Core Stabilization Exercises vs. Schroth's Three Dimensional Exercises to Treat Adolescent Idiopathic Scoliosis: A Systematic Review
Abstract
Background: Adolescent idiopathic scoliosis (AIS) is one of the most prevalent spinal abnormalities, appearing far into puberty. Schroth exercises (SE) and core-stabilization exercises (CE) have become very prominent among the specialized and general methods to scoliosis treatment. However, their effects are still unclear and there is insufficient evidence of superiority between them. Therefore, the aims of this review were to (1) evaluate and, (2) compare the effectiveness of these methods on Cobb angles (CA) in AIS.
Methods: A systematic review was performed on SE and CE papers. The databases included PubMed, Scopus, MEDLINE, Cochrane Library, CINAHL and Google Scholar from 2005 to June 2022. The PEDro scale assessed the quality of the papers.
Results: After screening 410 papers, nine papers (SE=5, CE=3 and SE vs. CE=1), with 339 participants, were admitted for review (PEDro=6). Among them, three (SE=moderate evidence) and two papers (CE=limited evidence) reported clinically significant reductions in CA>5˚, alone or compared to control or other exercise methods, while only one paper (very limited evidence) showed the relative superiority of SE (-7.16˚) compared to CE (-3.27˚). However, three papers did not show clinically significant results (CA<5˚).
Conclusions: Moderate and limited evidence suggests that both SE and CE can effectively improve CA, respectively. There is very limited evidence to suggest that SE is more effective than CE in treating AIS. Thus, the definitive answers to the questions, especially in regard to the superiority between these two methods, remained unclear. Further high-quality studies must be conducted in the future.
1. Li X, Shen J, Liang J, Zhou X, Yang Y, Wang D, et al. Effect of core-based exercise in people with scoliosis: A systematic review and meta-analysis. Clinical rehabilitation. 2021;35(5):669-80.
2. Konieczny MR, Senyurt H, Krauspe R. Epidemiology of adolescent idiopathic scoliosis. Journal of children's orthopaedics. 2013;7(1):3-9.
3. Kewwan K, Seji A, Kyoungkyu J. Asymmetry Improvement on Core Training for Adolescent Idiopathic Scoliosis. Iranian Journal of Public Health. 2020;49(11):2219.
4. Gheitasi M, Alizadeh MH, Rajabi R, Ebrahimi Takamjani E. Comparison of Three Methods of Routine, Self-correction, and Mixed Corrective Exercise on Lateral Curvature Degree in Non-Structural Scoliotic Subjects. The Scientific Journal of Rehabilitation Medicine. 2019;8(1):47-60.
5. Day JM, Fletcher J, Coghlan M, Ravine T. Review of scoliosis-specific exercise methods used to correct adolescent idiopathic scoliosis. Archives of physiotherapy. 2019;9(1):1-11.
6. Stokes IA, Spence H, Aronsson DD, Kilmer N. Mechanical modulation of vertebral body growth: implications for scoliosis progression. Spine. 1996;21(10):1162-7.
7. Van Rooyen C, Du Plessis LZ, Geldenhuys L, Myburgh E, Coetzee W, Vermeulen N, et al. The effectiveness of Schroth exercises in adolescents with idiopathic scoliosis: A systematic review and meta-analysis. South African Journal of Physiotherapy. 2019;75(1):1-9.
8. Rullander AC, Lundström M, Lindkvist M, Lindh V. Stress symptoms among adolescents before and after scoliosis surgery: correlations with postoperative pain. Journal of Clinical Nursing. 2016;25(7-8):1086-94.
9. Romano M, Minozzi S, Bettany‐Saltikov J, Zaina F, Chockalingam N, Kotwicki T, et al. Exercises for adolescent idiopathic scoliosis. Cochrane Database of Systematic Reviews. 2012(8).
10. Berdishevsky H, Lebel VA, Bettany-Saltikov J, Rigo M, Lebel A, Hennes A, et al. Physiotherapy scoliosis-specific exercises–a comprehensive review of seven major schools. Scoliosis and spinal disorders. 2016;11(1):1-52.
11. Gheitasi M, Bayattork M, Mahdavi SM. Effect of a long-term corrective exercises with using brace on cobb angle and postural control of a girl with adolescence idiopathic scoliosis. Physical Treatments-Specific Physical Therapy Journal. 2019;9(1):59-68.
