Do you use the gold standard for treating clients with scoliosis? If you treat, or are likely to treat, patients with scoliosis, then Three-Dimensional Treatment for Scoliosis by Christa Lehnert-Schroth, PT, is an invaluable resource. While 3-D treatment is the gold standard in German physiotherapy, the method is new to me. This technique involves specific breathing and spine-lengthening exercises. We would serve our clients well if we integrated this European treatment style into practice.

Katharina Schroth, the author's mom, developed the therapy in the 1920s to address her own spinal deformities, and then applied techniques to other people with similar conditions. She founded a clinic in Bad Sobernheim, Germany, which is now called the "Katharina Schroth Klinik." Patients from around the world receive treatment at the center.

One of the book's most significant features is the quantity of photos. Additionally, X-rays, diagrams and figures are abundant. These visual aids assist the reader with improved understanding of the material. There is a photograph for every exercise described in the exercise section. Rarely, photo quality limits its interpretation. I appreciated curvature degrees printed on X-rays taken before and after treatment to show improvements.

Five sections organize the text: 1) Theoretical basis of the Schroth Method; 2) Evidence-based theory; 3) Exercise instructions; 4) Documentation; and 5) General information. The first section details the division of the trunk into segments, describes postural deviations in different planes, recognizes breathing's usefulness in treatment, notes improvements in cardiopulmonary function, promotes sunlight and fresh air, and evaluates loss of spine length and its implications.

The evidence-based section refers to anatomy, reviews muscles involved, conceptualizes the curves into blocks, and addresses postural corrections and positions for exercises. Evidence, as defined in our culture, is covered in the documentation section. Documentation includes X-rays and photographs of specific cases along timelines to show visible changes from therapy. Treatment results are evaluated statistically for vital capacity, breathing movement, exhalation length, chest circumference, scoliometer values, electromyography, surface EMG, comparative X-rays, pulse measures and side effects such as psychological status. The clinic continues research with prospective and retrospective studies.

The exercise section covers breathing and exercise on wall bars, using a table or chair, on the floor, for the neck, with resistance bands, and to correct lumbosacral curves and the scoliotic pelvis. Problems in scoliosis treatment are listed and described in variable lengths. Therapy aids used to support corrections are explained and shown in figures. This was extremely helpful in understanding their purpose and application in treatment techniques.

General information reviews components of the inpatient program at the Katharina Schroth Klinik, expectations for daily life, and indications and contraindications for treatment. I found this section useful and interesting. An appendix notes the importance of exercise quality. Rotational breathing is described, along with six exercises explained in detail. I found the breathing description so useful; I wish I had read the appendix prior to reading any other part of the book. The conclusion has four patient testimonials as well as two reports of different cases and their associated treatments with photographs and/or X-rays.

This text clearly expresses that the patient and PT must be motivated for good results. Fresh air, nutrition and other factors are considered important in the rehab process, and patients exercise and rest outdoors whenever possible. Newly developed postures are integrated into daily activities, sleep and continued throughout life for maximum benefit and curve reduction.

My challenges in comprehending the text seemed to result from the amount of information, variation in technicality and overall organization of the material. Instead of a progression to greater understanding, I understood the earlier parts better because of reading the later sections. Certain ideas could have been repeated in more than one section to improve command of the subject.

A general statement lets the reader know that curves will be described by the thoracic spine. I believe it would be more useful to identify each curve, such as left thoracal convex curve, to improve understanding and allow someone to pick up the book and start reading it on any page. I highly recommend this book to anyone who treats people with scoliosis. I know I will use the text and expect to re-read parts when treating patients with a spinal deformity.

Three-Dimensional Treatment for Scoliosis is a 278-page, soft-cover text priced at $59.95 and available from The Martindale Press at www.schrothmethod.com

Karin J. Edwards is a consultant who practices most often in Alaska.