workshop and educatio meeting "physiotherapy 1 1
TRANSCRIPT
WORKSHOP
AND
EDUCATIO MEETING
PHYSIOTHERAPY
1 1 IOPATHle SCOLIOSIS
Poznan Poland Saturday 8th April 2006
1100-1330 - SESSION A - CONSERVATIVE MANAGEMENT OF IDiOPATHIC SCOLIOSIS
T Kotwicki (Poznan Poand) Idiopathie scoliosis - definition pathology diagnosis
ThB Grivas (Attica Greece) Idiopathie seoliosis - basic nomenclature
JC de Mauroy (Lyon France) Progression of scoliosis during puberty shy making therapeutie decision
A Nowakowski (Poznan Poand) Conservative treatment of scoliosis in the past centu ries
C Coillard (Montrea Canada) New radiological classification and corrective movement
J Cheneau (Tououse France) Mechanism of correction of seoliosis by brace
J OBrien (USA) Scolios is Patient Care More than just a method
DISCUSSION
1330-1415 - LUNCH
1415-1715 - SESSION B - PHYSIOTHERAPY - WORKSHOP
J Durmala (Katowice Poand) Role of physiotherapy in seoliosis
K Dobosiewicz (Katowice Poand) Dobosiewicz method
S Negrini M Romano (Mian tay) Scientific Exereises Approach to Seoliosis SEAS02
M Bialek A Mhango (Wroclaw Poand) Functional individual therapy of scoliosis
HR Weiss (Bad Sobernheim Germany) Bad Sobernheim Concept (Lehnert-Schroth-Weiss method)
DISCUSSION
1715-1730 M Riga (Barceone Spain) Concl usion shy conservative treatment of scoliosis
1730 - END OF THE EDUCATION MEETING
Biodynamiczna metoda t r6j p~aszczyznowej
korekcji skolioz idiopatycznych
Metoda Dohosiewicz
bull Istota metody oparta na patomecharice skolioz idiopatycznych polega na koncentracji dzia~ania w strefie skrzywienia na kr~gu szczytowym z zastosowaniem po stronie wklE~ej bodkow proprioceptywnych
a po stronie wypukfej bodkow eksteroceptywnych
Ruch sterowany jest asymetrycznym torem oddechowyrn
bull Metoda ma dziatanie segmentarne
a ruch ukierunkowany jest na maksymalnq kifotyzacj~ krEgos~upa w odcinku w ktorym wyst~puje proces pierwotnej lordotyzacji i rotacja kr~gu szczytowego
1
bull Derotacja kr~gu szczytowego Potclczoiluuml jest z rownoczesnym jego ruchem w pfaszczyinie strzatkowej N kierunku grzbietowym oraz w pfaszczyinie czcfowej w kierunku posrodkovym
bull Powstaje ruch trojpfaszczyznOllly kr~gostupa
Jest to ruch odwrotny do kierunku rozwoju skoliozy
Schemat post~powania
bull Cz~seacute wst~pna - Rozgrzewka
bull uruchomienie pOSlczegocirclnych segmentocircw ruchowych kr~oslupa w systemie calkowitego podwieszenia
bull efImlnacja przykurczy w stawach blodrowlch kolanowych 1 barkowych
bull Cz~seacute glowna - Asymetryczna tragravejplaszczyznowa mobilizacja kr~goslupa w sclSle
symetrycznych pOZcjach wyjsciowych bull w pozycjach czworacrych bull w siadzie skulnyrn 1 W sladzie prostm bull w kltku prostyrn bull w pozycji stoJtcej bull W p02ycji stojqcej ln ortezie Checircneau
Il cz~seacute kOrlcowa - Zestr6j ruchowy
bull utrwalanie odruchu postawy z wykorzystaniem bodiceacutew bI~dnikQwych bull cwiczenfa rozluznlajqce konczvn
Badanie postawy d ala
pl1odu ltylu boku
2
Test AdRmsa
Test Adamsa
3
Pozycje do eacutewiczen wg meody Dobosiewicl (cz 1)
4
Metoda Dobosiewicz
pozycja 1
Meota Dobosiewicz
prutwnik
Metoda Dobosiewicz
5
Zmi3ny w zakresie kllill Cobbll w wyniku Jlrowadzooej kinezyterapi i wg Dobosiewicz w grupie
progresnvoych skoliozjedl oillkowy cll - n=124 (ass obsenvncji ud 6 do 58 ntini~cy $~dD iw 197plusmnJ 185 Rlic3iqC3)
6
Zmiany w zakresie kqta rotacji osiowej kr~gu sZczytowego sknywiellia w wyniku prowadzonej kinezylerapii wg Dobosiewicz
w grupie progresywovch skoliozjednoillkowycfl - 0=124 (czas oburwRCji ad 6 do 58 mitJi~cy sndniR 197plusmn11S5 miesics)
Grupa skoiozjednoukowych typ J wg Ponsetiego - skrzywienia Th dx - leczeni kinczyterapill wg Dobosiewicz
(1174 015 ubscnvncji od 6 do 45 mieiircy s-cduin 211plusmn 111 rniesi~cn)
Zmiany w zakresie kllU CObbtr w wynlku prowadzooei kinezyluapii wg Duhosiewicz w gTUpj~
progresywnych skolioz dwulufwwycfl - 0=74 (aos obsrnvacji ad 6 do 45 micsi~y srcdnin 211 plusmn 1 1 mi~Icircqca)
DdciMk Th odcinek L
7
ZcDli~ny w zakresie kla rolaei osiowe krfgu sezytowego
sknywienia w wyniku prowadzonej kinezyterapii wg Dobosiewicz w grupie progrcsywnych skolioz dwulukowyell shy
n=74 (C7lS obserwacji ad 6 do 45 miesi~q srednia 211 plusmn 111 miesiqcR)
oddnek Th odcinek L
Grupa skoliozjednoillkowycll 0 kqcie Cobba lt 40deg - leaeni wyhCznie kinezyterapil wg Dobo~icwicz (n=44) (czas obserwacji od 5 do JI mi~ifCY ~redllia t 18plusmn604 mie-ihco)
tnnl qICIiIl fMtt[ IoooI ~)I l~Illli 1IqIlt00401 IftmiddotI-I llJ
~1 1~ u)~___- uul
c- -- a-J
Obserwowmo i ~totn~l korclacjt pomittuzy POZiUllllm opilnowilnia Illctody przcz chorych i cZccedilsloscj stosowaniu kjnc7ytcrapii a wiclkoscuuml rcgre~ji 7~niilnw zakrcsic kta Cubha i rutltjl OSIOWCJ krccedilgu szczytuwtgo skrz)wienia - wspOlczynnik Ptarsona wynusil Odpllwicdnio 016 i D53
Grupa skoliol dWlllu koovyeh 0 kItac Cobba lt3(jl
typ IV wg Ponltetiego - skrrywienia pienvotnie podw6le - piersitJwe pFlWosrUlII i lccedildiwi()we Iwostrow
-Ieczeni wylcznie kiDezyterapi~ wg Dobosiewicz (0=10) (nli obsrrvLcjicirc od ~ do 24 miesifCY _~ n~dllia 12453 micsi~ca)
Sndni ~~( Cobbl na pmltltu (ugraveurulJpii
wynosil
ft udcinku Th shy 179deg
W oddnku L-17deg
Srcdni )11 Cobb~ po killtylapi -rylltlsi l
W odcinku Th shy 1J7deg
W odciuku L shy 1320
JmiddotI) 1)Imiddotj ~ lIll11 i ~W --)WCcedilMtf
ClNlIltallj Nui 001
( -aItu ho
~lllj Cl F1r Wj~ omn)
8
Zmiany w zakresie k(ill rotllcji osiowej kr~gll szqytowego sfmyiellilllV wyniku prowadzonej kinezylerapii wg Dobosiewicz
w grupie progresywnvch skoliozjedllollkowycll - 0=124 (CZB5 ObSrrwRcji od 6 do 58 mielli~cy irednia 197plusmn1185 miesiqca)
Grupa skoiozjedllolukowych typ 1 wg Ponseliego - skrzywienia Th dx - leczeni kintZ) terapill wg Dobosiewicz
(11=74 aas ubscrwacji od 6 do 45 mieiIcircccedilcy srednin 211plusmnII 1 miesiJtcft)
Zmiany w zakresie kqta CoMa IV wyniku prowadzoDej kinezy tera pii wg Dobosicwiu w grupie
progresvwon h skolUgraveIl dWlllllkowych - 0=74 (ons ubs~rwacji od 6 do 45 mil3Icircccedilcy sredni3 211 plusmn 1J1 micii il cn)
Ddcil1t~ Tb oddnek L
7
Zmiany w zaknsie kIta rotacji osiowej krfgu szczytoweg() sG-z~vienin W wylliku prowaagravezonej kinezyterapii
wg Dobosicwicz w grupi~ progrzs)wnvcb skolioz dWlUcircuk()wJcll shyn=74
(cras obscnvacji od 6 do 45 miesifC)j srednio ZI I1 JI I micsilfca)
oddnek Th udciollk L
Grupa skoliozjednolukowych 0 kqcie Cobba lt 40deg - JeCJeni wyl~7ltie lunezyterapil wg Dobo~il-Wicz (n=44) (nl3 obstrwllcji od 5 do 31 mhticcedilcy sndui 1I8plusmn6U4 miesiacn)
Obs~rwowano istolm korclacj( pomiccediltlzy poziull1lll1 upmowlIniu mctody przcz chorych 1 czccedilstosti stosowilniu kine7ylerapii il wi~lklJseii rewcsji zmian w Zakrcsil kta Cob l13 i ro tacjl osiowcj kr~1u SZCzylowcgu skrzywienia - wspolczynnik PeanlOniJ wjnusil uJpowiedniu 016 i D53 -
Grupa skolioz dWlllukowych 0 kflfch Cobbf lt30 Iyp 11 wg POllsetiego - jknywienia pienvotnie podwojle
- piersimve prflwv~middottrolle i lccedildiwilJwe ltKJoslrotme -Ieezeni wyl4eznie kinzyterapi~ wg Dobosiewicz (0=10)
(nu obenvacji ad 5 do 2 mlcsiccedilcy ~r~clnil 124plusmn51 micii~cll)
Sredui k~1 Cubba na )uclltlll I~lerpi
wy nosil
w udcinku Th-17o
w odcinkll L - 170
Sn=dui kql Cubb aJu liugrave~tyIcTUpij wynosil
W odcinku Th shy 137deg Y udcinku L shy lJ20
4) 1)IIIIcirc w Jlm ~llIWiob_ l~ rlllW
JIIIIm-lollUcirciaftq jtQ0 1 t~~010
UpIJI~r~
8
9
Po 5 i 10 miesieacutecach
C- 18 R-S C-12 R-S C-S R-Q
10
Po 9 miesilcach
11
BP
Il rz
Th
Cmiddot 12
R-3
L
C-16
R-7
PoDP 7 mies 10 rz_
C-9 C-20 R-OR-2
--__ _ _----------shy
12
DP
8 ri
111 C-26 R-2
L C- 17
R-]
bull Metoda asymetrycznej trojplaszczyznowej mobilizacji kr~gostupa ma znaczeumllCV wptyw na zahamowanie progresji
w skoliozach idiopatycznych szybko post~pujqcych
bull Mobilizacja strony wkl~s~ej skrzywienia i osiowa derotacja kr~gu szczytowego zwi~ksza korektywnoseacute skolioz zmniejsza garb i ebrowy poprawia obj~toseacute klatki piersiowej i zwi~ksza wydolnoseacute oddechowq plue
13
bull Przedstawiona metoda jest
stosowana samodzielnie lub
w pO~qczeniu z ortezq Checircneau
a takie jako przygotowanie do
leczenia operacyjnego
Ocena progresywnosci w badaniu elektrofizjologicznym
odruchu z odci~zenia
i~middotmiddot ~=~-~ shy1 _--==shyocirc
14
EUT S pine J (1997) () 93-97 copy S pringer-Verl ag lY07 ORIGINAL ARTICLE
K Dobosiewicz Neurophysiological mechanism of the unloading reflex as a prognostic factor in the early stages of idiopathie adolescent scoliosis
Rcceivcd 29 M arch 1996 Revised 16 August 1996 Acccp tcd 10 Septem ber 1996
Absfract This paper presents a new nc urophy iologila1 methougrave of e valushyati ng the risk o f p rogression in ill ioshy
mo t important factors in the eva luashytion of progress ive id io pathie scolioshysis The met hod can be lIsed to deshy
pathie scoliosis in th early stages uf tll( progre jve idiopath ie scolios is the dis ase by illY middottigating tll e unshy in lhe early s tages of the d isease loading refl ex in paraspinal muscles T he high sensi livi ty of ilie method The study incl uded 394 pat ients wilh means il can be used as a basis un seo liosis and 70 hcalt y chil dre n which to take an earl y dcc ision to
K D obosicwicz Depuumll1 mel1 l of Rchabi lilu lioll Si lesilln Medical Academ y 42-604 Tamo wskie G6ry 4
Lmenty of the unloacli ng retle x and repeatabi li ty o f Ihe rcbound and silent period were anal ysed for eaeh reflex evoked Prolonged latency and
p rimiddotom1 surgery
Key words Id iopathie seoli o is Unloadi ng rcnex Re bound
Katowice Polaml minima1 numbe o f cycles are the Larency Si ent period
T he ai m of this sludy was to evaJ uate the use of the unshyIntroduction load ing Dex for octcction of prog ressive id iopath ie adoshy
le cem oIios is in its carl s tages in onl r to lake a dccishyProg ress io n of id iopatJl ic scolios is bas been the su bject of
sion ta perfo nn surgcry as soon as pussible many clin ical radiological and elecrromyographic in ve~ shy
tigalions T here is ho wellcr no sim ple quantita ti ve or qual itati ve pro noslic methoo [hat can be em ployed in the
Materials and melhodsearly ~tHges of the disease Monitoring of lhe unloading rc felx in paraspinal m llsck appcars 10 be a reliable Inv gtsi lgnlions were carricd uut 011 394 pa tie nt with adolescent method o f discriminating bctwcen diffcrcn l fomls of Cushy ~c li ed J ild 70 hCldr hy children The scoli osis group consisted of Iios is T he un loa ing re n cx can be evokcd in ail the 31 1 g irl s and 83 boys aged 9-1 8 year~ (mean age 125 ycars) The
ske lelal muscles through a suegrave den shortening of o luntary contro ls wcre 0 girl s and 10 boys aged tO-1 7 y~ar (rncan age 128 cars ) Imong Ihe stlbjeclS tudied wcre 9 patien l w ith cershyinnervated muscle l2~J When a musc le is unloaJ ed vico-thoilc i seo liosi s mean Cobb ang le 22 7deg 121 with Ihoracic
rapidly durin g an isomerric con trac tion Ihe norm al reacshy scolios is mean Cobb nngle 309deg I 1 w ith thoraco-Iurnbar seolioshylion is an eleclrically silent pe riod fo llowed by a burs t o f s is rne ~n Co bb ang le 26~g o 63 with lumbar cotlos is mean Cobb action potentials called rebmmd The pause in d ischarge ang le 279deg and 90 w ir h doubh major curve sc o Ii() ~ i s meull o bb
nng le 292deg and 28 5deg The sludy group includcd 231 right -s ided can be observed only when a certai n h reshold va lue of and 163 left-sided 5col iouumlc patien ls There were 112 patients w ith
acceJcration flnd shortening of he muscle is exceeded progress ive id iopath ie scoliosi (76 ri g hHidtd and 36 Ic 1t-s ided) an tl il occues wilh constant latcncy correspond ing to that 182 with no n-progressive idjopa thic scoliosis (1 13 ri ght- sided and of the propriocepti ve nflcx (9 18 20] T he rebound ufter 6 le rt-sided) M d 100 w ith pe lvic tilt (statie) scolios is (42 rightshy
s ided anp 58 l eft -~ i(kd )the silent period in the unloaugraveing re felx rcsul ts from ae lishySC9 1ios is is consIcircdered progressive if the Cobb Jngle inshyvalio n of a pool of motone urons aIl o f which fClt1ch lhe
creltseacutes by more lhan 6 in 1 yen r aile middotnl1 n-progrcssive if the anshyfiring thres hold simultancously afte r prcviou~ si lenœ [l nua i increase is less thll n (i The Cobb angle ranged lrom 8deg to 77deg 1 4 201 in Ihe palicnls w ilh progress ive scoliosis (mean 361 ) [rom 30 ta
lI f R (on- f Rt tt1IY 1lIfl pflla 1 )(~ r(Jnu n t shy
fI) _ ~
Pathomechanic basics of conservative treatment of progressive idiopathic scoliosIcircs
according ta Dobosiewicz method based upon radiologie evaluation
Kryslyna DobosiewlcZ Jacek Dunnala Kny ztof Czemicki Hanna Jcndf7cjek
Deparmem of Rellabtlifatoll Mediw Uninrsity ofSiltsia KatOllice Poand 40-635 Katowice fil ZiUCl 3537 POL4ND
e-mail relwbilitacjt1s11mfoctaonetpl
Abstract Conscralivc IrcalrnCnI of Idiopathie scoht)~1 espcclall y kinc ilhcrapy i ~
nOI widcly apprccilllcd due 10 Ils suspectccl low dfcCIIcircvcnc 5 in relalion [ (1 a urglcal Irc[llment ACter long-ycar il ses ment of palomcchanic f scolio icirc in Dcpanmenl of Rchnhllilallon f Mclii al Unlcrsi ly of Sile bull a concTvallvc mcthod ()f IrCtllmenl asymmclric Irunk mobili7alion in lnclly ymmelm po~itions WIS
de el ped_Thi mClh d enablc 10 delain pTogression f scol iosis or ccn de middotrca~c laIerai urvalurc of a spi ne and angle of rOlllion assummg adequate () perallon f palicnl and ilS famil)
J Introduction
Idiopathie scoliosi OS) is a thrccdimensonal dcfonnation of il vertebral col lmm an- cntire trunk Afler many years of extensive rescarchcs the cause of idiopathie coliosIcircs $ i remaIcircns unknown It is possible Ihat idiopathie scoliosis devel ps and progress on a baslS 0- ~
multifactor disorder perhaps diffcrent for curve initiation and curve progressi 11 Fion poss ible pathologie factors nervous system dysfunctIcircons affecting postural tquili brium ar proprioceptive control seem to be espc ially important [ l 2 6 JI Pro_ ression f iS could bot delermincd by vertcbrac remodeling under eccent ri c loading created by axia lly ce gravitational forces in presence of muscular imbalancc in the trunk [2 J The verte rai colwrz unde r scoliotic conditions 15 an unstable system with tcndency to fu rther tune dcvelopment fl2] Lateral bending of a vertebral column visible in X-ray examination L
only a two-dimensional prcstntation of a complex dcformity consisting of patho logica axi rota ti on torsion and othcr deformations of vertebrae [7 8 10 II 14J ln fS physiolog~ curvatures of vcrtebra l column are disturbed Total Icngth of an anterior column of a spi n~
consi ting of vertebral bodies and intcrvertebral dises bccomcs grcater lhan length of l posterior colwnn - vertebral arches and proccsses [11 15 J h is apparent that phy iologi ~
thoracic kyphosis in rcgion of a scoliotIcircC curve diminishes Each vcrtebra of a stru tu ~
urve of coliosis is oricntatcd in hypercxtcnsion in relation t adjacent vcrtcbrae [7 l resulting
1 n B Uri middota I l 11
H srut ft illtf j tI) t li orf1Hli d
IDS Prt ts 21)2
Influence of method of asymmetric trunk mobilization on shaping of a physiological
thoracic kyphosis in children and youth suffering from progressive idiopathie scoliosis
Krystyna Dobo icwicz Jacek Dunnala Hanna Jendrzejck Krzysztof Czernicki
Deparrment of Rehabilitation Medical University ofSilesia KaloKce Poand 40-635 Katowice ut Ziolowa 3537 POLAND
e-mail rehabiliracjas(u1poCmiddottaollelpl
Abslract Idiopathie scoliosis (lS) which i sub 1 ntially l threeshydimen ional derormation or a pine cau e nOl only laler l curvalurc and axial rotation of vertebral column but al lordoti allon of VCr1cbrac in structural curve eXl nsion ln an effect physiological thoracic kypho j diminishc or cvcn dbappears Method of a ymlllctric lrunk mobilisation in strictly symmetric po iljon according [ Do () lewicz not only dcteriorme progre ion of IS or evcn reduces lalera] curvalure but also significmtly rebuild physiological thoracic kyphosis Icircn cases of lS accompanicd by lraight baclc
1 Introduction
Despitc Ion year researchc etiology of IS is nOl yel resol ed Significant problem re laled lO morphology of IS apar1 from lateral bending and ax i 1 r tati n i deviation of shape of a spine in sagittal axis affecting physiologi al curvatu re of vertebral coJumn [3 5 6 8 9 J 0 1t 12 Lcngth of anLerior col umn of a pin constitutcd by venebral hafls anugrave intcrvencbral dises dominate ovcr Jength of po terier c lurnn buill from vertebral arches and processes [lOJ This condition uring scol io i progress ion and growth of a child effect in hallowing or even disappearing of phy iological Lhoracic kyphosis in scoliotic region It i well know n lhar cn~brae of structu ral Jaleral curve are positioncd in hyperextension - lordotisation [5 6] which in Lhoracic region Icad (0 reduction of kyphosi or to true lordo middotis Such kind of venebrae relation in thoracic region cau es ilS destabicirclisatIcircon whi h in u sociation with eccentricircc gfilvitali nal load fa pinc duc to muscu lar icircmbalance [21 pOdbly produces r tationaJ lordo is [56 Il] and further development of symptomatic scoHose ft ha becn proven [12J tha strengthening of the erector spinac muscle aggravates nce initialcd deform tion and deteriorates coliotic process Hyperextension and uxial rotati n a s clatcd with
357 Th B Grivas (Ed) Research inro Spinal Defoml ilis 4 lOS Press 2002
Exercise efficiency of girls with idiopathie
seoliosis based on the ventilatory anaerobie threshold
Jacek Durmala Krystyna Dobosiewicz Hanna Jendrzejek Wieslaw Pius
Department ofRehabililation Medical University ofSiiesiaa Katowice Poand 40-635 Katowice m ZioJowa 4547 POLAND
e-mail durmalaiacekyocztaonetpl Department ofPhysiology Academy ofPhysical Education Katowice Poand
Abslract The aim of the study was to estimate the exercise efficiency in the group of
girls with idiopathie scol iosis based on the venlilatory anaerobic threshold (V AT)
Material and method The investigation comprised 58 gi rls wilh idiopathie scoliosis
aged 10--6 years 32 girls (55200 ) wilh double major scolioSiS and 26 girls (448)
with single scotiosis The girls were eonservatively treated using Dobosiewiagrave
method The control group consisted of 3 1 healthy girls aged 10-1 6 years The
cxercise test was performed using eycle ergometer During the exercise the gas
exehange parameters wcre reeorded (minute expiralory venlilation minute oxygen
consumption earbon dioxide production) On the basis of recorded paramcters V AT
has been computcd using V -si ope method Results The following V AT values were
obtained in the group with scoliosis 207+305 ml 02minlkg bm in control group
219+350 ml 02minlkg bm The differences belween girls with idiopathie scoliosis
and control group were nol SLaliSlically significant Conclusions I The exercise
effieieney of girls with idiopathie scoliosis conservalively treated using Dobosiewicz
melhod is normal 2 Such high level of the exercise cfficiency of the studied group
probably was due to intensive 3-D respiratory exercises of these girls
1 Introduction
In practice there are researched useful efficiency rates which on base of laboratory tests results possible easy without using of the relatively hard or long exercise tests would give the belter forsighting of the range of homeostasis disturbances and rapidi ty of increase of
physical fatigue during varied workloads [1] The best known rate of trus kind is the maximal
minute oxygen consumption [2345] During progressive physical effort minute oxygen
consumption increases proportionally to workload The reaching of real maximal minute
oxygen consumption in time of progressive effort is iodicaled by minute oxygen consumption plateau [5 61 This result is rarely registered in children The progressive exercise test is most commonly used in children until physicaJ exhaustion and the highest registered minute
oxygen consumption is treated as maximal minute oxygen consu mption or so-called
symplomatic limited maximal minute oxygen consumption [678J Sorne authors regard
Orto-dlet Trau malaogis Roha b ilitacjaARTlKUL ORIGINALNY ORIGINAL ARTICLE Vol 5 Nr 1 2003 80-85
Jacek Durmala l Krystyna Dobosiewicz l Tomasz Kotwicki Hanna Jendrzejek 1
Katedra i Klinika Rehabilitacji Slqska Akadenia Medyczna Katowice Katedra i Klinika Ortopedii Dzieci~cej Akademia Medyczna PoznQll
Wplyw asymetrycznej mobilizacji tulowia na wartoseacute k~ta Cobba i rotacji w przypadkach skolioz idiopatycznych u dzieci i mlodzieZy
Influence ofasyn1n1etrie 111obilisation of the trunk on the Cobb angle and rotation in idiopathie seoliosisin
children and adolescents Slnwu kluce ac eJJic Cl chOlIU) Ice SKoio= idj)PO Imiddot(~I7tmiddot
K~Jmiddot w()rus consrieI ve I (OtlHelif idiopathie HUW JS
SUMlvfARY
BackgrouId The aim ofthe stldy Vas Ihe radiological evaluation ofthe treatllJent ofthe idiopathic scolioshysis utilising as)mmetric trunk mobilisation in the strict~ll I)mmetric illitial position
Material ([fJ(f lIIellOds Presented stud) lOS based IIpon J36 cases (13 oovs oged FOf11 ocirc la 6 lcars (lild
rn girls aged frum 6 la S pears) trealed due to the idiopathie sCuliosis ((rom Novell1her 999 0 F enflfUn 200) Among 48 ch idrcn sllfJering from dOlfble-major scoios is 6 cases wcre infoll scaliusis JOjuvel7lle und 22 adolescent Among 88 sillgle scoliosis 6 lere infw7t 33 juvenile and 49 adolescent
Radiological exami71ation 1as condueed always in the repeataole technical cOlldiions RadlOglOlI1 lier evaluated oy the same physician Radiologica analysis oIthe scolios is incuded value ofthe Coho al1gle ongle ofaxial rotaion
ReSIils ln double-major scoliosis observed dlring one year period in Ihe thoracic segmenl Cobb angle decreased inll l increased 1395 and in 292 Il OS 111changed Axial lolation angle in 167 (~rcascs
decreased in 354 incrcased and rernainM the sorne in 479 In Ihe llllnba segmenl Cobb ang le clccrcscucirc il1 354 increased in 39 6 remained in 5 Angle ofaxial rotation deceoscd in3 ofca es incrcuscd in 29 and persisted in 48
ln single scolio is Cobb angle decreased in 386 incrcased in 353 and in 261 was lInchonged Axiol rotarion angle in 216 ofcases deceased in 295 increased and rell1aincd the sallie in 489
CondlsioJ Asymmetrie mobilisation of the tf1f17k in strictly syl7111elric initial positions is a 1Clhod of choice in the cOl7senJalive treatment ofthe idiopathic seoiosis
STRESZCZENIE
WS~p Celem pracy jest radiologiezla ocena Icczenia skoiloz idiopaf)cznych metoda asvmetrycznejl7lOoili shyzocji tllowia w sciSe symetlyczl7ych pozycjach lV)jscio wych
M aterial i metody Przeprowadono retrospektYlIl7q analizri 136 przypadkeacuteM dzieci (13 chlopcow i 123 dziellshyczqt w wieku 6- 18 lat) z bocznym idiop atycnylll skrYll ieniem krrgoslupa leczonych zachowawczo w Klinice
1
Ortopedla TliJumatoogia RehlblllagraveeJa ARTYKUL POOL1 DOWY OPINION ARTICLE Vol 7 Nf 1 2005 49-$11
Krystyna Dobosiewicz Jacek Durmala Tomasz KotwickP
Katedra i Klinika Rehabilitacji SIAM Katowice 2 Katedra i Klinika Orlopedii Dziecircej AM Pozncrlz
Biodynamiczna metoda tr6jplaszczyznowej korekcji skolioz idiopatycznych - opis metody Biodynamic method for 3-D correction of idiopathie
scoliosis a description ofthe method
SIOWQ kluczowe leezenie zachowawcze skoliozy idiopatyczne korekeja tr6jplaszczyznowa Key words conservative treament idiopathie scoliosis 3-D correction
SUMMARY
The biodynamic method of hree-dfmensional carreeion of idiopathie scoliosis is based on Ihe palhomeshychanics of idiopathie scolioiiiii and consiss in aClive segmental three-dimensional correction ofspinal cllrshyvatlre The course of action focuses in the viciniy ofthe apical vertebra Proprioceptive facilitation is applied on Ihe concave side ofthe curvaJure and exteroceplivefacilitation on the convex side Correction likewise proshyprio- or exteroceplive facilitation is phase-oclœd with asymmetric respirarory movemenr as weil as wilh parshyticular phases of the respiratory cycle ln Ihe course ofexercises three-planar movement is generated opposite to the direction in which scoliosis Is progressing This method is in accordance with the stale ofthe art ofscoshyIiasis pathomechanics The method requires detaied training and can Ihen con be applied at home under periodic control by a physician and a physiolherapist The method con be applied in landem with a Cheneau brace as weil as in surgical pretreatment A elaUed description of Ihe method of three-dimensional scoliosis trealment will be presented in Ihis article
STRESZCZENIE
ISlofa biadynamicznej mefody Ir6jplaszczyznowej korekcji skoioz idiopatycmych oparlaj est na patomechashynice iikolioz idiopatycznych - poega ana na czynnej segmentanlej tr6jplaszczymowej korekcji skrzywienia Dzialanie koncentruj e siccedil w pobitu Icrllgll szczytowego sknywienia Stosowane iest bodicowanie propiocepshytywne po stronie wklllsej oraz eksteroceptywne po stronie wypuldej Korekcja i slosowanie bodicocircw propioshyi eksteroceprywnych zsynchronizowane j esl z asymetrycznym torem oddechowym oraz z poszczeg61nymi fazashymi oddechu W trakcie eacutewiczen powstaje odwrotny do lrierurzku rozwoju scoliozy tr6jplaszczyznowy ruch IcrFtshygoslupa Melodajesl zgodna z aktualnym stanem wiedzy na lemat patomechanizmu scoiozy nymaga szczegocircshy100-lego instniktaZu po clorym mote byeacute wykonywana w warunkach domowych Z olcresowq kontrolq przez leshycana i fizj oterapeutll Metoda mote byeacute stosowana r6wnolegle z leczeniem gorsetem korekcyjnym Cheneau a talcte w przygotowaniu do leczenia operacyjnego slcolioz W pracy przedslawiony zostal szczeg6owy apis meshytody leczenia
Skoliozy idlopatyczne stanowili znieksztalcenia patycznej rozwija siccedil poprzez przemieszczenie kr~gu tr6j~aszczyznowe charakteryzujltce siccedil wyboczeshy szczytowego w stosunku do krccedilgu g6mego j dolnego niem rotacjltt krccedilg6w klatki piersiowej i miednicy z r6wnoczesolljego rotacjl zgodnie z ruchem wskashyoraz zmianami w fizjologicznych krzywiznach kr~ z6wek zegara dia skrzywienia prawostronnego oraz goslupa w plaszczyinie slrzalkoweJ [ 123] przeciwnie do wskaz6wek zegara dIa skrzywienia leshy
Z punklu widz nia patomechaniki tr6jplaszczyshy wostronnego Koncepcja rozwoju skoliozy jako rotashyznowe znieksztalcenie krccedilgoslupa w skoliozie idio- cja i kontrotacja sugeruje ze sily korekcyjne powinshy
49
EDUCATION MEETING SATURDAY 8th of APRIL 2006
- CARDJOPULMONARY EXERCIS E
TEST IN GIRLS WITH
CONSERVA TIVEL Y TREA TED
IDIOPATHIC SCOLIOSIS
Jacek DURMALA Krystyna DOBOSIEWICZ
Department of Rehabilitation Medical University of Silesia
Katowice Poland jdurmalaqcmpl
The aim of the study was
to estimate the influence the conservative treatment (asymmetric mobilization of the trunk by Dobosiewicz) on physical efficiency in the group of girls with idiopathie scoliosis
Material
bull 87 girls with idiopathie scoliosis
aged 1 0-17 years
(mean age 135 years SO 161)
J Durmala K Dobosiewicz 1
EDUCATION MEETING SATURDAY8thof APRIL 2006
Material
bull 38 girls (437) with double major scol iosis (thoracic segment - Cobb angle 18-42deg mean 30deg SO 82 angle of axial rotation 4-32deg mean 21 deg SD 107 lumbar segment - Cobb angle 11 shy48deg mean 31deg SO 128 angle of axial rotation 5shy30deg mean 13deg SO 85)
bull 49 girls (563) with single scoliosis (Cobb angle 11-75deg mean 33deg SO 155 angle of axial rotat ion 5-30deg mean 14deg SD 83)
TIoracic kyphosis of the invesllgated group was 5-39deg mean 23deg SO 86 and lumbar lordosis 16-41middot mean 30 50 65)
Material
bull The 64 girls aged 10-17 years (m ean age 131
years SD 132) were conservat ively Ireated
using Dobosiewiczs method
bull Treatment period ranged from 5 months 10 3
years (mean 148 months SD 902)
Material The 23 girls aged 10-17 years (mean age 136 years SO 108) were treated u sing symmetric exercises - treatment period ranged from 4 months to 3 years (mean 161 months SO 1019)
bull 26 of ail g irls (18 girls earlier treated using Dobosiewiczs m ethod and 8 gi rls earlier treated using symmetric exercises) aged 10-17 years (mean age 134 years SO 108) were twice tested - at first and last day of Intensive hospital rehabilitation (asymmetnc mobllization of the trunk by Oobosiewicz) - mean hospitalization period 20 days (range 18-26 days)
i rf~8f6~~ or~~n~= ~~r~1~r~icircJ~~tb~~~~ mean 17-4 1deg meatl~(I SO 74 R n~le ofax 1 rotatIon 5-25ot mC3 111 3laquo S0 6icircl Ilnd 1 99t1S~ ~~~~I~~~~~$ruo~ras~ ~ocirc~~a~e~~~~~~~5euml1 9middotn~ tUfllbar Iord05ts 16-4 1deg mean 311 SO 68)
J Durmala K Dobosiewicz 2
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Material
The control group consisted of 77 healthy
girls aged 6-17 years (mean age 12
years SD 31)
Material
The examined girls participated in school
only in scheduled physical education
lessons and have not been enrolled in
other sporting activity
METHOD
The exercise cycle
ergometer test was
performed
J Durmala K Dobosiewicz 3
EDUCATION MEETING SATURDAY 8th of APRIL 2006
METHOD
The Incrementai exercise test has been applied
We have found that tests ln whlch the Incrementai part of the protocol ln completed between 8 -12 minutes duration glve the
bullhighest maximum VOz in normal subjects
METHOD
The workload was Increased stepwlse
bull by 10 Watt every minute - ln chlldren
with high ~ 135 cm
bull by 15 Watt every minute ln chlldren
with high gt 135 cm
METHOD
The test had been contlnued untll refusai of the patient or exceeding the pulse Ilmit
Durlng the exerclse the gas exchange parameters were recorded by Jaeger device model Oxycon Alfa uslng direct breath-byshybreath rnethod (with face mask)
J Durmala K Dobosewlcz 4
EDUCATION MEETING SATURDAY 8th of APRIL 2006
METHOD ~ ~~ r 3 min 3 min 8 - 12 min 6 min -~
_ 0 rpiYJ 0 rpm 60 rpm ~1 30 rpm
_ t o~w=att~o~~na ~~ att__~ tl~~S~~ l ad l ~~~~~r o~w= Hlcremenlal t
pedaillog i i ~
~ ilt ~I~-----tl-~ I t ~ i ~ lOSt sffortivB
lW r resututlon r rm-u middot 1 - bullA~cremen tal ~~ ~ ~ ifr- ~ VtI 1 ~i ~ tllng _
METHOD
On the basis of recorded parameters VAT
has been individually computed for each
child using V-slope method by
Wasserman
METHOD
For assesment of physical capacity
the maximal minute oxygen o
consumption (V02max) ventilatory
anaerobic threshold (VAT) and
maximal workload was used
J Durmala K Dobosiewicz 5
EDUCATION MEETING SATURDAY 8thof APRIL 2006
RESULTS
Ali girls with 18 have been classified
within normal range of predicted
values of
bull maximal minute oxygen uptake
bull VAT and
bull maximal workload
RESULTS
The differences between group of girls
treated using Dobosiewicz s method and
group of girl s treated using symmetric
exercises were statistically significant
Lower exercise efficiency of girls treated
using sym metric exercises has been
observed
RESULTS Girls wilh IS Irealed using
N=87 p value
Dobosiewlczs method N64
symmetJic oxor-ci Nz23
Perœnlage of predicled vaJue of
maximal minute oxygen uptake
98 905 0033
Percenlage of predicled value of
VAT 97 933 0049
Percenlage 01 predided value ni
maximal workload 101 939 0038
J Durmala K Dobosiewicz 6
EDUCATION MEETING SATURDAY8th of APRIL 2006
RESULTS 26 girl s twice tested - at fi rst and last day of intensive hospital rehabilitation
The value of ventilatory anaerobic threshold increased during intensive hospital rehabilitation (asymmetric mobilization of the trunk by Oobosiewicz) statistically significantly (p=00019)
2047 ml O2 minkg (SO 268)
vs 2239 ml O2 minkg (SO 232)
Conclusions
1 The exerc ise eff iciency of girls with IS treated by asymmetric exerc ises of Oobosiewicz is norm al
2 Such high level of the exercise efficiency of thIcircs group resulted fram using of Oobosiewiczs method
r
J Durmala K Dobosiewicz 7
REVIEWS
Role of physical exercise in tbe treattnent of mild idiopathie adolescent scoliosis
Revicw of th- literature
A NECRlNl N VElWNL s PARZI 1 A NEGRINJ 5 NEClU NI
P1t~silillxlrd~ Ihcrapy (or klucgtlttlwrlpyl i pro shy-tJm of physka] cXlrd-cs ipcci I(a~ (IJcloJgtcd hy l li trIWlltl phrslollwrapbt wilh tb m~ln a1mor pl shyVCnI in lhe ilAAfIVltilH1 llf the ucirccfonuity III mild IgtC )
Lil1Si bclpin~ thebm ( aocl co uaufllclilIg ils ~jd- clf IS in nlOdlJmiddotnh-culiosis Th middotalillofthi paper ito r (W
Ille Ii lc ram r 1 a-ccrulin wh kh of Ih bull Lu[Jalmlcrus Ind (Lb hili til~ CLlLt-cd br scnli()si- clluld bl pl Y nlcd or r d uccd hl phylolld LXtmiddotrdsi n Il p--to-da le knowl Uuml~l nr tIll~C aspcc[~ i ne bulled in oruer 10 dndc whclh~r 11Rf blLl adcqlmtt Ib(uuml n middotlicaJ balis fo r ora)aini l Ihe US4~ of lUgravellgtitlerap) wltcllj(r or fln l th e prtl1iœ of kimiddot ~lre IUlll poNjn~ a t iil ies ~bould h allowtcI II uuml middot c enliaI toltlentlf)wh k lu alClor ie - lf pl lr~kiJl -c rmiddot d gtlt- (Ic rnnhi UzJ( inn ni (t hl HrJltlon [ rtn~hcll iJl ~ or 1i1J(IChIumlJlJt etc) Sh llU Ld be TolullllCcluse ulemiddot l onld b- clclIimcntalancl wukh sho ll ld he IJlI-n~ifl~d I~~a l lhc (o uld h 11lfu 1 Know k dg CJnc1in t (wIn SeiCIImiddot Hlk rCS([lflt h daw ccordinll to Ih bull llVit w o f tIlt iii 111 1( plop(lsltd in (h i papcr lmiddotonllmJ l lnl plLyi 11 cxcr(j$( pn (nti or (tmiddotduce dhlblli t ic 1 ~lt Il Jj ll(k pl ti Jlt fadl j w(~ the nlIIIrl li7alinn n f poMural dd shylitS tu p n xJ llc aSl COIlMqnen c(middot 1 all )llal) or r(tn~ shys i middot middotlIrve Tilt u~c (I f appn1priattmiddot kincsiuuml wrlpy 0 in rcns polttllcal swhiIHy Icirc IIHmiddotorc Illta ll y (0 r 1(lt1 lllho UAh mon ltlccurlltc 1Ut dl1alkd -rLk l(lWfils 111111 )11 h Jlccdt(
11) wurcJlt 0 lit)-IcircS (Iumpy - x rcLs P()lun
n rllt lT(ltnklf u f COll1tlK H (rtd) I 1i plfho l og l ~$I rUlglng tr m low tmiddot k Pl 1l1 to IdiOpath ie SCUIshy
Submitt(oJ [or PUhltCl l1 011 uly Tt 2001 Acc~pttJ ugu - ~2 1(t-1l
Addre rltj-xlfll telt~I(middotb If) - grinl Flt(1(bziurllt r )(m Ofl ()(Cl1I shy Lt middotqlltœlll ro () - 1u I4t agravehLIlKil ta IYIL-lTt ilSllltp lfllmiddot ~ 1l1uumldull
CelII ~ (niiOS I I~ middot ann (1) IfUh middot lIlfU di louhilll(tymi ( Nlmiddot ~iI rli -ilIIUmiddotltlfl
Nlti(ir 1( ) il r() (ltbullagt1
lt vLL_ l IiII no 1ftfI
jS ) we are a IUil ly tJc ing n1n) ltblll lS 1 k l1 b ~J)w in~ tl~ t S Jfll l approad llt - l1n til hy on ielshyertd ~tan lard ugraveJuld ln m any ~1~ he lI ~t les i if Ilot dange r )ll lt rhlS is lrut of reil l lnw 1gtlt1lt1 pa in l ~ or 5urgi c ll lrea lmltnl5 in dbc r lmiddot ll Sc - 2
ln tlle cj-e ut ~ t lll(tlWtl i( li p l ll1JC luuml- I ~ middottnl ~() shyliosis phys cal ((_lt1(( is emr1uved ltI t()fIl1 0 lh~rtrv
lo ly in cel1l in L)lllllde (nluumlnlr in tilt Lltlll middotorkl i e Iw l) r llt t Srain hUI IIgt() 111 Gert11lny 5- 1~1 in other reg lOl1 wbere thi I-incl qf tre l tm e rll 1 p~ 1 pmiddot t 1( cI il Jws Ixen cri ri cilld md rel -cltd Lw m~lI1 1 11 Jlu~ Fue Fnlny r ~lrs thio middot15 a lsgt(ru( f ~rth r -~ltc rrJtf))~ ll t vit11 br1Cltcgt b r II1 ([C Llt n ClW grmvlng 1lt1 0 L Sti g
gcsti n the lIsefulnes- u r Ih is form o t treatm n t 1
Hmiddotu]rs have nerged jn El or uf pll y~ iLd eegraverdse eacute 00[ 1 but tlw are nUl yel 11 11 t llu i vIC~11 and r hi ~
f rm of trt ~ltmenr IS stiJ l Ul1 ckf ckhate FfI t Jt 111 il i 11t (eltary td 1I iFy 11umbtr ot
b l sic COI ceP rlJ lf w ill he cIh tt d in t hi pap r
Scollosis
DCijIrI iriolls
ScnUoSlS is Irlircc c1 lme nsIcircltnal (I(gt i l cj on ot tht spinc thar cau C a CU 1 lh lt ca n h e $ t~en ln (1 me1Sshy
ured ultinF Coh) lll ltllCXI o n HI anreu middot p rtc rilt r
EUJlOI -1 lœDICOPHYSlc~ IR
NECRI Nl
110
f)i)
1 7J
amp aS g 5li - 0 v
V
31
10
(1 1) Il 15
-tc i ytjtr~)
FigJ----jllph ot DlI w l-lkaupegraverel) The agloimvltltinn Or idio r lrhlc 50gt1iflll~ IS rpiJ bel~ en th e- [l0 IH P (l)ltg tnntll lol (JI PUllcmiddotny) mtl 1 ( f( lS-er sigll paiilivltecirc lt Dlt(i I1 11illg r the iti l 1Kgt n n t rll icirclicH a ) 111lt m omal prebulled the mno rche md ociks with lll I)ttlx flal gr Ih pll fl
rlcljoprdphLi 1 hl merl prestIK ~ of this curvt c10es n t autom~l ritllJy indi ate the pn$CI1(t of a defurshyTnitv (SlllKtUrd (Unel
It i~ possible tu clil1e ren tute a struCnlt t CI1tve fruIn a pogt urll 011e by identifyi og the hum]) du ring AdIlns tesr I~OQ looklng tra m beh lnd at the p atient w ho b benchng fUfward il is p -- ible ta d d~ct 1l1 eh ucirc n of o ne liidlt 0 1 the trunk usually n n the (onvex ~ jde ul tbe radiographie CUfve Ugrave1lr C Ul be mlt~I Slred lISin~
BUlln els S o liomere( 1 ~ l This h Uf1lp is du(- lO (Ile pregravegtecircn ~ of vertel ra i rolltion 1c1 Ollt tn tic f~YJ tllre o f the def trrnit tli [ c m be seen and measurc(i v ith Perddolles lb lsLometer on an amero-Ix)iferior radioshygrapb ~2
Seven ry pel cent o f li Ises a re conid 1lt 1tO be idiopa thie 1 bull ia l-nosilt in this CI$C is b exdlls i ~ n as idinpa thlc me-us t11H wc do n()[ know rJw origio of lheacute curvc [n othe] ~Ie$ it b Ix )~i ble ro ide nrify a dieak (bat CHl jusrify the c1etgtnniry slIch a rna lfo rshymar i ns I1(gtufol Ig ic~ l or genlttic cl iscas s Glnclt~r trauma etc )
[dicirc)parhk S(oliosis has been divicled ~(corcling (0
the ~Ie of tlie patient egrave1l the tiJ1ll of d~[ccli n of the condil ion into ti) ur t ypei ln fanUlc jU nik ltldolesshyccnt lnd aduh Til l m n st cnnunon (VPC IS the acloshylescegravenr o licirceacute I1IJctenzec1 hy 1 sud le l1 tggrH3l ion uuml uring the grow tll Spllrt (Hg 1)2
lhile p tu 1l sco liosi i5 Ycry lomnw n thl pre shy~Iknct ra te f r adole ent icuumlop~lthic structural CU IY~S in sch )o chilclren are 18middot20
- 10 Co bb d~grels o r m on l -lil
- 2) ~ohh dtgreclt or mort O 2~j - bull () (obb d gre -s )1 mOfeacute ()ll 2
Clin iltI [ d e isio ns lfl IXlSed 111 an lccu r~He pregshynosi which obt inccl in eJch pa ti nt mainly o n the basi of the nsidu~ll p()tlnllltl l of TH1h and the result s of 1 rh clin 1 1 ~l1d tadiogmpl i exlminashyti(ln12ll c noieq uentlya d inica ] la sifiou io n o f the ing le pHient tn -ome estent co incic1 ing w irh the
D diographic one c l n lw SLlIl1H1arizeci 1 1 folIcJ - mikl lc~ (1)(n 20 C bh de~r es - moderJt l betwlen ln md 15 ohh de~ rtes - StV re 111( gt1lt rh n ~J) )bh (kgf s
On the 1) lsis of [hi - dinic d d a lfic t i n (Vith l1l il el lrb tiOI ~ o f the ir b() und~ri e ) in Itllt l cente rS Of SCOtiO LS ITe ltlllent in the Lltin odcl (i rJ Ital lnmct md PI iJ Ugrave tre tmtnt i s plmmcd a fo lltJw 8l
- mild kineslth e (~1fw ~1Il (1 luok-ou t - Hl demte IJragravecegrave 1111101 c(~r md k i rws ithe lJpy - ~cven surgery
Physical exe rcL~e for S(ol iosis
Defi t tiOl l S
PhyS i 11 nU b lIKrlttp middot (or kines ithcIa Pl) i a p rvgrlill or plt~i Gl l (xeriltecircS ~1ci fi ( llJ y ltk ~ loped
y a -11 [ru ine 1pll yslo ther3pisr wirh th e m 10 Hllll
- pre (~ n tit1g tlc aggraaLion of the cl I )flnily in rnild bullcoUm is
- helping tlk Il ld Ct ~lOd ounter~lCtjng its skie elfects in III de rltegrave sc li sis
Tn tl1i_ feSpec1 kinesitl1ert py f JI s oliosis is tonshysider l a o on of peciticcedil training and s genecirc tltllly proposelt in sessions 0 1 4~ ro 60 minute IW) t) tour limes 1 Cee PhysiGtl exerci es can aLo ll v o ther auumlns 1S it oill he dise Issed in this plper
Ir 15 Ilot possib le to cl escribe a single progrlIT1 o r exerc ise a5 pro nrams ale USLIJUy p fgt nll ized ( ( lt
EUH PA ~illDI (DP1I YS IC~ 182
ROlL UF P l 1YSICAL lXl 1lt 1~E IN l IlE 11 ~l) IEd If IlU) l[)VP 1HI AIJ() J)~Cl~ r COl ~I NlG1W il
f)( 15 egraved ( )Il the nee L- 01 indi iuua l pJl itnts) al l l10ugh Lheacute) C l n h t 11 plicd o n a WOU p hJ~js (-1 (0 () pnients PC[ ~l ()lI r)middot lugrave reQCf lhese 1 10 grl lll frequt ml~ V IIT
hnm on in middotituk w allClthltJmiddot -Ill Jnv L l~egrave at Wc w Ht ~huw in lhis lyl peJ it i~ 111 n u -eII1 tu id e ntilv kirK itheJapturlc aims w hitl l ucircrr~spnd LO ugravelt~lil1 DUtshy
g X ir ur ph -s ici l lxtTi~l I~llhe r thln ln dj( us- indishyiJ u1 1progr-lfll
Aduumll l lxUl kisure time ~lOd h )u] Sp u lllll8 ~Ilttishy
i lt egrave~ i middotomm )Ly s iven lel mJ ing ro w hlf ~ Iuumlnsidshyer~d usdul or il lrmfu l in t1 lt rruning (lI tJw ptliJicirct ln tl1bplper Ugrave1 gent ltl l t rl ll bull p lwsiCUgrave lttG iviUes is rl ktll 10 JllI1ltlCc hOlll gtpOlt mJ kIJ1lsIcircl hc lJ l f
i ve lUen tloneumld )bo C on lv ine n dul( re Ull~ 1t~1 t s far Ilten publislt d f I~ mJ I(i noltgtithltl rgt is 11 11 a su h jel lnI deacutehate CJitk haltlt t llltit m itn ltl of l ny lorm o t p l1 ySiClI lxrcL e as a Itwr1 [ J- fo r i liopa tb il jcoJL~b un iL ()ri gin~ initial1) it WIS Ille r rOmiddotUumlK lt brgdv u f p l~lt titu gtllergt w h ) intervenecl hutll tc llcrl ll (mon as cltl HtilJ nic in terventi n man Jgt
1 t lltrJp utl t one 1 md rC j fkll l~ on rhe h sh lf som uni cOen I1v pn t I1cgts wt ldl hll ltl enl1 JI~ haLl nu na l scicnt lfic baisYmiddot HOlh tlle$( trr t peu shy to rh ~rl py tt nJecI to l~~rJ tte C Ih tk CUf -~ pnnshyclr~tll y as a f tsul t of lilo h llIzatio ll of tn imdqultdy ~u pp rt(d S pln eacute 7~ 12 to re-t1 r rI ltrl 1$ l l1C k o f WH llt~~rdl 10 I ndt~-dll()urnah tnd 11( on1 p~l per u suaJly Cl tc([ IS n prelimmtrf lll d 3 ln tt li w ay man (l rrlKpt(Hc H lf O iS Inll ph ~i C U l ~ d vi ~ cI nllog scnliotl pa t le nL~ 3gainst holll ph lca l egravexershyclc and p()rt~1
It m u st t~ n tfd [hat pllyknl txerc j~ tJe~ltm(nls t1iHer 1 lJ rd il1g r rhe rherlpcu tlC litTl~ on lllc h tJ rgt ap p lolc il l the IXlltent lncl hi im r IIIllHnt i- 1 (1(1 rI - 5lt1J lC igt tIl l ( f phJllIlllolopJ al rrea tmln ls Ihith cllffc r 1lt œQlfd- rhe m C cculc u ~t(l luI thl p al 1t n
~mc l 11i (lbE~e Tt i ~ P ~il k tlwreI[middote thll wuumlk ltlll t kin 1or ph~ i Clt1 1 lX r(j~ 1I 111~ t bc loidvd by t h~ Lo iurie IxujCJ1l al1ulhcr a dl ~IS nJI h~ iOg (1 11shygerols llugJr in racr le (wi ller d I ~fJIII ~ I ml thlls re(nl1l rn ndc(1
fn n UI cel1ll r we In(~ hccf) using 1 ) 1 1111 11 ve ) 1 (J p lw l icd ex(r(i~e (0 J ( 1I l tt i~ tlh aITt ~ l~d Ilv m ikl tru cflumiddott1 adokscltnt (cl ioj arh lC icoli is11 2)
ina the f U~ t rc-gt uJrs IefC pu b lishe - the pJ( )grd m 11lt1lt l1te n PWltllk d in fa c t deel()pnlln l~ in th t l itshy OlL1Ii in tl1 r b t ~() ycal f ha ve iclemi fiecl niO l l
m d 111 ur impl rnHm s md d i s )h ilir i (gt~ lue t idlo p lthk amp()lio -i ~ t Jll CIII he 1UO(l if Icirc 1by phyict1 egrave xert iSlgt l fe t rrncllt
l illl
111e aim of t l1JS r~l per ii tmiddot (tv iew tl1( l iterat urt to a(errl ln v llic ll of th~ impa irm 1t~ and Liit hil it il i GllIltec hy ~ o l i()gtj s -o ull he ll nt x or re middotlu celt1 Ili pl1ysical xerclse An u p-to-da te knOvkdge o f tl lt Lgtpecl-gt i necckC1 in rJeumlr) d -oek
- whetll~r there h ltl n adLtIIl ) l tht()d ical bbh fur or JqIIcirclb l l l1 Il( ) f k irt llit herlpy
- h N I)(1 ( 1 Dm tlle p r l c tIcirc(( o f Jebur tiJne )pOfung lcli v l ti ~ IIOU lci he tllf) -d o
II J U V f h 1 I11~ c~~lb li hed Ihe usefuhlLss 01 k il1 shyc ~thtrpy il i aIle dy l nsi 1([(( -r-tI Llleu i n )I11 plJt~ ut the wJrld ir ilt ecircS~nl i 1 I( id n Iv w l1i li ( 1shy
gories 0 1 pl1Vtl( 1excrClgtegt te D)bilI7it ric 1n (Ir st shylliuumlZltio f) lttlt tlgtbltn ing ni trcrccedilh ing erc) hn Id be
vnlcled he tll rhe nuld be lerrillldll1 1 md whidl s tlQu1d be inreœ jf ic(1 IJeClU~l tlley cOli lel Je LI ~ful
Ncuro1llotor impainncnts
Imv aUl llOr~ 11 lt1lt ~tlKlteJ lhe cltlndatiotl bd Ween tl UC1UmiddotIt t l ol(~C t nt id iopml je -nll ~J~ and cli~l l shyler~ lr 1tH lest ihuLIr yt 1 _ 13 ~ 311 D uhoussct 1
1-- ITS tln l ldiopath k s(o lio-L L cll -c d l J l hmgt in th terl tltr f prop li l l pu n md 1I1ar th e detrshyn Hi n i~ na tural 1 ~ronse to ril e need tu ts tu re p()tun ltlluilib riu Ul HcrmJJ1 31~ 11 () d tllat icliupathic ( liCl5j h l it re5u lt Ot1 rw nltuf mot r l ~ltelV
[Id )fcl 3 nI] ~1ltJ U Sr1lle nr to dtorders in centJtI lO~Cl shyIOIDNur) md 1xi~tI moro (Ul1lfOl syt( llI (Fig _l
N htIll -of) H1c S uumll h( rll1 ( ~ l( w ing JI t11 (oshyI-ie on the l l lO]ugy o b doll (nt Rl iu]icirc tlili- middot()lioL m unt fil t-hltll rhl ugravedcmnilV L th e fl5 ult o f 1 (k btcl 11lIFll llI ion nf som t11(WUgravetltnl md pO~ lur( (tnic l~ l licirc1 tl1lt if l p OgtlbJt b C 1l rlw sta l i lin 0f 11 1 Sf llle j lt g )tx l Tt) ohtil n a ))Cli U 1ILzltl I o f p ~llIr~il d l~flo [ in l1litkd ~J)llnSIS me CI Igt(middotqucnr J ~ a ~tmicirc ()nlly or regle Ie Llive
Ali th- 11yp ) tlw~es rd ~lte tr d irtl Itn t pnl1tlt o f [11 v hole ~piltm It11[ controls postu re ~nd mrw shyment lrre pell ic of tlh po int a d lI~ llv inH llYegraved il i ~ ll 1 nnable tCl aSUilll ri 1l tr l ll1 lo g thi ~ys ttm ( Qu it le 1I middoteli tl
lt ch ugt nlt~(S f rullliIl thil i nlomwtion th at p tlmiddot shyiCil J(tl iIies nw gt Il lInport~n t rr le to pbv [11Icircgt role ca n 1)lt slI i11l1lariztd ln lWO the ptu li ain Llt
- d elopmll1 l of p uumlltl St1 b Hlt ) - c1e veuml IOpm 1)[ o f bhll1ltc _
(k llhUl)lOr S Cll orr
ontrot oic whan-lt
------+ 1 ~ il lnll ugrave r AINnl
Cllnlr1
T bflt~ r
fltL1 tlli
lMini
l
~sary ~J-frlllen i )f
~ 1 ocirctnl
~UcirclllIJJlW Ll
AXl ~l1 n uumll l) r sy 5t ~nl
middoticoltoq ~ Fig 2-AcFgtrdong lU He-mutl 21 il is Fi)5~ ib1e rD prolXgtSlt l -oo ie1 mnd 1 ((if ~ elio egrave middotAhltr~d l)Qdy-p ati~ I I i u d) uren ttllOn k td LO In ~ory reHTt I1 eDi tn l al ) JdrnlV~ pn)4~ e l u r~o(Ofe 0-c1 eptunl dvstil t1 ctlon sltŒ(ry icircltu nu11t ilwnt [ ~mC ~ted tl l1 ce Ill trpntlshyUumlfJJl nd IKnle~ r~dibl jtugrave)n of -I) m tlosen Ir ~ig nj tl (I1vying ln fornll1U n (lI an ereltl ~piJl e Mmor aJJ r--a t ~) n ltgtf ti lt aXljl mowr plem iHUC Wh ~fl Ille 6ubjeco m uumlntl Icircn (1oJifitd perccpfLlI l ~na l ysilt of p n)lnocepti Icircnfu rnlaquol ti desnibJOS ~n t tecr spin A IICW motor co nrro l Ira I gy t adopt resu ltin~ in the ~tr ltctltr 1 ckformh y lf IdiopathirL scollos i=i Ht lrftU1uc nltnt l ISll I1lJy h1e- ~ I pro()und elkn on bralO Sfem flJll ct i(lnn~lLhu modifyRll Ille nltulltgtshytl10 ) 1 1111 Uu l-lHoror control 5~Shnl$ shy
As Srtgn1lt1 l ~ ltlssert~ if wc l C -Cp t 111 1 un o f the G IiC s oliosls L l tisorckr oi th e ltquilibrilltn sys t ~ms it is lagical to oriegravenrate physlCl l exercis( lherap y ln th is d ir(gtCli()[1
11lclte goals Cul tl lfOUgil ditrercn t modes 01 action be Olchic(-c1 witJ1 phykal accivit ie
- po rt ive Cll ities p ro ct LJ e aIl UgravelClltrtsc in 6lte nshyel ll )o rd in~lti n pinai pr0prinup ti_)[J nLi mOVeshyment control 0 vio lls iy ln thh repect ome lCtivshylites aœ pre um~I I)y lXrter tllln ntil crs
- kinrl lira py using pedJil exerCisocirc specially developecl lith th est 1101 5 in mind illVuuml VC I lllore prccilt( ll1d InC1 li zed cri n on rhe spiJw focusing
a90
1 ~~
lg -lNheJo ~1l l1 t r~l g rld in 1 1) h i(~ IImiddot ct r rHienl w i ll idlllhic _It ~i ~ _ iri s plt ~I le II find Jit ltH vlllleuml ~l Cgtbl tn~ ks III d il fef lt p ~ lt ihnS nu v~tl middot B ~a~pt u Il C middotl)Icircd ~(t l l11 C dlfkrCnl middot- hdween slllndi1g Uline nu nllt1Xinul oorrec ri nI t chied Vith Ct (J ) und tfdincJ ne lot es o UIine 1 fo llnVs middotIJfl tfi ni( - ltlrshy
reltiK)n ~ Ikexibiliry st3nucircing - -pirte - f ur~1 1IbjISC ltupin - ltorrcaion - - r~luci()il ll ymiddot For flmpllt in J npK l1 pH k1J il
plt1SSlhlc ln obtai n 10 u1 511ndlt)l [YLo lion yr ln Slt p ille rlOlgt itlugraven om l J ~ in ( gttf(C rigtIl lIex lbuil 15 i (r-l l=22deg pol lltl ~~J IIlpraquo is IcircO~-V- I t1 l nd tucircu(Ugrave) ilil) I~ 3laquoJO- IH-12
r ln Ugravel e abilit jl of tluuml [m e llu to co ntro l irse lr in ~ pac
fuld l oftlles uumlllelve ntio ns can presum1b1r incn~~ Ih enl ac )1 the orller and lHitlll r of Ille rn - 11 )ltd h e lllldenl lu EJ3)4il
Posl1l1-t collapse lnd slabilizariotl
lIle concept u fplt st lUal c(l lJap~e l l~t Iwen detin 61 by DlI II-T3e~tupegrave rL t Ac oJdin)j tu tl1i- ~ll1thor il [ nec(sary ~- l Hn Cv-tlualing th tleihility o f a col shylo tIcircC CUJVL (0 clistingu ih bt tVeen the re du ihil [ty index (th - li iffer gt le bet ~middot Il ~I r~tcli()grJph ie ~xnmshyinltio n of the iI111 pHienr in supine po ition m(i
ROte OF Pl rnmL EŒIlCISE IN THE TREAT-ŒNT OP ~I IJD IDIOPAnnC OOU~GEm seou SIS EltJRINI
I (~)-----------------------~
__ _~ _____ _~ __ __ L ___~ ________1 ____ _ __ ____ ___ ___ _____L___ _____ l___ ----------L ______ _
1 ~
1
-- ------- --1---- ---- ]---r --- -----_----t- ---- --- ---shy__ ______~---- __ ____ 1________ __ _1_ __ ____ __shy
~ (1 J
1
8 =~~=r=middotmiddotmiddotmiddoti~=-middotl--- middotmiddotmiddotshy--------------t----------~- -------- - ------__shy
~---- --- -- -~ -------------r---- -- -- ~-- - -------- --shy----i-------r-- - ---- ~~-shy
il 1~ 0
Dtl-Lmiddot ~ lttj l r~ UIltltlHt
f g 1 -TI1 u ilictf 1ld ( ii 11- ugraveu-sh) ld IX~ O 1d wllich ltJdnrshymII Il nf the pilll 1 ~tln~1 of th e -o lioti( spinc n IG~nI(J II IIIshytt) lhe iJeuml grl-e o f ~ ()Ii ti c (u rvH Il 1 w dcpc-nlknrly o l l he 10 111shy
P01(nl (pntt l ~ 1 1 nr ffll wrJ I) ln w hilth Ihe n i 1gt( ~ duc nL~ grlphs fm I h~lt 111lt hi~hr Iht Col h ~Ilu t (l f Lite ~Ul Ihe m Ol CI il y th t s(uumlJotil middotpin~ ~111 he ~middotJg gr~lVH(~(1
m mJxiTIt corrttt ion wll iJl i~ lIllCd to Ih - xt 1shy
lti Oilil y Jf tl1lt t Ut JO rl1t cdnUc idt md p OS shy
tU ll cul lapse ( th t ltHill enct b-tten l lUdioL) 1lphic egraveltamJl1ltlti OI1 J t th e ~lme pa tient in Sl il tl cling lOJ lline fX-sitiutl ) Wll ic h correb lc- onl wil ll fhe abilt ty of lllt p tu rl l gt s tem to C( lunternct lIk luree o r grl viry )cco d ing rv D lfVd- f3egraveLIprc po st li r t1 lt01shyIlDse is d ue to the Jnus -u lar ton a nd 11ll ex rCrIshy i) i itv of rhe tissus n the ( O IW-) si it (If the (01shyjl ti (~JtVe (Fi~ 3 L Pu~t llr1 C lltpstl lu lcl l ~~ reduc l-lt by llwans o f pl1ysica l cxerCles specitkally s tuclled ruuml i rnprove tIlus--ubr fOHt md lU pr )cllI Ct 1 ~11 hi shy
lizing ffCd
PararcL n tll CIJ cl the cr iti ca l (3 c1 thlsho ld beQ ld Il ich defol1J lHU n of the i pinlt 1 e~ in~ ne dtlllontr~1t _cl (1l ll t grclrf r mg] o f rllt C II in a qa m bng pos ition corn pOil 15 t l lowcr detormashytion lhnsllold (Fig 1) ie to ~11l Ulne3Se t the risk of pr ogr t~ lu n There t rh eJef re l J ea r l)iuuml 1itshycJ l ~ll1 l l(tl a 1 tnr tg ro b ohwined by d -cr t l ~ illg ilmiddot pU~lUrll cull lpse ptJcelJtge w bich lccording t i)
h llTd tnd ~l(heJ1l ~on 1~ b inde cl 1X llt icularly luumlgh Ugravel mllcl c Iio~ i (bdow 2( 0 ) (F ig 5 J
Fin a Il III ch iS respect lllljl hl and b um l 01 m linmiddot
ii iI 1 l _ _~ _ ___I ___ ___ __L ___ _ ___ ___J______ ___ 1 ___
li 1 1 1 1 i 1
1 i ___--____---___----__-_---_~- _ _--_ ___-+----
i
1
i -- ~- -- ---~-----_-~-_-_--_1-~
l ~
i
+----r--------t-------t------f-- J
Fj~ ~-Ac(XjJlin(Q luuml T O rIcd ~lnd Na(h(ln~ n i () dl( pCG w rd (rTIshy
POO ll is hiherin cu rvegt in wh ilt l1lh ~1flILWrd cII1I Olk l1t IS le- pr(v~knt ln th e grtph Ih t PogttJlJ I ugtnq) Ot1 -J1l j elfltS-e J tlt 1l1t obb dirr remc rlLIv obu incu f roll l the Cohb atl( 0 1stlI1dtJ1g IId gtupinc rldo~raf115 Ih Ille lt) [1l1t1 (i lndnl I pine) 511pille the ~(nlClu tJ1 compo l1lnt U rlk CU Y _VeJily I~ ltx p rlt 1 L1v UpUlt (obh Illeturo Ih t si _b Cct rtJeSIm l fie -ltn J trd Ugraveltuuml shyuumlo n A~-i)rding LP 11(lt uuta o n l ( r1I~( in ~I 2JQ sup itlt curvt 1hi C(]l)b ddhccno l l f lO is -J-lultt( thc s ldnd inr tnla Ol1l t lS wi Q) whil 11) 1 1)401 ~llp lne ClHVC If ~ 1Omiddot ( tcl Lhe ttnd trl~ nlca~ I(t I ~ ~I)
tli n ll w l lllE cq lin ti spin h~ i ng mo r ~ Llnt~II) 1 tlun the nOftl111 one n Cll l gr(lk ( (cU ve tl1u n da r u p shy
po rt in o r k r 10 m linrl in tht 1xi11po tuf_ n th ha__i of th egt onideratl lr1S it f(lll() rhJt
ph rH (~Uuml e erd es ulukl h u - ul iiuml tbeacuteY ~U-L lm cl 1l (It-d o pmg p05111 td C Jl1twl lS fuumlrnll~ rly d ccrll1td ln an Ql St if i imr ol1111 t ru t(( - tht m(d in C JI shy
r t t r sture fO Ir -ngthen tlll m u ck-gt of the spint mainl) in (11erl antig r3ilrl tIcirclt l]lli fun ctin ll U hy meU15 dl i )ll1 t trk ~ lhJ cl( -ll tlt C)nlr~lUions ~llld no l IdOshy
1l)llic d YIltll1k lt l jAJ lktic t) I1 ) II 11)t 111 hd posibleacute t lcluuml ee postura l io nrro and stfh ili lllllt IJI
w i thout food T1lw(ull r d I( Lf(11 Ibk t m ucircnuin Ihe c()rf ~ct [ ()S tu re for cl gtu ifKi IH lLl1gth 0f ti l11 ~
This i-l ddl usl a typl 11 dnmnin (tf k inesllh rap) in 11 (lt-11 [[k - p~d fk lnr in lng f u l1a in llllliCk is poss ihle lI sing ctrtain Idncl fJ l (lt) 11111 liun S p Ul in tb is Cl c is ulttful ooly sa I~tr 1~ il Iw lps t1w lxltknt 1 becuJl)t 1gtlt ltlt-I a ClJu~l inred irl ilL ntllru l o~ i cll
and I1lll~lJhl r-keJc LIl [rll-llIn~ middot etlt(wrs JI the int e rmiddot vlnrion
[J ROPA MfJ) I()Wf-I YSJ IR
1
ICR 1 1-1
r
1 shy ~
- shy
11 o-llrfOlhe5l~ o t Ih 1O~(1dity i n h ~ r ~ ll nr pbl1 l of ~ Spl11 in 111011 _llti1Gt l lPt f ltlJUCWJtl ( ~l Ihe Ir t 1 1gt illbll W Ilh LtltrJ1dlion Vln lbe rigronl middotUII~ l(I Dko n12 lIll h lumshydlanie1 1 [ nul 1 M hl whtrc M - gt) lnIUI1g 111laquo111laquo1 1 1 c rtJCshytjC~ f fce d -d Lill l1~ o f enr niI pUll spnmcl1y 1~ 111 mldlll1lt (n the fl1ur t 1 = tor~ of f(ward Ileuuml l = ughtel1lng fmiddotr p 1shynOf stn lClU= Alaquo rdtllg 1raquo Ihl~ - lin hull th l1ltgtllugrave ot tller1l lUr~Jtllrc F the ~pin t -ilh rlu1i tf Ihl 1 1Ibulll n lrlt InltT1 1
rbc prJI 3IJi l1ty d qrlOIJ~ n bull JI t IlJIII Hm lA the v=ltd gtc e lu-ing J 5lnK1ura i ltfnnity
Dioal e ch anicll itllp~lir J11 c nt
Ihrcemiddotdimcllgtional mc-cbal1in of the s pioc
~f Ikmiddot i t i nly l(œ ntly tlHr llk pr-5tnœ or nc ushy1 lnlo tnr impairment in Idiopttlllc s-ol ii IXl tknt liuml J$ heen h i- ll licircghlcJ hy re$eJ rh tll e preit ilegravee h inm b nIcirc Ji d lJutg~ lt hl ~ 1 ng t o n dO Ulll urcel 1 i5 (l lreldv well umlersrood H(j-ev~r nev lbt un h iomcrhankal im l) ion nI h1c rectm ly onk l n tIlt tre and p r~dou in f n rmtinn hou t pl1ykd (~fcl5( in t 11 0 tl1I _ltgt pbne of spact 1115 Im trqlt-u 1rom J i-[) v ing unclcrsrmdlng ot th l lmc -dim nshy~ilnl l l11 ~ hmk f the cO]jO[lC pln( ~2middot ) ) Ve- w ill )iI xnl t l1 d at lcL-orcltng tUl cl sif iol t lOn blsed o n gtolllt lricd h uumlCJ ) p lane
- b() rJzU[1tl ln th i pla n ~ th t 1o rm ll sp ine present no CUlye- w ll ile Uumll(~ ltc U Hic spLnc clevelops one of ir haracterls(Icircc deFo rm tiCs v elt tbrd ln lashytio n vh icl1 pJ()VcA~ theacute hw 11
- lgitltl in th llulJe U l(~ nonmll spIcirclle pl SenL kypl lOSis ~nd l dooi~ in tb lXI1 lhese [(Hu rts Vere m)( til ught [ 0 he relattd tlle scolkJtlc ( lI r Vegrave
- front l in hi pleme tht ncrmal p ine preseuron t no curYegrave whil thl ~11li tic p in ugravetI I ()~ icircl~ charshyad t Ilt I CU1C
Il Jri fJIIt palic
~l+I~na ra 3 r inr lut th l[ ber ll1d a œl1~lU1 degr 1
l f r()la tJo u lllu (lILa r forcKl ltxert ltJn tl ldefnmuumlng 1 tkllJ [J i1u a re- lhlt tll cly 11 [1 1 UI b y Olm ner w bn ~lh uiJwd tl egrave ro t1tic) l1 Ilm it ti lt p ica] lf shy
rhrl r() be (P (the Uma bevond Wl1iltJl th lCOJlb of [11( ~pmaJ musd ~ dthc COnCIt and nm ex ~l le btconk (t O li~[)
r ~l 18 ~1Il N lu t( ren i9 lun lu ted rlseurlt h in tlt ) tilt lULodeumlformipg1 tlo n ot tIH_ sc laquoJrle rh ox ercallkren lk 1l1~H li d11r once thl Il i ~ r tld1t5 [he lhrth ld f 111 JlIcirc lIi of tlle dnrlclc hurnp tlk
lI bslt Il l nt rlet()rlll lIcircon 01 the it l ()I~ C ( (ylm der (- sustalnecl by an H1tmi cforming aCOOIl
J1Ji h V hl rhyiical f~ f Ise CI 01 h spr n llnd kin middot ith ccedilrapJ my lX damlg ing vll e n l pplild as flle
igt Jk Iller ln SCC1IJ ~IS lllc lJ fxceed l auto in middot crca~ i n g lhrllgthuld [1 sh (~u Id ahn be j ofed that Ilw relscd pre sun 1l1111i insiugrave l fe pil1r inn) 1 mlshylt
- j Il- ( w atff 1 (nh ~1l 1(e Il10 utoldrml ng li1eCh~lI1 1sm
in flc l Geyer ~w tcd th1 t rm m 1 hI l)1ecircch1O lla1 puilll 0 l I C~ sw m mim t Ieuroamp no purpo t for cu lshyim le pllilt t1 s (weumlO middott r it is l~Jl(gtWl1 rhn in iculio r[ paULnl -iJl11T1ill~ doe_gt nor Il ~lp to i ncrt~SL n eur(1shym tor co mfU
(1irai p an (
Jerdnn lle 11 showecl thal ill CSl~ o f t10rLC IC 1i lUgrave
tllo lacolulllhil it lio_1 tlle cte tI llmiry in (he lg itt1 p lln t rn lnlftot il~ lf tspe iuUy in tlw initi 11 r luleuml )f cV IU[Icircon nf Ile ~oli ls W iU l 1 p(t)gr~s~ivlt il10middot~ shy
ment roward hvpok pho b G ll f ill~l Im lins l har dUflng (IN eWllLlfiu1 of 11Imh] co luumlgt i the l in t ot t l H~ gClyty Cegraven te l - 0 1 v llebed lxxli 5 r ro ject 1 seH fl r t side-ys and tlwn backlrcl bull thu~ p(0(1 lj n g a kyphQtlmg aet Il ln (h~ lu mhnr --PIl1 COftj tng
l l i tc Iugrave l lltl l( l rs1 tif s L -etllgt il l the lgirl11
1 Hl)
Ilu LE nI rIIY~Ic~L lXIlKISI 1 HI E TREhTMEtn OP JIU IDIOP llII C AD O USCUH O Ll Œl15 NEGR II
lLill tegt lre lenl1 ~I d ~fo rll1J[ ~ rhl recrSes the phyltiologiGII cmns of lh vine)
Accordlng () Dicion ~2 1 rtcluctio fl in the itgitttl CUIYtS combin l vi th a lueral Iviari n llltl ds t 1
mecban ism () ugravel~ta il ity in l he r rat r IllI1e which bVOf1i the unsd a nd i ncrea~e 0 1 co hlt1is (Fig 6 hiIf md Pl11jlbiJ Jl1eanwlt ile lt(udiecl lh e srnl ru t
orzyglpophySLs show ing t11 al ttleir 1I1tl rnic tl orienshytation f~I (jLi l~ltes aXIal ve rtegravebJl l rotllio ll in cun litluns lt f dorsal hypokrrhn Icirc tnd lum)H de i L lo IS
Tll t dat SLlgge 1 th t impOrfill ut pOitu res and l1lweil1 ) t Mudied in ord t r (CI mlIuml ntrlin or to reuwer fll e p llyslo lo~lCll ClIlye in lIe SlgJtta p lU)l Wlth the llm o t ch ~ kin~ rutltor in l~ bili ry7 AbC th ~e ~k-
1l11nL ~Irt del lnt [0 J jUc lt ftber l]kuti inrervenl ion vhich 1c)LJ k l IV - i(l ~ l compktl n l ililll on Il t c1 l shy-jel1 J11UVllT1ent IJ j o f 1uto-dOneacute(3tlon ( i e a -impk ld ion ) Iengtheni ng o f the pilleacute 011 a litlltl l aXl~ tll lt ((IT liJlI~rcdu e~ t lle ~---lJ linti- l lte ml-fkxj(l n h UI 11 - i llCrl I~t the plllH ](JgicJI dlt cr ~l S ( (1 k-yvllCiSh lIld O(ltOSh l o r c lch r1Iif n t a Ilew til(~ecirc dUuml llt Ilshy
si lflltl J ll1 u(~nlent iam ecl - 1l1t0- lIrfe rionmiddot7 4 llmshyp oed f Je-rura l iUIl cl middot-t1e- iltm lI1d ll1a intltnUlLe )( 5lg it d C Uf (gtS slig lll thltJrc i ypI1 tiZ) tIcircOI1 a nd lunugrave)ar 1()fdos i7~llion) sholild he esw b lb]HU 00 lb co
hl b oi hi p~l11il uU r -1Ir vlt Abo 111( e IlltUtl Chl lie o f purti n - a U vitk slJ1ultI h e )tuumlll ecl 1)] (1 n ldershy](ion r tl1i lt type for e upIe IilJ llyl)T S of repd shyiti( ml vemen prt n t in agonistK h)lnllltlSlks nI iIle kind f dlJ1ce C( uld he ([([r imentd
FmiddotO lllaljlallC and mobili ty of the SpIcircIlC
1 rd llo U 22 d L lm nrrare d lhlt in Illt fro nt a l pll ne
tilt 1 nge Clt 1)1lt vtment of tht scplit[i middot CU IY grcmr lIJ l il ~ d irectio n n f Lhe C ITelt tlO n tha n in tl le di re shyLion of pmgressi n l Fig 7 ) he IL o IS5err lJd tbat th15 mohiliry increac plrtil u la rly n apic [ cgcoeilts 1$ lh ~ ~c() li osb evolves Sragrm rJ 12 J ~ thus rigilt (0
VlI f n rller~p is ts Ilo t t) m o b uumliz - a sCtJl iu til curve w ilhout t [ uling ttwt tlle R lu tiOI o i til t ~a mt b fnlinruumln( 1hy l1tans o f ~I passic 01 1 rivE -uppnrt On tilt (ltllE r hand UgraveK d e iJlioJ1 in ease durill tlw tune 111 whicll tll C spmt i ~ not submjtrcd to correeshy( IV anl()n
j- Virh mi lei ol i b tlllt Upp i1n ill) lC tiol is d eveloped only lllmugil llClIf()mu$Cllbr f r llce thi ~
InegravelIl ~ thclcfo re tl1l[ inu eascgtt sp1J1all1extl)iity mua
11
Imiddotiumltgt 7-rurd illt Ir) 1 bull rdrilt I1 1 in tl lt frOlllll pbnlt- th( illl ge )r mOC llIeJlI o t the S-o UIIJC CUNe 1 supcrior in Ihlt diflt(l im ugrave( the n nKlIl thd n ll1 tllc dlrtcLion o f p rJ1(l( (llIl
be considrCtJ vntrl iJ)(l icltion and 1 undrli neocirc ab L a ~ubiljz~ILion 01 tilt spint pllss il)1y ohtl ll1td thrltJugll the stlengtlkl11ng o f the 1rltJgm vlt nonil lme shyCIC 111 illli orrant u bjcLliH- ln rhis r~f1 n sp u lllni lc tivitIumlLs sil uld lX tPI 10 dlegraveltl it l G lU t n w l1ik luring kine i Icircth lrr phyltical eXegraverci c~ tllat in ele
spinal m ot ilIcirclY sil nid 1e lt1 oid cdrt ~
Organ ie and psychologieal impainncuts and li islbi IiI le
A cgtI im lc pmi nr is moriOthl11 just 1 sp in and 1
compkt gt Ipp rnach to the gu in ad 1 ont i al~ shylute l e~se i t i11
[)a la 0 11[ [n ell lrom re semh pw tbat ome organi Iilnctiond cl fki ts suc]) as tlw clecrtiUe ut vild l tnd d fun ll l)Kity_orld ldly incrtJ k whil~ 0 shy[io s i -till in (1 miel q g of g JltlV ity ~ l ilI e 55 rtI lit
tllL pres e n ce )fl defidt Or Vi l~il Clp~1 - i~ ln one pIIiem in Ihr l ftectecl by 20 ICl 40 scoi stgt l ls~a r(h cunclutecl in tbe UA by Di Ruce- prod uegraveed an aaalo) u ll1lXimum 102 re u t in a group of Jd shyk 1ien t [(h sco llosls rang inF frum ) [0 1
Al10ther rudv bv rallt r m C chr111 lilcl NashycWrl1s( u 57 stlO eltt hil $(C 1 1 ui~ Ica js l( lllt cl (1 shy1prUlllI o f t1tgl lie bJd l imI in ~ul sct t1 t ltu b middot iects jlLltr l5 they are golng through ~I cltlici[e sllge in the fnm 1lt i n 01 tlWH o w n id uHitv t factor hit h Illy jeopmlize the cl velopme lit d ~ mIll lt lI1d htIshym cecl IWI sonalitr in Klulrhood
n RUI ~IEDl(( Ptl Y1-
ROU ltHmiddot PI [ I C~ 1 EXIRCIS]~ IN TI Il nW~JUNT OF SlllO lDIOP1HIC AI)C~ESΠ11 C(gt1[Oi 1S
This i why b IiCieacute ii is ~n imporrlIl t for p rcshyvegraveml e 1tLsr l tn en ou flge 1ari e nrs ~lfrecr(d by lIillcl middotu iosis ft) tlke p~l rt in portin -re rcatioluJ acrivitits Iha t 1eIU 10 L10 th r~1chophyinLl bull nd b~l )i 1l1o tur adlieem t n li 51Jmiddot2Even tlK)ugli [Dr bic mech~lnshy
ical mcl nellIUll10t 11 11 reltl ~ons lt r111 1gtomcrimes be l lefu l to ugg( ~t ne p rt in~ aCt iv ity r l h (gtr rll n anotlJer e th ink Ibal an exces~ ive IlHd icalizltion - Icirce l ll1posilion br plry~ilt i HlS nnejlor parents uf rh ry pe of po rt to lx p m lice 1 b Ule p 1Ucirc(Il L th1[ preshydLl ck l1 is fret clOice in lh ma tt r - -h II ll1 he avolc1ed wb 11 possLhle mainly for tlle i mport~ltll psyshyLb ) jogka l fe a SI)nS W( ha( ill ~ t nltntionegraved
Conclu ion
lbh ISsertegrave d t1H physkal tgtXtlci o is ) n fi ial whlIl practinu in order 10 ilnj rove the I11 llde
rœ nwh and tono C iral caplCiry and postu re o f the StOUO(I ~lIbj n II I nowkdge om ~ middotmg trom ci el1shyrlfi rls(~ Jrc li dJlJ accordl ng r the review 01 thE litshytirlture prnpo )td in t lli plpl r conflrm~ Ihe vuiclit ot th e -t ls ~rti ()ns
In l do l (ent Id iopl1il iC scoliuse il l n phee u i cl vk)pm e n t ( li tll iumlKh eXCC cl l g i en rhk thr hokl th e re i5 an und ubred need fn r l pprnpri 1tegrave (JJ1tOkJJe ~Ild Inr surgict1 therapics ill ortler 1) S l i p
the ( - Iuli on anugrave )JT~t~t UW ~pilll l dtlormities bull evshyerthtless in the illiti ~ll pl l~sC t ttlC c1iseLltc whcn the riS( r1 r euro )luli m is rtduced ocirc ~md tfle uifleal JOld threshold il ~ld flle po stural collai i reJcenw~ 43
JI l1 igh pllysicaJ egravexe rc ise - p revenc or r d llCe d i ~lh ilir ies o f [Iw ~ l() li )tic
p (iems R 28 J -6 5- 6 1 63
- f~KiHtare lh ( n utr ali711iCUl of postu m l d elicits tn produCel1 a coneql l nce J [)ti 0 I111)( or regre si -u lmiddotc 5middot Il 1 17 ~ M
-re 51udles U ~ n Ledecl tu con[mn or re jecr these conClLL i( 1 w l1 ich clerin-d frum 1l1 lIldytica l rcltw n f th e liter~iture appear r- ~Lo nlble Hnwecr Intil ne re ull are 31Iable wc should n r prevent our sroliotic patientmiddot trom tl ki ll p lt in s(loI1ing jshy
ir its pW1iada rly ltl t ~d1()o t () n til t c ntrHY -vith the l xcclrinn 01 gt[1 )11lt tIlat in rea-e t)1obility (tnU evc n thell oilly wh n progr~lgtion b p OSSibl) -uc h ~I( ucircvshyiUe -11 )ulu hl tIKoll w g ed The 11 S J ( rprOpriue kin (~irhe r~l Piuml to incr _~asc p()~tura l $llbil i ty is tl1egraveoretshyic tlly CiJUClt alttloughl more ~Iccu rtte aod deLli led ri k benefi rs anJlr~ is is netot1ed
Ria 1111tO
NIokl Mu d lle ftitYljJfu Jœl il 4IWr10UOifll S (JIvs i (1~1)Jshylidl ttno( cclIll le 11(11(1lt1 RCI fu lle ((lia LltfIt l1 I1I1i(i
LJ ci n s j(r3 pigt egrave li n IHUgru lkl di t rdz t fi sici pe e ft shytUlKm iluppno di un lisimerap15Ll rl lllcflt() 1 110 scopo di pnevirlt () fr en~lI 1-lgpwlllltnlcgt dclld lclonnitugrave o e il 5LOshy
Il i mi llon lt fH nugrave j (1 11ni dei co~e 1 lteIl I1J J nd ne ~Ii eifclti (()Tc rri udk s co lio si d i m e dia g rt iuuml ln que~ltlt
s rud i 30 llizzb mo i d ti cleU ric lca pel n ri Icare qJJ l lm 1 dis(imucirc x u le I[~ l z j-m i pro vna le da lla C gtl k A i json ere pr middote-nute () rk kl ducirc un~l rdeguCltl d nil cra pi lt di uJoseguerrnt Cjua li 1iU110 cli nbie tti 1 rcr lJ)tIId d~ fle)-UITC
n (- -fd7Io n~lcl)
Ut11claquo)si 1 lI tori htpnuuml )ludi-ttn I ~ cnntI1zttu fr Cq(in i idiJ)tic1 dbfl lOZ10l1 d d ~ leOla nelllOll1otoriO Lb un1I1cnUl 1n1l1i3 dcgli 111 lt1i ch DIJgt gtU l H crmU1 Nlch~mslt ( SIshygnaJ~l lerimiddot wo i esuemi -bletti d~ plt~e8lugraver- ne l pClZ le1lftgt scoliodcu kl s iluppo ddl ~ ~ uhjlil~ vertcbral~ lt o svilllp prJ Jdle JIl7 i() nl di ltCjuiljbrio Dng li studi sul lto lb( l~nlrale (OllddU i in pa rticdu d 1 DlIal-BeHJ (gtegraverl ~ P~II IId lI1 n~ llw - idente il v- m gtiu p eT il puientc clioti elgt di u n rnigb o t c)[ ro Ua sw mle dei radlldc onsegull o tramite il 11 fforzrlshyfl len to d e i l1luotoucirc l nllgr3ilri d e luOwo con crcbi ~Clltdr
in pOMltHJ corrctl e in va rie ~i[Jzioni s t llicb c c d inamIcirc tllt Dalle on sena d elb blOffiCcclIlicd tr idimlt n s io mlle d ei
r ~ chi Je ~oU()f icn ~Icirc ~videnuumll (l() ~llt tC p IYZIcircOSI ln(IiClZlfHicircl ~ 1I1shy
liumln fluenzt Je ll middote~rUrio tl SC) lgt lIi I rc pibull m i tldln sJlI71 Stl shygn~I I1 afferma che slI l p Ia no [11 middotccedilr~lk tre un œ rtlJ grado di l L1Liuuml IlC dclh vEltlh r1 apj(de le tu rœ mu SCltJ llri njtbc J n in $tJ ) t rodcfQfll1t1l1te PltJtantu b i r~it-~ r -lp il puugrave t~~
Ixnt-ftla solo nt Ile so )[j)~i Jl1Icirc na rl in qunnt ) ilon SlrM ntne )(l(Ofa tu soglb in caq ) co lltrLJIcircn l)lrilto llt~( i lJudotlsi di lfr~ lI1 C llg grVlmenl J 111 11 io lr riltd ll(17jOill leld rinlle 113 dimO~iumlrlto d llt nell o lin~l cl()~ li t th~oIOl))1 dri la defltgtrshymiti sul p iluO slfl iuale ~vohl lf1 (en5 ion~ sO lnm utto nd 1e bsi iniliali deWggrwm1Cnln mcn trl C a( lfLmn che occlleshyvoluzi ne dene = 110 i [ mhari IJ lin c l ki cen tri ch -1vi1( de i cp i CIt IJ rI Ji SI p m ittIl pnm l Iem lmeme e p o j pOS( shyrio fllwnte dtldnli mdv ( i un ziuuml ne ciloliz7nnl dd rlLtide lu mbJ œ ( lIlelttlaquo on NC n d d (gt11 uIdu m 1I1 Ilgt) cli r-Iure (0 eserClzi che IllUllengano 0 ltlUperifo le Clgt 6gt1 lo)iche sul pirluuml gilwlt Su l p iCl no fron itk Perdnulk il dlll1lt-trlto d1 lampkz-l d i LU ovimento amp111 lI rv Kolio ti ~ nd lt1 0 ddlJ cnrrc-LIcircQo i Ji gC 1 n lungl SUpegraveliltlrccedil 1M llS0 tlell 3ampIGI shyvamcnlo C che l~Jltmiddot mobiliti GlI mcnta co n l c lu7j o fle d l i) snAio i A ulln amplgrtJc1 ltllllmunjx~ i terlpGli nn n m obi shyUZ73It ma eutva coli ti0 1 1ct HsicVlfe nd tcmplt 11 1111nshyttllIcirc1nc n tc (k ll ~1 llu u zinnt n l1 un me77uuml d i sost l11( gt ln 0
e 11111ri b cle - Ilziunc egrave deorinatcl d l rlyarsi Snzcl la pr gtshy
liltlnl l i un() rtl~ i ptmiddot Jtl n(o 1S(Hl () (( ntJ() i ndit~tr i ~ Ii ISt (izi e l m iviL Illdlode ebe Hlmen tno laJlc ibiJii dcl rlc lide SCshy
li io) [n p articobre rune q lldl r C-I1 ich~ xlSiddcHe CUf t shyli ve ch~ iJllpi tgino e~rciii 01( biIi2 ZanUgrave HhnmL-trid () in tmiddot~t~nshy
sione kl fuchide O tne pure k- ~ttivit1 tnotoJII~ non prHi(~ llCcedil
in forma r k rel1tiva d Ie ~1I 11 rF~1l1( n otcol mcnlC 1 lll ubib Ll vcrteblmiddote (ad ~ flp j(l 11 n l) to L ginn ~Iilt Utl clkl rilshyC
mka la cli OT- tcc)
r1il to l~ _ I[Dl COlI rY IC~
NE olUNI
fillncr ( ni ((uuml(( n hIIo( rilclIO ~middothe k lln dtfidl fUr1z i shy
nlu CQll1~ la llcl llZIO 1e delb c apKJl ilde e della capacltl di 0170 mizianu luJndn le (OJ il~ gtna a nc r3 di m~i3 gmshy
v it ln G mlxl r i ~ gko Fl llslrom C dlllJ O e Nachcms(J h iU1I) dim lr JtQ che b o liosl p IOO C1 neUaduksœnr 10 SYil l1p pn d i lIniumlmn~gin nlt8Jliva de corpo in (o nridcnz di Ln ddic3w p ri d di f( m l lz i nlt deUa SUl idenritl condishyZltonc ch pOlrebh ~[I cubrmiddot ln vilu pp di un pe bull n nn lir m llur cd e quiJibfarn in t[C adulro TaU CO1DSCe nZe tvlde nshyZ[II)() la n ( middotess iti di ltimobre la plfte ip a7j0 r1e atl an ivi ll1ltHClr n gl b a li ltl h ~ di tlpO s pu rti middotu dl ittlrc nd gloani iCo lID ti i lirtugraveta z io ni llb vila di relazionc
ln concllliu fu la d tfoflll lL saliu iG egrave il sin l mo di lin) idrotnc C Il1pk 1 d e eoinvo l d middotmiddot= fu n (n i dd rgashynIcirc5H10 n Hi lhdli e lesenizjo fi 1lt0 se 1 Il indirill~t() pllO pr~cnin 0 odLf rgt t lli di fu nzlonicirc adlc s()Jj(bi 111Icircn(i rrHtatc CO ll nl1 cinesi rap i Quand l~ coli i ( n LS~middot iJ11 zia k il rischio evnluLIcircvo egrave lid [() mente no tcole 11 (ltlll asso p o lll shylal ltOtSltgllen7~1 _ ta cincsiterapia pc rslIk bidtlvi shyptutibulli d ubllIcirctIcirc vltnc brn1e di conrro llo )(JSu k d i 5IcirclupPQ d Ile rLlt ziofll d i eC[u ihb ugraveo dJ ftffr otZJH1 r1w dei IIl llJgtCili 1 11Icircshyg rdtarl in posru ra rrenu posslhile JnnalL in Illo lt i clsi l(j luucircun lt di lin ~c() li oi mi n rc ( ume [11 duumlnQstrIO la tinc~ jn~l el1lric ((1l1 ~rtlppi d i contnmiddotllo cnndnlt1 p nso i l entrt d e Massue di Li n nc da [ o llo n ~ Rodo l (1 986) Julndo il1vlce lIfU~ ho ~vutlJ tiVll 11lt1 1IjXIl to un dekrshyuina r o~itl di g rl vir~l bull a~-n lllull~nte n ec ~~uiu rlCUuml rf( ff dla tcrJpll rle si c a eo chirurg ica
1Ho le clllC ooliosi idjopHI 3 ttl1p ~ - E~er l zjo hsco shy11ln ~ I((fapil
l Bg 5 CUle Lo [la k ll oblems in tlu ll~ (U ni Cl) FrKUce CU ( )lIILr no 1 AllCPR lu b1lG1t10 11 middotCI 9()(iJ2 RockilJe MI) i)~Cr ~()f I [( al th all 1 () I ~Y 1(~Re~C~Hd ~gtutnlt Ilallb Srshy1ltC Cgt D~p(rulllnr CJf I Ilalil 11 1 HumlIl sen Lel 199-1
2 SI) lrzcf ( LcB I ~IIl( FE DupUb L ampkIll~ 1c ~ppro l c h ll tht rnent und mmgemlt-rlt ot ~ ct vlyrl~ led splnul (hs r)fder~ A monQglJph rr r d lll kic Re p o l1 or Ih Ou bcc TlSk Fu rcl 0 11 ipmd DIo rele Sp ine L9H LU) 59
) Clntino F 111i1 i(ll Ci nerte1H C Nou gltHhl C Kln(~Jl llBICII [lIe1 hmlln (Il dry rra ll1ltfll of QIil pa ll m log iC by l11e 1 lIb li 1le-llh laquorilC~ of ~ 10(lna 111 Jrc)Jcxli r~~ (of flle h l lntrnIUonll SVIll Illgt~iu tn - II 5lt Ik lIc lk0flllllic lu llln-I I r l III Fhhlt ri g 1092 -ltlIJ-7
i - ri of niii MA N()LJV II ~ mel h)ltks de kin ~~klk rlr k di lll J r~cdllclli (n d~s ~()li oes jn f ~tel r~1ruuml(ILI -lo s bl fl c sur IcIj cquishyl)œ~ Ik SOll ll l)(eacute Eli ror eetlfllS d )111 1~ 1)1-
5 iloll n G Ruumld(~ le s () I ~middotmiddots tnlcl l l1 I n in 1Ifc el kiwil~~ 1)11lt KillegraveSlthe ripJe SCleacutentlnlue lYl6 2 47 ~ 6
r) Feacuterr[ffgt en 1tsiero 5 Venlllfln A ll~~n () M MJglio nu N EfkUuml o r eXltClse tI~tl Yoj o n nild id iO rXllhlc iC() 1i()~ lrt~ lirnIcircIluy r sull Eur feltl lb)ii 1 1j34 Z5 -~ 1 NOilrill1 A Sbill P egn ni i Ll Linesilegraverpi l 1lt1 Itallllll~nlO
ddlJ soI K~ i llO 1 Orkl1Llllwnrl m efodoloil1c1 RbbilltlZiOllc Ot1(1 1 )29(1) 1l-~
8 Nli(rinl Nl(lr1n l A blll P LI rieduGlzione dl p llicml atflt rro (11 coli ns i idi opr lir1 l n SC(Um i le or h( JI 1rcLlIQn1 ~0Cl le Imc lI1etW)n11e de Recltcrchc ci 0 Ftude sm 1lt Radw jlt)(j S-71
gt Nftriruuml S SeJhrf U LI r i l bllh ~l liOlie dd plziecirc11te ulet1n 11 - r
lin Kllopd (1 In l1l Jgl L N eduoL Tf1It II d ll11e ji cln1 rJtbl IiIUvJ Milan) 1ltfddH~n(x~hl 2(1~111gt-1-PU ob L cllln t iRll p l nelLi rl tgtO llcui n~ dilt ~lio i - l rn~f- li ~iIa n 3efllnl -Kurflr 19-11
11 lIIra S lJll M EVtJltHlvugrave egraveI lt t rnrumel1t() d db S(oli - U r) surie doCum nUle fintgt 31 tIUUli Mibn SI rlin) KlIpf -r 199 2
L2 1 ~W I1l(IJ P _leacuteVia tio n I~lhra k~ du IlchlS ~- ( i( IoltS ccedil l r lI C1 l1 fl leq
Ene 1 l C hi r ApparctlIClCOn l~ ltll1 l ltx6lt (i W Er 20 j )7 l
U StrI tr d P Lcs 1) rm IlO du Hltlctli Parb ME n 115 li ~u n un_ l c- l ol lJn e~IL1roy JC EagtOllŒrio n sc lluocs
L cl middot Exp CO_fiL [-In 190 15 Xd BR llet13n) J Th ltJl-xwenc a l o-(l1 tUcn~kuud txer
C le re-glflW 1 lhe tfelmc nl o f id iopllhiC Collaraquo n lroc~-din) t Lhl 1 r 111(1ltli0 I111 Symf SiUl1l un 3-D Scl IiDliJ DclOfshymillelt ~k)J1[rlt u Gugtu l1Shltr Verbg 1lti t)L j32-t)
16 N1lh~Ir~il Al Peumlf r~o n LE Erree htJkmiddotmiddot~ n f t~U lt hfIl middot Ith J
hran in ~rls V ll ~ ttiVl ~HkJ k-nt IHuIXtthilaquo ic I) Li ~I~ts H t 1l1i JflIn t ~ j l~jl)5iuml7A(~)8Jj- 21 bull
17 M(jo n Y ( ullck J p ~ R A PrdulllnlIr rpurt 11 Iht e rt l f rnltJsu red 5l ren jl lh rrll nrl1 III ililleInr Hi rrt tllk scoJliagt
J lin1I IJisn rd 21 1 1)12) 102- - Hl Hunng CU[- -If p~lIll)~thc - Uonktd in -c h JI IL
c reacutetnl n~ ptnl l C)Q~ Z ) t 1 t(li-v 19 Kou )UrJKh L Glr~ k G KRI iJI G KLmiddotmiddotrnl kh g UlUI
) KrJ UkQULlk i~ ~l ~~ fl c+l l1ng ~t (w)j (h ildrcn frit ltt lmiddot( ti ~l~ 0 1 (he
isbnd of Cfdt J middotpin 1 Dior el 1 9J7 lIX( )middot i2 ~ middotl I i) SG IC1Iugrave lS r olle lCOS rh Zadrc C Ber E Xend s T A
ohool scr(l nin~ f r Loli rraquo pro~ p ah pidemlaIO)( Io Jl lUcJ ~middot In ncIfllwt~t~rll dncl Ctt1fLll Grttc J none 1cUlf ~)Ufg Arnl
19lt) ) JOJ )8-1)3 tl llunnd P n ohlecTln CfjtefO I1 f r SCCi II Ots t-CTctt1 lngJ BOIlt
Joi nl lIrg AI11 1~gt81 (1 )1)1 -0 22 re rdrlo lk R 11 gtcolk)c on Ftudc TrldrI1lUl i0 nnli1t FHIS
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EUROP MIDI C Pli hIC
EDUCATIONMEETING SATURDAY 8thof APRIL 2006
(iSS
SEAS02 Scientific
Exercises Approach to Scoliosis
version 2002
G
S Negrini 1
EDUCATION MEETING SATURDAY8th of APRIL 2006
Neuromotor disfunctions
Neuromuscular disfunctions
11 Postural collapse
Postural collapse
Duval-Beaupegravere
Flexibility of scoliotic curve
f---I--- I Postural element
-------1 Structural element
S Negrini 2
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Postural collapse
Duval-Beaupegravere
It is a value related to muscular tone and to flexibil ity of convex side tissues
Post ural collapse
Bunch e Patwardhan
Critical load
Load threshold beyond wh ich a spine begins buckling
JI~~Wt1lW~flfthtlJlœJtAr ~ J~It- l~l - IMS
Postu ral collapse
Bunch e Patwardhan
If a curve reduces there is an increase of the deformation threshold
~~~NW~-damaoc~IIIMf ~~ J~Iv JaJ-I7I9sect
S Negrini 3
EDUCATION MEETING SATURDAY 8th of APRIL2006
Postural collapse
Torrel e Nachemson ~
Scolioses below 20deg ~ ~ lt~
have a high ~ ~ percentage of ~ ~
~postural collapse (on u~
average 75) ~~ 2i~
CU~VE O EG~EE S WHllE SUPlti e
~laquotd~c6b ____lPffI1wtt1t~
$ww J(t ~~7 JM5
Postural collapse
Minor scolioses 7
Antigravity musc es strengthening D
Reduces postural collapse -G
Increases the critical threshold of deformation
G
Neuromotor disfunetions
Stagnara
If we admit that one of the causes of idiopathie scoliosis is a disfunction in balance systems it is logical to orientate physical exercises toward this direction
s Negrini 4
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Neuromotor disfunctions
Dubousset
Idiopathie seoliosis results fram alterations in praprioeeption centres and deformation is a natural compensation to restore postural balance
etattJtitIK ypothfQj~S ___~ own_ oJ)HQr lar 1t-1( r
Neuromotor disfunctions
Nachemson Initial idiopathie scoliosis
+ Goood spine stability
Neutralization of postural deficits
D Static curve
Neuromotor disfunctions
Therapeutic aims
c) Development of spine stability
C) Development of balance reactions
G
S Negrini 5
EDUCATION MEETING SATURDAY 8thof APRIL 2006
Biomechanical disfunctions
j Horizontal r-Ian
i Sagi ttal plan
Frontal plan
Frontal plan
q Frontal plan disfunetions
Fronta l plan
Perdriolle Movement magnitude
gt in the direction of lt in the direction of correction progression
S Negrini 6
EDUCATION MEETING SATURDAY8th of APRIL 2006
Frontal plan
Stagnara
Never mobilize a scoliotic curve without ensuring reduction maintenance over time otherwise a greater mobility favours scoliosis progression
Frontal plan
Ducongeacute~ research
On a group of adolescent idiopathie scolioses treated with
Meacuteziegraveres gymnastics
D After 1 year the mean angle of
curves increased from 18deg to 29deg
Frontal plan
Scoliosis without brace
D Greater spine
flexibility D-
Risk of progression
S Negrini 7
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Frontal plan
Mobilization is useful
D In preparation to
brace
D With brace
Sagittal plan
QSagittal plan disfunctions
Sagittal plan r middot _J o
Perdriolle scouos B CJ aDeformation of D
thoracic and thoraco-Iumbar curves evolves in extension
S Negrini 8
EDUCATION MEETING SATURDAY8th of APRIL 2006
Sagittal plan
Graf
The line of gravity centres in the vertebral bodies o s c oUOSt
projects itself firstly laterally and then fi
o
posteriorly lJ ~~ ~~ ~ ~~-_J-D ~nI~
Sagittal plan
Therapeutic a ims
D Maintain or
retrieve physiological curves on the sagittal plan
Horizontal plan
QHorizontal plan disfunctions
S Negnni 9
EDUCATION MEETINGSATURDAY 8th of APRIL 2006
Horizontal plan
Stagnara The forces applied ta the spi ne act in a autoshydeforming sense
Horizontal plan
Dimnet Rotation gt 200
ampII~ (
D The actions of concave and convex side
muscles become
agonistic
~ItJrOnrIIiItdllfUClltlluumlll~~tI ~1JIf1laJ
Horizontal plan
Minor scolioses never exceed these autoshy
deformation thresholds
S Negrini 10
EDUCATION MEETING SATURDAY8th of APRIL 2006
Disfunctions at a biological organic and psychological
lever
Oisfunclions at a biological organlc and psychologlcal lever
Cheng
Bane density in scoliotic teenagers is lower than in normal subjects
~~~~middotA~IIlUtIy ~7œl 1d l
Oisfunctions at a blologlcal organic and psychologicallevel
A significant reduction of vital capacity and V02max in teenagers with a medium severity scoliosis
S Negrini 11
li
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Disfunctions at a biological organic and psychologicallevel
Disorders in the development of body image that the teenager has of himherself
Disfunctions at a blologlca l organlc and psychologicallevel
Therapeutic aims
cJ Activate cardioshyrespiratory function
cJ Favour bone density increase
cJ Develop a positive image of the body
Disfunctions at il biological organi and psydlologicallevel
Stagnara
Sport
D The active side of
kinesitherapy
S Negrini 12
EDUCATION MEETING SATURDAY 8thof APRIL 2006
Disfunctions at a biological organic and psychological
level
Distunctions at a biologlcal organlc and psychologicallevel
Cheng
Bone density in scoliotic teenagers is lower than in normal subjects
~n~IIIvpWr~middotA~stWy s- XXJl M J
Disfunctions at a biological organic and psychologicallevel
A significant reduction of vital capacity and V02max in teenagers with a medium severity scoliosis
G
S Negrini 11
EDUCATIONMEETING SATURDAY 8th of APRIL 2006
Kinesitherapy on the scoliotic subject
q Postural control
q Axial stability
q Muscular trophism
q Balance
q Respiratory function
The limits of kinesitherapy
There is a threshold beyond which
rehabilitation alone is not enough
sssr
Kinesitherapy in scoliosis treatment with brace
Therapeutic aims
S Negrini 13
6
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Therapeutic aims Srace kinesitherapy
With brace
il Postural corrections and
vertebral stability are obtained by the brace
Therapeutic aims Srace kinesitherapy
In preparation to the brace
il Mobilize spine on ail plans
Therapeutic aims Srace kinesitherapy
With brace D
Maintain a normal spine elasticity
~ Maintain a good muscular toneshy
trophism
C Model the hump with kyphotizating
exercises
S Negrini 14
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Exercises and their methodologies can vary accord ing to learning and individual sensibility of the single rehabilitator that proposes the m provided that they stay within the
Iimits of fixed therapeutic objectives
li
Therapeutic modalities
(Exercises)
QAuto-correction
QRespiratory education
QErgonomie education
QMuscular strengthening
QDevelopment of balance reactions
WNeuromotor integration
ci Vertebral mobiJization
QSpecifie modalities in brace treatment
S Negrini 15
EDUCATION MEETING SATURDAY 8th of APRIL 2006
The protocol of kinesitherapic
treatment
G
QChoice and dosage of exercises
Variatiosn of the work program every 2 - 3 months
Q Execute e)(ercises on an individual base or in a small group
Q Frequency not less than 2 times 1 week
Involve and awaken the family
G
S Negrini 16
EDUCATION MEETINGSATURDAY 8thof APRIL 2006
Q Determine the action and the localization of auto-correction
QAuto-correction must be associated to ail exercises
QAt the end of treatment ergonomy lesson
Auto-correction didactics
G
SCOLIOSI DORSALE---- shy ----
r
S Negrini 17
EDUCATION MEETING SATURDAY8thof APRIL 2006
SCOLIOS OORSOLOMBARE
shy
SCOLIOSI OOIlSALE 011 bull LOMBARE S1I--shy
SCOLIOSI LOMBARE
il --~_-
S Negrini 18
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Scoliotic patients are not radiographs
middotSeoliotie Mtients are not ndiographs but hum beings with a vertebral deviation-
Slagnara
Metha For the physieian Cobb angle is of utmost
importance For the patient it is body deformity t hat eounts most rib hump a protruding seapula or hip We are in a situation in whieh today dodors eure the radiographie deformity but what the patient really desires is to get rid of clinieal deformity and of ensuing psyehologieal distress
CIIQItIo shDuIdtucirc lM WIld tJw~~ I~~M~~~~ J9f~
S Negrini 19
- Poznan_workshop_Physiotherapy
- physio2
- physio3pdf
- physio4
- physio5
- physio6
- physio7
- physio8
- physio9
- physio10
-
1100-1330 - SESSION A - CONSERVATIVE MANAGEMENT OF IDiOPATHIC SCOLIOSIS
T Kotwicki (Poznan Poand) Idiopathie scoliosis - definition pathology diagnosis
ThB Grivas (Attica Greece) Idiopathie seoliosis - basic nomenclature
JC de Mauroy (Lyon France) Progression of scoliosis during puberty shy making therapeutie decision
A Nowakowski (Poznan Poand) Conservative treatment of scoliosis in the past centu ries
C Coillard (Montrea Canada) New radiological classification and corrective movement
J Cheneau (Tououse France) Mechanism of correction of seoliosis by brace
J OBrien (USA) Scolios is Patient Care More than just a method
DISCUSSION
1330-1415 - LUNCH
1415-1715 - SESSION B - PHYSIOTHERAPY - WORKSHOP
J Durmala (Katowice Poand) Role of physiotherapy in seoliosis
K Dobosiewicz (Katowice Poand) Dobosiewicz method
S Negrini M Romano (Mian tay) Scientific Exereises Approach to Seoliosis SEAS02
M Bialek A Mhango (Wroclaw Poand) Functional individual therapy of scoliosis
HR Weiss (Bad Sobernheim Germany) Bad Sobernheim Concept (Lehnert-Schroth-Weiss method)
DISCUSSION
1715-1730 M Riga (Barceone Spain) Concl usion shy conservative treatment of scoliosis
1730 - END OF THE EDUCATION MEETING
Biodynamiczna metoda t r6j p~aszczyznowej
korekcji skolioz idiopatycznych
Metoda Dohosiewicz
bull Istota metody oparta na patomecharice skolioz idiopatycznych polega na koncentracji dzia~ania w strefie skrzywienia na kr~gu szczytowym z zastosowaniem po stronie wklE~ej bodkow proprioceptywnych
a po stronie wypukfej bodkow eksteroceptywnych
Ruch sterowany jest asymetrycznym torem oddechowyrn
bull Metoda ma dziatanie segmentarne
a ruch ukierunkowany jest na maksymalnq kifotyzacj~ krEgos~upa w odcinku w ktorym wyst~puje proces pierwotnej lordotyzacji i rotacja kr~gu szczytowego
1
bull Derotacja kr~gu szczytowego Potclczoiluuml jest z rownoczesnym jego ruchem w pfaszczyinie strzatkowej N kierunku grzbietowym oraz w pfaszczyinie czcfowej w kierunku posrodkovym
bull Powstaje ruch trojpfaszczyznOllly kr~gostupa
Jest to ruch odwrotny do kierunku rozwoju skoliozy
Schemat post~powania
bull Cz~seacute wst~pna - Rozgrzewka
bull uruchomienie pOSlczegocirclnych segmentocircw ruchowych kr~oslupa w systemie calkowitego podwieszenia
bull efImlnacja przykurczy w stawach blodrowlch kolanowych 1 barkowych
