EFFECT OF THERAPEUTIC EXERCISE ON SPINAL CURVATURE IN IDIOPATHIC SCOLIOSIS: A SYSTEMATIC REVIEW. Cindy Cole; Delinda S. Floyd; Tom Sneed* PT, Southwest Baptist University, Bolivar, MO PURPOSE: The purpose of this poster was to systematically review the literature for research studies that addressed the effect of therapeutic exercise on subjects with idiopathic scoliosis. A second purpose was to identify the specific exercises or exercise principles and approach being utilized in the rehabilitation of idiopathic scoliosis subjects for use in future research studies. BACKGROUNDS/SIGNIFICANCE: The diagnosis of idiopathic scoliosis is made by eliminating all other causes of a lateral curvature of the spine. Once a diagnosis of idiopathic scoliosis is made, current standard of care measures that follow include observation of curves less than 20 degrees, bracing for curves with a 5 degree progression to curve beyond 20-25 degrees, and surgery for curvatures beyond 40 degrees. The mainstays of intervention for idiopathic scoliosis have been bracing and surgery. The intervention of therapeutic exercise was not mentioned as a treatment option in the standard of care for the natural history and progression of the disease. Hawes and Weiss argue that there is a long-standing bias in the English language medical and scientific literature against the use of exercise in the treatment of scoliosis. Hawes goes on to point out that such organizations as the American Physical Therapy Association and National Institute of Arthritis and Musculoskeletal and Skin Diseases state that exercises are not a treatment, do not prevent or cure scoliosis, and will not stop progressive curves. There has been a recent effort by the International Research Society of Spinal Deformities (IRSSD) to counter this anti-exercise approach to the treatment of idiopathic scoliosis. Several individuals in this group contributed to a special publication focusing on conservative treatment of scoliosis including therapeutic exercise. In doing so, this group essentially put out a challenge to develop more research in the area of the beneficial effects of exercise on idiopathic scoliosis. SUBJECTS: Nine articles met specific criteria to be included in this systematic review. METHODS AND MATERIALS: A search of MEDLINE and the Cumulative Index of Nursing and Allied Health Literature (CINAHL) databases was performed in June 2004. The search for articles was restricted to those published in English utilizing the key word idiopathic scoliosis in combination with key words physical therapy, physiotherapy, therapy, exercise, therapeutic exercise, physical exercise, exercise therapy, strength training, resistance training, exercise program, rehabilitation, rehabilitation exercise, exercise and curve reduction, and exercise and curve progression. No date restrictions were placed on the searches. All titles and available abstracts were reviewed to identify articles/studies involving exercise and idiopathic scoliosis subjects. Reference lists from the identified articles were hand searched for any additional studies that might meet the inclusion criteria. ANALYSES: Inclusion criteria consisted of studies using subjects with a specific diagnosis of idiopathic scoliosis, subjects of juvenile, adolescent or adult age, addressing exercise as an intervention for curve correction, and be found in any kind of rehab setting. Each study meeting the above criteria was assessed for study design, number of subjects, male and female, age range of subjects, curve severity range, curve type, method of curve measurement, type of exercise intervention, length of follow-up, and outcome or effect of exercise. RESULTS: The results of the search strategy yielded 23 articles to review that met the established inclusion criteria. Based on the review of inclusion criteria, 2 articles were eliminated for addressing exercise with spinal mobilization/manipulation, 9 articles were eliminated for addressing exercise in bracing, and 2 articles were eliminated for addressing exercise for vital capacity and chest expansion. It should be noted that the authors failed to pull several articles in the title and abstract reviews that were obviously related to vital capacity or chest wall expansion using cardiopulmonary exercises. The final 10 articles were further reduced to 9 with one study being eliminated because the study only addressed measurement of muscle strength symmetry. The articles selected were then abstracted by the authors for assessment information by dividing the articles equally among the authors. Each author reported their assessment findings of their assigned articles for agreement of the other authors. The identified articles and results of the assessed information from the articles are summarized in a Article Assessment/Evidence Table. In all of the reviewed studies, more subjects showed a decrease or stabilization in curvature than a progression. There is some evidence postural correction exercise alone has a beneficial effect as does rotational and extension strengthening exercise alone. The positive effect of decreased or stabilization of curves appears to occur most during the age range when subjects are at the highest risk for curve progression. There was no consistent exercise program or approach among the studies. Exercise approaches took the form of strengthening, stretching, or posture correction/motor control. CONCLUSIONS: Based on the review of these studies, evidence supports that therapeutic exercise does have a positive effect on spinal curvature. The International Research Society of Spinal Deformities efforts to explore the effects of therapeutic exercise has raised questions that require more research to discover the effect of exercise on spinal curvature. Future research should focus on subjects that have the most potential to responding to therapeutic exercise such as subjects with curves under 20 degrees, that are in the observation stage which could lead to development of a more effective and uniform exercise program. FUNDING SOURCE: None KEYWORDS: physical therapy, strength training, rehabilitation, therapeutic exercise, idiopathic scoliosis Copyright 2009 by the American Physical Therapy Association. Requests for reprints should be directed to the corresponding author of the article. Educators, students, and other academic customers may receive permission to reprint copyrighted material from Physical Therapy (ISSN 1538-6724) by contacting the Copyright Clearance Center Inc, 222 Rosewood Dr, Danvers, MA 01923. 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