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Improving excellence in scoliosis rehabilitation: A controlled study ofmatched pairs

H.-R. WEISS, & R. KLEIN

Asklepios Katharina Schroth Spinal Deformities Rehabilitation Centre, Bad Sobernheim, Germany

AbstractObjectives: Physiotherapy programmes so far mainly address the lateral deformity of scoliosis, a few aim at the correction ofrotation and only very few address the sagittal profile. Meanwhile, there is evidence that correction forces applied in thesagittal plane are also able to correct the scoliotic deformity in the coronal and frontal planes. So it should be possible toimprove excellence in scoliosis rehabilitation by the implementation of exercises to correct the sagittal deformity in scoliosispatients. An exercise programme (physio-logic� exercises) aiming at a physiologic sagittal profile was developed to add to theprogramme applied at the centre or to replace certain exercises or exercising positions.Material and methods: To test the hypothesis that physio-logic� exercises improve the outcome of Scoliosis IntensiveRehabilitation (SIR), the following study design was chosen: Prospective controlled trial of pairs of patients with idiopathicscoliosis matched by sex, age, Cobb angle and curve pattern. There were 18 patients in the treatment group (SIRþ physio-logic� (exercises) and 18 patients in the control group (SIR only), all in matched pairs. Average Cobb angle in the treatmentgroup was 34.5� (SD 7.8) Cobb angle in the control group was 31.6� (SD 5.8). Age in the treatment group was at average15.3 years (SD 1.1) and in the control group 14.7 years (SD 1.3). Thirteen of the 18 patients in either group had a brace.Outcome parameter: average lateral deviation (mm), average surface rotation (�) and maximum Kyphosis angle (�) asevaluated with the help of surface topography (Formetric�-system).Results: Lateral deviation (mm) decreased significantly after the performance of the physio-logic� programme and highlysignificantly in the physio-logic� ADL posture; however, it was not significant after completion of the whole rehabilitationprogramme (2.3 vs 0.3 mm in the controls). Surface rotation improved at average 1.2� in the treatment group and 0.8� in thecontrols while Kyphosis angle did not improve in both groups.Discussion: The physio-logic� programme has to be regarded as a useful ‘add on’ to Scoliosis Rehabilitation with regardsto the lateral deviation of the scoliotic trunk. A longitudinal controlled study is necessary to evaluate the long-term effectof the physio-logic� programme also with the help of x-rays.

Keywords: Idiopathic scoliosis, rehabilitation, physiotherapy, schroth programme, physio-logic� programme

Introduction

Thoracic flatback has been assumed to be the

triggering factor for thoracic Idiopathic Scoliosis

[1–5]. So, if coupled rotation and lateral deviation of

the spine are secondary patterns of deformity in the

development of Idiopathic Scoliosis (IS), it should

be possible to correct or improve scoliosis by the

application of sagittal forces.

Flatback seems to be a major problem in the

treatment of patients with idiopathic scoliosis using

braces. It has been demonstrated that flatback may

be increased instead of corrected using several brac-

ing concepts [6]. There are also other studies to

support especially the Boston brace to reduce sagittal

curvatures of the spine and in a Pub Med search no

study has been found to support the opposite.

Boston braces, the Charleston bending brace and

most of the other types of scoliosis braces up to now

have no pressure points to address the sagittal profile

while in the last modifications of the original

Cheneau brace pressure points for the correction of

thoracic hypokyphosis were introduced [7].

Physiotherapy programmes so far mainly address

the lateral deformity of scoliosis [8–11], a few aim at

the correction of rotation [12–15] and only very

few address the sagittal profile [16–18], although

already before 1992 Negrini stated that the sagittal

deformation is also important to correct with the help

of exercises [19]. In some programmes, flatback is

addressed in extent; however, those programmes

failed to show good results [20]. All patients

Correspondence: Hans-Rudolf Weiss, MD, Asklepios Katharina Schroth Spinal Deformities Rehabilitation Centre, Korczakstr. 2, D-55566 Bad Sobernheim,

Germany. Tel: 0049 6751 874 151. Fax: 0049 6751 874 171. E-mail: [email protected]

