Schroth scoliosis exercises

1. Introduction

Version followed: the Schroth method as described for the Asklepios Katharina Schroth Klinik (Bad Sobernheim) and for the Barcelona Scoliosis Physical Therapy School (BSPTS, Rigo Concept) in the 2016 review of seven scoliosis-specific exercise schools, with the Schroth Best Practice programme (Hans-Rudolf Weiss) noted as a separate variant, placed within the 2016 SOSORT guidelines (published 2018). Written for a psychotherapist working alongside a Schroth-certified physiotherapist, not for delivering the exercises.

What it is. Schroth therapy is a physiotherapeutic scoliosis-specific exercise (PSSE) method for idiopathic and other scoliosis and some sagittal deformities. Katharina Schroth (born Dresden, 1894) began correcting her own scoliosis in front of a mirror around 1910; the method is dated to about 1920, and from 1921 she treated others in Meissen with her daughter Christa Lehnert-Schroth (1924–2015). After the Second World War the clinic moved to Bad Sobernheim and became the Asklepios Katharina Schroth Klinik in the 1980s; Hans-Rudolf Weiss, her grandson, was medical director from 1995 to 2008 [source: Berdishevsky et al. 2016]. Elena Salvá took the method to Barcelona in 1968, and the BSPTS (Gloria Quera-Salvá, Manuel Rigo) developed its own classification and certification from 1989 onwards [source: Berdishevsky et al. 2016].

How change is thought to happen. Patients learn, through mirror, verbal and manual feedback, to perceive their own asymmetric posture and actively correct it in three dimensions (elongation, deflection, derotation), to use an asymmetric "rotational" breathing pattern to expand collapsed areas of the trunk, and to hold the correction with muscle tension in exercise and daily life. The intended outcomes, as the schools and SOSORT state them, are slowing or stopping curve progression during growth, improving posture and appearance, breathing function and pain, and improving self-image and quality of life [source: Berdishevsky et al. 2016; Negrini et al. 2018]. These are the developers' and guideline authors' aims; the 2024 Cochrane review rated the evidence for therapeutic exercise in adolescents as low to very low certainty (see section 2) [source: Romano et al. 2024].

Who delivers it. Schroth exercises are taught by physiotherapists (and in some programmes other clinicians) who hold a Schroth or BSPTS certification, inside a team with a scoliosis-expert physician and an orthotist; SOSORT adds that a psychologist may be part of the team [source: Negrini et al. 2018]. A psychotherapist does not teach the exercises. The psychotherapist's role is assessment and support of the young person and family, body image and brace distress, adherence and motivation, school and peer difficulties, safeguarding, and collaboration with the team [synthesis, consistent with SOSORT team recommendations].

2. Framework

Schroth therapy has no psychotherapy phases. The framework below combines the medical decision pathway SOSORT describes, the exercise-learning formats the schools publish, and the psychotherapist's parallel track [source: Negrini et al. 2018; Berdishevsky et al. 2016; synthesis for the psychotherapy track].

Stage A: medical diagnosis and treatment decision. A scoliosis-expert physician confirms the diagnosis, curve type, size and skeletal maturity. SOSORT's Strength of Treatments Scheme ranks options from least to most demanding (observation, PSSE, types of bracing, special inpatient rehabilitation, surgery), and its Practical Approach Scheme selects within that range using prognostic factors, to avoid both over- and undertreatment [source: Negrini et al. 2018]. SOSORT advises that in evolving idiopathic scoliosis above 25° during growth, bracing is recommended and PSSE alone should not be used unless a scoliosis-expert physician prescribes it [source: Negrini et al. 2018]. The schools state that PSSE is not an alternative to or substitute for indicated bracing or surgery [source: Berdishevsky et al. 2016].

Psychotherapy track: assess distress about the diagnosis, the young person's and family's understanding, hopes and fears; support shared decisions without advising for or against any medical option [synthesis].

Stage B: assessment and curve-pattern classification by the physiotherapist. The Asklepios tradition describes the trunk as stacked "body blocks" deformed from rectangles into trapezoids, with curve types labelled by block letters and direction; the BSPTS uses the Rigo classification (sagittal deformities; structural thoracic patterns subdivided as 3C, 4C and N3N4; lumbar or thoracolumbar patterns), confirmed radiologically as types A–E [source: Berdishevsky et al. 2016]. Exercises are chosen to fit the pattern.

