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

Summary

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.

Conditions

• Adolescent Idiopathic Scoliosis
• Diaphragmatic Manual Techniques
• Schroth Exercises

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 lower ribs, and mobilization will be performed in a figure-eight pattern. For diaphragm mobilization, individuals will lie comfortably on their backs. The physiotherapist, positioned above the individual's head, will place the hypothenar region and the last three fingers of their hands bilaterally on the 7th-10th costal cartilages. The therapist will apply lateral and longitudinal pulls with their hands to support rib elevation during inspiration.

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 sets, and the therapist will monitor the corrections throughout the session.

Sponsors & Collaborators

• Akdeniz University

  lead OTHER

Principal Investigators

• Neriman Temel Aksu · Akdeniz University

Study Design

Allocation

RANDOMIZED

Purpose

PREVENTION

Masking

NONE

Model

PARALLEL

Eligibility

Min Age

10 Years

Max Age

18 Years

Sex

ALL

Healthy Volunteers

No

Timeline & Regulatory

Start

2026-08-01

Primary Completion

2027-02-01

Completion

2027-04-30

Countries

• Turkey (Türkiye)

Study Locations