Case Studies

Patient Profile

• Age: 15
• Gender: Female
• Relevant Medical History: Diagnosed with Adolescent Idiopathic Scoliosis (AIS) at age 14 with 41 degree thoracic curvature

Presenting Problem

The patient sought Schroth exercises to reduce risk of progression of her scoliosis to avoid surgery. She was also fitted for a WCR brace to be worn 17 hours daily to be combined with Schroth exercises. 

Assessment Findings

• Objective Measurements: Range of motion was within normal limits. She had a left-sided pelvic imbalance, a right thoracic Angle of Trunk Rotation (ATR) of 14 degrees, and a left lumbar ATR of 8 degrees.
• Pain: No pain reported by patient
• Diagnosis: Confirmed moderate towards severe right major thoracic scoliosis and minor left lumbar scoliosis, thoracic hypokyphosis, and 1 cm higher left iliac crest
• Imaging: Formetric scan was completed, and she had previous radiographic findings.

Treatment Plan

• Long-Term Goal: Avoid surgery and learn long-term management exercises.
• Short-Term Goal: To achieve independence in setting up and performing Schroth-based corrective exercises.
• Frequency: We started with appointments 2x/week for 3 weeks then transitioned to weekly, bimonthly, and monthly appointments as appropriate.
• Interventions: Scoliosis-specific exercises (Schroth method) performed 30-45 minutes/day, 5-7 days per week combined with 17 hours of WCR brace wear.

Progress and Outcomes

The patient has attended all prescribed sessions to date. She was instructed in Schroth scoliosis-specific exercises and has been compliant with prescribed brace time. She was encouraged to incorporate postural corrections into her daily activities while keeping active with her involvement in track. 

• Independent Exercise: The patient successfully became independent with her Schroth exercises.
• Functional Improvement: She has demonstrated significant improvement with postural awareness and stability with activities of daily living.
• Radiographic Changes: After ~4 months and ~10 months of therapy with brace wear, follow-up X-rays showed a significant improvement and signs of stabilization of her major thoracic curve:
  • 4 months: Thoracic curve reduced from 41 degrees to 36 degrees
  • 10 months: Thoracic curve decreased from 36 degrees to 32 degrees

Key Takeaways

• Schroth principles combined with brace prescription can be an effective conservative treatment for reducing and stabilizing Cobb angles in teenagers with Adolescent Idiopathic Scoliosis (AIS), even with larger curves over a 10 month period.
• Patient adherence, strong family support, 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, brace compliance if prescribed, and daily practice with integration of postural corrections, which can lead to measurable and lasting improvements.

Patient Profile: 

• Patient was diagnosed at 10 years old and was referred to orthopedics by pediatrician
• 12 years old at initial evaluation, premenarche, no family history of scoliosis
• Orthopedics referred to orthotist for daytime cheneau brace and night time providence brace
• She was experiencing pain in the spine and surrounding muscles, and is a dancer and musician.
• Patient Goal: decrease pain and continue playing in band

Assessment Findings:

• ATR 3 Right Thoracic
• ATR 7 Left Lumbar
• Forward posture
• Decreased lordosis
• 4/5 core strength
• Right sided pelvic imbalance
• Hypermobility

Diagnosis: 

• Right thoracic and left lumbar curve with right sided pelvic imbalance.
• Classified as R4C according to Schroth
• 23 deg lumbar
• 17 deg thoracic
• Pelvic imbalance: right
• Risser: 0-1
• Risk of progression calculated at about 55%
• Patient should begin PT treatment, and begin bracing

Treatment Plan:

• She was seen twice a week for 2 months to learn Schroth exercises. Then seen regularly 1x/month for monitoring as growth continued.
• Patient was prescribed 18hr Cheneau bracing and night time Providence bracing by orthotist

Progress and Outcome:

Aug 2024:

• Out of brace xray showing decreased lumbar curve, growth plates still open
• Compliant with HEP and bracing at night, less compliant with daytime brace
• 12 degree upper thoracic curve beginning to develop

Dec 2024:

• Patient’s daytime brace no longer fitting correctly, patient referred to orthotist

Feb 2025:

• Brace adjusted and fitting better
• X-ray showing decreased curve in thoracic and lumbar. 12 deg upper thoracic, 6 degree thoracic, 6 degree lumbar, ATR unchanged

Oct 2025:

• Menarche started, her curve increased to 23 deg in R thoracic spine possibly due to overcorrection and hypermobility. Orthotist consulted. ATR at 5 deg for both thoracic and lumbar.

