Tag: functional capacity

Physiotherapy may improve functional capacity in younger scoliosis patients

It’s been established (and we’ve written several times about it) that scoliosis can impact both quality of life, and functional capacity – that is to say, the ability of a patient to live without pain and move around normally without struggling. While not all patients are affected, a large number report either pain reduced functional capacity or both. A recent study suggests that a targeted, 12-week physiotherapy intervention can result in significant improvement where this is the case.


Scoliosis and functional capacity

While the primary issue with scoliosis is the spinal deformation, the conditional can also cause decreased spinal movement, weakening of muscles near the spine, chronic pain, psychological suffering, reduced pulmonary function, and respiratory dysfunction.[1] Typically, more significant scoliosis cases are associated with more severe symptoms, however abnormal ventilatory patterns and respiratory muscle involvement have been reported in patients even with asymptomatic mild scoliosis who may be free of any respiratory dysfunction at rest.[2] Impaired exercise tolerance and physical deconditioning can also be early manifestations in patients with mild scoliosis.[3]

The majority of research in this field, has to date, been focused on larger curves however – With this in mind, a recent study[4] sought to explore the pulmonary function and functional capacity in school children and adolescents with mild or moderate idiopathic scoliosis who were included in a rehabilitation programme


Study information

The study included 49 school children and adolescents with idiopathic scoliosis. The patients were selected from those who visited the Rehabilitation Department of Paediatric Surgery, Louis Turcanu Children’s Hospital Timisoara, Romania. For each participant, the study authors recorded their demographic characteristics (age, sex, weight, and height) and physical activity behaviours (hours of time spent at a desk and at a computer per week, and hours of competitive and non-competitive practice of exercise per week). The patients were assessed clinically by the same orthopaedic surgeon. An X-ray examination of the spinal column in the standing anterior–posterior view was then performed. The X-ray examination and Cobb angle measurement were performed by a single investigator who was a radiologist. Mild scoliosis was defined by a Cobb angle <20° and moderate scoliosis was characterized by a Cobb angle between 21° and 35°.

Study participants were assessed before beginning rehabilitation and then again at 12 weeks after an exercise-based rehabilitation programme. Each evaluation consisted of spirometry (breathing) tests and functional capacity testing (6-minute walk test). Assessment of pulmonary function and the 6MWT were performed by the same investigator who was a specialist in physical medicine and rehabilitation. At each assessment, the participants were also assessed for back pain – an issue which is increasingly being recognised as a feature of Scoliosis.


Physical therapy

The patients performed a 12-week exercise programme that consisted of three sessions per week in the Outpatient Rehabilitation Department. The goals of the rehabilitation treatment were to improve awareness of body alignment, axial elongation, de-rotation and stabilization of the spine, increase chest expansion, and enhance exercise capacity. The exercise programme consisted of stretching exercises on the concave side of scoliosis, strengthening exercises on the convex side of scoliosis, and breathing exercises. Some specific exercises for core stabilization were performed, including spider (patients faced the wall, leaned forward and walked with fingers up the wall rising to their toes, and after full extension, walked with the fingers back down), pelvic tilt, cat-camel pose, and basic trunk curl (crunch) exercises using a ball (back extensions, opposite arm, and leg rise), and quadriceps strengthening exercises, which are important in increasing work capacity. Patients used rotational breathing respiratory exercises, such as contraction of convex areas of the trunk and directing inspired air in the concave areas. In each case, the specific core stabilization programme was established according to the individual spinal characteristics.

Patients with moderate scoliosis also had the indication to wear a corrective orthosis (Chêneau brace) for 20 hours per day



Overall, the study concluded that in the participants, pulmonary parameters and functional capacity were improved after 12 weeks of supervised physical therapy. Results from the spirometry tests, as well as the 6-minute walk test, showed improvement – although the authors did note that the study participants still lagged behind their non-scoliosis counterparts in terms of respiratory factors.

