Schroth Exercises for Degenerative Scoliosis

(ADSET Trial)

Recruiting in Palo Alto (17 mi)

Overseen by Eric Parent, PT PhD

Age: 18+

Sex: Any

Travel: May Be Covered

Time Reimbursement: Varies

Trial Phase: Academic

Recruiting

Sponsor: University of Alberta

Disqualifiers: Curves over 50°, fractures, cancer, others

No Placebo Group

Trial Summary

What is the purpose of this trial?

Adult degenerative scoliosis is the most common spine deformity in adults. Patients present a lateral curvature of the spine and vertebra rotation. Curves meeting indications for treatment affect 24% of the aging adult population. Adult scoliosis causes pain, curve progression, and cosmetic deformity affecting quality of life and function. Pain affects 90% of patients with AS. Other than surgery for severe cases and pain medication, very little non-operative treatments have been investigated. Scoliosis-specific exercises have shown promise in a single study in adults and in an Alberta adolescent study. The goal of this pilot randomized controlled trial on the effect of Schroth exercises in adults with degenerative scoliosis compared to observation is to determine the feasibility of conducting a larger study. This study will help plan and secure funding for a larger study by examining the ability to recruit enough eligible participants, whether patients can follow the prescribed program session attendance and complete the home exercises prescribed. The early estimate the effects of the exercises on pain, quality of life, disability, deformity and posture measurements will help determine the potential of this approach and the likely success of a larger RCT. This study addresses a need of adults with degenerative scoliosis who do not meet surgical indications but still experience pain and disability by exploring a promising exercise approach.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications. It might be best to discuss this with the trial coordinators or your doctor.

What data supports the effectiveness of the treatment Schroth exercises for degenerative scoliosis?

Research shows that Schroth exercises, which are specific exercises for scoliosis, have been effective in reducing the progression of idiopathic scoliosis (a type of scoliosis with no known cause) in adolescents. These exercises help improve the spine's curve, reduce trunk rotation, and enhance quality of life, suggesting they may also be beneficial for degenerative scoliosis. ^{1 2 3 4 5}

Is the Schroth method safe for humans?

The available research on Schroth exercises, primarily focused on adolescent idiopathic scoliosis, does not report any significant safety concerns, suggesting it is generally safe for humans. ^{1 2 3 5 6}

How is the Schroth exercise treatment unique for degenerative scoliosis?

The Schroth exercise treatment is unique because it focuses on three-dimensional correction of the spine using specific exercises that combine sensorimotor, postural, and corrective breathing techniques, which are tailored to the individual's curve pattern. This approach is different from other treatments that may not address the three-dimensional aspect of scoliosis or incorporate such a comprehensive exercise regimen. ^{1 2 5 7 8}

Research Team

Eric Parent, PT PhD

Principal Investigator

University of Alberta

Eligibility Criteria

This trial is for adults over 50 with degenerative scoliosis, experiencing pain and having a spinal curve between 15°-45°. It's not for those who've had recent injections, surgery, or have conditions like fractures, cancer, severe heart issues, or weak bones.

Inclusion Criteria

I am over 50 with degenerative scoliosis and experience pain greater than 2 out of 10.

My spinal curve is between 15° and 45°.

Exclusion Criteria

I haven't had cortisone or anesthetic injections, surgery, and don't have exercise restrictions due to severe health issues in the last 3 months.

My spinal curve is less than 50 degrees.

Trial Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants in the Schroth exercise group will attend 5 individual sessions to learn exercises and participate in weekly group classes for 3 months.

12 weeks

5 individual sessions, weekly group classes

Control

Participants in the control group will be under observation without treatment or with previously prescribed pain medication for 3 months.

12 weeks

Follow-up

Participants are monitored for longer-term effects 3 months after the exercise program.

12 weeks

Treatment Details

Interventions

• Schroth exercises (Behavioural Intervention)

Trial Overview The study tests Schroth exercises—a specialized physical therapy—against no treatment in managing adult degenerative scoliosis. The focus is on the feasibility of a larger trial by looking at recruitment capability and participants' adherence to the exercise regimen.

