Effects of Derotational Breathing Exercises on Thoracic Cage Asymmetry in Adolescents with Thoracic Scoliosis.

Thoracic scoliosis is commonly associated with rib cage deformity and impaired respiratory mechanics. Derotational breathing exercises aim to correct three-dimensional trunk asymmetry by selectively expanding the concave hemithorax. This prospective quasi-experimental study investigated the effects of a 4-week supervised Schroth-based rotational angular breathing (RAB) program on intercostal distance (ICD), vertebral axial rotation, and Cobb angle in 20 female adolescents (age 14.30 ± 1.84 years; mean follow-up 33.45 ± 4.26 days) with thoracic idiopathic scoliosis. Radiographic measurements were obtained at the apical vertebra using Surgimap digital analysis. After intervention, concave upper ICD increased by 1.90 mm (p = 0.003) and concave lower ICD by 1.90 mm (p = 0.033), while convex ICD remained unchanged (p > 0.05). Raimondi vertebral rotation decreased by 4.75° (p = 0.002, dz = 0.807). Cobb angle reduction (1.75°) was not significant (p = 0.133). These preliminary findings suggest that structured derotational breathing may function as an active biomechanical force capable of expanding the collapsed concave thorax and reducing vertebral rotation in the short term.