Received 16 September 2004; accepted 1 February 2005

Pediatric Rehabilitation, Month?? 2005; 0(0): 1–11

ISSN 1363–8491 print/ISSN 1464–5270 online/??/???1–011 � Taylor & Francis Group Ltd

DOI: 10.1080/13638490500079583

+ 2005 style [10.3.2005–12:07pm] [1–11] [Page No. 1] First Proof {TandF}Tpdr/TPDR-107491.3d (TPDR) Paper: TPDR-107491 Keyword

in the treatment programme described got worse

within 1 year of regular treatment. So it seems not

reasonable to mobilize the scoliotic spine into a global

kyphosis.

In the Schroth programme, thoracic kyphosis is

addressed performing a special breathing technique

(Figure 1); however, in the exercising position the

flatback is clearly visible (Figure 2). The results of

the Schroth concept seem to be quite good and show

that progression can be prevented in many cases

[21–25]. So, the Schroth programme has developed

to be the gold standard of physiotherapy for the

treatment of scoliosis in many countries as well as for

Scoliosis Intensive Rehabilitation (SIR) [18].

Meanwhile, there is evidence that correction forces

applied in the sagittal plane are also able to correct

the scoliotic deformity in the coronal and frontal

planes [6]. In an experimental study comparing the

short time effect of two different braces it could be

shown that sagittal correction forces lead to similar

short-term corrections as can be measured with the

help of surface topography, as the 3D correction

brace at the moment gold standard in many

European countries.

Although the Schroth method addresses also the

sagittal plane in the long-term [17], the results

achieved in the experimental study lead to the idea

to improve excellence in scoliosis rehabilitation by

the implementation of exercises to correct the sagittal

deformity in scoliosis patients more powerfully. An

exercise programme was developed aiming at a

physiologic sagittal profile to add it to the pro-

gramme applied at the centre or to replace certain

exercises or exercising positions. The exercises of

this programme all have the same basic principle to

increase and so improve lumbar lordosis at L2 level

and lower thoracic kyphosis and are called physio-

logic� exercises. However, to finally implement it to

SIR it should first be shown to be effective in the

short-term.

Figure 1. Rotational breathing demonstrated in forward bending position. Breathing is directed dorsally and laterally as can be seen on the

right picture.

Figure 2. Typical Schroth exercise in standing position on the left, flatback clearly visible and is only corrected by rotational breathing

in this position, right in prone position with a roll underneath the ribs to correct flatback.

2 H.-R. Weiss and R. Klein


Materials and methods

To test the hypothesis that physio-logic� exercises

improve the outcome of SIR, the following study

design was chosen: Prospective controlled trial of

pairs of patients with idiopathic scoliosis matched by

sex, age, Cobb angle and curve pattern. Outcome

parameter: average lateral deviation (mm), average

surface rotation (�) and maximum Kyphosis angle (�)

as evaluated with the help of surface topography

(Formetric�-system).

Treatment group

In July 2004, 20 consecutive patients with adolescent

idiopathic scoliosis between 13–17 years old were

asked to take part in the study. They were all females

and were admitted regularly for an inpatient rehabi-

litation programme of minimum 4 weeks. All 20

patients and their parents agreed to take part in the

study. Curve magnitude (Cobb angle) and curve

pattern (King classification) were recorded.

The patients of this group had a regular inpatient

rehabilitation programme as prescribed and addi-

tionally in the second or third week of their 4-week-

programme five times 90 minutes of the new exercise

programme called physio-logic�. The experimental

design was arranged in a fashion that all the subjects

in either subject group had similar exercise hours/

day. There might have been different responses

among the subjects in the physio-logic� group as the

subjects had different periods of the intervention of

the physio-logic exercises (either at the 2nd or 3rd

week of the programme); however, as is needed

20 subjects with certain inclusion criteria given to be

treated during the same time as the control group

saw no other way to perform this study.

For this study group, surface topography was

performed before and after the 4-week-programme

as usual and additionally directly after the perfor-

mance of the 1-week physio-logic� programme.

Additionally to that, the physio-logic� ADL posture

trained at that week was tested with the help of the

Formetric surface topography system as well.

