Brace compliance process in adolescents with spinal deformities: A qualitative study.

BACKGROUND: Adolescent idiopathic scoliosis affects 2-4% of adolescents aged 10-16, while Scheuermann's kyphosis affects 0.4-10% of adolescents aged 11 to 16. Over the past 50 years, brace treatment has been recommended as the most common non-surgical intervention for treating these spinal deformities. The effectiveness of brace treatment depends on the duration of brace wearing. This study aimed to understand the brace compliance process for adolescents with spinal deformities through a qualitative approach. METHOD: This study applied multicenter exploratory qualitative research with an interpretative framework and enlisted the participation of as many individuals as possible involved in brace-wearing in adolescents with spinal deformities. Semi-structured, in-depth, and face-to-face interviews and telephone conversations from September 2020 to May 2021 were conducted. The recorded audio of each interview was typed into Word software with each personal code. The content analysis method was used to analyze the data. RESULTS: Seventy-four participants were interviewed, including 32 adolescents treated with braces and their parents (27 mothers, five fathers), six orthotists, two physiotherapists, and two spine surgeons. Following data analysis, four main categories, 14 categories, and 69 subcategories of 2403 related codes were discovered. CONCLUSION: Based on the analysis of the current qualitative research, adolescents with spinal deformities experience extensive challenges in the treatment process, which can affect the results and brace intervention efficacy. The current research findings showed that every adolescent goes through similar but unique conditions during the treatment. The importance of considering each adolescent's specific conditions and characteristics and providing functional solutions and support was understood to help them navigate critical situations more quickly and achieve effective treatment outcomes.

The immediate efficacy of the spinomed orthosis and biofeedback posture orthosis on balance and gait in older people with thoracic hyperkyphosis.

BACKGROUND: Increased kyphosis is a common condition among older people that may, directly or indirectly, be a risk factor for poor balance and gait. Spinomed and Biofeedback Posture Trainer (BPT) orthoses is an effective treatment approach for hyperkyphosis. This study aimed to compare the immediate effects of the Spinomed and BPT orthoses on balance and gait in the older population. METHODS: A total of 52 volunteer older people with hyperkyphosis (kyphosis angle>40°) participated in this study and were randomly allocated into two groups, to either the Spinomed orthosis (n = 26, mean age = 65.50 ± 5.50) or the BPT (n = 26, mean age = 65.38 ± 5.69) orthosis. All participants were asked to wear the orthoses for 1.5 h to get used to them. Balance parameters, which are Postural Stability Test (PST), Limits of Stability (LOS), and Clinical Test of Sensory Integration for Balance (m-CTSIB) were assessed using the Biodex Balance System, while walking parameters were assessed using the G-Walk with and without orthosis. RESULTS: The Spinomed had a positive effect on balance parameters (p < 0.05) except for the closed eyes firm surface and the opened eyes foam surface conditions of the m-CTSIB (p > 0.05). BPT had a significant impact on the PST score, LOS, and the closed eyes firm surface condition of the m-CTSIB (p < 0.001). Spinomed had a significant effect on cadence, speed, gait cycle duration, elaborated steps, and symmetry index of pelvic angles (p < 0.05), while the BPT had a significant effect only on step length and rotation symmetry index. No significant difference was detected between the two types of orthoses in the balance and gait parameters (p > 0.05). CONCLUSIONS: Spinomed and BPT were both effective in improving balance performance, with similar improvements demonstrated by both orthoses. Additionally, Spinomed may provide significant improvements in cadence, speed, gait cycle duration, elaborated steps, and all symmetry indexes of pelvic angles in the short term.

Effects of telerehabilitation-based respiratory and corrective exercises among the elderly with thoracic hyper-kyphosis: a clinical trial.

