Effects of Schroth-Based Exercise on Kyphosis Angle, Muscle Strength, Balance, Pain, and Quality of Life in Hyperkyphosis With Chronic Neck Pain

Official title

Effects of Schroth-Based Three-Dimensional Exercise Program on Angle of Kyphosis, Muscle Strength, Balance, Pain, and Quality of Life in Patients With Postural Hyperkyphosis With Chronic Neck Pain

Overview

The normal thoracic kyphosis angle of the spine is 20-40°, however, an angle of more than 40° is referred to as postural kyphosis, increased kyphosis or hyperkyphosis. Although postural kyphosis negatively affects individuals' general health status, physical performance, and quality of life, there is still no standardized protocol for correcting the thoracic kyphosis angle. Conservative treatment approaches such as postural training and exercises, manual therapy, postural corrective kinesiotaping, and orthotic use have been recommended for managing increased thoracic kyphosis. While numerous studies have demonstrated the effectiveness of three-dimensional exercise programs in the treatment of scoliosis, research examining their impact on kyphosis remains considerably limited.Nevertheless, the potential of these exercises to promote neuromuscular reorganization suggests that they may be similarly effective in individuals with thoracic kyphosis. This randomized controlled trial aims to evaluate the effects of a Schroth-based three-dimensional exercise program on kyphosis angle, trunk muscle strength, balance, pain, and quality of life in individuals with postural hyperkyphosis and chronic neck pain.

Detailed description

Increasing thoracic kyphosis, spinal extensor muscle weakness, decreased spinal extension mobility, lumbo-pelvic pain, muscle activation and displacement of the scapula with changing traction angles have been associated with postural changes. It is evident that such alterations in posture have a biomechanical effect on the cervical and lumbar vertebrae. The presence of thoracic dysfunction has been documented in individuals experiencing chronic neck pain. Increases in both the thoracic kyphosis angle and flexor posture have been demonstrated to result in anterior displacement of the central gravity line. Displacement of the body's centre of gravity anteriorly has the potential to exert adverse effects on postural control.The association between postural changes and spinal extensor muscle weakness, increased kyphotic posture, decreased spinal extension mobility, lumbo-pelvic pain, muscle activation and displacement of the scapula with changing traction angles has been demonstrated. These postural changes have been demonstrated to exert a detrimental effect on postural stability, back pain, physical performance and quality of life.

The present study was meticulously designed as a Schroth-based three-dimensional exercise group and a control group, with a duration of eight weeks. The two groups will both undergo a programme comprising 20 sessions of electrotherapy and exercise, to be administered over a period of four weeks. Subsequent to the completion of the fourth week of electrotherapy sessions, the exercise applications will be continued for a further four weeks by the physiotherapist responsible for the study, who will undertake the programme three days per week. The intervention will consist of a series of educational sessions focusing on the development of postural perception, with a particular emphasis on the identification of postural kyphosis and the adoption of optimal posture in daily living. These educational sessions will be administered to both groups. The training programme will be delivered in a practical manner by the physiotherapist. A brochure will be provided to patients, serving as a reference guide for the exercises and considerations.

Interventions

• Other Schroth Exercise Group
  The study group will receive electrotherapy treatment (hot pack, ultrasound, tens) to the neck area for 30 minutes in each session. After electrotherapy treatment, kyphotic posture correction exercises will be applied with the help of proprioceptive and extroceptive stimuli in the sagittal plane with mirror control and specific corrective breathing. In the exercise program, exercise practices will be performed in specific positions in supine, prone, sitting and standing. The exercise program wil
• Other Postural Exercises Group
  Patients to be included in the control group will receive electrotherapy treatment (ultrasound, tens, hotpack) to the neck area for 30 minutes in each session. After the electrotherapy treatment, posture corrective exercises will be applied. Corrective exercise program for posture will consist of deep neck flexor muscle strengthening exercises, lower and middle trapezius strengthening, neck isometric exercises. All strengthening exercises will be given 3 sets of 10 repetitions per day, each repe

Primary outcome measures

• Angle of thoracic kyphosis [Time frame: Baseline,4th week, 8th week]

Secondary outcome measures (7)

