Exercises reduce the progression rate of adolescent idiopathic scoliosis: Results of a comprehensive systematic review of the literature (Fragment)

  1. NEGRINI, C. FUSCO, S. MINOZZI, S. ATANASIO, F. ZAINA & M. ROMANO ISICO (Italian Scientific Spine Institute), Milan, Italy.



A previously published systematic review (Ped.Rehab.2003 –DARE 2004) documented the existence of the evidence of level 2a (Oxford EBM Centre) on the efficacy of specific exercises to reduce the progression of AIS (Adolescent Idiopathic Scoliosis).
Aim. To confirm whether the indication for treatment with specific exercises for AIS has changed in recent years.
Study design. Systematic review.
Methods. A bibliographic search with strict inclusion criteria (patients treated exclusively with exercises, outcome Cobb degrees, all study designs) was performed on the main electronic databases and through extensive manual searching. We retrieved 19 studies, including one RCT and eight controlled studies; 12 studies were prospective. A methodological and clinical evaluation was performed.
Results. The 19 papers considered included 1654 treated patients and 688 controls. The highest-quality study (RCT) compared two groups of 40 patients, showing an improvement of curvature in all treated patients after six months. We found three papers on Scoliosis Intensive Rehabilitation (Schroth), five on extrinsic autocorrection-based methods (Schroth, side-shift), four on intrinsic autocorrection-based approaches (Lyon and SEAS) and five with no autocorrection (three asymmetric, two symmetric exercises). Apart from one (no autocorrection, symmetric exercises, very low methodological quality), all studies confirmed the efficacy of exercises in reducing the progression rate (mainly in early puberty) and/or improving the Cobb angles (around the end of growth). Exercises were also shown to be effective in reducing brace prescription.
Conclusion. In five years, eight more papers have been published to the indexed literature coming from throughout the world (Asia, the US, Eastern Europe) and proving that interest in exercises is not exclusive to Western Europe. This systematic review confirms and strengthens the previous ones. The actual evidence on exercises for AIS is of level 1b.



Various types of treatments for AIS (Adolescent Idiopathic Scoliosis), whether conservative or surgical, have been reported. The majority of adolescents with AIS have been treated with conservative care that included bracing, simple observation and/or physical exercises (PEs) [1]. PEs for the treatment of AIS have been used since 500 BC, when Hippocrates [2], followed by Galenus [3], introduced their usage as means to maintain the flexibility of the chest wall. During the past centuries there was a considerable flowering of different approaches to PEs, but only at the beginning of the previous century, mainly in Germany with Klapp and Von Niederho¨ fer, was it possible to verify the first methods through deep scientific observation [4]. During the same period Katharina Schroth described her method [5]. Later, in many parts of Europe, authors described different methods: Between 1930 and 1950 the ‘IOP’ method was introduced in Italy, and the ‘Psoas’ method was produced in the Soviet Union [4]. The ‘Lyon’ method [6,7] and that of Me´zie`res [8] were described in France during the 1960s. Later, Souchard derived its treatment from Me´zie`res [9], and in Poland Dobosiewics proposed its approach [10], while Min Mehta introduced the ‘side-shift therapy’ [11] to arrive at the actual ‘Scientific Exercises Approach to Scoliosis (SEAS),’  again created in Italy [12]. Apart from each method, PEs were subjected during the years to various fates [13,14], and today the current evidence regarding the effectiveness of PEs and other conservative treatments for AIS remains insufficient [14 – 16]. At the moment there is certainty only in regard to the ineffectiveness of electrical stimulation [17]. Despite the fact the rationale for the choice of which conservative treatment should be used is unclear and the effectiveness of exercises has not been proved, in many areas of the world patients are expected to continue treatments that have an impact on their quality of life [14].