The Effect of Schroth Exercises and Orthotic Bracing on Changes in Sagittal Balance and Sagittal Index in Patients with Adolescent Idiopathic Scoliosis
Nikola Jevtić
,
Nikola Jevtić
Faculty of Sport and Physical Education,
University of Novi Sad
, Novi Sad
, Serbia
Introduction: Adolescent idiopathic scoliosis (AIS) is a three-dimensional spinal deformity characterized by lateral curvature, vertebral rotation, and sagittal imbalance. It affects 2–4% of adolescents, predominantly females (7:1 ratio). Progressive deformity can cause respiratory dysfunction, chronic pain, and psychosocial distress. Developing effective conservative treatments remains a major challenge in orthopedic rehabilitation. This study aimed to evaluate the effectiveness of combined Schroth therapy and 3D-Chêneau bracing in managing AIS, focusing on sagittal alignment, postural control, and functional improvement. Material and Methods: A prospective quasi-experimental study was conducted with 60 adolescents (mean age 13.3 ± 1.6 years) diagnosed with AIS (Cobb angle 20°–47°). The intervention consisted of two phases: an intensive 3-week supervised Schroth exercise program (21 sessions) followed by continued home exercises combined with a custom 3D-modified Chêneau brace. Assessments were performed at baseline, 4 weeks, 3 months, and 6 months. Primary outcomes included sagittal balance (mm) and sagittal index (mm), evaluated by standardized plumb-line analysis. Results: After six months, significant improvements were observed in sagittal alignment (p < 0.001). Sagittal balance increased toward the physiological reference (~20 mm), indicating improved postural symmetry and trunk stability. Sagittal index values reflected curve-specific and localization-dependent adaptations, particularly in thoracic deformities. Conclusion: Combined Schroth therapy and 3D-modified Chêneau bracing effectively enhanced sagittal spinal alignment in adolescents with AIS. This integrated conservative approach demonstrated measurable improvements in physiological balance and postural organization, supporting its role as a functional, noninvasive intervention for AIS management.
Almansour, H., Pepke, W., Bruckner, T., Diebo, B. G., & Akbar, M. (n.d.). Three-Dimensional Analysis of Initial Brace Correction in the Setting of Adolescent Idiopathic Scoliosis. Journal of Clinical Medicine, 8(11), 1804. https://doi.org/10.3390/jcm8111804
Berdishevsky, H., Lebel, V. A., Bettany-Saltikov, J., Rigo, M., Lebel, A., Hennes, A., Romano, M., Białek, M., M’hango, A., Betts, T., de Mauroy, J. C., & Durmala, J. (2016). Physiotherapy scoliosis-specific exercises – a comprehensive review of seven major schools. Scoliosis and Spinal Disorders, 11(1). https://doi.org/10.1186/s13013-016-0076-9
Bezalel, T., Carmeli, E., Levi, D., & Kalichman, L. (2019). The Effect of Schroth Therapy on Thoracic Kyphotic Curve and Quality of Life in Scheuermann’s Patients: A Randomized Controlled Trial. Asian Spine Journal, 13(3), 490–499. https://doi.org/10.31616/asj.2018.0097
Bidari, S., Kamyab, M., Ahmadi, A., & Ganjavian, M. S. (2019). Effect of exercise on static balance and Cobb angle during the weaning phase of brace management in idiopathic scoliosis and hyperkyphosis: A preliminary study. Journal of Back and Musculoskeletal Rehabilitation, 32(4), 639–646. https://doi.org/10.3233/bmr-181128
Burwell, R. G. (2003). Aetiology of idiopathic scoliosis: current concepts. Pediatric Rehabilitation, 6(3–4), 137–170. https://doi.org/10.1080/13638490310001642757
Cho, R. H., Yaszay, B., Bartley, C. E., Bastrom, T. P., & Newton, P. O. (2012). Which Lenke 1A Curves Are at the Greatest Risk for Adding-On... and Why? Spine, 37(16), 1384–1390. https://doi.org/10.1097/brs.0b013e31824bac7a