bull Cz~seacute glowna - Asymetryczna tragravejplaszczyznowa mobilizacja kr~goslupa w sclSle
symetrycznych pOZcjach wyjsciowych bull w pozycjach czworacrych bull w siadzie skulnyrn 1 W sladzie prostm bull w kltku prostyrn bull w pozycji stoJtcej bull W p02ycji stojqcej ln ortezie Checircneau
Il cz~seacute kOrlcowa - Zestr6j ruchowy
bull utrwalanie odruchu postawy z wykorzystaniem bodiceacutew bI~dnikQwych bull cwiczenfa rozluznlajqce konczvn
Badanie postawy d ala
pl1odu ltylu boku
2
Test AdRmsa
Test Adamsa
3
Pozycje do eacutewiczen wg meody Dobosiewicl (cz 1)
4
Metoda Dobosiewicz
pozycja 1
Meota Dobosiewicz
prutwnik
Metoda Dobosiewicz
5
Zmi3ny w zakresie kllill Cobbll w wyniku Jlrowadzooej kinezyterapi i wg Dobosiewicz w grupie
progresnvoych skoliozjedl oillkowy cll - n=124 (ass obsenvncji ud 6 do 58 ntini~cy $~dD iw 197plusmnJ 185 Rlic3iqC3)
6
Zmiany w zakresie kqta rotacji osiowej kr~gu sZczytowego sknywiellia w wyniku prowadzonej kinezylerapii wg Dobosiewicz
w grupie progresywovch skoliozjednoillkowycfl - 0=124 (czas oburwRCji ad 6 do 58 mitJi~cy sndniR 197plusmn11S5 miesics)
Grupa skoiozjednoukowych typ J wg Ponsetiego - skrzywienia Th dx - leczeni kinczyterapill wg Dobosiewicz
(1174 015 ubscnvncji od 6 do 45 mieiircy s-cduin 211plusmn 111 rniesi~cn)
Zmiany w zakresie kllU CObbtr w wynlku prowadzooei kinezyluapii wg Duhosiewicz w gTUpj~
progresywnych skolioz dwulufwwycfl - 0=74 (aos obsrnvacji ad 6 do 45 micsi~y srcdnin 211 plusmn 1 1 mi~Icircqca)
DdciMk Th odcinek L
7
ZcDli~ny w zakresie kla rolaei osiowe krfgu sezytowego
sknywienia w wyniku prowadzonej kinezyterapii wg Dobosiewicz w grupie progrcsywnych skolioz dwulukowyell shy
n=74 (C7lS obserwacji ad 6 do 45 miesi~q srednia 211 plusmn 111 miesiqcR)
oddnek Th odcinek L
Grupa skoliozjednoillkowycll 0 kqcie Cobba lt 40deg - leaeni wyhCznie kinezyterapil wg Dobo~icwicz (n=44) (czas obserwacji od 5 do JI mi~ifCY ~redllia t 18plusmn604 mie-ihco)
tnnl qICIiIl fMtt[ IoooI ~)I l~Illli 1IqIlt00401 IftmiddotI-I llJ
~1 1~ u)~___- uul
c- -- a-J
Obserwowmo i ~totn~l korclacjt pomittuzy POZiUllllm opilnowilnia Illctody przcz chorych i cZccedilsloscj stosowaniu kjnc7ytcrapii a wiclkoscuuml rcgre~ji 7~niilnw zakrcsic kta Cubha i rutltjl OSIOWCJ krccedilgu szczytuwtgo skrz)wienia - wspOlczynnik Ptarsona wynusil Odpllwicdnio 016 i D53
Grupa skoliol dWlllu koovyeh 0 kItac Cobba lt3(jl
typ IV wg Ponltetiego - skrrywienia pienvotnie podw6le - piersitJwe pFlWosrUlII i lccedildiwi()we Iwostrow
-Ieczeni wylcznie kiDezyterapi~ wg Dobosiewicz (0=10) (nli obsrrvLcjicirc od ~ do 24 miesifCY _~ n~dllia 12453 micsi~ca)
Sndni ~~( Cobbl na pmltltu (ugraveurulJpii
wynosil
ft udcinku Th shy 179deg
W oddnku L-17deg
Srcdni )11 Cobb~ po killtylapi -rylltlsi l
W odcinku Th shy 1J7deg
W odciuku L shy 1320
JmiddotI) 1)Imiddotj ~ lIll11 i ~W --)WCcedilMtf
ClNlIltallj Nui 001
( -aItu ho
~lllj Cl F1r Wj~ omn)
8
Zmiany w zakresie k(ill rotllcji osiowej kr~gll szqytowego sfmyiellilllV wyniku prowadzonej kinezylerapii wg Dobosiewicz
w grupie progresywnvch skoliozjedllollkowycll - 0=124 (CZB5 ObSrrwRcji od 6 do 58 mielli~cy irednia 197plusmn1185 miesiqca)
Grupa skoiozjedllolukowych typ 1 wg Ponseliego - skrzywienia Th dx - leczeni kintZ) terapill wg Dobosiewicz
(11=74 aas ubscrwacji od 6 do 45 mieiIcircccedilcy srednin 211plusmnII 1 miesiJtcft)
Zmiany w zakresie kqta CoMa IV wyniku prowadzoDej kinezy tera pii wg Dobosicwiu w grupie
progresvwon h skolUgraveIl dWlllllkowych - 0=74 (ons ubs~rwacji od 6 do 45 mil3Icircccedilcy sredni3 211 plusmn 1J1 micii il cn)
Ddcil1t~ Tb oddnek L
7
Zmiany w zaknsie kIta rotacji osiowej krfgu szczytoweg() sG-z~vienin W wylliku prowaagravezonej kinezyterapii
wg Dobosicwicz w grupi~ progrzs)wnvcb skolioz dWlUcircuk()wJcll shyn=74
(cras obscnvacji od 6 do 45 miesifC)j srednio ZI I1 JI I micsilfca)
oddnek Th udciollk L
Grupa skoliozjednolukowych 0 kqcie Cobba lt 40deg - JeCJeni wyl~7ltie lunezyterapil wg Dobo~il-Wicz (n=44) (nl3 obstrwllcji od 5 do 31 mhticcedilcy sndui 1I8plusmn6U4 miesiacn)
Obs~rwowano istolm korclacj( pomiccediltlzy poziull1lll1 upmowlIniu mctody przcz chorych 1 czccedilstosti stosowilniu kine7ylerapii il wi~lklJseii rewcsji zmian w Zakrcsil kta Cob l13 i ro tacjl osiowcj kr~1u SZCzylowcgu skrzywienia - wspolczynnik PeanlOniJ wjnusil uJpowiedniu 016 i D53 -
Grupa skolioz dWlllukowych 0 kflfch Cobbf lt30 Iyp 11 wg POllsetiego - jknywienia pienvotnie podwojle
- piersimve prflwv~middottrolle i lccedildiwilJwe ltKJoslrotme -Ieezeni wyl4eznie kinzyterapi~ wg Dobosiewicz (0=10)
(nu obenvacji ad 5 do 2 mlcsiccedilcy ~r~clnil 124plusmn51 micii~cll)
Sredui k~1 Cubba na )uclltlll I~lerpi
wy nosil
w udcinku Th-17o
w odcinkll L - 170
Sn=dui kql Cubb aJu liugrave~tyIcTUpij wynosil
W odcinku Th shy 137deg Y udcinku L shy lJ20
4) 1)IIIIcirc w Jlm ~llIWiob_ l~ rlllW
JIIIIm-lollUcirciaftq jtQ0 1 t~~010
UpIJI~r~
8
9
Po 5 i 10 miesieacutecach
C- 18 R-S C-12 R-S C-S R-Q
10
Po 9 miesilcach
11
BP
Il rz
Th
Cmiddot 12
R-3
L
C-16
R-7
PoDP 7 mies 10 rz_
C-9 C-20 R-OR-2
--__ _ _----------shy
12
DP
8 ri
111 C-26 R-2
L C- 17
R-]
bull Metoda asymetrycznej trojplaszczyznowej mobilizacji kr~gostupa ma znaczeumllCV wptyw na zahamowanie progresji
w skoliozach idiopatycznych szybko post~pujqcych
bull Mobilizacja strony wkl~s~ej skrzywienia i osiowa derotacja kr~gu szczytowego zwi~ksza korektywnoseacute skolioz zmniejsza garb i ebrowy poprawia obj~toseacute klatki piersiowej i zwi~ksza wydolnoseacute oddechowq plue
13
bull Przedstawiona metoda jest
stosowana samodzielnie lub
w pO~qczeniu z ortezq Checircneau
a takie jako przygotowanie do
leczenia operacyjnego
Ocena progresywnosci w badaniu elektrofizjologicznym
odruchu z odci~zenia
i~middotmiddot ~=~-~ shy1 _--==shyocirc
14
EUT S pine J (1997) () 93-97 copy S pringer-Verl ag lY07 ORIGINAL ARTICLE
K Dobosiewicz Neurophysiological mechanism of the unloading reflex as a prognostic factor in the early stages of idiopathie adolescent scoliosis
Rcceivcd 29 M arch 1996 Revised 16 August 1996 Acccp tcd 10 Septem ber 1996
Absfract This paper presents a new nc urophy iologila1 methougrave of e valushyati ng the risk o f p rogression in ill ioshy
mo t important factors in the eva luashytion of progress ive id io pathie scolioshysis The met hod can be lIsed to deshy
pathie scoliosis in th early stages uf tll( progre jve idiopath ie scolios is the dis ase by illY middottigating tll e unshy in lhe early s tages of the d isease loading refl ex in paraspinal muscles T he high sensi livi ty of ilie method The study incl uded 394 pat ients wilh means il can be used as a basis un seo liosis and 70 hcalt y chil dre n which to take an earl y dcc ision to
K D obosicwicz Depuumll1 mel1 l of Rchabi lilu lioll Si lesilln Medical Academ y 42-604 Tamo wskie G6ry 4
Lmenty of the unloacli ng retle x and repeatabi li ty o f Ihe rcbound and silent period were anal ysed for eaeh reflex evoked Prolonged latency and
p rimiddotom1 surgery
Key words Id iopathie seoli o is Unloadi ng rcnex Re bound
Katowice Polaml minima1 numbe o f cycles are the Larency Si ent period
T he ai m of this sludy was to evaJ uate the use of the unshyIntroduction load ing Dex for octcction of prog ressive id iopath ie adoshy
le cem oIios is in its carl s tages in onl r to lake a dccishyProg ress io n of id iopatJl ic scolios is bas been the su bject of
sion ta perfo nn surgcry as soon as pussible many clin ical radiological and elecrromyographic in ve~ shy
tigalions T here is ho wellcr no sim ple quantita ti ve or qual itati ve pro noslic methoo [hat can be em ployed in the
Materials and melhodsearly ~tHges of the disease Monitoring of lhe unloading rc felx in paraspinal m llsck appcars 10 be a reliable Inv gtsi lgnlions were carricd uut 011 394 pa tie nt with adolescent method o f discriminating bctwcen diffcrcn l fomls of Cushy ~c li ed J ild 70 hCldr hy children The scoli osis group consisted of Iios is T he un loa ing re n cx can be evokcd in ail the 31 1 g irl s and 83 boys aged 9-1 8 year~ (mean age 125 ycars) The
ske lelal muscles through a suegrave den shortening of o luntary contro ls wcre 0 girl s and 10 boys aged tO-1 7 y~ar (rncan age 128 cars ) Imong Ihe stlbjeclS tudied wcre 9 patien l w ith cershyinnervated muscle l2~J When a musc le is unloaJ ed vico-thoilc i seo liosi s mean Cobb ang le 22 7deg 121 with Ihoracic
rapidly durin g an isomerric con trac tion Ihe norm al reacshy scolios is mean Cobb nngle 309deg I 1 w ith thoraco-Iurnbar seolioshylion is an eleclrically silent pe riod fo llowed by a burs t o f s is rne ~n Co bb ang le 26~g o 63 with lumbar cotlos is mean Cobb action potentials called rebmmd The pause in d ischarge ang le 279deg and 90 w ir h doubh major curve sc o Ii() ~ i s meull o bb
nng le 292deg and 28 5deg The sludy group includcd 231 right -s ided can be observed only when a certai n h reshold va lue of and 163 left-sided 5col iouumlc patien ls There were 112 patients w ith
acceJcration flnd shortening of he muscle is exceeded progress ive id iopath ie scoliosi (76 ri g hHidtd and 36 Ic 1t-s ided) an tl il occues wilh constant latcncy correspond ing to that 182 with no n-progressive idjopa thic scoliosis (1 13 ri ght- sided and of the propriocepti ve nflcx (9 18 20] T he rebound ufter 6 le rt-sided) M d 100 w ith pe lvic tilt (statie) scolios is (42 rightshy
s ided anp 58 l eft -~ i(kd )the silent period in the unloaugraveing re felx rcsul ts from ae lishySC9 1ios is is consIcircdered progressive if the Cobb Jngle inshyvalio n of a pool of motone urons aIl o f which fClt1ch lhe
creltseacutes by more lhan 6 in 1 yen r aile middotnl1 n-progrcssive if the anshyfiring thres hold simultancously afte r prcviou~ si lenœ [l nua i increase is less thll n (i The Cobb angle ranged lrom 8deg to 77deg 1 4 201 in Ihe palicnls w ilh progress ive scoliosis (mean 361 ) [rom 30 ta
lI f R (on- f Rt tt1IY 1lIfl pflla 1 )(~ r(Jnu n t shy
fI) _ ~
Pathomechanic basics of conservative treatment of progressive idiopathic scoliosIcircs
according ta Dobosiewicz method based upon radiologie evaluation
Kryslyna DobosiewlcZ Jacek Dunnala Kny ztof Czemicki Hanna Jcndf7cjek
Deparmem of Rellabtlifatoll Mediw Uninrsity ofSiltsia KatOllice Poand 40-635 Katowice fil ZiUCl 3537 POL4ND
e-mail relwbilitacjt1s11mfoctaonetpl
Abstract Conscralivc IrcalrnCnI of Idiopathie scoht)~1 espcclall y kinc ilhcrapy i ~
nOI widcly apprccilllcd due 10 Ils suspectccl low dfcCIIcircvcnc 5 in relalion [ (1 a urglcal Irc[llment ACter long-ycar il ses ment of palomcchanic f scolio icirc in Dcpanmenl of Rchnhllilallon f Mclii al Unlcrsi ly of Sile bull a concTvallvc mcthod ()f IrCtllmenl asymmclric Irunk mobili7alion in lnclly ymmelm po~itions WIS
de el ped_Thi mClh d enablc 10 delain pTogression f scol iosis or ccn de middotrca~c laIerai urvalurc of a spi ne and angle of rOlllion assummg adequate () perallon f palicnl and ilS famil)
J Introduction
Idiopathie scoliosi OS) is a thrccdimensonal dcfonnation of il vertebral col lmm an- cntire trunk Afler many years of extensive rescarchcs the cause of idiopathie coliosIcircs $ i remaIcircns unknown It is possible Ihat idiopathie scoliosis devel ps and progress on a baslS 0- ~
multifactor disorder perhaps diffcrent for curve initiation and curve progressi 11 Fion poss ible pathologie factors nervous system dysfunctIcircons affecting postural tquili brium ar proprioceptive control seem to be espc ially important [ l 2 6 JI Pro_ ression f iS could bot delermincd by vertcbrac remodeling under eccent ri c loading created by axia lly ce gravitational forces in presence of muscular imbalancc in the trunk [2 J The verte rai colwrz unde r scoliotic conditions 15 an unstable system with tcndency to fu rther tune dcvelopment fl2] Lateral bending of a vertebral column visible in X-ray examination L
only a two-dimensional prcstntation of a complex dcformity consisting of patho logica axi rota ti on torsion and othcr deformations of vertebrae [7 8 10 II 14J ln fS physiolog~ curvatures of vcrtebra l column are disturbed Total Icngth of an anterior column of a spi n~
consi ting of vertebral bodies and intcrvertebral dises bccomcs grcater lhan length of l posterior colwnn - vertebral arches and proccsses [11 15 J h is apparent that phy iologi ~
thoracic kyphosis in rcgion of a scoliotIcircC curve diminishes Each vcrtebra of a stru tu ~
urve of coliosis is oricntatcd in hypercxtcnsion in relation t adjacent vcrtcbrae [7 l resulting
1 n B Uri middota I l 11
H srut ft illtf j tI) t li orf1Hli d
IDS Prt ts 21)2
Influence of method of asymmetric trunk mobilization on shaping of a physiological
thoracic kyphosis in children and youth suffering from progressive idiopathie scoliosis
Krystyna Dobo icwicz Jacek Dunnala Hanna Jendrzejck Krzysztof Czernicki
Deparrment of Rehabilitation Medical University ofSilesia KaloKce Poand 40-635 Katowice ut Ziolowa 3537 POLAND
e-mail rehabiliracjas(u1poCmiddottaollelpl
Abslract Idiopathie scoliosis (lS) which i sub 1 ntially l threeshydimen ional derormation or a pine cau e nOl only laler l curvalurc and axial rotation of vertebral column but al lordoti allon of VCr1cbrac in structural curve eXl nsion ln an effect physiological thoracic kypho j diminishc or cvcn dbappears Method of a ymlllctric lrunk mobilisation in strictly symmetric po iljon according [ Do () lewicz not only dcteriorme progre ion of IS or evcn reduces lalera] curvalure but also significmtly rebuild physiological thoracic kyphosis Icircn cases of lS accompanicd by lraight baclc
1 Introduction
Despitc Ion year researchc etiology of IS is nOl yel resol ed Significant problem re laled lO morphology of IS apar1 from lateral bending and ax i 1 r tati n i deviation of shape of a spine in sagittal axis affecting physiologi al curvatu re of vertebral coJumn [3 5 6 8 9 J 0 1t 12 Lcngth of anLerior col umn of a pin constitutcd by venebral hafls anugrave intcrvencbral dises dominate ovcr Jength of po terier c lurnn buill from vertebral arches and processes [lOJ This condition uring scol io i progress ion and growth of a child effect in hallowing or even disappearing of phy iological Lhoracic kyphosis in scoliotic region It i well know n lhar cn~brae of structu ral Jaleral curve are positioncd in hyperextension - lordotisation [5 6] which in Lhoracic region Icad (0 reduction of kyphosi or to true lordo middotis Such kind of venebrae relation in thoracic region cau es ilS destabicirclisatIcircon whi h in u sociation with eccentricircc gfilvitali nal load fa pinc duc to muscu lar icircmbalance [21 pOdbly produces r tationaJ lordo is [56 Il] and further development of symptomatic scoHose ft ha becn proven [12J tha strengthening of the erector spinac muscle aggravates nce initialcd deform tion and deteriorates coliotic process Hyperextension and uxial rotati n a s clatcd with
357 Th B Grivas (Ed) Research inro Spinal Defoml ilis 4 lOS Press 2002
Exercise efficiency of girls with idiopathie
seoliosis based on the ventilatory anaerobie threshold
Jacek Durmala Krystyna Dobosiewicz Hanna Jendrzejek Wieslaw Pius
Department ofRehabililation Medical University ofSiiesiaa Katowice Poand 40-635 Katowice m ZioJowa 4547 POLAND
e-mail durmalaiacekyocztaonetpl Department ofPhysiology Academy ofPhysical Education Katowice Poand
Abslract The aim of the study was to estimate the exercise efficiency in the group of
girls with idiopathie scol iosis based on the venlilatory anaerobic threshold (V AT)
Material and method The investigation comprised 58 gi rls wilh idiopathie scoliosis
aged 10--6 years 32 girls (55200 ) wilh double major scolioSiS and 26 girls (448)
with single scotiosis The girls were eonservatively treated using Dobosiewiagrave
method The control group consisted of 3 1 healthy girls aged 10-1 6 years The
cxercise test was performed using eycle ergometer During the exercise the gas
exehange parameters wcre reeorded (minute expiralory venlilation minute oxygen
consumption earbon dioxide production) On the basis of recorded paramcters V AT
has been computcd using V -si ope method Results The following V AT values were
obtained in the group with scoliosis 207+305 ml 02minlkg bm in control group
219+350 ml 02minlkg bm The differences belween girls with idiopathie scoliosis
and control group were nol SLaliSlically significant Conclusions I The exercise
effieieney of girls with idiopathie scoliosis conservalively treated using Dobosiewicz
melhod is normal 2 Such high level of the exercise cfficiency of the studied group
probably was due to intensive 3-D respiratory exercises of these girls
1 Introduction
In practice there are researched useful efficiency rates which on base of laboratory tests results possible easy without using of the relatively hard or long exercise tests would give the belter forsighting of the range of homeostasis disturbances and rapidi ty of increase of
physical fatigue during varied workloads [1] The best known rate of trus kind is the maximal
minute oxygen consumption [2345] During progressive physical effort minute oxygen
consumption increases proportionally to workload The reaching of real maximal minute
oxygen consumption in time of progressive effort is iodicaled by minute oxygen consumption plateau [5 61 This result is rarely registered in children The progressive exercise test is most commonly used in children until physicaJ exhaustion and the highest registered minute
oxygen consumption is treated as maximal minute oxygen consu mption or so-called
symplomatic limited maximal minute oxygen consumption [678J Sorne authors regard
Orto-dlet Trau malaogis Roha b ilitacjaARTlKUL ORIGINALNY ORIGINAL ARTICLE Vol 5 Nr 1 2003 80-85
Jacek Durmala l Krystyna Dobosiewicz l Tomasz Kotwicki Hanna Jendrzejek 1
Katedra i Klinika Rehabilitacji Slqska Akadenia Medyczna Katowice Katedra i Klinika Ortopedii Dzieci~cej Akademia Medyczna PoznQll
Wplyw asymetrycznej mobilizacji tulowia na wartoseacute k~ta Cobba i rotacji w przypadkach skolioz idiopatycznych u dzieci i mlodzieZy
Influence ofasyn1n1etrie 111obilisation of the trunk on the Cobb angle and rotation in idiopathie seoliosisin
children and adolescents Slnwu kluce ac eJJic Cl chOlIU) Ice SKoio= idj)PO Imiddot(~I7tmiddot
K~Jmiddot w()rus consrieI ve I (OtlHelif idiopathie HUW JS
SUMlvfARY
BackgrouId The aim ofthe stldy Vas Ihe radiological evaluation ofthe treatllJent ofthe idiopathic scolioshysis utilising as)mmetric trunk mobilisation in the strict~ll I)mmetric illitial position
Material ([fJ(f lIIellOds Presented stud) lOS based IIpon J36 cases (13 oovs oged FOf11 ocirc la 6 lcars (lild
rn girls aged frum 6 la S pears) trealed due to the idiopathie sCuliosis ((rom Novell1her 999 0 F enflfUn 200) Among 48 ch idrcn sllfJering from dOlfble-major scoios is 6 cases wcre infoll scaliusis JOjuvel7lle und 22 adolescent Among 88 sillgle scoliosis 6 lere infw7t 33 juvenile and 49 adolescent
Radiological exami71ation 1as condueed always in the repeataole technical cOlldiions RadlOglOlI1 lier evaluated oy the same physician Radiologica analysis oIthe scolios is incuded value ofthe Coho al1gle ongle ofaxial rotaion
ReSIils ln double-major scoliosis observed dlring one year period in Ihe thoracic segmenl Cobb angle decreased inll l increased 1395 and in 292 Il OS 111changed Axial lolation angle in 167 (~rcascs
decreased in 354 incrcased and rernainM the sorne in 479 In Ihe llllnba segmenl Cobb ang le clccrcscucirc il1 354 increased in 39 6 remained in 5 Angle ofaxial rotation deceoscd in3 ofca es incrcuscd in 29 and persisted in 48
ln single scolio is Cobb angle decreased in 386 incrcased in 353 and in 261 was lInchonged Axiol rotarion angle in 216 ofcases deceased in 295 increased and rell1aincd the sallie in 489
CondlsioJ Asymmetrie mobilisation of the tf1f17k in strictly syl7111elric initial positions is a 1Clhod of choice in the cOl7senJalive treatment ofthe idiopathic seoiosis
STRESZCZENIE
WS~p Celem pracy jest radiologiezla ocena Icczenia skoiloz idiopaf)cznych metoda asvmetrycznejl7lOoili shyzocji tllowia w sciSe symetlyczl7ych pozycjach lV)jscio wych
M aterial i metody Przeprowadono retrospektYlIl7q analizri 136 przypadkeacuteM dzieci (13 chlopcow i 123 dziellshyczqt w wieku 6- 18 lat) z bocznym idiop atycnylll skrYll ieniem krrgoslupa leczonych zachowawczo w Klinice
1
Ortopedla TliJumatoogia RehlblllagraveeJa ARTYKUL POOL1 DOWY OPINION ARTICLE Vol 7 Nf 1 2005 49-$11
Krystyna Dobosiewicz Jacek Durmala Tomasz KotwickP
Katedra i Klinika Rehabilitacji SIAM Katowice 2 Katedra i Klinika Orlopedii Dziecircej AM Pozncrlz
Biodynamiczna metoda tr6jplaszczyznowej korekcji skolioz idiopatycznych - opis metody Biodynamic method for 3-D correction of idiopathie
scoliosis a description ofthe method
SIOWQ kluczowe leezenie zachowawcze skoliozy idiopatyczne korekeja tr6jplaszczyznowa Key words conservative treament idiopathie scoliosis 3-D correction
SUMMARY
The biodynamic method of hree-dfmensional carreeion of idiopathie scoliosis is based on Ihe palhomeshychanics of idiopathie scolioiiiii and consiss in aClive segmental three-dimensional correction ofspinal cllrshyvatlre The course of action focuses in the viciniy ofthe apical vertebra Proprioceptive facilitation is applied on Ihe concave side ofthe curvaJure and exteroceplivefacilitation on the convex side Correction likewise proshyprio- or exteroceplive facilitation is phase-oclœd with asymmetric respirarory movemenr as weil as wilh parshyticular phases of the respiratory cycle ln Ihe course ofexercises three-planar movement is generated opposite to the direction in which scoliosis Is progressing This method is in accordance with the stale ofthe art ofscoshyIiasis pathomechanics The method requires detaied training and can Ihen con be applied at home under periodic control by a physician and a physiolherapist The method con be applied in landem with a Cheneau brace as weil as in surgical pretreatment A elaUed description of Ihe method of three-dimensional scoliosis trealment will be presented in Ihis article
STRESZCZENIE
ISlofa biadynamicznej mefody Ir6jplaszczyznowej korekcji skoioz idiopatycmych oparlaj est na patomechashynice iikolioz idiopatycznych - poega ana na czynnej segmentanlej tr6jplaszczymowej korekcji skrzywienia Dzialanie koncentruj e siccedil w pobitu Icrllgll szczytowego sknywienia Stosowane iest bodicowanie propiocepshytywne po stronie wklllsej oraz eksteroceptywne po stronie wypuldej Korekcja i slosowanie bodicocircw propioshyi eksteroceprywnych zsynchronizowane j esl z asymetrycznym torem oddechowym oraz z poszczeg61nymi fazashymi oddechu W trakcie eacutewiczen powstaje odwrotny do lrierurzku rozwoju scoliozy tr6jplaszczyznowy ruch IcrFtshygoslupa Melodajesl zgodna z aktualnym stanem wiedzy na lemat patomechanizmu scoiozy nymaga szczegocircshy100-lego instniktaZu po clorym mote byeacute wykonywana w warunkach domowych Z olcresowq kontrolq przez leshycana i fizj oterapeutll Metoda mote byeacute stosowana r6wnolegle z leczeniem gorsetem korekcyjnym Cheneau a talcte w przygotowaniu do leczenia operacyjnego slcolioz W pracy przedslawiony zostal szczeg6owy apis meshytody leczenia
Skoliozy idlopatyczne stanowili znieksztalcenia patycznej rozwija siccedil poprzez przemieszczenie kr~gu tr6j~aszczyznowe charakteryzujltce siccedil wyboczeshy szczytowego w stosunku do krccedilgu g6mego j dolnego niem rotacjltt krccedilg6w klatki piersiowej i miednicy z r6wnoczesolljego rotacjl zgodnie z ruchem wskashyoraz zmianami w fizjologicznych krzywiznach kr~ z6wek zegara dia skrzywienia prawostronnego oraz goslupa w plaszczyinie slrzalkoweJ [ 123] przeciwnie do wskaz6wek zegara dIa skrzywienia leshy
Z punklu widz nia patomechaniki tr6jplaszczyshy wostronnego Koncepcja rozwoju skoliozy jako rotashyznowe znieksztalcenie krccedilgoslupa w skoliozie idio- cja i kontrotacja sugeruje ze sily korekcyjne powinshy
49
EDUCATION MEETING SATURDAY 8th of APRIL 2006
- CARDJOPULMONARY EXERCIS E
TEST IN GIRLS WITH
CONSERVA TIVEL Y TREA TED
IDIOPATHIC SCOLIOSIS
Jacek DURMALA Krystyna DOBOSIEWICZ
Department of Rehabilitation Medical University of Silesia
Katowice Poland jdurmalaqcmpl
The aim of the study was
to estimate the influence the conservative treatment (asymmetric mobilization of the trunk by Dobosiewicz) on physical efficiency in the group of girls with idiopathie scoliosis
Material
bull 87 girls with idiopathie scoliosis
aged 1 0-17 years
(mean age 135 years SO 161)
J Durmala K Dobosiewicz 1
EDUCATION MEETING SATURDAY8thof APRIL 2006
Material
bull 38 girls (437) with double major scol iosis (thoracic segment - Cobb angle 18-42deg mean 30deg SO 82 angle of axial rotation 4-32deg mean 21 deg SD 107 lumbar segment - Cobb angle 11 shy48deg mean 31deg SO 128 angle of axial rotation 5shy30deg mean 13deg SO 85)
bull 49 girls (563) with single scoliosis (Cobb angle 11-75deg mean 33deg SO 155 angle of axial rotat ion 5-30deg mean 14deg SD 83)
TIoracic kyphosis of the invesllgated group was 5-39deg mean 23deg SO 86 and lumbar lordosis 16-41middot mean 30 50 65)
Material
bull The 64 girls aged 10-17 years (m ean age 131
years SD 132) were conservat ively Ireated
using Dobosiewiczs method
bull Treatment period ranged from 5 months 10 3
years (mean 148 months SD 902)
Material The 23 girls aged 10-17 years (mean age 136 years SO 108) were treated u sing symmetric exercises - treatment period ranged from 4 months to 3 years (mean 161 months SO 1019)
bull 26 of ail g irls (18 girls earlier treated using Dobosiewiczs m ethod and 8 gi rls earlier treated using symmetric exercises) aged 10-17 years (mean age 134 years SO 108) were twice tested - at first and last day of Intensive hospital rehabilitation (asymmetnc mobllization of the trunk by Oobosiewicz) - mean hospitalization period 20 days (range 18-26 days)
i rf~8f6~~ or~~n~= ~~r~1~r~icircJ~~tb~~~~ mean 17-4 1deg meatl~(I SO 74 R n~le ofax 1 rotatIon 5-25ot mC3 111 3laquo S0 6icircl Ilnd 1 99t1S~ ~~~~I~~~~~$ruo~ras~ ~ocirc~~a~e~~~~~~~5euml1 9middotn~ tUfllbar Iord05ts 16-4 1deg mean 311 SO 68)
J Durmala K Dobosiewicz 2
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Material
The control group consisted of 77 healthy
girls aged 6-17 years (mean age 12
years SD 31)
Material
The examined girls participated in school
only in scheduled physical education
lessons and have not been enrolled in
other sporting activity
METHOD
The exercise cycle
ergometer test was
performed
J Durmala K Dobosiewicz 3
EDUCATION MEETING SATURDAY 8th of APRIL 2006
METHOD
The Incrementai exercise test has been applied
We have found that tests ln whlch the Incrementai part of the protocol ln completed between 8 -12 minutes duration glve the
bullhighest maximum VOz in normal subjects
METHOD
The workload was Increased stepwlse
bull by 10 Watt every minute - ln chlldren
with high ~ 135 cm
bull by 15 Watt every minute ln chlldren
with high gt 135 cm
METHOD
The test had been contlnued untll refusai of the patient or exceeding the pulse Ilmit
Durlng the exerclse the gas exchange parameters were recorded by Jaeger device model Oxycon Alfa uslng direct breath-byshybreath rnethod (with face mask)
J Durmala K Dobosewlcz 4
EDUCATION MEETING SATURDAY 8th of APRIL 2006
METHOD ~ ~~ r 3 min 3 min 8 - 12 min 6 min -~
_ 0 rpiYJ 0 rpm 60 rpm ~1 30 rpm
_ t o~w=att~o~~na ~~ att__~ tl~~S~~ l ad l ~~~~~r o~w= Hlcremenlal t
pedaillog i i ~
~ ilt ~I~-----tl-~ I t ~ i ~ lOSt sffortivB
lW r resututlon r rm-u middot 1 - bullA~cremen tal ~~ ~ ~ ifr- ~ VtI 1 ~i ~ tllng _
METHOD
On the basis of recorded parameters VAT
has been individually computed for each
child using V-slope method by
Wasserman
METHOD
For assesment of physical capacity
the maximal minute oxygen o
consumption (V02max) ventilatory
anaerobic threshold (VAT) and
maximal workload was used
J Durmala K Dobosiewicz 5
EDUCATION MEETING SATURDAY 8thof APRIL 2006
RESULTS
Ali girls with 18 have been classified
within normal range of predicted
values of
bull maximal minute oxygen uptake
bull VAT and
bull maximal workload
RESULTS
The differences between group of girls
treated using Dobosiewicz s method and
group of girl s treated using symmetric
exercises were statistically significant
Lower exercise efficiency of girls treated
using sym metric exercises has been
observed
RESULTS Girls wilh IS Irealed using
N=87 p value
Dobosiewlczs method N64
symmetJic oxor-ci Nz23
Perœnlage of predicled vaJue of
maximal minute oxygen uptake
98 905 0033
Percenlage of predicled value of
VAT 97 933 0049
Percenlage 01 predided value ni
maximal workload 101 939 0038
J Durmala K Dobosiewicz 6
EDUCATION MEETING SATURDAY8th of APRIL 2006
RESULTS 26 girl s twice tested - at fi rst and last day of intensive hospital rehabilitation
The value of ventilatory anaerobic threshold increased during intensive hospital rehabilitation (asymmetric mobilization of the trunk by Oobosiewicz) statistically significantly (p=00019)
2047 ml O2 minkg (SO 268)
vs 2239 ml O2 minkg (SO 232)
Conclusions
1 The exerc ise eff iciency of girls with IS treated by asymmetric exerc ises of Oobosiewicz is norm al
2 Such high level of the exercise efficiency of thIcircs group resulted fram using of Oobosiewiczs method
r
J Durmala K Dobosiewicz 7
REVIEWS
Role of physical exercise in tbe treattnent of mild idiopathie adolescent scoliosis
Revicw of th- literature
A NECRlNl N VElWNL s PARZI 1 A NEGRINJ 5 NEClU NI
P1t~silillxlrd~ Ihcrapy (or klucgtlttlwrlpyl i pro shy-tJm of physka] cXlrd-cs ipcci I(a~ (IJcloJgtcd hy l li trIWlltl phrslollwrapbt wilh tb m~ln a1mor pl shyVCnI in lhe ilAAfIVltilH1 llf the ucirccfonuity III mild IgtC )
Lil1Si bclpin~ thebm ( aocl co uaufllclilIg ils ~jd- clf IS in nlOdlJmiddotnh-culiosis Th middotalillofthi paper ito r (W
Ille Ii lc ram r 1 a-ccrulin wh kh of Ih bull Lu[Jalmlcrus Ind (Lb hili til~ CLlLt-cd br scnli()si- clluld bl pl Y nlcd or r d uccd hl phylolld LXtmiddotrdsi n Il p--to-da le knowl Uuml~l nr tIll~C aspcc[~ i ne bulled in oruer 10 dndc whclh~r 11Rf blLl adcqlmtt Ib(uuml n middotlicaJ balis fo r ora)aini l Ihe US4~ of lUgravellgtitlerap) wltcllj(r or fln l th e prtl1iœ of kimiddot ~lre IUlll poNjn~ a t iil ies ~bould h allowtcI II uuml middot c enliaI toltlentlf)wh k lu alClor ie - lf pl lr~kiJl -c rmiddot d gtlt- (Ic rnnhi UzJ( inn ni (t hl HrJltlon [ rtn~hcll iJl ~ or 1i1J(IChIumlJlJt etc) Sh llU Ld be TolullllCcluse ulemiddot l onld b- clclIimcntalancl wukh sho ll ld he IJlI-n~ifl~d I~~a l lhc (o uld h 11lfu 1 Know k dg CJnc1in t (wIn SeiCIImiddot Hlk rCS([lflt h daw ccordinll to Ih bull llVit w o f tIlt iii 111 1( plop(lsltd in (h i papcr lmiddotonllmJ l lnl plLyi 11 cxcr(j$( pn (nti or (tmiddotduce dhlblli t ic 1 ~lt Il Jj ll(k pl ti Jlt fadl j w(~ the nlIIIrl li7alinn n f poMural dd shylitS tu p n xJ llc aSl COIlMqnen c(middot 1 all )llal) or r(tn~ shys i middot middotlIrve Tilt u~c (I f appn1priattmiddot kincsiuuml wrlpy 0 in rcns polttllcal swhiIHy Icirc IIHmiddotorc Illta ll y (0 r 1(lt1 lllho UAh mon ltlccurlltc 1Ut dl1alkd -rLk l(lWfils 111111 )11 h Jlccdt(
11) wurcJlt 0 lit)-IcircS (Iumpy - x rcLs P()lun
n rllt lT(ltnklf u f COll1tlK H (rtd) I 1i plfho l og l ~$I rUlglng tr m low tmiddot k Pl 1l1 to IdiOpath ie SCUIshy
Submitt(oJ [or PUhltCl l1 011 uly Tt 2001 Acc~pttJ ugu - ~2 1(t-1l
Addre rltj-xlfll telt~I(middotb If) - grinl Flt(1(bziurllt r )(m Ofl ()(Cl1I shy Lt middotqlltœlll ro () - 1u I4t agravehLIlKil ta IYIL-lTt ilSllltp lfllmiddot ~ 1l1uumldull
CelII ~ (niiOS I I~ middot ann (1) IfUh middot lIlfU di louhilll(tymi ( Nlmiddot ~iI rli -ilIIUmiddotltlfl
Nlti(ir 1( ) il r() (ltbullagt1
lt vLL_ l IiII no 1ftfI
jS ) we are a IUil ly tJc ing n1n) ltblll lS 1 k l1 b ~J)w in~ tl~ t S Jfll l approad llt - l1n til hy on ielshyertd ~tan lard ugraveJuld ln m any ~1~ he lI ~t les i if Ilot dange r )ll lt rhlS is lrut of reil l lnw 1gtlt1lt1 pa in l ~ or 5urgi c ll lrea lmltnl5 in dbc r lmiddot ll Sc - 2
ln tlle cj-e ut ~ t lll(tlWtl i( li p l ll1JC luuml- I ~ middottnl ~() shyliosis phys cal ((_lt1(( is emr1uved ltI t()fIl1 0 lh~rtrv
lo ly in cel1l in L)lllllde (nluumlnlr in tilt Lltlll middotorkl i e Iw l) r llt t Srain hUI IIgt() 111 Gert11lny 5- 1~1 in other reg lOl1 wbere thi I-incl qf tre l tm e rll 1 p~ 1 pmiddot t 1( cI il Jws Ixen cri ri cilld md rel -cltd Lw m~lI1 1 11 Jlu~ Fue Fnlny r ~lrs thio middot15 a lsgt(ru( f ~rth r -~ltc rrJtf))~ ll t vit11 br1Cltcgt b r II1 ([C Llt n ClW grmvlng 1lt1 0 L Sti g
gcsti n the lIsefulnes- u r Ih is form o t treatm n t 1
Hmiddotu]rs have nerged jn El or uf pll y~ iLd eegraverdse eacute 00[ 1 but tlw are nUl yel 11 11 t llu i vIC~11 and r hi ~
f rm of trt ~ltmenr IS stiJ l Ul1 ckf ckhate FfI t Jt 111 il i 11t (eltary td 1I iFy 11umbtr ot
b l sic COI ceP rlJ lf w ill he cIh tt d in t hi pap r
Scollosis
DCijIrI iriolls
ScnUoSlS is Irlircc c1 lme nsIcircltnal (I(gt i l cj on ot tht spinc thar cau C a CU 1 lh lt ca n h e $ t~en ln (1 me1Sshy
ured ultinF Coh) lll ltllCXI o n HI anreu middot p rtc rilt r
EUJlOI -1 lœDICOPHYSlc~ IR
NECRI Nl
110
f)i)
1 7J
amp aS g 5li - 0 v
V
31
10
(1 1) Il 15
-tc i ytjtr~)
FigJ----jllph ot DlI w l-lkaupegraverel) The agloimvltltinn Or idio r lrhlc 50gt1iflll~ IS rpiJ bel~ en th e- [l0 IH P (l)ltg tnntll lol (JI PUllcmiddotny) mtl 1 ( f( lS-er sigll paiilivltecirc lt Dlt(i I1 11illg r the iti l 1Kgt n n t rll icirclicH a ) 111lt m omal prebulled the mno rche md ociks with lll I)ttlx flal gr Ih pll fl
rlcljoprdphLi 1 hl merl prestIK ~ of this curvt c10es n t autom~l ritllJy indi ate the pn$CI1(t of a defurshyTnitv (SlllKtUrd (Unel
It i~ possible tu clil1e ren tute a struCnlt t CI1tve fruIn a pogt urll 011e by identifyi og the hum]) du ring AdIlns tesr I~OQ looklng tra m beh lnd at the p atient w ho b benchng fUfward il is p -- ible ta d d~ct 1l1 eh ucirc n of o ne liidlt 0 1 the trunk usually n n the (onvex ~ jde ul tbe radiographie CUfve Ugrave1lr C Ul be mlt~I Slred lISin~
BUlln els S o liomere( 1 ~ l This h Uf1lp is du(- lO (Ile pregravegtecircn ~ of vertel ra i rolltion 1c1 Ollt tn tic f~YJ tllre o f the def trrnit tli [ c m be seen and measurc(i v ith Perddolles lb lsLometer on an amero-Ix)iferior radioshygrapb ~2
Seven ry pel cent o f li Ises a re conid 1lt 1tO be idiopa thie 1 bull ia l-nosilt in this CI$C is b exdlls i ~ n as idinpa thlc me-us t11H wc do n()[ know rJw origio of lheacute curvc [n othe] ~Ie$ it b Ix )~i ble ro ide nrify a dieak (bat CHl jusrify the c1etgtnniry slIch a rna lfo rshymar i ns I1(gtufol Ig ic~ l or genlttic cl iscas s Glnclt~r trauma etc )
[dicirc)parhk S(oliosis has been divicled ~(corcling (0
the ~Ie of tlie patient egrave1l the tiJ1ll of d~[ccli n of the condil ion into ti) ur t ypei ln fanUlc jU nik ltldolesshyccnt lnd aduh Til l m n st cnnunon (VPC IS the acloshylescegravenr o licirceacute I1IJctenzec1 hy 1 sud le l1 tggrH3l ion uuml uring the grow tll Spllrt (Hg 1)2
lhile p tu 1l sco liosi i5 Ycry lomnw n thl pre shy~Iknct ra te f r adole ent icuumlop~lthic structural CU IY~S in sch )o chilclren are 18middot20
- 10 Co bb d~grels o r m on l -lil
- 2) ~ohh dtgreclt or mort O 2~j - bull () (obb d gre -s )1 mOfeacute ()ll 2
Clin iltI [ d e isio ns lfl IXlSed 111 an lccu r~He pregshynosi which obt inccl in eJch pa ti nt mainly o n the basi of the nsidu~ll p()tlnllltl l of TH1h and the result s of 1 rh clin 1 1 ~l1d tadiogmpl i exlminashyti(ln12ll c noieq uentlya d inica ] la sifiou io n o f the ing le pHient tn -ome estent co incic1 ing w irh the
D diographic one c l n lw SLlIl1H1arizeci 1 1 folIcJ - mikl lc~ (1)(n 20 C bh de~r es - moderJt l betwlen ln md 15 ohh de~ rtes - StV re 111( gt1lt rh n ~J) )bh (kgf s
On the 1) lsis of [hi - dinic d d a lfic t i n (Vith l1l il el lrb tiOI ~ o f the ir b() und~ri e ) in Itllt l cente rS Of SCOtiO LS ITe ltlllent in the Lltin odcl (i rJ Ital lnmct md PI iJ Ugrave tre tmtnt i s plmmcd a fo lltJw 8l
- mild kineslth e (~1fw ~1Il (1 luok-ou t - Hl demte IJragravecegrave 1111101 c(~r md k i rws ithe lJpy - ~cven surgery
Physical exe rcL~e for S(ol iosis
Defi t tiOl l S
PhyS i 11 nU b lIKrlttp middot (or kines ithcIa Pl) i a p rvgrlill or plt~i Gl l (xeriltecircS ~1ci fi ( llJ y ltk ~ loped
y a -11 [ru ine 1pll yslo ther3pisr wirh th e m 10 Hllll
- pre (~ n tit1g tlc aggraaLion of the cl I )flnily in rnild bullcoUm is
- helping tlk Il ld Ct ~lOd ounter~lCtjng its skie elfects in III de rltegrave sc li sis
Tn tl1i_ feSpec1 kinesitl1ert py f JI s oliosis is tonshysider l a o on of peciticcedil training and s genecirc tltllly proposelt in sessions 0 1 4~ ro 60 minute IW) t) tour limes 1 Cee PhysiGtl exerci es can aLo ll v o ther auumlns 1S it oill he dise Issed in this plper
Ir 15 Ilot possib le to cl escribe a single progrlIT1 o r exerc ise a5 pro nrams ale USLIJUy p fgt nll ized ( ( lt
EUH PA ~illDI (DP1I YS IC~ 182
ROlL UF P l 1YSICAL lXl 1lt 1~E IN l IlE 11 ~l) IEd If IlU) l[)VP 1HI AIJ() J)~Cl~ r COl ~I NlG1W il
f)( 15 egraved ( )Il the nee L- 01 indi iuua l pJl itnts) al l l10ugh Lheacute) C l n h t 11 plicd o n a WOU p hJ~js (-1 (0 () pnients PC[ ~l ()lI r)middot lugrave reQCf lhese 1 10 grl lll frequt ml~ V IIT
hnm on in middotituk w allClthltJmiddot -Ill Jnv L l~egrave at Wc w Ht ~huw in lhis lyl peJ it i~ 111 n u -eII1 tu id e ntilv kirK itheJapturlc aims w hitl l ucircrr~spnd LO ugravelt~lil1 DUtshy
g X ir ur ph -s ici l lxtTi~l I~llhe r thln ln dj( us- indishyiJ u1 1progr-lfll
Aduumll l lxUl kisure time ~lOd h )u] Sp u lllll8 ~Ilttishy
i lt egrave~ i middotomm )Ly s iven lel mJ ing ro w hlf ~ Iuumlnsidshyer~d usdul or il lrmfu l in t1 lt rruning (lI tJw ptliJicirct ln tl1bplper Ugrave1 gent ltl l t rl ll bull p lwsiCUgrave lttG iviUes is rl ktll 10 JllI1ltlCc hOlll gtpOlt mJ kIJ1lsIcircl hc lJ l f
i ve lUen tloneumld )bo C on lv ine n dul( re Ull~ 1t~1 t s far Ilten publislt d f I~ mJ I(i noltgtithltl rgt is 11 11 a su h jel lnI deacutehate CJitk haltlt t llltit m itn ltl of l ny lorm o t p l1 ySiClI lxrcL e as a Itwr1 [ J- fo r i liopa tb il jcoJL~b un iL ()ri gin~ initial1) it WIS Ille r rOmiddotUumlK lt brgdv u f p l~lt titu gtllergt w h ) intervenecl hutll tc llcrl ll (mon as cltl HtilJ nic in terventi n man Jgt
1 t lltrJp utl t one 1 md rC j fkll l~ on rhe h sh lf som uni cOen I1v pn t I1cgts wt ldl hll ltl enl1 JI~ haLl nu na l scicnt lfic baisYmiddot HOlh tlle$( trr t peu shy to rh ~rl py tt nJecI to l~~rJ tte C Ih tk CUf -~ pnnshyclr~tll y as a f tsul t of lilo h llIzatio ll of tn imdqultdy ~u pp rt(d S pln eacute 7~ 12 to re-t1 r rI ltrl 1$ l l1C k o f WH llt~~rdl 10 I ndt~-dll()urnah tnd 11( on1 p~l per u suaJly Cl tc([ IS n prelimmtrf lll d 3 ln tt li w ay man (l rrlKpt(Hc H lf O iS Inll ph ~i C U l ~ d vi ~ cI nllog scnliotl pa t le nL~ 3gainst holll ph lca l egravexershyclc and p()rt~1
It m u st t~ n tfd [hat pllyknl txerc j~ tJe~ltm(nls t1iHer 1 lJ rd il1g r rhe rherlpcu tlC litTl~ on lllc h tJ rgt ap p lolc il l the IXlltent lncl hi im r IIIllHnt i- 1 (1(1 rI - 5lt1J lC igt tIl l ( f phJllIlllolopJ al rrea tmln ls Ihith cllffc r 1lt œQlfd- rhe m C cculc u ~t(l luI thl p al 1t n
~mc l 11i (lbE~e Tt i ~ P ~il k tlwreI[middote thll wuumlk ltlll t kin 1or ph~ i Clt1 1 lX r(j~ 1I 111~ t bc loidvd by t h~ Lo iurie IxujCJ1l al1ulhcr a dl ~IS nJI h~ iOg (1 11shygerols llugJr in racr le (wi ller d I ~fJIII ~ I ml thlls re(nl1l rn ndc(1
fn n UI cel1ll r we In(~ hccf) using 1 ) 1 1111 11 ve ) 1 (J p lw l icd ex(r(i~e (0 J ( 1I l tt i~ tlh aITt ~ l~d Ilv m ikl tru cflumiddott1 adokscltnt (cl ioj arh lC icoli is11 2)
ina the f U~ t rc-gt uJrs IefC pu b lishe - the pJ( )grd m 11lt1lt l1te n PWltllk d in fa c t deel()pnlln l~ in th t l itshy OlL1Ii in tl1 r b t ~() ycal f ha ve iclemi fiecl niO l l
m d 111 ur impl rnHm s md d i s )h ilir i (gt~ lue t idlo p lthk amp()lio -i ~ t Jll CIII he 1UO(l if Icirc 1by phyict1 egrave xert iSlgt l fe t rrncllt
l illl
111e aim of t l1JS r~l per ii tmiddot (tv iew tl1( l iterat urt to a(errl ln v llic ll of th~ impa irm 1t~ and Liit hil it il i GllIltec hy ~ o l i()gtj s -o ull he ll nt x or re middotlu celt1 Ili pl1ysical xerclse An u p-to-da te knOvkdge o f tl lt Lgtpecl-gt i necckC1 in rJeumlr) d -oek
- whetll~r there h ltl n adLtIIl ) l tht()d ical bbh fur or JqIIcirclb l l l1 Il( ) f k irt llit herlpy
- h N I)(1 ( 1 Dm tlle p r l c tIcirc(( o f Jebur tiJne )pOfung lcli v l ti ~ IIOU lci he tllf) -d o
II J U V f h 1 I11~ c~~lb li hed Ihe usefuhlLss 01 k il1 shyc ~thtrpy il i aIle dy l nsi 1([(( -r-tI Llleu i n )I11 plJt~ ut the wJrld ir ilt ecircS~nl i 1 I( id n Iv w l1i li ( 1shy
gories 0 1 pl1Vtl( 1excrClgtegt te D)bilI7it ric 1n (Ir st shylliuumlZltio f) lttlt tlgtbltn ing ni trcrccedilh ing erc) hn Id be
vnlcled he tll rhe nuld be lerrillldll1 1 md whidl s tlQu1d be inreœ jf ic(1 IJeClU~l tlley cOli lel Je LI ~ful
Ncuro1llotor impainncnts
Imv aUl llOr~ 11 lt1lt ~tlKlteJ lhe cltlndatiotl bd Ween tl UC1UmiddotIt t l ol(~C t nt id iopml je -nll ~J~ and cli~l l shyler~ lr 1tH lest ihuLIr yt 1 _ 13 ~ 311 D uhoussct 1
1-- ITS tln l ldiopath k s(o lio-L L cll -c d l J l hmgt in th terl tltr f prop li l l pu n md 1I1ar th e detrshyn Hi n i~ na tural 1 ~ronse to ril e need tu ts tu re p()tun ltlluilib riu Ul HcrmJJ1 31~ 11 () d tllat icliupathic ( liCl5j h l it re5u lt Ot1 rw nltuf mot r l ~ltelV
[Id )fcl 3 nI] ~1ltJ U Sr1lle nr to dtorders in centJtI lO~Cl shyIOIDNur) md 1xi~tI moro (Ul1lfOl syt( llI (Fig _l
N htIll -of) H1c S uumll h( rll1 ( ~ l( w ing JI t11 (oshyI-ie on the l l lO]ugy o b doll (nt Rl iu]icirc tlili- middot()lioL m unt fil t-hltll rhl ugravedcmnilV L th e fl5 ult o f 1 (k btcl 11lIFll llI ion nf som t11(WUgravetltnl md pO~ lur( (tnic l~ l licirc1 tl1lt if l p OgtlbJt b C 1l rlw sta l i lin 0f 11 1 Sf llle j lt g )tx l Tt) ohtil n a ))Cli U 1ILzltl I o f p ~llIr~il d l~flo [ in l1litkd ~J)llnSIS me CI Igt(middotqucnr J ~ a ~tmicirc ()nlly or regle Ie Llive
Ali th- 11yp ) tlw~es rd ~lte tr d irtl Itn t pnl1tlt o f [11 v hole ~piltm It11[ controls postu re ~nd mrw shyment lrre pell ic of tlh po int a d lI~ llv inH llYegraved il i ~ ll 1 nnable tCl aSUilll ri 1l tr l ll1 lo g thi ~ys ttm ( Qu it le 1I middoteli tl
lt ch ugt nlt~(S f rullliIl thil i nlomwtion th at p tlmiddot shyiCil J(tl iIies nw gt Il lInport~n t rr le to pbv [11Icircgt role ca n 1)lt slI i11l1lariztd ln lWO the ptu li ain Llt
- d elopmll1 l of p uumlltl St1 b Hlt ) - c1e veuml IOpm 1)[ o f bhll1ltc _
(k llhUl)lOr S Cll orr
ontrot oic whan-lt
------+ 1 ~ il lnll ugrave r AINnl
Cllnlr1
T bflt~ r
fltL1 tlli
lMini
l
~sary ~J-frlllen i )f
~ 1 ocirctnl
~UcirclllIJJlW Ll
AXl ~l1 n uumll l) r sy 5t ~nl
middoticoltoq ~ Fig 2-AcFgtrdong lU He-mutl 21 il is Fi)5~ ib1e rD prolXgtSlt l -oo ie1 mnd 1 ((if ~ elio egrave middotAhltr~d l)Qdy-p ati~ I I i u d) uren ttllOn k td LO In ~ory reHTt I1 eDi tn l al ) JdrnlV~ pn)4~ e l u r~o(Ofe 0-c1 eptunl dvstil t1 ctlon sltŒ(ry icircltu nu11t ilwnt [ ~mC ~ted tl l1 ce Ill trpntlshyUumlfJJl nd IKnle~ r~dibl jtugrave)n of -I) m tlosen Ir ~ig nj tl (I1vying ln fornll1U n (lI an ereltl ~piJl e Mmor aJJ r--a t ~) n ltgtf ti lt aXljl mowr plem iHUC Wh ~fl Ille 6ubjeco m uumlntl Icircn (1oJifitd perccpfLlI l ~na l ysilt of p n)lnocepti Icircnfu rnlaquol ti desnibJOS ~n t tecr spin A IICW motor co nrro l Ira I gy t adopt resu ltin~ in the ~tr ltctltr 1 ckformh y lf IdiopathirL scollos i=i Ht lrftU1uc nltnt l ISll I1lJy h1e- ~ I pro()und elkn on bralO Sfem flJll ct i(lnn~lLhu modifyRll Ille nltulltgtshytl10 ) 1 1111 Uu l-lHoror control 5~Shnl$ shy
As Srtgn1lt1 l ~ ltlssert~ if wc l C -Cp t 111 1 un o f the G IiC s oliosls L l tisorckr oi th e ltquilibrilltn sys t ~ms it is lagical to oriegravenrate physlCl l exercis( lherap y ln th is d ir(gtCli()[1
11lclte goals Cul tl lfOUgil ditrercn t modes 01 action be Olchic(-c1 witJ1 phykal accivit ie
- po rt ive Cll ities p ro ct LJ e aIl UgravelClltrtsc in 6lte nshyel ll )o rd in~lti n pinai pr0prinup ti_)[J nLi mOVeshyment control 0 vio lls iy ln thh repect ome lCtivshylites aœ pre um~I I)y lXrter tllln ntil crs
- kinrl lira py using pedJil exerCisocirc specially developecl lith th est 1101 5 in mind illVuuml VC I lllore prccilt( ll1d InC1 li zed cri n on rhe spiJw focusing
a90
1 ~~
lg -lNheJo ~1l l1 t r~l g rld in 1 1) h i(~ IImiddot ct r rHienl w i ll idlllhic _It ~i ~ _ iri s plt ~I le II find Jit ltH vlllleuml ~l Cgtbl tn~ ks III d il fef lt p ~ lt ihnS nu v~tl middot B ~a~pt u Il C middotl)Icircd ~(t l l11 C dlfkrCnl middot- hdween slllndi1g Uline nu nllt1Xinul oorrec ri nI t chied Vith Ct (J ) und tfdincJ ne lot es o UIine 1 fo llnVs middotIJfl tfi ni( - ltlrshy
reltiK)n ~ Ikexibiliry st3nucircing - -pirte - f ur~1 1IbjISC ltupin - ltorrcaion - - r~luci()il ll ymiddot For flmpllt in J npK l1 pH k1J il
plt1SSlhlc ln obtai n 10 u1 511ndlt)l [YLo lion yr ln Slt p ille rlOlgt itlugraven om l J ~ in ( gttf(C rigtIl lIex lbuil 15 i (r-l l=22deg pol lltl ~~J IIlpraquo is IcircO~-V- I t1 l nd tucircu(Ugrave) ilil) I~ 3laquoJO- IH-12
r ln Ugravel e abilit jl of tluuml [m e llu to co ntro l irse lr in ~ pac
fuld l oftlles uumlllelve ntio ns can presum1b1r incn~~ Ih enl ac )1 the orller and lHitlll r of Ille rn - 11 )ltd h e lllldenl lu EJ3)4il
Posl1l1-t collapse lnd slabilizariotl
lIle concept u fplt st lUal c(l lJap~e l l~t Iwen detin 61 by DlI II-T3e~tupegrave rL t Ac oJdin)j tu tl1i- ~ll1thor il [ nec(sary ~- l Hn Cv-tlualing th tleihility o f a col shylo tIcircC CUJVL (0 clistingu ih bt tVeen the re du ihil [ty index (th - li iffer gt le bet ~middot Il ~I r~tcli()grJph ie ~xnmshyinltio n of the iI111 pHienr in supine po ition m(i
ROte OF Pl rnmL EŒIlCISE IN THE TREAT-ŒNT OP ~I IJD IDIOPAnnC OOU~GEm seou SIS EltJRINI
I (~)-----------------------~
__ _~ _____ _~ __ __ L ___~ ________1 ____ _ __ ____ ___ ___ _____L___ _____ l___ ----------L ______ _
1 ~
1
-- ------- --1---- ---- ]---r --- -----_----t- ---- --- ---shy__ ______~---- __ ____ 1________ __ _1_ __ ____ __shy
~ (1 J
1
8 =~~=r=middotmiddotmiddotmiddoti~=-middotl--- middotmiddotmiddotshy--------------t----------~- -------- - ------__shy
~---- --- -- -~ -------------r---- -- -- ~-- - -------- --shy----i-------r-- - ---- ~~-shy
il 1~ 0
Dtl-Lmiddot ~ lttj l r~ UIltltlHt
f g 1 -TI1 u ilictf 1ld ( ii 11- ugraveu-sh) ld IX~ O 1d wllich ltJdnrshymII Il nf the pilll 1 ~tln~1 of th e -o lioti( spinc n IG~nI(J II IIIshytt) lhe iJeuml grl-e o f ~ ()Ii ti c (u rvH Il 1 w dcpc-nlknrly o l l he 10 111shy
P01(nl (pntt l ~ 1 1 nr ffll wrJ I) ln w hilth Ihe n i 1gt( ~ duc nL~ grlphs fm I h~lt 111lt hi~hr Iht Col h ~Ilu t (l f Lite ~Ul Ihe m Ol CI il y th t s(uumlJotil middotpin~ ~111 he ~middotJg gr~lVH(~(1
m mJxiTIt corrttt ion wll iJl i~ lIllCd to Ih - xt 1shy
lti Oilil y Jf tl1lt t Ut JO rl1t cdnUc idt md p OS shy
tU ll cul lapse ( th t ltHill enct b-tten l lUdioL) 1lphic egraveltamJl1ltlti OI1 J t th e ~lme pa tient in Sl il tl cling lOJ lline fX-sitiutl ) Wll ic h correb lc- onl wil ll fhe abilt ty of lllt p tu rl l gt s tem to C( lunternct lIk luree o r grl viry )cco d ing rv D lfVd- f3egraveLIprc po st li r t1 lt01shyIlDse is d ue to the Jnus -u lar ton a nd 11ll ex rCrIshy i) i itv of rhe tissus n the ( O IW-) si it (If the (01shyjl ti (~JtVe (Fi~ 3 L Pu~t llr1 C lltpstl lu lcl l ~~ reduc l-lt by llwans o f pl1ysica l cxerCles specitkally s tuclled ruuml i rnprove tIlus--ubr fOHt md lU pr )cllI Ct 1 ~11 hi shy
lizing ffCd
PararcL n tll CIJ cl the cr iti ca l (3 c1 thlsho ld beQ ld Il ich defol1J lHU n of the i pinlt 1 e~ in~ ne dtlllontr~1t _cl (1l ll t grclrf r mg] o f rllt C II in a qa m bng pos ition corn pOil 15 t l lowcr detormashytion lhnsllold (Fig 1) ie to ~11l Ulne3Se t the risk of pr ogr t~ lu n There t rh eJef re l J ea r l)iuuml 1itshycJ l ~ll1 l l(tl a 1 tnr tg ro b ohwined by d -cr t l ~ illg ilmiddot pU~lUrll cull lpse ptJcelJtge w bich lccording t i)
h llTd tnd ~l(heJ1l ~on 1~ b inde cl 1X llt icularly luumlgh Ugravel mllcl c Iio~ i (bdow 2( 0 ) (F ig 5 J
Fin a Il III ch iS respect lllljl hl and b um l 01 m linmiddot
ii iI 1 l _ _~ _ ___I ___ ___ __L ___ _ ___ ___J______ ___ 1 ___
li 1 1 1 1 i 1
1 i ___--____---___----__-_---_~- _ _--_ ___-+----
i
1
i -- ~- -- ---~-----_-~-_-_--_1-~
l ~
i
+----r--------t-------t------f-- J
Fj~ ~-Ac(XjJlin(Q luuml T O rIcd ~lnd Na(h(ln~ n i () dl( pCG w rd (rTIshy
POO ll is hiherin cu rvegt in wh ilt l1lh ~1flILWrd cII1I Olk l1t IS le- pr(v~knt ln th e grtph Ih t PogttJlJ I ugtnq) Ot1 -J1l j elfltS-e J tlt 1l1t obb dirr remc rlLIv obu incu f roll l the Cohb atl( 0 1stlI1dtJ1g IId gtupinc rldo~raf115 Ih Ille lt) [1l1t1 (i lndnl I pine) 511pille the ~(nlClu tJ1 compo l1lnt U rlk CU Y _VeJily I~ ltx p rlt 1 L1v UpUlt (obh Illeturo Ih t si _b Cct rtJeSIm l fie -ltn J trd Ugraveltuuml shyuumlo n A~-i)rding LP 11(lt uuta o n l ( r1I~( in ~I 2JQ sup itlt curvt 1hi C(]l)b ddhccno l l f lO is -J-lultt( thc s ldnd inr tnla Ol1l t lS wi Q) whil 11) 1 1)401 ~llp lne ClHVC If ~ 1Omiddot ( tcl Lhe ttnd trl~ nlca~ I(t I ~ ~I)
tli n ll w l lllE cq lin ti spin h~ i ng mo r ~ Llnt~II) 1 tlun the nOftl111 one n Cll l gr(lk ( (cU ve tl1u n da r u p shy
po rt in o r k r 10 m linrl in tht 1xi11po tuf_ n th ha__i of th egt onideratl lr1S it f(lll() rhJt
ph rH (~Uuml e erd es ulukl h u - ul iiuml tbeacuteY ~U-L lm cl 1l (It-d o pmg p05111 td C Jl1twl lS fuumlrnll~ rly d ccrll1td ln an Ql St if i imr ol1111 t ru t(( - tht m(d in C JI shy
r t t r sture fO Ir -ngthen tlll m u ck-gt of the spint mainl) in (11erl antig r3ilrl tIcirclt l]lli fun ctin ll U hy meU15 dl i )ll1 t trk ~ lhJ cl( -ll tlt C)nlr~lUions ~llld no l IdOshy
1l)llic d YIltll1k lt l jAJ lktic t) I1 ) II 11)t 111 hd posibleacute t lcluuml ee postura l io nrro and stfh ili lllllt IJI
w i thout food T1lw(ull r d I( Lf(11 Ibk t m ucircnuin Ihe c()rf ~ct [ ()S tu re for cl gtu ifKi IH lLl1gth 0f ti l11 ~
This i-l ddl usl a typl 11 dnmnin (tf k inesllh rap) in 11 (lt-11 [[k - p~d fk lnr in lng f u l1a in llllliCk is poss ihle lI sing ctrtain Idncl fJ l (lt) 11111 liun S p Ul in tb is Cl c is ulttful ooly sa I~tr 1~ il Iw lps t1w lxltknt 1 becuJl)t 1gtlt ltlt-I a ClJu~l inred irl ilL ntllru l o~ i cll
and I1lll~lJhl r-keJc LIl [rll-llIn~ middot etlt(wrs JI the int e rmiddot vlnrion
[J ROPA MfJ) I()Wf-I YSJ IR
1
ICR 1 1-1
r
1 shy ~
- shy
11 o-llrfOlhe5l~ o t Ih 1O~(1dity i n h ~ r ~ ll nr pbl1 l of ~ Spl11 in 111011 _llti1Gt l lPt f ltlJUCWJtl ( ~l Ihe Ir t 1 1gt illbll W Ilh LtltrJ1dlion Vln lbe rigronl middotUII~ l(I Dko n12 lIll h lumshydlanie1 1 [ nul 1 M hl whtrc M - gt) lnIUI1g 111laquo111laquo1 1 1 c rtJCshytjC~ f fce d -d Lill l1~ o f enr niI pUll spnmcl1y 1~ 111 mldlll1lt (n the fl1ur t 1 = tor~ of f(ward Ileuuml l = ughtel1lng fmiddotr p 1shynOf stn lClU= Alaquo rdtllg 1raquo Ihl~ - lin hull th l1ltgtllugrave ot tller1l lUr~Jtllrc F the ~pin t -ilh rlu1i tf Ihl 1 1Ibulll n lrlt InltT1 1
rbc prJI 3IJi l1ty d qrlOIJ~ n bull JI t IlJIII Hm lA the v=ltd gtc e lu-ing J 5lnK1ura i ltfnnity
Dioal e ch anicll itllp~lir J11 c nt
Ihrcemiddotdimcllgtional mc-cbal1in of the s pioc
~f Ikmiddot i t i nly l(œ ntly tlHr llk pr-5tnœ or nc ushy1 lnlo tnr impairment in Idiopttlllc s-ol ii IXl tknt liuml J$ heen h i- ll licircghlcJ hy re$eJ rh tll e preit ilegravee h inm b nIcirc Ji d lJutg~ lt hl ~ 1 ng t o n dO Ulll urcel 1 i5 (l lreldv well umlersrood H(j-ev~r nev lbt un h iomcrhankal im l) ion nI h1c rectm ly onk l n tIlt tre and p r~dou in f n rmtinn hou t pl1ykd (~fcl5( in t 11 0 tl1I _ltgt pbne of spact 1115 Im trqlt-u 1rom J i-[) v ing unclcrsrmdlng ot th l lmc -dim nshy~ilnl l l11 ~ hmk f the cO]jO[lC pln( ~2middot ) ) Ve- w ill )iI xnl t l1 d at lcL-orcltng tUl cl sif iol t lOn blsed o n gtolllt lricd h uumlCJ ) p lane
- b() rJzU[1tl ln th i pla n ~ th t 1o rm ll sp ine present no CUlye- w ll ile Uumll(~ ltc U Hic spLnc clevelops one of ir haracterls(Icircc deFo rm tiCs v elt tbrd ln lashytio n vh icl1 pJ()VcA~ theacute hw 11
- lgitltl in th llulJe U l(~ nonmll spIcirclle pl SenL kypl lOSis ~nd l dooi~ in tb lXI1 lhese [(Hu rts Vere m)( til ught [ 0 he relattd tlle scolkJtlc ( lI r Vegrave
- front l in hi pleme tht ncrmal p ine preseuron t no curYegrave whil thl ~11li tic p in ugravetI I ()~ icircl~ charshyad t Ilt I CU1C
Il Jri fJIIt palic
~l+I~na ra 3 r inr lut th l[ ber ll1d a œl1~lU1 degr 1
l f r()la tJo u lllu (lILa r forcKl ltxert ltJn tl ldefnmuumlng 1 tkllJ [J i1u a re- lhlt tll cly 11 [1 1 UI b y Olm ner w bn ~lh uiJwd tl egrave ro t1tic) l1 Ilm it ti lt p ica] lf shy
rhrl r() be (P (the Uma bevond Wl1iltJl th lCOJlb of [11( ~pmaJ musd ~ dthc COnCIt and nm ex ~l le btconk (t O li~[)
r ~l 18 ~1Il N lu t( ren i9 lun lu ted rlseurlt h in tlt ) tilt lULodeumlformipg1 tlo n ot tIH_ sc laquoJrle rh ox ercallkren lk 1l1~H li d11r once thl Il i ~ r tld1t5 [he lhrth ld f 111 JlIcirc lIi of tlle dnrlclc hurnp tlk
lI bslt Il l nt rlet()rlll lIcircon 01 the it l ()I~ C ( (ylm der (- sustalnecl by an H1tmi cforming aCOOIl
J1Ji h V hl rhyiical f~ f Ise CI 01 h spr n llnd kin middot ith ccedilrapJ my lX damlg ing vll e n l pplild as flle
igt Jk Iller ln SCC1IJ ~IS lllc lJ fxceed l auto in middot crca~ i n g lhrllgthuld [1 sh (~u Id ahn be j ofed that Ilw relscd pre sun 1l1111i insiugrave l fe pil1r inn) 1 mlshylt
- j Il- ( w atff 1 (nh ~1l 1(e Il10 utoldrml ng li1eCh~lI1 1sm
in flc l Geyer ~w tcd th1 t rm m 1 hI l)1ecircch1O lla1 puilll 0 l I C~ sw m mim t Ieuroamp no purpo t for cu lshyim le pllilt t1 s (weumlO middott r it is l~Jl(gtWl1 rhn in iculio r[ paULnl -iJl11T1ill~ doe_gt nor Il ~lp to i ncrt~SL n eur(1shym tor co mfU
(1irai p an (
Jerdnn lle 11 showecl thal ill CSl~ o f t10rLC IC 1i lUgrave
tllo lacolulllhil it lio_1 tlle cte tI llmiry in (he lg itt1 p lln t rn lnlftot il~ lf tspe iuUy in tlw initi 11 r luleuml )f cV IU[Icircon nf Ile ~oli ls W iU l 1 p(t)gr~s~ivlt il10middot~ shy
ment roward hvpok pho b G ll f ill~l Im lins l har dUflng (IN eWllLlfiu1 of 11Imh] co luumlgt i the l in t ot t l H~ gClyty Cegraven te l - 0 1 v llebed lxxli 5 r ro ject 1 seH fl r t side-ys and tlwn backlrcl bull thu~ p(0(1 lj n g a kyphQtlmg aet Il ln (h~ lu mhnr --PIl1 COftj tng
l l i tc Iugrave l lltl l( l rs1 tif s L -etllgt il l the lgirl11
1 Hl)
Ilu LE nI rIIY~Ic~L lXIlKISI 1 HI E TREhTMEtn OP JIU IDIOP llII C AD O USCUH O Ll Œl15 NEGR II
lLill tegt lre lenl1 ~I d ~fo rll1J[ ~ rhl recrSes the phyltiologiGII cmns of lh vine)
Accordlng () Dicion ~2 1 rtcluctio fl in the itgitttl CUIYtS combin l vi th a lueral Iviari n llltl ds t 1
mecban ism () ugravel~ta il ity in l he r rat r IllI1e which bVOf1i the unsd a nd i ncrea~e 0 1 co hlt1is (Fig 6 hiIf md Pl11jlbiJ Jl1eanwlt ile lt(udiecl lh e srnl ru t
orzyglpophySLs show ing t11 al ttleir 1I1tl rnic tl orienshytation f~I (jLi l~ltes aXIal ve rtegravebJl l rotllio ll in cun litluns lt f dorsal hypokrrhn Icirc tnd lum)H de i L lo IS
Tll t dat SLlgge 1 th t impOrfill ut pOitu res and l1lweil1 ) t Mudied in ord t r (CI mlIuml ntrlin or to reuwer fll e p llyslo lo~lCll ClIlye in lIe SlgJtta p lU)l Wlth the llm o t ch ~ kin~ rutltor in l~ bili ry7 AbC th ~e ~k-
1l11nL ~Irt del lnt [0 J jUc lt ftber l]kuti inrervenl ion vhich 1c)LJ k l IV - i(l ~ l compktl n l ililll on Il t c1 l shy-jel1 J11UVllT1ent IJ j o f 1uto-dOneacute(3tlon ( i e a -impk ld ion ) Iengtheni ng o f the pilleacute 011 a litlltl l aXl~ tll lt ((IT liJlI~rcdu e~ t lle ~---lJ linti- l lte ml-fkxj(l n h UI 11 - i llCrl I~t the plllH ](JgicJI dlt cr ~l S ( (1 k-yvllCiSh lIld O(ltOSh l o r c lch r1Iif n t a Ilew til(~ecirc dUuml llt Ilshy
si lflltl J ll1 u(~nlent iam ecl - 1l1t0- lIrfe rionmiddot7 4 llmshyp oed f Je-rura l iUIl cl middot-t1e- iltm lI1d ll1a intltnUlLe )( 5lg it d C Uf (gtS slig lll thltJrc i ypI1 tiZ) tIcircOI1 a nd lunugrave)ar 1()fdos i7~llion) sholild he esw b lb]HU 00 lb co
hl b oi hi p~l11il uU r -1Ir vlt Abo 111( e IlltUtl Chl lie o f purti n - a U vitk slJ1ultI h e )tuumlll ecl 1)] (1 n ldershy](ion r tl1i lt type for e upIe IilJ llyl)T S of repd shyiti( ml vemen prt n t in agonistK h)lnllltlSlks nI iIle kind f dlJ1ce C( uld he ([([r imentd
FmiddotO lllaljlallC and mobili ty of the SpIcircIlC
1 rd llo U 22 d L lm nrrare d lhlt in Illt fro nt a l pll ne
tilt 1 nge Clt 1)1lt vtment of tht scplit[i middot CU IY grcmr lIJ l il ~ d irectio n n f Lhe C ITelt tlO n tha n in tl le di re shyLion of pmgressi n l Fig 7 ) he IL o IS5err lJd tbat th15 mohiliry increac plrtil u la rly n apic [ cgcoeilts 1$ lh ~ ~c() li osb evolves Sragrm rJ 12 J ~ thus rigilt (0
VlI f n rller~p is ts Ilo t t) m o b uumliz - a sCtJl iu til curve w ilhout t [ uling ttwt tlle R lu tiOI o i til t ~a mt b fnlinruumln( 1hy l1tans o f ~I passic 01 1 rivE -uppnrt On tilt (ltllE r hand UgraveK d e iJlioJ1 in ease durill tlw tune 111 whicll tll C spmt i ~ not submjtrcd to correeshy( IV anl()n
j- Virh mi lei ol i b tlllt Upp i1n ill) lC tiol is d eveloped only lllmugil llClIf()mu$Cllbr f r llce thi ~
InegravelIl ~ thclcfo re tl1l[ inu eascgtt sp1J1all1extl)iity mua
11
Imiddotiumltgt 7-rurd illt Ir) 1 bull rdrilt I1 1 in tl lt frOlllll pbnlt- th( illl ge )r mOC llIeJlI o t the S-o UIIJC CUNe 1 supcrior in Ihlt diflt(l im ugrave( the n nKlIl thd n ll1 tllc dlrtcLion o f p rJ1(l( (llIl
be considrCtJ vntrl iJ)(l icltion and 1 undrli neocirc ab L a ~ubiljz~ILion 01 tilt spint pllss il)1y ohtl ll1td thrltJugll the stlengtlkl11ng o f the 1rltJgm vlt nonil lme shyCIC 111 illli orrant u bjcLliH- ln rhis r~f1 n sp u lllni lc tivitIumlLs sil uld lX tPI 10 dlegraveltl it l G lU t n w l1ik luring kine i Icircth lrr phyltical eXegraverci c~ tllat in ele
spinal m ot ilIcirclY sil nid 1e lt1 oid cdrt ~
Organ ie and psychologieal impainncuts and li islbi IiI le
A cgtI im lc pmi nr is moriOthl11 just 1 sp in and 1
compkt gt Ipp rnach to the gu in ad 1 ont i al~ shylute l e~se i t i11
[)a la 0 11[ [n ell lrom re semh pw tbat ome organi Iilnctiond cl fki ts suc]) as tlw clecrtiUe ut vild l tnd d fun ll l)Kity_orld ldly incrtJ k whil~ 0 shy[io s i -till in (1 miel q g of g JltlV ity ~ l ilI e 55 rtI lit
tllL pres e n ce )fl defidt Or Vi l~il Clp~1 - i~ ln one pIIiem in Ihr l ftectecl by 20 ICl 40 scoi stgt l ls~a r(h cunclutecl in tbe UA by Di Ruce- prod uegraveed an aaalo) u ll1lXimum 102 re u t in a group of Jd shyk 1ien t [(h sco llosls rang inF frum ) [0 1
Al10ther rudv bv rallt r m C chr111 lilcl NashycWrl1s( u 57 stlO eltt hil $(C 1 1 ui~ Ica js l( lllt cl (1 shy1prUlllI o f t1tgl lie bJd l imI in ~ul sct t1 t ltu b middot iects jlLltr l5 they are golng through ~I cltlici[e sllge in the fnm 1lt i n 01 tlWH o w n id uHitv t factor hit h Illy jeopmlize the cl velopme lit d ~ mIll lt lI1d htIshym cecl IWI sonalitr in Klulrhood
n RUI ~IEDl(( Ptl Y1-
ROU ltHmiddot PI [ I C~ 1 EXIRCIS]~ IN TI Il nW~JUNT OF SlllO lDIOP1HIC AI)C~ESΠ11 C(gt1[Oi 1S
This i why b IiCieacute ii is ~n imporrlIl t for p rcshyvegraveml e 1tLsr l tn en ou flge 1ari e nrs ~lfrecr(d by lIillcl middotu iosis ft) tlke p~l rt in portin -re rcatioluJ acrivitits Iha t 1eIU 10 L10 th r~1chophyinLl bull nd b~l )i 1l1o tur adlieem t n li 51Jmiddot2Even tlK)ugli [Dr bic mech~lnshy
ical mcl nellIUll10t 11 11 reltl ~ons lt r111 1gtomcrimes be l lefu l to ugg( ~t ne p rt in~ aCt iv ity r l h (gtr rll n anotlJer e th ink Ibal an exces~ ive IlHd icalizltion - Icirce l ll1posilion br plry~ilt i HlS nnejlor parents uf rh ry pe of po rt to lx p m lice 1 b Ule p 1Ucirc(Il L th1[ preshydLl ck l1 is fret clOice in lh ma tt r - -h II ll1 he avolc1ed wb 11 possLhle mainly for tlle i mport~ltll psyshyLb ) jogka l fe a SI)nS W( ha( ill ~ t nltntionegraved
Conclu ion
lbh ISsertegrave d t1H physkal tgtXtlci o is ) n fi ial whlIl practinu in order 10 ilnj rove the I11 llde
rœ nwh and tono C iral caplCiry and postu re o f the StOUO(I ~lIbj n II I nowkdge om ~ middotmg trom ci el1shyrlfi rls(~ Jrc li dJlJ accordl ng r the review 01 thE litshytirlture prnpo )td in t lli plpl r conflrm~ Ihe vuiclit ot th e -t ls ~rti ()ns
In l do l (ent Id iopl1il iC scoliuse il l n phee u i cl vk)pm e n t ( li tll iumlKh eXCC cl l g i en rhk thr hokl th e re i5 an und ubred need fn r l pprnpri 1tegrave (JJ1tOkJJe ~Ild Inr surgict1 therapics ill ortler 1) S l i p
the ( - Iuli on anugrave )JT~t~t UW ~pilll l dtlormities bull evshyerthtless in the illiti ~ll pl l~sC t ttlC c1iseLltc whcn the riS( r1 r euro )luli m is rtduced ocirc ~md tfle uifleal JOld threshold il ~ld flle po stural collai i reJcenw~ 43
JI l1 igh pllysicaJ egravexe rc ise - p revenc or r d llCe d i ~lh ilir ies o f [Iw ~ l() li )tic
p (iems R 28 J -6 5- 6 1 63
- f~KiHtare lh ( n utr ali711iCUl of postu m l d elicits tn produCel1 a coneql l nce J [)ti 0 I111)( or regre si -u lmiddotc 5middot Il 1 17 ~ M
-re 51udles U ~ n Ledecl tu con[mn or re jecr these conClLL i( 1 w l1 ich clerin-d frum 1l1 lIldytica l rcltw n f th e liter~iture appear r- ~Lo nlble Hnwecr Intil ne re ull are 31Iable wc should n r prevent our sroliotic patientmiddot trom tl ki ll p lt in s(loI1ing jshy
ir its pW1iada rly ltl t ~d1()o t () n til t c ntrHY -vith the l xcclrinn 01 gt[1 )11lt tIlat in rea-e t)1obility (tnU evc n thell oilly wh n progr~lgtion b p OSSibl) -uc h ~I( ucircvshyiUe -11 )ulu hl tIKoll w g ed The 11 S J ( rprOpriue kin (~irhe r~l Piuml to incr _~asc p()~tura l $llbil i ty is tl1egraveoretshyic tlly CiJUClt alttloughl more ~Iccu rtte aod deLli led ri k benefi rs anJlr~ is is netot1ed
Ria 1111tO
NIokl Mu d lle ftitYljJfu Jœl il 4IWr10UOifll S (JIvs i (1~1)Jshylidl ttno( cclIll le 11(11(1lt1 RCI fu lle ((lia LltfIt l1 I1I1i(i
LJ ci n s j(r3 pigt egrave li n IHUgru lkl di t rdz t fi sici pe e ft shytUlKm iluppno di un lisimerap15Ll rl lllcflt() 1 110 scopo di pnevirlt () fr en~lI 1-lgpwlllltnlcgt dclld lclonnitugrave o e il 5LOshy
Il i mi llon lt fH nugrave j (1 11ni dei co~e 1 lteIl I1J J nd ne ~Ii eifclti (()Tc rri udk s co lio si d i m e dia g rt iuuml ln que~ltlt
s rud i 30 llizzb mo i d ti cleU ric lca pel n ri Icare qJJ l lm 1 dis(imucirc x u le I[~ l z j-m i pro vna le da lla C gtl k A i json ere pr middote-nute () rk kl ducirc un~l rdeguCltl d nil cra pi lt di uJoseguerrnt Cjua li 1iU110 cli nbie tti 1 rcr lJ)tIId d~ fle)-UITC
n (- -fd7Io n~lcl)
Ut11claquo)si 1 lI tori htpnuuml )ludi-ttn I ~ cnntI1zttu fr Cq(in i idiJ)tic1 dbfl lOZ10l1 d d ~ leOla nelllOll1otoriO Lb un1I1cnUl 1n1l1i3 dcgli 111 lt1i ch DIJgt gtU l H crmU1 Nlch~mslt ( SIshygnaJ~l lerimiddot wo i esuemi -bletti d~ plt~e8lugraver- ne l pClZ le1lftgt scoliodcu kl s iluppo ddl ~ ~ uhjlil~ vertcbral~ lt o svilllp prJ Jdle JIl7 i() nl di ltCjuiljbrio Dng li studi sul lto lb( l~nlrale (OllddU i in pa rticdu d 1 DlIal-BeHJ (gtegraverl ~ P~II IId lI1 n~ llw - idente il v- m gtiu p eT il puientc clioti elgt di u n rnigb o t c)[ ro Ua sw mle dei radlldc onsegull o tramite il 11 fforzrlshyfl len to d e i l1luotoucirc l nllgr3ilri d e luOwo con crcbi ~Clltdr
in pOMltHJ corrctl e in va rie ~i[Jzioni s t llicb c c d inamIcirc tllt Dalle on sena d elb blOffiCcclIlicd tr idimlt n s io mlle d ei
r ~ chi Je ~oU()f icn ~Icirc ~videnuumll (l() ~llt tC p IYZIcircOSI ln(IiClZlfHicircl ~ 1I1shy
liumln fluenzt Je ll middote~rUrio tl SC) lgt lIi I rc pibull m i tldln sJlI71 Stl shygn~I I1 afferma che slI l p Ia no [11 middotccedilr~lk tre un œ rtlJ grado di l L1Liuuml IlC dclh vEltlh r1 apj(de le tu rœ mu SCltJ llri njtbc J n in $tJ ) t rodcfQfll1t1l1te PltJtantu b i r~it-~ r -lp il puugrave t~~
Ixnt-ftla solo nt Ile so )[j)~i Jl1Icirc na rl in qunnt ) ilon SlrM ntne )(l(Ofa tu soglb in caq ) co lltrLJIcircn l)lrilto llt~( i lJudotlsi di lfr~ lI1 C llg grVlmenl J 111 11 io lr riltd ll(17jOill leld rinlle 113 dimO~iumlrlto d llt nell o lin~l cl()~ li t th~oIOl))1 dri la defltgtrshymiti sul p iluO slfl iuale ~vohl lf1 (en5 ion~ sO lnm utto nd 1e bsi iniliali deWggrwm1Cnln mcn trl C a( lfLmn che occlleshyvoluzi ne dene = 110 i [ mhari IJ lin c l ki cen tri ch -1vi1( de i cp i CIt IJ rI Ji SI p m ittIl pnm l Iem lmeme e p o j pOS( shyrio fllwnte dtldnli mdv ( i un ziuuml ne ciloliz7nnl dd rlLtide lu mbJ œ ( lIlelttlaquo on NC n d d (gt11 uIdu m 1I1 Ilgt) cli r-Iure (0 eserClzi che IllUllengano 0 ltlUperifo le Clgt 6gt1 lo)iche sul pirluuml gilwlt Su l p iCl no fron itk Perdnulk il dlll1lt-trlto d1 lampkz-l d i LU ovimento amp111 lI rv Kolio ti ~ nd lt1 0 ddlJ cnrrc-LIcircQo i Ji gC 1 n lungl SUpegraveliltlrccedil 1M llS0 tlell 3ampIGI shyvamcnlo C che l~Jltmiddot mobiliti GlI mcnta co n l c lu7j o fle d l i) snAio i A ulln amplgrtJc1 ltllllmunjx~ i terlpGli nn n m obi shyUZ73It ma eutva coli ti0 1 1ct HsicVlfe nd tcmplt 11 1111nshyttllIcirc1nc n tc (k ll ~1 llu u zinnt n l1 un me77uuml d i sost l11( gt ln 0
e 11111ri b cle - Ilziunc egrave deorinatcl d l rlyarsi Snzcl la pr gtshy
liltlnl l i un() rtl~ i ptmiddot Jtl n(o 1S(Hl () (( ntJ() i ndit~tr i ~ Ii ISt (izi e l m iviL Illdlode ebe Hlmen tno laJlc ibiJii dcl rlc lide SCshy
li io) [n p articobre rune q lldl r C-I1 ich~ xlSiddcHe CUf t shyli ve ch~ iJllpi tgino e~rciii 01( biIi2 ZanUgrave HhnmL-trid () in tmiddot~t~nshy
sione kl fuchide O tne pure k- ~ttivit1 tnotoJII~ non prHi(~ llCcedil
in forma r k rel1tiva d Ie ~1I 11 rF~1l1( n otcol mcnlC 1 lll ubib Ll vcrteblmiddote (ad ~ flp j(l 11 n l) to L ginn ~Iilt Utl clkl rilshyC
mka la cli OT- tcc)
r1il to l~ _ I[Dl COlI rY IC~
NE olUNI
fillncr ( ni ((uuml(( n hIIo( rilclIO ~middothe k lln dtfidl fUr1z i shy
nlu CQll1~ la llcl llZIO 1e delb c apKJl ilde e della capacltl di 0170 mizianu luJndn le (OJ il~ gtna a nc r3 di m~i3 gmshy
v it ln G mlxl r i ~ gko Fl llslrom C dlllJ O e Nachcms(J h iU1I) dim lr JtQ che b o liosl p IOO C1 neUaduksœnr 10 SYil l1p pn d i lIniumlmn~gin nlt8Jliva de corpo in (o nridcnz di Ln ddic3w p ri d di f( m l lz i nlt deUa SUl idenritl condishyZltonc ch pOlrebh ~[I cubrmiddot ln vilu pp di un pe bull n nn lir m llur cd e quiJibfarn in t[C adulro TaU CO1DSCe nZe tvlde nshyZ[II)() la n ( middotess iti di ltimobre la plfte ip a7j0 r1e atl an ivi ll1ltHClr n gl b a li ltl h ~ di tlpO s pu rti middotu dl ittlrc nd gloani iCo lID ti i lirtugraveta z io ni llb vila di relazionc
ln concllliu fu la d tfoflll lL saliu iG egrave il sin l mo di lin) idrotnc C Il1pk 1 d e eoinvo l d middotmiddot= fu n (n i dd rgashynIcirc5H10 n Hi lhdli e lesenizjo fi 1lt0 se 1 Il indirill~t() pllO pr~cnin 0 odLf rgt t lli di fu nzlonicirc adlc s()Jj(bi 111Icircn(i rrHtatc CO ll nl1 cinesi rap i Quand l~ coli i ( n LS~middot iJ11 zia k il rischio evnluLIcircvo egrave lid [() mente no tcole 11 (ltlll asso p o lll shylal ltOtSltgllen7~1 _ ta cincsiterapia pc rslIk bidtlvi shyptutibulli d ubllIcirctIcirc vltnc brn1e di conrro llo )(JSu k d i 5IcirclupPQ d Ile rLlt ziofll d i eC[u ihb ugraveo dJ ftffr otZJH1 r1w dei IIl llJgtCili 1 11Icircshyg rdtarl in posru ra rrenu posslhile JnnalL in Illo lt i clsi l(j luucircun lt di lin ~c() li oi mi n rc ( ume [11 duumlnQstrIO la tinc~ jn~l el1lric ((1l1 ~rtlppi d i contnmiddotllo cnndnlt1 p nso i l entrt d e Massue di Li n nc da [ o llo n ~ Rodo l (1 986) Julndo il1vlce lIfU~ ho ~vutlJ tiVll 11lt1 1IjXIl to un dekrshyuina r o~itl di g rl vir~l bull a~-n lllull~nte n ec ~~uiu rlCUuml rf( ff dla tcrJpll rle si c a eo chirurg ica
1Ho le clllC ooliosi idjopHI 3 ttl1p ~ - E~er l zjo hsco shy11ln ~ I((fapil
l Bg 5 CUle Lo [la k ll oblems in tlu ll~ (U ni Cl) FrKUce CU ( )lIILr no 1 AllCPR lu b1lG1t10 11 middotCI 9()(iJ2 RockilJe MI) i)~Cr ~()f I [( al th all 1 () I ~Y 1(~Re~C~Hd ~gtutnlt Ilallb Srshy1ltC Cgt D~p(rulllnr CJf I Ilalil 11 1 HumlIl sen Lel 199-1
2 SI) lrzcf ( LcB I ~IIl( FE DupUb L ampkIll~ 1c ~ppro l c h ll tht rnent und mmgemlt-rlt ot ~ ct vlyrl~ led splnul (hs r)fder~ A monQglJph rr r d lll kic Re p o l1 or Ih Ou bcc TlSk Fu rcl 0 11 ipmd DIo rele Sp ine L9H LU) 59
) Clntino F 111i1 i(ll Ci nerte1H C Nou gltHhl C Kln(~Jl llBICII [lIe1 hmlln (Il dry rra ll1ltfll of QIil pa ll m log iC by l11e 1 lIb li 1le-llh laquorilC~ of ~ 10(lna 111 Jrc)Jcxli r~~ (of flle h l lntrnIUonll SVIll Illgt~iu tn - II 5lt Ik lIc lk0flllllic lu llln-I I r l III Fhhlt ri g 1092 -ltlIJ-7
i - ri of niii MA N()LJV II ~ mel h)ltks de kin ~~klk rlr k di lll J r~cdllclli (n d~s ~()li oes jn f ~tel r~1ruuml(ILI -lo s bl fl c sur IcIj cquishyl)œ~ Ik SOll ll l)(eacute Eli ror eetlfllS d )111 1~ 1)1-
5 iloll n G Ruumld(~ le s () I ~middotmiddots tnlcl l l1 I n in 1Ifc el kiwil~~ 1)11lt KillegraveSlthe ripJe SCleacutentlnlue lYl6 2 47 ~ 6
r) Feacuterr[ffgt en 1tsiero 5 Venlllfln A ll~~n () M MJglio nu N EfkUuml o r eXltClse tI~tl Yoj o n nild id iO rXllhlc iC() 1i()~ lrt~ lirnIcircIluy r sull Eur feltl lb)ii 1 1j34 Z5 -~ 1 NOilrill1 A Sbill P egn ni i Ll Linesilegraverpi l 1lt1 Itallllll~nlO
ddlJ soI K~ i llO 1 Orkl1Llllwnrl m efodoloil1c1 RbbilltlZiOllc Ot1(1 1 )29(1) 1l-~
8 Nli(rinl Nl(lr1n l A blll P LI rieduGlzione dl p llicml atflt rro (11 coli ns i idi opr lir1 l n SC(Um i le or h( JI 1rcLlIQn1 ~0Cl le Imc lI1etW)n11e de Recltcrchc ci 0 Ftude sm 1lt Radw jlt)(j S-71
gt Nftriruuml S SeJhrf U LI r i l bllh ~l liOlie dd plziecirc11te ulet1n 11 - r
lin Kllopd (1 In l1l Jgl L N eduoL Tf1It II d ll11e ji cln1 rJtbl IiIUvJ Milan) 1ltfddH~n(x~hl 2(1~111gt-1-PU ob L cllln t iRll p l nelLi rl tgtO llcui n~ dilt ~lio i - l rn~f- li ~iIa n 3efllnl -Kurflr 19-11
11 lIIra S lJll M EVtJltHlvugrave egraveI lt t rnrumel1t() d db S(oli - U r) surie doCum nUle fintgt 31 tIUUli Mibn SI rlin) KlIpf -r 199 2
L2 1 ~W I1l(IJ P _leacuteVia tio n I~lhra k~ du IlchlS ~- ( i( IoltS ccedil l r lI C1 l1 fl leq
Ene 1 l C hi r ApparctlIClCOn l~ ltll1 l ltx6lt (i W Er 20 j )7 l
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L cl middot Exp CO_fiL [-In 190 15 Xd BR llet13n) J Th ltJl-xwenc a l o-(l1 tUcn~kuud txer
C le re-glflW 1 lhe tfelmc nl o f id iopllhiC Collaraquo n lroc~-din) t Lhl 1 r 111(1ltli0 I111 Symf SiUl1l un 3-D Scl IiDliJ DclOfshymillelt ~k)J1[rlt u Gugtu l1Shltr Verbg 1lti t)L j32-t)
16 N1lh~Ir~il Al Peumlf r~o n LE Erree htJkmiddotmiddot~ n f t~U lt hfIl middot Ith J
hran in ~rls V ll ~ ttiVl ~HkJ k-nt IHuIXtthilaquo ic I) Li ~I~ts H t 1l1i JflIn t ~ j l~jl)5iuml7A(~)8Jj- 21 bull
17 M(jo n Y ( ullck J p ~ R A PrdulllnlIr rpurt 11 Iht e rt l f rnltJsu red 5l ren jl lh rrll nrl1 III ililleInr Hi rrt tllk scoJliagt
J lin1I IJisn rd 21 1 1)12) 102- - Hl Hunng CU[- -If p~lIll)~thc - Uonktd in -c h JI IL
c reacutetnl n~ ptnl l C)Q~ Z ) t 1 t(li-v 19 Kou )UrJKh L Glr~ k G KRI iJI G KLmiddotmiddotrnl kh g UlUI
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Joi nl lIrg AI11 1~gt81 (1 )1)1 -0 22 re rdrlo lk R 11 gtcolk)c on Ftudc TrldrI1lUl i0 nnli1t FHIS
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2 u ttlllJil ~ 1 gtCli ll Ofli e 1lI tpLI lJ1lluak Hntd ~Nltmiddot ) lnLpmiddotmiddot Fi)) SdwrJ r ll r [(111lt1 1gtl( lEl ~ bri UI nc 1lt)79 Slone H neekman C H ill Cues V fuooks 1 IL 1bc d rrCl o f an c Xt rc lslt r rog tlm ~)n chanfe ln cur( in uJokS( r 1H wtt h lllinr l11bulll IdJo p thiC SC(J lioh A prcl rnunH) Iud Pill Th r 19-9597Yfgtl Rlt td J Ccedil d(dtltx middotnl IdOcircgtpUhinK()liosl fl(nsugiCIJ lrellmenl ln lt-C llSlt ln Sl edit The P edtlt r bull SpIn Prmclp ilt and 1 1 shyte t Nemiddot Yo rk RIVCJ) PrtS j~)f197- 10 1(gr Ul1 A il lulfo l7amenro rnu_ olu e in S bfClti p()n ~nuuml(f di d lsme rf lsill i middot Wb li La i inm~ti MtmiddotdiQ 19$nYl - l
)0 DuIYLls-oe J E~ 1 d hypot he~ d tk gj(lult~ d b = shyli(~ Id lOIllll1lqu ahleacute~ de Knlt~il hr p le l ~ ~llK l H I
31 1 hnrwll R MLm n J [j her A ~Wlu (middoti R bull nlfc k J IdlopalhK 0 1101- llId lll ntr1 nervrlU$ S)511111 p ine 1il-111 H
12 KheacutelTl~(l 11 i Srh lrClno T E1lrtcmiddot fil middotlm 1deJi lI Idio shy111111lt l(middot lk is plm 112 1i6-8middotf la i Fm rIC) PL ( IJIlfThJ 1 V I1W F 1--1 w hl P ) IlOI ) ) lIet ( fnorfis rnl IlI lnPrt d~IL I (lonrl Vie rkh r h -Df [ 11 lltd Rt JlJ Il 190jmiddot middot (3) 2)middot -8
H Slh lrJIHl T P(lrugt()Jl n A s rurl ( bbnintl1in lLllkrion in pllIents Vilh ad() l~eJ1t idiopcuhiccedil -collsl ioLI~ 0 11110 1 -C1lld 1)795)51
35 Siblll r l Si~tltm t ocircHboIJ f( t los pproajo (lIoneuroiq-k 0 Ib duta7Jltme PWlIlltrS(Kmiddotl C (ltl~I1OSlilt1 dei middotoUosl Pr~Smltl ar PchHria ~i(J S MarghrllL LigUflmiddot l( J
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301 Yum1ntv Il YJl1ll d~ r lqu lll lll1 ll Lppr 111 ICi ~rljritJccedil p tUf( ~cOILgtgk J)-6 1711
W NeW1 N~grm l ~ Xn[(ui chlncltltcfIILl 1 (L ln CfmuO r Bk r 1lt1 511 tn tlt [C IUIl~1 AUtlI IJt1 TecnILln J I TCI 1J1l flD ~ Cont rQnltl Mock n1 tl l J~ middot ) rollplt KIIlCSlherlplllLl Elirope ~H gtle 1 ra~tiI iUf lil ioII O~ l -N ill l- il middotmiddot
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1 r u I -rkIlp ~h 6 leltp1Tgt - Il lt1 rd A r lltoucirc Ully f 0 shy
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f lk craquohb n e l9J r III QJd~ wllh fdJopthK-C lllo~ls Spi n 1lt) U(I middotlZ=~7
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EUROP MIDI C Pli hIC
EDUCATIONMEETING SATURDAY 8thof APRIL 2006
(iSS
SEAS02 Scientific
Exercises Approach to Scoliosis
version 2002
G
S Negrini 1
EDUCATION MEETING SATURDAY8th of APRIL 2006
Neuromotor disfunctions
Neuromuscular disfunctions
11 Postural collapse
Postural collapse
Duval-Beaupegravere
Flexibility of scoliotic curve
f---I--- I Postural element
-------1 Structural element
S Negrini 2
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Postural collapse
Duval-Beaupegravere
It is a value related to muscular tone and to flexibil ity of convex side tissues
Post ural collapse
Bunch e Patwardhan
Critical load
Load threshold beyond wh ich a spine begins buckling
JI~~Wt1lW~flfthtlJlœJtAr ~ J~It- l~l - IMS
Postu ral collapse
Bunch e Patwardhan
If a curve reduces there is an increase of the deformation threshold
~~~NW~-damaoc~IIIMf ~~ J~Iv JaJ-I7I9sect
S Negrini 3
EDUCATION MEETING SATURDAY 8th of APRIL2006
Postural collapse
Torrel e Nachemson ~
Scolioses below 20deg ~ ~ lt~
have a high ~ ~ percentage of ~ ~
~postural collapse (on u~
average 75) ~~ 2i~
CU~VE O EG~EE S WHllE SUPlti e
~laquotd~c6b ____lPffI1wtt1t~
$ww J(t ~~7 JM5
Postural collapse
Minor scolioses 7
Antigravity musc es strengthening D
Reduces postural collapse -G
Increases the critical threshold of deformation
G
Neuromotor disfunetions
Stagnara
If we admit that one of the causes of idiopathie scoliosis is a disfunction in balance systems it is logical to orientate physical exercises toward this direction
s Negrini 4
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Neuromotor disfunctions
Dubousset
Idiopathie seoliosis results fram alterations in praprioeeption centres and deformation is a natural compensation to restore postural balance
etattJtitIK ypothfQj~S ___~ own_ oJ)HQr lar 1t-1( r
Neuromotor disfunctions
Nachemson Initial idiopathie scoliosis
+ Goood spine stability
Neutralization of postural deficits
D Static curve
Neuromotor disfunctions
Therapeutic aims
c) Development of spine stability
C) Development of balance reactions
G
S Negrini 5
EDUCATION MEETING SATURDAY 8thof APRIL 2006
Biomechanical disfunctions
j Horizontal r-Ian
i Sagi ttal plan
Frontal plan
Frontal plan
q Frontal plan disfunetions
Fronta l plan
Perdriolle Movement magnitude
gt in the direction of lt in the direction of correction progression
S Negrini 6
EDUCATION MEETING SATURDAY8th of APRIL 2006
Frontal plan
Stagnara
Never mobilize a scoliotic curve without ensuring reduction maintenance over time otherwise a greater mobility favours scoliosis progression
Frontal plan
Ducongeacute~ research
On a group of adolescent idiopathie scolioses treated with
Meacuteziegraveres gymnastics
D After 1 year the mean angle of
curves increased from 18deg to 29deg
Frontal plan
Scoliosis without brace
D Greater spine
flexibility D-
Risk of progression
S Negrini 7
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Frontal plan
Mobilization is useful
D In preparation to
brace
D With brace
Sagittal plan
QSagittal plan disfunctions
Sagittal plan r middot _J o
Perdriolle scouos B CJ aDeformation of D
thoracic and thoraco-Iumbar curves evolves in extension
S Negrini 8
EDUCATION MEETING SATURDAY8th of APRIL 2006
Sagittal plan
Graf
The line of gravity centres in the vertebral bodies o s c oUOSt
projects itself firstly laterally and then fi
o
posteriorly lJ ~~ ~~ ~ ~~-_J-D ~nI~
Sagittal plan
Therapeutic a ims
D Maintain or
retrieve physiological curves on the sagittal plan
Horizontal plan
QHorizontal plan disfunctions
S Negnni 9
EDUCATION MEETINGSATURDAY 8th of APRIL 2006
Horizontal plan
Stagnara The forces applied ta the spi ne act in a autoshydeforming sense
Horizontal plan
Dimnet Rotation gt 200
ampII~ (
D The actions of concave and convex side
muscles become
agonistic
~ItJrOnrIIiItdllfUClltlluumlll~~tI ~1JIf1laJ
Horizontal plan
Minor scolioses never exceed these autoshy
deformation thresholds
S Negrini 10
EDUCATION MEETING SATURDAY8th of APRIL 2006
Disfunctions at a biological organic and psychological
lever
Oisfunclions at a biological organlc and psychologlcal lever
Cheng
Bane density in scoliotic teenagers is lower than in normal subjects
~~~~middotA~IIlUtIy ~7œl 1d l
Oisfunctions at a blologlcal organic and psychologicallevel
A significant reduction of vital capacity and V02max in teenagers with a medium severity scoliosis
S Negrini 11
li
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Disfunctions at a biological organic and psychologicallevel
Disorders in the development of body image that the teenager has of himherself
Disfunctions at a blologlca l organlc and psychologicallevel
Therapeutic aims
cJ Activate cardioshyrespiratory function
cJ Favour bone density increase
cJ Develop a positive image of the body
Disfunctions at il biological organi and psydlologicallevel
Stagnara
Sport
D The active side of
kinesitherapy
S Negrini 12
EDUCATION MEETING SATURDAY 8thof APRIL 2006
Disfunctions at a biological organic and psychological
level
Distunctions at a biologlcal organlc and psychologicallevel
Cheng
Bone density in scoliotic teenagers is lower than in normal subjects
~n~IIIvpWr~middotA~stWy s- XXJl M J
Disfunctions at a biological organic and psychologicallevel
A significant reduction of vital capacity and V02max in teenagers with a medium severity scoliosis
G
S Negrini 11
EDUCATIONMEETING SATURDAY 8th of APRIL 2006
Kinesitherapy on the scoliotic subject
q Postural control
q Axial stability
q Muscular trophism
q Balance
q Respiratory function
The limits of kinesitherapy
There is a threshold beyond which
rehabilitation alone is not enough
sssr
Kinesitherapy in scoliosis treatment with brace
Therapeutic aims
S Negrini 13
6
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Therapeutic aims Srace kinesitherapy
With brace
il Postural corrections and
vertebral stability are obtained by the brace
Therapeutic aims Srace kinesitherapy
In preparation to the brace
il Mobilize spine on ail plans
Therapeutic aims Srace kinesitherapy
With brace D
Maintain a normal spine elasticity
~ Maintain a good muscular toneshy
trophism
C Model the hump with kyphotizating
exercises
S Negrini 14
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Exercises and their methodologies can vary accord ing to learning and individual sensibility of the single rehabilitator that proposes the m provided that they stay within the
Iimits of fixed therapeutic objectives
li
Therapeutic modalities
(Exercises)
QAuto-correction
QRespiratory education
QErgonomie education
QMuscular strengthening
QDevelopment of balance reactions
WNeuromotor integration
ci Vertebral mobiJization
QSpecifie modalities in brace treatment
S Negrini 15
EDUCATION MEETING SATURDAY 8th of APRIL 2006
The protocol of kinesitherapic
treatment
G
QChoice and dosage of exercises
Variatiosn of the work program every 2 - 3 months
Q Execute e)(ercises on an individual base or in a small group
Q Frequency not less than 2 times 1 week
Involve and awaken the family
G
S Negrini 16
EDUCATION MEETINGSATURDAY 8thof APRIL 2006
Q Determine the action and the localization of auto-correction
QAuto-correction must be associated to ail exercises
QAt the end of treatment ergonomy lesson
Auto-correction didactics
G
SCOLIOSI DORSALE---- shy ----
r
S Negrini 17
EDUCATION MEETING SATURDAY8thof APRIL 2006
SCOLIOS OORSOLOMBARE
shy
SCOLIOSI OOIlSALE 011 bull LOMBARE S1I--shy
SCOLIOSI LOMBARE
il --~_-
S Negrini 18
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Scoliotic patients are not radiographs
middotSeoliotie Mtients are not ndiographs but hum beings with a vertebral deviation-
Slagnara
Metha For the physieian Cobb angle is of utmost
importance For the patient it is body deformity t hat eounts most rib hump a protruding seapula or hip We are in a situation in whieh today dodors eure the radiographie deformity but what the patient really desires is to get rid of clinieal deformity and of ensuing psyehologieal distress
CIIQItIo shDuIdtucirc lM WIld tJw~~ I~~M~~~~ J9f~
S Negrini 19
- Poznan_workshop_Physiotherapy
- physio2
- physio3pdf
- physio4
- physio5
- physio6
- physio7
- physio8
- physio9
- physio10
-
Biodynamiczna metoda t r6j p~aszczyznowej
korekcji skolioz idiopatycznych
Metoda Dohosiewicz
bull Istota metody oparta na patomecharice skolioz idiopatycznych polega na koncentracji dzia~ania w strefie skrzywienia na kr~gu szczytowym z zastosowaniem po stronie wklE~ej bodkow proprioceptywnych
a po stronie wypukfej bodkow eksteroceptywnych
Ruch sterowany jest asymetrycznym torem oddechowyrn
bull Metoda ma dziatanie segmentarne
a ruch ukierunkowany jest na maksymalnq kifotyzacj~ krEgos~upa w odcinku w ktorym wyst~puje proces pierwotnej lordotyzacji i rotacja kr~gu szczytowego
1
bull Derotacja kr~gu szczytowego Potclczoiluuml jest z rownoczesnym jego ruchem w pfaszczyinie strzatkowej N kierunku grzbietowym oraz w pfaszczyinie czcfowej w kierunku posrodkovym
bull Powstaje ruch trojpfaszczyznOllly kr~gostupa
Jest to ruch odwrotny do kierunku rozwoju skoliozy
Schemat post~powania
bull Cz~seacute wst~pna - Rozgrzewka
bull uruchomienie pOSlczegocirclnych segmentocircw ruchowych kr~oslupa w systemie calkowitego podwieszenia
bull efImlnacja przykurczy w stawach blodrowlch kolanowych 1 barkowych
bull Cz~seacute glowna - Asymetryczna tragravejplaszczyznowa mobilizacja kr~goslupa w sclSle
symetrycznych pOZcjach wyjsciowych bull w pozycjach czworacrych bull w siadzie skulnyrn 1 W sladzie prostm bull w kltku prostyrn bull w pozycji stoJtcej bull W p02ycji stojqcej ln ortezie Checircneau
Il cz~seacute kOrlcowa - Zestr6j ruchowy
bull utrwalanie odruchu postawy z wykorzystaniem bodiceacutew bI~dnikQwych bull cwiczenfa rozluznlajqce konczvn
Badanie postawy d ala
pl1odu ltylu boku
2
Test AdRmsa
Test Adamsa
3
Pozycje do eacutewiczen wg meody Dobosiewicl (cz 1)
4
Metoda Dobosiewicz
pozycja 1
Meota Dobosiewicz
prutwnik
Metoda Dobosiewicz
5
Zmi3ny w zakresie kllill Cobbll w wyniku Jlrowadzooej kinezyterapi i wg Dobosiewicz w grupie
progresnvoych skoliozjedl oillkowy cll - n=124 (ass obsenvncji ud 6 do 58 ntini~cy $~dD iw 197plusmnJ 185 Rlic3iqC3)
6
Zmiany w zakresie kqta rotacji osiowej kr~gu sZczytowego sknywiellia w wyniku prowadzonej kinezylerapii wg Dobosiewicz
w grupie progresywovch skoliozjednoillkowycfl - 0=124 (czas oburwRCji ad 6 do 58 mitJi~cy sndniR 197plusmn11S5 miesics)
Grupa skoiozjednoukowych typ J wg Ponsetiego - skrzywienia Th dx - leczeni kinczyterapill wg Dobosiewicz
(1174 015 ubscnvncji od 6 do 45 mieiircy s-cduin 211plusmn 111 rniesi~cn)
Zmiany w zakresie kllU CObbtr w wynlku prowadzooei kinezyluapii wg Duhosiewicz w gTUpj~
progresywnych skolioz dwulufwwycfl - 0=74 (aos obsrnvacji ad 6 do 45 micsi~y srcdnin 211 plusmn 1 1 mi~Icircqca)
DdciMk Th odcinek L
7
ZcDli~ny w zakresie kla rolaei osiowe krfgu sezytowego
sknywienia w wyniku prowadzonej kinezyterapii wg Dobosiewicz w grupie progrcsywnych skolioz dwulukowyell shy
n=74 (C7lS obserwacji ad 6 do 45 miesi~q srednia 211 plusmn 111 miesiqcR)
oddnek Th odcinek L
Grupa skoliozjednoillkowycll 0 kqcie Cobba lt 40deg - leaeni wyhCznie kinezyterapil wg Dobo~icwicz (n=44) (czas obserwacji od 5 do JI mi~ifCY ~redllia t 18plusmn604 mie-ihco)
