Outcomes of 12 Weeks of Schroth and Asymmetric Spinal Stabilization Exercises on Cobb Angle, Angle of Trunk Rotation, and Quality of Life in Adolescent Boys with Idiopathic Scoliosis: A Randomized-controlled Trial

Document Type : RESEARCH PAPER

Authors

1 Department of Sport Sciences, Kish International Campus, University of Tehran, Kish, Iran

2 Department of Sports injury and biomechanics, Faculty of Sport Sciences and health, university of Tehran, Tehran, Iran

3 Department of Sport Injuries and Corrective Exercises, Faculty of Physical Education and Sport Sciences, University of Guilan, Rasht, Iran

4 Department of Health & Sport Rehabilitation, Faculty of Sport Science & Health, University of Shahid Beheshti, Tehran, Iran

Abstract

Objectives: The available evidence on the efficiency of well-known Schroth's exercises (SE) for 
correcting adolescent idiopathic scoliosis (AIS) is limited, especially in combination with the asymmetric 
spinal stabilization exercises (ASSE) method. Therefore, we hypothesized that, first, there is no 
difference in the efficiency of the combined exercises (SE+ASSE) and SE alone in improving Cobb 
angle, angle of trunk rotation (ATR), and quality of life (QoL) in AIS. Second, there is no difference in 
the efficiency of SE and no intervention on corresponding variables in treating AIS.
Methods: This randomized controlled trial (RCT) consisted of 40 patients with mild AIS (10-18-year-old boys) 
divided into three groups: SE (n=15), SE+ASSE (n=15), and a waitlist control group (n=10). For 12 weeks (three 
days a week), both experimental groups performed SE, the combined group additionally received ASSE, and the 
control group received no intervention. The assessment included Cobb angle (photogrammetry), ATR (Adam’s test), 
and QoL (Scoliosis Research Society-22 questionnaire).
Results: It was found that Cobb angle, ATR, and QoL improved significantly in the combined SE+ASSE group 
(Cobb=16.45° to 9.01°; ATR=4.93° to 1.33°) compared to the SE group (P<.001). In addition, the SE group showed 
significant amelioration in the mentioned variables (Cobb=15.09° to 9.77°; ATR=4.23° to 2.17°) compared to the 
control group (P<.001), whereas the control group remained almost unchanged.
Conclusion: Based on the obtained results, the combination of SE and ASSE provided more benefits than SE 
alone, and the SE results were efficient compared to the no-intervention group regarding the correction of scoliosis 
and related problems. However, patients with moderate to severe scoliosis should also be investigated in longer 
treatment periods in future.
 Level of evidence: I

