scoliosis refers to a 3-dimensional deformation of the natural bending of the spine1 . in the clinical setting , the cobb s angle 
 analysis method , which is a valid analysis of the size of the lateral bending through 
 radiographic methods , is generally used2 . minor scoliosis with less than a 20 cobb s angle requires periodic observation , and 
 scoliosis with a cobb s angle of 2040 requires the wearing of an orthosis to prevent 
 progress . if the cobb s angle is greater than 40 , it indicates the need of surgery3 . if scoliosis is detected and treated early , 
 most patients do not need surgical treatment4 ; in some cases , surgical treatment may have poorer results5 . the orthosis treatment , which is the first 
 stage of scoliosis treatment , can cause spondylosis and loss of the surrounding muscles6 . if this limitation of normal movement 
 occurs in growing adolescents , it could cause undesirable results7 . scoliosis causes deformations of the spinal column and 
 structures8 , decreases in spinal 
 flexibility by changing the characteristics of the erector spinae muscle9 , and leads to imbalances of the trunk and 
 pelvis depending on the shape and angle of the scoliosis10 . furthermore , it has been reported that correction and respiratory 
 treatment are essential because of the bending of the thoracic cage , which weakens the 
 respiratory muscle and lowers cardiopulmonary function11 . the treatment effects of the schroth therapy , a recent therapeutic 
 exercise , have been reported14 , 15 . often referred to as a 3-dimensional therapy , the schroth 
 exercise improves the trunk shape and respiratory ability by applying  rotational 
 breathing16 , and it has been reported 
 to improve the function of the thoracic wall and the symptoms of the respiratory system17 . many studies have investigated the 
 improvement effects of the schroth exercise on cobb s angle and vital capacity in scoliosis 
 patients , but most studies were on patients whose cobb s angle was smaller than 30 or the 
 studies combined the schroth exercise with orthosis treatment . studies on subjects with a 
 40 or higher cobb s angle who require surgery are still insufficient . therefore , this study 
 investigated the effects of the schroth exercise therapy in patients with scoliosis as a 
 surgical indication for the improvement of their cobb s angle and vital capacity . the subjects in this study were 5 female students among patients with thoracic scoliosis 
 whose cobb s angle was greater than 40 and whose risser sign was stage 3 or higher treated 
 at n hospital in daegu , south korea ( table 
 1table 1.general characteristics of the subjectsn=10 ( female : 6)age ( years)22.601.83height ( cm)167.007.45weight ( kg)63.8012.01cobb s angle ( )17.030.54risser sign ( phase)3.231.04meansd : meanstandard deviation ) . every subject was explained the purpose of this study and the exercise 
 method and voluntarily signed the informed consent form before participating in this 
 experiment , according to the ethical standards of the declaration of helsinki . we excluded 
 individuals who had neurological findings or an operation , who recently received surgical 
 treatment , who wore an orthosis , or who were periodically taking medicine from our study . subjects performed the schroth exercise 3 times a week for 12 weeks . each 60-minute session 
 consisted of preparation ( cat walking and breathing exercise : 10  min ) , stretching 
 ( stretching the chest part : 5  min ) , the main exercise ( laying right click concave , laying 
 aside static postural control training , sitting posture adjustment exercise , and muscle 
 cylinder : 40  min ) , and wrap - up ( moving ribs : 5  min ) . we applied the schroth exercise in 
 accordance with the bending shape of each subject , along with 3-dimensional schroth 
 rotational breathing18 . we measured 
 cobb s angle , with the patient standing straight , using a radiography apparatus ( cr 85-x , 
 usa ) . the trunk rotation angle was measured through the adam s forward bending test using a 
 scoliometer ( osi , usa ) . the vital capacity was measured 3 times after 3 or more breathing 
 exercises in a 90 sitting position using cardiotouch 3000s ( bionet , korea ) ; we recorded the 
 average values . to compare the changes in cobb s angle , thoracic trunk rotation angle , and 
 vital capacity after the schroth exercise , we analyzed the data using spss 18.0 . we used a 
 1-sample paired t - test with a significance level of p < 0.05 . the patients in our study had a thoracic trunk rotation angle decrease from 11.86  3.32 
 to 4.90  1.91 on average , cobb s angle decrease from 42.40  7.86 to 26.00  3.65 on 
