Three-Dimensional Scoliosis Exercises and Diaphragmatic Manual Techniques in Adolescents With Idiopathic Scoliosis

Official title

The Effectiveness of Three-Dimensional Scoliosis Exercises Supported by Diaphragmatic Manual Techniques in Adolescents With Idiopathic Scoliosis: A Randomized Controlled Study

Overview

Adolescent idiopathic scoliosis (AIS) is a three-dimensional deformity of the spine that emerges during growth and is characterized by lateral curvature, vertebral rotation, and trunk asymmetry. AIS can negatively affect not only the spinal structure but also postural control, trunk stability, muscle activation patterns, respiratory function, and the quality of life of individuals. Particularly in thoracic curvatures, decreased rib cage mobility and impaired functional effectiveness of the diaphragm and intercostal muscles can lead to reduced respiratory capacity and respiratory muscle strength. Therefore, in scoliosis rehabilitation, it is important to evaluate not only spinal alignment but also respiratory mechanics and diaphragmatic function. Currently, among conservative treatment approaches, Three-Dimensional Scoliosis Exercises (Schroth method) are widely used and reported to be effective in reducing curvature progression. However, scientific evidence regarding the effects of supporting Schroth exercises with diaphragmatic manual techniques on muscle activation, trunk derotation, and respiratory function is limited. Since the diaphragm is both a primary respiratory muscle and an important postural muscle involved in spinal stabilization, it is thought that improving diaphragmatic function may contribute to scoliosis rehabilitation. In this randomized controlled trial, 24 individuals aged 10-18 years diagnosed with AIS will be divided into two groups. The study group will receive Schroth exercises supported by diaphragmatic manual techniques, while the control group will receive only Schroth exercises. Participants will be evaluated before and after treatment in terms of superficial muscle activity, Cobb angle, trunk rotation angle, perception of cosmetic deformity, respiratory functions, respiratory muscle strength, and quality of life. The unique value of this research is that it is one of the limited number of studies that multidimensionally examine the effects of diaphragmatic manual techniques combined with Schroth exercises on electromyographic muscle activation, derotation, and respiratory functions. It is expected that the results will contribute to the development of new rehabilitation approaches in the conservative treatment of AIS, strengthen evidence-based physiotherapy practices, and improve the quality of life of individuals with scoliosis.

Detailed description

Adolescent idiopathic scoliosis is characterized by a three-dimensional deformity of the spine and can cause changes in muscle strength, muscle activation, trunk stability, and respiratory function. Considering the role of the diaphragm muscle in postural control and spinal stabilization, it is thought that disorders in diaphragmatic function may contribute to scoliosis progression. Three-dimensional scoliosis exercises (Schroth exercises), with their three-dimensional correction principles and rotational breathing techniques, are frequently used in scoliosis rehabilitation. However, the effects of supplementing Schroth exercises with diaphragmatic manual techniques on muscle activation and trunk derotation have not been sufficiently clarified. The results of this study are expected to contribute to determining the effectiveness of breath-based manual approaches in scoliosis rehabilitation and to provide a scientific basis for physiotherapy applications. Although there are studies in the literature examining the effects of Schroth exercises on curvature angle, posture, and quality of life, studies investigating the effects of applying diaphragmatic manual techniques in conjunction with Schroth exercises on electromyographic muscle activation and derotation are limited. Adolescent idiopathic scoliosis is a progressive musculoskeletal problem that emerges during the growth period and is characterized by a three-dimensional deformity of the spine. Lateral curvature, vertebral rotation, and trunk asymmetry in the spine can negatively affect individuals' postural control, respiratory functions, and muscle activation patterns. In recent years, three-dimensional scoliosis exercises and brace therapy have become widely used among conservative treatment methods, and these approaches have been reported to be effective in reducing curvature progression. However, the effects of diaphragmatic manual techniques on respiratory mechanics, trunk stabilization, and muscle activation, and the results of their combined use with three-dimensional scoliosis exercises, have not yet been sufficiently investigated. This study aims to investigate the effects of diaphragmatic manual techniques and 3D scoliosis exercises, applied for 12 weeks, on superficial muscle activity, scoliosis severity, trunk rotation angle, perception of cosmetic deformity, respiratory function, respiratory muscle strength, and quality of life in individuals with adolescent idiopathic scoliosis.

