camaralaura92@gmail.com

Laura Dayane Câmara do Nascimento*

laura.daiane2020@gmail.com

Eloíze Freitas de Lima*

eloizefreitas090@gmail.com

Ana Júlia de Freitas Cassimiro**

ajfcassimiro@gmail.com

Mariana Rosado Maia Jales+

014500257@prof.uninassau.edu.br

Roque Ribeiro da Silva Júnior++

roquejunior@alu.uern.br

*Graduanda em Fisioterapia

Centro Universitário Mauricio de Nassau (UNINASSAU)

**Graduada em fisioterapia pela Universidade Potiguar (UnP)

Pós-graduada em Dor Aguda e Crônica

do sistema musculoesquelético (Faculdade Vanguarda-SP)

Formação Completa em Reabilitação da ATM

e pós-operatório bucomaxilofacial (Biasottospinato)

Formação completa em Pilates (Voll Pilates Group)

Formações complementares em Liberação Miofascial e Instrumental,

Dry Needling, Teleatendimento Músculoesquelético,

Terapia Manual Ortopédica

+Mestra em Saúde e Sociedade

pelo Programa de Pós-Graduação em Saúde e Sociedade

Universidade do Estado do Rio Grande do Norte (UERN)

Pós-graduação Lato Sensu em Fisioterapia Onco-Funcional

pela Faculdade Redentor - RJ

Bacharel em Fisioterapia pela Universidade Católica de Pernambuco (UNICAP)

Formação Completa em Fisioterapia em Oftalmologia

(Avaliação, Tratamentos, Pré e Pós Operatório)

pelo Cursos Avançar - CE

Formação Profissional no Método Pilates

pela Metacorpus Studio Pilates

Formação Complementar em Reeducação Postural Global - RPG

pelo Instituto Philippe Souchard

Atua como fisioterapeuta na Liga Mossoroense

de Estudos e Combate ao Câncer (LMECC)

Docente na UNINASSAU

++Mestre em Saúde e Sociedade

pela Universidade do Estado do Rio Grande do Norte (UERN)

Especialista em Fisiologia Humana

pela Universidade Estadual do Ceará (UECE)

Especialista em Fisioterapia Traumato-Ortopédica

pela Faculdade Venda Nova do Imigrante (FAVENI)

Bacharel em Fisioterapia pela Faculdade do Vale Jaguaribe (FVJ)

Professor EMI e Coordenador do Curso de Massoterapia

pelo Instituto Centro de Ensino Tecnológico (CENTEC)

na EEEP Vereador José Batista Filho - Alto Santo, CE

(Brasil)

Reception: 08/12/2023 - Acceptance: 11/27/2023

1st Review: 09/29/2023 - 2nd Review: 11/22/2023

Accessible document. Law N° 26.653. WCAG 2.0

Suggested reference: Câmara, L. dos S., Nascimento, L.D.C. dos, Lima, E.F. de, Cassimiro, A.J. de F., Jales, M.R.M., & Silva Júnior, R.R. da (2024). Assessment of the Effects of the Schroth Method in Individuals with Idiopathic Scoliosis. A Systematic Review. Lecturas: Educación Física y Deportes, 28(310), 181-196. https://doi.org/10.46642/efd.v28i310.7172

 

Abstract

    Introduction: Scoliosis is a spinal deformity characterized by lateral deviation in an "S" shape. It can manifest in various regions of the vertebral column, with a higher incidence observed in the thoracic and lumbar regions. Scoliosis encompasses several distinct etiological categories, including congenital, neuromuscular, degenerative, and idiopathic forms. Objective: This study aims to investigate the impact of the Schroth method on the degree of spinal curvature in individuals diagnosed with idiopathic scoliosis. Methodology: This research comprises a systematic review conducted via comprehensive searches in the PubMed, BVS, and PEDro databases from February to May 2023. The search strategy incorporated the keywords "idiopathic scoliosis" and "exercise," employing Boolean operators to combine search terms. The inclusion criteria encompassed randomized clinical trials involving individuals aged 12 to 17 years with idiopathic scoliosis who received therapeutic intervention utilizing the Schroth method. The primary outcome measure focused on the amelioration of spinal curvature. The methodological quality of the included studies was assessed using the Risk of Bias tool. Results: Four clinical trials met the inclusion criteria, with methodological risk assessment yielding three articles categorized as low risk and one article classified as moderate risk. The collective sample size across these trials averaged 185 participants who underwent treatment with the Schroth method. Conclusions: The Schroth Method represents an efficacious treatment modality, particularly when employed in conjunction with other therapeutic modalities, such as orthotic vests or three-dimensionais approaches. The existing evidence substantiates its effectiveness in mitigating the progression of idiopathic scoliosis.