Also of interest, especially given other recent findings in this area, was that approximately three-quarters of the patients had back pain at the beginning of the study, whereas at the final evaluation, only 50% still had back pain.

Based on the results, the authors suggest treating scoliosis as soon as possible after diagnosis in a rehabilitation centre under medical qualified supervision. They also note that the Scientific Society on Scoliosis Orthopaedic and Rehabilitation Treatment currently recommends physiotherapeutic scoliosis-specific exercises as the first step for treating idiopathic scoliosis to prevent or limit the progression of the deformity and bracing and stress that Scoliosis-specific exercise programmes should also be designed by specifically trained therapists – further, they stress (as do we) that These programmes must be individualized and performed regularly throughout treatment.


[1]  Weinstein, SL, Dolan, LA, Spratt, KFet al. Health and function of patients with untreated idiopathic scoliosis: a 50-year natural history study. JAMA 2003; 289: 559–567.


[2]  Durmala, J, Tomalak, W, Kotwicki, T. Function of the respiratory system in patients with idiopathic scoliosis: reasons for impairment and methods of evaluation. Stud Health Technol Inform 2008; 135: 237–245.


[3] Koumbourlis, AC. Scoliosis and the respiratory system. Paediatr Respir Rev 2006; 7: 152–160.

[4] Elena Amăricăi et al. Respiratory function, functional capacity, and physical activity behaviours in children and adolescents with scoliosis. Journal of International Medical Research Volume: 48 issue: 4,

New research – Scoliosis impacts functional capacity

Tired out girl

Scoliosis can make exercise more difficult

Adolescent idiopathic scoliosis (AIS) is by far the most common cause of spinal deviation; it comprises about 80% of all idiopathic vertebral deformities and affects 2%–4% of adolescents.[1] The exact cause of AIS is still being investigated, but scientists generally agree that it is largely determined by genes that are activated by different factors.

When thinking about how we should direct the treatment of scoliosis, we often tend to focus on the well-known potential outcomes of the condition if left untreated- these include physical deformity, disability, pain and discomfort.  What we often forgotten is the impact that scoliosis can have in terms of overall health and fitness.

As it stands, research has already confirmed that that scoliosis influences factors like ease of breathing during exercise in a negative way[2] However, brand new research just published in the Journal of Paediatric exercise science now allows us to understand the degree to which cobb angle (the degree of the scoliotic curve) actually has an impact.

The research conducted at the Federal University of São Paulo in 2018, hypothesised that Individuals with scoliosis would have lower exercise tolerance in cardiopulmonary exercise testing (CPET) and in the incremental shuttle walk test (ISWT) – a suggestion which has already been confirmed in preceding studies.[3]  Researchers then sought to evaluate the functional capacity (that is to say, the ability of the participants bodies to cope with exercise) in patients with AIS with specific regard to the functional capacity and respiratory variables in patients with different degrees of scoliosis severity.



The study tested a cross section of participants with varying degrees of scoliosis severity. The group included eighteen patients with mild and moderate scoliosis, 8 patients with severe scoliosis, and 10 adolescents from a control group. Patients were selected from the Orthopaedic Clinic at a local hospital, and  they  were  submitted for radiography to evaluate the Cobb angles prior to the study.

In order to ensure the results were relevant and valid, patients were excluded if they had a previous or current history of heart, lung diseases or neuromuscular disorder, cognitive changes that influenced the understanding of tests, and all those who failed to perform the assessment proposed.



A 54 Degree Cobb angle (X-ray)

During the ISWT participants are asked to walk between two cones, placed 10 meters apart. Participants aim to match the pace provided by a simple beeping prompt. In this study, each of the partcipants performed the test twice, in order to try to ensure more even results.

