Schroth Physiotherapy

Scoliosis is a three-dimensional curvature and rotation of the spine. The Schroth method is the best known of a family of approaches called physiotherapeutic scoliosis-specific exercises, or PSSE. Rather than generic stretches, it uses tailored, curve-specific movements combining postural correction, muscle activation, sensorimotor and breathing techniques, aimed at improving posture, trunk control and spinal stability, and at helping the patient hold a more corrected position in daily life. It is taught by a specially trained physiotherapist, usually as supervised sessions plus a daily home programme.

Scoliosis is managed along a spectrum. Small curves are monitored. Larger, progressing curves in growing children may be braced. Very large or progressive curves may reach the point where surgery is considered. Scoliosis-specific exercise sits alongside monitoring and, where used, bracing — it is part of conservative management, not a replacement for it or for surgery when surgery is genuinely indicated. My role is to work out which part of that spectrum a person is on, and Schroth physiotherapy is one of the tools I can draw on for suitable curves, particularly in growing adolescents and for symptom management. It does not "cure" scoliosis, and it is important that expectations are realistic.

The evidence base has strengthened in recent years. A well-conducted, assessor-blinded randomised controlled trial in adolescents with idiopathic scoliosis found that adding supervised Schroth exercises to standard care led to better curve (Cobb angle) outcomes over six months than standard care alone, with a modest but statistically significant difference in the largest curve, and analyses have estimated how many patients need treatment to prevent one curve deteriorating. Broader reviews of scoliosis-specific exercise support a role in reducing curve progression and improving trunk asymmetry in appropriately selected adolescents. The evidence is most developed for supervised programmes with good adherence; benefits depend heavily on the exercises actually being done consistently. It would be dishonest to promise curve reversal — the realistic goals are helping to limit progression, improving posture and trunk control, and supporting confidence.

• Growing adolescents with idiopathic scoliosis under specialist monitoring, where a scoliosis-specific exercise approach is considered appropriate
• People using a brace, where exercise is often used alongside it
• People who want to take an active part in managing their curve and can commit to a regular home programme
• Suitability, and the choice between monitoring, exercise, bracing and surgery, is always decided individually after assessment
• It is not a substitute for surgery where a curve has reached the point at which surgery is genuinely indicated

A Schroth programme involves learning the exercises with a trained physiotherapist and then practising them regularly at home; consistency is the single biggest factor in whether it helps. The approach carries essentially no physical risk, but it does require commitment. The evidence, while supportive, comes largely from studies of adolescents and of supervised programmes, and improvements in the curve tend to be modest rather than dramatic. As a surgeon, I see it as a valuable, low-risk part of conservative care for the right person — and I will always be honest about when a curve has moved beyond what exercise can influence, and when a surgical opinion is the appropriate next step.

• —Schreiber S et al. Schroth physiotherapeutic scoliosis-specific exercises added to standard care lead to better Cobb angle outcomes in adolescents with idiopathic scoliosis — a randomised controlled trial. (PMC5198985)
• —Schreiber S et al. Schroth PSSE for adolescent idiopathic scoliosis: number needed to treat to prevent one deterioration — RCT (SOSORT 2017 Award). (PubMed 29164179)
• —Physiotherapeutic scoliosis-specific exercise methodologies: an extended literature review. (PMC9368145)
• —SOSORT — Management of spinal deformities and evidence of treatment effectiveness. (PMC5759105)