Keywords

Main Subjects

References

  1. Khaledi A, Minoonejad H, Daneshmandi H, Akoochakian M, Gheitasi M. The Effectiveness of Schroth vs SEAS Exercise Methods for Correcting Idiopathic Scoliosis in Adolescents: A Systematic Review. Physical Treatments-Specific Physical Therapy Journal. 2022; 12(1):1-12. doi: 10.32598/ptj.12.1.517.3.
  2. Konieczny MR, Senyurt H, Krauspe R. Epidemiology of adolescent idiopathic scoliosis. J Child Orthop. 2013; 7(1):3-9. doi: 10.1007/s11832-012-0457-4.
  3. Tome-Bermejo F, R. Piñera A, Alvarez L. Osteoporosis and the Management of Spinal Degenerative Disease (II). Arch Bone Jt Surg. 2017; 5(6):363-374. doi:10.22038/abjs.2017.19349.1498.
  4. Peng Y, Wang S-R, Qiu G-X, Zhang J-G, Zhuang Q-Y. Research progress on the etiology and pathogenesis of adolescent idiopathic scoliosis. Chin Med J (Engl). 2020; 133(04):483-493. doi: 10.1097/CM9.0000000000000652.
  5. Refsum HE, Næss-Andresen CF, Lange JE. Pulmonary function and gas exchange at rest and exercise in adolescent girls with mild idiopathic scoliosis during treatment with Boston thoracic brace. Spine. 1990; 15(5):420-423. doi: 10.1097/00007632-199005000-00014.
  6. Nikouei F, Ghandhari H, Ameri E, Mokarami F. Shoulder Imbalance in Adolescent Idiopathic Scoliosis: A Systematic Review of the Current State of the Art. Arch Bone Jt Surg. 2022; 10(12):992-1003. doi:10.22038/abjs.2022.64282.3086.
  7. Balagué F, Pellisé F. Adolescent idiopathic scoliosis and back pain. Scoliosis Spinal Disord. 2016; 11(1):1-15. doi: 10.1186/s13013-016-0086-7.
  8. Tan K-J, Moe MM, Vaithinathan R, Wong H-K. Curve progression in idiopathic scoliosis: follow-up study to skeletal maturity. Spine. 2009; 34(7):697-700. doi: 10.1097/BRS.0b013e31819c9431.
  9. Berdishevsky H, Lebel VA, Bettany-Saltikov J, et al. Physiotherapy scoliosis-specific exercises–a comprehensive review of seven major schools. Scoliosis Spinal Disord. 2016; 11(1):1-52. doi: 10.1186/s13013-016-0076-9.
  10. Romano M, Minozzi S, Bettany‐Saltikov J, et al. Exercises for adolescent idiopathic scoliosis. Cochrane Database Syst Rev. 22012; 2012(8):CD007837. doi: 10.1002/14651858.CD007837.pub2.
  11. Khaledi, A., Gheitasi, M., Akoochakian, M., Bayattork, M. The best therapeutic exercise methods based on age, Cobb and trunk rotation angles in children and adolescent idiopathic scoliosis: A systematic review. Sport Sciences and Health Research. 2021; 13(2): 176-193. doi: 10.22059/sshr.2021.85466.
  12. Khaledi A, Minoonejad H, Daneshmandi H, Akoochakian M, Gheitasi M. Is Core Stability Exercise Effective in Correcting Idiopathic Scoliosis in Adolescents? A Systematic Review. Review. Journal of Mazandaran University of Medical Sciences. 2023; 32(216):179-191.
  13. Khaledi, A., Minoonejad, H., Daneshmandi, H., Akoochakian, M., Gheitasi, M. Effectiveness of the Schroth Method in Improving Cobb Angle, Trunk Rotation, and Quality of Life in Adolescents With Idiopathic Scoliosis: A Systematic Review. The Scientific Journal of Rehabilitation Medicine.2023; 12(2): 202-217. doi: 10.32598/SJRM.12.2.15.
  14. Van Rooyen C, Du Plessis LZ, Geldenhuys L, et al. The effectiveness of Schroth exercises in adolescents with idiopathic scoliosis: A systematic review and meta-analysis. S Afr J Physiother. 2019; 75(1):1-9. doi: 10.4102/sajp.v75i1.904.
  15. Ceballos-Laita L, Carrasco-Uribarren A, Cabanillas-Barea S, Pérez-Guillén S, Pardos-Aguilella P, Jiménez Del Barrio S. The effectiveness of Schroth method in Cobb angle, quality of life and trunk rotation angle in adolescent idiopathic scoliosis: a systematic review and meta-analysis. Eur J Phys Rehabil Med. 2023; 59(2):228-236. doi: 10.23736/S1973-9087.23.07654-2.
  16. Dimitrijević V, Viduka D, Šćepanović T, et al. Effects of Schroth method and core stabilization exercises on idiopathic scoliosis: a systematic review and meta-analysis. Eur Spine J. 2022; 31(12):3500-3511. doi:10.1007/s00586-022-07407-4.
  17. Schreiber S, Parent EC, Moez EK, et al. The effect of Schroth exercises added to the standard of care on the quality of life and muscle endurance in adolescents with idiopathic scoliosis—an assessor and statistician blinded randomized controlled trial: “SOSORT 2015 Award Winner”. Scoliosis. 2015:10:24. doi: 10.1186/s13013-015-0048-5.
  18. Schreiber S, Parent EC, Khodayari Moez E, et al. Schroth physiotherapeutic scoliosis-specific exercises added to the standard of care lead to better Cobb angle outcomes in adolescents with idiopathic scoliosis–an assessor and statistician blinded randomized controlled trial. PLoS One. 2016; 11(12):e0168746. doi: 10.1371/journal.pone.0168746.
  19. Kim MJ, Park DS. The effect of Schroth's three-dimensional exercises in combination with respiratory muscle exercise on Cobb's angle and pulmonary function in patients with idiopathic scoliosis. Physical Therapy Rehabilitation Science. 2017; 6(3):113-119. doi: 10.14474/ptrs.2017.6.3.113.
  20. Ko JY, Suh JH, Kim H, Ryu JS. Proposal of a new exercise protocol for idiopathic scoliosis: A preliminary study. Medicine (Baltimore). 2018; 97(49). doi: 10.1097/MD.0000000000013336.
  21. Cheung J, Veldhuizen AG, Halbertsma JP, et al. The relation between electromyography and growth velocity of the spine in the evaluation of curve progression in idiopathic scoliosis. Spine. 2004; 29(9):1011-1016. doi: 10.1097/00007632-200405010-00012.
  22. Avikainen VJ, Rezasoltani A, Kauhanen HA. Asymmetry of paraspinal EMG-time characteristics in idiopathic scoliosis. J Spinal Disord. 1999; 12(1):61-67.
  23. Rrecaj-Malaj S, Beqaj S, Krasniqi V, Qorolli M, Tufekcievski A. Outcome of 24 weeks of combined schroth and pilates exercises on cobb angle, angle of trunk rotation, chest expansion, flexibility and quality of life in adolescents with idiopathic scoliosis. Med Sci Monit Basic Res. 2020; 26:e920449-1. doi: 10.12659/MSMBR.920449.