Daruwalla, J., & Balasubramaniam, P. (1985). Moire topography in scoliosis. Its accuracy in detecting the site and size of the curve. The Journal of Bone and Joint Surgery. British Volume, 67-B(2), 211–213. https://doi.org/10.1302/0301-620x.67b2.3980527
de Mendonça, R. G. M., Sawyer, J. R., & Kelly, D. M. (2016). Complications After Surgical Treatment of Adolescent Idiopathic Scoliosis. Orthopedic Clinics of North America, 47(2), 395–403. https://doi.org/10.1016/j.ocl.2015.09.012
Dimitrijević, V., Rašković, B., Popović, M. P., Viduka, D., Nikolić, S., Jevtić, N., Pjanić, S., & Obradović, B. (n.d.). Treatment of Adolescent Idiopathic Scoliosis with the Conservative Schroth Method: A Randomized Controlled Trial. Healthcare, 13(6), 688. https://doi.org/10.3390/healthcare13060688
Dimitrijević, V., Šćepanović, T., Jevtić, N., Rašković, B., Milankov, V., Milosević, Z., Ninković, S. S., Chockalingam, N., Obradović, B., & Drid, P. (n.d.). Application of the Schroth Method in the Treatment of Idiopathic Scoliosis: A Systematic Review and Meta-Analysis. International Journal of Environmental Research and Public Health, 19(24), 16730. https://doi.org/10.3390/ijerph192416730
Dimitrijević, V., Viduka, D., Šćepanović, T., Maksimović, N., Giustino, V., Bianco, A., & Drid, P. (2022). Effects of Schroth method and core stabilization exercises on idiopathic scoliosis: a systematic review and meta-analysis. European Spine Journal, 31(12), 3500–3511. https://doi.org/10.1007/s00586-022-07407-4
Divecha, H. M., Siddique, I., Breakwell, L. M., & Millner, P. A. (2014). Complications in spinal deformity surgery in the United Kingdom: 5-year results of the annual British Scoliosis Society National Audit of Morbidity and Mortality. European Spine Journal, 23(S1), 55–60. https://doi.org/10.1007/s00586-014-3197-y
Dolan, L. A., Donzelli, S., Zaina, F., Weinstein, S. L., & Negrini, S. (2020). Adolescent Idiopathic Scoliosis Bracing Success Is Influenced by Time in Brace. Spine, 45(17), 1193–1199. https://doi.org/10.1097/brs.0000000000003506
Effects of corrective, therapeutic exercise techniques on adolescent idiopathic scoliosis. A systematic review. (2018). Archivos Argentinos de Pediatria, 116(4). https://doi.org/10.5546/aap.2018.eng.e582
Grivas, T. B., Negrini, S., Aubin, C.-E., Aulisa, A. G., De Mauroy, J. C., Donzelli, S., Hresko, M. T., Kotwicki, T., Lou, E., Maruyama, T., Parent, E. C., Rigo, M., Thometz, J. G., Wong, M. S., & Zaina, F. (2022). Nonoperative management of adolescent idiopathic scoliosis (AIS) using braces. Prosthetics & Orthotics International, 46(4), 383–391. https://doi.org/10.1097/pxr.0000000000000117
Hamilton, D. K., Smith, J. S., Sansur, C. A., Glassman, S. D., Ames, C. P., Berven, S. H., Polly, D. W., Perra, J. H., Knapp, D. R., Boachie-Adjei, O., McCarthy, R. E., & Shaffrey, C. I. (2011). Rates of New Neurological Deficit Associated With Spine Surgery Based on 108,419 Procedures. Spine, 36(15), 1218–1228. https://doi.org/10.1097/brs.0b013e3181ec5fd9
Hedayati, Z., Ahmadi, A., Kamyab, M., Babaee, T., & Ganjavian, M. S. (2018). Effect of Group Exercising and Adjusting the Brace at Shorter Intervals on Cobb Angle and Quality of Life of Patients With Idiopathic Scoliosis. American Journal of Physical Medicine & Rehabilitation, 97(2), 104–109. https://doi.org/10.1097/phm.0000000000000812
Kim, G., & Hwangbo, G. (2016). Effects of Schroth and Pilates exercises on the Cobb angle and weight distribution of patients with scoliosis. Journal of Physical Therapy Science, 28(3), 1012–1016.