 average , and vital capacity increase from 2.83  1.23 l to 4.04  1.67 l on average . all 
 these effects were statistically significant ( p < 0.05 ; table 2table 2.pre- and post - intervention comparisons ( unit : ratio)pre - testpost - testtrunk rotation angle ( )11.863.324.901.91cobb s angle ( )42.407.8626.003.65vital capacity ( l ) 2.831.234.041.67meanse , * significant difference from pre - test , p<0.05 ) . in this study , to examine the effects of the schroth exercise on cobb s angle , thoracic 
 trunk rotation angle , and vital capacity of patients with scoliosis as a surgical 
 indication , the subjects performed the schroth exercise 3 times a week for 12 weeks . the schroth exercise has the advantage of correcting the posture according to the bending 
 type and is an effective mechanism to facilitate the correction of posture in the 3 
 dimensions of scoliosis19 . the schroth 
 3-dimensional rotational breathing exercise induces significant increases in rib movements 
 and vital capacity and induces a significant increase in the sagittal breathing exercise for 
 the improvement of flat back20 . furthermore , the schroth 3-dimensional exercise approach has been proven to decrease the 
 progress of idiopathic scoliosis , improve cobb s angle and resolve pain21 , 22 , and reduce the 
 prescription of orthosis23 . borysov et 
 al . measured cobb s angle with a scoliometer after applying the schroth exercise , which 
 significantly decreased from 8.9 to 6.524 . reported that the schroth exercise showed significant 
 effects not only on cobb s angle but also on vital capacity15 . after the schroth exercise , pain due to scoliosis resolved or 
 improved in 85% of the patients , which helped enhance their quality of life25 , and the vital capacity increased in 
 roughly 95% of the patients . the vital capacity increased by at least 600  ml in 22% of the 
 patients after 6 weeks and by 800  ml in 11% of the patients after the same period26 . the results of the present study also 
 showed significant effects in the thoracic cobb s angle , thoracic trunk rotation angle , and 
 vital capacity after the schroth exercise . the trunk rotation angle decreased when the 
 acromion of the rib was turned to the opposite side by the 3-dimensional rotational 
 breathing during the schroth exercise . this 3-dimensional rotational breathing allowed the 
 exercise to become more 3-dimensional , which expanded the narrowed thoracic cage . furthermore , with the use of the forced inspiratory and the forced expiratory muscles , the 
 angle of scoliosis and pulmonary function decreased simultaneously . therefore , this study 
 showed that the schroth exercise , which is a conservative therapy , was effective even for 
 subjects with a 40 or greater cobb s angle who need operative treatment . growing 
 adolescents have a high risk of progress owing to a high degree of scoliosis because they 
 spend much time sitting at school . in addition to this , universal exercises and 
 preventive education need to be more advanced than they are now . limitations of this study include the limited number of patients with 40 or greater 
 scoliosis and the difficulty in finding time for the subjects to participate in this study 
 because most were students who had to attend school . in the future , a study comparing the 
 effects with a group among whom the schroth exercise is combined with orthosis treatment 
 will be necessary .
[ purpose ] the purpose of this study was to investigate the effects of the schroth 
 exercise on the cobb s angle and vital capacity of patients with growing idiopathic 
 scoliosis , an operative indication . 
 [ subjects ] five idiopathic scoliosis patients with a 
 cobb s angle of the thoracic vertebra of 40 degrees or higher and risser sign stage 3 or 
 higher . [ methods ] 
 the schroth exercise was applied 3 times a week for 12 weeks . 
 we 
 measured the thoracic trunk inclination , cobb s angle , and vital capacity before and after 
 the exercise program . 
 [ results ] the thoracic trunk rotation angle decreased from 11.86  
 3.32 to 4.90  1.91 on average , the thoracic cobb s angle decreased from 42.40  7.86 
 to 26.0  3.65 on average , and the vital capacity also increased from 2.83  1.23 to 
 4.04  1.67 on average . 
 all these effects were significant . 
 [ conclusion ] the 12-week 
 schroth exercise caused significant effects in the thoracic trunk inclination , cobb s 
 angle , and vital capacity . 
 the conservative treatment method was found to be effective 
 even at a 40 degree or higher cobb s angle . in the future , 
 universal exercise approach 
 methods and preventive training for the treatment of scoliosis should be developed 
 further .