Clinical Effects of Proprioceptive Neuromuscular Facilitation Combined With Spiral Muscle Chain Training in the Treatment of Children With Scoliosis
Phase: NA
Conditions: Adolescent Idiopathic Scoliosis (AIS)
Sponsor: Nie danning

1. Detailed Experimental Protocol for PNF Therapy 
1） Scapular Diagonals 
①) Diagonal Movements 
Scapular and pelvic diagonal movements include anterior elevation–posterior depression and 
posterior elevation–anterior depression, forming an arc along the curvature of the participant’s 
trunk. During diagonal movements, the participant should avoid rocking forward and backward. 
 
Figure 1 Scapular and Pelvic Diagonal Movements 
②) Purpose 
Scapular muscles control or influence the cervical and thoracic spine. They help coordinate 
movement, reduce fatigue of scapular or trunk muscles, and promote cervical and upper-limb 
motion and stability. Upper-limb function also requires adequate scapular mobility and stability, 
which may help improve uneven shoulders and thoracic kyphotic posture. 
Table 1 ScapularMuscles Involved in Movement 
Movement 
Muscles 
Anterior 
elevation 
levator scapulae, rhomboids, serratus anterior 
Posterior 
depression 
lower serratus anterior, rhomboids, latissimus dorsi, lower trapezius 
Posterior 
elevation 
trapezius, levator scapulae, rhomboids 
Anterior 
depression 
rhomboids, serratus anterior, pectoralis minor, pectoralis major 
③) Resisted scapular anterior elevation 
The participant lies in a side-lying position. The scapula is drawn downward and backward 
toward the lower thoracic spine, so that the inferior angle rotates toward the spine. The 
glenohumeral joint complex is positioned posterior to the mid-axillary line, and the anterior 
cervical muscles are tense. During this process, avoid lifting the participant’s head, rolling the 
trunk backward, and rotation of adjacent spinal segments. The examiner applies an arc-shaped line 
of resistance to the participant’s scapula, resisting the inferior angle along the direction of the 
spine. Hand placement is anterior to the glenohumeral joint, with both hands grasping the 
acromion to apply pressure. The participant then moves the scapula upward and forward, bringing 
the acromion toward the nose. The scapular retractors and depressors are stretched; the inferior 
angle moves away from the spine, and the scapular retractors and depressors are activated. 
④) Resisted scapular posterior depression 
The participant lies in a side-lying position. The scapula is pushed anteriorly and superiorly, 
with the inferior angle moving away from the spine until the muscles posterior and inferior to the 
scapular spine become tense. During this process, avoid rolling the participant forward. The 
examiner applies an arc-shaped line of resistance, resisting movement of the inferior angle away 

from the spine. As the scapula moves posteriorly, resistance is directed anteriorly; at the end of the 
movement, resistance is directed upward with a rotational component away from the spine. Hand 
placement: the heels of both hands are placed along the vertebral border of the scapula; the fingers 
rest on the scapula pointing toward the acromion, applying pressure below the scapular spine. The 
participant then depresses and retracts the scapula; the glenohumeral joint complex is posterior to 
the mid-axillary line, and the vertebral border of the scapula lies flat. 
 
Figure2 Resisted ScapularAnterior Elevation Figure 3 Resisted ScapularPosterior Depression 
⑤) Resisted scapular anterior depression 
The participant lies in a side-lying position and lifts the scapula upward and posteriorly. The 
glenohumeral joint complex is positioned posterior to the mid-axillary line, and the abdominal 
wall muscles are tightened. Avoid rolling the participant backward or rotating adjacent spinal 
segments. The examiner applies resistance along the curvature of the participant’s body. Hand 
placement: one hand is positioned behind the shoulder, with the fingers grasping the lateral border 
of the scapula; the other hand is placed anterior to the shoulder to grasp the axillary border of the 
pectoralis major and the coracoid process. The participant then rolls forward. 
⑥) Resisted scapular posterior elevation 
The participant lies in a side-lying position. The scapula moves in an arc anteriorly and 
inferiorly toward the contralateral iliac crest, with the inferior angle moving toward the spine until 
the trapezius tightens. Avoid rolling the participant forward or rotating adjacent spinal segments. 
The examiner applies resistance along the curvature of the participant’s body. Hand placement is 
behind the upper trapezius, with both hands overlapped and maintained above the scapular spine. 
 
