1. Description and concept for ISST – Schroth Therapist courses
- Based upon common physiotherapeutic principles the Schroth Therapy was founded by Katharina Schroth in 1920 and continuously refined through the experience of Schroth therapists from all around the world and named today Asklepios Katharina Schroth.
- The use of postural exercises for scoliosis therapy is grounded in scientific principles that relate directly to known aetiologies and symptoms of spinal deformity.
- ISST-International Schroth 3-dimensional Scoliosis Therapy according to Asklepios Katharina Schroth is using an individualized exercise program combining corrective behavioral patterns with physiotherapeutic methods. The 3D scoliosis treatment, based on sensorimotor and kinästhetic principles. Its goals are to facilitate correction of the asymmetric trunk, spine, and posture and to teach patients to consciously maintain the corrections and control the scoliotic posture increasingly more in daily living activities.
- The main elements of the treatment approach are the correction of reversible spinal dysfunctions, scoliosis specific passive mobilization, active 3D stabilization, Corrective Breathing, postural control, client-centered education with a particular ADL aspect, developing a straightforward and safe home exercise program.
- Braces, if indicated and prescribed, are included in the therapeutic process helping patients to accept this effective therapeutic tool and use it as therapeutic equipment to improve the quality of exercises, especially for the home exercise program where the brace replace feedback from the Schroth therapist.
In the ISST- courses we will enlighten various scoliosis specific theoretical aspects in combination with functional parts of the therapy approach.
The course leads from the surface of scoliosis understanding to a more sophisticated and comprehensive clinical reasoning regarding the conservative management of scoliosis.
Goals and Summary
The ISST training enables physical therapists to provide sufficient conservative treatment for patients with spinal deviations mainly for idiopathic scoliosis and kyphosis.
The goal is to prevent surgery, decelerate, or stop the progression and develop effective coping strategies for the patients to improve their social participation and activities in their daily living. This has also a positive effect on the general HQL (health-related quality of life) for children, adults, and elderly patients suffering from scoliosis and kyphosis.
The training enables PT´s to understand the biomechanical conditions of the asymmetric postural aspects and asymmetric loading of the spine leading to functional and structural adaptations and further risk of progression.
Specific physical therapy is indicated for patients in a brace and patients reported for surgery or after surgery.
Therapists learn to define their role as team players in an interdisciplinary network of physicians, surgeons, orthopedic technicians (orthotists), parents, patients, and psychologists.
- Basics: Aetiology, biomechanical concept, vicious cycle-concept, progression, postural imbalance, function and structure, brace, surgery
- Medical assessment: Visual-manual examination, therapy protocol, X-ray evaluation, scoliometer, functional tests
- Classification: Schroth, King, Rigo, Lenke
- Specific mobilization: Passive, assistive, active specific manual techniques: side bending, tilt, side shift, derotation, sagittal realignment
- Breathing therapy: Corrective Breathing: a specific internal detorsional force to reverse scoliotic features and mobilize restrictive chest dysfunctions
- 3D stabilization: Exercises in the treatment of idiopathic scoliosis, from positioning to auto-self-correction including if available appropriate braces
- Activities of daily living: Posture variations, natural approaches for leisure, helping to avoid progression and reduce asymmetric loading – instructions for working with Basic Tension and balancing exercises
- Sagittal correction: Correction in the sagittal plane, easy to apply and essential for spinal stability especially in the lumbar area
- Exercises with the brace: Multidisciplinary concept including bracing
2. Eligibility to attend the ISST course
Schroth therapy historically is a physical therapy concept, and therefore the certification courses will be offered exclusively to physical therapists. Interested physicians were referred to SOSORT, SRS, scoliosis meetings, and conferences, as well as special courses or visitations in related clinical centers. In ISST-courses physicians and orthopedic technicians could participate in ISST-Basic course Part I as observers if space is available.
2.1 SOSORT Guidelines
SOSORT (The International Society of Orthopedic Scoliosis Rehabilitation and Treatment) was formed in 2004, with the key members of the leading European Schroth clinics as founding members. Since then, Schroth therapy has always been intimately involved in and follows the consensus recommendations of SOSORT. The 2011 SOSORT consensus on treatment guidelines for conservative scoliosis treatment defines the leading members of the multidisciplinary team as MD, orthotist, and physical therapist. The exercise methods being carried out under SOSORT treatment guidelines referred to “Physiotherapy Scoliosis Specific Exercises” (PSSE), which is inclusive of the Schroth Method.
3. ISST – Course Program for ISST-Schroth Therapist
The complete course includes two parts each five days with altogether 77 hours (CEU).
In the 3-6 month between the intensive five days of training sessions, the therapist has to implement and practice the learned elements thoroughly into his daily routine.
The instructor makes an assignment of duties required to participate in the next part.