Control group

To be able to establish a control group of biggest

homogeneity possible, one chose to take the matched

pair technique. One was looking for another 20

patients having inpatient rehabilitation at the same

time before applying physio-logic� exercises for the

treatment group. The patients of the control group

were matched by age, curve magnitude and curve

pattern in a way that in the end for every patient

from the treatment group had another patient in

the control group of similar curve pattern, curve

magnitude (�5�) and age (�1 year). All patients in

either group were female.

While the treatment group had the Schroth

inpatient rehabilitation programme as routinely

performed at the centre and an additional week

with 90 minutes of physio-logic exercises per day,

the control group only had the Schroth inpatient

rehabilitation programme as described in literature

[18]. As usual, the control group was investigated

by use of surface topography before and after

rehabilitation.

During the first 2 days performing the physio-

logic� programme two of the patients from the

treatment group cancelled their attendance.

Therefore, the patients were also removed from the

control group matched individually. In the end, there

were 18 patients in the treatment group and 18

patients in the control group as well all in matched

pairs. Average Cobb angle in the treatment group

was 34.5� (SD 7.8) Cobb angle in the control group

was 31.6� (SD 5.8). Age in the treatment group was

at average 15.3 years (SD 1.1) and in the control

group 14.7 years (SD 1.3). Thirteen of the 18

patients in either group had a brace.

Scoliosis intensive rehabilitation (SIR)

SIR employs an individualized exercise programme

combining corrective behavioural patterns with

physiotherapeutic methods, following principles

described by Lehnert-Schroth [12]. The three-

dimensional scoliosis treatment is based on senso-

motor and kinesthetic principles and its goals are

(1) to facilitate correction of the asymmetric posture

and (2) to teach the patient to maintain the corrected

posture in daily activities.

Referrals are from spine centres, general ortho-

paedic surgeons, paediatric physicians and general

practitioners. A 4-week minimum stay is required

for the first treatment and may be up to 6 weeks,

depending on prognosis; return treatments are 3–6

weeks in length, depending on symptoms and

prognosis. Patients are admitted in groups, with

the first day of the programme devoted to diagnosis

and evaluation of the three dimensional deformity,

supervized by seven staff physicians (one orthopaedic

surgeon and six general practitioners or specialists

for Physical Medicine and Rehabilitation) who also

provide oversight for each patient’s programme. On

the second day, instruction in basic human anatomy,

spinal deformity and principles of postural balancing

therapy is provided to the group. Each patient

receives a detailed summary of his/her own con-

dition and those with matching diagnoses (based

on age, degree and pattern of curvature) work

together in groups. Evening and weekend social

activities provide a sense of community and foster

A controlled study of matched pairs 3


development of psychological support systems that

can be maintained after treatment is complete.

The treatment programme consists of correction

of the scoliotic posture with the help of proprio-

ceptive and exteroceptive stimulation and begins on

the third day after admission. Each weekday, after a

20-minute group warm-up session, the patients exer-

cise in matched groups for 2 hours in the morning

and 2 hours in the afternoon and receive shorter

more individual training sessions in between. Central

to the individual and group exercise programmes

is therapist assistance, by a staff of 20 physical

therapists and sports therapists who supervize all

exercises and provide exteroceptive stimulation

needed to obtain desired correction. Depending on

individual curve patterns, the patients are assigned

to special exercise groups for an additional 2 hours

daily. Development and maintenance of the cor-

rected posture is facilitated using asymmetric stand-

ing exercises designed to employ targeted traction

to restore torso balance and mobility.