    Keywords: Scoliosis. Physical therapy modalities. Therapeutics.

 

Resumen

    Introducción: La escoliosis es una deformidad de columna caracterizada por una desviación lateral en forma de "S". Puede manifestarse en diversas regiones de la columna, sobre todo en torácica y lumbar. Existen varias categorías etiológicas como la congénita, neuromuscular, degenerativa e idiopática. Objetivo: Investigar el impacto del método Schroth en el grado de curvatura espinal en personas diagnosticadas con escoliosis idiopática. Metodología: Revisión sistemática mediante búsquedas exhaustivas en bases de datos PubMed, BVS y PEDro de febrero a mayo de 2023. La estrategia de búsqueda incorporó las palabras clave "idiopathic scoliosis" y "Schroth", empleando operadores booleanos para combinar términos. Los criterios de inclusión abarcaron ensayos clínicos aleatorios en los que participaron personas de 12 a 17 años con escoliosis idiopática que recibieron intervención terapéutica utilizando el método Schroth. La medida de resultado primario se centró en la mejora de la curvatura de columna. La calidad metodológica de los estudios incluidos se evaluó mediante la herramienta Riesgo de sesgo. Resultados: Cuatro ensayos clínicos cumplieron con los criterios de inclusión, y la evaluación metodológica del riesgo arrojó tres artículos categorizados como de bajo riesgo y un artículo clasificado como de riesgo moderado. El tamaño de la muestra colectiva en estos ensayos promedió 185 participantes que se sometieron a tratamiento con el método Schroth. Conclusiones: El Método Schroth representa una modalidad de tratamiento eficaz, particularmente cuando se emplea junto con otras modalidades terapéuticas, como chalecos ortopédicos o enfoques tridimensionales. La evidencia existente corrobora su eficacia para mitigar la progresión de la escoliosis idiopática.

    Palabras clave: Escoliosis. Modalidades de fisioterapia. Terapia.

 

Resumo

    Introdução: A escoliose é uma deformidade da coluna vertebral caracterizada por desvio lateral em formato de “S”. Pode se manifestar em diversas regiões da coluna, principalmente nas regiões torácica e lombar. Existem várias categorias etiológicas incluindo formas congênitas, neuromusculares, degenerativas e idiopáticas. Objetivo: Investigar o impacto do método Schroth no grau de curvatura da coluna vertebral em indivíduos com diagnóstico de escoliose idiopática. Metodologia: Esta pesquisa compreende uma revisão sistemática realizada por meio de buscas abrangentes nas bases de dados PubMed, BVS e PEDro de fevereiro a maio de 2023. A estratégia de busca incorporou as palavras-chave "escoliose idiopática" e "Schroth", empregando operadores booleanos para combinar os termos. Os critérios de inclusão abrangeram ensaios clínicos randomizados envolvendo indivíduos de 12 a 17 anos com escoliose idiopática que receberam intervenção terapêutica pelo método de Schroth. A medida de resultado primário focou na melhora da curvatura da coluna vertebral. A qualidade metodológica dos estudos incluídos foi avaliada por meio da ferramenta Risk of Bias. Resultados: Quatro ensaios clínicos preencheram os critérios de inclusão, com avaliação metodológica de risco rendendo três artigos categorizados como baixo risco e um artigo classificado como risco moderado. O tamanho da amostra coletiva nesses ensaios foi em média de 185 participantes submetidos ao tratamento com o método Schroth. Conclusões: O Método Schroth representa uma modalidade de tratamento eficaz, principalmente quando empregado em conjunto com outras modalidades terapêuticas, como coletes ortopédicos ou abordagens tridimensionais. A evidência existente comprova a sua eficácia na mitigação da progressão da escoliose idiopática.

    Unitermos: Escoliose. Modalidades de fisioterapia. Terapêutica.