tnnl qICIiIl fMtt[ IoooI ~)I l~Illli 1IqIlt00401 IftmiddotI-I llJ
~1 1~ u)~___- uul
c- -- a-J
Obserwowmo i ~totn~l korclacjt pomittuzy POZiUllllm opilnowilnia Illctody przcz chorych i cZccedilsloscj stosowaniu kjnc7ytcrapii a wiclkoscuuml rcgre~ji 7~niilnw zakrcsic kta Cubha i rutltjl OSIOWCJ krccedilgu szczytuwtgo skrz)wienia - wspOlczynnik Ptarsona wynusil Odpllwicdnio 016 i D53
Grupa skoliol dWlllu koovyeh 0 kItac Cobba lt3(jl
typ IV wg Ponltetiego - skrrywienia pienvotnie podw6le - piersitJwe pFlWosrUlII i lccedildiwi()we Iwostrow
-Ieczeni wylcznie kiDezyterapi~ wg Dobosiewicz (0=10) (nli obsrrvLcjicirc od ~ do 24 miesifCY _~ n~dllia 12453 micsi~ca)
Sndni ~~( Cobbl na pmltltu (ugraveurulJpii
wynosil
ft udcinku Th shy 179deg
W oddnku L-17deg
Srcdni )11 Cobb~ po killtylapi -rylltlsi l
W odcinku Th shy 1J7deg
W odciuku L shy 1320
JmiddotI) 1)Imiddotj ~ lIll11 i ~W --)WCcedilMtf
ClNlIltallj Nui 001
( -aItu ho
~lllj Cl F1r Wj~ omn)
8
Zmiany w zakresie k(ill rotllcji osiowej kr~gll szqytowego sfmyiellilllV wyniku prowadzonej kinezylerapii wg Dobosiewicz
w grupie progresywnvch skoliozjedllollkowycll - 0=124 (CZB5 ObSrrwRcji od 6 do 58 mielli~cy irednia 197plusmn1185 miesiqca)
Grupa skoiozjedllolukowych typ 1 wg Ponseliego - skrzywienia Th dx - leczeni kintZ) terapill wg Dobosiewicz
(11=74 aas ubscrwacji od 6 do 45 mieiIcircccedilcy srednin 211plusmnII 1 miesiJtcft)
Zmiany w zakresie kqta CoMa IV wyniku prowadzoDej kinezy tera pii wg Dobosicwiu w grupie
progresvwon h skolUgraveIl dWlllllkowych - 0=74 (ons ubs~rwacji od 6 do 45 mil3Icircccedilcy sredni3 211 plusmn 1J1 micii il cn)
Ddcil1t~ Tb oddnek L
7
Zmiany w zaknsie kIta rotacji osiowej krfgu szczytoweg() sG-z~vienin W wylliku prowaagravezonej kinezyterapii
wg Dobosicwicz w grupi~ progrzs)wnvcb skolioz dWlUcircuk()wJcll shyn=74
(cras obscnvacji od 6 do 45 miesifC)j srednio ZI I1 JI I micsilfca)
oddnek Th udciollk L
Grupa skoliozjednolukowych 0 kqcie Cobba lt 40deg - JeCJeni wyl~7ltie lunezyterapil wg Dobo~il-Wicz (n=44) (nl3 obstrwllcji od 5 do 31 mhticcedilcy sndui 1I8plusmn6U4 miesiacn)
Obs~rwowano istolm korclacj( pomiccediltlzy poziull1lll1 upmowlIniu mctody przcz chorych 1 czccedilstosti stosowilniu kine7ylerapii il wi~lklJseii rewcsji zmian w Zakrcsil kta Cob l13 i ro tacjl osiowcj kr~1u SZCzylowcgu skrzywienia - wspolczynnik PeanlOniJ wjnusil uJpowiedniu 016 i D53 -
Grupa skolioz dWlllukowych 0 kflfch Cobbf lt30 Iyp 11 wg POllsetiego - jknywienia pienvotnie podwojle
- piersimve prflwv~middottrolle i lccedildiwilJwe ltKJoslrotme -Ieezeni wyl4eznie kinzyterapi~ wg Dobosiewicz (0=10)
(nu obenvacji ad 5 do 2 mlcsiccedilcy ~r~clnil 124plusmn51 micii~cll)
Sredui k~1 Cubba na )uclltlll I~lerpi
wy nosil
w udcinku Th-17o
w odcinkll L - 170
Sn=dui kql Cubb aJu liugrave~tyIcTUpij wynosil
W odcinku Th shy 137deg Y udcinku L shy lJ20
4) 1)IIIIcirc w Jlm ~llIWiob_ l~ rlllW
JIIIIm-lollUcirciaftq jtQ0 1 t~~010
UpIJI~r~
8
9
Po 5 i 10 miesieacutecach
C- 18 R-S C-12 R-S C-S R-Q
10
Po 9 miesilcach
11
BP
Il rz
Th
Cmiddot 12
R-3
L
C-16
R-7
PoDP 7 mies 10 rz_
C-9 C-20 R-OR-2
--__ _ _----------shy
12
DP
8 ri
111 C-26 R-2
L C- 17
R-]
bull Metoda asymetrycznej trojplaszczyznowej mobilizacji kr~gostupa ma znaczeumllCV wptyw na zahamowanie progresji
w skoliozach idiopatycznych szybko post~pujqcych
bull Mobilizacja strony wkl~s~ej skrzywienia i osiowa derotacja kr~gu szczytowego zwi~ksza korektywnoseacute skolioz zmniejsza garb i ebrowy poprawia obj~toseacute klatki piersiowej i zwi~ksza wydolnoseacute oddechowq plue
13
bull Przedstawiona metoda jest
stosowana samodzielnie lub
w pO~qczeniu z ortezq Checircneau
a takie jako przygotowanie do
leczenia operacyjnego
Ocena progresywnosci w badaniu elektrofizjologicznym
odruchu z odci~zenia
i~middotmiddot ~=~-~ shy1 _--==shyocirc
14
EUT S pine J (1997) () 93-97 copy S pringer-Verl ag lY07 ORIGINAL ARTICLE
K Dobosiewicz Neurophysiological mechanism of the unloading reflex as a prognostic factor in the early stages of idiopathie adolescent scoliosis
Rcceivcd 29 M arch 1996 Revised 16 August 1996 Acccp tcd 10 Septem ber 1996
Absfract This paper presents a new nc urophy iologila1 methougrave of e valushyati ng the risk o f p rogression in ill ioshy
mo t important factors in the eva luashytion of progress ive id io pathie scolioshysis The met hod can be lIsed to deshy
pathie scoliosis in th early stages uf tll( progre jve idiopath ie scolios is the dis ase by illY middottigating tll e unshy in lhe early s tages of the d isease loading refl ex in paraspinal muscles T he high sensi livi ty of ilie method The study incl uded 394 pat ients wilh means il can be used as a basis un seo liosis and 70 hcalt y chil dre n which to take an earl y dcc ision to
K D obosicwicz Depuumll1 mel1 l of Rchabi lilu lioll Si lesilln Medical Academ y 42-604 Tamo wskie G6ry 4
Lmenty of the unloacli ng retle x and repeatabi li ty o f Ihe rcbound and silent period were anal ysed for eaeh reflex evoked Prolonged latency and
p rimiddotom1 surgery
Key words Id iopathie seoli o is Unloadi ng rcnex Re bound
Katowice Polaml minima1 numbe o f cycles are the Larency Si ent period
T he ai m of this sludy was to evaJ uate the use of the unshyIntroduction load ing Dex for octcction of prog ressive id iopath ie adoshy
le cem oIios is in its carl s tages in onl r to lake a dccishyProg ress io n of id iopatJl ic scolios is bas been the su bject of
sion ta perfo nn surgcry as soon as pussible many clin ical radiological and elecrromyographic in ve~ shy
tigalions T here is ho wellcr no sim ple quantita ti ve or qual itati ve pro noslic methoo [hat can be em ployed in the
Materials and melhodsearly ~tHges of the disease Monitoring of lhe unloading rc felx in paraspinal m llsck appcars 10 be a reliable Inv gtsi lgnlions were carricd uut 011 394 pa tie nt with adolescent method o f discriminating bctwcen diffcrcn l fomls of Cushy ~c li ed J ild 70 hCldr hy children The scoli osis group consisted of Iios is T he un loa ing re n cx can be evokcd in ail the 31 1 g irl s and 83 boys aged 9-1 8 year~ (mean age 125 ycars) The
ske lelal muscles through a suegrave den shortening of o luntary contro ls wcre 0 girl s and 10 boys aged tO-1 7 y~ar (rncan age 128 cars ) Imong Ihe stlbjeclS tudied wcre 9 patien l w ith cershyinnervated muscle l2~J When a musc le is unloaJ ed vico-thoilc i seo liosi s mean Cobb ang le 22 7deg 121 with Ihoracic
rapidly durin g an isomerric con trac tion Ihe norm al reacshy scolios is mean Cobb nngle 309deg I 1 w ith thoraco-Iurnbar seolioshylion is an eleclrically silent pe riod fo llowed by a burs t o f s is rne ~n Co bb ang le 26~g o 63 with lumbar cotlos is mean Cobb action potentials called rebmmd The pause in d ischarge ang le 279deg and 90 w ir h doubh major curve sc o Ii() ~ i s meull o bb
nng le 292deg and 28 5deg The sludy group includcd 231 right -s ided can be observed only when a certai n h reshold va lue of and 163 left-sided 5col iouumlc patien ls There were 112 patients w ith
acceJcration flnd shortening of he muscle is exceeded progress ive id iopath ie scoliosi (76 ri g hHidtd and 36 Ic 1t-s ided) an tl il occues wilh constant latcncy correspond ing to that 182 with no n-progressive idjopa thic scoliosis (1 13 ri ght- sided and of the propriocepti ve nflcx (9 18 20] T he rebound ufter 6 le rt-sided) M d 100 w ith pe lvic tilt (statie) scolios is (42 rightshy
s ided anp 58 l eft -~ i(kd )the silent period in the unloaugraveing re felx rcsul ts from ae lishySC9 1ios is is consIcircdered progressive if the Cobb Jngle inshyvalio n of a pool of motone urons aIl o f which fClt1ch lhe
creltseacutes by more lhan 6 in 1 yen r aile middotnl1 n-progrcssive if the anshyfiring thres hold simultancously afte r prcviou~ si lenœ [l nua i increase is less thll n (i The Cobb angle ranged lrom 8deg to 77deg 1 4 201 in Ihe palicnls w ilh progress ive scoliosis (mean 361 ) [rom 30 ta
lI f R (on- f Rt tt1IY 1lIfl pflla 1 )(~ r(Jnu n t shy
fI) _ ~
Pathomechanic basics of conservative treatment of progressive idiopathic scoliosIcircs
according ta Dobosiewicz method based upon radiologie evaluation
Kryslyna DobosiewlcZ Jacek Dunnala Kny ztof Czemicki Hanna Jcndf7cjek
Deparmem of Rellabtlifatoll Mediw Uninrsity ofSiltsia KatOllice Poand 40-635 Katowice fil ZiUCl 3537 POL4ND
e-mail relwbilitacjt1s11mfoctaonetpl
Abstract Conscralivc IrcalrnCnI of Idiopathie scoht)~1 espcclall y kinc ilhcrapy i ~
nOI widcly apprccilllcd due 10 Ils suspectccl low dfcCIIcircvcnc 5 in relalion [ (1 a urglcal Irc[llment ACter long-ycar il ses ment of palomcchanic f scolio icirc in Dcpanmenl of Rchnhllilallon f Mclii al Unlcrsi ly of Sile bull a concTvallvc mcthod ()f IrCtllmenl asymmclric Irunk mobili7alion in lnclly ymmelm po~itions WIS
de el ped_Thi mClh d enablc 10 delain pTogression f scol iosis or ccn de middotrca~c laIerai urvalurc of a spi ne and angle of rOlllion assummg adequate () perallon f palicnl and ilS famil)
J Introduction
Idiopathie scoliosi OS) is a thrccdimensonal dcfonnation of il vertebral col lmm an- cntire trunk Afler many years of extensive rescarchcs the cause of idiopathie coliosIcircs $ i remaIcircns unknown It is possible Ihat idiopathie scoliosis devel ps and progress on a baslS 0- ~
multifactor disorder perhaps diffcrent for curve initiation and curve progressi 11 Fion poss ible pathologie factors nervous system dysfunctIcircons affecting postural tquili brium ar proprioceptive control seem to be espc ially important [ l 2 6 JI Pro_ ression f iS could bot delermincd by vertcbrac remodeling under eccent ri c loading created by axia lly ce gravitational forces in presence of muscular imbalancc in the trunk [2 J The verte rai colwrz unde r scoliotic conditions 15 an unstable system with tcndency to fu rther tune dcvelopment fl2] Lateral bending of a vertebral column visible in X-ray examination L
only a two-dimensional prcstntation of a complex dcformity consisting of patho logica axi rota ti on torsion and othcr deformations of vertebrae [7 8 10 II 14J ln fS physiolog~ curvatures of vcrtebra l column are disturbed Total Icngth of an anterior column of a spi n~
consi ting of vertebral bodies and intcrvertebral dises bccomcs grcater lhan length of l posterior colwnn - vertebral arches and proccsses [11 15 J h is apparent that phy iologi ~
thoracic kyphosis in rcgion of a scoliotIcircC curve diminishes Each vcrtebra of a stru tu ~
urve of coliosis is oricntatcd in hypercxtcnsion in relation t adjacent vcrtcbrae [7 l resulting
1 n B Uri middota I l 11
H srut ft illtf j tI) t li orf1Hli d
IDS Prt ts 21)2
Influence of method of asymmetric trunk mobilization on shaping of a physiological
thoracic kyphosis in children and youth suffering from progressive idiopathie scoliosis
Krystyna Dobo icwicz Jacek Dunnala Hanna Jendrzejck Krzysztof Czernicki
Deparrment of Rehabilitation Medical University ofSilesia KaloKce Poand 40-635 Katowice ut Ziolowa 3537 POLAND
e-mail rehabiliracjas(u1poCmiddottaollelpl
Abslract Idiopathie scoliosis (lS) which i sub 1 ntially l threeshydimen ional derormation or a pine cau e nOl only laler l curvalurc and axial rotation of vertebral column but al lordoti allon of VCr1cbrac in structural curve eXl nsion ln an effect physiological thoracic kypho j diminishc or cvcn dbappears Method of a ymlllctric lrunk mobilisation in strictly symmetric po iljon according [ Do () lewicz not only dcteriorme progre ion of IS or evcn reduces lalera] curvalure but also significmtly rebuild physiological thoracic kyphosis Icircn cases of lS accompanicd by lraight baclc
1 Introduction
Despitc Ion year researchc etiology of IS is nOl yel resol ed Significant problem re laled lO morphology of IS apar1 from lateral bending and ax i 1 r tati n i deviation of shape of a spine in sagittal axis affecting physiologi al curvatu re of vertebral coJumn [3 5 6 8 9 J 0 1t 12 Lcngth of anLerior col umn of a pin constitutcd by venebral hafls anugrave intcrvencbral dises dominate ovcr Jength of po terier c lurnn buill from vertebral arches and processes [lOJ This condition uring scol io i progress ion and growth of a child effect in hallowing or even disappearing of phy iological Lhoracic kyphosis in scoliotic region It i well know n lhar cn~brae of structu ral Jaleral curve are positioncd in hyperextension - lordotisation [5 6] which in Lhoracic region Icad (0 reduction of kyphosi or to true lordo middotis Such kind of venebrae relation in thoracic region cau es ilS destabicirclisatIcircon whi h in u sociation with eccentricircc gfilvitali nal load fa pinc duc to muscu lar icircmbalance [21 pOdbly produces r tationaJ lordo is [56 Il] and further development of symptomatic scoHose ft ha becn proven [12J tha strengthening of the erector spinac muscle aggravates nce initialcd deform tion and deteriorates coliotic process Hyperextension and uxial rotati n a s clatcd with
357 Th B Grivas (Ed) Research inro Spinal Defoml ilis 4 lOS Press 2002
Exercise efficiency of girls with idiopathie
seoliosis based on the ventilatory anaerobie threshold
Jacek Durmala Krystyna Dobosiewicz Hanna Jendrzejek Wieslaw Pius
Department ofRehabililation Medical University ofSiiesiaa Katowice Poand 40-635 Katowice m ZioJowa 4547 POLAND
e-mail durmalaiacekyocztaonetpl Department ofPhysiology Academy ofPhysical Education Katowice Poand
Abslract The aim of the study was to estimate the exercise efficiency in the group of
girls with idiopathie scol iosis based on the venlilatory anaerobic threshold (V AT)
Material and method The investigation comprised 58 gi rls wilh idiopathie scoliosis
aged 10--6 years 32 girls (55200 ) wilh double major scolioSiS and 26 girls (448)
with single scotiosis The girls were eonservatively treated using Dobosiewiagrave
method The control group consisted of 3 1 healthy girls aged 10-1 6 years The
cxercise test was performed using eycle ergometer During the exercise the gas
exehange parameters wcre reeorded (minute expiralory venlilation minute oxygen
consumption earbon dioxide production) On the basis of recorded paramcters V AT
has been computcd using V -si ope method Results The following V AT values were
obtained in the group with scoliosis 207+305 ml 02minlkg bm in control group
219+350 ml 02minlkg bm The differences belween girls with idiopathie scoliosis
and control group were nol SLaliSlically significant Conclusions I The exercise
effieieney of girls with idiopathie scoliosis conservalively treated using Dobosiewicz
melhod is normal 2 Such high level of the exercise cfficiency of the studied group
probably was due to intensive 3-D respiratory exercises of these girls
1 Introduction
In practice there are researched useful efficiency rates which on base of laboratory tests results possible easy without using of the relatively hard or long exercise tests would give the belter forsighting of the range of homeostasis disturbances and rapidi ty of increase of
physical fatigue during varied workloads [1] The best known rate of trus kind is the maximal
minute oxygen consumption [2345] During progressive physical effort minute oxygen
consumption increases proportionally to workload The reaching of real maximal minute
oxygen consumption in time of progressive effort is iodicaled by minute oxygen consumption plateau [5 61 This result is rarely registered in children The progressive exercise test is most commonly used in children until physicaJ exhaustion and the highest registered minute
oxygen consumption is treated as maximal minute oxygen consu mption or so-called
symplomatic limited maximal minute oxygen consumption [678J Sorne authors regard
Orto-dlet Trau malaogis Roha b ilitacjaARTlKUL ORIGINALNY ORIGINAL ARTICLE Vol 5 Nr 1 2003 80-85
Jacek Durmala l Krystyna Dobosiewicz l Tomasz Kotwicki Hanna Jendrzejek 1
Katedra i Klinika Rehabilitacji Slqska Akadenia Medyczna Katowice Katedra i Klinika Ortopedii Dzieci~cej Akademia Medyczna PoznQll
Wplyw asymetrycznej mobilizacji tulowia na wartoseacute k~ta Cobba i rotacji w przypadkach skolioz idiopatycznych u dzieci i mlodzieZy
Influence ofasyn1n1etrie 111obilisation of the trunk on the Cobb angle and rotation in idiopathie seoliosisin
children and adolescents Slnwu kluce ac eJJic Cl chOlIU) Ice SKoio= idj)PO Imiddot(~I7tmiddot
K~Jmiddot w()rus consrieI ve I (OtlHelif idiopathie HUW JS
SUMlvfARY
BackgrouId The aim ofthe stldy Vas Ihe radiological evaluation ofthe treatllJent ofthe idiopathic scolioshysis utilising as)mmetric trunk mobilisation in the strict~ll I)mmetric illitial position
Material ([fJ(f lIIellOds Presented stud) lOS based IIpon J36 cases (13 oovs oged FOf11 ocirc la 6 lcars (lild
rn girls aged frum 6 la S pears) trealed due to the idiopathie sCuliosis ((rom Novell1her 999 0 F enflfUn 200) Among 48 ch idrcn sllfJering from dOlfble-major scoios is 6 cases wcre infoll scaliusis JOjuvel7lle und 22 adolescent Among 88 sillgle scoliosis 6 lere infw7t 33 juvenile and 49 adolescent
Radiological exami71ation 1as condueed always in the repeataole technical cOlldiions RadlOglOlI1 lier evaluated oy the same physician Radiologica analysis oIthe scolios is incuded value ofthe Coho al1gle ongle ofaxial rotaion
ReSIils ln double-major scoliosis observed dlring one year period in Ihe thoracic segmenl Cobb angle decreased inll l increased 1395 and in 292 Il OS 111changed Axial lolation angle in 167 (~rcascs
decreased in 354 incrcased and rernainM the sorne in 479 In Ihe llllnba segmenl Cobb ang le clccrcscucirc il1 354 increased in 39 6 remained in 5 Angle ofaxial rotation deceoscd in3 ofca es incrcuscd in 29 and persisted in 48
ln single scolio is Cobb angle decreased in 386 incrcased in 353 and in 261 was lInchonged Axiol rotarion angle in 216 ofcases deceased in 295 increased and rell1aincd the sallie in 489
CondlsioJ Asymmetrie mobilisation of the tf1f17k in strictly syl7111elric initial positions is a 1Clhod of choice in the cOl7senJalive treatment ofthe idiopathic seoiosis
STRESZCZENIE
WS~p Celem pracy jest radiologiezla ocena Icczenia skoiloz idiopaf)cznych metoda asvmetrycznejl7lOoili shyzocji tllowia w sciSe symetlyczl7ych pozycjach lV)jscio wych
M aterial i metody Przeprowadono retrospektYlIl7q analizri 136 przypadkeacuteM dzieci (13 chlopcow i 123 dziellshyczqt w wieku 6- 18 lat) z bocznym idiop atycnylll skrYll ieniem krrgoslupa leczonych zachowawczo w Klinice
1
Ortopedla TliJumatoogia RehlblllagraveeJa ARTYKUL POOL1 DOWY OPINION ARTICLE Vol 7 Nf 1 2005 49-$11
Krystyna Dobosiewicz Jacek Durmala Tomasz KotwickP
Katedra i Klinika Rehabilitacji SIAM Katowice 2 Katedra i Klinika Orlopedii Dziecircej AM Pozncrlz
Biodynamiczna metoda tr6jplaszczyznowej korekcji skolioz idiopatycznych - opis metody Biodynamic method for 3-D correction of idiopathie
scoliosis a description ofthe method
SIOWQ kluczowe leezenie zachowawcze skoliozy idiopatyczne korekeja tr6jplaszczyznowa Key words conservative treament idiopathie scoliosis 3-D correction
SUMMARY
The biodynamic method of hree-dfmensional carreeion of idiopathie scoliosis is based on Ihe palhomeshychanics of idiopathie scolioiiiii and consiss in aClive segmental three-dimensional correction ofspinal cllrshyvatlre The course of action focuses in the viciniy ofthe apical vertebra Proprioceptive facilitation is applied on Ihe concave side ofthe curvaJure and exteroceplivefacilitation on the convex side Correction likewise proshyprio- or exteroceplive facilitation is phase-oclœd with asymmetric respirarory movemenr as weil as wilh parshyticular phases of the respiratory cycle ln Ihe course ofexercises three-planar movement is generated opposite to the direction in which scoliosis Is progressing This method is in accordance with the stale ofthe art ofscoshyIiasis pathomechanics The method requires detaied training and can Ihen con be applied at home under periodic control by a physician and a physiolherapist The method con be applied in landem with a Cheneau brace as weil as in surgical pretreatment A elaUed description of Ihe method of three-dimensional scoliosis trealment will be presented in Ihis article
STRESZCZENIE
ISlofa biadynamicznej mefody Ir6jplaszczyznowej korekcji skoioz idiopatycmych oparlaj est na patomechashynice iikolioz idiopatycznych - poega ana na czynnej segmentanlej tr6jplaszczymowej korekcji skrzywienia Dzialanie koncentruj e siccedil w pobitu Icrllgll szczytowego sknywienia Stosowane iest bodicowanie propiocepshytywne po stronie wklllsej oraz eksteroceptywne po stronie wypuldej Korekcja i slosowanie bodicocircw propioshyi eksteroceprywnych zsynchronizowane j esl z asymetrycznym torem oddechowym oraz z poszczeg61nymi fazashymi oddechu W trakcie eacutewiczen powstaje odwrotny do lrierurzku rozwoju scoliozy tr6jplaszczyznowy ruch IcrFtshygoslupa Melodajesl zgodna z aktualnym stanem wiedzy na lemat patomechanizmu scoiozy nymaga szczegocircshy100-lego instniktaZu po clorym mote byeacute wykonywana w warunkach domowych Z olcresowq kontrolq przez leshycana i fizj oterapeutll Metoda mote byeacute stosowana r6wnolegle z leczeniem gorsetem korekcyjnym Cheneau a talcte w przygotowaniu do leczenia operacyjnego slcolioz W pracy przedslawiony zostal szczeg6owy apis meshytody leczenia
Skoliozy idlopatyczne stanowili znieksztalcenia patycznej rozwija siccedil poprzez przemieszczenie kr~gu tr6j~aszczyznowe charakteryzujltce siccedil wyboczeshy szczytowego w stosunku do krccedilgu g6mego j dolnego niem rotacjltt krccedilg6w klatki piersiowej i miednicy z r6wnoczesolljego rotacjl zgodnie z ruchem wskashyoraz zmianami w fizjologicznych krzywiznach kr~ z6wek zegara dia skrzywienia prawostronnego oraz goslupa w plaszczyinie slrzalkoweJ [ 123] przeciwnie do wskaz6wek zegara dIa skrzywienia leshy
Z punklu widz nia patomechaniki tr6jplaszczyshy wostronnego Koncepcja rozwoju skoliozy jako rotashyznowe znieksztalcenie krccedilgoslupa w skoliozie idio- cja i kontrotacja sugeruje ze sily korekcyjne powinshy
49
EDUCATION MEETING SATURDAY 8th of APRIL 2006
- CARDJOPULMONARY EXERCIS E
TEST IN GIRLS WITH
CONSERVA TIVEL Y TREA TED
IDIOPATHIC SCOLIOSIS
Jacek DURMALA Krystyna DOBOSIEWICZ
Department of Rehabilitation Medical University of Silesia
Katowice Poland jdurmalaqcmpl
The aim of the study was
to estimate the influence the conservative treatment (asymmetric mobilization of the trunk by Dobosiewicz) on physical efficiency in the group of girls with idiopathie scoliosis
Material
bull 87 girls with idiopathie scoliosis
aged 1 0-17 years
(mean age 135 years SO 161)
J Durmala K Dobosiewicz 1
EDUCATION MEETING SATURDAY8thof APRIL 2006
Material
bull 38 girls (437) with double major scol iosis (thoracic segment - Cobb angle 18-42deg mean 30deg SO 82 angle of axial rotation 4-32deg mean 21 deg SD 107 lumbar segment - Cobb angle 11 shy48deg mean 31deg SO 128 angle of axial rotation 5shy30deg mean 13deg SO 85)
bull 49 girls (563) with single scoliosis (Cobb angle 11-75deg mean 33deg SO 155 angle of axial rotat ion 5-30deg mean 14deg SD 83)
TIoracic kyphosis of the invesllgated group was 5-39deg mean 23deg SO 86 and lumbar lordosis 16-41middot mean 30 50 65)
Material
bull The 64 girls aged 10-17 years (m ean age 131
years SD 132) were conservat ively Ireated
using Dobosiewiczs method
bull Treatment period ranged from 5 months 10 3
years (mean 148 months SD 902)
Material The 23 girls aged 10-17 years (mean age 136 years SO 108) were treated u sing symmetric exercises - treatment period ranged from 4 months to 3 years (mean 161 months SO 1019)
bull 26 of ail g irls (18 girls earlier treated using Dobosiewiczs m ethod and 8 gi rls earlier treated using symmetric exercises) aged 10-17 years (mean age 134 years SO 108) were twice tested - at first and last day of Intensive hospital rehabilitation (asymmetnc mobllization of the trunk by Oobosiewicz) - mean hospitalization period 20 days (range 18-26 days)
i rf~8f6~~ or~~n~= ~~r~1~r~icircJ~~tb~~~~ mean 17-4 1deg meatl~(I SO 74 R n~le ofax 1 rotatIon 5-25ot mC3 111 3laquo S0 6icircl Ilnd 1 99t1S~ ~~~~I~~~~~$ruo~ras~ ~ocirc~~a~e~~~~~~~5euml1 9middotn~ tUfllbar Iord05ts 16-4 1deg mean 311 SO 68)
J Durmala K Dobosiewicz 2
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Material
The control group consisted of 77 healthy
girls aged 6-17 years (mean age 12
years SD 31)
Material
The examined girls participated in school
only in scheduled physical education
lessons and have not been enrolled in
other sporting activity
METHOD
The exercise cycle
ergometer test was
performed
J Durmala K Dobosiewicz 3
EDUCATION MEETING SATURDAY 8th of APRIL 2006
METHOD
The Incrementai exercise test has been applied
We have found that tests ln whlch the Incrementai part of the protocol ln completed between 8 -12 minutes duration glve the
bullhighest maximum VOz in normal subjects
METHOD
The workload was Increased stepwlse
bull by 10 Watt every minute - ln chlldren
with high ~ 135 cm
bull by 15 Watt every minute ln chlldren
with high gt 135 cm
METHOD
The test had been contlnued untll refusai of the patient or exceeding the pulse Ilmit
Durlng the exerclse the gas exchange parameters were recorded by Jaeger device model Oxycon Alfa uslng direct breath-byshybreath rnethod (with face mask)
J Durmala K Dobosewlcz 4
EDUCATION MEETING SATURDAY 8th of APRIL 2006
METHOD ~ ~~ r 3 min 3 min 8 - 12 min 6 min -~
_ 0 rpiYJ 0 rpm 60 rpm ~1 30 rpm
_ t o~w=att~o~~na ~~ att__~ tl~~S~~ l ad l ~~~~~r o~w= Hlcremenlal t
pedaillog i i ~
~ ilt ~I~-----tl-~ I t ~ i ~ lOSt sffortivB
lW r resututlon r rm-u middot 1 - bullA~cremen tal ~~ ~ ~ ifr- ~ VtI 1 ~i ~ tllng _
METHOD
On the basis of recorded parameters VAT
has been individually computed for each
child using V-slope method by
Wasserman
METHOD
For assesment of physical capacity
the maximal minute oxygen o
consumption (V02max) ventilatory
anaerobic threshold (VAT) and
maximal workload was used
J Durmala K Dobosiewicz 5
EDUCATION MEETING SATURDAY 8thof APRIL 2006
RESULTS
Ali girls with 18 have been classified
within normal range of predicted
values of
bull maximal minute oxygen uptake
bull VAT and
bull maximal workload
RESULTS
The differences between group of girls
treated using Dobosiewicz s method and
group of girl s treated using symmetric
exercises were statistically significant
Lower exercise efficiency of girls treated
using sym metric exercises has been
observed
RESULTS Girls wilh IS Irealed using
N=87 p value
Dobosiewlczs method N64
symmetJic oxor-ci Nz23
Perœnlage of predicled vaJue of
maximal minute oxygen uptake
98 905 0033
Percenlage of predicled value of
VAT 97 933 0049
Percenlage 01 predided value ni
maximal workload 101 939 0038
J Durmala K Dobosiewicz 6
EDUCATION MEETING SATURDAY8th of APRIL 2006
RESULTS 26 girl s twice tested - at fi rst and last day of intensive hospital rehabilitation
The value of ventilatory anaerobic threshold increased during intensive hospital rehabilitation (asymmetric mobilization of the trunk by Oobosiewicz) statistically significantly (p=00019)
2047 ml O2 minkg (SO 268)
vs 2239 ml O2 minkg (SO 232)
Conclusions
1 The exerc ise eff iciency of girls with IS treated by asymmetric exerc ises of Oobosiewicz is norm al
2 Such high level of the exercise efficiency of thIcircs group resulted fram using of Oobosiewiczs method
r
J Durmala K Dobosiewicz 7
REVIEWS
Role of physical exercise in tbe treattnent of mild idiopathie adolescent scoliosis
Revicw of th- literature
A NECRlNl N VElWNL s PARZI 1 A NEGRINJ 5 NEClU NI
P1t~silillxlrd~ Ihcrapy (or klucgtlttlwrlpyl i pro shy-tJm of physka] cXlrd-cs ipcci I(a~ (IJcloJgtcd hy l li trIWlltl phrslollwrapbt wilh tb m~ln a1mor pl shyVCnI in lhe ilAAfIVltilH1 llf the ucirccfonuity III mild IgtC )
Lil1Si bclpin~ thebm ( aocl co uaufllclilIg ils ~jd- clf IS in nlOdlJmiddotnh-culiosis Th middotalillofthi paper ito r (W
Ille Ii lc ram r 1 a-ccrulin wh kh of Ih bull Lu[Jalmlcrus Ind (Lb hili til~ CLlLt-cd br scnli()si- clluld bl pl Y nlcd or r d uccd hl phylolld LXtmiddotrdsi n Il p--to-da le knowl Uuml~l nr tIll~C aspcc[~ i ne bulled in oruer 10 dndc whclh~r 11Rf blLl adcqlmtt Ib(uuml n middotlicaJ balis fo r ora)aini l Ihe US4~ of lUgravellgtitlerap) wltcllj(r or fln l th e prtl1iœ of kimiddot ~lre IUlll poNjn~ a t iil ies ~bould h allowtcI II uuml middot c enliaI toltlentlf)wh k lu alClor ie - lf pl lr~kiJl -c rmiddot d gtlt- (Ic rnnhi UzJ( inn ni (t hl HrJltlon [ rtn~hcll iJl ~ or 1i1J(IChIumlJlJt etc) Sh llU Ld be TolullllCcluse ulemiddot l onld b- clclIimcntalancl wukh sho ll ld he IJlI-n~ifl~d I~~a l lhc (o uld h 11lfu 1 Know k dg CJnc1in t (wIn SeiCIImiddot Hlk rCS([lflt h daw ccordinll to Ih bull llVit w o f tIlt iii 111 1( plop(lsltd in (h i papcr lmiddotonllmJ l lnl plLyi 11 cxcr(j$( pn (nti or (tmiddotduce dhlblli t ic 1 ~lt Il Jj ll(k pl ti Jlt fadl j w(~ the nlIIIrl li7alinn n f poMural dd shylitS tu p n xJ llc aSl COIlMqnen c(middot 1 all )llal) or r(tn~ shys i middot middotlIrve Tilt u~c (I f appn1priattmiddot kincsiuuml wrlpy 0 in rcns polttllcal swhiIHy Icirc IIHmiddotorc Illta ll y (0 r 1(lt1 lllho UAh mon ltlccurlltc 1Ut dl1alkd -rLk l(lWfils 111111 )11 h Jlccdt(
11) wurcJlt 0 lit)-IcircS (Iumpy - x rcLs P()lun
n rllt lT(ltnklf u f COll1tlK H (rtd) I 1i plfho l og l ~$I rUlglng tr m low tmiddot k Pl 1l1 to IdiOpath ie SCUIshy
Submitt(oJ [or PUhltCl l1 011 uly Tt 2001 Acc~pttJ ugu - ~2 1(t-1l
Addre rltj-xlfll telt~I(middotb If) - grinl Flt(1(bziurllt r )(m Ofl ()(Cl1I shy Lt middotqlltœlll ro () - 1u I4t agravehLIlKil ta IYIL-lTt ilSllltp lfllmiddot ~ 1l1uumldull
CelII ~ (niiOS I I~ middot ann (1) IfUh middot lIlfU di louhilll(tymi ( Nlmiddot ~iI rli -ilIIUmiddotltlfl
Nlti(ir 1( ) il r() (ltbullagt1
lt vLL_ l IiII no 1ftfI
jS ) we are a IUil ly tJc ing n1n) ltblll lS 1 k l1 b ~J)w in~ tl~ t S Jfll l approad llt - l1n til hy on ielshyertd ~tan lard ugraveJuld ln m any ~1~ he lI ~t les i if Ilot dange r )ll lt rhlS is lrut of reil l lnw 1gtlt1lt1 pa in l ~ or 5urgi c ll lrea lmltnl5 in dbc r lmiddot ll Sc - 2
ln tlle cj-e ut ~ t lll(tlWtl i( li p l ll1JC luuml- I ~ middottnl ~() shyliosis phys cal ((_lt1(( is emr1uved ltI t()fIl1 0 lh~rtrv
lo ly in cel1l in L)lllllde (nluumlnlr in tilt Lltlll middotorkl i e Iw l) r llt t Srain hUI IIgt() 111 Gert11lny 5- 1~1 in other reg lOl1 wbere thi I-incl qf tre l tm e rll 1 p~ 1 pmiddot t 1( cI il Jws Ixen cri ri cilld md rel -cltd Lw m~lI1 1 11 Jlu~ Fue Fnlny r ~lrs thio middot15 a lsgt(ru( f ~rth r -~ltc rrJtf))~ ll t vit11 br1Cltcgt b r II1 ([C Llt n ClW grmvlng 1lt1 0 L Sti g
gcsti n the lIsefulnes- u r Ih is form o t treatm n t 1
Hmiddotu]rs have nerged jn El or uf pll y~ iLd eegraverdse eacute 00[ 1 but tlw are nUl yel 11 11 t llu i vIC~11 and r hi ~
f rm of trt ~ltmenr IS stiJ l Ul1 ckf ckhate FfI t Jt 111 il i 11t (eltary td 1I iFy 11umbtr ot
b l sic COI ceP rlJ lf w ill he cIh tt d in t hi pap r
Scollosis
DCijIrI iriolls
ScnUoSlS is Irlircc c1 lme nsIcircltnal (I(gt i l cj on ot tht spinc thar cau C a CU 1 lh lt ca n h e $ t~en ln (1 me1Sshy
ured ultinF Coh) lll ltllCXI o n HI anreu middot p rtc rilt r
EUJlOI -1 lœDICOPHYSlc~ IR
NECRI Nl
110
f)i)
1 7J
amp aS g 5li - 0 v
V
31
10
(1 1) Il 15
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FigJ----jllph ot DlI w l-lkaupegraverel) The agloimvltltinn Or idio r lrhlc 50gt1iflll~ IS rpiJ bel~ en th e- [l0 IH P (l)ltg tnntll lol (JI PUllcmiddotny) mtl 1 ( f( lS-er sigll paiilivltecirc lt Dlt(i I1 11illg r the iti l 1Kgt n n t rll icirclicH a ) 111lt m omal prebulled the mno rche md ociks with lll I)ttlx flal gr Ih pll fl
rlcljoprdphLi 1 hl merl prestIK ~ of this curvt c10es n t autom~l ritllJy indi ate the pn$CI1(t of a defurshyTnitv (SlllKtUrd (Unel
It i~ possible tu clil1e ren tute a struCnlt t CI1tve fruIn a pogt urll 011e by identifyi og the hum]) du ring AdIlns tesr I~OQ looklng tra m beh lnd at the p atient w ho b benchng fUfward il is p -- ible ta d d~ct 1l1 eh ucirc n of o ne liidlt 0 1 the trunk usually n n the (onvex ~ jde ul tbe radiographie CUfve Ugrave1lr C Ul be mlt~I Slred lISin~
BUlln els S o liomere( 1 ~ l This h Uf1lp is du(- lO (Ile pregravegtecircn ~ of vertel ra i rolltion 1c1 Ollt tn tic f~YJ tllre o f the def trrnit tli [ c m be seen and measurc(i v ith Perddolles lb lsLometer on an amero-Ix)iferior radioshygrapb ~2
Seven ry pel cent o f li Ises a re conid 1lt 1tO be idiopa thie 1 bull ia l-nosilt in this CI$C is b exdlls i ~ n as idinpa thlc me-us t11H wc do n()[ know rJw origio of lheacute curvc [n othe] ~Ie$ it b Ix )~i ble ro ide nrify a dieak (bat CHl jusrify the c1etgtnniry slIch a rna lfo rshymar i ns I1(gtufol Ig ic~ l or genlttic cl iscas s Glnclt~r trauma etc )
[dicirc)parhk S(oliosis has been divicled ~(corcling (0
the ~Ie of tlie patient egrave1l the tiJ1ll of d~[ccli n of the condil ion into ti) ur t ypei ln fanUlc jU nik ltldolesshyccnt lnd aduh Til l m n st cnnunon (VPC IS the acloshylescegravenr o licirceacute I1IJctenzec1 hy 1 sud le l1 tggrH3l ion uuml uring the grow tll Spllrt (Hg 1)2
lhile p tu 1l sco liosi i5 Ycry lomnw n thl pre shy~Iknct ra te f r adole ent icuumlop~lthic structural CU IY~S in sch )o chilclren are 18middot20
- 10 Co bb d~grels o r m on l -lil
- 2) ~ohh dtgreclt or mort O 2~j - bull () (obb d gre -s )1 mOfeacute ()ll 2
Clin iltI [ d e isio ns lfl IXlSed 111 an lccu r~He pregshynosi which obt inccl in eJch pa ti nt mainly o n the basi of the nsidu~ll p()tlnllltl l of TH1h and the result s of 1 rh clin 1 1 ~l1d tadiogmpl i exlminashyti(ln12ll c noieq uentlya d inica ] la sifiou io n o f the ing le pHient tn -ome estent co incic1 ing w irh the
D diographic one c l n lw SLlIl1H1arizeci 1 1 folIcJ - mikl lc~ (1)(n 20 C bh de~r es - moderJt l betwlen ln md 15 ohh de~ rtes - StV re 111( gt1lt rh n ~J) )bh (kgf s
On the 1) lsis of [hi - dinic d d a lfic t i n (Vith l1l il el lrb tiOI ~ o f the ir b() und~ri e ) in Itllt l cente rS Of SCOtiO LS ITe ltlllent in the Lltin odcl (i rJ Ital lnmct md PI iJ Ugrave tre tmtnt i s plmmcd a fo lltJw 8l
- mild kineslth e (~1fw ~1Il (1 luok-ou t - Hl demte IJragravecegrave 1111101 c(~r md k i rws ithe lJpy - ~cven surgery
Physical exe rcL~e for S(ol iosis
Defi t tiOl l S
PhyS i 11 nU b lIKrlttp middot (or kines ithcIa Pl) i a p rvgrlill or plt~i Gl l (xeriltecircS ~1ci fi ( llJ y ltk ~ loped
y a -11 [ru ine 1pll yslo ther3pisr wirh th e m 10 Hllll
- pre (~ n tit1g tlc aggraaLion of the cl I )flnily in rnild bullcoUm is
- helping tlk Il ld Ct ~lOd ounter~lCtjng its skie elfects in III de rltegrave sc li sis
Tn tl1i_ feSpec1 kinesitl1ert py f JI s oliosis is tonshysider l a o on of peciticcedil training and s genecirc tltllly proposelt in sessions 0 1 4~ ro 60 minute IW) t) tour limes 1 Cee PhysiGtl exerci es can aLo ll v o ther auumlns 1S it oill he dise Issed in this plper
Ir 15 Ilot possib le to cl escribe a single progrlIT1 o r exerc ise a5 pro nrams ale USLIJUy p fgt nll ized ( ( lt
EUH PA ~illDI (DP1I YS IC~ 182
ROlL UF P l 1YSICAL lXl 1lt 1~E IN l IlE 11 ~l) IEd If IlU) l[)VP 1HI AIJ() J)~Cl~ r COl ~I NlG1W il
f)( 15 egraved ( )Il the nee L- 01 indi iuua l pJl itnts) al l l10ugh Lheacute) C l n h t 11 plicd o n a WOU p hJ~js (-1 (0 () pnients PC[ ~l ()lI r)middot lugrave reQCf lhese 1 10 grl lll frequt ml~ V IIT
hnm on in middotituk w allClthltJmiddot -Ill Jnv L l~egrave at Wc w Ht ~huw in lhis lyl peJ it i~ 111 n u -eII1 tu id e ntilv kirK itheJapturlc aims w hitl l ucircrr~spnd LO ugravelt~lil1 DUtshy
g X ir ur ph -s ici l lxtTi~l I~llhe r thln ln dj( us- indishyiJ u1 1progr-lfll
Aduumll l lxUl kisure time ~lOd h )u] Sp u lllll8 ~Ilttishy
i lt egrave~ i middotomm )Ly s iven lel mJ ing ro w hlf ~ Iuumlnsidshyer~d usdul or il lrmfu l in t1 lt rruning (lI tJw ptliJicirct ln tl1bplper Ugrave1 gent ltl l t rl ll bull p lwsiCUgrave lttG iviUes is rl ktll 10 JllI1ltlCc hOlll gtpOlt mJ kIJ1lsIcircl hc lJ l f
i ve lUen tloneumld )bo C on lv ine n dul( re Ull~ 1t~1 t s far Ilten publislt d f I~ mJ I(i noltgtithltl rgt is 11 11 a su h jel lnI deacutehate CJitk haltlt t llltit m itn ltl of l ny lorm o t p l1 ySiClI lxrcL e as a Itwr1 [ J- fo r i liopa tb il jcoJL~b un iL ()ri gin~ initial1) it WIS Ille r rOmiddotUumlK lt brgdv u f p l~lt titu gtllergt w h ) intervenecl hutll tc llcrl ll (mon as cltl HtilJ nic in terventi n man Jgt
1 t lltrJp utl t one 1 md rC j fkll l~ on rhe h sh lf som uni cOen I1v pn t I1cgts wt ldl hll ltl enl1 JI~ haLl nu na l scicnt lfic baisYmiddot HOlh tlle$( trr t peu shy to rh ~rl py tt nJecI to l~~rJ tte C Ih tk CUf -~ pnnshyclr~tll y as a f tsul t of lilo h llIzatio ll of tn imdqultdy ~u pp rt(d S pln eacute 7~ 12 to re-t1 r rI ltrl 1$ l l1C k o f WH llt~~rdl 10 I ndt~-dll()urnah tnd 11( on1 p~l per u suaJly Cl tc([ IS n prelimmtrf lll d 3 ln tt li w ay man (l rrlKpt(Hc H lf O iS Inll ph ~i C U l ~ d vi ~ cI nllog scnliotl pa t le nL~ 3gainst holll ph lca l egravexershyclc and p()rt~1
It m u st t~ n tfd [hat pllyknl txerc j~ tJe~ltm(nls t1iHer 1 lJ rd il1g r rhe rherlpcu tlC litTl~ on lllc h tJ rgt ap p lolc il l the IXlltent lncl hi im r IIIllHnt i- 1 (1(1 rI - 5lt1J lC igt tIl l ( f phJllIlllolopJ al rrea tmln ls Ihith cllffc r 1lt œQlfd- rhe m C cculc u ~t(l luI thl p al 1t n
~mc l 11i (lbE~e Tt i ~ P ~il k tlwreI[middote thll wuumlk ltlll t kin 1or ph~ i Clt1 1 lX r(j~ 1I 111~ t bc loidvd by t h~ Lo iurie IxujCJ1l al1ulhcr a dl ~IS nJI h~ iOg (1 11shygerols llugJr in racr le (wi ller d I ~fJIII ~ I ml thlls re(nl1l rn ndc(1
fn n UI cel1ll r we In(~ hccf) using 1 ) 1 1111 11 ve ) 1 (J p lw l icd ex(r(i~e (0 J ( 1I l tt i~ tlh aITt ~ l~d Ilv m ikl tru cflumiddott1 adokscltnt (cl ioj arh lC icoli is11 2)
ina the f U~ t rc-gt uJrs IefC pu b lishe - the pJ( )grd m 11lt1lt l1te n PWltllk d in fa c t deel()pnlln l~ in th t l itshy OlL1Ii in tl1 r b t ~() ycal f ha ve iclemi fiecl niO l l
m d 111 ur impl rnHm s md d i s )h ilir i (gt~ lue t idlo p lthk amp()lio -i ~ t Jll CIII he 1UO(l if Icirc 1by phyict1 egrave xert iSlgt l fe t rrncllt
l illl
111e aim of t l1JS r~l per ii tmiddot (tv iew tl1( l iterat urt to a(errl ln v llic ll of th~ impa irm 1t~ and Liit hil it il i GllIltec hy ~ o l i()gtj s -o ull he ll nt x or re middotlu celt1 Ili pl1ysical xerclse An u p-to-da te knOvkdge o f tl lt Lgtpecl-gt i necckC1 in rJeumlr) d -oek
- whetll~r there h ltl n adLtIIl ) l tht()d ical bbh fur or JqIIcirclb l l l1 Il( ) f k irt llit herlpy
- h N I)(1 ( 1 Dm tlle p r l c tIcirc(( o f Jebur tiJne )pOfung lcli v l ti ~ IIOU lci he tllf) -d o
II J U V f h 1 I11~ c~~lb li hed Ihe usefuhlLss 01 k il1 shyc ~thtrpy il i aIle dy l nsi 1([(( -r-tI Llleu i n )I11 plJt~ ut the wJrld ir ilt ecircS~nl i 1 I( id n Iv w l1i li ( 1shy
gories 0 1 pl1Vtl( 1excrClgtegt te D)bilI7it ric 1n (Ir st shylliuumlZltio f) lttlt tlgtbltn ing ni trcrccedilh ing erc) hn Id be
vnlcled he tll rhe nuld be lerrillldll1 1 md whidl s tlQu1d be inreœ jf ic(1 IJeClU~l tlley cOli lel Je LI ~ful
Ncuro1llotor impainncnts
Imv aUl llOr~ 11 lt1lt ~tlKlteJ lhe cltlndatiotl bd Ween tl UC1UmiddotIt t l ol(~C t nt id iopml je -nll ~J~ and cli~l l shyler~ lr 1tH lest ihuLIr yt 1 _ 13 ~ 311 D uhoussct 1
1-- ITS tln l ldiopath k s(o lio-L L cll -c d l J l hmgt in th terl tltr f prop li l l pu n md 1I1ar th e detrshyn Hi n i~ na tural 1 ~ronse to ril e need tu ts tu re p()tun ltlluilib riu Ul HcrmJJ1 31~ 11 () d tllat icliupathic ( liCl5j h l it re5u lt Ot1 rw nltuf mot r l ~ltelV
[Id )fcl 3 nI] ~1ltJ U Sr1lle nr to dtorders in centJtI lO~Cl shyIOIDNur) md 1xi~tI moro (Ul1lfOl syt( llI (Fig _l
N htIll -of) H1c S uumll h( rll1 ( ~ l( w ing JI t11 (oshyI-ie on the l l lO]ugy o b doll (nt Rl iu]icirc tlili- middot()lioL m unt fil t-hltll rhl ugravedcmnilV L th e fl5 ult o f 1 (k btcl 11lIFll llI ion nf som t11(WUgravetltnl md pO~ lur( (tnic l~ l licirc1 tl1lt if l p OgtlbJt b C 1l rlw sta l i lin 0f 11 1 Sf llle j lt g )tx l Tt) ohtil n a ))Cli U 1ILzltl I o f p ~llIr~il d l~flo [ in l1litkd ~J)llnSIS me CI Igt(middotqucnr J ~ a ~tmicirc ()nlly or regle Ie Llive
Ali th- 11yp ) tlw~es rd ~lte tr d irtl Itn t pnl1tlt o f [11 v hole ~piltm It11[ controls postu re ~nd mrw shyment lrre pell ic of tlh po int a d lI~ llv inH llYegraved il i ~ ll 1 nnable tCl aSUilll ri 1l tr l ll1 lo g thi ~ys ttm ( Qu it le 1I middoteli tl
lt ch ugt nlt~(S f rullliIl thil i nlomwtion th at p tlmiddot shyiCil J(tl iIies nw gt Il lInport~n t rr le to pbv [11Icircgt role ca n 1)lt slI i11l1lariztd ln lWO the ptu li ain Llt
- d elopmll1 l of p uumlltl St1 b Hlt ) - c1e veuml IOpm 1)[ o f bhll1ltc _
(k llhUl)lOr S Cll orr
ontrot oic whan-lt
------+ 1 ~ il lnll ugrave r AINnl
Cllnlr1
T bflt~ r
fltL1 tlli
lMini
l
~sary ~J-frlllen i )f
~ 1 ocirctnl
~UcirclllIJJlW Ll
AXl ~l1 n uumll l) r sy 5t ~nl
middoticoltoq ~ Fig 2-AcFgtrdong lU He-mutl 21 il is Fi)5~ ib1e rD prolXgtSlt l -oo ie1 mnd 1 ((if ~ elio egrave middotAhltr~d l)Qdy-p ati~ I I i u d) uren ttllOn k td LO In ~ory reHTt I1 eDi tn l al ) JdrnlV~ pn)4~ e l u r~o(Ofe 0-c1 eptunl dvstil t1 ctlon sltŒ(ry icircltu nu11t ilwnt [ ~mC ~ted tl l1 ce Ill trpntlshyUumlfJJl nd IKnle~ r~dibl jtugrave)n of -I) m tlosen Ir ~ig nj tl (I1vying ln fornll1U n (lI an ereltl ~piJl e Mmor aJJ r--a t ~) n ltgtf ti lt aXljl mowr plem iHUC Wh ~fl Ille 6ubjeco m uumlntl Icircn (1oJifitd perccpfLlI l ~na l ysilt of p n)lnocepti Icircnfu rnlaquol ti desnibJOS ~n t tecr spin A IICW motor co nrro l Ira I gy t adopt resu ltin~ in the ~tr ltctltr 1 ckformh y lf IdiopathirL scollos i=i Ht lrftU1uc nltnt l ISll I1lJy h1e- ~ I pro()und elkn on bralO Sfem flJll ct i(lnn~lLhu modifyRll Ille nltulltgtshytl10 ) 1 1111 Uu l-lHoror control 5~Shnl$ shy
As Srtgn1lt1 l ~ ltlssert~ if wc l C -Cp t 111 1 un o f the G IiC s oliosls L l tisorckr oi th e ltquilibrilltn sys t ~ms it is lagical to oriegravenrate physlCl l exercis( lherap y ln th is d ir(gtCli()[1
11lclte goals Cul tl lfOUgil ditrercn t modes 01 action be Olchic(-c1 witJ1 phykal accivit ie
- po rt ive Cll ities p ro ct LJ e aIl UgravelClltrtsc in 6lte nshyel ll )o rd in~lti n pinai pr0prinup ti_)[J nLi mOVeshyment control 0 vio lls iy ln thh repect ome lCtivshylites aœ pre um~I I)y lXrter tllln ntil crs
- kinrl lira py using pedJil exerCisocirc specially developecl lith th est 1101 5 in mind illVuuml VC I lllore prccilt( ll1d InC1 li zed cri n on rhe spiJw focusing
a90
1 ~~
lg -lNheJo ~1l l1 t r~l g rld in 1 1) h i(~ IImiddot ct r rHienl w i ll idlllhic _It ~i ~ _ iri s plt ~I le II find Jit ltH vlllleuml ~l Cgtbl tn~ ks III d il fef lt p ~ lt ihnS nu v~tl middot B ~a~pt u Il C middotl)Icircd ~(t l l11 C dlfkrCnl middot- hdween slllndi1g Uline nu nllt1Xinul oorrec ri nI t chied Vith Ct (J ) und tfdincJ ne lot es o UIine 1 fo llnVs middotIJfl tfi ni( - ltlrshy
reltiK)n ~ Ikexibiliry st3nucircing - -pirte - f ur~1 1IbjISC ltupin - ltorrcaion - - r~luci()il ll ymiddot For flmpllt in J npK l1 pH k1J il
plt1SSlhlc ln obtai n 10 u1 511ndlt)l [YLo lion yr ln Slt p ille rlOlgt itlugraven om l J ~ in ( gttf(C rigtIl lIex lbuil 15 i (r-l l=22deg pol lltl ~~J IIlpraquo is IcircO~-V- I t1 l nd tucircu(Ugrave) ilil) I~ 3laquoJO- IH-12
r ln Ugravel e abilit jl of tluuml [m e llu to co ntro l irse lr in ~ pac
fuld l oftlles uumlllelve ntio ns can presum1b1r incn~~ Ih enl ac )1 the orller and lHitlll r of Ille rn - 11 )ltd h e lllldenl lu EJ3)4il
Posl1l1-t collapse lnd slabilizariotl
lIle concept u fplt st lUal c(l lJap~e l l~t Iwen detin 61 by DlI II-T3e~tupegrave rL t Ac oJdin)j tu tl1i- ~ll1thor il [ nec(sary ~- l Hn Cv-tlualing th tleihility o f a col shylo tIcircC CUJVL (0 clistingu ih bt tVeen the re du ihil [ty index (th - li iffer gt le bet ~middot Il ~I r~tcli()grJph ie ~xnmshyinltio n of the iI111 pHienr in supine po ition m(i
ROte OF Pl rnmL EŒIlCISE IN THE TREAT-ŒNT OP ~I IJD IDIOPAnnC OOU~GEm seou SIS EltJRINI
I (~)-----------------------~
__ _~ _____ _~ __ __ L ___~ ________1 ____ _ __ ____ ___ ___ _____L___ _____ l___ ----------L ______ _
1 ~
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-- ------- --1---- ---- ]---r --- -----_----t- ---- --- ---shy__ ______~---- __ ____ 1________ __ _1_ __ ____ __shy
~ (1 J
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8 =~~=r=middotmiddotmiddotmiddoti~=-middotl--- middotmiddotmiddotshy--------------t----------~- -------- - ------__shy
~---- --- -- -~ -------------r---- -- -- ~-- - -------- --shy----i-------r-- - ---- ~~-shy
il 1~ 0
Dtl-Lmiddot ~ lttj l r~ UIltltlHt
f g 1 -TI1 u ilictf 1ld ( ii 11- ugraveu-sh) ld IX~ O 1d wllich ltJdnrshymII Il nf the pilll 1 ~tln~1 of th e -o lioti( spinc n IG~nI(J II IIIshytt) lhe iJeuml grl-e o f ~ ()Ii ti c (u rvH Il 1 w dcpc-nlknrly o l l he 10 111shy
P01(nl (pntt l ~ 1 1 nr ffll wrJ I) ln w hilth Ihe n i 1gt( ~ duc nL~ grlphs fm I h~lt 111lt hi~hr Iht Col h ~Ilu t (l f Lite ~Ul Ihe m Ol CI il y th t s(uumlJotil middotpin~ ~111 he ~middotJg gr~lVH(~(1
m mJxiTIt corrttt ion wll iJl i~ lIllCd to Ih - xt 1shy
lti Oilil y Jf tl1lt t Ut JO rl1t cdnUc idt md p OS shy
tU ll cul lapse ( th t ltHill enct b-tten l lUdioL) 1lphic egraveltamJl1ltlti OI1 J t th e ~lme pa tient in Sl il tl cling lOJ lline fX-sitiutl ) Wll ic h correb lc- onl wil ll fhe abilt ty of lllt p tu rl l gt s tem to C( lunternct lIk luree o r grl viry )cco d ing rv D lfVd- f3egraveLIprc po st li r t1 lt01shyIlDse is d ue to the Jnus -u lar ton a nd 11ll ex rCrIshy i) i itv of rhe tissus n the ( O IW-) si it (If the (01shyjl ti (~JtVe (Fi~ 3 L Pu~t llr1 C lltpstl lu lcl l ~~ reduc l-lt by llwans o f pl1ysica l cxerCles specitkally s tuclled ruuml i rnprove tIlus--ubr fOHt md lU pr )cllI Ct 1 ~11 hi shy
lizing ffCd
PararcL n tll CIJ cl the cr iti ca l (3 c1 thlsho ld beQ ld Il ich defol1J lHU n of the i pinlt 1 e~ in~ ne dtlllontr~1t _cl (1l ll t grclrf r mg] o f rllt C II in a qa m bng pos ition corn pOil 15 t l lowcr detormashytion lhnsllold (Fig 1) ie to ~11l Ulne3Se t the risk of pr ogr t~ lu n There t rh eJef re l J ea r l)iuuml 1itshycJ l ~ll1 l l(tl a 1 tnr tg ro b ohwined by d -cr t l ~ illg ilmiddot pU~lUrll cull lpse ptJcelJtge w bich lccording t i)
h llTd tnd ~l(heJ1l ~on 1~ b inde cl 1X llt icularly luumlgh Ugravel mllcl c Iio~ i (bdow 2( 0 ) (F ig 5 J
Fin a Il III ch iS respect lllljl hl and b um l 01 m linmiddot
ii iI 1 l _ _~ _ ___I ___ ___ __L ___ _ ___ ___J______ ___ 1 ___
li 1 1 1 1 i 1
1 i ___--____---___----__-_---_~- _ _--_ ___-+----
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+----r--------t-------t------f-- J
Fj~ ~-Ac(XjJlin(Q luuml T O rIcd ~lnd Na(h(ln~ n i () dl( pCG w rd (rTIshy
POO ll is hiherin cu rvegt in wh ilt l1lh ~1flILWrd cII1I Olk l1t IS le- pr(v~knt ln th e grtph Ih t PogttJlJ I ugtnq) Ot1 -J1l j elfltS-e J tlt 1l1t obb dirr remc rlLIv obu incu f roll l the Cohb atl( 0 1stlI1dtJ1g IId gtupinc rldo~raf115 Ih Ille lt) [1l1t1 (i lndnl I pine) 511pille the ~(nlClu tJ1 compo l1lnt U rlk CU Y _VeJily I~ ltx p rlt 1 L1v UpUlt (obh Illeturo Ih t si _b Cct rtJeSIm l fie -ltn J trd Ugraveltuuml shyuumlo n A~-i)rding LP 11(lt uuta o n l ( r1I~( in ~I 2JQ sup itlt curvt 1hi C(]l)b ddhccno l l f lO is -J-lultt( thc s ldnd inr tnla Ol1l t lS wi Q) whil 11) 1 1)401 ~llp lne ClHVC If ~ 1Omiddot ( tcl Lhe ttnd trl~ nlca~ I(t I ~ ~I)
tli n ll w l lllE cq lin ti spin h~ i ng mo r ~ Llnt~II) 1 tlun the nOftl111 one n Cll l gr(lk ( (cU ve tl1u n da r u p shy
po rt in o r k r 10 m linrl in tht 1xi11po tuf_ n th ha__i of th egt onideratl lr1S it f(lll() rhJt
ph rH (~Uuml e erd es ulukl h u - ul iiuml tbeacuteY ~U-L lm cl 1l (It-d o pmg p05111 td C Jl1twl lS fuumlrnll~ rly d ccrll1td ln an Ql St if i imr ol1111 t ru t(( - tht m(d in C JI shy
r t t r sture fO Ir -ngthen tlll m u ck-gt of the spint mainl) in (11erl antig r3ilrl tIcirclt l]lli fun ctin ll U hy meU15 dl i )ll1 t trk ~ lhJ cl( -ll tlt C)nlr~lUions ~llld no l IdOshy
1l)llic d YIltll1k lt l jAJ lktic t) I1 ) II 11)t 111 hd posibleacute t lcluuml ee postura l io nrro and stfh ili lllllt IJI
w i thout food T1lw(ull r d I( Lf(11 Ibk t m ucircnuin Ihe c()rf ~ct [ ()S tu re for cl gtu ifKi IH lLl1gth 0f ti l11 ~
This i-l ddl usl a typl 11 dnmnin (tf k inesllh rap) in 11 (lt-11 [[k - p~d fk lnr in lng f u l1a in llllliCk is poss ihle lI sing ctrtain Idncl fJ l (lt) 11111 liun S p Ul in tb is Cl c is ulttful ooly sa I~tr 1~ il Iw lps t1w lxltknt 1 becuJl)t 1gtlt ltlt-I a ClJu~l inred irl ilL ntllru l o~ i cll
and I1lll~lJhl r-keJc LIl [rll-llIn~ middot etlt(wrs JI the int e rmiddot vlnrion
[J ROPA MfJ) I()Wf-I YSJ IR
1
ICR 1 1-1
r
1 shy ~
- shy
11 o-llrfOlhe5l~ o t Ih 1O~(1dity i n h ~ r ~ ll nr pbl1 l of ~ Spl11 in 111011 _llti1Gt l lPt f ltlJUCWJtl ( ~l Ihe Ir t 1 1gt illbll W Ilh LtltrJ1dlion Vln lbe rigronl middotUII~ l(I Dko n12 lIll h lumshydlanie1 1 [ nul 1 M hl whtrc M - gt) lnIUI1g 111laquo111laquo1 1 1 c rtJCshytjC~ f fce d -d Lill l1~ o f enr niI pUll spnmcl1y 1~ 111 mldlll1lt (n the fl1ur t 1 = tor~ of f(ward Ileuuml l = ughtel1lng fmiddotr p 1shynOf stn lClU= Alaquo rdtllg 1raquo Ihl~ - lin hull th l1ltgtllugrave ot tller1l lUr~Jtllrc F the ~pin t -ilh rlu1i tf Ihl 1 1Ibulll n lrlt InltT1 1
rbc prJI 3IJi l1ty d qrlOIJ~ n bull JI t IlJIII Hm lA the v=ltd gtc e lu-ing J 5lnK1ura i ltfnnity
Dioal e ch anicll itllp~lir J11 c nt
Ihrcemiddotdimcllgtional mc-cbal1in of the s pioc
~f Ikmiddot i t i nly l(œ ntly tlHr llk pr-5tnœ or nc ushy1 lnlo tnr impairment in Idiopttlllc s-ol ii IXl tknt liuml J$ heen h i- ll licircghlcJ hy re$eJ rh tll e preit ilegravee h inm b nIcirc Ji d lJutg~ lt hl ~ 1 ng t o n dO Ulll urcel 1 i5 (l lreldv well umlersrood H(j-ev~r nev lbt un h iomcrhankal im l) ion nI h1c rectm ly onk l n tIlt tre and p r~dou in f n rmtinn hou t pl1ykd (~fcl5( in t 11 0 tl1I _ltgt pbne of spact 1115 Im trqlt-u 1rom J i-[) v ing unclcrsrmdlng ot th l lmc -dim nshy~ilnl l l11 ~ hmk f the cO]jO[lC pln( ~2middot ) ) Ve- w ill )iI xnl t l1 d at lcL-orcltng tUl cl sif iol t lOn blsed o n gtolllt lricd h uumlCJ ) p lane
- b() rJzU[1tl ln th i pla n ~ th t 1o rm ll sp ine present no CUlye- w ll ile Uumll(~ ltc U Hic spLnc clevelops one of ir haracterls(Icircc deFo rm tiCs v elt tbrd ln lashytio n vh icl1 pJ()VcA~ theacute hw 11
- lgitltl in th llulJe U l(~ nonmll spIcirclle pl SenL kypl lOSis ~nd l dooi~ in tb lXI1 lhese [(Hu rts Vere m)( til ught [ 0 he relattd tlle scolkJtlc ( lI r Vegrave
- front l in hi pleme tht ncrmal p ine preseuron t no curYegrave whil thl ~11li tic p in ugravetI I ()~ icircl~ charshyad t Ilt I CU1C
Il Jri fJIIt palic
~l+I~na ra 3 r inr lut th l[ ber ll1d a œl1~lU1 degr 1
l f r()la tJo u lllu (lILa r forcKl ltxert ltJn tl ldefnmuumlng 1 tkllJ [J i1u a re- lhlt tll cly 11 [1 1 UI b y Olm ner w bn ~lh uiJwd tl egrave ro t1tic) l1 Ilm it ti lt p ica] lf shy
rhrl r() be (P (the Uma bevond Wl1iltJl th lCOJlb of [11( ~pmaJ musd ~ dthc COnCIt and nm ex ~l le btconk (t O li~[)
r ~l 18 ~1Il N lu t( ren i9 lun lu ted rlseurlt h in tlt ) tilt lULodeumlformipg1 tlo n ot tIH_ sc laquoJrle rh ox ercallkren lk 1l1~H li d11r once thl Il i ~ r tld1t5 [he lhrth ld f 111 JlIcirc lIi of tlle dnrlclc hurnp tlk
lI bslt Il l nt rlet()rlll lIcircon 01 the it l ()I~ C ( (ylm der (- sustalnecl by an H1tmi cforming aCOOIl
J1Ji h V hl rhyiical f~ f Ise CI 01 h spr n llnd kin middot ith ccedilrapJ my lX damlg ing vll e n l pplild as flle
igt Jk Iller ln SCC1IJ ~IS lllc lJ fxceed l auto in middot crca~ i n g lhrllgthuld [1 sh (~u Id ahn be j ofed that Ilw relscd pre sun 1l1111i insiugrave l fe pil1r inn) 1 mlshylt
- j Il- ( w atff 1 (nh ~1l 1(e Il10 utoldrml ng li1eCh~lI1 1sm
in flc l Geyer ~w tcd th1 t rm m 1 hI l)1ecircch1O lla1 puilll 0 l I C~ sw m mim t Ieuroamp no purpo t for cu lshyim le pllilt t1 s (weumlO middott r it is l~Jl(gtWl1 rhn in iculio r[ paULnl -iJl11T1ill~ doe_gt nor Il ~lp to i ncrt~SL n eur(1shym tor co mfU
(1irai p an (
Jerdnn lle 11 showecl thal ill CSl~ o f t10rLC IC 1i lUgrave
tllo lacolulllhil it lio_1 tlle cte tI llmiry in (he lg itt1 p lln t rn lnlftot il~ lf tspe iuUy in tlw initi 11 r luleuml )f cV IU[Icircon nf Ile ~oli ls W iU l 1 p(t)gr~s~ivlt il10middot~ shy
ment roward hvpok pho b G ll f ill~l Im lins l har dUflng (IN eWllLlfiu1 of 11Imh] co luumlgt i the l in t ot t l H~ gClyty Cegraven te l - 0 1 v llebed lxxli 5 r ro ject 1 seH fl r t side-ys and tlwn backlrcl bull thu~ p(0(1 lj n g a kyphQtlmg aet Il ln (h~ lu mhnr --PIl1 COftj tng
l l i tc Iugrave l lltl l( l rs1 tif s L -etllgt il l the lgirl11
1 Hl)
Ilu LE nI rIIY~Ic~L lXIlKISI 1 HI E TREhTMEtn OP JIU IDIOP llII C AD O USCUH O Ll Œl15 NEGR II
lLill tegt lre lenl1 ~I d ~fo rll1J[ ~ rhl recrSes the phyltiologiGII cmns of lh vine)
Accordlng () Dicion ~2 1 rtcluctio fl in the itgitttl CUIYtS combin l vi th a lueral Iviari n llltl ds t 1
mecban ism () ugravel~ta il ity in l he r rat r IllI1e which bVOf1i the unsd a nd i ncrea~e 0 1 co hlt1is (Fig 6 hiIf md Pl11jlbiJ Jl1eanwlt ile lt(udiecl lh e srnl ru t
orzyglpophySLs show ing t11 al ttleir 1I1tl rnic tl orienshytation f~I (jLi l~ltes aXIal ve rtegravebJl l rotllio ll in cun litluns lt f dorsal hypokrrhn Icirc tnd lum)H de i L lo IS
Tll t dat SLlgge 1 th t impOrfill ut pOitu res and l1lweil1 ) t Mudied in ord t r (CI mlIuml ntrlin or to reuwer fll e p llyslo lo~lCll ClIlye in lIe SlgJtta p lU)l Wlth the llm o t ch ~ kin~ rutltor in l~ bili ry7 AbC th ~e ~k-
1l11nL ~Irt del lnt [0 J jUc lt ftber l]kuti inrervenl ion vhich 1c)LJ k l IV - i(l ~ l compktl n l ililll on Il t c1 l shy-jel1 J11UVllT1ent IJ j o f 1uto-dOneacute(3tlon ( i e a -impk ld ion ) Iengtheni ng o f the pilleacute 011 a litlltl l aXl~ tll lt ((IT liJlI~rcdu e~ t lle ~---lJ linti- l lte ml-fkxj(l n h UI 11 - i llCrl I~t the plllH ](JgicJI dlt cr ~l S ( (1 k-yvllCiSh lIld O(ltOSh l o r c lch r1Iif n t a Ilew til(~ecirc dUuml llt Ilshy
si lflltl J ll1 u(~nlent iam ecl - 1l1t0- lIrfe rionmiddot7 4 llmshyp oed f Je-rura l iUIl cl middot-t1e- iltm lI1d ll1a intltnUlLe )( 5lg it d C Uf (gtS slig lll thltJrc i ypI1 tiZ) tIcircOI1 a nd lunugrave)ar 1()fdos i7~llion) sholild he esw b lb]HU 00 lb co
hl b oi hi p~l11il uU r -1Ir vlt Abo 111( e IlltUtl Chl lie o f purti n - a U vitk slJ1ultI h e )tuumlll ecl 1)] (1 n ldershy](ion r tl1i lt type for e upIe IilJ llyl)T S of repd shyiti( ml vemen prt n t in agonistK h)lnllltlSlks nI iIle kind f dlJ1ce C( uld he ([([r imentd
FmiddotO lllaljlallC and mobili ty of the SpIcircIlC
1 rd llo U 22 d L lm nrrare d lhlt in Illt fro nt a l pll ne
tilt 1 nge Clt 1)1lt vtment of tht scplit[i middot CU IY grcmr lIJ l il ~ d irectio n n f Lhe C ITelt tlO n tha n in tl le di re shyLion of pmgressi n l Fig 7 ) he IL o IS5err lJd tbat th15 mohiliry increac plrtil u la rly n apic [ cgcoeilts 1$ lh ~ ~c() li osb evolves Sragrm rJ 12 J ~ thus rigilt (0
VlI f n rller~p is ts Ilo t t) m o b uumliz - a sCtJl iu til curve w ilhout t [ uling ttwt tlle R lu tiOI o i til t ~a mt b fnlinruumln( 1hy l1tans o f ~I passic 01 1 rivE -uppnrt On tilt (ltllE r hand UgraveK d e iJlioJ1 in ease durill tlw tune 111 whicll tll C spmt i ~ not submjtrcd to correeshy( IV anl()n
j- Virh mi lei ol i b tlllt Upp i1n ill) lC tiol is d eveloped only lllmugil llClIf()mu$Cllbr f r llce thi ~
InegravelIl ~ thclcfo re tl1l[ inu eascgtt sp1J1all1extl)iity mua
11
Imiddotiumltgt 7-rurd illt Ir) 1 bull rdrilt I1 1 in tl lt frOlllll pbnlt- th( illl ge )r mOC llIeJlI o t the S-o UIIJC CUNe 1 supcrior in Ihlt diflt(l im ugrave( the n nKlIl thd n ll1 tllc dlrtcLion o f p rJ1(l( (llIl
be considrCtJ vntrl iJ)(l icltion and 1 undrli neocirc ab L a ~ubiljz~ILion 01 tilt spint pllss il)1y ohtl ll1td thrltJugll the stlengtlkl11ng o f the 1rltJgm vlt nonil lme shyCIC 111 illli orrant u bjcLliH- ln rhis r~f1 n sp u lllni lc tivitIumlLs sil uld lX tPI 10 dlegraveltl it l G lU t n w l1ik luring kine i Icircth lrr phyltical eXegraverci c~ tllat in ele
spinal m ot ilIcirclY sil nid 1e lt1 oid cdrt ~
Organ ie and psychologieal impainncuts and li islbi IiI le
A cgtI im lc pmi nr is moriOthl11 just 1 sp in and 1
compkt gt Ipp rnach to the gu in ad 1 ont i al~ shylute l e~se i t i11
[)a la 0 11[ [n ell lrom re semh pw tbat ome organi Iilnctiond cl fki ts suc]) as tlw clecrtiUe ut vild l tnd d fun ll l)Kity_orld ldly incrtJ k whil~ 0 shy[io s i -till in (1 miel q g of g JltlV ity ~ l ilI e 55 rtI lit
tllL pres e n ce )fl defidt Or Vi l~il Clp~1 - i~ ln one pIIiem in Ihr l ftectecl by 20 ICl 40 scoi stgt l ls~a r(h cunclutecl in tbe UA by Di Ruce- prod uegraveed an aaalo) u ll1lXimum 102 re u t in a group of Jd shyk 1ien t [(h sco llosls rang inF frum ) [0 1
Al10ther rudv bv rallt r m C chr111 lilcl NashycWrl1s( u 57 stlO eltt hil $(C 1 1 ui~ Ica js l( lllt cl (1 shy1prUlllI o f t1tgl lie bJd l imI in ~ul sct t1 t ltu b middot iects jlLltr l5 they are golng through ~I cltlici[e sllge in the fnm 1lt i n 01 tlWH o w n id uHitv t factor hit h Illy jeopmlize the cl velopme lit d ~ mIll lt lI1d htIshym cecl IWI sonalitr in Klulrhood
n RUI ~IEDl(( Ptl Y1-
ROU ltHmiddot PI [ I C~ 1 EXIRCIS]~ IN TI Il nW~JUNT OF SlllO lDIOP1HIC AI)C~ESΠ11 C(gt1[Oi 1S
This i why b IiCieacute ii is ~n imporrlIl t for p rcshyvegraveml e 1tLsr l tn en ou flge 1ari e nrs ~lfrecr(d by lIillcl middotu iosis ft) tlke p~l rt in portin -re rcatioluJ acrivitits Iha t 1eIU 10 L10 th r~1chophyinLl bull nd b~l )i 1l1o tur adlieem t n li 51Jmiddot2Even tlK)ugli [Dr bic mech~lnshy
ical mcl nellIUll10t 11 11 reltl ~ons lt r111 1gtomcrimes be l lefu l to ugg( ~t ne p rt in~ aCt iv ity r l h (gtr rll n anotlJer e th ink Ibal an exces~ ive IlHd icalizltion - Icirce l ll1posilion br plry~ilt i HlS nnejlor parents uf rh ry pe of po rt to lx p m lice 1 b Ule p 1Ucirc(Il L th1[ preshydLl ck l1 is fret clOice in lh ma tt r - -h II ll1 he avolc1ed wb 11 possLhle mainly for tlle i mport~ltll psyshyLb ) jogka l fe a SI)nS W( ha( ill ~ t nltntionegraved
Conclu ion
lbh ISsertegrave d t1H physkal tgtXtlci o is ) n fi ial whlIl practinu in order 10 ilnj rove the I11 llde
rœ nwh and tono C iral caplCiry and postu re o f the StOUO(I ~lIbj n II I nowkdge om ~ middotmg trom ci el1shyrlfi rls(~ Jrc li dJlJ accordl ng r the review 01 thE litshytirlture prnpo )td in t lli plpl r conflrm~ Ihe vuiclit ot th e -t ls ~rti ()ns
In l do l (ent Id iopl1il iC scoliuse il l n phee u i cl vk)pm e n t ( li tll iumlKh eXCC cl l g i en rhk thr hokl th e re i5 an und ubred need fn r l pprnpri 1tegrave (JJ1tOkJJe ~Ild Inr surgict1 therapics ill ortler 1) S l i p
the ( - Iuli on anugrave )JT~t~t UW ~pilll l dtlormities bull evshyerthtless in the illiti ~ll pl l~sC t ttlC c1iseLltc whcn the riS( r1 r euro )luli m is rtduced ocirc ~md tfle uifleal JOld threshold il ~ld flle po stural collai i reJcenw~ 43
JI l1 igh pllysicaJ egravexe rc ise - p revenc or r d llCe d i ~lh ilir ies o f [Iw ~ l() li )tic
p (iems R 28 J -6 5- 6 1 63
- f~KiHtare lh ( n utr ali711iCUl of postu m l d elicits tn produCel1 a coneql l nce J [)ti 0 I111)( or regre si -u lmiddotc 5middot Il 1 17 ~ M
-re 51udles U ~ n Ledecl tu con[mn or re jecr these conClLL i( 1 w l1 ich clerin-d frum 1l1 lIldytica l rcltw n f th e liter~iture appear r- ~Lo nlble Hnwecr Intil ne re ull are 31Iable wc should n r prevent our sroliotic patientmiddot trom tl ki ll p lt in s(loI1ing jshy
ir its pW1iada rly ltl t ~d1()o t () n til t c ntrHY -vith the l xcclrinn 01 gt[1 )11lt tIlat in rea-e t)1obility (tnU evc n thell oilly wh n progr~lgtion b p OSSibl) -uc h ~I( ucircvshyiUe -11 )ulu hl tIKoll w g ed The 11 S J ( rprOpriue kin (~irhe r~l Piuml to incr _~asc p()~tura l $llbil i ty is tl1egraveoretshyic tlly CiJUClt alttloughl more ~Iccu rtte aod deLli led ri k benefi rs anJlr~ is is netot1ed
Ria 1111tO
NIokl Mu d lle ftitYljJfu Jœl il 4IWr10UOifll S (JIvs i (1~1)Jshylidl ttno( cclIll le 11(11(1lt1 RCI fu lle ((lia LltfIt l1 I1I1i(i
LJ ci n s j(r3 pigt egrave li n IHUgru lkl di t rdz t fi sici pe e ft shytUlKm iluppno di un lisimerap15Ll rl lllcflt() 1 110 scopo di pnevirlt () fr en~lI 1-lgpwlllltnlcgt dclld lclonnitugrave o e il 5LOshy
Il i mi llon lt fH nugrave j (1 11ni dei co~e 1 lteIl I1J J nd ne ~Ii eifclti (()Tc rri udk s co lio si d i m e dia g rt iuuml ln que~ltlt
s rud i 30 llizzb mo i d ti cleU ric lca pel n ri Icare qJJ l lm 1 dis(imucirc x u le I[~ l z j-m i pro vna le da lla C gtl k A i json ere pr middote-nute () rk kl ducirc un~l rdeguCltl d nil cra pi lt di uJoseguerrnt Cjua li 1iU110 cli nbie tti 1 rcr lJ)tIId d~ fle)-UITC
n (- -fd7Io n~lcl)
Ut11claquo)si 1 lI tori htpnuuml )ludi-ttn I ~ cnntI1zttu fr Cq(in i idiJ)tic1 dbfl lOZ10l1 d d ~ leOla nelllOll1otoriO Lb un1I1cnUl 1n1l1i3 dcgli 111 lt1i ch DIJgt gtU l H crmU1 Nlch~mslt ( SIshygnaJ~l lerimiddot wo i esuemi -bletti d~ plt~e8lugraver- ne l pClZ le1lftgt scoliodcu kl s iluppo ddl ~ ~ uhjlil~ vertcbral~ lt o svilllp prJ Jdle JIl7 i() nl di ltCjuiljbrio Dng li studi sul lto lb( l~nlrale (OllddU i in pa rticdu d 1 DlIal-BeHJ (gtegraverl ~ P~II IId lI1 n~ llw - idente il v- m gtiu p eT il puientc clioti elgt di u n rnigb o t c)[ ro Ua sw mle dei radlldc onsegull o tramite il 11 fforzrlshyfl len to d e i l1luotoucirc l nllgr3ilri d e luOwo con crcbi ~Clltdr
in pOMltHJ corrctl e in va rie ~i[Jzioni s t llicb c c d inamIcirc tllt Dalle on sena d elb blOffiCcclIlicd tr idimlt n s io mlle d ei
r ~ chi Je ~oU()f icn ~Icirc ~videnuumll (l() ~llt tC p IYZIcircOSI ln(IiClZlfHicircl ~ 1I1shy
liumln fluenzt Je ll middote~rUrio tl SC) lgt lIi I rc pibull m i tldln sJlI71 Stl shygn~I I1 afferma che slI l p Ia no [11 middotccedilr~lk tre un œ rtlJ grado di l L1Liuuml IlC dclh vEltlh r1 apj(de le tu rœ mu SCltJ llri njtbc J n in $tJ ) t rodcfQfll1t1l1te PltJtantu b i r~it-~ r -lp il puugrave t~~
Ixnt-ftla solo nt Ile so )[j)~i Jl1Icirc na rl in qunnt ) ilon SlrM ntne )(l(Ofa tu soglb in caq ) co lltrLJIcircn l)lrilto llt~( i lJudotlsi di lfr~ lI1 C llg grVlmenl J 111 11 io lr riltd ll(17jOill leld rinlle 113 dimO~iumlrlto d llt nell o lin~l cl()~ li t th~oIOl))1 dri la defltgtrshymiti sul p iluO slfl iuale ~vohl lf1 (en5 ion~ sO lnm utto nd 1e bsi iniliali deWggrwm1Cnln mcn trl C a( lfLmn che occlleshyvoluzi ne dene = 110 i [ mhari IJ lin c l ki cen tri ch -1vi1( de i cp i CIt IJ rI Ji SI p m ittIl pnm l Iem lmeme e p o j pOS( shyrio fllwnte dtldnli mdv ( i un ziuuml ne ciloliz7nnl dd rlLtide lu mbJ œ ( lIlelttlaquo on NC n d d (gt11 uIdu m 1I1 Ilgt) cli r-Iure (0 eserClzi che IllUllengano 0 ltlUperifo le Clgt 6gt1 lo)iche sul pirluuml gilwlt Su l p iCl no fron itk Perdnulk il dlll1lt-trlto d1 lampkz-l d i LU ovimento amp111 lI rv Kolio ti ~ nd lt1 0 ddlJ cnrrc-LIcircQo i Ji gC 1 n lungl SUpegraveliltlrccedil 1M llS0 tlell 3ampIGI shyvamcnlo C che l~Jltmiddot mobiliti GlI mcnta co n l c lu7j o fle d l i) snAio i A ulln amplgrtJc1 ltllllmunjx~ i terlpGli nn n m obi shyUZ73It ma eutva coli ti0 1 1ct HsicVlfe nd tcmplt 11 1111nshyttllIcirc1nc n tc (k ll ~1 llu u zinnt n l1 un me77uuml d i sost l11( gt ln 0
e 11111ri b cle - Ilziunc egrave deorinatcl d l rlyarsi Snzcl la pr gtshy
liltlnl l i un() rtl~ i ptmiddot Jtl n(o 1S(Hl () (( ntJ() i ndit~tr i ~ Ii ISt (izi e l m iviL Illdlode ebe Hlmen tno laJlc ibiJii dcl rlc lide SCshy
li io) [n p articobre rune q lldl r C-I1 ich~ xlSiddcHe CUf t shyli ve ch~ iJllpi tgino e~rciii 01( biIi2 ZanUgrave HhnmL-trid () in tmiddot~t~nshy
sione kl fuchide O tne pure k- ~ttivit1 tnotoJII~ non prHi(~ llCcedil
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EUROP MIDI C Pli hIC
EDUCATIONMEETING SATURDAY 8thof APRIL 2006
(iSS
SEAS02 Scientific
Exercises Approach to Scoliosis
version 2002
G
S Negrini 1
EDUCATION MEETING SATURDAY8th of APRIL 2006
Neuromotor disfunctions
Neuromuscular disfunctions
11 Postural collapse
Postural collapse
Duval-Beaupegravere
Flexibility of scoliotic curve
f---I--- I Postural element
-------1 Structural element
S Negrini 2
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Postural collapse
Duval-Beaupegravere
It is a value related to muscular tone and to flexibil ity of convex side tissues
Post ural collapse
Bunch e Patwardhan
Critical load
Load threshold beyond wh ich a spine begins buckling
JI~~Wt1lW~flfthtlJlœJtAr ~ J~It- l~l - IMS
Postu ral collapse
Bunch e Patwardhan
If a curve reduces there is an increase of the deformation threshold
~~~NW~-damaoc~IIIMf ~~ J~Iv JaJ-I7I9sect
S Negrini 3
EDUCATION MEETING SATURDAY 8th of APRIL2006
Postural collapse
Torrel e Nachemson ~
Scolioses below 20deg ~ ~ lt~
have a high ~ ~ percentage of ~ ~
~postural collapse (on u~
average 75) ~~ 2i~
CU~VE O EG~EE S WHllE SUPlti e
~laquotd~c6b ____lPffI1wtt1t~
$ww J(t ~~7 JM5
Postural collapse
Minor scolioses 7
Antigravity musc es strengthening D
Reduces postural collapse -G
Increases the critical threshold of deformation
G
Neuromotor disfunetions
Stagnara
If we admit that one of the causes of idiopathie scoliosis is a disfunction in balance systems it is logical to orientate physical exercises toward this direction
s Negrini 4
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Neuromotor disfunctions
Dubousset
Idiopathie seoliosis results fram alterations in praprioeeption centres and deformation is a natural compensation to restore postural balance
etattJtitIK ypothfQj~S ___~ own_ oJ)HQr lar 1t-1( r
Neuromotor disfunctions
Nachemson Initial idiopathie scoliosis
+ Goood spine stability
Neutralization of postural deficits
D Static curve
Neuromotor disfunctions
Therapeutic aims
c) Development of spine stability
C) Development of balance reactions
G
S Negrini 5
EDUCATION MEETING SATURDAY 8thof APRIL 2006
Biomechanical disfunctions
j Horizontal r-Ian
i Sagi ttal plan
Frontal plan
Frontal plan
q Frontal plan disfunetions
Fronta l plan
Perdriolle Movement magnitude
gt in the direction of lt in the direction of correction progression
S Negrini 6
EDUCATION MEETING SATURDAY8th of APRIL 2006
Frontal plan
Stagnara
Never mobilize a scoliotic curve without ensuring reduction maintenance over time otherwise a greater mobility favours scoliosis progression
Frontal plan
Ducongeacute~ research
On a group of adolescent idiopathie scolioses treated with
Meacuteziegraveres gymnastics
D After 1 year the mean angle of
curves increased from 18deg to 29deg
Frontal plan
Scoliosis without brace
D Greater spine
flexibility D-
Risk of progression
S Negrini 7
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Frontal plan
Mobilization is useful
D In preparation to
brace
D With brace
Sagittal plan
QSagittal plan disfunctions
Sagittal plan r middot _J o
Perdriolle scouos B CJ aDeformation of D
thoracic and thoraco-Iumbar curves evolves in extension
S Negrini 8
EDUCATION MEETING SATURDAY8th of APRIL 2006
Sagittal plan
Graf
The line of gravity centres in the vertebral bodies o s c oUOSt
projects itself firstly laterally and then fi
o
posteriorly lJ ~~ ~~ ~ ~~-_J-D ~nI~
Sagittal plan
Therapeutic a ims
D Maintain or
retrieve physiological curves on the sagittal plan
Horizontal plan
QHorizontal plan disfunctions
S Negnni 9
EDUCATION MEETINGSATURDAY 8th of APRIL 2006
Horizontal plan
Stagnara The forces applied ta the spi ne act in a autoshydeforming sense
Horizontal plan
Dimnet Rotation gt 200
ampII~ (
D The actions of concave and convex side
muscles become
agonistic
~ItJrOnrIIiItdllfUClltlluumlll~~tI ~1JIf1laJ
Horizontal plan
Minor scolioses never exceed these autoshy
deformation thresholds
S Negrini 10
EDUCATION MEETING SATURDAY8th of APRIL 2006
Disfunctions at a biological organic and psychological
lever
Oisfunclions at a biological organlc and psychologlcal lever
Cheng
Bane density in scoliotic teenagers is lower than in normal subjects
~~~~middotA~IIlUtIy ~7œl 1d l
Oisfunctions at a blologlcal organic and psychologicallevel
A significant reduction of vital capacity and V02max in teenagers with a medium severity scoliosis
S Negrini 11
li
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Disfunctions at a biological organic and psychologicallevel
Disorders in the development of body image that the teenager has of himherself
Disfunctions at a blologlca l organlc and psychologicallevel
Therapeutic aims
cJ Activate cardioshyrespiratory function
cJ Favour bone density increase
cJ Develop a positive image of the body
Disfunctions at il biological organi and psydlologicallevel
Stagnara
Sport
D The active side of
kinesitherapy
S Negrini 12
EDUCATION MEETING SATURDAY 8thof APRIL 2006
Disfunctions at a biological organic and psychological
level
Distunctions at a biologlcal organlc and psychologicallevel
Cheng
Bone density in scoliotic teenagers is lower than in normal subjects
~n~IIIvpWr~middotA~stWy s- XXJl M J
Disfunctions at a biological organic and psychologicallevel
A significant reduction of vital capacity and V02max in teenagers with a medium severity scoliosis
G
S Negrini 11
EDUCATIONMEETING SATURDAY 8th of APRIL 2006
Kinesitherapy on the scoliotic subject
q Postural control
q Axial stability
q Muscular trophism
q Balance
q Respiratory function
The limits of kinesitherapy
There is a threshold beyond which
rehabilitation alone is not enough
sssr
Kinesitherapy in scoliosis treatment with brace
Therapeutic aims
S Negrini 13
6
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Therapeutic aims Srace kinesitherapy
With brace
il Postural corrections and
vertebral stability are obtained by the brace
Therapeutic aims Srace kinesitherapy
In preparation to the brace
il Mobilize spine on ail plans
Therapeutic aims Srace kinesitherapy
With brace D
Maintain a normal spine elasticity
~ Maintain a good muscular toneshy
trophism
C Model the hump with kyphotizating
exercises
S Negrini 14
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Exercises and their methodologies can vary accord ing to learning and individual sensibility of the single rehabilitator that proposes the m provided that they stay within the
Iimits of fixed therapeutic objectives
li
Therapeutic modalities
(Exercises)
QAuto-correction
QRespiratory education
QErgonomie education
QMuscular strengthening
QDevelopment of balance reactions
WNeuromotor integration
ci Vertebral mobiJization
QSpecifie modalities in brace treatment
S Negrini 15
EDUCATION MEETING SATURDAY 8th of APRIL 2006
The protocol of kinesitherapic
treatment
G
QChoice and dosage of exercises
Variatiosn of the work program every 2 - 3 months
Q Execute e)(ercises on an individual base or in a small group
Q Frequency not less than 2 times 1 week
Involve and awaken the family
G
S Negrini 16
EDUCATION MEETINGSATURDAY 8thof APRIL 2006
Q Determine the action and the localization of auto-correction
QAuto-correction must be associated to ail exercises
QAt the end of treatment ergonomy lesson
Auto-correction didactics
G
SCOLIOSI DORSALE---- shy ----
r
S Negrini 17
EDUCATION MEETING SATURDAY8thof APRIL 2006
SCOLIOS OORSOLOMBARE
shy
SCOLIOSI OOIlSALE 011 bull LOMBARE S1I--shy
SCOLIOSI LOMBARE
il --~_-
S Negrini 18
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Scoliotic patients are not radiographs
middotSeoliotie Mtients are not ndiographs but hum beings with a vertebral deviation-
Slagnara
Metha For the physieian Cobb angle is of utmost
importance For the patient it is body deformity t hat eounts most rib hump a protruding seapula or hip We are in a situation in whieh today dodors eure the radiographie deformity but what the patient really desires is to get rid of clinieal deformity and of ensuing psyehologieal distress
CIIQItIo shDuIdtucirc lM WIld tJw~~ I~~M~~~~ J9f~
S Negrini 19
- Poznan_workshop_Physiotherapy
- physio2
- physio3pdf
- physio4
- physio5
- physio6
- physio7
- physio8
- physio9
- physio10
-
bull Derotacja kr~gu szczytowego Potclczoiluuml jest z rownoczesnym jego ruchem w pfaszczyinie strzatkowej N kierunku grzbietowym oraz w pfaszczyinie czcfowej w kierunku posrodkovym
bull Powstaje ruch trojpfaszczyznOllly kr~gostupa
Jest to ruch odwrotny do kierunku rozwoju skoliozy
Schemat post~powania
bull Cz~seacute wst~pna - Rozgrzewka
bull uruchomienie pOSlczegocirclnych segmentocircw ruchowych kr~oslupa w systemie calkowitego podwieszenia
bull efImlnacja przykurczy w stawach blodrowlch kolanowych 1 barkowych
bull Cz~seacute glowna - Asymetryczna tragravejplaszczyznowa mobilizacja kr~goslupa w sclSle
symetrycznych pOZcjach wyjsciowych bull w pozycjach czworacrych bull w siadzie skulnyrn 1 W sladzie prostm bull w kltku prostyrn bull w pozycji stoJtcej bull W p02ycji stojqcej ln ortezie Checircneau
Il cz~seacute kOrlcowa - Zestr6j ruchowy
bull utrwalanie odruchu postawy z wykorzystaniem bodiceacutew bI~dnikQwych bull cwiczenfa rozluznlajqce konczvn
Badanie postawy d ala
pl1odu ltylu boku
2
Test AdRmsa
Test Adamsa
3
Pozycje do eacutewiczen wg meody Dobosiewicl (cz 1)
4
Metoda Dobosiewicz
pozycja 1
Meota Dobosiewicz
prutwnik
Metoda Dobosiewicz
5
Zmi3ny w zakresie kllill Cobbll w wyniku Jlrowadzooej kinezyterapi i wg Dobosiewicz w grupie
progresnvoych skoliozjedl oillkowy cll - n=124 (ass obsenvncji ud 6 do 58 ntini~cy $~dD iw 197plusmnJ 185 Rlic3iqC3)
6
Zmiany w zakresie kqta rotacji osiowej kr~gu sZczytowego sknywiellia w wyniku prowadzonej kinezylerapii wg Dobosiewicz
w grupie progresywovch skoliozjednoillkowycfl - 0=124 (czas oburwRCji ad 6 do 58 mitJi~cy sndniR 197plusmn11S5 miesics)
Grupa skoiozjednoukowych typ J wg Ponsetiego - skrzywienia Th dx - leczeni kinczyterapill wg Dobosiewicz
(1174 015 ubscnvncji od 6 do 45 mieiircy s-cduin 211plusmn 111 rniesi~cn)
Zmiany w zakresie kllU CObbtr w wynlku prowadzooei kinezyluapii wg Duhosiewicz w gTUpj~
progresywnych skolioz dwulufwwycfl - 0=74 (aos obsrnvacji ad 6 do 45 micsi~y srcdnin 211 plusmn 1 1 mi~Icircqca)
DdciMk Th odcinek L
7
ZcDli~ny w zakresie kla rolaei osiowe krfgu sezytowego
sknywienia w wyniku prowadzonej kinezyterapii wg Dobosiewicz w grupie progrcsywnych skolioz dwulukowyell shy
n=74 (C7lS obserwacji ad 6 do 45 miesi~q srednia 211 plusmn 111 miesiqcR)
oddnek Th odcinek L
Grupa skoliozjednoillkowycll 0 kqcie Cobba lt 40deg - leaeni wyhCznie kinezyterapil wg Dobo~icwicz (n=44) (czas obserwacji od 5 do JI mi~ifCY ~redllia t 18plusmn604 mie-ihco)
tnnl qICIiIl fMtt[ IoooI ~)I l~Illli 1IqIlt00401 IftmiddotI-I llJ
~1 1~ u)~___- uul
c- -- a-J
Obserwowmo i ~totn~l korclacjt pomittuzy POZiUllllm opilnowilnia Illctody przcz chorych i cZccedilsloscj stosowaniu kjnc7ytcrapii a wiclkoscuuml rcgre~ji 7~niilnw zakrcsic kta Cubha i rutltjl OSIOWCJ krccedilgu szczytuwtgo skrz)wienia - wspOlczynnik Ptarsona wynusil Odpllwicdnio 016 i D53
Grupa skoliol dWlllu koovyeh 0 kItac Cobba lt3(jl
typ IV wg Ponltetiego - skrrywienia pienvotnie podw6le - piersitJwe pFlWosrUlII i lccedildiwi()we Iwostrow
-Ieczeni wylcznie kiDezyterapi~ wg Dobosiewicz (0=10) (nli obsrrvLcjicirc od ~ do 24 miesifCY _~ n~dllia 12453 micsi~ca)
Sndni ~~( Cobbl na pmltltu (ugraveurulJpii
wynosil
ft udcinku Th shy 179deg
W oddnku L-17deg
Srcdni )11 Cobb~ po killtylapi -rylltlsi l
W odcinku Th shy 1J7deg
W odciuku L shy 1320
JmiddotI) 1)Imiddotj ~ lIll11 i ~W --)WCcedilMtf
ClNlIltallj Nui 001
( -aItu ho
~lllj Cl F1r Wj~ omn)
8
Zmiany w zakresie k(ill rotllcji osiowej kr~gll szqytowego sfmyiellilllV wyniku prowadzonej kinezylerapii wg Dobosiewicz
w grupie progresywnvch skoliozjedllollkowycll - 0=124 (CZB5 ObSrrwRcji od 6 do 58 mielli~cy irednia 197plusmn1185 miesiqca)
Grupa skoiozjedllolukowych typ 1 wg Ponseliego - skrzywienia Th dx - leczeni kintZ) terapill wg Dobosiewicz
(11=74 aas ubscrwacji od 6 do 45 mieiIcircccedilcy srednin 211plusmnII 1 miesiJtcft)
Zmiany w zakresie kqta CoMa IV wyniku prowadzoDej kinezy tera pii wg Dobosicwiu w grupie
progresvwon h skolUgraveIl dWlllllkowych - 0=74 (ons ubs~rwacji od 6 do 45 mil3Icircccedilcy sredni3 211 plusmn 1J1 micii il cn)
Ddcil1t~ Tb oddnek L
7
Zmiany w zaknsie kIta rotacji osiowej krfgu szczytoweg() sG-z~vienin W wylliku prowaagravezonej kinezyterapii
wg Dobosicwicz w grupi~ progrzs)wnvcb skolioz dWlUcircuk()wJcll shyn=74
(cras obscnvacji od 6 do 45 miesifC)j srednio ZI I1 JI I micsilfca)
oddnek Th udciollk L
Grupa skoliozjednolukowych 0 kqcie Cobba lt 40deg - JeCJeni wyl~7ltie lunezyterapil wg Dobo~il-Wicz (n=44) (nl3 obstrwllcji od 5 do 31 mhticcedilcy sndui 1I8plusmn6U4 miesiacn)
Obs~rwowano istolm korclacj( pomiccediltlzy poziull1lll1 upmowlIniu mctody przcz chorych 1 czccedilstosti stosowilniu kine7ylerapii il wi~lklJseii rewcsji zmian w Zakrcsil kta Cob l13 i ro tacjl osiowcj kr~1u SZCzylowcgu skrzywienia - wspolczynnik PeanlOniJ wjnusil uJpowiedniu 016 i D53 -
Grupa skolioz dWlllukowych 0 kflfch Cobbf lt30 Iyp 11 wg POllsetiego - jknywienia pienvotnie podwojle
- piersimve prflwv~middottrolle i lccedildiwilJwe ltKJoslrotme -Ieezeni wyl4eznie kinzyterapi~ wg Dobosiewicz (0=10)
(nu obenvacji ad 5 do 2 mlcsiccedilcy ~r~clnil 124plusmn51 micii~cll)
Sredui k~1 Cubba na )uclltlll I~lerpi
wy nosil
w udcinku Th-17o
w odcinkll L - 170
Sn=dui kql Cubb aJu liugrave~tyIcTUpij wynosil
W odcinku Th shy 137deg Y udcinku L shy lJ20
4) 1)IIIIcirc w Jlm ~llIWiob_ l~ rlllW
JIIIIm-lollUcirciaftq jtQ0 1 t~~010
UpIJI~r~
8
9
Po 5 i 10 miesieacutecach
C- 18 R-S C-12 R-S C-S R-Q
10
Po 9 miesilcach
11
BP
Il rz
Th
Cmiddot 12
R-3
L
C-16
R-7
PoDP 7 mies 10 rz_
C-9 C-20 R-OR-2
--__ _ _----------shy
12
DP
8 ri
111 C-26 R-2
L C- 17
R-]
bull Metoda asymetrycznej trojplaszczyznowej mobilizacji kr~gostupa ma znaczeumllCV wptyw na zahamowanie progresji
w skoliozach idiopatycznych szybko post~pujqcych
bull Mobilizacja strony wkl~s~ej skrzywienia i osiowa derotacja kr~gu szczytowego zwi~ksza korektywnoseacute skolioz zmniejsza garb i ebrowy poprawia obj~toseacute klatki piersiowej i zwi~ksza wydolnoseacute oddechowq plue
13
bull Przedstawiona metoda jest
stosowana samodzielnie lub
w pO~qczeniu z ortezq Checircneau
a takie jako przygotowanie do
leczenia operacyjnego
Ocena progresywnosci w badaniu elektrofizjologicznym
odruchu z odci~zenia
i~middotmiddot ~=~-~ shy1 _--==shyocirc
14
EUT S pine J (1997) () 93-97 copy S pringer-Verl ag lY07 ORIGINAL ARTICLE
K Dobosiewicz Neurophysiological mechanism of the unloading reflex as a prognostic factor in the early stages of idiopathie adolescent scoliosis
Rcceivcd 29 M arch 1996 Revised 16 August 1996 Acccp tcd 10 Septem ber 1996
Absfract This paper presents a new nc urophy iologila1 methougrave of e valushyati ng the risk o f p rogression in ill ioshy
mo t important factors in the eva luashytion of progress ive id io pathie scolioshysis The met hod can be lIsed to deshy
pathie scoliosis in th early stages uf tll( progre jve idiopath ie scolios is the dis ase by illY middottigating tll e unshy in lhe early s tages of the d isease loading refl ex in paraspinal muscles T he high sensi livi ty of ilie method The study incl uded 394 pat ients wilh means il can be used as a basis un seo liosis and 70 hcalt y chil dre n which to take an earl y dcc ision to
K D obosicwicz Depuumll1 mel1 l of Rchabi lilu lioll Si lesilln Medical Academ y 42-604 Tamo wskie G6ry 4
Lmenty of the unloacli ng retle x and repeatabi li ty o f Ihe rcbound and silent period were anal ysed for eaeh reflex evoked Prolonged latency and
p rimiddotom1 surgery
Key words Id iopathie seoli o is Unloadi ng rcnex Re bound
Katowice Polaml minima1 numbe o f cycles are the Larency Si ent period
T he ai m of this sludy was to evaJ uate the use of the unshyIntroduction load ing Dex for octcction of prog ressive id iopath ie adoshy
le cem oIios is in its carl s tages in onl r to lake a dccishyProg ress io n of id iopatJl ic scolios is bas been the su bject of
sion ta perfo nn surgcry as soon as pussible many clin ical radiological and elecrromyographic in ve~ shy
tigalions T here is ho wellcr no sim ple quantita ti ve or qual itati ve pro noslic methoo [hat can be em ployed in the
Materials and melhodsearly ~tHges of the disease Monitoring of lhe unloading rc felx in paraspinal m llsck appcars 10 be a reliable Inv gtsi lgnlions were carricd uut 011 394 pa tie nt with adolescent method o f discriminating bctwcen diffcrcn l fomls of Cushy ~c li ed J ild 70 hCldr hy children The scoli osis group consisted of Iios is T he un loa ing re n cx can be evokcd in ail the 31 1 g irl s and 83 boys aged 9-1 8 year~ (mean age 125 ycars) The
ske lelal muscles through a suegrave den shortening of o luntary contro ls wcre 0 girl s and 10 boys aged tO-1 7 y~ar (rncan age 128 cars ) Imong Ihe stlbjeclS tudied wcre 9 patien l w ith cershyinnervated muscle l2~J When a musc le is unloaJ ed vico-thoilc i seo liosi s mean Cobb ang le 22 7deg 121 with Ihoracic
rapidly durin g an isomerric con trac tion Ihe norm al reacshy scolios is mean Cobb nngle 309deg I 1 w ith thoraco-Iurnbar seolioshylion is an eleclrically silent pe riod fo llowed by a burs t o f s is rne ~n Co bb ang le 26~g o 63 with lumbar cotlos is mean Cobb action potentials called rebmmd The pause in d ischarge ang le 279deg and 90 w ir h doubh major curve sc o Ii() ~ i s meull o bb
nng le 292deg and 28 5deg The sludy group includcd 231 right -s ided can be observed only when a certai n h reshold va lue of and 163 left-sided 5col iouumlc patien ls There were 112 patients w ith
acceJcration flnd shortening of he muscle is exceeded progress ive id iopath ie scoliosi (76 ri g hHidtd and 36 Ic 1t-s ided) an tl il occues wilh constant latcncy correspond ing to that 182 with no n-progressive idjopa thic scoliosis (1 13 ri ght- sided and of the propriocepti ve nflcx (9 18 20] T he rebound ufter 6 le rt-sided) M d 100 w ith pe lvic tilt (statie) scolios is (42 rightshy
s ided anp 58 l eft -~ i(kd )the silent period in the unloaugraveing re felx rcsul ts from ae lishySC9 1ios is is consIcircdered progressive if the Cobb Jngle inshyvalio n of a pool of motone urons aIl o f which fClt1ch lhe
creltseacutes by more lhan 6 in 1 yen r aile middotnl1 n-progrcssive if the anshyfiring thres hold simultancously afte r prcviou~ si lenœ [l nua i increase is less thll n (i The Cobb angle ranged lrom 8deg to 77deg 1 4 201 in Ihe palicnls w ilh progress ive scoliosis (mean 361 ) [rom 30 ta
lI f R (on- f Rt tt1IY 1lIfl pflla 1 )(~ r(Jnu n t shy
fI) _ ~
Pathomechanic basics of conservative treatment of progressive idiopathic scoliosIcircs
according ta Dobosiewicz method based upon radiologie evaluation
Kryslyna DobosiewlcZ Jacek Dunnala Kny ztof Czemicki Hanna Jcndf7cjek
Deparmem of Rellabtlifatoll Mediw Uninrsity ofSiltsia KatOllice Poand 40-635 Katowice fil ZiUCl 3537 POL4ND
e-mail relwbilitacjt1s11mfoctaonetpl
Abstract Conscralivc IrcalrnCnI of Idiopathie scoht)~1 espcclall y kinc ilhcrapy i ~
nOI widcly apprccilllcd due 10 Ils suspectccl low dfcCIIcircvcnc 5 in relalion [ (1 a urglcal Irc[llment ACter long-ycar il ses ment of palomcchanic f scolio icirc in Dcpanmenl of Rchnhllilallon f Mclii al Unlcrsi ly of Sile bull a concTvallvc mcthod ()f IrCtllmenl asymmclric Irunk mobili7alion in lnclly ymmelm po~itions WIS
de el ped_Thi mClh d enablc 10 delain pTogression f scol iosis or ccn de middotrca~c laIerai urvalurc of a spi ne and angle of rOlllion assummg adequate () perallon f palicnl and ilS famil)
J Introduction
Idiopathie scoliosi OS) is a thrccdimensonal dcfonnation of il vertebral col lmm an- cntire trunk Afler many years of extensive rescarchcs the cause of idiopathie coliosIcircs $ i remaIcircns unknown It is possible Ihat idiopathie scoliosis devel ps and progress on a baslS 0- ~
multifactor disorder perhaps diffcrent for curve initiation and curve progressi 11 Fion poss ible pathologie factors nervous system dysfunctIcircons affecting postural tquili brium ar proprioceptive control seem to be espc ially important [ l 2 6 JI Pro_ ression f iS could bot delermincd by vertcbrac remodeling under eccent ri c loading created by axia lly ce gravitational forces in presence of muscular imbalancc in the trunk [2 J The verte rai colwrz unde r scoliotic conditions 15 an unstable system with tcndency to fu rther tune dcvelopment fl2] Lateral bending of a vertebral column visible in X-ray examination L
