Conservative treatment for AIS
AIS - Adolescent Idiopathic Scoliosis
EVIDENCES OF EFFECTIVENESS:
PHYSICAL EXERCISES IN SCOLIOSIS
Mantana Vongsirinavarat PT PhD.
May 29th, 2015, 9.00-11.30AM
Clinical Is scoliosis-specific exercise effective
Question
in delaying progression of, or reducing
speed at which curve progresses?
o Scoliosis Specific Exercises (SSE)
o Physical Therapy
o Bracing
o Electrical Stimulation
o Manipulation
o Insoles
Recent Systematic Reviews of SSE
1. Beetany-Saltikov J, Parent E, Romano M, Villagrasa M, Negrini S.
Physiotherapeutic scoliosis-specific exercises for adolescents with
idiopathic scoliosis. Eur J Phys Rehab Med 2014; 50: 111-21
2. Romano M, Minozzi S, Zaina F, Bettany-Saltikov J, Chockalingam N,
Kotwicki T, Hennes A, Negrini S. Exercises for Adolescent Idiopathic
Scoliosis. A Cochrane Systematic Review. SPINE 2013:38 (14);88393.
3. Fusco C, Zaina F, Atanasio S, Romano M, Negrini A, Negrini S. Physical
exercises in the treatment of adolescent idiopathic scoliosis: An
updated systematic review. Physiotherapy Theory and Practice 2011:
27(1):80114, 201.
4. Negrini S, Fusco C, Minozzi S, Atanasio S, Zaina F, Romano M. Exercises
reduce the progression rate of adolescent idiopathic scoliosis: Results
of a comprehensive systematic review of the literature. Disability and
Rehabilitation, 2008; 30(10): 772 85.
Review evidences 1
Conclusions of Reviews Conclusions of Reviews
Negrini et al, 2003 & 2008
The Cochrane review (Romano, 2013) on effect of
Systematic Review Evidence on effectiveness of exercises for scoliosis
Physical Exercises for AIS - level 1b
Not possible to recommend the use of PSSE for AIS
Fusco et al, 2011
Other reviews which included lower methodological
SSE,if correctly administered, can prevent curve
quality
worsening, sometimes can result in not using brace
Results consistently in favor of efficiency of exercises in
Romano, 2013
reducing progression rate (mainly early puberty) and/
No evidence for or against the use of SSE for or improve Cobb angles (around the end of growth)
treating idiopathic scoliosis Effective in reducing brace prescription
Beetany-Saltikov et al, 2014
Guidelines and indications for SSE

Recommendation
By orthopedic surgeons and physicians specialized
Current Consensus in the field of conservative management of scoliosis
2 Organizations
Guidelines, Indications, and 1. The Society on scoliosis orthopedic rehabilitation and
Recommendations treatment (SOSORT)
2. The scoliosis society (SRS)
Lack of clinical agreement across professions and
different countries

Review evidences 2
Clinical guideline
The Society on scoliosis orthopedic rehabilitation
and treatment (SOSORT)
The scoliosis society (SRS)
Alternative treatments to prevent curve progression -
-- such as chiropractic medicine, physical therapy, yoga, etc.
have not demonstrated any scientific value in the treatment
of scoliosis. However, these and other methods can be
utilized if they provide some physical benefit to the patient
such as core strengthening, symptom relief, etc. These should
not however, be utilized to formally treat the curvature in
hopes of improving the scoliosis.
Current evidences (Beetany-Saltikov et al, 2014)
Physiotherapeutic exercise as first step of treatment
of AIS to avoid and/or limit curve progression
(grade B evidence)
Bracing when exercise unable to prevent progression
(grade B evidence)
Spinal fusion (grade C evidence) when
AIScauses symptoms
Failed conservative treatment
Well informed patient requests surgery

Recent guidelines Indication of SSE

Exercise is recommended for Sole use of Before

exercise for wearing
Skeletal immature(Risser sign 3 or less)with curve11-30
mild curve a brace
Skeletal mature (Risser sign 4 or 5) with curve11-45