Psychotherapy track: baseline of body image, mood, anxiety, school attendance and social life; screen for eating difficulties and compulsive exercise [synthesis].

Stage C: learning the corrections. Delivered one-to-one or in groups. Published structures, stated as facts: the BSPTS describes roughly 60 group hours plus 20 individual hours to reach a high technical level, with home practice often possible after about nine group hours [source: Berdishevsky et al. 2016]; SOSORT reports outpatient PSSE frequencies ranging from twice to seven days a week depending on technique, motivation and ability, often two to four times weekly in long-term outpatient care [source: Negrini et al. 2018]. The Schroth Best Practice basic course for clinicians includes patient groups of six training with therapists [source: Schroth Best Practice Academy course document]. These are descriptions, not a schedule to recommend.

Psychotherapy track: prepare the young person for mirror work and manual correction (consent), help with self-consciousness in groups, problem-solve fitting practice into school life [synthesis].

Stage D: special inpatient rehabilitation (SIR), optional. SOSORT describes SIR as about 3–6 weeks at a specialised centre with several hours of PSSE daily [source: Negrini et al. 2018]. The Asklepios Katharina Schroth Klinik's 2024 facility concept recommends 28–42 days for adolescents and first-time adults, admits from age 7, requires children under 12 to come with a permanent accompanying adult, offers a hospital school or local school, afternoon supervision by educators, psychologists and a weekly child-welfare team meeting [source: Asklepios Einrichtungskonzept 2024].

Psychotherapy track: homesickness, separation, missed school, return to peers; liaise with the centre's psychologist where the family consents [synthesis].

Stage E: home programme, daily-life integration and follow-up. Corrections are carried into sitting, standing, walking, sleeping, carrying bags and brace wear [source: Berdishevsky et al. 2016]. SOSORT recommends regular follow-up of braced patients (at least every 3–6 months, individually adjusted), regular compliance checks, attention to the patient's mood at brace delivery and follow-ups, and consistent agreed messages from the whole team [source: Negrini et al. 2018]. The schools describe modified, less intense versions for juvenile and early-onset scoliosis, painful adult scoliosis and sagittal deformities [source: Berdishevsky et al. 2016].

Criteria for moving between stages. Medical stage changes (starting or stopping a brace, SIR, surgical referral) are the physician's decision based on curve progression, maturity and prognostic factors [source: Negrini et al. 2018]. Moving from supervised learning to independent home practice depends on the patient performing the corrections reliably without cues, a judgement made by the physiotherapist [source: Berdishevsky et al. 2016; synthesis on the criterion]. For the psychotherapy track, step down when distress no longer interferes with school, friendships, sleep or treatment, and step up if mood, eating, self-harm or safeguarding concerns appear [synthesis].

Evidence status (brief, for informed referral). The 2024 Cochrane review of therapeutic exercises for adolescent idiopathic scoliosis included 13 randomised trials (583 participants); certainty ranged from low to very low, only one study followed participants to the end of growth, and no included study assessed adverse events [source: Romano et al. 2024]. SOSORT grades most of its PSSE recommendations at level B [source: Negrini et al. 2018]. Present Schroth therapy to families as a recommended conservative option within a medical plan, not as a cure.

3. Guiding principles

Principles of the method as the schools publish them (for the psychotherapist's understanding):

Three-dimensional correction (auto-elongation, deflection, derotation, plus sagittal normalisation in the BSPTS) [source: Berdishevsky et al. 2016]. Practical meaning: the young person is being asked to hold an unfamiliar posture that may feel "wrong" or look odd to them; expect self-consciousness.
Pelvic and global alignment first (pelvic corrections before main corrections; BSPTS starts after aligning legs, pelvis and trunk) [source: Berdishevsky et al. 2016]. Practical meaning: corrections are whole-body and detailed; frustration with fine control is common and normal.
Rotational (angular) breathing to expand concave, collapsed areas of the trunk and support derotation [source: Berdishevsky et al. 2016; Asklepios Einrichtungskonzept 2024]. Practical meaning: this is a physiotherapy technique; the psychotherapist neither teaches nor modifies it and does not combine it with breath-retention or breathwork.
Stabilisation by muscle (isometric) tension of the corrected posture [source: Berdishevsky et al. 2016]. Practical meaning: effort and fatigue are part of the method; distinguish ordinary effort from pain the physiotherapist should hear about.
Sensorimotor and visual feedback: mirror monitoring has been central since the original programme; training also includes manual correction grips by the therapist [source: BMC Figure 2 caption; Asklepios training page]. Practical meaning: mirrors and hands-on cueing can be hard for adolescents with body dissatisfaction or trauma histories; consent and preparation matter.
Integration into activities of daily living [source: Berdishevsky et al. 2016; Negrini et al. 2018]. Practical meaning: the method asks for habits across the day, so adherence is a behavioural and family issue as much as a physical one.
Pattern-specific, individualised programmes [source: Berdishevsky et al. 2016]. Practical meaning: never compare a client's programme with a friend's or an online video; refer questions to the physiotherapist.
Avoiding false fears in mild or stable curves (BSPTS) [source: Berdishevsky et al. 2016]. Practical meaning: help families keep worry proportionate.