 

Lecturas: Educación Física y Deportes, Vol. 28, Núm. 310, Mar. (2024)

---

 

Introduction 

 

    Scoliosis is a spinal condition characterized by a lateral deviation that results in an "S" shaped appearance. This deviation can impact various sections of the spine, but it was most observed in the upper (thoracic) and lower back (lumbar) regions (Weiss, & Moramarco, 2016). The condition can arise from different causes, including congenital factors (present from birth), neuromuscular issues (related to neurological or muscular conditions), degenerative changes (due to aging-related wear and tear), and idiopathic origins (unknown cause). (Kuznia, Hernandez, & Lee, 2020)

 

    Idiopathic scoliosis is marked by specific signs and symptoms, including an abnormal lateral curvature of the spine that may be noticeable when standing, pelvic tilting, uneven shoulder heights, rib cage deformity, and differing leg lengths. These signs might become more pronounced when leaning forward. (Trobisch, Suess, & Schwab, 2010)

 

    Furthermore, scoliosis can lead to back pain, especially when the spine is subjected to repetitive strain. This discomfort can be described as a sensation of heaviness, pressure, or tension (Dimitrijevic et al., 2022a). In certain cases, it can also result in muscle fatigue on the back, neck, and shoulders. Mobility and balance might be affected, especially in severe instances. In rare occurrences, scoliosis can lead to neurological complications, with symptoms such as numbness, tingling, muscle weakness, and even urinary and fecal incontinence. (Sheehan, & Grayhack, 2017)

 

    The diagnosis of scoliosis starts with a thorough physical evaluation and a comprehensive medical history review of the patient. During the physical assessment, healthcare professionals observe body alignment, leg symmetry and length, and shoulder blade angles. The primary diagnostic tool for assessing scoliosis is radiography, which measures the curvature of the spine using the Cobb angle. (Horne, 2014)

 

    In addition, the Adams test can be conducted during the physical examination to assess scoliosis: the individual clasps their hands in front of their body while the examiner checks for any abnormal curvature of the spine (Vialle et al., 2023). If a deviation is observed, the examiner can measure the curve's angle using a tool like a goniometer. The Adams test is useful for detecting scoliosis early on or when the curvature isn't evident during a standard physical assessment. (Yilmaz et al., 2020)

 

    The Schroth Method is a three-dimensional physiotherapy program employed for treating scoliosis and other spinal deformities. Originating in the 1920s, the method was developed by German physiotherapist Katharina Schroth, who had scoliosis herself and created the approach to address her own deformity (Weiss, 2011). A key aspect of the Schroth Method involves using three-dimensional imagery to help patients comprehend and visualize their own spinal curvature. The goal is to teach individuals to maintain proper spinal alignment even during daily activities. (Dimitrijevic et al., 2022b)

 

    This method encompasses a variety of exercises tailored to the patient's specific spinal curvature and individual needs. Common exercises within the Schroth Method include three-dimensional breathing, which train the patients to expand their rib cages in all directions, including backward, thereby enhancing posture and spinal mobility (Romano et al., 2012). Axial stretching, performed while lying down, aims to elongate the spine and increase intervertebral space. Rotation correction instructs patients to contract specific spinal muscles to address spinal rotation. Lateral stretching aims to stretch the entire spinal musculature, while standing exercises teach patients to maintain proper spinal alignment during day-to-day activities such as walking, stair climbing, and lifting objects. (Marya et al., 2022)

 

    For the Schroth Method to be implemented safely and effectively, it's crucial for the treatment to be administered under the guidance of a physiotherapist specialized in Schroth techniques. Each patient should receive a personalized program based on their specific spinal curvature and unique needs. (Shakil, Iqbal, & Al-Ghadir, 2014)

 

    Because the Schroth Method involves exercise-based techniques, it is relatively easy to apply and accessible for patients. Nonetheless, there remains a limited understanding of both the specific method itself and idiopathic scoliosis.

 

    The aim of the present study was to investigate the effect of the Schroth method on the degrees of spinal curvature in individuals with idiopathic scoliosis.

 

Methodology 

 

Method 

 

    This is a systematic review using the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines developed by Page et al. (2020).

 

Period and databases 

 

    National Library of Medicine (PubMed), Virtual Health Library (BVS) and Physiotherapy Evidence Databases (PEDro), from February to May 2023.

 

Search strategy 

 

    The descriptors of this research consider the controlled vocabulary for indexing Medical Subject articles Headings (MeSH) and Health Sciences Descriptors (DeCs), the following descriptors were chosen: scollis idiopatica and schrolth. When necessary, boolean operators of the “AND” type was used. The combination scoliosis was used and Schroth on the Pubmed platform, in turn, on the PEDro platform adolescent was used idiopathic scoliosis.

