The Effect of Three-Dimensional Exercises ( Schroth Method ) on Trunk Muscle Endurance, Sleep Quality, and Quality of Life in Adolescents With Hyperkyphosis

Обзор

Adolescence is a critical period for spinal growth, and progression of thoracic hyperkyphosis may lead to pain, weak trunk muscles, sleep disturbances, and reduced quality of life. This study aims to investigate the effects of three-dimensional exercise program based on the Schroth Method on trunk muscle endurance, thoracic kyphosis angle, pain, sleep quality and quality of life in adolescents aged 12-18 years with hyperkyphosis.

Подробное описание

Childhood and adolescence are critical developmental stages characterized by rapid spinal growth, as well as the formation of postural habits and the musculoskeletal system. During this process, various spinal deformities may arise due to neuromuscular, structural, postural, or functional causes, and if not addressed in a timely manner, they can lead to permanent postural abnormalities carried into adulthood.

Thoracic kyphosis is the physiologically present forward curvature of the spine in the sagittal plane and is generally considered normal within the range of 20°-45°. However, when this angle exceeds 45°, it is referred to as hyperkyphosis. Hyperkyphosis can develop due to many different causes, such as postural abnormalities, muscle imbalances, and vertebral developmental anomalies. This deformity can become more pronounced, especially during adolescence when growth spurts occur.

The progression of hyperkyphosis that emerges during the developmental period can lead to serious clinical consequences in children and adolescents, including aesthetic concerns, weak trunk muscles, pain around the spine, sleep disorders, and a decline in quality of life. Timely diagnosis and effective rehabilitation of adolescent hyperkyphosis are critical in controlling the progression of the deformity and preventing functional loss.

The literature reports that exercise-based approaches are effective in treating kyphosis in this age group. Schroth exercises, in particular, are a specialized physical therapy protocol used in the treatment of 3-dimensional scoliosis and kyphosis. They offer individualized, breathing-integrated postural correction techniques that target interplanar asymmetry of the spine. With this approach, patients are taught positioning to actively correct spinal segments, proprioceptive awareness, and breathing control. The Schroth method aims not only at passive posture correction but also at reestablishing muscle balance and maintaining correct posture in daily life.

In this context, Schroth exercises, which specifically target 3-dimensional spinal correction, are among the interventions frequently recommended in the literature.

The aim of this study is to evaluate the effect of Schroth exercises on back muscle endurance, thoracic kyphosis angle, pain, quality of life, and sleep in adolescents with hyperkyphosis.

Вмешательства

• Диагностический тест Kyphosis Study Form
  Kyphosis study form consisting of clinical and radiological measurements of patients aged 12-18 years who applied to the outpatient clinic with spine deformity will be filled in detail.
• Диагностический тест Scoliosis X-ray (Orthoroentgenogram)
  Adolescents aged 12-18 years presenting to the scoliosis outpatient clinic will undergo a standardized physical examination. Posture will be assessed in standing position from both anterior and lateral views in front of a posture chart. In patients where thoracic kyphosis is clinically suspected, a standing orthoroentgenogram (whole-spine radiograph) will be requested. On these radiographs, thoracic kyphosis angles will be measured to confirm the diagnosis and establish baseline values. Clinical
• Диагностический тест Inclinometer Measurement
  Thoracic kyphosis angle will also be assessed using a bubble inclinometer during physical examination. The participant will stand in a relaxed upright position, and the inclinometer will be placed over the spinous processes from T3 to T12 to measure the sagittal alignment of the thoracic spine. Three consecutive measurements will be taken for each participant, and the mean value will be recorded for analysis. This provides a reliable clinical estimate of thoracic kyphosis in addition to radiogra
• Диагностический тест Biering-Sorensen Test (Back Extensor Endurance Test)
  The Biering-Sorensen test is a standardized clinical assessment used to evaluate the isometric endurance of the trunk extensor muscles. During the test, the participant lies prone on an examination table with the upper edge of the iliac crests aligned with the edge of the table. The lower body (pelvis, knees, and ankles) is stabilized using straps or manual fixation. The upper body is extended horizontally beyond the edge of the table, with the arms crossed over the chest. The participant is ins

Первичные конечные точки

• Biering-Sorensen Test (Back Extensor Endurance Test) [Срок оценки: Assessments will be performed at baseline (one day before the exercise program ), at 1 month and at 3 months after the initiation of exercises.]
• Thoracic Kyphosis Angle (Inclinometer Measurement) [Срок оценки: Assessments will be performed at baseline (one day before the exercise program), at 1 month and at 3 months after the initiation of exercises.]

Вторичные конечные точки (5)

• Thoracic Kyphosis Angle (Inclinometer Measurement) [Срок оценки: Assessments will be performed at baseline (one day before the exercise program), at 1 month and at 3 months after the initiation of exercises.]
• Pittsburgh Sleep Quality Index (PSQI) [Срок оценки: Assessments will be performed at baseline (one day before the exercise programme ), at 1 month and at 3 months after the initiation of exercises.]
• Adolescent Insomnia Questionnaire (AIQ) [Срок оценки: Assessments will be performed at baseline (one day before the exercise programme ), at 1 month and at 3 months after the initiation of exercises.]
• Visual Analog Scale [Срок оценки: Assessments will be performed at baseline (one day before the exercise programme ), at 1 month and at 3 months after the initiation of exercises.]
• Scoliosis Research Society-22 Questionnaire [Срок оценки: Assessments will be performed at baseline (one day before the exercise programme ), at 1 month and at 3 months after the initiation of exercises.]

Критерии участия

Критерии включения

• Adolescents between 12 and 18 years of age
• Presence of thoracic kyphosis with a T3-T12 Cobb angle ≥45° measured on a lateral thoracic radiograph
• Sufficient physical and cognitive ability to actively participate in the exercise protocol for at least 3 months
• Adequate communication and cognitive capacity to understand the educational materials provided
• Ability and willingness to regularly complete the exercise log throughout the study period

Критерии исключения

• Scoliosis with a Cobb angle >10° in the coronal plane
• Presence of structural spinal deformities such as vertebral fracture, spondylolisthesis
• History of previous spinal surgery
• Neuromuscular disorders that may affect the spine (e.g., cerebral palsy, muscular dystrophy)
• Structural or functional pathologies involving the spine, pelvic complex, or shoulder girdle
• Balance disorders such as vestibular dysfunction, vertigo, or other conditions affecting postural control
• Inability to comply with the exercise protocol due to intellectual disability, severe behavioral disorders, or significant communication impairments
• Participation in professional-level sports activities that may influence exercise capacity or musculoskeletal function
• Presence of serious cardiopulmonary diseases (e.g., congenital heart disease, pulmonary hypertension)

Критерии приведены из реестра в оригинале (на английском). Окончательную оценку соответствия проводит исследовательский центр.

Здоровые добровольцы: Нет

Дизайн исследования

Распределение

Рандомизированное

Модель

Параллельные группы

Маскирование

Двойное слепое

Основная цель

Лечение

Центры проведения

Turkey (Türkiye) · 1 центр

• Gazisomanpasa Training and Research Hospital — Istanbul

Публикации

• Schreiber S, Parent EC, Moez EK, Hedden DM, Hill D, Moreau MJ, Lou E, Watkins EM, Southon SC. 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 Sep 18;10:24. doi: 10.1186/s13013-015-0048-5. eCo PMID 26413145

Идентификаторы

NCT: NCT07261358 · 1024

Первоисточники (государственные реестры)

• ClinicalTrials.gov (NIH, США)

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