Schroth and Scapular Muscle Activation in Hyperkyphosis

Istanbul University - Cerrahpasa

Status: Enrolling

Conditions: Exercise Therapy; Scapula; Deformity, Acquired; Muscle Activation; Hyperkyphosis, Adolescent

Treatments: Other: Schroth

Study type: Interventional

Funder types: Other

Identifiers

NCT06907914

aza_isu2

Details and patient eligibility

About

This randomized controlled trial aims to investigate the effects of Schroth exercises on scapular muscle activation in children with thoracic hyperkyphosis. A total of 56 participants will be randomly assigned to either the Schroth exercise group or the control group receiving postural education. The intervention group will complete an 8-week supervised Schroth program focusing on three-dimensional correction, rotational breathing, and postural awareness. Primary outcome is scapular muscle activation measured by surface EMG. Secondary outcomes include muscle strength, scapular endurance, kyphotic appearance, posture, and pain. The results will guide clinical management and preventive strategies for children with postural thoracic hyperkyphosis.

Full description

This prospective, randomized controlled trial aims to investigate the effects of Schroth-based three-dimensional exercises on scapular muscle activation in children with postural thoracic hyperkyphosis. Thoracic hyperkyphosis, commonly observed during childhood and adolescence, not only leads to spinal deformity but also negatively impacts scapular positioning, upper extremity function, and overall posture. Weakness and poor activation of scapular stabilizing muscles may contribute to the progression of kyphosis and functional limitations.

The Schroth method is a scoliosis-specific exercise approach designed to improve spinal alignment through three-dimensional postural correction, rotational breathing, and muscle stabilization techniques. Although widely used for spinal deformities such as scoliosis and kyphosis, its specific effects on scapular muscle activation remain insufficiently studied. This study will explore the potential of Schroth exercises to enhance scapular muscle function, which may contribute to improved posture, increased muscle strength and endurance, better scapular performance, reduced kyphotic appearance, and alleviation of pain.

The intervention group will participate in an 8-week supervised exercise program consisting of individualized Schroth exercises, focusing on postural awareness and scapular control during functional activities. By targeting scapular muscle activation, the study seeks to determine whether integrating Schroth exercises into physiotherapy practice can improve clinical outcomes and inform evidence-based approaches for managing postural thoracic hyperkyphosis in the pediatric population. Findings from this study may also contribute to developing preventive health strategies to protect musculoskeletal health in children and adolescents.

Enrollment: 56 estimated patients

Sex: All

Ages: 7 to 18 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Thoracic kyphosis angle (Cobb) between ≥40° and <70° on lateral radiographs
• Aged 7-18 years
• Risser stage 0-5, indicating ongoing skeletal development

Exclusion criteria

• Congenital or rigid spinal deformities/anomalies
• Major musculoskeletal surgery or trauma, especially involving the spine
• Physiotherapeutic intervention for the spine in the last 6 months
• Current brace use
• BMI ≥ 30
• Regular upper extremity sports involvement (e.g., swimming, volleyball) at least twice a week for one year
• More than 60 minutes of moderate-to-high intensity physical activity per week
• Visual impairments or light sensitivity
• Positive vestibular (Unterberger) test
• Hearing impairments
• Cognitive difficulties affecting comprehension
• Systemic diseases (diabetes, hypothyroidism, infection, malignancy)
• Neurological disorders
• Active rheumatic diseases

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Double Blind

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56 participants in 2 patient groups

Group A

Experimental group

Description:

Participants in the experimental group will undergo a supervised 3D Schroth-based exercise program with postural education. The intervention will be applied 3 times per week for 8 weeks, totaling 24 sessions, each lasting approximately 45 minutes, delivered in-person by a trained physiotherapist. Exercises will include corrective postural training, scapular stabilization, rotational breathing, and static stretching. The program is delivered in two progressive phases: Weeks 1-4: Postural awareness and basic muscle activation Weeks 5-8: Functional integration and advanced stabilization Progression criteria are based on repetitions: exercises begin at 9 reps × 3 sets, and progress to 15 reps × 3 sets. Static stretches start with 20 seconds × 2 sets and are increased to 3 sets before progressing. All exercises are individualized based on clinical assessment.

Treatment:

Other: Schroth

Group B

No Intervention group

Description:

The control group will receive a single, standardized session of postural education at the beginning of the study, during which general information about correct posture, ergonomic principles, and spinal health will be provided. Following this session, participants in the control group will be placed on a waiting list and monitored for a period of 8 weeks. During this time, they will not receive any specific exercise intervention or additional therapeutic program related to posture or muscle strengthening. Regular follow-up will be conducted to ensure participant safety and to monitor any changes or adverse events throughout the waiting period.