Jan 2026:

• New brace fabricated due to new curve pattern.
• Patient learning to modify schroth exercises as needed to address the changes from growth and bracing.

Key Takeaways/Learning Points:

• Use of orthotics and schroth exercises together can be effective at decreasing curvature.
• Hypermobility can cause development of upper thoracic curve when braced.
• Even with development of upper thoracic curve, she is still maintaining her curve well below surgical range through growth phases.
• Starting scoliosis interventions at Risser 0 can improve outcomes, allowing time for adaptations as necessary.
• Imaging helps to catch changes relatively quickly.

Patient Profile

• Age: 17
• Gender: Female
• Relevant Medical History: Diagnosed with Adolescent Idiopathic Scoliosis (AIS) at age 15, where her curve was measured at 45° in the thoracic spine and 26° in the lumbar spine. Bracing was not recommended due to growth plates being mostly closed.

Presenting Problem

The patient’s mother was seeking physical therapy for management of the curve, to try and prevent the curve from progressing as she was in surgical range. The patient was less engaged in physical therapy initially and didn’t see the need to address her curve as she had no pain.

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 10 degrees, and a left lumbar ATR of 5 degrees.
• Pain: No pain reported during day to day, but right shoulder blade pain with specific sport activity.
• Diagnoses: Confirmed diagnoses included right thoracic and left lumbar scoliosis with a right pelvic imbalance.
• Imaging: Formetric and x-rays.

Treatment Plan

• Long-Term Goal: To prevent the progression of her curve.
• Short-Term Goal: To achieve independence in setting up and performing Schroth-based corrective exercises.
• To find motivation and her “why” in doing scoliosis specific exercises.
• Frequency: 2x/week for 3 weeks, 1x/week for 2 weeks, Biweekly for 1 month, then every 4-6 months check in
• Interventions: Therapeutic exercise, Physiotherapeutic Scoliosis Specific Exercises (PSSE) (including the Schroth Method), therapeutic activity, neuromuscular re-education, and manual therapy.

Progress and Outcomes

The patient attended 12/12 of her original plan of care, with on-going visits every 4-6 months. She was instructed in Schroth scoliosis-specific exercises and supplementary strengthening routines to address sport specific pains in the right shoulder blade. Pt was also encouraged to integrate her postural corrections while sitting at school all day.

• • Independent Exercise: The patient successfully became independent with her Schroth exercises.
  • Functional Improvement: Pt was able to return to sport specific activity with minimal to no pain in the right shoulder blade.

• Motivation: Pt found her “why” and became motivated and independent with her home exercise program.

• Radiographic Changes: After 6 months of consistent practice, a follow-up X-ray showed an improvement in her spinal curves:
  • Her thoracic curve reduced from 45 degrees to 41 degrees (taking her out of surgical range).
  • Her lumbar curve stayed at 26 degrees.
  • Another 6 month scan was taken after these improvements, which showed the Cobb angles stable at 41/26 degrees respectively.

Key Takeaways

• Schroth principles can be an effective conservative treatment for managing Cobb angles and potentially reducing it, as seen in this case.
• Patient adherence and the ability of the patient to integrate these corrections in day to day activities is vital in achieving desired outcomes.
• In this case specifically, it shows the importance of patient education, time in clinic with specialized therapists, and motivational interviewing to allow the patient to understand the importance of managing their spine.

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.