Proprioceptive Neuromuscular Facilitation Combined With Spiral Muscle Chain Training for Adolescent Spinal Curvature Abnormalities

Clinical Effects of Proprioceptive Neuromuscular Facilitation Combined With Spiral Muscle Chain Training in Adolescents With Spinal Curvature Abnormalities: A Randomized Controlled Trial

The goal of this clinical trial is to evaluate the clinical effectiveness of proprioceptive neuromuscular facilitation (PNF) combined with spiral muscle chain training in improving spinal function and posture in adolescents aged 13 to 18 years with spinal curvature abnormalities.

The main questions it aims to answer are:

Does exercise-based intervention improve trunk inclination angle, kyphotic angle, and body balance parameters in adolescents with spinal curvature abnormalities?

Does the combined intervention improve spinal mobility and paraspinal muscle endurance compared with single-intervention approaches?

Does the combined intervention lead to favorable changes in surface electromyography (sEMG) indicators of the paraspinal muscles?

Researchers will compare a PNF therapy group, a spiral muscle chain training group, and a combined PNF plus spiral muscle chain training group to assess differences in trunk inclination angle, kyphotic angle, spinal mobility, paraspinal muscle endurance, and neuromuscular activation outcomes. Body mass index, fat-to-muscle ratio, and other body-composition-related indicators will be analyzed as exploratory post hoc outcomes.

Participants will:

Be assigned to one of three intervention groups: PNF therapy alone, spiral muscle chain training alone, or combined PNF plus spiral muscle chain training.

Participate in supervised exercise training sessions three times per week for 12 weeks.

Undergo pre- and post-intervention assessments, including body composition testing, electronic spinal measurements, and surface electromyography testing.

Study Overview

• Status: Completed
• Conditions: Adolescent Idiopathic Scoliosis (AIS); Kyphosis; Spinal Curvature Abnormalities; Flat Back
• Intervention / Treatment: Behavioral: Proprioceptive Neuromuscular Facilitation (PNF) Therapy; Behavioral: Spiral Muscle Chain (SPS) Training; Behavioral: Combined Exercise Therapy

• Study Type: Interventional
• Enrollment (Actual): 189
• Phase: Not Applicable

Contacts and Locations

Study Locations

• China
  • Jiangsu
    • Nanjing, Jiangsu, China, 210023
      • The Affiliated High School of Nanjing Normal University

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child; Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Aged 13 to 18 years
• Newly diagnosed with no prior treatment and meeting the diagnostic criteria for spinal curvature abnormalities
• Scoliosis or coronal spinal curvature abnormality determined by poor posture and angle of trunk inclination or angle of trunk rotation of 5° or greater
• Anterior-posterior spinal curvature abnormality determined by poor posture or abnormal spinal side-view assessment, including kyphotic angle less than 20° or greater than 40°
• No prior brace treatment
• No history of spinal surgery
• Able to complete proprioceptive neuromuscular facilitation therapy, spiral muscle chain training, or combined exercise training as required
• Written informed consent obtained from participants and their parents or legal guardians

Exclusion Criteria:

• Menstruating females at the time of assessment
• Metal implants
• History of brace use or prior treatment for spinal curvature abnormalities
• Severe scoliosis, defined as angle of trunk inclination or angle of trunk rotation greater than 13°
• Congenital spinal curvature abnormality
• Neuromuscular disorders
• Respiratory dysfunction
• Any contraindication to exercise
• Any trauma within the previous 6 months
• Any accompanying neurological, rheumatological, or mental health problems

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

3

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Proprioceptive Neuromuscular Facilitation (PNF) Therapy; Participants receive proprioceptive neuromuscular facilitation (PNF) therapy as an exercise intervention for abnormal spinal curvature. Training is conducted 3 times per week (every other day) for 12 weeks. The PNF protocol includes resisted scapular-pelvic patterns, cervical flexion/extension, trunk chopping/lifting patterns, bilateral upper-limb patterns, and bridge exercises (per PNF schedule).	Behavioral: Proprioceptive Neuromuscular Facilitation (PNF) Therapy; Proprioceptive neuromuscular facilitation (PNF) therapy is used as an exercise-based intervention to address abnormal spinal curvature in children with adolescent idiopathic scoliosis. The PNF program includes resisted scapular-pelvic patterns, cervical flexion and extension, trunk diagonal patterns (chopping and lifting), bilateral upper-limb diagonal patterns, and bridge exercises. Training sessions are supervised and conducted three times per week (every other day) for 12 weeks.; Other Names: Proprioceptive Neuromuscular Facilitation
Experimental: Spiral Muscle Chain (SPS) Training; Participants receive spiral stabilizing muscle chain (SPS) training as an exercise intervention for abnormal spinal curvature. Training is conducted 3 times per week (every other day) for 12 weeks. The SPS program follows the SPS training schedule (Training 1A-6A, 7C-10C, and stretching component), with planned repetitions/sets and practice time as listed in the protocol schedule.	Behavioral: Spiral Muscle Chain (SPS) Training; Spiral muscle chain (SPS) training is applied as an exercise-based intervention aimed at improving spinal alignment, postural control, and neuromuscular coordination in children with adolescent idiopathic scoliosis. The SPS program consists of spiral stabilization exercises performed with elastic resistance, body positioning control, and stretching components according to a standardized training protocol. Training sessions are supervised and conducted three times per week (every other day) for 12 weeks.; Other Names: Spiral Stabilization Training
Experimental: Combined Exercise Therapy; Participants receive a combined program consisting of PNF therapy plus SPS spiral muscle chain training as an exercise intervention for abnormal spinal curvature. Training is conducted 3 times per week (every other day) for 12 weeks.	Behavioral: Combined Exercise Therapy; The combined intervention integrates proprioceptive neuromuscular facilitation (PNF) therapy and spiral muscle chain (SPS) training as a comprehensive exercise program for children with adolescent idiopathic scoliosis. Participants perform both PNF and SPS exercise components within each training cycle to target spinal alignment, muscle endurance, and neuromuscular activation. Training sessions are supervised and conducted three times per week (every other day) for 12 weeks.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in Trunk Tilt Angle (ATI)	Trunk tilt angle (Angle of Trunk Rotation, ATI) measured using an electronic spine assessment device to evaluate changes in spinal asymmetry and trunk alignment.	Baseline and after 12 weeks of intervention
Change in Body Balance Parameters	Body balance parameters assessed by electronic spine measurement, including head lateral deviation, shoulder asymmetry, and pelvic tilt.	Baseline and after 12 weeks of intervention
Change in Kyphotic Angle (KA)	Kyphotic angle will be measured using an electronic spinal assessment device to evaluate changes in sagittal spinal curvature.	Baseline and after 12 weeks of intervention

