The Effect of Schroth Exercises on Pelvic Floor Muscles

The aim of this study is to evaluate the effect of Schroth exercise training and Traditional Scoliosis exercise training applied 3 days a week for 6 weeks in people with Adolescent Idiopathic Scoliosis on the pelvic floor muscles and to compare these results with the control group, to evaluate pelvic asymmetry, pain, posture, body awareness, flexibility and life expectancy. It will be planned as a prospective randomized controlled trial to evaluate the correlation between 3 groups on the quality of life.

Scoliosis is defined as the lateral curvature of the spine more than 10 degrees to the right or left, detected radiologically in the coronal plane, but scoliosis is a complex three-dimensional orthopedic deformity that also affects the spine, shoulder girdle and pelvis. The etiopathogenesis of scoliosis is still unclear and the cause cannot be determined in 80% of cases, and it is called idiopathic scoliosis. Other causes include neurological, bone origin, trauma, joint and connective tissue pathologies. Scoliosis causes postural changes in the whole body of the person due to the rotation and angulation of the spine. Especially the abdominal muscles, rib cage, back and waist extensors are most affected by this condition, and it causes biomechanical changes in the pelvis, shoulder girdle and even lower extremities and feet. The spine causes severe morphological changes due to vertebral wedging and rib cage distortion. Vertebral wedging causes a progressive vertebral deformation associated with axial rotation and scoliosis progression. This vertebral deformation is not only associated with the deterioration of the bone structure and the spine, but also causes changes in the structures of the upper extremity and lower extremity. In the treatment of scoliosis; There are four main categories as observation, corset, physiotherapy and rehabilitation applications and surgery. These treatments should be decided by considering the risk of curvature progression. The main purpose in the treatment of scoliosis is to prevent curvature progression. In scoliosis, besides the spine, the shoulder girdle, pelvis and even the lower extremities are also affected by this pathological condition and postural problems occur. Therefore, a detailed clinical analysis and evaluation of the entire musculoskeletal system should be performed in individuals with scoliosis. The problem is determined by revealing in detail the length, strength and functional status of the muscles and ligaments that cause impaired body cosmetics. It has been reported in the literature that pelvic anomalies occur with the progression of scoliosis. Qui et al. reported that there is a difference between the right and left of the pelvis, which is not due to developmental asymmetry or distortion of the pelvis, but due to horizontal rotation. At the same time, Gum et al. reported that people with adolescent idiopathic scoliosis (AIS) have advanced pelvic rotations in the transverse plane. Stylianides et al. reported for the first time iliac crest asymmetry in people with untreated AIS using 3D electromagnetic pointers. In individuals with severe scoliosis angles, skeletal deformity of the spine is associated with pelvis misalignment and morphological asymmetry. The importance of spinopelvic parameters has been reported when defining sagittal balance in scoliosis. The European Society of Scoliosis Orthopedics and Rehabilitation (SOSORT) recommends scoliosis-specific exercises in addition to bracing for scoliosis. It has been reported that the progression of the curve is very rapid if there is a progression of 5.4 degrees and above in the measurements taken every 6 months for curves of 25 degrees and above and these people should be included in the treatment. Although bracing is a difficult treatment to accept in some children, the acceptance of exercise therapy is higher. Schroth exercises are specialized exercises for scoliosis and have been reported to reduce the Cobb angle of curvature, improve neuromotor control, increase respiratory function and back flexibility, and improve cosmetic appearance. The Schroth method includes scoliosis-specific sensorimotor, posture and breathing exercises, and provides the prevention of 3-dimensional spinal deformities in the spine by the formation of postural realignment in people with AIS. With the autocorrection included in the method, self-elongation and postural correction are provided to each curvature pattern and the person's muscle imbalance is balanced. It has been reported that with Schroth exercises, muscle strength and flexibility are increased, the Cobb angle is improved, and surgery rates are reduced. Schreiber et al. reported a significant difference in pain, curvature progression and body awareness in the intervention group in which they included 50 people with AIS, compared to the control group. In this study, in which the endurance of the back muscles was evaluated for the first time, the Schroth intervention group showed improvement. In another study by Schreiber et al., it was reported that Schroth exercises had positive effects on reducing the progression of the curvature. Although it has been reported that the strength of the back muscles is increased with schroth exercises, there is no study in the literature reporting the relationship between pelvic floor muscles and schroth exercises in individuals with scoliosis. The aim of this study is to evaluate the effectiveness of the Schroth method on pelvic floor muscle activity and pelvic asymmetry in people with AIS.

Eligibility Criteria:
Inclusion Criteria:

* Having been diagnosed with idiopathic scoliosis by a specialist physician,
* 7-25 years old,
* The primary curvature is between 10-45 degrees according to the Cobb method,
* C or S scoliosis,
* Pain in the back/lumbar region due to scoliosis,
* Those who have not received any exercise therapy for scoliosis before,
* Volunteer to participate in the study,
* Having the cognitive capacity to cooperate with the guidance of the physiotherapist,
* Have not had any musculoskeletal injury in the last 6 months,
* No neurological, orthopedic or cardiopulmonary disorders other than the diagnosis of scoliosis,
* Young individuals who have not undergone any surgery related to the diagnosis of scoliosis will be included in the study.

Exclusion Criteria:

* The patient has any contraindications for exercise,
* Having previously undergone spine surgery and pelvic surgery,
* Having any mental problems,
* The fact that scoliosis is not idiopathic but has arisen for different reasons (neurological, congenital),
* In case of neurological, psychiatric, muscular, rheumatic or orthopedic diseases, these people will not be included in the study.