Although there are studies in the literature examining the effects of 3D scoliosis exercises on curvature angle, posture, and quality of life, studies evaluating the effects of applying diaphragmatic manual techniques in conjunction with 3D scoliosis exercises on EMG activation, scoliosis severity, trunk rotation angle, perception of cosmetic deformity, respiratory function, respiratory muscle strength, and quality of life are limited. Therefore, the aim of this research is to contribute to the development of new rehabilitation approaches in the conservative treatment of adolescent idiopathic scoliosis.This study aims to investigate the effects of diaphragmatic manual techniques and 3D scoliosis exercises, applied for 12 weeks, on superficial muscle activity, scoliosis severity, trunk rotation angle, perception of cosmetic deformity, respiratory function, respiratory muscle strength, and quality of life in individuals with adolescent idiopathic scoliosis. Although there are studies in the literature examining the effects of 3D scoliosis exercises on curvature angle, posture, and quality of life, studies evaluating the effects of applying diaphragmatic manual techniques in conjunction with 3D scoliosis exercises on EMG activation, scoliosis severity, trunk rotation angle, perception of cosmetic deformity, respiratory function, respiratory muscle strength, and quality of life are limited. Therefore, the aim of this research is to contribute to the development of new rehabilitation approaches in the conservative treatment of adolescent idiopathic scoliosis.

Interventions

• Other Diaphragmatic manual techniques
  With the patient sitting upright, the physiotherapist will position themselves behind the patient, placing their hands across the rib cage and fingertips to the subcostal margins. As the patient exhales, the physiotherapist will apply gentle but firm lateral pulling force from the subcostal margin to stretch the diaphragm. This pulling will be continued during inhalation. After repeating this for several breathing cycles, the patient will be placed supine, with hands bilaterally placed on the lo
• Other Schroth exercises
  During a Schroth exercise session, the goal is to stabilize proper posture by lengthening shortened muscles and activating stretched muscles through rotational breathing, based on the principles of active elongation, deflection, and derotation postural correction. Individuals will be positioned in three different positions-sleeping, sitting, and standing-with passive or active support, and stabilization will be achieved through isometric stretching. Each position will be held for 10 breaths\*3 s

Primary outcome measures

• Change of Ossification of the Iliac Apophysis [Time frame: Changes from baseline Ossification of the Iliac Apophysis at 12 weeks.]
• Change of Severity of Scoliosis [Time frame: Change from baseline severity of scoliosis at 12 weeks.]
• Change of Trunk Rotation Angle [Time frame: Change from baseline trunk rotation angle at 12 weeks.]
• Change of Cosmetic Deformity Perception [Time frame: Changes from baseline Cosmetic Deformity Perception at 12 weeks.]
• Change of Quality of Life [Time frame: Change from Baseline Quality of Life at 12 weeks.]
• Change of Electromyographic Activity of Muscles [Time frame: Change from Baseline Electromyographic Activities of Muscles at 12 weeks.]
• Change of Pulmonary Function [Time frame: Change from Baseline Pulmonary Function at 8 weeks.]
• Change of Respiratory Muscle Strength [Time frame: Change from Baseline Respiratory Muscle Strength at 12 weeks.]

Secondary outcome measures (3)

• Height in Meters [Time frame: Initial assessment before surgery]
• Weight in Kilograms [Time frame: Initial assessment before surgery]
• Body Mass Index (BMI) in kg/m^2 [Time frame: Initial assessment before surgery]

Eligibility criteria

Inclusion criteria

• Individuals aged 10-18 years, in adolescence.
• Scoliosis curvature in the thoracic region.
• Individuals and their parents (those who have signed the informed consent form) who agree to participate in regular follow-up and exercise programs throughout the study period.
• Diagnosis of AIS by a physician.
• Patients with idiopathic scoliosis diagnosed radiologically and with a Cobb angle less than 30°.
• The child and family agree to participate in and adhere to the 12-week treatment process.
• Ability to understand and speak Turkish.
• Not being in another treatment program. Individuals without any systemic disease that prevents participation in the physical exercise program.

Exclusion criteria

• Individuals who report that they cannot participate regularly during the exercise period or who will not adhere to the study schedule.
• Individuals who have not previously undergone surgery for scoliosis
• Those with accompanying neuromuscular or rheumatic diseases
• Those receiving other scoliosis-related treatment during the study
• Malignancy
• Those using braces
• Individuals with cognitive impairment that prevents them from understanding and performing the exercises mentally or physically.
• Those with respiratory and cardiovascular system diseases requiring regular medication

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

Healthy volunteers: No

Study design

Allocation

Randomized

Model

Parallel assignment

Masking

Open label

Primary purpose

Prevention

Study locations

Turkey (Türkiye) · 1 center

• Akdeniz University — Antalya

Identifiers

NCT: NCT07683533 · akdenizscoliosis

Primary sources (government registries)

• ClinicalTrials.gov (US NIH)

View this study on ClinicalTrials.gov ↗