The Effects of Core Exercise and Manipulation of the Thoracic Spine on the Balance and Body type in Adults with Scoliosis


Byeongseon Moon, Je Ju Ryu, Seung in Oh, So Hee Kim, Kyung tae Yoo*

Department of Physical Therapy, Namseoul University, 21 Maeju-ri, Seonghwan-eup, Seobuk-Gu, Cheonan-Si 331-707, Republic of Korea

*Corresponding Author E-mail:



Background/Objectives: The purpose of the study is to observe how thoracic manipulation methods and core exercises affect the balance and body type.

Methods/Statistical analysis: The subjects were 20 patients diagnosed with scoliosis and without a medical history of neurological and surgical problems in their thoracic spine. The BT4 and Formetric 4D were used to check the balance and posture of the patients. Data management and analysis were performed using the SPSS 20.0 version software. The paired T-test was conducted to compare the exercise group and the manipulation group. All statistical tests were carried out at the level of significance of 0.05.

Findings: Significant changes within the core exercise (CE) group were observed in forward, rearward, and sagittal imbalance. In the manipulation (MP) group, only the forward imbalance was noticeably affected. The differences between the two groups were only notably different with regard to forward imbalance.

Improvements/Applications: The statistical analysis showed notable differences in the change of equilibrium and body type through core exercises and manipulation. These results could be useful in future studies in related research.


KEYWORDS: scoliosis, core exercise, manipulation, limit of stability (LOS), Body Type.




In the modern industrial age, the human lifestyle is becoming increasingly sedentary. Ranging from driving to spending extended periods in front of a computer, such activities result in the daily progression of spinal instability; therefore, an increase in musculo-skeletal ailments and lumbago is inevitable. Pain and deformity will eventually spread throughout the body in patients with spinal disorders1,2.


The lack of a regular exercise regimen is not the only cause of spinal deformities. These issues also arise from other destructive daily habits, and they are increasing in number. In particular, there is a rise in scoliosis. The morphological changes in the trunk and thorax are accompanied by rotational deformation in the horizontal plane. The shapes of the trunk and rib cage not only affect the head and shoulders but also trigger a change in the placement of the pelvis, which will eventually affect the balance of the patient3.


Although in a few cases the diagnostic standard is set at 5° and above, normally, a patient is diagnosed with scoliosis if the Cobb's angle is above 10°4,5. Early diagnosis enables treatment to prevent further curvature. Crucially, unnecessary surgery may be avoided. Research on exercise programs and physical therapy using tools, hip stabilizing exercises, and rehabilitative exercise programs are becoming of increasing importance in curbing the current national increase in scoliosis in the population, including adolescents with idiopathic scoliosis6,7.


Recent trends have shown an increase in public awareness regarding scoliosis and other spinal deformities as well as the recognition that core exercises, manual therapy, and other treatment methods help prevent these effects.


Core, trunk, lumbopelvic, and segmental (vertebral) stabilization as well as neutral spine control are all used as terms for hip stabilization8. Verstegen and William conducted research on hip stabilization exercises9.They recommended that in order to maintain the body’s structural stability, the muscles around the lumbar vertebrae should be strengthened. Shinand Song reported that hip stabilization exercises led to a positive effect in reducing the Cobb’s angle and increasing stamina, passive balance, flexibility, and equilibrium10.


SLR exercises effectively strengthen both the external obliques and the rectus abdomen is. However, if the rectus abdomen is weak, then the hip flexor muscles overcompensate, which leads to pelvic anterior tilting and hyperextension of the hip. The nerve then becomes compressed, resulting in pain and tension in the weakened abdominals, which may occur in lumbago.


The father of chiropractic was D.D. Palmer, who first associated spinal misalignment with subluxation, from which point chiropractic techniques diversified. Among these spinal adjustment methods, the most frequently used Diversified Technique (DT) creates mobility through realignment of the spine when spinal misalignment caused by rotation and displacement, which results in nerve impairment and the development of lumbago. Treatment in then applied to address these issues in the musculoskeletal system.


