Sowmya M. V.1, Dhivya S.2, Jumanah Haseen R.2
1Assistant Professor, Saveetha College of Physiotherapy, Thandalam.
2BPT Student, Saveetha College of Physiotherapy, Thandalam.
Background: Scoliosis refers to a three-dimensional deformation of the natural curvature of the spine. Schroth exercise improves the trunk shape and the respiratory ability by applying rotational breathing. It has been reported to improve the function of the thoracic wall and the symptoms of the respiratory system. There is less evidence on the effects of Schroth exercise on a cobb’s angle of 40 degrees or higher. Hence, the purpose of the study was to investigate the effects of the Schroth exercise on the cobb’s angle in idiopathic scoliosis. Methods: Four patients with growing idiopathic scoliosis having a cobb’s angle of 40 degrees or higher in the thoracic vertebrae were included in the study. The Schroth exercise was performed 3 times a week for 3 months. The thoracic cobb’s angle was measured before and after the exercise program. Result: The thoracic cobb’s angle decreased from 40.28±7.72 to 24.0±2.65 on average. These effects were significant. Conclusion: The 3 months Schroth exercise caused significant effects in the thoracic cobb’s angle. The conservative treatment method was found to be effective even at a 40 degree for higher cobb’s angle. In the future universal exercise approach methods and preventive training for the treatment of scoliosis should be developed further.
Scoliosis refers to a 3-dimensional deformation of the natural bending of the spine. In the clinical setting, the Cobb’s angle analysis method, which is a valid analysis of the degree of the lateral bending is done through radiography. In modern society, abnormal bending of the spinal column is caused by sitting for long periods, and an unbalanced body shape is caused by a lack of awareness about body imbalance. Although the causes are unclear, scoliosis is associated with genetic factors, poor posture, and insufficient exercise. Physical problems resulting from these factors include deformation of the spinal column and associated structures.
Minor scoliosis with less than a 20° Cobb’s angle requires periodic observation, and scoliosis with a Cobb’s angle of 20–40° requires the wearing of an orthosis to prevent progress. If the Cobb’s angle is greater than 40°, it indicates the need of surgery. If scoliosis is detected and treated early, most patients do not need surgical treatment. In some cases, surgical treatment may have poorer results. The orthosis treatment, which is the first stage of scoliosis treatment, can cause spondylosis and loss of the surrounding muscles. If this limitation of normal movement occurs in growing adolescents, it could cause undesirable results. Scoliosis causes deformations of the spinal column and structures8, decreases the spinal flexibility by changing the characteristics of the erector spinae muscle, and leads to imbalances of the trunk and pelvis depending on the shape and angle of the scoliosis. Furthermore, it has been reported that correction and respiratory treatment are essential because of the bending of the thoracic cage, which weakens the respiratory muscle and lowers cardiopulmonary function.
Various core and breathing exercises are used to treat scoliosis. The beneficial treatment effects of the Schroth therapy, a recent therapeutic exercise, have been reported. Many studies have investigated the improvement produced by Schroth exercise on Cobb’s angle in scoliosis patients, but most studies were on patients whose
Cobb’s angle was smaller than 30° or the studies combined the Schroth exercise with orthosis treatment. Studies on subjects with a 40° or higher Cobb’s angle who require surgery are still insufficient. Therefore, this study investigated the effects of the Schroth exercise therapy in patients with scoliosis as a surgical indication for the improvement of their Cobb’s angle.
MATERIALS AND METHODS:
The study was conducted in Saveetha Medical Hospital, Thandalam, Chennai with 4 female patients aged 22.65± 1.82 with thoracic scoliosis whose Cobb’s angles were greater than 40°. (Table1). Individuals who had neurological findings or an operation, who recently received surgical treatment, who wore an orthosis, or who were periodically taking medicine were excluded from the study. Subjects performed the Schroth exercise 3 times a week for 12 weeks. Each 60-minute session consisted of preparation (cat walking and breathing exercise: 10 min), stretching (stretching the chest part: 5 min), the main exercise (laying right click concave, laying aside static postural control training, sitting posture adjustment exercise, and muscle cylinder: 40 min), and wrap-up (moving ribs: 5 min). Schroth exercise was applied in accordance with the bending shape of each subject, along with 3-dimensional Schroth rotational breathing. Cobb’s angle was measured with the patient standing straight by radiography. The trunk rotation angle was measured through the Adam’s forward bending test using a scoliometer.