12. Weiss H-R. The method of Katharina Schroth-history, principles and current development. Scoliosis. 2011;6(1):1-22.
13. Park JY, Kim SH, Lee JC, Ju SB. Effect of Schroth Rehabilitation Exercise Program on Scoliometer Readings, Lumbar Lordosis and Calcaneal Valgus Angle in Patients with Idiopathic Scoliosis. Iranian Journal of Public Health. 2020;49(4):808.
14. Panjabi MM. The stabilizing system of the spine. Part I. Function, dysfunction, adaptation, and enhancement. Journal of spinal disorders. 1992;5:383-.
15. Gou Y, Lei H, Zeng Y, Tao J, Kong W, Wu J. The effect of Pilates exercise training for scoliosis on improving spinal deformity and quality of life: Meta-analysis of randomized controlled trials. Medicine. 2021;100(39).
16. Gheitasi M, Pasandideh Z, Lordgouie M, Samavi M, Allafan N. Effect of eight-weeks pilates exercises on non-structural scoliosis deformity and improve balance in female students. Journal of Applied Exercise Physiology. 2018;13(26):78-90.
17. Huxel Bliven KC, Anderson BE. Core stability training for injury prevention. Sports health. 2013;5(6):514-22.
18. Gheitasi M, Khaledi A, Daneshjoo A. The Effect of Combined Core Stability and Sensory-motor Exercises on Pain, Performance and Movement Fear in Retired Male Athletes with Non-specific Chronic Low Back Pain. jap. 2020;11(1):38-48.
19. Zhou Z, Liu F, Li R, Chen X. The effects of exercise therapy on adolescent idiopathic scoliosis: an overview of systematic reviews and meta-analyses. Complementary Therapies in Medicine. 2021:102697.
20. Khaledi A, Minoonejad H, Daneshmandi H, Akoochakian M, Gheitasi M. The Effectiveness of Schroth vs SEAS Exercise Methods for Correcting Idiopathic Scoliosis in Adolescents: A Systematic Review. USWR. 2022;12(1):1-12.
21. Park J-H, Jeon H-S, Park H-W. Effects of the Schroth exercise on idiopathic scoliosis: a meta-analysis. European journal of physical and rehabilitation medicine. 2017;54(3):440-9.
22. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. International Journal of Surgery. 2021;88:105906.
23. Eriksen MB, Frandsen TF. The impact of patient, intervention, comparison, outcome (PICO) as a search strategy tool on literature search quality: a systematic review. Journal of the Medical Library Association: JMLA. 2018;106(4):420.
24. Moseley AM, Herbert RD, Sherrington C, Maher CG. Evidence for physiotherapy practice: a survey of the Physiotherapy Evidence Database PEDro. Australian Journal of Physiotherapy. 2002;48(1):43-9.
25. Van Tulder M, Furlan A, Bombardier C, Bouter L, Group EBotCCBR. Updated method guidelines for systematic reviews in the cochrane collaboration back review group. Spine. 2003;28(12):1290-9.
26. Kuru T. The efficacy of three-dimensional Schroth exercises in adolescent idiopathic scoliosis: a randomised controlled clinical trial. Clinical rehabilitation. 2016;30(2):181-90.
27. Gür G, Ayhan C, Yakut Y. The effectiveness of core stabilization exercise in adolescent idiopathic scoliosis: A randomized controlled trial. Prosthetics and orthotics international. 2017;41(3):303-10.
28. Yagci G, Yakut Y. Core stabilization exercises versus scoliosis-specific exercises in moderate idiopathic scoliosis treatment. Prosthetics and orthotics international. 2019;43(3):301-8.
29. Kocaman H. The effectiveness of two different exercise approaches in adolescent idiopathic scoliosis: A single-blind, randomized-controlled trial. PloS one. 2021;16(4):e0249492.
30. Mohamed R, Yousef A. Impact of Schroth three-dimensional vs. proprioceptive neuromuscular facilitation techniques in adolescent idiopathic scoliosis: a randomized controlled study. European review for medical and pharmacological sciences. 2021;25(24):7717-25.
31. Schreiber S, Parent EC, Khodayari Moez E, Hedden DM, Hill DL, Moreau M, et al. Schroth physiotherapeutic scoliosis-specific exercises added to the standard of care lead to better Cobb angle outcomes in adolescents with idiopathic scoliosis–an assessor and statistician blinded randomized controlled trial. PloS one. 2016;11(12):e0168746.