Alternatively, balance capability effects the performance of day-to-day actions and aids in maintaining the body in a state of equilibrium. In passive exercise, balance capability is also necessary in order to react appropriately to changes in posture, stability, and the external environmental11. Nault et al. conducted research to examine altered interactions between the vertebral bodies while the subject was standing in order to induce instability12.


In that study, patients with scoliosis, a leading presentation of spinal musculoskeletal functional disability, were asked to stand. Their balance capabilities were compared with normal individuals and were found to be remarkably low. In order for the spine to maintain stability and perform movements smoothly, it is imperative that the muscular contractions between the muscles are harmonious.


The correct structure of the spine has an important role the body. Forming the hip and pelvis, the weakening of the erector spinae, multifidus, quadratus lumborum, iliopsoas, and abdominal muscles lower the stability of the spine and cause persistent postural imbalance in performing daily activities13.This persistent imbalance becomes the primary cause of musculoskeletal and spinal disorders and contributes to secondary issues.


Various methods have been recommended for stabilizing the spine and trunk. Kimand Khil carried out research on patients suffering from lumbago by observing the effects of core exercise and manual therapy on their flexibility and body type14. Similarly, Jeongapplied manual manipulation to correct the vertebral arrangement and the subsequent effects on flexibility15.Jeon et al. monitored the corrective balance and trunk musculature as well as the flexibility of patients diagnosed with scoliosis3.


The previous research focused on passive balance and flexibility. However, little research has been carried out to apply core exercises and manual manipulation to the thoracic spine in order to look at their effects on the limit of stability (LOS) as well as change in body type.


The findings of previous research showed that core stability exercises using the plankand manipulation using the DT affected the stability of the trunk. Therefore, the present study focuses on applying the plank core exercise and DT manipulation in adults diagnosed with scoliosis to investigate the effects on balance and body type.



2.1. Sub-title:

The 20 subjects used in this study included, 10 adult women and 10 adult men in their 20s. The Subjects were selected in an initial examination using the Formetric 4Dto obtain measurement values. Subjects diagnosed with scoliosis and a Cobb’s angle greater than 5 degrees were chosen. The subjects who were selected for participation had no medical history of surgery regarding herniated intervertebral discs. With the exception of lumbago, they had no other ailments.


The participants also signed a consent form that described the aims of this study. Among the participants, six had an angle of 6°~10°, seven had an angle of 11°~15°, and seven had an angle of 16°. In order to assign the subjects to a group, the height, weight, and age of each individual was measured. Afterwards, using random sampling, the core exercise (CE) group and the manipulation(MP) group were each assigned five male and five female subjects. Thus, each group consisted of 10 subjects.


In order to obtain uniformity between the CE and MP groups, the physical characteristics and ages of the subjects were as similar as possible. By using Levene’s Test, it was determined that there was no difference between the groups (age=.250, height=.130, and weight=.441[p>.05]).


Before the treatment and examination, an orientation was held in order to thoroughly explain to the participants the purpose and procedure of the research and the practice drills used in the measurement process.


The study was carried out between 23 January 2017 and 17 February 2017 CE group was overseen by a therapist with 10 years of experience. Each subject was required to carry out the exercise 15sec*15sets (1 minute break between sets) for one day, three times a day. The MP group was overseen by a therapist with five years of experience twice a week (Monday and Thursday, Tuesday and Friday). DT was applied to the thoracic spine of each participant.


2.2. Apparatus used for Measurement and Experimentation:

2.2.1. General Characteristics:

The BSM 330 was used to obtain the general characteristics by measuring the height and weight of each participant.


2.2.2. Measurement of Equilibrium:

The BT4 was used to determine the LOS by measuring forward, rearward, leftward, and rightward.


2.2.3. Measurement of Body Type:

The Formetric 4D was used to determine body type. This was done by measuring the front and back sagittal imbalance, coronal imbalance, pelvic obliquity, pelvic torsion, kyphotic angle, lordotic angle, vertebral rotation, lateral deviation, and scoliosis angle.