The correction is supported by ‘rotational breath-

ing’ exercises, an integral part of the regime: By

selective contraction of convex areas of the trunk, the

inspired air is directed to the concave areas of the

chest and the ribs to lengthen and mobilize soft

tissues in these regions. Female patients wear bikini

tops during all sessions and ceiling and wall mirrors

enable the patients to self-monitor progress at all

times during standing and floor exercises; this

practice facilitates optimum correction during exer-

cises and fosters patient proprioception of a balanced

posture. Four full time massage therapists provide

bi-weekly mobilization therapy for each patient,

using myofascial release, manual traction, ischemic

pressure and pressure point therapy. Two full-time

respiratory therapists meet weekly with each patient

to monitor vital capacity and to provide training in

corrected breathing patterns. Psychological counsel-

ling is provided by two staff psychologists to help

patients cope with feelings about the diagnosis of

deformity as well as the impact of treatment, as

needed; patients can request individual psycho-

therapy in response to anxiety, depression or other

psychological distress. Optional evening group ses-

sions devoted to relaxation therapies including

meditation and visualization approaches are also

available. Osteopathic manipulation and acupunc-

ture by staff therapists are available to treat pain as

needed, upon request by the patient.

At the end of in-patient treatment, the primary

goal is for patients to be able to assume their personal

corrected postural stereotype, independent of the

therapist and without mirror control and to maintain

this position in their daily activities. Recommended

at-home follow-up treatment includes three to four

exercises for 30 minutes daily in order to maintain

the improved postural balance. Therapists through-

out Germany receive training in the Schroth Clinic

approaches so that local outpatient resources are

available to patients after discharge. In case of pain,

curvature progression or pulmonary symptom devel-

opment repeat SIR treatment is available by referral

from primary care physicians.

The physio-logic� exercise programme

Within the physio-logic� exercise programme, one

provides

1. Symmetric mobilizing exercises to improve lor-

dosing mobility of the lumbar spine and kyphos-

ing mobility of the thoracic spine;

2. Asymmetric exercises to improve postural correc-

tions also in frontal and coronal plane; and

3. The physio-logic� ADL posture

The symmetric mobilizing exercises are performed

repeatedly. Those exercises can only be performed

with the help of postural reflexes. First, lumbar

lordosis is empowered actively and the pelvis is tilted

forward while the upper trunk is reclined backwards

to improve thoracic kyphosis reflectorily.

It is not the aim of the exercises to increase lumbar

lordosis at the L5/S1 level for this region is

responding with unspecified low back pain when

stressed. Therefore, one aims at a lordosis at the L2

level. One can enforce the exactness of the exercise

by ventralizing the lower ribbows (Figure 3).

For the asymmetric postural correction in 3D, one

can use exercises from the Schroth programme

modified due to the principles of the physio-logic�

exercise programme (Figure 4).

Activities of daily living (ADL) are very important

to change postural stereotype and for this reason the

physio-logic� ADL posture is trained in standing and

walking (Figures 5 and 6). Therefore, the patients

are trained to perform the ‘Catwalk’ which includes

the basic principles of the physio-logic� programme

addressing the sagittal plane (Figure 5) and the ADL

(Activities of daily living) posture called ‘Nuba’-

position. This position is derived from the normal

upright standing and walking position the Nuba

(people from North Africa) perform usually.

Actually there is no angle and possible range of

thoracic kyphosis and lumbar lordosis defined to

perform or maintain in the physio-logic� exercises.

Muscle groups involved for the exercise action are

not identified yet. This might be subject to further

investigation.

Surface topography system used for this study

The print-out of the Formetric�-system itself

gives a lot of values, the most important are the


Figure 3. Left: Lordosing exercise with the risk of low back pain due to L5/S1 stress. Right: Ventralization of the lower ventral ribs

to improve Lordosis at L2 level, where it naturally belongs [http:\\www.leni-riefenstahl.de\eng\dienubav\1.html]. In this position L5\S1 stress

is reduced.

Figure 4. Schroth exercise (see also Figure 2) changed to physio-logic� style. Lumbar lordosing and thoracic with increased kyphosis.


Figure 5. Physio-logic� ADL posture in standing position. Lumbar lordosis is increased, pelvis is corrected to the opposite side of

deformity while the hand on the lumbar hump helps to redress the lumbar curve. It is also possible to redress the ventral ribhump with the

other hand (right).

Figure 6. Catwalk’ with the patients from the treatment group. Ventralizing the lower ribs is important to reduce L5/S1 stress and

so the possibility of low back pain.


following: Lateral asymmetry, surface rotation and

kyphotic angle.