The patients in this study had thoracic Cobb’s angle reduce from 40.28±7.72 to 24.0±2.65 on average. The thoracic trunk rotation angle decreased from 11.86± 3.32° to 4.90±1.91°. All these effects were significant. (Table 2)
In this study, to examine the effects of the Schroth exercise on Cobb’s angle and thoracic trunk rotation angle of patients with scoliosis as a surgical indication, the subjects performed the Schroth exercise 3 times a week for 12 weeks. The Schroth exercise has the advantage of correcting the posture according to the bending type and is an effective mechanism to facilitate the correction of posture in the 3 dimensions of scoliosis . Furthermore, the Schroth 3-dimensional exercise approach has been proven to decrease the progress of idiopathic scoliosis, improve Cobb’s angle and resolve pain, and reduce the prescription of orthosis. Borysov et al. measured Cobb’s angle with a scoliometer after applying the Schroth exercise, which significantly decreased from 8.9° to 6.5°. There are therapeutic approaches to scoliosis from various perspectives, and the basis for the effects of exercise therapy as a conservative treatment method has been reported recently. The goal of conservative treatment is to stop the progress of bending. The therapeutic effects of the Schroth exercise have been reported recently. The results of the present study also showed significant effects in the thoracic Cobb’s angle and thoracic trunk rotation angle after the Schroth exercise. The trunk rotation angle decreased when the acromion of the rib was turned to the opposite side by the 3-dimensional rotational breathing during the Schroth exercise. This 3-dimensional rotational breathing allowed the exercise to become more 3-dimensional, which expanded the narrowed thoracic cage.
Furthermore, with the forced use of the inspiratory and the expiratory muscles, the angle of scoliosis and pulmonary function decreased simultaneously. Therefore, this study showed that the Schroth exercise, which is a conservative therapy, was effective even for subjects with a 40° or greater Cobb’s angle who needed operative treatment. Growing adolescents have a high risk of progress owing to a high degree of scoliosis because they spend much time sitting at school. Limitations of this study include the limited number of patients with 40° or greater scoliosis and the difficulty in finding time for the subjects to participate as they were post graduate students. In the future, a study comparing the effects with a group among whom the Schroth exercise is combined with orthosis treatment will be necessary.
The 12 weeks of Schroth exercise caused significant effects in the thoracic Cobb’s angle. The conservative treatment method was found to be effective even at a 40 degree for higher Cobb’s angle.
In the future, universal exercise approach methods for the treatment and preventive training for scoliosis should be developed further.
1. Beamer S, Mignotte M, Parent S, et al.: 3D/2D registration and segmentation of scoliotic vertebrae using statistical models. Computerized Medical Imaging and Graphics, 2003, 27: 321–337.
2. Cassar-Pullicino VN, Eisenstein SM: Imaging in scoliosis: what, why and how? Clinical Radiology, 2002, 57: 543–562.
3. Kim BJ: A comparison on the influences of Schroth-based static scoliosis exercise and asymmetric scoliosis exercise on the patients with scoliosis. Graduate School of Daegu University, PhD thesis, 2014.
4. Lee JH, Kim SY: Comparative effectiveness of Schroth therapeutic exercise versus sling therapeutic exercise in flxibility, balance, spine angle and chest expansion in patient with scoliosis. Journal of the Korean Society of Physical Medicine, 2014, 9: 11–23.
5. Mooney V, Gulick J: A report on the effect of measured strength training in adolescent idiopathic scoliosis. Journal of Spinal Disorders, 2000, 13: 102–107.
6. Zabjek KF, Leroux MA, Coillard C, et al.: Acute postural adaptations induced by a shoe lift in idiopathic scoliosis patients. European Spine Journal, 2001, 10: 107–113.