BACKGROUND: Aging is associated with changes in the musculoskeletal system, including increased susceptibility to spine malalignments. Utilizing corrective exercises with a therapeutic emphasis can be beneficial in the elderly with thoracic spine hyperkyphosis. OBJECTIVE: This study aimed to investigate the effects of six weeks of telerehabilitation-based respiratory and corrective exercises on quality of life, disability, thoracic kyphosis, craniovertebral angle, shoulder angle, cranial angle, and chest expansion in the elderly with thoracic spine hyperkyphosis. METHODS: In this clinical trial, a total of 40 participants aged 60 and above with thoracic hyperkyphosis were randomly divided into the control (N = 20) and experimental (N = 20) groups. The experimental group performed the corrective exercises for six weeks (3 sessions per week). The control group performed general stretching exercises during the same time period. We measured the outcomes of quality of life, disability, thoracic kyphosis, craniovertebral angle, shoulder angle, cranial angle, and lung expansion before and after the intervention. Analysis of covariance (ANCOVA) was employed to analyze the data. A P-value ≤ 0.05 was considered statistically significant. RESULTS: Quality of life (P < 0.001, Effect Size (ES): 0.44), chest expansion (P < 0.001, ES: 0.56), thoracic kyphosis angle (P < 0.001, ES: 0.31), craniovertebral (P < 0.001, ES: 0.33), cranial (P < 0.001, ES: 0.38), and shoulder (P = 0.005, ES: 0.20) angles were significantly improved in the experimental group as compared with controls. However, no statistically significant difference was observed between the two groups in terms of physical ability (P = 0.251, ES: 0.04). CONCLUSION: It is therefore recommended that online corrective exercises be used in the rehabilitation protocol to improve the quality of life, posture, chest expansion, and disability in the elderly with thoracic kyphosis.

The effect of various therapeutic exercises on forward head posture, rounded shoulder, and hyperkyphosis among people with upper crossed syndrome: a systematic review and meta-analysis.

OBJECTIVES: This review study aimed to evaluate the impact of therapeutic exercises on Upper-Crossed Syndrome (UCS). The study utilized a systematic review and meta-analysis approach to investigate the effects of various therapeutic exercises on forward head posture, rounded shoulders, and hyperkyphosis associated with upper crossed syndrome. METHODS: The study identified relevant keywords for each independent and dependent variable and conducted a search in scientific databases, including PubMed, Web of Science, Scopus, and Google Scholar, without any time limitations until 12 August 2023. Overall, 4625 articles were found in the selected databases, which were reduced to 1085 after being entered into the EndNote software and removing duplicate data. The full texts of 30 remaining studies were reviewed; ten articles meeting the criteria were included. Additionally, 12 studies from the Google Scholar database were included, resulting in 22 studies. Using Comprehensive meta-analysis software (CMA ver 3), data heterogeneity was measured with I2 and the Q tests. The Funnel Plot and Egger test methods were utilized to determine the possibility of publication bias. The JBI checklist was used to assess the quality of the studies. RESULTS: The results of the meta-analysis showed that therapeutic exercises were effective in improving forward head, rounded shoulders, and thoracic kyphosis angles (CI 95% = -1.85-1.161, P = 0.001, P = 0.001, CI95%=-1.822-1.15, and P = 0.001, CI 95%= -1.83-1.09, respectively). CONCLUSION: Based on the results, it appears that performing therapeutic exercises in the form of strength exercises, stretching, shoulder-based exercises, and incredibly comprehensive exercises that target all muscles may be effective in reducing forward head, rounded shoulders, thoracic kyphosis, and overall UCS.

Automated design of nighttime braces for adolescent idiopathic scoliosis with global shape optimization using a patient-specific finite element model.

Adolescent idiopathic scoliosis is a complex three-dimensional deformity of the spine, the moderate forms of which require treatment with an orthopedic brace. Existing brace design approaches rely mainly on empirical manual processes, vary considerably depending on the training and expertise of the orthotist, and do not always guarantee biomechanical effectiveness. To address these issues, we propose a new automated design method for creating bespoke nighttime braces requiring virtually no user input in the process. From standard biplanar radiographs and a surface topography torso scan, a personalized finite element model of the patient is created to simulate bracing and the resulting spine growth over the treatment period. Then, the topography of an automatically generated brace is modified and simulated over hundreds of iterations by a clinically driven optimization algorithm aiming to improve brace immediate and long-term effectiveness while respecting safety thresholds. This method was clinically tested on 17 patients prospectively recruited. The optimized braces showed a highly effective immediate correction of the thoracic and lumbar curves (70% and 90% respectively), with no modifications needed to fit the braces onto the patients. In addition, the simulated lumbar lordosis and thoracic apical rotation were improved by 5° ± 3° and 2° ± 3° respectively. Our approach distinguishes from traditional brace design as it relies solely on biomechanically validated models of the patient's digital twin and a design strategy that is entirely abstracted from empirical knowledge. It provides clinicians with an efficient way to create effective braces without relying on lengthy manual processes and variable orthotist expertise to ensure a proper correction of scoliosis.