32. Otman S, Kose N, Yakut Y. The efficacy of Schroth’s 3-dimensional exercise therapy in the treatment of adolescent idiopathic scoliosis in Turkey. Neurosciences Journal. 2005;10(4):277-83.
33. Ko K-J, Kang S-J. Effects of 12-week core stabilization exercise on the Cobb angle and lumbar muscle strength of adolescents with idiopathic scoliosis. Journal of exercise rehabilitation. 2017;13(2):244.
34. Kwan KYH, Cheng AC, Koh HY, Chiu AY, Cheung KMC. Effectiveness of Schroth exercises during bracing in adolescent idiopathic scoliosis: results from a preliminary study—SOSORT Award 2017 Winner. Scoliosis and spinal disorders. 2017;12(1):1-7.
35. Fan Y, Ren Q, To MKT, Cheung JPY. Effectiveness of scoliosis-specific exercises for alleviating adolescent idiopathic scoliosis: a systematic review. BMC musculoskeletal disorders. 2020;21(1):1-13.
36. Thompson J, Williamson E, Williams M, Heine P, Lamb S, Group AS. Effectiveness of scoliosis-specific exercises for adolescent idiopathic scoliosis compared with other non-surgical interventions: a systematic review and meta-analysis. Physiotherapy. 2019;105(2):214-34.
37. Khaledi A, Gheitasi M, Akoochakian M, Bayattork M. The Best Therapeutic Exercise Methods based on Age, Cobb and Trunk Rotation Angle in Children and Adolescent Idiopathic Scoliosis: A Systematic Review. Journal of Exercise Science and Medicine. 2021;13(2).
38. Richards BS, Bernstein RM, D’Amato CR, Thompson GH. Standardization of criteria for adolescent idiopathic scoliosis brace studies: SRS Committee on Bracing and Nonoperative Management. Spine. 2005;30(18):2068-75.
39. Park YH, Park YS, Lee YT, Shin HS, Oh M-K, Hong J, et al. The effect of a core exercise program on Cobb angle and back muscle activity in male students with functional scoliosis: a prospective, randomized, parallel-group, comparative study. Journal of International Medical Research. 2016;44(3):728-34.
40. Tolo VT, Herring JA. Scoliosis-specific exercises: a state of the art review. Spine deformity. 2020;8(2):149-55.
41. Won S-H, Oh D-W, Shen M. An 18-month follow-up study on the effect of a neuromuscular stabilization technique on Cobb’s angle in adolescent idiopathic scoliosis: A single-blind, age-matched controlled trial. Journal of Back and Musculoskeletal Rehabilitation. 2021;34(1):87-93.
2. Konieczny MR, Senyurt H, Krauspe R. Epidemiology of adolescent idiopathic scoliosis. Journal of children's orthopaedics. 2013;7(1):3-9.
3. Kewwan K, Seji A, Kyoungkyu J. Asymmetry Improvement on Core Training for Adolescent Idiopathic Scoliosis. Iranian Journal of Public Health. 2020;49(11):2219.
4. Gheitasi M, Alizadeh MH, Rajabi R, Ebrahimi Takamjani E. Comparison of Three Methods of Routine, Self-correction, and Mixed Corrective Exercise on Lateral Curvature Degree in Non-Structural Scoliotic Subjects. The Scientific Journal of Rehabilitation Medicine. 2019;8(1):47-60.
5. Day JM, Fletcher J, Coghlan M, Ravine T. Review of scoliosis-specific exercise methods used to correct adolescent idiopathic scoliosis. Archives of physiotherapy. 2019;9(1):1-11.
6. Stokes IA, Spence H, Aronsson DD, Kilmer N. Mechanical modulation of vertebral body growth: implications for scoliosis progression. Spine. 1996;21(10):1162-7.
7. Van Rooyen C, Du Plessis LZ, Geldenhuys L, Myburgh E, Coetzee W, Vermeulen N, et al. The effectiveness of Schroth exercises in adolescents with idiopathic scoliosis: A systematic review and meta-analysis. South African Journal of Physiotherapy. 2019;75(1):1-9.
