Case Studies

Patient Profile

• Age: 35
• Gender: Female
• Relevant Medical History: Diagnosed with Adolescent Idiopathic Scoliosis (AIS) at age 15. The patient has a 23-degree lumbar curve. She was briefly braced as an adolescent but treatment was interrupted after an accident. Pain has gradually increased over the last two years. She has had no other treatments or surgery.
• Presenting Problem: The patient presented with progressively worsening low back pain (LBP) and hip pain. This pain began to limit her ability to participate in daily activities and recreation, including sitting, standing, walking, running, and lifting weights.

Assessment Findings

• Objective Measurements:
  • Range of Motion (ROM): Within normal limits.
  • Muscle Strength: Hip abduction and extension were 5/5.
  • Postural Findings: Noted a left-sided pelvic imbalance and significant hypomobility in the thoracic spine with a posterior-to-anterior (PA) glide test. The patient also showed a right-sided Angle of Trunk Rotation (ATR) of 13 degrees.
• Pain Scale:
  • Pain at rest: 5/10 (constant, unchanging, dull pain).
  • Pain with activity: 8/10.
• Functional Score: The patient’s Modified Oswestry Disability Index score was 16, indicating moderate disability.
• Imaging: No imaging was available at the time of assessment.
• Diagnosis: The diagnosis was moderate right lumbar scoliosis with hypomobility of the thoracic region.

Treatment Plan

• Long-Term Goal: Decrease back pain during sitting, standing, and activity over the course of treatment.
• Short-Term Goal: The patient was to become independent with the setup and performance of Schroth positions.
• Frequency: Twice a week for four weeks.
• Interventions: A combination of E-stim, therapeutic exercise (specifically Schroth Method), therapeutic activity, neuromuscular re-education, and manual therapy.

Progress and Outcomes

The patient attended six of the eight scheduled visits.

• By the second visit, she had already shown improved thoracic spine mobility. She also reported receiving acupuncture treatment, which she felt helped to ease her pain.
• By the fourth visit, she reported that the Schroth exercises were helping to improve her posture.
• By the fifth visit, the patient expressed that the therapy was definitely decreasing her pain and that she was pleased with her progress.
• During the sixth and final visit, she was able to perform exercises that had previously caused pain without any discomfort. The patient was also able to independently perform the Schroth exercises and other activities without back pain.

The patient self-discharged after the sixth visit.

Key Takeaways

This case study highlights several important points:

• Schroth treatment can be an effective, non-surgical method for managing pain related to scoliosis in adults.
• Consistent adherence to a prescribed exercise program, such as the Schroth Method, can lead to significant improvements in posture and a reduction in pain.
• Patients who are engaged in their treatment and perform their exercises consistently are more likely to achieve their goals and see positive results.

Patient Profile

• Age: 35
• Gender: Female
• Relevant Medical History: Diagnosed with Adolescent Idiopathic Scoliosis (AIS) at age 15. The patient has a 23-degree lumbar curve. She was briefly braced as an adolescent but treatment was interrupted after an accident. Pain has gradually increased over the last two years. She has had no other treatments or surgery.
• Presenting Problem: The patient presented with progressively worsening low back pain (LBP) and hip pain. This pain began to limit her ability to participate in daily activities and recreation, including sitting, standing, walking, running, and lifting weights.

Assessment Findings

• Objective Measurements:
  • Range of Motion (ROM): Within normal limits.
  • Muscle Strength: Hip abduction and extension were 5/5.
  • Postural Findings: Noted a left-sided pelvic imbalance and significant hypomobility in the thoracic spine with a posterior-to-anterior (PA) glide test. The patient also showed a right-sided Angle of Trunk Rotation (ATR) of 13 degrees.
• Pain Scale:
  • Pain at rest: 5/10 (constant, unchanging, dull pain).
  • Pain with activity: 8/10.
• Functional Score: The patient’s Modified Oswestry Disability Index score was 16, indicating moderate disability.
• Imaging: No imaging was available at the time of assessment.
• Diagnosis: The diagnosis was moderate right lumbar scoliosis with hypomobility of the thoracic region.