Figure 4 Resisted ScapularAnterior Depression       Figure 5 Resisted Scapular 
2） Pelvic Diagonals 
①) Purpose 
Pelvic muscles play a role in controlling or influencing pelvic alignment. They help 
coordinate movement and prevent or reduce fatigue of the working muscles, promote trunk and 
lower-limb movement and stability, and have significant effects on improving pelvic height 
asymmetry, tilt, and rotation. 
 
 
 

Table 2 PelvicMuscles Involved in Movement 
Movement 
Muscles 
Anterior 
elevation 
internal oblique, external oblique 
Posterior 
depression 
contralateral internal obliqueexternal oblique 
Posterior 
elevation 
ipsilateral quadratus lumborum, ipsilateral latissimus dorsi, iliopsoas, 
longissimus thoracis 
Anterior 
depression 
contralateralquadratus lumborum, latissimus dorsi, iliopsoas, longissimus 
thoracis 
②) Resisted pelvic anterior elevation 
The participanta side-lying position, pelvisPosterior depressiondirection, arc-shapedposterior 
to contralateral, AvoidThe participantposteriorspinerotation. The examinerapplyresistance, Hand 
placement. ThenThe participantpelvissuperior, , trunk. 
③) Resisted pelvic posterior depression 
The 
participanta 
side-lying 
position, 
anteriorcontralateral, 
AvoidThe 
participantanteriorspinerotation. The examinerThe participantapply, anterior, Hand placement, 
direction. ThenThe participantpelvisposterior, trunk. 
 
Figure 6 Resisted PelvicAnterior Elevation Figure7 Resisted PelvicPosterior Depression 
④) Symmetrical and Asymmetrical Exercises 
Symmetrical exercise: both pelvis and scapula move anteriorly or posteriorly 
Asymmetrical exercise: scapular and pelvic diagonals are opposite and non-parallel 
3） Upper Limb Diagonals 
①） Diagonal Movements 
Upper-limb diagonal movements primarily include two diagonals: flexion–abduction–
external rotation with extension–adduction–internal rotation; and flexion–adduction–external 
rotation with extension–abduction–internal rotation. The shoulder and the wrist–hand complex are 
linked and work synergistically within these patterns. 
 
Figure 8 Upper-limb Diagonals 

②） Purpose 
Arm patterns are three-dimensional spiral movements connected to the trunk. They are 
commonly used to treat functional impairments caused by neurological problems, muscle 
disorders, or limited joint mobility, and are also applied in trunk training. Resisted activation of 
the upper-limb muscles can produce irradiation effects that facilitate weaker muscles in other 
regions. 
Table 6Upper-limbMuscles Involved in Movement 
Movement 
Muscles 
scapulaPosterior elevation 
trapezius, levator scapulae, serratus anterior 
scapulaPosterior depression 
rhomboids 
scapulaAnterior elevation 
serratus anterior, trapezius 
scapulaAnterior depression 
serratus anterior, pectoralis minor, rhomboids 
flexionabductionexternal rotation 
deltoid, biceps brachii, coracobrachialis, supraspinatus, 
infraspinatus, teres minor 
flexionadductionexternal rotation 
pectoralis major, deltoid, biceps brachii, coracobrachialis 
extensionadductioninternal rotation 
pectoralis major, teres major, subscapularis 
extensionabductioninternal rotation 
latissimus dorsi, deltoid, triceps brachii, teres major, 
subscapularis 
Elbow Extension 
triceps brachii, anconeus 
Elbow Flexion 
biceps brachii, brachialis 
Forearm Pronation 
brachioradialis, pronator muscles 
Forearm Supination 
biceps brachii, brachioradialis, supinator 
Wrist Ulnar Deviation 
flexor carpi ulnaris 
Wrist Radial Deviation 
extensor carpi radialis 
Finger Flexion with Radial/Ulnar 
Deviation 
finger flexors, lumbricals, interossei 
Finger Extension with Radial/Ulnar 
Deviation 
extensor digitorum, lumbricals, interossei 
Thumb Flexion–Adduction–
Opposition 
thumb flexors, adductor pollicis, opponens pollicis 
Thumb Extension–Abduction 
Thumb extensors, Extensor pollicis longus 
③） Flexion–abduction–external rotation with elbow flexion (or elbow extension) 
The participant lies in a supine or standing position, with the wrist placed in ulnar 
deviation and the forearm in pronation, maintaining the position of the wrist and hand. The 
elbow is flexed while the shoulder moves into extension and adduction, and the trunk laterally 
flexes to the right. Excessive wrist flexion should be avoided. The examiner’s proximal hand 
moves upward to grasp the humerus or scapula, encircling the humerus medially and applying 
pressure opposite to the direction of movement, while providing traction to the participant’s 
shoulder and hand. As the wrist moves into radial deviation, the fingers and thumb extend, and 
the radial side leads the shoulder into flexion with abduction and external rotation, with the 
scapula moving into posterior elevation. The examiner’s distal hand applies rotational resistance 
through traction on the extended wrist, resisting radial deviation, forearm supination, and 
shoulder external rotation. The line of resistance is directed posteriorly toward the starting 
position, while maintaining traction to guide resistance along an appropriate arc. The participant 
then achieves full humeral flexion, with the scapula in posterior elevation, the elbow flexed (or 
extended), the wrist fully radially deviated, and the fingers and thumb deviated radially. 