 

Medline via PubMed	#1 "Scoliosis" [Mesh] OR (Musculoskeletal Diseases) OR (Bone Diseases) OR (Spinal Diseases) OR (Spinal Curvatures)  #2 "Exercise" [Mesh] OR (Exercises) OR (Physical Activity) OR (Activities, Physical) OR (Activity, Physical) OR (Physical Activities) OR (Exercise, Physical) OR (Exercises, Physical) OR (Physical Exercise) OR (Physical Exercises) OR (Acute Exercise) OR (Acute Exercises) OR (Exercise, Acute) OR (Exercises, Acute) OR (Exercise, Isometric) OR (Exercises, Isometric) OR (Isometric Exercises) OR (Isometric Exercise) OR (Exercise, Aerobic) OR (Aerobic Exercise) OR (Aerobic Exercises) OR (Exercises, Aerobic) OR (Exercise Training) OR (Exercise Trainings) OR (Training, Exercise) OR (Trainings, Exercise) #3 (randomized controlled trial[pt] OR controlled clinical trial[pt] OR randomized controlled trials[mh] OR random allocation[mh] OR double-blind method[mh] OR single- blind method[mh] OR clinical trial[pt] OR clinical trials[mh] OR ("clinical trial"[tw]) OR ((singl*[tw] OR doubl*[tw] OR trebl*[tw] OR tripl*[tw]) AND (mask*[tw] OR blind*[tw])) OR ("latin square"[tw]) OR placebos[mh] OR placebo*[tw] OR random*[tw] OR research design[mh:noexp] OR follow-up studies[mh] OR prospective studies[mh] OR cross-over studies[mh] OR control*[tw] OR prospectiv*[tw] OR volunteer*[tw]) NOT (animal[mh] NOT human[mh])
PEDro	#1 "Scoliosis" OR (Musculoskeletal Diseases) OR (Bone Diseases) OR (Spinal Diseases) OR (Spinal Curvatures)  #2 (Exercise) OR (Exercises) OR (Physical Activity) OR (Activities, Physical) OR (Activity, Physical) OR (Physical Activities) OR (Exercise, Physical) OR (Exercises, Physical) OR (Physical Exercise) OR (Physical Exercises) OR (Acute Exercise) OR (Acute Exercises) OR (Exercise, Acute) OR (Exercises, Acute) OR (Exercise, Isometric) OR (Exercises, Isometric) OR (Isometric Exercises) OR (Isometric Exercise) OR (Exercise, Aerobic) OR (Aerobic Exercise) OR (Aerobic Exercises) OR (Exercises, Aerobic) OR (Exercise Training) OR (Exercise Trainings) OR (Training, Exercise) OR (Trainings, Exercise)
BVS	#1 "Scoliosis" OR (Musculoskeletal Diseases) OR (Bone Diseases) OR (Spinal Diseases) OR (Spinal Curvatures)  #2 (Exercise) OR (Exercises) OR (Physical Activity) OR (Activities, Physical) OR (Activity, Physical) OR (Physical Activities) OR (Exercise, Physical) OR (Exercises, Physical) OR (Physical Exercise) OR (Physical Exercises) OR (Acute Exercise) OR (Acute Exercises) OR (Exercise, Acute) OR (Exercises, Acute) OR (Exercise, Isometric) OR (Exercises, Isometric) OR (Isometric Exercises) OR (Isometric Exercise) OR (Exercise, Aerobic) OR (Aerobic Exercise) OR (Aerobic Exercises) OR (Exercises, Aerobic) OR (Exercise Training) OR (Exercise Trainings) OR (Training, Exercise) OR (Trainings, Exercise)

Source: Authors

 

Inclusion and exclusion criteria 

 

    Studies with patients diagnosed with severe idiopathic scoliosis who underwent randomized clinical trials (RCTs) using the Schroth method as their therapeutic intervention and whose primary outcome was a reduction in degree of curvature were included because they are relevant to the proposed theme. It excluded people such as adults or even the elderly; people with obesity were also excluded. Our search was carried out in English, and articles published between 2014 and 2023 were selected.