only a two-dimensional prcstntation of a complex dcformity consisting of patho logica axi rota ti on torsion and othcr deformations of vertebrae [7 8 10 II 14J ln fS physiolog~ curvatures of vcrtebra l column are disturbed Total Icngth of an anterior column of a spi n~
consi ting of vertebral bodies and intcrvertebral dises bccomcs grcater lhan length of l posterior colwnn - vertebral arches and proccsses [11 15 J h is apparent that phy iologi ~
thoracic kyphosis in rcgion of a scoliotIcircC curve diminishes Each vcrtebra of a stru tu ~
urve of coliosis is oricntatcd in hypercxtcnsion in relation t adjacent vcrtcbrae [7 l resulting
1 n B Uri middota I l 11
H srut ft illtf j tI) t li orf1Hli d
IDS Prt ts 21)2
Influence of method of asymmetric trunk mobilization on shaping of a physiological
thoracic kyphosis in children and youth suffering from progressive idiopathie scoliosis
Krystyna Dobo icwicz Jacek Dunnala Hanna Jendrzejck Krzysztof Czernicki
Deparrment of Rehabilitation Medical University ofSilesia KaloKce Poand 40-635 Katowice ut Ziolowa 3537 POLAND
e-mail rehabiliracjas(u1poCmiddottaollelpl
Abslract Idiopathie scoliosis (lS) which i sub 1 ntially l threeshydimen ional derormation or a pine cau e nOl only laler l curvalurc and axial rotation of vertebral column but al lordoti allon of VCr1cbrac in structural curve eXl nsion ln an effect physiological thoracic kypho j diminishc or cvcn dbappears Method of a ymlllctric lrunk mobilisation in strictly symmetric po iljon according [ Do () lewicz not only dcteriorme progre ion of IS or evcn reduces lalera] curvalure but also significmtly rebuild physiological thoracic kyphosis Icircn cases of lS accompanicd by lraight baclc
1 Introduction
Despitc Ion year researchc etiology of IS is nOl yel resol ed Significant problem re laled lO morphology of IS apar1 from lateral bending and ax i 1 r tati n i deviation of shape of a spine in sagittal axis affecting physiologi al curvatu re of vertebral coJumn [3 5 6 8 9 J 0 1t 12 Lcngth of anLerior col umn of a pin constitutcd by venebral hafls anugrave intcrvencbral dises dominate ovcr Jength of po terier c lurnn buill from vertebral arches and processes [lOJ This condition uring scol io i progress ion and growth of a child effect in hallowing or even disappearing of phy iological Lhoracic kyphosis in scoliotic region It i well know n lhar cn~brae of structu ral Jaleral curve are positioncd in hyperextension - lordotisation [5 6] which in Lhoracic region Icad (0 reduction of kyphosi or to true lordo middotis Such kind of venebrae relation in thoracic region cau es ilS destabicirclisatIcircon whi h in u sociation with eccentricircc gfilvitali nal load fa pinc duc to muscu lar icircmbalance [21 pOdbly produces r tationaJ lordo is [56 Il] and further development of symptomatic scoHose ft ha becn proven [12J tha strengthening of the erector spinac muscle aggravates nce initialcd deform tion and deteriorates coliotic process Hyperextension and uxial rotati n a s clatcd with
357 Th B Grivas (Ed) Research inro Spinal Defoml ilis 4 lOS Press 2002
Exercise efficiency of girls with idiopathie
seoliosis based on the ventilatory anaerobie threshold
Jacek Durmala Krystyna Dobosiewicz Hanna Jendrzejek Wieslaw Pius
Department ofRehabililation Medical University ofSiiesiaa Katowice Poand 40-635 Katowice m ZioJowa 4547 POLAND
e-mail durmalaiacekyocztaonetpl Department ofPhysiology Academy ofPhysical Education Katowice Poand
Abslract The aim of the study was to estimate the exercise efficiency in the group of
girls with idiopathie scol iosis based on the venlilatory anaerobic threshold (V AT)
Material and method The investigation comprised 58 gi rls wilh idiopathie scoliosis
aged 10--6 years 32 girls (55200 ) wilh double major scolioSiS and 26 girls (448)
with single scotiosis The girls were eonservatively treated using Dobosiewiagrave
method The control group consisted of 3 1 healthy girls aged 10-1 6 years The
cxercise test was performed using eycle ergometer During the exercise the gas
exehange parameters wcre reeorded (minute expiralory venlilation minute oxygen
consumption earbon dioxide production) On the basis of recorded paramcters V AT
has been computcd using V -si ope method Results The following V AT values were
obtained in the group with scoliosis 207+305 ml 02minlkg bm in control group
219+350 ml 02minlkg bm The differences belween girls with idiopathie scoliosis
and control group were nol SLaliSlically significant Conclusions I The exercise
effieieney of girls with idiopathie scoliosis conservalively treated using Dobosiewicz
melhod is normal 2 Such high level of the exercise cfficiency of the studied group
probably was due to intensive 3-D respiratory exercises of these girls
1 Introduction
In practice there are researched useful efficiency rates which on base of laboratory tests results possible easy without using of the relatively hard or long exercise tests would give the belter forsighting of the range of homeostasis disturbances and rapidi ty of increase of
physical fatigue during varied workloads [1] The best known rate of trus kind is the maximal
minute oxygen consumption [2345] During progressive physical effort minute oxygen
consumption increases proportionally to workload The reaching of real maximal minute
oxygen consumption in time of progressive effort is iodicaled by minute oxygen consumption plateau [5 61 This result is rarely registered in children The progressive exercise test is most commonly used in children until physicaJ exhaustion and the highest registered minute
oxygen consumption is treated as maximal minute oxygen consu mption or so-called
symplomatic limited maximal minute oxygen consumption [678J Sorne authors regard
Orto-dlet Trau malaogis Roha b ilitacjaARTlKUL ORIGINALNY ORIGINAL ARTICLE Vol 5 Nr 1 2003 80-85
Jacek Durmala l Krystyna Dobosiewicz l Tomasz Kotwicki Hanna Jendrzejek 1
Katedra i Klinika Rehabilitacji Slqska Akadenia Medyczna Katowice Katedra i Klinika Ortopedii Dzieci~cej Akademia Medyczna PoznQll
Wplyw asymetrycznej mobilizacji tulowia na wartoseacute k~ta Cobba i rotacji w przypadkach skolioz idiopatycznych u dzieci i mlodzieZy
Influence ofasyn1n1etrie 111obilisation of the trunk on the Cobb angle and rotation in idiopathie seoliosisin
children and adolescents Slnwu kluce ac eJJic Cl chOlIU) Ice SKoio= idj)PO Imiddot(~I7tmiddot
K~Jmiddot w()rus consrieI ve I (OtlHelif idiopathie HUW JS
SUMlvfARY
BackgrouId The aim ofthe stldy Vas Ihe radiological evaluation ofthe treatllJent ofthe idiopathic scolioshysis utilising as)mmetric trunk mobilisation in the strict~ll I)mmetric illitial position
Material ([fJ(f lIIellOds Presented stud) lOS based IIpon J36 cases (13 oovs oged FOf11 ocirc la 6 lcars (lild
rn girls aged frum 6 la S pears) trealed due to the idiopathie sCuliosis ((rom Novell1her 999 0 F enflfUn 200) Among 48 ch idrcn sllfJering from dOlfble-major scoios is 6 cases wcre infoll scaliusis JOjuvel7lle und 22 adolescent Among 88 sillgle scoliosis 6 lere infw7t 33 juvenile and 49 adolescent
Radiological exami71ation 1as condueed always in the repeataole technical cOlldiions RadlOglOlI1 lier evaluated oy the same physician Radiologica analysis oIthe scolios is incuded value ofthe Coho al1gle ongle ofaxial rotaion
ReSIils ln double-major scoliosis observed dlring one year period in Ihe thoracic segmenl Cobb angle decreased inll l increased 1395 and in 292 Il OS 111changed Axial lolation angle in 167 (~rcascs
decreased in 354 incrcased and rernainM the sorne in 479 In Ihe llllnba segmenl Cobb ang le clccrcscucirc il1 354 increased in 39 6 remained in 5 Angle ofaxial rotation deceoscd in3 ofca es incrcuscd in 29 and persisted in 48
ln single scolio is Cobb angle decreased in 386 incrcased in 353 and in 261 was lInchonged Axiol rotarion angle in 216 ofcases deceased in 295 increased and rell1aincd the sallie in 489
CondlsioJ Asymmetrie mobilisation of the tf1f17k in strictly syl7111elric initial positions is a 1Clhod of choice in the cOl7senJalive treatment ofthe idiopathic seoiosis
STRESZCZENIE
WS~p Celem pracy jest radiologiezla ocena Icczenia skoiloz idiopaf)cznych metoda asvmetrycznejl7lOoili shyzocji tllowia w sciSe symetlyczl7ych pozycjach lV)jscio wych
M aterial i metody Przeprowadono retrospektYlIl7q analizri 136 przypadkeacuteM dzieci (13 chlopcow i 123 dziellshyczqt w wieku 6- 18 lat) z bocznym idiop atycnylll skrYll ieniem krrgoslupa leczonych zachowawczo w Klinice
1
Ortopedla TliJumatoogia RehlblllagraveeJa ARTYKUL POOL1 DOWY OPINION ARTICLE Vol 7 Nf 1 2005 49-$11
Krystyna Dobosiewicz Jacek Durmala Tomasz KotwickP
Katedra i Klinika Rehabilitacji SIAM Katowice 2 Katedra i Klinika Orlopedii Dziecircej AM Pozncrlz
Biodynamiczna metoda tr6jplaszczyznowej korekcji skolioz idiopatycznych - opis metody Biodynamic method for 3-D correction of idiopathie
scoliosis a description ofthe method
SIOWQ kluczowe leezenie zachowawcze skoliozy idiopatyczne korekeja tr6jplaszczyznowa Key words conservative treament idiopathie scoliosis 3-D correction
SUMMARY
The biodynamic method of hree-dfmensional carreeion of idiopathie scoliosis is based on Ihe palhomeshychanics of idiopathie scolioiiiii and consiss in aClive segmental three-dimensional correction ofspinal cllrshyvatlre The course of action focuses in the viciniy ofthe apical vertebra Proprioceptive facilitation is applied on Ihe concave side ofthe curvaJure and exteroceplivefacilitation on the convex side Correction likewise proshyprio- or exteroceplive facilitation is phase-oclœd with asymmetric respirarory movemenr as weil as wilh parshyticular phases of the respiratory cycle ln Ihe course ofexercises three-planar movement is generated opposite to the direction in which scoliosis Is progressing This method is in accordance with the stale ofthe art ofscoshyIiasis pathomechanics The method requires detaied training and can Ihen con be applied at home under periodic control by a physician and a physiolherapist The method con be applied in landem with a Cheneau brace as weil as in surgical pretreatment A elaUed description of Ihe method of three-dimensional scoliosis trealment will be presented in Ihis article
STRESZCZENIE
ISlofa biadynamicznej mefody Ir6jplaszczyznowej korekcji skoioz idiopatycmych oparlaj est na patomechashynice iikolioz idiopatycznych - poega ana na czynnej segmentanlej tr6jplaszczymowej korekcji skrzywienia Dzialanie koncentruj e siccedil w pobitu Icrllgll szczytowego sknywienia Stosowane iest bodicowanie propiocepshytywne po stronie wklllsej oraz eksteroceptywne po stronie wypuldej Korekcja i slosowanie bodicocircw propioshyi eksteroceprywnych zsynchronizowane j esl z asymetrycznym torem oddechowym oraz z poszczeg61nymi fazashymi oddechu W trakcie eacutewiczen powstaje odwrotny do lrierurzku rozwoju scoliozy tr6jplaszczyznowy ruch IcrFtshygoslupa Melodajesl zgodna z aktualnym stanem wiedzy na lemat patomechanizmu scoiozy nymaga szczegocircshy100-lego instniktaZu po clorym mote byeacute wykonywana w warunkach domowych Z olcresowq kontrolq przez leshycana i fizj oterapeutll Metoda mote byeacute stosowana r6wnolegle z leczeniem gorsetem korekcyjnym Cheneau a talcte w przygotowaniu do leczenia operacyjnego slcolioz W pracy przedslawiony zostal szczeg6owy apis meshytody leczenia
Skoliozy idlopatyczne stanowili znieksztalcenia patycznej rozwija siccedil poprzez przemieszczenie kr~gu tr6j~aszczyznowe charakteryzujltce siccedil wyboczeshy szczytowego w stosunku do krccedilgu g6mego j dolnego niem rotacjltt krccedilg6w klatki piersiowej i miednicy z r6wnoczesolljego rotacjl zgodnie z ruchem wskashyoraz zmianami w fizjologicznych krzywiznach kr~ z6wek zegara dia skrzywienia prawostronnego oraz goslupa w plaszczyinie slrzalkoweJ [ 123] przeciwnie do wskaz6wek zegara dIa skrzywienia leshy
Z punklu widz nia patomechaniki tr6jplaszczyshy wostronnego Koncepcja rozwoju skoliozy jako rotashyznowe znieksztalcenie krccedilgoslupa w skoliozie idio- cja i kontrotacja sugeruje ze sily korekcyjne powinshy
49
EDUCATION MEETING SATURDAY 8th of APRIL 2006
- CARDJOPULMONARY EXERCIS E
TEST IN GIRLS WITH
CONSERVA TIVEL Y TREA TED
IDIOPATHIC SCOLIOSIS
Jacek DURMALA Krystyna DOBOSIEWICZ
Department of Rehabilitation Medical University of Silesia
Katowice Poland jdurmalaqcmpl
The aim of the study was
to estimate the influence the conservative treatment (asymmetric mobilization of the trunk by Dobosiewicz) on physical efficiency in the group of girls with idiopathie scoliosis
Material
bull 87 girls with idiopathie scoliosis
aged 1 0-17 years
(mean age 135 years SO 161)
J Durmala K Dobosiewicz 1
EDUCATION MEETING SATURDAY8thof APRIL 2006
Material
bull 38 girls (437) with double major scol iosis (thoracic segment - Cobb angle 18-42deg mean 30deg SO 82 angle of axial rotation 4-32deg mean 21 deg SD 107 lumbar segment - Cobb angle 11 shy48deg mean 31deg SO 128 angle of axial rotation 5shy30deg mean 13deg SO 85)
bull 49 girls (563) with single scoliosis (Cobb angle 11-75deg mean 33deg SO 155 angle of axial rotat ion 5-30deg mean 14deg SD 83)
TIoracic kyphosis of the invesllgated group was 5-39deg mean 23deg SO 86 and lumbar lordosis 16-41middot mean 30 50 65)
Material
bull The 64 girls aged 10-17 years (m ean age 131
years SD 132) were conservat ively Ireated
using Dobosiewiczs method
bull Treatment period ranged from 5 months 10 3
years (mean 148 months SD 902)
Material The 23 girls aged 10-17 years (mean age 136 years SO 108) were treated u sing symmetric exercises - treatment period ranged from 4 months to 3 years (mean 161 months SO 1019)
bull 26 of ail g irls (18 girls earlier treated using Dobosiewiczs m ethod and 8 gi rls earlier treated using symmetric exercises) aged 10-17 years (mean age 134 years SO 108) were twice tested - at first and last day of Intensive hospital rehabilitation (asymmetnc mobllization of the trunk by Oobosiewicz) - mean hospitalization period 20 days (range 18-26 days)
i rf~8f6~~ or~~n~= ~~r~1~r~icircJ~~tb~~~~ mean 17-4 1deg meatl~(I SO 74 R n~le ofax 1 rotatIon 5-25ot mC3 111 3laquo S0 6icircl Ilnd 1 99t1S~ ~~~~I~~~~~$ruo~ras~ ~ocirc~~a~e~~~~~~~5euml1 9middotn~ tUfllbar Iord05ts 16-4 1deg mean 311 SO 68)
J Durmala K Dobosiewicz 2
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Material
The control group consisted of 77 healthy
girls aged 6-17 years (mean age 12
years SD 31)
Material
The examined girls participated in school
only in scheduled physical education
lessons and have not been enrolled in
other sporting activity
METHOD
The exercise cycle
ergometer test was
performed
J Durmala K Dobosiewicz 3
EDUCATION MEETING SATURDAY 8th of APRIL 2006
METHOD
The Incrementai exercise test has been applied
We have found that tests ln whlch the Incrementai part of the protocol ln completed between 8 -12 minutes duration glve the
bullhighest maximum VOz in normal subjects
METHOD
The workload was Increased stepwlse
bull by 10 Watt every minute - ln chlldren
with high ~ 135 cm
bull by 15 Watt every minute ln chlldren
with high gt 135 cm
METHOD
The test had been contlnued untll refusai of the patient or exceeding the pulse Ilmit
Durlng the exerclse the gas exchange parameters were recorded by Jaeger device model Oxycon Alfa uslng direct breath-byshybreath rnethod (with face mask)
J Durmala K Dobosewlcz 4
EDUCATION MEETING SATURDAY 8th of APRIL 2006
METHOD ~ ~~ r 3 min 3 min 8 - 12 min 6 min -~
_ 0 rpiYJ 0 rpm 60 rpm ~1 30 rpm
_ t o~w=att~o~~na ~~ att__~ tl~~S~~ l ad l ~~~~~r o~w= Hlcremenlal t
pedaillog i i ~
~ ilt ~I~-----tl-~ I t ~ i ~ lOSt sffortivB
lW r resututlon r rm-u middot 1 - bullA~cremen tal ~~ ~ ~ ifr- ~ VtI 1 ~i ~ tllng _
METHOD
On the basis of recorded parameters VAT
has been individually computed for each
child using V-slope method by
Wasserman
METHOD
For assesment of physical capacity
the maximal minute oxygen o
consumption (V02max) ventilatory
anaerobic threshold (VAT) and
maximal workload was used
J Durmala K Dobosiewicz 5
EDUCATION MEETING SATURDAY 8thof APRIL 2006
RESULTS
Ali girls with 18 have been classified
within normal range of predicted
values of
bull maximal minute oxygen uptake
bull VAT and
bull maximal workload
RESULTS
The differences between group of girls
treated using Dobosiewicz s method and
group of girl s treated using symmetric
exercises were statistically significant
Lower exercise efficiency of girls treated
using sym metric exercises has been
observed
RESULTS Girls wilh IS Irealed using
N=87 p value
Dobosiewlczs method N64
symmetJic oxor-ci Nz23
Perœnlage of predicled vaJue of
maximal minute oxygen uptake
98 905 0033
Percenlage of predicled value of
VAT 97 933 0049
Percenlage 01 predided value ni
maximal workload 101 939 0038
J Durmala K Dobosiewicz 6
EDUCATION MEETING SATURDAY8th of APRIL 2006
RESULTS 26 girl s twice tested - at fi rst and last day of intensive hospital rehabilitation
The value of ventilatory anaerobic threshold increased during intensive hospital rehabilitation (asymmetric mobilization of the trunk by Oobosiewicz) statistically significantly (p=00019)
2047 ml O2 minkg (SO 268)
vs 2239 ml O2 minkg (SO 232)
Conclusions
1 The exerc ise eff iciency of girls with IS treated by asymmetric exerc ises of Oobosiewicz is norm al
2 Such high level of the exercise efficiency of thIcircs group resulted fram using of Oobosiewiczs method
r
J Durmala K Dobosiewicz 7
REVIEWS
Role of physical exercise in tbe treattnent of mild idiopathie adolescent scoliosis
Revicw of th- literature
A NECRlNl N VElWNL s PARZI 1 A NEGRINJ 5 NEClU NI
P1t~silillxlrd~ Ihcrapy (or klucgtlttlwrlpyl i pro shy-tJm of physka] cXlrd-cs ipcci I(a~ (IJcloJgtcd hy l li trIWlltl phrslollwrapbt wilh tb m~ln a1mor pl shyVCnI in lhe ilAAfIVltilH1 llf the ucirccfonuity III mild IgtC )
Lil1Si bclpin~ thebm ( aocl co uaufllclilIg ils ~jd- clf IS in nlOdlJmiddotnh-culiosis Th middotalillofthi paper ito r (W
Ille Ii lc ram r 1 a-ccrulin wh kh of Ih bull Lu[Jalmlcrus Ind (Lb hili til~ CLlLt-cd br scnli()si- clluld bl pl Y nlcd or r d uccd hl phylolld LXtmiddotrdsi n Il p--to-da le knowl Uuml~l nr tIll~C aspcc[~ i ne bulled in oruer 10 dndc whclh~r 11Rf blLl adcqlmtt Ib(uuml n middotlicaJ balis fo r ora)aini l Ihe US4~ of lUgravellgtitlerap) wltcllj(r or fln l th e prtl1iœ of kimiddot ~lre IUlll poNjn~ a t iil ies ~bould h allowtcI II uuml middot c enliaI toltlentlf)wh k lu alClor ie - lf pl lr~kiJl -c rmiddot d gtlt- (Ic rnnhi UzJ( inn ni (t hl HrJltlon [ rtn~hcll iJl ~ or 1i1J(IChIumlJlJt etc) Sh llU Ld be TolullllCcluse ulemiddot l onld b- clclIimcntalancl wukh sho ll ld he IJlI-n~ifl~d I~~a l lhc (o uld h 11lfu 1 Know k dg CJnc1in t (wIn SeiCIImiddot Hlk rCS([lflt h daw ccordinll to Ih bull llVit w o f tIlt iii 111 1( plop(lsltd in (h i papcr lmiddotonllmJ l lnl plLyi 11 cxcr(j$( pn (nti or (tmiddotduce dhlblli t ic 1 ~lt Il Jj ll(k pl ti Jlt fadl j w(~ the nlIIIrl li7alinn n f poMural dd shylitS tu p n xJ llc aSl COIlMqnen c(middot 1 all )llal) or r(tn~ shys i middot middotlIrve Tilt u~c (I f appn1priattmiddot kincsiuuml wrlpy 0 in rcns polttllcal swhiIHy Icirc IIHmiddotorc Illta ll y (0 r 1(lt1 lllho UAh mon ltlccurlltc 1Ut dl1alkd -rLk l(lWfils 111111 )11 h Jlccdt(
11) wurcJlt 0 lit)-IcircS (Iumpy - x rcLs P()lun
n rllt lT(ltnklf u f COll1tlK H (rtd) I 1i plfho l og l ~$I rUlglng tr m low tmiddot k Pl 1l1 to IdiOpath ie SCUIshy
Submitt(oJ [or PUhltCl l1 011 uly Tt 2001 Acc~pttJ ugu - ~2 1(t-1l
Addre rltj-xlfll telt~I(middotb If) - grinl Flt(1(bziurllt r )(m Ofl ()(Cl1I shy Lt middotqlltœlll ro () - 1u I4t agravehLIlKil ta IYIL-lTt ilSllltp lfllmiddot ~ 1l1uumldull
CelII ~ (niiOS I I~ middot ann (1) IfUh middot lIlfU di louhilll(tymi ( Nlmiddot ~iI rli -ilIIUmiddotltlfl
Nlti(ir 1( ) il r() (ltbullagt1
lt vLL_ l IiII no 1ftfI
jS ) we are a IUil ly tJc ing n1n) ltblll lS 1 k l1 b ~J)w in~ tl~ t S Jfll l approad llt - l1n til hy on ielshyertd ~tan lard ugraveJuld ln m any ~1~ he lI ~t les i if Ilot dange r )ll lt rhlS is lrut of reil l lnw 1gtlt1lt1 pa in l ~ or 5urgi c ll lrea lmltnl5 in dbc r lmiddot ll Sc - 2
ln tlle cj-e ut ~ t lll(tlWtl i( li p l ll1JC luuml- I ~ middottnl ~() shyliosis phys cal ((_lt1(( is emr1uved ltI t()fIl1 0 lh~rtrv
lo ly in cel1l in L)lllllde (nluumlnlr in tilt Lltlll middotorkl i e Iw l) r llt t Srain hUI IIgt() 111 Gert11lny 5- 1~1 in other reg lOl1 wbere thi I-incl qf tre l tm e rll 1 p~ 1 pmiddot t 1( cI il Jws Ixen cri ri cilld md rel -cltd Lw m~lI1 1 11 Jlu~ Fue Fnlny r ~lrs thio middot15 a lsgt(ru( f ~rth r -~ltc rrJtf))~ ll t vit11 br1Cltcgt b r II1 ([C Llt n ClW grmvlng 1lt1 0 L Sti g
gcsti n the lIsefulnes- u r Ih is form o t treatm n t 1
Hmiddotu]rs have nerged jn El or uf pll y~ iLd eegraverdse eacute 00[ 1 but tlw are nUl yel 11 11 t llu i vIC~11 and r hi ~
f rm of trt ~ltmenr IS stiJ l Ul1 ckf ckhate FfI t Jt 111 il i 11t (eltary td 1I iFy 11umbtr ot
b l sic COI ceP rlJ lf w ill he cIh tt d in t hi pap r
Scollosis
DCijIrI iriolls
ScnUoSlS is Irlircc c1 lme nsIcircltnal (I(gt i l cj on ot tht spinc thar cau C a CU 1 lh lt ca n h e $ t~en ln (1 me1Sshy
ured ultinF Coh) lll ltllCXI o n HI anreu middot p rtc rilt r
EUJlOI -1 lœDICOPHYSlc~ IR
NECRI Nl
110
f)i)
1 7J
amp aS g 5li - 0 v
V
31
10
(1 1) Il 15
-tc i ytjtr~)
FigJ----jllph ot DlI w l-lkaupegraverel) The agloimvltltinn Or idio r lrhlc 50gt1iflll~ IS rpiJ bel~ en th e- [l0 IH P (l)ltg tnntll lol (JI PUllcmiddotny) mtl 1 ( f( lS-er sigll paiilivltecirc lt Dlt(i I1 11illg r the iti l 1Kgt n n t rll icirclicH a ) 111lt m omal prebulled the mno rche md ociks with lll I)ttlx flal gr Ih pll fl
rlcljoprdphLi 1 hl merl prestIK ~ of this curvt c10es n t autom~l ritllJy indi ate the pn$CI1(t of a defurshyTnitv (SlllKtUrd (Unel
It i~ possible tu clil1e ren tute a struCnlt t CI1tve fruIn a pogt urll 011e by identifyi og the hum]) du ring AdIlns tesr I~OQ looklng tra m beh lnd at the p atient w ho b benchng fUfward il is p -- ible ta d d~ct 1l1 eh ucirc n of o ne liidlt 0 1 the trunk usually n n the (onvex ~ jde ul tbe radiographie CUfve Ugrave1lr C Ul be mlt~I Slred lISin~
BUlln els S o liomere( 1 ~ l This h Uf1lp is du(- lO (Ile pregravegtecircn ~ of vertel ra i rolltion 1c1 Ollt tn tic f~YJ tllre o f the def trrnit tli [ c m be seen and measurc(i v ith Perddolles lb lsLometer on an amero-Ix)iferior radioshygrapb ~2
Seven ry pel cent o f li Ises a re conid 1lt 1tO be idiopa thie 1 bull ia l-nosilt in this CI$C is b exdlls i ~ n as idinpa thlc me-us t11H wc do n()[ know rJw origio of lheacute curvc [n othe] ~Ie$ it b Ix )~i ble ro ide nrify a dieak (bat CHl jusrify the c1etgtnniry slIch a rna lfo rshymar i ns I1(gtufol Ig ic~ l or genlttic cl iscas s Glnclt~r trauma etc )
[dicirc)parhk S(oliosis has been divicled ~(corcling (0
the ~Ie of tlie patient egrave1l the tiJ1ll of d~[ccli n of the condil ion into ti) ur t ypei ln fanUlc jU nik ltldolesshyccnt lnd aduh Til l m n st cnnunon (VPC IS the acloshylescegravenr o licirceacute I1IJctenzec1 hy 1 sud le l1 tggrH3l ion uuml uring the grow tll Spllrt (Hg 1)2
lhile p tu 1l sco liosi i5 Ycry lomnw n thl pre shy~Iknct ra te f r adole ent icuumlop~lthic structural CU IY~S in sch )o chilclren are 18middot20
- 10 Co bb d~grels o r m on l -lil
- 2) ~ohh dtgreclt or mort O 2~j - bull () (obb d gre -s )1 mOfeacute ()ll 2
Clin iltI [ d e isio ns lfl IXlSed 111 an lccu r~He pregshynosi which obt inccl in eJch pa ti nt mainly o n the basi of the nsidu~ll p()tlnllltl l of TH1h and the result s of 1 rh clin 1 1 ~l1d tadiogmpl i exlminashyti(ln12ll c noieq uentlya d inica ] la sifiou io n o f the ing le pHient tn -ome estent co incic1 ing w irh the
D diographic one c l n lw SLlIl1H1arizeci 1 1 folIcJ - mikl lc~ (1)(n 20 C bh de~r es - moderJt l betwlen ln md 15 ohh de~ rtes - StV re 111( gt1lt rh n ~J) )bh (kgf s
On the 1) lsis of [hi - dinic d d a lfic t i n (Vith l1l il el lrb tiOI ~ o f the ir b() und~ri e ) in Itllt l cente rS Of SCOtiO LS ITe ltlllent in the Lltin odcl (i rJ Ital lnmct md PI iJ Ugrave tre tmtnt i s plmmcd a fo lltJw 8l
- mild kineslth e (~1fw ~1Il (1 luok-ou t - Hl demte IJragravecegrave 1111101 c(~r md k i rws ithe lJpy - ~cven surgery
Physical exe rcL~e for S(ol iosis
Defi t tiOl l S
PhyS i 11 nU b lIKrlttp middot (or kines ithcIa Pl) i a p rvgrlill or plt~i Gl l (xeriltecircS ~1ci fi ( llJ y ltk ~ loped
y a -11 [ru ine 1pll yslo ther3pisr wirh th e m 10 Hllll
- pre (~ n tit1g tlc aggraaLion of the cl I )flnily in rnild bullcoUm is
- helping tlk Il ld Ct ~lOd ounter~lCtjng its skie elfects in III de rltegrave sc li sis
Tn tl1i_ feSpec1 kinesitl1ert py f JI s oliosis is tonshysider l a o on of peciticcedil training and s genecirc tltllly proposelt in sessions 0 1 4~ ro 60 minute IW) t) tour limes 1 Cee PhysiGtl exerci es can aLo ll v o ther auumlns 1S it oill he dise Issed in this plper
Ir 15 Ilot possib le to cl escribe a single progrlIT1 o r exerc ise a5 pro nrams ale USLIJUy p fgt nll ized ( ( lt
EUH PA ~illDI (DP1I YS IC~ 182
ROlL UF P l 1YSICAL lXl 1lt 1~E IN l IlE 11 ~l) IEd If IlU) l[)VP 1HI AIJ() J)~Cl~ r COl ~I NlG1W il
f)( 15 egraved ( )Il the nee L- 01 indi iuua l pJl itnts) al l l10ugh Lheacute) C l n h t 11 plicd o n a WOU p hJ~js (-1 (0 () pnients PC[ ~l ()lI r)middot lugrave reQCf lhese 1 10 grl lll frequt ml~ V IIT
hnm on in middotituk w allClthltJmiddot -Ill Jnv L l~egrave at Wc w Ht ~huw in lhis lyl peJ it i~ 111 n u -eII1 tu id e ntilv kirK itheJapturlc aims w hitl l ucircrr~spnd LO ugravelt~lil1 DUtshy
g X ir ur ph -s ici l lxtTi~l I~llhe r thln ln dj( us- indishyiJ u1 1progr-lfll
Aduumll l lxUl kisure time ~lOd h )u] Sp u lllll8 ~Ilttishy
i lt egrave~ i middotomm )Ly s iven lel mJ ing ro w hlf ~ Iuumlnsidshyer~d usdul or il lrmfu l in t1 lt rruning (lI tJw ptliJicirct ln tl1bplper Ugrave1 gent ltl l t rl ll bull p lwsiCUgrave lttG iviUes is rl ktll 10 JllI1ltlCc hOlll gtpOlt mJ kIJ1lsIcircl hc lJ l f
i ve lUen tloneumld )bo C on lv ine n dul( re Ull~ 1t~1 t s far Ilten publislt d f I~ mJ I(i noltgtithltl rgt is 11 11 a su h jel lnI deacutehate CJitk haltlt t llltit m itn ltl of l ny lorm o t p l1 ySiClI lxrcL e as a Itwr1 [ J- fo r i liopa tb il jcoJL~b un iL ()ri gin~ initial1) it WIS Ille r rOmiddotUumlK lt brgdv u f p l~lt titu gtllergt w h ) intervenecl hutll tc llcrl ll (mon as cltl HtilJ nic in terventi n man Jgt
1 t lltrJp utl t one 1 md rC j fkll l~ on rhe h sh lf som uni cOen I1v pn t I1cgts wt ldl hll ltl enl1 JI~ haLl nu na l scicnt lfic baisYmiddot HOlh tlle$( trr t peu shy to rh ~rl py tt nJecI to l~~rJ tte C Ih tk CUf -~ pnnshyclr~tll y as a f tsul t of lilo h llIzatio ll of tn imdqultdy ~u pp rt(d S pln eacute 7~ 12 to re-t1 r rI ltrl 1$ l l1C k o f WH llt~~rdl 10 I ndt~-dll()urnah tnd 11( on1 p~l per u suaJly Cl tc([ IS n prelimmtrf lll d 3 ln tt li w ay man (l rrlKpt(Hc H lf O iS Inll ph ~i C U l ~ d vi ~ cI nllog scnliotl pa t le nL~ 3gainst holll ph lca l egravexershyclc and p()rt~1
It m u st t~ n tfd [hat pllyknl txerc j~ tJe~ltm(nls t1iHer 1 lJ rd il1g r rhe rherlpcu tlC litTl~ on lllc h tJ rgt ap p lolc il l the IXlltent lncl hi im r IIIllHnt i- 1 (1(1 rI - 5lt1J lC igt tIl l ( f phJllIlllolopJ al rrea tmln ls Ihith cllffc r 1lt œQlfd- rhe m C cculc u ~t(l luI thl p al 1t n
~mc l 11i (lbE~e Tt i ~ P ~il k tlwreI[middote thll wuumlk ltlll t kin 1or ph~ i Clt1 1 lX r(j~ 1I 111~ t bc loidvd by t h~ Lo iurie IxujCJ1l al1ulhcr a dl ~IS nJI h~ iOg (1 11shygerols llugJr in racr le (wi ller d I ~fJIII ~ I ml thlls re(nl1l rn ndc(1
fn n UI cel1ll r we In(~ hccf) using 1 ) 1 1111 11 ve ) 1 (J p lw l icd ex(r(i~e (0 J ( 1I l tt i~ tlh aITt ~ l~d Ilv m ikl tru cflumiddott1 adokscltnt (cl ioj arh lC icoli is11 2)
ina the f U~ t rc-gt uJrs IefC pu b lishe - the pJ( )grd m 11lt1lt l1te n PWltllk d in fa c t deel()pnlln l~ in th t l itshy OlL1Ii in tl1 r b t ~() ycal f ha ve iclemi fiecl niO l l
m d 111 ur impl rnHm s md d i s )h ilir i (gt~ lue t idlo p lthk amp()lio -i ~ t Jll CIII he 1UO(l if Icirc 1by phyict1 egrave xert iSlgt l fe t rrncllt
l illl
111e aim of t l1JS r~l per ii tmiddot (tv iew tl1( l iterat urt to a(errl ln v llic ll of th~ impa irm 1t~ and Liit hil it il i GllIltec hy ~ o l i()gtj s -o ull he ll nt x or re middotlu celt1 Ili pl1ysical xerclse An u p-to-da te knOvkdge o f tl lt Lgtpecl-gt i necckC1 in rJeumlr) d -oek
- whetll~r there h ltl n adLtIIl ) l tht()d ical bbh fur or JqIIcirclb l l l1 Il( ) f k irt llit herlpy
- h N I)(1 ( 1 Dm tlle p r l c tIcirc(( o f Jebur tiJne )pOfung lcli v l ti ~ IIOU lci he tllf) -d o
II J U V f h 1 I11~ c~~lb li hed Ihe usefuhlLss 01 k il1 shyc ~thtrpy il i aIle dy l nsi 1([(( -r-tI Llleu i n )I11 plJt~ ut the wJrld ir ilt ecircS~nl i 1 I( id n Iv w l1i li ( 1shy
gories 0 1 pl1Vtl( 1excrClgtegt te D)bilI7it ric 1n (Ir st shylliuumlZltio f) lttlt tlgtbltn ing ni trcrccedilh ing erc) hn Id be
vnlcled he tll rhe nuld be lerrillldll1 1 md whidl s tlQu1d be inreœ jf ic(1 IJeClU~l tlley cOli lel Je LI ~ful
Ncuro1llotor impainncnts
Imv aUl llOr~ 11 lt1lt ~tlKlteJ lhe cltlndatiotl bd Ween tl UC1UmiddotIt t l ol(~C t nt id iopml je -nll ~J~ and cli~l l shyler~ lr 1tH lest ihuLIr yt 1 _ 13 ~ 311 D uhoussct 1
1-- ITS tln l ldiopath k s(o lio-L L cll -c d l J l hmgt in th terl tltr f prop li l l pu n md 1I1ar th e detrshyn Hi n i~ na tural 1 ~ronse to ril e need tu ts tu re p()tun ltlluilib riu Ul HcrmJJ1 31~ 11 () d tllat icliupathic ( liCl5j h l it re5u lt Ot1 rw nltuf mot r l ~ltelV
[Id )fcl 3 nI] ~1ltJ U Sr1lle nr to dtorders in centJtI lO~Cl shyIOIDNur) md 1xi~tI moro (Ul1lfOl syt( llI (Fig _l
N htIll -of) H1c S uumll h( rll1 ( ~ l( w ing JI t11 (oshyI-ie on the l l lO]ugy o b doll (nt Rl iu]icirc tlili- middot()lioL m unt fil t-hltll rhl ugravedcmnilV L th e fl5 ult o f 1 (k btcl 11lIFll llI ion nf som t11(WUgravetltnl md pO~ lur( (tnic l~ l licirc1 tl1lt if l p OgtlbJt b C 1l rlw sta l i lin 0f 11 1 Sf llle j lt g )tx l Tt) ohtil n a ))Cli U 1ILzltl I o f p ~llIr~il d l~flo [ in l1litkd ~J)llnSIS me CI Igt(middotqucnr J ~ a ~tmicirc ()nlly or regle Ie Llive
Ali th- 11yp ) tlw~es rd ~lte tr d irtl Itn t pnl1tlt o f [11 v hole ~piltm It11[ controls postu re ~nd mrw shyment lrre pell ic of tlh po int a d lI~ llv inH llYegraved il i ~ ll 1 nnable tCl aSUilll ri 1l tr l ll1 lo g thi ~ys ttm ( Qu it le 1I middoteli tl
lt ch ugt nlt~(S f rullliIl thil i nlomwtion th at p tlmiddot shyiCil J(tl iIies nw gt Il lInport~n t rr le to pbv [11Icircgt role ca n 1)lt slI i11l1lariztd ln lWO the ptu li ain Llt
- d elopmll1 l of p uumlltl St1 b Hlt ) - c1e veuml IOpm 1)[ o f bhll1ltc _
(k llhUl)lOr S Cll orr
ontrot oic whan-lt
------+ 1 ~ il lnll ugrave r AINnl
Cllnlr1
T bflt~ r
fltL1 tlli
lMini
l
~sary ~J-frlllen i )f
~ 1 ocirctnl
~UcirclllIJJlW Ll
AXl ~l1 n uumll l) r sy 5t ~nl
middoticoltoq ~ Fig 2-AcFgtrdong lU He-mutl 21 il is Fi)5~ ib1e rD prolXgtSlt l -oo ie1 mnd 1 ((if ~ elio egrave middotAhltr~d l)Qdy-p ati~ I I i u d) uren ttllOn k td LO In ~ory reHTt I1 eDi tn l al ) JdrnlV~ pn)4~ e l u r~o(Ofe 0-c1 eptunl dvstil t1 ctlon sltŒ(ry icircltu nu11t ilwnt [ ~mC ~ted tl l1 ce Ill trpntlshyUumlfJJl nd IKnle~ r~dibl jtugrave)n of -I) m tlosen Ir ~ig nj tl (I1vying ln fornll1U n (lI an ereltl ~piJl e Mmor aJJ r--a t ~) n ltgtf ti lt aXljl mowr plem iHUC Wh ~fl Ille 6ubjeco m uumlntl Icircn (1oJifitd perccpfLlI l ~na l ysilt of p n)lnocepti Icircnfu rnlaquol ti desnibJOS ~n t tecr spin A IICW motor co nrro l Ira I gy t adopt resu ltin~ in the ~tr ltctltr 1 ckformh y lf IdiopathirL scollos i=i Ht lrftU1uc nltnt l ISll I1lJy h1e- ~ I pro()und elkn on bralO Sfem flJll ct i(lnn~lLhu modifyRll Ille nltulltgtshytl10 ) 1 1111 Uu l-lHoror control 5~Shnl$ shy
As Srtgn1lt1 l ~ ltlssert~ if wc l C -Cp t 111 1 un o f the G IiC s oliosls L l tisorckr oi th e ltquilibrilltn sys t ~ms it is lagical to oriegravenrate physlCl l exercis( lherap y ln th is d ir(gtCli()[1
11lclte goals Cul tl lfOUgil ditrercn t modes 01 action be Olchic(-c1 witJ1 phykal accivit ie
- po rt ive Cll ities p ro ct LJ e aIl UgravelClltrtsc in 6lte nshyel ll )o rd in~lti n pinai pr0prinup ti_)[J nLi mOVeshyment control 0 vio lls iy ln thh repect ome lCtivshylites aœ pre um~I I)y lXrter tllln ntil crs
- kinrl lira py using pedJil exerCisocirc specially developecl lith th est 1101 5 in mind illVuuml VC I lllore prccilt( ll1d InC1 li zed cri n on rhe spiJw focusing
a90
1 ~~
lg -lNheJo ~1l l1 t r~l g rld in 1 1) h i(~ IImiddot ct r rHienl w i ll idlllhic _It ~i ~ _ iri s plt ~I le II find Jit ltH vlllleuml ~l Cgtbl tn~ ks III d il fef lt p ~ lt ihnS nu v~tl middot B ~a~pt u Il C middotl)Icircd ~(t l l11 C dlfkrCnl middot- hdween slllndi1g Uline nu nllt1Xinul oorrec ri nI t chied Vith Ct (J ) und tfdincJ ne lot es o UIine 1 fo llnVs middotIJfl tfi ni( - ltlrshy
reltiK)n ~ Ikexibiliry st3nucircing - -pirte - f ur~1 1IbjISC ltupin - ltorrcaion - - r~luci()il ll ymiddot For flmpllt in J npK l1 pH k1J il
plt1SSlhlc ln obtai n 10 u1 511ndlt)l [YLo lion yr ln Slt p ille rlOlgt itlugraven om l J ~ in ( gttf(C rigtIl lIex lbuil 15 i (r-l l=22deg pol lltl ~~J IIlpraquo is IcircO~-V- I t1 l nd tucircu(Ugrave) ilil) I~ 3laquoJO- IH-12
r ln Ugravel e abilit jl of tluuml [m e llu to co ntro l irse lr in ~ pac
fuld l oftlles uumlllelve ntio ns can presum1b1r incn~~ Ih enl ac )1 the orller and lHitlll r of Ille rn - 11 )ltd h e lllldenl lu EJ3)4il
Posl1l1-t collapse lnd slabilizariotl
lIle concept u fplt st lUal c(l lJap~e l l~t Iwen detin 61 by DlI II-T3e~tupegrave rL t Ac oJdin)j tu tl1i- ~ll1thor il [ nec(sary ~- l Hn Cv-tlualing th tleihility o f a col shylo tIcircC CUJVL (0 clistingu ih bt tVeen the re du ihil [ty index (th - li iffer gt le bet ~middot Il ~I r~tcli()grJph ie ~xnmshyinltio n of the iI111 pHienr in supine po ition m(i
ROte OF Pl rnmL EŒIlCISE IN THE TREAT-ŒNT OP ~I IJD IDIOPAnnC OOU~GEm seou SIS EltJRINI
I (~)-----------------------~
__ _~ _____ _~ __ __ L ___~ ________1 ____ _ __ ____ ___ ___ _____L___ _____ l___ ----------L ______ _
1 ~
1
-- ------- --1---- ---- ]---r --- -----_----t- ---- --- ---shy__ ______~---- __ ____ 1________ __ _1_ __ ____ __shy
~ (1 J
1
8 =~~=r=middotmiddotmiddotmiddoti~=-middotl--- middotmiddotmiddotshy--------------t----------~- -------- - ------__shy
~---- --- -- -~ -------------r---- -- -- ~-- - -------- --shy----i-------r-- - ---- ~~-shy
il 1~ 0
Dtl-Lmiddot ~ lttj l r~ UIltltlHt
f g 1 -TI1 u ilictf 1ld ( ii 11- ugraveu-sh) ld IX~ O 1d wllich ltJdnrshymII Il nf the pilll 1 ~tln~1 of th e -o lioti( spinc n IG~nI(J II IIIshytt) lhe iJeuml grl-e o f ~ ()Ii ti c (u rvH Il 1 w dcpc-nlknrly o l l he 10 111shy
P01(nl (pntt l ~ 1 1 nr ffll wrJ I) ln w hilth Ihe n i 1gt( ~ duc nL~ grlphs fm I h~lt 111lt hi~hr Iht Col h ~Ilu t (l f Lite ~Ul Ihe m Ol CI il y th t s(uumlJotil middotpin~ ~111 he ~middotJg gr~lVH(~(1
m mJxiTIt corrttt ion wll iJl i~ lIllCd to Ih - xt 1shy
lti Oilil y Jf tl1lt t Ut JO rl1t cdnUc idt md p OS shy
tU ll cul lapse ( th t ltHill enct b-tten l lUdioL) 1lphic egraveltamJl1ltlti OI1 J t th e ~lme pa tient in Sl il tl cling lOJ lline fX-sitiutl ) Wll ic h correb lc- onl wil ll fhe abilt ty of lllt p tu rl l gt s tem to C( lunternct lIk luree o r grl viry )cco d ing rv D lfVd- f3egraveLIprc po st li r t1 lt01shyIlDse is d ue to the Jnus -u lar ton a nd 11ll ex rCrIshy i) i itv of rhe tissus n the ( O IW-) si it (If the (01shyjl ti (~JtVe (Fi~ 3 L Pu~t llr1 C lltpstl lu lcl l ~~ reduc l-lt by llwans o f pl1ysica l cxerCles specitkally s tuclled ruuml i rnprove tIlus--ubr fOHt md lU pr )cllI Ct 1 ~11 hi shy
lizing ffCd
PararcL n tll CIJ cl the cr iti ca l (3 c1 thlsho ld beQ ld Il ich defol1J lHU n of the i pinlt 1 e~ in~ ne dtlllontr~1t _cl (1l ll t grclrf r mg] o f rllt C II in a qa m bng pos ition corn pOil 15 t l lowcr detormashytion lhnsllold (Fig 1) ie to ~11l Ulne3Se t the risk of pr ogr t~ lu n There t rh eJef re l J ea r l)iuuml 1itshycJ l ~ll1 l l(tl a 1 tnr tg ro b ohwined by d -cr t l ~ illg ilmiddot pU~lUrll cull lpse ptJcelJtge w bich lccording t i)
h llTd tnd ~l(heJ1l ~on 1~ b inde cl 1X llt icularly luumlgh Ugravel mllcl c Iio~ i (bdow 2( 0 ) (F ig 5 J
Fin a Il III ch iS respect lllljl hl and b um l 01 m linmiddot
ii iI 1 l _ _~ _ ___I ___ ___ __L ___ _ ___ ___J______ ___ 1 ___
li 1 1 1 1 i 1
1 i ___--____---___----__-_---_~- _ _--_ ___-+----
i
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i -- ~- -- ---~-----_-~-_-_--_1-~
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+----r--------t-------t------f-- J
Fj~ ~-Ac(XjJlin(Q luuml T O rIcd ~lnd Na(h(ln~ n i () dl( pCG w rd (rTIshy
POO ll is hiherin cu rvegt in wh ilt l1lh ~1flILWrd cII1I Olk l1t IS le- pr(v~knt ln th e grtph Ih t PogttJlJ I ugtnq) Ot1 -J1l j elfltS-e J tlt 1l1t obb dirr remc rlLIv obu incu f roll l the Cohb atl( 0 1stlI1dtJ1g IId gtupinc rldo~raf115 Ih Ille lt) [1l1t1 (i lndnl I pine) 511pille the ~(nlClu tJ1 compo l1lnt U rlk CU Y _VeJily I~ ltx p rlt 1 L1v UpUlt (obh Illeturo Ih t si _b Cct rtJeSIm l fie -ltn J trd Ugraveltuuml shyuumlo n A~-i)rding LP 11(lt uuta o n l ( r1I~( in ~I 2JQ sup itlt curvt 1hi C(]l)b ddhccno l l f lO is -J-lultt( thc s ldnd inr tnla Ol1l t lS wi Q) whil 11) 1 1)401 ~llp lne ClHVC If ~ 1Omiddot ( tcl Lhe ttnd trl~ nlca~ I(t I ~ ~I)
tli n ll w l lllE cq lin ti spin h~ i ng mo r ~ Llnt~II) 1 tlun the nOftl111 one n Cll l gr(lk ( (cU ve tl1u n da r u p shy
po rt in o r k r 10 m linrl in tht 1xi11po tuf_ n th ha__i of th egt onideratl lr1S it f(lll() rhJt
ph rH (~Uuml e erd es ulukl h u - ul iiuml tbeacuteY ~U-L lm cl 1l (It-d o pmg p05111 td C Jl1twl lS fuumlrnll~ rly d ccrll1td ln an Ql St if i imr ol1111 t ru t(( - tht m(d in C JI shy
r t t r sture fO Ir -ngthen tlll m u ck-gt of the spint mainl) in (11erl antig r3ilrl tIcirclt l]lli fun ctin ll U hy meU15 dl i )ll1 t trk ~ lhJ cl( -ll tlt C)nlr~lUions ~llld no l IdOshy
1l)llic d YIltll1k lt l jAJ lktic t) I1 ) II 11)t 111 hd posibleacute t lcluuml ee postura l io nrro and stfh ili lllllt IJI
w i thout food T1lw(ull r d I( Lf(11 Ibk t m ucircnuin Ihe c()rf ~ct [ ()S tu re for cl gtu ifKi IH lLl1gth 0f ti l11 ~
This i-l ddl usl a typl 11 dnmnin (tf k inesllh rap) in 11 (lt-11 [[k - p~d fk lnr in lng f u l1a in llllliCk is poss ihle lI sing ctrtain Idncl fJ l (lt) 11111 liun S p Ul in tb is Cl c is ulttful ooly sa I~tr 1~ il Iw lps t1w lxltknt 1 becuJl)t 1gtlt ltlt-I a ClJu~l inred irl ilL ntllru l o~ i cll
and I1lll~lJhl r-keJc LIl [rll-llIn~ middot etlt(wrs JI the int e rmiddot vlnrion
[J ROPA MfJ) I()Wf-I YSJ IR
1
ICR 1 1-1
r
1 shy ~
- shy
11 o-llrfOlhe5l~ o t Ih 1O~(1dity i n h ~ r ~ ll nr pbl1 l of ~ Spl11 in 111011 _llti1Gt l lPt f ltlJUCWJtl ( ~l Ihe Ir t 1 1gt illbll W Ilh LtltrJ1dlion Vln lbe rigronl middotUII~ l(I Dko n12 lIll h lumshydlanie1 1 [ nul 1 M hl whtrc M - gt) lnIUI1g 111laquo111laquo1 1 1 c rtJCshytjC~ f fce d -d Lill l1~ o f enr niI pUll spnmcl1y 1~ 111 mldlll1lt (n the fl1ur t 1 = tor~ of f(ward Ileuuml l = ughtel1lng fmiddotr p 1shynOf stn lClU= Alaquo rdtllg 1raquo Ihl~ - lin hull th l1ltgtllugrave ot tller1l lUr~Jtllrc F the ~pin t -ilh rlu1i tf Ihl 1 1Ibulll n lrlt InltT1 1
rbc prJI 3IJi l1ty d qrlOIJ~ n bull JI t IlJIII Hm lA the v=ltd gtc e lu-ing J 5lnK1ura i ltfnnity
Dioal e ch anicll itllp~lir J11 c nt
Ihrcemiddotdimcllgtional mc-cbal1in of the s pioc
~f Ikmiddot i t i nly l(œ ntly tlHr llk pr-5tnœ or nc ushy1 lnlo tnr impairment in Idiopttlllc s-ol ii IXl tknt liuml J$ heen h i- ll licircghlcJ hy re$eJ rh tll e preit ilegravee h inm b nIcirc Ji d lJutg~ lt hl ~ 1 ng t o n dO Ulll urcel 1 i5 (l lreldv well umlersrood H(j-ev~r nev lbt un h iomcrhankal im l) ion nI h1c rectm ly onk l n tIlt tre and p r~dou in f n rmtinn hou t pl1ykd (~fcl5( in t 11 0 tl1I _ltgt pbne of spact 1115 Im trqlt-u 1rom J i-[) v ing unclcrsrmdlng ot th l lmc -dim nshy~ilnl l l11 ~ hmk f the cO]jO[lC pln( ~2middot ) ) Ve- w ill )iI xnl t l1 d at lcL-orcltng tUl cl sif iol t lOn blsed o n gtolllt lricd h uumlCJ ) p lane
- b() rJzU[1tl ln th i pla n ~ th t 1o rm ll sp ine present no CUlye- w ll ile Uumll(~ ltc U Hic spLnc clevelops one of ir haracterls(Icircc deFo rm tiCs v elt tbrd ln lashytio n vh icl1 pJ()VcA~ theacute hw 11
- lgitltl in th llulJe U l(~ nonmll spIcirclle pl SenL kypl lOSis ~nd l dooi~ in tb lXI1 lhese [(Hu rts Vere m)( til ught [ 0 he relattd tlle scolkJtlc ( lI r Vegrave
- front l in hi pleme tht ncrmal p ine preseuron t no curYegrave whil thl ~11li tic p in ugravetI I ()~ icircl~ charshyad t Ilt I CU1C
Il Jri fJIIt palic
~l+I~na ra 3 r inr lut th l[ ber ll1d a œl1~lU1 degr 1
l f r()la tJo u lllu (lILa r forcKl ltxert ltJn tl ldefnmuumlng 1 tkllJ [J i1u a re- lhlt tll cly 11 [1 1 UI b y Olm ner w bn ~lh uiJwd tl egrave ro t1tic) l1 Ilm it ti lt p ica] lf shy
rhrl r() be (P (the Uma bevond Wl1iltJl th lCOJlb of [11( ~pmaJ musd ~ dthc COnCIt and nm ex ~l le btconk (t O li~[)
r ~l 18 ~1Il N lu t( ren i9 lun lu ted rlseurlt h in tlt ) tilt lULodeumlformipg1 tlo n ot tIH_ sc laquoJrle rh ox ercallkren lk 1l1~H li d11r once thl Il i ~ r tld1t5 [he lhrth ld f 111 JlIcirc lIi of tlle dnrlclc hurnp tlk
lI bslt Il l nt rlet()rlll lIcircon 01 the it l ()I~ C ( (ylm der (- sustalnecl by an H1tmi cforming aCOOIl
J1Ji h V hl rhyiical f~ f Ise CI 01 h spr n llnd kin middot ith ccedilrapJ my lX damlg ing vll e n l pplild as flle
igt Jk Iller ln SCC1IJ ~IS lllc lJ fxceed l auto in middot crca~ i n g lhrllgthuld [1 sh (~u Id ahn be j ofed that Ilw relscd pre sun 1l1111i insiugrave l fe pil1r inn) 1 mlshylt
- j Il- ( w atff 1 (nh ~1l 1(e Il10 utoldrml ng li1eCh~lI1 1sm
in flc l Geyer ~w tcd th1 t rm m 1 hI l)1ecircch1O lla1 puilll 0 l I C~ sw m mim t Ieuroamp no purpo t for cu lshyim le pllilt t1 s (weumlO middott r it is l~Jl(gtWl1 rhn in iculio r[ paULnl -iJl11T1ill~ doe_gt nor Il ~lp to i ncrt~SL n eur(1shym tor co mfU
(1irai p an (
Jerdnn lle 11 showecl thal ill CSl~ o f t10rLC IC 1i lUgrave
tllo lacolulllhil it lio_1 tlle cte tI llmiry in (he lg itt1 p lln t rn lnlftot il~ lf tspe iuUy in tlw initi 11 r luleuml )f cV IU[Icircon nf Ile ~oli ls W iU l 1 p(t)gr~s~ivlt il10middot~ shy
ment roward hvpok pho b G ll f ill~l Im lins l har dUflng (IN eWllLlfiu1 of 11Imh] co luumlgt i the l in t ot t l H~ gClyty Cegraven te l - 0 1 v llebed lxxli 5 r ro ject 1 seH fl r t side-ys and tlwn backlrcl bull thu~ p(0(1 lj n g a kyphQtlmg aet Il ln (h~ lu mhnr --PIl1 COftj tng
l l i tc Iugrave l lltl l( l rs1 tif s L -etllgt il l the lgirl11
1 Hl)
Ilu LE nI rIIY~Ic~L lXIlKISI 1 HI E TREhTMEtn OP JIU IDIOP llII C AD O USCUH O Ll Œl15 NEGR II
lLill tegt lre lenl1 ~I d ~fo rll1J[ ~ rhl recrSes the phyltiologiGII cmns of lh vine)
Accordlng () Dicion ~2 1 rtcluctio fl in the itgitttl CUIYtS combin l vi th a lueral Iviari n llltl ds t 1
mecban ism () ugravel~ta il ity in l he r rat r IllI1e which bVOf1i the unsd a nd i ncrea~e 0 1 co hlt1is (Fig 6 hiIf md Pl11jlbiJ Jl1eanwlt ile lt(udiecl lh e srnl ru t
orzyglpophySLs show ing t11 al ttleir 1I1tl rnic tl orienshytation f~I (jLi l~ltes aXIal ve rtegravebJl l rotllio ll in cun litluns lt f dorsal hypokrrhn Icirc tnd lum)H de i L lo IS
Tll t dat SLlgge 1 th t impOrfill ut pOitu res and l1lweil1 ) t Mudied in ord t r (CI mlIuml ntrlin or to reuwer fll e p llyslo lo~lCll ClIlye in lIe SlgJtta p lU)l Wlth the llm o t ch ~ kin~ rutltor in l~ bili ry7 AbC th ~e ~k-
1l11nL ~Irt del lnt [0 J jUc lt ftber l]kuti inrervenl ion vhich 1c)LJ k l IV - i(l ~ l compktl n l ililll on Il t c1 l shy-jel1 J11UVllT1ent IJ j o f 1uto-dOneacute(3tlon ( i e a -impk ld ion ) Iengtheni ng o f the pilleacute 011 a litlltl l aXl~ tll lt ((IT liJlI~rcdu e~ t lle ~---lJ linti- l lte ml-fkxj(l n h UI 11 - i llCrl I~t the plllH ](JgicJI dlt cr ~l S ( (1 k-yvllCiSh lIld O(ltOSh l o r c lch r1Iif n t a Ilew til(~ecirc dUuml llt Ilshy
si lflltl J ll1 u(~nlent iam ecl - 1l1t0- lIrfe rionmiddot7 4 llmshyp oed f Je-rura l iUIl cl middot-t1e- iltm lI1d ll1a intltnUlLe )( 5lg it d C Uf (gtS slig lll thltJrc i ypI1 tiZ) tIcircOI1 a nd lunugrave)ar 1()fdos i7~llion) sholild he esw b lb]HU 00 lb co
hl b oi hi p~l11il uU r -1Ir vlt Abo 111( e IlltUtl Chl lie o f purti n - a U vitk slJ1ultI h e )tuumlll ecl 1)] (1 n ldershy](ion r tl1i lt type for e upIe IilJ llyl)T S of repd shyiti( ml vemen prt n t in agonistK h)lnllltlSlks nI iIle kind f dlJ1ce C( uld he ([([r imentd
FmiddotO lllaljlallC and mobili ty of the SpIcircIlC
1 rd llo U 22 d L lm nrrare d lhlt in Illt fro nt a l pll ne
tilt 1 nge Clt 1)1lt vtment of tht scplit[i middot CU IY grcmr lIJ l il ~ d irectio n n f Lhe C ITelt tlO n tha n in tl le di re shyLion of pmgressi n l Fig 7 ) he IL o IS5err lJd tbat th15 mohiliry increac plrtil u la rly n apic [ cgcoeilts 1$ lh ~ ~c() li osb evolves Sragrm rJ 12 J ~ thus rigilt (0
VlI f n rller~p is ts Ilo t t) m o b uumliz - a sCtJl iu til curve w ilhout t [ uling ttwt tlle R lu tiOI o i til t ~a mt b fnlinruumln( 1hy l1tans o f ~I passic 01 1 rivE -uppnrt On tilt (ltllE r hand UgraveK d e iJlioJ1 in ease durill tlw tune 111 whicll tll C spmt i ~ not submjtrcd to correeshy( IV anl()n
j- Virh mi lei ol i b tlllt Upp i1n ill) lC tiol is d eveloped only lllmugil llClIf()mu$Cllbr f r llce thi ~
InegravelIl ~ thclcfo re tl1l[ inu eascgtt sp1J1all1extl)iity mua
11
Imiddotiumltgt 7-rurd illt Ir) 1 bull rdrilt I1 1 in tl lt frOlllll pbnlt- th( illl ge )r mOC llIeJlI o t the S-o UIIJC CUNe 1 supcrior in Ihlt diflt(l im ugrave( the n nKlIl thd n ll1 tllc dlrtcLion o f p rJ1(l( (llIl
be considrCtJ vntrl iJ)(l icltion and 1 undrli neocirc ab L a ~ubiljz~ILion 01 tilt spint pllss il)1y ohtl ll1td thrltJugll the stlengtlkl11ng o f the 1rltJgm vlt nonil lme shyCIC 111 illli orrant u bjcLliH- ln rhis r~f1 n sp u lllni lc tivitIumlLs sil uld lX tPI 10 dlegraveltl it l G lU t n w l1ik luring kine i Icircth lrr phyltical eXegraverci c~ tllat in ele
spinal m ot ilIcirclY sil nid 1e lt1 oid cdrt ~
Organ ie and psychologieal impainncuts and li islbi IiI le
A cgtI im lc pmi nr is moriOthl11 just 1 sp in and 1
compkt gt Ipp rnach to the gu in ad 1 ont i al~ shylute l e~se i t i11
[)a la 0 11[ [n ell lrom re semh pw tbat ome organi Iilnctiond cl fki ts suc]) as tlw clecrtiUe ut vild l tnd d fun ll l)Kity_orld ldly incrtJ k whil~ 0 shy[io s i -till in (1 miel q g of g JltlV ity ~ l ilI e 55 rtI lit
tllL pres e n ce )fl defidt Or Vi l~il Clp~1 - i~ ln one pIIiem in Ihr l ftectecl by 20 ICl 40 scoi stgt l ls~a r(h cunclutecl in tbe UA by Di Ruce- prod uegraveed an aaalo) u ll1lXimum 102 re u t in a group of Jd shyk 1ien t [(h sco llosls rang inF frum ) [0 1
Al10ther rudv bv rallt r m C chr111 lilcl NashycWrl1s( u 57 stlO eltt hil $(C 1 1 ui~ Ica js l( lllt cl (1 shy1prUlllI o f t1tgl lie bJd l imI in ~ul sct t1 t ltu b middot iects jlLltr l5 they are golng through ~I cltlici[e sllge in the fnm 1lt i n 01 tlWH o w n id uHitv t factor hit h Illy jeopmlize the cl velopme lit d ~ mIll lt lI1d htIshym cecl IWI sonalitr in Klulrhood
n RUI ~IEDl(( Ptl Y1-
ROU ltHmiddot PI [ I C~ 1 EXIRCIS]~ IN TI Il nW~JUNT OF SlllO lDIOP1HIC AI)C~ESΠ11 C(gt1[Oi 1S
This i why b IiCieacute ii is ~n imporrlIl t for p rcshyvegraveml e 1tLsr l tn en ou flge 1ari e nrs ~lfrecr(d by lIillcl middotu iosis ft) tlke p~l rt in portin -re rcatioluJ acrivitits Iha t 1eIU 10 L10 th r~1chophyinLl bull nd b~l )i 1l1o tur adlieem t n li 51Jmiddot2Even tlK)ugli [Dr bic mech~lnshy
ical mcl nellIUll10t 11 11 reltl ~ons lt r111 1gtomcrimes be l lefu l to ugg( ~t ne p rt in~ aCt iv ity r l h (gtr rll n anotlJer e th ink Ibal an exces~ ive IlHd icalizltion - Icirce l ll1posilion br plry~ilt i HlS nnejlor parents uf rh ry pe of po rt to lx p m lice 1 b Ule p 1Ucirc(Il L th1[ preshydLl ck l1 is fret clOice in lh ma tt r - -h II ll1 he avolc1ed wb 11 possLhle mainly for tlle i mport~ltll psyshyLb ) jogka l fe a SI)nS W( ha( ill ~ t nltntionegraved
Conclu ion
lbh ISsertegrave d t1H physkal tgtXtlci o is ) n fi ial whlIl practinu in order 10 ilnj rove the I11 llde
rœ nwh and tono C iral caplCiry and postu re o f the StOUO(I ~lIbj n II I nowkdge om ~ middotmg trom ci el1shyrlfi rls(~ Jrc li dJlJ accordl ng r the review 01 thE litshytirlture prnpo )td in t lli plpl r conflrm~ Ihe vuiclit ot th e -t ls ~rti ()ns
In l do l (ent Id iopl1il iC scoliuse il l n phee u i cl vk)pm e n t ( li tll iumlKh eXCC cl l g i en rhk thr hokl th e re i5 an und ubred need fn r l pprnpri 1tegrave (JJ1tOkJJe ~Ild Inr surgict1 therapics ill ortler 1) S l i p
the ( - Iuli on anugrave )JT~t~t UW ~pilll l dtlormities bull evshyerthtless in the illiti ~ll pl l~sC t ttlC c1iseLltc whcn the riS( r1 r euro )luli m is rtduced ocirc ~md tfle uifleal JOld threshold il ~ld flle po stural collai i reJcenw~ 43
JI l1 igh pllysicaJ egravexe rc ise - p revenc or r d llCe d i ~lh ilir ies o f [Iw ~ l() li )tic
p (iems R 28 J -6 5- 6 1 63
- f~KiHtare lh ( n utr ali711iCUl of postu m l d elicits tn produCel1 a coneql l nce J [)ti 0 I111)( or regre si -u lmiddotc 5middot Il 1 17 ~ M
-re 51udles U ~ n Ledecl tu con[mn or re jecr these conClLL i( 1 w l1 ich clerin-d frum 1l1 lIldytica l rcltw n f th e liter~iture appear r- ~Lo nlble Hnwecr Intil ne re ull are 31Iable wc should n r prevent our sroliotic patientmiddot trom tl ki ll p lt in s(loI1ing jshy
ir its pW1iada rly ltl t ~d1()o t () n til t c ntrHY -vith the l xcclrinn 01 gt[1 )11lt tIlat in rea-e t)1obility (tnU evc n thell oilly wh n progr~lgtion b p OSSibl) -uc h ~I( ucircvshyiUe -11 )ulu hl tIKoll w g ed The 11 S J ( rprOpriue kin (~irhe r~l Piuml to incr _~asc p()~tura l $llbil i ty is tl1egraveoretshyic tlly CiJUClt alttloughl more ~Iccu rtte aod deLli led ri k benefi rs anJlr~ is is netot1ed
Ria 1111tO
NIokl Mu d lle ftitYljJfu Jœl il 4IWr10UOifll S (JIvs i (1~1)Jshylidl ttno( cclIll le 11(11(1lt1 RCI fu lle ((lia LltfIt l1 I1I1i(i
LJ ci n s j(r3 pigt egrave li n IHUgru lkl di t rdz t fi sici pe e ft shytUlKm iluppno di un lisimerap15Ll rl lllcflt() 1 110 scopo di pnevirlt () fr en~lI 1-lgpwlllltnlcgt dclld lclonnitugrave o e il 5LOshy
Il i mi llon lt fH nugrave j (1 11ni dei co~e 1 lteIl I1J J nd ne ~Ii eifclti (()Tc rri udk s co lio si d i m e dia g rt iuuml ln que~ltlt
s rud i 30 llizzb mo i d ti cleU ric lca pel n ri Icare qJJ l lm 1 dis(imucirc x u le I[~ l z j-m i pro vna le da lla C gtl k A i json ere pr middote-nute () rk kl ducirc un~l rdeguCltl d nil cra pi lt di uJoseguerrnt Cjua li 1iU110 cli nbie tti 1 rcr lJ)tIId d~ fle)-UITC
n (- -fd7Io n~lcl)
Ut11claquo)si 1 lI tori htpnuuml )ludi-ttn I ~ cnntI1zttu fr Cq(in i idiJ)tic1 dbfl lOZ10l1 d d ~ leOla nelllOll1otoriO Lb un1I1cnUl 1n1l1i3 dcgli 111 lt1i ch DIJgt gtU l H crmU1 Nlch~mslt ( SIshygnaJ~l lerimiddot wo i esuemi -bletti d~ plt~e8lugraver- ne l pClZ le1lftgt scoliodcu kl s iluppo ddl ~ ~ uhjlil~ vertcbral~ lt o svilllp prJ Jdle JIl7 i() nl di ltCjuiljbrio Dng li studi sul lto lb( l~nlrale (OllddU i in pa rticdu d 1 DlIal-BeHJ (gtegraverl ~ P~II IId lI1 n~ llw - idente il v- m gtiu p eT il puientc clioti elgt di u n rnigb o t c)[ ro Ua sw mle dei radlldc onsegull o tramite il 11 fforzrlshyfl len to d e i l1luotoucirc l nllgr3ilri d e luOwo con crcbi ~Clltdr
in pOMltHJ corrctl e in va rie ~i[Jzioni s t llicb c c d inamIcirc tllt Dalle on sena d elb blOffiCcclIlicd tr idimlt n s io mlle d ei
r ~ chi Je ~oU()f icn ~Icirc ~videnuumll (l() ~llt tC p IYZIcircOSI ln(IiClZlfHicircl ~ 1I1shy
liumln fluenzt Je ll middote~rUrio tl SC) lgt lIi I rc pibull m i tldln sJlI71 Stl shygn~I I1 afferma che slI l p Ia no [11 middotccedilr~lk tre un œ rtlJ grado di l L1Liuuml IlC dclh vEltlh r1 apj(de le tu rœ mu SCltJ llri njtbc J n in $tJ ) t rodcfQfll1t1l1te PltJtantu b i r~it-~ r -lp il puugrave t~~
Ixnt-ftla solo nt Ile so )[j)~i Jl1Icirc na rl in qunnt ) ilon SlrM ntne )(l(Ofa tu soglb in caq ) co lltrLJIcircn l)lrilto llt~( i lJudotlsi di lfr~ lI1 C llg grVlmenl J 111 11 io lr riltd ll(17jOill leld rinlle 113 dimO~iumlrlto d llt nell o lin~l cl()~ li t th~oIOl))1 dri la defltgtrshymiti sul p iluO slfl iuale ~vohl lf1 (en5 ion~ sO lnm utto nd 1e bsi iniliali deWggrwm1Cnln mcn trl C a( lfLmn che occlleshyvoluzi ne dene = 110 i [ mhari IJ lin c l ki cen tri ch -1vi1( de i cp i CIt IJ rI Ji SI p m ittIl pnm l Iem lmeme e p o j pOS( shyrio fllwnte dtldnli mdv ( i un ziuuml ne ciloliz7nnl dd rlLtide lu mbJ œ ( lIlelttlaquo on NC n d d (gt11 uIdu m 1I1 Ilgt) cli r-Iure (0 eserClzi che IllUllengano 0 ltlUperifo le Clgt 6gt1 lo)iche sul pirluuml gilwlt Su l p iCl no fron itk Perdnulk il dlll1lt-trlto d1 lampkz-l d i LU ovimento amp111 lI rv Kolio ti ~ nd lt1 0 ddlJ cnrrc-LIcircQo i Ji gC 1 n lungl SUpegraveliltlrccedil 1M llS0 tlell 3ampIGI shyvamcnlo C che l~Jltmiddot mobiliti GlI mcnta co n l c lu7j o fle d l i) snAio i A ulln amplgrtJc1 ltllllmunjx~ i terlpGli nn n m obi shyUZ73It ma eutva coli ti0 1 1ct HsicVlfe nd tcmplt 11 1111nshyttllIcirc1nc n tc (k ll ~1 llu u zinnt n l1 un me77uuml d i sost l11( gt ln 0
e 11111ri b cle - Ilziunc egrave deorinatcl d l rlyarsi Snzcl la pr gtshy
liltlnl l i un() rtl~ i ptmiddot Jtl n(o 1S(Hl () (( ntJ() i ndit~tr i ~ Ii ISt (izi e l m iviL Illdlode ebe Hlmen tno laJlc ibiJii dcl rlc lide SCshy
li io) [n p articobre rune q lldl r C-I1 ich~ xlSiddcHe CUf t shyli ve ch~ iJllpi tgino e~rciii 01( biIi2 ZanUgrave HhnmL-trid () in tmiddot~t~nshy
sione kl fuchide O tne pure k- ~ttivit1 tnotoJII~ non prHi(~ llCcedil
in forma r k rel1tiva d Ie ~1I 11 rF~1l1( n otcol mcnlC 1 lll ubib Ll vcrteblmiddote (ad ~ flp j(l 11 n l) to L ginn ~Iilt Utl clkl rilshyC
mka la cli OT- tcc)
r1il to l~ _ I[Dl COlI rY IC~
NE olUNI
fillncr ( ni ((uuml(( n hIIo( rilclIO ~middothe k lln dtfidl fUr1z i shy
nlu CQll1~ la llcl llZIO 1e delb c apKJl ilde e della capacltl di 0170 mizianu luJndn le (OJ il~ gtna a nc r3 di m~i3 gmshy
v it ln G mlxl r i ~ gko Fl llslrom C dlllJ O e Nachcms(J h iU1I) dim lr JtQ che b o liosl p IOO C1 neUaduksœnr 10 SYil l1p pn d i lIniumlmn~gin nlt8Jliva de corpo in (o nridcnz di Ln ddic3w p ri d di f( m l lz i nlt deUa SUl idenritl condishyZltonc ch pOlrebh ~[I cubrmiddot ln vilu pp di un pe bull n nn lir m llur cd e quiJibfarn in t[C adulro TaU CO1DSCe nZe tvlde nshyZ[II)() la n ( middotess iti di ltimobre la plfte ip a7j0 r1e atl an ivi ll1ltHClr n gl b a li ltl h ~ di tlpO s pu rti middotu dl ittlrc nd gloani iCo lID ti i lirtugraveta z io ni llb vila di relazionc
ln concllliu fu la d tfoflll lL saliu iG egrave il sin l mo di lin) idrotnc C Il1pk 1 d e eoinvo l d middotmiddot= fu n (n i dd rgashynIcirc5H10 n Hi lhdli e lesenizjo fi 1lt0 se 1 Il indirill~t() pllO pr~cnin 0 odLf rgt t lli di fu nzlonicirc adlc s()Jj(bi 111Icircn(i rrHtatc CO ll nl1 cinesi rap i Quand l~ coli i ( n LS~middot iJ11 zia k il rischio evnluLIcircvo egrave lid [() mente no tcole 11 (ltlll asso p o lll shylal ltOtSltgllen7~1 _ ta cincsiterapia pc rslIk bidtlvi shyptutibulli d ubllIcirctIcirc vltnc brn1e di conrro llo )(JSu k d i 5IcirclupPQ d Ile rLlt ziofll d i eC[u ihb ugraveo dJ ftffr otZJH1 r1w dei IIl llJgtCili 1 11Icircshyg rdtarl in posru ra rrenu posslhile JnnalL in Illo lt i clsi l(j luucircun lt di lin ~c() li oi mi n rc ( ume [11 duumlnQstrIO la tinc~ jn~l el1lric ((1l1 ~rtlppi d i contnmiddotllo cnndnlt1 p nso i l entrt d e Massue di Li n nc da [ o llo n ~ Rodo l (1 986) Julndo il1vlce lIfU~ ho ~vutlJ tiVll 11lt1 1IjXIl to un dekrshyuina r o~itl di g rl vir~l bull a~-n lllull~nte n ec ~~uiu rlCUuml rf( ff dla tcrJpll rle si c a eo chirurg ica
1Ho le clllC ooliosi idjopHI 3 ttl1p ~ - E~er l zjo hsco shy11ln ~ I((fapil
l Bg 5 CUle Lo [la k ll oblems in tlu ll~ (U ni Cl) FrKUce CU ( )lIILr no 1 AllCPR lu b1lG1t10 11 middotCI 9()(iJ2 RockilJe MI) i)~Cr ~()f I [( al th all 1 () I ~Y 1(~Re~C~Hd ~gtutnlt Ilallb Srshy1ltC Cgt D~p(rulllnr CJf I Ilalil 11 1 HumlIl sen Lel 199-1
2 SI) lrzcf ( LcB I ~IIl( FE DupUb L ampkIll~ 1c ~ppro l c h ll tht rnent und mmgemlt-rlt ot ~ ct vlyrl~ led splnul (hs r)fder~ A monQglJph rr r d lll kic Re p o l1 or Ih Ou bcc TlSk Fu rcl 0 11 ipmd DIo rele Sp ine L9H LU) 59
) Clntino F 111i1 i(ll Ci nerte1H C Nou gltHhl C Kln(~Jl llBICII [lIe1 hmlln (Il dry rra ll1ltfll of QIil pa ll m log iC by l11e 1 lIb li 1le-llh laquorilC~ of ~ 10(lna 111 Jrc)Jcxli r~~ (of flle h l lntrnIUonll SVIll Illgt~iu tn - II 5lt Ik lIc lk0flllllic lu llln-I I r l III Fhhlt ri g 1092 -ltlIJ-7
i - ri of niii MA N()LJV II ~ mel h)ltks de kin ~~klk rlr k di lll J r~cdllclli (n d~s ~()li oes jn f ~tel r~1ruuml(ILI -lo s bl fl c sur IcIj cquishyl)œ~ Ik SOll ll l)(eacute Eli ror eetlfllS d )111 1~ 1)1-
5 iloll n G Ruumld(~ le s () I ~middotmiddots tnlcl l l1 I n in 1Ifc el kiwil~~ 1)11lt KillegraveSlthe ripJe SCleacutentlnlue lYl6 2 47 ~ 6
r) Feacuterr[ffgt en 1tsiero 5 Venlllfln A ll~~n () M MJglio nu N EfkUuml o r eXltClse tI~tl Yoj o n nild id iO rXllhlc iC() 1i()~ lrt~ lirnIcircIluy r sull Eur feltl lb)ii 1 1j34 Z5 -~ 1 NOilrill1 A Sbill P egn ni i Ll Linesilegraverpi l 1lt1 Itallllll~nlO
ddlJ soI K~ i llO 1 Orkl1Llllwnrl m efodoloil1c1 RbbilltlZiOllc Ot1(1 1 )29(1) 1l-~
8 Nli(rinl Nl(lr1n l A blll P LI rieduGlzione dl p llicml atflt rro (11 coli ns i idi opr lir1 l n SC(Um i le or h( JI 1rcLlIQn1 ~0Cl le Imc lI1etW)n11e de Recltcrchc ci 0 Ftude sm 1lt Radw jlt)(j S-71
gt Nftriruuml S SeJhrf U LI r i l bllh ~l liOlie dd plziecirc11te ulet1n 11 - r
lin Kllopd (1 In l1l Jgl L N eduoL Tf1It II d ll11e ji cln1 rJtbl IiIUvJ Milan) 1ltfddH~n(x~hl 2(1~111gt-1-PU ob L cllln t iRll p l nelLi rl tgtO llcui n~ dilt ~lio i - l rn~f- li ~iIa n 3efllnl -Kurflr 19-11
11 lIIra S lJll M EVtJltHlvugrave egraveI lt t rnrumel1t() d db S(oli - U r) surie doCum nUle fintgt 31 tIUUli Mibn SI rlin) KlIpf -r 199 2
L2 1 ~W I1l(IJ P _leacuteVia tio n I~lhra k~ du IlchlS ~- ( i( IoltS ccedil l r lI C1 l1 fl leq
Ene 1 l C hi r ApparctlIClCOn l~ ltll1 l ltx6lt (i W Er 20 j )7 l
U StrI tr d P Lcs 1) rm IlO du Hltlctli Parb ME n 115 li ~u n un_ l c- l ol lJn e~IL1roy JC EagtOllŒrio n sc lluocs
L cl middot Exp CO_fiL [-In 190 15 Xd BR llet13n) J Th ltJl-xwenc a l o-(l1 tUcn~kuud txer
C le re-glflW 1 lhe tfelmc nl o f id iopllhiC Collaraquo n lroc~-din) t Lhl 1 r 111(1ltli0 I111 Symf SiUl1l un 3-D Scl IiDliJ DclOfshymillelt ~k)J1[rlt u Gugtu l1Shltr Verbg 1lti t)L j32-t)
16 N1lh~Ir~il Al Peumlf r~o n LE Erree htJkmiddotmiddot~ n f t~U lt hfIl middot Ith J
hran in ~rls V ll ~ ttiVl ~HkJ k-nt IHuIXtthilaquo ic I) Li ~I~ts H t 1l1i JflIn t ~ j l~jl)5iuml7A(~)8Jj- 21 bull
17 M(jo n Y ( ullck J p ~ R A PrdulllnlIr rpurt 11 Iht e rt l f rnltJsu red 5l ren jl lh rrll nrl1 III ililleInr Hi rrt tllk scoJliagt
J lin1I IJisn rd 21 1 1)12) 102- - Hl Hunng CU[- -If p~lIll)~thc - Uonktd in -c h JI IL
c reacutetnl n~ ptnl l C)Q~ Z ) t 1 t(li-v 19 Kou )UrJKh L Glr~ k G KRI iJI G KLmiddotmiddotrnl kh g UlUI
) KrJ UkQULlk i~ ~l ~~ fl c+l l1ng ~t (w)j (h ildrcn frit ltt lmiddot( ti ~l~ 0 1 (he
isbnd of Cfdt J middotpin 1 Dior el 1 9J7 lIX( )middot i2 ~ middotl I i) SG IC1Iugrave lS r olle lCOS rh Zadrc C Ber E Xend s T A
ohool scr(l nin~ f r Loli rraquo pro~ p ah pidemlaIO)( Io Jl lUcJ ~middot In ncIfllwt~t~rll dncl Ctt1fLll Grttc J none 1cUlf ~)Ufg Arnl
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EUROP MIDI C Pli hIC
EDUCATIONMEETING SATURDAY 8thof APRIL 2006
(iSS
SEAS02 Scientific
Exercises Approach to Scoliosis
version 2002
G
S Negrini 1
EDUCATION MEETING SATURDAY8th of APRIL 2006
Neuromotor disfunctions
Neuromuscular disfunctions
11 Postural collapse
Postural collapse
Duval-Beaupegravere
Flexibility of scoliotic curve
f---I--- I Postural element
-------1 Structural element
S Negrini 2
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Postural collapse
Duval-Beaupegravere
It is a value related to muscular tone and to flexibil ity of convex side tissues
Post ural collapse
Bunch e Patwardhan
Critical load
Load threshold beyond wh ich a spine begins buckling
JI~~Wt1lW~flfthtlJlœJtAr ~ J~It- l~l - IMS
Postu ral collapse
Bunch e Patwardhan
If a curve reduces there is an increase of the deformation threshold
~~~NW~-damaoc~IIIMf ~~ J~Iv JaJ-I7I9sect
S Negrini 3
EDUCATION MEETING SATURDAY 8th of APRIL2006
Postural collapse
Torrel e Nachemson ~
Scolioses below 20deg ~ ~ lt~
have a high ~ ~ percentage of ~ ~
~postural collapse (on u~
average 75) ~~ 2i~
CU~VE O EG~EE S WHllE SUPlti e
~laquotd~c6b ____lPffI1wtt1t~
$ww J(t ~~7 JM5
Postural collapse
Minor scolioses 7
Antigravity musc es strengthening D
Reduces postural collapse -G
Increases the critical threshold of deformation
G
Neuromotor disfunetions
Stagnara
If we admit that one of the causes of idiopathie scoliosis is a disfunction in balance systems it is logical to orientate physical exercises toward this direction
s Negrini 4
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Neuromotor disfunctions
Dubousset
Idiopathie seoliosis results fram alterations in praprioeeption centres and deformation is a natural compensation to restore postural balance
etattJtitIK ypothfQj~S ___~ own_ oJ)HQr lar 1t-1( r
Neuromotor disfunctions
Nachemson Initial idiopathie scoliosis
+ Goood spine stability
Neutralization of postural deficits
D Static curve
Neuromotor disfunctions
Therapeutic aims
c) Development of spine stability
C) Development of balance reactions
G
S Negrini 5
EDUCATION MEETING SATURDAY 8thof APRIL 2006
Biomechanical disfunctions
j Horizontal r-Ian
i Sagi ttal plan
Frontal plan
Frontal plan
q Frontal plan disfunetions
Fronta l plan
Perdriolle Movement magnitude
gt in the direction of lt in the direction of correction progression
S Negrini 6
EDUCATION MEETING SATURDAY8th of APRIL 2006
Frontal plan
Stagnara
Never mobilize a scoliotic curve without ensuring reduction maintenance over time otherwise a greater mobility favours scoliosis progression
Frontal plan
Ducongeacute~ research
On a group of adolescent idiopathie scolioses treated with
Meacuteziegraveres gymnastics
D After 1 year the mean angle of
curves increased from 18deg to 29deg
Frontal plan
Scoliosis without brace
D Greater spine
flexibility D-
Risk of progression
S Negrini 7
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Frontal plan
Mobilization is useful
D In preparation to
brace
D With brace
Sagittal plan
QSagittal plan disfunctions
Sagittal plan r middot _J o
Perdriolle scouos B CJ aDeformation of D
thoracic and thoraco-Iumbar curves evolves in extension
S Negrini 8
EDUCATION MEETING SATURDAY8th of APRIL 2006
Sagittal plan
Graf
The line of gravity centres in the vertebral bodies o s c oUOSt
projects itself firstly laterally and then fi
o
posteriorly lJ ~~ ~~ ~ ~~-_J-D ~nI~
Sagittal plan
Therapeutic a ims
D Maintain or
retrieve physiological curves on the sagittal plan
Horizontal plan
QHorizontal plan disfunctions
S Negnni 9
EDUCATION MEETINGSATURDAY 8th of APRIL 2006
Horizontal plan
Stagnara The forces applied ta the spi ne act in a autoshydeforming sense
Horizontal plan
Dimnet Rotation gt 200
ampII~ (
D The actions of concave and convex side
muscles become
agonistic
~ItJrOnrIIiItdllfUClltlluumlll~~tI ~1JIf1laJ
Horizontal plan
Minor scolioses never exceed these autoshy
deformation thresholds
S Negrini 10
EDUCATION MEETING SATURDAY8th of APRIL 2006
Disfunctions at a biological organic and psychological
lever
Oisfunclions at a biological organlc and psychologlcal lever
Cheng
Bane density in scoliotic teenagers is lower than in normal subjects
~~~~middotA~IIlUtIy ~7œl 1d l
Oisfunctions at a blologlcal organic and psychologicallevel
A significant reduction of vital capacity and V02max in teenagers with a medium severity scoliosis
S Negrini 11
li
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Disfunctions at a biological organic and psychologicallevel
Disorders in the development of body image that the teenager has of himherself
Disfunctions at a blologlca l organlc and psychologicallevel
Therapeutic aims
cJ Activate cardioshyrespiratory function
cJ Favour bone density increase
cJ Develop a positive image of the body
Disfunctions at il biological organi and psydlologicallevel
Stagnara
Sport
D The active side of
kinesitherapy
S Negrini 12
EDUCATION MEETING SATURDAY 8thof APRIL 2006
Disfunctions at a biological organic and psychological
level
Distunctions at a biologlcal organlc and psychologicallevel
Cheng
Bone density in scoliotic teenagers is lower than in normal subjects
~n~IIIvpWr~middotA~stWy s- XXJl M J
Disfunctions at a biological organic and psychologicallevel
A significant reduction of vital capacity and V02max in teenagers with a medium severity scoliosis
G
S Negrini 11
EDUCATIONMEETING SATURDAY 8th of APRIL 2006
Kinesitherapy on the scoliotic subject
q Postural control
q Axial stability
q Muscular trophism
q Balance
q Respiratory function
The limits of kinesitherapy
There is a threshold beyond which
rehabilitation alone is not enough
sssr
Kinesitherapy in scoliosis treatment with brace
Therapeutic aims
S Negrini 13
6
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Therapeutic aims Srace kinesitherapy
With brace
il Postural corrections and
vertebral stability are obtained by the brace
Therapeutic aims Srace kinesitherapy
In preparation to the brace
il Mobilize spine on ail plans
Therapeutic aims Srace kinesitherapy
With brace D
Maintain a normal spine elasticity
~ Maintain a good muscular toneshy
trophism
C Model the hump with kyphotizating
exercises
S Negrini 14
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Exercises and their methodologies can vary accord ing to learning and individual sensibility of the single rehabilitator that proposes the m provided that they stay within the
Iimits of fixed therapeutic objectives
li
Therapeutic modalities
(Exercises)
QAuto-correction
QRespiratory education
QErgonomie education
QMuscular strengthening
QDevelopment of balance reactions
WNeuromotor integration
ci Vertebral mobiJization
QSpecifie modalities in brace treatment
S Negrini 15
EDUCATION MEETING SATURDAY 8th of APRIL 2006
The protocol of kinesitherapic
treatment
G
QChoice and dosage of exercises
Variatiosn of the work program every 2 - 3 months
Q Execute e)(ercises on an individual base or in a small group
Q Frequency not less than 2 times 1 week
Involve and awaken the family
G
S Negrini 16
EDUCATION MEETINGSATURDAY 8thof APRIL 2006
Q Determine the action and the localization of auto-correction
QAuto-correction must be associated to ail exercises
QAt the end of treatment ergonomy lesson
Auto-correction didactics
G
SCOLIOSI DORSALE---- shy ----
r
S Negrini 17
EDUCATION MEETING SATURDAY8thof APRIL 2006
SCOLIOS OORSOLOMBARE
shy
SCOLIOSI OOIlSALE 011 bull LOMBARE S1I--shy
SCOLIOSI LOMBARE
il --~_-
S Negrini 18
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Scoliotic patients are not radiographs
middotSeoliotie Mtients are not ndiographs but hum beings with a vertebral deviation-
Slagnara
Metha For the physieian Cobb angle is of utmost
importance For the patient it is body deformity t hat eounts most rib hump a protruding seapula or hip We are in a situation in whieh today dodors eure the radiographie deformity but what the patient really desires is to get rid of clinieal deformity and of ensuing psyehologieal distress
CIIQItIo shDuIdtucirc lM WIld tJw~~ I~~M~~~~ J9f~
S Negrini 19
- Poznan_workshop_Physiotherapy
- physio2
- physio3pdf
- physio4
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- physio6
- physio7
- physio8
- physio9
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-
Test AdRmsa
Test Adamsa
3
Pozycje do eacutewiczen wg meody Dobosiewicl (cz 1)
4
Metoda Dobosiewicz
pozycja 1
Meota Dobosiewicz
prutwnik
Metoda Dobosiewicz
5
Zmi3ny w zakresie kllill Cobbll w wyniku Jlrowadzooej kinezyterapi i wg Dobosiewicz w grupie
progresnvoych skoliozjedl oillkowy cll - n=124 (ass obsenvncji ud 6 do 58 ntini~cy $~dD iw 197plusmnJ 185 Rlic3iqC3)
6
Zmiany w zakresie kqta rotacji osiowej kr~gu sZczytowego sknywiellia w wyniku prowadzonej kinezylerapii wg Dobosiewicz
w grupie progresywovch skoliozjednoillkowycfl - 0=124 (czas oburwRCji ad 6 do 58 mitJi~cy sndniR 197plusmn11S5 miesics)
Grupa skoiozjednoukowych typ J wg Ponsetiego - skrzywienia Th dx - leczeni kinczyterapill wg Dobosiewicz
(1174 015 ubscnvncji od 6 do 45 mieiircy s-cduin 211plusmn 111 rniesi~cn)
Zmiany w zakresie kllU CObbtr w wynlku prowadzooei kinezyluapii wg Duhosiewicz w gTUpj~
progresywnych skolioz dwulufwwycfl - 0=74 (aos obsrnvacji ad 6 do 45 micsi~y srcdnin 211 plusmn 1 1 mi~Icircqca)
DdciMk Th odcinek L
7
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sknywienia w wyniku prowadzonej kinezyterapii wg Dobosiewicz w grupie progrcsywnych skolioz dwulukowyell shy
n=74 (C7lS obserwacji ad 6 do 45 miesi~q srednia 211 plusmn 111 miesiqcR)
oddnek Th odcinek L
Grupa skoliozjednoillkowycll 0 kqcie Cobba lt 40deg - leaeni wyhCznie kinezyterapil wg Dobo~icwicz (n=44) (czas obserwacji od 5 do JI mi~ifCY ~redllia t 18plusmn604 mie-ihco)
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Grupa skoliol dWlllu koovyeh 0 kItac Cobba lt3(jl
typ IV wg Ponltetiego - skrrywienia pienvotnie podw6le - piersitJwe pFlWosrUlII i lccedildiwi()we Iwostrow
-Ieczeni wylcznie kiDezyterapi~ wg Dobosiewicz (0=10) (nli obsrrvLcjicirc od ~ do 24 miesifCY _~ n~dllia 12453 micsi~ca)
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wynosil
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8
Zmiany w zakresie k(ill rotllcji osiowej kr~gll szqytowego sfmyiellilllV wyniku prowadzonej kinezylerapii wg Dobosiewicz
w grupie progresywnvch skoliozjedllollkowycll - 0=124 (CZB5 ObSrrwRcji od 6 do 58 mielli~cy irednia 197plusmn1185 miesiqca)
Grupa skoiozjedllolukowych typ 1 wg Ponseliego - skrzywienia Th dx - leczeni kintZ) terapill wg Dobosiewicz
(11=74 aas ubscrwacji od 6 do 45 mieiIcircccedilcy srednin 211plusmnII 1 miesiJtcft)
Zmiany w zakresie kqta CoMa IV wyniku prowadzoDej kinezy tera pii wg Dobosicwiu w grupie
progresvwon h skolUgraveIl dWlllllkowych - 0=74 (ons ubs~rwacji od 6 do 45 mil3Icircccedilcy sredni3 211 plusmn 1J1 micii il cn)
Ddcil1t~ Tb oddnek L
7
Zmiany w zaknsie kIta rotacji osiowej krfgu szczytoweg() sG-z~vienin W wylliku prowaagravezonej kinezyterapii
wg Dobosicwicz w grupi~ progrzs)wnvcb skolioz dWlUcircuk()wJcll shyn=74
(cras obscnvacji od 6 do 45 miesifC)j srednio ZI I1 JI I micsilfca)
oddnek Th udciollk L
Grupa skoliozjednolukowych 0 kqcie Cobba lt 40deg - JeCJeni wyl~7ltie lunezyterapil wg Dobo~il-Wicz (n=44) (nl3 obstrwllcji od 5 do 31 mhticcedilcy sndui 1I8plusmn6U4 miesiacn)
Obs~rwowano istolm korclacj( pomiccediltlzy poziull1lll1 upmowlIniu mctody przcz chorych 1 czccedilstosti stosowilniu kine7ylerapii il wi~lklJseii rewcsji zmian w Zakrcsil kta Cob l13 i ro tacjl osiowcj kr~1u SZCzylowcgu skrzywienia - wspolczynnik PeanlOniJ wjnusil uJpowiedniu 016 i D53 -
Grupa skolioz dWlllukowych 0 kflfch Cobbf lt30 Iyp 11 wg POllsetiego - jknywienia pienvotnie podwojle
- piersimve prflwv~middottrolle i lccedildiwilJwe ltKJoslrotme -Ieezeni wyl4eznie kinzyterapi~ wg Dobosiewicz (0=10)
(nu obenvacji ad 5 do 2 mlcsiccedilcy ~r~clnil 124plusmn51 micii~cll)
Sredui k~1 Cubba na )uclltlll I~lerpi
wy nosil
w udcinku Th-17o
w odcinkll L - 170
Sn=dui kql Cubb aJu liugrave~tyIcTUpij wynosil
W odcinku Th shy 137deg Y udcinku L shy lJ20
4) 1)IIIIcirc w Jlm ~llIWiob_ l~ rlllW
JIIIIm-lollUcirciaftq jtQ0 1 t~~010
UpIJI~r~
8
9
Po 5 i 10 miesieacutecach
C- 18 R-S C-12 R-S C-S R-Q
10
Po 9 miesilcach
11
BP
Il rz
Th
Cmiddot 12
R-3
L
C-16
R-7
PoDP 7 mies 10 rz_
C-9 C-20 R-OR-2
--__ _ _----------shy
12
DP
8 ri
111 C-26 R-2
L C- 17
R-]
bull Metoda asymetrycznej trojplaszczyznowej mobilizacji kr~gostupa ma znaczeumllCV wptyw na zahamowanie progresji
w skoliozach idiopatycznych szybko post~pujqcych
bull Mobilizacja strony wkl~s~ej skrzywienia i osiowa derotacja kr~gu szczytowego zwi~ksza korektywnoseacute skolioz zmniejsza garb i ebrowy poprawia obj~toseacute klatki piersiowej i zwi~ksza wydolnoseacute oddechowq plue
13
bull Przedstawiona metoda jest
stosowana samodzielnie lub
w pO~qczeniu z ortezq Checircneau
a takie jako przygotowanie do
leczenia operacyjnego
Ocena progresywnosci w badaniu elektrofizjologicznym
odruchu z odci~zenia
i~middotmiddot ~=~-~ shy1 _--==shyocirc
14
EUT S pine J (1997) () 93-97 copy S pringer-Verl ag lY07 ORIGINAL ARTICLE
K Dobosiewicz Neurophysiological mechanism of the unloading reflex as a prognostic factor in the early stages of idiopathie adolescent scoliosis
Rcceivcd 29 M arch 1996 Revised 16 August 1996 Acccp tcd 10 Septem ber 1996
Absfract This paper presents a new nc urophy iologila1 methougrave of e valushyati ng the risk o f p rogression in ill ioshy
mo t important factors in the eva luashytion of progress ive id io pathie scolioshysis The met hod can be lIsed to deshy
pathie scoliosis in th early stages uf tll( progre jve idiopath ie scolios is the dis ase by illY middottigating tll e unshy in lhe early s tages of the d isease loading refl ex in paraspinal muscles T he high sensi livi ty of ilie method The study incl uded 394 pat ients wilh means il can be used as a basis un seo liosis and 70 hcalt y chil dre n which to take an earl y dcc ision to
K D obosicwicz Depuumll1 mel1 l of Rchabi lilu lioll Si lesilln Medical Academ y 42-604 Tamo wskie G6ry 4
Lmenty of the unloacli ng retle x and repeatabi li ty o f Ihe rcbound and silent period were anal ysed for eaeh reflex evoked Prolonged latency and
p rimiddotom1 surgery
Key words Id iopathie seoli o is Unloadi ng rcnex Re bound
Katowice Polaml minima1 numbe o f cycles are the Larency Si ent period
T he ai m of this sludy was to evaJ uate the use of the unshyIntroduction load ing Dex for octcction of prog ressive id iopath ie adoshy
le cem oIios is in its carl s tages in onl r to lake a dccishyProg ress io n of id iopatJl ic scolios is bas been the su bject of
sion ta perfo nn surgcry as soon as pussible many clin ical radiological and elecrromyographic in ve~ shy
tigalions T here is ho wellcr no sim ple quantita ti ve or qual itati ve pro noslic methoo [hat can be em ployed in the
Materials and melhodsearly ~tHges of the disease Monitoring of lhe unloading rc felx in paraspinal m llsck appcars 10 be a reliable Inv gtsi lgnlions were carricd uut 011 394 pa tie nt with adolescent method o f discriminating bctwcen diffcrcn l fomls of Cushy ~c li ed J ild 70 hCldr hy children The scoli osis group consisted of Iios is T he un loa ing re n cx can be evokcd in ail the 31 1 g irl s and 83 boys aged 9-1 8 year~ (mean age 125 ycars) The
ske lelal muscles through a suegrave den shortening of o luntary contro ls wcre 0 girl s and 10 boys aged tO-1 7 y~ar (rncan age 128 cars ) Imong Ihe stlbjeclS tudied wcre 9 patien l w ith cershyinnervated muscle l2~J When a musc le is unloaJ ed vico-thoilc i seo liosi s mean Cobb ang le 22 7deg 121 with Ihoracic
rapidly durin g an isomerric con trac tion Ihe norm al reacshy scolios is mean Cobb nngle 309deg I 1 w ith thoraco-Iurnbar seolioshylion is an eleclrically silent pe riod fo llowed by a burs t o f s is rne ~n Co bb ang le 26~g o 63 with lumbar cotlos is mean Cobb action potentials called rebmmd The pause in d ischarge ang le 279deg and 90 w ir h doubh major curve sc o Ii() ~ i s meull o bb
nng le 292deg and 28 5deg The sludy group includcd 231 right -s ided can be observed only when a certai n h reshold va lue of and 163 left-sided 5col iouumlc patien ls There were 112 patients w ith
acceJcration flnd shortening of he muscle is exceeded progress ive id iopath ie scoliosi (76 ri g hHidtd and 36 Ic 1t-s ided) an tl il occues wilh constant latcncy correspond ing to that 182 with no n-progressive idjopa thic scoliosis (1 13 ri ght- sided and of the propriocepti ve nflcx (9 18 20] T he rebound ufter 6 le rt-sided) M d 100 w ith pe lvic tilt (statie) scolios is (42 rightshy
s ided anp 58 l eft -~ i(kd )the silent period in the unloaugraveing re felx rcsul ts from ae lishySC9 1ios is is consIcircdered progressive if the Cobb Jngle inshyvalio n of a pool of motone urons aIl o f which fClt1ch lhe
creltseacutes by more lhan 6 in 1 yen r aile middotnl1 n-progrcssive if the anshyfiring thres hold simultancously afte r prcviou~ si lenœ [l nua i increase is less thll n (i The Cobb angle ranged lrom 8deg to 77deg 1 4 201 in Ihe palicnls w ilh progress ive scoliosis (mean 361 ) [rom 30 ta
lI f R (on- f Rt tt1IY 1lIfl pflla 1 )(~ r(Jnu n t shy
fI) _ ~
Pathomechanic basics of conservative treatment of progressive idiopathic scoliosIcircs
according ta Dobosiewicz method based upon radiologie evaluation
Kryslyna DobosiewlcZ Jacek Dunnala Kny ztof Czemicki Hanna Jcndf7cjek
Deparmem of Rellabtlifatoll Mediw Uninrsity ofSiltsia KatOllice Poand 40-635 Katowice fil ZiUCl 3537 POL4ND
e-mail relwbilitacjt1s11mfoctaonetpl
Abstract Conscralivc IrcalrnCnI of Idiopathie scoht)~1 espcclall y kinc ilhcrapy i ~
nOI widcly apprccilllcd due 10 Ils suspectccl low dfcCIIcircvcnc 5 in relalion [ (1 a urglcal Irc[llment ACter long-ycar il ses ment of palomcchanic f scolio icirc in Dcpanmenl of Rchnhllilallon f Mclii al Unlcrsi ly of Sile bull a concTvallvc mcthod ()f IrCtllmenl asymmclric Irunk mobili7alion in lnclly ymmelm po~itions WIS
de el ped_Thi mClh d enablc 10 delain pTogression f scol iosis or ccn de middotrca~c laIerai urvalurc of a spi ne and angle of rOlllion assummg adequate () perallon f palicnl and ilS famil)
J Introduction
Idiopathie scoliosi OS) is a thrccdimensonal dcfonnation of il vertebral col lmm an- cntire trunk Afler many years of extensive rescarchcs the cause of idiopathie coliosIcircs $ i remaIcircns unknown It is possible Ihat idiopathie scoliosis devel ps and progress on a baslS 0- ~
multifactor disorder perhaps diffcrent for curve initiation and curve progressi 11 Fion poss ible pathologie factors nervous system dysfunctIcircons affecting postural tquili brium ar proprioceptive control seem to be espc ially important [ l 2 6 JI Pro_ ression f iS could bot delermincd by vertcbrac remodeling under eccent ri c loading created by axia lly ce gravitational forces in presence of muscular imbalancc in the trunk [2 J The verte rai colwrz unde r scoliotic conditions 15 an unstable system with tcndency to fu rther tune dcvelopment fl2] Lateral bending of a vertebral column visible in X-ray examination L
only a two-dimensional prcstntation of a complex dcformity consisting of patho logica axi rota ti on torsion and othcr deformations of vertebrae [7 8 10 II 14J ln fS physiolog~ curvatures of vcrtebra l column are disturbed Total Icngth of an anterior column of a spi n~
consi ting of vertebral bodies and intcrvertebral dises bccomcs grcater lhan length of l posterior colwnn - vertebral arches and proccsses [11 15 J h is apparent that phy iologi ~
thoracic kyphosis in rcgion of a scoliotIcircC curve diminishes Each vcrtebra of a stru tu ~
urve of coliosis is oricntatcd in hypercxtcnsion in relation t adjacent vcrtcbrae [7 l resulting
1 n B Uri middota I l 11
H srut ft illtf j tI) t li orf1Hli d
IDS Prt ts 21)2
Influence of method of asymmetric trunk mobilization on shaping of a physiological
thoracic kyphosis in children and youth suffering from progressive idiopathie scoliosis
Krystyna Dobo icwicz Jacek Dunnala Hanna Jendrzejck Krzysztof Czernicki
Deparrment of Rehabilitation Medical University ofSilesia KaloKce Poand 40-635 Katowice ut Ziolowa 3537 POLAND
e-mail rehabiliracjas(u1poCmiddottaollelpl
Abslract Idiopathie scoliosis (lS) which i sub 1 ntially l threeshydimen ional derormation or a pine cau e nOl only laler l curvalurc and axial rotation of vertebral column but al lordoti allon of VCr1cbrac in structural curve eXl nsion ln an effect physiological thoracic kypho j diminishc or cvcn dbappears Method of a ymlllctric lrunk mobilisation in strictly symmetric po iljon according [ Do () lewicz not only dcteriorme progre ion of IS or evcn reduces lalera] curvalure but also significmtly rebuild physiological thoracic kyphosis Icircn cases of lS accompanicd by lraight baclc
1 Introduction
Despitc Ion year researchc etiology of IS is nOl yel resol ed Significant problem re laled lO morphology of IS apar1 from lateral bending and ax i 1 r tati n i deviation of shape of a spine in sagittal axis affecting physiologi al curvatu re of vertebral coJumn [3 5 6 8 9 J 0 1t 12 Lcngth of anLerior col umn of a pin constitutcd by venebral hafls anugrave intcrvencbral dises dominate ovcr Jength of po terier c lurnn buill from vertebral arches and processes [lOJ This condition uring scol io i progress ion and growth of a child effect in hallowing or even disappearing of phy iological Lhoracic kyphosis in scoliotic region It i well know n lhar cn~brae of structu ral Jaleral curve are positioncd in hyperextension - lordotisation [5 6] which in Lhoracic region Icad (0 reduction of kyphosi or to true lordo middotis Such kind of venebrae relation in thoracic region cau es ilS destabicirclisatIcircon whi h in u sociation with eccentricircc gfilvitali nal load fa pinc duc to muscu lar icircmbalance [21 pOdbly produces r tationaJ lordo is [56 Il] and further development of symptomatic scoHose ft ha becn proven [12J tha strengthening of the erector spinac muscle aggravates nce initialcd deform tion and deteriorates coliotic process Hyperextension and uxial rotati n a s clatcd with
357 Th B Grivas (Ed) Research inro Spinal Defoml ilis 4 lOS Press 2002
Exercise efficiency of girls with idiopathie
seoliosis based on the ventilatory anaerobie threshold
Jacek Durmala Krystyna Dobosiewicz Hanna Jendrzejek Wieslaw Pius
Department ofRehabililation Medical University ofSiiesiaa Katowice Poand 40-635 Katowice m ZioJowa 4547 POLAND
e-mail durmalaiacekyocztaonetpl Department ofPhysiology Academy ofPhysical Education Katowice Poand
Abslract The aim of the study was to estimate the exercise efficiency in the group of
girls with idiopathie scol iosis based on the venlilatory anaerobic threshold (V AT)
Material and method The investigation comprised 58 gi rls wilh idiopathie scoliosis
aged 10--6 years 32 girls (55200 ) wilh double major scolioSiS and 26 girls (448)
with single scotiosis The girls were eonservatively treated using Dobosiewiagrave
method The control group consisted of 3 1 healthy girls aged 10-1 6 years The
cxercise test was performed using eycle ergometer During the exercise the gas
exehange parameters wcre reeorded (minute expiralory venlilation minute oxygen
consumption earbon dioxide production) On the basis of recorded paramcters V AT
has been computcd using V -si ope method Results The following V AT values were
obtained in the group with scoliosis 207+305 ml 02minlkg bm in control group
219+350 ml 02minlkg bm The differences belween girls with idiopathie scoliosis
and control group were nol SLaliSlically significant Conclusions I The exercise
effieieney of girls with idiopathie scoliosis conservalively treated using Dobosiewicz
melhod is normal 2 Such high level of the exercise cfficiency of the studied group
probably was due to intensive 3-D respiratory exercises of these girls
1 Introduction
In practice there are researched useful efficiency rates which on base of laboratory tests results possible easy without using of the relatively hard or long exercise tests would give the belter forsighting of the range of homeostasis disturbances and rapidi ty of increase of
physical fatigue during varied workloads [1] The best known rate of trus kind is the maximal
minute oxygen consumption [2345] During progressive physical effort minute oxygen
consumption increases proportionally to workload The reaching of real maximal minute
oxygen consumption in time of progressive effort is iodicaled by minute oxygen consumption plateau [5 61 This result is rarely registered in children The progressive exercise test is most commonly used in children until physicaJ exhaustion and the highest registered minute
oxygen consumption is treated as maximal minute oxygen consu mption or so-called
symplomatic limited maximal minute oxygen consumption [678J Sorne authors regard
Orto-dlet Trau malaogis Roha b ilitacjaARTlKUL ORIGINALNY ORIGINAL ARTICLE Vol 5 Nr 1 2003 80-85
