놀랍게 회복되는 측만증 치료법 : method of Katharina Schroth - 정리중

[문형철]

측만증 치료를 완전히 포기했었다.

이유는 너무도 어렵고 복잡하고 

치료적 대안으로 주어지는 운동치료법을 제대로 따라올 환자가 없었다.

너무도 어려웠던 측만증이라는 문제가 해결되고 있다.

카타리나 쉬로스의 3대 개념

1. specific postural correction

2. correction of breathing patterns 

3. correction of postural perception

어떤 특정한 패턴을 가진 올바른 움직임으로 overcorrecting(과수정)으로 치료를 시도함

panic bird..

http://www.scoliosisjournal.com/content/pdf/1748-7161-6-17.pdf

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.

- 1894년 독일 드레스덴에서 태어난 카타리나 쉬로스

- 그녀는 자신이 측만증으로 고통을 겪고 있었고, 그녀 자신이 자가치료를 결정하기 전 16세까지 steel brace를 차고 있었음. 

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.

- 부풀어오르는 풍선에 영감을 받고, 그녀는 거울앞에서 자신몸의  오목하게 틀어짐 팽창에 의해 자신의 몸통변형을 호흡에 의해서 올바르게 잡으려고 시도함. 

- 그녀는 또한 거울의 틀어짐으로 어떤 특정한 패턴을 가진 올바른 움직임으로 overcorrecting(과수정)으로 치료를 시도함. 

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.

- 그녀는 자세조절은 오직 자세인지의 변화에 의해서만 달성될 수 있다는 것을 알게됨.

- 1921년부터 시행한 특이자세조절 치료법, 호흡패턴의 바로잡음, 자세인지의 바로잡음을 시행함. 

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. 

- 보조기, 재활시간, 환자가 변함. 

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.

- 측만증 재활치료시간이 줄어고....

- 카타리나 쉬로스의 specific postural correlation, correlation of breathing patterns, correlation of postural perception의 3차원 치료법에 기초한 프로그램....

사례 정리...

원리 탐구

- 독일에서 3대째 측만증 등 부정렬 치료의 새역사를 써가고 있는 Schroth 가문

- 뇌에서 올바르다고 인식하는 자세를 수정하는 것

- 흉추의 회전과 늑골의 관계를 호흡을 이용하여 재정렬 움직임을 주는 것

- 3 curve pattern 4가지 분류, 4 curve pattern 3가지 분류 .. 총 7가지 측만증 type으로 분류함.

- rib hump를 적극적 재활운동 3개월만에 교정한 사례

- 참으로 놀라울 따름이다.  

- 우리는 안된다고, 불가능하다고만 생각하고 포기한 사례를 쉬로스 가문은 놀랍게도 치료하고 있다. 

Lehnert-Schroth의 3 curve pattern과 4 curve pattern

- 3은 흉추가 main curve일때, 4는 요추가 main curve일때

- 3CH는 흉추가 우측 주커브로 측만되고, Hip(골반)이 좌측으로 보상한 측만증. 

- 3CTL은 흉추가 주커브로 측만되고 TL(흉요추연접)이 틀어진 측만증

- 3C는 흉추가 주커브로 측만.

- 3CL은 흉추가 주커브로 측만되고 요추가 틀어진 측만증

- 4C는 요추가 주커브로 틀어진 측만증

- ...

History of Katharina Schroth’s method of scoliosis treatment

The history of conservative treatment of scoliosis is rather long and leads us back to the original methods of Hippocrates (460-370 BC) [1]. Although more than two thousand years have passed since the century of Hippocrates, the main approach of conservative scoliosis treatment has been based on mechanical viewpoints still in the early 20th Century and in most of the approaches still existing today. 

- 측만증 보존치료의 역사는 길어서 기원전 460-370년경 히포크라테스 시대로 거슬러 올라감.

Correction exercises were widely distributed in whole of Europe during the last two centuries; some of them were using three therapists for one patient (Figure 1) during scoliosis correction [2].

