Effects of Core Stabilization Exercises and Rotation Angular Breathing Exercises Among Idiopathic Scoliosis Patients (CSE RAB IS)

Effects of Core Stabilization Exercises and Rotational Angular Breathing Exercises on Cobb's Angle, Trunk Rotation, Inspiratory Capacity and Spinal Appearance Among Idopathic Scoliosis Patients

This study is a single-blind, two-arm parallel-group randomized controlled trial designed to evaluate the effects of core stabilization exercises combined with rotational angular breathing exercises on adolescents with idiopathic scoliosis. Participants aged 10-18 years with a Cobb angle between 10° and 25° will be randomly assigned to either an experimental group receiving a structured exercise program or a control group receiving standard care.

The intervention will be conducted over 12 weeks, with outcomes assessed at baseline, post-intervention, and follow-up periods. Primary outcomes include Cobb angle, angle of trunk rotation, inspiratory capacity, and spinal appearance. The study aims to determine whether the combined exercise approach is more effective than standard care in improving spinal alignment, respiratory function, and physical appearance.

Study Overview

• Status: Not yet recruiting
• Conditions: Scoliosis Idiopathic; Idiopathic Adolescent Scoliosis
• Intervention / Treatment: Other: Core Stabilization Exercises; Other: Standard Care (in control arm)

Detailed Description

Adolescent idiopathic scoliosis (AIS) is a three-dimensional spinal deformity characterized by lateral curvature and vertebral rotation, commonly developing during adolescence. It is associated with postural asymmetry, trunk deformity, reduced pulmonary function, and decreased quality of life. Conservative management strategies, particularly exercise-based interventions, are widely used to prevent progression and improve functional outcomes.

Core stabilization exercises focus on strengthening the muscles surrounding the spine, including abdominal, paraspinal, and pelvic muscles. These exercises enhance spinal stability, improve postural control, and reduce compensatory movement patterns. However, core stabilization alone may not fully address thoracic asymmetry and respiratory limitations associated with scoliosis.

Rotational angular breathing exercises are scoliosis-specific techniques aimed at improving thoracic expansion, promoting spinal de-rotation, and enhancing pulmonary function. These exercises involve controlled breathing patterns that target the concave side of the rib cage, facilitating improved ventilation and postural correction.

Although both interventions have shown individual effectiveness, limited evidence exists regarding their combined effects on structural, functional, and patient-reported outcomes in adolescents with idiopathic scoliosis. Therefore, this study aims to evaluate the combined impact of core stabilization and rotational angular breathing exercises on multiple clinical outcomes.

This study will be conducted as a single-blind, randomized controlled trial with two parallel groups. A total of 32 participants meeting eligibility criteria will be recruited and randomly assigned in a 1:1 ratio to either the experimental group or the control group.

Participants in the experimental group will undergo a supervised exercise program consisting of core stabilization exercises (planks, bridges, bird dog, and dead bug) combined with rotational angular breathing exercises. The program will be performed 3-4 times per week for 12 weeks, with gradual progression in intensity and duration. The control group will receive standard care without a structured exercise program.

Outcome measures will be assessed at baseline, immediately after the 12-week intervention, and at 3-month and 6-month follow-up periods. Primary outcomes include Cobb angle measured via radiographs, angle of trunk rotation assessed using a scoliometer, inspiratory capacity measured using spirometry, and spinal appearance evaluated using the Spinal Appearance Questionnaire. Secondary outcomes include quality of life assessed using the Scoliosis Research Society-22 questionnaire.

Blinding will be applied at the level of outcome assessors to reduce measurement bias. Statistical analysis will be conducted to compare within-group and between-group differences over time.

The results of this study are expected to provide evidence on the effectiveness of a combined exercise approach targeting both biomechanical and respiratory components of scoliosis. This may support the development of comprehensive rehabilitation protocols for adolescents with idiopathic scoliosis.

