Adnan Apti

Bu mektup, Yürekli ve Şenel’in “Pilates egzersizlerinin omurga postür bozukluklarına etkisi” adlı derleme çalışmasına yönelik eleştirileri içermektedir. Yazarların Pilates egzersizlerinin omurga postür bozukluklarına etkisini incelemeyi amaçladıkları bu derleme yazısında önemli metodolojik problemler olduğu kanısındayız. Eleştiriler, çalışmada farklı yaş grupları ve tanılara sahip bireylerin aynı başlık altında ele alınmasının sonuçları genelleme açısından sorunlu hale getirdiği, skolyoza dair bazı bulguların derlemede yer almadığı ve skolyozun diğer postür bozukluklarından farklı olarak değerlendirilmesi gerektiği yönündedir. Ayrıca, Pilates’in kemiksel deformiteler ve skolyoz gibi durumlar için etkinliğine dair yeterli bilimsel kanıt bulunmadığı vurgulanmıştır. Bu nedenlerle, yazarlar derlemenin metodolojik eksiklikler içerdiğini ve yanıltıcı sonuçlar doğurabileceğini belirtmektedir.

Background/Objectives: The effectiveness of night braces alone or in combination with other treatments for adolescent idiopathic scoliosis remains unclear. This systematic review study aimed to review and analyze the available literature to determine whether night braces are an effective treatment for idiopathic scoliosis. Methods: A total of 162 databases, including Cochrane Library (reviews, protocols, trials), Web of Science, PubMed, Medline, Scopus, PEDro, CINAHL (EBSCO), Ovid and Google Scholar, were searched for published articles from inception to February 2024. The available literature was screened by the following terms: “scoliosis and night-time brace”, “scoliosis and night brace”, “scoliosis and part-time bracing”, “scoliosis and Providence” and “scoliosis and Charleston”. Results: Twenty studies were included; only one study was a randomized controlled trial, and most of the studies were retrospectively designed. Providence, Charleston and Boston braces were used as night braces. The Cobb angle was evaluated in all studies, and Cobb angle change after treatment and surgical treatment rates were the parameters that were evaluated the most. In one study, the angle of trunk rotation, quality of life, perception of spinal appearance, and physical activity level were measured. In one study, sagittal plane assessments were performed in addition to the Cobb angle. Conclusions: The results of this review suggest that there is no evidence to support the use of night braces in the treatment of adolescent idiopathic scoliosis. Randomized controlled trials with a well-designed methodology are needed to determine the efficacy of night braces.

(1) Background: Semi-hanging and muscle cylinder exercises have been defined as scoliosis-specific corrective exercises. The aim of this study was to evaluate the immediate effect of muscle cylinder and semi-hanging exercises on the angle of trunk rotation in patients with adolescent idiopathic scoliosis (AIS). (2) Methods: Twenty-seven patients with AIS with a mean age of 18.6 years were retrospectively analyzed. The angle of trunk rotation (ATR) values were measured before and after performing semi-hanging and standing muscle cylinder exercises. Both exercises were performed for three to five respiratory cycles. The semi-hanging exercise was performed first, followed by the muscle cylinder exercise, in this order, in all participants. For statistical analysis, the Wilcoxon signed-rank test was used to analyze ATR changes after the exercises, and the Kruskal–Wallis test was used to compare ATR changes according to the main curve location. (3) Results: The thoracic, thoracolumbar and lumbar maximum ATR values were significantly increased after the semi-hanging exercise (p < 0.001) and decreased after the muscle cylinder exercise (p < 0.001). The ATR change was greater in the lumbar region than in the thoracic and thoracolumbar regions. (4) Conclusion: The results of this study of a small group of patients emphasized that one of the scoliosis-specific corrective exercises, the standing muscle cylinder exercise, improved ATR, while the other, the semi-hanging exercise, worsened ATR in patients with AIS. It is recommended that each scoliosis-specific corrective exercise be evaluated and redesigned to maximize the three-dimensional corrective effect, considering the biomechanics of the spine and the pathomechanics of scoliosis.

Background: Increased femoral anteversion (IFA) causes functional problems (i.e., tripping, frequently falling, and fatigue) by affecting the pelvis and lower extremity biomechanics. In the frontal plane, increased contralateral pelvic drop and ipsilateral hip adduction, which are mainly considered deteriorated hip abductor muscle mechanisms, are associated with hip and knee injuries. Aims: The aim of this study was to examine the effects of femoral anteversion on hip abductor weakness and frontal plane pelvis–hip biomechanics during walking. Methods: The study included nine subjects with increased femoral anteversion and a control group of eleven subjects. Maximum isometric voluntary contraction (MIVC) values of the hip abductor muscles were measured with a handheld dynamometer. Three-dimensional gait analysis was performed for kinetic, kinematic, and temporo-spatial gait parameters. Non-parametric tests were used for statistical analysis (p < 0.05). Results: There was no significant difference found between the MIVC values of the IFA and control groups (p = 0.14). Moreover, no significant difference was determined between the ipsilateral peak hip adduction (p = 0.088) and contralateral pelvic drop (p = 0.149) in the stance phase. Additionally, there was no correlation between the peak hip adduction angle in the stance phase and normalized MIVC values in the IFA group (r = −0.198, p = 0.44), or in the control group (r = −0.174, p = 0.55). The deviations of pelvic rotation (p = 0.022), hip internal rotation (p = 0.003), and internal foot progression (p = 0.022), were found to be higher in the IFA group than in the controls. Conclusions: IFA may not be associated with hip abductor muscle weakness, and it may not lead to the hip adduction and pelvic depression that can be seen in hip abductor weakness. Increased pelvic rotation and internal hip rotation during walking might be considered as a compensation for the femoral head–acetabulum alignment mechanism in the frontal plane.

Background: Although the number of studies showing the efficacy of conservative treatment in adolescent idiopathic scoliosis has increased, studies with long-term follow-up are very limited. The aim of this study was to present the long-term effects of a conservative management method including exercise and brace in adolescent idiopathic scoliosis patients. Methods: This retrospective cohort study included patients with idiopathic scoliosis who presented at our department and were followed up for at least 2 years after completing the treatment. The main outcome measurements were the Cobb angle and angle of trunk rotation (ATR). Results: The cohort participants were 90.4% female, with a mean age of 11 years and the maximum Cobb angle was mean 32.1°. The mean post-treatment follow-up period was 27.8 months (range 24–71 months). The improvements after treatment in mean maximum Cobb angle (p < 0.001) and ATR (p = 0.001) were statistically significant. At the end of treatment, the maximum Cobb angle was improved in 88.1% of the patients and worsened in 11.9% compared to baseline. In the long-term follow-up evaluations, 83.3% of the curvatures remained stable. Conclusions: The results of this study showed that moderate idiopathic scoliosis in growing adolescents can be successfully halted with appropriate conservative treatment and that long-term improvement is largely maintained.