Principles for the psychotherapist's own stance [synthesis unless tagged]:

Stay in role. Do not teach, correct or prescribe exercises, breathing or brace hours; route all physical questions to the physiotherapist or physician.
Team, one message. SOSORT asks the team to give consistent agreed messages and counsel families [source: Negrini et al. 2018]. Practical meaning: with consent, agree with the team what is said about prognosis and adherence.
Compliance is relational. SOSORT frames brace compliance as a result of team–patient interaction, not the patient alone [source: Negrini et al. 2018]. Practical meaning: avoid blaming language; look for barriers.
Appearance concerns are legitimate. Body image and appearance strongly shape quality of life in scoliosis [source: Negrini et al. 2018; Balboni et al. 2024]. Practical meaning: take aesthetic worries seriously rather than reassuring them away.
Ask about feelings directly. In the studies summarised by Balboni et al., only 5% of adolescents had discussed emotional concerns with a clinician although 90% wanted to [source: Balboni et al. 2024]. Practical meaning: ask, every time.
Assent and consent. The young person's assent is sought alongside parental consent; their views count more as they mature.
Safeguarding first. Hands-on treatment, undressing for posture assessment, residential stays and photography of the trunk require clear safeguarding arrangements.
No promises. Make no claims about curve reduction or avoiding surgery; report developers' aims as aims.

4. Intervention inventory

The inventory has two parts. Part A describes each component of Schroth therapy as the schools publish it, so the psychotherapist can explain it, prepare the client and spot problems; these are delivered only by a certified physiotherapist, and nothing in Part A is an exercise instruction. Part B gives the psychotherapist's own interventions; these are [synthesis] unless a source is tagged.

Part A: components of Schroth therapy (physiotherapist-delivered; descriptive only)

A1. Assessment and curve-pattern classification

Purpose: identify the curve pattern so corrections and exercises fit it [source: Berdishevsky et al. 2016].
Steps (what the client experiences): history and physical examination of the trunk in standing and bending, often with the back exposed; review of radiographs; measurements such as trunk rotation; classification by the Schroth body-block model or the Rigo classification; often posture photographs for later comparison [source: Berdishevsky et al. 2016; Schroth Best Practice Academy course document lists Cobb and trunk-rotation measurement].
Example language (illustrative): "The physio will look at your back and may take photos. You can ask what each photo is for, who sees it, and to keep underwear or a sports top on."
Watch for: shame about undressing or being photographed; distress at seeing one's own back for the first time; catastrophic readings of the X-ray. Working well: the young person can name their curve type in their own words without alarm.

A2. Three-dimensional self-correction (auto-elongation, deflection, derotation)

Purpose: actively reduce the deformity in all three planes, starting with the pelvis, then the trunk blocks [source: Berdishevsky et al. 2016].
Steps (descriptive): the therapist guides the patient to lengthen the spine, shift trunk sections against the lateral curve, and turn them against the rotation, in a sequence fitted to the curve pattern; BSPTS adds sagittal normalisation and an "expansion/contraction" technique and starts only after aligning legs, pelvis and trunk [source: Berdishevsky et al. 2016].
Example language (illustrative): "It sounds as though the corrected position feels lopsided to you even though the mirror shows it straighter. What is that like?"
Watch for: frustration with fine motor control, perfectionism ("never straight enough"), pain that the client hides. Working well: the client describes correction as something they can do, not something done to them.