   
 
Figure 9 Flexion–abduction–external rotation with elbow flexion Figure 10 Flexion–abduction–
external rotation with elbow extension 
④） Extension–adduction–internal rotation with elbow extension (or elbow flexion) 
The participant again lies in a supine or standing position, with the wrist placed in radial 
deviation and the forearm in supination, lengthening the shoulder and scapular muscles. Full 
humeral flexion (or extension) drives the scapula into posterior elevation. The examiner’s distal 
hand contacts the palmar surface of the participant’s hand, with the fingers on the radial side and 
the thumb applying low pressure along the ulnar border. The proximal hand encircles the inferior 
aspect of the humerus, guiding the participant’s trunk to be diagonally lengthened from left to 
right with a quick traction combined with rotation, while avoiding excessive shoulder flexion and 
wrist hyperextension. The examiner’s distal hand applies traction and rotational resistance at the 
participant’s flexed wrist to resist ulnar deviation, forearm pronation, and shoulder adduction 
and internal rotation. The proximal hand combines traction with rotational resistance, with the 
line of resistance directed toward the starting position and applied along an arc. The participant 
then moves the scapula into anterior depression, with the shoulder performing extension, 
adduction, and internal rotation, crossing and stabilizing beyond the midline to the right. The 
forearm pronates, the elbow fully extends (or flexes), and the wrist and fingers flex, with the palm 
facing the right iliac crest. 
 
Figure 11 Extension–adduction–internal rotation with elbow extension 
 
Figure 12 Extension–adduction–internal rotation with elbow flexion 
⑤） Flexion–adduction–external rotation with elbow flexion (or elbow extension) 
The participant lies in a supine or standing position, with the wrist placed in ulnar deviation 
and the forearm in pronation. The shoulder moves into extension and abduction, and traction 
facilitates the scapula into posterior depression. The trunk shortens with left lateral flexion, while 
excessive internal rotation that would cause anterior scapular tilting is avoided. The examiner’s 
distal hand contacts the palmar surface of the participant’s hand, while the proximal hand grasps 
the forearm; when the elbow is flexed, the humerus is grasped. Rapid traction and rotational input 
are applied to the shoulder joint and scapula. 
The examiner’s distal hand applies traction to the flexed wrist combined with rotational 

resistance against radial deviation. Rotational resistance at the wrist provides resistance to forearm 
supination, shoulder adduction, and external rotation, while resisting flexion of both the wrist and 
shoulder. The line of resistance is directed toward the starting position, with traction maintained to 
guide resistance along an arc. The participant then moves the scapula into anterior elevation, with 
the shoulder performing flexion and adduction accompanied by external rotation. The humerus 
crosses the midline, the forearm supinates, the elbow flexes (or extends), and the hand may reach 
the right ear, inducing trunk rotation and elongation. 
 
