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Results Exercises caused a statistically significant decrease of 3.6 ± 5° of scoliosis (-3.2 ± 4.3° per year): 1 patient progressed, 45% improved; in sub-group A results were identical, after a previous worsening of 9.7 ± 6.8° (+2.1 ± 4.3° per year); in sub-group B stopping exercises caused a progression of 8.3 ± 3.8° (+1.4 ± 0.5° per year). The best results were observed in patients exercising since, even if some patients continued to decrease their curve during the years.

Background It has been known since many years that scoliosis can continue to progress after skeletal maturity: the rate of progression has shown to be linear, and it can be used to establish an individual prognosis. Once there is progression there is an indication for treatment: usually it is proposed a surgical one. There are very few papers on an alternative rehabilitation approach; since many years we propose specific SEAS exercises and the aim of this study is to present one case report on this approach. Case presentation All radiographs have been measured blindly twice using the same protractor by one expert physician whose repeatability error proved to be < 3° Cobb; the average measurement has been used. In this case a 25 years old female scoliosis patient, previously treated from 14 (Risser 1) to 19 years of age with a decrease of the curve from 46° to 37°, showed a progression of 10° Cobb in 6 years. The patient has then been treated with SEAS exercises only, and in one year progression has been reverted from 47° to 28.5°. Conclusion A scoliosis curve is made of different components: the structural bony and ligamentous components, and a postural one that counts up to 9° in children, while it has not been quantified in adults. This case shows that when adult scoliosis aggravates it is possible to intervene with specific exercises (SEAS) not just to get stability, but to recover last years collapse. The reduction of scoliotic curve through rehabilitation presumably does not indicate a reduction of the bone deformity, but rely on a recovery of the upright postural collapse. This reduction can decrease the chronic asymmetric load on the spine and, in the long run, reduce the risks of progression.

Objective To compare the effect of Scientific Exercises Approach to Scoliosis (SEAS) exercises with "usual care" rehabilitation programmes in terms of the avoidance of brace prescription and prevention of curve progression in adolescent idiopathic scoliosis. Design Prospective controlled cohort observational study. Patients Seventy-four consecutive outpatients with adolescent idiopathic scoliosis, mean 15 degrees (standard deviation 6) Cobb angle, 12.4 (standard deviation 2.2) years old, at risk of bracing who had not been treated previously. Methods Thirty-five patients were included in the SEAS exercises group and 39 in the usual physiotherapy group. The primary outcome included the number of braced patients, Cobb angle and the angle of trunk rotation. Results There were 6.1% braced patients in the SEAS exercises group vs 25.0% in the usual physiotherapy group. Failures of treatment in the worst-case analysis were 11.5% and 30.8%, respectively. In both cases the differences were statistically significant. Cobb angle improved in the SEAS exercises group, but worsened in the usual physiotherapy group. In the SEAS exercises group, 23.5% of patients improved and 11.8% worsened, while in the usual physiotherapy group 11.1% improved and 13.9% worsened. Conclusion These data confirm the effectiveness of exercises in patients with scoliosis who are at high risk of progression. Compared with non-adapted exercises, a specific and personalized treatment (SEAS) appears to be more effective.

In the literature the rate of surgery for AIS (Adolescent Idiopathic Scoliosis) of 30 degrees ranges from 22.4% to 31% when braces are used, versus the natural history rate of 28.1%. When a complete conservative approach is used (braces and exercises), this rate decreases to the range of 3.8% to 7.3%. All these studies are retrospective.The aim was to evaluate the final results of a prospective set of patients treated in a center fully dedicated to a complete conservative treatment (exercises and braces) of AIS.This is an everyday clinical, retrospective study on a prospective data base. The population included 112 AIS patients, 13.2+/-1.8 years old, with 23.4+/-11.5 degrees Cobb degrees at the start of treatment. All the patients had been treated with a full set of conservative treatments, including exercises, according to their individual needs. We used the SEAS (Scientific Exercises Approach to Scoliosis) protocol and the ISICO approach, while the orthosis used included: Risser cast, and the Lyon, Sforzesco-SPoRT, Sibilla-Chêneau and Lapadula braces. The patients had been followed up by the same physician, braces had been made and exercises had been applied by the same team. The outcomes were established for each single patient: The absolute aim was to avoid surgery, while the minimal and optimal outcomes were defined according to the starting curve. An efficacy analysis and worst-case analysis had been performed.The rate of surgery was 0.9% (efficacy analysis), and 4.5% (worst case); the minimal outcomes had been obtained in 99% of patients and the optimal ones in 84%. Overall, the curves over 40 degrees , which numbered eleven at the start of observation, were reduced to three. In total, eight patients exited the presumable area of risk in adulthood (final curve over 30 degrees ). The treatment produced a statistically significant reduction in the worst curves, and the best results have been obtained in the curves over 40 degrees.Provided the use of a complete conservative approach, there is very little doubt that it is possible to reduce the rate of surgery in AIS treatment.

