent trunk elongation with caudal and cranial forces. While, according to Newton’s Law of Gravity, we can predict where the apple that falls from a tree will land, we cannot similarly predict where a leaf that falls from a tree will land. Preparation for correction: sensory motor balance training, detection and elimination of myofascial tension, which restricts three-plane corrective movements (Figs. Once the best possible correction has been achieved in any specific starting position (the starting positions can vary in accordance with the above described functional types), the subject will be asked to produce muscle tension in order to maintain the correction. In Figs. This also reduces the amount of time needed to practice the highly demanding exercises and allows patients to spend more time in leisure activities and to live a normal life. BSPTS encourages patients to continue living their lives and to pursue normal psychosocial growth and maturation. Moreover, SEAS has a strong modern neurophysiological basis, to reduce requirements for patients and possibly the costs for families linked to the frequency and intensity of treatment and evaluations. Specific exercises performed in the period of brace weaning can avoid loss of correction in Adolescent Idiopathic Scoliosis (AIS) patients: Winner of SOSORT’s 2008 Award for Best Clinical Paper. What Happens After Scoliosis Spinal Fusion? “While doing the exercise, am I able to maintain the correction?”. Patient examination and education include physical examination of the flexibility of the scoliotic spine in functional positions and patient education to help the patient become aware of their deformity (Figs. Kuru T, Yeldan İ, Dereli EE, Özdinçler AR, Dikici F, Çolak İ. 2006;1:6. The Dobomed method employs the use of mirrors, photographs, and video to assist with scoliosis treatment exercises. T – Thoracic block between UEV and LEV of the thoracic curve. In such cases, the chosen brace will be less rigid (Sibilla) and will have to be worn for 18 to 20 h each day until the end of the progressive period (up to Risser stage 3), at which point the patient will be weaned off the brace. Concave rib mobilization to expand and derotate the ribs. Schroth exercises are tailored to your unique curvature of the spine. This reaction cannot be properly invoked unless the patient has been able to train themselves properly. Green half-moons represent areas of expansion of the concavities. Hold for 60 seconds. Rigo M, Weiss HR. 2011;6(1):25. Initially, exercises are performed with the assistance of a physical therapist and then later are performed independently. Hold for 15 to 30 seconds, then switch sides. During complete brace weaning, SEAS teaches ergonomic elements aimed at avoiding spinal damage in adulthood. These abnormalities in the spine, costal-vertebral joints, and the rib cage produce a ‘convex’ and ‘concave’ hemithorax. Breathing movements, and growth and development, are facilitated in the corrective direction by the brace, so time is essential as a corrective principle as well. Pediatr Rehabil. This type of unpredictability also defines the development and progression of scoliosis in an individual. Seated Bicep Curls 6. A patient with a double scoliosis curve seen on radiograph (a) stands in a neutral position (b). (a, b, c, d): Schroth Body Blocks. Negrini S, Aulisa AG, Aulisa L, Circo AB, Claude de Mauroy J, Durmala J, Grivas, TB, Knott P, Kotwicki T, Maruyama T, Minozzi S, O’Brien JP, Papadopoulos D, Rigo M, Rivard CH, Romano M, Wynne JH, Villagrasa M, Weiss HR, Zaina F. 2011 SOSORT guidelines: Orthopaedic and Rehabilitation treatment of idiopathic scoliosis during growth. Repeat radiographs taken in the ARTbrace show a decreased Cobb angle on PA radiograph (b) and an increased kyphosis on lateral radiograph (d), (a, b, c): Radiographic series of patient ‘S’ at one year (b) and two years (c) after brace weaning. Diagram shows the before therapy (a), and after myofascial therapy (b). The Side Shift approach includes principles of the Schroth method and treatment indications as outlined in the 2011 SOSORT guidelines [9]. Begin seated on your heels. Active 3D self-correction with SEAS requires that the patient ask themselves four questions and respond accordingly: While performing SEAS exercises, patients are always told to start from where the spine is in a position of basic support. Designed for severe scoliosis in adolescents, the Sforzesco brace is prescribed for scoliosis curves up to 45°–50° Cobb angle or more if surgery is not an option. Stretch your arms and hands out in front of you. The dark blue arrow pointing upwards from the right elbow represents the shoulder traction, The Schroth prone exercise. The principles of correction follow the global postural alignment and are applied with high intensity forces created inside the body (‘from inside’) involving isometric tensions, expansions and specific breathing. The treatment is individualized depending on the curve type (described in About the method above) and is done only after the individual has achieved their best global postural alignment by organizing the lower extremities, the pelvis and the trunk in the best possible posture. For adolescent idiopathic scoliosis (AIS), 11 to 18 years old, FITS applies principles intended to prevent curve progression before the end of the patient's growth process. Your email address will not be published. Because bone plasticity ends at the end of skeletal growth and bone vertebral deformities are fixed, the primary treatment goal in adults is not to realign the spine and reduce the magnitude of the curve, but rather, to stabilize the spine and prevent further curve progression. Take deep breaths and relax as you feel your back and spine muscles lengthening. The method also includes mobilization and flexibility in the spine and between ribs to enhance joint mobility prior to the exercises. Salvá returned to Spain with a new perspective on scoliosis treatment and founded the Elena Salvá Institute for the conservative treatment of spinal deformities in Barcelona. New York: Praeger; 1985. p. 126–40. The Schroth system of scoliosis curve classification is derived from the Schroth principle of dividing the body into “body blocks” as pictured anatomically (a) and schematically (b). The SEAS method can be used in preparation for bracing (Fig. Physiotherapy is an integral part of the Lyon approach to the management of scoliosis in conjunction with casting and bracing. Breathing exercises are included to improve expansion of the concave side of the curve and derotation of the ribs on the convex side of the curve, helping to improve vital capacity. During the brace-wearing period, modeling exercises to increase brace pressure on the humps as well as muscular endurance strengthening exercises, requiring lumbar lordosis and thoracic kyphosis preservation, are recommended. 78a-b). Thoracic spine mobilization to increase thoracic flexion. Their studies [15–29] demonstrate positive outcomes from use of the Schroth method on back muscle strength, breathing function, pain, quality of life and self-image, slowing curve progression, improving Cobb angles and decreasing the prevalence of surgery. PubMed Central  Place your elbows on a table. (a, b): Corrective breathing exercises in the supine position with a scoliometer, which shows the patient and the physical therapist where the rib expansion is occurring during expiration (a) and inspiration (b), In-brace 3D corrective breathing. While correcting the curve position through trunk shifts, the body is using muscular forces and connective tissue stretches to increase mobility and re-align the soft tissue components of the scoliosis. The patient’s right leg is supported by a stool (in case of 4C/major lumbar scoliosis) and the patient’s right arm is supported on a chair during the exercise. 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