Figure 13 Flexion–adduction–external rotation with elbow flexion Figure 14 Flexion–adduction–
external rotation with elbow extension 
⑥） Extension–abduction–internal rotation with elbow extension (or elbow flexion) 
The participant lies in a supine or standing position, with the wrist placed in radial deviation 
and the forearm in supination, maintaining the position of the wrist and hand. The shoulder moves 
into flexion and adduction, facilitating anterior elevation of the scapula and lengthening the 
shoulder musculature. The elbow is fully extended (or flexed), promoting trunk elongation with 
rightward rotation. The examiner’s distal hand grasps the dorsum of the participant’s hand, while 
the proximal hand grasps the medial aspect of the forearm, simultaneously providing traction to 
the shoulder and hand. The proximal hand applies rapid traction with rotation to the shoulder and 
scapula, while the distal hand applies traction to the wrist. 
During wrist extension, the examiner’s distal hand applies rotational resistance against ulnar 
deviation, with wrist rotational resistance opposing forearm pronation and shoulder internal 
rotation and abduction. The participant then moves the scapula into full posterior depression, the 
humerus extends toward the left, the forearm pronates, and the wrist assumes ulnar deviation. 
 
Figure 15 Extension–abduction–internal rotation with elbow extension 
⑦) Bilateral Arm Pattern Combinations 
• 
Bilateral symmetrical: flexion–abduction–external rotation 
• 
Bilateral asymmetrical: right arm flexion–abduction–external rotation; left arm flexion–
adduction–external rotation 
• 
Bilateral symmetrical alternating: right arm flexion–abduction–external rotation; left 
arm extension–adduction–internal rotation 
• 
Bilateral asymmetrical alternating: right arm extension–adduction–internal rotation; 
left arm flexion–adduction–external rotation 
Positions: side-lying, elbow-supported, sitting, quadruped, and kneeling positions. 

4） Neck Diagonals 
①) Diagonal Movements 
Cervical patterns include flexion, extension, lateral flexion, and rotation, using the nose, chin, 
and vertex lines as movement axes. 
 
Figure 16 Scapular and Pelvic Diagonal Movements 
②) Purpose 
Optimal head control and correct cervical alignment and mobility form the foundation for 
performing activities of daily living. These patterns help guide trunk movement, improve posture, 
and produce irradiation effects to other parts of the body. 
Table 7Cervical Flexion, Lateral Flexion, and RotationMuscles Involved in Movement 
Movement 
Muscles 
flexion 
longus capitis, rectus capitis anterior, suprahyoid muscles, infrahyoid muscles 
flexion 
longus colli, platysma, anterior scalene, sternocleidomastoid 
rotation 
scalenes, ipsilateralsternocleidomastoid, longus capitis, longus colli, rectus 
capitis anterior 
lateral flexion 
longus colli, scalenes, sternocleidomastoid 
extension 
iliocostalis, longissimus capitis, obliquus capitis muscles, rectus capitis 
posterior muscles, semispinalis capitis, splenius capitis, trapezius 
extension 
iliocostalis cervicis, longissimus cervicis, splenius cervicis, multifidus, 
rotatores, semispinalis cervicis, splenius cervicis, trapezius 
rotation 
multifidus, rotatores, semispinalis capitis, ipsilateraltrapezius, , splenius 
cervicis, splenius capitis 
lateral flexion 
iliocostalis cervicis, intertransversarii, longissimus capitis, , splenius cervicis, 
splenius capitis, trapezius 
③) neckflexion-lateral flexion- 
The participant sits with the chin elevated, the neck lengthened, and the head rotated and 
tilted to the right, stretching the soft tissues on the left side of the neck. Avoid compressing the 
participant’s facet joints. The examiner instructs the participant to rotate the chin to the left, retract 
the chin, and look down toward the hip. The examiner’s right hand applies traction along the 
mandibular line and provides resistance against left rotation, while the left hand applies a 
rotational force to the posterior aspect of the head. Hand placement: the left hand supports the 
vertex slightly left of the midline; the right hand is placed beneath the participant’s chin and lifts 
along the diagonal direction. The participant then moves into full flexion of the head, neck, and 
upper thoracic spine. 
④) neckextension-lateral flexion- 
The participant sits with the chin retracted and the neck flexed. The head is rotated and tilted 
to the left, stretching the soft tissues on the right side of the neck. Avoid compressing the 
participant’s facet joints. The examiner instructs the participant to rotate the chin to the right and 

lift the head to look upward. The examiner’s right hand applies pressure along the mandibular line, 
providing resistance to right rotation, while the left hand applies a rotational force to the posterior 
aspect of the head. Hand placement: the right hand is placed at the center of the chin; the left hand 
supports the vertex slightly right of the midline. The participant then positions the head, neck, and 
upper thoracic spine in extension and elongation. 
 