In the video rasterstereography (Formetric�-

system), the whole object is illuminated by a pattern

of parallel lines, recorded in a single frame and

needing only a short measurement time (40 milli-

seconds). The automatic image processing consists

of the identification of the raster lines and automatic

3-D reconstruction of the back; shape analysis is

performed by a mini computer. The computer helps

to evaluate the spine with the assistance of trian-

gulation [26, 27]. The video rasterstereography

(Formetric�-system) has a point discrimination of

0.15 mm and in a typical case of measurement

25 000 surface points are calculated (Figure 7).

Parameters used to compare the short-term effects

of the different treatment concepts described were

average lateral deformation (root mean square, rms)

with a technical error of 3 mm, average surface

rotation (rms) with a technical error of 1.5� and

average kyphosis angle with a technical error of

2.5� as measured and calculated by the Formetric�

surface topography system [28–30].

The surface topography values for the treatment

group were compared as follows: The values after

the treatment were compared with respect to the first

value before treatment as were the values directly

after performing the physio-logic� programme and

in the physio-logic� ADL position. In the control

group, the pre-treatment values were compared to

the post-treatment values in the same way. The

surface topography values were compared statisti-

cally using Winstart� Software.

Results

The Formetric� values Lateral Deviation in mm,

Surface Rotation in � and Kyphosis Angle in � before

Scoliosis Intensive Rehabilitation (SIR), after SIR,

after 5� 90 minutes performing the physio-logic�

programme (PL) and in the physio-logic� ADL

position (ADL) for the treatment group as well as

for the control group can be seen in Table I.

The difference between Lateral Deviation before/

after SIR, before SIR/after performing the physio-

logic� programme (PL) and before SIR/in the

Figure 7. Printout of the Formetric�-system (left: frontal view with lateral deviation of the trunk, right: lateral view showing a flatback

without a sign of thoracic kyphosis or lumbar lordosis).


physio-logic� ADL position (ADL) for the treatment

and the control group is documented in Table II and

Figure 8.

The only significant change in the control group

was the improvement of Surface Rotation (�0.75�,

p¼ 0.015) compared to the improvement before/

after SIR (�1.2�, p¼ 0.1) which, however, was not

significant (Figure 9).

Interestingly, the physio-logic� programme itself

did not have an impact on Surface Rotation directly

after the programme was applied in the physio-logic�

ADL position. However, Lateral Deviation was

changed significantly in the treatment group com-

pared to the control group. Kyphosis Angle was only

changed slightly with a tendency to decrease instead

of the expected increase (Figure 10).

Discussion

Video rasterstereography (Formetric�-system) has

been used for the evaluation of brace and physio-

therapy effects [31–35]. Although there are certain

limitations to respect, it has been demonstrated that

certain exercises tend to improve scoliosis as well

as kyphosis in the short-term [32–35]. While in

Scheuermann’s kyphosis the degree of curvature

decreased significantly after in patient rehabilitation

[34], there is no evidence for the short-term effect of

exercises on the flatback related to IS [32, 33, 35].

However, there is evidence that the Schroth phy-

siotherapy programme as well as the Cheneau brace

are able to correct thoracic flatback in the long-term

[17, 31].

Table I. Lateral deviation in mm, surface rotation in � and Kyphosis angle in � before Scoliosis Intensive

Rehabilitation (SIR), after SIR, after 5� 90 minutes performing the physio-logic� programme (PL) and in the

physio-logic� ADL position (ADL) for the treatment group as well as for the control group.

Before SIR After PL ADL After SIR

Treatment group

Lateral deviation (mm) 15.4 (SD 5.1) 13.1 (SD 5.9) 11.0 (SD 5.1) 13.1 (SD 5.0)

Surface rotation (�) 7.4 (SD 2.7) 7.0 (SD 2.5) 7.1 (SD 3.1) 6.2 (SD 1.8)

Kyphosis angle (�) 46.5 (SD 8.0) 42.1 (SD 8.2) 39.0 (SD 9.3) 45.8 (SD 7.7)

Control group

Lateral deviation (mm) 13.5 (SD 6.8) 13.1 (SD 6.2)

Surface rotation (�) 7.3 (SD 2.4) 6.5 (SD 2.3)

Kyphosis angle (�) 48.8 (SD 11.0) 46.8 (SD 10.2)

Before SIR/after PL

Before SIR/inADL

Before SIR/after SIR


0

2

4

6

Average LateralDeviation in mm

Figure 8. Average lateral deviation changes in the treatment group

(first three columns) compared to the control group (solid

column). The improvements are better for the SIRþphysio-

logic� group and significant.

