The spine is a basic structure and enables our body to maintain a physiologically correct posture and movement. For us to be able to move freely and undisturbed, it must not only be stable but also mobile. In the case of scoliosis, the spinal column is no longer present in its physiological form.
If you look at the spine from behind, a straight line should be visible. Seen from the side, it has a double S-shape. It is precisely this shape that ensures that it can stabilize the entire skeletal system.
It must withstand compressive, tensile and shearing forces and transfer these to the adjacent bones. If scoliosis is present, the vertebral bodies are twisted towards each other and thus shifted to the side. Such a deformation is possible in all sections of the spine.
When viewed from behind, the spinal column no longer shows a straight line, but rather a concave or convex curvature called scoliosis. Since the ribs are connected to the thoracic vertebrae, the thorax is affected and torn from its shape. In scoliosis, there is a static imbalance which the adjacent structures (cartilage, ligaments, muscles, etc.) try to compensate for. Thus, not only the spine is affected as the starting point, but also the entire body from foot to head.
Physiotherapeutic intervention
The Schroth concept was first developed by Katharina Schroth. The starting point was her own story of suffering from scoliosis. To this day, Schroth’s physiotherapy is used as an effective therapy against scoliosis.
Due to the deformation of the ribs, the lungs cannot expand and inhalation is restricted. Thus, respiratory gymnastics promotes inhalation into a certain region of the lung. The aim of Schroth’s physiotherapy is to stretch the spine out of its static condition.
Schroth uses targeted breathing into the respective cavities/indentations of the existing false statics of the upper body. Depending on which area is affected, this is targeted. This can be achieved by deep breathing in combination with contact of the hands to the desired area.
Due to the contact the patient has a target where he should breathe. By means of certain stretching positions, targeted breathing into the stretched area is promoted. By massaging and stretching the chest and back muscles, an improved mobility of the ribs is induced.
To create even more space for the rib cage, the physiotherapist uses packing grips and lifts a skin fold. This is held for a certain time and the patient breathes into this region again in a targeted manner. Exhalation is also not neglected and is in any case promoted alone or in combination with inhalation.
To deepen the ventilation, the patient breathes in through the nose and out through the mouth. In order to improve the mobility of the thorax and to guide deformed body parts back into correction, mobilizations are important in physiotherapy according to Schroth. This enables the physiotherapist to use mobilizing grips and move these sections into the correct position.
This involves looking not only at the spine, but also at the rest of the body. The posture and position of the head, shoulder girdle, pelvis, legs and feet are observed. It is looked into which planes they are shifted and how they influence each other.
In Schroth’s concept, each part of the body is like a block that should lie perfectly on the next. If this is not the case and several blocks are shifted from each other, all deviations have to be corrected simultaneously so that the blocks lie on top of each other again. At first, the patient remains passive and takes war, where it is moved to.
Immobile structures are mobilized again and held in the right direction. This is conducive to the training of body perception so that the patient has an idea of a physiological posture. In this way, he then tries to adopt and maintain the correct posture without a physiotherapist.
During the active exercise, strength and stability are improved and the physiotherapist can additionally set resistance. Especially the strength is an important factor to hold a position. Weak muscles are activated again and a balance is restored.
With the increase in repetitions and resistance, the patient’s endurance during Schroth physiotherapy is improved. In addition to the spinal section, it is important to always correct the pelvic block as well during Schroth physiotherapy. This can often be involved and can shift with the spinal column.If the pelvis is shifted to the side and the lumbar spine is deformed, both are compensated at the same time.
When the body sections are steered back into the right direction, stretching is helpful in addition to mobilizing grips. In the case of curvature/coliosis, one side is always stretched and the muscles on the other side are shortened. To counteract this shortening, they are put under traction.
If the patient has an increased forward curvature of the thoracic spine, the front muscles (chest and abdomen) are stretched. This makes it easier for the upper body to straighten up. Passive measures are also certain positions that the patient can adopt.
The principle behind this is that deformed parts of the body are supported by cushions and the remaining parts are directed in one direction by gravity. If, as already mentioned, the patient has an increased curvature of the thoracic vertebrae to the back, the thoracic spine section is underlaid and the shoulders are thus directed backwards. This results in a targeted straightening of the upper body.
Other underlaying materials in Schroth’s physiotherapy are pezzi balls on which patients can lie down in a certain position. In Schroth physiotherapy, the weak side is always trained. This is because when a deformation occurs, one side is always used and stressed more.
To counteract the scoliotic posture, the less used side is trained and thus steered in this direction. Let’s take the example again, with the increased curvature of the thoracic spine to the back. This trains the back muscles so that they can pull the torso upright. If the spinal column section is deformed to the left, the muscles on the right side are trained to strengthen them and direct the vertebral bodies.