Figure 17 Neck flexion–left lateral flexion–left rotation Figure 18 Neck extension–right lateral flexion–
right rotation 
5） Trunk Diagonals 
①) Diagonal Movements 
Trunk diagonal movements include flexion/extension, lateral flexion, and rotation, spanning 
from the coracoid process to the contralateral anterior superior iliac spine, representing trunk side-
bending with rotational flexion or extension. 
②) Purpose 
Trunk control is the foundation for supporting limb movement. Resisted trunk patterns 
provide irradiation for indirect treatment of the cervical and scapular muscles and can be effective 
for managing thoracic kyphosis, lumbar lordosis, or scoliosis. 
Table 8 Trunk Muscles Involved in Movement 
Movement 
Muscles 
Chopping to the 
left 
Left external oblique, rectus abdominis, right internal oblique 
Bilateral lower-
limb flexion to the 
left 
Left internal oblique, rectus abdominis, right external oblique 
Lifting up to the 
right 
  Cervical and back extensors, left multifidus and rotatores 
Bilateral lower 
limbs to the right 
Back and cervical extensors, right quadratus lumborum, left multifidus and 
rotatores 
With extension bias 
and rotation 
Quadratus lumborum, iliocostalis lumborum, longissimus thoracis, 
latissimus dorsi 
With flexion bias 
and rotation 
Right internal oblique, right external oblique 
 
③) Chopping 
The participant lies in a supine position (to facilitate trunk flexors). The left arm is in 
flexion–adduction–external rotation; the right hand grasps the left wrist, and the right arm is in 
abduction and external rotation. Traction is applied to the left arm and scapula to lengthen the arm 
and trunk muscles. The examiner’s left hand grasps the participant’s left wrist, and the right hand 
is placed on the participant’s forehead with the fingers pointing toward the vertex, applying 
resistance to the arm movement and guiding both arms toward the contralateral shoulder. The 
examiner primarily guides head and neck movement to facilitate trunk activation. The participant 
moves the arms and head against resistance, maintaining contraction of the trunk flexors. Then the 

participant laterally flexes the upper trunk to the left as much as possible. 
④) Lifting 
The participant lies in a supine position (to prevent excessive cervical and lumbar lordosis 
during movement). The left arm is in extension–adduction–internal rotation; the right hand grasps 
the wrist, and the right arm is in extension–abduction–internal rotation. The participant looks at 
the left hand, the neck laterally flexes to the right, and traction is applied to the left arm and 
scapula to lengthen the arm and trunk muscles. The head and neck extend toward the left; the 
upper trunk moves into extension with left rotation and left lateral flexion. The examiner’s left 
hand grasps the participant’s left wrist, and the right hand is placed on the top of the head. 
Resistance is applied to the arm and head and transmitted toward the contralateral hip to facilitate 
activation of the back extensors. The arm and head complete the movement against resistance 
while maintaining contraction of the trunk extensors. Then the participant fully flexes both arms, 
extends the head toward the left, and extends and lengthens the trunk to the left. 
 
Figure 19 Chopping                                   Figure 20 Lifting 
⑤) Bilateral Lower Limbs Facilitating Trunk Flexion 
The participant sits supported at the edge of a platform/step. The left leg is extended–
abducted–internally rotated; the right leg is extended–adducted–externally rotated. The trunk is 
extended and lengthened to the left with left rotation and lateral bending, avoiding excessive 
lumbar extension. The examiner’s left hand grasps both feet and resists rotation of the trunk and 
hips. Then the participant fully flexes, adducts, and internally rotates the right leg, and fully flexes, 
adducts, and externally rotates the left leg; the lower trunk flexes with rotation and right lateral 
flexion. 
⑥) Bilateral Lower Limbs Facilitating Trunk Extension 
The participant sits supported at the edge of a platform/step. Both legs are flexed to the right: 
the right leg in flexion–abduction–internal rotation with knee flexion; the left leg in flexion–
adduction–external rotation with knee flexion. The trunk is lengthened with rotation and left 
lateral bending, then moves into flexion with rotation and right lateral flexion, avoiding excessive 
lumbar extension. The participant’s left hand grasps both feet; the right arm is placed under the 
participant’s thighs. Pressure applied to the feet resists trunk and hip rotation. Then the participant 
extends the left leg into abduction and internal rotation and extends the right leg into adduction 
and external rotation; the lower trunk is lengthened with rotation and left lateral flexion. 
 
