Adolescent Scoliosis (Schroth)

Adolescent idiopathic scoliosis (AIS) is a three-dimensional curvature of the spine that develops during the rapid growth phase of adolescence - typically between 10 and 16 years of age. “Idiopathic” means the cause is not known. AIS affects 2-3% of adolescents, with significant curves more common in girls. Schroth therapy - a physiotherapeutic scoliosis-specific exercise (PSSE) approach - is the most evidence-supported form of physiotherapy for AIS and is part of the international standard of care alongside bracing and surgical monitoring.

What is the Schroth method?

The Schroth method is a three-dimensional approach to correcting the postural and muscular asymmetries of scoliosis. It was developed in Germany in the 1920s by Katharina Schroth (who had scoliosis herself) and has been extensively researched since. It is specifically included in the SOSORT (Society on Scoliosis Orthopaedic and Rehabilitation Treatment) international guidelines as a first-line physiotherapy approach.

The principles of Schroth include:

• Three-dimensional correction: exercises are designed to address the lateral deviation, rotation, and sagittal plane changes of the scoliotic spine simultaneously
• Rotational angular breathing (RAB): using breathing to expand the concave side of the rib cage and derotate the spine - a central and unique feature of the Schroth approach
• Postural correction: the patient learns to actively correct their posture in specific positions, and progressively in more functional and dynamic activities
• Muscle activation: targeted strengthening of the muscles that stabilise the spine in the corrected position for long-term stability

Who is Schroth therapy (PSSE) for?

Schroth therapy is most beneficial for adolescents with a confirmed Cobb angle (the standard measurement of scoliosis curve severity) of 10 degrees or greater. Current guidelines suggest:

• Under 20-25 degrees: physiotherapy-specific scoliosis exercises (PSSE, including Schroth) are the primary active treatment, alongside monitoring
• Under 40-45 degrees: bracing (e.g. a TLSO brace, fitted by an orthotist) is typically recommended alongside PSSE
• 40-45 degrees and above, or aggressive progressive curves: surgical consultation is indicated. Physiotherapy still plays a role in pre- and post-surgical conditioning

These thresholds are guides; management decisions are individualised and made by the treating orthopaedic or paediatric spine team.

What does a Schroth session at Goji involve?

The first session is a thorough assessment. Our physiotherapist will review your child’s imaging (X-rays are needed to measure Cobb angle), take a history of when the curve was first identified, what treatment has occurred, and what symptoms - if any - your child experiences. Physical assessment includes:

• Postural assessment: observing the three-dimensional presentation of the curve, including the Adam’s forward bend test
• Mobility and range of motion: spinal and lower limb mobility
• Breathing assessment: chest expansion and ribcage mechanics
• General strength and core/pelvic stability

Schroth exercises are then taught progressively - typically beginning with foundational positions and breathing awareness before progressing to functional and dynamic exercises. Each exercise programme is curve-specific: a right thoracic curve requires a different correction pattern from a left lumbar curve. Sessions are usually 45-60 minutes. The home programme is central to outcomes, and our physiotherapist will ensure your child and family are confident and clear on what to practise between sessions.

Does Schroth therapy prevent surgery?

The evidence supports Schroth therapy as reducing or stabilising the rate of curve progression and, in some cases, reducing the Cobb angle - particularly when started early, during active skeletal growth, and when bracing is also appropriate. It is most effective when sessions and the home programme are done regularly. However, it is not possible to predict for an individual patient whether surgery will ultimately be needed, as every child’s curve progression potential is different. The goal of PSSE and bracing is to maximise the chances of avoiding surgery; it does not guarantee this outcome.

Frequently asked questions

My daughter was just told she has scoliosis at her school screening. What should we do first?

Scoliosis identified at school screening typically needs confirmation with a standing spine X-ray (to measure the Cobb angle) arranged by a medical doctor, spinal specialist, or paediatrician. Once you have the Cobb angle, contact us and we can advise whether physiotherapy is appropriate to start immediately.

My son has a 30-degree curve and has been told to wear a brace. Does he also need Schroth?

Yes - the international guidelines recommend both brace and Schroth for curves in the bracing range. Bracing reduces curve progression by providing passive external correction; Schroth builds the active muscle patterns that maintain correction and support the brace’s effectiveness. The two work together.

Is scoliosis painful in adolescents?

Most adolescents with AIS do not experience significant pain during the growth phase. Pain is more common in adulthood, particularly if curves progressed significantly or were untreated. Some adolescents with rib cage asymmetry or postural strain report back discomfort or fatigue. Physiotherapy can address these symptoms alongside curve management.

How often do Schroth sessions happen?

An intensive initial phase (more frequent sessions to establish the programme) is typically followed by regular review sessions to progress the exercises and check compliance. The frequency depends on the curve severity, growth rate, and how quickly the patient learns. Our physiotherapist will advise on an appropriate schedule after assessment.

Can adults with scoliosis benefit from Schroth?

Yes. While the evidence base is strongest for adolescents during active growth, Schroth-based exercises are used in adults with scoliosis to address pain, posture, and function. The goal shifts from curve reduction to pain management and maintaining spinal function. Goji can offer this for adult patients as well.

My child also wears a brace. Will this affect the Schroth exercises?

Schroth exercises are typically done out of the brace. They build the active muscle patterns that complement the passive correction the brace provides. Our physiotherapist will coordinate the exercise programme with your child’s bracing schedule and advise on timing.