24.              Kuru T, Yeldan İ, Dereli EE, Özdinçler AR, Dikici F, Çolak İ. The efficacy of three-dimensional Schroth exercises in adolescent 

  1. Khaledi A, Minoonejad H, Daneshmandi H, Akoochakian M, Gheitasi M. The Effectiveness of Schroth vs SEAS Exercise Methods for Correcting Idiopathic Scoliosis in Adolescents: A Systematic Review. Physical Treatments-Specific Physical Therapy Journal. 2022; 12(1):1-12. doi: 10.32598/ptj.12.1.517.3.
  2. Konieczny MR, Senyurt H, Krauspe R. Epidemiology of adolescent idiopathic scoliosis. J Child Orthop. 2013; 7(1):3-9. doi: 10.1007/s11832-012-0457-4.
  3. Tome-Bermejo F, R. Piñera A, Alvarez L. Osteoporosis and the Management of Spinal Degenerative Disease (II). Arch Bone Jt Surg. 2017; 5(6):363-374. doi:10.22038/abjs.2017.19349.1498.
  4. Peng Y, Wang S-R, Qiu G-X, Zhang J-G, Zhuang Q-Y. Research progress on the etiology and pathogenesis of adolescent idiopathic scoliosis. Chin Med J (Engl). 2020; 133(04):483-493. doi: 10.1097/CM9.0000000000000652.
  5. Refsum HE, Næss-Andresen CF, Lange JE. Pulmonary function and gas exchange at rest and exercise in adolescent girls with mild idiopathic scoliosis during treatment with Boston thoracic brace. Spine. 1990; 15(5):420-423. doi: 10.1097/00007632-199005000-00014.
  6. Nikouei F, Ghandhari H, Ameri E, Mokarami F. Shoulder Imbalance in Adolescent Idiopathic Scoliosis: A Systematic Review of the Current State of the Art. Arch Bone Jt Surg. 2022; 10(12):992-1003. doi:10.22038/abjs.2022.64282.3086.
  7. Balagué F, Pellisé F. Adolescent idiopathic scoliosis and back pain. Scoliosis Spinal Disord. 2016; 11(1):1-15. doi: 10.1186/s13013-016-0086-7.
  8. Tan K-J, Moe MM, Vaithinathan R, Wong H-K. Curve progression in idiopathic scoliosis: follow-up study to skeletal maturity. Spine. 2009; 34(7):697-700. doi: 10.1097/BRS.0b013e31819c9431.
  9. Berdishevsky H, Lebel VA, Bettany-Saltikov J, et al. Physiotherapy scoliosis-specific exercises–a comprehensive review of seven major schools. Scoliosis Spinal Disord. 2016; 11(1):1-52. doi: 10.1186/s13013-016-0076-9.
  10. Romano M, Minozzi S, Bettany‐Saltikov J, et al. Exercises for adolescent idiopathic scoliosis. Cochrane Database Syst Rev. 22012; 2012(8):CD007837. doi: 10.1002/14651858.CD007837.pub2.
  11. Khaledi, A., Gheitasi, M., Akoochakian, M., Bayattork, M. The best therapeutic exercise methods based on age, Cobb and trunk rotation angles in children and adolescent idiopathic scoliosis: A systematic review. Sport Sciences and Health Research. 2021; 13(2): 176-193. doi: 10.22059/sshr.2021.85466.
  12. Khaledi A, Minoonejad H, Daneshmandi H, Akoochakian M, Gheitasi M. Is Core Stability Exercise Effective in Correcting Idiopathic Scoliosis in Adolescents? A Systematic Review. Review. Journal of Mazandaran University of Medical Sciences. 2023; 32(216):179-191.
  13. Khaledi, A., Minoonejad, H., Daneshmandi, H., Akoochakian, M., Gheitasi, M. Effectiveness of the Schroth Method in Improving Cobb Angle, Trunk Rotation, and Quality of Life in Adolescents With Idiopathic Scoliosis: A Systematic Review. The Scientific Journal of Rehabilitation Medicine.2023; 12(2): 202-217. doi: 10.32598/SJRM.12.2.15.