 

Selection of articles 

 

    The survey was carried out between March and May on the following platforms: Pubmed, BVS and Pedro. After a high-sensitivity database search, articles were selected using Rayyan QCRI. The technical review of the journal was divided into two stages. The first stage had two reviewers, and in the event of disagreement between them, the article was transferred to the second stage. In the event of disagreement between reviewers, a third reviewer would evaluate the article and decide whether it should be included.

 

Methodological quality assessment 

 

    The assessment grid was performed using Risk of Bias 2.0 (RoB 2.0), a method for assessing the methodological quality of randomized controlled trials provided by the Cochrane Collaboration in 2016. RoB 2.0 can be classified as having a high-risk bias, a moderate- risk bias or a low-risk bias.Should these requirements be classified as high risk of bias and interventions with misallocation,absence or low relevance of interventions; consequences of lack of data; in turn, moderate risk of bias is the process of randomizing individuals with little clarity and lack of attention to statistical errors of types 1 and 2. and finally classifies it as low risk of bias as it is a clinical trial with slight or no methodological changes.

 

Results 

 

    A total of 231 articles were initially identified across the PubMed, BVS, and PEDro platforms. Of these, 191 journals were excluded due to duplication between the databases consulted in this study. Consequently, a total of 40 studies remained for evaluation. These 40 articles underwent a rigorous analysis to determine their eligibility based on the criteria established in the methodology. Following this screening process, 12 studies met the established eligibility criteria. Subsequently, these 12 studies underwent a methodological bias assessment, resulting in the exclusion of those classified as having a high risk of bias. In the end, four articles were deemed eligible and included in the research findings. See the flowchart below.

 

Source: Authors

 

    Journals are reviewed and categorized based on their titles, publication years, authors, locations, objectives, methodologies, methodological evaluations using RoB 2.0, and key findings.

 

    Four (4) articles were included, published between 2015 and 2023, thereby focusing on the past decade. These studies were conducted in clinics, university hospitals, or at participants' homes, and being foreign research, they were presented in English. The articles primarily examine Schroth method programs aimed at adolescents with idiopathic scoliosis. In terms of research categories, they fall under the clinical trial type, with the core aim of understanding the impact of Schroth exercises.

 

    The studies collectively involved a significant number of participants. The study carried out by Moawd et al. (2023) investigated the effects of combining the Schroth method with the Gensingen orthosis over six months, focusing on the Cobb angle, axial trunk rotation and lung function in adolescents with idiopathic scoliosis. The study involved 42 adolescents, aged 10 to 18, of both sexes. The results indicated that the combined exercise program had a positive correlation with improved quality of life.

 

    In turn, in the clinical trial produced by Kuru et al. (2016), the objective was to compare the effectiveness of three-dimensional (3D) Schroth exercises in treating idiopathic scoliosis patients. The study included 51 adolescents, aged 10 to 18, divided into three groups: the first received Schroth's 3D exercises at the clinic, the second undertook them as a home program, and the third served as a control. The clinical exercise group exhibited significant improvement, particularly in spinal deformity (-68.66 mm; P=0.000) and waist asymmetry, while quality of life remained relatively unchanged for both groups.

 

    Schreiber et al. (2019) introduced a Schroth exercise intervention alongside standard treatment, involving 50 adolescents. Despite not exceeding the conventional limit of 5° for improving the Cobb angle, patients noticed better back condition with the Schroth treatment.

 

    Finally, the studies conducted by Schreiber et al. (2016) aimed to evaluate the impact of a six-month Schroth or Physiotherapeutic Scoliosis-Specific Exercises (PSSE) intervention added to standard treatment for patients with AIS. The study covered 50 individuals aged between 10 and 18 years. The results favored Schroth PSSE added to standard treatment, as it was shown to be superior in reducing curve severity compared to standard treatment alone. In summary, the selected articles address the effects and benefits of Schroth Method programs for adolescents with idiopathic scoliosis. Studies reveal the positive impact of combining exercise methods and the potential for improving quality of life and reducing the severity of the curve.

