Physiotherapeutic Scoliosis-Specific Exercise Methodologies Used for Conservative Treatment of Adolescent Idiopathic Scoliosis, and Their Effectiveness: An Extended Literature Review of Current Research and Practice

Seleviciene, Vaiva; Cesnaviciute, Aiste; Strukčinskienė, Birutė; Marcinowicz, Ludmiła; Strazdienė, Neringa; Genowska, Agnieszka

doi:10.3390/ijerph19159240

Cited by 22 publications

(17 citation statements)

References 59 publications

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“…Firstly, spinal muscles mediate stability and counteract scoliosis in the straight spine and small-curve AIS but are scoliogenic in further curve progression (>~20 ° of CA). Specific muscle exercises that seem to reduce the risk of AIS progression are indicative of this role of the spinal muscles [ 52 , 70 , 71 ]. Secondly, in the process of maintaining spinal balance, fatigue and morphological changes can occur.…”

Section: Discussionmentioning

confidence: 99%

Using Electric Stimulation of the Spinal Muscles and Electromyography during Motor Tasks for Evaluation of the Role in Development and Progression of Adolescent Idiopathic Scoliosis

Wong,

Shayestehpour,

Koutras

et al. 2024

JCM

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Introduction: The role of the spinal muscles in scoliogenesis is not fully substantiated. Do they act scoliogenic (inducing scoliosis) or counteract scoliosis in adolescent idiopathic scoliosis (AIS)? In this study, we will examine this by using selectively placed Transcutaneous Electric Stimulation (TES) combined with a cinematic radiographic technique and by performing electromyographic (EMG) evaluations during various motor tasks. Method: This is a cross-sectional study of subjects with small-curve AIS. Using cinematic radiography, they were evaluated dynamically either under electrical stimulation or when performing motor tasks of left and right lateral bending and rotation whilst measuring the muscle activity by EMG. Results: Forty-five patients with AIS were included as subjects. Five subjects volunteered for TES and six subjects performed the motor tasks with EMG. At the initial visual evaluation, and when stimulated with TES, the frontal plane spatial positions of the vertebral bodies showed discrete changes without an apparent pattern. However, analyzing the spatial positions when calibrated, we found that the spinal muscles exert a compressive ‘response’ with a minor change in the Cobb angle (CA) in small-curve AIS (CA = 10–20°). In larger curves (CA > 20°), TES induced a ‘larger deformity’ with a relative four-fold change in the CA compared to small-curve AIS with a ratio of 0.6. When evaluating local amplitude (peak) or cumulative (mean) EMG signals, we were unable to find consistent asymmetries. However, one subject had rapid progression and one regressed to a straight spine. When adding the absolute EMG ratios for all four motor tasks, the subject with progression had almost 10-fold less summed EMG ratios, and the subject with regression had more than 3-fold higher summed EMG ratios. Discussion: Based on these findings, we suggest that the spinal muscles in small-curve AIS have a stabilizing function maintaining a straight spine and keeping it in the midline. When deformities are larger (CA > 20°), the spine muscle curve exerts a scoliogenic ‘response’. This suggests that the role of the muscles converts from counteracting AIS and stabilizing the spine to being scoliogenic for a CA of more than 20°. Moreover, we interpret higher EMG ratios as heightened asymmetric spinal muscle activity when the spinal muscles try to balance the spine to maintain or correct the deformity. When progression occurs, this is preceded or accompanied by decreased EMG ratios. These findings must be substantiated by larger studies.

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Section: Discussionmentioning

confidence: 99%

Using Electric Stimulation of the Spinal Muscles and Electromyography during Motor Tasks for Evaluation of the Role in Development and Progression of Adolescent Idiopathic Scoliosis

Wong,

Shayestehpour,

Koutras

et al. 2024

JCM

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“…Assessment of the ATR helps estimate IS progression. Schroth training can signi cantly reduce the ATR [29]. The participants in one study who underwent 10 weeks of Schroth training showed signi cant improvements in Cobb angle, thoracic trunk rotation angle, cosmetic trunk deformity, and SRS-22 [1].…”

Section: Discussionmentioning

confidence: 99%

Clinical Efficacy Study of Schroth Exercise Combined with Orthotic Treatment of Different Wearing Times in Adolescent Idiopathic Scoliosis—A Randomized Controlled Trial

