Two CHOC pediatric physical therapists, Ruchi Bagrodia and Adam Shilling, answer questions about the Schroth Method, a physical therapy treatment option for patients with idiopathic scoliosis. The non-invasive approach can improve symptoms and, in some cases, can even prevent the need for surgery. Bagrodia and Shilling are among a limited number of specialists in the nation who are certified in the Schroth Method.
What do you want referring physicians to know about the Schroth Method?
Schroth is a research-supported, conservative treatment method used for individuals with Adolescent Idiopathic Scoliosis. Treatment is provided by physical therapists who have completed a rigorous nine-day course and obtained a Schroth certification. The goals of Schroth treatment are to improve posture, prevent curve progression, decrease the likelihood for surgery, reduce pain, increase body awareness (proprioception) and strengthen the postural muscles.
How does Schroth Method differ from traditional physical therapy? What are the benefits?
physical therapy can be helpful for improving trunk and core strength, range of
motion and pain. However, it usually fails to address the three-dimensional
changes of the trunk caused by an individual’s unique scoliosis.
With Schroth treatment, each person is guided through specific postural corrections to achieve the most optimal spinal position possible as well as strengthening exercises to maintain this posture during everyday activities. The benefits include improved postural alignment and awareness, a more balanced body position, decreased pain, improved efficiency of breathing and increased trunk and core strength.
Is the Schroth Method a new program?
Schroth Method was first developed by Katherina Schroth in Germany in the
1920s. In 1968, the Barcelona Scoliosis Physical Therapy School was founded,
which follows the original Schroth principles, providing three-dimensional treatment
based on breathing and muscle activation. Since then, it has continued to gain
attention worldwide due to successful, research-supported outcomes.
Are there certain types or degrees of scoliosis that the Schroth Method is effective for?
wide range of patients benefit from the Schroth Method. At CHOC, we aim to help
patients stop the progression of their curve and avoid surgery. Treatment can
also be beneficial for those who have already had surgery to improve strength and
body awareness. In addition to looking at curve severity, orthopaedic doctors
and Schroth-certified physical therapists will consider the patient’s age and
skeletal maturity, as these three factors help indicate likelihood of
What does the Schroth Method entail? Is there a typical course of sessions patients can expect?
treatment is designed and progressed based on an individual’s specific
scoliosis. It involves facilitation techniques for elongation and de-rotation
of the spine in different positions, as well as exercises aimed to increase
proprioception (body awareness) and strength of postural muscles.
usually include a brief proprioceptive warm-up followed by postural exercises
to promote elongation and de-rotation of the spine in specific areas. Next, the
patient is challenged to maintain their newly achieved postural alignment
during functional activities and everyday movements, such as getting up off the
floor, standing from a chair or climbing stairs.
individuals would benefit from attending weekly Schroth Physical Therapy for up
to 12 weeks and are also expected to perform a specific home exercise program
at least five days per week to achieve best outcomes.
Can the Schroth Method be used in place of traditional physical therapy? Of other scoliosis treatment?
Schroth Method is specific to treating scoliosis, and not all physical
therapists are Schroth Certified. It involves specialized treatment sessions
with a physical therapist and supports collaboration with a medical team
including the orthopaedic doctor, orthotist and sometimes a psychologist. The
Schroth Method is often used in conjunction with bracing when recommended by an
orthopaedic doctor. In some cases, it can even prevent the need for spine surgery.
What are the outcomes of Schroth Method treatment? How does it differ from outcomes of other physical therapy methods for scoliosis?
The primary outcome measure for those seeking to avoid surgery is a decrease in Cobb Angle, which is measured on X-rays. Additional outcome measures include self-postural alignment, muscle strength and endurance, balance, shoulder range of motion, height, chest circumference, functional lung volume, pain management and quality of life.
An oral antibiotic used to treat leprosy is safe and
well-tolerated in the treatment of children with challenging-to-treat mycobacterium
abscessus infections, the CHOC Children’s infectious
disease team has found.
In their study, clofazimine was given to 27 patients during an outbreak of odontogenic mycobacterial infections as part of a multidrug regimen. Though clofazimine performed well in test-tube experiments against M. abscessus, reports in children were previously limited.
This group of patients represents the highest number of
children to receive clofazimine outside of leprosy treatment settings.
Breastfeeding offers extensive health benefits for moms and
their babies, facilitates bonding and even has financial and environmental
benefits. But with it comes challenges that—for some women—leads to an earlier
end to breastfeeding than planned.
Below is a list of resources providers can share with
breastfeeding patients to help ease worries and frustrations. These articles cover
a range of concerns and provide helpful tips for both mom and baby.
The excitement of breastfeeding can quickly turn to frustration,
discomfort or defeat if issues aren’t dealt with quickly. Encourage breastfeeding
patients to get help from the experts, covered in this CHOC Children’s blog about
consultants and the CHOC Lactation
Spanish language breastfeeding resources
The CHOC Lactation Services team presents several useful flyers about breastfeeding for Spanish-speaking patients:
“Arthritis is something elderly people get,” is something Dr.
Andrew Shulman, CHOC Children’s pediatric
rheumatologist, has heard countless times. People are often surprised to
learn that kids — even toddlers — can develop arthritis.
Joint pain can be a bit of a mystery to most people, especially when it comes to young children. With August being Juvenile Arthritis Awareness Month, we looked to Dr. Shulman to learn more about this and other common juvenile joint pain myths he finds most important for pediatricians to recognize and communicate with patients.
Myth 1: All joint pain is arthritis.
False. If joint pain is the primary symptom, chances are it is not arthritis. The most common initial symptoms of arthritis are persistent swelling, redness, stiffness and limited range of motion.
The type of joint pain that is associated with juvenile
idiopathic arthritis (or JIA — formerly called juvenile rheumatoid arthritis)
is pain in an articular location that is dull, throbbing or sharp and that
improves throughout the day with movement. This pain is commonly exacerbated by
prolonged sitting, naps and specific tasks, and improves with activity and
non-steroidal anti-inflammatory drugs (NSAIDs). Sometimes skin redness is
Myth 2: Arthritis is a precise diagnosis.
False. It is a symptom and a finding, much like a cough is not an official diagnosis. More testing is needed to determine whether or not joint pain is caused by a specific type of arthritis or another rheumatic condition, such as pain from overuse or a neuropathic disorder.
Myth 3: Arthritis is diagnosed with laboratory tests.
False. Labs can be used to characterize arthritis when it is present, but lab work can be totally normal in kids who do have arthritis. Using lab tests alone as a diagnostic tool can lead to a missed diagnosis.
Dr. Shulman urges pediatricians to keep in mind that routine
lab work is more useful initially than specialized tests are. “A complete blood
count (CBC) with differential, chemistry panel, erythrocyte sedimentation rate
(ESR) and c-reactive protein (CRP) tests present more information and are
better initial screening tests than specialized tests such as antibody tests
and complement studies,” he says.
Myth 4: Only elderly people get arthritis.
False. The incidence rate of JIA is one to 10 out of 10,000 per year, making it a more common condition among young people than cystic fibrosis, juvenile diabetes and muscular dystrophy combined.