 

1. Title / Year	Combined effect of Schroth method and Gensingen brace on Cobb's angle and pulmonary functions in teenager idiopathic scoliosis: a prospective, single blinded randomized controlled trial - 2023
Authors	Moawd et al.
Objective	Schroth method added to the Gensingen orthosis for six months on Cobb angle, axial trunk rotation and lung function in adolescent idiopathic scoliosis.
Method	Randomized and Randomized Clinical Trial
Risk of Bias Assessment (RoB 2.0)	Some Concerns
Sample	42 male individuals between 10 and 18 years old.
Main findings	Six months of Schroth method added to Gensingen Brace demonstrate favorable results on Cobb angle, thoracic trunk rotation angle, and lung function in adolescent idiopathic scoliosis.
2. Title / Year	The efficacy of three-dimensional Schroth exercises in teenager idiopathic scoliosis: a randomized controlled clinical trial - 2016
Authors	Kuru et al.
Objective	Schroth exercises in patients with adolescent idiopathic scoliosis.
Method	Randomized and Randomized Clinical Trial
Risk of Bias Assessment (RoB 2.0)	Low
Sample	50 adolescent subjects
Main findings	Patients undergoing the Schroth treatment noticed an improvement in the condition of their backs, even though the Cobb angle did not improve beyond the conventionally accepted limit of 5°. Given the very small MID, the perceived improvement in back status is likely due to something other than the Cobb angle. This study justifies the investigation of alternatives to the Cobb angle that may be more relevant for patients.
3. Title / Year	Patients with teenager idiopathic scoliosis perceive positive improvements regardless of change in the Cobb angle - Results from a randomized controlled trial comparing to 6-month Schroth intervention added to standard care and standard care alone. SOSORT 2018 Award winner - 2019
Authors	Schreiber et al.
Objective	To determine the Cobb angle change threshold in adolescents with idiopathic scoliosis (AIS) perceiving improvement in a 6-month randomized controlled trial comparing a Schroth exercise intervention added to standard of care to standard of care alone
Method	Clinical Study
Risk of Bias Assessment (RoB 2.0)	Low
Sample	50 adolescent subjects
Main findings	Patients undergoing the Schroth treatment noticed an improvement in the condition of their backs, even though the Cobb angle did not improve beyond the conventionally accepted limit of 5°. Given the very small MID, the perceived improvement in back status is likely due to something other than the Cobb angle. This study justifies the investigation of alternatives to the Cobb angle that may be more relevant for patients.
4. Title / Year	Schroth physiotherapeutic Scoliosis-Specific Exercises Added I'm the Standard of Care Lead to Better Cobb Angle Outcomes in Adolescents with Idiopathic Scoliosis - an Assessor and Statistician Blinded Randomized Controlled Trial - 2016
Authors	Schreiber et al.
Objective	To determine the effect of a six-month Schroth PSSE intervention added to standard care (experimental group) on Cobb angle compared with standard care alone (control group) in patients with AIS.
Method	Randomized and Randomized Clinical Trial
Risk of Bias Assessment (RoB 2.0)	Low
Sample	50 teenagers between 10 and 17 years old.
Main findings	Schroth PSSE added to standard of care was superior compared to standard of care alone for reducing curve severity in patients with AIS.

Source: Authors

 

    The articles were evaluated for methodological quality using RoB 2.0, as shown in Figure 2 below.

 

Source: Sterne et al. (2019)

 

Discussions 

 

    According to the study conducted by Moawd et al. (2023), the primary objective was to assess the impact of the Schroth method in conjunction with the Gensingen brace over six months on the Cobb angle, axial trunk rotation, and pulmonary function (vital capacity, forced expiratory volume, and maximum voluntary ventilation) in adolescents with idiopathic scoliosis. The study involved 42 male adolescents, aged 10 to 18 years, diagnosed with adolescent idiopathic scoliosis (AIS), who were divided into three groups, labeled A, B, and C. All groups underwent a six-month intervention, carried out seven days a week. Group A received treatment consisting of Schroth exercises combined with the Gensingen brace. Group B underwent only the Gensingen brace intervention, without any other form of treatment, while Group C exclusively performed conventional physiotherapy exercises for scoliosis treatment.

 

    The study's results indicated that Group A achieved a p-value of <0.001 in the ANOVA test compared to the other two groups, concerning the reduction in Cobb angle degrees and axial trunk rotation. This suggests that the combination of the Schroth method with the Gensingen brace resulted in a significant decrease in spinal curvature and axial rotation. Regarding pulmonary function, Group A obtained a p-value of <0.002, once again demonstrating improvements in the previously mentioned respiratory functions when compared to Groups B and C. Therefore, it is evident that the combination of a brace with Schroth method treatment provides benefits related to the reduction of Cobb angle degrees, trunk rotation, and respiratory function.