2.3. Method and Protocol:

2.3.1. Core Exercise (CE):

In the plank exercise, the forearms were placed in front of the chest with the body prone. During the plank exercise, the body weight was supported by the toes and the forearms, and the torso was lifted in a straight line from head to toe. In the prone position with elbows in contact with the floor, the shoulders were bent at 90 degrees. To prevent an increase in lumbago, the abdominal drawing-in maneuver was used to maintain a neutral position, after which the plank exercise commenced.


Figure 1. Core exercise (Plank)


2.3.2. Manipulation (MP):

Anterior thoracic manipulation was conducted in the supine position.


The therapist stood next to the subject and placed a hand on the TP of the vertebra to be manipulated. The subject's arms were placed on top of the chest or behind the head/neck with hands clasped. In order to keep the subject near, the therapist hold the arm of the subject and then placed the other hand on the area of manipulation. The therapist used the arm in front to fixate the elbow of the subject. Then the subject was bent forward at the area of manipulation. During exhalation, the therapist applied thrust manipulation in a front-to-back direction from T1~T416.


Figure 2. Manipulation (Diversi-fied Technique)


2.4. Data Collection and Analysis:

The SPSS version 20.0 was used to analyze the data and perform the statistical analysis. The K-S test was used to evaluate the normal distribution of the data.


The independent T-test was used in order to find the value of changes between the groups. The paired T-test was used to find the value of change before and after the treatment in each group. The statistical significance level was set at .05.



1. The General Characteristics of the Subjects:

A total of 20 subjects participated in this research. Their general characteristics are shown in Table 1.The age range in the CE group was 20.6±.84 and 21.4±.78 in the MP group. The height of the CE group was 170.3±.3 cm; the height of the MP group was 169.8±.35 cm. The weight of the CE group was 66.8±.24 kg; the weight of the MP was 64.0±.15 kg.


Table1.General Characteristics





20.6 ± 0.84

170.3 ± 7.30

66.8 ± 14.24


21.4 ± 1.78

169.8 ± 12.35

64.0 ± 14.15









*CE (Core Exercise group), MP (Manipulation group) p≤.05

2. In the CE group the forward and rearward equilibrium and the sagittal imbalance of the body type showed changes in statistical significance. In the DT group, only the forward equilibrium showed a notable change. The changes between the two groups showed a value of significance in forward equilibrium. Table 2 shows the values of the LOS at different points in time before and after the experiment using the BT4. Table 3 shows the comparison of the values of changes in LOS between the two groups using the BT4. Table 4 shows the changes in the values of body type before and after the experiment as measured using the Formetric 4D. Table 5 shows the comparison of the values in body type between both groups using the Formetric 4D.



Table2.Variationsin LOS in the CE and MP groups


























*CE (Core Exercise group), MP (Manipulation group) p≤.05


Table3. Variations in Equilibrium in the CE and MP Groups



Change value























































*CE (Core Exercise group), MP(Manipulation group) p≤.05


Table4. Variations in Body type in the CE and MP Groups



Change value



Trunk length













Sagittal imbalance













Coronal imbalance













Pelvic obliquity













Pelvic torsion













Kyphotic angle













Lordotic angle













Vertebral rotation













Lateral deviation













Scoliosis angle













*CE (Core Exercise group), MP (Manipulation group) p≤.05



Table5. Variationsin Equilibrium of Body typesin CE and MP Groups






Trunk length





Sagittal imbalance





Coronal mbalance





Pelvic obliquity





Pelvic torsion





Kyphotic angle





Lordotic angle





Vertebral rotation





Lateral deviation





Scoliosis angle





*CE (Core Exercise group), MP (Manipulation group) p≤.05


The aim of this study was to determine the diversity in spinal rehabilitation by studying the effects of core exercise and thoracic manipulation on the balance of the body and the body type as well as to compare the effectiveness of treatment in both groups. Abdominal activation occurs to counter to the pulling of the hip flexor muscles and acts as a pelvic stabilizer. This element is crucial because when the pelvis is stabilized, any external pressure applied to the torso is effectively passed through the lower extremity and hip17.