Before SIR/after PL

Before SIR/inADL



0

0.5

1

1.5

Average surfaceRotation in °

Figure 9. Average surface rotation changes in the treatment group


column). The improvements are better for the SIRþ physio-

logic� group after SIR; however, not significant.

Table II. Difference between lateral deviation before/after SIR,

before SIR/after performing the physio-logic� programme (PL)

and before SIR/in the physio-logic� ADL position (ADL) for the

treatment and the control group.

Lateral deviation

(mm)

Average

difference T-value p

Treatment

group

Before SIR/

after PL

2.32 (SD 3.8) 2.6 0.02

Before SIR/

in ADL

4.38 (SD 4.7) 3.9 0.001

Before SIR/

after SIR

2.31 (SD 5.6) 1.8 0.1

Control

group

Before SIR/

after SIR

0.32 (SD 2.5) 0.54 0.6


In this study, Lateral Deviation was significantly

improved in the treatment group (SIRþ physio-

logic�), especially directly after the performance of

the physio-logic� programme and in the physio-

logic� ADL position. The control group (SIR)

showed no significant changes.

In the preceding studies, Surface Rotation did not

change significantly [32, 33]; however, in the control

group significant improvements were found which,

however, were lower than in the treatment group

but in this group not significant.

Kyphosis Angle decreased in both groups, sig-

nificantly in the treatment group and not significant

in the control group although the physio-logic�

programme aims at an increase of thoracic kyphosis,

as can be seen in Figures 3–6. The hypothesis is that

in the development of IS the sagittal deformity comes

first and though is the stiffest component of the 3D

deformity. Secondly, trunk torsion appears which is

also more stiff than lateral deformation that seems to

be the least stiff part of the 3D deformity and so in

the short-term the best correctable. This theory is

supported in a controlled study by the fact that it is

possible to correct flatback by the exercises of the

SIR programme in the long-term [17]. Another

theory is that the measured value may not fully reflect

the actual skeletal curvatures. It seems that the

measured thoracic kyphosis is relatively normal but

not having hypo-kyphosis because the Formetric�-

system measures kyphosis not in the standard range

(T4; most tilted vertebra in the lower end of the

curve).

Of course, one has to take into account the

technical error of the Formetric�-system, which is

bigger than the average changes provided by the

exercise programmes. Only in the physio-logic�

ADL position the improvement of lateral

Deformity exceeded 3 mm (regarded as the technical

error due to postural sway of the patients [28]).

However, differences are found that are at least in

part statistically significant comparing the two groups

and also medically relevant differences justifying

conclusions. One has, of course, to accept that

there are limitations of this study due to the relatively

big technical error of the measuring system (15–20%

for Lateral Deviation and Surface Rotation; 5% for

Kyphosis Angle [28–30]); however, postural sway

cannot be regarded as a systematic error and,

therefore, one would expect small changes not to

be registered with the help of this device, whereas

clear tendencies or significant changes erase from the

general variability and so are medically relevant. On

the other hand, there is no other device to measure

the effects of exercises in short-term objectively other

than x-rays not suitable for a study of this design

because of the exposition to radiation.

Either subject group itself was not totally homo-

genous. Some subjects were under a mixture of brace

treatment and physical exercise treatment but some

were with physical exercise treatment only. During

SIR, the braces are worn in the evening and during

night time, while during daytime there are exercises

to be performed for �6 hours.

As the proportion of patients with a brace was the

same in both groups, brace wearing should not have

an influence on the results. Rigo et al. [35]

recognized that brace treatment does not affect the

results of the 4 weeks exercise programme obtained

with the Formetric�-system.

