Effectiveness of Exercises in Adolescent Idiopathic Scoliosis
Effectiveness of Exercises in Adolescent Idiopathic Scoliosis
The aim of this study was to compare the effects of spinal stabilization and body awareness
 in addition to brace wearing versus classical exercises on subjective verticality perception,
 trunk symmetry and quality of life in AIS. Study included 30 AIS patients between the ages of
 14.40±201 years (stabilization group), 14.2±2 years (Body awareness) and 13.60±1.65
 (classical). Cobb angles, rotation, subjective visual (SVV), postural (SPV) and haptic (SHV)
 and deformity perception, quality of life were assessed at baseline and after 10th week of
 treatment. Cobb angle decreased in stabilization and awareness groups. Rotation decreased in
 three groups. SVV improved in all groups. SPV and SHV, body asymmetry and cosmetic deformity
 improved in stabilization and awareness groups. Only function improved with stabilization
 treatment. Stabilization and body awareness exercises created positive changes in AIS.
In patients with idiopathic scoliosis (IS), in addition to curve progression there are many
 problems including altered posture, gait deviations, muscular imbalance, functional
 limitations, back pain, negative physico-social, body image effects, and in severe cases
 pulmonary symptoms commonly occur. To cope with these complications and more, conservative
 treatment of adolescent idiopathic scoliosis (AIS) involves a variety of bracing methods and
 exercises.

 Spinal bracing is an important treatment option to prevent curve progression in moderate
 curves (between 20-40) and severe curves in AIS. Bracing success rate is reported 80% in the
 long term but the level of evidence is still low.

 In literature, exercises are recommended to reduce progression, to improve spine and thoracic
 cage flexibility, muscle elasticity and strength, to correct postural behavior, and
 neuro-motor control, spine stability. In general, traditional exercises (TE) including
 stretching, strengthening exercises for spinal musculature, postural training, respiratory
 exercises have been used for many years for IS. Besides traditional exercises, there are
 several exercise concepts including SEAS, Schroth, Dobomed, Side Shift methods... etc.
 Effectiveness of exercise is still in debate and there is need for further studies, which
 investigate the role of specific exercises for scoliosis in conservative treatment.

 In scoliosis, muscle imbalances, the deficiency of muscle ability to stabilize posture, the
 loss in balance of pelvis-spine relation due to lateral tilt of the body and postural control
 impairment resulting from these problems are defined. In addition, the tree dimensional
 scoliotic deformity cause sensory disturbances, standing instability and gait modifications.
 Core stabilization exercises (CSE) are described as therapy technique that improve
 neuromuscular control, strength of trunk stabilization muscles, endurance of postural
 muscles, trunk mobilization muscles around spine, balance between pelvis and spine in order
 to maintain functional stability and postural control.

 It was indicated in the literature that patients with AIS exhibit disturbances of vertical
 perception. Postural vertical line is important for a person to perceive body orientation in
 space and thereby to provide and maintain upright posture and gait. Body Awareness Therapy
 (BAT) is a mind-body approach, which aims to improve body awareness, body posture, quality of
 movements, balance, postural control integrating with slow movement co-ordination and
 breathing exercises. BAT programs also contain stretching exercises, relaxing exercises and
 gait training. Patients are instructed to concentrate body vertical line and all movements
 are thought to initiate from body center. BAT have been studied in many medical conditions
 including back pain, anxiety, fibromyalgia, eating disorders, heart diseases, falls in
 elderly.

 However, there are limited studies determining CSE effects on patients with scoliosis: one
 have reported improvement in Cobb's angle and pain and the other in sitting balance with
 lumbar stabilization exercises. There was no research examining the effects of BAT in
 scoliosis. However for the reasons mentioned above, we hypothesized that CSE and BAT
 therapies can have positive effects on postural re-alignment and trunk deformity in patients
 with AIS. The aim of this study was to investigate the effects of core stabilization and body
 awareness exercises versus traditional exercises in addition to brace wearing on vertical
 perception, trunk asymmetry, cosmetic deformity and health related quality of life in
 patients with AIS.

 The aim of this study was to compare the effects of spinal stabilization and body awareness
 exercises in addition to brace wearing versus traditional exercises on subjective verticality
 perception, trunk symmetry, cosmetic deformity and health related quality of life in
 Adolescent idiopathic scoliosis (AIS). This study included 30 AIS patients between the ages
 of 14,40 ± 2,01 years (stabilization group), 14,2 ± 2 years (Body awareness group) ve 13,60 ±
 1,65 (classical group). Following recording demographic data, bone maturation level according
 to Riser, curve types according to King, spinal region, which includes curve, were recorded.
 Cobb angles by antero-posterior X-ray, rotation degrees with scoliometer in Adam's forward
 bend test, subjective visual (SVV), postural (SPV) and haptic (SHV) verticality perception
 with laser stick system, cosmetic deformity perception for patient, family and
 physiotherapist according with Walter Reed Visual Assessment Scale (WRVAS), trunk asymmetries
 with Posterior Trunk Asymmetry Index (POTSI) and health related quality of life with SRS-22
 were assessed at baseline and after 10th week of treatment.
Inclusion Criteria:

 -  patients who were diagnosed with idiopathic scoliosis

 -  ages between 10 and 16 who were prescribed a brace

 Exclusion Criteria:

 -  Patients who did not accept to participate in the study or wear a spinal brace

 -  congenital curve

 -  neuromuscular, rheumatologic, renal, cardiovascular, pulmonary or vestibular diseases,
 tumors,

 -  previous surgical correction or conservative therapy