- 측만증 교정재활치료는 지난 세기동안 유럽에서 널리 퍼짐. 

The history of the Schroth method is a history involving the professional work of three generations. The initiation of the programme was the result of Katharina Schroths studies (Additional file 1 and 2), in part a development from studying her own body, her own spinal function and the corrective movements possible. Mirror monitoring plays an important role in the original Schroth programme so as to allow synchronizing the corrective movement and the postural perception with the visual input (Figure 2). 

- 쉬로스 치료법의 역사는 3대에 걸쳐 발전함. 

- 시작은 카타리나 쉬로스가 자신의 몸을 치료하면서 발달함. 

- 거울 모니터링은 본래 쉬로스 프로그램에서 중요한 역할.

As breathing and its functional correction played an important role, her first pamphlet focused on breathing in general [3] and later on also describing the importance of postural perception by the patient and its improvement with the help of specific correction exercises [4,5].

- 호흡과 그것의 기능적 교정은 중요한 역할을 담당함. 

In the 70’s Christa Lehnert-Schroth further developed the method and introduced a simple classification, which is still used today by physiotherapists (Figure 3).

- 1970년대에 크리스티나 레너트 쉬로스는 간단분류법을 개발함.

Additionally, she discovered the importance of the lumbosacral (counter-) curve (4th Curve) for pattern specific postural correction and described all this in her book, which was first published in 1973 and is now available in the 7th edition [6]. This historically important book is also available in English and Korean [7].

- 게다가 그녀는 요천추 커브(4번째 커브)의 중요성을 발견함.

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 [8] and the book was translated into Spanish [9].

- 1990년대 리고와 저자는 중요한 진전을 이룸

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 [12].

- 2010년에 새로운 교육법과 sagittal profile의 교정법의 접근이 발달함. 

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).

- 출발은 1894년 독일 드레스덴에서 태어난 카타리나 쉬로스에서 출발..

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.

- 부풀어오르는 풍선에 영감을 받고, 그녀는 거울앞에서 자신몸의  오목하게 틀어짐 팽창에 의해 자신의 몸통변형을 호흡에 의해서 올바르게 잡으려고 시도함. 

- 그녀는 또한 거울의 틀어짐으로 어떤 특정한 패턴을 가진 올바른 움직임으로 overcorrecting(과수정)으로 치료를 시도함. 

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.

- 또한 그녀는 자세조절은 오직 자세인지 변화에 의해서만 달성될 수 있음을 인식함. 

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. From 1921 on this new form of treatment with specific postural correction, correction of breathing and correction of postural perception was performed with rehabilitation times of three to sometime six months in her own little institute in Meissen (Figure 4, 5) and from the late 30’s she was supported by her daughter, Christa Schroth (Figure 6, 7).

- 카타리나 쉬로스는 ... 1921년 specific postural correction, correction of breathing and correction of postural perception과 함께 치료를 시작. 

During that time, patients with curvatures exceeding 80° with huge rib humps and very stiff deformities of different origins were the main attraction (Figure 8, 9 and 10).

- 당시에 아래 그림과 같이 심한 측만증과 rib hump환자에 많은 흥미를 가짐. 

Besides individual exercises, also with passive manual correction by a therapist, a group setting was established allowing the treatment of patients with similar curve patterns in one group (Figure 11).

- 측만증이 비슷한 그룹에서는 개별화된 치료적 운동이외에 집단운동을 시행함. 

The institute had a large garden and a little hut with some helpful tools for individal and group treatment. Most of the treatment was carried out in the garden, fresh air and sunrays increased the patient’s general health at a time where people were not used to exposing their skin to the sun or indeed to other people (Figure 12).

Mirror monitoring has always been important as can be seen in Figure 2 and 10 in an individual session of patients in front of a mirror treated by Christa Schroth in the 40’s. Franz Schroth, Katharina Schroth’s husband, also helped in the first institute with individual corrections and special strengthening exercises (Figure 13).