Figure 21 Bilateral Lower Limbs Facilitating Trunk Flexion 

 Figure 22 Bilateral Lower Limbs Facilitating Trunk Extension 
⑦) Left lateral flexion with flexion bias 
The participant sits supported at the edge of a platform/step and performs full hip rotation 
while performing trunk motion with a flexion bias. The examiner provides traction through the 
femur, shortens the hip into flexion, applies lateral pressure to resist hip lateral movement, and 
stabilizes both knees and feet to resist hip rotation. Then the participant rotates both hips to the left; 
the lumbar spine bends to the left, and the pelvis moves toward the rib cage. 
⑧) Right lateral flexion with extension bias 
The participant sits supported at the edge of a platform/step. With both legs fully flexed to the 
left, the participant begins full hip rotation. The examiner instructs a static contraction of hip and 
knee extension; the examiner resists hip extension and lateral movement, while the distal hand 
stabilizes the knee and foot to resist dynamic hip rotation. Then the participant fully rotates both 
hips to the left; the lumbar spine extends and bends to the right. 
 
Figure 23 Right Lateral Flexion with Extension Bias 
Note: The images above are sourced from the book Practical PNF (5th ed.): Illustrated Guide to 
Proprioceptive Neuromuscular Facilitation Techniques. 
 
2. Detailed Experimental Protocol for SPS Training 
1） Muscle Chain Anatomy 
①) ES (Erector Spinae) muscle chain: erector spinae, longissimus thoracis, iliocostalis, 
piriformis, gluteus maximus, adductor magnus, biceps femoris, semitendinosus, 
semimembranosus, peroneal muscles 
②) OL (Quadratus Lumborum) muscle chain: rectus capitis posterior major, semispinalis capitis, 
semispinalis cervicis, quadratus lumborum, intertransversarii, intertransverse ligaments, 
iliacus, rectus femoris, biceps femoris, peroneal muscles, soleus 
③) SA (Serratus Anterior) muscle chain: splenius capitis, rhomboids, transversus thoracis, 
serratus anterior, external oblique, internal intercostals, serratus posterior inferior, internal 
oblique, transversus abdominis, gluteus maximus, fascia lata, adductor group, soleus, tibialis 
anterior, tibialis posterior 
④) PM (Pectoralis Major) muscle chain: transversus thoracis, pectoralis major, external oblique, 
internal oblique, internal intercostals, serratus posterior inferior, transversus abdominis, 
gluteus maximus, fascia lata, tibialis anterior, tibialis posterior 
⑤) LD (Latissimus Dorsi) muscle chain: latissimus dorsi, rotatores, levator costarum, external 
intercostals, external oblique, gluteus maximus, fascia lata, sartorius, adductor group, soleus, 
tibialis anterior, tibialis posterior 
⑥) TR (Trapezius) muscle chain: trapezius, rotatores, levator costarum, external intercostals, 
transversus thoracis, external oblique, transversus abdominis, serratus posterior inferior, 
internal oblique, psoas major, gluteus maximus, adductor group, hamstrings, soleus, tibialis 

anterior, tibialis posterior 
⑦) IP (Iliopsoas) muscle chain: rectus capitis anterior, longus capitis, longus colli, spinalis, 
psoas major, biceps femoris, peroneal muscles 
⑧) RA (Rectus Femoris) muscle chain: sternocleidomastoid, anterior scalene, pectoralis minor, 
external intercostals, sternalis, rectus abdominis, gracilis, flexor hallucis longus 
⑨) SS (Semispinalis) muscle chain: rectus capitis posterior major, semispinalis cervicis, scalenes, 
levator costarum, external intercostals, quadratus lumborum, external oblique, multifidus, 
psoas major, gluteus medius, hamstrings, vastus lateralis, soleus, peroneal muscles 
         