SEAS is an acronym for "Scientific Exercises Approach to Scoliosis". Main characteristics of SEAS are team approach and cognitive-behavioural approach because in our view these are two indispensable elements in chronic disease rehabilitation. In this article we describe the main differences between SEAS approach and other exercise techniques as well as theoretical bases and therapeutic goals. We illustrate practical application of SEAS concept and scientific results in order to reduce the patient's progress of scoliosis so that a brace would be needed. When compared to usual care, improvement of scoliosis parameters and balance normalization in scoliosis patients.

Study design All fifty-eight patients (17% male, 83% female) who finished their treatment in the Centre of Vigevano of our Institute were included. Mean Cobb angle at the start of treatment was 22.6 ± 10.6 degrees (see Table 1), and mean age was 13.4 ± 2.4 years. Treatment groups considered included exercises, bracing+exercises, cast+exercises. Starting Cobb degrees, by groups, were: 11–20, 21–30, 31–40, over 40 degrees (see Table 2).

Study design The design was a prospective controlled study of AIS patients who were prescribed exercises only, to avoid progression to brace treatment. All patients were enrolled consecutively. These results report on the second year of radiological follow-up. We had three groups: (1) SEAS exercises according to the SEAS.02 protocol (n = 20); (2) CONT, classical physiotherapy (n = 29); (3) MIX, patients who changed protocol during treatment (n = 8). Mean age was 12.7 ± 2.2 years, mean Cobb angle was 15.3 ± 5.4 degrees, and Bunnell angle of trunk rotation (ATR) [2] was 8.9 ± 2.8 degrees. There were no differences among the groups, using t-test for uncoupled data, Mann-Whitney, Fisher's Exact and chi-square with α = 0.05.

The Lyon school has proposed a preparation to brace wearing through an intensive mobilization in order to obtain a better reduction of the braced scoliotic curve. Our aim was to verify this hypothesis.A prospective controlled study on consecutive patients having idiopathic scoliosis with brace management.Results after 5 months of brace wearing were reviewed by radiographic examination without the brace.SEAS Group exercises according to the protocol SEAS.02 (Scientific Exercises Approach to Scoliosis, version 2002); CONT Group various type of exercises. Population. 110 patients (34 females), 13.5+/-2.4 years, 31.1 degrees +/-11.1 degrees Cobb (degrees C), 14.4 degrees +/-6.0 degrees Bunnell (degrees B). All parameters improved at follow-up in both groups. SEAS had better results than CONT for degrees C. Clinical results (variations of at least 5 degrees C and 2 degrees B) were better in SEAS than CONT. This study proves the efficacy of SEAS.02 exercises preparatory for bracing. Bracing demonstrated its short term efficacy.

There is low evidence on the possible efficacy of exercises to treat idiopathic scoliosis, graded as C by the existing Italian Guidelines. Our aim was to verify if exercises quality has an effect on results.Prospective controlled study on idiopathic scoliosis patients that performed only exercises to avoid progression.SEAS Group make exercises according to the protocol SEAS.02 (Scientific Exercises Approach to Scoliosis, version 2002). The CONT Group performed exercises at a local structure according to different protocols preferred by the treating therapists. Population. SEAS: 48 patients (37 females), 12.5+/-2.2 years, 15.1 degrees +/-5.7 degrees Cobb (degrees C), 9.0 degrees +/-3.3 degrees Bunnell (degrees B). The difference in the number of braced patients within the first year has been almost statistically significant (P=0.07): 1 in SEAS vs. 5 in CONT. Cobb degrees improved with treatment (P0.05) only in the SEAS group. Clinical results (variation of at least 5 degrees C or 2 degrees B) were better in SEAS than CONT. Not all exercises for scoliosis have the same efficacy: this study proves the short term efficacy of SEAS.02 when compared to usual care.

