Integrative conservative rehabilitation for adolescent idiopathic scoliosis: a randomized controlled trial of traditional Chinese manual therapy combined with Schroth training.

BACKGROUND: Adolescent idiopathic scoliosis (AIS) is a three-dimensional spinal deformity that can lead to postural imbalance, functional limitations, and reduced quality of life. While Schroth exercises are established as an effective conservative intervention, the potential benefits of combining Traditional Chinese manual therapy (TCM) with Schroth exercises remain underexplored. OBJECTIVE: To evaluate the efficacy and safety of TCM combined with Schroth exercises compared with Schroth exercises alone in adolescents with AIS. The primary objective was to determine whether the combined intervention results in greater improvement in Cobb angle over 12 weeks. METHODS: n this single-center, randomized, parallel-group controlled trial, 86 adolescents with AIS (Cobb angle 10°-45°, age 8-18 years) were randomized 1:1 to receive either Traditional Chinese manual therapy plus Schroth exercises (n = 43) or Schroth exercises alone (n = 43). Participants receiving brace treatment were excluded, and no bracing was permitted during the study. The intervention lasted 12 weeks, including a 2-week supervised phase followed by a 10-week home program. The primary outcome was change in Cobb angle from baseline to week 12. Secondary outcomes included angle of trunk rotation (ATR), paraspinal thermal asymmetry (ΔT), and health-related quality of life (SRS-22r). A follow-up assessment at 2 weeks was included to capture early treatment response, but the study was not powered to evaluate trajectory or time-to-maximum correction. Analyses were performed using ANCOVA and linear mixed-effects models under an intention-to-treat framework. RESULTS: The combined intervention group showed greater improvement in Cobb angle compared with the control group (mean difference in change: -2.5°, p < 0.001). Significant between-group differences were also observed in ATR reduction, ΔT change, and SRS-22r improvement. An early improvement pattern was observed, with a substantial proportion of total change occurring within the first 2 weeks, suggesting rapid initial adaptation rather than confirmed sustained structural correction. Both interventions were well tolerated, and no serious adverse events were reported. CONCLUSION: Traditional Chinese manual therapy combined with Schroth exercises was associated with short-term improvements in spinal alignment and quality of life compared with Schroth exercises alone in adolescents with AIS. However, these findings reflect early short-term treatment effects and should not be interpreted as evidence of long-term stability or curve progression control. Further multicenter studies with longer follow-up are required to confirm durability and clinical relevance.