The Effect of Three-Dimensional Exercises ( Schroth Method ) on Trunk Muscle Endurance, Sleep Quality, and Quality of Life in Adolescents With Hyperkyphosis

Childhood and adolescence are critical developmental stages characterized by rapid spinal growth, as well as the formation of postural habits and the musculoskeletal system. During this process, various spinal deformities may arise due to neuromuscular, structural, postural, or functional causes, and if not addressed in a timely manner, they can lead to permanent postural abnormalities carried into adulthood.

Thoracic kyphosis is the physiologically present forward curvature of the spine in the sagittal plane and is generally considered normal within the range of 20°-45°. However, when this angle exceeds 45°, it is referred to as hyperkyphosis. Hyperkyphosis can develop due to many different causes, such as postural abnormalities, muscle imbalances, and vertebral developmental anomalies. This deformity can become more pronounced, especially during adolescence when growth spurts occur.

The progression of hyperkyphosis that emerges during the developmental period can lead to serious clinical consequences in children and adolescents, including aesthetic concerns, weak trunk muscles, pain around the spine, sleep disorders, and a decline in quality of life. Timely diagnosis and effective rehabilitation of adolescent hyperkyphosis are critical in controlling the progression of the deformity and preventing functional loss.

The literature reports that exercise-based approaches are effective in treating kyphosis in this age group. Schroth exercises, in particular, are a specialized physical therapy protocol used in the treatment of 3-dimensional scoliosis and kyphosis. They offer individualized, breathing-integrated postural correction techniques that target interplanar asymmetry of the spine. With this approach, patients are taught positioning to actively correct spinal segments, proprioceptive awareness, and breathing control. The Schroth method aims not only at passive posture correction but also at reestablishing muscle balance and maintaining correct posture in daily life.

In this context, Schroth exercises, which specifically target 3-dimensional spinal correction, are among the interventions frequently recommended in the literature.

The aim of this study is to evaluate the effect of Schroth exercises on back muscle endurance, thoracic kyphosis angle, pain, quality of life, and sleep in adolescents with hyperkyphosis.

Inclusion criteria

• Adolescents between 12 and 18 years of age
• Presence of thoracic kyphosis with a T3-T12 Cobb angle ≥45° measured on a lateral thoracic radiograph
• Sufficient physical and cognitive ability to actively participate in the exercise protocol for at least 3 months
• Adequate communication and cognitive capacity to understand the educational materials provided
• Ability and willingness to regularly complete the exercise log throughout the study period

Exclusion criteria

• Scoliosis with a Cobb angle >10° in the coronal plane
• Presence of structural spinal deformities such as vertebral fracture, spondylolisthesis
• History of previous spinal surgery
• Neuromuscular disorders that may affect the spine (e.g., cerebral palsy, muscular dystrophy)
• Structural or functional pathologies involving the spine, pelvic complex, or shoulder girdle
• Balance disorders such as vestibular dysfunction, vertigo, or other conditions affecting postural control
• Inability to comply with the exercise protocol due to intellectual disability, severe behavioral disorders, or significant communication impairments
• Participation in professional-level sports activities that may influence exercise capacity or musculoskeletal function
• Presence of serious cardiopulmonary diseases (e.g., congenital heart disease, pulmonary hypertension)