The method of Katharina Schroth - history, principles and current development
© Weiss; licensee BioMed Central Ltd. 2011
Received: 18 August 2011
Accepted: 30 August 2011
Published: 30 August 2011
Katharina Schroth, born February 22nd 1894 in Dresden Germany, was suffering from a moderate scoliosis herself and underwent treatment with a steel brace at the age of 16 years before she decided to develop a more functional approach of treatment for herself.
Inspired by a balloon, she tried to correct by breathing away the deformities of her own trunk by inflating the concavities of her body selectively in front of a mirror. She also tried to ‚mirror' the deformity, by overcorrecting with the help of certain pattern specific corrective movements. She recognized that postural control can only be achieved by changing postural perception.
From 1921 this new form of treatment with specific postural correction, correction of breathing patterns and correction of postural perception was performed with rehabilitation times of 3 months in her own little institute in Meissen and in the late 30's and early 40's she was supported by her daughter, Christa Schroth.
After World War II, Katharina Schroth and her daughter moved to West Germany to open a new little institute in Sobernheim, which constantly grew to a clinic with more than 150 in-patients at a time, treated as a rule for 6 weeks. In the 80's this institute was renamed to ‚Katharina Schroth Klinik'. At this time the first studies were carried out and the patient series for the first prospective controlled trial was derived from the patient samples of 1989-1991.
Content, rehabilitation times and patients meanwhile have changed, and braces have been developed to offer highest treatment security.
Therefore today, bracing in the patient at risk has to be regarded as the primary treatment. We have been able to reduce the training times by adapting the old techniques and introducing new forms of postural education (sagittal correction, ADL correction and experiential learning) whilst the programme is still based on the original approaches of the 3-dimensional treatment according to Katharina Schroth, namely specific postural correction, correction of breathing patterns and correction of postural perception.
History of Katharina Schroth's method of scoliosis treatment
In the 90's, Dr. Rigo and the author constantly improved the programme and as a result of this collaboration the book ‚Befundgerechte Physiotherapie bei Skoliose' was written by both of them (1st edition 2001) until the second edition appeared in 2006  and the book was translated into Spanish .
In 2010 the latest developments were published including new educational approaches and the correction of the sagittal profile [10, 11] and now the 3rd edition of the German book ‚Befundgerechte Physiotherapie bei Skoliose' is dedicated to these new aspects .
The history of all this, however began in East Germany in the first decade of the last century:
How it all started
Katharina Schroth, born February 22nd 1894 in Dresden Germany, was suffering from a moderate scoliosis herself and underwent treatment with a steel brace at the age of 16 before she decided to develop a more functional approach of treatment for herself (1910).
Inspired by a balloon, she tried to correct by breathing away the deformities of her own trunk by inflating the concavities of her body selectively in front of a mirror. She also tried to ‚mirror' the deformity, by overcorrecting with the help of certain pattern specific corrective movements. Additionally, she recognized that postural control can only be achieved by changing postural perception. These aspects were published as early as 1924 and later on [3–5] and were elaborated even more during the first decade of her professional career as a gymnast.
Katharina Schroth began her professional life as a teacher at a Business & Language school, however she decided to leave this field and undergo training at a gymnast's school in order to be able to treat patients herself.
As early as in the late 20's of the last century a battle of methods began. A Professor from Leipzig (Prof. Scheede), where Hoffa exercises were performed, fought against the little centre of Katharina Schroth heavily as she was neither a professional trainer, nor a physician, but had started her programme as a schoolteacher who followed a class of gymnasts after she had started her insitute.
After World War II Katharina Schroth was forced to leave her little institute in Meissen. Before she went to the West she was employed by the state to offer her services together with her daughter in a medical centre at Gottleuba during the early 50's.
New start in the West
In the 70's a series of investigations were carried out with respect to vital capacity improvements and improvement of cardiopulmonary function contributing to the acknowledgement of the method at some universities [13, 14].
Christa Lehnert-Schroth recognized the spontaneous correction of a functional leg length discrepancy just by straightening the lumbar curve .
In the 80's the institute, ‚Sanatorium Lehnert-Schroth' was renamed to ‚Katharina Schroth Klinik' while Katharina Schroth was not as active as in the 60's and early 70's. Nevertheless, she fought constantly for her method of treatment and had lots of arguments with professors from different German universities.