Purposes
1. Stop curve progression at puberty (or reduce it) In conjunction During
2. Prevent or treat respiratory dysfunction
with braces adulthood
3. Prevent or treat spinal pain
4. Improve aesthetics via postural correction Before and
after surgical
correction

Review evidences 3
SSE for Mild scoliosis SSE for Moderate scoliosis with brace
Cobb 30 - brace prescription
Cobb <25
Use SSE with brace treatment
To stabilizing spine combined with 3D autocorrection
of spine, pelvis, and rib cage Aims
before bracing to reduce
SSE help to improve
spinal stiffness and improve mobility,
patients QoL by maintaining
thus help to achieve better correction
curve and rib hump for
reduce side effects of wearing brace
as long as possible, thus
(muscle weakness, rigidity, flat back)
reducing the need for braces and improve efficacy of internal brace pads
help avoid losing correction while weaning the brace

SSE for Scoliosis in Adults

Scoliosis exceeds certain

thresholds
Studies of SSE Effectiveness
develop problems
back pain, breathing dysfunction,
contractures, and progressive
deformity
Address impairments and
consequent disability through
exercises

Review evidences 4
 Types of Participants Risser Sign 0 to 5
Patients diagnosed AIS with at least 10 Cobb
Ages 10 years to end stage of bone growth
(female ~ 15-17 yr; male~16-19 yr)
the Risser sign Stage 4 (total ossification of apophysis)
or 5 (fusion of apophysis to iliac crest)
Not secondary scoliosis (congenital, neurological,
The ossification of
metabolic, post-traumatic, etc.) the iliac apophysis
creates the Risser sign
(X-ray courtesy of John T.
Killian, M.D.)
From http://www.srs.org/professionals/conditions_and_treatment/
adolescent_idiopathic_scoliosis/treatment.htm

Outcomes Cochrane Review in 2013

Progression of scoliosis
Cobb angle, Trunk rotation angle, Number of subjects
progressed > 5 , Number of subjects prescribed brace or
surgery
Cosmetic issues
Objective surface measurements, Topographic measurements
QoL and disability - Specific questionnaires
Back pain - Visual analog scale, Use of drugs
Psychological issues - Specific questionnaires
Two studies met the methodological criteria
1. one short-term RCT (Wan et al, 2005)
compared protocol of ES, traction and postural training
with and without exercises
Low quality evidence in favor of exercise versus same
protocol without exercise
2. One prospective controlled cohort study
compare the SEAS exercises versus PT
Very low quality evidence in favor of SEAS

Review evidences 5

Effects of Interventions from RCT
Progression of scoliosis
Thoracic curve : Mean difference 9.00, (95% CI, 5.47
12.53). Statistically significant decrease in favor of the
exercise group
Lumbar curve : Mean difference 8.00, (95% CI, 5.08
10.92). Statistically significant decrease in favor of the
exercise group
no evidence for patient-related outcomes of
cosmetic improvement, general improvement,
disability, or back pain
Effects of Interventions from prospective
controlled cohort study
Considering the per protocol analysis
RR for brace prescription 0.24, (95% CI, 0.061.04)
intention-to-treat analysis: RR 0.37, (95% CI, 0.131.05)
Cobb angle
RR for improvement 2.23 (95% CI, 0.736.76)
RR for getting worse 0.89 (95% CI, 0.263.06)
For Patient stability RR 0.85 (95% CI, 0.641.15), The
differences not statically significant

Effects of Interventions from prospective

controlled cohort study
Ongoing RCT
Angle of trunk rotation 3 ongoing RCT on exercises
RR for improvement 3.34 (95% CI, 0.3630.68) Parent et al in Canada
for getting worse 0.56 (95% CI, 0.211.47) Williams et al in UK
for stability 1.11 (95% CI, 0.851.47). The differences Abbot et al in Sweden
were not statically significant
Focus on curves, QOL, and perceived appearance
The quality of evidence concerning the use of SSEs
Preliminary findings good results on Cobb angle,
to reduce progression of scoliosis is very low
postural measurements and perceived appearance
No studies on the efficacy of SSE to improve
cosmetic issues, QoL and disability, back pain, and
psychological issues