Effectiveness of bracing to achieve curve regression in adolescent idiopathic scoliosis.

Aims: To systematically evaluate whether bracing can effectively achieve curve regression in patients with adolescent idiopathic scoliosis (AIS), and to identify any predictors of curve regression after bracing. Methods: Two independent reviewers performed a comprehensive literature search in PubMed, Ovid, Web of Science, Scopus, and Cochrane Library to obtain all published information about the effectiveness of bracing in achieving curve regression in AIS patients. Search terms included "brace treatment" or "bracing," "idiopathic scoliosis," and "curve regression" or "curve reduction." Inclusion criteria were studies recruiting patients with AIS undergoing brace treatment and one of the study outcomes must be curve regression or reduction, defined as > 5° reduction in coronal Cobb angle of a major curve upon bracing completion. Exclusion criteria were studies including non-AIS patients, studies not reporting p-value or confidence interval, animal studies, case reports, case series, and systematic reviews. The GRADE approach to assessing quality of evidence was used to evaluate each publication. Results: After abstract and full-text screening, 205 out of 216 articles were excluded. The 11 included studies all reported occurrence of curve regression among AIS patients who were braced. Regression rate ranged from 16.7% to 100%. We found evidence that bracing is effective in achieving curve regression among compliant AIS patients eligible for bracing, i.e. curves of 25° to 40°. A similar effect was also found in patients with major curve sizes ranging from 40° to 60° when combined with scoliosis-specific exercises. There was also evidence showing that a low apical vertebral body height ratio, in-brace correction, smaller pre-brace Cobb angle, and daily pattern of brace-wear compliance predict curve regression after bracing. Conclusion: Bracing provides a corrective effect on scoliotic curves of AIS patients to achieve curve regression, given there is high compliance rate and the incorporation of exercises.

Effects of elastic taping on kyphosis and body balance in the elderly: a randomized crossover study.

Kyphosis produces abnormal posture and reduced body balance in the elderly. Elastic tape may be useful at improving kyphotic posture and body balance. This study aims to evaluate the effects of elastic taping on kyphosis and body balance in the elderly. Ten elderly participants with degenerative kyphotic posture were recruited and randomly assigned to two groups (back taped with stretched elastic tape for 15 min and back taped with non-stretched elastic tape for 15 min). After a 1-h washout period, the groups were swapped over to receive the other intervention. The outcomes measured after each taping technique were Cobb's angle measurement by inclinometer, perceived pain, and balance measurements by single leg stance test, time up and go test, center of gravity alignment (COG) and modified clinical test of sensory interaction on balance test (mCTSIB). There was a significant reduction in kyphotic angle and back pain in both the stretched and non-stretched taping groups (p < 0.05). We also found both taping techniques significantly reduced sway velocity on a foam surface with eyes closed and open (p < 0.05). However, there was no significant difference between taping groups for kyphotic angle, pain reduction or balance. The application of 15 min of stretched and non-stretched elastic tape in the elderly reduced kyphotic angle, back pain, and sway velocity while standing on foam surface in the mCTSIB test. If these changes persist over the long term (days and weeks) taping may be a useful intervention for elderly patients with kyphosis.

Effect of taping on posture of thoracic region in patients with thoracic kyphosis using acceleration.