A3. Rotational angular breathing (RAB)

Purpose: assist rib and vertebral derotation by directing breathing into concave, collapsed areas of the trunk [source: Berdishevsky et al. 2016]; the Asklepios clinic describes Drehwinkelatmung as developed by Katharina Schroth and pairs it with lung-function work [source: Asklepios Einrichtungskonzept 2024].
Steps (descriptive): while in a corrected position, the patient is guided to breathe asymmetrically into specific trunk areas, with mirror and hand cues. Timings and counts are set by the physiotherapist and are not given here.
Example language (illustrative): "The breathing your physio teaches is a spinal technique. In our sessions we will not change it or add any other breathing exercise; if it ever makes you dizzy or anxious, tell them."
Watch for: light-headedness, panic or air hunger during breathing practice (refer back to the physiotherapist); clients with panic disorder who interpret effortful breathing as danger. Working well: the client can practise without anxiety rising [synthesis on watch points].

A4. Stabilisation of the corrected posture

Purpose: hold the correction with muscle activity, described as isometric tension [source: Berdishevsky et al. 2016].
Steps (descriptive): after correcting and breathing, the patient tightens muscles to hold the position, then the correction is practised in functional positions.
Example language (illustrative): "Tired muscles after practice are expected; pain that stays or gets sharper is something your physio needs to hear about."
Watch for: pushing through pain, breath-holding while straining, discouragement. Working well: effort is sustainable and pain is reported.

A5. Mirror feedback

Purpose: let the patient see and match the correction; mirror monitoring has been central since the original programme [source: BMC Figure 2 caption]; all Asklepios therapy halls have wall bars and mirrors [source: Asklepios Einrichtungskonzept 2024].
Steps (descriptive): the patient practises in front of fixed or mobile mirrors, comparing body outline before and after correction.
Example language (illustrative): "Some people find the mirror useful and some find it hard. What do you notice in yourself when you look?"
Watch for: body checking, harsh self-commentary, avoidance of mirrors, worsening body dissatisfaction or eating concerns. Working well: the mirror becomes a tool for feedback rather than a trigger for criticism.

A6. Manual correction and tactile cueing (touch)

Purpose: guide correction and breathing through hands-on cues; Schroth therapist training content includes manual correction and mobilisation grips [source: Asklepios Schroth training page].
Steps (descriptive): the physiotherapist places hands on the trunk, ribs or pelvis to show direction of correction or where to breathe.
Example language (illustrative): "You are allowed to ask before any touch, to ask for a different way of being shown, and to stop at any moment. Would it help to plan what you will say?"
Watch for: freezing, dissociation, flinching, or compliance without real agreement, especially in clients with trauma histories; any touch that is not clearly clinical must be reported under safeguarding procedures. Touch is always with explicit consent before and during, the right to stop, a chaperone or parent present for children where the setting's policy provides, and never sexual [synthesis; touch ethics as in the USABP code, which requires informed consent before touch techniques and a client's right to refuse or end touch at any time]. The psychotherapist does not give hands-on correction.

A7. Pattern-specific exercise positions

Purpose: practise correction in positions that suit the curve pattern [source: Berdishevsky et al. 2016].
Steps (descriptive): exercises named in the Asklepios tradition include a ball-based exercise ("50 x Pezziball"), prone positions with shoulder traction and counter-traction, "Sail", and the side-lying "muscle cylinder" for lumbar correction; BSPTS positions include supine (fine corrections without gravity), side-lying (frontal-plane correction), prone on a stool, and muscle cylinder (advanced, mainly for 4C patterns) [source: Berdishevsky et al. 2016]. Schroth Best Practice names physio-logic exercises, 3D-made-easy exercises, Schroth exercise sets I–V, de-tethering exercises and systematic self-correction [source: Schroth Best Practice Academy course document]. No repetitions, holds or durations are given here.
Example language (illustrative): "Your exercises are made for your curve pattern, so please check with your physio before trying anything from videos or from a friend's programme."
Watch for: copying online exercises, doing extra sessions to "speed things up", equipment-related injury at home. Working well: the client follows the programme as the physiotherapist set it.