 

    In agreement with the previously mentioned author and with similar results, the experiments conducted by Kuru et al. (2016) aimed to compare the effectiveness of three-dimensional (3D) Schroth exercises in adolescents with idiopathic scoliosis. The sample included 50 adolescents of both sexes, divided into three groups: Clinic Schroth Treatment Group (CSTG), Home Schroth Treatment Group (HSTG), and Control Group (CG). Scoliosis degrees were assessed using the Cobb angle, and rotation angles were measured using a scoliometer. All groups underwent a six-month treatment period, with four sessions per week. CSTG received Schroth method treatment under professional supervision, HSTG received guidance for at-home training without professional supervision, while CG did not receive any form of treatment or therapy. The results showed a significant decrease in the Cobb angle (-2.53°; P=0.003) and rotation angles (-4.23°; P=0.000) in the CSTG compared to the other study groups.

 

    It is evident that in both studies, groups that received Schroth method treatment demonstrated a significant reduction in spinal curvature. Importantly, in the Moawd et al. (2023) study, the combination of brace use with therapy yielded positive results, whereas in the Kuru et al. (2016) study, Schroth therapy alone also achieved positive results.

 

    Confirming the findings by Kuru et al. (2016), the clinical trial conducted by Schreiber et al. (2019) aimed to evaluate the impact of the Schroth method on adolescent idiopathic scoliosis. The sample consisted of 50 individuals of both sexes, aged 12 to 17 years, who were divided into two groups: Schroth Group (SG) and Control Group (CG). Similar to previous studies, both groups underwent a six-month treatment period, with sessions conducted four times a week. Cobb angles and trunk rotation of the participants were evaluated. The results revealed a statistically significant improvement in the Schroth Group (SG) compared to the Control Group (CG), demonstrating that treatment with Schroth exercises provides superior clinical improvement compared to the control group.

 

    In the same line of reasoning, the experiments conducted by Schreiber et al. (2016) aimed to assess the effect of a six-month Schroth method intervention added to standard treatment (experimental group) compared to standard treatment alone (control group) in adolescent patients with idiopathic scoliosis. The study included 50 individuals aged 10 to 17 years, divided into three groups: Schroth Group (SG), Conventional Physiotherapy Exercise Group (CPEG), and Control Group (CG). All participants underwent a six-month treatment period, with sessions lasting 30 to 45 minutes, conducted seven times a week. During the study, Cobb angles and trunk rotation in adolescents were evaluated. The Schroth Group (SG) exhibited a statistically significant improvement in the Cobb angle compared to the other study groups.

 

    This indicates that Schroth method treatment achieved significant improvements when combined with other physiotherapy techniques, and it also demonstrated improvements compared to conventional physiotherapy techniques (manual therapy and global postural reeducation), as well as the control group. Therefore, it is clear that the Schroth method is a safe and effective alternative when implemented for at least six months of treatment, both in isolation and in combination with other therapeutic techniques.

 

Conclusions 

 

    Schroth Method is an effective treatment alternative with proven evidence, especially when combined with other forms of treatment, such as the use of vests or three-dimensional methods. Research in teens ages 10 to 18 shows how much patients improved during the 6 months of the study, stating the effectiveness of the Schroth exercise added to standard of care was superior compared to standard of care alone for reducing curve severity in patients with idiopathic scoliosis.

 

References 

 

Dimitrijević, V., Šćepanović, T., Jevtić, N., Rašković, B., Milankov, V., Milosević, Z., Ninković, SS, Chockalingam, N., Obradović, B., & Drid, P. (2022a). Application of the Schroth Method in the Treatment of Idiopathic Scoliosis: A Systematic Review and Meta-Analysis. International journal of environmental research and public health, 19(24), 16730. https://doi.org/10.3390/ijerph192416730

 

Dimitrijević, V., Viduka, D., Šćepanović, T., Maksimović, N., Giustino, V., Bianco, A., & Drid, P. (2022b). Effects of Schroth method and core stabilization exercises on idiopathic scoliosis: a systematic review and meta-analysis. European Spine Journal, 31(12), 3500-3511. https://doi.org/10.1007/s00586-022-07407-4

 

Horne, J.P., Flannery, R., & Usman, S. (2014). Adolescent idiopathic scoliosis: diagnosis and management. American family physician, 89(3), 193-198. https://pubmed.ncbi.nlm.nih.gov/24506121/

 

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Lecturas: Educación Física y Deportes, Vol. 28, Núm. 310, Mar. (2024)