More emphasis at that time was laid upon the correction of pelvic asymmetries to address the lumbosacral curve and unfortunately the powerful corrections initially defining the treatment of Katharina Schroth were increasingly lost.
This was the time of making the treatment more and more complicated, focusing on little deviations while the main curvature correction was drifting out of sight.
First investigations-first scientific evidence
At this time, first studies were completed and the patient series for the first prospective controlled trial was derived from the patient samples of 1989-1991, a sample first published in 1995 as a prospective study in German , 1997 in English  and later on including age and sex matched controls from another regional study on untreated patients as a prospective controlled study . Studies on the improvement of cardiopulmonary capacity, vital capacity improvement, electromyography and influence of the treatment of pain followed [20–24].
Most of the studies were cohort studies in a pre-/postintervention design and there were no mid- or long-term follow-ups. Nevertheless, huge numbers of patients were investigated. 794 Patients were investigated with the ECG showing that even signs of manifest right cardiac strain were reduced highly significantly after an in-patient rehabilitation of 6 weeks using the Schroth programme . More than 800 Patients were material for the study on vital capacity and rib mobility published in Spine 1991 , the material in the study on muscle activity reductions after intensive rehabilitation consisted of more than 300 patients .
The only mid-term study with a follow-up of more than a 30 months period was the one with the cohort treated between 1989 and 1991 first published in the English language in 1997 , which was the basis for our prospective controlled trial published in 2003 .
In horizontal starting positions these precorrections due to postural reflex activity could not be achieved and therefore these postural corrections cannot be regarded as effective in beginning an exercise in asymmetric upright postition.
The programme was getting more complex and complicated during the 90's, but a clear direction of development was no longer visible. While brace treatment constantly developed and improved, the exercise programme lost its effectiveness compared to other centres after the Katharina Schroth Klinik was taken over by Asklepios in 1995. The groups of sometimes 15-16 patients were too big for significant gains and with only one therapist.
The same programme was also performed at that time in the Elena Salva Institute in Barcelona under the supervision of Dr. Manuel Rigo. Together with the author he improved many parts of the original programme according to the latest knowledge throughout the 90's.
He also offered more intensive courses with groups of 10 patients and two or three therapists at the same time and was able to achieve significant postural improvements also exceeding the margins of technical error measured with the help of the Formetric system [26, 27]. While Dr. Rigo's patients only received half of the treatment time than those patients in the Asklepios centre, they clearly had better outcomes with a similar program compared to the results published 1999  not exceeding the technical error .
Courses for therapists
At the end of the 80's the author began a training programme for professionals and soon Dr. Rigo was one of the most important international instructors. He brought the original progamme to the US and the UK, thus distributing the knowledge worldwide together with the author, investigating the outcome of such treatment [10, 11, 17–25]. Consequently, the Schroth programme is now known and recognized all over the world.
Content, rehabilitation times and patients meanwhile have changed, while braces today have been developed to offer highest treatment securitiy .
Today, especially towards the end of the bracing period, more intensive physiotherapy is advisable. However todays' programme focusses on the activities of daily living (ADL) in order to avoid losing postural control in everday activity.
30 minutes of exercising is useless when the curve is loaded during the rest of the day.
Unloading the spine and curve therefore, is the major aim of the new programme derived from the original. The exercises today are regarded to be important for gaining postural control but not as an exercise per se.
Todays ‚New Power Schroth' programme is designed for small and moderate curvatures. Once a thoracic curve exceeds 70° of course the original Schroth programme seems to offer the greatest advantage for the patient.
In conclusion: The original concept of Katharina Schroth was, and still is, the appropriate programme to address large curvatures, especially main thoracic curves.
The latest developments (‚New Power Schroth' as part of the Scoliologic™'Best Practice' programme) are designed for small and moderate curves-nowadays the main indication for physiotherapy. For this new programme, however rehabilitation times of more than one week are no longer necessary [30, 33].
The author wishes to thank his mother, Christa Lehnert Schroth, for her kind support providing her data base of historical pictures.
I wish to thank Pflaum company to allow the publication of pictures taken or modified from the book with the title ‚Befundgerechte Physiotherapie bei Skoliose'  and pictures 21 and 22 taken from the 8th. edition of ‚Ich habe Skoliose' in press .
Thanks to Lesley Schneider for copyediting my paper and for correcting my non-native English.
To my grandmother, Katharina Schroth and to my mother, Christa Lehnert-Schroth, who have dedicated their lives to the treatment of patients with spinal deformities.
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