Participant Groups

Group I: Schroth exercise group Experimental Treatment 1 Intervention

Will attend 5 1-hr long individual sessions to learn Schroth exercises and the home program. A 30-min. daily home program of 3 to 4 exercises will be progressed by the certified Schroth therapist using an algorithm. Patients will attend weekly 1-hr long group therapist-led exercise classes for 3 months. At each group class, adequate exercise performance will be assessed using the checklist. An algorithm guides the prescription of exercises intensity and progression from static to dynamic depending on the participant's ability. Prescription begins with Sitting on a Ball. If performed adequately, a more challenging exercise is attempted. The 3 most challenging exercises performed adequately as per the checklist will be prescribed with a detailed handout.

Group II: Control group Active Control 1 Intervention

Observation without treatment or with previously prescribed pain medication is the current standard for adults with degenerative scoliosis not planning surgery.

Who Is Running the Clinical Trial?

University of Alberta

Lead Sponsor

Trials

957

Recruited

437,000+

Bill Flanagan

University of Alberta

Chief Executive Officer since 2020

LLB from University of Toronto, LLM from Columbia University

Dr. Verna Yiu

University of Alberta

Chief Medical Officer since 2012

MD from University of Alberta, Fellowship in Pediatric Nephrology at Harvard University

Findings from Research

In a study of 51 patients with adolescent idiopathic scoliosis, supervised three-dimensional (3D) Schroth exercises in a clinic setting led to significant improvements in scoliosis angles and waist asymmetry compared to home exercises and a control group.

The clinic group showed a decrease in the Cobb angle by 2.53° and rotation angle by 4.23°, while the control group experienced worsening of their condition, highlighting the efficacy of supervised exercise in managing scoliosis.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The efficacy of three-dimensional Schroth exercises in adolescent idiopathic scoliosis: a randomised controlled clinical trial. Kuru, T., Yeldan, İ., Dereli, EE., et al.[2022]

The Schroth method, a physiotherapeutic exercise for adolescent idiopathic scoliosis (AIS), significantly improved the Cobb angle, trunk rotation angle, and quality of life in 144 patients compared to no intervention or other conservative treatments.

While the Schroth method showed positive short-term effects, the reduction in Cobb angle did not surpass the minimum clinically important difference, indicating that while beneficial, the changes may not be substantial enough to be considered clinically significant.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The effectiveness of Schroth method in Cobb angle, quality of life and trunk rotation angle in adolescent idiopathic scoliosis: a systematic review and meta-analysis. Ceballos-Laita, L., Carrasco-Uribarren, A., Cabanillas-Barea, S., et al.[2023]

This study will evaluate the effectiveness of Schroth scoliosis-specific exercises combined with standard care over 6 months in 258 adolescents with idiopathic scoliosis, aiming to improve both radiographic and clinical outcomes.

The trial will also assess whether the benefits of Schroth therapy are maintained 6 months after the intervention ends, potentially influencing future clinical practices regarding exercise prescriptions for scoliosis treatment.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effect of Schroth exercises on curve characteristics and clinical outcomes in adolescent idiopathic scoliosis: protocol for a multicentre randomised controlled trial. Schreiber, S., Parent, EC., Hedden, DM., et al.[2022]

The Schroth method, focusing on active holding exercises, was applied to three patients with scoliosis three times a week for 15 weeks, resulting in decreased pain and improved Cobb's angle.

This study suggests that the Schroth exercise program can effectively reduce pain and improve spinal alignment in patients with idiopathic scoliosis.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effect of the Schroth method of emphasis of active holding on Cobb's angle in patients with scoliosis: a case report. Lee, HJ., Seong, HD., Bae, YH., et al.[2020]

The Schroth scoliosis-specific exercises significantly reduce the Cobb angle and angle of trunk rotation in children with idiopathic scoliosis, with effect sizes indicating moderate to large improvements.