Jacek Durmala l Krystyna Dobosiewicz l Tomasz Kotwicki Hanna Jendrzejek 1
Katedra i Klinika Rehabilitacji Slqska Akadenia Medyczna Katowice Katedra i Klinika Ortopedii Dzieci~cej Akademia Medyczna PoznQll
Wplyw asymetrycznej mobilizacji tulowia na wartoseacute k~ta Cobba i rotacji w przypadkach skolioz idiopatycznych u dzieci i mlodzieZy
Influence ofasyn1n1etrie 111obilisation of the trunk on the Cobb angle and rotation in idiopathie seoliosisin
children and adolescents Slnwu kluce ac eJJic Cl chOlIU) Ice SKoio= idj)PO Imiddot(~I7tmiddot
K~Jmiddot w()rus consrieI ve I (OtlHelif idiopathie HUW JS
SUMlvfARY
BackgrouId The aim ofthe stldy Vas Ihe radiological evaluation ofthe treatllJent ofthe idiopathic scolioshysis utilising as)mmetric trunk mobilisation in the strict~ll I)mmetric illitial position
Material ([fJ(f lIIellOds Presented stud) lOS based IIpon J36 cases (13 oovs oged FOf11 ocirc la 6 lcars (lild
rn girls aged frum 6 la S pears) trealed due to the idiopathie sCuliosis ((rom Novell1her 999 0 F enflfUn 200) Among 48 ch idrcn sllfJering from dOlfble-major scoios is 6 cases wcre infoll scaliusis JOjuvel7lle und 22 adolescent Among 88 sillgle scoliosis 6 lere infw7t 33 juvenile and 49 adolescent
Radiological exami71ation 1as condueed always in the repeataole technical cOlldiions RadlOglOlI1 lier evaluated oy the same physician Radiologica analysis oIthe scolios is incuded value ofthe Coho al1gle ongle ofaxial rotaion
ReSIils ln double-major scoliosis observed dlring one year period in Ihe thoracic segmenl Cobb angle decreased inll l increased 1395 and in 292 Il OS 111changed Axial lolation angle in 167 (~rcascs
decreased in 354 incrcased and rernainM the sorne in 479 In Ihe llllnba segmenl Cobb ang le clccrcscucirc il1 354 increased in 39 6 remained in 5 Angle ofaxial rotation deceoscd in3 ofca es incrcuscd in 29 and persisted in 48
ln single scolio is Cobb angle decreased in 386 incrcased in 353 and in 261 was lInchonged Axiol rotarion angle in 216 ofcases deceased in 295 increased and rell1aincd the sallie in 489
CondlsioJ Asymmetrie mobilisation of the tf1f17k in strictly syl7111elric initial positions is a 1Clhod of choice in the cOl7senJalive treatment ofthe idiopathic seoiosis
STRESZCZENIE
WS~p Celem pracy jest radiologiezla ocena Icczenia skoiloz idiopaf)cznych metoda asvmetrycznejl7lOoili shyzocji tllowia w sciSe symetlyczl7ych pozycjach lV)jscio wych
M aterial i metody Przeprowadono retrospektYlIl7q analizri 136 przypadkeacuteM dzieci (13 chlopcow i 123 dziellshyczqt w wieku 6- 18 lat) z bocznym idiop atycnylll skrYll ieniem krrgoslupa leczonych zachowawczo w Klinice
1
Ortopedla TliJumatoogia RehlblllagraveeJa ARTYKUL POOL1 DOWY OPINION ARTICLE Vol 7 Nf 1 2005 49-$11
Krystyna Dobosiewicz Jacek Durmala Tomasz KotwickP
Katedra i Klinika Rehabilitacji SIAM Katowice 2 Katedra i Klinika Orlopedii Dziecircej AM Pozncrlz
Biodynamiczna metoda tr6jplaszczyznowej korekcji skolioz idiopatycznych - opis metody Biodynamic method for 3-D correction of idiopathie
scoliosis a description ofthe method
SIOWQ kluczowe leezenie zachowawcze skoliozy idiopatyczne korekeja tr6jplaszczyznowa Key words conservative treament idiopathie scoliosis 3-D correction
SUMMARY
The biodynamic method of hree-dfmensional carreeion of idiopathie scoliosis is based on Ihe palhomeshychanics of idiopathie scolioiiiii and consiss in aClive segmental three-dimensional correction ofspinal cllrshyvatlre The course of action focuses in the viciniy ofthe apical vertebra Proprioceptive facilitation is applied on Ihe concave side ofthe curvaJure and exteroceplivefacilitation on the convex side Correction likewise proshyprio- or exteroceplive facilitation is phase-oclœd with asymmetric respirarory movemenr as weil as wilh parshyticular phases of the respiratory cycle ln Ihe course ofexercises three-planar movement is generated opposite to the direction in which scoliosis Is progressing This method is in accordance with the stale ofthe art ofscoshyIiasis pathomechanics The method requires detaied training and can Ihen con be applied at home under periodic control by a physician and a physiolherapist The method con be applied in landem with a Cheneau brace as weil as in surgical pretreatment A elaUed description of Ihe method of three-dimensional scoliosis trealment will be presented in Ihis article
STRESZCZENIE
ISlofa biadynamicznej mefody Ir6jplaszczyznowej korekcji skoioz idiopatycmych oparlaj est na patomechashynice iikolioz idiopatycznych - poega ana na czynnej segmentanlej tr6jplaszczymowej korekcji skrzywienia Dzialanie koncentruj e siccedil w pobitu Icrllgll szczytowego sknywienia Stosowane iest bodicowanie propiocepshytywne po stronie wklllsej oraz eksteroceptywne po stronie wypuldej Korekcja i slosowanie bodicocircw propioshyi eksteroceprywnych zsynchronizowane j esl z asymetrycznym torem oddechowym oraz z poszczeg61nymi fazashymi oddechu W trakcie eacutewiczen powstaje odwrotny do lrierurzku rozwoju scoliozy tr6jplaszczyznowy ruch IcrFtshygoslupa Melodajesl zgodna z aktualnym stanem wiedzy na lemat patomechanizmu scoiozy nymaga szczegocircshy100-lego instniktaZu po clorym mote byeacute wykonywana w warunkach domowych Z olcresowq kontrolq przez leshycana i fizj oterapeutll Metoda mote byeacute stosowana r6wnolegle z leczeniem gorsetem korekcyjnym Cheneau a talcte w przygotowaniu do leczenia operacyjnego slcolioz W pracy przedslawiony zostal szczeg6owy apis meshytody leczenia
Skoliozy idlopatyczne stanowili znieksztalcenia patycznej rozwija siccedil poprzez przemieszczenie kr~gu tr6j~aszczyznowe charakteryzujltce siccedil wyboczeshy szczytowego w stosunku do krccedilgu g6mego j dolnego niem rotacjltt krccedilg6w klatki piersiowej i miednicy z r6wnoczesolljego rotacjl zgodnie z ruchem wskashyoraz zmianami w fizjologicznych krzywiznach kr~ z6wek zegara dia skrzywienia prawostronnego oraz goslupa w plaszczyinie slrzalkoweJ [ 123] przeciwnie do wskaz6wek zegara dIa skrzywienia leshy
Z punklu widz nia patomechaniki tr6jplaszczyshy wostronnego Koncepcja rozwoju skoliozy jako rotashyznowe znieksztalcenie krccedilgoslupa w skoliozie idio- cja i kontrotacja sugeruje ze sily korekcyjne powinshy
49
EDUCATION MEETING SATURDAY 8th of APRIL 2006
- CARDJOPULMONARY EXERCIS E
TEST IN GIRLS WITH
CONSERVA TIVEL Y TREA TED
IDIOPATHIC SCOLIOSIS
Jacek DURMALA Krystyna DOBOSIEWICZ
Department of Rehabilitation Medical University of Silesia
Katowice Poland jdurmalaqcmpl
The aim of the study was
to estimate the influence the conservative treatment (asymmetric mobilization of the trunk by Dobosiewicz) on physical efficiency in the group of girls with idiopathie scoliosis
Material
bull 87 girls with idiopathie scoliosis
aged 1 0-17 years
(mean age 135 years SO 161)
J Durmala K Dobosiewicz 1
EDUCATION MEETING SATURDAY8thof APRIL 2006
Material
bull 38 girls (437) with double major scol iosis (thoracic segment - Cobb angle 18-42deg mean 30deg SO 82 angle of axial rotation 4-32deg mean 21 deg SD 107 lumbar segment - Cobb angle 11 shy48deg mean 31deg SO 128 angle of axial rotation 5shy30deg mean 13deg SO 85)
bull 49 girls (563) with single scoliosis (Cobb angle 11-75deg mean 33deg SO 155 angle of axial rotat ion 5-30deg mean 14deg SD 83)
TIoracic kyphosis of the invesllgated group was 5-39deg mean 23deg SO 86 and lumbar lordosis 16-41middot mean 30 50 65)
Material
bull The 64 girls aged 10-17 years (m ean age 131
years SD 132) were conservat ively Ireated
using Dobosiewiczs method
bull Treatment period ranged from 5 months 10 3
years (mean 148 months SD 902)
Material The 23 girls aged 10-17 years (mean age 136 years SO 108) were treated u sing symmetric exercises - treatment period ranged from 4 months to 3 years (mean 161 months SO 1019)
bull 26 of ail g irls (18 girls earlier treated using Dobosiewiczs m ethod and 8 gi rls earlier treated using symmetric exercises) aged 10-17 years (mean age 134 years SO 108) were twice tested - at first and last day of Intensive hospital rehabilitation (asymmetnc mobllization of the trunk by Oobosiewicz) - mean hospitalization period 20 days (range 18-26 days)
i rf~8f6~~ or~~n~= ~~r~1~r~icircJ~~tb~~~~ mean 17-4 1deg meatl~(I SO 74 R n~le ofax 1 rotatIon 5-25ot mC3 111 3laquo S0 6icircl Ilnd 1 99t1S~ ~~~~I~~~~~$ruo~ras~ ~ocirc~~a~e~~~~~~~5euml1 9middotn~ tUfllbar Iord05ts 16-4 1deg mean 311 SO 68)
J Durmala K Dobosiewicz 2
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Material
The control group consisted of 77 healthy
girls aged 6-17 years (mean age 12
years SD 31)
Material
The examined girls participated in school
only in scheduled physical education
lessons and have not been enrolled in
other sporting activity
METHOD
The exercise cycle
ergometer test was
performed
J Durmala K Dobosiewicz 3
EDUCATION MEETING SATURDAY 8th of APRIL 2006
METHOD
The Incrementai exercise test has been applied
We have found that tests ln whlch the Incrementai part of the protocol ln completed between 8 -12 minutes duration glve the
bullhighest maximum VOz in normal subjects
METHOD
The workload was Increased stepwlse
bull by 10 Watt every minute - ln chlldren
with high ~ 135 cm
bull by 15 Watt every minute ln chlldren
with high gt 135 cm
METHOD
The test had been contlnued untll refusai of the patient or exceeding the pulse Ilmit
Durlng the exerclse the gas exchange parameters were recorded by Jaeger device model Oxycon Alfa uslng direct breath-byshybreath rnethod (with face mask)
J Durmala K Dobosewlcz 4
EDUCATION MEETING SATURDAY 8th of APRIL 2006
METHOD ~ ~~ r 3 min 3 min 8 - 12 min 6 min -~
_ 0 rpiYJ 0 rpm 60 rpm ~1 30 rpm
_ t o~w=att~o~~na ~~ att__~ tl~~S~~ l ad l ~~~~~r o~w= Hlcremenlal t
pedaillog i i ~
~ ilt ~I~-----tl-~ I t ~ i ~ lOSt sffortivB
lW r resututlon r rm-u middot 1 - bullA~cremen tal ~~ ~ ~ ifr- ~ VtI 1 ~i ~ tllng _
METHOD
On the basis of recorded parameters VAT
has been individually computed for each
child using V-slope method by
Wasserman
METHOD
For assesment of physical capacity
the maximal minute oxygen o
consumption (V02max) ventilatory
anaerobic threshold (VAT) and
maximal workload was used
J Durmala K Dobosiewicz 5
EDUCATION MEETING SATURDAY 8thof APRIL 2006
RESULTS
Ali girls with 18 have been classified
within normal range of predicted
values of
bull maximal minute oxygen uptake
bull VAT and
bull maximal workload
RESULTS
The differences between group of girls
treated using Dobosiewicz s method and
group of girl s treated using symmetric
exercises were statistically significant
Lower exercise efficiency of girls treated
using sym metric exercises has been
observed
RESULTS Girls wilh IS Irealed using
N=87 p value
Dobosiewlczs method N64
symmetJic oxor-ci Nz23
Perœnlage of predicled vaJue of
maximal minute oxygen uptake
98 905 0033
Percenlage of predicled value of
VAT 97 933 0049
Percenlage 01 predided value ni
maximal workload 101 939 0038
J Durmala K Dobosiewicz 6
EDUCATION MEETING SATURDAY8th of APRIL 2006
RESULTS 26 girl s twice tested - at fi rst and last day of intensive hospital rehabilitation
The value of ventilatory anaerobic threshold increased during intensive hospital rehabilitation (asymmetric mobilization of the trunk by Oobosiewicz) statistically significantly (p=00019)
2047 ml O2 minkg (SO 268)
vs 2239 ml O2 minkg (SO 232)
Conclusions
1 The exerc ise eff iciency of girls with IS treated by asymmetric exerc ises of Oobosiewicz is norm al
2 Such high level of the exercise efficiency of thIcircs group resulted fram using of Oobosiewiczs method
r
J Durmala K Dobosiewicz 7
REVIEWS
Role of physical exercise in tbe treattnent of mild idiopathie adolescent scoliosis
Revicw of th- literature
A NECRlNl N VElWNL s PARZI 1 A NEGRINJ 5 NEClU NI
P1t~silillxlrd~ Ihcrapy (or klucgtlttlwrlpyl i pro shy-tJm of physka] cXlrd-cs ipcci I(a~ (IJcloJgtcd hy l li trIWlltl phrslollwrapbt wilh tb m~ln a1mor pl shyVCnI in lhe ilAAfIVltilH1 llf the ucirccfonuity III mild IgtC )
Lil1Si bclpin~ thebm ( aocl co uaufllclilIg ils ~jd- clf IS in nlOdlJmiddotnh-culiosis Th middotalillofthi paper ito r (W
Ille Ii lc ram r 1 a-ccrulin wh kh of Ih bull Lu[Jalmlcrus Ind (Lb hili til~ CLlLt-cd br scnli()si- clluld bl pl Y nlcd or r d uccd hl phylolld LXtmiddotrdsi n Il p--to-da le knowl Uuml~l nr tIll~C aspcc[~ i ne bulled in oruer 10 dndc whclh~r 11Rf blLl adcqlmtt Ib(uuml n middotlicaJ balis fo r ora)aini l Ihe US4~ of lUgravellgtitlerap) wltcllj(r or fln l th e prtl1iœ of kimiddot ~lre IUlll poNjn~ a t iil ies ~bould h allowtcI II uuml middot c enliaI toltlentlf)wh k lu alClor ie - lf pl lr~kiJl -c rmiddot d gtlt- (Ic rnnhi UzJ( inn ni (t hl HrJltlon [ rtn~hcll iJl ~ or 1i1J(IChIumlJlJt etc) Sh llU Ld be TolullllCcluse ulemiddot l onld b- clclIimcntalancl wukh sho ll ld he IJlI-n~ifl~d I~~a l lhc (o uld h 11lfu 1 Know k dg CJnc1in t (wIn SeiCIImiddot Hlk rCS([lflt h daw ccordinll to Ih bull llVit w o f tIlt iii 111 1( plop(lsltd in (h i papcr lmiddotonllmJ l lnl plLyi 11 cxcr(j$( pn (nti or (tmiddotduce dhlblli t ic 1 ~lt Il Jj ll(k pl ti Jlt fadl j w(~ the nlIIIrl li7alinn n f poMural dd shylitS tu p n xJ llc aSl COIlMqnen c(middot 1 all )llal) or r(tn~ shys i middot middotlIrve Tilt u~c (I f appn1priattmiddot kincsiuuml wrlpy 0 in rcns polttllcal swhiIHy Icirc IIHmiddotorc Illta ll y (0 r 1(lt1 lllho UAh mon ltlccurlltc 1Ut dl1alkd -rLk l(lWfils 111111 )11 h Jlccdt(
11) wurcJlt 0 lit)-IcircS (Iumpy - x rcLs P()lun
n rllt lT(ltnklf u f COll1tlK H (rtd) I 1i plfho l og l ~$I rUlglng tr m low tmiddot k Pl 1l1 to IdiOpath ie SCUIshy
Submitt(oJ [or PUhltCl l1 011 uly Tt 2001 Acc~pttJ ugu - ~2 1(t-1l
Addre rltj-xlfll telt~I(middotb If) - grinl Flt(1(bziurllt r )(m Ofl ()(Cl1I shy Lt middotqlltœlll ro () - 1u I4t agravehLIlKil ta IYIL-lTt ilSllltp lfllmiddot ~ 1l1uumldull
CelII ~ (niiOS I I~ middot ann (1) IfUh middot lIlfU di louhilll(tymi ( Nlmiddot ~iI rli -ilIIUmiddotltlfl
Nlti(ir 1( ) il r() (ltbullagt1
lt vLL_ l IiII no 1ftfI
jS ) we are a IUil ly tJc ing n1n) ltblll lS 1 k l1 b ~J)w in~ tl~ t S Jfll l approad llt - l1n til hy on ielshyertd ~tan lard ugraveJuld ln m any ~1~ he lI ~t les i if Ilot dange r )ll lt rhlS is lrut of reil l lnw 1gtlt1lt1 pa in l ~ or 5urgi c ll lrea lmltnl5 in dbc r lmiddot ll Sc - 2
ln tlle cj-e ut ~ t lll(tlWtl i( li p l ll1JC luuml- I ~ middottnl ~() shyliosis phys cal ((_lt1(( is emr1uved ltI t()fIl1 0 lh~rtrv
lo ly in cel1l in L)lllllde (nluumlnlr in tilt Lltlll middotorkl i e Iw l) r llt t Srain hUI IIgt() 111 Gert11lny 5- 1~1 in other reg lOl1 wbere thi I-incl qf tre l tm e rll 1 p~ 1 pmiddot t 1( cI il Jws Ixen cri ri cilld md rel -cltd Lw m~lI1 1 11 Jlu~ Fue Fnlny r ~lrs thio middot15 a lsgt(ru( f ~rth r -~ltc rrJtf))~ ll t vit11 br1Cltcgt b r II1 ([C Llt n ClW grmvlng 1lt1 0 L Sti g
gcsti n the lIsefulnes- u r Ih is form o t treatm n t 1
Hmiddotu]rs have nerged jn El or uf pll y~ iLd eegraverdse eacute 00[ 1 but tlw are nUl yel 11 11 t llu i vIC~11 and r hi ~
f rm of trt ~ltmenr IS stiJ l Ul1 ckf ckhate FfI t Jt 111 il i 11t (eltary td 1I iFy 11umbtr ot
b l sic COI ceP rlJ lf w ill he cIh tt d in t hi pap r
Scollosis
DCijIrI iriolls
ScnUoSlS is Irlircc c1 lme nsIcircltnal (I(gt i l cj on ot tht spinc thar cau C a CU 1 lh lt ca n h e $ t~en ln (1 me1Sshy
ured ultinF Coh) lll ltllCXI o n HI anreu middot p rtc rilt r
EUJlOI -1 lœDICOPHYSlc~ IR
NECRI Nl
110
f)i)
1 7J
amp aS g 5li - 0 v
V
31
10
(1 1) Il 15
-tc i ytjtr~)
FigJ----jllph ot DlI w l-lkaupegraverel) The agloimvltltinn Or idio r lrhlc 50gt1iflll~ IS rpiJ bel~ en th e- [l0 IH P (l)ltg tnntll lol (JI PUllcmiddotny) mtl 1 ( f( lS-er sigll paiilivltecirc lt Dlt(i I1 11illg r the iti l 1Kgt n n t rll icirclicH a ) 111lt m omal prebulled the mno rche md ociks with lll I)ttlx flal gr Ih pll fl
rlcljoprdphLi 1 hl merl prestIK ~ of this curvt c10es n t autom~l ritllJy indi ate the pn$CI1(t of a defurshyTnitv (SlllKtUrd (Unel
It i~ possible tu clil1e ren tute a struCnlt t CI1tve fruIn a pogt urll 011e by identifyi og the hum]) du ring AdIlns tesr I~OQ looklng tra m beh lnd at the p atient w ho b benchng fUfward il is p -- ible ta d d~ct 1l1 eh ucirc n of o ne liidlt 0 1 the trunk usually n n the (onvex ~ jde ul tbe radiographie CUfve Ugrave1lr C Ul be mlt~I Slred lISin~
BUlln els S o liomere( 1 ~ l This h Uf1lp is du(- lO (Ile pregravegtecircn ~ of vertel ra i rolltion 1c1 Ollt tn tic f~YJ tllre o f the def trrnit tli [ c m be seen and measurc(i v ith Perddolles lb lsLometer on an amero-Ix)iferior radioshygrapb ~2
Seven ry pel cent o f li Ises a re conid 1lt 1tO be idiopa thie 1 bull ia l-nosilt in this CI$C is b exdlls i ~ n as idinpa thlc me-us t11H wc do n()[ know rJw origio of lheacute curvc [n othe] ~Ie$ it b Ix )~i ble ro ide nrify a dieak (bat CHl jusrify the c1etgtnniry slIch a rna lfo rshymar i ns I1(gtufol Ig ic~ l or genlttic cl iscas s Glnclt~r trauma etc )
[dicirc)parhk S(oliosis has been divicled ~(corcling (0
the ~Ie of tlie patient egrave1l the tiJ1ll of d~[ccli n of the condil ion into ti) ur t ypei ln fanUlc jU nik ltldolesshyccnt lnd aduh Til l m n st cnnunon (VPC IS the acloshylescegravenr o licirceacute I1IJctenzec1 hy 1 sud le l1 tggrH3l ion uuml uring the grow tll Spllrt (Hg 1)2
lhile p tu 1l sco liosi i5 Ycry lomnw n thl pre shy~Iknct ra te f r adole ent icuumlop~lthic structural CU IY~S in sch )o chilclren are 18middot20
- 10 Co bb d~grels o r m on l -lil
- 2) ~ohh dtgreclt or mort O 2~j - bull () (obb d gre -s )1 mOfeacute ()ll 2
Clin iltI [ d e isio ns lfl IXlSed 111 an lccu r~He pregshynosi which obt inccl in eJch pa ti nt mainly o n the basi of the nsidu~ll p()tlnllltl l of TH1h and the result s of 1 rh clin 1 1 ~l1d tadiogmpl i exlminashyti(ln12ll c noieq uentlya d inica ] la sifiou io n o f the ing le pHient tn -ome estent co incic1 ing w irh the
D diographic one c l n lw SLlIl1H1arizeci 1 1 folIcJ - mikl lc~ (1)(n 20 C bh de~r es - moderJt l betwlen ln md 15 ohh de~ rtes - StV re 111( gt1lt rh n ~J) )bh (kgf s
On the 1) lsis of [hi - dinic d d a lfic t i n (Vith l1l il el lrb tiOI ~ o f the ir b() und~ri e ) in Itllt l cente rS Of SCOtiO LS ITe ltlllent in the Lltin odcl (i rJ Ital lnmct md PI iJ Ugrave tre tmtnt i s plmmcd a fo lltJw 8l
- mild kineslth e (~1fw ~1Il (1 luok-ou t - Hl demte IJragravecegrave 1111101 c(~r md k i rws ithe lJpy - ~cven surgery
Physical exe rcL~e for S(ol iosis
Defi t tiOl l S
PhyS i 11 nU b lIKrlttp middot (or kines ithcIa Pl) i a p rvgrlill or plt~i Gl l (xeriltecircS ~1ci fi ( llJ y ltk ~ loped
y a -11 [ru ine 1pll yslo ther3pisr wirh th e m 10 Hllll
- pre (~ n tit1g tlc aggraaLion of the cl I )flnily in rnild bullcoUm is
- helping tlk Il ld Ct ~lOd ounter~lCtjng its skie elfects in III de rltegrave sc li sis
Tn tl1i_ feSpec1 kinesitl1ert py f JI s oliosis is tonshysider l a o on of peciticcedil training and s genecirc tltllly proposelt in sessions 0 1 4~ ro 60 minute IW) t) tour limes 1 Cee PhysiGtl exerci es can aLo ll v o ther auumlns 1S it oill he dise Issed in this plper
Ir 15 Ilot possib le to cl escribe a single progrlIT1 o r exerc ise a5 pro nrams ale USLIJUy p fgt nll ized ( ( lt
EUH PA ~illDI (DP1I YS IC~ 182
ROlL UF P l 1YSICAL lXl 1lt 1~E IN l IlE 11 ~l) IEd If IlU) l[)VP 1HI AIJ() J)~Cl~ r COl ~I NlG1W il
f)( 15 egraved ( )Il the nee L- 01 indi iuua l pJl itnts) al l l10ugh Lheacute) C l n h t 11 plicd o n a WOU p hJ~js (-1 (0 () pnients PC[ ~l ()lI r)middot lugrave reQCf lhese 1 10 grl lll frequt ml~ V IIT
hnm on in middotituk w allClthltJmiddot -Ill Jnv L l~egrave at Wc w Ht ~huw in lhis lyl peJ it i~ 111 n u -eII1 tu id e ntilv kirK itheJapturlc aims w hitl l ucircrr~spnd LO ugravelt~lil1 DUtshy
g X ir ur ph -s ici l lxtTi~l I~llhe r thln ln dj( us- indishyiJ u1 1progr-lfll
Aduumll l lxUl kisure time ~lOd h )u] Sp u lllll8 ~Ilttishy
i lt egrave~ i middotomm )Ly s iven lel mJ ing ro w hlf ~ Iuumlnsidshyer~d usdul or il lrmfu l in t1 lt rruning (lI tJw ptliJicirct ln tl1bplper Ugrave1 gent ltl l t rl ll bull p lwsiCUgrave lttG iviUes is rl ktll 10 JllI1ltlCc hOlll gtpOlt mJ kIJ1lsIcircl hc lJ l f
i ve lUen tloneumld )bo C on lv ine n dul( re Ull~ 1t~1 t s far Ilten publislt d f I~ mJ I(i noltgtithltl rgt is 11 11 a su h jel lnI deacutehate CJitk haltlt t llltit m itn ltl of l ny lorm o t p l1 ySiClI lxrcL e as a Itwr1 [ J- fo r i liopa tb il jcoJL~b un iL ()ri gin~ initial1) it WIS Ille r rOmiddotUumlK lt brgdv u f p l~lt titu gtllergt w h ) intervenecl hutll tc llcrl ll (mon as cltl HtilJ nic in terventi n man Jgt
1 t lltrJp utl t one 1 md rC j fkll l~ on rhe h sh lf som uni cOen I1v pn t I1cgts wt ldl hll ltl enl1 JI~ haLl nu na l scicnt lfic baisYmiddot HOlh tlle$( trr t peu shy to rh ~rl py tt nJecI to l~~rJ tte C Ih tk CUf -~ pnnshyclr~tll y as a f tsul t of lilo h llIzatio ll of tn imdqultdy ~u pp rt(d S pln eacute 7~ 12 to re-t1 r rI ltrl 1$ l l1C k o f WH llt~~rdl 10 I ndt~-dll()urnah tnd 11( on1 p~l per u suaJly Cl tc([ IS n prelimmtrf lll d 3 ln tt li w ay man (l rrlKpt(Hc H lf O iS Inll ph ~i C U l ~ d vi ~ cI nllog scnliotl pa t le nL~ 3gainst holll ph lca l egravexershyclc and p()rt~1
It m u st t~ n tfd [hat pllyknl txerc j~ tJe~ltm(nls t1iHer 1 lJ rd il1g r rhe rherlpcu tlC litTl~ on lllc h tJ rgt ap p lolc il l the IXlltent lncl hi im r IIIllHnt i- 1 (1(1 rI - 5lt1J lC igt tIl l ( f phJllIlllolopJ al rrea tmln ls Ihith cllffc r 1lt œQlfd- rhe m C cculc u ~t(l luI thl p al 1t n
~mc l 11i (lbE~e Tt i ~ P ~il k tlwreI[middote thll wuumlk ltlll t kin 1or ph~ i Clt1 1 lX r(j~ 1I 111~ t bc loidvd by t h~ Lo iurie IxujCJ1l al1ulhcr a dl ~IS nJI h~ iOg (1 11shygerols llugJr in racr le (wi ller d I ~fJIII ~ I ml thlls re(nl1l rn ndc(1
fn n UI cel1ll r we In(~ hccf) using 1 ) 1 1111 11 ve ) 1 (J p lw l icd ex(r(i~e (0 J ( 1I l tt i~ tlh aITt ~ l~d Ilv m ikl tru cflumiddott1 adokscltnt (cl ioj arh lC icoli is11 2)
ina the f U~ t rc-gt uJrs IefC pu b lishe - the pJ( )grd m 11lt1lt l1te n PWltllk d in fa c t deel()pnlln l~ in th t l itshy OlL1Ii in tl1 r b t ~() ycal f ha ve iclemi fiecl niO l l
m d 111 ur impl rnHm s md d i s )h ilir i (gt~ lue t idlo p lthk amp()lio -i ~ t Jll CIII he 1UO(l if Icirc 1by phyict1 egrave xert iSlgt l fe t rrncllt
l illl
111e aim of t l1JS r~l per ii tmiddot (tv iew tl1( l iterat urt to a(errl ln v llic ll of th~ impa irm 1t~ and Liit hil it il i GllIltec hy ~ o l i()gtj s -o ull he ll nt x or re middotlu celt1 Ili pl1ysical xerclse An u p-to-da te knOvkdge o f tl lt Lgtpecl-gt i necckC1 in rJeumlr) d -oek
- whetll~r there h ltl n adLtIIl ) l tht()d ical bbh fur or JqIIcirclb l l l1 Il( ) f k irt llit herlpy
- h N I)(1 ( 1 Dm tlle p r l c tIcirc(( o f Jebur tiJne )pOfung lcli v l ti ~ IIOU lci he tllf) -d o
II J U V f h 1 I11~ c~~lb li hed Ihe usefuhlLss 01 k il1 shyc ~thtrpy il i aIle dy l nsi 1([(( -r-tI Llleu i n )I11 plJt~ ut the wJrld ir ilt ecircS~nl i 1 I( id n Iv w l1i li ( 1shy
gories 0 1 pl1Vtl( 1excrClgtegt te D)bilI7it ric 1n (Ir st shylliuumlZltio f) lttlt tlgtbltn ing ni trcrccedilh ing erc) hn Id be
vnlcled he tll rhe nuld be lerrillldll1 1 md whidl s tlQu1d be inreœ jf ic(1 IJeClU~l tlley cOli lel Je LI ~ful
Ncuro1llotor impainncnts
Imv aUl llOr~ 11 lt1lt ~tlKlteJ lhe cltlndatiotl bd Ween tl UC1UmiddotIt t l ol(~C t nt id iopml je -nll ~J~ and cli~l l shyler~ lr 1tH lest ihuLIr yt 1 _ 13 ~ 311 D uhoussct 1
1-- ITS tln l ldiopath k s(o lio-L L cll -c d l J l hmgt in th terl tltr f prop li l l pu n md 1I1ar th e detrshyn Hi n i~ na tural 1 ~ronse to ril e need tu ts tu re p()tun ltlluilib riu Ul HcrmJJ1 31~ 11 () d tllat icliupathic ( liCl5j h l it re5u lt Ot1 rw nltuf mot r l ~ltelV
[Id )fcl 3 nI] ~1ltJ U Sr1lle nr to dtorders in centJtI lO~Cl shyIOIDNur) md 1xi~tI moro (Ul1lfOl syt( llI (Fig _l
N htIll -of) H1c S uumll h( rll1 ( ~ l( w ing JI t11 (oshyI-ie on the l l lO]ugy o b doll (nt Rl iu]icirc tlili- middot()lioL m unt fil t-hltll rhl ugravedcmnilV L th e fl5 ult o f 1 (k btcl 11lIFll llI ion nf som t11(WUgravetltnl md pO~ lur( (tnic l~ l licirc1 tl1lt if l p OgtlbJt b C 1l rlw sta l i lin 0f 11 1 Sf llle j lt g )tx l Tt) ohtil n a ))Cli U 1ILzltl I o f p ~llIr~il d l~flo [ in l1litkd ~J)llnSIS me CI Igt(middotqucnr J ~ a ~tmicirc ()nlly or regle Ie Llive
Ali th- 11yp ) tlw~es rd ~lte tr d irtl Itn t pnl1tlt o f [11 v hole ~piltm It11[ controls postu re ~nd mrw shyment lrre pell ic of tlh po int a d lI~ llv inH llYegraved il i ~ ll 1 nnable tCl aSUilll ri 1l tr l ll1 lo g thi ~ys ttm ( Qu it le 1I middoteli tl
lt ch ugt nlt~(S f rullliIl thil i nlomwtion th at p tlmiddot shyiCil J(tl iIies nw gt Il lInport~n t rr le to pbv [11Icircgt role ca n 1)lt slI i11l1lariztd ln lWO the ptu li ain Llt
- d elopmll1 l of p uumlltl St1 b Hlt ) - c1e veuml IOpm 1)[ o f bhll1ltc _
(k llhUl)lOr S Cll orr
ontrot oic whan-lt
------+ 1 ~ il lnll ugrave r AINnl
Cllnlr1
T bflt~ r
fltL1 tlli
lMini
l
~sary ~J-frlllen i )f
~ 1 ocirctnl
~UcirclllIJJlW Ll
AXl ~l1 n uumll l) r sy 5t ~nl
middoticoltoq ~ Fig 2-AcFgtrdong lU He-mutl 21 il is Fi)5~ ib1e rD prolXgtSlt l -oo ie1 mnd 1 ((if ~ elio egrave middotAhltr~d l)Qdy-p ati~ I I i u d) uren ttllOn k td LO In ~ory reHTt I1 eDi tn l al ) JdrnlV~ pn)4~ e l u r~o(Ofe 0-c1 eptunl dvstil t1 ctlon sltŒ(ry icircltu nu11t ilwnt [ ~mC ~ted tl l1 ce Ill trpntlshyUumlfJJl nd IKnle~ r~dibl jtugrave)n of -I) m tlosen Ir ~ig nj tl (I1vying ln fornll1U n (lI an ereltl ~piJl e Mmor aJJ r--a t ~) n ltgtf ti lt aXljl mowr plem iHUC Wh ~fl Ille 6ubjeco m uumlntl Icircn (1oJifitd perccpfLlI l ~na l ysilt of p n)lnocepti Icircnfu rnlaquol ti desnibJOS ~n t tecr spin A IICW motor co nrro l Ira I gy t adopt resu ltin~ in the ~tr ltctltr 1 ckformh y lf IdiopathirL scollos i=i Ht lrftU1uc nltnt l ISll I1lJy h1e- ~ I pro()und elkn on bralO Sfem flJll ct i(lnn~lLhu modifyRll Ille nltulltgtshytl10 ) 1 1111 Uu l-lHoror control 5~Shnl$ shy
As Srtgn1lt1 l ~ ltlssert~ if wc l C -Cp t 111 1 un o f the G IiC s oliosls L l tisorckr oi th e ltquilibrilltn sys t ~ms it is lagical to oriegravenrate physlCl l exercis( lherap y ln th is d ir(gtCli()[1
11lclte goals Cul tl lfOUgil ditrercn t modes 01 action be Olchic(-c1 witJ1 phykal accivit ie
- po rt ive Cll ities p ro ct LJ e aIl UgravelClltrtsc in 6lte nshyel ll )o rd in~lti n pinai pr0prinup ti_)[J nLi mOVeshyment control 0 vio lls iy ln thh repect ome lCtivshylites aœ pre um~I I)y lXrter tllln ntil crs
- kinrl lira py using pedJil exerCisocirc specially developecl lith th est 1101 5 in mind illVuuml VC I lllore prccilt( ll1d InC1 li zed cri n on rhe spiJw focusing
a90
1 ~~
lg -lNheJo ~1l l1 t r~l g rld in 1 1) h i(~ IImiddot ct r rHienl w i ll idlllhic _It ~i ~ _ iri s plt ~I le II find Jit ltH vlllleuml ~l Cgtbl tn~ ks III d il fef lt p ~ lt ihnS nu v~tl middot B ~a~pt u Il C middotl)Icircd ~(t l l11 C dlfkrCnl middot- hdween slllndi1g Uline nu nllt1Xinul oorrec ri nI t chied Vith Ct (J ) und tfdincJ ne lot es o UIine 1 fo llnVs middotIJfl tfi ni( - ltlrshy
reltiK)n ~ Ikexibiliry st3nucircing - -pirte - f ur~1 1IbjISC ltupin - ltorrcaion - - r~luci()il ll ymiddot For flmpllt in J npK l1 pH k1J il
plt1SSlhlc ln obtai n 10 u1 511ndlt)l [YLo lion yr ln Slt p ille rlOlgt itlugraven om l J ~ in ( gttf(C rigtIl lIex lbuil 15 i (r-l l=22deg pol lltl ~~J IIlpraquo is IcircO~-V- I t1 l nd tucircu(Ugrave) ilil) I~ 3laquoJO- IH-12
r ln Ugravel e abilit jl of tluuml [m e llu to co ntro l irse lr in ~ pac
fuld l oftlles uumlllelve ntio ns can presum1b1r incn~~ Ih enl ac )1 the orller and lHitlll r of Ille rn - 11 )ltd h e lllldenl lu EJ3)4il
Posl1l1-t collapse lnd slabilizariotl
lIle concept u fplt st lUal c(l lJap~e l l~t Iwen detin 61 by DlI II-T3e~tupegrave rL t Ac oJdin)j tu tl1i- ~ll1thor il [ nec(sary ~- l Hn Cv-tlualing th tleihility o f a col shylo tIcircC CUJVL (0 clistingu ih bt tVeen the re du ihil [ty index (th - li iffer gt le bet ~middot Il ~I r~tcli()grJph ie ~xnmshyinltio n of the iI111 pHienr in supine po ition m(i
ROte OF Pl rnmL EŒIlCISE IN THE TREAT-ŒNT OP ~I IJD IDIOPAnnC OOU~GEm seou SIS EltJRINI
I (~)-----------------------~
__ _~ _____ _~ __ __ L ___~ ________1 ____ _ __ ____ ___ ___ _____L___ _____ l___ ----------L ______ _
1 ~
1
-- ------- --1---- ---- ]---r --- -----_----t- ---- --- ---shy__ ______~---- __ ____ 1________ __ _1_ __ ____ __shy
~ (1 J
1
8 =~~=r=middotmiddotmiddotmiddoti~=-middotl--- middotmiddotmiddotshy--------------t----------~- -------- - ------__shy
~---- --- -- -~ -------------r---- -- -- ~-- - -------- --shy----i-------r-- - ---- ~~-shy
il 1~ 0
Dtl-Lmiddot ~ lttj l r~ UIltltlHt
f g 1 -TI1 u ilictf 1ld ( ii 11- ugraveu-sh) ld IX~ O 1d wllich ltJdnrshymII Il nf the pilll 1 ~tln~1 of th e -o lioti( spinc n IG~nI(J II IIIshytt) lhe iJeuml grl-e o f ~ ()Ii ti c (u rvH Il 1 w dcpc-nlknrly o l l he 10 111shy
P01(nl (pntt l ~ 1 1 nr ffll wrJ I) ln w hilth Ihe n i 1gt( ~ duc nL~ grlphs fm I h~lt 111lt hi~hr Iht Col h ~Ilu t (l f Lite ~Ul Ihe m Ol CI il y th t s(uumlJotil middotpin~ ~111 he ~middotJg gr~lVH(~(1
m mJxiTIt corrttt ion wll iJl i~ lIllCd to Ih - xt 1shy
lti Oilil y Jf tl1lt t Ut JO rl1t cdnUc idt md p OS shy
tU ll cul lapse ( th t ltHill enct b-tten l lUdioL) 1lphic egraveltamJl1ltlti OI1 J t th e ~lme pa tient in Sl il tl cling lOJ lline fX-sitiutl ) Wll ic h correb lc- onl wil ll fhe abilt ty of lllt p tu rl l gt s tem to C( lunternct lIk luree o r grl viry )cco d ing rv D lfVd- f3egraveLIprc po st li r t1 lt01shyIlDse is d ue to the Jnus -u lar ton a nd 11ll ex rCrIshy i) i itv of rhe tissus n the ( O IW-) si it (If the (01shyjl ti (~JtVe (Fi~ 3 L Pu~t llr1 C lltpstl lu lcl l ~~ reduc l-lt by llwans o f pl1ysica l cxerCles specitkally s tuclled ruuml i rnprove tIlus--ubr fOHt md lU pr )cllI Ct 1 ~11 hi shy
lizing ffCd
PararcL n tll CIJ cl the cr iti ca l (3 c1 thlsho ld beQ ld Il ich defol1J lHU n of the i pinlt 1 e~ in~ ne dtlllontr~1t _cl (1l ll t grclrf r mg] o f rllt C II in a qa m bng pos ition corn pOil 15 t l lowcr detormashytion lhnsllold (Fig 1) ie to ~11l Ulne3Se t the risk of pr ogr t~ lu n There t rh eJef re l J ea r l)iuuml 1itshycJ l ~ll1 l l(tl a 1 tnr tg ro b ohwined by d -cr t l ~ illg ilmiddot pU~lUrll cull lpse ptJcelJtge w bich lccording t i)
h llTd tnd ~l(heJ1l ~on 1~ b inde cl 1X llt icularly luumlgh Ugravel mllcl c Iio~ i (bdow 2( 0 ) (F ig 5 J
Fin a Il III ch iS respect lllljl hl and b um l 01 m linmiddot
ii iI 1 l _ _~ _ ___I ___ ___ __L ___ _ ___ ___J______ ___ 1 ___
li 1 1 1 1 i 1
1 i ___--____---___----__-_---_~- _ _--_ ___-+----
i
1
i -- ~- -- ---~-----_-~-_-_--_1-~
l ~
i
+----r--------t-------t------f-- J
Fj~ ~-Ac(XjJlin(Q luuml T O rIcd ~lnd Na(h(ln~ n i () dl( pCG w rd (rTIshy
POO ll is hiherin cu rvegt in wh ilt l1lh ~1flILWrd cII1I Olk l1t IS le- pr(v~knt ln th e grtph Ih t PogttJlJ I ugtnq) Ot1 -J1l j elfltS-e J tlt 1l1t obb dirr remc rlLIv obu incu f roll l the Cohb atl( 0 1stlI1dtJ1g IId gtupinc rldo~raf115 Ih Ille lt) [1l1t1 (i lndnl I pine) 511pille the ~(nlClu tJ1 compo l1lnt U rlk CU Y _VeJily I~ ltx p rlt 1 L1v UpUlt (obh Illeturo Ih t si _b Cct rtJeSIm l fie -ltn J trd Ugraveltuuml shyuumlo n A~-i)rding LP 11(lt uuta o n l ( r1I~( in ~I 2JQ sup itlt curvt 1hi C(]l)b ddhccno l l f lO is -J-lultt( thc s ldnd inr tnla Ol1l t lS wi Q) whil 11) 1 1)401 ~llp lne ClHVC If ~ 1Omiddot ( tcl Lhe ttnd trl~ nlca~ I(t I ~ ~I)
tli n ll w l lllE cq lin ti spin h~ i ng mo r ~ Llnt~II) 1 tlun the nOftl111 one n Cll l gr(lk ( (cU ve tl1u n da r u p shy
po rt in o r k r 10 m linrl in tht 1xi11po tuf_ n th ha__i of th egt onideratl lr1S it f(lll() rhJt
ph rH (~Uuml e erd es ulukl h u - ul iiuml tbeacuteY ~U-L lm cl 1l (It-d o pmg p05111 td C Jl1twl lS fuumlrnll~ rly d ccrll1td ln an Ql St if i imr ol1111 t ru t(( - tht m(d in C JI shy
r t t r sture fO Ir -ngthen tlll m u ck-gt of the spint mainl) in (11erl antig r3ilrl tIcirclt l]lli fun ctin ll U hy meU15 dl i )ll1 t trk ~ lhJ cl( -ll tlt C)nlr~lUions ~llld no l IdOshy
1l)llic d YIltll1k lt l jAJ lktic t) I1 ) II 11)t 111 hd posibleacute t lcluuml ee postura l io nrro and stfh ili lllllt IJI
w i thout food T1lw(ull r d I( Lf(11 Ibk t m ucircnuin Ihe c()rf ~ct [ ()S tu re for cl gtu ifKi IH lLl1gth 0f ti l11 ~
This i-l ddl usl a typl 11 dnmnin (tf k inesllh rap) in 11 (lt-11 [[k - p~d fk lnr in lng f u l1a in llllliCk is poss ihle lI sing ctrtain Idncl fJ l (lt) 11111 liun S p Ul in tb is Cl c is ulttful ooly sa I~tr 1~ il Iw lps t1w lxltknt 1 becuJl)t 1gtlt ltlt-I a ClJu~l inred irl ilL ntllru l o~ i cll
and I1lll~lJhl r-keJc LIl [rll-llIn~ middot etlt(wrs JI the int e rmiddot vlnrion
[J ROPA MfJ) I()Wf-I YSJ IR
1
ICR 1 1-1
r
1 shy ~
- shy
11 o-llrfOlhe5l~ o t Ih 1O~(1dity i n h ~ r ~ ll nr pbl1 l of ~ Spl11 in 111011 _llti1Gt l lPt f ltlJUCWJtl ( ~l Ihe Ir t 1 1gt illbll W Ilh LtltrJ1dlion Vln lbe rigronl middotUII~ l(I Dko n12 lIll h lumshydlanie1 1 [ nul 1 M hl whtrc M - gt) lnIUI1g 111laquo111laquo1 1 1 c rtJCshytjC~ f fce d -d Lill l1~ o f enr niI pUll spnmcl1y 1~ 111 mldlll1lt (n the fl1ur t 1 = tor~ of f(ward Ileuuml l = ughtel1lng fmiddotr p 1shynOf stn lClU= Alaquo rdtllg 1raquo Ihl~ - lin hull th l1ltgtllugrave ot tller1l lUr~Jtllrc F the ~pin t -ilh rlu1i tf Ihl 1 1Ibulll n lrlt InltT1 1
rbc prJI 3IJi l1ty d qrlOIJ~ n bull JI t IlJIII Hm lA the v=ltd gtc e lu-ing J 5lnK1ura i ltfnnity
Dioal e ch anicll itllp~lir J11 c nt
Ihrcemiddotdimcllgtional mc-cbal1in of the s pioc
~f Ikmiddot i t i nly l(œ ntly tlHr llk pr-5tnœ or nc ushy1 lnlo tnr impairment in Idiopttlllc s-ol ii IXl tknt liuml J$ heen h i- ll licircghlcJ hy re$eJ rh tll e preit ilegravee h inm b nIcirc Ji d lJutg~ lt hl ~ 1 ng t o n dO Ulll urcel 1 i5 (l lreldv well umlersrood H(j-ev~r nev lbt un h iomcrhankal im l) ion nI h1c rectm ly onk l n tIlt tre and p r~dou in f n rmtinn hou t pl1ykd (~fcl5( in t 11 0 tl1I _ltgt pbne of spact 1115 Im trqlt-u 1rom J i-[) v ing unclcrsrmdlng ot th l lmc -dim nshy~ilnl l l11 ~ hmk f the cO]jO[lC pln( ~2middot ) ) Ve- w ill )iI xnl t l1 d at lcL-orcltng tUl cl sif iol t lOn blsed o n gtolllt lricd h uumlCJ ) p lane
- b() rJzU[1tl ln th i pla n ~ th t 1o rm ll sp ine present no CUlye- w ll ile Uumll(~ ltc U Hic spLnc clevelops one of ir haracterls(Icircc deFo rm tiCs v elt tbrd ln lashytio n vh icl1 pJ()VcA~ theacute hw 11
- lgitltl in th llulJe U l(~ nonmll spIcirclle pl SenL kypl lOSis ~nd l dooi~ in tb lXI1 lhese [(Hu rts Vere m)( til ught [ 0 he relattd tlle scolkJtlc ( lI r Vegrave
- front l in hi pleme tht ncrmal p ine preseuron t no curYegrave whil thl ~11li tic p in ugravetI I ()~ icircl~ charshyad t Ilt I CU1C
Il Jri fJIIt palic
~l+I~na ra 3 r inr lut th l[ ber ll1d a œl1~lU1 degr 1
l f r()la tJo u lllu (lILa r forcKl ltxert ltJn tl ldefnmuumlng 1 tkllJ [J i1u a re- lhlt tll cly 11 [1 1 UI b y Olm ner w bn ~lh uiJwd tl egrave ro t1tic) l1 Ilm it ti lt p ica] lf shy
rhrl r() be (P (the Uma bevond Wl1iltJl th lCOJlb of [11( ~pmaJ musd ~ dthc COnCIt and nm ex ~l le btconk (t O li~[)
r ~l 18 ~1Il N lu t( ren i9 lun lu ted rlseurlt h in tlt ) tilt lULodeumlformipg1 tlo n ot tIH_ sc laquoJrle rh ox ercallkren lk 1l1~H li d11r once thl Il i ~ r tld1t5 [he lhrth ld f 111 JlIcirc lIi of tlle dnrlclc hurnp tlk
lI bslt Il l nt rlet()rlll lIcircon 01 the it l ()I~ C ( (ylm der (- sustalnecl by an H1tmi cforming aCOOIl
J1Ji h V hl rhyiical f~ f Ise CI 01 h spr n llnd kin middot ith ccedilrapJ my lX damlg ing vll e n l pplild as flle
igt Jk Iller ln SCC1IJ ~IS lllc lJ fxceed l auto in middot crca~ i n g lhrllgthuld [1 sh (~u Id ahn be j ofed that Ilw relscd pre sun 1l1111i insiugrave l fe pil1r inn) 1 mlshylt
- j Il- ( w atff 1 (nh ~1l 1(e Il10 utoldrml ng li1eCh~lI1 1sm
in flc l Geyer ~w tcd th1 t rm m 1 hI l)1ecircch1O lla1 puilll 0 l I C~ sw m mim t Ieuroamp no purpo t for cu lshyim le pllilt t1 s (weumlO middott r it is l~Jl(gtWl1 rhn in iculio r[ paULnl -iJl11T1ill~ doe_gt nor Il ~lp to i ncrt~SL n eur(1shym tor co mfU
(1irai p an (
Jerdnn lle 11 showecl thal ill CSl~ o f t10rLC IC 1i lUgrave
tllo lacolulllhil it lio_1 tlle cte tI llmiry in (he lg itt1 p lln t rn lnlftot il~ lf tspe iuUy in tlw initi 11 r luleuml )f cV IU[Icircon nf Ile ~oli ls W iU l 1 p(t)gr~s~ivlt il10middot~ shy
ment roward hvpok pho b G ll f ill~l Im lins l har dUflng (IN eWllLlfiu1 of 11Imh] co luumlgt i the l in t ot t l H~ gClyty Cegraven te l - 0 1 v llebed lxxli 5 r ro ject 1 seH fl r t side-ys and tlwn backlrcl bull thu~ p(0(1 lj n g a kyphQtlmg aet Il ln (h~ lu mhnr --PIl1 COftj tng
l l i tc Iugrave l lltl l( l rs1 tif s L -etllgt il l the lgirl11
1 Hl)
Ilu LE nI rIIY~Ic~L lXIlKISI 1 HI E TREhTMEtn OP JIU IDIOP llII C AD O USCUH O Ll Œl15 NEGR II
lLill tegt lre lenl1 ~I d ~fo rll1J[ ~ rhl recrSes the phyltiologiGII cmns of lh vine)
Accordlng () Dicion ~2 1 rtcluctio fl in the itgitttl CUIYtS combin l vi th a lueral Iviari n llltl ds t 1
mecban ism () ugravel~ta il ity in l he r rat r IllI1e which bVOf1i the unsd a nd i ncrea~e 0 1 co hlt1is (Fig 6 hiIf md Pl11jlbiJ Jl1eanwlt ile lt(udiecl lh e srnl ru t
orzyglpophySLs show ing t11 al ttleir 1I1tl rnic tl orienshytation f~I (jLi l~ltes aXIal ve rtegravebJl l rotllio ll in cun litluns lt f dorsal hypokrrhn Icirc tnd lum)H de i L lo IS
Tll t dat SLlgge 1 th t impOrfill ut pOitu res and l1lweil1 ) t Mudied in ord t r (CI mlIuml ntrlin or to reuwer fll e p llyslo lo~lCll ClIlye in lIe SlgJtta p lU)l Wlth the llm o t ch ~ kin~ rutltor in l~ bili ry7 AbC th ~e ~k-
1l11nL ~Irt del lnt [0 J jUc lt ftber l]kuti inrervenl ion vhich 1c)LJ k l IV - i(l ~ l compktl n l ililll on Il t c1 l shy-jel1 J11UVllT1ent IJ j o f 1uto-dOneacute(3tlon ( i e a -impk ld ion ) Iengtheni ng o f the pilleacute 011 a litlltl l aXl~ tll lt ((IT liJlI~rcdu e~ t lle ~---lJ linti- l lte ml-fkxj(l n h UI 11 - i llCrl I~t the plllH ](JgicJI dlt cr ~l S ( (1 k-yvllCiSh lIld O(ltOSh l o r c lch r1Iif n t a Ilew til(~ecirc dUuml llt Ilshy
si lflltl J ll1 u(~nlent iam ecl - 1l1t0- lIrfe rionmiddot7 4 llmshyp oed f Je-rura l iUIl cl middot-t1e- iltm lI1d ll1a intltnUlLe )( 5lg it d C Uf (gtS slig lll thltJrc i ypI1 tiZ) tIcircOI1 a nd lunugrave)ar 1()fdos i7~llion) sholild he esw b lb]HU 00 lb co
hl b oi hi p~l11il uU r -1Ir vlt Abo 111( e IlltUtl Chl lie o f purti n - a U vitk slJ1ultI h e )tuumlll ecl 1)] (1 n ldershy](ion r tl1i lt type for e upIe IilJ llyl)T S of repd shyiti( ml vemen prt n t in agonistK h)lnllltlSlks nI iIle kind f dlJ1ce C( uld he ([([r imentd
FmiddotO lllaljlallC and mobili ty of the SpIcircIlC
1 rd llo U 22 d L lm nrrare d lhlt in Illt fro nt a l pll ne
tilt 1 nge Clt 1)1lt vtment of tht scplit[i middot CU IY grcmr lIJ l il ~ d irectio n n f Lhe C ITelt tlO n tha n in tl le di re shyLion of pmgressi n l Fig 7 ) he IL o IS5err lJd tbat th15 mohiliry increac plrtil u la rly n apic [ cgcoeilts 1$ lh ~ ~c() li osb evolves Sragrm rJ 12 J ~ thus rigilt (0
VlI f n rller~p is ts Ilo t t) m o b uumliz - a sCtJl iu til curve w ilhout t [ uling ttwt tlle R lu tiOI o i til t ~a mt b fnlinruumln( 1hy l1tans o f ~I passic 01 1 rivE -uppnrt On tilt (ltllE r hand UgraveK d e iJlioJ1 in ease durill tlw tune 111 whicll tll C spmt i ~ not submjtrcd to correeshy( IV anl()n
j- Virh mi lei ol i b tlllt Upp i1n ill) lC tiol is d eveloped only lllmugil llClIf()mu$Cllbr f r llce thi ~
InegravelIl ~ thclcfo re tl1l[ inu eascgtt sp1J1all1extl)iity mua
11
Imiddotiumltgt 7-rurd illt Ir) 1 bull rdrilt I1 1 in tl lt frOlllll pbnlt- th( illl ge )r mOC llIeJlI o t the S-o UIIJC CUNe 1 supcrior in Ihlt diflt(l im ugrave( the n nKlIl thd n ll1 tllc dlrtcLion o f p rJ1(l( (llIl
be considrCtJ vntrl iJ)(l icltion and 1 undrli neocirc ab L a ~ubiljz~ILion 01 tilt spint pllss il)1y ohtl ll1td thrltJugll the stlengtlkl11ng o f the 1rltJgm vlt nonil lme shyCIC 111 illli orrant u bjcLliH- ln rhis r~f1 n sp u lllni lc tivitIumlLs sil uld lX tPI 10 dlegraveltl it l G lU t n w l1ik luring kine i Icircth lrr phyltical eXegraverci c~ tllat in ele
spinal m ot ilIcirclY sil nid 1e lt1 oid cdrt ~
Organ ie and psychologieal impainncuts and li islbi IiI le
A cgtI im lc pmi nr is moriOthl11 just 1 sp in and 1
compkt gt Ipp rnach to the gu in ad 1 ont i al~ shylute l e~se i t i11
[)a la 0 11[ [n ell lrom re semh pw tbat ome organi Iilnctiond cl fki ts suc]) as tlw clecrtiUe ut vild l tnd d fun ll l)Kity_orld ldly incrtJ k whil~ 0 shy[io s i -till in (1 miel q g of g JltlV ity ~ l ilI e 55 rtI lit
tllL pres e n ce )fl defidt Or Vi l~il Clp~1 - i~ ln one pIIiem in Ihr l ftectecl by 20 ICl 40 scoi stgt l ls~a r(h cunclutecl in tbe UA by Di Ruce- prod uegraveed an aaalo) u ll1lXimum 102 re u t in a group of Jd shyk 1ien t [(h sco llosls rang inF frum ) [0 1
Al10ther rudv bv rallt r m C chr111 lilcl NashycWrl1s( u 57 stlO eltt hil $(C 1 1 ui~ Ica js l( lllt cl (1 shy1prUlllI o f t1tgl lie bJd l imI in ~ul sct t1 t ltu b middot iects jlLltr l5 they are golng through ~I cltlici[e sllge in the fnm 1lt i n 01 tlWH o w n id uHitv t factor hit h Illy jeopmlize the cl velopme lit d ~ mIll lt lI1d htIshym cecl IWI sonalitr in Klulrhood
n RUI ~IEDl(( Ptl Y1-
ROU ltHmiddot PI [ I C~ 1 EXIRCIS]~ IN TI Il nW~JUNT OF SlllO lDIOP1HIC AI)C~ESΠ11 C(gt1[Oi 1S
This i why b IiCieacute ii is ~n imporrlIl t for p rcshyvegraveml e 1tLsr l tn en ou flge 1ari e nrs ~lfrecr(d by lIillcl middotu iosis ft) tlke p~l rt in portin -re rcatioluJ acrivitits Iha t 1eIU 10 L10 th r~1chophyinLl bull nd b~l )i 1l1o tur adlieem t n li 51Jmiddot2Even tlK)ugli [Dr bic mech~lnshy
ical mcl nellIUll10t 11 11 reltl ~ons lt r111 1gtomcrimes be l lefu l to ugg( ~t ne p rt in~ aCt iv ity r l h (gtr rll n anotlJer e th ink Ibal an exces~ ive IlHd icalizltion - Icirce l ll1posilion br plry~ilt i HlS nnejlor parents uf rh ry pe of po rt to lx p m lice 1 b Ule p 1Ucirc(Il L th1[ preshydLl ck l1 is fret clOice in lh ma tt r - -h II ll1 he avolc1ed wb 11 possLhle mainly for tlle i mport~ltll psyshyLb ) jogka l fe a SI)nS W( ha( ill ~ t nltntionegraved
Conclu ion
lbh ISsertegrave d t1H physkal tgtXtlci o is ) n fi ial whlIl practinu in order 10 ilnj rove the I11 llde
rœ nwh and tono C iral caplCiry and postu re o f the StOUO(I ~lIbj n II I nowkdge om ~ middotmg trom ci el1shyrlfi rls(~ Jrc li dJlJ accordl ng r the review 01 thE litshytirlture prnpo )td in t lli plpl r conflrm~ Ihe vuiclit ot th e -t ls ~rti ()ns
In l do l (ent Id iopl1il iC scoliuse il l n phee u i cl vk)pm e n t ( li tll iumlKh eXCC cl l g i en rhk thr hokl th e re i5 an und ubred need fn r l pprnpri 1tegrave (JJ1tOkJJe ~Ild Inr surgict1 therapics ill ortler 1) S l i p
the ( - Iuli on anugrave )JT~t~t UW ~pilll l dtlormities bull evshyerthtless in the illiti ~ll pl l~sC t ttlC c1iseLltc whcn the riS( r1 r euro )luli m is rtduced ocirc ~md tfle uifleal JOld threshold il ~ld flle po stural collai i reJcenw~ 43
JI l1 igh pllysicaJ egravexe rc ise - p revenc or r d llCe d i ~lh ilir ies o f [Iw ~ l() li )tic
p (iems R 28 J -6 5- 6 1 63
- f~KiHtare lh ( n utr ali711iCUl of postu m l d elicits tn produCel1 a coneql l nce J [)ti 0 I111)( or regre si -u lmiddotc 5middot Il 1 17 ~ M
-re 51udles U ~ n Ledecl tu con[mn or re jecr these conClLL i( 1 w l1 ich clerin-d frum 1l1 lIldytica l rcltw n f th e liter~iture appear r- ~Lo nlble Hnwecr Intil ne re ull are 31Iable wc should n r prevent our sroliotic patientmiddot trom tl ki ll p lt in s(loI1ing jshy
ir its pW1iada rly ltl t ~d1()o t () n til t c ntrHY -vith the l xcclrinn 01 gt[1 )11lt tIlat in rea-e t)1obility (tnU evc n thell oilly wh n progr~lgtion b p OSSibl) -uc h ~I( ucircvshyiUe -11 )ulu hl tIKoll w g ed The 11 S J ( rprOpriue kin (~irhe r~l Piuml to incr _~asc p()~tura l $llbil i ty is tl1egraveoretshyic tlly CiJUClt alttloughl more ~Iccu rtte aod deLli led ri k benefi rs anJlr~ is is netot1ed
Ria 1111tO
NIokl Mu d lle ftitYljJfu Jœl il 4IWr10UOifll S (JIvs i (1~1)Jshylidl ttno( cclIll le 11(11(1lt1 RCI fu lle ((lia LltfIt l1 I1I1i(i
LJ ci n s j(r3 pigt egrave li n IHUgru lkl di t rdz t fi sici pe e ft shytUlKm iluppno di un lisimerap15Ll rl lllcflt() 1 110 scopo di pnevirlt () fr en~lI 1-lgpwlllltnlcgt dclld lclonnitugrave o e il 5LOshy
Il i mi llon lt fH nugrave j (1 11ni dei co~e 1 lteIl I1J J nd ne ~Ii eifclti (()Tc rri udk s co lio si d i m e dia g rt iuuml ln que~ltlt
s rud i 30 llizzb mo i d ti cleU ric lca pel n ri Icare qJJ l lm 1 dis(imucirc x u le I[~ l z j-m i pro vna le da lla C gtl k A i json ere pr middote-nute () rk kl ducirc un~l rdeguCltl d nil cra pi lt di uJoseguerrnt Cjua li 1iU110 cli nbie tti 1 rcr lJ)tIId d~ fle)-UITC
n (- -fd7Io n~lcl)
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(i OWgt1lC IC PiClT1 5 Y tuU 71tllll d lnla-lre tUll u l [ ral rlll l ltl)[i InltrlIenlO dh -Ii ltl 1[ r iJ1nL~ tk eda 1)3- ) 2 _middot1
EUROP MIDI C Pli hIC
EDUCATIONMEETING SATURDAY 8thof APRIL 2006
(iSS
SEAS02 Scientific
Exercises Approach to Scoliosis
version 2002
G
S Negrini 1
EDUCATION MEETING SATURDAY8th of APRIL 2006
Neuromotor disfunctions
Neuromuscular disfunctions
11 Postural collapse
Postural collapse
Duval-Beaupegravere
Flexibility of scoliotic curve
f---I--- I Postural element
-------1 Structural element
S Negrini 2
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Postural collapse
Duval-Beaupegravere
It is a value related to muscular tone and to flexibil ity of convex side tissues
Post ural collapse
Bunch e Patwardhan
Critical load
Load threshold beyond wh ich a spine begins buckling
JI~~Wt1lW~flfthtlJlœJtAr ~ J~It- l~l - IMS
Postu ral collapse
Bunch e Patwardhan
If a curve reduces there is an increase of the deformation threshold
~~~NW~-damaoc~IIIMf ~~ J~Iv JaJ-I7I9sect
S Negrini 3
EDUCATION MEETING SATURDAY 8th of APRIL2006
Postural collapse
Torrel e Nachemson ~
Scolioses below 20deg ~ ~ lt~
have a high ~ ~ percentage of ~ ~
~postural collapse (on u~
average 75) ~~ 2i~
CU~VE O EG~EE S WHllE SUPlti e
~laquotd~c6b ____lPffI1wtt1t~
$ww J(t ~~7 JM5
Postural collapse
Minor scolioses 7
Antigravity musc es strengthening D
Reduces postural collapse -G
Increases the critical threshold of deformation
G
Neuromotor disfunetions
Stagnara
If we admit that one of the causes of idiopathie scoliosis is a disfunction in balance systems it is logical to orientate physical exercises toward this direction
s Negrini 4
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Neuromotor disfunctions
Dubousset
Idiopathie seoliosis results fram alterations in praprioeeption centres and deformation is a natural compensation to restore postural balance
etattJtitIK ypothfQj~S ___~ own_ oJ)HQr lar 1t-1( r
Neuromotor disfunctions
Nachemson Initial idiopathie scoliosis
+ Goood spine stability
Neutralization of postural deficits
D Static curve
Neuromotor disfunctions
Therapeutic aims
c) Development of spine stability
C) Development of balance reactions
G
S Negrini 5
EDUCATION MEETING SATURDAY 8thof APRIL 2006
Biomechanical disfunctions
j Horizontal r-Ian
i Sagi ttal plan
Frontal plan
Frontal plan
q Frontal plan disfunetions
Fronta l plan
Perdriolle Movement magnitude
gt in the direction of lt in the direction of correction progression
S Negrini 6
EDUCATION MEETING SATURDAY8th of APRIL 2006
Frontal plan
Stagnara
Never mobilize a scoliotic curve without ensuring reduction maintenance over time otherwise a greater mobility favours scoliosis progression
Frontal plan
Ducongeacute~ research
On a group of adolescent idiopathie scolioses treated with
Meacuteziegraveres gymnastics
D After 1 year the mean angle of
curves increased from 18deg to 29deg
Frontal plan
Scoliosis without brace
D Greater spine
flexibility D-
Risk of progression
S Negrini 7
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Frontal plan
Mobilization is useful
D In preparation to
brace
D With brace
Sagittal plan
QSagittal plan disfunctions
Sagittal plan r middot _J o
Perdriolle scouos B CJ aDeformation of D
thoracic and thoraco-Iumbar curves evolves in extension
S Negrini 8
EDUCATION MEETING SATURDAY8th of APRIL 2006
Sagittal plan
Graf
The line of gravity centres in the vertebral bodies o s c oUOSt
projects itself firstly laterally and then fi
o
posteriorly lJ ~~ ~~ ~ ~~-_J-D ~nI~
Sagittal plan
Therapeutic a ims
D Maintain or
retrieve physiological curves on the sagittal plan
Horizontal plan
QHorizontal plan disfunctions
S Negnni 9
EDUCATION MEETINGSATURDAY 8th of APRIL 2006
Horizontal plan
Stagnara The forces applied ta the spi ne act in a autoshydeforming sense
Horizontal plan
Dimnet Rotation gt 200
ampII~ (
D The actions of concave and convex side
muscles become
agonistic
~ItJrOnrIIiItdllfUClltlluumlll~~tI ~1JIf1laJ
Horizontal plan
Minor scolioses never exceed these autoshy
deformation thresholds
S Negrini 10
EDUCATION MEETING SATURDAY8th of APRIL 2006
Disfunctions at a biological organic and psychological
lever
Oisfunclions at a biological organlc and psychologlcal lever
Cheng
Bane density in scoliotic teenagers is lower than in normal subjects
~~~~middotA~IIlUtIy ~7œl 1d l
Oisfunctions at a blologlcal organic and psychologicallevel
A significant reduction of vital capacity and V02max in teenagers with a medium severity scoliosis
S Negrini 11
li
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Disfunctions at a biological organic and psychologicallevel
Disorders in the development of body image that the teenager has of himherself
Disfunctions at a blologlca l organlc and psychologicallevel
Therapeutic aims
cJ Activate cardioshyrespiratory function
cJ Favour bone density increase
cJ Develop a positive image of the body
Disfunctions at il biological organi and psydlologicallevel
Stagnara
Sport
D The active side of
kinesitherapy
S Negrini 12
EDUCATION MEETING SATURDAY 8thof APRIL 2006
Disfunctions at a biological organic and psychological
level
Distunctions at a biologlcal organlc and psychologicallevel
Cheng
Bone density in scoliotic teenagers is lower than in normal subjects
~n~IIIvpWr~middotA~stWy s- XXJl M J
Disfunctions at a biological organic and psychologicallevel
A significant reduction of vital capacity and V02max in teenagers with a medium severity scoliosis
G
S Negrini 11
EDUCATIONMEETING SATURDAY 8th of APRIL 2006
Kinesitherapy on the scoliotic subject
q Postural control
q Axial stability
q Muscular trophism
q Balance
q Respiratory function
The limits of kinesitherapy
There is a threshold beyond which
rehabilitation alone is not enough
sssr
Kinesitherapy in scoliosis treatment with brace
Therapeutic aims
S Negrini 13
6
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Therapeutic aims Srace kinesitherapy
With brace
il Postural corrections and
vertebral stability are obtained by the brace
Therapeutic aims Srace kinesitherapy
In preparation to the brace
il Mobilize spine on ail plans
Therapeutic aims Srace kinesitherapy
With brace D
Maintain a normal spine elasticity
~ Maintain a good muscular toneshy
trophism
C Model the hump with kyphotizating
exercises
S Negrini 14
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Exercises and their methodologies can vary accord ing to learning and individual sensibility of the single rehabilitator that proposes the m provided that they stay within the
Iimits of fixed therapeutic objectives
li
Therapeutic modalities
(Exercises)
QAuto-correction
QRespiratory education
QErgonomie education
QMuscular strengthening
QDevelopment of balance reactions
WNeuromotor integration
ci Vertebral mobiJization
QSpecifie modalities in brace treatment
S Negrini 15
EDUCATION MEETING SATURDAY 8th of APRIL 2006
The protocol of kinesitherapic
treatment
G
QChoice and dosage of exercises
Variatiosn of the work program every 2 - 3 months
Q Execute e)(ercises on an individual base or in a small group
Q Frequency not less than 2 times 1 week
Involve and awaken the family
G
S Negrini 16
EDUCATION MEETINGSATURDAY 8thof APRIL 2006
Q Determine the action and the localization of auto-correction
QAuto-correction must be associated to ail exercises
QAt the end of treatment ergonomy lesson
Auto-correction didactics
G
SCOLIOSI DORSALE---- shy ----
r
S Negrini 17
EDUCATION MEETING SATURDAY8thof APRIL 2006
SCOLIOS OORSOLOMBARE
shy
SCOLIOSI OOIlSALE 011 bull LOMBARE S1I--shy
SCOLIOSI LOMBARE
il --~_-
S Negrini 18
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Scoliotic patients are not radiographs
middotSeoliotie Mtients are not ndiographs but hum beings with a vertebral deviation-
Slagnara
Metha For the physieian Cobb angle is of utmost
importance For the patient it is body deformity t hat eounts most rib hump a protruding seapula or hip We are in a situation in whieh today dodors eure the radiographie deformity but what the patient really desires is to get rid of clinieal deformity and of ensuing psyehologieal distress
CIIQItIo shDuIdtucirc lM WIld tJw~~ I~~M~~~~ J9f~
S Negrini 19
- Poznan_workshop_Physiotherapy
- physio2
- physio3pdf
- physio4
- physio5
- physio6
- physio7
- physio8
- physio9
- physio10
-
Pozycje do eacutewiczen wg meody Dobosiewicl (cz 1)
4
Metoda Dobosiewicz
pozycja 1
Meota Dobosiewicz
prutwnik
Metoda Dobosiewicz
5
Zmi3ny w zakresie kllill Cobbll w wyniku Jlrowadzooej kinezyterapi i wg Dobosiewicz w grupie
progresnvoych skoliozjedl oillkowy cll - n=124 (ass obsenvncji ud 6 do 58 ntini~cy $~dD iw 197plusmnJ 185 Rlic3iqC3)
6
Zmiany w zakresie kqta rotacji osiowej kr~gu sZczytowego sknywiellia w wyniku prowadzonej kinezylerapii wg Dobosiewicz
w grupie progresywovch skoliozjednoillkowycfl - 0=124 (czas oburwRCji ad 6 do 58 mitJi~cy sndniR 197plusmn11S5 miesics)
Grupa skoiozjednoukowych typ J wg Ponsetiego - skrzywienia Th dx - leczeni kinczyterapill wg Dobosiewicz
(1174 015 ubscnvncji od 6 do 45 mieiircy s-cduin 211plusmn 111 rniesi~cn)
Zmiany w zakresie kllU CObbtr w wynlku prowadzooei kinezyluapii wg Duhosiewicz w gTUpj~
progresywnych skolioz dwulufwwycfl - 0=74 (aos obsrnvacji ad 6 do 45 micsi~y srcdnin 211 plusmn 1 1 mi~Icircqca)
DdciMk Th odcinek L
7
ZcDli~ny w zakresie kla rolaei osiowe krfgu sezytowego
sknywienia w wyniku prowadzonej kinezyterapii wg Dobosiewicz w grupie progrcsywnych skolioz dwulukowyell shy
n=74 (C7lS obserwacji ad 6 do 45 miesi~q srednia 211 plusmn 111 miesiqcR)
oddnek Th odcinek L
Grupa skoliozjednoillkowycll 0 kqcie Cobba lt 40deg - leaeni wyhCznie kinezyterapil wg Dobo~icwicz (n=44) (czas obserwacji od 5 do JI mi~ifCY ~redllia t 18plusmn604 mie-ihco)
tnnl qICIiIl fMtt[ IoooI ~)I l~Illli 1IqIlt00401 IftmiddotI-I llJ
~1 1~ u)~___- uul
c- -- a-J
Obserwowmo i ~totn~l korclacjt pomittuzy POZiUllllm opilnowilnia Illctody przcz chorych i cZccedilsloscj stosowaniu kjnc7ytcrapii a wiclkoscuuml rcgre~ji 7~niilnw zakrcsic kta Cubha i rutltjl OSIOWCJ krccedilgu szczytuwtgo skrz)wienia - wspOlczynnik Ptarsona wynusil Odpllwicdnio 016 i D53
Grupa skoliol dWlllu koovyeh 0 kItac Cobba lt3(jl
typ IV wg Ponltetiego - skrrywienia pienvotnie podw6le - piersitJwe pFlWosrUlII i lccedildiwi()we Iwostrow
-Ieczeni wylcznie kiDezyterapi~ wg Dobosiewicz (0=10) (nli obsrrvLcjicirc od ~ do 24 miesifCY _~ n~dllia 12453 micsi~ca)
Sndni ~~( Cobbl na pmltltu (ugraveurulJpii
wynosil
ft udcinku Th shy 179deg
W oddnku L-17deg
Srcdni )11 Cobb~ po killtylapi -rylltlsi l
W odcinku Th shy 1J7deg
W odciuku L shy 1320
JmiddotI) 1)Imiddotj ~ lIll11 i ~W --)WCcedilMtf
ClNlIltallj Nui 001
( -aItu ho
~lllj Cl F1r Wj~ omn)
8
Zmiany w zakresie k(ill rotllcji osiowej kr~gll szqytowego sfmyiellilllV wyniku prowadzonej kinezylerapii wg Dobosiewicz
w grupie progresywnvch skoliozjedllollkowycll - 0=124 (CZB5 ObSrrwRcji od 6 do 58 mielli~cy irednia 197plusmn1185 miesiqca)
Grupa skoiozjedllolukowych typ 1 wg Ponseliego - skrzywienia Th dx - leczeni kintZ) terapill wg Dobosiewicz
(11=74 aas ubscrwacji od 6 do 45 mieiIcircccedilcy srednin 211plusmnII 1 miesiJtcft)
Zmiany w zakresie kqta CoMa IV wyniku prowadzoDej kinezy tera pii wg Dobosicwiu w grupie
progresvwon h skolUgraveIl dWlllllkowych - 0=74 (ons ubs~rwacji od 6 do 45 mil3Icircccedilcy sredni3 211 plusmn 1J1 micii il cn)
Ddcil1t~ Tb oddnek L
7
Zmiany w zaknsie kIta rotacji osiowej krfgu szczytoweg() sG-z~vienin W wylliku prowaagravezonej kinezyterapii
wg Dobosicwicz w grupi~ progrzs)wnvcb skolioz dWlUcircuk()wJcll shyn=74
(cras obscnvacji od 6 do 45 miesifC)j srednio ZI I1 JI I micsilfca)
oddnek Th udciollk L
Grupa skoliozjednolukowych 0 kqcie Cobba lt 40deg - JeCJeni wyl~7ltie lunezyterapil wg Dobo~il-Wicz (n=44) (nl3 obstrwllcji od 5 do 31 mhticcedilcy sndui 1I8plusmn6U4 miesiacn)
Obs~rwowano istolm korclacj( pomiccediltlzy poziull1lll1 upmowlIniu mctody przcz chorych 1 czccedilstosti stosowilniu kine7ylerapii il wi~lklJseii rewcsji zmian w Zakrcsil kta Cob l13 i ro tacjl osiowcj kr~1u SZCzylowcgu skrzywienia - wspolczynnik PeanlOniJ wjnusil uJpowiedniu 016 i D53 -
Grupa skolioz dWlllukowych 0 kflfch Cobbf lt30 Iyp 11 wg POllsetiego - jknywienia pienvotnie podwojle
- piersimve prflwv~middottrolle i lccedildiwilJwe ltKJoslrotme -Ieezeni wyl4eznie kinzyterapi~ wg Dobosiewicz (0=10)
(nu obenvacji ad 5 do 2 mlcsiccedilcy ~r~clnil 124plusmn51 micii~cll)
Sredui k~1 Cubba na )uclltlll I~lerpi
wy nosil
w udcinku Th-17o
w odcinkll L - 170
Sn=dui kql Cubb aJu liugrave~tyIcTUpij wynosil
W odcinku Th shy 137deg Y udcinku L shy lJ20
4) 1)IIIIcirc w Jlm ~llIWiob_ l~ rlllW
JIIIIm-lollUcirciaftq jtQ0 1 t~~010
UpIJI~r~
8
9
Po 5 i 10 miesieacutecach
C- 18 R-S C-12 R-S C-S R-Q
10
Po 9 miesilcach
11
BP
Il rz
Th
Cmiddot 12
R-3
L
C-16
R-7
PoDP 7 mies 10 rz_
C-9 C-20 R-OR-2
--__ _ _----------shy
12
DP
8 ri
111 C-26 R-2
L C- 17
R-]
bull Metoda asymetrycznej trojplaszczyznowej mobilizacji kr~gostupa ma znaczeumllCV wptyw na zahamowanie progresji
w skoliozach idiopatycznych szybko post~pujqcych
bull Mobilizacja strony wkl~s~ej skrzywienia i osiowa derotacja kr~gu szczytowego zwi~ksza korektywnoseacute skolioz zmniejsza garb i ebrowy poprawia obj~toseacute klatki piersiowej i zwi~ksza wydolnoseacute oddechowq plue
13
bull Przedstawiona metoda jest
stosowana samodzielnie lub
w pO~qczeniu z ortezq Checircneau
a takie jako przygotowanie do
leczenia operacyjnego
Ocena progresywnosci w badaniu elektrofizjologicznym
odruchu z odci~zenia
i~middotmiddot ~=~-~ shy1 _--==shyocirc
14
EUT S pine J (1997) () 93-97 copy S pringer-Verl ag lY07 ORIGINAL ARTICLE
K Dobosiewicz Neurophysiological mechanism of the unloading reflex as a prognostic factor in the early stages of idiopathie adolescent scoliosis
Rcceivcd 29 M arch 1996 Revised 16 August 1996 Acccp tcd 10 Septem ber 1996
Absfract This paper presents a new nc urophy iologila1 methougrave of e valushyati ng the risk o f p rogression in ill ioshy
mo t important factors in the eva luashytion of progress ive id io pathie scolioshysis The met hod can be lIsed to deshy
pathie scoliosis in th early stages uf tll( progre jve idiopath ie scolios is the dis ase by illY middottigating tll e unshy in lhe early s tages of the d isease loading refl ex in paraspinal muscles T he high sensi livi ty of ilie method The study incl uded 394 pat ients wilh means il can be used as a basis un seo liosis and 70 hcalt y chil dre n which to take an earl y dcc ision to
K D obosicwicz Depuumll1 mel1 l of Rchabi lilu lioll Si lesilln Medical Academ y 42-604 Tamo wskie G6ry 4
Lmenty of the unloacli ng retle x and repeatabi li ty o f Ihe rcbound and silent period were anal ysed for eaeh reflex evoked Prolonged latency and
p rimiddotom1 surgery
Key words Id iopathie seoli o is Unloadi ng rcnex Re bound
Katowice Polaml minima1 numbe o f cycles are the Larency Si ent period
T he ai m of this sludy was to evaJ uate the use of the unshyIntroduction load ing Dex for octcction of prog ressive id iopath ie adoshy
le cem oIios is in its carl s tages in onl r to lake a dccishyProg ress io n of id iopatJl ic scolios is bas been the su bject of
sion ta perfo nn surgcry as soon as pussible many clin ical radiological and elecrromyographic in ve~ shy
tigalions T here is ho wellcr no sim ple quantita ti ve or qual itati ve pro noslic methoo [hat can be em ployed in the
Materials and melhodsearly ~tHges of the disease Monitoring of lhe unloading rc felx in paraspinal m llsck appcars 10 be a reliable Inv gtsi lgnlions were carricd uut 011 394 pa tie nt with adolescent method o f discriminating bctwcen diffcrcn l fomls of Cushy ~c li ed J ild 70 hCldr hy children The scoli osis group consisted of Iios is T he un loa ing re n cx can be evokcd in ail the 31 1 g irl s and 83 boys aged 9-1 8 year~ (mean age 125 ycars) The
ske lelal muscles through a suegrave den shortening of o luntary contro ls wcre 0 girl s and 10 boys aged tO-1 7 y~ar (rncan age 128 cars ) Imong Ihe stlbjeclS tudied wcre 9 patien l w ith cershyinnervated muscle l2~J When a musc le is unloaJ ed vico-thoilc i seo liosi s mean Cobb ang le 22 7deg 121 with Ihoracic
rapidly durin g an isomerric con trac tion Ihe norm al reacshy scolios is mean Cobb nngle 309deg I 1 w ith thoraco-Iurnbar seolioshylion is an eleclrically silent pe riod fo llowed by a burs t o f s is rne ~n Co bb ang le 26~g o 63 with lumbar cotlos is mean Cobb action potentials called rebmmd The pause in d ischarge ang le 279deg and 90 w ir h doubh major curve sc o Ii() ~ i s meull o bb
nng le 292deg and 28 5deg The sludy group includcd 231 right -s ided can be observed only when a certai n h reshold va lue of and 163 left-sided 5col iouumlc patien ls There were 112 patients w ith
acceJcration flnd shortening of he muscle is exceeded progress ive id iopath ie scoliosi (76 ri g hHidtd and 36 Ic 1t-s ided) an tl il occues wilh constant latcncy correspond ing to that 182 with no n-progressive idjopa thic scoliosis (1 13 ri ght- sided and of the propriocepti ve nflcx (9 18 20] T he rebound ufter 6 le rt-sided) M d 100 w ith pe lvic tilt (statie) scolios is (42 rightshy
s ided anp 58 l eft -~ i(kd )the silent period in the unloaugraveing re felx rcsul ts from ae lishySC9 1ios is is consIcircdered progressive if the Cobb Jngle inshyvalio n of a pool of motone urons aIl o f which fClt1ch lhe
creltseacutes by more lhan 6 in 1 yen r aile middotnl1 n-progrcssive if the anshyfiring thres hold simultancously afte r prcviou~ si lenœ [l nua i increase is less thll n (i The Cobb angle ranged lrom 8deg to 77deg 1 4 201 in Ihe palicnls w ilh progress ive scoliosis (mean 361 ) [rom 30 ta
lI f R (on- f Rt tt1IY 1lIfl pflla 1 )(~ r(Jnu n t shy
fI) _ ~
Pathomechanic basics of conservative treatment of progressive idiopathic scoliosIcircs
according ta Dobosiewicz method based upon radiologie evaluation
Kryslyna DobosiewlcZ Jacek Dunnala Kny ztof Czemicki Hanna Jcndf7cjek
Deparmem of Rellabtlifatoll Mediw Uninrsity ofSiltsia KatOllice Poand 40-635 Katowice fil ZiUCl 3537 POL4ND
e-mail relwbilitacjt1s11mfoctaonetpl
Abstract Conscralivc IrcalrnCnI of Idiopathie scoht)~1 espcclall y kinc ilhcrapy i ~
nOI widcly apprccilllcd due 10 Ils suspectccl low dfcCIIcircvcnc 5 in relalion [ (1 a urglcal Irc[llment ACter long-ycar il ses ment of palomcchanic f scolio icirc in Dcpanmenl of Rchnhllilallon f Mclii al Unlcrsi ly of Sile bull a concTvallvc mcthod ()f IrCtllmenl asymmclric Irunk mobili7alion in lnclly ymmelm po~itions WIS
de el ped_Thi mClh d enablc 10 delain pTogression f scol iosis or ccn de middotrca~c laIerai urvalurc of a spi ne and angle of rOlllion assummg adequate () perallon f palicnl and ilS famil)
J Introduction
Idiopathie scoliosi OS) is a thrccdimensonal dcfonnation of il vertebral col lmm an- cntire trunk Afler many years of extensive rescarchcs the cause of idiopathie coliosIcircs $ i remaIcircns unknown It is possible Ihat idiopathie scoliosis devel ps and progress on a baslS 0- ~
multifactor disorder perhaps diffcrent for curve initiation and curve progressi 11 Fion poss ible pathologie factors nervous system dysfunctIcircons affecting postural tquili brium ar proprioceptive control seem to be espc ially important [ l 2 6 JI Pro_ ression f iS could bot delermincd by vertcbrac remodeling under eccent ri c loading created by axia lly ce gravitational forces in presence of muscular imbalancc in the trunk [2 J The verte rai colwrz unde r scoliotic conditions 15 an unstable system with tcndency to fu rther tune dcvelopment fl2] Lateral bending of a vertebral column visible in X-ray examination L
only a two-dimensional prcstntation of a complex dcformity consisting of patho logica axi rota ti on torsion and othcr deformations of vertebrae [7 8 10 II 14J ln fS physiolog~ curvatures of vcrtebra l column are disturbed Total Icngth of an anterior column of a spi n~
consi ting of vertebral bodies and intcrvertebral dises bccomcs grcater lhan length of l posterior colwnn - vertebral arches and proccsses [11 15 J h is apparent that phy iologi ~
thoracic kyphosis in rcgion of a scoliotIcircC curve diminishes Each vcrtebra of a stru tu ~
urve of coliosis is oricntatcd in hypercxtcnsion in relation t adjacent vcrtcbrae [7 l resulting
1 n B Uri middota I l 11
H srut ft illtf j tI) t li orf1Hli d
IDS Prt ts 21)2
Influence of method of asymmetric trunk mobilization on shaping of a physiological
thoracic kyphosis in children and youth suffering from progressive idiopathie scoliosis
Krystyna Dobo icwicz Jacek Dunnala Hanna Jendrzejck Krzysztof Czernicki
Deparrment of Rehabilitation Medical University ofSilesia KaloKce Poand 40-635 Katowice ut Ziolowa 3537 POLAND
e-mail rehabiliracjas(u1poCmiddottaollelpl
Abslract Idiopathie scoliosis (lS) which i sub 1 ntially l threeshydimen ional derormation or a pine cau e nOl only laler l curvalurc and axial rotation of vertebral column but al lordoti allon of VCr1cbrac in structural curve eXl nsion ln an effect physiological thoracic kypho j diminishc or cvcn dbappears Method of a ymlllctric lrunk mobilisation in strictly symmetric po iljon according [ Do () lewicz not only dcteriorme progre ion of IS or evcn reduces lalera] curvalure but also significmtly rebuild physiological thoracic kyphosis Icircn cases of lS accompanicd by lraight baclc
1 Introduction
Despitc Ion year researchc etiology of IS is nOl yel resol ed Significant problem re laled lO morphology of IS apar1 from lateral bending and ax i 1 r tati n i deviation of shape of a spine in sagittal axis affecting physiologi al curvatu re of vertebral coJumn [3 5 6 8 9 J 0 1t 12 Lcngth of anLerior col umn of a pin constitutcd by venebral hafls anugrave intcrvencbral dises dominate ovcr Jength of po terier c lurnn buill from vertebral arches and processes [lOJ This condition uring scol io i progress ion and growth of a child effect in hallowing or even disappearing of phy iological Lhoracic kyphosis in scoliotic region It i well know n lhar cn~brae of structu ral Jaleral curve are positioncd in hyperextension - lordotisation [5 6] which in Lhoracic region Icad (0 reduction of kyphosi or to true lordo middotis Such kind of venebrae relation in thoracic region cau es ilS destabicirclisatIcircon whi h in u sociation with eccentricircc gfilvitali nal load fa pinc duc to muscu lar icircmbalance [21 pOdbly produces r tationaJ lordo is [56 Il] and further development of symptomatic scoHose ft ha becn proven [12J tha strengthening of the erector spinac muscle aggravates nce initialcd deform tion and deteriorates coliotic process Hyperextension and uxial rotati n a s clatcd with
357 Th B Grivas (Ed) Research inro Spinal Defoml ilis 4 lOS Press 2002
Exercise efficiency of girls with idiopathie
seoliosis based on the ventilatory anaerobie threshold
Jacek Durmala Krystyna Dobosiewicz Hanna Jendrzejek Wieslaw Pius
Department ofRehabililation Medical University ofSiiesiaa Katowice Poand 40-635 Katowice m ZioJowa 4547 POLAND
e-mail durmalaiacekyocztaonetpl Department ofPhysiology Academy ofPhysical Education Katowice Poand
Abslract The aim of the study was to estimate the exercise efficiency in the group of
girls with idiopathie scol iosis based on the venlilatory anaerobic threshold (V AT)
Material and method The investigation comprised 58 gi rls wilh idiopathie scoliosis
aged 10--6 years 32 girls (55200 ) wilh double major scolioSiS and 26 girls (448)
with single scotiosis The girls were eonservatively treated using Dobosiewiagrave
method The control group consisted of 3 1 healthy girls aged 10-1 6 years The
cxercise test was performed using eycle ergometer During the exercise the gas
exehange parameters wcre reeorded (minute expiralory venlilation minute oxygen
consumption earbon dioxide production) On the basis of recorded paramcters V AT
has been computcd using V -si ope method Results The following V AT values were
obtained in the group with scoliosis 207+305 ml 02minlkg bm in control group
219+350 ml 02minlkg bm The differences belween girls with idiopathie scoliosis
and control group were nol SLaliSlically significant Conclusions I The exercise
effieieney of girls with idiopathie scoliosis conservalively treated using Dobosiewicz
melhod is normal 2 Such high level of the exercise cfficiency of the studied group
probably was due to intensive 3-D respiratory exercises of these girls
1 Introduction
In practice there are researched useful efficiency rates which on base of laboratory tests results possible easy without using of the relatively hard or long exercise tests would give the belter forsighting of the range of homeostasis disturbances and rapidi ty of increase of
physical fatigue during varied workloads [1] The best known rate of trus kind is the maximal
minute oxygen consumption [2345] During progressive physical effort minute oxygen
consumption increases proportionally to workload The reaching of real maximal minute
oxygen consumption in time of progressive effort is iodicaled by minute oxygen consumption plateau [5 61 This result is rarely registered in children The progressive exercise test is most commonly used in children until physicaJ exhaustion and the highest registered minute
oxygen consumption is treated as maximal minute oxygen consu mption or so-called
symplomatic limited maximal minute oxygen consumption [678J Sorne authors regard
Orto-dlet Trau malaogis Roha b ilitacjaARTlKUL ORIGINALNY ORIGINAL ARTICLE Vol 5 Nr 1 2003 80-85
Jacek Durmala l Krystyna Dobosiewicz l Tomasz Kotwicki Hanna Jendrzejek 1
Katedra i Klinika Rehabilitacji Slqska Akadenia Medyczna Katowice Katedra i Klinika Ortopedii Dzieci~cej Akademia Medyczna PoznQll
Wplyw asymetrycznej mobilizacji tulowia na wartoseacute k~ta Cobba i rotacji w przypadkach skolioz idiopatycznych u dzieci i mlodzieZy
Influence ofasyn1n1etrie 111obilisation of the trunk on the Cobb angle and rotation in idiopathie seoliosisin
children and adolescents Slnwu kluce ac eJJic Cl chOlIU) Ice SKoio= idj)PO Imiddot(~I7tmiddot
K~Jmiddot w()rus consrieI ve I (OtlHelif idiopathie HUW JS
SUMlvfARY
BackgrouId The aim ofthe stldy Vas Ihe radiological evaluation ofthe treatllJent ofthe idiopathic scolioshysis utilising as)mmetric trunk mobilisation in the strict~ll I)mmetric illitial position
Material ([fJ(f lIIellOds Presented stud) lOS based IIpon J36 cases (13 oovs oged FOf11 ocirc la 6 lcars (lild
rn girls aged frum 6 la S pears) trealed due to the idiopathie sCuliosis ((rom Novell1her 999 0 F enflfUn 200) Among 48 ch idrcn sllfJering from dOlfble-major scoios is 6 cases wcre infoll scaliusis JOjuvel7lle und 22 adolescent Among 88 sillgle scoliosis 6 lere infw7t 33 juvenile and 49 adolescent
Radiological exami71ation 1as condueed always in the repeataole technical cOlldiions RadlOglOlI1 lier evaluated oy the same physician Radiologica analysis oIthe scolios is incuded value ofthe Coho al1gle ongle ofaxial rotaion
ReSIils ln double-major scoliosis observed dlring one year period in Ihe thoracic segmenl Cobb angle decreased inll l increased 1395 and in 292 Il OS 111changed Axial lolation angle in 167 (~rcascs
decreased in 354 incrcased and rernainM the sorne in 479 In Ihe llllnba segmenl Cobb ang le clccrcscucirc il1 354 increased in 39 6 remained in 5 Angle ofaxial rotation deceoscd in3 ofca es incrcuscd in 29 and persisted in 48
ln single scolio is Cobb angle decreased in 386 incrcased in 353 and in 261 was lInchonged Axiol rotarion angle in 216 ofcases deceased in 295 increased and rell1aincd the sallie in 489
CondlsioJ Asymmetrie mobilisation of the tf1f17k in strictly syl7111elric initial positions is a 1Clhod of choice in the cOl7senJalive treatment ofthe idiopathic seoiosis
STRESZCZENIE
WS~p Celem pracy jest radiologiezla ocena Icczenia skoiloz idiopaf)cznych metoda asvmetrycznejl7lOoili shyzocji tllowia w sciSe symetlyczl7ych pozycjach lV)jscio wych
M aterial i metody Przeprowadono retrospektYlIl7q analizri 136 przypadkeacuteM dzieci (13 chlopcow i 123 dziellshyczqt w wieku 6- 18 lat) z bocznym idiop atycnylll skrYll ieniem krrgoslupa leczonych zachowawczo w Klinice
1
Ortopedla TliJumatoogia RehlblllagraveeJa ARTYKUL POOL1 DOWY OPINION ARTICLE Vol 7 Nf 1 2005 49-$11
Krystyna Dobosiewicz Jacek Durmala Tomasz KotwickP
Katedra i Klinika Rehabilitacji SIAM Katowice 2 Katedra i Klinika Orlopedii Dziecircej AM Pozncrlz
Biodynamiczna metoda tr6jplaszczyznowej korekcji skolioz idiopatycznych - opis metody Biodynamic method for 3-D correction of idiopathie
scoliosis a description ofthe method
SIOWQ kluczowe leezenie zachowawcze skoliozy idiopatyczne korekeja tr6jplaszczyznowa Key words conservative treament idiopathie scoliosis 3-D correction
SUMMARY
The biodynamic method of hree-dfmensional carreeion of idiopathie scoliosis is based on Ihe palhomeshychanics of idiopathie scolioiiiii and consiss in aClive segmental three-dimensional correction ofspinal cllrshyvatlre The course of action focuses in the viciniy ofthe apical vertebra Proprioceptive facilitation is applied on Ihe concave side ofthe curvaJure and exteroceplivefacilitation on the convex side Correction likewise proshyprio- or exteroceplive facilitation is phase-oclœd with asymmetric respirarory movemenr as weil as wilh parshyticular phases of the respiratory cycle ln Ihe course ofexercises three-planar movement is generated opposite to the direction in which scoliosis Is progressing This method is in accordance with the stale ofthe art ofscoshyIiasis pathomechanics The method requires detaied training and can Ihen con be applied at home under periodic control by a physician and a physiolherapist The method con be applied in landem with a Cheneau brace as weil as in surgical pretreatment A elaUed description of Ihe method of three-dimensional scoliosis trealment will be presented in Ihis article
STRESZCZENIE
ISlofa biadynamicznej mefody Ir6jplaszczyznowej korekcji skoioz idiopatycmych oparlaj est na patomechashynice iikolioz idiopatycznych - poega ana na czynnej segmentanlej tr6jplaszczymowej korekcji skrzywienia Dzialanie koncentruj e siccedil w pobitu Icrllgll szczytowego sknywienia Stosowane iest bodicowanie propiocepshytywne po stronie wklllsej oraz eksteroceptywne po stronie wypuldej Korekcja i slosowanie bodicocircw propioshyi eksteroceprywnych zsynchronizowane j esl z asymetrycznym torem oddechowym oraz z poszczeg61nymi fazashymi oddechu W trakcie eacutewiczen powstaje odwrotny do lrierurzku rozwoju scoliozy tr6jplaszczyznowy ruch IcrFtshygoslupa Melodajesl zgodna z aktualnym stanem wiedzy na lemat patomechanizmu scoiozy nymaga szczegocircshy100-lego instniktaZu po clorym mote byeacute wykonywana w warunkach domowych Z olcresowq kontrolq przez leshycana i fizj oterapeutll Metoda mote byeacute stosowana r6wnolegle z leczeniem gorsetem korekcyjnym Cheneau a talcte w przygotowaniu do leczenia operacyjnego slcolioz W pracy przedslawiony zostal szczeg6owy apis meshytody leczenia
Skoliozy idlopatyczne stanowili znieksztalcenia patycznej rozwija siccedil poprzez przemieszczenie kr~gu tr6j~aszczyznowe charakteryzujltce siccedil wyboczeshy szczytowego w stosunku do krccedilgu g6mego j dolnego niem rotacjltt krccedilg6w klatki piersiowej i miednicy z r6wnoczesolljego rotacjl zgodnie z ruchem wskashyoraz zmianami w fizjologicznych krzywiznach kr~ z6wek zegara dia skrzywienia prawostronnego oraz goslupa w plaszczyinie slrzalkoweJ [ 123] przeciwnie do wskaz6wek zegara dIa skrzywienia leshy
Z punklu widz nia patomechaniki tr6jplaszczyshy wostronnego Koncepcja rozwoju skoliozy jako rotashyznowe znieksztalcenie krccedilgoslupa w skoliozie idio- cja i kontrotacja sugeruje ze sily korekcyjne powinshy
49
EDUCATION MEETING SATURDAY 8th of APRIL 2006
- CARDJOPULMONARY EXERCIS E
TEST IN GIRLS WITH
CONSERVA TIVEL Y TREA TED
IDIOPATHIC SCOLIOSIS
Jacek DURMALA Krystyna DOBOSIEWICZ
Department of Rehabilitation Medical University of Silesia
Katowice Poland jdurmalaqcmpl
The aim of the study was
to estimate the influence the conservative treatment (asymmetric mobilization of the trunk by Dobosiewicz) on physical efficiency in the group of girls with idiopathie scoliosis
Material
bull 87 girls with idiopathie scoliosis
aged 1 0-17 years
(mean age 135 years SO 161)
J Durmala K Dobosiewicz 1
EDUCATION MEETING SATURDAY8thof APRIL 2006
Material
bull 38 girls (437) with double major scol iosis (thoracic segment - Cobb angle 18-42deg mean 30deg SO 82 angle of axial rotation 4-32deg mean 21 deg SD 107 lumbar segment - Cobb angle 11 shy48deg mean 31deg SO 128 angle of axial rotation 5shy30deg mean 13deg SO 85)
bull 49 girls (563) with single scoliosis (Cobb angle 11-75deg mean 33deg SO 155 angle of axial rotat ion 5-30deg mean 14deg SD 83)
TIoracic kyphosis of the invesllgated group was 5-39deg mean 23deg SO 86 and lumbar lordosis 16-41middot mean 30 50 65)
Material
bull The 64 girls aged 10-17 years (m ean age 131
years SD 132) were conservat ively Ireated
using Dobosiewiczs method
bull Treatment period ranged from 5 months 10 3
years (mean 148 months SD 902)
Material The 23 girls aged 10-17 years (mean age 136 years SO 108) were treated u sing symmetric exercises - treatment period ranged from 4 months to 3 years (mean 161 months SO 1019)
bull 26 of ail g irls (18 girls earlier treated using Dobosiewiczs m ethod and 8 gi rls earlier treated using symmetric exercises) aged 10-17 years (mean age 134 years SO 108) were twice tested - at first and last day of Intensive hospital rehabilitation (asymmetnc mobllization of the trunk by Oobosiewicz) - mean hospitalization period 20 days (range 18-26 days)
i rf~8f6~~ or~~n~= ~~r~1~r~icircJ~~tb~~~~ mean 17-4 1deg meatl~(I SO 74 R n~le ofax 1 rotatIon 5-25ot mC3 111 3laquo S0 6icircl Ilnd 1 99t1S~ ~~~~I~~~~~$ruo~ras~ ~ocirc~~a~e~~~~~~~5euml1 9middotn~ tUfllbar Iord05ts 16-4 1deg mean 311 SO 68)
J Durmala K Dobosiewicz 2
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Material
The control group consisted of 77 healthy
girls aged 6-17 years (mean age 12
years SD 31)
Material
The examined girls participated in school
only in scheduled physical education
lessons and have not been enrolled in
other sporting activity
METHOD
The exercise cycle
ergometer test was
performed
J Durmala K Dobosiewicz 3
EDUCATION MEETING SATURDAY 8th of APRIL 2006
METHOD
The Incrementai exercise test has been applied
We have found that tests ln whlch the Incrementai part of the protocol ln completed between 8 -12 minutes duration glve the
bullhighest maximum VOz in normal subjects
METHOD
The workload was Increased stepwlse
bull by 10 Watt every minute - ln chlldren
with high ~ 135 cm
bull by 15 Watt every minute ln chlldren
with high gt 135 cm
METHOD
The test had been contlnued untll refusai of the patient or exceeding the pulse Ilmit
Durlng the exerclse the gas exchange parameters were recorded by Jaeger device model Oxycon Alfa uslng direct breath-byshybreath rnethod (with face mask)
J Durmala K Dobosewlcz 4
EDUCATION MEETING SATURDAY 8th of APRIL 2006
METHOD ~ ~~ r 3 min 3 min 8 - 12 min 6 min -~
_ 0 rpiYJ 0 rpm 60 rpm ~1 30 rpm
_ t o~w=att~o~~na ~~ att__~ tl~~S~~ l ad l ~~~~~r o~w= Hlcremenlal t
pedaillog i i ~
~ ilt ~I~-----tl-~ I t ~ i ~ lOSt sffortivB
lW r resututlon r rm-u middot 1 - bullA~cremen tal ~~ ~ ~ ifr- ~ VtI 1 ~i ~ tllng _
METHOD
On the basis of recorded parameters VAT
has been individually computed for each
child using V-slope method by
Wasserman
METHOD
For assesment of physical capacity
the maximal minute oxygen o
consumption (V02max) ventilatory
anaerobic threshold (VAT) and
maximal workload was used
J Durmala K Dobosiewicz 5
EDUCATION MEETING SATURDAY 8thof APRIL 2006
RESULTS
Ali girls with 18 have been classified
within normal range of predicted
values of
bull maximal minute oxygen uptake
bull VAT and
bull maximal workload
RESULTS
The differences between group of girls
treated using Dobosiewicz s method and
group of girl s treated using symmetric
exercises were statistically significant
Lower exercise efficiency of girls treated
using sym metric exercises has been
observed
RESULTS Girls wilh IS Irealed using
N=87 p value
Dobosiewlczs method N64
symmetJic oxor-ci Nz23
Perœnlage of predicled vaJue of
maximal minute oxygen uptake
98 905 0033
Percenlage of predicled value of
VAT 97 933 0049
Percenlage 01 predided value ni
maximal workload 101 939 0038
J Durmala K Dobosiewicz 6
EDUCATION MEETING SATURDAY8th of APRIL 2006
RESULTS 26 girl s twice tested - at fi rst and last day of intensive hospital rehabilitation
The value of ventilatory anaerobic threshold increased during intensive hospital rehabilitation (asymmetric mobilization of the trunk by Oobosiewicz) statistically significantly (p=00019)
2047 ml O2 minkg (SO 268)
vs 2239 ml O2 minkg (SO 232)
Conclusions
1 The exerc ise eff iciency of girls with IS treated by asymmetric exerc ises of Oobosiewicz is norm al
2 Such high level of the exercise efficiency of thIcircs group resulted fram using of Oobosiewiczs method
r
J Durmala K Dobosiewicz 7
REVIEWS
Role of physical exercise in tbe treattnent of mild idiopathie adolescent scoliosis
Revicw of th- literature
A NECRlNl N VElWNL s PARZI 1 A NEGRINJ 5 NEClU NI
P1t~silillxlrd~ Ihcrapy (or klucgtlttlwrlpyl i pro shy-tJm of physka] cXlrd-cs ipcci I(a~ (IJcloJgtcd hy l li trIWlltl phrslollwrapbt wilh tb m~ln a1mor pl shyVCnI in lhe ilAAfIVltilH1 llf the ucirccfonuity III mild IgtC )
Lil1Si bclpin~ thebm ( aocl co uaufllclilIg ils ~jd- clf IS in nlOdlJmiddotnh-culiosis Th middotalillofthi paper ito r (W
Ille Ii lc ram r 1 a-ccrulin wh kh of Ih bull Lu[Jalmlcrus Ind (Lb hili til~ CLlLt-cd br scnli()si- clluld bl pl Y nlcd or r d uccd hl phylolld LXtmiddotrdsi n Il p--to-da le knowl Uuml~l nr tIll~C aspcc[~ i ne bulled in oruer 10 dndc whclh~r 11Rf blLl adcqlmtt Ib(uuml n middotlicaJ balis fo r ora)aini l Ihe US4~ of lUgravellgtitlerap) wltcllj(r or fln l th e prtl1iœ of kimiddot ~lre IUlll poNjn~ a t iil ies ~bould h allowtcI II uuml middot c enliaI toltlentlf)wh k lu alClor ie - lf pl lr~kiJl -c rmiddot d gtlt- (Ic rnnhi UzJ( inn ni (t hl HrJltlon [ rtn~hcll iJl ~ or 1i1J(IChIumlJlJt etc) Sh llU Ld be TolullllCcluse ulemiddot l onld b- clclIimcntalancl wukh sho ll ld he IJlI-n~ifl~d I~~a l lhc (o uld h 11lfu 1 Know k dg CJnc1in t (wIn SeiCIImiddot Hlk rCS([lflt h daw ccordinll to Ih bull llVit w o f tIlt iii 111 1( plop(lsltd in (h i papcr lmiddotonllmJ l lnl plLyi 11 cxcr(j$( pn (nti or (tmiddotduce dhlblli t ic 1 ~lt Il Jj ll(k pl ti Jlt fadl j w(~ the nlIIIrl li7alinn n f poMural dd shylitS tu p n xJ llc aSl COIlMqnen c(middot 1 all )llal) or r(tn~ shys i middot middotlIrve Tilt u~c (I f appn1priattmiddot kincsiuuml wrlpy 0 in rcns polttllcal swhiIHy Icirc IIHmiddotorc Illta ll y (0 r 1(lt1 lllho UAh mon ltlccurlltc 1Ut dl1alkd -rLk l(lWfils 111111 )11 h Jlccdt(
11) wurcJlt 0 lit)-IcircS (Iumpy - x rcLs P()lun
n rllt lT(ltnklf u f COll1tlK H (rtd) I 1i plfho l og l ~$I rUlglng tr m low tmiddot k Pl 1l1 to IdiOpath ie SCUIshy
Submitt(oJ [or PUhltCl l1 011 uly Tt 2001 Acc~pttJ ugu - ~2 1(t-1l
Addre rltj-xlfll telt~I(middotb If) - grinl Flt(1(bziurllt r )(m Ofl ()(Cl1I shy Lt middotqlltœlll ro () - 1u I4t agravehLIlKil ta IYIL-lTt ilSllltp lfllmiddot ~ 1l1uumldull
CelII ~ (niiOS I I~ middot ann (1) IfUh middot lIlfU di louhilll(tymi ( Nlmiddot ~iI rli -ilIIUmiddotltlfl
Nlti(ir 1( ) il r() (ltbullagt1
lt vLL_ l IiII no 1ftfI
