Background Research shows that China's primary and secondary school students scoliosis rate of 4.40%, the high incidence of age 13-15 years old, 79.5% of students with mild scoliosis, the number of incidence and the degree of scoliosis with the time of the annual trend, prevention and control of the situation is grim.
Objective To investigate the efficacy of 3-times-weekly proprioceptive neuromuscular facilitation (PNF) technique combined with spiral stabilizing muscle chain training (SPS) on adolescent idiopathic scoliosis (AIS), which can promote the high quality of adolescent spinal health management work and provide a reference to achieve multifaceted screening and monitoring and precise scoliosis prevention and control.
Methods The experiment was designed to screen 1 060 primary and middle school students in Nanjing from January to March 2024. A total of 32 AIS students aged 10 to 18 years with an angle of trunk rotation (ATR) of 5°to <10° were finally included as study subjects, and the students were randomly and equally grouped into the SPS, PNF, combined, and control groups of 8 students each based on electronic spinal measurements selected from previous subjects and surface electromyography measurements in Sorensen test. The 4 groups of students underwent a period of 12-week exercise intervention with 3 training sessions per week: the SPS group used only SPS, the PNF group used only PNF, the combined group used SPS combined with PNF, and the control group used traditional core stabilization training. The primary outcome measures will include the degree of scoliosis and the angle of trunk inclination angle (ATI), and the secondary outcome measures will include the body balance parameters of head deflection, shoulder height, hip height, and the surface electromyographic indices of root mean square (RMS), integrated electromyography (IEMG), median frequency (MF), and mean power frequency (MPF). Spine morphology and surface EMG indexes before and after the intervention were compared among the four groups, and correlation analysis was used to explore the correlation between electronic spine measurements and surface EMG values before and after the exercise intervention.
Results The results showed that Comparison of baseline age, BMI, type of column scoliosis, direction of scoliosis, site of scoliosis, degree of scoliosis, ATI, head deflection, shoulder height, hip height among the students in the 4 groups showed no statistically significant differences (P>0.05). The degree of scoliosis, ATI, head deflection, shoulder height of students in the combined group were lower than those in the control group after the intervention (P<0.05) ; compared with the pre-intervention period, the degree of scoliosis, ATI, head deflection, shoulder height, and hip height of the students in the SPS group, the PNF group, and the combined group were all lower after the intervention (P<0.05). The results of correlation analysis showed that ATI and RMS ratio (RMSR) before and after the intervention were positively correlated with the degree of scoliosis before and after the intervention (P<0.05) ; ATI after the intervention was positively correlated with head deflection, shoulder height after the intervention (P<0.05) ; and RMSR after the intervention was positively correlated with head deflection and hip height after the intervention (P<0.05). The RMS and IEMG of the trapezius muscle on both sides were higher than those of the PNF group and those of the multifidus muscle on both sides were higher than those of the control group in the combined group after the intervention (P<0.05) ; compared with the pre-intervention period, the RMS and IEMG of the trapezius, erector spinae, and multifidus muscles on both sides were higher after the intervention in the students of the SPS group, the PNF group, and the combined group, and the overall RMSR was lower after the intervention (P<0.05). Compared with pre-intervention, SlopeMF was elevated in both trapezius, erector spinae, and multifidus muscles in the SPS group and combined group of students after intervention; and in both trapezius, erector spinae, and left multifidus muscles in the PNF group of students after intervention (P<0.05). Compared with the pre-intervention period, SlopeMPF of the trapezius, erector spinae, and left multifidus muscles on both sides were elevated after intervention for students in the SPS, PNF, and combined groups; SlopeMPF of the right multifidus muscle was elevated after intervention for students in the SPS and combined groups (P<0.05). Shoulder height after intervention was negatively correlated with the RMS of both trapezius and right multifidus muscles, the SlopeMPF of left erector spinae muscle, and the SlopeMF of right multifidus muscle (P<0.05) ; hip height was negatively correlated with the RMS of both trapezius and both multifidus muscles (P<0.05) .
Conclusion Our findings suggest that ATI, body balance, and surface EMG values improved significantly in all test groups (SPS, PNF, and combined groups) after treatment, with the combined group showing a particularly strong treatment effect in shoulder and hip balance, and fatigue resistance of the paravertebral muscles on both sides of the joint group after treatment. The PNF combined with the SPS intervention can benefit AIS students through the activation of more muscle fibers for exercise and improved muscle fatigue.
