Hyperkyphosis, AdolescentNCT06907914
Schroth and Scapular Muscle Activation in Hyperkyphosis
A study testing Schroth in people with Hyperkyphosis, Adolescent and Muscle Activation, run by Istanbul University - Cerrahpasa at 1 site in Turkey (Türkiye).
Trial summary
This randomized controlled trial aims to investigate the effects of Schroth exercises on scapular muscle activation in children with thoracic hyperkyphosis. A total of 56 participants will be randomly assigned to either the Schroth exercise group or the control group receiving postural education. Read more about this study
- Who is it for?
- Ages 7 to 18 years
- Conditions the study is for
- Hyperkyphosis, Adolescent, Muscle Activation, Scapula; Deformity, Acquired
- What is being tested?
- Schroth
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 56 participants
- Where
- 1 siteTurkey (Türkiye)
- Study dates
- 15 Jun 2025to 1 Aug 2026
- Phase
- Interventional
- Are there results?
- Not yet: the study is under way
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 7 to 18 years
- All sexes
- No healthy volunteers
- Child, Adult
Who may be able to join
- Thoracic kyphosis angle (Cobb) between ≥40° and <70° on lateral radiographs
- Aged 7-18 years
- Risser stage 0-5, indicating ongoing skeletal development
Who cannot join
- 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
Show all 14Show fewer
- 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
Trial locations and contacts
1 site in 1 country. Contact the study team or a site near you to ask about taking part.
Turgut Akgül, Prof contact
Turkey (Türkiye)1 site, 1 recruiting
- Recruiting
Istanbul University-Cerrahpasa
Istanbul, Istanbul
Ayşe Zengin Alpozgen, Assoc. Prof., 05526830479, azengin@iuc.edu.tr
Kübra Kardeş, Asst. Prof
About this study
Official title: The Effect of Schroth Exercises on Scapular Muscle Activation in Children With Thoracic Hyperkyphosis
This randomized controlled trial aims to investigate the effects of Schroth exercises on scapular muscle activation in children with thoracic hyperkyphosis. A total of 56 participants will be randomly assigned to either the Schroth exercise group or the control group receiving postural education. The intervention group will complete an 8-week supervised Schroth program focusing on three-dimensional correction, rotational breathing, and postural awareness. Primary outcome is scapular muscle activation measured by surface EMG. Secondary outcomes include muscle strength, scapular endurance, kyphotic appearance, posture, and pain. The results will guide clinical management and preventive strategies for children with postural thoracic hyperkyphosis.
Read the detailed description
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.
- Conditions
- Hyperkyphosis, Adolescent, Muscle Activation, Scapula; Deformity, Acquired, Exercise Therapy
- Being tested
- Schroth
- Keywords
- Spine, Schroth, sEMG, Physiotehrapy, Scapula, Thoracic Hyperkyphosis
- Medical subject headings
- Scheuermann Disease, Congenital Abnormalities
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
SchrothOther
The Schroth intervention consists of a structured, three-dimensional exercise program based on scoliosis-specific principles. It incorporates corrective postural alignment, rotational breathing techniques, and targeted activation of spinal and scapular stabilizing muscles. The exercises are designed to improve postural control, enhance muscle endurance, and promote neuromuscular re-education for better functional alignment during daily activities.
| Study group | Role | What they receive |
|---|---|---|
| Group A | Experimental | Participants in the experimental group will undergo a supervised 3D Schroth-based exercise program with postural education. The intervention will be applied 3 times per week for 8 weeks, totaling 24 sessions, each lasting approximately 45 minutes, delivered in-person by a trained physiotherapist.
Exercises will include corrective postural training, scapular stabilization, rotational breathing, and static stretching. The program is delivered in two progressive phases:
Weeks 1-4: Postural awareness and basic muscle activation
Weeks 5-8: Functional integration and advanced stabilization
Progression criteria are based on repetitions: exercises begin at 9 reps × 3 sets, and progress to 15 reps × 3 sets. Static stretches start with 20 seconds × 2 sets and are increased to 3 sets before progressing. All exercises are individualized based on clinical assessment. Receives: Other: Schroth |
| Group B | No intervention | The control group will receive a single, standardized session of postural education at the beginning of the study, during which general information about correct posture, ergonomic principles, and spinal health will be provided. Following this session, participants in the control group will be placed on a waiting list and monitored for a period of 8 weeks. During this time, they will not receive any specific exercise intervention or additional therapeutic program related to posture or muscle strengthening. Regular follow-up will be conducted to ensure participant safety and to monitor any changes or adverse events throughout the waiting period. |
What is being measured
The primary outcome is the main question the study is designed to answer.