Kim, H. J., Lenke, L. G., Shaffrey, C. I., Van Alstyne, E. M., & Skelly, A. C. (2012). Proximal Junctional Kyphosis as a Distinct Form of Adjacent Segment Pathology After Spinal Deformity Surgery. Spine, 37, S144–S164. https://doi.org/10.1097/brs.0b013e31826d611b
Kim, M.-J., & Park, D.-S. (2017). The effect of Schroth’s three-dimensional exercises in combination with respiratory muscle exercise on Cobb’s angle and pulmonary function in patients with idiopathic scoliosis. Physical Therapy Rehabilitation Science, 6(3), 113–119. https://doi.org/10.14474/ptrs.2017.6.3.113
Kocaman, H., Bek, N., Kaya, M. H., Büyükturan, B., Yetiş, M., & Büyükturan, Ö. (n.d.). The effectiveness of two different exercise approaches in adolescent idiopathic scoliosis: A single-blind, randomized-controlled trial. PLOS ONE, 16(4), e0249492. https://doi.org/10.1371/journal.pone.0249492
Kotwicki, T. (2008). Evaluation of scoliosis today: Examination, X-rays and beyond. Disability and Rehabilitation, 30(10), 742–751. https://doi.org/10.1080/09638280801889519
Kuru, T., Yeldan, İ., Dereli, E. E., Özdinçler, A. R., Dikici, F., & Çolak, İ. (2016). The efficacy of three-dimensional Schroth exercises in adolescent idiopathic scoliosis: a randomised controlled clinical trial. Clinical Rehabilitation, 30(2), 181–190. https://doi.org/10.1177/0269215515575745
Kwiatkowski, M., Mnich, K., Karpiński, M., Domański, K., Milewski, R., & Popko, J. (2015). Assessment of Idiopathic Scoliosis Patients’ Satisfaction with Thoracolumbar Brace Treatment. Ortopedia Traumatologia Rehabilitacja, 17(2), 111–119. https://doi.org/10.5604/15093492.1157087
Lee, S. G., Lee, J. H., & Park, S. Y. (2015). Effects of Schroth exercise on the Cobb angle and the thoracic kyphotic angle in patients with idiopathic scoliosis. Journal of Physical Therapy Science, 27(12), 3921–3924.
Luhmann, S. J., Lenke, L. G., Bridwell, K. H., & Schootman, M. (2009). Revision Surgery After Primary Spine Fusion for Idiopathic Scoliosis. Spine, 34(20), 2191–2197. https://doi.org/10.1097/brs.0b013e3181b3515a
Lykissas, M. G., Jain, V. V., Nathan, S. T., Pawar, V., Eismann, E. A., Sturm, P. F., & Crawford, A. H. (2013). Mid- to Long-Term Outcomes in Adolescent Idiopathic Scoliosis After Instrumented Posterior Spinal Fusion. Spine, 38(2), E113–E119. https://doi.org/10.1097/brs.0b013e31827ae3d0
Monticone, M., Ambrosini, E., Cazzaniga, D., Rocca, B., & Ferrante, S. (2014). Active self-correction and task-oriented exercises reduce spinal deformity and improve quality of life in subjects with mild adolescent idiopathic scoliosis. Results of a randomised controlled trial. European Spine Journal, 23(6), 1204–1214. https://doi.org/10.1007/s00586-014-3241-y
Negrini, S., Aulisa, A. G., Aulisa, L., Circo, A. B., Mauroy, J. C., Durmala, J., & Zaina, F. (2012). 2011 SOSORT guidelines: Orthopaedic & rehab treatment during growth. Scoliosis, 7(1), 3.
