Skip to main content

Active self-correction and task-oriented exercises reduce spinal deformity and improve quality of life in subjects with mild adolescent idiopathic scoliosis. Results of a randomised controlled trial



To evaluate the effect of a programme of active self-correction and task-oriented exercises on spinal deformities and health-related quality of life (HRQL) in patients with mild adolescent idiopathic scoliosis (AIS) (Cobb angle <25°).


This was a parallel-group, randomised, superiority-controlled study in which 110 patients were randomly assigned to a rehabilitation programme consisting of active self-correction, task-oriented spinal exercises and education (experimental group, 55 subjects) or traditional spinal exercises (control group, 55 subjects). Before treatment, at the end of treatment (analysis at skeletal maturity), and 12 months later (follow-up), all of the patients underwent radiological deformity (Cobb angle), surface deformity (angle of trunk rotation) and HRQL evaluations (SRS-22 questionnaire). A linear mixed model for repeated measures was used for each outcome measure.


There were main effects of time (p < 0.001), group (p < 0.001) and time by group interaction (p < 0.001) on radiological deformity: training in the experimental group led to a significant improvement (decrease in Cobb angle of >5°), whereas the control group remained stable. Analysis of all of the secondary outcome measures revealed significant effects of time, group and time by group interaction in favour of the experimental group.


The programme of active self-correction and task-oriented exercises was superior to traditional exercises in reducing spinal deformities and enhancing the HRQL in patients with mild AIS. The effects lasted for at least 1 year after the intervention ended.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Fig. 3
Fig. 4


  1. 1.

    Asher MA, Burton DC (2006) Adolescent idiopathic scoliosis: natural history and long term treatment effects. Scoliosis 1:2

    PubMed Central  PubMed  Article  Google Scholar 

  2. 2.

    Weinstein SL, Dolan LA, Cheng JCY, Danielsson A, Morcuende JA (2008) Adolescent idiopathic scoliosis. Lancet 371:1527–1537

    PubMed  Article  Google Scholar 

  3. 3.

    Weinstein SL, Ponseti IV (1983) Curve progression in idiopathic scoliosis. J Bone Joint Surg Am 65:447–455

    CAS  PubMed  Google Scholar 

  4. 4.

    Ascani E, Bartolozzi P, Logroscino A, Marchetti PG, Ponte A, Savini R, Travaglini F, Binazzi R, Silvestre MDI (1996) Natural history of untreated idiopathic scoliosis after skeletal maturity. Spine 11:784–789

    Article  Google Scholar 

  5. 5.

    Tan KJ, Moe MM, Vaithinathan R, Wong HK (2009) Curve progression in idiopathic scoliosis. Follow-up study to skeletal maturity. Spine 34(7):697–700

    PubMed  Article  Google Scholar 

  6. 6.

    Goldberg MS, Mayo NE, Poitras B, Scott S, Hanley J (1994) The Ste-Justine adolescent idiopathic scoliosis cohort study: Part II: Perception of health, self and body image, and participation in physical activities. Spine 19:1562–1572

    CAS  PubMed  Article  Google Scholar 

  7. 7.

    Nachemson AL, Peterson LE (1995) Effectiveness of treatment with a brace in girls who have adolescent idiopathic scoliosis. A prospective, controlled study based on data from the Brace Study of the Scoliosis Research Society. J Bone Joint Surg Am 77(6):815–822

    CAS  PubMed  Google Scholar 

  8. 8.

    Wong MS, Cheng JC, Lam TP, Ng BK, Sin SW, Lee-Shum SL, Chow DH, Tam SY (2008) The effect of rigid versus flexible spinal orthosis on the clinical efficacy and acceptance of the patients with adolescent idiopathic scoliosis. Spine 33(12):1360–1365

    PubMed  Article  Google Scholar 

  9. 9.

    Mordecai SC, Dabke HV (2012) Efficacy of exercise therapy for the treatment of adolescent idiopathic scoliosis: a review of the literature. Eur Spine J 21:382–389

    PubMed Central  PubMed  Article  Google Scholar 

  10. 10.