Meng

Luo

et al. 2023

Preprint

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Background The International Scientific Society on Scoliosis Orthopedic and Rehabilitation Treatment (SOSORT) proposes that the effect of brace treatment combined with physiotherapeutic scoliosis-specific exercises is significantly better than that of either alone. Wearing full-time rigid braces 23 h a day can effectively control the progression of scoliosis. However, long-term wearing of braces can cause psychological disorders, dyskinesia, lung function disorders, and other issues. Nevertheless, exercise can increase muscle function, correct the physical line, and compensate for the side effects of orthotic treatment. Objective To explore the clinical effects of wearing a full-time rigid brace for 20–24 h/day compared to a part-time rigid brace for 14–18 h/day combined with Schroth three-dimensional exercises on scoliosis correction and quality of life in patients with adolescent idiopathic scoliosis (AIS). Methods Sixty AIS patients were randomly assigned to the full-time brace group and the part-time brace combined with Schroth exercise group, with 30 patients in each group. Patients in the full-time brace group were treated with a rigid thoracolumbar orthosis and were required to wear it for 20–23 h/d. Patients in the part-time brace combined with Schroth exercise group were treated with Schroth three-dimensional exercise, with home and outpatient training together at least 5 times per week. The weekly training time was at least 4–5 hours, and the orthotic device was worn for 14–18 h/d. The two groups of patients were evaluated for Cobb angles and the angle of trunk rotation (ATR), thoracic expansion, and scoliosis research society 22-item (SRS-22) patient questionnaire before enrollment and after 6 months of treatment. Results In the intragroup comparison, Cobb angles, ATR, and thoracic expansion were significantly improved in the combined treatment group after 6 months of treatment compared to before treatment (p < 0.01), and the four indices of SRS-22 were improved before and after treatment, but there was no significant difference (p > 0.05). In the full-time brace group, there was a significant reduction in the Cobb angles (P < 0.01), but there was no statistically significant difference in the ATR, thoracic expansion, or SRS-22 before and after treatment. Comparing between groups, the combined treatment group showed greater improvement in Cobb angles, ATR, thoracic expansion, and the items of pain and psychology in the SRS-22 compared to the full-time brace group (p < 0.05). There were no differences between the two groups in self-image and function on the SRS-22 (P > 0.05). The satisfaction survey in the SRS-22 of the combined treatment group was better than that of the brace group, but there was no significant difference (P > 0.05). Conclusion The full-time brace and the Schroth 3D motion combined with a part-time brace both decreased the Cobb angle in AIS patients after 6 months of treatment. In addition, the brace combined with Schroth exercise showed significant improvement in the ATR, thoracic expansion, and psychological status and relieved pain. Adequate Schroth exercise can appropriately reduce the time of brace wear without affecting clinical outcomes and support brace treatment. Therefore, conservative treatment of idiopathic scoliosis with bracing combined with Schroth 3D exercise is recommended.

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“…A range of treatments for AIS are available and these range from exercises to bracing and finally surgery for those with severe disease and a large degree of deviation (i.e., Cobb angle) ( Day et al, 2019 ; Kaelin, 2020 ; Dufvenberg et al, 2021 ; Bowden et al, 2022 ; Park et al, 2022 ; Seleviciene et al, 2022 ; Turner et al, 2022 ; Zaina et al, 2022 ). For those patients with severe disease and needing surgery, the implantation of rods and screws can alleviate the curvature-associated complications but can also affect quality of life during post-skeletal maturity.…”

Section: Sex Differences In Risk For Injury To Msk Tissues During Dev...mentioning

confidence: 99%

Sex differences in musculoskeletal injury and disease risks across the lifespan: Are there unique subsets of females at higher risk than males for these conditions at distinct stages of the life cycle?

Hart

2023

Front. Physiol.

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Sex differences have been reported for diseases of the musculoskeletal system (MSK) as well as the risk for injuries to tissues of the MSK system. For females, some of these occur prior to the onset of puberty, following the onset of puberty, and following the onset of menopause. Therefore, they can occur across the lifespan. While some conditions are related to immune dysfunction, others are associated with specific tissues of the MSK more directly. Based on this life spectrum of sex differences in both risk for injury and onset of diseases, a role for sex hormones in the initiation and progression of this risk is somewhat variable. Sex hormone receptor expression and functioning can also vary with life events such as the menstrual cycle in females, with different tissues being affected. Furthermore, some sex hormone receptors can affect gene expression independent of sex hormones and some transitional events such as puberty are accompanied by epigenetic alterations that can further lead to sex differences in MSK gene regulation. Some of the sex differences in injury risk and the post-menopausal disease risk may be “imprinted” in the genomes of females and males during development and sex hormones and their consequences only modulators of such risks later in life as the sex hormone milieu changes. The purpose of this review is to discuss some of the relevant conditions associated with sex differences in risks for loss of MSK tissue integrity across the lifespan, and further discuss several of the implications of their variable relationship with sex hormones, their receptors and life events.

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Physiotherapeutic Scoliosis-Specific Exercise Methodologies Used for Conservative Treatment of Adolescent Idiopathic Scoliosis, and Their Effectiveness: An Extended Literature Review of Current Research and Practice

Cited by 22 publications

References 59 publications

Using Electric Stimulation of the Spinal Muscles and Electromyography during Motor Tasks for Evaluation of the Role in Development and Progression of Adolescent Idiopathic Scoliosis

Using Electric Stimulation of the Spinal Muscles and Electromyography during Motor Tasks for Evaluation of the Role in Development and Progression of Adolescent Idiopathic Scoliosis

Clinical Efficacy Study of Schroth Exercise Combined with Orthotic Treatment of Different Wearing Times in Adolescent Idiopathic Scoliosis—A Randomized Controlled Trial

Sex differences in musculoskeletal injury and disease risks across the lifespan: Are there unique subsets of females at higher risk than males for these conditions at distinct stages of the life cycle?

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