Review evidences 6
 Main schools of scoliosis exercises
Schools
Specific Scoliosis Exercise Programs
Schroth

Standard features according to SOSORT (2005) Barcelona scoliosis physical therapy school (BSPTS)
1. Patient and family education Dobemed

2. 3D self correction, stabilization in correction Side shift

3. Training in ADL Functional individual therapy of scoliosis (FITS)

Lyon

Scientific exercise approach to scoliosis (SEAS)

Commonalities of SSE Autocorrection exercises

Most important common feature 3D correction and Reduce spinal deformity by patients active postural
Auto-correction
realignment of spine
Attain best possible correction through muscle contraction (all)
Using external aids (Schroth, BSPTS) Activate trunk and limb muscles
Use side shift of torso towards concavities (SEAS, Schroth, move spine in 3 planes
BSPTS, Side shift, Lyon) 1) Coronal plane
Use isometric and stabilization type contraction in corrected correct lateral deviation
posture (SEAS, Schroth, BSPTS, Lyon)
2) Sagittal plane
Derotation (SEAS, Schroth, BSPTS, Domomed)
promote physiological curvatures
Self elongation (Schroth, BSPTS, Lyon)
Derotation and controlled breathing exercise (Schroth, BSPTS,
3) Transverse plane
Domomed) reduce axial plane deformity by reduction in rotation

Review evidences 7
Summary of
21 studies
included in
the systematic
review by
Fusco, 2011

Wan, Wang, and Bian (2005):

Specific Asymmetric Strengthening

Clinical Results RCT, 80 Chinese patients (40 per group)

Age 15 4 yrs, Cobb 24 12
All patients received ES, traction, postural training
Treatment group also underwent specific asymmetric
strengthening PEs for scoliosis correction once a day
After 6 months
sig change Cobb in thoracic and lumbar segments in both
groups (p< 0.05)
mean improvement - PEs gr (15) sig higher than controls (7)

Review evidences 8
 Inpatient Schroth program:
Scoliosis intensive inpatient rehabilitation (SIR)

Inpatient Exercise Inpatient protocol

Program 46wks, 56 hrs/day, 6 days/wk,
and home exercise program 30 mins/day
4 studies - Autocorrection Exercises
All by Weiss correct posture (elongation, realign trunk, arms
positioning, specific corrective muscle tension)
3 studies - Schroth in inpatient setting
specific breathing patterns with help of proprioception,
1 study -Expanded Schroth program
external stimulus, and mirror control
The Integrated scoliosis rehabilitation [ISR] external stimulus PTs hand, wall assisted exercises,
proprioceptive stimulation

Examples of Schroth Techniques Examples of Schroth Techniques

Habitual posture Conscious posture Relaxed posture Functional exercise with auxillary handhold

Review evidences 9
 Examples of Schroth Techniques Study1: SIR (Weiss,1992)

Prospective cohort study

107 patients (age10.948.8 yrs)
mean curves of 43 (10114)
Intensive inpatient 46 wks program, 68 hrs/dy
each day
improvement 44%

worsening 3%

Muscle cylinder Weiss HR 1992 Influence of an in-patient exercise program

on scoliotic curve. Italian Journal of Orthopaedics and
Traumatology 18: 395406

Study2: SIR (Weiss,1997) Study3: SIR (Weiss, 2003)

Prospective cohort study Prospective cohort controlled study
181 adolescents (12.7 yrs, Cobb 27) 2 subgroups
46 wks of intense PT , 56 hrs/day, each day 1st gr - age 10 yrs, Cobb 21
30-min home program for continued treatment 2nd gr- age 13 yrs and Cobb of 29.5
curves did not progress in 33 mths Control group - matched sex, age
end of treatment:
2925% worsened
18% improved Weiss HR, Weiss G, Petermann F. Incidence of
curvature progression in idiopathic scoliosis patients
Weiss HR, Lohschmidt K, el-Obeidi N, Verres C 1997 treated with scoliosis in-patient rehabilitation (SIR): An
Preliminary results and worst-case analysis of in-patient age- and sex-matched controlled study. Pediatric
scoliosis rehabilitation. Pediatric Rehabilitation 1: 3540 Rehabilitation2003:6;2330.

