Effective conservative treatment for scoliosis
Education and training for non-surgical scoliosis treatment
provided by: ISST – International
Founder: Axel Hennes
Concept and Guidelines for ISST – Schroth Training
ISST – course: International Schroth 3dimensional Scoliosis Therapy according to Asklepios – Katharina Schroth
Training for ISST – Schroth Therapists and ISST – Instructors
Under the leadership of Axel Hennes, PT, Senior Schroth Instructor
1. Description and concept for ISST – Schroth Therapist course
- 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.
- 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 is using an individualized exercise program combining corrective behavioral patterns with physiotherapeutic methods. The 3D scoliosis treatment, based on sensorimotor and kinetic principles its goals are to facilitate correction of the asymmetric trunk and posture and to teach patients to consciously maintain the corrected posture increasingly more in daily living activities.
- Main elements of the treatment approach are the correction of reversible spinal dysfunctions, scoliosis specific passive mobilization, active 3D stabilization, Corrective Breathing, postural control, remedial 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 useful therapeutic tool and use it also as therapeutic equipment to improve the quality of exercises, especially for the home exercise program.
In the ISST- training 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 also has 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 a further risk of progression.
Specific physical therapy 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, psychologists.
- Basics: Aetiology, biomechanical concept, vicious cycle-concept, progression, postural imbalance, function and structure, brace, surgery
- Medical assessment: Visual-manual examination, a therapy protocol, X-ray evaluation, scoliometer, functional tests
- Classification: Schroth, King, Rigo, Lenke
- Specific mobilisation: 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
- Activities of daily living: Posture variations, natural approaches for leisure, helping to avoid progression and reduce asymmetric loading – instructions for working with Basic Tension, balancing exercises, and providing an individual adjusted intensive home-exercise program.
- 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 is a physical therapy concept including manual techniques, and therefore the certification courses will be offered exclusively to physical therapists (physiotherapists). Interested physicians were referred to SOSORT, SRS, scoliosis meetings and conferences, as well as special courses or visitations in related clinical centers. Orthotists were referred to the ISST-training courses for orthotists in cooperation with Human Study.
Non-physical therapists working in the scoliosis field could be accepted for a course only from the course instructor to observe parts of an ISST-Basic Course part I if space is available. The number of observers has to be less than 20% of the number of regular participants. These participants get a letter of attendance no certification.
Observers are not allowed to participate at ISST-Basic courses part II and could not participate at all when real patients are treated in a course, e.g., Asklepios combo course.
2.1 SOSORT Guidelines
SOSORT (The International Society of Orthopedic Scoliosis Rehabilitation and Treatment) 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 2011/2016 SOSORT consensus on treatment guidelines for conservative scoliosis treatment define 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 77hours (CEU).
In the 3-6 month between the intensive five days 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 – Part I and ISST – 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 in 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 traction. Manual techniques will be used for proprioceptive teaching and to improve functional capability of the patients.
Basic 3 dimensional stabilizing exercises in stable positioning help to restore physiological alignment. Important is to adapt and internalize the typical exercise instructions to reach an automated state in the learning process.
At the end of part I the written exam takes place (see also certification and examination 3.2)
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 presented and discussed.
Students have to read the 2011 Sosort guidelines scoliosis. Pubmed, scoliosis journal is an open access journal: www.scoliosisjournal.com
The goal for 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) regarding the assessment of the risk of progression. To get in contact with the scoliosis journal is necessary to find more current and developing information in the scoliosis field.
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 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 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. At this moment 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, certification process, and privacy
The certification authorizes for the treatment according to the concept of Katharina Schroth but does not permit to teach other professionals the method. In case of non-compliance, the certification and the status ISST Schroth therapist will be deprived by ISST – International and the Asklepios company.
Qualified participants have to pass a written and practical exam to get the ISST certification and become a listed ISST-Schroth therapist according to Asklepios Katharina Schroth.
The written exam is conducted at the end of Part I. In case of failure a course participant has to repeat the exam at the first or latest on the second day of Part II.
The practical exam is conducted at the end of Part II.
In the ten-day combo course, the written exam takes place on the eighth or ninth day. In case of failure, the re-exam is on the ninth or tenth day before the practical exam.
In case of failure the second written exam the participant could not take the practical exam and get only a letter of attendance.
Before the practical exam, the participant has to prepare a therapy plan for a fictional or real patient including therapy diagram, scoliometer data, standardized exercise program and an evaluation of the risk of progression. In the practical exam, the therapist presents his patient with his/her typical features and selected elements (mobilization techniques, exercises) of the treatment program to the instructor and answers question from the instructor.
In case of failure the practical exam the participant has to be re-examined at another ISST- Basic course Part II. For this reason, he/she has to apply especially for the practical exam which always starts with the preparation on the day before the exam.
Audio and video recording during the course presentations and practical demonstrations is due to the privacy and the possible misuse of the data not allowed.
Photos are allowed if the instructor gives explicit permission.
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 ISST – International in different regions.
3.3 Course fee
The course fee for different courses in different countries could vary due to specific conditions like the need for a translator, translated manual, assistants, rent for the venue, number of participants, etc.
The ISST-instructor is negotiating the teacher fee with the additional travel costs, and accommodation independently with the course organizer. Also, a deposit is possible in case a course is canceled to cover the costs for already bought flight tickets.
The ISST – International fixes a license fee per participant per 5 day-course. The fee is for preparing and updating of the course presentations and the course manual as well well as for the certifications.
ISST-International provides the “General conditions for ISST-courses” as an orientation for the ISST-instructor and the course organizer.
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 instructor Part I. Prices may occasionally vary depending on the number of participants and the local conditions.
5. ISST – Advanced Course
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 at one ISST Refresher course.
To apply, it is requested additionally to present a poster-presentation or a speaker-presentation at a SOSORT or SRS conference.
The senior Schroth instructor holds the course. Prices may vary depending on the number of participants.
6. ISST – Instructors
Instructor Part I: Assigned to organize and provide ISST Part I course, including the written exam. The course language is English or the local language.
Instructor Part I and Part II: Assigned to organize and provide ISST course Part I and II including the written and practical exam, within a defined country or region. The course language is English or the local language.
Senior Schroth Instructor: Responsible for the complete ISST course system, education, and assignment for new instructors, the organization of instructor-meetings.
7. Website and List of ISST – Schroth therapists and instructors
All information regarding the courses, training, and dates will be published on the ISST – website www.scoliosis-rehabilitation.com
The website provides a list of ISST – Schroth therapists and instructors assorted by countries. The course participants voluntarily decide before (declaration of acceptance) or after finishing ISST – Part I if they are willing to be published in that list.
International ISST – Senior Schroth Instructor
Axel Hennes, was one of the senior PT´s of the Asklepios Katharina Schroth clinic in Germany. Since 1990 he was in charge with the educational part of the Schroth method. He has mainly influenced the course system in Germany and started in 2008 as an international Schroth Senior Instructor to offer international Schroth courses in English language. Since that time he has developed the ISST program concentrating clearly on a conservative out-patient therapy approach.
Regional ISST Instructor
Phone: +81 749 46 2311
Company: Shiga School of Medical Technology
Address: Unknown, Japan
Regional Schroth Instructor
Address: 621 Plainfield Road, Ste 105, Willowbrook, IL 60527, USA