A8. Corrections in daily activities and with the brace

Purpose: carry the correction into sitting, standing, walking, sleeping, carrying bags and brace wear [source: Berdishevsky et al. 2016]; SOSORT lists daily-activity training as a core PSSE element [source: Berdishevsky et al. 2016 citing SOSORT consensus]. With a rigid brace, SOSORT implies exercises when out of the brace [source: Negrini et al. 2018].
Steps (descriptive): the physiotherapist identifies the client's habitual postures and teaches small corrections for school desks, bags, screens and sleep.
Example language (illustrative): "Which part of the school day makes the corrections hardest to remember? Let's think about what would make it easier."
Watch for: constant self-monitoring that crowds out ordinary life, embarrassment about correcting posture in class. Working well: corrections become habits without preoccupation.

A9. Group sessions

Purpose: BSPTS describes group sessions as providing support as well as reducing cost [source: Berdishevsky et al. 2016].
Steps (descriptive): small groups practise with one or more therapists; individual sessions are added for fine correction.
Example language (illustrative): "How was it being in the group: more comparing, or more company?"
Watch for: comparison of curves, teasing, exposure of the body in front of peers. Working well: the client feels less alone.

A10. Special inpatient rehabilitation (SIR)

Purpose: intensive learning over a residential stay [source: Negrini et al. 2018].
Steps (descriptive): a stay of weeks at a specialist centre with several hours of PSSE daily, plus psychology, occupational therapy, sport and schooling; at Asklepios, children under 12 come with an accompanying adult and have a hospital school or local school option [source: Asklepios Einrichtungskonzept 2024].
Example language (illustrative): "What do you imagine the weeks away will be like? What would help with missing friends or school?"
Watch for: homesickness, separation anxiety, fatigue, falling behind at school, difficulty on return. Working well: the client returns with a usable home routine and without major disruption to school or friendships.

A11. Education, self-help and the home programme

Purpose: the Asklepios goals include postural training, information to support decisions, a home programme, self-help support, pain coping and improved self-image [source: Berdishevsky et al. 2016]; BSPTS adds family education and participation in activity and sport [source: Berdishevsky et al. 2016]. SOSORT asks the team to explain treatment fully with aids such as photos, brochures and video [source: Negrini et al. 2018].
Steps (descriptive): explanations of the curve, the reasons for each correction and for bracing, and a written or illustrated home programme.
Example language (illustrative): "In your own words, what did the team say the exercises are for?"
Watch for: misunderstandings (for example, believing exercise will "straighten" the spine), fear out of proportion to a mild curve. Working well: the family's account matches the team's.

Part B: the psychotherapist's interventions

B1. Referral conversation and checking the practitioner

Purpose: help a family reach a qualified Schroth practitioner within a medical plan, and not substitute exercise for indicated bracing or surgery [source for the last point: Berdishevsky et al. 2016; Negrini et al. 2018].
Steps: (1) confirm a scoliosis-expert physician is involved; Schroth therapy is not started on the psychotherapist's suggestion alone. (2) Explain that certification routes differ: the Asklepios Katharina Schroth training is an 8-day course with an examination leading to admission to its therapist network [source: Asklepios Schroth training page]; the BSPTS (Rigo Concept) runs a Base course and a Level 1 course for physiotherapists ending in a written examination [source: physiotherapy.ca BSPTS L1 page]; the Schroth Best Practice Academy runs a basic course open to physical and occupational therapists, osteopaths, chiropractors and physicians, with advanced courses no earlier than 12 months after basic certification [source: Schroth Best Practice Academy course document]. About 2,500 certified Schroth therapists were reported worldwide in 2016 [source: Berdishevsky et al. 2016]. (3) Suggest the family ask which certification the therapist holds, and check the therapist's registration with their national physiotherapy regulator [synthesis; regulator details by country: uncertain: not verified]. (4) With consent, agree how you and the physiotherapist will communicate.
Example language (illustrative): "Schroth therapists train through different schools. It is reasonable to ask which one, and whether they work with your consultant and orthotist."
Watch for: practitioners who promise to "cure" or reverse scoliosis, discourage medical follow-up or bracing, or sell expensive packages under pressure. Working well: the family knows who is on the team and how they communicate.