 
Figure 1 Dynamic Stability Diagram of Spiral Muscle Chain Movements 
 Figure 2 Static Stability Diagram of Vertical Muscle Chains 
2） Reciprocal Inhibition within the Muscle Chain 
①) Active inhibition: contraction of agonists within the spiral muscle chains TR (trapezius) and 
LD (latissimus dorsi) relaxes the vertical muscle chains ES (erector spinae) and IP (iliopsoas); 
this occurs during standing exercises. 
②) Postural response: increased plantar pressure enhances activation of abdominal muscles that 
stabilize posture; this reflects the motor nervous system for postural maintenance. 
③) Sensorimotor effect: activation of spiral muscle chains TR and LD activates the center of the 
foot, increases leg muscle tone, generates trunk traction, and stretches/elongates the spine; 
this reflects the motor nervous system governing movement. 
④) Spiral stabilization “muscle straps”: the muscle straps stabilize the spine, straighten it 
along the midline, provide centralized traction, and maintain stable movement of the spine. 
 
Figure 3 Schematic Diagram of Active Inhibition in Muscle Chains 
 Figure 4 Whole-System Response Diagram of the Central Nervous System 
3） Spiral Stabilization Training Method 
①) Training 1A, 3A, and 4A 
The participant faces (or stands with the back to) the elastic band, standing (or kneeling) in a 
relaxed posture. Both arms cross in front of the body, the back is rounded, and the legs are slightly 
flexed. The hips are stabilized, the pelvis is aligned, and lumbar lordosis is reduced/straightened, 
gradually forming standing balance. At the same time, the elbows are pulled downward and 
gradually approach the posterior trunk; the palms face upward, and the area below the elbows 

approaches the spine. 
 
Figure 5 Muscle Balance Diagram for Training 1A/2A/3A 
 Figure 6 Training 1A and 3A Movement Illustration 
②) Training 2A 
The participant stands relaxed, side-on to the elastic band. The back is rounded, the legs are 
slightly flexed; stabilize the hips, align the pelvis, and straighten lumbar lordosis, gradually 
forming standing balance. The right (or left) elbow is pulled horizontally backward, gradually 
approaching the posterior trunk; the right (or left) scapula moves toward the spine and slightly 
depresses, with the training-side shoulder lower than the contralateral side. Then the participant 
raises the right (or left) hand over the head and moves it backward until the forearm is level and 
extended; the palm faces upward. The right scapula draws firmly toward the spine and depresses. 
The participant stands with the back to the elastic band, rounds the back, slightly flexes the 
legs, stabilizes the hips, aligns the pelvis, and straightens lumbar lordosis to gradually form 
standing balance. The elbows are pulled backward, gradually approaching the posterior trunk; the 
palms face upward, and the area below the elbows approaches the spine. 
 
Figure 7 Training 2A Movement Illustration 
 Figure 8 Training 4A Movement Illustration 
③) Training 5A 
The participant faces the elastic band and kneels on one knee on a mat; the left leg is 
extended. Both arms move toward the knee side of the flexed leg. The back is rounded; both arms 
pull toward the mat. Stabilize the hips, align the pelvis, and straighten lumbar lordosis. The body 
gradually becomes upright along the vertical axis. The elbows are pulled backward, gradually 
approaching the posterior trunk; the palms face upward, and the scapulae draw toward the spine. 
④) Training 6A 
The participant faces away from the elastic band, lifts the arms backward, and pushes the 
elbows and palms backward as far as possible; lift the head. The arms are fully raised and 
extended; the rear knee flexes. The body continues to bend downward, pulling the chest toward 
the pelvis, and the arms slowly extend to complete a circular movement. 

 
Figure 9 Muscle Balance Diagram for Training 4A/5A 
Figure 10 Training 5A Movement Illustration 
 Figure 11 Training 6A Movement Illustration 
⑤) Training 7C 
The participant faces the elastic band, stands relaxed, rounds the back, and slightly flexes the 
legs. The left (or right) arm naturally extends forward. Stabilize the hips, align the pelvis, and 
straighten lumbar lordosis to gradually form standing balance. The left (or right) elbow is pulled 
backward to the back with the palm facing upward. The inferior part of the left (or right) scapula 
draws forcefully toward the spine and slightly depresses. Alternating leg lifts are performed by hip 
hiking. 
 