Heart rate, blood pressure and fatigue were measured by modified Borg scale before and after the test[4]. The results of the study were conclusive. In the study, patients with AIS definitely performed worse than test subjects without scoliosis. Those with scoliosis found the test harder (more physically taxing) and also displayed a lower level of respiratory function. What’s more, the performance of the individuals with scoliosis was worse in individuals with a more severe cobb angle. Overall, patients with AIS walked shorter distance during the ISWT when compared with adolescents without scoliosis. Patients with  AIS > 45°  and  AIS < 45°  walked,  respectively, 156 m and 117 m less than the control group.

This study therefore identified that patients with severe scoliosis present worse functional capacity and, perhaps of greatest interest, it draws attention to the fact that even patients with mild and moderate scoliosis already show a significant reduction in functional capacity.


What we learn from this study.

At the UK scoliosis clinic, we are committed to ensuring that all our approach to treating scoliosis is always grounded in the most up to date scientific research available. From the results of the study there are two important take-aways.

In the first instance, the study goes to show the degree to which even a minor case of scoliosis (of the sort which may respond particularly well to bracing) may impact the quality of life and capability of an individual to participate in exercise – both for health-related purposes, and indeed as a social exercise. This is particularly interesting given that the authors of this study also noted a correlation between individuals with scoliosis and low exercise participation rates. Specifically the authors note “Adolescents with scoliosis for some reason are physically unconditioned; some authors believe that this fact is related only to the low adherence of individuals to physical activity, mainly due to the constraint of the disease deformity” .  This research therefore goes to underscore the importance of early intervention in dealing with cases of adolescent idiopathic scoliosis.

Secondly, this study (by its methodology) suggest that the ISWT can be a valuable tool for assessing functional capacity in patients with AIS. As a relatively low-cost but widely applicable test, the ISWT may therefore be worth further consideration within the scoliosis treatment community. Dr Irvine is keen to follow up on this insight and will be considering its possible applications within our clinic.


The main source article for this post was:

 SARAIVA, BA; et al. “Impact of Scoliosis Severity on Functional Capacity in Patients With Adolescent Idiopathic Scoliosis”. Pediatric Exercise Science. 30, 2, 243-250, May 2018



[1] Weinstein SL, Dolan LA, Cheng JCY, Danielsson A, Morcuende JA. Adolescent idiopathic scoliosis. Lancet. 2008;371:1527–37. PubMed doi:10.1016/S0140-6736 (08)60658-3


[2] Sperandio EF, Alexandre AS, Yi LC, et al. Functional aerobic exercise capacity limitation in adolescent idio- pathic scoliosis. Spine J. 2014;14(10):2366–72. PubMed doi:10.1016/j.spinee.2014.01.041


[3] Sperandio EF, Alexandre AS, Yi LC, et al. Functional aerobic exercise capacity limitation in adolescent idio- pathic scoliosis. Spine J. 2014;14(10):2366–72. PubMed doi:10.1016/j.spinee.2014.01.041


Sperandio EF, Vidotto MC, Alexandre AS, Yi LC, Gotfryd AO, Dourado VZ. Exercise capacity, lung function and chest wall shape in patients with adolescent idiopathic scoliosis. Fisioter Mov. 2015;28(3):563–72. doi:10.1590/0103-5150.028.003.AO15


Barrios C, Pérez-Encinas C, Maruenda JI, Laguía M. Significant ventilatory functional restriction in adoles- cents with mild or moderate scoliosis during maximal exercise tolerance test. Spine. 2005;30(14):1610–5. doi:10.1097/01.brs.0000169447.55556.01


Bas P, Romagnoli M, Gomez-Cabrera MC, et al. Beneficial effects of aerobic training in adolescent patients with mod- erate idiopathic scoliosis. Eur Spine J. 2011;20 Suppl 3: 415–9. PubMed doi:10.1007/s00586-011-1902-7


[4] Hommerding PX, Donadio MV, Paim TF, Marostica PJ. The Borg scale is accurate in children and adolescents older than 9 years with cystic fibrosis. Respir Care. 2010;55(6):729–33. PubMed