Review evidences 10
Study3: SIR (Weiss, 2003)

In both SIR grs: 46 wks on initial intensive Integrated Scoliosis Rehabilitation (ISR)
inpatient PT program
follow-up 33 months A multifaceted approach evolved from Schroth,
better results compared to control groups no treatment includes 4 specific modalities:
1) Physiologics exercises
1st gr (younger)
2) 3D exercises made easy
53% improve Cobb vs. 29% in matched controls 3) Pattern-specific ADL
2nd gr (older) 4) the Schroth method
70% improve vs. 44% in matched control Weiss HR, Klein R 2006 Improving excellence in
scoliosis rehabilitation: A controlled study of matched
pairs. Pediatric Rehabilitation 9: 190200

ISR ScoliologicTM ISR ScoliologicTM

Reclining trunk leads to an increased

thoracic kyphosis also stress in lumbosacral
region
High thoracolumbar curve treated like thoracic curve
prevented by ventralizing the lower ribs to
increase lordosis at the L2 level 1) pelvic overcorrection 2) shoulder retraction with alignment of the sagittal profile
the physio-logics exercise
3) Breathing 4) Stabilization via trunk muscle tension in corrected position
Snake in the mountains

Review evidences 11
 ISR ScoliologicTM ISR ScoliologicTM

Double major curve functional three-curve scoliosis --- ADL in standing and sitting
1) pelvic overcorrection 2) shoulder retraction with alignment of sagittal profile corrective movement ends in a clinical overcorrection as far as possible
3) Breathing 4)stabilization via trunk muscle tension in corrected position

ISR ScoliologicTM ISR ScoliologicTM

functional four-curve scoliosis --- ADL in standing and sitting single lumbar scoliosis--- ADL in standing and sitting in
corrective movement ends in overcorrection as far as possible simple corrective movement - clinical overcorrection pushing pelvis to opposite side

Review evidences 12
 ISR ScoliologicTM ISR (Weiss and Klein, 2006)
Prospective controlled trial
Matched by sex, age, Cobb angle, curve pattern

18 patients each group

Experimental gr (age 15.3 1.1 yrs, Cobb 34.5 7.8)

Control gr (age14.71.3 yrs, Cobb 31.65.8)
13 of either group had a brace (different braces with
different corrective effectiveness) , matched

functional 3-curve scoliosis with decompensation

recompensate the pelvic shift

ISR (Weiss and Klein, 2006) ISR (Weiss and Klein, 2006)
Inpatient rehab of 4 wks results: Surface topographic analysis
Control:56 hrs/day, 6 days/wk, then home experimental gr improved lateral deviation (2.3 mm) and
exercise program 30 min/day surface rotation (1.28) more than control gr (0.3 mm
and 0.88)
Experimental: same exercises, but in the 2nd wk add
90 min/day of the physio-logic exercises appears that the physiologic add-on to SIR may
be helpful in reducing lateral deviation of scoliosis
The physio-logic exercise program
Symmetric mobilizing exercises
Asymmetric 3D exercises
Practice postures during typical ADLs

Review evidences 13
 Outpatient Exercise Programs

12 studies
OUTPATIENT 2 - the Schroth in outpatient setting
REHABILITATION 1 - the DoboMed exercise program

EXERCISE PROGRAMS 3 - the side shift exercise program

6 - the active intrinsic approach (SEAS)

The Schroth in outpatient setting Schroth in outpatient (Rigo et al,1991)

