Rehab science grad expands boundaries of scoliosis research

PhD student Sanja Schreiber finds Schroth exercises substantially improve spinal deformity, self-image and muscle endurance while reducing pain in adolescents with idiopathic scoliosis.

Bryan Alary - 02 June 2015

(Edmonton) For most North American children with scoliosis, treatment is a waiting game.

If the S-shaped spinal deformity is mild, observation is the standard prescription to see if the curvature worsens over time. In more moderate cases, children are outfitted with hard plastic braces to halt the progression, which again requires monitoring.

Spinal fusion surgery-straightening the spine by inserting rods, hooks or screws-becomes an option in extreme cases when the spine is bent more than 45 degrees, but the procedure can be painful and comes with a months-long recovery period.

University of Alberta PhD graduate Sanja Schreiber says there's another option to help children and adolescents with idiopathic scoliosis lead healthier lives: the Schroth method. It's a series of exercises popular in Europe but until recently has been greeted with scepticism on this side of the Atlantic.

"I'm hoping this study will open some new doors to get people the treatment they deserve." -Sanja Schreiber, PhD graduate

Schreiber is leading efforts to change those attitudes thanks to her PhD research, which showed the Schroth method helps reduce spinal curvature and pain, improves muscle endurance and helps with body image.

"I'm hoping this study will open some new doors to get people the treatment they deserve.

Not everyone wants to just wait and see what's going to happen with standard treatment," says Schreiber, who on June 5 will receive her PhD in rehabilitation science from the Faculty of Rehabilitation Medicine.

"Patients and parents want to be more proactive. They want something to at least try."

A kinesiologist by background, Schreiber first became interested in using exercise to treat scoliosis while volunteering at a sports medicine centre in her native Serbia. The centre specialized in treating musculoskeletal disorders and spinal deformities such as scoliosis, and seeing several adolescent girls coping with the condition-often going to elaborate lengths to modify clothing to hide their spinal curvature-left a powerful impression.

Schreiber tried treating several girls, first with regular kinesiotherapy exercises and then a form of pilates. Neither had any effect on the spine or pain.

Schroth method, using exercise to treat scoliosis

After learning about the Schroth method, Schreiber decided to complete certification training at the Asklepios Katharina Schroth Klinik, in Bad Sobernheim, Germany. The clinic is named after German Katharina Schroth, who herself suffered from moderate scoliosis and in 1921 designed a series of exercises to help improve her condition.

The method features exercises, stretching and breathing techniques that are customized for each patient based on their spinal curvature. Once certified, Schreiber returned to Serbia and introduced the method to one of her previous patients. It wasn't long before they noticed drastic improvements in both lumbar and thoracic curvature.

"She improved within three to four months. Her doctor couldn't believe the improvement," says Schreiber, who went on to work with many more patients.

Despite its popularity in Europe, the Schroth method hasn't gained widespread acceptance due to a lack of rigorous evidence as to its benefits. Schreiber was interested in changing that, and in 2009 opted to move halfway across the world to work under the supervision of Eric Parent, an associate professor in the Department of Physical Therapy.

With startup funding from Parent, the faculty, Glenrose Rehabilitation Hospital Foundation, and the Scoliosis Research Society, Schreiber launched a randomized controlled trial to study the effectiveness of Schroth exercises combined with standard treatment. Fifty adolescents between 10 and 18 years old with spinal curvatures between 10 and 45 degrees were assigned at random to either receive standard treatment alone (bracing or observation) or Schroth exercises combined with standard care.

Over a period of six months, patients in the Schroth group did home exercises daily for 30 to 45 minutes at a stretch, in addition to weekly one-hour group classes. Their progress was monitored at the start and again at three and six months, and one year; participants in the Schroth group showed significant improvements in curvature, pain, self image and back muscle endurance compared to those in the control.

"It is a big deal. Very few of our students have actually conducted a full-blown randomized controlled trial and it's a long-term trial." - Eric Parent, PhD supervisor

The results are already turning some heads, with her presentation winning an award at the Society on Scoliosis Orthopaedic and Rehabilitation Treatment's annual conference last month. The society will soon publish her findings in the journal Scoliosis-a significant milestone after three years of work on the research.

"When you believe in something then all of a sudden you see what you believe in actually works and brings benefits to people, you're just over the top. It feels really great to be able to help people."

Parent says Schreiber's clinical expertise and familiarity with Schroth were invaluable to overseeing such an "ambitious project" with multiple moving parts.

"It is a big deal. Very few of our students have actually conducted a full-blown randomized controlled trial and it's a long-term trial," he says. "There was a lot of patient contact and she had to work hard to keep them motivated, not only to come here and participating in the exercise, but to also stick with the exercises at home."

Parent also credits Schreiber for developing an algorithm used to determine what classification type each patient falls into-an advance he says could eventually change how therapists are trained in managing scoliosis care.

When she moved to Edmonton, Schreiber was Western Canada's first therapist certified in the Schroth method. Four colleagues at the U of A, including Parent, have since received certification, and in fact Parent is building upon the research started by Schreiber through a three-year Schroth scoliosis trial that will ultimately involve 258 patients in Edmonton and Montreal.

Schreiber says it was rewarding learning from Parent who, though demanding, pushed her to be better.

"He knows that, at the start, I always hated to receive his comments on my manuscripts, which were very tough. It wasn't always an easy road, but I am grateful for that because it made me a better writer."

Learn more about scoliosis treatment and research

Scoliosis Alberta

Setting Scoliosis Straight handbook for parents and children

Scoliosis Screening brochure

Scoliosis Research Society