• Trunk Muscle Strength [Time frame: Baseline,4th week, 8th week]
• Balance Assessment [Time frame: Baseline,4th week, 8th week]
• Spinal Stabilisation Activity [Time frame: Baseline,4th week, 8th week]
• Visual Analogue Scale (VAS) [Time frame: Baseline,4th week, 8th week]
• Occiput Wall and Tragus Wall Distance [Time frame: Baseline,4th week, 8th week]
• Neck Disability Index [Time frame: Baseline,4th week, 8th week]
• Assessment of Quality of Life [Time frame: Baseline,4th week, 8th week]

Eligibility criteria

Inclusion criteria

• Thoracic kyphosis angle > 45 degrees,
• Aged between 20 and 50 years,
• Have neck pain for more than 3 months,
• Neck pain visual analogue scale > 3,
• Not being treated for postural kyphosis in the last 6 months,
• Has no systemic disease

Exclusion criteria

• History of trauma or surgery on spinal joints,
• Participants with rheumatological and metabolic disorders,
• Participants with congenital postural deformity and scoliosis

Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.

Healthy volunteers: Yes

Study design

Allocation

Randomized

Model

Parallel assignment

Masking

Single blind

Primary purpose

Treatment

Study locations

Turkey (Türkiye) · 1 center

• Baskent University Umitkoy Outpatient Clinic — Ankara

Publications

• Bulut D, Dilek B, Kilinc A, Ellidokuz H, Oncel S. An investigation into the effects of kinesiotaping for posture correction on kyphosis angle, pain, and balance in patients with postmenopausal osteoporosis-associated thoracic kyphosis. Arch Osteoporos. 2019 Aug 13;14(1):89. doi: 10.1007/s11657-019-0634-x. PMID 31410649
• Alanay A, Cil A, Berk H, Acaroglu RE, Yazici M, Akcali O, Kosay C, Genc Y, Surat A. Reliability and validity of adapted Turkish Version of Scoliosis Research Society-22 (SRS-22) questionnaire. Spine (Phila Pa 1976). 2005 Nov 1;30(21):2464-8. doi: 10.1097/01.brs.0000184366.71761.84. PMID 16261127
• Telci EA, Karaduman A, Yakut Y, Aras B, Simsek IE, Yagli N. The cultural adaptation, reliability, and validity of neck disability index in patients with neck pain: a Turkish version study. Spine (Phila Pa 1976). 2009 Jul 15;34(16):1732-5. doi: 10.1097/BRS.0b013e3181ac9055. PMID 19770615
• Crasto CFB, Montes AM, Carvalho P, Carral JMC. Pressure biofeedback unit to assess and train lumbopelvic stability in supine individuals with chronic low back pain. J Phys Ther Sci. 2019 Oct;31(10):755-759. doi: 10.1589/jpts.31.755. Epub 2019 Oct 19. PMID 31645801
• Akkaya N, Doganlar N, Celik E, Aysse SE, Akkaya S, Gungor HR, Sahin F. TEST-RETEST RELIABILITY OF TETRAX(R) STATIC POSTUROGRAPHY SYSTEM IN YOUNG ADULTS WITH LOW PHYSICAL ACTIVITY LEVEL. Int J Sports Phys Ther. 2015 Nov;10(6):893-900. PMID 26618068
• De Blaiser C, De Ridder R, Willems T, Danneels L, Roosen P. Reliability and validity of trunk flexor and trunk extensor strength measurements using handheld dynamometry in a healthy athletic population. Phys Ther Sport. 2018 Nov;34:180-186. doi: 10.1016/j.ptsp.2018.10.005. Epub 2018 Oct 12. PMID 30366246
• Amatachaya P, Wongsa S, Sooknuan T, Thaweewannakij T, Laophosri M, Manimanakorn N, Amatachaya S. Validity and reliability of a thoracic kyphotic assessment tool measuring distance of the seventh cervical vertebra from the wall. Hong Kong Physiother J. 2016 Jul 13;35:30-36. doi: 10.1016/j.hkpj.2016.05.001. eCollection 2016 Dec. PMID 30931031
• Hunter DJ, Rivett DA, McKiernan S, Weerasekara I, Snodgrass SJ. Is the inclinometer a valid measure of thoracic kyphosis? A cross-sectional study. Braz J Phys Ther. 2018 Jul-Aug;22(4):310-317. doi: 10.1016/j.bjpt.2018.02.005. Epub 2018 Mar 6. PMID 29576490

Identifiers

NCT: NCT06835608 · KA24/125

Primary sources (government registries)

• ClinicalTrials.gov (US NIH)

View this study on ClinicalTrials.gov ↗