Side Plank Pose Exercises for Adolescent Idiopathic Scoliosis Patients—Some Concerns About a Randomized Controlled Trial

Abstract

In their recent article, Side Plank Pose Exercises for Adolescent Idiopathic Scoliosis Patients, Sarkisova, et. al. found no beneficial effect using the simple poses that Drs. Groessl, Sherman and I found successful in reversing adolescent idiopathic scoliosis (AIS) and degenerative scoliosis (DS). Although they tried to follow our protocol exactly, they did not. They did not distinguish thoracic from lumbar or thoracolumbar from complex (both thoracic and lumbar) curves, affecting the randomization. See Figure 2 in their study. The side plank is only intended to reverse lumbar and thoracolumbar curves, and actually exaggerates thoracic curves, and the thoracic component of complex curves. The vicissitudes of randomization placed 25 lumbar and thoracolumbar curves in the control and non-compliant groups, but no lumbar and only one thoracolumbar in the intervention group that did the side plank. This trial did not prove that the side plank does not reduce lumbar curves: none were tested.

In their recent article, Side Plank Pose Exercises for Adolescent Idiopathic Scoliosis Patients, Sarkisova, et. al. found no beneficial effect using the simple poses that Drs. Groessl, Sherman and I found successful in reversing adolescent idiopathic scoliosis (AIS) and degenerative scoliosis (DS). ¹ Although they tried to follow our protocol exactly, they did not:

They did not distinguish thoracic from lumbar or thoracolumbar from complex (both thoracic and lumbar) curves, affecting the randomization. See the study’s Figure 2. The side plank is only intended to reverse lumbar and thoracolumbar curves, and otherwise may exaggerates thoracic curves. The subsequent randomization did not place any lumbar curves and only one thoracolumbar curve in the intervention group that actually did the side plank. This trial did not prove that the side plank does not reduce lumbar curves: none were tested.

Patients doing the side plank did not stack their feet so that only the outer edge of the lower foot actually made contact with the floor. See Figure 1. We learned though experience that both feet on the floor vitiates or nullifies the pose’s ability to strengthen the muscles of the convex side of lumbar curves. No one can be faulted for this. The figures in our paper were unclear on this point.

They did not use the modified half-moon pose or anything else for thoracic curves, but rather misapplied the side-plank to those curves. Our latest paper ² tests two new poses that appear effective.

Finally, we question how forcibly the authors insisted on their 11 compliant participants’ maintaining the side plank for as long as possible. This is crucial for success. The side plank strengthens postural muscles whose strength lies in their endurance. It is that characteristic that appears most relevant to reversing scoliosis, and requires significant daily effort on the patients’ part. In 2017 Dr. Groessl, Paul Bernstein and I published a second paper ³ of 74 lumbar and 35 thoracic curves that showed significant mean improvement in AIS and DS patients using the side plank and the half-moon poses, and I have published another successful series with 56 pediatric patients in this journal in February, 2021. ² Our methods and our ability to describe them have evolved since that first paper. While Sarkisova et. al. cannot be faulted for failing to follow a protocol that was incompletely specified, refinements and better description of a method that has now benefited hundreds of people may warrant another, more representative RCT.