Retrospective, 43 patients
The modification
average age 12 yrs, Cobb19.5
Frequency - from 2-5 dys/wk
exercised twice a week, 2 hrs/session
(Daily in the traditional inpatient Schroth program) minimum 3 months
Duration- 24 hrs/day without home exercise program
(68 hrs/dy in the traditional program)
Results
Setting - outpatient clinic
1.6% worsened
Rigo M, Quera-Salva G, Puigdevall N. Effect of the
44.2% improved exclusive employment of physiotherapy in patients with
idiopathic scoliosis. In: Proceedings Book of the 11th
International Congress of the World Confederation for
Physical Therapy, 1991, pp 13191321. London

Review evidences 14
Schroth in outpatient (Otman, 2005)

Prospective, 50 adolescents Dobomed program

Age 14.1 yrs (1117), Cobb 26.1
6 wks (4 hrs/day, 5 days/wk), home exercise Introduced by Prof. Dobosiewicz
program -same exercise 90 min/day Katowice, Poland
Results in 1979
Progressive improvement of Cobb to17.8at 1 year
All 50 patients showed an improvement

Otman S, Kose N, Yakut Y. The efficacy of Schroth 3-

dimensional exercise therapy in the treatment of
adolescent idiopathic scoliosis in Turkey. Saudi Medical
Journal. 2005 26: 14291435.

DoboMed DoboMed

Active 3-dimensional autocorrection

Move spine toward normal position in axial plane
Exercises in closed kinematic chains, based on
symmetrically positioned pelvis and shoulder girdle
Selective respiratory movements guide derotation of
thoracic spine
Performed active stabilization of corrected and
Gradual progression of increasing neck,
endured as postural habit trunk, and hip flexion.
The break inserted between A, B, and C
to achieve a maximal kyphotic position

Review evidences 15
 DoboMed DoboMed

(FH) Transition from the low positions to the higher positions ending
Gradual progression of increasing neck, trunk, and hip flexion (D) with standing H
ability to carry over the outcomes achieved in previous positions to
standing position

DoboMed DoboMed (Durmala et al, 2003)

Transverse plane derotation of
apical area in low position is Evaluated a program of asymmetric trunk
phase-locked with respiratory
cycle
mobilization
(A) Start position followed 136 patients, 618 yrs old, for 12 mths
(BC) Concave expansion during Exercises 1 hour daily in and out of brace
inspiration with facilitation by pressure on
the concavity Reported 3139% decrease of Cobb angle
(D) End of inspiration
(E) Convex depression during expiration
with tactile facilitation on the convexity
(F) End of expiration
Durmala J, Dobosiewicz K, Kotwicki T, Jendrzejek H.
Influence of asymmetric mobilisation of the trunk on the
The hypercorrection obtained is fixed Cobb angle and rotation in idiopathic scoliosis in
by isometric contraction children and adolescents. Ortopedia, Traumatologia,
Rehabilitacja. 2003:5; 8085.

Review evidences 16
 Side shift program

Autocorrection of curve through a lateral shift

Side shift program of trunk to the curve concavity
Proposed by Mehta in1985 Lateral tilt at the inferior end vertebra is

reduced or reversed, and curve is corrected in

side shift position

Mehta MH Active correction by side-shift: An alternative

treatment for early idiopathic scoliosis. In: Warner JO,
Mehta MH (eds) Scoliosis prevention. 1985, pp 126
140. New York, Praeger

Side shift exercise Hitch shift exercise

(A) patient with left
thoracolumbar curve
(B) standing in neutral
(C) hitch position
Lift heel on convexity
of curve while keeping
hip and knee straight
Reduced asymmetry
of waistline in hitch
Patient standing in neutral and side shift position
position
Shift trunk to the concavity of curve