  14. Van Rooyen C, Du Plessis LZ, Geldenhuys L, et al. The effectiveness of Schroth exercises in adolescents with idiopathic scoliosis: A systematic review and meta-analysis. S Afr J Physiother. 2019; 75(1):1-9. doi: 10.4102/sajp.v75i1.904.
  15. Ceballos-Laita L, Carrasco-Uribarren A, Cabanillas-Barea S, Pérez-Guillén S, Pardos-Aguilella P, Jiménez Del Barrio S. The effectiveness of Schroth method in Cobb angle, quality of life and trunk rotation angle in adolescent idiopathic scoliosis: a systematic review and meta-analysis. Eur J Phys Rehabil Med. 2023; 59(2):228-236. doi: 10.23736/S1973-9087.23.07654-2.
  16. Dimitrijević V, Viduka D, Šćepanović T, et al. Effects of Schroth method and core stabilization exercises on idiopathic scoliosis: a systematic review and meta-analysis. Eur Spine J. 2022; 31(12):3500-3511. doi:10.1007/s00586-022-07407-4.
  17. Schreiber S, Parent EC, Moez EK, et al. The effect of Schroth exercises added to the standard of care on the quality of life and muscle endurance in adolescents with idiopathic scoliosis—an assessor and statistician blinded randomized controlled trial: “SOSORT 2015 Award Winner”. Scoliosis. 2015:10:24. doi: 10.1186/s13013-015-0048-5.
  18. Schreiber S, Parent EC, Khodayari Moez E, et al. Schroth physiotherapeutic scoliosis-specific exercises added to the standard of care lead to better Cobb angle outcomes in adolescents with idiopathic scoliosis–an assessor and statistician blinded randomized controlled trial. PLoS One. 2016; 11(12):e0168746. doi: 10.1371/journal.pone.0168746.
  19. Kim MJ, Park DS. The effect of Schroth's three-dimensional exercises in combination with respiratory muscle exercise on Cobb's angle and pulmonary function in patients with idiopathic scoliosis. Physical Therapy Rehabilitation Science. 2017; 6(3):113-119. doi: 10.14474/ptrs.2017.6.3.113.
  20. Ko JY, Suh JH, Kim H, Ryu JS. Proposal of a new exercise protocol for idiopathic scoliosis: A preliminary study. Medicine (Baltimore). 2018; 97(49). doi: 10.1097/MD.0000000000013336.
  21. Cheung J, Veldhuizen AG, Halbertsma JP, et al. The relation between electromyography and growth velocity of the spine in the evaluation of curve progression in idiopathic scoliosis. Spine. 2004; 29(9):1011-1016. doi: 10.1097/00007632-200405010-00012.
  22. Avikainen VJ, Rezasoltani A, Kauhanen HA. Asymmetry of paraspinal EMG-time characteristics in idiopathic scoliosis. J Spinal Disord. 1999; 12(1):61-67.
  23. Rrecaj-Malaj S, Beqaj S, Krasniqi V, Qorolli M, Tufekcievski A. Outcome of 24 weeks of combined schroth and pilates exercises on cobb angle, angle of trunk rotation, chest expansion, flexibility and quality of life in adolescents with idiopathic scoliosis. Med Sci Monit Basic Res. 2020; 26:e920449-1. doi: 10.12659/MSMBR.920449.
  24. Kuru T, Yeldan İ, Dereli EE, Özdinçler AR, Dikici F, Çolak İ. The efficacy of three-dimensional Schroth exercises in adolescent idiopathic scoliosis: a randomised controlled clinical trial. Clin Rehabil. 2016; 30(2):181-190. doi:

 

10.1177/0269215515575745.