B2. Physical-safety screening and medical clearance

Purpose: ensure physical concerns go to the right clinician.
Steps: (1) ask whether the physician has cleared the client for PSSE. (2) Know that specialist centres set their own exclusions; the Asklepios Katharina Schroth Klinik's inpatient programme lists, among others, neuromuscular disease requiring permanent wheelchair use, severe intellectual disability or dementia, cardiopulmonary decompensation, addiction, psychosis, severe osteoporosis, and age under 7 or over 75; pregnancy is not an absolute contraindication and rehabilitation is possible in months 4–6 with a gynaecological certificate [source: Asklepios Einrichtungskonzept 2024]. These are admission criteria for that inpatient setting, not universal rules. (3) For active psychosis or substance misuse, coordinate with the physician before intensive or residential programmes [synthesis, consistent with the Asklepios exclusions]. (4) Pass on to the physician promptly any new or worsening back pain, numbness, weakness, breathlessness or chest symptoms the client mentions [synthesis].
Example language (illustrative): "I'm not the person to judge what your back is doing, but that sounds worth telling your physio and doctor this week. Shall we write down what you noticed?"
Watch for: the client minimising symptoms to avoid missing activities or to avoid surgery talk. Working well: symptoms reach the team quickly.

B3. Preparing for touch, undressing and mirror work

Purpose: make hands-on and visual feedback tolerable and consensual, especially after trauma or with body-image distress.
Steps: (1) explain in advance what the physiotherapy sessions involve (A1, A5, A6). (2) Rehearse how to ask questions, decline a particular touch, ask for a chaperone or parent, keep clothing on, or stop. (3) Agree a stop signal the client can use. (4) With consent, let the physiotherapist know of preferences (not trauma details) such as "please describe before touching". (5) Debrief after early sessions.
Example language (illustrative): "You can say 'please show me without touching' or 'can my mum stay in the room'. Saying that is part of good treatment, not being difficult."
Watch for: freezing, dissociation, nightmares or avoidance after sessions; reports of touch that was not clearly clinical (act under B8). Working well: the client reports feeling in control.
Note: a psychotherapist does not combine psychotherapy with hands-on correction. The mainstream talk-therapy codes reviewed (for example BACP, UKCP, APA) prohibit sexual contact with clients and require working within competence and referring when appropriate, without specific touch provisions; body-psychotherapy codes (USABP, EABP) require informed consent before touch, the right to refuse or end it, and state that sexual touch is always inappropriate [source: professional codes listed under Sources].

B4. Body-image work

Purpose: reduce distress about appearance of the trunk, asymmetry, the brace and scars.
Steps: (1) assess body image, self-esteem, mood and anxiety at baseline and periodically; Balboni et al. report that poor body image and low self-esteem are likely risk factors for mental health problems, girls reported worse body image than boys, and anxiety and depression are more common in adolescents with scoliosis than controls [source: Balboni et al. 2024]. (2) Normalise and name the concern without over-reassurance. (3) Use standard CBT or compassion-focused methods for appearance anxiety: identify appearance-related thoughts, reduce checking and avoidance, broaden self-worth beyond appearance [synthesis]. (4) Address clothing choices practically. (5) Watch for disordered eating.
Example language (illustrative): "Lots of people with scoliosis notice their shape in mirrors or clothes. What do you say to yourself when you notice it?"
Watch for: increased mirror checking linked to exercise sessions, avoidance of swimming or changing rooms, weight-control behaviours. Working well: less avoidance, more flexible self-description.

B5. Brace distress and adherence support

Purpose: help the young person live with brace wear and exercise routines.
Steps: (1) ask about brace stress directly; in one study cited by Balboni et al., stress from the brace exceeded stress from the deformity itself, and distress was lower after more than six months of wear [source: Balboni et al. 2024]. (2) Use a non-judgemental, motivational approach: explore the client's own reasons, barriers (discomfort, heat, embarrassment, sleep) and possible solutions [synthesis]. (3) Bring practical barriers to the orthotist and physiotherapist with consent; SOSORT says compliance results from team–patient interaction and asks teams to use ethical means to improve compliance [source: Negrini et al. 2018]. (4) Avoid becoming the hours-monitor for the family.
Example language (illustrative): "On a scale you choose, how hard is the brace this month? What gets in the way most?"
Watch for: secret non-wear with guilt and conflict at home; self-reported wear is often overstated [source: Negrini et al. 2018]. Working well: honest conversations about wear and barriers raised with the team.

