The Effect of Three-Dimensional Exercises ( Schroth Method ) on Trunk Muscle Endurance, Sleep Quality, and Quality of Life in Adolescents With Hyperkyphosis

Gaziosmanpasa Research and Education Hospital

Status: Enrolling

Conditions: Spine Deformity; Sleep Quality; Adolescent; Trunk Muscle Endurance; Kyphosis

Treatments: Diagnostic Test: Inclinometer Measurement; Diagnostic Test: Scoliosis X-ray (Orthoroentgenogram); Diagnostic Test: Kyphosis Study Form; Diagnostic Test: Biering-Sorensen Test (Back Extensor Endurance Test)

Study type: Observational

Funder types: Other

Identifiers

NCT07261358

1024

Details and patient eligibility

About

Adolescence is a critical period for spinal growth, and progression of thoracic hyperkyphosis may lead to pain, weak trunk muscles, sleep disturbances, and reduced quality of life. This study aims to investigate the effects of three-dimensional exercise program based on the Schroth Method on trunk muscle endurance, thoracic kyphosis angle, pain, sleep quality and quality of life in adolescents aged 12-18 years with hyperkyphosis.

Full description

Childhood and adolescence are critical developmental stages characterized by rapid spinal growth, as well as the formation of postural habits and the musculoskeletal system. During this process, various spinal deformities may arise due to neuromuscular, structural, postural, or functional causes, and if not addressed in a timely manner, they can lead to permanent postural abnormalities carried into adulthood.

Thoracic kyphosis is the physiologically present forward curvature of the spine in the sagittal plane and is generally considered normal within the range of 20°-45°. However, when this angle exceeds 45°, it is referred to as hyperkyphosis. Hyperkyphosis can develop due to many different causes, such as postural abnormalities, muscle imbalances, and vertebral developmental anomalies. This deformity can become more pronounced, especially during adolescence when growth spurts occur.

The progression of hyperkyphosis that emerges during the developmental period can lead to serious clinical consequences in children and adolescents, including aesthetic concerns, weak trunk muscles, pain around the spine, sleep disorders, and a decline in quality of life. Timely diagnosis and effective rehabilitation of adolescent hyperkyphosis are critical in controlling the progression of the deformity and preventing functional loss.

The literature reports that exercise-based approaches are effective in treating kyphosis in this age group. Schroth exercises, in particular, are a specialized physical therapy protocol used in the treatment of 3-dimensional scoliosis and kyphosis. They offer individualized, breathing-integrated postural correction techniques that target interplanar asymmetry of the spine. With this approach, patients are taught positioning to actively correct spinal segments, proprioceptive awareness, and breathing control. The Schroth method aims not only at passive posture correction but also at reestablishing muscle balance and maintaining correct posture in daily life.

In this context, Schroth exercises, which specifically target 3-dimensional spinal correction, are among the interventions frequently recommended in the literature.

The aim of this study is to evaluate the effect of Schroth exercises on back muscle endurance, thoracic kyphosis angle, pain, quality of life, and sleep in adolescents with hyperkyphosis.

Enrollment: 42 estimated patients

Sex: All

Ages: 12 to 18 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

Adolescents between 12 and 18 years of age Presence of thoracic kyphosis with a T3-T12 Cobb angle ≥45° measured on a lateral thoracic radiograph Sufficient physical and cognitive ability to actively participate in the exercise protocol for at least 3 months Adequate communication and cognitive capacity to understand the educational materials provided Ability and willingness to regularly complete the exercise log throughout the study period

Exclusion criteria

Scoliosis with a Cobb angle >10° in the coronal plane Presence of structural spinal deformities such as vertebral fracture, spondylolisthesis History of previous spinal surgery Neuromuscular disorders that may affect the spine (e.g., cerebral palsy, muscular dystrophy) Structural or functional pathologies involving the spine, pelvic complex, or shoulder girdle Balance disorders such as vestibular dysfunction, vertigo, or other conditions affecting postural control Inability to comply with the exercise protocol due to intellectual disability, severe behavioral disorders, or significant communication impairments Participation in professional-level sports activities that may influence exercise capacity or musculoskeletal function Presence of serious cardiopulmonary diseases (e.g., congenital heart disease, pulmonary hypertension)

Trial design

42 participants in 2 patient groups

Three-Dimensional Exercise Group

Description:

Adolescents aged 12 to 18 years with a diagnosis of kyphosis will undergo a supervised three-dimensional exercise program based on the Schroth Method. The intervention is specifically tailored for adolescents with kyphosis and aims to improve postural alignment, increase spinal mobility, enhance back extensor muscle endurance, and restore trunk muscle balance. The program consists of 10 outpatient sessions (approximately 60 minutes each), delivered by a physiotherapist trained in the Schroth Method. Exercises include postural correction, rotational angular breathing techniques, stabilization strategies, and individualized corrective postures adapted to the patient's spinal deformity pattern. After completing the supervised sessions, participants will be instructed to continue performing the Schroth exercises as a home-based program for the remainder of the study period, with adherence monitored through exercise logs and outpatient follow-up.

Treatment:

Diagnostic Test: Biering-Sorensen Test (Back Extensor Endurance Test)

Diagnostic Test: Kyphosis Study Form

Diagnostic Test: Scoliosis X-ray (Orthoroentgenogram)

Diagnostic Test: Inclinometer Measurement

Control Group

Description:

Adolescents aged 12 to 18 years with a diagnosis of kyphosis will be assigned to a home-based back extensor strengthening exercise program. Participants will receive detailed written and illustrated instructions on standardized back extensor strengthening exercises. After an initial instruction session, they will be asked to perform the exercises independently at home, every day per week, for the duration of the study period. Adherence will be monitored through exercise logs and outpatient follow-up visits.

Treatment:

Diagnostic Test: Biering-Sorensen Test (Back Extensor Endurance Test)

Diagnostic Test: Kyphosis Study Form

Diagnostic Test: Scoliosis X-ray (Orthoroentgenogram)

Diagnostic Test: Inclinometer Measurement