In order to avoid the negative effects of abdominal strengthening exercises, a varied program of exercises were utilized to stabilize the torso and strengthen the muscles in the upper body. The plank exercise, which countered the trunk, was used to test the stability of the torso.


Shekelle described the chiropractic techniques as grasping specific areas of the vertebrae and joints in order to stimulate them at a rapid speed and low amplitude18. This technique applies force to the joints that goes beyond the elastic range of the joint, which is the limit of normal range of motion, and extends to the anatomical physiology itself. Lumbar rehabilitation exercise requires the maintenance of muscle strength, muscle endurance, and flexibility in order to extend the actions of functional structures, such as joints, ligaments, and tendons. Furthermore, increasing the blood flow aids in the recovery of the injured area and prevents the recurrence of back pain. These effects of chiropractic treatment have been reported to be very effective in relieving lumbar pain and correcting dislocation.


Lim et al., (2012) found that a lumbar stabilization exercise program combined with manual manipulation was effective in not only increasing the muscles around the lumbar spine but also the physical stability of patients with chronic lower back pain13. Moffroid (1997) reported that a spinal rehabilitation exercise program improved muscle endurance around the lumbar spine, which is an important component in preventing lumbago19.

Lumbar stabilization exercises were fund to strengthen the spine’s mobility and stability, which restored the motor control of the muscle20.Spinal stability stimulated not only special awareness but also the nervous system’s positional control, motion, and the muscular system, which then had a remedial effect on the balance of the spine through the interactions of the upper and lower limbs involving the nervous system, skeletal system and muscular system21. Based on the findings of these previous studies, it was determined that in spinal rehabilitation exercise programs, a treatment approach that utilized core exercise and manipulation would have the greatest effects on trunk stabilization.


The results of the present study, showed a significant difference in sagittal imbalance in the CE group and the MP group, from which it could be inferred that the manipulation treatment and core exercise had a positive effect. The values of change in each group showed a significant difference between the forward value and the rearward value in the balance.


Seo reported no significant difference in sagittal imbalance between test groups at different points in middle-aged women doing lumbar stabilization exercises22.However, the results regarding the changes before and after the experiment were similar to those found in the present study (p<.05).


These results indicate that the core exercise and manipulation effected the balance of the body. The results of the Formetric 4D showed that there was a significant difference in sagittal imbalance values in each group. However, no significant difference was found in the other values because the thoracic spine is structurally more stable than the cervical spine and the lumbar spine are because of the presence of the rib cage. Furthermore, in previous studies that showed higher effectiveness in treatment. The study periods were four weeks. In comparison, the duration of the present study was limited. Further limitations of this study include the data collection. The quality of the results would have been better if during the measurement of balance capability other factors, such as the angle of the knee joint or changes in various components, had been observed. In addition, comprehensive data would have been obtained by increasing the number of subjects, the duration of the experiment, and the number of treatments In order to demonstrate that core exercise and manipulation are effective in treating scoliosis, various experimental designs that consider several variables are needed.



This research was conducted to determine the effects of a core exercise and manipulation on the thoracic spine. Although many previous studies focused on the cervical and lumbar spine, there is very little information available regarding the thoracic spine.


The findings of the present study showed a change in all values; however, statistically, the BT4 determined that only forward and rearward equilibrium changed noticeably.


The results of this study confirmed that both core exercise and manipulation increased the LOS of the front and back. In addition, although the other values were not determined to be statistically significant, it cannot be denied that the results showed positive change. Therefore, the findings of this study indicate that treatment in conjunction with core exercise could result in a positive therapeutic outcome.



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Received on 23.06.2017          Modified on 21.07.2017

Accepted on 25.08.2017        © RJPT All right reserved

Research J. Pharm. and Tech. 2017; 10(9): 3123-3128.

DOI: 10.5958/0974-360X.2017.00555.8