Negrini, S., Donzelli, S., Aulisa, A. G., Czaprowski, D., Schreiber, S., de Mauroy, J. C., Diers, H., Grivas, T. B., Knott, P., Kotwicki, T., Lebel, A., Marti, C., Maruyama, T., O’Brien, J., Price, N., Parent, E., Rigo, M., Romano, M., Stikeleather, L., … Zaina, F. (2018). 2016 SOSORT guidelines: orthopaedic and rehabilitation treatment of idiopathic scoliosis during growth. Scoliosis and Spinal Disorders, 13(1). https://doi.org/10.1186/s13013-017-0145-8
Negrini, S., Donzelli, S., Negrini, A., Parzini, S., Romano, M., & Zaina, F. (2019). Specific exercises reduce the need for bracing in adolescents with idiopathic scoliosis: A practical clinical trial. Annals of Physical and Rehabilitation Medicine, 62(2), 69–76. https://doi.org/10.1016/j.rehab.2018.07.010
Otman, S., Kose, N., & Yakut, Y. (2005). Efficacy of Schroth’s 3-D exercise therapy in AIS. Saudi Medical Journal, 26, 277–283.
Pastorelli, F., Di Silvestre, M., Plasmati, R., Michelucci, R., Greggi, T., Morigi, A., Bacchin, M. R., Bonarelli, S., Cioni, A., Vommaro, F., Fini, N., Lolli, F., & Parisini, P. (2011). The prevention of neural complications in the surgical treatment of scoliosis: the role of the neurophysiological intraoperative monitoring. European Spine Journal, 20(S1), 105–114. https://doi.org/10.1007/s00586-011-1756-z
Reames, D. L., Smith, J. S., Fu, K.-M. G., Polly, D. W., Ames, C. P., Berven, S. H., Perra, J. H., Glassman, S. D., McCarthy, R. E., Knapp, R. D., Heary, R., & Shaffrey, C. I. (2011). Complications in the Surgical Treatment of 19,360 Cases of Pediatric Scoliosis. Spine, 36(18), 1484–1491. https://doi.org/10.1097/brs.0b013e3181f3a326
Scoliosis: Review of Diagnosis and Treatment. (n.d.). International Journal of Convergence in Healthcare, 4(1). https://doi.org/10.55487/x8sqsj51
Tournavitis, N., Çolak, T. K., & Voutsas, C. (n.d.). Effect of Chêneau style braces on vertebral wedging amongst individuals with adolescent idiopathic scoliosis. South African Journal of Physiotherapy, 77(2). https://doi.org/10.4102/sajp.v77i2.1617
Weinstein, S. L., Dolan, L. A., Wright, J. G., & Dobbs, M. B. (2013). Effects of Bracing in Adolescents with Idiopathic Scoliosis. New England Journal of Medicine, 369(16), 1512–1521. https://doi.org/10.1056/nejmoa1307337
Weiss, H.-R., & Goodall, D. (2008). Rate of complications in scoliosis surgery – a systematic review of the Pub Med literature. Scoliosis, 3(1). https://doi.org/10.1186/1748-7161-3-9
Weiss, H.-R., & Moramarco, M. (2013). Indication for surgical treatment in patients with adolescent Idiopathic Scoliosis – a critical appraisal. Patient Safety in Surgery, 7(1), 17. https://doi.org/10.1186/1754-9493-7-17
Wibmer, C., Trotsenko, P., Gilg, M. M., Leithner, A., Sperl, M., & Saraph, V. (2019). Observational retrospective study on socio-economic and quality of life outcomes in 41 patients with adolescent idiopathic scoliosis 5 years after bracing combined with physiotherapeutic scoliosis-specific exercises (PSSE). European Spine Journal, 28(3), 611–618. https://doi.org/10.1007/s00586-018-5746-2
Yaman, O., & Dalbayrak, S. (2013). Kyphosis and review of the literature. Turkish Neurosurgery. https://doi.org/10.5137/1019-5149.jtn.8940-13.0
Zaina, F., Negrini, S., & Atanasio, S. (2009). TRACE (Trunk Aesthetic Clinical Evaluation), a routine clinical tool to evaluate aesthetics in scoliosis patients: development from the Aesthetic Index (AI) and repeatability. Scoliosis, 4(1). https://doi.org/10.1186/1748-7161-4-3
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Data Availability
The datasets generated and analyzed during the current study are available from the corresponding author on reasonable request.
Funding Statement
This research was supported by the Provincial Secretariat for Higher Education and Scientific Research of AP Vojvodina, grant number: 142-451-2595.
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