An exception is a ten-day course combining Part I and Part II due to training conditions in specific facilities.
The intention is to install a severe and intensive delving into practical experience.
Prices for the courses vary regarding the number of participants and local conditions.
3.1 ISST – Basic Course Part I and ISST – Basic Course Part II
3.1.1 Part I Goals and Description
In the first course, it is the presentation of an overview regarding theory and practical parts of the approach combined with general information regarding scoliosis.
The students will learn to recognize scoliosis features, assess scoliosis, categorize patients, and start to develop thinking in “Body Blocks” and necessary corrections in body planes around biomechanical axes. Corrective Breathing provides a fundamental element for the use of intrinsic forces to improve functional activities and mobility in the concavities of the deformed and altered trunk.
Positioning with simple tools is a crucial part of the learning process from a simple to a more complex understanding and also a first step in the adaptation of the ISST elements into the daily routine of the therapy process.
Participants learn the Basic Corrections including pelvic corrections with Basic Tension and assistive Shoulder Counter-Traction. Manual techniques will be used for proprioceptive teaching and to improve the functional capability of the patients.
Basic 3-dimensional stabilizing exercises in stable positions help to restore physiological alignment. Important is to adapt and internalize typical exercise instructions to reach an associative followed by an autonomous stage in the learning process.
At the end of Part I the written exam takes place.
Homework task / study task
Between Part I and Part II participants have to prepare documentation of 2 case reports for two different patients.
The documentation includes examination protocol, positioning diagram, photos from patients in a standing position (front-back-side-Adams test), with Basic Corrections in lying and sitting position and the therapy plan: 3 exercises, one breathing exercise, two mobilizing techniques, two home-exercises.
In Part II these papers will be a prerequisite for the certification process; some of the case reports will be presented and discussed.
Students have to read the 2011 Sosort guidelines: Orthopedic and rehabilitation Treatment of idiopathic scoliosis during growth, in Scoliosis and Spinal Disorders, BioMed Central
The goal of the homework task and study is to work independently with the examination assessment tools and practice the evaluation, preparation, and documentation of the scoliosis specific therapy.
The case presentation in Part II describes ways to install the program in the daily routine and offers the chance to discuss the limitations and the prospects of the approach.
Studying the Sosort Guidelines 2011 helps to understand the range of different, less and more, intensive conservative therapy elements (regular observation, exercise-based pro-active therapy, part-time/full-time bracing, surgical intervention) according to the risk of progression.
3.1.2 Part II Goals and Description
Part II gives a deep inside in the educational process of the ISST- Schroth method. The theoretical aspects would be revised and refined; additional classifications like King, Lenke, and Rigo discussed; the main principles of bracing presented.
Part II completes the standardized therapeutic process from physical examination to the individual therapy plan consisting of exercises, postural teaching, and more specific auxiliary manual techniques. The typical exercises are used with more functional and challenging variations to adapt the therapy program to the developing exercise capacity of the patients.
The relationship between scoliosis and Laterolisthesis will be introduced. Hereby the therapist learns more regarding scoliosis in adult and elderly patients. Scoliosis and pain is the central aspect of this group of patients, and both entities have to be included, mostly separated, in the therapy program.
In the functional parts, the participants work self-independent supervised by the instructor and have the chance to discuss problems within the therapeutic team.
To understand more about the surgical way of treatment a short overview of the history and the typical techniques would be given.
3.2 Ethics and certification process
The certification authorizes for the ISST treatment according to the concept of Asklepios Katharina Schroth but does not permit to teach other professionals the method. In case of non-compliance, the certification and the status of the ISST Schroth therapist will be deprived.
To pass a written and practical exam is required to get the ISST certification.
In the practical exam, the student has to prepare a therapy plan for a fictional patient including therapy diagram, scoliometer data, standardized exercise program, and an evaluation of the risk of progression. In the second part, the therapist presents his patient with his/her typical features and selected elements of the treatment program.
Continuous Education Credits (CEC): To keep the certificate valid ISST Schroth therapists have to participate in ISST refresher courses within 3yr after the last renewal. The refresher courses were organized either by the regional instructors or the senior instructor. Participants can freely choose refresher courses approved by the ISST-International – Training Institute in different regions.
4. ISST – Refresher Course
ISST Refresher course is a two-day course: consisting of practical and theoretical topics as well as case reports and held by regional ISST-instructors or the senior instructor. Prices may occasionally vary depending on the number of participants and the local conditions.
5. ISST – Advanced Course (planned for the future)
ISST Advanced course is a course for advanced ISST Schroth therapists after five years of practical experience. Interested therapists had to be certified in the ISST-Schroth method and participated at least one ISST Refresher course.
The course consists of preparation for scientific studies and scoliosis brace management.
Date of the statutes-version: August 19th, 2020