Figure 12 Muscle Balance Diagram for Training 7/8/9/10C 
Figure 13 Training 7C Movement Illustration 
 Figure 14 Training 8C Movement Illustration 
⑥) Training 8C 
The participant stands relaxed side-on to the elastic band, rounds the back, and slightly flexes 
the legs. The left (or right) arm naturally extends in front of the body toward the right (or left) side. 
Stabilize the hips, align the pelvis, and straighten lumbar lordosis to gradually form standing 
balance. The left (or right) arm is lifted overhead and extended backward until the forearm is level 
and extended; the palm faces upward. The left (or right) scapula draws firmly toward the spine and 
depresses. Alternating leg lifts are performed by hip hiking. 
⑦) Training 9C 
The participant stands relaxed with the back to the elastic band. Stabilize the hips, align the 
pelvis, and straighten lumbar lordosis to gradually form standing balance. The left arm is pulled 
backward over the head; the head lowers and the chest moves toward the pelvis. The back is 
rounded, and alternating leg lifts are performed by hip hiking. 
⑧) Training 10C 
The participant stands relaxed side-on to the elastic band with both legs extended. The left (or 
right) arm naturally extends to the side; stabilize the hips. The left (or right) arm is pulled to the 
front of the body and upward over the head. Alternating leg lifts are performed by hip hiking. 
4） Stretching Exercises 

①) Training 33 
The participant stands relaxed beside the exercise bar. Both hands firmly grasp the bar, and the 
legs are crossed. The left (or right) hip is stabilized, and the pelvis is pushed anteriorly and 
inferiorly. 
 
Figure 15 Training 9C Movement Illustration 
Figure 16 Training 10C Movement Illustration 
 Figure 17 Training 33 Movement Illustration 
 
Figure 18 Gait Adjustment Diagram for 11 Training Movements 
Note: The images above are sourced from the book Spiral Muscle Chain Training: Treatment for Disc 
Herniation and Scoliosis . 
 
 

3. Experimental Schedule for PNF Therapy and SPS Training 
Table 9 SPSTable 
SPS 
Repetitions 
Sets 
Exercise Time 
Rest Time 
Training 1A 
10 
2 
20mins 
Rest 2 min 
Training 2A 
Training 3A 
Training 4A 
Training 5A 
Training 6A 
Training 7C 
Rest 2 min 
Training 8C 
Training 9C 
Training 10C 
Training 33 
5 
1 
15s/ 
 
Total 
30 
13 
21.25mins 
4mins 
Table 10 PNFTable 
Region/Met
hod 
PNF Techniques 
Repetitio
ns 
Sets 
Exercise 
Time 
Rest 
Time 
pelvis 
Resisted scapular anterior elevation, 
resisted pelvic posterior depression 
2 
1 
45s 
Rest 1 
min 
Resisted scapular anterior depression, 
resisted pelvic posterior depression 
2 
1 
45s 
Resisted scapular posterior elevation, 
resisted pelvic posterior depression 
2 
1 
45s 
Resisted scapular posterior depression, 
resisted pelvic anterior elevation 
2 
1 
45s 
neckflexionextension 
2 
1 
45s 
trunk 
Figure  
 
 
 
flexionextension 
2 
1 
45s 
Rest 1 
min 
flexionextension 
2 
1 
45s 
flexion 
2 
1 
45s 
flexion 
2 
1 
45s 
Bilateral 
Arm 
Patterns 
Flexion–abduction–external rotation with 
elbow flexion to Extension–adduction–
internal rotation with elbow extension 
2 
1 
45s 
Rest 1 
min 
Flexion–adduction–external rotation with 
elbow flexion to Extension–abduction–
internal rotation with elbow extension 
2 
1 
45s 
   Bridge 
Exercises 
Bilateral glute bridge with resistance 
4/ 
1 
45s 
Rest 1 
min 
   Single-leg glute bridge with resistance 
4/ 
1 
45s 
Total 
 
30 
13 
9.7mins 
4mins