Introduction
Physical health and an optimal body posture are of significant importance, as various physical abnormalities can influence other aspects of an individual’s life [1]. One contemporary method used in advanced societies to correct postural abnormalities in upper and lower limbs is incorporating corrective games. These games are increasingly utilized to address postural abnormalities in children [2]. Based on existing literature, addressing physical abnormalities during adolescence is essential for ensuring proper body alignment. If left uncorrected, such abnormalities can alter the center of gravity relative to the base of support [3]. Corrective games represent one of the most promising interventions for individuals in this age group. Although previous studies report improvements in physical abnormalities following corrective game interventions, some researchers have questioned their efficacy. Due to these discrepancies, a comprehensive review is warranted. Accordingly, the present study systematically reviews existing research on the effects of corrective games on musculoskeletal abnormalities. The results of this study will serve as a valuable guide for identifying effective corrective games to improve musculoskeletal health in children and adolescents. We applied the population, intervention, comparison, outcomes, and study types (PICOS) format of questions to screen, choose and review the literature (Table 1).




Methods
In this study, a systematic review (preferred reporting items for systematic reviews and meta-analyses) was conducted regarding the investigation of the effects of corrective games on the improvement of musculoskeletal abnormalities by searching PubMed, Scopus, Web of Science, Science Direct, and Google Scholar databases as well as Persian databases, such as Google Scholar, Megapaper, IranDoc, Magiran and Scientific Information Database (SID) with the following keywords: “Game” OR “game-based corrective exercise” AND “genu valgum” OR “genu varus” OR “abnormalities” OR “lower limb” OR “upper crossed syndrome” from 2000 to February 2024.

Results
An initial search across the specified databases yielded 985 articles. Following a rigorous screening process based on predefined inclusion criteria, nine studies were selected for inclusion in this review. Two focused on lower limb abnormalities, and seven focused on upper limb abnormalities. The synthesized evidence indicates that game-based corrective interventions improve musculoskeletal abnormalities across upper and lower extremities, highlighting their potential as a viable, engaging, and non-invasive rehabilitation strategy in pediatric and adolescent populations.

Conclusion
Play is recognized as a fundamental component for children’s holistic development and health maintenance [4]. Children naturally engage in various movement patterns during play, including walking, sitting, running, and coordinated actions involving upper and lower limbs. A study comparing the effects of corrective games in aquatic and dry land environments indicated significant improvements in kyphosis among boys aged 13–17 years [5]. Similarly, Salamat et al. [20] investigated the effects of corrective games on upper crossed syndrome in boys aged 10–13 years and reported reductions in forward head posture, rounded shoulders and thoracic kyphosis [6]. These results support targeted game-based interventions to prevent and correct upper crossed syndrome-related postural abnormalities. Scoliosis is one of the most prevalent structural disorders of the spine observed in children and adults [7], with an estimated prevalence of 2% to 4% among children [8].
 In a study by Sadidi et al. [12], the effects of a three-week corrective game intervention were examined in girls aged 10–12 years diagnosed with non-structural scoliosis. The results demonstrated a significant reduction in the lateral curvature of the spine, indicating that game-based corrective exercises can effectively decrease scoliosis severity in this population [9]. Lower limb abnormalities are likely to increase weight asymmetry, leading to postural instability and adversely affecting motor control, ultimately resulting in functional impairments [10]. Moreover, a study examining the effect of corrective games and exercises on the genu varum in boys aged 10–12 years revealed that corrective games contributed significantly to improving the genu varum abnormality, reinforcing their utility as a rehabilitative approach in this age group [11]. 
Collectively, the evidence suggests that corrective games can effectively improve a range of musculoskeletal abnormalities, including hyper-kyphosis and scoliosis in the upper limb, as well as genu varum and flatfoot in the lower limb. Some limitations were identified in the reviewed studies. First, the duration and frequency of the corrective game-based interventions were relatively short in terms of the number of sessions and overall intervention weeks. Future studies should consider implementing longer intervention periods to assess the sustained effects of these programs more accurately. Second, none of the included studies conducted follow-up assessments to evaluate the long-term retention of training effects after the completion of the intervention. Therefore, future research should incorporate follow-up measurements over extended periods to examine the durability of outcomes. It is recommended that coaches and therapists working with children and adolescents consider incorporating game-based exercises into intervention programs aimed at correcting these postural abnormalities. However, these findings should be interpreted cautiously due to the limitations noted in the reviewed studies and the present analysis.

Ethical Considerations

Compliance with ethical guidelines
There were no ethical considerations to be considered in this research. 

Funding
This research received no specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Authors contributions
Conceptualization, design and preparing the initial draft: Ebrahim Ebrahimi and Somayeh Mozafari; Statistical analysis, administrative, technical, or material support: Ebrahim Ebrahimi and Hamid Zolghadr; Study supervision: Hamid Zolghadr; Data collection, critical revision and data analysis: All authors.

Conflicts of interest
The authors declared no conflict of interest.
 

References