jS ) we are a IUil ly tJc ing n1n) ltblll lS 1 k l1 b ~J)w in~ tl~ t S Jfll l approad llt - l1n til hy on ielshyertd ~tan lard ugraveJuld ln m any ~1~ he lI ~t les i if Ilot dange r )ll lt rhlS is lrut of reil l lnw 1gtlt1lt1 pa in l ~ or 5urgi c ll lrea lmltnl5 in dbc r lmiddot ll Sc - 2
ln tlle cj-e ut ~ t lll(tlWtl i( li p l ll1JC luuml- I ~ middottnl ~() shyliosis phys cal ((_lt1(( is emr1uved ltI t()fIl1 0 lh~rtrv
lo ly in cel1l in L)lllllde (nluumlnlr in tilt Lltlll middotorkl i e Iw l) r llt t Srain hUI IIgt() 111 Gert11lny 5- 1~1 in other reg lOl1 wbere thi I-incl qf tre l tm e rll 1 p~ 1 pmiddot t 1( cI il Jws Ixen cri ri cilld md rel -cltd Lw m~lI1 1 11 Jlu~ Fue Fnlny r ~lrs thio middot15 a lsgt(ru( f ~rth r -~ltc rrJtf))~ ll t vit11 br1Cltcgt b r II1 ([C Llt n ClW grmvlng 1lt1 0 L Sti g
gcsti n the lIsefulnes- u r Ih is form o t treatm n t 1
Hmiddotu]rs have nerged jn El or uf pll y~ iLd eegraverdse eacute 00[ 1 but tlw are nUl yel 11 11 t llu i vIC~11 and r hi ~
f rm of trt ~ltmenr IS stiJ l Ul1 ckf ckhate FfI t Jt 111 il i 11t (eltary td 1I iFy 11umbtr ot
b l sic COI ceP rlJ lf w ill he cIh tt d in t hi pap r
Scollosis
DCijIrI iriolls
ScnUoSlS is Irlircc c1 lme nsIcircltnal (I(gt i l cj on ot tht spinc thar cau C a CU 1 lh lt ca n h e $ t~en ln (1 me1Sshy
ured ultinF Coh) lll ltllCXI o n HI anreu middot p rtc rilt r
EUJlOI -1 lœDICOPHYSlc~ IR
NECRI Nl
110
f)i)
1 7J
amp aS g 5li - 0 v
V
31
10
(1 1) Il 15
-tc i ytjtr~)
FigJ----jllph ot DlI w l-lkaupegraverel) The agloimvltltinn Or idio r lrhlc 50gt1iflll~ IS rpiJ bel~ en th e- [l0 IH P (l)ltg tnntll lol (JI PUllcmiddotny) mtl 1 ( f( lS-er sigll paiilivltecirc lt Dlt(i I1 11illg r the iti l 1Kgt n n t rll icirclicH a ) 111lt m omal prebulled the mno rche md ociks with lll I)ttlx flal gr Ih pll fl
rlcljoprdphLi 1 hl merl prestIK ~ of this curvt c10es n t autom~l ritllJy indi ate the pn$CI1(t of a defurshyTnitv (SlllKtUrd (Unel
It i~ possible tu clil1e ren tute a struCnlt t CI1tve fruIn a pogt urll 011e by identifyi og the hum]) du ring AdIlns tesr I~OQ looklng tra m beh lnd at the p atient w ho b benchng fUfward il is p -- ible ta d d~ct 1l1 eh ucirc n of o ne liidlt 0 1 the trunk usually n n the (onvex ~ jde ul tbe radiographie CUfve Ugrave1lr C Ul be mlt~I Slred lISin~
BUlln els S o liomere( 1 ~ l This h Uf1lp is du(- lO (Ile pregravegtecircn ~ of vertel ra i rolltion 1c1 Ollt tn tic f~YJ tllre o f the def trrnit tli [ c m be seen and measurc(i v ith Perddolles lb lsLometer on an amero-Ix)iferior radioshygrapb ~2
Seven ry pel cent o f li Ises a re conid 1lt 1tO be idiopa thie 1 bull ia l-nosilt in this CI$C is b exdlls i ~ n as idinpa thlc me-us t11H wc do n()[ know rJw origio of lheacute curvc [n othe] ~Ie$ it b Ix )~i ble ro ide nrify a dieak (bat CHl jusrify the c1etgtnniry slIch a rna lfo rshymar i ns I1(gtufol Ig ic~ l or genlttic cl iscas s Glnclt~r trauma etc )
[dicirc)parhk S(oliosis has been divicled ~(corcling (0
the ~Ie of tlie patient egrave1l the tiJ1ll of d~[ccli n of the condil ion into ti) ur t ypei ln fanUlc jU nik ltldolesshyccnt lnd aduh Til l m n st cnnunon (VPC IS the acloshylescegravenr o licirceacute I1IJctenzec1 hy 1 sud le l1 tggrH3l ion uuml uring the grow tll Spllrt (Hg 1)2
lhile p tu 1l sco liosi i5 Ycry lomnw n thl pre shy~Iknct ra te f r adole ent icuumlop~lthic structural CU IY~S in sch )o chilclren are 18middot20
- 10 Co bb d~grels o r m on l -lil
- 2) ~ohh dtgreclt or mort O 2~j - bull () (obb d gre -s )1 mOfeacute ()ll 2
Clin iltI [ d e isio ns lfl IXlSed 111 an lccu r~He pregshynosi which obt inccl in eJch pa ti nt mainly o n the basi of the nsidu~ll p()tlnllltl l of TH1h and the result s of 1 rh clin 1 1 ~l1d tadiogmpl i exlminashyti(ln12ll c noieq uentlya d inica ] la sifiou io n o f the ing le pHient tn -ome estent co incic1 ing w irh the
D diographic one c l n lw SLlIl1H1arizeci 1 1 folIcJ - mikl lc~ (1)(n 20 C bh de~r es - moderJt l betwlen ln md 15 ohh de~ rtes - StV re 111( gt1lt rh n ~J) )bh (kgf s
On the 1) lsis of [hi - dinic d d a lfic t i n (Vith l1l il el lrb tiOI ~ o f the ir b() und~ri e ) in Itllt l cente rS Of SCOtiO LS ITe ltlllent in the Lltin odcl (i rJ Ital lnmct md PI iJ Ugrave tre tmtnt i s plmmcd a fo lltJw 8l
- mild kineslth e (~1fw ~1Il (1 luok-ou t - Hl demte IJragravecegrave 1111101 c(~r md k i rws ithe lJpy - ~cven surgery
Physical exe rcL~e for S(ol iosis
Defi t tiOl l S
PhyS i 11 nU b lIKrlttp middot (or kines ithcIa Pl) i a p rvgrlill or plt~i Gl l (xeriltecircS ~1ci fi ( llJ y ltk ~ loped
y a -11 [ru ine 1pll yslo ther3pisr wirh th e m 10 Hllll
- pre (~ n tit1g tlc aggraaLion of the cl I )flnily in rnild bullcoUm is
- helping tlk Il ld Ct ~lOd ounter~lCtjng its skie elfects in III de rltegrave sc li sis
Tn tl1i_ feSpec1 kinesitl1ert py f JI s oliosis is tonshysider l a o on of peciticcedil training and s genecirc tltllly proposelt in sessions 0 1 4~ ro 60 minute IW) t) tour limes 1 Cee PhysiGtl exerci es can aLo ll v o ther auumlns 1S it oill he dise Issed in this plper
Ir 15 Ilot possib le to cl escribe a single progrlIT1 o r exerc ise a5 pro nrams ale USLIJUy p fgt nll ized ( ( lt
EUH PA ~illDI (DP1I YS IC~ 182
ROlL UF P l 1YSICAL lXl 1lt 1~E IN l IlE 11 ~l) IEd If IlU) l[)VP 1HI AIJ() J)~Cl~ r COl ~I NlG1W il
f)( 15 egraved ( )Il the nee L- 01 indi iuua l pJl itnts) al l l10ugh Lheacute) C l n h t 11 plicd o n a WOU p hJ~js (-1 (0 () pnients PC[ ~l ()lI r)middot lugrave reQCf lhese 1 10 grl lll frequt ml~ V IIT
hnm on in middotituk w allClthltJmiddot -Ill Jnv L l~egrave at Wc w Ht ~huw in lhis lyl peJ it i~ 111 n u -eII1 tu id e ntilv kirK itheJapturlc aims w hitl l ucircrr~spnd LO ugravelt~lil1 DUtshy
g X ir ur ph -s ici l lxtTi~l I~llhe r thln ln dj( us- indishyiJ u1 1progr-lfll
Aduumll l lxUl kisure time ~lOd h )u] Sp u lllll8 ~Ilttishy
i lt egrave~ i middotomm )Ly s iven lel mJ ing ro w hlf ~ Iuumlnsidshyer~d usdul or il lrmfu l in t1 lt rruning (lI tJw ptliJicirct ln tl1bplper Ugrave1 gent ltl l t rl ll bull p lwsiCUgrave lttG iviUes is rl ktll 10 JllI1ltlCc hOlll gtpOlt mJ kIJ1lsIcircl hc lJ l f
i ve lUen tloneumld )bo C on lv ine n dul( re Ull~ 1t~1 t s far Ilten publislt d f I~ mJ I(i noltgtithltl rgt is 11 11 a su h jel lnI deacutehate CJitk haltlt t llltit m itn ltl of l ny lorm o t p l1 ySiClI lxrcL e as a Itwr1 [ J- fo r i liopa tb il jcoJL~b un iL ()ri gin~ initial1) it WIS Ille r rOmiddotUumlK lt brgdv u f p l~lt titu gtllergt w h ) intervenecl hutll tc llcrl ll (mon as cltl HtilJ nic in terventi n man Jgt
1 t lltrJp utl t one 1 md rC j fkll l~ on rhe h sh lf som uni cOen I1v pn t I1cgts wt ldl hll ltl enl1 JI~ haLl nu na l scicnt lfic baisYmiddot HOlh tlle$( trr t peu shy to rh ~rl py tt nJecI to l~~rJ tte C Ih tk CUf -~ pnnshyclr~tll y as a f tsul t of lilo h llIzatio ll of tn imdqultdy ~u pp rt(d S pln eacute 7~ 12 to re-t1 r rI ltrl 1$ l l1C k o f WH llt~~rdl 10 I ndt~-dll()urnah tnd 11( on1 p~l per u suaJly Cl tc([ IS n prelimmtrf lll d 3 ln tt li w ay man (l rrlKpt(Hc H lf O iS Inll ph ~i C U l ~ d vi ~ cI nllog scnliotl pa t le nL~ 3gainst holll ph lca l egravexershyclc and p()rt~1
It m u st t~ n tfd [hat pllyknl txerc j~ tJe~ltm(nls t1iHer 1 lJ rd il1g r rhe rherlpcu tlC litTl~ on lllc h tJ rgt ap p lolc il l the IXlltent lncl hi im r IIIllHnt i- 1 (1(1 rI - 5lt1J lC igt tIl l ( f phJllIlllolopJ al rrea tmln ls Ihith cllffc r 1lt œQlfd- rhe m C cculc u ~t(l luI thl p al 1t n
~mc l 11i (lbE~e Tt i ~ P ~il k tlwreI[middote thll wuumlk ltlll t kin 1or ph~ i Clt1 1 lX r(j~ 1I 111~ t bc loidvd by t h~ Lo iurie IxujCJ1l al1ulhcr a dl ~IS nJI h~ iOg (1 11shygerols llugJr in racr le (wi ller d I ~fJIII ~ I ml thlls re(nl1l rn ndc(1
fn n UI cel1ll r we In(~ hccf) using 1 ) 1 1111 11 ve ) 1 (J p lw l icd ex(r(i~e (0 J ( 1I l tt i~ tlh aITt ~ l~d Ilv m ikl tru cflumiddott1 adokscltnt (cl ioj arh lC icoli is11 2)
ina the f U~ t rc-gt uJrs IefC pu b lishe - the pJ( )grd m 11lt1lt l1te n PWltllk d in fa c t deel()pnlln l~ in th t l itshy OlL1Ii in tl1 r b t ~() ycal f ha ve iclemi fiecl niO l l
m d 111 ur impl rnHm s md d i s )h ilir i (gt~ lue t idlo p lthk amp()lio -i ~ t Jll CIII he 1UO(l if Icirc 1by phyict1 egrave xert iSlgt l fe t rrncllt
l illl
111e aim of t l1JS r~l per ii tmiddot (tv iew tl1( l iterat urt to a(errl ln v llic ll of th~ impa irm 1t~ and Liit hil it il i GllIltec hy ~ o l i()gtj s -o ull he ll nt x or re middotlu celt1 Ili pl1ysical xerclse An u p-to-da te knOvkdge o f tl lt Lgtpecl-gt i necckC1 in rJeumlr) d -oek
- whetll~r there h ltl n adLtIIl ) l tht()d ical bbh fur or JqIIcirclb l l l1 Il( ) f k irt llit herlpy
- h N I)(1 ( 1 Dm tlle p r l c tIcirc(( o f Jebur tiJne )pOfung lcli v l ti ~ IIOU lci he tllf) -d o
II J U V f h 1 I11~ c~~lb li hed Ihe usefuhlLss 01 k il1 shyc ~thtrpy il i aIle dy l nsi 1([(( -r-tI Llleu i n )I11 plJt~ ut the wJrld ir ilt ecircS~nl i 1 I( id n Iv w l1i li ( 1shy
gories 0 1 pl1Vtl( 1excrClgtegt te D)bilI7it ric 1n (Ir st shylliuumlZltio f) lttlt tlgtbltn ing ni trcrccedilh ing erc) hn Id be
vnlcled he tll rhe nuld be lerrillldll1 1 md whidl s tlQu1d be inreœ jf ic(1 IJeClU~l tlley cOli lel Je LI ~ful
Ncuro1llotor impainncnts
Imv aUl llOr~ 11 lt1lt ~tlKlteJ lhe cltlndatiotl bd Ween tl UC1UmiddotIt t l ol(~C t nt id iopml je -nll ~J~ and cli~l l shyler~ lr 1tH lest ihuLIr yt 1 _ 13 ~ 311 D uhoussct 1
1-- ITS tln l ldiopath k s(o lio-L L cll -c d l J l hmgt in th terl tltr f prop li l l pu n md 1I1ar th e detrshyn Hi n i~ na tural 1 ~ronse to ril e need tu ts tu re p()tun ltlluilib riu Ul HcrmJJ1 31~ 11 () d tllat icliupathic ( liCl5j h l it re5u lt Ot1 rw nltuf mot r l ~ltelV
[Id )fcl 3 nI] ~1ltJ U Sr1lle nr to dtorders in centJtI lO~Cl shyIOIDNur) md 1xi~tI moro (Ul1lfOl syt( llI (Fig _l
N htIll -of) H1c S uumll h( rll1 ( ~ l( w ing JI t11 (oshyI-ie on the l l lO]ugy o b doll (nt Rl iu]icirc tlili- middot()lioL m unt fil t-hltll rhl ugravedcmnilV L th e fl5 ult o f 1 (k btcl 11lIFll llI ion nf som t11(WUgravetltnl md pO~ lur( (tnic l~ l licirc1 tl1lt if l p OgtlbJt b C 1l rlw sta l i lin 0f 11 1 Sf llle j lt g )tx l Tt) ohtil n a ))Cli U 1ILzltl I o f p ~llIr~il d l~flo [ in l1litkd ~J)llnSIS me CI Igt(middotqucnr J ~ a ~tmicirc ()nlly or regle Ie Llive
Ali th- 11yp ) tlw~es rd ~lte tr d irtl Itn t pnl1tlt o f [11 v hole ~piltm It11[ controls postu re ~nd mrw shyment lrre pell ic of tlh po int a d lI~ llv inH llYegraved il i ~ ll 1 nnable tCl aSUilll ri 1l tr l ll1 lo g thi ~ys ttm ( Qu it le 1I middoteli tl
lt ch ugt nlt~(S f rullliIl thil i nlomwtion th at p tlmiddot shyiCil J(tl iIies nw gt Il lInport~n t rr le to pbv [11Icircgt role ca n 1)lt slI i11l1lariztd ln lWO the ptu li ain Llt
- d elopmll1 l of p uumlltl St1 b Hlt ) - c1e veuml IOpm 1)[ o f bhll1ltc _
(k llhUl)lOr S Cll orr
ontrot oic whan-lt
------+ 1 ~ il lnll ugrave r AINnl
Cllnlr1
T bflt~ r
fltL1 tlli
lMini
l
~sary ~J-frlllen i )f
~ 1 ocirctnl
~UcirclllIJJlW Ll
AXl ~l1 n uumll l) r sy 5t ~nl
middoticoltoq ~ Fig 2-AcFgtrdong lU He-mutl 21 il is Fi)5~ ib1e rD prolXgtSlt l -oo ie1 mnd 1 ((if ~ elio egrave middotAhltr~d l)Qdy-p ati~ I I i u d) uren ttllOn k td LO In ~ory reHTt I1 eDi tn l al ) JdrnlV~ pn)4~ e l u r~o(Ofe 0-c1 eptunl dvstil t1 ctlon sltŒ(ry icircltu nu11t ilwnt [ ~mC ~ted tl l1 ce Ill trpntlshyUumlfJJl nd IKnle~ r~dibl jtugrave)n of -I) m tlosen Ir ~ig nj tl (I1vying ln fornll1U n (lI an ereltl ~piJl e Mmor aJJ r--a t ~) n ltgtf ti lt aXljl mowr plem iHUC Wh ~fl Ille 6ubjeco m uumlntl Icircn (1oJifitd perccpfLlI l ~na l ysilt of p n)lnocepti Icircnfu rnlaquol ti desnibJOS ~n t tecr spin A IICW motor co nrro l Ira I gy t adopt resu ltin~ in the ~tr ltctltr 1 ckformh y lf IdiopathirL scollos i=i Ht lrftU1uc nltnt l ISll I1lJy h1e- ~ I pro()und elkn on bralO Sfem flJll ct i(lnn~lLhu modifyRll Ille nltulltgtshytl10 ) 1 1111 Uu l-lHoror control 5~Shnl$ shy
As Srtgn1lt1 l ~ ltlssert~ if wc l C -Cp t 111 1 un o f the G IiC s oliosls L l tisorckr oi th e ltquilibrilltn sys t ~ms it is lagical to oriegravenrate physlCl l exercis( lherap y ln th is d ir(gtCli()[1
11lclte goals Cul tl lfOUgil ditrercn t modes 01 action be Olchic(-c1 witJ1 phykal accivit ie
- po rt ive Cll ities p ro ct LJ e aIl UgravelClltrtsc in 6lte nshyel ll )o rd in~lti n pinai pr0prinup ti_)[J nLi mOVeshyment control 0 vio lls iy ln thh repect ome lCtivshylites aœ pre um~I I)y lXrter tllln ntil crs
- kinrl lira py using pedJil exerCisocirc specially developecl lith th est 1101 5 in mind illVuuml VC I lllore prccilt( ll1d InC1 li zed cri n on rhe spiJw focusing
a90
1 ~~
lg -lNheJo ~1l l1 t r~l g rld in 1 1) h i(~ IImiddot ct r rHienl w i ll idlllhic _It ~i ~ _ iri s plt ~I le II find Jit ltH vlllleuml ~l Cgtbl tn~ ks III d il fef lt p ~ lt ihnS nu v~tl middot B ~a~pt u Il C middotl)Icircd ~(t l l11 C dlfkrCnl middot- hdween slllndi1g Uline nu nllt1Xinul oorrec ri nI t chied Vith Ct (J ) und tfdincJ ne lot es o UIine 1 fo llnVs middotIJfl tfi ni( - ltlrshy
reltiK)n ~ Ikexibiliry st3nucircing - -pirte - f ur~1 1IbjISC ltupin - ltorrcaion - - r~luci()il ll ymiddot For flmpllt in J npK l1 pH k1J il
plt1SSlhlc ln obtai n 10 u1 511ndlt)l [YLo lion yr ln Slt p ille rlOlgt itlugraven om l J ~ in ( gttf(C rigtIl lIex lbuil 15 i (r-l l=22deg pol lltl ~~J IIlpraquo is IcircO~-V- I t1 l nd tucircu(Ugrave) ilil) I~ 3laquoJO- IH-12
r ln Ugravel e abilit jl of tluuml [m e llu to co ntro l irse lr in ~ pac
fuld l oftlles uumlllelve ntio ns can presum1b1r incn~~ Ih enl ac )1 the orller and lHitlll r of Ille rn - 11 )ltd h e lllldenl lu EJ3)4il
Posl1l1-t collapse lnd slabilizariotl
lIle concept u fplt st lUal c(l lJap~e l l~t Iwen detin 61 by DlI II-T3e~tupegrave rL t Ac oJdin)j tu tl1i- ~ll1thor il [ nec(sary ~- l Hn Cv-tlualing th tleihility o f a col shylo tIcircC CUJVL (0 clistingu ih bt tVeen the re du ihil [ty index (th - li iffer gt le bet ~middot Il ~I r~tcli()grJph ie ~xnmshyinltio n of the iI111 pHienr in supine po ition m(i
ROte OF Pl rnmL EŒIlCISE IN THE TREAT-ŒNT OP ~I IJD IDIOPAnnC OOU~GEm seou SIS EltJRINI
I (~)-----------------------~
__ _~ _____ _~ __ __ L ___~ ________1 ____ _ __ ____ ___ ___ _____L___ _____ l___ ----------L ______ _
1 ~
1
-- ------- --1---- ---- ]---r --- -----_----t- ---- --- ---shy__ ______~---- __ ____ 1________ __ _1_ __ ____ __shy
~ (1 J
1
8 =~~=r=middotmiddotmiddotmiddoti~=-middotl--- middotmiddotmiddotshy--------------t----------~- -------- - ------__shy
~---- --- -- -~ -------------r---- -- -- ~-- - -------- --shy----i-------r-- - ---- ~~-shy
il 1~ 0
Dtl-Lmiddot ~ lttj l r~ UIltltlHt
f g 1 -TI1 u ilictf 1ld ( ii 11- ugraveu-sh) ld IX~ O 1d wllich ltJdnrshymII Il nf the pilll 1 ~tln~1 of th e -o lioti( spinc n IG~nI(J II IIIshytt) lhe iJeuml grl-e o f ~ ()Ii ti c (u rvH Il 1 w dcpc-nlknrly o l l he 10 111shy
P01(nl (pntt l ~ 1 1 nr ffll wrJ I) ln w hilth Ihe n i 1gt( ~ duc nL~ grlphs fm I h~lt 111lt hi~hr Iht Col h ~Ilu t (l f Lite ~Ul Ihe m Ol CI il y th t s(uumlJotil middotpin~ ~111 he ~middotJg gr~lVH(~(1
m mJxiTIt corrttt ion wll iJl i~ lIllCd to Ih - xt 1shy
lti Oilil y Jf tl1lt t Ut JO rl1t cdnUc idt md p OS shy
tU ll cul lapse ( th t ltHill enct b-tten l lUdioL) 1lphic egraveltamJl1ltlti OI1 J t th e ~lme pa tient in Sl il tl cling lOJ lline fX-sitiutl ) Wll ic h correb lc- onl wil ll fhe abilt ty of lllt p tu rl l gt s tem to C( lunternct lIk luree o r grl viry )cco d ing rv D lfVd- f3egraveLIprc po st li r t1 lt01shyIlDse is d ue to the Jnus -u lar ton a nd 11ll ex rCrIshy i) i itv of rhe tissus n the ( O IW-) si it (If the (01shyjl ti (~JtVe (Fi~ 3 L Pu~t llr1 C lltpstl lu lcl l ~~ reduc l-lt by llwans o f pl1ysica l cxerCles specitkally s tuclled ruuml i rnprove tIlus--ubr fOHt md lU pr )cllI Ct 1 ~11 hi shy
lizing ffCd
PararcL n tll CIJ cl the cr iti ca l (3 c1 thlsho ld beQ ld Il ich defol1J lHU n of the i pinlt 1 e~ in~ ne dtlllontr~1t _cl (1l ll t grclrf r mg] o f rllt C II in a qa m bng pos ition corn pOil 15 t l lowcr detormashytion lhnsllold (Fig 1) ie to ~11l Ulne3Se t the risk of pr ogr t~ lu n There t rh eJef re l J ea r l)iuuml 1itshycJ l ~ll1 l l(tl a 1 tnr tg ro b ohwined by d -cr t l ~ illg ilmiddot pU~lUrll cull lpse ptJcelJtge w bich lccording t i)
h llTd tnd ~l(heJ1l ~on 1~ b inde cl 1X llt icularly luumlgh Ugravel mllcl c Iio~ i (bdow 2( 0 ) (F ig 5 J
Fin a Il III ch iS respect lllljl hl and b um l 01 m linmiddot
ii iI 1 l _ _~ _ ___I ___ ___ __L ___ _ ___ ___J______ ___ 1 ___
li 1 1 1 1 i 1
1 i ___--____---___----__-_---_~- _ _--_ ___-+----
i
1
i -- ~- -- ---~-----_-~-_-_--_1-~
l ~
i
+----r--------t-------t------f-- J
Fj~ ~-Ac(XjJlin(Q luuml T O rIcd ~lnd Na(h(ln~ n i () dl( pCG w rd (rTIshy
POO ll is hiherin cu rvegt in wh ilt l1lh ~1flILWrd cII1I Olk l1t IS le- pr(v~knt ln th e grtph Ih t PogttJlJ I ugtnq) Ot1 -J1l j elfltS-e J tlt 1l1t obb dirr remc rlLIv obu incu f roll l the Cohb atl( 0 1stlI1dtJ1g IId gtupinc rldo~raf115 Ih Ille lt) [1l1t1 (i lndnl I pine) 511pille the ~(nlClu tJ1 compo l1lnt U rlk CU Y _VeJily I~ ltx p rlt 1 L1v UpUlt (obh Illeturo Ih t si _b Cct rtJeSIm l fie -ltn J trd Ugraveltuuml shyuumlo n A~-i)rding LP 11(lt uuta o n l ( r1I~( in ~I 2JQ sup itlt curvt 1hi C(]l)b ddhccno l l f lO is -J-lultt( thc s ldnd inr tnla Ol1l t lS wi Q) whil 11) 1 1)401 ~llp lne ClHVC If ~ 1Omiddot ( tcl Lhe ttnd trl~ nlca~ I(t I ~ ~I)
tli n ll w l lllE cq lin ti spin h~ i ng mo r ~ Llnt~II) 1 tlun the nOftl111 one n Cll l gr(lk ( (cU ve tl1u n da r u p shy
po rt in o r k r 10 m linrl in tht 1xi11po tuf_ n th ha__i of th egt onideratl lr1S it f(lll() rhJt
ph rH (~Uuml e erd es ulukl h u - ul iiuml tbeacuteY ~U-L lm cl 1l (It-d o pmg p05111 td C Jl1twl lS fuumlrnll~ rly d ccrll1td ln an Ql St if i imr ol1111 t ru t(( - tht m(d in C JI shy
r t t r sture fO Ir -ngthen tlll m u ck-gt of the spint mainl) in (11erl antig r3ilrl tIcirclt l]lli fun ctin ll U hy meU15 dl i )ll1 t trk ~ lhJ cl( -ll tlt C)nlr~lUions ~llld no l IdOshy
1l)llic d YIltll1k lt l jAJ lktic t) I1 ) II 11)t 111 hd posibleacute t lcluuml ee postura l io nrro and stfh ili lllllt IJI
w i thout food T1lw(ull r d I( Lf(11 Ibk t m ucircnuin Ihe c()rf ~ct [ ()S tu re for cl gtu ifKi IH lLl1gth 0f ti l11 ~
This i-l ddl usl a typl 11 dnmnin (tf k inesllh rap) in 11 (lt-11 [[k - p~d fk lnr in lng f u l1a in llllliCk is poss ihle lI sing ctrtain Idncl fJ l (lt) 11111 liun S p Ul in tb is Cl c is ulttful ooly sa I~tr 1~ il Iw lps t1w lxltknt 1 becuJl)t 1gtlt ltlt-I a ClJu~l inred irl ilL ntllru l o~ i cll
and I1lll~lJhl r-keJc LIl [rll-llIn~ middot etlt(wrs JI the int e rmiddot vlnrion
[J ROPA MfJ) I()Wf-I YSJ IR
1
ICR 1 1-1
r
1 shy ~
- shy
11 o-llrfOlhe5l~ o t Ih 1O~(1dity i n h ~ r ~ ll nr pbl1 l of ~ Spl11 in 111011 _llti1Gt l lPt f ltlJUCWJtl ( ~l Ihe Ir t 1 1gt illbll W Ilh LtltrJ1dlion Vln lbe rigronl middotUII~ l(I Dko n12 lIll h lumshydlanie1 1 [ nul 1 M hl whtrc M - gt) lnIUI1g 111laquo111laquo1 1 1 c rtJCshytjC~ f fce d -d Lill l1~ o f enr niI pUll spnmcl1y 1~ 111 mldlll1lt (n the fl1ur t 1 = tor~ of f(ward Ileuuml l = ughtel1lng fmiddotr p 1shynOf stn lClU= Alaquo rdtllg 1raquo Ihl~ - lin hull th l1ltgtllugrave ot tller1l lUr~Jtllrc F the ~pin t -ilh rlu1i tf Ihl 1 1Ibulll n lrlt InltT1 1
rbc prJI 3IJi l1ty d qrlOIJ~ n bull JI t IlJIII Hm lA the v=ltd gtc e lu-ing J 5lnK1ura i ltfnnity
Dioal e ch anicll itllp~lir J11 c nt
Ihrcemiddotdimcllgtional mc-cbal1in of the s pioc
~f Ikmiddot i t i nly l(œ ntly tlHr llk pr-5tnœ or nc ushy1 lnlo tnr impairment in Idiopttlllc s-ol ii IXl tknt liuml J$ heen h i- ll licircghlcJ hy re$eJ rh tll e preit ilegravee h inm b nIcirc Ji d lJutg~ lt hl ~ 1 ng t o n dO Ulll urcel 1 i5 (l lreldv well umlersrood H(j-ev~r nev lbt un h iomcrhankal im l) ion nI h1c rectm ly onk l n tIlt tre and p r~dou in f n rmtinn hou t pl1ykd (~fcl5( in t 11 0 tl1I _ltgt pbne of spact 1115 Im trqlt-u 1rom J i-[) v ing unclcrsrmdlng ot th l lmc -dim nshy~ilnl l l11 ~ hmk f the cO]jO[lC pln( ~2middot ) ) Ve- w ill )iI xnl t l1 d at lcL-orcltng tUl cl sif iol t lOn blsed o n gtolllt lricd h uumlCJ ) p lane
- b() rJzU[1tl ln th i pla n ~ th t 1o rm ll sp ine present no CUlye- w ll ile Uumll(~ ltc U Hic spLnc clevelops one of ir haracterls(Icircc deFo rm tiCs v elt tbrd ln lashytio n vh icl1 pJ()VcA~ theacute hw 11
- lgitltl in th llulJe U l(~ nonmll spIcirclle pl SenL kypl lOSis ~nd l dooi~ in tb lXI1 lhese [(Hu rts Vere m)( til ught [ 0 he relattd tlle scolkJtlc ( lI r Vegrave
- front l in hi pleme tht ncrmal p ine preseuron t no curYegrave whil thl ~11li tic p in ugravetI I ()~ icircl~ charshyad t Ilt I CU1C
Il Jri fJIIt palic
~l+I~na ra 3 r inr lut th l[ ber ll1d a œl1~lU1 degr 1
l f r()la tJo u lllu (lILa r forcKl ltxert ltJn tl ldefnmuumlng 1 tkllJ [J i1u a re- lhlt tll cly 11 [1 1 UI b y Olm ner w bn ~lh uiJwd tl egrave ro t1tic) l1 Ilm it ti lt p ica] lf shy
rhrl r() be (P (the Uma bevond Wl1iltJl th lCOJlb of [11( ~pmaJ musd ~ dthc COnCIt and nm ex ~l le btconk (t O li~[)
r ~l 18 ~1Il N lu t( ren i9 lun lu ted rlseurlt h in tlt ) tilt lULodeumlformipg1 tlo n ot tIH_ sc laquoJrle rh ox ercallkren lk 1l1~H li d11r once thl Il i ~ r tld1t5 [he lhrth ld f 111 JlIcirc lIi of tlle dnrlclc hurnp tlk
lI bslt Il l nt rlet()rlll lIcircon 01 the it l ()I~ C ( (ylm der (- sustalnecl by an H1tmi cforming aCOOIl
J1Ji h V hl rhyiical f~ f Ise CI 01 h spr n llnd kin middot ith ccedilrapJ my lX damlg ing vll e n l pplild as flle
igt Jk Iller ln SCC1IJ ~IS lllc lJ fxceed l auto in middot crca~ i n g lhrllgthuld [1 sh (~u Id ahn be j ofed that Ilw relscd pre sun 1l1111i insiugrave l fe pil1r inn) 1 mlshylt
- j Il- ( w atff 1 (nh ~1l 1(e Il10 utoldrml ng li1eCh~lI1 1sm
in flc l Geyer ~w tcd th1 t rm m 1 hI l)1ecircch1O lla1 puilll 0 l I C~ sw m mim t Ieuroamp no purpo t for cu lshyim le pllilt t1 s (weumlO middott r it is l~Jl(gtWl1 rhn in iculio r[ paULnl -iJl11T1ill~ doe_gt nor Il ~lp to i ncrt~SL n eur(1shym tor co mfU
(1irai p an (
Jerdnn lle 11 showecl thal ill CSl~ o f t10rLC IC 1i lUgrave
tllo lacolulllhil it lio_1 tlle cte tI llmiry in (he lg itt1 p lln t rn lnlftot il~ lf tspe iuUy in tlw initi 11 r luleuml )f cV IU[Icircon nf Ile ~oli ls W iU l 1 p(t)gr~s~ivlt il10middot~ shy
ment roward hvpok pho b G ll f ill~l Im lins l har dUflng (IN eWllLlfiu1 of 11Imh] co luumlgt i the l in t ot t l H~ gClyty Cegraven te l - 0 1 v llebed lxxli 5 r ro ject 1 seH fl r t side-ys and tlwn backlrcl bull thu~ p(0(1 lj n g a kyphQtlmg aet Il ln (h~ lu mhnr --PIl1 COftj tng
l l i tc Iugrave l lltl l( l rs1 tif s L -etllgt il l the lgirl11
1 Hl)
Ilu LE nI rIIY~Ic~L lXIlKISI 1 HI E TREhTMEtn OP JIU IDIOP llII C AD O USCUH O Ll Œl15 NEGR II
lLill tegt lre lenl1 ~I d ~fo rll1J[ ~ rhl recrSes the phyltiologiGII cmns of lh vine)
Accordlng () Dicion ~2 1 rtcluctio fl in the itgitttl CUIYtS combin l vi th a lueral Iviari n llltl ds t 1
mecban ism () ugravel~ta il ity in l he r rat r IllI1e which bVOf1i the unsd a nd i ncrea~e 0 1 co hlt1is (Fig 6 hiIf md Pl11jlbiJ Jl1eanwlt ile lt(udiecl lh e srnl ru t
orzyglpophySLs show ing t11 al ttleir 1I1tl rnic tl orienshytation f~I (jLi l~ltes aXIal ve rtegravebJl l rotllio ll in cun litluns lt f dorsal hypokrrhn Icirc tnd lum)H de i L lo IS
Tll t dat SLlgge 1 th t impOrfill ut pOitu res and l1lweil1 ) t Mudied in ord t r (CI mlIuml ntrlin or to reuwer fll e p llyslo lo~lCll ClIlye in lIe SlgJtta p lU)l Wlth the llm o t ch ~ kin~ rutltor in l~ bili ry7 AbC th ~e ~k-
1l11nL ~Irt del lnt [0 J jUc lt ftber l]kuti inrervenl ion vhich 1c)LJ k l IV - i(l ~ l compktl n l ililll on Il t c1 l shy-jel1 J11UVllT1ent IJ j o f 1uto-dOneacute(3tlon ( i e a -impk ld ion ) Iengtheni ng o f the pilleacute 011 a litlltl l aXl~ tll lt ((IT liJlI~rcdu e~ t lle ~---lJ linti- l lte ml-fkxj(l n h UI 11 - i llCrl I~t the plllH ](JgicJI dlt cr ~l S ( (1 k-yvllCiSh lIld O(ltOSh l o r c lch r1Iif n t a Ilew til(~ecirc dUuml llt Ilshy
si lflltl J ll1 u(~nlent iam ecl - 1l1t0- lIrfe rionmiddot7 4 llmshyp oed f Je-rura l iUIl cl middot-t1e- iltm lI1d ll1a intltnUlLe )( 5lg it d C Uf (gtS slig lll thltJrc i ypI1 tiZ) tIcircOI1 a nd lunugrave)ar 1()fdos i7~llion) sholild he esw b lb]HU 00 lb co
hl b oi hi p~l11il uU r -1Ir vlt Abo 111( e IlltUtl Chl lie o f purti n - a U vitk slJ1ultI h e )tuumlll ecl 1)] (1 n ldershy](ion r tl1i lt type for e upIe IilJ llyl)T S of repd shyiti( ml vemen prt n t in agonistK h)lnllltlSlks nI iIle kind f dlJ1ce C( uld he ([([r imentd
FmiddotO lllaljlallC and mobili ty of the SpIcircIlC
1 rd llo U 22 d L lm nrrare d lhlt in Illt fro nt a l pll ne
tilt 1 nge Clt 1)1lt vtment of tht scplit[i middot CU IY grcmr lIJ l il ~ d irectio n n f Lhe C ITelt tlO n tha n in tl le di re shyLion of pmgressi n l Fig 7 ) he IL o IS5err lJd tbat th15 mohiliry increac plrtil u la rly n apic [ cgcoeilts 1$ lh ~ ~c() li osb evolves Sragrm rJ 12 J ~ thus rigilt (0
VlI f n rller~p is ts Ilo t t) m o b uumliz - a sCtJl iu til curve w ilhout t [ uling ttwt tlle R lu tiOI o i til t ~a mt b fnlinruumln( 1hy l1tans o f ~I passic 01 1 rivE -uppnrt On tilt (ltllE r hand UgraveK d e iJlioJ1 in ease durill tlw tune 111 whicll tll C spmt i ~ not submjtrcd to correeshy( IV anl()n
j- Virh mi lei ol i b tlllt Upp i1n ill) lC tiol is d eveloped only lllmugil llClIf()mu$Cllbr f r llce thi ~
InegravelIl ~ thclcfo re tl1l[ inu eascgtt sp1J1all1extl)iity mua
11
Imiddotiumltgt 7-rurd illt Ir) 1 bull rdrilt I1 1 in tl lt frOlllll pbnlt- th( illl ge )r mOC llIeJlI o t the S-o UIIJC CUNe 1 supcrior in Ihlt diflt(l im ugrave( the n nKlIl thd n ll1 tllc dlrtcLion o f p rJ1(l( (llIl
be considrCtJ vntrl iJ)(l icltion and 1 undrli neocirc ab L a ~ubiljz~ILion 01 tilt spint pllss il)1y ohtl ll1td thrltJugll the stlengtlkl11ng o f the 1rltJgm vlt nonil lme shyCIC 111 illli orrant u bjcLliH- ln rhis r~f1 n sp u lllni lc tivitIumlLs sil uld lX tPI 10 dlegraveltl it l G lU t n w l1ik luring kine i Icircth lrr phyltical eXegraverci c~ tllat in ele
spinal m ot ilIcirclY sil nid 1e lt1 oid cdrt ~
Organ ie and psychologieal impainncuts and li islbi IiI le
A cgtI im lc pmi nr is moriOthl11 just 1 sp in and 1
compkt gt Ipp rnach to the gu in ad 1 ont i al~ shylute l e~se i t i11
[)a la 0 11[ [n ell lrom re semh pw tbat ome organi Iilnctiond cl fki ts suc]) as tlw clecrtiUe ut vild l tnd d fun ll l)Kity_orld ldly incrtJ k whil~ 0 shy[io s i -till in (1 miel q g of g JltlV ity ~ l ilI e 55 rtI lit
tllL pres e n ce )fl defidt Or Vi l~il Clp~1 - i~ ln one pIIiem in Ihr l ftectecl by 20 ICl 40 scoi stgt l ls~a r(h cunclutecl in tbe UA by Di Ruce- prod uegraveed an aaalo) u ll1lXimum 102 re u t in a group of Jd shyk 1ien t [(h sco llosls rang inF frum ) [0 1
Al10ther rudv bv rallt r m C chr111 lilcl NashycWrl1s( u 57 stlO eltt hil $(C 1 1 ui~ Ica js l( lllt cl (1 shy1prUlllI o f t1tgl lie bJd l imI in ~ul sct t1 t ltu b middot iects jlLltr l5 they are golng through ~I cltlici[e sllge in the fnm 1lt i n 01 tlWH o w n id uHitv t factor hit h Illy jeopmlize the cl velopme lit d ~ mIll lt lI1d htIshym cecl IWI sonalitr in Klulrhood
n RUI ~IEDl(( Ptl Y1-
ROU ltHmiddot PI [ I C~ 1 EXIRCIS]~ IN TI Il nW~JUNT OF SlllO lDIOP1HIC AI)C~ESΠ11 C(gt1[Oi 1S
This i why b IiCieacute ii is ~n imporrlIl t for p rcshyvegraveml e 1tLsr l tn en ou flge 1ari e nrs ~lfrecr(d by lIillcl middotu iosis ft) tlke p~l rt in portin -re rcatioluJ acrivitits Iha t 1eIU 10 L10 th r~1chophyinLl bull nd b~l )i 1l1o tur adlieem t n li 51Jmiddot2Even tlK)ugli [Dr bic mech~lnshy
ical mcl nellIUll10t 11 11 reltl ~ons lt r111 1gtomcrimes be l lefu l to ugg( ~t ne p rt in~ aCt iv ity r l h (gtr rll n anotlJer e th ink Ibal an exces~ ive IlHd icalizltion - Icirce l ll1posilion br plry~ilt i HlS nnejlor parents uf rh ry pe of po rt to lx p m lice 1 b Ule p 1Ucirc(Il L th1[ preshydLl ck l1 is fret clOice in lh ma tt r - -h II ll1 he avolc1ed wb 11 possLhle mainly for tlle i mport~ltll psyshyLb ) jogka l fe a SI)nS W( ha( ill ~ t nltntionegraved
Conclu ion
lbh ISsertegrave d t1H physkal tgtXtlci o is ) n fi ial whlIl practinu in order 10 ilnj rove the I11 llde
rœ nwh and tono C iral caplCiry and postu re o f the StOUO(I ~lIbj n II I nowkdge om ~ middotmg trom ci el1shyrlfi rls(~ Jrc li dJlJ accordl ng r the review 01 thE litshytirlture prnpo )td in t lli plpl r conflrm~ Ihe vuiclit ot th e -t ls ~rti ()ns
In l do l (ent Id iopl1il iC scoliuse il l n phee u i cl vk)pm e n t ( li tll iumlKh eXCC cl l g i en rhk thr hokl th e re i5 an und ubred need fn r l pprnpri 1tegrave (JJ1tOkJJe ~Ild Inr surgict1 therapics ill ortler 1) S l i p
the ( - Iuli on anugrave )JT~t~t UW ~pilll l dtlormities bull evshyerthtless in the illiti ~ll pl l~sC t ttlC c1iseLltc whcn the riS( r1 r euro )luli m is rtduced ocirc ~md tfle uifleal JOld threshold il ~ld flle po stural collai i reJcenw~ 43
JI l1 igh pllysicaJ egravexe rc ise - p revenc or r d llCe d i ~lh ilir ies o f [Iw ~ l() li )tic
p (iems R 28 J -6 5- 6 1 63
- f~KiHtare lh ( n utr ali711iCUl of postu m l d elicits tn produCel1 a coneql l nce J [)ti 0 I111)( or regre si -u lmiddotc 5middot Il 1 17 ~ M
-re 51udles U ~ n Ledecl tu con[mn or re jecr these conClLL i( 1 w l1 ich clerin-d frum 1l1 lIldytica l rcltw n f th e liter~iture appear r- ~Lo nlble Hnwecr Intil ne re ull are 31Iable wc should n r prevent our sroliotic patientmiddot trom tl ki ll p lt in s(loI1ing jshy
ir its pW1iada rly ltl t ~d1()o t () n til t c ntrHY -vith the l xcclrinn 01 gt[1 )11lt tIlat in rea-e t)1obility (tnU evc n thell oilly wh n progr~lgtion b p OSSibl) -uc h ~I( ucircvshyiUe -11 )ulu hl tIKoll w g ed The 11 S J ( rprOpriue kin (~irhe r~l Piuml to incr _~asc p()~tura l $llbil i ty is tl1egraveoretshyic tlly CiJUClt alttloughl more ~Iccu rtte aod deLli led ri k benefi rs anJlr~ is is netot1ed
Ria 1111tO
NIokl Mu d lle ftitYljJfu Jœl il 4IWr10UOifll S (JIvs i (1~1)Jshylidl ttno( cclIll le 11(11(1lt1 RCI fu lle ((lia LltfIt l1 I1I1i(i
LJ ci n s j(r3 pigt egrave li n IHUgru lkl di t rdz t fi sici pe e ft shytUlKm iluppno di un lisimerap15Ll rl lllcflt() 1 110 scopo di pnevirlt () fr en~lI 1-lgpwlllltnlcgt dclld lclonnitugrave o e il 5LOshy
Il i mi llon lt fH nugrave j (1 11ni dei co~e 1 lteIl I1J J nd ne ~Ii eifclti (()Tc rri udk s co lio si d i m e dia g rt iuuml ln que~ltlt
s rud i 30 llizzb mo i d ti cleU ric lca pel n ri Icare qJJ l lm 1 dis(imucirc x u le I[~ l z j-m i pro vna le da lla C gtl k A i json ere pr middote-nute () rk kl ducirc un~l rdeguCltl d nil cra pi lt di uJoseguerrnt Cjua li 1iU110 cli nbie tti 1 rcr lJ)tIId d~ fle)-UITC
n (- -fd7Io n~lcl)
Ut11claquo)si 1 lI tori htpnuuml )ludi-ttn I ~ cnntI1zttu fr Cq(in i idiJ)tic1 dbfl lOZ10l1 d d ~ leOla nelllOll1otoriO Lb un1I1cnUl 1n1l1i3 dcgli 111 lt1i ch DIJgt gtU l H crmU1 Nlch~mslt ( SIshygnaJ~l lerimiddot wo i esuemi -bletti d~ plt~e8lugraver- ne l pClZ le1lftgt scoliodcu kl s iluppo ddl ~ ~ uhjlil~ vertcbral~ lt o svilllp prJ Jdle JIl7 i() nl di ltCjuiljbrio Dng li studi sul lto lb( l~nlrale (OllddU i in pa rticdu d 1 DlIal-BeHJ (gtegraverl ~ P~II IId lI1 n~ llw - idente il v- m gtiu p eT il puientc clioti elgt di u n rnigb o t c)[ ro Ua sw mle dei radlldc onsegull o tramite il 11 fforzrlshyfl len to d e i l1luotoucirc l nllgr3ilri d e luOwo con crcbi ~Clltdr
in pOMltHJ corrctl e in va rie ~i[Jzioni s t llicb c c d inamIcirc tllt Dalle on sena d elb blOffiCcclIlicd tr idimlt n s io mlle d ei
r ~ chi Je ~oU()f icn ~Icirc ~videnuumll (l() ~llt tC p IYZIcircOSI ln(IiClZlfHicircl ~ 1I1shy
liumln fluenzt Je ll middote~rUrio tl SC) lgt lIi I rc pibull m i tldln sJlI71 Stl shygn~I I1 afferma che slI l p Ia no [11 middotccedilr~lk tre un œ rtlJ grado di l L1Liuuml IlC dclh vEltlh r1 apj(de le tu rœ mu SCltJ llri njtbc J n in $tJ ) t rodcfQfll1t1l1te PltJtantu b i r~it-~ r -lp il puugrave t~~
Ixnt-ftla solo nt Ile so )[j)~i Jl1Icirc na rl in qunnt ) ilon SlrM ntne )(l(Ofa tu soglb in caq ) co lltrLJIcircn l)lrilto llt~( i lJudotlsi di lfr~ lI1 C llg grVlmenl J 111 11 io lr riltd ll(17jOill leld rinlle 113 dimO~iumlrlto d llt nell o lin~l cl()~ li t th~oIOl))1 dri la defltgtrshymiti sul p iluO slfl iuale ~vohl lf1 (en5 ion~ sO lnm utto nd 1e bsi iniliali deWggrwm1Cnln mcn trl C a( lfLmn che occlleshyvoluzi ne dene = 110 i [ mhari IJ lin c l ki cen tri ch -1vi1( de i cp i CIt IJ rI Ji SI p m ittIl pnm l Iem lmeme e p o j pOS( shyrio fllwnte dtldnli mdv ( i un ziuuml ne ciloliz7nnl dd rlLtide lu mbJ œ ( lIlelttlaquo on NC n d d (gt11 uIdu m 1I1 Ilgt) cli r-Iure (0 eserClzi che IllUllengano 0 ltlUperifo le Clgt 6gt1 lo)iche sul pirluuml gilwlt Su l p iCl no fron itk Perdnulk il dlll1lt-trlto d1 lampkz-l d i LU ovimento amp111 lI rv Kolio ti ~ nd lt1 0 ddlJ cnrrc-LIcircQo i Ji gC 1 n lungl SUpegraveliltlrccedil 1M llS0 tlell 3ampIGI shyvamcnlo C che l~Jltmiddot mobiliti GlI mcnta co n l c lu7j o fle d l i) snAio i A ulln amplgrtJc1 ltllllmunjx~ i terlpGli nn n m obi shyUZ73It ma eutva coli ti0 1 1ct HsicVlfe nd tcmplt 11 1111nshyttllIcirc1nc n tc (k ll ~1 llu u zinnt n l1 un me77uuml d i sost l11( gt ln 0
e 11111ri b cle - Ilziunc egrave deorinatcl d l rlyarsi Snzcl la pr gtshy
liltlnl l i un() rtl~ i ptmiddot Jtl n(o 1S(Hl () (( ntJ() i ndit~tr i ~ Ii ISt (izi e l m iviL Illdlode ebe Hlmen tno laJlc ibiJii dcl rlc lide SCshy
li io) [n p articobre rune q lldl r C-I1 ich~ xlSiddcHe CUf t shyli ve ch~ iJllpi tgino e~rciii 01( biIi2 ZanUgrave HhnmL-trid () in tmiddot~t~nshy
sione kl fuchide O tne pure k- ~ttivit1 tnotoJII~ non prHi(~ llCcedil
in forma r k rel1tiva d Ie ~1I 11 rF~1l1( n otcol mcnlC 1 lll ubib Ll vcrteblmiddote (ad ~ flp j(l 11 n l) to L ginn ~Iilt Utl clkl rilshyC
mka la cli OT- tcc)
r1il to l~ _ I[Dl COlI rY IC~
NE olUNI
fillncr ( ni ((uuml(( n hIIo( rilclIO ~middothe k lln dtfidl fUr1z i shy
nlu CQll1~ la llcl llZIO 1e delb c apKJl ilde e della capacltl di 0170 mizianu luJndn le (OJ il~ gtna a nc r3 di m~i3 gmshy
v it ln G mlxl r i ~ gko Fl llslrom C dlllJ O e Nachcms(J h iU1I) dim lr JtQ che b o liosl p IOO C1 neUaduksœnr 10 SYil l1p pn d i lIniumlmn~gin nlt8Jliva de corpo in (o nridcnz di Ln ddic3w p ri d di f( m l lz i nlt deUa SUl idenritl condishyZltonc ch pOlrebh ~[I cubrmiddot ln vilu pp di un pe bull n nn lir m llur cd e quiJibfarn in t[C adulro TaU CO1DSCe nZe tvlde nshyZ[II)() la n ( middotess iti di ltimobre la plfte ip a7j0 r1e atl an ivi ll1ltHClr n gl b a li ltl h ~ di tlpO s pu rti middotu dl ittlrc nd gloani iCo lID ti i lirtugraveta z io ni llb vila di relazionc
ln concllliu fu la d tfoflll lL saliu iG egrave il sin l mo di lin) idrotnc C Il1pk 1 d e eoinvo l d middotmiddot= fu n (n i dd rgashynIcirc5H10 n Hi lhdli e lesenizjo fi 1lt0 se 1 Il indirill~t() pllO pr~cnin 0 odLf rgt t lli di fu nzlonicirc adlc s()Jj(bi 111Icircn(i rrHtatc CO ll nl1 cinesi rap i Quand l~ coli i ( n LS~middot iJ11 zia k il rischio evnluLIcircvo egrave lid [() mente no tcole 11 (ltlll asso p o lll shylal ltOtSltgllen7~1 _ ta cincsiterapia pc rslIk bidtlvi shyptutibulli d ubllIcirctIcirc vltnc brn1e di conrro llo )(JSu k d i 5IcirclupPQ d Ile rLlt ziofll d i eC[u ihb ugraveo dJ ftffr otZJH1 r1w dei IIl llJgtCili 1 11Icircshyg rdtarl in posru ra rrenu posslhile JnnalL in Illo lt i clsi l(j luucircun lt di lin ~c() li oi mi n rc ( ume [11 duumlnQstrIO la tinc~ jn~l el1lric ((1l1 ~rtlppi d i contnmiddotllo cnndnlt1 p nso i l entrt d e Massue di Li n nc da [ o llo n ~ Rodo l (1 986) Julndo il1vlce lIfU~ ho ~vutlJ tiVll 11lt1 1IjXIl to un dekrshyuina r o~itl di g rl vir~l bull a~-n lllull~nte n ec ~~uiu rlCUuml rf( ff dla tcrJpll rle si c a eo chirurg ica
1Ho le clllC ooliosi idjopHI 3 ttl1p ~ - E~er l zjo hsco shy11ln ~ I((fapil
l Bg 5 CUle Lo [la k ll oblems in tlu ll~ (U ni Cl) FrKUce CU ( )lIILr no 1 AllCPR lu b1lG1t10 11 middotCI 9()(iJ2 RockilJe MI) i)~Cr ~()f I [( al th all 1 () I ~Y 1(~Re~C~Hd ~gtutnlt Ilallb Srshy1ltC Cgt D~p(rulllnr CJf I Ilalil 11 1 HumlIl sen Lel 199-1
2 SI) lrzcf ( LcB I ~IIl( FE DupUb L ampkIll~ 1c ~ppro l c h ll tht rnent und mmgemlt-rlt ot ~ ct vlyrl~ led splnul (hs r)fder~ A monQglJph rr r d lll kic Re p o l1 or Ih Ou bcc TlSk Fu rcl 0 11 ipmd DIo rele Sp ine L9H LU) 59
) Clntino F 111i1 i(ll Ci nerte1H C Nou gltHhl C Kln(~Jl llBICII [lIe1 hmlln (Il dry rra ll1ltfll of QIil pa ll m log iC by l11e 1 lIb li 1le-llh laquorilC~ of ~ 10(lna 111 Jrc)Jcxli r~~ (of flle h l lntrnIUonll SVIll Illgt~iu tn - II 5lt Ik lIc lk0flllllic lu llln-I I r l III Fhhlt ri g 1092 -ltlIJ-7
i - ri of niii MA N()LJV II ~ mel h)ltks de kin ~~klk rlr k di lll J r~cdllclli (n d~s ~()li oes jn f ~tel r~1ruuml(ILI -lo s bl fl c sur IcIj cquishyl)œ~ Ik SOll ll l)(eacute Eli ror eetlfllS d )111 1~ 1)1-
5 iloll n G Ruumld(~ le s () I ~middotmiddots tnlcl l l1 I n in 1Ifc el kiwil~~ 1)11lt KillegraveSlthe ripJe SCleacutentlnlue lYl6 2 47 ~ 6
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EUROP MIDI C Pli hIC
EDUCATIONMEETING SATURDAY 8thof APRIL 2006
(iSS
SEAS02 Scientific
Exercises Approach to Scoliosis
version 2002
G
S Negrini 1
EDUCATION MEETING SATURDAY8th of APRIL 2006
Neuromotor disfunctions
Neuromuscular disfunctions
11 Postural collapse
Postural collapse
Duval-Beaupegravere
Flexibility of scoliotic curve
f---I--- I Postural element
-------1 Structural element
S Negrini 2
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Postural collapse
Duval-Beaupegravere
It is a value related to muscular tone and to flexibil ity of convex side tissues
Post ural collapse
Bunch e Patwardhan
Critical load
Load threshold beyond wh ich a spine begins buckling
JI~~Wt1lW~flfthtlJlœJtAr ~ J~It- l~l - IMS
Postu ral collapse
Bunch e Patwardhan
If a curve reduces there is an increase of the deformation threshold
~~~NW~-damaoc~IIIMf ~~ J~Iv JaJ-I7I9sect
S Negrini 3
EDUCATION MEETING SATURDAY 8th of APRIL2006
Postural collapse
Torrel e Nachemson ~
Scolioses below 20deg ~ ~ lt~
have a high ~ ~ percentage of ~ ~
~postural collapse (on u~
average 75) ~~ 2i~
CU~VE O EG~EE S WHllE SUPlti e
~laquotd~c6b ____lPffI1wtt1t~
$ww J(t ~~7 JM5
Postural collapse
Minor scolioses 7
Antigravity musc es strengthening D
Reduces postural collapse -G
Increases the critical threshold of deformation
G
Neuromotor disfunetions
Stagnara
If we admit that one of the causes of idiopathie scoliosis is a disfunction in balance systems it is logical to orientate physical exercises toward this direction
s Negrini 4
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Neuromotor disfunctions
Dubousset
Idiopathie seoliosis results fram alterations in praprioeeption centres and deformation is a natural compensation to restore postural balance
etattJtitIK ypothfQj~S ___~ own_ oJ)HQr lar 1t-1( r
Neuromotor disfunctions
Nachemson Initial idiopathie scoliosis
+ Goood spine stability
Neutralization of postural deficits
D Static curve
Neuromotor disfunctions
Therapeutic aims
c) Development of spine stability
C) Development of balance reactions
G
S Negrini 5
EDUCATION MEETING SATURDAY 8thof APRIL 2006
Biomechanical disfunctions
j Horizontal r-Ian
i Sagi ttal plan
Frontal plan
Frontal plan
q Frontal plan disfunetions
Fronta l plan
Perdriolle Movement magnitude
gt in the direction of lt in the direction of correction progression
S Negrini 6
EDUCATION MEETING SATURDAY8th of APRIL 2006
Frontal plan
Stagnara
Never mobilize a scoliotic curve without ensuring reduction maintenance over time otherwise a greater mobility favours scoliosis progression
Frontal plan
Ducongeacute~ research
On a group of adolescent idiopathie scolioses treated with
Meacuteziegraveres gymnastics
D After 1 year the mean angle of
curves increased from 18deg to 29deg
Frontal plan
Scoliosis without brace
D Greater spine
flexibility D-
Risk of progression
S Negrini 7
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Frontal plan
Mobilization is useful
D In preparation to
brace
D With brace
Sagittal plan
QSagittal plan disfunctions
Sagittal plan r middot _J o
Perdriolle scouos B CJ aDeformation of D
thoracic and thoraco-Iumbar curves evolves in extension
S Negrini 8
EDUCATION MEETING SATURDAY8th of APRIL 2006
Sagittal plan
Graf
The line of gravity centres in the vertebral bodies o s c oUOSt
projects itself firstly laterally and then fi
o
posteriorly lJ ~~ ~~ ~ ~~-_J-D ~nI~
Sagittal plan
Therapeutic a ims
D Maintain or
retrieve physiological curves on the sagittal plan
Horizontal plan
QHorizontal plan disfunctions
S Negnni 9
EDUCATION MEETINGSATURDAY 8th of APRIL 2006
Horizontal plan
Stagnara The forces applied ta the spi ne act in a autoshydeforming sense
Horizontal plan
Dimnet Rotation gt 200
ampII~ (
D The actions of concave and convex side
muscles become
agonistic
~ItJrOnrIIiItdllfUClltlluumlll~~tI ~1JIf1laJ
Horizontal plan
Minor scolioses never exceed these autoshy
deformation thresholds
S Negrini 10
EDUCATION MEETING SATURDAY8th of APRIL 2006
Disfunctions at a biological organic and psychological
lever
Oisfunclions at a biological organlc and psychologlcal lever
Cheng
Bane density in scoliotic teenagers is lower than in normal subjects
~~~~middotA~IIlUtIy ~7œl 1d l
Oisfunctions at a blologlcal organic and psychologicallevel
A significant reduction of vital capacity and V02max in teenagers with a medium severity scoliosis
S Negrini 11
li
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Disfunctions at a biological organic and psychologicallevel
Disorders in the development of body image that the teenager has of himherself
Disfunctions at a blologlca l organlc and psychologicallevel
Therapeutic aims
cJ Activate cardioshyrespiratory function
cJ Favour bone density increase
cJ Develop a positive image of the body
Disfunctions at il biological organi and psydlologicallevel
Stagnara
Sport
D The active side of
kinesitherapy
S Negrini 12
EDUCATION MEETING SATURDAY 8thof APRIL 2006
Disfunctions at a biological organic and psychological
level
Distunctions at a biologlcal organlc and psychologicallevel
Cheng
Bone density in scoliotic teenagers is lower than in normal subjects
~n~IIIvpWr~middotA~stWy s- XXJl M J
Disfunctions at a biological organic and psychologicallevel
A significant reduction of vital capacity and V02max in teenagers with a medium severity scoliosis
G
S Negrini 11
EDUCATIONMEETING SATURDAY 8th of APRIL 2006
Kinesitherapy on the scoliotic subject
q Postural control
q Axial stability
q Muscular trophism
q Balance
q Respiratory function
The limits of kinesitherapy
There is a threshold beyond which
rehabilitation alone is not enough
sssr
Kinesitherapy in scoliosis treatment with brace
Therapeutic aims
S Negrini 13
6
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Therapeutic aims Srace kinesitherapy
With brace
il Postural corrections and
vertebral stability are obtained by the brace
Therapeutic aims Srace kinesitherapy
In preparation to the brace
il Mobilize spine on ail plans
Therapeutic aims Srace kinesitherapy
With brace D
Maintain a normal spine elasticity
~ Maintain a good muscular toneshy
trophism
C Model the hump with kyphotizating
exercises
S Negrini 14
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Exercises and their methodologies can vary accord ing to learning and individual sensibility of the single rehabilitator that proposes the m provided that they stay within the
Iimits of fixed therapeutic objectives
li
Therapeutic modalities
(Exercises)
QAuto-correction
QRespiratory education
QErgonomie education
QMuscular strengthening
QDevelopment of balance reactions
WNeuromotor integration
ci Vertebral mobiJization
QSpecifie modalities in brace treatment
S Negrini 15
EDUCATION MEETING SATURDAY 8th of APRIL 2006
The protocol of kinesitherapic
treatment
G
QChoice and dosage of exercises
Variatiosn of the work program every 2 - 3 months
Q Execute e)(ercises on an individual base or in a small group
Q Frequency not less than 2 times 1 week
Involve and awaken the family
G
S Negrini 16
EDUCATION MEETINGSATURDAY 8thof APRIL 2006
Q Determine the action and the localization of auto-correction
QAuto-correction must be associated to ail exercises
QAt the end of treatment ergonomy lesson
Auto-correction didactics
G
SCOLIOSI DORSALE---- shy ----
r
S Negrini 17
EDUCATION MEETING SATURDAY8thof APRIL 2006
SCOLIOS OORSOLOMBARE
shy
SCOLIOSI OOIlSALE 011 bull LOMBARE S1I--shy
SCOLIOSI LOMBARE
il --~_-
S Negrini 18
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Scoliotic patients are not radiographs
middotSeoliotie Mtients are not ndiographs but hum beings with a vertebral deviation-
Slagnara
Metha For the physieian Cobb angle is of utmost
importance For the patient it is body deformity t hat eounts most rib hump a protruding seapula or hip We are in a situation in whieh today dodors eure the radiographie deformity but what the patient really desires is to get rid of clinieal deformity and of ensuing psyehologieal distress
CIIQItIo shDuIdtucirc lM WIld tJw~~ I~~M~~~~ J9f~
S Negrini 19
- Poznan_workshop_Physiotherapy
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Metoda Dobosiewicz
pozycja 1
Meota Dobosiewicz
prutwnik
Metoda Dobosiewicz
5
Zmi3ny w zakresie kllill Cobbll w wyniku Jlrowadzooej kinezyterapi i wg Dobosiewicz w grupie
progresnvoych skoliozjedl oillkowy cll - n=124 (ass obsenvncji ud 6 do 58 ntini~cy $~dD iw 197plusmnJ 185 Rlic3iqC3)
6
Zmiany w zakresie kqta rotacji osiowej kr~gu sZczytowego sknywiellia w wyniku prowadzonej kinezylerapii wg Dobosiewicz
w grupie progresywovch skoliozjednoillkowycfl - 0=124 (czas oburwRCji ad 6 do 58 mitJi~cy sndniR 197plusmn11S5 miesics)
Grupa skoiozjednoukowych typ J wg Ponsetiego - skrzywienia Th dx - leczeni kinczyterapill wg Dobosiewicz
(1174 015 ubscnvncji od 6 do 45 mieiircy s-cduin 211plusmn 111 rniesi~cn)
Zmiany w zakresie kllU CObbtr w wynlku prowadzooei kinezyluapii wg Duhosiewicz w gTUpj~
progresywnych skolioz dwulufwwycfl - 0=74 (aos obsrnvacji ad 6 do 45 micsi~y srcdnin 211 plusmn 1 1 mi~Icircqca)
DdciMk Th odcinek L
7
ZcDli~ny w zakresie kla rolaei osiowe krfgu sezytowego
sknywienia w wyniku prowadzonej kinezyterapii wg Dobosiewicz w grupie progrcsywnych skolioz dwulukowyell shy
n=74 (C7lS obserwacji ad 6 do 45 miesi~q srednia 211 plusmn 111 miesiqcR)
oddnek Th odcinek L
Grupa skoliozjednoillkowycll 0 kqcie Cobba lt 40deg - leaeni wyhCznie kinezyterapil wg Dobo~icwicz (n=44) (czas obserwacji od 5 do JI mi~ifCY ~redllia t 18plusmn604 mie-ihco)
tnnl qICIiIl fMtt[ IoooI ~)I l~Illli 1IqIlt00401 IftmiddotI-I llJ
~1 1~ u)~___- uul
c- -- a-J
Obserwowmo i ~totn~l korclacjt pomittuzy POZiUllllm opilnowilnia Illctody przcz chorych i cZccedilsloscj stosowaniu kjnc7ytcrapii a wiclkoscuuml rcgre~ji 7~niilnw zakrcsic kta Cubha i rutltjl OSIOWCJ krccedilgu szczytuwtgo skrz)wienia - wspOlczynnik Ptarsona wynusil Odpllwicdnio 016 i D53
Grupa skoliol dWlllu koovyeh 0 kItac Cobba lt3(jl
typ IV wg Ponltetiego - skrrywienia pienvotnie podw6le - piersitJwe pFlWosrUlII i lccedildiwi()we Iwostrow
-Ieczeni wylcznie kiDezyterapi~ wg Dobosiewicz (0=10) (nli obsrrvLcjicirc od ~ do 24 miesifCY _~ n~dllia 12453 micsi~ca)
Sndni ~~( Cobbl na pmltltu (ugraveurulJpii
wynosil
ft udcinku Th shy 179deg
W oddnku L-17deg
Srcdni )11 Cobb~ po killtylapi -rylltlsi l
W odcinku Th shy 1J7deg
W odciuku L shy 1320
JmiddotI) 1)Imiddotj ~ lIll11 i ~W --)WCcedilMtf
ClNlIltallj Nui 001
( -aItu ho
~lllj Cl F1r Wj~ omn)
8
Zmiany w zakresie k(ill rotllcji osiowej kr~gll szqytowego sfmyiellilllV wyniku prowadzonej kinezylerapii wg Dobosiewicz
w grupie progresywnvch skoliozjedllollkowycll - 0=124 (CZB5 ObSrrwRcji od 6 do 58 mielli~cy irednia 197plusmn1185 miesiqca)
Grupa skoiozjedllolukowych typ 1 wg Ponseliego - skrzywienia Th dx - leczeni kintZ) terapill wg Dobosiewicz
(11=74 aas ubscrwacji od 6 do 45 mieiIcircccedilcy srednin 211plusmnII 1 miesiJtcft)
Zmiany w zakresie kqta CoMa IV wyniku prowadzoDej kinezy tera pii wg Dobosicwiu w grupie
progresvwon h skolUgraveIl dWlllllkowych - 0=74 (ons ubs~rwacji od 6 do 45 mil3Icircccedilcy sredni3 211 plusmn 1J1 micii il cn)
Ddcil1t~ Tb oddnek L
7
Zmiany w zaknsie kIta rotacji osiowej krfgu szczytoweg() sG-z~vienin W wylliku prowaagravezonej kinezyterapii
wg Dobosicwicz w grupi~ progrzs)wnvcb skolioz dWlUcircuk()wJcll shyn=74
(cras obscnvacji od 6 do 45 miesifC)j srednio ZI I1 JI I micsilfca)
oddnek Th udciollk L
Grupa skoliozjednolukowych 0 kqcie Cobba lt 40deg - JeCJeni wyl~7ltie lunezyterapil wg Dobo~il-Wicz (n=44) (nl3 obstrwllcji od 5 do 31 mhticcedilcy sndui 1I8plusmn6U4 miesiacn)
Obs~rwowano istolm korclacj( pomiccediltlzy poziull1lll1 upmowlIniu mctody przcz chorych 1 czccedilstosti stosowilniu kine7ylerapii il wi~lklJseii rewcsji zmian w Zakrcsil kta Cob l13 i ro tacjl osiowcj kr~1u SZCzylowcgu skrzywienia - wspolczynnik PeanlOniJ wjnusil uJpowiedniu 016 i D53 -
Grupa skolioz dWlllukowych 0 kflfch Cobbf lt30 Iyp 11 wg POllsetiego - jknywienia pienvotnie podwojle
- piersimve prflwv~middottrolle i lccedildiwilJwe ltKJoslrotme -Ieezeni wyl4eznie kinzyterapi~ wg Dobosiewicz (0=10)
(nu obenvacji ad 5 do 2 mlcsiccedilcy ~r~clnil 124plusmn51 micii~cll)
Sredui k~1 Cubba na )uclltlll I~lerpi
wy nosil
w udcinku Th-17o
w odcinkll L - 170
Sn=dui kql Cubb aJu liugrave~tyIcTUpij wynosil
W odcinku Th shy 137deg Y udcinku L shy lJ20
4) 1)IIIIcirc w Jlm ~llIWiob_ l~ rlllW
JIIIIm-lollUcirciaftq jtQ0 1 t~~010
UpIJI~r~
8
9
Po 5 i 10 miesieacutecach
C- 18 R-S C-12 R-S C-S R-Q
10
Po 9 miesilcach
11
BP
Il rz
Th
Cmiddot 12
R-3
L
C-16
R-7
PoDP 7 mies 10 rz_
C-9 C-20 R-OR-2
--__ _ _----------shy
12
DP
8 ri
111 C-26 R-2
L C- 17
R-]
bull Metoda asymetrycznej trojplaszczyznowej mobilizacji kr~gostupa ma znaczeumllCV wptyw na zahamowanie progresji
w skoliozach idiopatycznych szybko post~pujqcych
bull Mobilizacja strony wkl~s~ej skrzywienia i osiowa derotacja kr~gu szczytowego zwi~ksza korektywnoseacute skolioz zmniejsza garb i ebrowy poprawia obj~toseacute klatki piersiowej i zwi~ksza wydolnoseacute oddechowq plue
13
bull Przedstawiona metoda jest
stosowana samodzielnie lub
w pO~qczeniu z ortezq Checircneau
a takie jako przygotowanie do
leczenia operacyjnego
Ocena progresywnosci w badaniu elektrofizjologicznym
odruchu z odci~zenia
i~middotmiddot ~=~-~ shy1 _--==shyocirc
14
EUT S pine J (1997) () 93-97 copy S pringer-Verl ag lY07 ORIGINAL ARTICLE
K Dobosiewicz Neurophysiological mechanism of the unloading reflex as a prognostic factor in the early stages of idiopathie adolescent scoliosis
Rcceivcd 29 M arch 1996 Revised 16 August 1996 Acccp tcd 10 Septem ber 1996
Absfract This paper presents a new nc urophy iologila1 methougrave of e valushyati ng the risk o f p rogression in ill ioshy
mo t important factors in the eva luashytion of progress ive id io pathie scolioshysis The met hod can be lIsed to deshy
pathie scoliosis in th early stages uf tll( progre jve idiopath ie scolios is the dis ase by illY middottigating tll e unshy in lhe early s tages of the d isease loading refl ex in paraspinal muscles T he high sensi livi ty of ilie method The study incl uded 394 pat ients wilh means il can be used as a basis un seo liosis and 70 hcalt y chil dre n which to take an earl y dcc ision to
K D obosicwicz Depuumll1 mel1 l of Rchabi lilu lioll Si lesilln Medical Academ y 42-604 Tamo wskie G6ry 4
Lmenty of the unloacli ng retle x and repeatabi li ty o f Ihe rcbound and silent period were anal ysed for eaeh reflex evoked Prolonged latency and
p rimiddotom1 surgery
Key words Id iopathie seoli o is Unloadi ng rcnex Re bound
Katowice Polaml minima1 numbe o f cycles are the Larency Si ent period
T he ai m of this sludy was to evaJ uate the use of the unshyIntroduction load ing Dex for octcction of prog ressive id iopath ie adoshy
le cem oIios is in its carl s tages in onl r to lake a dccishyProg ress io n of id iopatJl ic scolios is bas been the su bject of
sion ta perfo nn surgcry as soon as pussible many clin ical radiological and elecrromyographic in ve~ shy
tigalions T here is ho wellcr no sim ple quantita ti ve or qual itati ve pro noslic methoo [hat can be em ployed in the
Materials and melhodsearly ~tHges of the disease Monitoring of lhe unloading rc felx in paraspinal m llsck appcars 10 be a reliable Inv gtsi lgnlions were carricd uut 011 394 pa tie nt with adolescent method o f discriminating bctwcen diffcrcn l fomls of Cushy ~c li ed J ild 70 hCldr hy children The scoli osis group consisted of Iios is T he un loa ing re n cx can be evokcd in ail the 31 1 g irl s and 83 boys aged 9-1 8 year~ (mean age 125 ycars) The
ske lelal muscles through a suegrave den shortening of o luntary contro ls wcre 0 girl s and 10 boys aged tO-1 7 y~ar (rncan age 128 cars ) Imong Ihe stlbjeclS tudied wcre 9 patien l w ith cershyinnervated muscle l2~J When a musc le is unloaJ ed vico-thoilc i seo liosi s mean Cobb ang le 22 7deg 121 with Ihoracic
rapidly durin g an isomerric con trac tion Ihe norm al reacshy scolios is mean Cobb nngle 309deg I 1 w ith thoraco-Iurnbar seolioshylion is an eleclrically silent pe riod fo llowed by a burs t o f s is rne ~n Co bb ang le 26~g o 63 with lumbar cotlos is mean Cobb action potentials called rebmmd The pause in d ischarge ang le 279deg and 90 w ir h doubh major curve sc o Ii() ~ i s meull o bb
nng le 292deg and 28 5deg The sludy group includcd 231 right -s ided can be observed only when a certai n h reshold va lue of and 163 left-sided 5col iouumlc patien ls There were 112 patients w ith
acceJcration flnd shortening of he muscle is exceeded progress ive id iopath ie scoliosi (76 ri g hHidtd and 36 Ic 1t-s ided) an tl il occues wilh constant latcncy correspond ing to that 182 with no n-progressive idjopa thic scoliosis (1 13 ri ght- sided and of the propriocepti ve nflcx (9 18 20] T he rebound ufter 6 le rt-sided) M d 100 w ith pe lvic tilt (statie) scolios is (42 rightshy
s ided anp 58 l eft -~ i(kd )the silent period in the unloaugraveing re felx rcsul ts from ae lishySC9 1ios is is consIcircdered progressive if the Cobb Jngle inshyvalio n of a pool of motone urons aIl o f which fClt1ch lhe
creltseacutes by more lhan 6 in 1 yen r aile middotnl1 n-progrcssive if the anshyfiring thres hold simultancously afte r prcviou~ si lenœ [l nua i increase is less thll n (i The Cobb angle ranged lrom 8deg to 77deg 1 4 201 in Ihe palicnls w ilh progress ive scoliosis (mean 361 ) [rom 30 ta
lI f R (on- f Rt tt1IY 1lIfl pflla 1 )(~ r(Jnu n t shy
fI) _ ~
Pathomechanic basics of conservative treatment of progressive idiopathic scoliosIcircs
according ta Dobosiewicz method based upon radiologie evaluation
Kryslyna DobosiewlcZ Jacek Dunnala Kny ztof Czemicki Hanna Jcndf7cjek
Deparmem of Rellabtlifatoll Mediw Uninrsity ofSiltsia KatOllice Poand 40-635 Katowice fil ZiUCl 3537 POL4ND
e-mail relwbilitacjt1s11mfoctaonetpl
Abstract Conscralivc IrcalrnCnI of Idiopathie scoht)~1 espcclall y kinc ilhcrapy i ~
nOI widcly apprccilllcd due 10 Ils suspectccl low dfcCIIcircvcnc 5 in relalion [ (1 a urglcal Irc[llment ACter long-ycar il ses ment of palomcchanic f scolio icirc in Dcpanmenl of Rchnhllilallon f Mclii al Unlcrsi ly of Sile bull a concTvallvc mcthod ()f IrCtllmenl asymmclric Irunk mobili7alion in lnclly ymmelm po~itions WIS
de el ped_Thi mClh d enablc 10 delain pTogression f scol iosis or ccn de middotrca~c laIerai urvalurc of a spi ne and angle of rOlllion assummg adequate () perallon f palicnl and ilS famil)
J Introduction
Idiopathie scoliosi OS) is a thrccdimensonal dcfonnation of il vertebral col lmm an- cntire trunk Afler many years of extensive rescarchcs the cause of idiopathie coliosIcircs $ i remaIcircns unknown It is possible Ihat idiopathie scoliosis devel ps and progress on a baslS 0- ~
multifactor disorder perhaps diffcrent for curve initiation and curve progressi 11 Fion poss ible pathologie factors nervous system dysfunctIcircons affecting postural tquili brium ar proprioceptive control seem to be espc ially important [ l 2 6 JI Pro_ ression f iS could bot delermincd by vertcbrac remodeling under eccent ri c loading created by axia lly ce gravitational forces in presence of muscular imbalancc in the trunk [2 J The verte rai colwrz unde r scoliotic conditions 15 an unstable system with tcndency to fu rther tune dcvelopment fl2] Lateral bending of a vertebral column visible in X-ray examination L
only a two-dimensional prcstntation of a complex dcformity consisting of patho logica axi rota ti on torsion and othcr deformations of vertebrae [7 8 10 II 14J ln fS physiolog~ curvatures of vcrtebra l column are disturbed Total Icngth of an anterior column of a spi n~
consi ting of vertebral bodies and intcrvertebral dises bccomcs grcater lhan length of l posterior colwnn - vertebral arches and proccsses [11 15 J h is apparent that phy iologi ~
thoracic kyphosis in rcgion of a scoliotIcircC curve diminishes Each vcrtebra of a stru tu ~
urve of coliosis is oricntatcd in hypercxtcnsion in relation t adjacent vcrtcbrae [7 l resulting
1 n B Uri middota I l 11
H srut ft illtf j tI) t li orf1Hli d
IDS Prt ts 21)2
Influence of method of asymmetric trunk mobilization on shaping of a physiological
thoracic kyphosis in children and youth suffering from progressive idiopathie scoliosis
Krystyna Dobo icwicz Jacek Dunnala Hanna Jendrzejck Krzysztof Czernicki
Deparrment of Rehabilitation Medical University ofSilesia KaloKce Poand 40-635 Katowice ut Ziolowa 3537 POLAND
e-mail rehabiliracjas(u1poCmiddottaollelpl
Abslract Idiopathie scoliosis (lS) which i sub 1 ntially l threeshydimen ional derormation or a pine cau e nOl only laler l curvalurc and axial rotation of vertebral column but al lordoti allon of VCr1cbrac in structural curve eXl nsion ln an effect physiological thoracic kypho j diminishc or cvcn dbappears Method of a ymlllctric lrunk mobilisation in strictly symmetric po iljon according [ Do () lewicz not only dcteriorme progre ion of IS or evcn reduces lalera] curvalure but also significmtly rebuild physiological thoracic kyphosis Icircn cases of lS accompanicd by lraight baclc
1 Introduction
Despitc Ion year researchc etiology of IS is nOl yel resol ed Significant problem re laled lO morphology of IS apar1 from lateral bending and ax i 1 r tati n i deviation of shape of a spine in sagittal axis affecting physiologi al curvatu re of vertebral coJumn [3 5 6 8 9 J 0 1t 12 Lcngth of anLerior col umn of a pin constitutcd by venebral hafls anugrave intcrvencbral dises dominate ovcr Jength of po terier c lurnn buill from vertebral arches and processes [lOJ This condition uring scol io i progress ion and growth of a child effect in hallowing or even disappearing of phy iological Lhoracic kyphosis in scoliotic region It i well know n lhar cn~brae of structu ral Jaleral curve are positioncd in hyperextension - lordotisation [5 6] which in Lhoracic region Icad (0 reduction of kyphosi or to true lordo middotis Such kind of venebrae relation in thoracic region cau es ilS destabicirclisatIcircon whi h in u sociation with eccentricircc gfilvitali nal load fa pinc duc to muscu lar icircmbalance [21 pOdbly produces r tationaJ lordo is [56 Il] and further development of symptomatic scoHose ft ha becn proven [12J tha strengthening of the erector spinac muscle aggravates nce initialcd deform tion and deteriorates coliotic process Hyperextension and uxial rotati n a s clatcd with
357 Th B Grivas (Ed) Research inro Spinal Defoml ilis 4 lOS Press 2002
Exercise efficiency of girls with idiopathie
seoliosis based on the ventilatory anaerobie threshold
Jacek Durmala Krystyna Dobosiewicz Hanna Jendrzejek Wieslaw Pius
Department ofRehabililation Medical University ofSiiesiaa Katowice Poand 40-635 Katowice m ZioJowa 4547 POLAND
e-mail durmalaiacekyocztaonetpl Department ofPhysiology Academy ofPhysical Education Katowice Poand
Abslract The aim of the study was to estimate the exercise efficiency in the group of
girls with idiopathie scol iosis based on the venlilatory anaerobic threshold (V AT)
Material and method The investigation comprised 58 gi rls wilh idiopathie scoliosis
aged 10--6 years 32 girls (55200 ) wilh double major scolioSiS and 26 girls (448)
with single scotiosis The girls were eonservatively treated using Dobosiewiagrave
method The control group consisted of 3 1 healthy girls aged 10-1 6 years The
cxercise test was performed using eycle ergometer During the exercise the gas
exehange parameters wcre reeorded (minute expiralory venlilation minute oxygen
consumption earbon dioxide production) On the basis of recorded paramcters V AT
has been computcd using V -si ope method Results The following V AT values were
obtained in the group with scoliosis 207+305 ml 02minlkg bm in control group
219+350 ml 02minlkg bm The differences belween girls with idiopathie scoliosis
and control group were nol SLaliSlically significant Conclusions I The exercise
effieieney of girls with idiopathie scoliosis conservalively treated using Dobosiewicz
melhod is normal 2 Such high level of the exercise cfficiency of the studied group
probably was due to intensive 3-D respiratory exercises of these girls
1 Introduction
In practice there are researched useful efficiency rates which on base of laboratory tests results possible easy without using of the relatively hard or long exercise tests would give the belter forsighting of the range of homeostasis disturbances and rapidi ty of increase of
physical fatigue during varied workloads [1] The best known rate of trus kind is the maximal
minute oxygen consumption [2345] During progressive physical effort minute oxygen
consumption increases proportionally to workload The reaching of real maximal minute
oxygen consumption in time of progressive effort is iodicaled by minute oxygen consumption plateau [5 61 This result is rarely registered in children The progressive exercise test is most commonly used in children until physicaJ exhaustion and the highest registered minute
oxygen consumption is treated as maximal minute oxygen consu mption or so-called
symplomatic limited maximal minute oxygen consumption [678J Sorne authors regard
Orto-dlet Trau malaogis Roha b ilitacjaARTlKUL ORIGINALNY ORIGINAL ARTICLE Vol 5 Nr 1 2003 80-85
Jacek Durmala l Krystyna Dobosiewicz l Tomasz Kotwicki Hanna Jendrzejek 1
Katedra i Klinika Rehabilitacji Slqska Akadenia Medyczna Katowice Katedra i Klinika Ortopedii Dzieci~cej Akademia Medyczna PoznQll
Wplyw asymetrycznej mobilizacji tulowia na wartoseacute k~ta Cobba i rotacji w przypadkach skolioz idiopatycznych u dzieci i mlodzieZy
Influence ofasyn1n1etrie 111obilisation of the trunk on the Cobb angle and rotation in idiopathie seoliosisin
children and adolescents Slnwu kluce ac eJJic Cl chOlIU) Ice SKoio= idj)PO Imiddot(~I7tmiddot
K~Jmiddot w()rus consrieI ve I (OtlHelif idiopathie HUW JS
SUMlvfARY
BackgrouId The aim ofthe stldy Vas Ihe radiological evaluation ofthe treatllJent ofthe idiopathic scolioshysis utilising as)mmetric trunk mobilisation in the strict~ll I)mmetric illitial position
Material ([fJ(f lIIellOds Presented stud) lOS based IIpon J36 cases (13 oovs oged FOf11 ocirc la 6 lcars (lild
rn girls aged frum 6 la S pears) trealed due to the idiopathie sCuliosis ((rom Novell1her 999 0 F enflfUn 200) Among 48 ch idrcn sllfJering from dOlfble-major scoios is 6 cases wcre infoll scaliusis JOjuvel7lle und 22 adolescent Among 88 sillgle scoliosis 6 lere infw7t 33 juvenile and 49 adolescent
Radiological exami71ation 1as condueed always in the repeataole technical cOlldiions RadlOglOlI1 lier evaluated oy the same physician Radiologica analysis oIthe scolios is incuded value ofthe Coho al1gle ongle ofaxial rotaion
ReSIils ln double-major scoliosis observed dlring one year period in Ihe thoracic segmenl Cobb angle decreased inll l increased 1395 and in 292 Il OS 111changed Axial lolation angle in 167 (~rcascs
decreased in 354 incrcased and rernainM the sorne in 479 In Ihe llllnba segmenl Cobb ang le clccrcscucirc il1 354 increased in 39 6 remained in 5 Angle ofaxial rotation deceoscd in3 ofca es incrcuscd in 29 and persisted in 48
ln single scolio is Cobb angle decreased in 386 incrcased in 353 and in 261 was lInchonged Axiol rotarion angle in 216 ofcases deceased in 295 increased and rell1aincd the sallie in 489
CondlsioJ Asymmetrie mobilisation of the tf1f17k in strictly syl7111elric initial positions is a 1Clhod of choice in the cOl7senJalive treatment ofthe idiopathic seoiosis
STRESZCZENIE
WS~p Celem pracy jest radiologiezla ocena Icczenia skoiloz idiopaf)cznych metoda asvmetrycznejl7lOoili shyzocji tllowia w sciSe symetlyczl7ych pozycjach lV)jscio wych
M aterial i metody Przeprowadono retrospektYlIl7q analizri 136 przypadkeacuteM dzieci (13 chlopcow i 123 dziellshyczqt w wieku 6- 18 lat) z bocznym idiop atycnylll skrYll ieniem krrgoslupa leczonych zachowawczo w Klinice
1
Ortopedla TliJumatoogia RehlblllagraveeJa ARTYKUL POOL1 DOWY OPINION ARTICLE Vol 7 Nf 1 2005 49-$11
Krystyna Dobosiewicz Jacek Durmala Tomasz KotwickP
Katedra i Klinika Rehabilitacji SIAM Katowice 2 Katedra i Klinika Orlopedii Dziecircej AM Pozncrlz
Biodynamiczna metoda tr6jplaszczyznowej korekcji skolioz idiopatycznych - opis metody Biodynamic method for 3-D correction of idiopathie
scoliosis a description ofthe method
SIOWQ kluczowe leezenie zachowawcze skoliozy idiopatyczne korekeja tr6jplaszczyznowa Key words conservative treament idiopathie scoliosis 3-D correction
SUMMARY
The biodynamic method of hree-dfmensional carreeion of idiopathie scoliosis is based on Ihe palhomeshychanics of idiopathie scolioiiiii and consiss in aClive segmental three-dimensional correction ofspinal cllrshyvatlre The course of action focuses in the viciniy ofthe apical vertebra Proprioceptive facilitation is applied on Ihe concave side ofthe curvaJure and exteroceplivefacilitation on the convex side Correction likewise proshyprio- or exteroceplive facilitation is phase-oclœd with asymmetric respirarory movemenr as weil as wilh parshyticular phases of the respiratory cycle ln Ihe course ofexercises three-planar movement is generated opposite to the direction in which scoliosis Is progressing This method is in accordance with the stale ofthe art ofscoshyIiasis pathomechanics The method requires detaied training and can Ihen con be applied at home under periodic control by a physician and a physiolherapist The method con be applied in landem with a Cheneau brace as weil as in surgical pretreatment A elaUed description of Ihe method of three-dimensional scoliosis trealment will be presented in Ihis article
STRESZCZENIE
ISlofa biadynamicznej mefody Ir6jplaszczyznowej korekcji skoioz idiopatycmych oparlaj est na patomechashynice iikolioz idiopatycznych - poega ana na czynnej segmentanlej tr6jplaszczymowej korekcji skrzywienia Dzialanie koncentruj e siccedil w pobitu Icrllgll szczytowego sknywienia Stosowane iest bodicowanie propiocepshytywne po stronie wklllsej oraz eksteroceptywne po stronie wypuldej Korekcja i slosowanie bodicocircw propioshyi eksteroceprywnych zsynchronizowane j esl z asymetrycznym torem oddechowym oraz z poszczeg61nymi fazashymi oddechu W trakcie eacutewiczen powstaje odwrotny do lrierurzku rozwoju scoliozy tr6jplaszczyznowy ruch IcrFtshygoslupa Melodajesl zgodna z aktualnym stanem wiedzy na lemat patomechanizmu scoiozy nymaga szczegocircshy100-lego instniktaZu po clorym mote byeacute wykonywana w warunkach domowych Z olcresowq kontrolq przez leshycana i fizj oterapeutll Metoda mote byeacute stosowana r6wnolegle z leczeniem gorsetem korekcyjnym Cheneau a talcte w przygotowaniu do leczenia operacyjnego slcolioz W pracy przedslawiony zostal szczeg6owy apis meshytody leczenia
Skoliozy idlopatyczne stanowili znieksztalcenia patycznej rozwija siccedil poprzez przemieszczenie kr~gu tr6j~aszczyznowe charakteryzujltce siccedil wyboczeshy szczytowego w stosunku do krccedilgu g6mego j dolnego niem rotacjltt krccedilg6w klatki piersiowej i miednicy z r6wnoczesolljego rotacjl zgodnie z ruchem wskashyoraz zmianami w fizjologicznych krzywiznach kr~ z6wek zegara dia skrzywienia prawostronnego oraz goslupa w plaszczyinie slrzalkoweJ [ 123] przeciwnie do wskaz6wek zegara dIa skrzywienia leshy
Z punklu widz nia patomechaniki tr6jplaszczyshy wostronnego Koncepcja rozwoju skoliozy jako rotashyznowe znieksztalcenie krccedilgoslupa w skoliozie idio- cja i kontrotacja sugeruje ze sily korekcyjne powinshy
49
EDUCATION MEETING SATURDAY 8th of APRIL 2006
- CARDJOPULMONARY EXERCIS E
TEST IN GIRLS WITH
CONSERVA TIVEL Y TREA TED
IDIOPATHIC SCOLIOSIS
Jacek DURMALA Krystyna DOBOSIEWICZ
Department of Rehabilitation Medical University of Silesia
Katowice Poland jdurmalaqcmpl
The aim of the study was
to estimate the influence the conservative treatment (asymmetric mobilization of the trunk by Dobosiewicz) on physical efficiency in the group of girls with idiopathie scoliosis
Material
bull 87 girls with idiopathie scoliosis
aged 1 0-17 years
(mean age 135 years SO 161)
J Durmala K Dobosiewicz 1
EDUCATION MEETING SATURDAY8thof APRIL 2006
Material
bull 38 girls (437) with double major scol iosis (thoracic segment - Cobb angle 18-42deg mean 30deg SO 82 angle of axial rotation 4-32deg mean 21 deg SD 107 lumbar segment - Cobb angle 11 shy48deg mean 31deg SO 128 angle of axial rotation 5shy30deg mean 13deg SO 85)
bull 49 girls (563) with single scoliosis (Cobb angle 11-75deg mean 33deg SO 155 angle of axial rotat ion 5-30deg mean 14deg SD 83)
TIoracic kyphosis of the invesllgated group was 5-39deg mean 23deg SO 86 and lumbar lordosis 16-41middot mean 30 50 65)
Material
bull The 64 girls aged 10-17 years (m ean age 131
years SD 132) were conservat ively Ireated
using Dobosiewiczs method
bull Treatment period ranged from 5 months 10 3
years (mean 148 months SD 902)
Material The 23 girls aged 10-17 years (mean age 136 years SO 108) were treated u sing symmetric exercises - treatment period ranged from 4 months to 3 years (mean 161 months SO 1019)
bull 26 of ail g irls (18 girls earlier treated using Dobosiewiczs m ethod and 8 gi rls earlier treated using symmetric exercises) aged 10-17 years (mean age 134 years SO 108) were twice tested - at first and last day of Intensive hospital rehabilitation (asymmetnc mobllization of the trunk by Oobosiewicz) - mean hospitalization period 20 days (range 18-26 days)
i rf~8f6~~ or~~n~= ~~r~1~r~icircJ~~tb~~~~ mean 17-4 1deg meatl~(I SO 74 R n~le ofax 1 rotatIon 5-25ot mC3 111 3laquo S0 6icircl Ilnd 1 99t1S~ ~~~~I~~~~~$ruo~ras~ ~ocirc~~a~e~~~~~~~5euml1 9middotn~ tUfllbar Iord05ts 16-4 1deg mean 311 SO 68)
J Durmala K Dobosiewicz 2
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Material
The control group consisted of 77 healthy
girls aged 6-17 years (mean age 12
years SD 31)
Material
The examined girls participated in school
only in scheduled physical education
lessons and have not been enrolled in
other sporting activity
METHOD
The exercise cycle
ergometer test was
performed
J Durmala K Dobosiewicz 3
EDUCATION MEETING SATURDAY 8th of APRIL 2006
METHOD
The Incrementai exercise test has been applied
We have found that tests ln whlch the Incrementai part of the protocol ln completed between 8 -12 minutes duration glve the
bullhighest maximum VOz in normal subjects
METHOD
The workload was Increased stepwlse
bull by 10 Watt every minute - ln chlldren
with high ~ 135 cm
bull by 15 Watt every minute ln chlldren
with high gt 135 cm
METHOD
The test had been contlnued untll refusai of the patient or exceeding the pulse Ilmit
Durlng the exerclse the gas exchange parameters were recorded by Jaeger device model Oxycon Alfa uslng direct breath-byshybreath rnethod (with face mask)
J Durmala K Dobosewlcz 4
EDUCATION MEETING SATURDAY 8th of APRIL 2006
METHOD ~ ~~ r 3 min 3 min 8 - 12 min 6 min -~
_ 0 rpiYJ 0 rpm 60 rpm ~1 30 rpm
_ t o~w=att~o~~na ~~ att__~ tl~~S~~ l ad l ~~~~~r o~w= Hlcremenlal t
pedaillog i i ~
~ ilt ~I~-----tl-~ I t ~ i ~ lOSt sffortivB
lW r resututlon r rm-u middot 1 - bullA~cremen tal ~~ ~ ~ ifr- ~ VtI 1 ~i ~ tllng _
METHOD
On the basis of recorded parameters VAT
has been individually computed for each
child using V-slope method by
Wasserman
METHOD
For assesment of physical capacity
the maximal minute oxygen o
consumption (V02max) ventilatory
anaerobic threshold (VAT) and
maximal workload was used
J Durmala K Dobosiewicz 5
EDUCATION MEETING SATURDAY 8thof APRIL 2006
RESULTS
Ali girls with 18 have been classified
within normal range of predicted
values of
bull maximal minute oxygen uptake
bull VAT and
bull maximal workload
RESULTS
The differences between group of girls
treated using Dobosiewicz s method and
group of girl s treated using symmetric
exercises were statistically significant
Lower exercise efficiency of girls treated
using sym metric exercises has been
observed
RESULTS Girls wilh IS Irealed using
N=87 p value
Dobosiewlczs method N64
symmetJic oxor-ci Nz23
Perœnlage of predicled vaJue of
maximal minute oxygen uptake
98 905 0033
Percenlage of predicled value of
VAT 97 933 0049
Percenlage 01 predided value ni
maximal workload 101 939 0038
J Durmala K Dobosiewicz 6
EDUCATION MEETING SATURDAY8th of APRIL 2006
RESULTS 26 girl s twice tested - at fi rst and last day of intensive hospital rehabilitation
The value of ventilatory anaerobic threshold increased during intensive hospital rehabilitation (asymmetric mobilization of the trunk by Oobosiewicz) statistically significantly (p=00019)
2047 ml O2 minkg (SO 268)
vs 2239 ml O2 minkg (SO 232)
Conclusions
1 The exerc ise eff iciency of girls with IS treated by asymmetric exerc ises of Oobosiewicz is norm al
2 Such high level of the exercise efficiency of thIcircs group resulted fram using of Oobosiewiczs method
r
J Durmala K Dobosiewicz 7
REVIEWS
Role of physical exercise in tbe treattnent of mild idiopathie adolescent scoliosis
Revicw of th- literature
A NECRlNl N VElWNL s PARZI 1 A NEGRINJ 5 NEClU NI
P1t~silillxlrd~ Ihcrapy (or klucgtlttlwrlpyl i pro shy-tJm of physka] cXlrd-cs ipcci I(a~ (IJcloJgtcd hy l li trIWlltl phrslollwrapbt wilh tb m~ln a1mor pl shyVCnI in lhe ilAAfIVltilH1 llf the ucirccfonuity III mild IgtC )
Lil1Si bclpin~ thebm ( aocl co uaufllclilIg ils ~jd- clf IS in nlOdlJmiddotnh-culiosis Th middotalillofthi paper ito r (W
Ille Ii lc ram r 1 a-ccrulin wh kh of Ih bull Lu[Jalmlcrus Ind (Lb hili til~ CLlLt-cd br scnli()si- clluld bl pl Y nlcd or r d uccd hl phylolld LXtmiddotrdsi n Il p--to-da le knowl Uuml~l nr tIll~C aspcc[~ i ne bulled in oruer 10 dndc whclh~r 11Rf blLl adcqlmtt Ib(uuml n middotlicaJ balis fo r ora)aini l Ihe US4~ of lUgravellgtitlerap) wltcllj(r or fln l th e prtl1iœ of kimiddot ~lre IUlll poNjn~ a t iil ies ~bould h allowtcI II uuml middot c enliaI toltlentlf)wh k lu alClor ie - lf pl lr~kiJl -c rmiddot d gtlt- (Ic rnnhi UzJ( inn ni (t hl HrJltlon [ rtn~hcll iJl ~ or 1i1J(IChIumlJlJt etc) Sh llU Ld be TolullllCcluse ulemiddot l onld b- clclIimcntalancl wukh sho ll ld he IJlI-n~ifl~d I~~a l lhc (o uld h 11lfu 1 Know k dg CJnc1in t (wIn SeiCIImiddot Hlk rCS([lflt h daw ccordinll to Ih bull llVit w o f tIlt iii 111 1( plop(lsltd in (h i papcr lmiddotonllmJ l lnl plLyi 11 cxcr(j$( pn (nti or (tmiddotduce dhlblli t ic 1 ~lt Il Jj ll(k pl ti Jlt fadl j w(~ the nlIIIrl li7alinn n f poMural dd shylitS tu p n xJ llc aSl COIlMqnen c(middot 1 all )llal) or r(tn~ shys i middot middotlIrve Tilt u~c (I f appn1priattmiddot kincsiuuml wrlpy 0 in rcns polttllcal swhiIHy Icirc IIHmiddotorc Illta ll y (0 r 1(lt1 lllho UAh mon ltlccurlltc 1Ut dl1alkd -rLk l(lWfils 111111 )11 h Jlccdt(
11) wurcJlt 0 lit)-IcircS (Iumpy - x rcLs P()lun
n rllt lT(ltnklf u f COll1tlK H (rtd) I 1i plfho l og l ~$I rUlglng tr m low tmiddot k Pl 1l1 to IdiOpath ie SCUIshy
Submitt(oJ [or PUhltCl l1 011 uly Tt 2001 Acc~pttJ ugu - ~2 1(t-1l
Addre rltj-xlfll telt~I(middotb If) - grinl Flt(1(bziurllt r )(m Ofl ()(Cl1I shy Lt middotqlltœlll ro () - 1u I4t agravehLIlKil ta IYIL-lTt ilSllltp lfllmiddot ~ 1l1uumldull
CelII ~ (niiOS I I~ middot ann (1) IfUh middot lIlfU di louhilll(tymi ( Nlmiddot ~iI rli -ilIIUmiddotltlfl
Nlti(ir 1( ) il r() (ltbullagt1
lt vLL_ l IiII no 1ftfI
jS ) we are a IUil ly tJc ing n1n) ltblll lS 1 k l1 b ~J)w in~ tl~ t S Jfll l approad llt - l1n til hy on ielshyertd ~tan lard ugraveJuld ln m any ~1~ he lI ~t les i if Ilot dange r )ll lt rhlS is lrut of reil l lnw 1gtlt1lt1 pa in l ~ or 5urgi c ll lrea lmltnl5 in dbc r lmiddot ll Sc - 2
ln tlle cj-e ut ~ t lll(tlWtl i( li p l ll1JC luuml- I ~ middottnl ~() shyliosis phys cal ((_lt1(( is emr1uved ltI t()fIl1 0 lh~rtrv
lo ly in cel1l in L)lllllde (nluumlnlr in tilt Lltlll middotorkl i e Iw l) r llt t Srain hUI IIgt() 111 Gert11lny 5- 1~1 in other reg lOl1 wbere thi I-incl qf tre l tm e rll 1 p~ 1 pmiddot t 1( cI il Jws Ixen cri ri cilld md rel -cltd Lw m~lI1 1 11 Jlu~ Fue Fnlny r ~lrs thio middot15 a lsgt(ru( f ~rth r -~ltc rrJtf))~ ll t vit11 br1Cltcgt b r II1 ([C Llt n ClW grmvlng 1lt1 0 L Sti g
gcsti n the lIsefulnes- u r Ih is form o t treatm n t 1
Hmiddotu]rs have nerged jn El or uf pll y~ iLd eegraverdse eacute 00[ 1 but tlw are nUl yel 11 11 t llu i vIC~11 and r hi ~
f rm of trt ~ltmenr IS stiJ l Ul1 ckf ckhate FfI t Jt 111 il i 11t (eltary td 1I iFy 11umbtr ot
b l sic COI ceP rlJ lf w ill he cIh tt d in t hi pap r
Scollosis
DCijIrI iriolls
ScnUoSlS is Irlircc c1 lme nsIcircltnal (I(gt i l cj on ot tht spinc thar cau C a CU 1 lh lt ca n h e $ t~en ln (1 me1Sshy
ured ultinF Coh) lll ltllCXI o n HI anreu middot p rtc rilt r
EUJlOI -1 lœDICOPHYSlc~ IR
NECRI Nl
110
f)i)
1 7J
amp aS g 5li - 0 v
V
31
10
(1 1) Il 15
-tc i ytjtr~)
FigJ----jllph ot DlI w l-lkaupegraverel) The agloimvltltinn Or idio r lrhlc 50gt1iflll~ IS rpiJ bel~ en th e- [l0 IH P (l)ltg tnntll lol (JI PUllcmiddotny) mtl 1 ( f( lS-er sigll paiilivltecirc lt Dlt(i I1 11illg r the iti l 1Kgt n n t rll icirclicH a ) 111lt m omal prebulled the mno rche md ociks with lll I)ttlx flal gr Ih pll fl
rlcljoprdphLi 1 hl merl prestIK ~ of this curvt c10es n t autom~l ritllJy indi ate the pn$CI1(t of a defurshyTnitv (SlllKtUrd (Unel
It i~ possible tu clil1e ren tute a struCnlt t CI1tve fruIn a pogt urll 011e by identifyi og the hum]) du ring AdIlns tesr I~OQ looklng tra m beh lnd at the p atient w ho b benchng fUfward il is p -- ible ta d d~ct 1l1 eh ucirc n of o ne liidlt 0 1 the trunk usually n n the (onvex ~ jde ul tbe radiographie CUfve Ugrave1lr C Ul be mlt~I Slred lISin~
BUlln els S o liomere( 1 ~ l This h Uf1lp is du(- lO (Ile pregravegtecircn ~ of vertel ra i rolltion 1c1 Ollt tn tic f~YJ tllre o f the def trrnit tli [ c m be seen and measurc(i v ith Perddolles lb lsLometer on an amero-Ix)iferior radioshygrapb ~2
Seven ry pel cent o f li Ises a re conid 1lt 1tO be idiopa thie 1 bull ia l-nosilt in this CI$C is b exdlls i ~ n as idinpa thlc me-us t11H wc do n()[ know rJw origio of lheacute curvc [n othe] ~Ie$ it b Ix )~i ble ro ide nrify a dieak (bat CHl jusrify the c1etgtnniry slIch a rna lfo rshymar i ns I1(gtufol Ig ic~ l or genlttic cl iscas s Glnclt~r trauma etc )
[dicirc)parhk S(oliosis has been divicled ~(corcling (0
the ~Ie of tlie patient egrave1l the tiJ1ll of d~[ccli n of the condil ion into ti) ur t ypei ln fanUlc jU nik ltldolesshyccnt lnd aduh Til l m n st cnnunon (VPC IS the acloshylescegravenr o licirceacute I1IJctenzec1 hy 1 sud le l1 tggrH3l ion uuml uring the grow tll Spllrt (Hg 1)2
lhile p tu 1l sco liosi i5 Ycry lomnw n thl pre shy~Iknct ra te f r adole ent icuumlop~lthic structural CU IY~S in sch )o chilclren are 18middot20
- 10 Co bb d~grels o r m on l -lil
- 2) ~ohh dtgreclt or mort O 2~j - bull () (obb d gre -s )1 mOfeacute ()ll 2
Clin iltI [ d e isio ns lfl IXlSed 111 an lccu r~He pregshynosi which obt inccl in eJch pa ti nt mainly o n the basi of the nsidu~ll p()tlnllltl l of TH1h and the result s of 1 rh clin 1 1 ~l1d tadiogmpl i exlminashyti(ln12ll c noieq uentlya d inica ] la sifiou io n o f the ing le pHient tn -ome estent co incic1 ing w irh the
D diographic one c l n lw SLlIl1H1arizeci 1 1 folIcJ - mikl lc~ (1)(n 20 C bh de~r es - moderJt l betwlen ln md 15 ohh de~ rtes - StV re 111( gt1lt rh n ~J) )bh (kgf s
On the 1) lsis of [hi - dinic d d a lfic t i n (Vith l1l il el lrb tiOI ~ o f the ir b() und~ri e ) in Itllt l cente rS Of SCOtiO LS ITe ltlllent in the Lltin odcl (i rJ Ital lnmct md PI iJ Ugrave tre tmtnt i s plmmcd a fo lltJw 8l
- mild kineslth e (~1fw ~1Il (1 luok-ou t - Hl demte IJragravecegrave 1111101 c(~r md k i rws ithe lJpy - ~cven surgery
Physical exe rcL~e for S(ol iosis
Defi t tiOl l S
PhyS i 11 nU b lIKrlttp middot (or kines ithcIa Pl) i a p rvgrlill or plt~i Gl l (xeriltecircS ~1ci fi ( llJ y ltk ~ loped
y a -11 [ru ine 1pll yslo ther3pisr wirh th e m 10 Hllll
- pre (~ n tit1g tlc aggraaLion of the cl I )flnily in rnild bullcoUm is
- helping tlk Il ld Ct ~lOd ounter~lCtjng its skie elfects in III de rltegrave sc li sis
Tn tl1i_ feSpec1 kinesitl1ert py f JI s oliosis is tonshysider l a o on of peciticcedil training and s genecirc tltllly proposelt in sessions 0 1 4~ ro 60 minute IW) t) tour limes 1 Cee PhysiGtl exerci es can aLo ll v o ther auumlns 1S it oill he dise Issed in this plper
Ir 15 Ilot possib le to cl escribe a single progrlIT1 o r exerc ise a5 pro nrams ale USLIJUy p fgt nll ized ( ( lt
EUH PA ~illDI (DP1I YS IC~ 182
ROlL UF P l 1YSICAL lXl 1lt 1~E IN l IlE 11 ~l) IEd If IlU) l[)VP 1HI AIJ() J)~Cl~ r COl ~I NlG1W il
f)( 15 egraved ( )Il the nee L- 01 indi iuua l pJl itnts) al l l10ugh Lheacute) C l n h t 11 plicd o n a WOU p hJ~js (-1 (0 () pnients PC[ ~l ()lI r)middot lugrave reQCf lhese 1 10 grl lll frequt ml~ V IIT
hnm on in middotituk w allClthltJmiddot -Ill Jnv L l~egrave at Wc w Ht ~huw in lhis lyl peJ it i~ 111 n u -eII1 tu id e ntilv kirK itheJapturlc aims w hitl l ucircrr~spnd LO ugravelt~lil1 DUtshy
g X ir ur ph -s ici l lxtTi~l I~llhe r thln ln dj( us- indishyiJ u1 1progr-lfll
Aduumll l lxUl kisure time ~lOd h )u] Sp u lllll8 ~Ilttishy
i lt egrave~ i middotomm )Ly s iven lel mJ ing ro w hlf ~ Iuumlnsidshyer~d usdul or il lrmfu l in t1 lt rruning (lI tJw ptliJicirct ln tl1bplper Ugrave1 gent ltl l t rl ll bull p lwsiCUgrave lttG iviUes is rl ktll 10 JllI1ltlCc hOlll gtpOlt mJ kIJ1lsIcircl hc lJ l f
i ve lUen tloneumld )bo C on lv ine n dul( re Ull~ 1t~1 t s far Ilten publislt d f I~ mJ I(i noltgtithltl rgt is 11 11 a su h jel lnI deacutehate CJitk haltlt t llltit m itn ltl of l ny lorm o t p l1 ySiClI lxrcL e as a Itwr1 [ J- fo r i liopa tb il jcoJL~b un iL ()ri gin~ initial1) it WIS Ille r rOmiddotUumlK lt brgdv u f p l~lt titu gtllergt w h ) intervenecl hutll tc llcrl ll (mon as cltl HtilJ nic in terventi n man Jgt
1 t lltrJp utl t one 1 md rC j fkll l~ on rhe h sh lf som uni cOen I1v pn t I1cgts wt ldl hll ltl enl1 JI~ haLl nu na l scicnt lfic baisYmiddot HOlh tlle$( trr t peu shy to rh ~rl py tt nJecI to l~~rJ tte C Ih tk CUf -~ pnnshyclr~tll y as a f tsul t of lilo h llIzatio ll of tn imdqultdy ~u pp rt(d S pln eacute 7~ 12 to re-t1 r rI ltrl 1$ l l1C k o f WH llt~~rdl 10 I ndt~-dll()urnah tnd 11( on1 p~l per u suaJly Cl tc([ IS n prelimmtrf lll d 3 ln tt li w ay man (l rrlKpt(Hc H lf O iS Inll ph ~i C U l ~ d vi ~ cI nllog scnliotl pa t le nL~ 3gainst holll ph lca l egravexershyclc and p()rt~1
It m u st t~ n tfd [hat pllyknl txerc j~ tJe~ltm(nls t1iHer 1 lJ rd il1g r rhe rherlpcu tlC litTl~ on lllc h tJ rgt ap p lolc il l the IXlltent lncl hi im r IIIllHnt i- 1 (1(1 rI - 5lt1J lC igt tIl l ( f phJllIlllolopJ al rrea tmln ls Ihith cllffc r 1lt œQlfd- rhe m C cculc u ~t(l luI thl p al 1t n
~mc l 11i (lbE~e Tt i ~ P ~il k tlwreI[middote thll wuumlk ltlll t kin 1or ph~ i Clt1 1 lX r(j~ 1I 111~ t bc loidvd by t h~ Lo iurie IxujCJ1l al1ulhcr a dl ~IS nJI h~ iOg (1 11shygerols llugJr in racr le (wi ller d I ~fJIII ~ I ml thlls re(nl1l rn ndc(1
fn n UI cel1ll r we In(~ hccf) using 1 ) 1 1111 11 ve ) 1 (J p lw l icd ex(r(i~e (0 J ( 1I l tt i~ tlh aITt ~ l~d Ilv m ikl tru cflumiddott1 adokscltnt (cl ioj arh lC icoli is11 2)
ina the f U~ t rc-gt uJrs IefC pu b lishe - the pJ( )grd m 11lt1lt l1te n PWltllk d in fa c t deel()pnlln l~ in th t l itshy OlL1Ii in tl1 r b t ~() ycal f ha ve iclemi fiecl niO l l