BACKGROUND: In the working environment of modern society, a poor sitting posture for a prolonged time may lead to abnormal spinal alignment such as thoracic kyphosis (TK). OBJECTIVE: This study aimed to evaluate the efficacy of taping for posture correction of patients with TK, providing theoretical and empirical guidance for clinicians attempting to rectify TK posture. METHODS: The study included 15 subjects aged 30-60 years, all with a TK angle of ⩾ 40∘. Subjects were required to ascend and descend a set of three steps (a low step, high step, and second low step) under three different conditions: without tape assistance, with taping assistance using 20% elongation, and with taping assistance using 40% elongation. A triaxial accelerometer was employed to measure and compare the anterior-posterior (AP), vertical (VT), and medial-lateral (MIL) movements of the thoracic vertebrae in the different conditions. RESULTS: There were no significant differences in the MIL (P= 0.903) or AP (P= 0.114) movements between the no tape assistance and 20% elongation taping conditions. However, a significant difference was found in the VT movement (P= 0.017). Comparing the no assistance condition to the 40% elongation taping condition, no significant changes were noted in the MIL movement (P= 0.650), but significant differences were detected in both the VT (P= 0.003) and AP movements (P= 0.016). No significant differences were found in any of the three measurements between 20% and 40% elongation taping. CONCLUSION: Taping serves as an effective method for immediately improving kyphotic posture. It corrects the position of the scapula and cervicothoracic line and exerts passive retraction on the relevant muscles, thus mitigating trunk imbalance.

Improving Kyphotic Postures and Neck Pain in Young Adults: A Meta-Analysis of Exercise-Based Interventions.

The study aimed to review the findings concerning the effects of exercises on Cobb angle and pain in patients suffering from cervical pain caused by thoracic kyphosis. Two investigators separately conducted a systematic review of the electronic literature from 2018 till 2022. PubMed, MEDLINE, Web of Science, Science Direct, Cochrane Central Register of Controlled Clinical Trials, Google Scholar, and Scopus were among the electronic databases that were accessed. This meta-analysis included 5 studies, published between 2019 and 2022. A sample size of 261 patients; included in 5 studies were estimated on Cobb angle and pain. The between-groups pooled random SMD for Cobb angle and pain showed a larger effect size of -2.146 and -1.126, respectively. The findings suggested that physical therapy exercise may result in larger changes among the Cobb angle and neck pain of kyphotic patients. Key Words: Exercise, Physical therapy, Cobb angle, Pain, Thoracic kyphotic angle, Conservative management.

Remission of Dowager's hump by manipulative correction of spinal alignment: a case report.

Dowager's hump is described as excessive kyphotic curvature in the thoracic spine with a Cobb angle of more than 40 degrees. This case report presents a 61 years old female office clerk who experienced headaches and neck pain for 3 years that extended into her right shoulder and upper chest. She consulted her primary care physician two months before seeing the chiropractor when the neck pain worsened. A diagnosis of cervicalgia related to osteoarthritis was made based on cervical and thoracic X-ray findings. The patient received non-steroid anti-inflammatory drugs (celecoxib and etoricoxib) and stretching exercises at home. At the onset of chiropractic care, radiographs showed loss of cervical lordosis, narrowing at the C4-5, C5-C6, and C6-7 intervertebral disc space with marginal osteophytes. Based on these findings, a working diagnosis of cervicogenic headache was established. After treatment for 9 months, the patient showed improvement in symptoms and function from cervical curve radiographic change and dextro-convexity of the thoracic spine. Avoiding forward head flexion and maintaining correct posture in daily activities will be key mechanisms to prevent the reoccurrence of Dowager's hump. The improvement of symptoms following chiropractic therapy has been shown to correlate with radiographic markers of spinal realignment.

The Effects of Exercise in Older Adults with Hyperkyphotic Posture.

The objective of this review was to investigate the effects of exercise in older adults with hyperkyphosis. Medline and Google Scholar databases were searched from June to August 2022 for studies related to exercise interventions in older adults above 60 years of age. All types of exercise interventions (such as strengthening, stretching, Yoga, and/or any other exercise with a focus on treatment or prevention of postural malalignment) were included. The keywords used were "hyperkyphosis," "exercise," and "older adults." Ten studies were included involving 625 older adults with hyperkyphotic posture. The exercise interventions included spine strengthening (strengthening of back and abdominal muscles), poses of Yoga and postural alignment, and flexibility and respiratory muscle exercises. Duration of exercise programs varied from 6 weeks (1 study) to 8 weeks (3 studies), 12 weeks (4 studies), and 6 months (3 studies). Exercise adherence was generally good in studies. In summary, low to moderate evidence suggest that exercises in age-related hyperkyphosis have a role in the management of this group of patients. It can be beneficial in order to improve postural control, spinal stability, and kyphosis outcomes. The adherence reported across studies suggests that exercise is an acceptable treatment option for people with age-related hyperkyphosis. Types of exercise and dose-response parameters of exercise eliciting improvement warrant further investigation. Due to heterogeneity in clinical trials, future research is needed with the goal of improving the health of our growing geriatric population.

