Exercises in Adolescent Idiopathic Scoliosis
Condition: Adolescent Idiopathic Scoliosis
MeSH terms: Scoliosis
Study type: Interventional

Summary: 
      The purpose of this study was to investigate the effectiveness of two different exercises in
      adolescent idiopathic scoliosis. In total, 28 subjects with adolescent idiopathic scoliosis
      were randomly divided into two groups: Schroth (n = 14) and stabilization group (n = 14). The
      Schroth group received Schroth exercises in addition to traditional rehabilitation, and the
      stabilization group received core stabilization in addition to traditional rehabilitation for
      10 weeks. The outcome measures were based on Cobb angle, angle of trunk rotation, spinal
      mobility, cosmetic trunk deformity, muscle strength, and quality of life.
    

Detailed description: 
      Adolescent idiopathic scoliosis (AIS) is a progressive growth disease with unknown etiology,
      characterized by a three-dimensional deformity of the spine (frontal translation, sagittal
      modification, and torsion of the spinous processes on the concave side of the scoliotic curve
      on radiographs).

      In patients with AIS, in addition to curve progression there are many problems commonly occur
      such as; muscular imbalance, functional limitations, altered posture, gait deviations,
      reduced flexibility of the spine, back pain, negative physico-social, body image effects, and
      in severe cases pulmonary symptoms. The asymmetry of the trunk and pelvis are affected
      related to the shape and angle of scoliosis, and the weight distribution position changes
      depending on the shape and the Cobb angle of scoliosis. To deal with these complications and
      more, various treatment approaches have been proposed for AIS, including exercise, bracing,
      casting, traction, biofeedback, surgery, and simple observation to prevent, correct or halt
      the progression of the deformity. Conservative treatment methods including physiotherapy and
      bracing are accepted in Central Europe.

      In literature, exercises are recommended to decrease progression, to improve spine and
      thoracic cage flexibility, muscle strengths, and elasticity, to correct postural behavior,
      and neuro-motor control, spine stability. In general, traditional exercises (TE) including
      postural training, stretching, and strengthening exercises for spinal musculature,
      respiratory exercises have been used for many years for scoliosis. Except for the traditional
      exercises, there are several exercise concepts including Schroth, Side Shift, Dobomed
      methods... etc. Schroth exercises are asymmetric scoliosis-specific postural exercises that
      aim to improve the curve, function, posture, self-image, and pain. Schroth exercises target
      strength and endurance training of the back, abdominal, and leg muscles. Also one of the aim
      of Schroth exercises is to improve motor control of the posture by repeating corrective
      movements with progressively less feedback. Schroth exercises are the most studied scoliosis
      exercises but there are limited randomized controlled studies on Schroth exercises.

      Recently general physiotherapeutic exercises including, Core stabilization (CS) exercises,
      Pilates have been used in the conservative treatment of idiopathic scoliosis. CS exercises
      are described as therapy techniques that improve postural control, and functional stability
      through increasing neuromuscular control, the strength of trunk stabilization muscles, the
      endurance of postural muscles around the spine, the balance between pelvis and spine.
      However, limited studies are determining CS exercises' effect on patients with AIS. In a
      study CS exercises found to be more effective in reducing pain and rotational deformity than
      traditional exercises in the conservative rehabilitation of AIS.

      A recent systematic review showed that therapeutic exercise had been effective to reduce
      symptoms, Cobb's angle, trunk rotation, craniovertebral angle, and body asymmetries, and to
      improve muscular endurance, pulmonary function, and functional capacity of patients with AIS.
      Corrective, therapeutic exercises appear to have positive effects by improving function and
      reducing symptoms, as well as various angles and body asymmetries. However, further studies
      with better methodological quality are required to confirm these outcomes and detect the best
      therapeutic exercise intervention. And also there is a need for randomized controlled studies
      on different methods of exercise to choose the most effective exercise in clinical practice.

      There was no research compared to the effects of the Schroth method and CS exercises in
      patients with AIS. And also there was no research examining the effects of the Schroth method
      on peripheral muscle strengths. This study aimed to investigate the effects of the Schroth
      versus CS exercises in addition to traditional exercises, on Cobb angle, trunk rotation,
      peripheral muscle strengths, spine mobility, cosmetic deformity, and health-related quality
      of life in patients with AIS.
    

Intervention name(s): Schroth Exercises; Core stabilization Exercises
Intervention type(s): Other; Other
Intervention description(s): The Schroth approach consists of 3D scoliosis-specific exercises based on kinesthetic and sensorimotor principles. The goal of Schroth exercises is to teach patients to consciously maintain the correct posture in daily living activities in order to improve the curve, pain, and self-image. The treatment program consists of scoliotic posture correction and a breathing pattern with the help of proprioceptive and exteroceptive stimulations and mirror control. Traditional exercises program included strengthening back, abdominal, pelvis and shoulder girdle muscles and also muscles in the convex side of the curve, stretching exercises especially for the concave side of the curve, postural training, flexibility exercises for the spine, and breathing exercises. Schroth group received Schroth exercises in addition to traditional rehabilitation for 10 weeks. Patients received 30 sessions for 90 minutes at the clinic for ten-week treatment period.; Each exercise session consisted of a warm-up exercise, core stabilization exercise, and a cool-down exercise. The core stabilization exercise was designed with consideration of local, global muscle stability training, global muscle mobility training,and strengthening training of these core structures was carried out progressively advancing more difficult. Traditional exercises program included strengthening back, abdominal, pelvis and shoulder girdle muscles and also muscles in the convex side of the curve, stretching exercises especially for the concave side of the curve, postural training, flexibility exercises for the spine, and breathing exercises. The Stabilization group received Core stabilization in addition to traditional rehabilitation for 10 weeks. Patients received 30 sessions for 90 minutes at the clinic for ten-week treatment period.
Other intervention name(s): Schroth Method; Scoliosis specific exercises
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: Each patient selected a number in a closed envelope, which was sorted via the 'Research Randomiser' program for the randomisation process, and the patients were separated into the following two groups; Schroth group (n=14) and stabilization group (n=14)
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: Adolescent Idiopathic Scoliosis, Scoliosis, Exercise