It has been emphasized that brace loads are not

applied in an optimal way to correct the 3-D

deformities associated with thoracic idiopathic sco-

liosis and that loads applied on the posterior rib

hump should be re-equilibrated to reduce anterior

displacement of the trunk [36]. This is what has been

found in an experimental study as well where it has

been demonstrated that a brace designed to correct

sagittal profile may only also correct scoliosis in 3D

[6]. So the same principles seem reasonable to be

applied in postural re-education and correction using

exercises as well.

From experience, one has no explanation for the

fact that hypokyphosis in the short-term could not

be corrected by the physiotherapy programmes

described, although both apply a 3-point pressure

in the sagittal plane. The same applies for braces

correcting the sagittal planes directly [6]. The

hypothesis is that in IS the sagittal deformity is the

primary problem. This theory is supported by quite

a number of studies [1–4, 37]. The deformity in the

sagittal plane, though, may be the stiffest and,

therefore, not as easy to correct as the deformities

in the other planes.

Before SIR/after PL

Before SIR/inADL



0

5

10

Max. KyphosisAngle in °

Figure 10. Max. Kyphosis angle changes in the treatment group


column). The decreases are bigger for the SIRþphysio-logic�

group (significant) than for the SIR group (not significant).

Interestingly, the mobilization into a thoracic Kyphosis seems to

increase flatback reflectorily in short-term. Treatment and control

group showed changes in the same direction.


Conclusions

The physio-logic� programme has to be regarded as

a useful ‘add on’ to Scoliosis Intensive Rehabilitation

(SIR) with regards to the lateral deviation of the

scoliotic trunk. The physio-logic� ADL position

corrects lateral deviation of the scoliotic trunk not

only highly significant but also on average more than

the technical error of the measuring system and so

should be trained regularly during SIR.

A longitudinal controlled study is necessary to

evaluate the long-term effect of the the physio-logic�

programme also with the help of x-rays.

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idiopathiques: prevention a l’ecole. Personal communication.

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[15] Rigo M, Quera-Salva G, Puigdevall N. Effect of the exclusive

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Preliminary results and worst-case analysis of in-

patient scoliosis rehabilitation. Pediatric Rehabilitation

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progression in idiopathic scoliosis patients treated with

scoliosis in-patient rehabilitation (SIR): an age- and sex-

matched controlled study. Pediatric Rehabilitation

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management on the prevalence of surgery in patients with

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nahmen. Stuttgart: Fischer; 1993.

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relation to breathing—a comparative analysis with the

formetric system. In: Sevastik JA, Diab KM, editors.

Research into spinal deformities 1. Amsterdam: IOS Press;

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sungssystemen zur beurteilung von haltungsstorungen und

kyphosen. Orthopadische Praxis 1998;34:765–769.

[31] Rigo M. 3D correction of trunk deformity in patients with

idiopathic scoliosis using Cheneau brace. In: Stokes IAF,

editor. Research into spinal deformities 2. Amsterdam: IOS

Press; 1999. p 362–365.

[32] Weiss HR. Ergebnisqualitatsanalyse der rehabilitation von

patienten mit wirbelsaulendeformitaten durch objektive

analyse der ruckenform. Orthop Prax 1998;34:770–775.

[33] Weiss HR. Ermittlung der ergebnisqualitat der rehabilitation

von patienten mit wirbelsaulendeformitaten durch

objektive analyse der ruckenform. Phys Rehab Kur Med

1999;9:41–4799.


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[34] Weiss HR, Dieckmann J, Gerner J. The practical use of sur-

face topography: following up patients with Scheuermann’s

disease. Pediatric Rehabilitation 2003;6:39–45.

[35] Rigo M, Quera G, Puigdevall N, Corbella C, Gil MJ,

Martinez S, Villagrasa M. Biomechanics of specific exercises

to correct scoliosis in 3D. Pediatric Rehabilitation 2004;

7:53–54.

[36] Aubin CE, Dansereau J, de Guise JA, Labelle H.

Rib cage-spine coupling patterns involved in brace treatment

of adolescent idiopathic scoliosis. Spine 1997;22:629–635.

[37] Millner PA, Dickson RA. Idiopathic scoliosis: bio-

mechanics and biology. European Spine Journal 1996;

5:362–373.


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