7. Roach JW: Adolescent idiopathic scoliosis. Orthopedic Clinics of North America, 1999, 30: 353–365
8. Landauer F, Wimmer C, Behensky H: Estimating the fial outcome of brace treatment for idiopathic thoracic scoliosis at 6-month follow-up. Journal of Pediatric Rehabilitation Medicine, 2003, 6: 201–207.
9. Weiss HR: Adolescent Idiopathic Scoliosis—case report of a patient with clinical deterioration after surgery. Patient Safety in Surgery, 2007, 1: 7.
10. Kotwicki T, Napiontek M: Intravertebral deformation in idiopathic scoliosis: a transverse plane computer tomographic study. Journal of PediatricOrthopedics, 2008, 28: 225–229.
11. Mahaudens P, Banse X, Mousny M, et al.: Very short-term effect of brace wearing on gait in adolescent idiopathic scoliosis girls. European Spine Journal, 2013, 22: 2399–2406.
12. Zabjek KF, Leroux MA, Coillard C, et al.: Acute postural adaptations induced by a shoe lift in idiopathic scoliosis patients. European Spine Journal, 2001, 10: 107–113.
13. Trobisch P, Suess O, Schwab F: Idiopathic scoliosis. Deutsches Ärzteblatt International, 2010, 107: 875–883, quiz 884.
14. Park JY, Park GD, Lee SG, et al.: The effect of scoliosis angle on center of gravity sway. Journal of physical therapy science, 2013, 25:1629–1631.
15. Lonstein JE: Adolescent idiopathic scoliosis. Lancet, 1994, 344: 1407–1412.
16. Kim JJ, Song GB, Park EC: Effects of Swiss ball exercise and resistance exercise on respiratory function and trunk control ability in patients with scoliosis. Journal of Physical Therapy Science, 2015, 27: 1775–1778.
17. Lee MG, Hwang JS, Seo BD, et al.: The effects of the core muscle release technique on scoliosis. Journal of Physical Therapy Science, 2013, 25: 445–448.
18. Yang JM, Lee JH, Lee DH: Effects of consecutive application of stretching, Schroth, and strengthening exercises on Cobb’s angle and the rib hump in an adult with idiopathic scoliosis. Journal Of Physical Therapy Science, 2015, 27: 2667–2669.
19. Negrini S, Antonini G, Carabalona R, et al.: Physical exercises as a treatment for adolescent idiopathic scoliosis. A systematic review. Pediatric Rehabilitation, 2003, 6: 227–235.
20. Weiss HR: The effect of an exercise program on vital capacity and rib mobility in patients with idiopathic scoliosis. Spine, 1991, 16: 88–93.
21. Fusco C, Zaina F, Atanasio S, et al.: Physical exercises in the treatment of adolescent idiopathic scoliosis: an updated systematic review. Physiotherapy: Theory and Practice, 2011, 27: 80–114.
22. Weiss HR: “Brace technology” thematic series - the Gensingen brace in the treatment of scoliosis. Scoliosis, 2010, 5:22.
23. Negrini S, Fusco C, Minozzi S, et al.: Exercises reduce the progression rate of adolescent idiopathic scoliosis: results of a comprehensive systematic review of the literature. Disability and Rehabilitation, 2008, 30: 772–785.
24. Lenssinck ML, Frijlink AC, Berger MY, et al.: Effect of bracing and other conservative interventions in the treatment of idiopathic scoliosis in adolescents: a systematic review of clinical trials. Physical Therapy, 2005, 85: 1329–1339.
25. Landauer F, Wimmer C, Behensky H: Estimating the fial outcome of brace treatment for idiopathic thoracic scoliosis at 6-month follow-up. Pediatric Rehabilitation, 2003, 6: 201–207.
26. Yang JM, Lee JH, Lee DH: Effects of consecutive application of stretching, Schroth, and strengthening exercises on Cobb’s angle and the rib hump in an adult with idiopathic scoliosis. Journal Of Physical Therapy Science, 2015, 27: 2667–2669.
Received on 29.01.2019 Modified on 21.02.2019
Accepted on 29.03.2019 © RJPT All right reserved