Reversed lateral tilt at inferior end vertebra

Review evidences 17
 Hitch shift exercise Side Shift Program I (den Boer et al, 1999)

lift heel on Prospective

convex side of Compared Side shift exercises (N=44) VS bracing
lower curve as (N=120)
hitch exercise
to immobilize
mean age13.6 yr, Cobb 2032
lower curve by Side shift program
her hand, and
1012 half hour sessions, once a week, to learn to
shift her trunk
to concavity of side shift
upper curve instructed to remember to shift as often as possible
during day
hitch shift exercise is indicated for double curve

Side Shift Program I (den Boer et al, 1999) Side Shift Program II (Maruyama et al, 2002)
Exercise lasted over 2.2 years Prospective 69 patients (age16.3 yrs, Cobb 31.5)
Started exercise after skeletal maturity (Risser grade IV
Brace for 3 year
or V, postmenarche since more than 2 years)
Results - Mean progression in Cobb angle
Perform 2 exercises daily
2.6 in side shift group Shifting trunk to concavity, hold 10 sec, return to neutral
2.5 in brace group Lifting heel on convex side while keep hip and knee straight,
no statistical significant differences between groups hold position for 10 sec, return to neutral
at least 30 times/day

average follow-up 4.2 years, 22% curves progressed,

den Boer WA, Anderson PG, Limbeek J, Kooijman MA.
Treatment of idiopathic scoliosis with side-shift therapy:
An initial comparison with a brace treatment historical
cohort. European Spine Journal. 1999 :8; 406410
14% improved (4% by 10or more)
Maruyama T, Kitagawa T, Takeshita K, Nakainura K 2002 Side shift exercise for idiopathic
scoliosis after skeletal maturity. Studies in Health Technology and Informatics 91: 361364

Review evidences 18
Side shift program III (Maruyama et al, 2003)
confirmed the results retrospectively in 53 patients
(age 16.3, Cobb angle 33.3 at beginning of treatment)
SEAS program
after 41 months of treatment - side shift and hitch
scientific exercises approach to scoliosis
exercises - Cobb 32.2
by ISICO

Maruyama T, Matsushita T, Takeshita K, Kitagawa K,

Nakamura K, Kurokawa T. 2003b Side shift exercises
for idiopathic scoliosis after skeletal maturity. Journal of
Bone and Joint Surgery (Br) 85B; Supp 1: 89.

SEAS program (Negrini, 2007) SEAS program

Autocorrection program 1ry therapeutic goal
Based on Lyon School methods of autoelongation Increase spinal stability (scoliosis=intrinsic instability)
exercise (not 3-dimensional) Reinterpreted to be Working on stabilizing muscles without reduction of
3-dimensional in the SEAS spine ROM
Autocorrect through deep paravertebral muscles in Add balance perturbation to elicit trunk muscles
3-planes without external help activity to enhance stabilizing function
Principle of a cognitive-behavioral approach

Review evidences 19
 The SEAS concept The SEAS concept

active self-correction and stays on one foot in forward overhanging active self-correction and pushes stick with great force into the
position to enhance contraction of back stabilization muscles ground to enhance contraction of abdominal stabilization muscles

The SEAS concept The SEAS concept

active selfcorrection --
falls forward and
catches self on wall and
still keeps active self-
correction and pushes
back to standing

sitting on ball - holds active self-correction and slides in coronal plane

Review evidences 20
The SEAS concept
holds active self-correction
and walks in place
The SEAS concept
Quadruped and wears brace
PTs hand lays on brace at
hump level
patient exerts vigorous push
to allow a maximum thoracic
kyphosis
hump is pushed into brace
pad, while at the same time
PT exerts a push in opposite
direction
The SEAS concept
Active spine mobilization in
transverse plane to increase
ROM
when patient wears brace ---
pressure of braces pads will
exert maximum possible
correction
SEAS program I (Mollon and Rodot, 1986)
Studied entire growth period of 210 patients, mean
age 10.1 yrs
50 controls and 160 patients treated with posture control,
strengthening and balance training (Lyon method)
Increase neuromotor control through external input, mainly
proprioceptive
Prospective 4 yrs, significant different results
63% improved in treated patients (34% worsened, 3% unchanged)
20% improved in control group (75% worsened, 5% unchanged)
Review evidences 21
 SEAS program II (Duconge, 2002) SEAS program III (Ferraro et al, 1998)
Confirmed long term results of study I 34 outpatients
42% of 422 treated patients worsened Treated twice a week (plus custom home sessions)
77% of 169 control patients worsened Results

the maximal participation (30 min/day) slowed

down or even halted progression of scoliosis,
compared to the minimal compliance (10 min/day)
9difference between groups: statistically and
clinically significant