8. Rullander AC, Lundström M, Lindkvist M, Lindh V. Stress symptoms among adolescents before and after scoliosis surgery: correlations with postoperative pain. Journal of Clinical Nursing. 2016;25(7-8):1086-94.
9. Romano M, Minozzi S, Bettany‐Saltikov J, Zaina F, Chockalingam N, Kotwicki T, et al. Exercises for adolescent idiopathic scoliosis. Cochrane Database of Systematic Reviews. 2012(8).
10. Berdishevsky H, Lebel VA, Bettany-Saltikov J, Rigo M, Lebel A, Hennes A, et al. Physiotherapy scoliosis-specific exercises–a comprehensive review of seven major schools. Scoliosis and spinal disorders. 2016;11(1):1-52.
11. Gheitasi M, Bayattork M, Mahdavi SM. Effect of a long-term corrective exercises with using brace on cobb angle and postural control of a girl with adolescence idiopathic scoliosis. Physical Treatments-Specific Physical Therapy Journal. 2019;9(1):59-68.
12. Weiss H-R. The method of Katharina Schroth-history, principles and current development. Scoliosis. 2011;6(1):1-22.
13. Park JY, Kim SH, Lee JC, Ju SB. Effect of Schroth Rehabilitation Exercise Program on Scoliometer Readings, Lumbar Lordosis and Calcaneal Valgus Angle in Patients with Idiopathic Scoliosis. Iranian Journal of Public Health. 2020;49(4):808.
14. Panjabi MM. The stabilizing system of the spine. Part I. Function, dysfunction, adaptation, and enhancement. Journal of spinal disorders. 1992;5:383-.
15. Gou Y, Lei H, Zeng Y, Tao J, Kong W, Wu J. The effect of Pilates exercise training for scoliosis on improving spinal deformity and quality of life: Meta-analysis of randomized controlled trials. Medicine. 2021;100(39).
16. Gheitasi M, Pasandideh Z, Lordgouie M, Samavi M, Allafan N. Effect of eight-weeks pilates exercises on non-structural scoliosis deformity and improve balance in female students. Journal of Applied Exercise Physiology. 2018;13(26):78-90.
17. Huxel Bliven KC, Anderson BE. Core stability training for injury prevention. Sports health. 2013;5(6):514-22.
18. Gheitasi M, Khaledi A, Daneshjoo A. The Effect of Combined Core Stability and Sensory-motor Exercises on Pain, Performance and Movement Fear in Retired Male Athletes with Non-specific Chronic Low Back Pain. jap. 2020;11(1):38-48.
19. Zhou Z, Liu F, Li R, Chen X. The effects of exercise therapy on adolescent idiopathic scoliosis: an overview of systematic reviews and meta-analyses. Complementary Therapies in Medicine. 2021:102697.
20. Khaledi A, Minoonejad H, Daneshmandi H, Akoochakian M, Gheitasi M. The Effectiveness of Schroth vs SEAS Exercise Methods for Correcting Idiopathic Scoliosis in Adolescents: A Systematic Review. USWR. 2022;12(1):1-12.
21. Park J-H, Jeon H-S, Park H-W. Effects of the Schroth exercise on idiopathic scoliosis: a meta-analysis. European journal of physical and rehabilitation medicine. 2017;54(3):440-9.
22. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. International Journal of Surgery. 2021;88:105906.
23. Eriksen MB, Frandsen TF. The impact of patient, intervention, comparison, outcome (PICO) as a search strategy tool on literature search quality: a systematic review. Journal of the Medical Library Association: JMLA. 2018;106(4):420.
24. Moseley AM, Herbert RD, Sherrington C, Maher CG. Evidence for physiotherapy practice: a survey of the Physiotherapy Evidence Database PEDro. Australian Journal of Physiotherapy. 2002;48(1):43-9.
25. Van Tulder M, Furlan A, Bombardier C, Bouter L, Group EBotCCBR. Updated method guidelines for systematic reviews in the cochrane collaboration back review group. Spine. 2003;28(12):1290-9.
26. Kuru T. The efficacy of three-dimensional Schroth exercises in adolescent idiopathic scoliosis: a randomised controlled clinical trial. Clinical rehabilitation. 2016;30(2):181-90.
27. Gür G, Ayhan C, Yakut Y. The effectiveness of core stabilization exercise in adolescent idiopathic scoliosis: A randomized controlled trial. Prosthetics and orthotics international. 2017;41(3):303-10.
