Three-Dimensional Scoliosis Exercises and Diaphragmatic Manual Techniques in Adolescents With Idiopathic Scoliosis

Adolescent idiopathic scoliosis (AIS) is a three-dimensional deformity of the spine that emerges during growth and is characterized by lateral curvature, vertebral rotation, and trunk asymmetry. AIS can negatively affect not only the spinal structure but also postural control, trunk stability, muscle activation patterns, respiratory function, and the quality of life of individuals. Particularly in thoracic curvatures, decreased rib cage mobility and impaired functional effectiveness of the diaphragm and intercostal muscles can lead to reduced respiratory capacity and respiratory muscle strength. Therefore, in scoliosis rehabilitation, it is important to evaluate not only spinal alignment but also respiratory mechanics and diaphragmatic function. Currently, among conservative treatment approaches, Three-Dimensional Scoliosis Exercises (Schroth method) are widely used and reported to be effective in reducing curvature progression. However, scientific evidence regarding the effects of supporting Schroth exercises with diaphragmatic manual techniques on muscle activation, trunk derotation, and respiratory function is limited. Since the diaphragm is both a primary respiratory muscle and an important postural muscle involved in spinal stabilization, it is thought that improving diaphragmatic function may contribute to scoliosis rehabilitation. In this randomized controlled trial, 24 individuals aged 10-18 years diagnosed with AIS will be divided into two groups. The study group will receive Schroth exercises supported by diaphragmatic manual techniques, while the control group will receive only Schroth exercises. Participants will be evaluated before and after treatment in terms of superficial muscle activity, Cobb angle, trunk rotation angle, perception of cosmetic deformity, respiratory functions, respiratory muscle strength, and quality of life. The unique value of this research is that it is one of the limited number of studies that multidimensionally examine the effects of diaphragmatic manual techniques combined with Schroth exercises on electromyographic muscle activation, derotation, and respiratory functions. It is expected that the results will contribute to the development of new rehabilitation approaches in the conservative treatment of AIS, strengthen evidence-based physiotherapy practices, and improve the quality of life of individuals with scoliosis.

Inclusion Criteria: * Individuals aged 10-18 years, in adolescence. * Scoliosis curvature in the thoracic region. * Individuals and their parents (those who have signed the informed consent form) who agree to participate in regular follow-up and exercise programs throughout the study period. * Diagnosis of AIS by a physician. * Patients with idiopathic scoliosis diagnosed radiologically and with a Cobb angle less than 30°. * The child and family agree to participate in and adhere to the 12-week treatment process. * Ability to understand and speak Turkish. * Not being in another treatment program. Individuals without any systemic disease that prevents participation in the physical exercise program. Exclusion Criteria: * Individuals who report that they cannot participate regularly during the exercise period or who will not adhere to the study schedule. * Individuals who have not previously undergone surgery for scoliosis * Those with accompanying neuromuscular or rheumatic diseases * Those receiving other scoliosis-related treatment during the study * Malignancy * Those using braces * Individuals with cognitive impairment that prevents them from understanding and performing the exercises mentally or physically. * Those with respiratory and cardiovascular system diseases requiring regular medication