Treatment Plan

• Long-Term Goal: Decrease back pain during sitting, standing, and activity over the course of treatment.
• Short-Term Goal: The patient was to become independent with the setup and performance of Schroth positions.
• Frequency: Twice a week for four weeks.
• Interventions: A combination of E-stim, therapeutic exercise (specifically Schroth Method), therapeutic activity, neuromuscular re-education, and manual therapy.

Progress and Outcomes

The patient attended six of the eight scheduled visits.

• By the second visit, she had already shown improved thoracic spine mobility. She also reported receiving acupuncture treatment, which she felt helped to ease her pain.
• By the fourth visit, she reported that the Schroth exercises were helping to improve her posture.
• By the fifth visit, the patient expressed that the therapy was definitely decreasing her pain and that she was pleased with her progress.
• During the sixth and final visit, she was able to perform exercises that had previously caused pain without any discomfort. The patient was also able to independently perform the Schroth exercises and other activities without back pain.

The patient self-discharged after the sixth visit.

Key Takeaways

This case study highlights several important points:

• Schroth treatment can be an effective, non-surgical method for managing pain related to scoliosis in adults.
• Consistent adherence to a prescribed exercise program, such as the Schroth Method, can lead to significant improvements in posture and a reduction in pain.
• Patients who are engaged in their treatment and perform their exercises consistently are more likely to achieve their goals and see positive results.

Patient Profile

• • Age: 66
  • Gender: Female
  • Relevant Medical History: Diagnosed with Adolescent Idiopathic Scoliosis (AIS) at age 14 and was braced for 22 months. At age 60, imaging showed a 42-degree lumbar curve and a 28-degree thoracic curve. She also has a diagnosis of Grade 1 L5-S1 spondylolisthesis and osteoporosis. Despite chronic low back pain, the patient remained physically active, participating in horseback riding and dance.

Presenting Problem

The patient sought physical therapy for chronic low back and rib pain, and expressed concern about the potential progression of her spinal curvature.

Assessment Findings

• Objective Measurements: Range of motion was within normal limits. She had a right-sided pelvic imbalance, a right thoracic Angle of Trunk Rotation (ATR) of 6 degrees, and a left lumbar ATR of 5 degrees.
• Pain: The patient reported low back and rib pain.
• Diagnoses: Confirmed diagnoses included right thoracic and left lumbar scoliosis with a right pelvic imbalance, Grade 1 L5-S1 spondylolisthesis, and osteoporosis.
• Imaging: Formetric and postural photos were completed, and she had previous radiographic findings.

Treatment Plan

• Long-Term Goal: To decrease back and rib pain during sitting, standing, and physical activity.
• Short-Term Goal: To achieve independence in setting up and performing Schroth-based corrective exercises.
• Frequency: The patient was scheduled for once-weekly sessions over 6 weeks.
• Interventions: Therapeutic exercise (including the Schroth Method), therapeutic activity, neuromuscular re-education, and manual therapy.

Progress and Outcomes

The patient attended 8 of 15 prescribed sessions. She was instructed in Schroth scoliosis-specific exercises and supplementary strengthening routines. She also began using a heel lift for a mild leg length discrepancy and was encouraged to incorporate postural corrections into her daily activities, including dance.

• Independent Exercise: The patient successfully became independent with her Schroth exercises.
• Functional Improvement: She was able to return to dancing with minimal to no back pain.
• Radiographic Changes: After 5 months of consistent practice, a follow-up X-ray showed a significant improvement in her spinal curves:
  • Her thoracic curve reduced from 28 degrees to 21 degrees.
  • Her lumbar curve reduced from 42 degrees to 37 degrees.
  • The Grade 1 spondylolisthesis remained stable.

Key Takeaways

• Schroth principles can be an effective conservative treatment for managing pain and potentially reducing Cobb angles in older adults with Adolescent Idiopathic Scoliosis (AIS), even in the presence of degenerative changes like spondylolisthesis and osteoporosis.
• Patient adherence and the ability to integrate postural corrections into daily life are crucial for the success of treatment. This case demonstrates the importance of consistent exercise practice, which can lead to measurable and lasting improvements.