Conservative treatment for dropped head syndrome.

PURPOSE: Previous reports on the outcome of conservative treatment for dropped head syndrome (DHS) are scarce. The purpose of this study was to elucidate the efficacy of conservative treatment for DHS and to identify possible predictive factors relating to the outcome. METHODS: Among 76 DHS patients, conservative treatment (2-3 months collar application, active neck range of motion exercise, and occasional prescription of analgesics) succeeded in 17 patients (22.4%, group S, 4 male, 13 female, mean age 75.9 years). The treatment failed in the remaining 59 patients (group F). Clinical and radiological parameters were compared between the groups. Radiological findings of group S were compared between before treatment and at follow-up. RESULTS: Duration of disease was 6.6 ± 9.3 months in group S and 20.0 ± 27.6 months in group F. C2-7 angle (degree), the incidence of anterior slippage of the vertebra (%), reducibility (%), and upper thoracic kyphosis angle (degree) in group S/F were - 19.2 ± 17.5/- 34.6 ± 26.6, 23.5/62.7, 100/52, and 6.7 ± 8.6/17.9 ± 13.7, respectively. C2-7 angles were - 19.2 ± 17.5 degrees at pre-treatment and 10.2 ± 20.7 degrees at follow-up. These differences were statistically significant. CONCLUSIONS: The present study indicated that conservative treatment was successful in 22% of DHS patients, with improvement in their cervical kyphotic alignment. Shorter duration of disease, relatively smaller cervical kyphosis without anterior slippage of the vertebra, reducibility, and abundant compensation at the upper thoracic region were good indications for the success of conservative treatment.

Effects of a Pilates programme in spinal curvatures and hamstring extensibility in adolescents with thoracic hyperkyphosis: a randomised controlled trial.

AIM: To evaluate the effects of a 9-month Pilates exercise programme on the sagittal spinal posture and hamstring extensibility of adolescents with thoracic hyperkyphosis. DESIGN: Randomised controlled trial with blinded examiner. PATIENTS: One-hundred and three adolescents with thoracic hyperkyphosis. INTERVENTIONS: Participants were randomly placed into an experimental group which participated in a Pilates exercise programme implemented for a total of 38 weeks (two sessions/week, 15 min/session) (Pilates group (PG), sample = 49, or control group (CG), sample = 48). MAIN OUTCOME MEASURES: The outcome measures were the thoracic curve in sagittal spinal curvature in relaxed standing, sagittal spinal curvatures and pelvic tilt in relaxed standing and sit-and-reach positions, and hamstring extensibility. RESULTS: There was a significant adjusted mean difference between groups in favour of the PG in the thoracic curve in relaxed standing position (-5.6°, p = 0.003), pelvic tilt (-2.9°, p = 0.03) and all straight leg tests (p<0.001). The PG showed a significant change in thoracic curve (-5.9, p<0.001) and in lumbar angle (4.0, p = 0.001) in relaxed standing position and in all straight leg raise tests (+6.4 to +15°, p<0.0001). CONCLUSIONS: The adolescents with thoracic hyperkyphosis from the PG had a decreased thoracic kyphosis in relaxed standing position, and improved hamstring extensibility as compared with the CG. More than 50% of the participants obtained kyphosis values inside normality, showing an adjusted mean difference between groups in the thoracic curve of about 73% of the baseline mean, resulting in a large improvement and high clinical importance. TRIAL REGISTRATION NUMBER: NCT03831867.

Effects of corrective and breathing exercises on respiratory function of older adults with a history of COVID-19 infection: a randomized controlled trial.