m d 111 ur impl rnHm s md d i s )h ilir i (gt~ lue t idlo p lthk amp()lio -i ~ t Jll CIII he 1UO(l if Icirc 1by phyict1 egrave xert iSlgt l fe t rrncllt
l illl
111e aim of t l1JS r~l per ii tmiddot (tv iew tl1( l iterat urt to a(errl ln v llic ll of th~ impa irm 1t~ and Liit hil it il i GllIltec hy ~ o l i()gtj s -o ull he ll nt x or re middotlu celt1 Ili pl1ysical xerclse An u p-to-da te knOvkdge o f tl lt Lgtpecl-gt i necckC1 in rJeumlr) d -oek
- whetll~r there h ltl n adLtIIl ) l tht()d ical bbh fur or JqIIcirclb l l l1 Il( ) f k irt llit herlpy
- h N I)(1 ( 1 Dm tlle p r l c tIcirc(( o f Jebur tiJne )pOfung lcli v l ti ~ IIOU lci he tllf) -d o
II J U V f h 1 I11~ c~~lb li hed Ihe usefuhlLss 01 k il1 shyc ~thtrpy il i aIle dy l nsi 1([(( -r-tI Llleu i n )I11 plJt~ ut the wJrld ir ilt ecircS~nl i 1 I( id n Iv w l1i li ( 1shy
gories 0 1 pl1Vtl( 1excrClgtegt te D)bilI7it ric 1n (Ir st shylliuumlZltio f) lttlt tlgtbltn ing ni trcrccedilh ing erc) hn Id be
vnlcled he tll rhe nuld be lerrillldll1 1 md whidl s tlQu1d be inreœ jf ic(1 IJeClU~l tlley cOli lel Je LI ~ful
Ncuro1llotor impainncnts
Imv aUl llOr~ 11 lt1lt ~tlKlteJ lhe cltlndatiotl bd Ween tl UC1UmiddotIt t l ol(~C t nt id iopml je -nll ~J~ and cli~l l shyler~ lr 1tH lest ihuLIr yt 1 _ 13 ~ 311 D uhoussct 1
1-- ITS tln l ldiopath k s(o lio-L L cll -c d l J l hmgt in th terl tltr f prop li l l pu n md 1I1ar th e detrshyn Hi n i~ na tural 1 ~ronse to ril e need tu ts tu re p()tun ltlluilib riu Ul HcrmJJ1 31~ 11 () d tllat icliupathic ( liCl5j h l it re5u lt Ot1 rw nltuf mot r l ~ltelV
[Id )fcl 3 nI] ~1ltJ U Sr1lle nr to dtorders in centJtI lO~Cl shyIOIDNur) md 1xi~tI moro (Ul1lfOl syt( llI (Fig _l
N htIll -of) H1c S uumll h( rll1 ( ~ l( w ing JI t11 (oshyI-ie on the l l lO]ugy o b doll (nt Rl iu]icirc tlili- middot()lioL m unt fil t-hltll rhl ugravedcmnilV L th e fl5 ult o f 1 (k btcl 11lIFll llI ion nf som t11(WUgravetltnl md pO~ lur( (tnic l~ l licirc1 tl1lt if l p OgtlbJt b C 1l rlw sta l i lin 0f 11 1 Sf llle j lt g )tx l Tt) ohtil n a ))Cli U 1ILzltl I o f p ~llIr~il d l~flo [ in l1litkd ~J)llnSIS me CI Igt(middotqucnr J ~ a ~tmicirc ()nlly or regle Ie Llive
Ali th- 11yp ) tlw~es rd ~lte tr d irtl Itn t pnl1tlt o f [11 v hole ~piltm It11[ controls postu re ~nd mrw shyment lrre pell ic of tlh po int a d lI~ llv inH llYegraved il i ~ ll 1 nnable tCl aSUilll ri 1l tr l ll1 lo g thi ~ys ttm ( Qu it le 1I middoteli tl
lt ch ugt nlt~(S f rullliIl thil i nlomwtion th at p tlmiddot shyiCil J(tl iIies nw gt Il lInport~n t rr le to pbv [11Icircgt role ca n 1)lt slI i11l1lariztd ln lWO the ptu li ain Llt
- d elopmll1 l of p uumlltl St1 b Hlt ) - c1e veuml IOpm 1)[ o f bhll1ltc _
(k llhUl)lOr S Cll orr
ontrot oic whan-lt
------+ 1 ~ il lnll ugrave r AINnl
Cllnlr1
T bflt~ r
fltL1 tlli
lMini
l
~sary ~J-frlllen i )f
~ 1 ocirctnl
~UcirclllIJJlW Ll
AXl ~l1 n uumll l) r sy 5t ~nl
middoticoltoq ~ Fig 2-AcFgtrdong lU He-mutl 21 il is Fi)5~ ib1e rD prolXgtSlt l -oo ie1 mnd 1 ((if ~ elio egrave middotAhltr~d l)Qdy-p ati~ I I i u d) uren ttllOn k td LO In ~ory reHTt I1 eDi tn l al ) JdrnlV~ pn)4~ e l u r~o(Ofe 0-c1 eptunl dvstil t1 ctlon sltŒ(ry icircltu nu11t ilwnt [ ~mC ~ted tl l1 ce Ill trpntlshyUumlfJJl nd IKnle~ r~dibl jtugrave)n of -I) m tlosen Ir ~ig nj tl (I1vying ln fornll1U n (lI an ereltl ~piJl e Mmor aJJ r--a t ~) n ltgtf ti lt aXljl mowr plem iHUC Wh ~fl Ille 6ubjeco m uumlntl Icircn (1oJifitd perccpfLlI l ~na l ysilt of p n)lnocepti Icircnfu rnlaquol ti desnibJOS ~n t tecr spin A IICW motor co nrro l Ira I gy t adopt resu ltin~ in the ~tr ltctltr 1 ckformh y lf IdiopathirL scollos i=i Ht lrftU1uc nltnt l ISll I1lJy h1e- ~ I pro()und elkn on bralO Sfem flJll ct i(lnn~lLhu modifyRll Ille nltulltgtshytl10 ) 1 1111 Uu l-lHoror control 5~Shnl$ shy
As Srtgn1lt1 l ~ ltlssert~ if wc l C -Cp t 111 1 un o f the G IiC s oliosls L l tisorckr oi th e ltquilibrilltn sys t ~ms it is lagical to oriegravenrate physlCl l exercis( lherap y ln th is d ir(gtCli()[1
11lclte goals Cul tl lfOUgil ditrercn t modes 01 action be Olchic(-c1 witJ1 phykal accivit ie
- po rt ive Cll ities p ro ct LJ e aIl UgravelClltrtsc in 6lte nshyel ll )o rd in~lti n pinai pr0prinup ti_)[J nLi mOVeshyment control 0 vio lls iy ln thh repect ome lCtivshylites aœ pre um~I I)y lXrter tllln ntil crs
- kinrl lira py using pedJil exerCisocirc specially developecl lith th est 1101 5 in mind illVuuml VC I lllore prccilt( ll1d InC1 li zed cri n on rhe spiJw focusing
a90
1 ~~
lg -lNheJo ~1l l1 t r~l g rld in 1 1) h i(~ IImiddot ct r rHienl w i ll idlllhic _It ~i ~ _ iri s plt ~I le II find Jit ltH vlllleuml ~l Cgtbl tn~ ks III d il fef lt p ~ lt ihnS nu v~tl middot B ~a~pt u Il C middotl)Icircd ~(t l l11 C dlfkrCnl middot- hdween slllndi1g Uline nu nllt1Xinul oorrec ri nI t chied Vith Ct (J ) und tfdincJ ne lot es o UIine 1 fo llnVs middotIJfl tfi ni( - ltlrshy
reltiK)n ~ Ikexibiliry st3nucircing - -pirte - f ur~1 1IbjISC ltupin - ltorrcaion - - r~luci()il ll ymiddot For flmpllt in J npK l1 pH k1J il
plt1SSlhlc ln obtai n 10 u1 511ndlt)l [YLo lion yr ln Slt p ille rlOlgt itlugraven om l J ~ in ( gttf(C rigtIl lIex lbuil 15 i (r-l l=22deg pol lltl ~~J IIlpraquo is IcircO~-V- I t1 l nd tucircu(Ugrave) ilil) I~ 3laquoJO- IH-12
r ln Ugravel e abilit jl of tluuml [m e llu to co ntro l irse lr in ~ pac
fuld l oftlles uumlllelve ntio ns can presum1b1r incn~~ Ih enl ac )1 the orller and lHitlll r of Ille rn - 11 )ltd h e lllldenl lu EJ3)4il
Posl1l1-t collapse lnd slabilizariotl
lIle concept u fplt st lUal c(l lJap~e l l~t Iwen detin 61 by DlI II-T3e~tupegrave rL t Ac oJdin)j tu tl1i- ~ll1thor il [ nec(sary ~- l Hn Cv-tlualing th tleihility o f a col shylo tIcircC CUJVL (0 clistingu ih bt tVeen the re du ihil [ty index (th - li iffer gt le bet ~middot Il ~I r~tcli()grJph ie ~xnmshyinltio n of the iI111 pHienr in supine po ition m(i
ROte OF Pl rnmL EŒIlCISE IN THE TREAT-ŒNT OP ~I IJD IDIOPAnnC OOU~GEm seou SIS EltJRINI
I (~)-----------------------~
__ _~ _____ _~ __ __ L ___~ ________1 ____ _ __ ____ ___ ___ _____L___ _____ l___ ----------L ______ _
1 ~
1
-- ------- --1---- ---- ]---r --- -----_----t- ---- --- ---shy__ ______~---- __ ____ 1________ __ _1_ __ ____ __shy
~ (1 J
1
8 =~~=r=middotmiddotmiddotmiddoti~=-middotl--- middotmiddotmiddotshy--------------t----------~- -------- - ------__shy
~---- --- -- -~ -------------r---- -- -- ~-- - -------- --shy----i-------r-- - ---- ~~-shy
il 1~ 0
Dtl-Lmiddot ~ lttj l r~ UIltltlHt
f g 1 -TI1 u ilictf 1ld ( ii 11- ugraveu-sh) ld IX~ O 1d wllich ltJdnrshymII Il nf the pilll 1 ~tln~1 of th e -o lioti( spinc n IG~nI(J II IIIshytt) lhe iJeuml grl-e o f ~ ()Ii ti c (u rvH Il 1 w dcpc-nlknrly o l l he 10 111shy
P01(nl (pntt l ~ 1 1 nr ffll wrJ I) ln w hilth Ihe n i 1gt( ~ duc nL~ grlphs fm I h~lt 111lt hi~hr Iht Col h ~Ilu t (l f Lite ~Ul Ihe m Ol CI il y th t s(uumlJotil middotpin~ ~111 he ~middotJg gr~lVH(~(1
m mJxiTIt corrttt ion wll iJl i~ lIllCd to Ih - xt 1shy
lti Oilil y Jf tl1lt t Ut JO rl1t cdnUc idt md p OS shy
tU ll cul lapse ( th t ltHill enct b-tten l lUdioL) 1lphic egraveltamJl1ltlti OI1 J t th e ~lme pa tient in Sl il tl cling lOJ lline fX-sitiutl ) Wll ic h correb lc- onl wil ll fhe abilt ty of lllt p tu rl l gt s tem to C( lunternct lIk luree o r grl viry )cco d ing rv D lfVd- f3egraveLIprc po st li r t1 lt01shyIlDse is d ue to the Jnus -u lar ton a nd 11ll ex rCrIshy i) i itv of rhe tissus n the ( O IW-) si it (If the (01shyjl ti (~JtVe (Fi~ 3 L Pu~t llr1 C lltpstl lu lcl l ~~ reduc l-lt by llwans o f pl1ysica l cxerCles specitkally s tuclled ruuml i rnprove tIlus--ubr fOHt md lU pr )cllI Ct 1 ~11 hi shy
lizing ffCd
PararcL n tll CIJ cl the cr iti ca l (3 c1 thlsho ld beQ ld Il ich defol1J lHU n of the i pinlt 1 e~ in~ ne dtlllontr~1t _cl (1l ll t grclrf r mg] o f rllt C II in a qa m bng pos ition corn pOil 15 t l lowcr detormashytion lhnsllold (Fig 1) ie to ~11l Ulne3Se t the risk of pr ogr t~ lu n There t rh eJef re l J ea r l)iuuml 1itshycJ l ~ll1 l l(tl a 1 tnr tg ro b ohwined by d -cr t l ~ illg ilmiddot pU~lUrll cull lpse ptJcelJtge w bich lccording t i)
h llTd tnd ~l(heJ1l ~on 1~ b inde cl 1X llt icularly luumlgh Ugravel mllcl c Iio~ i (bdow 2( 0 ) (F ig 5 J
Fin a Il III ch iS respect lllljl hl and b um l 01 m linmiddot
ii iI 1 l _ _~ _ ___I ___ ___ __L ___ _ ___ ___J______ ___ 1 ___
li 1 1 1 1 i 1
1 i ___--____---___----__-_---_~- _ _--_ ___-+----
i
1
i -- ~- -- ---~-----_-~-_-_--_1-~
l ~
i
+----r--------t-------t------f-- J
Fj~ ~-Ac(XjJlin(Q luuml T O rIcd ~lnd Na(h(ln~ n i () dl( pCG w rd (rTIshy
POO ll is hiherin cu rvegt in wh ilt l1lh ~1flILWrd cII1I Olk l1t IS le- pr(v~knt ln th e grtph Ih t PogttJlJ I ugtnq) Ot1 -J1l j elfltS-e J tlt 1l1t obb dirr remc rlLIv obu incu f roll l the Cohb atl( 0 1stlI1dtJ1g IId gtupinc rldo~raf115 Ih Ille lt) [1l1t1 (i lndnl I pine) 511pille the ~(nlClu tJ1 compo l1lnt U rlk CU Y _VeJily I~ ltx p rlt 1 L1v UpUlt (obh Illeturo Ih t si _b Cct rtJeSIm l fie -ltn J trd Ugraveltuuml shyuumlo n A~-i)rding LP 11(lt uuta o n l ( r1I~( in ~I 2JQ sup itlt curvt 1hi C(]l)b ddhccno l l f lO is -J-lultt( thc s ldnd inr tnla Ol1l t lS wi Q) whil 11) 1 1)401 ~llp lne ClHVC If ~ 1Omiddot ( tcl Lhe ttnd trl~ nlca~ I(t I ~ ~I)
tli n ll w l lllE cq lin ti spin h~ i ng mo r ~ Llnt~II) 1 tlun the nOftl111 one n Cll l gr(lk ( (cU ve tl1u n da r u p shy
po rt in o r k r 10 m linrl in tht 1xi11po tuf_ n th ha__i of th egt onideratl lr1S it f(lll() rhJt
ph rH (~Uuml e erd es ulukl h u - ul iiuml tbeacuteY ~U-L lm cl 1l (It-d o pmg p05111 td C Jl1twl lS fuumlrnll~ rly d ccrll1td ln an Ql St if i imr ol1111 t ru t(( - tht m(d in C JI shy
r t t r sture fO Ir -ngthen tlll m u ck-gt of the spint mainl) in (11erl antig r3ilrl tIcirclt l]lli fun ctin ll U hy meU15 dl i )ll1 t trk ~ lhJ cl( -ll tlt C)nlr~lUions ~llld no l IdOshy
1l)llic d YIltll1k lt l jAJ lktic t) I1 ) II 11)t 111 hd posibleacute t lcluuml ee postura l io nrro and stfh ili lllllt IJI
w i thout food T1lw(ull r d I( Lf(11 Ibk t m ucircnuin Ihe c()rf ~ct [ ()S tu re for cl gtu ifKi IH lLl1gth 0f ti l11 ~
This i-l ddl usl a typl 11 dnmnin (tf k inesllh rap) in 11 (lt-11 [[k - p~d fk lnr in lng f u l1a in llllliCk is poss ihle lI sing ctrtain Idncl fJ l (lt) 11111 liun S p Ul in tb is Cl c is ulttful ooly sa I~tr 1~ il Iw lps t1w lxltknt 1 becuJl)t 1gtlt ltlt-I a ClJu~l inred irl ilL ntllru l o~ i cll
and I1lll~lJhl r-keJc LIl [rll-llIn~ middot etlt(wrs JI the int e rmiddot vlnrion
[J ROPA MfJ) I()Wf-I YSJ IR
1
ICR 1 1-1
r
1 shy ~
- shy
11 o-llrfOlhe5l~ o t Ih 1O~(1dity i n h ~ r ~ ll nr pbl1 l of ~ Spl11 in 111011 _llti1Gt l lPt f ltlJUCWJtl ( ~l Ihe Ir t 1 1gt illbll W Ilh LtltrJ1dlion Vln lbe rigronl middotUII~ l(I Dko n12 lIll h lumshydlanie1 1 [ nul 1 M hl whtrc M - gt) lnIUI1g 111laquo111laquo1 1 1 c rtJCshytjC~ f fce d -d Lill l1~ o f enr niI pUll spnmcl1y 1~ 111 mldlll1lt (n the fl1ur t 1 = tor~ of f(ward Ileuuml l = ughtel1lng fmiddotr p 1shynOf stn lClU= Alaquo rdtllg 1raquo Ihl~ - lin hull th l1ltgtllugrave ot tller1l lUr~Jtllrc F the ~pin t -ilh rlu1i tf Ihl 1 1Ibulll n lrlt InltT1 1
rbc prJI 3IJi l1ty d qrlOIJ~ n bull JI t IlJIII Hm lA the v=ltd gtc e lu-ing J 5lnK1ura i ltfnnity
Dioal e ch anicll itllp~lir J11 c nt
Ihrcemiddotdimcllgtional mc-cbal1in of the s pioc
~f Ikmiddot i t i nly l(œ ntly tlHr llk pr-5tnœ or nc ushy1 lnlo tnr impairment in Idiopttlllc s-ol ii IXl tknt liuml J$ heen h i- ll licircghlcJ hy re$eJ rh tll e preit ilegravee h inm b nIcirc Ji d lJutg~ lt hl ~ 1 ng t o n dO Ulll urcel 1 i5 (l lreldv well umlersrood H(j-ev~r nev lbt un h iomcrhankal im l) ion nI h1c rectm ly onk l n tIlt tre and p r~dou in f n rmtinn hou t pl1ykd (~fcl5( in t 11 0 tl1I _ltgt pbne of spact 1115 Im trqlt-u 1rom J i-[) v ing unclcrsrmdlng ot th l lmc -dim nshy~ilnl l l11 ~ hmk f the cO]jO[lC pln( ~2middot ) ) Ve- w ill )iI xnl t l1 d at lcL-orcltng tUl cl sif iol t lOn blsed o n gtolllt lricd h uumlCJ ) p lane
- b() rJzU[1tl ln th i pla n ~ th t 1o rm ll sp ine present no CUlye- w ll ile Uumll(~ ltc U Hic spLnc clevelops one of ir haracterls(Icircc deFo rm tiCs v elt tbrd ln lashytio n vh icl1 pJ()VcA~ theacute hw 11
- lgitltl in th llulJe U l(~ nonmll spIcirclle pl SenL kypl lOSis ~nd l dooi~ in tb lXI1 lhese [(Hu rts Vere m)( til ught [ 0 he relattd tlle scolkJtlc ( lI r Vegrave
- front l in hi pleme tht ncrmal p ine preseuron t no curYegrave whil thl ~11li tic p in ugravetI I ()~ icircl~ charshyad t Ilt I CU1C
Il Jri fJIIt palic
~l+I~na ra 3 r inr lut th l[ ber ll1d a œl1~lU1 degr 1
l f r()la tJo u lllu (lILa r forcKl ltxert ltJn tl ldefnmuumlng 1 tkllJ [J i1u a re- lhlt tll cly 11 [1 1 UI b y Olm ner w bn ~lh uiJwd tl egrave ro t1tic) l1 Ilm it ti lt p ica] lf shy
rhrl r() be (P (the Uma bevond Wl1iltJl th lCOJlb of [11( ~pmaJ musd ~ dthc COnCIt and nm ex ~l le btconk (t O li~[)
r ~l 18 ~1Il N lu t( ren i9 lun lu ted rlseurlt h in tlt ) tilt lULodeumlformipg1 tlo n ot tIH_ sc laquoJrle rh ox ercallkren lk 1l1~H li d11r once thl Il i ~ r tld1t5 [he lhrth ld f 111 JlIcirc lIi of tlle dnrlclc hurnp tlk
lI bslt Il l nt rlet()rlll lIcircon 01 the it l ()I~ C ( (ylm der (- sustalnecl by an H1tmi cforming aCOOIl
J1Ji h V hl rhyiical f~ f Ise CI 01 h spr n llnd kin middot ith ccedilrapJ my lX damlg ing vll e n l pplild as flle
igt Jk Iller ln SCC1IJ ~IS lllc lJ fxceed l auto in middot crca~ i n g lhrllgthuld [1 sh (~u Id ahn be j ofed that Ilw relscd pre sun 1l1111i insiugrave l fe pil1r inn) 1 mlshylt
- j Il- ( w atff 1 (nh ~1l 1(e Il10 utoldrml ng li1eCh~lI1 1sm
in flc l Geyer ~w tcd th1 t rm m 1 hI l)1ecircch1O lla1 puilll 0 l I C~ sw m mim t Ieuroamp no purpo t for cu lshyim le pllilt t1 s (weumlO middott r it is l~Jl(gtWl1 rhn in iculio r[ paULnl -iJl11T1ill~ doe_gt nor Il ~lp to i ncrt~SL n eur(1shym tor co mfU
(1irai p an (
Jerdnn lle 11 showecl thal ill CSl~ o f t10rLC IC 1i lUgrave
tllo lacolulllhil it lio_1 tlle cte tI llmiry in (he lg itt1 p lln t rn lnlftot il~ lf tspe iuUy in tlw initi 11 r luleuml )f cV IU[Icircon nf Ile ~oli ls W iU l 1 p(t)gr~s~ivlt il10middot~ shy
ment roward hvpok pho b G ll f ill~l Im lins l har dUflng (IN eWllLlfiu1 of 11Imh] co luumlgt i the l in t ot t l H~ gClyty Cegraven te l - 0 1 v llebed lxxli 5 r ro ject 1 seH fl r t side-ys and tlwn backlrcl bull thu~ p(0(1 lj n g a kyphQtlmg aet Il ln (h~ lu mhnr --PIl1 COftj tng
l l i tc Iugrave l lltl l( l rs1 tif s L -etllgt il l the lgirl11
1 Hl)
Ilu LE nI rIIY~Ic~L lXIlKISI 1 HI E TREhTMEtn OP JIU IDIOP llII C AD O USCUH O Ll Œl15 NEGR II
lLill tegt lre lenl1 ~I d ~fo rll1J[ ~ rhl recrSes the phyltiologiGII cmns of lh vine)
Accordlng () Dicion ~2 1 rtcluctio fl in the itgitttl CUIYtS combin l vi th a lueral Iviari n llltl ds t 1
mecban ism () ugravel~ta il ity in l he r rat r IllI1e which bVOf1i the unsd a nd i ncrea~e 0 1 co hlt1is (Fig 6 hiIf md Pl11jlbiJ Jl1eanwlt ile lt(udiecl lh e srnl ru t
orzyglpophySLs show ing t11 al ttleir 1I1tl rnic tl orienshytation f~I (jLi l~ltes aXIal ve rtegravebJl l rotllio ll in cun litluns lt f dorsal hypokrrhn Icirc tnd lum)H de i L lo IS
Tll t dat SLlgge 1 th t impOrfill ut pOitu res and l1lweil1 ) t Mudied in ord t r (CI mlIuml ntrlin or to reuwer fll e p llyslo lo~lCll ClIlye in lIe SlgJtta p lU)l Wlth the llm o t ch ~ kin~ rutltor in l~ bili ry7 AbC th ~e ~k-
1l11nL ~Irt del lnt [0 J jUc lt ftber l]kuti inrervenl ion vhich 1c)LJ k l IV - i(l ~ l compktl n l ililll on Il t c1 l shy-jel1 J11UVllT1ent IJ j o f 1uto-dOneacute(3tlon ( i e a -impk ld ion ) Iengtheni ng o f the pilleacute 011 a litlltl l aXl~ tll lt ((IT liJlI~rcdu e~ t lle ~---lJ linti- l lte ml-fkxj(l n h UI 11 - i llCrl I~t the plllH ](JgicJI dlt cr ~l S ( (1 k-yvllCiSh lIld O(ltOSh l o r c lch r1Iif n t a Ilew til(~ecirc dUuml llt Ilshy
si lflltl J ll1 u(~nlent iam ecl - 1l1t0- lIrfe rionmiddot7 4 llmshyp oed f Je-rura l iUIl cl middot-t1e- iltm lI1d ll1a intltnUlLe )( 5lg it d C Uf (gtS slig lll thltJrc i ypI1 tiZ) tIcircOI1 a nd lunugrave)ar 1()fdos i7~llion) sholild he esw b lb]HU 00 lb co
hl b oi hi p~l11il uU r -1Ir vlt Abo 111( e IlltUtl Chl lie o f purti n - a U vitk slJ1ultI h e )tuumlll ecl 1)] (1 n ldershy](ion r tl1i lt type for e upIe IilJ llyl)T S of repd shyiti( ml vemen prt n t in agonistK h)lnllltlSlks nI iIle kind f dlJ1ce C( uld he ([([r imentd
FmiddotO lllaljlallC and mobili ty of the SpIcircIlC
1 rd llo U 22 d L lm nrrare d lhlt in Illt fro nt a l pll ne
tilt 1 nge Clt 1)1lt vtment of tht scplit[i middot CU IY grcmr lIJ l il ~ d irectio n n f Lhe C ITelt tlO n tha n in tl le di re shyLion of pmgressi n l Fig 7 ) he IL o IS5err lJd tbat th15 mohiliry increac plrtil u la rly n apic [ cgcoeilts 1$ lh ~ ~c() li osb evolves Sragrm rJ 12 J ~ thus rigilt (0
VlI f n rller~p is ts Ilo t t) m o b uumliz - a sCtJl iu til curve w ilhout t [ uling ttwt tlle R lu tiOI o i til t ~a mt b fnlinruumln( 1hy l1tans o f ~I passic 01 1 rivE -uppnrt On tilt (ltllE r hand UgraveK d e iJlioJ1 in ease durill tlw tune 111 whicll tll C spmt i ~ not submjtrcd to correeshy( IV anl()n
j- Virh mi lei ol i b tlllt Upp i1n ill) lC tiol is d eveloped only lllmugil llClIf()mu$Cllbr f r llce thi ~
InegravelIl ~ thclcfo re tl1l[ inu eascgtt sp1J1all1extl)iity mua
11
Imiddotiumltgt 7-rurd illt Ir) 1 bull rdrilt I1 1 in tl lt frOlllll pbnlt- th( illl ge )r mOC llIeJlI o t the S-o UIIJC CUNe 1 supcrior in Ihlt diflt(l im ugrave( the n nKlIl thd n ll1 tllc dlrtcLion o f p rJ1(l( (llIl
be considrCtJ vntrl iJ)(l icltion and 1 undrli neocirc ab L a ~ubiljz~ILion 01 tilt spint pllss il)1y ohtl ll1td thrltJugll the stlengtlkl11ng o f the 1rltJgm vlt nonil lme shyCIC 111 illli orrant u bjcLliH- ln rhis r~f1 n sp u lllni lc tivitIumlLs sil uld lX tPI 10 dlegraveltl it l G lU t n w l1ik luring kine i Icircth lrr phyltical eXegraverci c~ tllat in ele
spinal m ot ilIcirclY sil nid 1e lt1 oid cdrt ~
Organ ie and psychologieal impainncuts and li islbi IiI le
A cgtI im lc pmi nr is moriOthl11 just 1 sp in and 1
compkt gt Ipp rnach to the gu in ad 1 ont i al~ shylute l e~se i t i11
[)a la 0 11[ [n ell lrom re semh pw tbat ome organi Iilnctiond cl fki ts suc]) as tlw clecrtiUe ut vild l tnd d fun ll l)Kity_orld ldly incrtJ k whil~ 0 shy[io s i -till in (1 miel q g of g JltlV ity ~ l ilI e 55 rtI lit
tllL pres e n ce )fl defidt Or Vi l~il Clp~1 - i~ ln one pIIiem in Ihr l ftectecl by 20 ICl 40 scoi stgt l ls~a r(h cunclutecl in tbe UA by Di Ruce- prod uegraveed an aaalo) u ll1lXimum 102 re u t in a group of Jd shyk 1ien t [(h sco llosls rang inF frum ) [0 1
Al10ther rudv bv rallt r m C chr111 lilcl NashycWrl1s( u 57 stlO eltt hil $(C 1 1 ui~ Ica js l( lllt cl (1 shy1prUlllI o f t1tgl lie bJd l imI in ~ul sct t1 t ltu b middot iects jlLltr l5 they are golng through ~I cltlici[e sllge in the fnm 1lt i n 01 tlWH o w n id uHitv t factor hit h Illy jeopmlize the cl velopme lit d ~ mIll lt lI1d htIshym cecl IWI sonalitr in Klulrhood
n RUI ~IEDl(( Ptl Y1-
ROU ltHmiddot PI [ I C~ 1 EXIRCIS]~ IN TI Il nW~JUNT OF SlllO lDIOP1HIC AI)C~ESΠ11 C(gt1[Oi 1S
This i why b IiCieacute ii is ~n imporrlIl t for p rcshyvegraveml e 1tLsr l tn en ou flge 1ari e nrs ~lfrecr(d by lIillcl middotu iosis ft) tlke p~l rt in portin -re rcatioluJ acrivitits Iha t 1eIU 10 L10 th r~1chophyinLl bull nd b~l )i 1l1o tur adlieem t n li 51Jmiddot2Even tlK)ugli [Dr bic mech~lnshy
ical mcl nellIUll10t 11 11 reltl ~ons lt r111 1gtomcrimes be l lefu l to ugg( ~t ne p rt in~ aCt iv ity r l h (gtr rll n anotlJer e th ink Ibal an exces~ ive IlHd icalizltion - Icirce l ll1posilion br plry~ilt i HlS nnejlor parents uf rh ry pe of po rt to lx p m lice 1 b Ule p 1Ucirc(Il L th1[ preshydLl ck l1 is fret clOice in lh ma tt r - -h II ll1 he avolc1ed wb 11 possLhle mainly for tlle i mport~ltll psyshyLb ) jogka l fe a SI)nS W( ha( ill ~ t nltntionegraved
Conclu ion
lbh ISsertegrave d t1H physkal tgtXtlci o is ) n fi ial whlIl practinu in order 10 ilnj rove the I11 llde
rœ nwh and tono C iral caplCiry and postu re o f the StOUO(I ~lIbj n II I nowkdge om ~ middotmg trom ci el1shyrlfi rls(~ Jrc li dJlJ accordl ng r the review 01 thE litshytirlture prnpo )td in t lli plpl r conflrm~ Ihe vuiclit ot th e -t ls ~rti ()ns
In l do l (ent Id iopl1il iC scoliuse il l n phee u i cl vk)pm e n t ( li tll iumlKh eXCC cl l g i en rhk thr hokl th e re i5 an und ubred need fn r l pprnpri 1tegrave (JJ1tOkJJe ~Ild Inr surgict1 therapics ill ortler 1) S l i p
the ( - Iuli on anugrave )JT~t~t UW ~pilll l dtlormities bull evshyerthtless in the illiti ~ll pl l~sC t ttlC c1iseLltc whcn the riS( r1 r euro )luli m is rtduced ocirc ~md tfle uifleal JOld threshold il ~ld flle po stural collai i reJcenw~ 43
JI l1 igh pllysicaJ egravexe rc ise - p revenc or r d llCe d i ~lh ilir ies o f [Iw ~ l() li )tic
p (iems R 28 J -6 5- 6 1 63
- f~KiHtare lh ( n utr ali711iCUl of postu m l d elicits tn produCel1 a coneql l nce J [)ti 0 I111)( or regre si -u lmiddotc 5middot Il 1 17 ~ M
-re 51udles U ~ n Ledecl tu con[mn or re jecr these conClLL i( 1 w l1 ich clerin-d frum 1l1 lIldytica l rcltw n f th e liter~iture appear r- ~Lo nlble Hnwecr Intil ne re ull are 31Iable wc should n r prevent our sroliotic patientmiddot trom tl ki ll p lt in s(loI1ing jshy
ir its pW1iada rly ltl t ~d1()o t () n til t c ntrHY -vith the l xcclrinn 01 gt[1 )11lt tIlat in rea-e t)1obility (tnU evc n thell oilly wh n progr~lgtion b p OSSibl) -uc h ~I( ucircvshyiUe -11 )ulu hl tIKoll w g ed The 11 S J ( rprOpriue kin (~irhe r~l Piuml to incr _~asc p()~tura l $llbil i ty is tl1egraveoretshyic tlly CiJUClt alttloughl more ~Iccu rtte aod deLli led ri k benefi rs anJlr~ is is netot1ed
Ria 1111tO
NIokl Mu d lle ftitYljJfu Jœl il 4IWr10UOifll S (JIvs i (1~1)Jshylidl ttno( cclIll le 11(11(1lt1 RCI fu lle ((lia LltfIt l1 I1I1i(i
LJ ci n s j(r3 pigt egrave li n IHUgru lkl di t rdz t fi sici pe e ft shytUlKm iluppno di un lisimerap15Ll rl lllcflt() 1 110 scopo di pnevirlt () fr en~lI 1-lgpwlllltnlcgt dclld lclonnitugrave o e il 5LOshy
Il i mi llon lt fH nugrave j (1 11ni dei co~e 1 lteIl I1J J nd ne ~Ii eifclti (()Tc rri udk s co lio si d i m e dia g rt iuuml ln que~ltlt
s rud i 30 llizzb mo i d ti cleU ric lca pel n ri Icare qJJ l lm 1 dis(imucirc x u le I[~ l z j-m i pro vna le da lla C gtl k A i json ere pr middote-nute () rk kl ducirc un~l rdeguCltl d nil cra pi lt di uJoseguerrnt Cjua li 1iU110 cli nbie tti 1 rcr lJ)tIId d~ fle)-UITC
n (- -fd7Io n~lcl)
Ut11claquo)si 1 lI tori htpnuuml )ludi-ttn I ~ cnntI1zttu fr Cq(in i idiJ)tic1 dbfl lOZ10l1 d d ~ leOla nelllOll1otoriO Lb un1I1cnUl 1n1l1i3 dcgli 111 lt1i ch DIJgt gtU l H crmU1 Nlch~mslt ( SIshygnaJ~l lerimiddot wo i esuemi -bletti d~ plt~e8lugraver- ne l pClZ le1lftgt scoliodcu kl s iluppo ddl ~ ~ uhjlil~ vertcbral~ lt o svilllp prJ Jdle JIl7 i() nl di ltCjuiljbrio Dng li studi sul lto lb( l~nlrale (OllddU i in pa rticdu d 1 DlIal-BeHJ (gtegraverl ~ P~II IId lI1 n~ llw - idente il v- m gtiu p eT il puientc clioti elgt di u n rnigb o t c)[ ro Ua sw mle dei radlldc onsegull o tramite il 11 fforzrlshyfl len to d e i l1luotoucirc l nllgr3ilri d e luOwo con crcbi ~Clltdr
in pOMltHJ corrctl e in va rie ~i[Jzioni s t llicb c c d inamIcirc tllt Dalle on sena d elb blOffiCcclIlicd tr idimlt n s io mlle d ei
r ~ chi Je ~oU()f icn ~Icirc ~videnuumll (l() ~llt tC p IYZIcircOSI ln(IiClZlfHicircl ~ 1I1shy
liumln fluenzt Je ll middote~rUrio tl SC) lgt lIi I rc pibull m i tldln sJlI71 Stl shygn~I I1 afferma che slI l p Ia no [11 middotccedilr~lk tre un œ rtlJ grado di l L1Liuuml IlC dclh vEltlh r1 apj(de le tu rœ mu SCltJ llri njtbc J n in $tJ ) t rodcfQfll1t1l1te PltJtantu b i r~it-~ r -lp il puugrave t~~
Ixnt-ftla solo nt Ile so )[j)~i Jl1Icirc na rl in qunnt ) ilon SlrM ntne )(l(Ofa tu soglb in caq ) co lltrLJIcircn l)lrilto llt~( i lJudotlsi di lfr~ lI1 C llg grVlmenl J 111 11 io lr riltd ll(17jOill leld rinlle 113 dimO~iumlrlto d llt nell o lin~l cl()~ li t th~oIOl))1 dri la defltgtrshymiti sul p iluO slfl iuale ~vohl lf1 (en5 ion~ sO lnm utto nd 1e bsi iniliali deWggrwm1Cnln mcn trl C a( lfLmn che occlleshyvoluzi ne dene = 110 i [ mhari IJ lin c l ki cen tri ch -1vi1( de i cp i CIt IJ rI Ji SI p m ittIl pnm l Iem lmeme e p o j pOS( shyrio fllwnte dtldnli mdv ( i un ziuuml ne ciloliz7nnl dd rlLtide lu mbJ œ ( lIlelttlaquo on NC n d d (gt11 uIdu m 1I1 Ilgt) cli r-Iure (0 eserClzi che IllUllengano 0 ltlUperifo le Clgt 6gt1 lo)iche sul pirluuml gilwlt Su l p iCl no fron itk Perdnulk il dlll1lt-trlto d1 lampkz-l d i LU ovimento amp111 lI rv Kolio ti ~ nd lt1 0 ddlJ cnrrc-LIcircQo i Ji gC 1 n lungl SUpegraveliltlrccedil 1M llS0 tlell 3ampIGI shyvamcnlo C che l~Jltmiddot mobiliti GlI mcnta co n l c lu7j o fle d l i) snAio i A ulln amplgrtJc1 ltllllmunjx~ i terlpGli nn n m obi shyUZ73It ma eutva coli ti0 1 1ct HsicVlfe nd tcmplt 11 1111nshyttllIcirc1nc n tc (k ll ~1 llu u zinnt n l1 un me77uuml d i sost l11( gt ln 0
e 11111ri b cle - Ilziunc egrave deorinatcl d l rlyarsi Snzcl la pr gtshy
liltlnl l i un() rtl~ i ptmiddot Jtl n(o 1S(Hl () (( ntJ() i ndit~tr i ~ Ii ISt (izi e l m iviL Illdlode ebe Hlmen tno laJlc ibiJii dcl rlc lide SCshy
li io) [n p articobre rune q lldl r C-I1 ich~ xlSiddcHe CUf t shyli ve ch~ iJllpi tgino e~rciii 01( biIi2 ZanUgrave HhnmL-trid () in tmiddot~t~nshy
sione kl fuchide O tne pure k- ~ttivit1 tnotoJII~ non prHi(~ llCcedil
in forma r k rel1tiva d Ie ~1I 11 rF~1l1( n otcol mcnlC 1 lll ubib Ll vcrteblmiddote (ad ~ flp j(l 11 n l) to L ginn ~Iilt Utl clkl rilshyC
mka la cli OT- tcc)
r1il to l~ _ I[Dl COlI rY IC~
NE olUNI
fillncr ( ni ((uuml(( n hIIo( rilclIO ~middothe k lln dtfidl fUr1z i shy
nlu CQll1~ la llcl llZIO 1e delb c apKJl ilde e della capacltl di 0170 mizianu luJndn le (OJ il~ gtna a nc r3 di m~i3 gmshy
v it ln G mlxl r i ~ gko Fl llslrom C dlllJ O e Nachcms(J h iU1I) dim lr JtQ che b o liosl p IOO C1 neUaduksœnr 10 SYil l1p pn d i lIniumlmn~gin nlt8Jliva de corpo in (o nridcnz di Ln ddic3w p ri d di f( m l lz i nlt deUa SUl idenritl condishyZltonc ch pOlrebh ~[I cubrmiddot ln vilu pp di un pe bull n nn lir m llur cd e quiJibfarn in t[C adulro TaU CO1DSCe nZe tvlde nshyZ[II)() la n ( middotess iti di ltimobre la plfte ip a7j0 r1e atl an ivi ll1ltHClr n gl b a li ltl h ~ di tlpO s pu rti middotu dl ittlrc nd gloani iCo lID ti i lirtugraveta z io ni llb vila di relazionc
ln concllliu fu la d tfoflll lL saliu iG egrave il sin l mo di lin) idrotnc C Il1pk 1 d e eoinvo l d middotmiddot= fu n (n i dd rgashynIcirc5H10 n Hi lhdli e lesenizjo fi 1lt0 se 1 Il indirill~t() pllO pr~cnin 0 odLf rgt t lli di fu nzlonicirc adlc s()Jj(bi 111Icircn(i rrHtatc CO ll nl1 cinesi rap i Quand l~ coli i ( n LS~middot iJ11 zia k il rischio evnluLIcircvo egrave lid [() mente no tcole 11 (ltlll asso p o lll shylal ltOtSltgllen7~1 _ ta cincsiterapia pc rslIk bidtlvi shyptutibulli d ubllIcirctIcirc vltnc brn1e di conrro llo )(JSu k d i 5IcirclupPQ d Ile rLlt ziofll d i eC[u ihb ugraveo dJ ftffr otZJH1 r1w dei IIl llJgtCili 1 11Icircshyg rdtarl in posru ra rrenu posslhile JnnalL in Illo lt i clsi l(j luucircun lt di lin ~c() li oi mi n rc ( ume [11 duumlnQstrIO la tinc~ jn~l el1lric ((1l1 ~rtlppi d i contnmiddotllo cnndnlt1 p nso i l entrt d e Massue di Li n nc da [ o llo n ~ Rodo l (1 986) Julndo il1vlce lIfU~ ho ~vutlJ tiVll 11lt1 1IjXIl to un dekrshyuina r o~itl di g rl vir~l bull a~-n lllull~nte n ec ~~uiu rlCUuml rf( ff dla tcrJpll rle si c a eo chirurg ica
1Ho le clllC ooliosi idjopHI 3 ttl1p ~ - E~er l zjo hsco shy11ln ~ I((fapil
l Bg 5 CUle Lo [la k ll oblems in tlu ll~ (U ni Cl) FrKUce CU ( )lIILr no 1 AllCPR lu b1lG1t10 11 middotCI 9()(iJ2 RockilJe MI) i)~Cr ~()f I [( al th all 1 () I ~Y 1(~Re~C~Hd ~gtutnlt Ilallb Srshy1ltC Cgt D~p(rulllnr CJf I Ilalil 11 1 HumlIl sen Lel 199-1
2 SI) lrzcf ( LcB I ~IIl( FE DupUb L ampkIll~ 1c ~ppro l c h ll tht rnent und mmgemlt-rlt ot ~ ct vlyrl~ led splnul (hs r)fder~ A monQglJph rr r d lll kic Re p o l1 or Ih Ou bcc TlSk Fu rcl 0 11 ipmd DIo rele Sp ine L9H LU) 59
) Clntino F 111i1 i(ll Ci nerte1H C Nou gltHhl C Kln(~Jl llBICII [lIe1 hmlln (Il dry rra ll1ltfll of QIil pa ll m log iC by l11e 1 lIb li 1le-llh laquorilC~ of ~ 10(lna 111 Jrc)Jcxli r~~ (of flle h l lntrnIUonll SVIll Illgt~iu tn - II 5lt Ik lIc lk0flllllic lu llln-I I r l III Fhhlt ri g 1092 -ltlIJ-7
i - ri of niii MA N()LJV II ~ mel h)ltks de kin ~~klk rlr k di lll J r~cdllclli (n d~s ~()li oes jn f ~tel r~1ruuml(ILI -lo s bl fl c sur IcIj cquishyl)œ~ Ik SOll ll l)(eacute Eli ror eetlfllS d )111 1~ 1)1-
5 iloll n G Ruumld(~ le s () I ~middotmiddots tnlcl l l1 I n in 1Ifc el kiwil~~ 1)11lt KillegraveSlthe ripJe SCleacutentlnlue lYl6 2 47 ~ 6
r) Feacuterr[ffgt en 1tsiero 5 Venlllfln A ll~~n () M MJglio nu N EfkUuml o r eXltClse tI~tl Yoj o n nild id iO rXllhlc iC() 1i()~ lrt~ lirnIcircIluy r sull Eur feltl lb)ii 1 1j34 Z5 -~ 1 NOilrill1 A Sbill P egn ni i Ll Linesilegraverpi l 1lt1 Itallllll~nlO
ddlJ soI K~ i llO 1 Orkl1Llllwnrl m efodoloil1c1 RbbilltlZiOllc Ot1(1 1 )29(1) 1l-~
8 Nli(rinl Nl(lr1n l A blll P LI rieduGlzione dl p llicml atflt rro (11 coli ns i idi opr lir1 l n SC(Um i le or h( JI 1rcLlIQn1 ~0Cl le Imc lI1etW)n11e de Recltcrchc ci 0 Ftude sm 1lt Radw jlt)(j S-71
gt Nftriruuml S SeJhrf U LI r i l bllh ~l liOlie dd plziecirc11te ulet1n 11 - r
lin Kllopd (1 In l1l Jgl L N eduoL Tf1It II d ll11e ji cln1 rJtbl IiIUvJ Milan) 1ltfddH~n(x~hl 2(1~111gt-1-PU ob L cllln t iRll p l nelLi rl tgtO llcui n~ dilt ~lio i - l rn~f- li ~iIa n 3efllnl -Kurflr 19-11
11 lIIra S lJll M EVtJltHlvugrave egraveI lt t rnrumel1t() d db S(oli - U r) surie doCum nUle fintgt 31 tIUUli Mibn SI rlin) KlIpf -r 199 2
L2 1 ~W I1l(IJ P _leacuteVia tio n I~lhra k~ du IlchlS ~- ( i( IoltS ccedil l r lI C1 l1 fl leq
Ene 1 l C hi r ApparctlIClCOn l~ ltll1 l ltx6lt (i W Er 20 j )7 l
U StrI tr d P Lcs 1) rm IlO du Hltlctli Parb ME n 115 li ~u n un_ l c- l ol lJn e~IL1roy JC EagtOllŒrio n sc lluocs
L cl middot Exp CO_fiL [-In 190 15 Xd BR llet13n) J Th ltJl-xwenc a l o-(l1 tUcn~kuud txer
C le re-glflW 1 lhe tfelmc nl o f id iopllhiC Collaraquo n lroc~-din) t Lhl 1 r 111(1ltli0 I111 Symf SiUl1l un 3-D Scl IiDliJ DclOfshymillelt ~k)J1[rlt u Gugtu l1Shltr Verbg 1lti t)L j32-t)
16 N1lh~Ir~il Al Peumlf r~o n LE Erree htJkmiddotmiddot~ n f t~U lt hfIl middot Ith J
hran in ~rls V ll ~ ttiVl ~HkJ k-nt IHuIXtthilaquo ic I) Li ~I~ts H t 1l1i JflIn t ~ j l~jl)5iuml7A(~)8Jj- 21 bull
17 M(jo n Y ( ullck J p ~ R A PrdulllnlIr rpurt 11 Iht e rt l f rnltJsu red 5l ren jl lh rrll nrl1 III ililleInr Hi rrt tllk scoJliagt
J lin1I IJisn rd 21 1 1)12) 102- - Hl Hunng CU[- -If p~lIll)~thc - Uonktd in -c h JI IL
c reacutetnl n~ ptnl l C)Q~ Z ) t 1 t(li-v 19 Kou )UrJKh L Glr~ k G KRI iJI G KLmiddotmiddotrnl kh g UlUI
) KrJ UkQULlk i~ ~l ~~ fl c+l l1ng ~t (w)j (h ildrcn frit ltt lmiddot( ti ~l~ 0 1 (he
isbnd of Cfdt J middotpin 1 Dior el 1 9J7 lIX( )middot i2 ~ middotl I i) SG IC1Iugrave lS r olle lCOS rh Zadrc C Ber E Xend s T A
ohool scr(l nin~ f r Loli rraquo pro~ p ah pidemlaIO)( Io Jl lUcJ ~middot In ncIfllwt~t~rll dncl Ctt1fLll Grttc J none 1cUlf ~)Ufg Arnl
19lt) ) JOJ )8-1)3 tl llunnd P n ohlecTln CfjtefO I1 f r SCCi II Ots t-CTctt1 lngJ BOIlt
Joi nl lIrg AI11 1~gt81 (1 )1)1 -0 22 re rdrlo lk R 11 gtcolk)c on Ftudc TrldrI1lUl i0 nnli1t FHIS
~Lluin l) Du vd-BtlltJpmiddotre Icirc Dubcu ttJ Qllln~Hl P GrC6 l~)f d Po ur Url tb (~fniumll~ uniqU( d t l rlmiddot q lultllI degrave -oU clt rr S4~ ftftxl-a[tmiddot [9 nJ8 11Icirc l -0
2L COl 7 G Fla~ l rdi M Ubllhr I- Ili ~ U)( ciplt-rfmof1lal ~c()lir t Prtlaquo l1 ttJ Ir lh t 1~l Eu n pL Il eacuteollhr~- 1lt11 -~ 11ltb und Ky phojj DulJr wnik Y ugmla O IO(-f 1 9$5
2 u ttlllJil ~ 1 gtCli ll Ofli e 1lI tpLI lJ1lluak Hntd ~Nltmiddot ) lnLpmiddotmiddot Fi)) SdwrJ r ll r [(111lt1 1gtl( lEl ~ bri UI nc 1lt)79 Slone H neekman C H ill Cues V fuooks 1 IL 1bc d rrCl o f an c Xt rc lslt r rog tlm ~)n chanfe ln cur( in uJokS( r 1H wtt h lllinr l11bulll IdJo p thiC SC(J lioh A prcl rnunH) Iud Pill Th r 19-9597Yfgtl Rlt td J Ccedil d(dtltx middotnl IdOcircgtpUhinK()liosl fl(nsugiCIJ lrellmenl ln lt-C llSlt ln Sl edit The P edtlt r bull SpIn Prmclp ilt and 1 1 shyte t Nemiddot Yo rk RIVCJ) PrtS j~)f197- 10 1(gr Ul1 A il lulfo l7amenro rnu_ olu e in S bfClti p()n ~nuuml(f di d lsme rf lsill i middot Wb li La i inm~ti MtmiddotdiQ 19$nYl - l
)0 DuIYLls-oe J E~ 1 d hypot he~ d tk gj(lult~ d b = shyli(~ Id lOIllll1lqu ahleacute~ de Knlt~il hr p le l ~ ~llK l H I
31 1 hnrwll R MLm n J [j her A ~Wlu (middoti R bull nlfc k J IdlopalhK 0 1101- llId lll ntr1 nervrlU$ S)511111 p ine 1il-111 H
12 KheacutelTl~(l 11 i Srh lrClno T E1lrtcmiddot fil middotlm 1deJi lI Idio shy111111lt l(middot lk is plm 112 1i6-8middotf la i Fm rIC) PL ( IJIlfThJ 1 V I1W F 1--1 w hl P ) IlOI ) ) lIet ( fnorfis rnl IlI lnPrt d~IL I (lonrl Vie rkh r h -Df [ 11 lltd Rt JlJ Il 190jmiddot middot (3) 2)middot -8
H Slh lrJIHl T P(lrugt()Jl n A s rurl ( bbnintl1in lLllkrion in pllIents Vilh ad() l~eJ1t idiopcuhiccedil -collsl ioLI~ 0 11110 1 -C1lld 1)795)51
35 Siblll r l Si~tltm t ocircHboIJ f( t los pproajo (lIoneuroiq-k 0 Ib duta7Jltme PWlIlltrS(Kmiddotl C (ltl~I1OSlilt1 dei middotoUosl Pr~Smltl ar PchHria ~i(J S MarghrllL LigUflmiddot l( J
lH9
RfU o r Pll~ IGL bull
x ilgtlIh P lt-ejcanl N~1(fl l ll At_1 n~sIO Alp nl O J(0nuoo 1 lt a l ~l rpfn 1 1K1nuumll uIcircl n ln ~ccedilr)liO~i 1-~lIu~H I_1j hy the l n ~Ul [ rltllc~cJr()grnrhy 1o TI)lU li K LgIlt1111 M ~I rt ~d i r rs r il ull f md t u r11 fl on l l l itJLLlUl Eb--Icr SC legrave nu B V 19~middotH ~)-l2
)7 Y~lI J ib K Y IOUJJl(lro 1r T~ t lll1r~t l TtZIlLl 1 rmiddot ~b lplnt nr (f ltmltomiddotjmiddot unkr nu rf j 1 1 pa rtlCub rtv in (dHUH l ull bl~lllcm l b numiddotIUllltk- J fkm I n rg 1 lt gt 17
301 Yum1ntv Il YJl1ll d~ r lqu lll lll1 ll Lppr 111 ICi ~rljritJccedil p tUf( ~cOILgtgk J)-6 1711
W NeW1 N~grm l ~ Xn[(ui chlncltltcfIILl 1 (L ln CfmuO r Bk r 1lt1 511 tn tlt [C IUIl~1 AUtlI IJt1 TecnILln J I TCI 1J1l flD ~ Cont rQnltl Mock n1 tl l J~ middot ) rollplt KIIlCSlherlplllLl Elirope ~H gtle 1 ra~tiI iUf lil ioII O~ l -N ill l- il middotmiddot
1) Negrini ~wn UllnnQ c 0 1i ~ 1 lucirc lopau c-l prnlo l i1Ii Ilnki 1 L1 otiltJlliU lt fldl ll u ru middot j ltId bull itcll lJ pt)ol llrUgravec Lt flblrtl 1 I dilt l middoth ~ 1 +gt-I1
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EUROP MIDI C Pli hIC
EDUCATIONMEETING SATURDAY 8thof APRIL 2006
(iSS
SEAS02 Scientific
Exercises Approach to Scoliosis
version 2002
G
S Negrini 1
EDUCATION MEETING SATURDAY8th of APRIL 2006
Neuromotor disfunctions
Neuromuscular disfunctions
11 Postural collapse
Postural collapse
Duval-Beaupegravere
Flexibility of scoliotic curve
f---I--- I Postural element
-------1 Structural element
S Negrini 2
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Postural collapse
Duval-Beaupegravere
It is a value related to muscular tone and to flexibil ity of convex side tissues
Post ural collapse
Bunch e Patwardhan
Critical load
Load threshold beyond wh ich a spine begins buckling
JI~~Wt1lW~flfthtlJlœJtAr ~ J~It- l~l - IMS
Postu ral collapse
Bunch e Patwardhan
If a curve reduces there is an increase of the deformation threshold
~~~NW~-damaoc~IIIMf ~~ J~Iv JaJ-I7I9sect
S Negrini 3
EDUCATION MEETING SATURDAY 8th of APRIL2006
Postural collapse
Torrel e Nachemson ~
Scolioses below 20deg ~ ~ lt~
have a high ~ ~ percentage of ~ ~
~postural collapse (on u~
average 75) ~~ 2i~
CU~VE O EG~EE S WHllE SUPlti e
~laquotd~c6b ____lPffI1wtt1t~
$ww J(t ~~7 JM5
Postural collapse
Minor scolioses 7
Antigravity musc es strengthening D
Reduces postural collapse -G
Increases the critical threshold of deformation
G
Neuromotor disfunetions
Stagnara
If we admit that one of the causes of idiopathie scoliosis is a disfunction in balance systems it is logical to orientate physical exercises toward this direction
s Negrini 4
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Neuromotor disfunctions
Dubousset
Idiopathie seoliosis results fram alterations in praprioeeption centres and deformation is a natural compensation to restore postural balance
etattJtitIK ypothfQj~S ___~ own_ oJ)HQr lar 1t-1( r
Neuromotor disfunctions
Nachemson Initial idiopathie scoliosis
+ Goood spine stability
Neutralization of postural deficits
D Static curve
Neuromotor disfunctions
Therapeutic aims
c) Development of spine stability
C) Development of balance reactions
G
S Negrini 5
EDUCATION MEETING SATURDAY 8thof APRIL 2006
Biomechanical disfunctions
j Horizontal r-Ian
i Sagi ttal plan
Frontal plan
Frontal plan
q Frontal plan disfunetions
Fronta l plan
Perdriolle Movement magnitude
gt in the direction of lt in the direction of correction progression
S Negrini 6
EDUCATION MEETING SATURDAY8th of APRIL 2006
Frontal plan
Stagnara
Never mobilize a scoliotic curve without ensuring reduction maintenance over time otherwise a greater mobility favours scoliosis progression
Frontal plan
Ducongeacute~ research
On a group of adolescent idiopathie scolioses treated with
Meacuteziegraveres gymnastics
D After 1 year the mean angle of
curves increased from 18deg to 29deg
Frontal plan
Scoliosis without brace
D Greater spine
flexibility D-
Risk of progression
S Negrini 7
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Frontal plan
Mobilization is useful
D In preparation to
brace
D With brace
Sagittal plan
QSagittal plan disfunctions
Sagittal plan r middot _J o
Perdriolle scouos B CJ aDeformation of D
thoracic and thoraco-Iumbar curves evolves in extension
S Negrini 8
EDUCATION MEETING SATURDAY8th of APRIL 2006
Sagittal plan
Graf
The line of gravity centres in the vertebral bodies o s c oUOSt
projects itself firstly laterally and then fi
o
posteriorly lJ ~~ ~~ ~ ~~-_J-D ~nI~
Sagittal plan
Therapeutic a ims
D Maintain or
retrieve physiological curves on the sagittal plan
Horizontal plan
QHorizontal plan disfunctions
S Negnni 9
EDUCATION MEETINGSATURDAY 8th of APRIL 2006
Horizontal plan
Stagnara The forces applied ta the spi ne act in a autoshydeforming sense
Horizontal plan
Dimnet Rotation gt 200
ampII~ (
D The actions of concave and convex side
muscles become
agonistic
~ItJrOnrIIiItdllfUClltlluumlll~~tI ~1JIf1laJ
Horizontal plan
Minor scolioses never exceed these autoshy
deformation thresholds
S Negrini 10
EDUCATION MEETING SATURDAY8th of APRIL 2006
Disfunctions at a biological organic and psychological
lever
Oisfunclions at a biological organlc and psychologlcal lever
Cheng
Bane density in scoliotic teenagers is lower than in normal subjects
~~~~middotA~IIlUtIy ~7œl 1d l
Oisfunctions at a blologlcal organic and psychologicallevel
A significant reduction of vital capacity and V02max in teenagers with a medium severity scoliosis
S Negrini 11
li
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Disfunctions at a biological organic and psychologicallevel
Disorders in the development of body image that the teenager has of himherself
Disfunctions at a blologlca l organlc and psychologicallevel
Therapeutic aims
cJ Activate cardioshyrespiratory function
cJ Favour bone density increase
cJ Develop a positive image of the body
Disfunctions at il biological organi and psydlologicallevel
Stagnara
Sport
D The active side of
kinesitherapy
S Negrini 12
EDUCATION MEETING SATURDAY 8thof APRIL 2006
Disfunctions at a biological organic and psychological
level
Distunctions at a biologlcal organlc and psychologicallevel
Cheng
Bone density in scoliotic teenagers is lower than in normal subjects
~n~IIIvpWr~middotA~stWy s- XXJl M J
Disfunctions at a biological organic and psychologicallevel
A significant reduction of vital capacity and V02max in teenagers with a medium severity scoliosis
G
S Negrini 11
EDUCATIONMEETING SATURDAY 8th of APRIL 2006
Kinesitherapy on the scoliotic subject
q Postural control
q Axial stability
q Muscular trophism
q Balance
q Respiratory function
The limits of kinesitherapy
There is a threshold beyond which
rehabilitation alone is not enough
sssr
Kinesitherapy in scoliosis treatment with brace
Therapeutic aims
S Negrini 13
6
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Therapeutic aims Srace kinesitherapy
With brace
il Postural corrections and
vertebral stability are obtained by the brace
Therapeutic aims Srace kinesitherapy
In preparation to the brace
il Mobilize spine on ail plans
Therapeutic aims Srace kinesitherapy
With brace D
Maintain a normal spine elasticity
~ Maintain a good muscular toneshy
trophism
C Model the hump with kyphotizating
exercises
S Negrini 14
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Exercises and their methodologies can vary accord ing to learning and individual sensibility of the single rehabilitator that proposes the m provided that they stay within the
Iimits of fixed therapeutic objectives
li
Therapeutic modalities
(Exercises)
QAuto-correction
QRespiratory education
QErgonomie education
QMuscular strengthening
QDevelopment of balance reactions
WNeuromotor integration
ci Vertebral mobiJization
QSpecifie modalities in brace treatment
S Negrini 15
EDUCATION MEETING SATURDAY 8th of APRIL 2006
The protocol of kinesitherapic
treatment
G
QChoice and dosage of exercises
Variatiosn of the work program every 2 - 3 months
Q Execute e)(ercises on an individual base or in a small group
Q Frequency not less than 2 times 1 week
Involve and awaken the family
G
S Negrini 16
EDUCATION MEETINGSATURDAY 8thof APRIL 2006
Q Determine the action and the localization of auto-correction
QAuto-correction must be associated to ail exercises
QAt the end of treatment ergonomy lesson
Auto-correction didactics
G
SCOLIOSI DORSALE---- shy ----
r
S Negrini 17
EDUCATION MEETING SATURDAY8thof APRIL 2006
SCOLIOS OORSOLOMBARE
shy
SCOLIOSI OOIlSALE 011 bull LOMBARE S1I--shy
SCOLIOSI LOMBARE
il --~_-
S Negrini 18
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Scoliotic patients are not radiographs
middotSeoliotie Mtients are not ndiographs but hum beings with a vertebral deviation-
Slagnara
Metha For the physieian Cobb angle is of utmost
importance For the patient it is body deformity t hat eounts most rib hump a protruding seapula or hip We are in a situation in whieh today dodors eure the radiographie deformity but what the patient really desires is to get rid of clinieal deformity and of ensuing psyehologieal distress
CIIQItIo shDuIdtucirc lM WIld tJw~~ I~~M~~~~ J9f~
S Negrini 19
- Poznan_workshop_Physiotherapy
- physio2
- physio3pdf
- physio4
- physio5
- physio6
- physio7
- physio8
- physio9
- physio10
-
Zmi3ny w zakresie kllill Cobbll w wyniku Jlrowadzooej kinezyterapi i wg Dobosiewicz w grupie
progresnvoych skoliozjedl oillkowy cll - n=124 (ass obsenvncji ud 6 do 58 ntini~cy $~dD iw 197plusmnJ 185 Rlic3iqC3)
6
Zmiany w zakresie kqta rotacji osiowej kr~gu sZczytowego sknywiellia w wyniku prowadzonej kinezylerapii wg Dobosiewicz
w grupie progresywovch skoliozjednoillkowycfl - 0=124 (czas oburwRCji ad 6 do 58 mitJi~cy sndniR 197plusmn11S5 miesics)
Grupa skoiozjednoukowych typ J wg Ponsetiego - skrzywienia Th dx - leczeni kinczyterapill wg Dobosiewicz
(1174 015 ubscnvncji od 6 do 45 mieiircy s-cduin 211plusmn 111 rniesi~cn)
Zmiany w zakresie kllU CObbtr w wynlku prowadzooei kinezyluapii wg Duhosiewicz w gTUpj~
progresywnych skolioz dwulufwwycfl - 0=74 (aos obsrnvacji ad 6 do 45 micsi~y srcdnin 211 plusmn 1 1 mi~Icircqca)
DdciMk Th odcinek L
7
ZcDli~ny w zakresie kla rolaei osiowe krfgu sezytowego
sknywienia w wyniku prowadzonej kinezyterapii wg Dobosiewicz w grupie progrcsywnych skolioz dwulukowyell shy
n=74 (C7lS obserwacji ad 6 do 45 miesi~q srednia 211 plusmn 111 miesiqcR)
oddnek Th odcinek L
Grupa skoliozjednoillkowycll 0 kqcie Cobba lt 40deg - leaeni wyhCznie kinezyterapil wg Dobo~icwicz (n=44) (czas obserwacji od 5 do JI mi~ifCY ~redllia t 18plusmn604 mie-ihco)
tnnl qICIiIl fMtt[ IoooI ~)I l~Illli 1IqIlt00401 IftmiddotI-I llJ
~1 1~ u)~___- uul
c- -- a-J
Obserwowmo i ~totn~l korclacjt pomittuzy POZiUllllm opilnowilnia Illctody przcz chorych i cZccedilsloscj stosowaniu kjnc7ytcrapii a wiclkoscuuml rcgre~ji 7~niilnw zakrcsic kta Cubha i rutltjl OSIOWCJ krccedilgu szczytuwtgo skrz)wienia - wspOlczynnik Ptarsona wynusil Odpllwicdnio 016 i D53
Grupa skoliol dWlllu koovyeh 0 kItac Cobba lt3(jl
typ IV wg Ponltetiego - skrrywienia pienvotnie podw6le - piersitJwe pFlWosrUlII i lccedildiwi()we Iwostrow
-Ieczeni wylcznie kiDezyterapi~ wg Dobosiewicz (0=10) (nli obsrrvLcjicirc od ~ do 24 miesifCY _~ n~dllia 12453 micsi~ca)
Sndni ~~( Cobbl na pmltltu (ugraveurulJpii
wynosil
ft udcinku Th shy 179deg
W oddnku L-17deg
Srcdni )11 Cobb~ po killtylapi -rylltlsi l
W odcinku Th shy 1J7deg
W odciuku L shy 1320
JmiddotI) 1)Imiddotj ~ lIll11 i ~W --)WCcedilMtf
ClNlIltallj Nui 001
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8
Zmiany w zakresie k(ill rotllcji osiowej kr~gll szqytowego sfmyiellilllV wyniku prowadzonej kinezylerapii wg Dobosiewicz
w grupie progresywnvch skoliozjedllollkowycll - 0=124 (CZB5 ObSrrwRcji od 6 do 58 mielli~cy irednia 197plusmn1185 miesiqca)
Grupa skoiozjedllolukowych typ 1 wg Ponseliego - skrzywienia Th dx - leczeni kintZ) terapill wg Dobosiewicz
(11=74 aas ubscrwacji od 6 do 45 mieiIcircccedilcy srednin 211plusmnII 1 miesiJtcft)
Zmiany w zakresie kqta CoMa IV wyniku prowadzoDej kinezy tera pii wg Dobosicwiu w grupie
progresvwon h skolUgraveIl dWlllllkowych - 0=74 (ons ubs~rwacji od 6 do 45 mil3Icircccedilcy sredni3 211 plusmn 1J1 micii il cn)
Ddcil1t~ Tb oddnek L
7
Zmiany w zaknsie kIta rotacji osiowej krfgu szczytoweg() sG-z~vienin W wylliku prowaagravezonej kinezyterapii
wg Dobosicwicz w grupi~ progrzs)wnvcb skolioz dWlUcircuk()wJcll shyn=74
(cras obscnvacji od 6 do 45 miesifC)j srednio ZI I1 JI I micsilfca)
oddnek Th udciollk L
Grupa skoliozjednolukowych 0 kqcie Cobba lt 40deg - JeCJeni wyl~7ltie lunezyterapil wg Dobo~il-Wicz (n=44) (nl3 obstrwllcji od 5 do 31 mhticcedilcy sndui 1I8plusmn6U4 miesiacn)
Obs~rwowano istolm korclacj( pomiccediltlzy poziull1lll1 upmowlIniu mctody przcz chorych 1 czccedilstosti stosowilniu kine7ylerapii il wi~lklJseii rewcsji zmian w Zakrcsil kta Cob l13 i ro tacjl osiowcj kr~1u SZCzylowcgu skrzywienia - wspolczynnik PeanlOniJ wjnusil uJpowiedniu 016 i D53 -
Grupa skolioz dWlllukowych 0 kflfch Cobbf lt30 Iyp 11 wg POllsetiego - jknywienia pienvotnie podwojle
- piersimve prflwv~middottrolle i lccedildiwilJwe ltKJoslrotme -Ieezeni wyl4eznie kinzyterapi~ wg Dobosiewicz (0=10)
(nu obenvacji ad 5 do 2 mlcsiccedilcy ~r~clnil 124plusmn51 micii~cll)
Sredui k~1 Cubba na )uclltlll I~lerpi
wy nosil
w udcinku Th-17o
w odcinkll L - 170
Sn=dui kql Cubb aJu liugrave~tyIcTUpij wynosil
W odcinku Th shy 137deg Y udcinku L shy lJ20
4) 1)IIIIcirc w Jlm ~llIWiob_ l~ rlllW
JIIIIm-lollUcirciaftq jtQ0 1 t~~010
UpIJI~r~
8
9
Po 5 i 10 miesieacutecach
C- 18 R-S C-12 R-S C-S R-Q
10
Po 9 miesilcach
11
BP
Il rz
Th
Cmiddot 12
R-3
L
C-16
R-7
PoDP 7 mies 10 rz_
C-9 C-20 R-OR-2
--__ _ _----------shy
12
DP
8 ri
111 C-26 R-2
L C- 17
R-]
bull Metoda asymetrycznej trojplaszczyznowej mobilizacji kr~gostupa ma znaczeumllCV wptyw na zahamowanie progresji
w skoliozach idiopatycznych szybko post~pujqcych
bull Mobilizacja strony wkl~s~ej skrzywienia i osiowa derotacja kr~gu szczytowego zwi~ksza korektywnoseacute skolioz zmniejsza garb i ebrowy poprawia obj~toseacute klatki piersiowej i zwi~ksza wydolnoseacute oddechowq plue
13
bull Przedstawiona metoda jest
stosowana samodzielnie lub
w pO~qczeniu z ortezq Checircneau
a takie jako przygotowanie do
leczenia operacyjnego
Ocena progresywnosci w badaniu elektrofizjologicznym
odruchu z odci~zenia
i~middotmiddot ~=~-~ shy1 _--==shyocirc
14
EUT S pine J (1997) () 93-97 copy S pringer-Verl ag lY07 ORIGINAL ARTICLE
K Dobosiewicz Neurophysiological mechanism of the unloading reflex as a prognostic factor in the early stages of idiopathie adolescent scoliosis
Rcceivcd 29 M arch 1996 Revised 16 August 1996 Acccp tcd 10 Septem ber 1996
Absfract This paper presents a new nc urophy iologila1 methougrave of e valushyati ng the risk o f p rogression in ill ioshy
mo t important factors in the eva luashytion of progress ive id io pathie scolioshysis The met hod can be lIsed to deshy
pathie scoliosis in th early stages uf tll( progre jve idiopath ie scolios is the dis ase by illY middottigating tll e unshy in lhe early s tages of the d isease loading refl ex in paraspinal muscles T he high sensi livi ty of ilie method The study incl uded 394 pat ients wilh means il can be used as a basis un seo liosis and 70 hcalt y chil dre n which to take an earl y dcc ision to
K D obosicwicz Depuumll1 mel1 l of Rchabi lilu lioll Si lesilln Medical Academ y 42-604 Tamo wskie G6ry 4
Lmenty of the unloacli ng retle x and repeatabi li ty o f Ihe rcbound and silent period were anal ysed for eaeh reflex evoked Prolonged latency and
p rimiddotom1 surgery
Key words Id iopathie seoli o is Unloadi ng rcnex Re bound
Katowice Polaml minima1 numbe o f cycles are the Larency Si ent period
T he ai m of this sludy was to evaJ uate the use of the unshyIntroduction load ing Dex for octcction of prog ressive id iopath ie adoshy
le cem oIios is in its carl s tages in onl r to lake a dccishyProg ress io n of id iopatJl ic scolios is bas been the su bject of
sion ta perfo nn surgcry as soon as pussible many clin ical radiological and elecrromyographic in ve~ shy
tigalions T here is ho wellcr no sim ple quantita ti ve or qual itati ve pro noslic methoo [hat can be em ployed in the
Materials and melhodsearly ~tHges of the disease Monitoring of lhe unloading rc felx in paraspinal m llsck appcars 10 be a reliable Inv gtsi lgnlions were carricd uut 011 394 pa tie nt with adolescent method o f discriminating bctwcen diffcrcn l fomls of Cushy ~c li ed J ild 70 hCldr hy children The scoli osis group consisted of Iios is T he un loa ing re n cx can be evokcd in ail the 31 1 g irl s and 83 boys aged 9-1 8 year~ (mean age 125 ycars) The
ske lelal muscles through a suegrave den shortening of o luntary contro ls wcre 0 girl s and 10 boys aged tO-1 7 y~ar (rncan age 128 cars ) Imong Ihe stlbjeclS tudied wcre 9 patien l w ith cershyinnervated muscle l2~J When a musc le is unloaJ ed vico-thoilc i seo liosi s mean Cobb ang le 22 7deg 121 with Ihoracic
rapidly durin g an isomerric con trac tion Ihe norm al reacshy scolios is mean Cobb nngle 309deg I 1 w ith thoraco-Iurnbar seolioshylion is an eleclrically silent pe riod fo llowed by a burs t o f s is rne ~n Co bb ang le 26~g o 63 with lumbar cotlos is mean Cobb action potentials called rebmmd The pause in d ischarge ang le 279deg and 90 w ir h doubh major curve sc o Ii() ~ i s meull o bb
nng le 292deg and 28 5deg The sludy group includcd 231 right -s ided can be observed only when a certai n h reshold va lue of and 163 left-sided 5col iouumlc patien ls There were 112 patients w ith
acceJcration flnd shortening of he muscle is exceeded progress ive id iopath ie scoliosi (76 ri g hHidtd and 36 Ic 1t-s ided) an tl il occues wilh constant latcncy correspond ing to that 182 with no n-progressive idjopa thic scoliosis (1 13 ri ght- sided and of the propriocepti ve nflcx (9 18 20] T he rebound ufter 6 le rt-sided) M d 100 w ith pe lvic tilt (statie) scolios is (42 rightshy
s ided anp 58 l eft -~ i(kd )the silent period in the unloaugraveing re felx rcsul ts from ae lishySC9 1ios is is consIcircdered progressive if the Cobb Jngle inshyvalio n of a pool of motone urons aIl o f which fClt1ch lhe
creltseacutes by more lhan 6 in 1 yen r aile middotnl1 n-progrcssive if the anshyfiring thres hold simultancously afte r prcviou~ si lenœ [l nua i increase is less thll n (i The Cobb angle ranged lrom 8deg to 77deg 1 4 201 in Ihe palicnls w ilh progress ive scoliosis (mean 361 ) [rom 30 ta
lI f R (on- f Rt tt1IY 1lIfl pflla 1 )(~ r(Jnu n t shy
fI) _ ~
Pathomechanic basics of conservative treatment of progressive idiopathic scoliosIcircs
according ta Dobosiewicz method based upon radiologie evaluation
Kryslyna DobosiewlcZ Jacek Dunnala Kny ztof Czemicki Hanna Jcndf7cjek
Deparmem of Rellabtlifatoll Mediw Uninrsity ofSiltsia KatOllice Poand 40-635 Katowice fil ZiUCl 3537 POL4ND
e-mail relwbilitacjt1s11mfoctaonetpl
Abstract Conscralivc IrcalrnCnI of Idiopathie scoht)~1 espcclall y kinc ilhcrapy i ~
nOI widcly apprccilllcd due 10 Ils suspectccl low dfcCIIcircvcnc 5 in relalion [ (1 a urglcal Irc[llment ACter long-ycar il ses ment of palomcchanic f scolio icirc in Dcpanmenl of Rchnhllilallon f Mclii al Unlcrsi ly of Sile bull a concTvallvc mcthod ()f IrCtllmenl asymmclric Irunk mobili7alion in lnclly ymmelm po~itions WIS
de el ped_Thi mClh d enablc 10 delain pTogression f scol iosis or ccn de middotrca~c laIerai urvalurc of a spi ne and angle of rOlllion assummg adequate () perallon f palicnl and ilS famil)
J Introduction
Idiopathie scoliosi OS) is a thrccdimensonal dcfonnation of il vertebral col lmm an- cntire trunk Afler many years of extensive rescarchcs the cause of idiopathie coliosIcircs $ i remaIcircns unknown It is possible Ihat idiopathie scoliosis devel ps and progress on a baslS 0- ~
multifactor disorder perhaps diffcrent for curve initiation and curve progressi 11 Fion poss ible pathologie factors nervous system dysfunctIcircons affecting postural tquili brium ar proprioceptive control seem to be espc ially important [ l 2 6 JI Pro_ ression f iS could bot delermincd by vertcbrac remodeling under eccent ri c loading created by axia lly ce gravitational forces in presence of muscular imbalancc in the trunk [2 J The verte rai colwrz unde r scoliotic conditions 15 an unstable system with tcndency to fu rther tune dcvelopment fl2] Lateral bending of a vertebral column visible in X-ray examination L
only a two-dimensional prcstntation of a complex dcformity consisting of patho logica axi rota ti on torsion and othcr deformations of vertebrae [7 8 10 II 14J ln fS physiolog~ curvatures of vcrtebra l column are disturbed Total Icngth of an anterior column of a spi n~
consi ting of vertebral bodies and intcrvertebral dises bccomcs grcater lhan length of l posterior colwnn - vertebral arches and proccsses [11 15 J h is apparent that phy iologi ~
thoracic kyphosis in rcgion of a scoliotIcircC curve diminishes Each vcrtebra of a stru tu ~
urve of coliosis is oricntatcd in hypercxtcnsion in relation t adjacent vcrtcbrae [7 l resulting
1 n B Uri middota I l 11
H srut ft illtf j tI) t li orf1Hli d
IDS Prt ts 21)2
Influence of method of asymmetric trunk mobilization on shaping of a physiological
thoracic kyphosis in children and youth suffering from progressive idiopathie scoliosis
Krystyna Dobo icwicz Jacek Dunnala Hanna Jendrzejck Krzysztof Czernicki
Deparrment of Rehabilitation Medical University ofSilesia KaloKce Poand 40-635 Katowice ut Ziolowa 3537 POLAND
e-mail rehabiliracjas(u1poCmiddottaollelpl
Abslract Idiopathie scoliosis (lS) which i sub 1 ntially l threeshydimen ional derormation or a pine cau e nOl only laler l curvalurc and axial rotation of vertebral column but al lordoti allon of VCr1cbrac in structural curve eXl nsion ln an effect physiological thoracic kypho j diminishc or cvcn dbappears Method of a ymlllctric lrunk mobilisation in strictly symmetric po iljon according [ Do () lewicz not only dcteriorme progre ion of IS or evcn reduces lalera] curvalure but also significmtly rebuild physiological thoracic kyphosis Icircn cases of lS accompanicd by lraight baclc
1 Introduction
Despitc Ion year researchc etiology of IS is nOl yel resol ed Significant problem re laled lO morphology of IS apar1 from lateral bending and ax i 1 r tati n i deviation of shape of a spine in sagittal axis affecting physiologi al curvatu re of vertebral coJumn [3 5 6 8 9 J 0 1t 12 Lcngth of anLerior col umn of a pin constitutcd by venebral hafls anugrave intcrvencbral dises dominate ovcr Jength of po terier c lurnn buill from vertebral arches and processes [lOJ This condition uring scol io i progress ion and growth of a child effect in hallowing or even disappearing of phy iological Lhoracic kyphosis in scoliotic region It i well know n lhar cn~brae of structu ral Jaleral curve are positioncd in hyperextension - lordotisation [5 6] which in Lhoracic region Icad (0 reduction of kyphosi or to true lordo middotis Such kind of venebrae relation in thoracic region cau es ilS destabicirclisatIcircon whi h in u sociation with eccentricircc gfilvitali nal load fa pinc duc to muscu lar icircmbalance [21 pOdbly produces r tationaJ lordo is [56 Il] and further development of symptomatic scoHose ft ha becn proven [12J tha strengthening of the erector spinac muscle aggravates nce initialcd deform tion and deteriorates coliotic process Hyperextension and uxial rotati n a s clatcd with
357 Th B Grivas (Ed) Research inro Spinal Defoml ilis 4 lOS Press 2002
Exercise efficiency of girls with idiopathie
seoliosis based on the ventilatory anaerobie threshold
Jacek Durmala Krystyna Dobosiewicz Hanna Jendrzejek Wieslaw Pius
Department ofRehabililation Medical University ofSiiesiaa Katowice Poand 40-635 Katowice m ZioJowa 4547 POLAND
e-mail durmalaiacekyocztaonetpl Department ofPhysiology Academy ofPhysical Education Katowice Poand
Abslract The aim of the study was to estimate the exercise efficiency in the group of
girls with idiopathie scol iosis based on the venlilatory anaerobic threshold (V AT)
Material and method The investigation comprised 58 gi rls wilh idiopathie scoliosis
aged 10--6 years 32 girls (55200 ) wilh double major scolioSiS and 26 girls (448)
with single scotiosis The girls were eonservatively treated using Dobosiewiagrave
method The control group consisted of 3 1 healthy girls aged 10-1 6 years The
cxercise test was performed using eycle ergometer During the exercise the gas
exehange parameters wcre reeorded (minute expiralory venlilation minute oxygen
consumption earbon dioxide production) On the basis of recorded paramcters V AT
has been computcd using V -si ope method Results The following V AT values were
obtained in the group with scoliosis 207+305 ml 02minlkg bm in control group
219+350 ml 02minlkg bm The differences belween girls with idiopathie scoliosis
and control group were nol SLaliSlically significant Conclusions I The exercise
effieieney of girls with idiopathie scoliosis conservalively treated using Dobosiewicz
melhod is normal 2 Such high level of the exercise cfficiency of the studied group
probably was due to intensive 3-D respiratory exercises of these girls
1 Introduction
In practice there are researched useful efficiency rates which on base of laboratory tests results possible easy without using of the relatively hard or long exercise tests would give the belter forsighting of the range of homeostasis disturbances and rapidi ty of increase of
physical fatigue during varied workloads [1] The best known rate of trus kind is the maximal
minute oxygen consumption [2345] During progressive physical effort minute oxygen
consumption increases proportionally to workload The reaching of real maximal minute
oxygen consumption in time of progressive effort is iodicaled by minute oxygen consumption plateau [5 61 This result is rarely registered in children The progressive exercise test is most commonly used in children until physicaJ exhaustion and the highest registered minute
oxygen consumption is treated as maximal minute oxygen consu mption or so-called
symplomatic limited maximal minute oxygen consumption [678J Sorne authors regard
Orto-dlet Trau malaogis Roha b ilitacjaARTlKUL ORIGINALNY ORIGINAL ARTICLE Vol 5 Nr 1 2003 80-85
Jacek Durmala l Krystyna Dobosiewicz l Tomasz Kotwicki Hanna Jendrzejek 1
Katedra i Klinika Rehabilitacji Slqska Akadenia Medyczna Katowice Katedra i Klinika Ortopedii Dzieci~cej Akademia Medyczna PoznQll
Wplyw asymetrycznej mobilizacji tulowia na wartoseacute k~ta Cobba i rotacji w przypadkach skolioz idiopatycznych u dzieci i mlodzieZy
Influence ofasyn1n1etrie 111obilisation of the trunk on the Cobb angle and rotation in idiopathie seoliosisin
children and adolescents Slnwu kluce ac eJJic Cl chOlIU) Ice SKoio= idj)PO Imiddot(~I7tmiddot
K~Jmiddot w()rus consrieI ve I (OtlHelif idiopathie HUW JS
SUMlvfARY
BackgrouId The aim ofthe stldy Vas Ihe radiological evaluation ofthe treatllJent ofthe idiopathic scolioshysis utilising as)mmetric trunk mobilisation in the strict~ll I)mmetric illitial position
Material ([fJ(f lIIellOds Presented stud) lOS based IIpon J36 cases (13 oovs oged FOf11 ocirc la 6 lcars (lild
rn girls aged frum 6 la S pears) trealed due to the idiopathie sCuliosis ((rom Novell1her 999 0 F enflfUn 200) Among 48 ch idrcn sllfJering from dOlfble-major scoios is 6 cases wcre infoll scaliusis JOjuvel7lle und 22 adolescent Among 88 sillgle scoliosis 6 lere infw7t 33 juvenile and 49 adolescent
Radiological exami71ation 1as condueed always in the repeataole technical cOlldiions RadlOglOlI1 lier evaluated oy the same physician Radiologica analysis oIthe scolios is incuded value ofthe Coho al1gle ongle ofaxial rotaion
ReSIils ln double-major scoliosis observed dlring one year period in Ihe thoracic segmenl Cobb angle decreased inll l increased 1395 and in 292 Il OS 111changed Axial lolation angle in 167 (~rcascs
decreased in 354 incrcased and rernainM the sorne in 479 In Ihe llllnba segmenl Cobb ang le clccrcscucirc il1 354 increased in 39 6 remained in 5 Angle ofaxial rotation deceoscd in3 ofca es incrcuscd in 29 and persisted in 48
ln single scolio is Cobb angle decreased in 386 incrcased in 353 and in 261 was lInchonged Axiol rotarion angle in 216 ofcases deceased in 295 increased and rell1aincd the sallie in 489
CondlsioJ Asymmetrie mobilisation of the tf1f17k in strictly syl7111elric initial positions is a 1Clhod of choice in the cOl7senJalive treatment ofthe idiopathic seoiosis
STRESZCZENIE
WS~p Celem pracy jest radiologiezla ocena Icczenia skoiloz idiopaf)cznych metoda asvmetrycznejl7lOoili shyzocji tllowia w sciSe symetlyczl7ych pozycjach lV)jscio wych
M aterial i metody Przeprowadono retrospektYlIl7q analizri 136 przypadkeacuteM dzieci (13 chlopcow i 123 dziellshyczqt w wieku 6- 18 lat) z bocznym idiop atycnylll skrYll ieniem krrgoslupa leczonych zachowawczo w Klinice
1
Ortopedla TliJumatoogia RehlblllagraveeJa ARTYKUL POOL1 DOWY OPINION ARTICLE Vol 7 Nf 1 2005 49-$11
Krystyna Dobosiewicz Jacek Durmala Tomasz KotwickP
Katedra i Klinika Rehabilitacji SIAM Katowice 2 Katedra i Klinika Orlopedii Dziecircej AM Pozncrlz
Biodynamiczna metoda tr6jplaszczyznowej korekcji skolioz idiopatycznych - opis metody Biodynamic method for 3-D correction of idiopathie
scoliosis a description ofthe method
SIOWQ kluczowe leezenie zachowawcze skoliozy idiopatyczne korekeja tr6jplaszczyznowa Key words conservative treament idiopathie scoliosis 3-D correction
SUMMARY
The biodynamic method of hree-dfmensional carreeion of idiopathie scoliosis is based on Ihe palhomeshychanics of idiopathie scolioiiiii and consiss in aClive segmental three-dimensional correction ofspinal cllrshyvatlre The course of action focuses in the viciniy ofthe apical vertebra Proprioceptive facilitation is applied on Ihe concave side ofthe curvaJure and exteroceplivefacilitation on the convex side Correction likewise proshyprio- or exteroceplive facilitation is phase-oclœd with asymmetric respirarory movemenr as weil as wilh parshyticular phases of the respiratory cycle ln Ihe course ofexercises three-planar movement is generated opposite to the direction in which scoliosis Is progressing This method is in accordance with the stale ofthe art ofscoshyIiasis pathomechanics The method requires detaied training and can Ihen con be applied at home under periodic control by a physician and a physiolherapist The method con be applied in landem with a Cheneau brace as weil as in surgical pretreatment A elaUed description of Ihe method of three-dimensional scoliosis trealment will be presented in Ihis article
STRESZCZENIE
ISlofa biadynamicznej mefody Ir6jplaszczyznowej korekcji skoioz idiopatycmych oparlaj est na patomechashynice iikolioz idiopatycznych - poega ana na czynnej segmentanlej tr6jplaszczymowej korekcji skrzywienia Dzialanie koncentruj e siccedil w pobitu Icrllgll szczytowego sknywienia Stosowane iest bodicowanie propiocepshytywne po stronie wklllsej oraz eksteroceptywne po stronie wypuldej Korekcja i slosowanie bodicocircw propioshyi eksteroceprywnych zsynchronizowane j esl z asymetrycznym torem oddechowym oraz z poszczeg61nymi fazashymi oddechu W trakcie eacutewiczen powstaje odwrotny do lrierurzku rozwoju scoliozy tr6jplaszczyznowy ruch IcrFtshygoslupa Melodajesl zgodna z aktualnym stanem wiedzy na lemat patomechanizmu scoiozy nymaga szczegocircshy100-lego instniktaZu po clorym mote byeacute wykonywana w warunkach domowych Z olcresowq kontrolq przez leshycana i fizj oterapeutll Metoda mote byeacute stosowana r6wnolegle z leczeniem gorsetem korekcyjnym Cheneau a talcte w przygotowaniu do leczenia operacyjnego slcolioz W pracy przedslawiony zostal szczeg6owy apis meshytody leczenia
Skoliozy idlopatyczne stanowili znieksztalcenia patycznej rozwija siccedil poprzez przemieszczenie kr~gu tr6j~aszczyznowe charakteryzujltce siccedil wyboczeshy szczytowego w stosunku do krccedilgu g6mego j dolnego niem rotacjltt krccedilg6w klatki piersiowej i miednicy z r6wnoczesolljego rotacjl zgodnie z ruchem wskashyoraz zmianami w fizjologicznych krzywiznach kr~ z6wek zegara dia skrzywienia prawostronnego oraz goslupa w plaszczyinie slrzalkoweJ [ 123] przeciwnie do wskaz6wek zegara dIa skrzywienia leshy
Z punklu widz nia patomechaniki tr6jplaszczyshy wostronnego Koncepcja rozwoju skoliozy jako rotashyznowe znieksztalcenie krccedilgoslupa w skoliozie idio- cja i kontrotacja sugeruje ze sily korekcyjne powinshy
49
EDUCATION MEETING SATURDAY 8th of APRIL 2006
- CARDJOPULMONARY EXERCIS E
TEST IN GIRLS WITH
CONSERVA TIVEL Y TREA TED
IDIOPATHIC SCOLIOSIS
Jacek DURMALA Krystyna DOBOSIEWICZ
Department of Rehabilitation Medical University of Silesia
Katowice Poland jdurmalaqcmpl
The aim of the study was
to estimate the influence the conservative treatment (asymmetric mobilization of the trunk by Dobosiewicz) on physical efficiency in the group of girls with idiopathie scoliosis
Material
bull 87 girls with idiopathie scoliosis
aged 1 0-17 years
(mean age 135 years SO 161)
J Durmala K Dobosiewicz 1
EDUCATION MEETING SATURDAY8thof APRIL 2006
Material
bull 38 girls (437) with double major scol iosis (thoracic segment - Cobb angle 18-42deg mean 30deg SO 82 angle of axial rotation 4-32deg mean 21 deg SD 107 lumbar segment - Cobb angle 11 shy48deg mean 31deg SO 128 angle of axial rotation 5shy30deg mean 13deg SO 85)
bull 49 girls (563) with single scoliosis (Cobb angle 11-75deg mean 33deg SO 155 angle of axial rotat ion 5-30deg mean 14deg SD 83)
TIoracic kyphosis of the invesllgated group was 5-39deg mean 23deg SO 86 and lumbar lordosis 16-41middot mean 30 50 65)
Material
bull The 64 girls aged 10-17 years (m ean age 131
years SD 132) were conservat ively Ireated
using Dobosiewiczs method
bull Treatment period ranged from 5 months 10 3
years (mean 148 months SD 902)
Material The 23 girls aged 10-17 years (mean age 136 years SO 108) were treated u sing symmetric exercises - treatment period ranged from 4 months to 3 years (mean 161 months SO 1019)
bull 26 of ail g irls (18 girls earlier treated using Dobosiewiczs m ethod and 8 gi rls earlier treated using symmetric exercises) aged 10-17 years (mean age 134 years SO 108) were twice tested - at first and last day of Intensive hospital rehabilitation (asymmetnc mobllization of the trunk by Oobosiewicz) - mean hospitalization period 20 days (range 18-26 days)
i rf~8f6~~ or~~n~= ~~r~1~r~icircJ~~tb~~~~ mean 17-4 1deg meatl~(I SO 74 R n~le ofax 1 rotatIon 5-25ot mC3 111 3laquo S0 6icircl Ilnd 1 99t1S~ ~~~~I~~~~~$ruo~ras~ ~ocirc~~a~e~~~~~~~5euml1 9middotn~ tUfllbar Iord05ts 16-4 1deg mean 311 SO 68)
J Durmala K Dobosiewicz 2
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Material
The control group consisted of 77 healthy
girls aged 6-17 years (mean age 12
years SD 31)
Material
The examined girls participated in school
only in scheduled physical education
lessons and have not been enrolled in
other sporting activity
METHOD
The exercise cycle
ergometer test was
performed
J Durmala K Dobosiewicz 3
EDUCATION MEETING SATURDAY 8th of APRIL 2006
METHOD
The Incrementai exercise test has been applied
We have found that tests ln whlch the Incrementai part of the protocol ln completed between 8 -12 minutes duration glve the
bullhighest maximum VOz in normal subjects
METHOD
The workload was Increased stepwlse
bull by 10 Watt every minute - ln chlldren
with high ~ 135 cm
bull by 15 Watt every minute ln chlldren
with high gt 135 cm
METHOD
The test had been contlnued untll refusai of the patient or exceeding the pulse Ilmit
Durlng the exerclse the gas exchange parameters were recorded by Jaeger device model Oxycon Alfa uslng direct breath-byshybreath rnethod (with face mask)
J Durmala K Dobosewlcz 4
EDUCATION MEETING SATURDAY 8th of APRIL 2006
METHOD ~ ~~ r 3 min 3 min 8 - 12 min 6 min -~
_ 0 rpiYJ 0 rpm 60 rpm ~1 30 rpm
_ t o~w=att~o~~na ~~ att__~ tl~~S~~ l ad l ~~~~~r o~w= Hlcremenlal t
pedaillog i i ~
~ ilt ~I~-----tl-~ I t ~ i ~ lOSt sffortivB
lW r resututlon r rm-u middot 1 - bullA~cremen tal ~~ ~ ~ ifr- ~ VtI 1 ~i ~ tllng _
METHOD
On the basis of recorded parameters VAT
has been individually computed for each
child using V-slope method by
Wasserman
METHOD
For assesment of physical capacity
the maximal minute oxygen o
consumption (V02max) ventilatory
anaerobic threshold (VAT) and
maximal workload was used
J Durmala K Dobosiewicz 5
EDUCATION MEETING SATURDAY 8thof APRIL 2006
RESULTS
Ali girls with 18 have been classified
within normal range of predicted
values of
bull maximal minute oxygen uptake
bull VAT and
bull maximal workload
RESULTS
The differences between group of girls
treated using Dobosiewicz s method and
group of girl s treated using symmetric
exercises were statistically significant
Lower exercise efficiency of girls treated
using sym metric exercises has been
observed
RESULTS Girls wilh IS Irealed using
N=87 p value
Dobosiewlczs method N64
symmetJic oxor-ci Nz23
Perœnlage of predicled vaJue of
maximal minute oxygen uptake
98 905 0033
Percenlage of predicled value of
VAT 97 933 0049
Percenlage 01 predided value ni
maximal workload 101 939 0038
J Durmala K Dobosiewicz 6
EDUCATION MEETING SATURDAY8th of APRIL 2006
RESULTS 26 girl s twice tested - at fi rst and last day of intensive hospital rehabilitation
The value of ventilatory anaerobic threshold increased during intensive hospital rehabilitation (asymmetric mobilization of the trunk by Oobosiewicz) statistically significantly (p=00019)
2047 ml O2 minkg (SO 268)
vs 2239 ml O2 minkg (SO 232)
Conclusions
1 The exerc ise eff iciency of girls with IS treated by asymmetric exerc ises of Oobosiewicz is norm al
2 Such high level of the exercise efficiency of thIcircs group resulted fram using of Oobosiewiczs method
r
J Durmala K Dobosiewicz 7
REVIEWS
Role of physical exercise in tbe treattnent of mild idiopathie adolescent scoliosis
Revicw of th- literature
A NECRlNl N VElWNL s PARZI 1 A NEGRINJ 5 NEClU NI
P1t~silillxlrd~ Ihcrapy (or klucgtlttlwrlpyl i pro shy-tJm of physka] cXlrd-cs ipcci I(a~ (IJcloJgtcd hy l li trIWlltl phrslollwrapbt wilh tb m~ln a1mor pl shyVCnI in lhe ilAAfIVltilH1 llf the ucirccfonuity III mild IgtC )
Lil1Si bclpin~ thebm ( aocl co uaufllclilIg ils ~jd- clf IS in nlOdlJmiddotnh-culiosis Th middotalillofthi paper ito r (W
Ille Ii lc ram r 1 a-ccrulin wh kh of Ih bull Lu[Jalmlcrus Ind (Lb hili til~ CLlLt-cd br scnli()si- clluld bl pl Y nlcd or r d uccd hl phylolld LXtmiddotrdsi n Il p--to-da le knowl Uuml~l nr tIll~C aspcc[~ i ne bulled in oruer 10 dndc whclh~r 11Rf blLl adcqlmtt Ib(uuml n middotlicaJ balis fo r ora)aini l Ihe US4~ of lUgravellgtitlerap) wltcllj(r or fln l th e prtl1iœ of kimiddot ~lre IUlll poNjn~ a t iil ies ~bould h allowtcI II uuml middot c enliaI toltlentlf)wh k lu alClor ie - lf pl lr~kiJl -c rmiddot d gtlt- (Ic rnnhi UzJ( inn ni (t hl HrJltlon [ rtn~hcll iJl ~ or 1i1J(IChIumlJlJt etc) Sh llU Ld be TolullllCcluse ulemiddot l onld b- clclIimcntalancl wukh sho ll ld he IJlI-n~ifl~d I~~a l lhc (o uld h 11lfu 1 Know k dg CJnc1in t (wIn SeiCIImiddot Hlk rCS([lflt h daw ccordinll to Ih bull llVit w o f tIlt iii 111 1( plop(lsltd in (h i papcr lmiddotonllmJ l lnl plLyi 11 cxcr(j$( pn (nti or (tmiddotduce dhlblli t ic 1 ~lt Il Jj ll(k pl ti Jlt fadl j w(~ the nlIIIrl li7alinn n f poMural dd shylitS tu p n xJ llc aSl COIlMqnen c(middot 1 all )llal) or r(tn~ shys i middot middotlIrve Tilt u~c (I f appn1priattmiddot kincsiuuml wrlpy 0 in rcns polttllcal swhiIHy Icirc IIHmiddotorc Illta ll y (0 r 1(lt1 lllho UAh mon ltlccurlltc 1Ut dl1alkd -rLk l(lWfils 111111 )11 h Jlccdt(
11) wurcJlt 0 lit)-IcircS (Iumpy - x rcLs P()lun
n rllt lT(ltnklf u f COll1tlK H (rtd) I 1i plfho l og l ~$I rUlglng tr m low tmiddot k Pl 1l1 to IdiOpath ie SCUIshy
Submitt(oJ [or PUhltCl l1 011 uly Tt 2001 Acc~pttJ ugu - ~2 1(t-1l
Addre rltj-xlfll telt~I(middotb If) - grinl Flt(1(bziurllt r )(m Ofl ()(Cl1I shy Lt middotqlltœlll ro () - 1u I4t agravehLIlKil ta IYIL-lTt ilSllltp lfllmiddot ~ 1l1uumldull
CelII ~ (niiOS I I~ middot ann (1) IfUh middot lIlfU di louhilll(tymi ( Nlmiddot ~iI rli -ilIIUmiddotltlfl
Nlti(ir 1( ) il r() (ltbullagt1
lt vLL_ l IiII no 1ftfI
jS ) we are a IUil ly tJc ing n1n) ltblll lS 1 k l1 b ~J)w in~ tl~ t S Jfll l approad llt - l1n til hy on ielshyertd ~tan lard ugraveJuld ln m any ~1~ he lI ~t les i if Ilot dange r )ll lt rhlS is lrut of reil l lnw 1gtlt1lt1 pa in l ~ or 5urgi c ll lrea lmltnl5 in dbc r lmiddot ll Sc - 2
ln tlle cj-e ut ~ t lll(tlWtl i( li p l ll1JC luuml- I ~ middottnl ~() shyliosis phys cal ((_lt1(( is emr1uved ltI t()fIl1 0 lh~rtrv
lo ly in cel1l in L)lllllde (nluumlnlr in tilt Lltlll middotorkl i e Iw l) r llt t Srain hUI IIgt() 111 Gert11lny 5- 1~1 in other reg lOl1 wbere thi I-incl qf tre l tm e rll 1 p~ 1 pmiddot t 1( cI il Jws Ixen cri ri cilld md rel -cltd Lw m~lI1 1 11 Jlu~ Fue Fnlny r ~lrs thio middot15 a lsgt(ru( f ~rth r -~ltc rrJtf))~ ll t vit11 br1Cltcgt b r II1 ([C Llt n ClW grmvlng 1lt1 0 L Sti g
gcsti n the lIsefulnes- u r Ih is form o t treatm n t 1
Hmiddotu]rs have nerged jn El or uf pll y~ iLd eegraverdse eacute 00[ 1 but tlw are nUl yel 11 11 t llu i vIC~11 and r hi ~
f rm of trt ~ltmenr IS stiJ l Ul1 ckf ckhate FfI t Jt 111 il i 11t (eltary td 1I iFy 11umbtr ot
b l sic COI ceP rlJ lf w ill he cIh tt d in t hi pap r
Scollosis
DCijIrI iriolls
ScnUoSlS is Irlircc c1 lme nsIcircltnal (I(gt i l cj on ot tht spinc thar cau C a CU 1 lh lt ca n h e $ t~en ln (1 me1Sshy
ured ultinF Coh) lll ltllCXI o n HI anreu middot p rtc rilt r
EUJlOI -1 lœDICOPHYSlc~ IR
NECRI Nl
110
f)i)
1 7J
amp aS g 5li - 0 v
V
31
10
(1 1) Il 15
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FigJ----jllph ot DlI w l-lkaupegraverel) The agloimvltltinn Or idio r lrhlc 50gt1iflll~ IS rpiJ bel~ en th e- [l0 IH P (l)ltg tnntll lol (JI PUllcmiddotny) mtl 1 ( f( lS-er sigll paiilivltecirc lt Dlt(i I1 11illg r the iti l 1Kgt n n t rll icirclicH a ) 111lt m omal prebulled the mno rche md ociks with lll I)ttlx flal gr Ih pll fl
rlcljoprdphLi 1 hl merl prestIK ~ of this curvt c10es n t autom~l ritllJy indi ate the pn$CI1(t of a defurshyTnitv (SlllKtUrd (Unel
It i~ possible tu clil1e ren tute a struCnlt t CI1tve fruIn a pogt urll 011e by identifyi og the hum]) du ring AdIlns tesr I~OQ looklng tra m beh lnd at the p atient w ho b benchng fUfward il is p -- ible ta d d~ct 1l1 eh ucirc n of o ne liidlt 0 1 the trunk usually n n the (onvex ~ jde ul tbe radiographie CUfve Ugrave1lr C Ul be mlt~I Slred lISin~
BUlln els S o liomere( 1 ~ l This h Uf1lp is du(- lO (Ile pregravegtecircn ~ of vertel ra i rolltion 1c1 Ollt tn tic f~YJ tllre o f the def trrnit tli [ c m be seen and measurc(i v ith Perddolles lb lsLometer on an amero-Ix)iferior radioshygrapb ~2
Seven ry pel cent o f li Ises a re conid 1lt 1tO be idiopa thie 1 bull ia l-nosilt in this CI$C is b exdlls i ~ n as idinpa thlc me-us t11H wc do n()[ know rJw origio of lheacute curvc [n othe] ~Ie$ it b Ix )~i ble ro ide nrify a dieak (bat CHl jusrify the c1etgtnniry slIch a rna lfo rshymar i ns I1(gtufol Ig ic~ l or genlttic cl iscas s Glnclt~r trauma etc )
[dicirc)parhk S(oliosis has been divicled ~(corcling (0
the ~Ie of tlie patient egrave1l the tiJ1ll of d~[ccli n of the condil ion into ti) ur t ypei ln fanUlc jU nik ltldolesshyccnt lnd aduh Til l m n st cnnunon (VPC IS the acloshylescegravenr o licirceacute I1IJctenzec1 hy 1 sud le l1 tggrH3l ion uuml uring the grow tll Spllrt (Hg 1)2
lhile p tu 1l sco liosi i5 Ycry lomnw n thl pre shy~Iknct ra te f r adole ent icuumlop~lthic structural CU IY~S in sch )o chilclren are 18middot20
- 10 Co bb d~grels o r m on l -lil
- 2) ~ohh dtgreclt or mort O 2~j - bull () (obb d gre -s )1 mOfeacute ()ll 2
Clin iltI [ d e isio ns lfl IXlSed 111 an lccu r~He pregshynosi which obt inccl in eJch pa ti nt mainly o n the basi of the nsidu~ll p()tlnllltl l of TH1h and the result s of 1 rh clin 1 1 ~l1d tadiogmpl i exlminashyti(ln12ll c noieq uentlya d inica ] la sifiou io n o f the ing le pHient tn -ome estent co incic1 ing w irh the
D diographic one c l n lw SLlIl1H1arizeci 1 1 folIcJ - mikl lc~ (1)(n 20 C bh de~r es - moderJt l betwlen ln md 15 ohh de~ rtes - StV re 111( gt1lt rh n ~J) )bh (kgf s
On the 1) lsis of [hi - dinic d d a lfic t i n (Vith l1l il el lrb tiOI ~ o f the ir b() und~ri e ) in Itllt l cente rS Of SCOtiO LS ITe ltlllent in the Lltin odcl (i rJ Ital lnmct md PI iJ Ugrave tre tmtnt i s plmmcd a fo lltJw 8l
- mild kineslth e (~1fw ~1Il (1 luok-ou t - Hl demte IJragravecegrave 1111101 c(~r md k i rws ithe lJpy - ~cven surgery
Physical exe rcL~e for S(ol iosis
Defi t tiOl l S
PhyS i 11 nU b lIKrlttp middot (or kines ithcIa Pl) i a p rvgrlill or plt~i Gl l (xeriltecircS ~1ci fi ( llJ y ltk ~ loped
y a -11 [ru ine 1pll yslo ther3pisr wirh th e m 10 Hllll
- pre (~ n tit1g tlc aggraaLion of the cl I )flnily in rnild bullcoUm is
- helping tlk Il ld Ct ~lOd ounter~lCtjng its skie elfects in III de rltegrave sc li sis
Tn tl1i_ feSpec1 kinesitl1ert py f JI s oliosis is tonshysider l a o on of peciticcedil training and s genecirc tltllly proposelt in sessions 0 1 4~ ro 60 minute IW) t) tour limes 1 Cee PhysiGtl exerci es can aLo ll v o ther auumlns 1S it oill he dise Issed in this plper
Ir 15 Ilot possib le to cl escribe a single progrlIT1 o r exerc ise a5 pro nrams ale USLIJUy p fgt nll ized ( ( lt
EUH PA ~illDI (DP1I YS IC~ 182
ROlL UF P l 1YSICAL lXl 1lt 1~E IN l IlE 11 ~l) IEd If IlU) l[)VP 1HI AIJ() J)~Cl~ r COl ~I NlG1W il
f)( 15 egraved ( )Il the nee L- 01 indi iuua l pJl itnts) al l l10ugh Lheacute) C l n h t 11 plicd o n a WOU p hJ~js (-1 (0 () pnients PC[ ~l ()lI r)middot lugrave reQCf lhese 1 10 grl lll frequt ml~ V IIT
hnm on in middotituk w allClthltJmiddot -Ill Jnv L l~egrave at Wc w Ht ~huw in lhis lyl peJ it i~ 111 n u -eII1 tu id e ntilv kirK itheJapturlc aims w hitl l ucircrr~spnd LO ugravelt~lil1 DUtshy
g X ir ur ph -s ici l lxtTi~l I~llhe r thln ln dj( us- indishyiJ u1 1progr-lfll
Aduumll l lxUl kisure time ~lOd h )u] Sp u lllll8 ~Ilttishy
i lt egrave~ i middotomm )Ly s iven lel mJ ing ro w hlf ~ Iuumlnsidshyer~d usdul or il lrmfu l in t1 lt rruning (lI tJw ptliJicirct ln tl1bplper Ugrave1 gent ltl l t rl ll bull p lwsiCUgrave lttG iviUes is rl ktll 10 JllI1ltlCc hOlll gtpOlt mJ kIJ1lsIcircl hc lJ l f
i ve lUen tloneumld )bo C on lv ine n dul( re Ull~ 1t~1 t s far Ilten publislt d f I~ mJ I(i noltgtithltl rgt is 11 11 a su h jel lnI deacutehate CJitk haltlt t llltit m itn ltl of l ny lorm o t p l1 ySiClI lxrcL e as a Itwr1 [ J- fo r i liopa tb il jcoJL~b un iL ()ri gin~ initial1) it WIS Ille r rOmiddotUumlK lt brgdv u f p l~lt titu gtllergt w h ) intervenecl hutll tc llcrl ll (mon as cltl HtilJ nic in terventi n man Jgt
1 t lltrJp utl t one 1 md rC j fkll l~ on rhe h sh lf som uni cOen I1v pn t I1cgts wt ldl hll ltl enl1 JI~ haLl nu na l scicnt lfic baisYmiddot HOlh tlle$( trr t peu shy to rh ~rl py tt nJecI to l~~rJ tte C Ih tk CUf -~ pnnshyclr~tll y as a f tsul t of lilo h llIzatio ll of tn imdqultdy ~u pp rt(d S pln eacute 7~ 12 to re-t1 r rI ltrl 1$ l l1C k o f WH llt~~rdl 10 I ndt~-dll()urnah tnd 11( on1 p~l per u suaJly Cl tc([ IS n prelimmtrf lll d 3 ln tt li w ay man (l rrlKpt(Hc H lf O iS Inll ph ~i C U l ~ d vi ~ cI nllog scnliotl pa t le nL~ 3gainst holll ph lca l egravexershyclc and p()rt~1
It m u st t~ n tfd [hat pllyknl txerc j~ tJe~ltm(nls t1iHer 1 lJ rd il1g r rhe rherlpcu tlC litTl~ on lllc h tJ rgt ap p lolc il l the IXlltent lncl hi im r IIIllHnt i- 1 (1(1 rI - 5lt1J lC igt tIl l ( f phJllIlllolopJ al rrea tmln ls Ihith cllffc r 1lt œQlfd- rhe m C cculc u ~t(l luI thl p al 1t n
~mc l 11i (lbE~e Tt i ~ P ~il k tlwreI[middote thll wuumlk ltlll t kin 1or ph~ i Clt1 1 lX r(j~ 1I 111~ t bc loidvd by t h~ Lo iurie IxujCJ1l al1ulhcr a dl ~IS nJI h~ iOg (1 11shygerols llugJr in racr le (wi ller d I ~fJIII ~ I ml thlls re(nl1l rn ndc(1
fn n UI cel1ll r we In(~ hccf) using 1 ) 1 1111 11 ve ) 1 (J p lw l icd ex(r(i~e (0 J ( 1I l tt i~ tlh aITt ~ l~d Ilv m ikl tru cflumiddott1 adokscltnt (cl ioj arh lC icoli is11 2)
ina the f U~ t rc-gt uJrs IefC pu b lishe - the pJ( )grd m 11lt1lt l1te n PWltllk d in fa c t deel()pnlln l~ in th t l itshy OlL1Ii in tl1 r b t ~() ycal f ha ve iclemi fiecl niO l l
m d 111 ur impl rnHm s md d i s )h ilir i (gt~ lue t idlo p lthk amp()lio -i ~ t Jll CIII he 1UO(l if Icirc 1by phyict1 egrave xert iSlgt l fe t rrncllt
l illl
111e aim of t l1JS r~l per ii tmiddot (tv iew tl1( l iterat urt to a(errl ln v llic ll of th~ impa irm 1t~ and Liit hil it il i GllIltec hy ~ o l i()gtj s -o ull he ll nt x or re middotlu celt1 Ili pl1ysical xerclse An u p-to-da te knOvkdge o f tl lt Lgtpecl-gt i necckC1 in rJeumlr) d -oek
- whetll~r there h ltl n adLtIIl ) l tht()d ical bbh fur or JqIIcirclb l l l1 Il( ) f k irt llit herlpy
- h N I)(1 ( 1 Dm tlle p r l c tIcirc(( o f Jebur tiJne )pOfung lcli v l ti ~ IIOU lci he tllf) -d o
II J U V f h 1 I11~ c~~lb li hed Ihe usefuhlLss 01 k il1 shyc ~thtrpy il i aIle dy l nsi 1([(( -r-tI Llleu i n )I11 plJt~ ut the wJrld ir ilt ecircS~nl i 1 I( id n Iv w l1i li ( 1shy
gories 0 1 pl1Vtl( 1excrClgtegt te D)bilI7it ric 1n (Ir st shylliuumlZltio f) lttlt tlgtbltn ing ni trcrccedilh ing erc) hn Id be
vnlcled he tll rhe nuld be lerrillldll1 1 md whidl s tlQu1d be inreœ jf ic(1 IJeClU~l tlley cOli lel Je LI ~ful
Ncuro1llotor impainncnts
Imv aUl llOr~ 11 lt1lt ~tlKlteJ lhe cltlndatiotl bd Ween tl UC1UmiddotIt t l ol(~C t nt id iopml je -nll ~J~ and cli~l l shyler~ lr 1tH lest ihuLIr yt 1 _ 13 ~ 311 D uhoussct 1
1-- ITS tln l ldiopath k s(o lio-L L cll -c d l J l hmgt in th terl tltr f prop li l l pu n md 1I1ar th e detrshyn Hi n i~ na tural 1 ~ronse to ril e need tu ts tu re p()tun ltlluilib riu Ul HcrmJJ1 31~ 11 () d tllat icliupathic ( liCl5j h l it re5u lt Ot1 rw nltuf mot r l ~ltelV
[Id )fcl 3 nI] ~1ltJ U Sr1lle nr to dtorders in centJtI lO~Cl shyIOIDNur) md 1xi~tI moro (Ul1lfOl syt( llI (Fig _l
N htIll -of) H1c S uumll h( rll1 ( ~ l( w ing JI t11 (oshyI-ie on the l l lO]ugy o b doll (nt Rl iu]icirc tlili- middot()lioL m unt fil t-hltll rhl ugravedcmnilV L th e fl5 ult o f 1 (k btcl 11lIFll llI ion nf som t11(WUgravetltnl md pO~ lur( (tnic l~ l licirc1 tl1lt if l p OgtlbJt b C 1l rlw sta l i lin 0f 11 1 Sf llle j lt g )tx l Tt) ohtil n a ))Cli U 1ILzltl I o f p ~llIr~il d l~flo [ in l1litkd ~J)llnSIS me CI Igt(middotqucnr J ~ a ~tmicirc ()nlly or regle Ie Llive
Ali th- 11yp ) tlw~es rd ~lte tr d irtl Itn t pnl1tlt o f [11 v hole ~piltm It11[ controls postu re ~nd mrw shyment lrre pell ic of tlh po int a d lI~ llv inH llYegraved il i ~ ll 1 nnable tCl aSUilll ri 1l tr l ll1 lo g thi ~ys ttm ( Qu it le 1I middoteli tl