The Schroth method also positively impacts the quality of life for these patients, suggesting it is an effective non-surgical intervention for managing idiopathic scoliosis.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Application of the Schroth Method in the Treatment of Idiopathic Scoliosis: A Systematic Review and Meta-Analysis. Dimitrijević, V., Šćepanović, T., Jevtić, N., et al.[2023]

In a randomized controlled trial involving 50 adolescents with idiopathic scoliosis, those who participated in supervised Schroth exercises alongside standard care showed a significant improvement in back muscle endurance, increasing by 32.3 seconds compared to just 4.8 seconds in the control group after 3 months.

The Schroth exercise group also experienced a notable enhancement in self-image and pain scores from 3 to 6 months, indicating that these exercises can provide additional benefits beyond standard treatment for quality of life in adolescents with scoliosis.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The effect of Schroth exercises added to the standard of care on the quality of life and muscle endurance in adolescents with idiopathic scoliosis-an assessor and statistician blinded randomized controlled trial: "SOSORT 2015 Award Winner". Schreiber, S., Parent, EC., Moez, EK., et al.[2022]

A six-week physiotherapy program using the Schroth method, modified by H.R. Weiss, was evaluated in 21 patients with idiopathic scoliosis, showing improvements in their musculoskeletal system.

Instrumental diagnostic techniques, including computer optical topography and electromyography, confirmed that the modified Schroth exercises enhance the effectiveness of treatment for children with scoliosis.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Corrective exercises in multimodality therapy of idiopathic scoliosis in children - analysis of six weeks efficiency - pilot study. Pugacheva, N.[2022]

The Schroth exercise significantly improves paraspinal muscle symmetry in patients with adolescent idiopathic scoliosis (AIS), as indicated by a reduction in the paraspinal muscle symmetry index (PMSI) after the exercise.

Different types of Schroth exercises affect muscle activity differently, with symmetric exercises leading to lower PMSI and asymmetric exercises increasing it, suggesting that targeted exercises can enhance muscle performance on both sides of the scoliotic curve.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

How do Paraspinal Muscles Contract during the Schroth Exercise Treatment in Patients with Adolescent Idiopathic Scoliosis (AIS)? He, C., Yang, JT., Zheng, Q., et al.[2023]

References

1. England pubmed.ncbi.nlm.nih.gov

The efficacy of three-dimensional Schroth exercises in adolescent idiopathic scoliosis: a randomised controlled clinical trial. [2022]

2. Italy pubmed.ncbi.nlm.nih.gov

The effectiveness of Schroth method in Cobb angle, quality of life and trunk rotation angle in adolescent idiopathic scoliosis: a systematic review and meta-analysis. [2023]

3. Netherlands pubmed.ncbi.nlm.nih.gov

Effect of Schroth exercises on curve characteristics and clinical outcomes in adolescent idiopathic scoliosis: protocol for a multicentre randomised controlled trial. [2022]

4. Japan pubmed.ncbi.nlm.nih.gov

Effect of the Schroth method of emphasis of active holding on Cobb's angle in patients with scoliosis: a case report. [2020]

5. Switzerland pubmed.ncbi.nlm.nih.gov

Application of the Schroth Method in the Treatment of Idiopathic Scoliosis: A Systematic Review and Meta-Analysis. [2023]

6. England pubmed.ncbi.nlm.nih.gov

The effect of Schroth exercises added to the standard of care on the quality of life and muscle endurance in adolescents with idiopathic scoliosis-an assessor and statistician blinded randomized controlled trial: "SOSORT 2015 Award Winner". [2022]

7. Netherlands pubmed.ncbi.nlm.nih.gov

Corrective exercises in multimodality therapy of idiopathic scoliosis in children - analysis of six weeks efficiency - pilot study. [2022]

8. Switzerland pubmed.ncbi.nlm.nih.gov

How do Paraspinal Muscles Contract during the Schroth Exercise Treatment in Patients with Adolescent Idiopathic Scoliosis (AIS)? [2023]