BACKGROUND: Patients with a history of COVID-19 infection may suffer from different physical problems. This study aimed to investigate the effect of corrective and breathing exercises on improving respiratory function among patients with a history of COVID-19 infection. METHODS: In this clinical trial study, thirty elderlies with a history of COVID-19 disease were divided into two groups (mean age 63.60 ± 3.56 experimental, 59.87 ± 2.99 control groups) based on the study inclusion criteria. Exercise interventions included two sections- breathing exercises and corrective exercises in the cervical and thoracic spine. The spirometry test, craniovertebral angle, and thoracic kyphosis test were used. To evaluate differences between variables, paired-samples t-test and ANCOVA were used (p-value < 0.01). Also, Eta-squared was measured to assess the effect size. RESULTS: Results showed a significant difference between the two groups in craniovertebral angle (P = 0.001), thoracic kyphosis (P = 0.007), and respiratory capacity including Forced expiratory volume in one second (FEV1) (P = 0.002), FEV1/FVC (P = 0.003), Peripheral oxygen saturation (SPO2) (P = 0.001), while no significant differences were observed between two groups in terms of chest anthropometric indices (P > 0.01). The Eta-squared value of 0.51 for the Craniovertebral angle and the SPO2 indicates a large effect size. CONCLUSIONS: The results showed the combination of corrective and breathing exercises could improve pulmonary function and correct cervical and thoracic posture in patients with a history of COVID-19 infection. Therefore, corrective and breathing exercises can be helpful as a complementary treatment along with pharmaceutical therapy to reduce chronic pulmonary complications in patients infected with COVID-19. TRIAL REGISTRATION: This research was registered in the Iranian Registry of Clinical Trials (IRCT registration number: IRCT20160815029373N7, First trial registration: 23/08/2021, Registration date: 01/09/2021).

Finite element simulation of growth modulation during brace treatment of adolescent idiopathic scoliosis.

Adolescent idiopathic scoliosis (AIS) is a spine deformity whose progression during growth is affected by asymmetrical loads acting on the spine. The conservative brace treatment aims to limit the deformity's progression until the end of skeletal growth. This study's objective was to develop a patient-specific finite element model (FEM) simulating immediate in-brace (IB) correction and subsequent growth modulation over 2 years of treatment. Thirty-five retrospective AIS cases with documented correction over 2 years were analyzed. For each case, a patient-specific FEM was built and IB correction was simulated. Vertebral growth and its modulation were modeled using simulated pressures on epiphyseal vertebral growth plates, including a compliance factor representing the recorded brace wear. The simulated Cobb angles, thoracic kyphosis, lumbar lordosis, and apical vertebral rotation were compared with the actual measurements immediately IB and out-of-brace (OOB) at the 2-year follow-up. Treatment outcomes according to simulated compliance scenarios of no brace-wear versus full brace-wear were also computed. The average immediate IB difference between the simulated and actual Cobb angle was 4.9° (main thoracic [MT]) and 3.7° (thoraco-lumbar/lumbar [TL/L]). Two-year OOB, it was 5.6° (MT) and 5.4° (TL/L). The no brace-wear and full brace-wear compliance scenarios resulted respectively in 15/35 (43%) and 31/35 (89%) simulated spine deformities progressing by <5° over 2 years of treatment. Clinical significance: the FEM's ability to simulate the final correction with an accuracy on the order of the radiological measurements' interoperator reproducibility, combined with its sensitivity to brace-wear compliance, provides confidence in the model's predictions for a comparative context of use like improving a brace's design before its application.

A randomized controlled study of the effect of functional exercises on postural kyphosis: Schroth-based three-dimensional exercises versus postural corrective exercises.