    Weinstein SL, Dolan LA, Wright JG, Dobbs MB (2013) Effects of bracing in adolescents with idiopathic scoliosis. N Engl J Med 369(16):1512–1521

    CAS  PubMed Central  PubMed  Article  Google Scholar 

  11. 11.

    Negrini S, Zaina F, Romano M, Negrini A, Parzini S (2008) Specific exercises reduce brace prescription in adolescent idiopathic scoliosis: a prospective controlled cohort study with worst-case analysis. J Rehabil Med 40(6):451–455

    PubMed  Article  Google Scholar 

  12. 12.

    Diab AA (2012) The role of forward head correction in management of adolescent idiopathic scoliotic patients: a randomized controlled trial. Clin Rehabil 26(12):1123–1132

    PubMed  Article  Google Scholar 

  13. 13.

    El-Sayyad M, Conine TA (1994) Effect of exercise, bracing and electrical surface stimulation on idiopathic scoliosis: a preliminary study. Int J Rehabil Res 17(1):70–74

    CAS  PubMed  Article  Google Scholar 

  14. 14.

    Mamyama T, Kitagawal T, Takeshita K, Nakainura K (2002) Side shift exercise for idiopathic scoliosis after skeletal maturity. Stud Health Technol Inform 91:361–364

    PubMed  Google Scholar 

  15. 15.

    Durmala J, Dobosiewicz K, Kotwicki T, Jendrzejek H (2003) Influence of asymmetric mobilisation of the trunk on the Cobb angle and rotation in idiopathic scoliosis in children and adolescents. Ortop Traumatol Rehab 5(1):80–85

    Google Scholar 

  16. 16.

    McIntire KL, Asher MA, Burton DC, Liu W (2008) Treatment of adolescent idiopathic scoliosis with quantified trunk rotational strength training: a pilot study. J Spinal Disord Tech 21(5):349–358

    PubMed  Article  Google Scholar 

  17. 17.

    Mooney V, Brigham A (2003) The role of measured resistance exercises in adolescent scoliosis. Orthopedics 26(2):167–171

    PubMed  Google Scholar 

  18. 18.

    Wan L, G-x Wang, Bian R (2005) Exercise therapy in treatment of essential S-shaped scoliosis: evaluation of Cobb angle in breast and lumbar segment through a follow-up of half a year. Zhongguo Linchuang Kangfu 9:82–84

    Google Scholar 

  19. 19.

    Weiss HR, Lohschmidt K, el-Obeidi N, Verres C (1997) Preliminary results and worst-case analysis of in patient scoliosis rehabilitation. Pediatr Rehabil 1(1):35–40

    CAS  PubMed  Google Scholar 

  20. 20.

    Weiss HR, Weiss G, Petermann F (2003) Incidence of curvature progression in idiopathic scoliosis patients treated with scoliosis in-patient rehabilitation (SIR): an age- and sex-matched controlled study. Pediatr Rehabil 6(1):23–30

    PubMed  Google Scholar 

  21. 21.

    Otman S, Kose N, Yakut Y (2005) The efficacy of Schroth’s 3-dimensional exercise therapy in the treatment of adolescent idiopathic scoliosis in Turkey. Saudi Med J 26(9):1429–1435

    PubMed  Google Scholar 

  22. 22.

    Weiss HR, Klein R (2006) Improving excellence in scoliosis rehabilitation: a controlled study of matched pairs. Pediatr Rehabil 9(3):190–200

    PubMed  Google Scholar 

  23. 23.

    Morley S (2011) Efficacy and effectiveness of cognitive behaviour therapy for chronic pain: progress and some challenges. Pain 152:S99–S106

    PubMed  Article  Google Scholar 

  24. 24.

    Matthews JNS (2006) Methods of allocation. In: Introduction to randomized controlled clinical trials, 2nd edn. Chapman and Hall/CRC, New York, pp 43–64

  25. 25.