• Study Type: Interventional
• Enrollment (Estimated): 32
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Umber Nawaz, Phd Scholar; Phone Number: +92 3334888279; Email: umber.nawaz@ubas.edu.pk
• Study Contact Backup: Name: Usama Ahmad, MS Physical Therapy; Phone Number: +92 3013115017; Email: ua950366@gmail.com

Study Locations

• Pakistan
  • Punjab Province
    • Lahore, Punjab Province, Pakistan, 5400
      • General hospital lahore
      • Contact: Dr. Ijaz Ahmad Burq, PhD PT; Phone Number: +92 334615892; Email: burq802@yahoo.com
    • Lahore, Punjab Province, Pakistan, 5400
      • Ghurki trust and teaching hospital lahore
      • Contact: Prof. Hafiz Muhammad Asim, PhD; Phone Number: +92 3009400346; Email: info@hafizasim.com

Participation Criteria

Eligibility Criteria

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

Description

Inclusion Criteria:

• Adolescents aged 10-17 years
• Both male and female participants
• Diagnosed cases of idiopathic scoliosis
• Cobb's angle between 10° and 25°
• Both thoracic and lumbar spine scoliosis patients
• Both C-shaped or S-shaped curve scoliosis patients

Exclusion Criteria:

• Previous spinal surgery
• Significant neuromuscular disorders (e.g, muscular dystrophy, cerebral palsy)
• Other medical conditions affecting participation (e.g, respiratory or cardiac)
• Any contraindication to exercise program

Study Plan

How is the study designed?

Design Details

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

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Core stabilization and rotational angular breathing exercises; Planks involve maintaining a straight body position from head to heels while resting on the forearms and toes, effectively strengthening the abdominal muscles and lower back. Bridges require participants to lie on their backs with knees bent and feet flat, lifting their hips to create a straight line from shoulders to knees, targeting the glutes and hamstrings for enhanced pelvic stability. The bird dog exercise is performed on hands and knees, where participants extend one arm and the opposite leg, promoting balance and coordination while engaging the core. Lastly, dead bugs involve lying on the back with arms and legs raised, lowering one arm and the opposite leg while keeping the lower back pressed into the floor, which effectively engages deep core muscles. Additionally, the program will incorporate rotational angular breathing exercises, focusing on enhancing thoracic expansion and postural control through specific breathing techniques.	Other: Core Stabilization Exercises; Core stabilization exercises: planks, bridges, bird dog, and dead bug Rotational angular breathing exercises: emphasizing thoracic expansion, asymmetric rib cage mobility, and postural correction through controlled inhalation and prolonged exhalation All exercises will be performed under supervised conditions initially, with emphasis on neuromuscular control, spinal stability, and coordinated breathing. Each session will last 40 minutes, including: 3 sessions per week 12-week intervention period 5 minutes warm-up 25 minutes core stabilization exercises 10 minutes rotational angular breathing exercises • Cool-down and postural awareness exercises
Active Comparator: Standard care; Participants in the active comparator group will receive conventional physiotherapy routinely provided for individuals with idiopathic scoliosis. The program will focus on general posture correction, flexibility, spinal mobility, and basic strengthening exercises without specialized core stabilization or rotational angular breathing techniques. Standard Care Intervention: General stretching exercises for trunk and lower limb muscles Active range of motion exercises for spinal mobility Conventional postural correction exercises Basic strengthening exercises for back and abdominal muscles Breathing awareness exercises without rotational angular emphasis Education regarding posture maintenance and ergonomic advice Frequency: 3 sessions per week Total Duration: 12 weeks Session Duration: 40 minutes Session Structure 5 minutes warm-up 25 minutes conventional physiotherapy exercises 5 minutes breathing and relaxation exercises 5 minutes cool-down and posture education	Other: Standard Care (in control arm); Participants in the control group will receive conventional physiotherapy management routinely used for idiopathic scoliosis. The intervention will focus on posture correction, spinal mobility, flexibility, general strengthening, and breathing awareness exercises without specialized core stabilization or rotational angular breathing techniques. The program will include: Warm-up exercises Stretching exercises for trunk and lower limb muscles Spinal mobility exercises Basic abdominal and back strengthening exercises Postural correction and ergonomic education Diaphragmatic breathing and relaxation exercises Cool-down exercises Sessions will be supervised initially by a physiotherapist to ensure correct technique and safety. Frequency and Duration 3 sessions per week 12-week intervention period 40 minutes per session Session Structure 5 minutes warm-up 25 minutes conventional physiotherapy exercises 5 minutes breathing exercises 5 minutes cool-down and posture education