  1. PP R. Human experimentation. Code of ethics of the world medical association. Declaration of Helsinki. Br Med J. 1964; 2(5402):177-177. doi: 10.1136/bmj.2.5402.177.
  2. Slattery C, Verma K. Classifications in brief: The Lenke classification for adolescent idiopathic scoliosis. Clin Orthop Relat Res. 2018; 476(11):2271. doi: 10.1097/CORR.0000000000000405.
  3. Suresh K. An overview of randomization techniques: an unbiased assessment of outcome in clinical research. J Hum Reprod Sci. 2011; 4(1):8. doi: 10.4103/0974-1208.82352.
  4. Research Randomizer. Available at: http://www.randomizer.org/. Accessed December 1, 2010.
  5. Faul F, Erdfelder E, Lang A-G, Buchner A. G* Power 3: A flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods. 2007; 39(2):175-191. doi: 10.3758/BF03193146.
  6. Kocaman H, Bek N, Kaya MH, Büyükturan B, Yetiş M, Büyükturan Ö. The effectiveness of two different exercise approaches in adolescent idiopathic scoliosis: A single-blind, randomized-controlled trial. PLoS One. 2021; 16(4):e0249492. doi: 10.1371/journal.pone.0249492.
  7. Mohamed R, Yousef A. Impact of Schroth three-dimensional vs. proprioceptive neuromuscular facilitation techniques in adolescent idiopathic scoliosis: a randomized controlled study. Eur Rev Med Pharmacol Sci. 2021; 25:7717-7725. doi: 10.26355/eurrev_202112_27618.
  8. Bushman BA. Developing the P (for Progression) in a FITT-VP Exercise Prescription. ACSM's Health & Fitness Journal. 2018; 22(3):6-9. doi: 10.1249/FIT.0000000000000378.
  9. Saad KR, Colombo AS, João SMA. Reliability and validity of the photogrammetry for scoliosis evaluation: a cross-sectional prospective study. J Manipulative Physiol Ther. 2009; 32(6):423-430. doi: 10.1016/j.jmpt.2009.06.003.
  10. Amendt LE, Ause-Ellias KL, Eybers JL, Wadsworth CT, Nielsen DH, Weinstein SL. Validity and reliability testing of the Scoliometer. Phys Ther. 1990; 70(2):108-117. doi.org/10.1093/ptj/70.2.108.
  11. Mousavi SJ, Mobini B, Mehdian H, et al. Reliability and validity of the Persian version of the Scoliosis Research Society-22r questionnaire. Spine. 2010; 35(7):784-789. doi: 10.1097/BRS.0b013e3181bad0e8.
  12. Richards BS, Bernstein RM, D’Amato CR, Thompson GH. Standardization of criteria for adolescent idiopathic scoliosis brace studies: SRS Committee on Bracing and Nonoperative Management. Spine. 2005; 30(18):2068-2075. doi: 10.1097/01.brs.0000178819.90239.d0.
  13. Lee H-J, Lee S-M. Effects of Schroth exercise therapy on curvature and body appearance of patients with lumbar idiopathic scoliosis. Physical Therapy Rehabilitation Science. 2020; 9(4):230-237. doi: 10.14474/ptrs.2020.9.4.230.
  14. Li X, Shen J, Liang J, et al. Effect of core-based exercise in people with scoliosis: A systematic review and meta-analysis. Clin Rehabil. 2021; 35(5):669-680. doi: 10.1177/0269215520975105.
  15. Vasiliadis E, Grivas TB. Quality of life after conservative treatment of adolescent idiopathic scoliosis. Stud Health Technol Inform. 2008; 135:409.
  16. Gao A, Li J-Y, Shao R, et al. Schroth exercises improve health-related quality of life and radiographic parameters in adolescent idiopathic scoliosis patients. Chin Med J (Engl). 2021; 134(21):2589-2596. doi: 10.1097/CM9.0000000000001799.
The Archives of Bone and Joint Surgery
Volume 12, Issue 1
January 2024
Pages 26-35

Files

History

  • Receive Date: 24 April 2023
  • Revise Date: 17 November 2023
  • Accept Date: 02 November 2023

Share

How to cite

Statistics