SEAS program IV (Negrini et al, 2006) SEAS program V (Negrini et al, 2008) **
1-year prospective controlled study, compare Prospective controlled cohort study on patients never
SEAS with usual physiotherapy treated before
74 patients, 12.4 years old, curves 15, at risk of bracing
48 patients (mean age 12.4 yrs, cobb15)
2 groups
Number of braced patients (failure of treatment) 34 SEAS group
was significantly reduced by specific exercises (4.3% 39 usual physiotherapy (physical exercises with different method,
vs. 20%) not strictly specific for scoliosis)
Improvement 28.9% in SEAS vs 5% in controls
Group Cobb at start Cobb at end
SEAS 30 25
Control 31 28

Review evidences 22
SEAS program V (Negrini et al, 2008)
primary outcome - number of braced patients, Cobb
angle, angle of trunk rotation (scoliometer)
Results
6.1% braced patients in SEAS exercises group vs. 25.0% in
usual PT group
The worst case analysis: Failure of treatment (i.e., patients
who needed a brace) 11.5% in SEAS group and 30.8% in
usual PT group
Cobb angle SEAS group (23.5% improved and 11.8%
worsened), usual PT group (11.1% improved and 13.8%
worsened)
SEAS program (Negrini et al, 2008)
Explored usefulness of PEs in preparation to brace
(Negrini et al, 2006b)
SEAS protocol - general mobilization (e.g., stretching of
hamstrings and scapular musculature) and localized
mobilization (e.g., spine stretching and manual therapy)
Efficacy in increasing brace correction at 5 months
40 patients vs. 70 controls 13.4 years old with 30.9
curves:
58% improvement rate and 1.5% worsening in PE treated
vs. 45.8% improving and 10.3% worsening in controls

Asymmetric exercises

3 studies not use autocorrection principles but used

asymmetric exercises for trunk mobilization according
OUTPATIENT to different theories
REHABILITATION EXERCISE
PROGRAM 2 pilot studies used

a rehabilitation device
WITH NO AUTOCORRECTION
the MedX Rotatory Torso Machine
for trunk rotation strength training

Review evidences 23
Asymmetric exercises I (Mooney et al, 2000)
Pilot study in 12 patients (age 13.1yrs, Cobb
33.512.2)
2 sessions/wk until achieved equal strength
between sides
reduce to once a week for 4 mths using the MedX
Rotary Torso Machine
Curves improved 19% with mean curves reduced to
27.214.7
Only 1 patient worsened
Symmetric exercises (Stone et al, 1979)
Not use autocorrection principles
42 patients, 1215 years, Cobb10 (422)
followed a 12-month home program of mobilization,
strengthening, and posture control (The Milwaukee
method, based on autoelongation)
Results - no differences between PE group and 57
retrospective controls
Asymmetric exercises II (McIntire et al, 2006)
9 patients (mean age14 years, average curve 29)
2 sessions/wk (2530 min), 4 months
at least 30 sessions using the MedX Rotary Torso
Machine - performed repeated trunk rotational
isometric strength training
Significant reduction of curve 5
Conclusion
Usual physiotherapy based on older theories may
lead to mistakes in the treatment of patients
the need to use specific exercises for scoliosis chosen
according to strong scientific sources
PEs, if correctly administered, can
preventa worsening of curve
sometimes can result in not having to use brace
Review evidences 24
Questions or
Comments
Please

Review evidences 25