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Cobb's angle	Cobb angle is a radiographic measure used to quantify the degree of spinal curvature in scoliosis. It is measured by identifying the most tilted vertebrae at the upper and lower ends of the curve on an anteroposterior spinal radiograph and calculating the angle between intersecting perpendicular lines drawn from these vertebrae. Time Frame: Baseline, 4 weeks, 8 weeks and 12 weeks	12 Weeks
Trunk rotation	Angle of Trunk Rotation (ATR) is assessed using a scoliometer during the Adam's Forward Bend Test. The device is placed over the spine at the point of maximum deformity to quantify axial trunk rotation and rib hump prominence. Time Frame: Baseline, 4 weeks, 8 weeks and 12 weeks	12 weeks
Inspiratory capacity	Inspiratory capacity is defined as the maximum volume of air that can be inhaled after a normal expiration. It is measured using spirometry with a calibrated spirometer to assess pulmonary function and thoracic expansion. Time Frame: Baseline, 4 weeks, 8 weeks and 12 weeks	12 weeks
Spinal appearance	The Spinal Appearance Questionnaire (SAQ) is a patient-reported outcome measure that evaluates the perception of spinal deformity and cosmetic appearance. It includes domains related to trunk asymmetry, curve perception, and self-image. Time Frame: Baseline, 4 weeks, 8 weeks and 12 weeks	12 weeks

Collaborators and Investigators

• Sponsor: Lahore University of Biological and Applied Sciences
• Collaborators: Ghurki Trust and Teaching Hospital
• Investigators: Study Chair: Prof. Shoaib Waqas, Phd, Lahore University of Biological and Applied Sciences

Study record dates

Study Major Dates

• Study Start (Estimated): May 15, 2026
• Primary Completion (Estimated): October 15, 2026
• Study Completion (Estimated): November 15, 2026

Study Registration Dates

• First Submitted: May 15, 2026
• First Submitted That Met QC Criteria: May 15, 2026
• First Posted (Actual): May 22, 2026

Study Record Updates

• Last Update Posted (Actual): May 22, 2026
• Last Update Submitted That Met QC Criteria: May 15, 2026
• Last Verified: April 1, 2026

More Information

Terms related to this study

• Keywords: Idiopathic scoliosis; Inspiratory capacity; Cobb's angle; Core stabilization exercises; Rotational Angular Breathing Exercises; Spinal Appearance; Trunk rotation
• Additional Relevant MeSH Terms: Health Services Administration; Health Care Quality, Access, and Evaluation; Quality of Health Care; Quality Indicators, Health Care; Standard of Care
• Other Study ID Numbers: UBAS/ERB/26/04/035; U1111-1339-6644 (Registry Identifier: WHO, ICTRP)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES
• IPD Plan Description: I commit to not sharing any data obtained during the study until its publication, ensuring confidentiality throughout the research process. Following the study, all collected data will be retained for a period of two years to allow for necessary analysis and validation. After this retention period, all data will be permanently deleted to comply with data protection regulations and to safeguard the privacy of all participants involved.
• IPD Sharing Time Frame: 2 years
• IPD Sharing Access Criteria: The data will be available upon request from the corresponding author via email.
• IPD Sharing Supporting Information Type: STUDY_PROTOCOL; ICF

Drug and device information, study documents

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