28. Yagci G, Yakut Y. Core stabilization exercises versus scoliosis-specific exercises in moderate idiopathic scoliosis treatment. Prosthetics and orthotics international. 2019;43(3):301-8.
29. Kocaman H. The effectiveness of two different exercise approaches in adolescent idiopathic scoliosis: A single-blind, randomized-controlled trial. PloS one. 2021;16(4):e0249492.
30. Mohamed R, Yousef A. Impact of Schroth three-dimensional vs. proprioceptive neuromuscular facilitation techniques in adolescent idiopathic scoliosis: a randomized controlled study. European review for medical and pharmacological sciences. 2021;25(24):7717-25.
31. Schreiber S, Parent EC, Khodayari Moez E, Hedden DM, Hill DL, Moreau M, et al. Schroth physiotherapeutic scoliosis-specific exercises added to the standard of care lead to better Cobb angle outcomes in adolescents with idiopathic scoliosis–an assessor and statistician blinded randomized controlled trial. PloS one. 2016;11(12):e0168746.
32. Otman S, Kose N, Yakut Y. The efficacy of Schroth’s 3-dimensional exercise therapy in the treatment of adolescent idiopathic scoliosis in Turkey. Neurosciences Journal. 2005;10(4):277-83.
33. Ko K-J, Kang S-J. Effects of 12-week core stabilization exercise on the Cobb angle and lumbar muscle strength of adolescents with idiopathic scoliosis. Journal of exercise rehabilitation. 2017;13(2):244.
34. Kwan KYH, Cheng AC, Koh HY, Chiu AY, Cheung KMC. Effectiveness of Schroth exercises during bracing in adolescent idiopathic scoliosis: results from a preliminary study—SOSORT Award 2017 Winner. Scoliosis and spinal disorders. 2017;12(1):1-7.
35. Fan Y, Ren Q, To MKT, Cheung JPY. Effectiveness of scoliosis-specific exercises for alleviating adolescent idiopathic scoliosis: a systematic review. BMC musculoskeletal disorders. 2020;21(1):1-13.
36. Thompson J, Williamson E, Williams M, Heine P, Lamb S, Group AS. Effectiveness of scoliosis-specific exercises for adolescent idiopathic scoliosis compared with other non-surgical interventions: a systematic review and meta-analysis. Physiotherapy. 2019;105(2):214-34.
37. Khaledi A, Gheitasi M, Akoochakian M, Bayattork M. The Best Therapeutic Exercise Methods based on Age, Cobb and Trunk Rotation Angle in Children and Adolescent Idiopathic Scoliosis: A Systematic Review. Journal of Exercise Science and Medicine. 2021;13(2).
38. Richards BS, Bernstein RM, D’Amato CR, Thompson GH. Standardization of criteria for adolescent idiopathic scoliosis brace studies: SRS Committee on Bracing and Nonoperative Management. Spine. 2005;30(18):2068-75.
39. Park YH, Park YS, Lee YT, Shin HS, Oh M-K, Hong J, et al. The effect of a core exercise program on Cobb angle and back muscle activity in male students with functional scoliosis: a prospective, randomized, parallel-group, comparative study. Journal of International Medical Research. 2016;44(3):728-34.
40. Tolo VT, Herring JA. Scoliosis-specific exercises: a state of the art review. Spine deformity. 2020;8(2):149-55.
41. Won S-H, Oh D-W, Shen M. An 18-month follow-up study on the effect of a neuromuscular stabilization technique on Cobb’s angle in adolescent idiopathic scoliosis: A single-blind, age-matched controlled trial. Journal of Back and Musculoskeletal Rehabilitation. 2021;34(1):87-93.
| Files | ||
| Issue | Vol 53 No 1 (2024) | |
| Section | Review Article(s) | |
| DOI | https://doi.org/10.18502/ijph.v53i1.14685 | |
| Keywords | ||
| Systematic review Scoliosis Exercise therapy Core stabilization Schroth method | ||
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How to Cite
1.
Khaledi A, Minoonejad H, Akoochakian M, Gheitasi M. Core Stabilization Exercises vs. Schroth’s Three Dimensional Exercises to Treat Adolescent Idiopathic Scoliosis: A Systematic Review. Iran J Public Health. 2023;53(1):81-92.