- 거울 모니터링은 항상 중요한 역할을 함. 

- Franz 쉬로스(카타리나 쉬로스의 남편)은 아래 그림과 같이 specificial strengthening exercise와 개별화된 교정운동을 처음 시행함. 

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

After World War II, Katharina Schroth and her daughter moved to West Germany to open a new little institute in Sobernheim in the early 60’s, which constantly grew to a clinic with sometimes more than 150 inpatients treated as a rule for 6 weeks (Figure 14 and 15).

- 2차대전 후 카타리나 쉬로스와 그의 딸은 서독으로 가서 치료실을 개설. 

- 한번에 150명을 6주동안 집단치료하는 프로그램.

After her divorce from her first husband, Ernst Weiss, Christa Schroth married Adalbert Lehnert, who helped her to build up this new centre and who was also involved in the treatment of patients (Figure 16).

- 새로운 남편 Adalbert Lehnert가 도와서 치료 시작

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]. It was also in the 70’s, when the impact of the lumbosacral curve on the correction of certain curve patterns was discovered [15,16].

- 1970년대에 lumbosacral curve의 중요성이 발견됨

Christa Lehnert-Schroth recognized the spontaneous correction of a functional leg length discrepancy just by straightening the lumbar curve [15].

- 크리스타 레너트 쉬로스는 요추커브를 올바르게 함에 의해서 기능적 다리길이차이가 자발적으로 교정되는 것을 알게됨 

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.

- 1980년대 산아토리움 레너트 쉬로스는 클리닉 이름을 새로지음.

- 그럼에도 불구하고 독일 대학 교수와 수많은 차이에 의해 지속적인 논쟁

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. More patients with curvature angles of less than 40° and typical flatback deformities were treated, but there was no real development towards a systematical correction of the sagittal profile. 

While the original programme was for thoracic curves exceeding 80° with trunk rotations and rib humps leading to a more kyphotic inclination of the trunk, the moderate curvatures were addressed quite well in the frontal and coronal plane, but the sagittal profile was still underestimated. The only correction of a thoracic flatback was through rotational breathing while the starting positions of the exercises was still with both arms in elevation increasing the flatback deformity (Figure 17 and 18).

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 [17], 1997 in English [18] and later on including age and sex matched controls from another regional study on untreated patients as a prospective controlled study [19].

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 [20].

More than 800 Patients were material for the study on vital capacity and rib mobility published in Spine 1991 [21], the material in the study on muscle activity reductions after intensive rehabilitation consisted of more than 300 patients [22].

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 [18], which was the basis for our prospective controlled trial published in 2003 [19].

During the 90’s there was some development with respect to the correction of thoracolumbar curves including the derotational effect of the psoas muscle. More and more exercises were performed in horizontal positions with as many corrective tools as possible, surely not available during the patients’ home programmes (Figure 19).

- 요천추 커브의 교정에 psoas muscle의 derotational effect를 포함함. 

In the 80’s the author performed an analysis of the different aspects of the original Schroth method [25]. One of the most important factors of the original Schroth method was the automated precorrection of the deformity with the help of postural reflex activity in certain asymmetric upright starting positions. The exercise began precorrected with the help of postural reflex activity in upright asymmetric starting positions and the exercise itself increased this precorrection (Figure 20).

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].

frog at the pond

[우루사]

분류나 용어들이 많이 바뀐상태입니다. 현재는 분류도 많이 바뀌고 근거또한 많이변항상태입니다.
그래도 호흡컨샙과 운동은 거의 변하지 않았다고 합니다. 확실히 얼마나 변한지는 모르겠습니다만..^^;

[문형철]

그렇군요.. ㅎㅎㅎ

[이성용]

어제 본 내용이 새록하고 앞으로 정리될 내용이 두근두근 기대됩니다....운동까지 정리된거 보고싶네요..^^

[gene]

좋은정보 감사합니다~

[송영석]

척추측만증/슈로스운동/ scoliosis / 검색용