B6. School and peer issues

Purpose: protect school attendance and friendships.
Steps: (1) ask about missed school, PE, changing rooms, teasing and social withdrawal; in one study cited by Balboni et al., among 43 girls, 42% stayed home due to embarrassment, 35% missed school because of the brace and 41% found socialising harder [source: Balboni et al. 2024]. (2) Plan what the young person wants to tell peers, if anything, and rehearse it. (3) With consent, help the family ask the school for reasonable adjustments (for example private changing, seating, time for brace care) [synthesis]. (4) Address bullying through school procedures.
Example language (illustrative): "Who at school knows, and who do you want to know? Let's practise what you'd say if someone asks about it."
Watch for: school refusal, isolation, online teasing. Working well: attendance and friendships stable.

B7. Supporting parents: decisions, hope, guilt and family burden

Purpose: help parents make informed decisions and carry the load of home programmes, brace wear and appointments. SOSORT asks teams to counsel each patient and family as needed and to assess mood and counsel the family at brace delivery and follow-ups [source: Negrini et al. 2018].
Steps: (1) explore what parents have been told, what they hope for and fear (often surgery). (2) Distinguish the medical decision (physician's) from the family's values and practical constraints. (3) Address guilt ("we should have noticed sooner") and conflict over adherence. (4) Discuss time and cost of private courses or residential stays openly. (5) Never advise starting or stopping any medical treatment; encourage questions to the physician or a second opinion from a scoliosis specialist if they are unsure [synthesis].
Example language (illustrative): "It sounds as if every evening has become a check on the brace and the exercises. What would it look like if home felt less like a clinic?"
Watch for: parents acting as enforcers, sibling resentment, hope pinned on exercise alone, financial strain. Working well: shared, calm routines and parents who feel informed.

B8. Safeguarding, consent and assent

Purpose: keep the young person safe in a treatment involving undressing, touch, photography and sometimes residential stays.
Steps: (1) obtain parental consent and the young person's assent for psychotherapy and for information sharing with the team, revisiting assent as the child matures. (2) Know the settings' arrangements: the Asklepios inpatient centre requires children under 12 to be accompanied, provides afternoon supervision by educators and holds a weekly child-welfare team meeting [source: Asklepios Einrichtungskonzept 2024]. (3) Ask in general terms whether sessions feel safe and respectful. (4) Act on any disclosure or concern about inappropriate touch, photography or conduct using your local child-protection procedures and professional duties; do not investigate yourself [synthesis].
Example language (illustrative): "If anything in any treatment ever feels uncomfortable or not right, you can tell me or your parent, and it will be taken seriously."
Watch for: secrecy, reluctance to attend a particular practitioner, changes in mood around sessions. Working well: the young person knows whom to tell and how.

B9. Compulsive exercise, perfectionism and eating-disorder caution

Purpose: prevent a corrective routine turning into compulsive exercise or body control.
Steps: (1) ask how much time goes on exercises beyond the agreed programme and how the client feels if a session is missed. (2) Screen for disordered eating and weight-control behaviour using your usual instruments. (3) If compulsive patterns appear, inform the physiotherapist (with consent) so the programme can be framed flexibly, and treat the compulsion in therapy. (4) Refer to eating-disorder services where indicated [synthesis].
Example language (illustrative): "When you skip a practice, what happens inside you?"
Watch for: extra unprescribed sessions, distress at missed practice, exercising through pain, weight loss. Working well: practice is done as agreed, without guilt-driven escalation.

B10. Integrating movement experiences into psychotherapy

Purpose: use what the client learns in Schroth sessions (body awareness, effort, the felt sense of correction) as material for therapy.
Steps: (1) invite the client to describe sessions in their own words. (2) Explore meanings ("standing straight", "being corrected") without moralising about posture. (3) Link experiences of agency in correction to other areas of life where relevant. (4) Keep exercise content itself with the physiotherapist [synthesis].
Example language (illustrative): "You said that when you get the correction right you feel taller inside as well. Where else do you feel that?"
Watch for: the body becoming a site of shame or constant self-surveillance. Working well: the client relates to their body with more curiosity and less criticism.

B11. Recognising and passing on adverse effects; team coordination

Purpose: make sure physical or psychological adverse effects reach the team. The 2024 Cochrane review notes that none of the included trials assessed adverse events [source: Romano et al. 2024], so clinicians should not assume none occur.
Steps: (1) ask at intervals about pain, fatigue, sleep, mood, and distress linked to sessions. (2) With consent, report physical issues to the physiotherapist or physician and psychological issues that affect treatment to the team. (3) Join team discussions where invited; SOSORT recommends an interdisciplinary team even across different sites, delivering agreed messages [source: Negrini et al. 2018]. (4) Record what was passed on and to whom [synthesis].
Example language (illustrative): "Would it be OK for me to let your physio know that the side-lying exercise has been painful, and that you'd like it explained before they start?"
Watch for: contradictory messages between clinicians; the client caught in the middle. Working well: one coherent plan.

