Schroth and Pilates for Adolescent Idiopathic Scoliosis

Scoliosis is a three-dimensional spinal deformity characterized by a lateral curvature greater than 10° measured using the Cobb angle, accompanied by vertebral rotation . Approximately 80% of idiopathic scoliosis cases occur during adolescence . Adolescent idiopathic scoliosis (AIS) typically develops between the ages of 10 and 18 years. Several factors, including the initial curve magnitude, curve location, apical vertebral rotation, and age, have been identified as risk factors for curve progression .

Treatment of AIS depends on the severity of the spinal curvature and may include bracing, exercise-based interventions, or surgical treatment. The International Society on Scoliosis Orthopaedic and Rehabilitation Treatment (SOSORT) classifies scoliosis exercise approaches under the category of Physiotherapeutic Scoliosis-Specific Exercises (PSSE). Among these approaches, the Schroth method, which is based on rotational angular breathing, is one of the most widely used and extensively studied treatment methods in the literature . revious research has demonstrated that Schroth therapy may contribute to reductions in Cobb angle and improvements in quality of life in adolescents with idiopathic scoliosis. In addition, Schroth-based exercises have been associated with enhanced thoracic and lumbar proprioception.

The literature has associated increases in thoracic curvature, measured by the Cobb angle, with reductions in pulmonary function. Although these reductions have not yet been classified as abnormal by the American Thoracic Society, decreased pulmonary function has been observed even in individuals with mild spinal curvatures. It has been estimated that every 4-5° increase in Cobb angle is associated with approximately a 1% reduction in total lung capacity .

Pilates, originally referred to as "Contrology", was developed by Joseph Pilates and has become widely practiced in both fitness and rehabilitation settings . Although relatively few studies have investigated the effects of Pilates on scoliosis, existing evidence suggests that it may have beneficial effects in this population . Gou et al. reported that Pilates exercises reduced the Cobb angle while improving quality of life and trunk range of motion.

In a 12-week intervention study, Khaledi et al. compared Schroth exercises combined with asymmetric spinal stabilization exercises and found no significant between-group differences in back muscle endurance. Nevertheless, numerical improvements favored the combined exercise group compared with the control group. Similarly, previous studies were compared Schroth exercises with core stabilization exercises in adolescents with idiopathic scoliosis and found that participants receiving Schroth training demonstrated significantly greater improvements in perceived cosmetic appearance than those performing core stabilization exercises. Despite these promising findings, the level of evidence supporting the effectiveness of Pilates exercises in the management of scoliosis-related deformities remains limited. Pilates exercises have been reported to reduce asymmetrical posture in individuals with mild scoliosis and a low risk of progression. Both Schroth and Pilates exercises are considered to have positive effects on lung capacity, trunk proprioception, trunk muscle strength, and quality of life in individuals with AIS. However, previous studies have primarily investigated the effects of these exercise approaches separately. Based on the current literature, no study has evaluated the effects of Pilates-based core stabilization exercises added to Schroth training in individuals with adolescent idiopathic scoliosis. Therefore, further research is needed to investigate the potential benefits of this combined intervention.