Methods Setting: outpatient tertiary referral clinics. Participants: consecutive patients from start of the database to 31/12/2010. Inclusion criteria: IS; Risser 0-2; 11° to 20° Cobb; age 10 years or more; first evaluation. Exclusion criteria: consultations only; immediate prescription of a brace. Groups: Physiotherapic Specific Scoliosis Exercises SEAS school (PSSE: at least 45 min/week, 3 cognitivebehavioral sessions/year); Controls (CON: less than 15 min/week); Usual Physiotherapy (UP: other institutes/ protocols). End-Of-Treatment (EOT): medical prescription, bracing, Risser 3. Failures: bracing for scoliosis; EOT above 30°. Statistical analysis: intent-to-treat (ITT: drop-outs included as failures) and efficacy (EA: only EOT patients). Relative Risk of failure (RR), 95% Confidence Interval (CI), and clinical and radiographic changes have been calculated.

Background SEAS is the acronym for “Scientific Exercise Approach to Scoliosis”, a name related to the continuous changes of the approach based on results published in the literature. Rehabilitation program SEAS is an individualized exercise program adapted to all situations of conservative treatment of scoliosis: stand-alone in low-medium degree curves during growth to reduce the risk of bracing; complimentary to bracing in medium-high degree curves during growth, with the aim to increase correction, prepare weaning, and avoid/reduce side-effects; for adults either progressing or fused, to help stabilising the curve and reduce disability. SEAS is based on a specific active self-correction technique performed without external aid, and incorporated in functional exercises. Evaluation tests guide the choice of the exercises most appropriate to the individual patient. Improvement of the stability of the spine in active self-correction is the primary objective of SEAS. SEAS exercises train neuromotor function so to stimulate by reflex a self-corrected posture during the activities of daily life. SEAS can be performed as an outpatient (two/three times a week 45 for minutes) or as a home program to be performed 20 minutes daily. In the last case, expert physiotherapy sessions of 1.5 hours every three months are proposed. Results Different papers, including a randomized controlled trial (2014), published over the past several years, documented the efficacy of the SEAS approach applied in the various phases of scoliosis treatment in reducing Cobb angle progression and the need to wear a brace. Conclusions SEAS is an approach to scoliosis exercise treatment with a strong modern neurophysiological basis, to reduce requirements for patients and possibly the costs for families linked to the frequency and intensity of treatment and evaluations. Therefore, SEAS allows treating a large number of patients coming from far away. Even if SEAS appears simple by requiring less physiotherapist supervision and by using fewer home exercises prescribed at a lower dose than some of the other scoliosis-specific exercise approaches, real expertise in scoliosis, exercises, and patient and family management is required. The program has no copyrights, and teachers are being trained all over the world.

Materials and methods Population: 357 consecutive scoliosis patients with 23 hours per day brace prescription (299 females, Age 13.2±11.1 °Cobb: 41.4±9.5, Risser 1.2±1.2). Control: outof-brace 6 months x-ray. The 206 SEAS patients have been divided according to time elapsed between start of mobilization exercises and start of brace wearing. We also had two control groups: one Usual Physiotherapy (UP: 115) and one No exercises (NE: 36) Statistical analysis: Anova, T-Test and Relative Risk.

Materials and methods A prospective controlled study was done with 38 adolescent idiopathic scoliosis patients (6 male; 32 female, 13.5 +/3.5 years of age; Risser 0-3; Cobb Angle > 10°, Bunnel Angle > 5°) who were prescribed only exercises to avoid progression at the time of their first evaluation. All patients were enrolled consecutively. Patient were then divided into three groups: SEAS group treated with specific SEAS exercise, CONTROL group with no treatment and an OTHER group treated with a different protocol.

Materials and methods Population: 288 consecutive scoliosis patients over 10 years of age, curves range 10-20°, Risser 0-3 (190 Females, Age 12.8±1.5). We had 5 groups: · Brace (BG, 40 patients): bracing 18 hours per day · SEAS (101 patients): specific SEAS exercises (at least 3 controls per year) · Usual Physiotherapy (UP, 70 patients): different type of exercises · Not Compliant (NC, 46 patients): SEAS exercises 2 (or less) controls per year · Controls (CG, 31 patients): no treatment. Main outcome (after 12±4 months): Relative Risk of failure of treatment (worsening of 5°C or brace prescription).