Muscle Activation (sEMG)
Surface electromyography (sEMG) will assess the activation of the upper, middle, lower trapezius, and serratus anterior muscles, following SENIAM protocols. Signals will be normalized to %MVC and analyzed for concentric, isometric, and eccentric phases using RMS methods with a 20 Hz high-pass filter.
Measured: 8 weeks
Secondary outcomes (7)
Muscle Strength
Scapular stabilizing muscle strength will be measured using a handheld dynamometer (Lafayette Instrument). Higher force values (in Newtons) indicate greater muscle strength and improved functional capacity of the scapular muscles. An increase in the score reflects muscle strength gains, while a decrease indicates weakness or functional decline.
Measured: 8 weeks
Scapular Muscle Endurance Test
Scapular muscle endurance will be evaluated using the Scapular Muscle Endurance Test, which measures the duration (in seconds) that scapular muscles can sustain an isometric contraction. A higher score indicates better endurance capacity, while a lower score reflects fatigue or reduced muscle endurance.
Measured: 8 weeks
Kyphosis-Specific Spinal Appearance Questionnaire
The Kyphosis-Specific Spinal Appearance Questionnaire is a 10-item, 5-point Likert scale (range: 1 to 5 per item, total score range: 10 to 50) designed to assess patients' perception of their spinal appearance related to thoracic hyperkyphosis. Higher scores indicate worse perceived deformity and greater concern about appearance.
Measured: 8 weeks
PostureScreen Mobile Application
Provides objective measurements of postural deviations. Improvements are indicated by reductions in deviation angles or distances.
Measured: 8 weeks
Postural Habits and Awareness Scale
The Postural Habits and Awareness Scale consists of 19 items, each scored on a 5-point Likert scale (total score range: 19 to 95). Higher scores indicate better postural habits and awareness.
Measured: 8 weeks
Numeric Rating Scale (NRS)
Pain intensity will be measured using the Numeric Rating Scale (NRS) during rest, physical activity, and at night. The scale ranges from 0 (no pain) to 10 (worst possible pain). A decrease in NRS scores indicates pain relief, while an increase signifies worsening pain.
Measured: 8 weeks
Global Rating of Change (GROC) scale
Participant satisfaction with the intervention will be assessed using the Global Rating of Change (GROC) scale. The GROC is an 7-point scale ranging from -3 (very much worse) to +3 (completely recovered), with 0 indicating no change. Positive scores indicate perceived improvement, zero represents no change, and negative scores indicate worsening of symptoms or dissatisfaction with the treatment.
Measured: 8 weeks
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted2 Apr 2025
- Study start15 Jun 2025
- Primary completion1 May 2026 (estimated)
- Study completion1 Aug 2026 (estimated)
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Other trials for Hyperkyphosis, AdolescentStudies of the same condition, open and under way.
- More trials run by Istanbul University - CerrahpasaThe sponsor's other registered studies.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase N/A
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Model description
- Participants will be randomly assigned to one of two parallel groups: the intervention group receiving Schroth exercises combined with postural education, and the control group receiving only postural education while placed on a waiting list. Both groups will be evaluated at baseline and after the 8-week intervention period
- Masking
- Double blind
- Who is masked
- Investigator, Outcomes assessor
- Enrolment
- 56 participants (estimated)
Sponsor and investigators
- Lead sponsor
- Istanbul University - Cerrahpasa
- Sponsor type
- University, hospital or other
- Responsible party
- Principal investigator, Ayse Zengin Alpozgen, Istanbul University - Cerrahpasa
- Investigators
- Ayşe Zengin Alpözgen, Assoc Prof., Principal investigator, Istanbul University - Cerrahpasa
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT06907914
- Sponsor's protocol ID
- aza_isu2
- Status last verified
- Apr 2025
- First submitted
- 26 Mar 2025
- Last updated
- 1 Oct 2025
- Results posted
- No
- Data monitoring committee
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
Study at a glance
From the registry record, last updated by the sponsor on 1 Oct 2025. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- The Effect of Schroth Exercises on Scapular Muscle Activation in Children With Thoracic Hyperkyphosis
- ClinicalTrials.gov ID
- NCT06907914
- Acronym / sponsor ID
- aza_isu2
- Conditions
- Hyperkyphosis, Adolescent, Muscle Activation, Scapula; Deformity, Acquired, Exercise Therapy
- Keywords
- Spine, Schroth, sEMG, Physiotehrapy, Scapula, Thoracic Hyperkyphosis
- Study type
- Interventional
- Recruitment status
- Recruiting
- Enrolment
- 56 participants (estimated)
- Lead sponsor
- Istanbul University - CerrahpasaUniversity, hospital or other
- Study start
- 15 Jun 2025 (actual)
- Primary completion
- 1 May 2026 (estimated)
- Study completion
- 1 Aug 2026 (estimated)
- First posted
- 2 Apr 2025 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
This randomized controlled trial aims to investigate the effects of Schroth exercises on scapular muscle activation in children with thoracic hyperkyphosis. A total of 56 participants will be randomly assigned to either the Schroth exercise group or the control group receiving postural education. The intervention group will complete an 8-week supervised Schroth program focusing on three-dimensional correction, rotational breathing, and postural awareness. Primary outcome is scapular muscle activation measured by surface EMG. Secondary outcomes include muscle strength, scapular endurance, kyphotic appearance, posture, and pain. The results will guide clinical management and preventive strategies for children with postural thoracic hyperkyphosis.
