Schroth and Scapular Muscle Activation in Hyperkyphosis

This prospective, randomized controlled trial aims to investigate the effects of Schroth-based three-dimensional exercises on scapular muscle activation in children with postural thoracic hyperkyphosis. Thoracic hyperkyphosis, commonly observed during childhood and adolescence, not only leads to spinal deformity but also negatively impacts scapular positioning, upper extremity function, and overall posture. Weakness and poor activation of scapular stabilizing muscles may contribute to the progression of kyphosis and functional limitations.

The Schroth method is a scoliosis-specific exercise approach designed to improve spinal alignment through three-dimensional postural correction, rotational breathing, and muscle stabilization techniques. Although widely used for spinal deformities such as scoliosis and kyphosis, its specific effects on scapular muscle activation remain insufficiently studied. This study will explore the potential of Schroth exercises to enhance scapular muscle function, which may contribute to improved posture, increased muscle strength and endurance, better scapular performance, reduced kyphotic appearance, and alleviation of pain.

The intervention group will participate in an 8-week supervised exercise program consisting of individualized Schroth exercises, focusing on postural awareness and scapular control during functional activities. By targeting scapular muscle activation, the study seeks to determine whether integrating Schroth exercises into physiotherapy practice can improve clinical outcomes and inform evidence-based approaches for managing postural thoracic hyperkyphosis in the pediatric population. Findings from this study may also contribute to developing preventive health strategies to protect musculoskeletal health in children and adolescents.

Inclusion criteria

• Thoracic kyphosis angle (Cobb) between ≥40° and <70° on lateral radiographs
• Aged 7-18 years
• Risser stage 0-5, indicating ongoing skeletal development

Exclusion criteria

• Congenital or rigid spinal deformities/anomalies
• Major musculoskeletal surgery or trauma, especially involving the spine
• Physiotherapeutic intervention for the spine in the last 6 months
• Current brace use
• BMI ≥ 30
• Regular upper extremity sports involvement (e.g., swimming, volleyball) at least twice a week for one year
• More than 60 minutes of moderate-to-high intensity physical activity per week
• Visual impairments or light sensitivity
• Positive vestibular (Unterberger) test
• Hearing impairments
• Cognitive difficulties affecting comprehension
• Systemic diseases (diabetes, hypothyroidism, infection, malignancy)
• Neurological disorders
• Active rheumatic diseases