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in Spinal Mobility	Spinal mobility assessed by electronic spine measurement, including lateral flexion, flexion-extension, and rotational range of motion.	Baseline and after 12 weeks of intervention
Change in Body Mass Index (BMI)	Body mass index will be calculated from measured height and weight to evaluate changes in body composition and growth-related physical characteristics after the 12-week exercise intervention.	Baseline and after 12 weeks of intervention
Change in Fat-to-Muscle Ratio (FMR)	Fat-to-muscle ratio will be derived from body composition testing to evaluate changes in the relative distribution of fat mass and muscle mass after the 12-week exercise intervention.	Baseline and after 12 weeks of intervention
Change in Surface Electromyography Parameters	Surface electromyography parameters of the trunk and paraspinal muscles will be assessed, including amplitude-domain and frequency-domain indicators such as integrated electromyography, mean power frequency, and median frequency.	Baseline and after 12 weeks of intervention
Change in Trunk Muscle Activation Patterns	Trunk muscle activation patterns will be assessed during standardized functional tasks using surface electromyography to evaluate neuromuscular coordination and activation symmetry of trunk and paraspinal muscles.	Baseline and after 12 weeks of intervention
Change in Paraspinal Muscle Endurance	Paraspinal muscle endurance will be assessed using standardized endurance testing, such as the Biering-Sorensen test, to evaluate the sustained contraction capacity of the trunk extensor muscles.	Baseline and after 12 weeks of intervention

Collaborators and Investigators

• Sponsor: Nie danning

Publications and helpful links

General Publications

• Xu Y, Feng M, Wu R, Wang Y, Yang Z, Wang Z, Kang Z, Xie L, Liu H. Effect of adding proprioceptive neuromuscular facilitation to conventional physiotherapy on scapular balance and shoulder proprioception in adolescents with idiopathic scoliosis: a randomised controlled trial protocol. BMJ Open. 2025 Nov 19;15(11):e106848. doi: 10.1136/bmjopen-2025-106848.
• Nechvatal P, Hitrik T, Kendrova LD, Macej M. Comparison of the effect of the McKenzie method and spiral stabilization in patients with low back pain: A prospective, randomized clinical trial. J Back Musculoskelet Rehabil. 2022;35(3):641-647. doi: 10.3233/BMR-210055.
• Maruyama T, Kitagawa T, Takeshita K, Mochizuki K, Nakamura K. Conservative treatment for adolescent idiopathic scoliosis: can it reduce the incidence of surgical treatment? Pediatr Rehabil. 2003 Jul-Dec;6(3-4):215-9. doi: 10.1080/13638490310001642748.

Study record dates

Study Major Dates

• Study Start (Actual): March 5, 2024
• Primary Completion (Actual): December 30, 2024
• Study Completion (Actual): December 30, 2024

Study Registration Dates

• First Submitted: December 20, 2025
• First Submitted That Met QC Criteria: December 20, 2025
• First Posted (Actual): January 6, 2026

Study Record Updates

• Last Update Posted (Actual): May 14, 2026
• Last Update Submitted That Met QC Criteria: May 12, 2026
• Last Verified: May 1, 2026

More Information

Terms related to this study

• Keywords: Rehabilitation; Exercise Therapy; Proprioceptive Neuromuscular Facilitation; Adolescent Idiopathic Scoliosis; Spiral Muscle Chain Training; Spinal Curvature Abnormalities
• Additional Relevant MeSH Terms: Bone Diseases; Musculoskeletal Diseases; Spinal Diseases; Spinal Curvatures; Kyphosis; Motor Activity; Movement; Musculoskeletal Physiological Phenomena; Musculoskeletal and Neural Physiological Phenomena; Physical Therapy Modalities; Patient Care; Exercise Therapy; Rehabilitation; Aftercare; Continuity of Patient Care; Exercise; Therapeutics; Muscle Stretching Exercises
• Other Study ID Numbers: NNU202410016

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: Individual participant data (IPD) will not be shared because the study involves minors, and the data include sensitive health information related to spinal posture and neuromuscular function. According to the approved ethics protocol, strict measures are required to protect participants' privacy and confidentiality. Although all data are de-identified, sharing IPD may still pose a potential risk of re-identification. Therefore, IPD will not be made publicly available in order to ensure compliance with ethical requirements and data protection regulations.

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No