PURPOSE: To compare the effects of postural corrective and Schroth-based three-dimensional exercises on thoracic kyphosis angle (TKA), lumbar lordosis angle (LLA), balance and quality of life (QoL) in individuals with postural kyphosis. METHODS: This was a single-blind randomized controlled clinical trial with a total of 63 subjects (57 women, 6 men) with TKA of ≥40°. Subjects were separated into three groups: postural corrective exercise group (PCEG), Schroth-based three-dimensional exercise group (SBEG) and control group (CG). Participants in the exercise groups participated in the exercise program twice a week for eight weeks under the supervision of a physiotherapist: CG performed no exercise but was generally informed. The primary outcome variable was TKA. Secondary outcome variables were LLA, balance and QoL. RESULTS: After the functional exercise programs, TKA (mean change for PCEG, SBEG: -9.71, -14.76, p < 0.001), static postural stability index overall (-0.22, -0.40, p < 0.05), and QoL (-0.41, -0.37, p < 0.001) significantly improved in both training groups compared with CG. The LLA (-3.95, p = 0.003) was significantly lower in the SBEG group than in CG. CONCLUSION: This study demonstrated that Schroth-based three-dimensional exercises are an effective treatment for individuals with postural kyphosis and have a large effect size that improves TKA, LLA, balance and QoL. Clinical trial registration number: NCT03706495 Implications for rehabilitationEight weeks of postural corrective or Schroth-based three-dimensional functional exercise programs are effective in addressing thoracic kyphosis angle (TKA), balance, and quality of life in individuals with postural kyphosis.An eight-week Schroth-based three-dimensional exercise program was more effective than postural corrective exercises in improving TKA, lumbar lordosis angle, and balance for patients with postural kyphosis.Schroth-based three-dimensional exercise programs could promote balance and spinal health in young adults with thoracic kyphosis.

Adding corrective exercises along with bracing for postural hyperkyphosis among adolescents: A randomized controlled trial.

BACKGROUND: Although most attention has been paid to the effectiveness of corrective exercises and bracing to improve thoracic hyperkyphosis, no study, to the best of our knowledge, has compared the effects of exercises plus bracing to bracing alone. OBJECTIVE: To compare the effect of corrective exercises and bracing and bracing alone on the Cobb angle of thoracic kyphosis. DESIGN: A parallel-group, blinded, randomized, controlled trial. PARTICIPANTS: The participants included 180 adolescents with thoracic hyperkyphosis who were randomized into corrective exercises plus bracing (N = 60), only bracing (N = 60), and a waitlist control group (N = 60). INTERVENTION: Intervention groups received their programs for 24 weeks, whereas the control group was placed on a waitlist for 6 months before receiving a delayed intervention. MAIN OUTCOME MEASUREMENTS: The primary outcome was change from baseline to 6 months in Cobb angle measured from standing lateral spine radiographs. RESULTS: Significant differences were observed in the Cobb angle of thoracic kyphosis between all groups at the posttest (p <.001). In post hoc analyses, we found significant differences between the corrective exercise plus bracing group (15.5° decline) and the bracing only group (8.8° decline), p <.001; both groups had bigger improvements than the control group, which increased by 1.2° (p <.001). CONCLUSION: The combination of corrective exercises and bracing demonstrated better overall outcomes in Cobb angle compared to only bracing, as well as waitlist control in adolescents with thoracic hyperkyphosis.

Scoliosis: Brace treatment - from the past 50 years to the future.

OBJECTIVE: This paper deals with scoliosis treatment over the past 50 years. The review of the literature from the point of view of the current formation of opinion. From conservative forms of treatment, the pendulum has swung to surgical measures. To visualize this temporarily rejection of conservative treatment is the goal of this article. MATERIALS AND METHODS: A review of the literature over the last 50 years was performed from the perspective of current opinion, this with a pinch of personal experience in bracing and scoliosis surgery since 1972. The MESH terms (scoliosis, idiopathic scoliosis, adolescent idiopathic scoliosis) are presented in their number in a flow diagram and the publications on conservative therapies (brace, physiotherapy) are compared to surgical therapies (surgery).Opinions of "eminences" in the 1980s have been replaced by the rules of evidence-based medicine (EBM) at end of the 1990s. This transition will be visualized in the graph of PubMed statistics. In a statement, the future scoliosis treatment is derived from history. RESULTS: The total number of publications shows a ratio of brace to surgery of 13.9% and physiotherapy to surgery of 6.7% for the MESH terms "scoliosis". When "scoliosis" is supplemented with "idiopathic", the brace to surgery ratio changes from 24.5% and physiotherapy to surgery 8.2%. Focusing on adolescent scoliosis the addition of "adolescent" changes the brace to surgery ratio from 24.8% and physiotherapy to surgery 8.1%. In the total number of publications, "adolescent idiopathic scoliosis" is treated by 25.26%. The patient numbers of our own scoliosis outpatient clinic (1482 patients) over the last 15 years show a ratio of brace (Cobb angle 20°-50° brace-indication) to surgery (Cobb angle >50° indication to surgery) of 1 to 0.06. The scientific focus on surgical therapy is evident from the figures of PubMed mentioned. The number of conservative publications shows a depression in the 1990s. In the remainder of this article, opinion-forming developments are outlined and supported by literature citations, responsible for the recovery of publications on conservative scoliosis treatment. New technologies provide additional treatment options. CONCLUSIONS: In this sense, brace therapy is a success story with a future in the digital world of AI (artificial intelligence), mathematical model calculations, and production perhaps from the 3D printer. The central message from the history of the last 50 years is: "The scientific review of treatment results is essential for the further acceptance of brace treatment."

