Proposal of a new exercise protocol for idiopathic scoliosis: A preliminary study

Jin Young Ko, Jee Hyun Suh, Hayoung Kim, Ju Seok Ryu, Jin Young Ko, Jee Hyun Suh, Hayoung Kim, Ju Seok Ryu

Abstract

In clinical practice, we found a unilateral instability in patients with right thoracic scoliosis during asymmetric spinal stabilization exercise (ASSE), which can be an important clue to identify the pathophysiology of idiopathic scoliosis (IS).We investigated the relationship between unilateral postural instability and weakness of paraspinal muscles according to curve pattern. And finally, we propose the new exercise method based on the curve pattern.Combined use of prospective and retrospective clinical trials.Fifteen participants without IS and 10 patients with IS in 1 tertiary referral hospital.In 15 participants without IS, surface electromyography (sEMG) was used to evaluate the muscular activation patterns in the bilateral erector spinae (ES), rectus abdominis (RA), and external oblique (EO) muscles during ASSE. In addition, to assess the clinical effect of ASSE, Cobb angle and rotation grade were measured from 10 patients with IS.The most significant findings from the sEMG data were the increased activities of ipsilateral 7th thoracic ES during hand-up motion, ipsilateral 3rd lumbar ES during leg-up motion, and 12th thoracic and 3rd lumbar ES during side-bridging. In a radiographic analysis, specific components of ASSE that activates the concave side muscles were found to be effective for IS.The paraspinal muscle strengthening of the concave side using ASSE can improve the severity of scoliosis. Based on this research, we could propose a new exercise protocol that can be personalized according to the curve pattern.

Figures

Figure 1
Figure 1
This figure shows the asymmetric spinal stabilizing exercise (ASSE) from the in dividualized graded lumbar stabilization exercise. Type I exercise consists of 4 movements in prone position. Type II exercise is composed of 3 movements in quadruped position. Type III exercise is known as the so-called side bridging exercise.
Figure 2
Figure 2
Asymmetric components of asymmetric spinal stabilizing exercise (ASSE) that activate the concave side muscles of scoliotic spine were effective for correcting idiopathic scoliosis.
Figure 3
Figure 3
Strength of muscles during ASSE using asymmetric index (AI). (A) Type I (A–D), (B) Type II (A–C), (C) Type III (A). ASSE = asymmetric spinal stabilization exercise.
Figure 4
Figure 4
Ryu scoliosis exercise protocol for idiopathic scoliosis using asymmetric spinal stabilizing exercises (ASSE, prone, quadruped, and side lying exercises) depending on the type of spinal curvature. Dumbbells and sand bags can be used on limbs to control the intensity of exercise. ASSE = asymmetric spinal stabilization exercise.
Figure 5
Figure 5
This figure shows how asymmetric weakness provokes scoliosis. Though we often think of muscles acting dynamically around the joints, paravertebral muscles act to keep the spine straight. As you see from this picture, the spine is inclined to the weaker side.

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