B12. Transitions: end of growth, surgery referral and adulthood

Purpose: support the young person through changes in the medical plan.
Steps: (1) prepare for appointments where progression, surgical referral or ending the brace may be discussed. (2) Process disappointment or grief if exercise and bracing did not prevent progression, without blame. (3) Support the end of intensive routines and return to ordinary activity; BSPTS goals include participation in activity and sport [source: Berdishevsky et al. 2016]. (4) Note that the schools describe adapted programmes for adults with pain [source: Berdishevsky et al. 2016].
Example language (illustrative): "Whatever the scan shows, the work you put in counted. What would help you feel ready for that appointment?"
Watch for: self-blame after progression, fear of surgery, loss of structure when the brace ends. Working well: the client can talk about outcomes without self-blame.

5. Handling problems

All responses below are [synthesis] unless tagged; the Schroth and SOSORT sources address compliance and team counselling but not psychotherapy problems in detail.

The young person refuses the exercises or the brace. Do not argue for adherence. Explore their reasons, what the curve and treatment mean to them, and what would make treatment more acceptable; bring practical barriers to the team. Remember SOSORT's framing that compliance arises from the team–patient interaction [source: Negrini et al. 2018].
Stuck: "I do everything and it's still getting worse." Validate effort; separate effort from outcome; make sure the physician has explained what the treatment can and cannot achieve. Avoid implying that progression is the client's fault.
Overwhelm or panic during breathing or correction practice. Ask the client to stop the exercise and tell the physiotherapist; in therapy, use your usual grounding and anxiety approaches that do not involve breath manipulation, and coordinate with the physiotherapist about pacing. Do not alter the Schroth breathing yourself.
Distress with mirrors or touch. Revisit B3; with consent ask the physiotherapist about alternatives (for example more verbal cueing, clothing choices, a familiar adult present). If distress persists, consider whether trauma-focused work is needed first.
Family conflict over home practice. Move parents from enforcer to supporter: shared planning, agreed reminders chosen by the young person, praise for effort rather than checking. Consider family sessions.
Non-adherence hidden from the team. Encourage honest disclosure; explain that the team needs accurate information to make decisions, and help the client plan how to say it. Respect confidentiality limits agreed at the start.
Rupture with the physiotherapist or psychotherapist. Name it, ask what felt wrong, and repair. If the client feels judged by the physiotherapist, help them voice this; with consent, raise it with the physiotherapist.
Body checking, compulsive exercise or eating concerns. See B9; treat as a priority and inform the team with consent.
Low mood, self-harm or suicidal thoughts. Assess and manage risk using current standard practice and your service's procedures; anxiety and depression are more common in adolescents with scoliosis than in controls [source: Balboni et al. 2024].
Pressure from commercial providers or online communities. Help the family weigh claims; describe developers' aims as aims and give the evidence status as the Cochrane review states it [source: Romano et al. 2024]. Support groups and internet forums can help, as SOSORT notes [source: Negrini et al. 2018], but misinformation is common.
Residential programme difficulties (homesickness, missed school, behaviour). Liaise, with consent, with the centre's psychologist and educators; at Asklepios, early discharge is possible for medical or disciplinary reasons [source: Asklepios Einrichtungskonzept 2024].
Safeguarding concern about a practitioner. Follow child-protection procedures immediately; do not wait to gather evidence.
Adult clients with scoliosis pain. Adapted, less intense programmes are described for adult scoliosis [source: Berdishevsky et al. 2016]; the psychotherapist's role then includes pain coping, body image and activity pacing, coordinated with the treating physiotherapist.

Sources

Web sources

Books

Christa Lehnert-Schroth's textbook on three-dimensional scoliosis treatment is the classic primary text of the method [uncertain: not verified; bibliographic details not given].

Not verified

Details of national physiotherapy regulators by country, total hours and levels of the Asklepios and BSPTS certification routes, and the full text of the 2011 history paper on the Schroth method [uncertain: not verified].

← Previous · X-099Hébert's méthode naturelle and natural movement (MovNat)Next · X-101 →Walking and Nordic walking programmes