    Morrissy RT, Goldsmith GS, Hall EC, Kehl D, Cowie GH (1990) Measurement of the Cobb angle on radiographs of patients who have scoliosis. Evaluation of intrinsic error. J Bone Joint Surg Am 72(3):320–327

    CAS  PubMed  Google Scholar 

  26. 26.

    Shea KG, Stevens PM, Nelson M, Smith JT, Masters KS, Yandow S (1998) A comparison of manual versus computer-assisted radiographic measurement. Intraobserver measurement variability for Cobb angles. Spine 23(5):551–555

    CAS  PubMed  Article  Google Scholar 

  27. 27.

    Tanure MC, Pinheiro AP, Oliveira AS (2010) Reliability assessment of Cobb angle measurements using manual and digital methods. Spine J 30(10):769–774

    Article  Google Scholar 

  28. 28.

    Ponseti IV, Friedman B (1950) Prognosis in idiopathic scoliosis. J Bone Joint Surg Am 32A(2):381–395

    CAS  PubMed  Google Scholar 

  29. 29.

    Bunnell WP (1984) An objective criterion for scoliosis screening. J Bone Joint Surg Am 66(9):1381–1387

    CAS  PubMed  Google Scholar 

  30. 30.

    Bunnell WP (1993) Outcome of spinal screening. Spine 18(12):1572–1580

    CAS  PubMed  Article  Google Scholar 

  31. 31.

    Asher MA, Lai SM, Burton DB et al (2003) The reliability and concurrent validity of the SRS-22 Patient Questionnaire for idiopathic scoliosis. Spine (Phila Pa 1976) 28:63–69

    Article  Google Scholar 

  32. 32.

    Monticone M, Baiardi P, Calabrò D, Calabrò F, Foti C (2010) Development of the Italian version of the revised Scoliosis Research Society-22 Patient Questionnaire, SRS-22r-I. Cross-cultural adaptation, factor analysis, reliability and validity. Spine (Phila Pa 1976) 35(24):E1412–E1417

    Article  Google Scholar 

  33. 33.

    Fielding S, Fayers P, Ramsay CR (2012) Analysing randomised controlled trials with missing data: choice of approach affects conclusions. Contemp Clin Trials 33(3):461–469

    PubMed  Article  Google Scholar 

  34. 34.

    Siddiqui O, Hung HMJ, O’Neill R (2009) MMRM vs. LOCF: a comprehensive comparison based on simulation study and 25 NDA datasets. J Biopharm Stat 19(2):227–246

    PubMed  Article  Google Scholar 

  35. 35.

    Lonstein JE, Carlson JM (1984) The prediction of curve progression in untreated idiopathic scoliosis during growth. J Bone Joint Surg Am 66(7):1061–1071

    CAS  PubMed  Google Scholar 

  36. 36.

    Burton AK, Balagué F, Cardon G, Eriksen HR, Henrotin Y, Lahad A, Leclerc A, Müller G, van der Beek AJ, COST B13 Working Group on Guidelines for Prevention in Low Back Pain (2006) Chapter 2. European guidelines for prevention in low back pain: November 2004. Eur Spine J 15(2):S136–S168

    PubMed Central  PubMed  Article  Google Scholar 

  37. 37.

    de Jong JR, Vlaeyen JWS, Onghena P et al (2005) Fear of movement/(re)injury in chronic low back pain. Education or exposure in vivo as mediator to fear reduction? Clin J Pain 21:9–17

    PubMed  Article  Google Scholar 

Download references


The authors would like to thank Kevin Smart for his help in preparing the English version of this paper.

Conflict of interest


Author information



Corresponding author

Correspondence to Marco Monticone.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Monticone, M., Ambrosini, E., Cazzaniga, D. et al. Active self-correction and task-oriented exercises reduce spinal deformity and improve quality of life in subjects with mild adolescent idiopathic scoliosis. Results of a randomised controlled trial. Eur Spine J 23, 1204–1214 (2014).

Download citation


  • Adolescent idiopathic scoliosis
  • Rehabilitation
  • Self-correction
  • Task-oriented exercises
  • Education