Detailed description
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.
Study design
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Double blind (investigator, outcomes assessor)
- Number of arms
- 2
- Model description
- Participants will be randomly assigned to one of two parallel groups: the intervention group receiving Schroth exercises combined with postural education, and the control group receiving only postural education while placed on a waiting list. Both groups will be evaluated at baseline and after the 8-week intervention period
| Arm | Type | Receives |
|---|---|---|
| Group A | Experimental | Other: SchrothParticipants in the experimental group will undergo a supervised 3D Schroth-based exercise program with postural education. The intervention will be applied 3 times per week for 8 weeks, totaling 24 sessions, each lasting approximately 45 minutes, delivered in-person by a trained physiotherapist. Exercises will include corrective postural training, scapular stabilization, rotational breathing, and static stretching. The program is delivered in two progressive phases: Weeks 1-4: Postural awareness and basic muscle activation Weeks 5-8: Functional integration and advanced stabilization Progression criteria are based on repetitions: exercises begin at 9 reps × 3 sets, and progress to 15 reps × 3 sets. Static stretches start with 20 seconds × 2 sets and are increased to 3 sets before progressing. All exercises are individualized based on clinical assessment. |
| Group B | No intervention | –The control group will receive a single, standardized session of postural education at the beginning of the study, during which general information about correct posture, ergonomic principles, and spinal health will be provided. Following this session, participants in the control group will be placed on a waiting list and monitored for a period of 8 weeks. During this time, they will not receive any specific exercise intervention or additional therapeutic program related to posture or muscle strengthening. Regular follow-up will be conducted to ensure participant safety and to monitor any changes or adverse events throughout the waiting period. |
Who may qualify
- Ages
- 7 to 18 years
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Child, Adult
Key inclusion criteria (3 listed)
- Thoracic kyphosis angle (Cobb) between ≥40° and <70° on lateral radiographs
- Aged 7-18 years
- Risser stage 0-5, indicating ongoing skeletal development
Key exclusion criteria (14 listed)
- 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
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| SchrothThe Schroth intervention consists of a structured, three-dimensional exercise program based on scoliosis-specific principles. It incorporates corrective postural alignment, rotational breathing techniques, and targeted activation of spinal and scapular stabilizing muscles. The exercises are designed to improve postural control, enhance muscle endurance, and promote neuromuscular re-education for better functional alignment during daily activities. | Other | Group A |
Primary outcome
Muscle Activation (sEMG)
Time frame: 8 weeks
Surface electromyography (sEMG) will assess the activation of the upper, middle, lower trapezius, and serratus anterior muscles, following SENIAM protocols. Signals will be normalized to %MVC and analyzed for concentric, isometric, and eccentric phases using RMS methods with a 20 Hz high-pass filter.
7 secondary outcomes
Muscle Strength
Time frame: 8 weeks
Scapular Muscle Endurance Test
Time frame: 8 weeks
Kyphosis-Specific Spinal Appearance Questionnaire
Time frame: 8 weeks
PostureScreen Mobile Application
Time frame: 8 weeks
Postural Habits and Awareness Scale
Time frame: 8 weeks
Numeric Rating Scale (NRS)
Time frame: 8 weeks
Global Rating of Change (GROC) scale
Time frame: 8 weeks
Results and safety
This study is still under way. Results are not available in the source record yet.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 1 Oct 2025.
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part.
Turgut Akgül, Prof contact
Ayşe Zengin Alpözgen, Assoc Prof. principal investigator
Istanbul University - Cerrahpasa
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing Schroth in people with Hyperkyphosis, Adolescent and Muscle Activation, run by Istanbul University - Cerrahpasa at 1 site in Turkey (Türkiye).
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 3 inclusion and 14 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: looking for participants now, as of the sponsor's last update on 1 Oct 2025. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in Turkey (Türkiye). Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
This study is still under way. Results are not available in the source record yet.
How can a doctor refer a patient or contact the research team?
Contact Kübra Kardeş, PhD (905387115631, kubra.koce@istinye.edu.tr), or a site near the patient. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Muscle Activation (sEMG) (time frame: 8 weeks). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 1 Oct 2025.