Effects of bracing on pelvic parameters in adolescent idiopathic scoliosis: A retrospective study.

To evaluate the effects of Chêneau bracing on Cobb's angle (CA) and spinopelvic parameters in adolescent idiopathic scoliosis (AIS) patients. In this retrospective study, we evaluated 51 AIS patients who received Chêneau bracing treatment between January 2020 and August 2021. The prebracing and in-bracing radiographs were analyzed about the spinopelvic parameters. The CA, pelvic coronal obliquity angle, thoracolumbar kyphosis (TLK), lumbar lordosis (LL), pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), sagittal vertical angle, and coronal vertical angle were measured. Paired t-test was used to compare prebracing and in-bracing spinopelvic parameters. The Pearson correlation analysis was used to identify the relationships between the variations in the spinopelvic parameters. The mean age at the initiation of bracing was 13.6 ± 1.5 years. The mean prebracing CA was 24.0° ± 6.3°. There were no statistically significant differences between prebracing and in-bracing measurements of sagittal and coronal vertical angles. However, there were statistically significant differences between the prebracing and in-bracing measurements of the CA, pelvic coronal obliquity angle, TLK, LL, PT, and SS. A significant correlation was observed between PT and thoracolumbar kyphosis variations in the sagittal plane. The pelvic coronal obliquity angle variation was correlated to the prebracing pelvic coronal obliquity angle in the coronal plane. Chêneau's bracing effects of AIS can be extended to the pelvis. Affected by the Chêneau brace, the pelvis should be retro-rotated correspondingly to TLK hyperkyphosis on the sagittal plane, whereas in the coronal plane, pelvic obliquity was improved independently. The effect of Chêneau braces on the pelvic parameters should be fully considered before bracing treatment.

Correlation between thoracic kyphosis and dry needle length required to reach the pleural space needling the upper trapezius: A cadaveric fluoroscopic assessment.

BACKGROUND: It is unknown whether greater prone thoracic kyphosis increases pneumothorax risk during upper trapezius dry needling. OBJECTIVES: To fluoroscopically assess for a correlation between prone thoracic kyphosis and needle length required to reach the pleural space dry needling the upper trapezius in prone. DESIGN: Cadaveric study. METHODS: Prone thoracic kyphosis was assessed using dual bubble inclinometers. A 30 mm dry needle was inserted into the midsubstance of the upper trapezius perpendicular to the thoracic kyphosis. A single C-arm fluoroscopic image was obtained. This procedure was repeated with 40, 50, and 60 mm needles. Images were independently viewed by a radiologist to make a binary decision (yes vs. no) whether the needle had potentially broached the pleural space. RESULTS: Fifteen cadaveric specimens with a mean age of 74.9 ± 9.7 and mean kyphosis of 21.5° ±7.7 were used. A 30 mm needle never reached the pleural space. The pleural space was potentially broached on one, four and six occasions by the 40, 50, and 60 mm needle respectively. The correlation between needle depth penetration and kyphosis was not significant (r = 0.03, p = 0.93). Longer needles (50 and 60 mm) were significantly (p = 0.0049) more likely to reach the pleural space than shorter needles (30 and 40 mm). CONCLUSION: Thoracic kyphosis was not correlated with needle length required to reach the pleural space. Clinicians may consider selecting shorter needles (<40 mm) to mitigate potential risk while dry needling the upper trapezius in prone.