lt ch ugt nlt~(S f rullliIl thil i nlomwtion th at p tlmiddot shyiCil J(tl iIies nw gt Il lInport~n t rr le to pbv [11Icircgt role ca n 1)lt slI i11l1lariztd ln lWO the ptu li ain Llt
- d elopmll1 l of p uumlltl St1 b Hlt ) - c1e veuml IOpm 1)[ o f bhll1ltc _
(k llhUl)lOr S Cll orr
ontrot oic whan-lt
------+ 1 ~ il lnll ugrave r AINnl
Cllnlr1
T bflt~ r
fltL1 tlli
lMini
l
~sary ~J-frlllen i )f
~ 1 ocirctnl
~UcirclllIJJlW Ll
AXl ~l1 n uumll l) r sy 5t ~nl
middoticoltoq ~ Fig 2-AcFgtrdong lU He-mutl 21 il is Fi)5~ ib1e rD prolXgtSlt l -oo ie1 mnd 1 ((if ~ elio egrave middotAhltr~d l)Qdy-p ati~ I I i u d) uren ttllOn k td LO In ~ory reHTt I1 eDi tn l al ) JdrnlV~ pn)4~ e l u r~o(Ofe 0-c1 eptunl dvstil t1 ctlon sltŒ(ry icircltu nu11t ilwnt [ ~mC ~ted tl l1 ce Ill trpntlshyUumlfJJl nd IKnle~ r~dibl jtugrave)n of -I) m tlosen Ir ~ig nj tl (I1vying ln fornll1U n (lI an ereltl ~piJl e Mmor aJJ r--a t ~) n ltgtf ti lt aXljl mowr plem iHUC Wh ~fl Ille 6ubjeco m uumlntl Icircn (1oJifitd perccpfLlI l ~na l ysilt of p n)lnocepti Icircnfu rnlaquol ti desnibJOS ~n t tecr spin A IICW motor co nrro l Ira I gy t adopt resu ltin~ in the ~tr ltctltr 1 ckformh y lf IdiopathirL scollos i=i Ht lrftU1uc nltnt l ISll I1lJy h1e- ~ I pro()und elkn on bralO Sfem flJll ct i(lnn~lLhu modifyRll Ille nltulltgtshytl10 ) 1 1111 Uu l-lHoror control 5~Shnl$ shy
As Srtgn1lt1 l ~ ltlssert~ if wc l C -Cp t 111 1 un o f the G IiC s oliosls L l tisorckr oi th e ltquilibrilltn sys t ~ms it is lagical to oriegravenrate physlCl l exercis( lherap y ln th is d ir(gtCli()[1
11lclte goals Cul tl lfOUgil ditrercn t modes 01 action be Olchic(-c1 witJ1 phykal accivit ie
- po rt ive Cll ities p ro ct LJ e aIl UgravelClltrtsc in 6lte nshyel ll )o rd in~lti n pinai pr0prinup ti_)[J nLi mOVeshyment control 0 vio lls iy ln thh repect ome lCtivshylites aœ pre um~I I)y lXrter tllln ntil crs
- kinrl lira py using pedJil exerCisocirc specially developecl lith th est 1101 5 in mind illVuuml VC I lllore prccilt( ll1d InC1 li zed cri n on rhe spiJw focusing
a90
1 ~~
lg -lNheJo ~1l l1 t r~l g rld in 1 1) h i(~ IImiddot ct r rHienl w i ll idlllhic _It ~i ~ _ iri s plt ~I le II find Jit ltH vlllleuml ~l Cgtbl tn~ ks III d il fef lt p ~ lt ihnS nu v~tl middot B ~a~pt u Il C middotl)Icircd ~(t l l11 C dlfkrCnl middot- hdween slllndi1g Uline nu nllt1Xinul oorrec ri nI t chied Vith Ct (J ) und tfdincJ ne lot es o UIine 1 fo llnVs middotIJfl tfi ni( - ltlrshy
reltiK)n ~ Ikexibiliry st3nucircing - -pirte - f ur~1 1IbjISC ltupin - ltorrcaion - - r~luci()il ll ymiddot For flmpllt in J npK l1 pH k1J il
plt1SSlhlc ln obtai n 10 u1 511ndlt)l [YLo lion yr ln Slt p ille rlOlgt itlugraven om l J ~ in ( gttf(C rigtIl lIex lbuil 15 i (r-l l=22deg pol lltl ~~J IIlpraquo is IcircO~-V- I t1 l nd tucircu(Ugrave) ilil) I~ 3laquoJO- IH-12
r ln Ugravel e abilit jl of tluuml [m e llu to co ntro l irse lr in ~ pac
fuld l oftlles uumlllelve ntio ns can presum1b1r incn~~ Ih enl ac )1 the orller and lHitlll r of Ille rn - 11 )ltd h e lllldenl lu EJ3)4il
Posl1l1-t collapse lnd slabilizariotl
lIle concept u fplt st lUal c(l lJap~e l l~t Iwen detin 61 by DlI II-T3e~tupegrave rL t Ac oJdin)j tu tl1i- ~ll1thor il [ nec(sary ~- l Hn Cv-tlualing th tleihility o f a col shylo tIcircC CUJVL (0 clistingu ih bt tVeen the re du ihil [ty index (th - li iffer gt le bet ~middot Il ~I r~tcli()grJph ie ~xnmshyinltio n of the iI111 pHienr in supine po ition m(i
ROte OF Pl rnmL EŒIlCISE IN THE TREAT-ŒNT OP ~I IJD IDIOPAnnC OOU~GEm seou SIS EltJRINI
I (~)-----------------------~
__ _~ _____ _~ __ __ L ___~ ________1 ____ _ __ ____ ___ ___ _____L___ _____ l___ ----------L ______ _
1 ~
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-- ------- --1---- ---- ]---r --- -----_----t- ---- --- ---shy__ ______~---- __ ____ 1________ __ _1_ __ ____ __shy
~ (1 J
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8 =~~=r=middotmiddotmiddotmiddoti~=-middotl--- middotmiddotmiddotshy--------------t----------~- -------- - ------__shy
~---- --- -- -~ -------------r---- -- -- ~-- - -------- --shy----i-------r-- - ---- ~~-shy
il 1~ 0
Dtl-Lmiddot ~ lttj l r~ UIltltlHt
f g 1 -TI1 u ilictf 1ld ( ii 11- ugraveu-sh) ld IX~ O 1d wllich ltJdnrshymII Il nf the pilll 1 ~tln~1 of th e -o lioti( spinc n IG~nI(J II IIIshytt) lhe iJeuml grl-e o f ~ ()Ii ti c (u rvH Il 1 w dcpc-nlknrly o l l he 10 111shy
P01(nl (pntt l ~ 1 1 nr ffll wrJ I) ln w hilth Ihe n i 1gt( ~ duc nL~ grlphs fm I h~lt 111lt hi~hr Iht Col h ~Ilu t (l f Lite ~Ul Ihe m Ol CI il y th t s(uumlJotil middotpin~ ~111 he ~middotJg gr~lVH(~(1
m mJxiTIt corrttt ion wll iJl i~ lIllCd to Ih - xt 1shy
lti Oilil y Jf tl1lt t Ut JO rl1t cdnUc idt md p OS shy
tU ll cul lapse ( th t ltHill enct b-tten l lUdioL) 1lphic egraveltamJl1ltlti OI1 J t th e ~lme pa tient in Sl il tl cling lOJ lline fX-sitiutl ) Wll ic h correb lc- onl wil ll fhe abilt ty of lllt p tu rl l gt s tem to C( lunternct lIk luree o r grl viry )cco d ing rv D lfVd- f3egraveLIprc po st li r t1 lt01shyIlDse is d ue to the Jnus -u lar ton a nd 11ll ex rCrIshy i) i itv of rhe tissus n the ( O IW-) si it (If the (01shyjl ti (~JtVe (Fi~ 3 L Pu~t llr1 C lltpstl lu lcl l ~~ reduc l-lt by llwans o f pl1ysica l cxerCles specitkally s tuclled ruuml i rnprove tIlus--ubr fOHt md lU pr )cllI Ct 1 ~11 hi shy
lizing ffCd
PararcL n tll CIJ cl the cr iti ca l (3 c1 thlsho ld beQ ld Il ich defol1J lHU n of the i pinlt 1 e~ in~ ne dtlllontr~1t _cl (1l ll t grclrf r mg] o f rllt C II in a qa m bng pos ition corn pOil 15 t l lowcr detormashytion lhnsllold (Fig 1) ie to ~11l Ulne3Se t the risk of pr ogr t~ lu n There t rh eJef re l J ea r l)iuuml 1itshycJ l ~ll1 l l(tl a 1 tnr tg ro b ohwined by d -cr t l ~ illg ilmiddot pU~lUrll cull lpse ptJcelJtge w bich lccording t i)
h llTd tnd ~l(heJ1l ~on 1~ b inde cl 1X llt icularly luumlgh Ugravel mllcl c Iio~ i (bdow 2( 0 ) (F ig 5 J
Fin a Il III ch iS respect lllljl hl and b um l 01 m linmiddot
ii iI 1 l _ _~ _ ___I ___ ___ __L ___ _ ___ ___J______ ___ 1 ___
li 1 1 1 1 i 1
1 i ___--____---___----__-_---_~- _ _--_ ___-+----
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+----r--------t-------t------f-- J
Fj~ ~-Ac(XjJlin(Q luuml T O rIcd ~lnd Na(h(ln~ n i () dl( pCG w rd (rTIshy
POO ll is hiherin cu rvegt in wh ilt l1lh ~1flILWrd cII1I Olk l1t IS le- pr(v~knt ln th e grtph Ih t PogttJlJ I ugtnq) Ot1 -J1l j elfltS-e J tlt 1l1t obb dirr remc rlLIv obu incu f roll l the Cohb atl( 0 1stlI1dtJ1g IId gtupinc rldo~raf115 Ih Ille lt) [1l1t1 (i lndnl I pine) 511pille the ~(nlClu tJ1 compo l1lnt U rlk CU Y _VeJily I~ ltx p rlt 1 L1v UpUlt (obh Illeturo Ih t si _b Cct rtJeSIm l fie -ltn J trd Ugraveltuuml shyuumlo n A~-i)rding LP 11(lt uuta o n l ( r1I~( in ~I 2JQ sup itlt curvt 1hi C(]l)b ddhccno l l f lO is -J-lultt( thc s ldnd inr tnla Ol1l t lS wi Q) whil 11) 1 1)401 ~llp lne ClHVC If ~ 1Omiddot ( tcl Lhe ttnd trl~ nlca~ I(t I ~ ~I)
tli n ll w l lllE cq lin ti spin h~ i ng mo r ~ Llnt~II) 1 tlun the nOftl111 one n Cll l gr(lk ( (cU ve tl1u n da r u p shy
po rt in o r k r 10 m linrl in tht 1xi11po tuf_ n th ha__i of th egt onideratl lr1S it f(lll() rhJt
ph rH (~Uuml e erd es ulukl h u - ul iiuml tbeacuteY ~U-L lm cl 1l (It-d o pmg p05111 td C Jl1twl lS fuumlrnll~ rly d ccrll1td ln an Ql St if i imr ol1111 t ru t(( - tht m(d in C JI shy
r t t r sture fO Ir -ngthen tlll m u ck-gt of the spint mainl) in (11erl antig r3ilrl tIcirclt l]lli fun ctin ll U hy meU15 dl i )ll1 t trk ~ lhJ cl( -ll tlt C)nlr~lUions ~llld no l IdOshy
1l)llic d YIltll1k lt l jAJ lktic t) I1 ) II 11)t 111 hd posibleacute t lcluuml ee postura l io nrro and stfh ili lllllt IJI
w i thout food T1lw(ull r d I( Lf(11 Ibk t m ucircnuin Ihe c()rf ~ct [ ()S tu re for cl gtu ifKi IH lLl1gth 0f ti l11 ~
This i-l ddl usl a typl 11 dnmnin (tf k inesllh rap) in 11 (lt-11 [[k - p~d fk lnr in lng f u l1a in llllliCk is poss ihle lI sing ctrtain Idncl fJ l (lt) 11111 liun S p Ul in tb is Cl c is ulttful ooly sa I~tr 1~ il Iw lps t1w lxltknt 1 becuJl)t 1gtlt ltlt-I a ClJu~l inred irl ilL ntllru l o~ i cll
and I1lll~lJhl r-keJc LIl [rll-llIn~ middot etlt(wrs JI the int e rmiddot vlnrion
[J ROPA MfJ) I()Wf-I YSJ IR
1
ICR 1 1-1
r
1 shy ~
- shy
11 o-llrfOlhe5l~ o t Ih 1O~(1dity i n h ~ r ~ ll nr pbl1 l of ~ Spl11 in 111011 _llti1Gt l lPt f ltlJUCWJtl ( ~l Ihe Ir t 1 1gt illbll W Ilh LtltrJ1dlion Vln lbe rigronl middotUII~ l(I Dko n12 lIll h lumshydlanie1 1 [ nul 1 M hl whtrc M - gt) lnIUI1g 111laquo111laquo1 1 1 c rtJCshytjC~ f fce d -d Lill l1~ o f enr niI pUll spnmcl1y 1~ 111 mldlll1lt (n the fl1ur t 1 = tor~ of f(ward Ileuuml l = ughtel1lng fmiddotr p 1shynOf stn lClU= Alaquo rdtllg 1raquo Ihl~ - lin hull th l1ltgtllugrave ot tller1l lUr~Jtllrc F the ~pin t -ilh rlu1i tf Ihl 1 1Ibulll n lrlt InltT1 1
rbc prJI 3IJi l1ty d qrlOIJ~ n bull JI t IlJIII Hm lA the v=ltd gtc e lu-ing J 5lnK1ura i ltfnnity
Dioal e ch anicll itllp~lir J11 c nt
Ihrcemiddotdimcllgtional mc-cbal1in of the s pioc
~f Ikmiddot i t i nly l(œ ntly tlHr llk pr-5tnœ or nc ushy1 lnlo tnr impairment in Idiopttlllc s-ol ii IXl tknt liuml J$ heen h i- ll licircghlcJ hy re$eJ rh tll e preit ilegravee h inm b nIcirc Ji d lJutg~ lt hl ~ 1 ng t o n dO Ulll urcel 1 i5 (l lreldv well umlersrood H(j-ev~r nev lbt un h iomcrhankal im l) ion nI h1c rectm ly onk l n tIlt tre and p r~dou in f n rmtinn hou t pl1ykd (~fcl5( in t 11 0 tl1I _ltgt pbne of spact 1115 Im trqlt-u 1rom J i-[) v ing unclcrsrmdlng ot th l lmc -dim nshy~ilnl l l11 ~ hmk f the cO]jO[lC pln( ~2middot ) ) Ve- w ill )iI xnl t l1 d at lcL-orcltng tUl cl sif iol t lOn blsed o n gtolllt lricd h uumlCJ ) p lane
- b() rJzU[1tl ln th i pla n ~ th t 1o rm ll sp ine present no CUlye- w ll ile Uumll(~ ltc U Hic spLnc clevelops one of ir haracterls(Icircc deFo rm tiCs v elt tbrd ln lashytio n vh icl1 pJ()VcA~ theacute hw 11
- lgitltl in th llulJe U l(~ nonmll spIcirclle pl SenL kypl lOSis ~nd l dooi~ in tb lXI1 lhese [(Hu rts Vere m)( til ught [ 0 he relattd tlle scolkJtlc ( lI r Vegrave
- front l in hi pleme tht ncrmal p ine preseuron t no curYegrave whil thl ~11li tic p in ugravetI I ()~ icircl~ charshyad t Ilt I CU1C
Il Jri fJIIt palic
~l+I~na ra 3 r inr lut th l[ ber ll1d a œl1~lU1 degr 1
l f r()la tJo u lllu (lILa r forcKl ltxert ltJn tl ldefnmuumlng 1 tkllJ [J i1u a re- lhlt tll cly 11 [1 1 UI b y Olm ner w bn ~lh uiJwd tl egrave ro t1tic) l1 Ilm it ti lt p ica] lf shy
rhrl r() be (P (the Uma bevond Wl1iltJl th lCOJlb of [11( ~pmaJ musd ~ dthc COnCIt and nm ex ~l le btconk (t O li~[)
r ~l 18 ~1Il N lu t( ren i9 lun lu ted rlseurlt h in tlt ) tilt lULodeumlformipg1 tlo n ot tIH_ sc laquoJrle rh ox ercallkren lk 1l1~H li d11r once thl Il i ~ r tld1t5 [he lhrth ld f 111 JlIcirc lIi of tlle dnrlclc hurnp tlk
lI bslt Il l nt rlet()rlll lIcircon 01 the it l ()I~ C ( (ylm der (- sustalnecl by an H1tmi cforming aCOOIl
J1Ji h V hl rhyiical f~ f Ise CI 01 h spr n llnd kin middot ith ccedilrapJ my lX damlg ing vll e n l pplild as flle
igt Jk Iller ln SCC1IJ ~IS lllc lJ fxceed l auto in middot crca~ i n g lhrllgthuld [1 sh (~u Id ahn be j ofed that Ilw relscd pre sun 1l1111i insiugrave l fe pil1r inn) 1 mlshylt
- j Il- ( w atff 1 (nh ~1l 1(e Il10 utoldrml ng li1eCh~lI1 1sm
in flc l Geyer ~w tcd th1 t rm m 1 hI l)1ecircch1O lla1 puilll 0 l I C~ sw m mim t Ieuroamp no purpo t for cu lshyim le pllilt t1 s (weumlO middott r it is l~Jl(gtWl1 rhn in iculio r[ paULnl -iJl11T1ill~ doe_gt nor Il ~lp to i ncrt~SL n eur(1shym tor co mfU
(1irai p an (
Jerdnn lle 11 showecl thal ill CSl~ o f t10rLC IC 1i lUgrave
tllo lacolulllhil it lio_1 tlle cte tI llmiry in (he lg itt1 p lln t rn lnlftot il~ lf tspe iuUy in tlw initi 11 r luleuml )f cV IU[Icircon nf Ile ~oli ls W iU l 1 p(t)gr~s~ivlt il10middot~ shy
ment roward hvpok pho b G ll f ill~l Im lins l har dUflng (IN eWllLlfiu1 of 11Imh] co luumlgt i the l in t ot t l H~ gClyty Cegraven te l - 0 1 v llebed lxxli 5 r ro ject 1 seH fl r t side-ys and tlwn backlrcl bull thu~ p(0(1 lj n g a kyphQtlmg aet Il ln (h~ lu mhnr --PIl1 COftj tng
l l i tc Iugrave l lltl l( l rs1 tif s L -etllgt il l the lgirl11
1 Hl)
Ilu LE nI rIIY~Ic~L lXIlKISI 1 HI E TREhTMEtn OP JIU IDIOP llII C AD O USCUH O Ll Œl15 NEGR II
lLill tegt lre lenl1 ~I d ~fo rll1J[ ~ rhl recrSes the phyltiologiGII cmns of lh vine)
Accordlng () Dicion ~2 1 rtcluctio fl in the itgitttl CUIYtS combin l vi th a lueral Iviari n llltl ds t 1
mecban ism () ugravel~ta il ity in l he r rat r IllI1e which bVOf1i the unsd a nd i ncrea~e 0 1 co hlt1is (Fig 6 hiIf md Pl11jlbiJ Jl1eanwlt ile lt(udiecl lh e srnl ru t
orzyglpophySLs show ing t11 al ttleir 1I1tl rnic tl orienshytation f~I (jLi l~ltes aXIal ve rtegravebJl l rotllio ll in cun litluns lt f dorsal hypokrrhn Icirc tnd lum)H de i L lo IS
Tll t dat SLlgge 1 th t impOrfill ut pOitu res and l1lweil1 ) t Mudied in ord t r (CI mlIuml ntrlin or to reuwer fll e p llyslo lo~lCll ClIlye in lIe SlgJtta p lU)l Wlth the llm o t ch ~ kin~ rutltor in l~ bili ry7 AbC th ~e ~k-
1l11nL ~Irt del lnt [0 J jUc lt ftber l]kuti inrervenl ion vhich 1c)LJ k l IV - i(l ~ l compktl n l ililll on Il t c1 l shy-jel1 J11UVllT1ent IJ j o f 1uto-dOneacute(3tlon ( i e a -impk ld ion ) Iengtheni ng o f the pilleacute 011 a litlltl l aXl~ tll lt ((IT liJlI~rcdu e~ t lle ~---lJ linti- l lte ml-fkxj(l n h UI 11 - i llCrl I~t the plllH ](JgicJI dlt cr ~l S ( (1 k-yvllCiSh lIld O(ltOSh l o r c lch r1Iif n t a Ilew til(~ecirc dUuml llt Ilshy
si lflltl J ll1 u(~nlent iam ecl - 1l1t0- lIrfe rionmiddot7 4 llmshyp oed f Je-rura l iUIl cl middot-t1e- iltm lI1d ll1a intltnUlLe )( 5lg it d C Uf (gtS slig lll thltJrc i ypI1 tiZ) tIcircOI1 a nd lunugrave)ar 1()fdos i7~llion) sholild he esw b lb]HU 00 lb co
hl b oi hi p~l11il uU r -1Ir vlt Abo 111( e IlltUtl Chl lie o f purti n - a U vitk slJ1ultI h e )tuumlll ecl 1)] (1 n ldershy](ion r tl1i lt type for e upIe IilJ llyl)T S of repd shyiti( ml vemen prt n t in agonistK h)lnllltlSlks nI iIle kind f dlJ1ce C( uld he ([([r imentd
FmiddotO lllaljlallC and mobili ty of the SpIcircIlC
1 rd llo U 22 d L lm nrrare d lhlt in Illt fro nt a l pll ne
tilt 1 nge Clt 1)1lt vtment of tht scplit[i middot CU IY grcmr lIJ l il ~ d irectio n n f Lhe C ITelt tlO n tha n in tl le di re shyLion of pmgressi n l Fig 7 ) he IL o IS5err lJd tbat th15 mohiliry increac plrtil u la rly n apic [ cgcoeilts 1$ lh ~ ~c() li osb evolves Sragrm rJ 12 J ~ thus rigilt (0
VlI f n rller~p is ts Ilo t t) m o b uumliz - a sCtJl iu til curve w ilhout t [ uling ttwt tlle R lu tiOI o i til t ~a mt b fnlinruumln( 1hy l1tans o f ~I passic 01 1 rivE -uppnrt On tilt (ltllE r hand UgraveK d e iJlioJ1 in ease durill tlw tune 111 whicll tll C spmt i ~ not submjtrcd to correeshy( IV anl()n
j- Virh mi lei ol i b tlllt Upp i1n ill) lC tiol is d eveloped only lllmugil llClIf()mu$Cllbr f r llce thi ~
InegravelIl ~ thclcfo re tl1l[ inu eascgtt sp1J1all1extl)iity mua
11
Imiddotiumltgt 7-rurd illt Ir) 1 bull rdrilt I1 1 in tl lt frOlllll pbnlt- th( illl ge )r mOC llIeJlI o t the S-o UIIJC CUNe 1 supcrior in Ihlt diflt(l im ugrave( the n nKlIl thd n ll1 tllc dlrtcLion o f p rJ1(l( (llIl
be considrCtJ vntrl iJ)(l icltion and 1 undrli neocirc ab L a ~ubiljz~ILion 01 tilt spint pllss il)1y ohtl ll1td thrltJugll the stlengtlkl11ng o f the 1rltJgm vlt nonil lme shyCIC 111 illli orrant u bjcLliH- ln rhis r~f1 n sp u lllni lc tivitIumlLs sil uld lX tPI 10 dlegraveltl it l G lU t n w l1ik luring kine i Icircth lrr phyltical eXegraverci c~ tllat in ele
spinal m ot ilIcirclY sil nid 1e lt1 oid cdrt ~
Organ ie and psychologieal impainncuts and li islbi IiI le
A cgtI im lc pmi nr is moriOthl11 just 1 sp in and 1
compkt gt Ipp rnach to the gu in ad 1 ont i al~ shylute l e~se i t i11
[)a la 0 11[ [n ell lrom re semh pw tbat ome organi Iilnctiond cl fki ts suc]) as tlw clecrtiUe ut vild l tnd d fun ll l)Kity_orld ldly incrtJ k whil~ 0 shy[io s i -till in (1 miel q g of g JltlV ity ~ l ilI e 55 rtI lit
tllL pres e n ce )fl defidt Or Vi l~il Clp~1 - i~ ln one pIIiem in Ihr l ftectecl by 20 ICl 40 scoi stgt l ls~a r(h cunclutecl in tbe UA by Di Ruce- prod uegraveed an aaalo) u ll1lXimum 102 re u t in a group of Jd shyk 1ien t [(h sco llosls rang inF frum ) [0 1
Al10ther rudv bv rallt r m C chr111 lilcl NashycWrl1s( u 57 stlO eltt hil $(C 1 1 ui~ Ica js l( lllt cl (1 shy1prUlllI o f t1tgl lie bJd l imI in ~ul sct t1 t ltu b middot iects jlLltr l5 they are golng through ~I cltlici[e sllge in the fnm 1lt i n 01 tlWH o w n id uHitv t factor hit h Illy jeopmlize the cl velopme lit d ~ mIll lt lI1d htIshym cecl IWI sonalitr in Klulrhood
n RUI ~IEDl(( Ptl Y1-
ROU ltHmiddot PI [ I C~ 1 EXIRCIS]~ IN TI Il nW~JUNT OF SlllO lDIOP1HIC AI)C~ESΠ11 C(gt1[Oi 1S
This i why b IiCieacute ii is ~n imporrlIl t for p rcshyvegraveml e 1tLsr l tn en ou flge 1ari e nrs ~lfrecr(d by lIillcl middotu iosis ft) tlke p~l rt in portin -re rcatioluJ acrivitits Iha t 1eIU 10 L10 th r~1chophyinLl bull nd b~l )i 1l1o tur adlieem t n li 51Jmiddot2Even tlK)ugli [Dr bic mech~lnshy
ical mcl nellIUll10t 11 11 reltl ~ons lt r111 1gtomcrimes be l lefu l to ugg( ~t ne p rt in~ aCt iv ity r l h (gtr rll n anotlJer e th ink Ibal an exces~ ive IlHd icalizltion - Icirce l ll1posilion br plry~ilt i HlS nnejlor parents uf rh ry pe of po rt to lx p m lice 1 b Ule p 1Ucirc(Il L th1[ preshydLl ck l1 is fret clOice in lh ma tt r - -h II ll1 he avolc1ed wb 11 possLhle mainly for tlle i mport~ltll psyshyLb ) jogka l fe a SI)nS W( ha( ill ~ t nltntionegraved
Conclu ion
lbh ISsertegrave d t1H physkal tgtXtlci o is ) n fi ial whlIl practinu in order 10 ilnj rove the I11 llde
rœ nwh and tono C iral caplCiry and postu re o f the StOUO(I ~lIbj n II I nowkdge om ~ middotmg trom ci el1shyrlfi rls(~ Jrc li dJlJ accordl ng r the review 01 thE litshytirlture prnpo )td in t lli plpl r conflrm~ Ihe vuiclit ot th e -t ls ~rti ()ns
In l do l (ent Id iopl1il iC scoliuse il l n phee u i cl vk)pm e n t ( li tll iumlKh eXCC cl l g i en rhk thr hokl th e re i5 an und ubred need fn r l pprnpri 1tegrave (JJ1tOkJJe ~Ild Inr surgict1 therapics ill ortler 1) S l i p
the ( - Iuli on anugrave )JT~t~t UW ~pilll l dtlormities bull evshyerthtless in the illiti ~ll pl l~sC t ttlC c1iseLltc whcn the riS( r1 r euro )luli m is rtduced ocirc ~md tfle uifleal JOld threshold il ~ld flle po stural collai i reJcenw~ 43
JI l1 igh pllysicaJ egravexe rc ise - p revenc or r d llCe d i ~lh ilir ies o f [Iw ~ l() li )tic
p (iems R 28 J -6 5- 6 1 63
- f~KiHtare lh ( n utr ali711iCUl of postu m l d elicits tn produCel1 a coneql l nce J [)ti 0 I111)( or regre si -u lmiddotc 5middot Il 1 17 ~ M
-re 51udles U ~ n Ledecl tu con[mn or re jecr these conClLL i( 1 w l1 ich clerin-d frum 1l1 lIldytica l rcltw n f th e liter~iture appear r- ~Lo nlble Hnwecr Intil ne re ull are 31Iable wc should n r prevent our sroliotic patientmiddot trom tl ki ll p lt in s(loI1ing jshy
ir its pW1iada rly ltl t ~d1()o t () n til t c ntrHY -vith the l xcclrinn 01 gt[1 )11lt tIlat in rea-e t)1obility (tnU evc n thell oilly wh n progr~lgtion b p OSSibl) -uc h ~I( ucircvshyiUe -11 )ulu hl tIKoll w g ed The 11 S J ( rprOpriue kin (~irhe r~l Piuml to incr _~asc p()~tura l $llbil i ty is tl1egraveoretshyic tlly CiJUClt alttloughl more ~Iccu rtte aod deLli led ri k benefi rs anJlr~ is is netot1ed
Ria 1111tO
NIokl Mu d lle ftitYljJfu Jœl il 4IWr10UOifll S (JIvs i (1~1)Jshylidl ttno( cclIll le 11(11(1lt1 RCI fu lle ((lia LltfIt l1 I1I1i(i
LJ ci n s j(r3 pigt egrave li n IHUgru lkl di t rdz t fi sici pe e ft shytUlKm iluppno di un lisimerap15Ll rl lllcflt() 1 110 scopo di pnevirlt () fr en~lI 1-lgpwlllltnlcgt dclld lclonnitugrave o e il 5LOshy
Il i mi llon lt fH nugrave j (1 11ni dei co~e 1 lteIl I1J J nd ne ~Ii eifclti (()Tc rri udk s co lio si d i m e dia g rt iuuml ln que~ltlt
s rud i 30 llizzb mo i d ti cleU ric lca pel n ri Icare qJJ l lm 1 dis(imucirc x u le I[~ l z j-m i pro vna le da lla C gtl k A i json ere pr middote-nute () rk kl ducirc un~l rdeguCltl d nil cra pi lt di uJoseguerrnt Cjua li 1iU110 cli nbie tti 1 rcr lJ)tIId d~ fle)-UITC
n (- -fd7Io n~lcl)
Ut11claquo)si 1 lI tori htpnuuml )ludi-ttn I ~ cnntI1zttu fr Cq(in i idiJ)tic1 dbfl lOZ10l1 d d ~ leOla nelllOll1otoriO Lb un1I1cnUl 1n1l1i3 dcgli 111 lt1i ch DIJgt gtU l H crmU1 Nlch~mslt ( SIshygnaJ~l lerimiddot wo i esuemi -bletti d~ plt~e8lugraver- ne l pClZ le1lftgt scoliodcu kl s iluppo ddl ~ ~ uhjlil~ vertcbral~ lt o svilllp prJ Jdle JIl7 i() nl di ltCjuiljbrio Dng li studi sul lto lb( l~nlrale (OllddU i in pa rticdu d 1 DlIal-BeHJ (gtegraverl ~ P~II IId lI1 n~ llw - idente il v- m gtiu p eT il puientc clioti elgt di u n rnigb o t c)[ ro Ua sw mle dei radlldc onsegull o tramite il 11 fforzrlshyfl len to d e i l1luotoucirc l nllgr3ilri d e luOwo con crcbi ~Clltdr
in pOMltHJ corrctl e in va rie ~i[Jzioni s t llicb c c d inamIcirc tllt Dalle on sena d elb blOffiCcclIlicd tr idimlt n s io mlle d ei
r ~ chi Je ~oU()f icn ~Icirc ~videnuumll (l() ~llt tC p IYZIcircOSI ln(IiClZlfHicircl ~ 1I1shy
liumln fluenzt Je ll middote~rUrio tl SC) lgt lIi I rc pibull m i tldln sJlI71 Stl shygn~I I1 afferma che slI l p Ia no [11 middotccedilr~lk tre un œ rtlJ grado di l L1Liuuml IlC dclh vEltlh r1 apj(de le tu rœ mu SCltJ llri njtbc J n in $tJ ) t rodcfQfll1t1l1te PltJtantu b i r~it-~ r -lp il puugrave t~~
Ixnt-ftla solo nt Ile so )[j)~i Jl1Icirc na rl in qunnt ) ilon SlrM ntne )(l(Ofa tu soglb in caq ) co lltrLJIcircn l)lrilto llt~( i lJudotlsi di lfr~ lI1 C llg grVlmenl J 111 11 io lr riltd ll(17jOill leld rinlle 113 dimO~iumlrlto d llt nell o lin~l cl()~ li t th~oIOl))1 dri la defltgtrshymiti sul p iluO slfl iuale ~vohl lf1 (en5 ion~ sO lnm utto nd 1e bsi iniliali deWggrwm1Cnln mcn trl C a( lfLmn che occlleshyvoluzi ne dene = 110 i [ mhari IJ lin c l ki cen tri ch -1vi1( de i cp i CIt IJ rI Ji SI p m ittIl pnm l Iem lmeme e p o j pOS( shyrio fllwnte dtldnli mdv ( i un ziuuml ne ciloliz7nnl dd rlLtide lu mbJ œ ( lIlelttlaquo on NC n d d (gt11 uIdu m 1I1 Ilgt) cli r-Iure (0 eserClzi che IllUllengano 0 ltlUperifo le Clgt 6gt1 lo)iche sul pirluuml gilwlt Su l p iCl no fron itk Perdnulk il dlll1lt-trlto d1 lampkz-l d i LU ovimento amp111 lI rv Kolio ti ~ nd lt1 0 ddlJ cnrrc-LIcircQo i Ji gC 1 n lungl SUpegraveliltlrccedil 1M llS0 tlell 3ampIGI shyvamcnlo C che l~Jltmiddot mobiliti GlI mcnta co n l c lu7j o fle d l i) snAio i A ulln amplgrtJc1 ltllllmunjx~ i terlpGli nn n m obi shyUZ73It ma eutva coli ti0 1 1ct HsicVlfe nd tcmplt 11 1111nshyttllIcirc1nc n tc (k ll ~1 llu u zinnt n l1 un me77uuml d i sost l11( gt ln 0
e 11111ri b cle - Ilziunc egrave deorinatcl d l rlyarsi Snzcl la pr gtshy
liltlnl l i un() rtl~ i ptmiddot Jtl n(o 1S(Hl () (( ntJ() i ndit~tr i ~ Ii ISt (izi e l m iviL Illdlode ebe Hlmen tno laJlc ibiJii dcl rlc lide SCshy
li io) [n p articobre rune q lldl r C-I1 ich~ xlSiddcHe CUf t shyli ve ch~ iJllpi tgino e~rciii 01( biIi2 ZanUgrave HhnmL-trid () in tmiddot~t~nshy
sione kl fuchide O tne pure k- ~ttivit1 tnotoJII~ non prHi(~ llCcedil
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EUROP MIDI C Pli hIC
EDUCATIONMEETING SATURDAY 8thof APRIL 2006
(iSS
SEAS02 Scientific
Exercises Approach to Scoliosis
version 2002
G
S Negrini 1
EDUCATION MEETING SATURDAY8th of APRIL 2006
Neuromotor disfunctions
Neuromuscular disfunctions
11 Postural collapse
Postural collapse
Duval-Beaupegravere
Flexibility of scoliotic curve
f---I--- I Postural element
-------1 Structural element
S Negrini 2
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Postural collapse
Duval-Beaupegravere
It is a value related to muscular tone and to flexibil ity of convex side tissues
Post ural collapse
Bunch e Patwardhan
Critical load
Load threshold beyond wh ich a spine begins buckling
JI~~Wt1lW~flfthtlJlœJtAr ~ J~It- l~l - IMS
Postu ral collapse
Bunch e Patwardhan
If a curve reduces there is an increase of the deformation threshold
~~~NW~-damaoc~IIIMf ~~ J~Iv JaJ-I7I9sect
S Negrini 3
EDUCATION MEETING SATURDAY 8th of APRIL2006
Postural collapse
Torrel e Nachemson ~
Scolioses below 20deg ~ ~ lt~
have a high ~ ~ percentage of ~ ~
~postural collapse (on u~
average 75) ~~ 2i~
CU~VE O EG~EE S WHllE SUPlti e
~laquotd~c6b ____lPffI1wtt1t~
$ww J(t ~~7 JM5
Postural collapse
Minor scolioses 7
Antigravity musc es strengthening D
Reduces postural collapse -G
Increases the critical threshold of deformation
G
Neuromotor disfunetions
Stagnara
If we admit that one of the causes of idiopathie scoliosis is a disfunction in balance systems it is logical to orientate physical exercises toward this direction
s Negrini 4
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Neuromotor disfunctions
Dubousset
Idiopathie seoliosis results fram alterations in praprioeeption centres and deformation is a natural compensation to restore postural balance
etattJtitIK ypothfQj~S ___~ own_ oJ)HQr lar 1t-1( r
Neuromotor disfunctions
Nachemson Initial idiopathie scoliosis
+ Goood spine stability
Neutralization of postural deficits
D Static curve
Neuromotor disfunctions
Therapeutic aims
c) Development of spine stability
C) Development of balance reactions
G
S Negrini 5
EDUCATION MEETING SATURDAY 8thof APRIL 2006
Biomechanical disfunctions
j Horizontal r-Ian
i Sagi ttal plan
Frontal plan
Frontal plan
q Frontal plan disfunetions
Fronta l plan
Perdriolle Movement magnitude
gt in the direction of lt in the direction of correction progression
S Negrini 6
EDUCATION MEETING SATURDAY8th of APRIL 2006
Frontal plan
Stagnara
Never mobilize a scoliotic curve without ensuring reduction maintenance over time otherwise a greater mobility favours scoliosis progression
Frontal plan
Ducongeacute~ research
On a group of adolescent idiopathie scolioses treated with
Meacuteziegraveres gymnastics
D After 1 year the mean angle of
curves increased from 18deg to 29deg
Frontal plan
Scoliosis without brace
D Greater spine
flexibility D-
Risk of progression
S Negrini 7
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Frontal plan
Mobilization is useful
D In preparation to
brace
D With brace
Sagittal plan
QSagittal plan disfunctions
Sagittal plan r middot _J o
Perdriolle scouos B CJ aDeformation of D
thoracic and thoraco-Iumbar curves evolves in extension
S Negrini 8
EDUCATION MEETING SATURDAY8th of APRIL 2006
Sagittal plan
Graf
The line of gravity centres in the vertebral bodies o s c oUOSt
projects itself firstly laterally and then fi
o
posteriorly lJ ~~ ~~ ~ ~~-_J-D ~nI~
Sagittal plan
Therapeutic a ims
D Maintain or
retrieve physiological curves on the sagittal plan
Horizontal plan
QHorizontal plan disfunctions
S Negnni 9
EDUCATION MEETINGSATURDAY 8th of APRIL 2006
Horizontal plan
Stagnara The forces applied ta the spi ne act in a autoshydeforming sense
Horizontal plan
Dimnet Rotation gt 200
ampII~ (
D The actions of concave and convex side
muscles become
agonistic
~ItJrOnrIIiItdllfUClltlluumlll~~tI ~1JIf1laJ
Horizontal plan
Minor scolioses never exceed these autoshy
deformation thresholds
S Negrini 10
EDUCATION MEETING SATURDAY8th of APRIL 2006
Disfunctions at a biological organic and psychological
lever
Oisfunclions at a biological organlc and psychologlcal lever
Cheng
Bane density in scoliotic teenagers is lower than in normal subjects
~~~~middotA~IIlUtIy ~7œl 1d l
Oisfunctions at a blologlcal organic and psychologicallevel
A significant reduction of vital capacity and V02max in teenagers with a medium severity scoliosis
S Negrini 11
li
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Disfunctions at a biological organic and psychologicallevel
Disorders in the development of body image that the teenager has of himherself
Disfunctions at a blologlca l organlc and psychologicallevel
Therapeutic aims
cJ Activate cardioshyrespiratory function
cJ Favour bone density increase
cJ Develop a positive image of the body
Disfunctions at il biological organi and psydlologicallevel
Stagnara
Sport
D The active side of
kinesitherapy
S Negrini 12
EDUCATION MEETING SATURDAY 8thof APRIL 2006
Disfunctions at a biological organic and psychological
level
Distunctions at a biologlcal organlc and psychologicallevel
Cheng
Bone density in scoliotic teenagers is lower than in normal subjects
~n~IIIvpWr~middotA~stWy s- XXJl M J
Disfunctions at a biological organic and psychologicallevel
A significant reduction of vital capacity and V02max in teenagers with a medium severity scoliosis
G
S Negrini 11
EDUCATIONMEETING SATURDAY 8th of APRIL 2006
Kinesitherapy on the scoliotic subject
q Postural control
q Axial stability
q Muscular trophism
q Balance
q Respiratory function
The limits of kinesitherapy
There is a threshold beyond which
rehabilitation alone is not enough
sssr
Kinesitherapy in scoliosis treatment with brace
Therapeutic aims
S Negrini 13
6
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Therapeutic aims Srace kinesitherapy
With brace
il Postural corrections and
vertebral stability are obtained by the brace
Therapeutic aims Srace kinesitherapy
In preparation to the brace
il Mobilize spine on ail plans
Therapeutic aims Srace kinesitherapy
With brace D
Maintain a normal spine elasticity
~ Maintain a good muscular toneshy
trophism
C Model the hump with kyphotizating
exercises
S Negrini 14
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Exercises and their methodologies can vary accord ing to learning and individual sensibility of the single rehabilitator that proposes the m provided that they stay within the
Iimits of fixed therapeutic objectives
li
Therapeutic modalities
(Exercises)
QAuto-correction
QRespiratory education
QErgonomie education
QMuscular strengthening
QDevelopment of balance reactions
WNeuromotor integration
ci Vertebral mobiJization
QSpecifie modalities in brace treatment
S Negrini 15
EDUCATION MEETING SATURDAY 8th of APRIL 2006
The protocol of kinesitherapic
treatment
G
QChoice and dosage of exercises
Variatiosn of the work program every 2 - 3 months
Q Execute e)(ercises on an individual base or in a small group
Q Frequency not less than 2 times 1 week
Involve and awaken the family
G
S Negrini 16
EDUCATION MEETINGSATURDAY 8thof APRIL 2006
Q Determine the action and the localization of auto-correction
QAuto-correction must be associated to ail exercises
QAt the end of treatment ergonomy lesson
Auto-correction didactics
G
SCOLIOSI DORSALE---- shy ----
r
S Negrini 17
EDUCATION MEETING SATURDAY8thof APRIL 2006
SCOLIOS OORSOLOMBARE
shy
SCOLIOSI OOIlSALE 011 bull LOMBARE S1I--shy
SCOLIOSI LOMBARE
il --~_-
S Negrini 18
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Scoliotic patients are not radiographs
middotSeoliotie Mtients are not ndiographs but hum beings with a vertebral deviation-
Slagnara
Metha For the physieian Cobb angle is of utmost
importance For the patient it is body deformity t hat eounts most rib hump a protruding seapula or hip We are in a situation in whieh today dodors eure the radiographie deformity but what the patient really desires is to get rid of clinieal deformity and of ensuing psyehologieal distress
CIIQItIo shDuIdtucirc lM WIld tJw~~ I~~M~~~~ J9f~
S Negrini 19
- Poznan_workshop_Physiotherapy
- physio2
- physio3pdf
- physio4
- physio5
- physio6
- physio7
- physio8
- physio9
- physio10
-
Zmiany w zakresie kqta rotacji osiowej kr~gu sZczytowego sknywiellia w wyniku prowadzonej kinezylerapii wg Dobosiewicz
w grupie progresywovch skoliozjednoillkowycfl - 0=124 (czas oburwRCji ad 6 do 58 mitJi~cy sndniR 197plusmn11S5 miesics)
Grupa skoiozjednoukowych typ J wg Ponsetiego - skrzywienia Th dx - leczeni kinczyterapill wg Dobosiewicz
(1174 015 ubscnvncji od 6 do 45 mieiircy s-cduin 211plusmn 111 rniesi~cn)
Zmiany w zakresie kllU CObbtr w wynlku prowadzooei kinezyluapii wg Duhosiewicz w gTUpj~
progresywnych skolioz dwulufwwycfl - 0=74 (aos obsrnvacji ad 6 do 45 micsi~y srcdnin 211 plusmn 1 1 mi~Icircqca)
DdciMk Th odcinek L
7
ZcDli~ny w zakresie kla rolaei osiowe krfgu sezytowego
sknywienia w wyniku prowadzonej kinezyterapii wg Dobosiewicz w grupie progrcsywnych skolioz dwulukowyell shy
n=74 (C7lS obserwacji ad 6 do 45 miesi~q srednia 211 plusmn 111 miesiqcR)
oddnek Th odcinek L
Grupa skoliozjednoillkowycll 0 kqcie Cobba lt 40deg - leaeni wyhCznie kinezyterapil wg Dobo~icwicz (n=44) (czas obserwacji od 5 do JI mi~ifCY ~redllia t 18plusmn604 mie-ihco)
tnnl qICIiIl fMtt[ IoooI ~)I l~Illli 1IqIlt00401 IftmiddotI-I llJ
~1 1~ u)~___- uul
c- -- a-J
Obserwowmo i ~totn~l korclacjt pomittuzy POZiUllllm opilnowilnia Illctody przcz chorych i cZccedilsloscj stosowaniu kjnc7ytcrapii a wiclkoscuuml rcgre~ji 7~niilnw zakrcsic kta Cubha i rutltjl OSIOWCJ krccedilgu szczytuwtgo skrz)wienia - wspOlczynnik Ptarsona wynusil Odpllwicdnio 016 i D53
Grupa skoliol dWlllu koovyeh 0 kItac Cobba lt3(jl
typ IV wg Ponltetiego - skrrywienia pienvotnie podw6le - piersitJwe pFlWosrUlII i lccedildiwi()we Iwostrow
-Ieczeni wylcznie kiDezyterapi~ wg Dobosiewicz (0=10) (nli obsrrvLcjicirc od ~ do 24 miesifCY _~ n~dllia 12453 micsi~ca)
Sndni ~~( Cobbl na pmltltu (ugraveurulJpii
wynosil
ft udcinku Th shy 179deg
W oddnku L-17deg
Srcdni )11 Cobb~ po killtylapi -rylltlsi l
W odcinku Th shy 1J7deg
W odciuku L shy 1320
JmiddotI) 1)Imiddotj ~ lIll11 i ~W --)WCcedilMtf
ClNlIltallj Nui 001
( -aItu ho
~lllj Cl F1r Wj~ omn)
8
Zmiany w zakresie k(ill rotllcji osiowej kr~gll szqytowego sfmyiellilllV wyniku prowadzonej kinezylerapii wg Dobosiewicz
w grupie progresywnvch skoliozjedllollkowycll - 0=124 (CZB5 ObSrrwRcji od 6 do 58 mielli~cy irednia 197plusmn1185 miesiqca)
Grupa skoiozjedllolukowych typ 1 wg Ponseliego - skrzywienia Th dx - leczeni kintZ) terapill wg Dobosiewicz
(11=74 aas ubscrwacji od 6 do 45 mieiIcircccedilcy srednin 211plusmnII 1 miesiJtcft)
Zmiany w zakresie kqta CoMa IV wyniku prowadzoDej kinezy tera pii wg Dobosicwiu w grupie
progresvwon h skolUgraveIl dWlllllkowych - 0=74 (ons ubs~rwacji od 6 do 45 mil3Icircccedilcy sredni3 211 plusmn 1J1 micii il cn)
Ddcil1t~ Tb oddnek L
7
Zmiany w zaknsie kIta rotacji osiowej krfgu szczytoweg() sG-z~vienin W wylliku prowaagravezonej kinezyterapii
wg Dobosicwicz w grupi~ progrzs)wnvcb skolioz dWlUcircuk()wJcll shyn=74
(cras obscnvacji od 6 do 45 miesifC)j srednio ZI I1 JI I micsilfca)
oddnek Th udciollk L
Grupa skoliozjednolukowych 0 kqcie Cobba lt 40deg - JeCJeni wyl~7ltie lunezyterapil wg Dobo~il-Wicz (n=44) (nl3 obstrwllcji od 5 do 31 mhticcedilcy sndui 1I8plusmn6U4 miesiacn)
Obs~rwowano istolm korclacj( pomiccediltlzy poziull1lll1 upmowlIniu mctody przcz chorych 1 czccedilstosti stosowilniu kine7ylerapii il wi~lklJseii rewcsji zmian w Zakrcsil kta Cob l13 i ro tacjl osiowcj kr~1u SZCzylowcgu skrzywienia - wspolczynnik PeanlOniJ wjnusil uJpowiedniu 016 i D53 -
Grupa skolioz dWlllukowych 0 kflfch Cobbf lt30 Iyp 11 wg POllsetiego - jknywienia pienvotnie podwojle
- piersimve prflwv~middottrolle i lccedildiwilJwe ltKJoslrotme -Ieezeni wyl4eznie kinzyterapi~ wg Dobosiewicz (0=10)
(nu obenvacji ad 5 do 2 mlcsiccedilcy ~r~clnil 124plusmn51 micii~cll)
Sredui k~1 Cubba na )uclltlll I~lerpi
wy nosil
w udcinku Th-17o
w odcinkll L - 170
Sn=dui kql Cubb aJu liugrave~tyIcTUpij wynosil
W odcinku Th shy 137deg Y udcinku L shy lJ20
4) 1)IIIIcirc w Jlm ~llIWiob_ l~ rlllW
JIIIIm-lollUcirciaftq jtQ0 1 t~~010
UpIJI~r~
8
9
Po 5 i 10 miesieacutecach
C- 18 R-S C-12 R-S C-S R-Q
10
Po 9 miesilcach
11
BP
Il rz
Th
Cmiddot 12
R-3
L
C-16
R-7
PoDP 7 mies 10 rz_
C-9 C-20 R-OR-2
--__ _ _----------shy
12
DP
8 ri
111 C-26 R-2
L C- 17
R-]
bull Metoda asymetrycznej trojplaszczyznowej mobilizacji kr~gostupa ma znaczeumllCV wptyw na zahamowanie progresji
w skoliozach idiopatycznych szybko post~pujqcych
bull Mobilizacja strony wkl~s~ej skrzywienia i osiowa derotacja kr~gu szczytowego zwi~ksza korektywnoseacute skolioz zmniejsza garb i ebrowy poprawia obj~toseacute klatki piersiowej i zwi~ksza wydolnoseacute oddechowq plue
13
bull Przedstawiona metoda jest
stosowana samodzielnie lub
w pO~qczeniu z ortezq Checircneau
a takie jako przygotowanie do
leczenia operacyjnego
Ocena progresywnosci w badaniu elektrofizjologicznym
odruchu z odci~zenia
i~middotmiddot ~=~-~ shy1 _--==shyocirc
14
EUT S pine J (1997) () 93-97 copy S pringer-Verl ag lY07 ORIGINAL ARTICLE
K Dobosiewicz Neurophysiological mechanism of the unloading reflex as a prognostic factor in the early stages of idiopathie adolescent scoliosis
Rcceivcd 29 M arch 1996 Revised 16 August 1996 Acccp tcd 10 Septem ber 1996
Absfract This paper presents a new nc urophy iologila1 methougrave of e valushyati ng the risk o f p rogression in ill ioshy
mo t important factors in the eva luashytion of progress ive id io pathie scolioshysis The met hod can be lIsed to deshy
pathie scoliosis in th early stages uf tll( progre jve idiopath ie scolios is the dis ase by illY middottigating tll e unshy in lhe early s tages of the d isease loading refl ex in paraspinal muscles T he high sensi livi ty of ilie method The study incl uded 394 pat ients wilh means il can be used as a basis un seo liosis and 70 hcalt y chil dre n which to take an earl y dcc ision to
K D obosicwicz Depuumll1 mel1 l of Rchabi lilu lioll Si lesilln Medical Academ y 42-604 Tamo wskie G6ry 4
Lmenty of the unloacli ng retle x and repeatabi li ty o f Ihe rcbound and silent period were anal ysed for eaeh reflex evoked Prolonged latency and
p rimiddotom1 surgery
Key words Id iopathie seoli o is Unloadi ng rcnex Re bound
Katowice Polaml minima1 numbe o f cycles are the Larency Si ent period
T he ai m of this sludy was to evaJ uate the use of the unshyIntroduction load ing Dex for octcction of prog ressive id iopath ie adoshy
le cem oIios is in its carl s tages in onl r to lake a dccishyProg ress io n of id iopatJl ic scolios is bas been the su bject of
sion ta perfo nn surgcry as soon as pussible many clin ical radiological and elecrromyographic in ve~ shy
tigalions T here is ho wellcr no sim ple quantita ti ve or qual itati ve pro noslic methoo [hat can be em ployed in the
Materials and melhodsearly ~tHges of the disease Monitoring of lhe unloading rc felx in paraspinal m llsck appcars 10 be a reliable Inv gtsi lgnlions were carricd uut 011 394 pa tie nt with adolescent method o f discriminating bctwcen diffcrcn l fomls of Cushy ~c li ed J ild 70 hCldr hy children The scoli osis group consisted of Iios is T he un loa ing re n cx can be evokcd in ail the 31 1 g irl s and 83 boys aged 9-1 8 year~ (mean age 125 ycars) The
ske lelal muscles through a suegrave den shortening of o luntary contro ls wcre 0 girl s and 10 boys aged tO-1 7 y~ar (rncan age 128 cars ) Imong Ihe stlbjeclS tudied wcre 9 patien l w ith cershyinnervated muscle l2~J When a musc le is unloaJ ed vico-thoilc i seo liosi s mean Cobb ang le 22 7deg 121 with Ihoracic
rapidly durin g an isomerric con trac tion Ihe norm al reacshy scolios is mean Cobb nngle 309deg I 1 w ith thoraco-Iurnbar seolioshylion is an eleclrically silent pe riod fo llowed by a burs t o f s is rne ~n Co bb ang le 26~g o 63 with lumbar cotlos is mean Cobb action potentials called rebmmd The pause in d ischarge ang le 279deg and 90 w ir h doubh major curve sc o Ii() ~ i s meull o bb
nng le 292deg and 28 5deg The sludy group includcd 231 right -s ided can be observed only when a certai n h reshold va lue of and 163 left-sided 5col iouumlc patien ls There were 112 patients w ith
acceJcration flnd shortening of he muscle is exceeded progress ive id iopath ie scoliosi (76 ri g hHidtd and 36 Ic 1t-s ided) an tl il occues wilh constant latcncy correspond ing to that 182 with no n-progressive idjopa thic scoliosis (1 13 ri ght- sided and of the propriocepti ve nflcx (9 18 20] T he rebound ufter 6 le rt-sided) M d 100 w ith pe lvic tilt (statie) scolios is (42 rightshy
s ided anp 58 l eft -~ i(kd )the silent period in the unloaugraveing re felx rcsul ts from ae lishySC9 1ios is is consIcircdered progressive if the Cobb Jngle inshyvalio n of a pool of motone urons aIl o f which fClt1ch lhe
creltseacutes by more lhan 6 in 1 yen r aile middotnl1 n-progrcssive if the anshyfiring thres hold simultancously afte r prcviou~ si lenœ [l nua i increase is less thll n (i The Cobb angle ranged lrom 8deg to 77deg 1 4 201 in Ihe palicnls w ilh progress ive scoliosis (mean 361 ) [rom 30 ta
lI f R (on- f Rt tt1IY 1lIfl pflla 1 )(~ r(Jnu n t shy
fI) _ ~
Pathomechanic basics of conservative treatment of progressive idiopathic scoliosIcircs
according ta Dobosiewicz method based upon radiologie evaluation
Kryslyna DobosiewlcZ Jacek Dunnala Kny ztof Czemicki Hanna Jcndf7cjek
Deparmem of Rellabtlifatoll Mediw Uninrsity ofSiltsia KatOllice Poand 40-635 Katowice fil ZiUCl 3537 POL4ND
e-mail relwbilitacjt1s11mfoctaonetpl
Abstract Conscralivc IrcalrnCnI of Idiopathie scoht)~1 espcclall y kinc ilhcrapy i ~
nOI widcly apprccilllcd due 10 Ils suspectccl low dfcCIIcircvcnc 5 in relalion [ (1 a urglcal Irc[llment ACter long-ycar il ses ment of palomcchanic f scolio icirc in Dcpanmenl of Rchnhllilallon f Mclii al Unlcrsi ly of Sile bull a concTvallvc mcthod ()f IrCtllmenl asymmclric Irunk mobili7alion in lnclly ymmelm po~itions WIS
de el ped_Thi mClh d enablc 10 delain pTogression f scol iosis or ccn de middotrca~c laIerai urvalurc of a spi ne and angle of rOlllion assummg adequate () perallon f palicnl and ilS famil)
J Introduction
Idiopathie scoliosi OS) is a thrccdimensonal dcfonnation of il vertebral col lmm an- cntire trunk Afler many years of extensive rescarchcs the cause of idiopathie coliosIcircs $ i remaIcircns unknown It is possible Ihat idiopathie scoliosis devel ps and progress on a baslS 0- ~
multifactor disorder perhaps diffcrent for curve initiation and curve progressi 11 Fion poss ible pathologie factors nervous system dysfunctIcircons affecting postural tquili brium ar proprioceptive control seem to be espc ially important [ l 2 6 JI Pro_ ression f iS could bot delermincd by vertcbrac remodeling under eccent ri c loading created by axia lly ce gravitational forces in presence of muscular imbalancc in the trunk [2 J The verte rai colwrz unde r scoliotic conditions 15 an unstable system with tcndency to fu rther tune dcvelopment fl2] Lateral bending of a vertebral column visible in X-ray examination L
only a two-dimensional prcstntation of a complex dcformity consisting of patho logica axi rota ti on torsion and othcr deformations of vertebrae [7 8 10 II 14J ln fS physiolog~ curvatures of vcrtebra l column are disturbed Total Icngth of an anterior column of a spi n~
consi ting of vertebral bodies and intcrvertebral dises bccomcs grcater lhan length of l posterior colwnn - vertebral arches and proccsses [11 15 J h is apparent that phy iologi ~
thoracic kyphosis in rcgion of a scoliotIcircC curve diminishes Each vcrtebra of a stru tu ~
urve of coliosis is oricntatcd in hypercxtcnsion in relation t adjacent vcrtcbrae [7 l resulting
1 n B Uri middota I l 11
H srut ft illtf j tI) t li orf1Hli d
IDS Prt ts 21)2
Influence of method of asymmetric trunk mobilization on shaping of a physiological
thoracic kyphosis in children and youth suffering from progressive idiopathie scoliosis
Krystyna Dobo icwicz Jacek Dunnala Hanna Jendrzejck Krzysztof Czernicki
Deparrment of Rehabilitation Medical University ofSilesia KaloKce Poand 40-635 Katowice ut Ziolowa 3537 POLAND
e-mail rehabiliracjas(u1poCmiddottaollelpl
Abslract Idiopathie scoliosis (lS) which i sub 1 ntially l threeshydimen ional derormation or a pine cau e nOl only laler l curvalurc and axial rotation of vertebral column but al lordoti allon of VCr1cbrac in structural curve eXl nsion ln an effect physiological thoracic kypho j diminishc or cvcn dbappears Method of a ymlllctric lrunk mobilisation in strictly symmetric po iljon according [ Do () lewicz not only dcteriorme progre ion of IS or evcn reduces lalera] curvalure but also significmtly rebuild physiological thoracic kyphosis Icircn cases of lS accompanicd by lraight baclc
1 Introduction
Despitc Ion year researchc etiology of IS is nOl yel resol ed Significant problem re laled lO morphology of IS apar1 from lateral bending and ax i 1 r tati n i deviation of shape of a spine in sagittal axis affecting physiologi al curvatu re of vertebral coJumn [3 5 6 8 9 J 0 1t 12 Lcngth of anLerior col umn of a pin constitutcd by venebral hafls anugrave intcrvencbral dises dominate ovcr Jength of po terier c lurnn buill from vertebral arches and processes [lOJ This condition uring scol io i progress ion and growth of a child effect in hallowing or even disappearing of phy iological Lhoracic kyphosis in scoliotic region It i well know n lhar cn~brae of structu ral Jaleral curve are positioncd in hyperextension - lordotisation [5 6] which in Lhoracic region Icad (0 reduction of kyphosi or to true lordo middotis Such kind of venebrae relation in thoracic region cau es ilS destabicirclisatIcircon whi h in u sociation with eccentricircc gfilvitali nal load fa pinc duc to muscu lar icircmbalance [21 pOdbly produces r tationaJ lordo is [56 Il] and further development of symptomatic scoHose ft ha becn proven [12J tha strengthening of the erector spinac muscle aggravates nce initialcd deform tion and deteriorates coliotic process Hyperextension and uxial rotati n a s clatcd with
357 Th B Grivas (Ed) Research inro Spinal Defoml ilis 4 lOS Press 2002
Exercise efficiency of girls with idiopathie
seoliosis based on the ventilatory anaerobie threshold
Jacek Durmala Krystyna Dobosiewicz Hanna Jendrzejek Wieslaw Pius
Department ofRehabililation Medical University ofSiiesiaa Katowice Poand 40-635 Katowice m ZioJowa 4547 POLAND
e-mail durmalaiacekyocztaonetpl Department ofPhysiology Academy ofPhysical Education Katowice Poand
Abslract The aim of the study was to estimate the exercise efficiency in the group of
girls with idiopathie scol iosis based on the venlilatory anaerobic threshold (V AT)
Material and method The investigation comprised 58 gi rls wilh idiopathie scoliosis
aged 10--6 years 32 girls (55200 ) wilh double major scolioSiS and 26 girls (448)
with single scotiosis The girls were eonservatively treated using Dobosiewiagrave
method The control group consisted of 3 1 healthy girls aged 10-1 6 years The
cxercise test was performed using eycle ergometer During the exercise the gas
exehange parameters wcre reeorded (minute expiralory venlilation minute oxygen
consumption earbon dioxide production) On the basis of recorded paramcters V AT
has been computcd using V -si ope method Results The following V AT values were
obtained in the group with scoliosis 207+305 ml 02minlkg bm in control group
219+350 ml 02minlkg bm The differences belween girls with idiopathie scoliosis
and control group were nol SLaliSlically significant Conclusions I The exercise
effieieney of girls with idiopathie scoliosis conservalively treated using Dobosiewicz
melhod is normal 2 Such high level of the exercise cfficiency of the studied group
probably was due to intensive 3-D respiratory exercises of these girls
1 Introduction
In practice there are researched useful efficiency rates which on base of laboratory tests results possible easy without using of the relatively hard or long exercise tests would give the belter forsighting of the range of homeostasis disturbances and rapidi ty of increase of
physical fatigue during varied workloads [1] The best known rate of trus kind is the maximal
minute oxygen consumption [2345] During progressive physical effort minute oxygen
consumption increases proportionally to workload The reaching of real maximal minute
oxygen consumption in time of progressive effort is iodicaled by minute oxygen consumption plateau [5 61 This result is rarely registered in children The progressive exercise test is most commonly used in children until physicaJ exhaustion and the highest registered minute
oxygen consumption is treated as maximal minute oxygen consu mption or so-called
symplomatic limited maximal minute oxygen consumption [678J Sorne authors regard
Orto-dlet Trau malaogis Roha b ilitacjaARTlKUL ORIGINALNY ORIGINAL ARTICLE Vol 5 Nr 1 2003 80-85
Jacek Durmala l Krystyna Dobosiewicz l Tomasz Kotwicki Hanna Jendrzejek 1
Katedra i Klinika Rehabilitacji Slqska Akadenia Medyczna Katowice Katedra i Klinika Ortopedii Dzieci~cej Akademia Medyczna PoznQll
Wplyw asymetrycznej mobilizacji tulowia na wartoseacute k~ta Cobba i rotacji w przypadkach skolioz idiopatycznych u dzieci i mlodzieZy
Influence ofasyn1n1etrie 111obilisation of the trunk on the Cobb angle and rotation in idiopathie seoliosisin
children and adolescents Slnwu kluce ac eJJic Cl chOlIU) Ice SKoio= idj)PO Imiddot(~I7tmiddot
K~Jmiddot w()rus consrieI ve I (OtlHelif idiopathie HUW JS
SUMlvfARY
BackgrouId The aim ofthe stldy Vas Ihe radiological evaluation ofthe treatllJent ofthe idiopathic scolioshysis utilising as)mmetric trunk mobilisation in the strict~ll I)mmetric illitial position
Material ([fJ(f lIIellOds Presented stud) lOS based IIpon J36 cases (13 oovs oged FOf11 ocirc la 6 lcars (lild
rn girls aged frum 6 la S pears) trealed due to the idiopathie sCuliosis ((rom Novell1her 999 0 F enflfUn 200) Among 48 ch idrcn sllfJering from dOlfble-major scoios is 6 cases wcre infoll scaliusis JOjuvel7lle und 22 adolescent Among 88 sillgle scoliosis 6 lere infw7t 33 juvenile and 49 adolescent
Radiological exami71ation 1as condueed always in the repeataole technical cOlldiions RadlOglOlI1 lier evaluated oy the same physician Radiologica analysis oIthe scolios is incuded value ofthe Coho al1gle ongle ofaxial rotaion
ReSIils ln double-major scoliosis observed dlring one year period in Ihe thoracic segmenl Cobb angle decreased inll l increased 1395 and in 292 Il OS 111changed Axial lolation angle in 167 (~rcascs
decreased in 354 incrcased and rernainM the sorne in 479 In Ihe llllnba segmenl Cobb ang le clccrcscucirc il1 354 increased in 39 6 remained in 5 Angle ofaxial rotation deceoscd in3 ofca es incrcuscd in 29 and persisted in 48
ln single scolio is Cobb angle decreased in 386 incrcased in 353 and in 261 was lInchonged Axiol rotarion angle in 216 ofcases deceased in 295 increased and rell1aincd the sallie in 489
CondlsioJ Asymmetrie mobilisation of the tf1f17k in strictly syl7111elric initial positions is a 1Clhod of choice in the cOl7senJalive treatment ofthe idiopathic seoiosis
STRESZCZENIE
WS~p Celem pracy jest radiologiezla ocena Icczenia skoiloz idiopaf)cznych metoda asvmetrycznejl7lOoili shyzocji tllowia w sciSe symetlyczl7ych pozycjach lV)jscio wych
M aterial i metody Przeprowadono retrospektYlIl7q analizri 136 przypadkeacuteM dzieci (13 chlopcow i 123 dziellshyczqt w wieku 6- 18 lat) z bocznym idiop atycnylll skrYll ieniem krrgoslupa leczonych zachowawczo w Klinice
1
Ortopedla TliJumatoogia RehlblllagraveeJa ARTYKUL POOL1 DOWY OPINION ARTICLE Vol 7 Nf 1 2005 49-$11
Krystyna Dobosiewicz Jacek Durmala Tomasz KotwickP
Katedra i Klinika Rehabilitacji SIAM Katowice 2 Katedra i Klinika Orlopedii Dziecircej AM Pozncrlz
Biodynamiczna metoda tr6jplaszczyznowej korekcji skolioz idiopatycznych - opis metody Biodynamic method for 3-D correction of idiopathie
scoliosis a description ofthe method
SIOWQ kluczowe leezenie zachowawcze skoliozy idiopatyczne korekeja tr6jplaszczyznowa Key words conservative treament idiopathie scoliosis 3-D correction
SUMMARY
The biodynamic method of hree-dfmensional carreeion of idiopathie scoliosis is based on Ihe palhomeshychanics of idiopathie scolioiiiii and consiss in aClive segmental three-dimensional correction ofspinal cllrshyvatlre The course of action focuses in the viciniy ofthe apical vertebra Proprioceptive facilitation is applied on Ihe concave side ofthe curvaJure and exteroceplivefacilitation on the convex side Correction likewise proshyprio- or exteroceplive facilitation is phase-oclœd with asymmetric respirarory movemenr as weil as wilh parshyticular phases of the respiratory cycle ln Ihe course ofexercises three-planar movement is generated opposite to the direction in which scoliosis Is progressing This method is in accordance with the stale ofthe art ofscoshyIiasis pathomechanics The method requires detaied training and can Ihen con be applied at home under periodic control by a physician and a physiolherapist The method con be applied in landem with a Cheneau brace as weil as in surgical pretreatment A elaUed description of Ihe method of three-dimensional scoliosis trealment will be presented in Ihis article
STRESZCZENIE
ISlofa biadynamicznej mefody Ir6jplaszczyznowej korekcji skoioz idiopatycmych oparlaj est na patomechashynice iikolioz idiopatycznych - poega ana na czynnej segmentanlej tr6jplaszczymowej korekcji skrzywienia Dzialanie koncentruj e siccedil w pobitu Icrllgll szczytowego sknywienia Stosowane iest bodicowanie propiocepshytywne po stronie wklllsej oraz eksteroceptywne po stronie wypuldej Korekcja i slosowanie bodicocircw propioshyi eksteroceprywnych zsynchronizowane j esl z asymetrycznym torem oddechowym oraz z poszczeg61nymi fazashymi oddechu W trakcie eacutewiczen powstaje odwrotny do lrierurzku rozwoju scoliozy tr6jplaszczyznowy ruch IcrFtshygoslupa Melodajesl zgodna z aktualnym stanem wiedzy na lemat patomechanizmu scoiozy nymaga szczegocircshy100-lego instniktaZu po clorym mote byeacute wykonywana w warunkach domowych Z olcresowq kontrolq przez leshycana i fizj oterapeutll Metoda mote byeacute stosowana r6wnolegle z leczeniem gorsetem korekcyjnym Cheneau a talcte w przygotowaniu do leczenia operacyjnego slcolioz W pracy przedslawiony zostal szczeg6owy apis meshytody leczenia
Skoliozy idlopatyczne stanowili znieksztalcenia patycznej rozwija siccedil poprzez przemieszczenie kr~gu tr6j~aszczyznowe charakteryzujltce siccedil wyboczeshy szczytowego w stosunku do krccedilgu g6mego j dolnego niem rotacjltt krccedilg6w klatki piersiowej i miednicy z r6wnoczesolljego rotacjl zgodnie z ruchem wskashyoraz zmianami w fizjologicznych krzywiznach kr~ z6wek zegara dia skrzywienia prawostronnego oraz goslupa w plaszczyinie slrzalkoweJ [ 123] przeciwnie do wskaz6wek zegara dIa skrzywienia leshy
Z punklu widz nia patomechaniki tr6jplaszczyshy wostronnego Koncepcja rozwoju skoliozy jako rotashyznowe znieksztalcenie krccedilgoslupa w skoliozie idio- cja i kontrotacja sugeruje ze sily korekcyjne powinshy
49
EDUCATION MEETING SATURDAY 8th of APRIL 2006
- CARDJOPULMONARY EXERCIS E
TEST IN GIRLS WITH
CONSERVA TIVEL Y TREA TED
IDIOPATHIC SCOLIOSIS
Jacek DURMALA Krystyna DOBOSIEWICZ
Department of Rehabilitation Medical University of Silesia
Katowice Poland jdurmalaqcmpl
The aim of the study was
to estimate the influence the conservative treatment (asymmetric mobilization of the trunk by Dobosiewicz) on physical efficiency in the group of girls with idiopathie scoliosis
Material
bull 87 girls with idiopathie scoliosis
aged 1 0-17 years
(mean age 135 years SO 161)
J Durmala K Dobosiewicz 1
EDUCATION MEETING SATURDAY8thof APRIL 2006
Material
bull 38 girls (437) with double major scol iosis (thoracic segment - Cobb angle 18-42deg mean 30deg SO 82 angle of axial rotation 4-32deg mean 21 deg SD 107 lumbar segment - Cobb angle 11 shy48deg mean 31deg SO 128 angle of axial rotation 5shy30deg mean 13deg SO 85)
bull 49 girls (563) with single scoliosis (Cobb angle 11-75deg mean 33deg SO 155 angle of axial rotat ion 5-30deg mean 14deg SD 83)
TIoracic kyphosis of the invesllgated group was 5-39deg mean 23deg SO 86 and lumbar lordosis 16-41middot mean 30 50 65)
Material
bull The 64 girls aged 10-17 years (m ean age 131
years SD 132) were conservat ively Ireated
using Dobosiewiczs method
bull Treatment period ranged from 5 months 10 3
years (mean 148 months SD 902)
Material The 23 girls aged 10-17 years (mean age 136 years SO 108) were treated u sing symmetric exercises - treatment period ranged from 4 months to 3 years (mean 161 months SO 1019)
bull 26 of ail g irls (18 girls earlier treated using Dobosiewiczs m ethod and 8 gi rls earlier treated using symmetric exercises) aged 10-17 years (mean age 134 years SO 108) were twice tested - at first and last day of Intensive hospital rehabilitation (asymmetnc mobllization of the trunk by Oobosiewicz) - mean hospitalization period 20 days (range 18-26 days)
i rf~8f6~~ or~~n~= ~~r~1~r~icircJ~~tb~~~~ mean 17-4 1deg meatl~(I SO 74 R n~le ofax 1 rotatIon 5-25ot mC3 111 3laquo S0 6icircl Ilnd 1 99t1S~ ~~~~I~~~~~$ruo~ras~ ~ocirc~~a~e~~~~~~~5euml1 9middotn~ tUfllbar Iord05ts 16-4 1deg mean 311 SO 68)
J Durmala K Dobosiewicz 2
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Material
The control group consisted of 77 healthy
girls aged 6-17 years (mean age 12
years SD 31)
Material
The examined girls participated in school
only in scheduled physical education
lessons and have not been enrolled in
other sporting activity
METHOD
The exercise cycle
ergometer test was
performed
J Durmala K Dobosiewicz 3
EDUCATION MEETING SATURDAY 8th of APRIL 2006
METHOD
The Incrementai exercise test has been applied
We have found that tests ln whlch the Incrementai part of the protocol ln completed between 8 -12 minutes duration glve the
bullhighest maximum VOz in normal subjects
METHOD
The workload was Increased stepwlse
bull by 10 Watt every minute - ln chlldren
with high ~ 135 cm
bull by 15 Watt every minute ln chlldren
with high gt 135 cm
METHOD
The test had been contlnued untll refusai of the patient or exceeding the pulse Ilmit
Durlng the exerclse the gas exchange parameters were recorded by Jaeger device model Oxycon Alfa uslng direct breath-byshybreath rnethod (with face mask)
J Durmala K Dobosewlcz 4
EDUCATION MEETING SATURDAY 8th of APRIL 2006
METHOD ~ ~~ r 3 min 3 min 8 - 12 min 6 min -~
_ 0 rpiYJ 0 rpm 60 rpm ~1 30 rpm
_ t o~w=att~o~~na ~~ att__~ tl~~S~~ l ad l ~~~~~r o~w= Hlcremenlal t
pedaillog i i ~
~ ilt ~I~-----tl-~ I t ~ i ~ lOSt sffortivB
lW r resututlon r rm-u middot 1 - bullA~cremen tal ~~ ~ ~ ifr- ~ VtI 1 ~i ~ tllng _
METHOD
On the basis of recorded parameters VAT
has been individually computed for each
child using V-slope method by
Wasserman
METHOD
For assesment of physical capacity
the maximal minute oxygen o
consumption (V02max) ventilatory
anaerobic threshold (VAT) and
maximal workload was used
J Durmala K Dobosiewicz 5
EDUCATION MEETING SATURDAY 8thof APRIL 2006
RESULTS
Ali girls with 18 have been classified
within normal range of predicted
values of
bull maximal minute oxygen uptake
bull VAT and
bull maximal workload
RESULTS
The differences between group of girls
treated using Dobosiewicz s method and
group of girl s treated using symmetric
exercises were statistically significant
Lower exercise efficiency of girls treated
using sym metric exercises has been
observed
RESULTS Girls wilh IS Irealed using
N=87 p value
Dobosiewlczs method N64
symmetJic oxor-ci Nz23
Perœnlage of predicled vaJue of
maximal minute oxygen uptake
98 905 0033
Percenlage of predicled value of
VAT 97 933 0049
Percenlage 01 predided value ni
maximal workload 101 939 0038
J Durmala K Dobosiewicz 6
EDUCATION MEETING SATURDAY8th of APRIL 2006
RESULTS 26 girl s twice tested - at fi rst and last day of intensive hospital rehabilitation
The value of ventilatory anaerobic threshold increased during intensive hospital rehabilitation (asymmetric mobilization of the trunk by Oobosiewicz) statistically significantly (p=00019)
2047 ml O2 minkg (SO 268)
vs 2239 ml O2 minkg (SO 232)
Conclusions
1 The exerc ise eff iciency of girls with IS treated by asymmetric exerc ises of Oobosiewicz is norm al
2 Such high level of the exercise efficiency of thIcircs group resulted fram using of Oobosiewiczs method
r
J Durmala K Dobosiewicz 7
REVIEWS
Role of physical exercise in tbe treattnent of mild idiopathie adolescent scoliosis
Revicw of th- literature
A NECRlNl N VElWNL s PARZI 1 A NEGRINJ 5 NEClU NI
P1t~silillxlrd~ Ihcrapy (or klucgtlttlwrlpyl i pro shy-tJm of physka] cXlrd-cs ipcci I(a~ (IJcloJgtcd hy l li trIWlltl phrslollwrapbt wilh tb m~ln a1mor pl shyVCnI in lhe ilAAfIVltilH1 llf the ucirccfonuity III mild IgtC )
Lil1Si bclpin~ thebm ( aocl co uaufllclilIg ils ~jd- clf IS in nlOdlJmiddotnh-culiosis Th middotalillofthi paper ito r (W
Ille Ii lc ram r 1 a-ccrulin wh kh of Ih bull Lu[Jalmlcrus Ind (Lb hili til~ CLlLt-cd br scnli()si- clluld bl pl Y nlcd or r d uccd hl phylolld LXtmiddotrdsi n Il p--to-da le knowl Uuml~l nr tIll~C aspcc[~ i ne bulled in oruer 10 dndc whclh~r 11Rf blLl adcqlmtt Ib(uuml n middotlicaJ balis fo r ora)aini l Ihe US4~ of lUgravellgtitlerap) wltcllj(r or fln l th e prtl1iœ of kimiddot ~lre IUlll poNjn~ a t iil ies ~bould h allowtcI II uuml middot c enliaI toltlentlf)wh k lu alClor ie - lf pl lr~kiJl -c rmiddot d gtlt- (Ic rnnhi UzJ( inn ni (t hl HrJltlon [ rtn~hcll iJl ~ or 1i1J(IChIumlJlJt etc) Sh llU Ld be TolullllCcluse ulemiddot l onld b- clclIimcntalancl wukh sho ll ld he IJlI-n~ifl~d I~~a l lhc (o uld h 11lfu 1 Know k dg CJnc1in t (wIn SeiCIImiddot Hlk rCS([lflt h daw ccordinll to Ih bull llVit w o f tIlt iii 111 1( plop(lsltd in (h i papcr lmiddotonllmJ l lnl plLyi 11 cxcr(j$( pn (nti or (tmiddotduce dhlblli t ic 1 ~lt Il Jj ll(k pl ti Jlt fadl j w(~ the nlIIIrl li7alinn n f poMural dd shylitS tu p n xJ llc aSl COIlMqnen c(middot 1 all )llal) or r(tn~ shys i middot middotlIrve Tilt u~c (I f appn1priattmiddot kincsiuuml wrlpy 0 in rcns polttllcal swhiIHy Icirc IIHmiddotorc Illta ll y (0 r 1(lt1 lllho UAh mon ltlccurlltc 1Ut dl1alkd -rLk l(lWfils 111111 )11 h Jlccdt(
11) wurcJlt 0 lit)-IcircS (Iumpy - x rcLs P()lun
n rllt lT(ltnklf u f COll1tlK H (rtd) I 1i plfho l og l ~$I rUlglng tr m low tmiddot k Pl 1l1 to IdiOpath ie SCUIshy
Submitt(oJ [or PUhltCl l1 011 uly Tt 2001 Acc~pttJ ugu - ~2 1(t-1l
Addre rltj-xlfll telt~I(middotb If) - grinl Flt(1(bziurllt r )(m Ofl ()(Cl1I shy Lt middotqlltœlll ro () - 1u I4t agravehLIlKil ta IYIL-lTt ilSllltp lfllmiddot ~ 1l1uumldull
CelII ~ (niiOS I I~ middot ann (1) IfUh middot lIlfU di louhilll(tymi ( Nlmiddot ~iI rli -ilIIUmiddotltlfl
Nlti(ir 1( ) il r() (ltbullagt1
lt vLL_ l IiII no 1ftfI
jS ) we are a IUil ly tJc ing n1n) ltblll lS 1 k l1 b ~J)w in~ tl~ t S Jfll l approad llt - l1n til hy on ielshyertd ~tan lard ugraveJuld ln m any ~1~ he lI ~t les i if Ilot dange r )ll lt rhlS is lrut of reil l lnw 1gtlt1lt1 pa in l ~ or 5urgi c ll lrea lmltnl5 in dbc r lmiddot ll Sc - 2
ln tlle cj-e ut ~ t lll(tlWtl i( li p l ll1JC luuml- I ~ middottnl ~() shyliosis phys cal ((_lt1(( is emr1uved ltI t()fIl1 0 lh~rtrv
lo ly in cel1l in L)lllllde (nluumlnlr in tilt Lltlll middotorkl i e Iw l) r llt t Srain hUI IIgt() 111 Gert11lny 5- 1~1 in other reg lOl1 wbere thi I-incl qf tre l tm e rll 1 p~ 1 pmiddot t 1( cI il Jws Ixen cri ri cilld md rel -cltd Lw m~lI1 1 11 Jlu~ Fue Fnlny r ~lrs thio middot15 a lsgt(ru( f ~rth r -~ltc rrJtf))~ ll t vit11 br1Cltcgt b r II1 ([C Llt n ClW grmvlng 1lt1 0 L Sti g
gcsti n the lIsefulnes- u r Ih is form o t treatm n t 1
Hmiddotu]rs have nerged jn El or uf pll y~ iLd eegraverdse eacute 00[ 1 but tlw are nUl yel 11 11 t llu i vIC~11 and r hi ~
f rm of trt ~ltmenr IS stiJ l Ul1 ckf ckhate FfI t Jt 111 il i 11t (eltary td 1I iFy 11umbtr ot
b l sic COI ceP rlJ lf w ill he cIh tt d in t hi pap r
Scollosis
DCijIrI iriolls
ScnUoSlS is Irlircc c1 lme nsIcircltnal (I(gt i l cj on ot tht spinc thar cau C a CU 1 lh lt ca n h e $ t~en ln (1 me1Sshy
ured ultinF Coh) lll ltllCXI o n HI anreu middot p rtc rilt r
EUJlOI -1 lœDICOPHYSlc~ IR
NECRI Nl
110
f)i)
1 7J
amp aS g 5li - 0 v
V
31
10
(1 1) Il 15
-tc i ytjtr~)
FigJ----jllph ot DlI w l-lkaupegraverel) The agloimvltltinn Or idio r lrhlc 50gt1iflll~ IS rpiJ bel~ en th e- [l0 IH P (l)ltg tnntll lol (JI PUllcmiddotny) mtl 1 ( f( lS-er sigll paiilivltecirc lt Dlt(i I1 11illg r the iti l 1Kgt n n t rll icirclicH a ) 111lt m omal prebulled the mno rche md ociks with lll I)ttlx flal gr Ih pll fl
rlcljoprdphLi 1 hl merl prestIK ~ of this curvt c10es n t autom~l ritllJy indi ate the pn$CI1(t of a defurshyTnitv (SlllKtUrd (Unel
It i~ possible tu clil1e ren tute a struCnlt t CI1tve fruIn a pogt urll 011e by identifyi og the hum]) du ring AdIlns tesr I~OQ looklng tra m beh lnd at the p atient w ho b benchng fUfward il is p -- ible ta d d~ct 1l1 eh ucirc n of o ne liidlt 0 1 the trunk usually n n the (onvex ~ jde ul tbe radiographie CUfve Ugrave1lr C Ul be mlt~I Slred lISin~
BUlln els S o liomere( 1 ~ l This h Uf1lp is du(- lO (Ile pregravegtecircn ~ of vertel ra i rolltion 1c1 Ollt tn tic f~YJ tllre o f the def trrnit tli [ c m be seen and measurc(i v ith Perddolles lb lsLometer on an amero-Ix)iferior radioshygrapb ~2
Seven ry pel cent o f li Ises a re conid 1lt 1tO be idiopa thie 1 bull ia l-nosilt in this CI$C is b exdlls i ~ n as idinpa thlc me-us t11H wc do n()[ know rJw origio of lheacute curvc [n othe] ~Ie$ it b Ix )~i ble ro ide nrify a dieak (bat CHl jusrify the c1etgtnniry slIch a rna lfo rshymar i ns I1(gtufol Ig ic~ l or genlttic cl iscas s Glnclt~r trauma etc )
[dicirc)parhk S(oliosis has been divicled ~(corcling (0
the ~Ie of tlie patient egrave1l the tiJ1ll of d~[ccli n of the condil ion into ti) ur t ypei ln fanUlc jU nik ltldolesshyccnt lnd aduh Til l m n st cnnunon (VPC IS the acloshylescegravenr o licirceacute I1IJctenzec1 hy 1 sud le l1 tggrH3l ion uuml uring the grow tll Spllrt (Hg 1)2
lhile p tu 1l sco liosi i5 Ycry lomnw n thl pre shy~Iknct ra te f r adole ent icuumlop~lthic structural CU IY~S in sch )o chilclren are 18middot20
- 10 Co bb d~grels o r m on l -lil
- 2) ~ohh dtgreclt or mort O 2~j - bull () (obb d gre -s )1 mOfeacute ()ll 2
Clin iltI [ d e isio ns lfl IXlSed 111 an lccu r~He pregshynosi which obt inccl in eJch pa ti nt mainly o n the basi of the nsidu~ll p()tlnllltl l of TH1h and the result s of 1 rh clin 1 1 ~l1d tadiogmpl i exlminashyti(ln12ll c noieq uentlya d inica ] la sifiou io n o f the ing le pHient tn -ome estent co incic1 ing w irh the
D diographic one c l n lw SLlIl1H1arizeci 1 1 folIcJ - mikl lc~ (1)(n 20 C bh de~r es - moderJt l betwlen ln md 15 ohh de~ rtes - StV re 111( gt1lt rh n ~J) )bh (kgf s
On the 1) lsis of [hi - dinic d d a lfic t i n (Vith l1l il el lrb tiOI ~ o f the ir b() und~ri e ) in Itllt l cente rS Of SCOtiO LS ITe ltlllent in the Lltin odcl (i rJ Ital lnmct md PI iJ Ugrave tre tmtnt i s plmmcd a fo lltJw 8l
- mild kineslth e (~1fw ~1Il (1 luok-ou t - Hl demte IJragravecegrave 1111101 c(~r md k i rws ithe lJpy - ~cven surgery
Physical exe rcL~e for S(ol iosis
Defi t tiOl l S
PhyS i 11 nU b lIKrlttp middot (or kines ithcIa Pl) i a p rvgrlill or plt~i Gl l (xeriltecircS ~1ci fi ( llJ y ltk ~ loped
y a -11 [ru ine 1pll yslo ther3pisr wirh th e m 10 Hllll
- pre (~ n tit1g tlc aggraaLion of the cl I )flnily in rnild bullcoUm is
- helping tlk Il ld Ct ~lOd ounter~lCtjng its skie elfects in III de rltegrave sc li sis
Tn tl1i_ feSpec1 kinesitl1ert py f JI s oliosis is tonshysider l a o on of peciticcedil training and s genecirc tltllly proposelt in sessions 0 1 4~ ro 60 minute IW) t) tour limes 1 Cee PhysiGtl exerci es can aLo ll v o ther auumlns 1S it oill he dise Issed in this plper
Ir 15 Ilot possib le to cl escribe a single progrlIT1 o r exerc ise a5 pro nrams ale USLIJUy p fgt nll ized ( ( lt
EUH PA ~illDI (DP1I YS IC~ 182
ROlL UF P l 1YSICAL lXl 1lt 1~E IN l IlE 11 ~l) IEd If IlU) l[)VP 1HI AIJ() J)~Cl~ r COl ~I NlG1W il
f)( 15 egraved ( )Il the nee L- 01 indi iuua l pJl itnts) al l l10ugh Lheacute) C l n h t 11 plicd o n a WOU p hJ~js (-1 (0 () pnients PC[ ~l ()lI r)middot lugrave reQCf lhese 1 10 grl lll frequt ml~ V IIT
hnm on in middotituk w allClthltJmiddot -Ill Jnv L l~egrave at Wc w Ht ~huw in lhis lyl peJ it i~ 111 n u -eII1 tu id e ntilv kirK itheJapturlc aims w hitl l ucircrr~spnd LO ugravelt~lil1 DUtshy
g X ir ur ph -s ici l lxtTi~l I~llhe r thln ln dj( us- indishyiJ u1 1progr-lfll
Aduumll l lxUl kisure time ~lOd h )u] Sp u lllll8 ~Ilttishy
i lt egrave~ i middotomm )Ly s iven lel mJ ing ro w hlf ~ Iuumlnsidshyer~d usdul or il lrmfu l in t1 lt rruning (lI tJw ptliJicirct ln tl1bplper Ugrave1 gent ltl l t rl ll bull p lwsiCUgrave lttG iviUes is rl ktll 10 JllI1ltlCc hOlll gtpOlt mJ kIJ1lsIcircl hc lJ l f
i ve lUen tloneumld )bo C on lv ine n dul( re Ull~ 1t~1 t s far Ilten publislt d f I~ mJ I(i noltgtithltl rgt is 11 11 a su h jel lnI deacutehate CJitk haltlt t llltit m itn ltl of l ny lorm o t p l1 ySiClI lxrcL e as a Itwr1 [ J- fo r i liopa tb il jcoJL~b un iL ()ri gin~ initial1) it WIS Ille r rOmiddotUumlK lt brgdv u f p l~lt titu gtllergt w h ) intervenecl hutll tc llcrl ll (mon as cltl HtilJ nic in terventi n man Jgt
1 t lltrJp utl t one 1 md rC j fkll l~ on rhe h sh lf som uni cOen I1v pn t I1cgts wt ldl hll ltl enl1 JI~ haLl nu na l scicnt lfic baisYmiddot HOlh tlle$( trr t peu shy to rh ~rl py tt nJecI to l~~rJ tte C Ih tk CUf -~ pnnshyclr~tll y as a f tsul t of lilo h llIzatio ll of tn imdqultdy ~u pp rt(d S pln eacute 7~ 12 to re-t1 r rI ltrl 1$ l l1C k o f WH llt~~rdl 10 I ndt~-dll()urnah tnd 11( on1 p~l per u suaJly Cl tc([ IS n prelimmtrf lll d 3 ln tt li w ay man (l rrlKpt(Hc H lf O iS Inll ph ~i C U l ~ d vi ~ cI nllog scnliotl pa t le nL~ 3gainst holll ph lca l egravexershyclc and p()rt~1
It m u st t~ n tfd [hat pllyknl txerc j~ tJe~ltm(nls t1iHer 1 lJ rd il1g r rhe rherlpcu tlC litTl~ on lllc h tJ rgt ap p lolc il l the IXlltent lncl hi im r IIIllHnt i- 1 (1(1 rI - 5lt1J lC igt tIl l ( f phJllIlllolopJ al rrea tmln ls Ihith cllffc r 1lt œQlfd- rhe m C cculc u ~t(l luI thl p al 1t n
~mc l 11i (lbE~e Tt i ~ P ~il k tlwreI[middote thll wuumlk ltlll t kin 1or ph~ i Clt1 1 lX r(j~ 1I 111~ t bc loidvd by t h~ Lo iurie IxujCJ1l al1ulhcr a dl ~IS nJI h~ iOg (1 11shygerols llugJr in racr le (wi ller d I ~fJIII ~ I ml thlls re(nl1l rn ndc(1
fn n UI cel1ll r we In(~ hccf) using 1 ) 1 1111 11 ve ) 1 (J p lw l icd ex(r(i~e (0 J ( 1I l tt i~ tlh aITt ~ l~d Ilv m ikl tru cflumiddott1 adokscltnt (cl ioj arh lC icoli is11 2)
ina the f U~ t rc-gt uJrs IefC pu b lishe - the pJ( )grd m 11lt1lt l1te n PWltllk d in fa c t deel()pnlln l~ in th t l itshy OlL1Ii in tl1 r b t ~() ycal f ha ve iclemi fiecl niO l l
m d 111 ur impl rnHm s md d i s )h ilir i (gt~ lue t idlo p lthk amp()lio -i ~ t Jll CIII he 1UO(l if Icirc 1by phyict1 egrave xert iSlgt l fe t rrncllt
l illl
111e aim of t l1JS r~l per ii tmiddot (tv iew tl1( l iterat urt to a(errl ln v llic ll of th~ impa irm 1t~ and Liit hil it il i GllIltec hy ~ o l i()gtj s -o ull he ll nt x or re middotlu celt1 Ili pl1ysical xerclse An u p-to-da te knOvkdge o f tl lt Lgtpecl-gt i necckC1 in rJeumlr) d -oek
- whetll~r there h ltl n adLtIIl ) l tht()d ical bbh fur or JqIIcirclb l l l1 Il( ) f k irt llit herlpy
- h N I)(1 ( 1 Dm tlle p r l c tIcirc(( o f Jebur tiJne )pOfung lcli v l ti ~ IIOU lci he tllf) -d o
II J U V f h 1 I11~ c~~lb li hed Ihe usefuhlLss 01 k il1 shyc ~thtrpy il i aIle dy l nsi 1([(( -r-tI Llleu i n )I11 plJt~ ut the wJrld ir ilt ecircS~nl i 1 I( id n Iv w l1i li ( 1shy
gories 0 1 pl1Vtl( 1excrClgtegt te D)bilI7it ric 1n (Ir st shylliuumlZltio f) lttlt tlgtbltn ing ni trcrccedilh ing erc) hn Id be
vnlcled he tll rhe nuld be lerrillldll1 1 md whidl s tlQu1d be inreœ jf ic(1 IJeClU~l tlley cOli lel Je LI ~ful
Ncuro1llotor impainncnts
Imv aUl llOr~ 11 lt1lt ~tlKlteJ lhe cltlndatiotl bd Ween tl UC1UmiddotIt t l ol(~C t nt id iopml je -nll ~J~ and cli~l l shyler~ lr 1tH lest ihuLIr yt 1 _ 13 ~ 311 D uhoussct 1
1-- ITS tln l ldiopath k s(o lio-L L cll -c d l J l hmgt in th terl tltr f prop li l l pu n md 1I1ar th e detrshyn Hi n i~ na tural 1 ~ronse to ril e need tu ts tu re p()tun ltlluilib riu Ul HcrmJJ1 31~ 11 () d tllat icliupathic ( liCl5j h l it re5u lt Ot1 rw nltuf mot r l ~ltelV
[Id )fcl 3 nI] ~1ltJ U Sr1lle nr to dtorders in centJtI lO~Cl shyIOIDNur) md 1xi~tI moro (Ul1lfOl syt( llI (Fig _l
N htIll -of) H1c S uumll h( rll1 ( ~ l( w ing JI t11 (oshyI-ie on the l l lO]ugy o b doll (nt Rl iu]icirc tlili- middot()lioL m unt fil t-hltll rhl ugravedcmnilV L th e fl5 ult o f 1 (k btcl 11lIFll llI ion nf som t11(WUgravetltnl md pO~ lur( (tnic l~ l licirc1 tl1lt if l p OgtlbJt b C 1l rlw sta l i lin 0f 11 1 Sf llle j lt g )tx l Tt) ohtil n a ))Cli U 1ILzltl I o f p ~llIr~il d l~flo [ in l1litkd ~J)llnSIS me CI Igt(middotqucnr J ~ a ~tmicirc ()nlly or regle Ie Llive
Ali th- 11yp ) tlw~es rd ~lte tr d irtl Itn t pnl1tlt o f [11 v hole ~piltm It11[ controls postu re ~nd mrw shyment lrre pell ic of tlh po int a d lI~ llv inH llYegraved il i ~ ll 1 nnable tCl aSUilll ri 1l tr l ll1 lo g thi ~ys ttm ( Qu it le 1I middoteli tl
lt ch ugt nlt~(S f rullliIl thil i nlomwtion th at p tlmiddot shyiCil J(tl iIies nw gt Il lInport~n t rr le to pbv [11Icircgt role ca n 1)lt slI i11l1lariztd ln lWO the ptu li ain Llt
- d elopmll1 l of p uumlltl St1 b Hlt ) - c1e veuml IOpm 1)[ o f bhll1ltc _
(k llhUl)lOr S Cll orr
ontrot oic whan-lt
------+ 1 ~ il lnll ugrave r AINnl
Cllnlr1
T bflt~ r
fltL1 tlli
lMini
l
~sary ~J-frlllen i )f
~ 1 ocirctnl
~UcirclllIJJlW Ll
AXl ~l1 n uumll l) r sy 5t ~nl
middoticoltoq ~ Fig 2-AcFgtrdong lU He-mutl 21 il is Fi)5~ ib1e rD prolXgtSlt l -oo ie1 mnd 1 ((if ~ elio egrave middotAhltr~d l)Qdy-p ati~ I I i u d) uren ttllOn k td LO In ~ory reHTt I1 eDi tn l al ) JdrnlV~ pn)4~ e l u r~o(Ofe 0-c1 eptunl dvstil t1 ctlon sltŒ(ry icircltu nu11t ilwnt [ ~mC ~ted tl l1 ce Ill trpntlshyUumlfJJl nd IKnle~ r~dibl jtugrave)n of -I) m tlosen Ir ~ig nj tl (I1vying ln fornll1U n (lI an ereltl ~piJl e Mmor aJJ r--a t ~) n ltgtf ti lt aXljl mowr plem iHUC Wh ~fl Ille 6ubjeco m uumlntl Icircn (1oJifitd perccpfLlI l ~na l ysilt of p n)lnocepti Icircnfu rnlaquol ti desnibJOS ~n t tecr spin A IICW motor co nrro l Ira I gy t adopt resu ltin~ in the ~tr ltctltr 1 ckformh y lf IdiopathirL scollos i=i Ht lrftU1uc nltnt l ISll I1lJy h1e- ~ I pro()und elkn on bralO Sfem flJll ct i(lnn~lLhu modifyRll Ille nltulltgtshytl10 ) 1 1111 Uu l-lHoror control 5~Shnl$ shy
As Srtgn1lt1 l ~ ltlssert~ if wc l C -Cp t 111 1 un o f the G IiC s oliosls L l tisorckr oi th e ltquilibrilltn sys t ~ms it is lagical to oriegravenrate physlCl l exercis( lherap y ln th is d ir(gtCli()[1
11lclte goals Cul tl lfOUgil ditrercn t modes 01 action be Olchic(-c1 witJ1 phykal accivit ie
- po rt ive Cll ities p ro ct LJ e aIl UgravelClltrtsc in 6lte nshyel ll )o rd in~lti n pinai pr0prinup ti_)[J nLi mOVeshyment control 0 vio lls iy ln thh repect ome lCtivshylites aœ pre um~I I)y lXrter tllln ntil crs
- kinrl lira py using pedJil exerCisocirc specially developecl lith th est 1101 5 in mind illVuuml VC I lllore prccilt( ll1d InC1 li zed cri n on rhe spiJw focusing
a90
1 ~~
lg -lNheJo ~1l l1 t r~l g rld in 1 1) h i(~ IImiddot ct r rHienl w i ll idlllhic _It ~i ~ _ iri s plt ~I le II find Jit ltH vlllleuml ~l Cgtbl tn~ ks III d il fef lt p ~ lt ihnS nu v~tl middot B ~a~pt u Il C middotl)Icircd ~(t l l11 C dlfkrCnl middot- hdween slllndi1g Uline nu nllt1Xinul oorrec ri nI t chied Vith Ct (J ) und tfdincJ ne lot es o UIine 1 fo llnVs middotIJfl tfi ni( - ltlrshy
reltiK)n ~ Ikexibiliry st3nucircing - -pirte - f ur~1 1IbjISC ltupin - ltorrcaion - - r~luci()il ll ymiddot For flmpllt in J npK l1 pH k1J il
plt1SSlhlc ln obtai n 10 u1 511ndlt)l [YLo lion yr ln Slt p ille rlOlgt itlugraven om l J ~ in ( gttf(C rigtIl lIex lbuil 15 i (r-l l=22deg pol lltl ~~J IIlpraquo is IcircO~-V- I t1 l nd tucircu(Ugrave) ilil) I~ 3laquoJO- IH-12
r ln Ugravel e abilit jl of tluuml [m e llu to co ntro l irse lr in ~ pac
fuld l oftlles uumlllelve ntio ns can presum1b1r incn~~ Ih enl ac )1 the orller and lHitlll r of Ille rn - 11 )ltd h e lllldenl lu EJ3)4il
Posl1l1-t collapse lnd slabilizariotl
lIle concept u fplt st lUal c(l lJap~e l l~t Iwen detin 61 by DlI II-T3e~tupegrave rL t Ac oJdin)j tu tl1i- ~ll1thor il [ nec(sary ~- l Hn Cv-tlualing th tleihility o f a col shylo tIcircC CUJVL (0 clistingu ih bt tVeen the re du ihil [ty index (th - li iffer gt le bet ~middot Il ~I r~tcli()grJph ie ~xnmshyinltio n of the iI111 pHienr in supine po ition m(i
ROte OF Pl rnmL EŒIlCISE IN THE TREAT-ŒNT OP ~I IJD IDIOPAnnC OOU~GEm seou SIS EltJRINI
I (~)-----------------------~
__ _~ _____ _~ __ __ L ___~ ________1 ____ _ __ ____ ___ ___ _____L___ _____ l___ ----------L ______ _
1 ~
1
-- ------- --1---- ---- ]---r --- -----_----t- ---- --- ---shy__ ______~---- __ ____ 1________ __ _1_ __ ____ __shy
~ (1 J
1
8 =~~=r=middotmiddotmiddotmiddoti~=-middotl--- middotmiddotmiddotshy--------------t----------~- -------- - ------__shy
~---- --- -- -~ -------------r---- -- -- ~-- - -------- --shy----i-------r-- - ---- ~~-shy
il 1~ 0
Dtl-Lmiddot ~ lttj l r~ UIltltlHt
f g 1 -TI1 u ilictf 1ld ( ii 11- ugraveu-sh) ld IX~ O 1d wllich ltJdnrshymII Il nf the pilll 1 ~tln~1 of th e -o lioti( spinc n IG~nI(J II IIIshytt) lhe iJeuml grl-e o f ~ ()Ii ti c (u rvH Il 1 w dcpc-nlknrly o l l he 10 111shy
P01(nl (pntt l ~ 1 1 nr ffll wrJ I) ln w hilth Ihe n i 1gt( ~ duc nL~ grlphs fm I h~lt 111lt hi~hr Iht Col h ~Ilu t (l f Lite ~Ul Ihe m Ol CI il y th t s(uumlJotil middotpin~ ~111 he ~middotJg gr~lVH(~(1
m mJxiTIt corrttt ion wll iJl i~ lIllCd to Ih - xt 1shy
lti Oilil y Jf tl1lt t Ut JO rl1t cdnUc idt md p OS shy
tU ll cul lapse ( th t ltHill enct b-tten l lUdioL) 1lphic egraveltamJl1ltlti OI1 J t th e ~lme pa tient in Sl il tl cling lOJ lline fX-sitiutl ) Wll ic h correb lc- onl wil ll fhe abilt ty of lllt p tu rl l gt s tem to C( lunternct lIk luree o r grl viry )cco d ing rv D lfVd- f3egraveLIprc po st li r t1 lt01shyIlDse is d ue to the Jnus -u lar ton a nd 11ll ex rCrIshy i) i itv of rhe tissus n the ( O IW-) si it (If the (01shyjl ti (~JtVe (Fi~ 3 L Pu~t llr1 C lltpstl lu lcl l ~~ reduc l-lt by llwans o f pl1ysica l cxerCles specitkally s tuclled ruuml i rnprove tIlus--ubr fOHt md lU pr )cllI Ct 1 ~11 hi shy
lizing ffCd
PararcL n tll CIJ cl the cr iti ca l (3 c1 thlsho ld beQ ld Il ich defol1J lHU n of the i pinlt 1 e~ in~ ne dtlllontr~1t _cl (1l ll t grclrf r mg] o f rllt C II in a qa m bng pos ition corn pOil 15 t l lowcr detormashytion lhnsllold (Fig 1) ie to ~11l Ulne3Se t the risk of pr ogr t~ lu n There t rh eJef re l J ea r l)iuuml 1itshycJ l ~ll1 l l(tl a 1 tnr tg ro b ohwined by d -cr t l ~ illg ilmiddot pU~lUrll cull lpse ptJcelJtge w bich lccording t i)
h llTd tnd ~l(heJ1l ~on 1~ b inde cl 1X llt icularly luumlgh Ugravel mllcl c Iio~ i (bdow 2( 0 ) (F ig 5 J
Fin a Il III ch iS respect lllljl hl and b um l 01 m linmiddot
ii iI 1 l _ _~ _ ___I ___ ___ __L ___ _ ___ ___J______ ___ 1 ___
li 1 1 1 1 i 1
1 i ___--____---___----__-_---_~- _ _--_ ___-+----
i
1
i -- ~- -- ---~-----_-~-_-_--_1-~
l ~
i
+----r--------t-------t------f-- J
Fj~ ~-Ac(XjJlin(Q luuml T O rIcd ~lnd Na(h(ln~ n i () dl( pCG w rd (rTIshy
POO ll is hiherin cu rvegt in wh ilt l1lh ~1flILWrd cII1I Olk l1t IS le- pr(v~knt ln th e grtph Ih t PogttJlJ I ugtnq) Ot1 -J1l j elfltS-e J tlt 1l1t obb dirr remc rlLIv obu incu f roll l the Cohb atl( 0 1stlI1dtJ1g IId gtupinc rldo~raf115 Ih Ille lt) [1l1t1 (i lndnl I pine) 511pille the ~(nlClu tJ1 compo l1lnt U rlk CU Y _VeJily I~ ltx p rlt 1 L1v UpUlt (obh Illeturo Ih t si _b Cct rtJeSIm l fie -ltn J trd Ugraveltuuml shyuumlo n A~-i)rding LP 11(lt uuta o n l ( r1I~( in ~I 2JQ sup itlt curvt 1hi C(]l)b ddhccno l l f lO is -J-lultt( thc s ldnd inr tnla Ol1l t lS wi Q) whil 11) 1 1)401 ~llp lne ClHVC If ~ 1Omiddot ( tcl Lhe ttnd trl~ nlca~ I(t I ~ ~I)
tli n ll w l lllE cq lin ti spin h~ i ng mo r ~ Llnt~II) 1 tlun the nOftl111 one n Cll l gr(lk ( (cU ve tl1u n da r u p shy
po rt in o r k r 10 m linrl in tht 1xi11po tuf_ n th ha__i of th egt onideratl lr1S it f(lll() rhJt
ph rH (~Uuml e erd es ulukl h u - ul iiuml tbeacuteY ~U-L lm cl 1l (It-d o pmg p05111 td C Jl1twl lS fuumlrnll~ rly d ccrll1td ln an Ql St if i imr ol1111 t ru t(( - tht m(d in C JI shy
r t t r sture fO Ir -ngthen tlll m u ck-gt of the spint mainl) in (11erl antig r3ilrl tIcirclt l]lli fun ctin ll U hy meU15 dl i )ll1 t trk ~ lhJ cl( -ll tlt C)nlr~lUions ~llld no l IdOshy
1l)llic d YIltll1k lt l jAJ lktic t) I1 ) II 11)t 111 hd posibleacute t lcluuml ee postura l io nrro and stfh ili lllllt IJI
w i thout food T1lw(ull r d I( Lf(11 Ibk t m ucircnuin Ihe c()rf ~ct [ ()S tu re for cl gtu ifKi IH lLl1gth 0f ti l11 ~
This i-l ddl usl a typl 11 dnmnin (tf k inesllh rap) in 11 (lt-11 [[k - p~d fk lnr in lng f u l1a in llllliCk is poss ihle lI sing ctrtain Idncl fJ l (lt) 11111 liun S p Ul in tb is Cl c is ulttful ooly sa I~tr 1~ il Iw lps t1w lxltknt 1 becuJl)t 1gtlt ltlt-I a ClJu~l inred irl ilL ntllru l o~ i cll
and I1lll~lJhl r-keJc LIl [rll-llIn~ middot etlt(wrs JI the int e rmiddot vlnrion
[J ROPA MfJ) I()Wf-I YSJ IR
1
ICR 1 1-1
r
1 shy ~
- shy
11 o-llrfOlhe5l~ o t Ih 1O~(1dity i n h ~ r ~ ll nr pbl1 l of ~ Spl11 in 111011 _llti1Gt l lPt f ltlJUCWJtl ( ~l Ihe Ir t 1 1gt illbll W Ilh LtltrJ1dlion Vln lbe rigronl middotUII~ l(I Dko n12 lIll h lumshydlanie1 1 [ nul 1 M hl whtrc M - gt) lnIUI1g 111laquo111laquo1 1 1 c rtJCshytjC~ f fce d -d Lill l1~ o f enr niI pUll spnmcl1y 1~ 111 mldlll1lt (n the fl1ur t 1 = tor~ of f(ward Ileuuml l = ughtel1lng fmiddotr p 1shynOf stn lClU= Alaquo rdtllg 1raquo Ihl~ - lin hull th l1ltgtllugrave ot tller1l lUr~Jtllrc F the ~pin t -ilh rlu1i tf Ihl 1 1Ibulll n lrlt InltT1 1
rbc prJI 3IJi l1ty d qrlOIJ~ n bull JI t IlJIII Hm lA the v=ltd gtc e lu-ing J 5lnK1ura i ltfnnity
Dioal e ch anicll itllp~lir J11 c nt
Ihrcemiddotdimcllgtional mc-cbal1in of the s pioc
~f Ikmiddot i t i nly l(œ ntly tlHr llk pr-5tnœ or nc ushy1 lnlo tnr impairment in Idiopttlllc s-ol ii IXl tknt liuml J$ heen h i- ll licircghlcJ hy re$eJ rh tll e preit ilegravee h inm b nIcirc Ji d lJutg~ lt hl ~ 1 ng t o n dO Ulll urcel 1 i5 (l lreldv well umlersrood H(j-ev~r nev lbt un h iomcrhankal im l) ion nI h1c rectm ly onk l n tIlt tre and p r~dou in f n rmtinn hou t pl1ykd (~fcl5( in t 11 0 tl1I _ltgt pbne of spact 1115 Im trqlt-u 1rom J i-[) v ing unclcrsrmdlng ot th l lmc -dim nshy~ilnl l l11 ~ hmk f the cO]jO[lC pln( ~2middot ) ) Ve- w ill )iI xnl t l1 d at lcL-orcltng tUl cl sif iol t lOn blsed o n gtolllt lricd h uumlCJ ) p lane
- b() rJzU[1tl ln th i pla n ~ th t 1o rm ll sp ine present no CUlye- w ll ile Uumll(~ ltc U Hic spLnc clevelops one of ir haracterls(Icircc deFo rm tiCs v elt tbrd ln lashytio n vh icl1 pJ()VcA~ theacute hw 11
- lgitltl in th llulJe U l(~ nonmll spIcirclle pl SenL kypl lOSis ~nd l dooi~ in tb lXI1 lhese [(Hu rts Vere m)( til ught [ 0 he relattd tlle scolkJtlc ( lI r Vegrave
- front l in hi pleme tht ncrmal p ine preseuron t no curYegrave whil thl ~11li tic p in ugravetI I ()~ icircl~ charshyad t Ilt I CU1C
Il Jri fJIIt palic
~l+I~na ra 3 r inr lut th l[ ber ll1d a œl1~lU1 degr 1
l f r()la tJo u lllu (lILa r forcKl ltxert ltJn tl ldefnmuumlng 1 tkllJ [J i1u a re- lhlt tll cly 11 [1 1 UI b y Olm ner w bn ~lh uiJwd tl egrave ro t1tic) l1 Ilm it ti lt p ica] lf shy
rhrl r() be (P (the Uma bevond Wl1iltJl th lCOJlb of [11( ~pmaJ musd ~ dthc COnCIt and nm ex ~l le btconk (t O li~[)
r ~l 18 ~1Il N lu t( ren i9 lun lu ted rlseurlt h in tlt ) tilt lULodeumlformipg1 tlo n ot tIH_ sc laquoJrle rh ox ercallkren lk 1l1~H li d11r once thl Il i ~ r tld1t5 [he lhrth ld f 111 JlIcirc lIi of tlle dnrlclc hurnp tlk
lI bslt Il l nt rlet()rlll lIcircon 01 the it l ()I~ C ( (ylm der (- sustalnecl by an H1tmi cforming aCOOIl
J1Ji h V hl rhyiical f~ f Ise CI 01 h spr n llnd kin middot ith ccedilrapJ my lX damlg ing vll e n l pplild as flle
igt Jk Iller ln SCC1IJ ~IS lllc lJ fxceed l auto in middot crca~ i n g lhrllgthuld [1 sh (~u Id ahn be j ofed that Ilw relscd pre sun 1l1111i insiugrave l fe pil1r inn) 1 mlshylt
- j Il- ( w atff 1 (nh ~1l 1(e Il10 utoldrml ng li1eCh~lI1 1sm
in flc l Geyer ~w tcd th1 t rm m 1 hI l)1ecircch1O lla1 puilll 0 l I C~ sw m mim t Ieuroamp no purpo t for cu lshyim le pllilt t1 s (weumlO middott r it is l~Jl(gtWl1 rhn in iculio r[ paULnl -iJl11T1ill~ doe_gt nor Il ~lp to i ncrt~SL n eur(1shym tor co mfU
(1irai p an (
Jerdnn lle 11 showecl thal ill CSl~ o f t10rLC IC 1i lUgrave
tllo lacolulllhil it lio_1 tlle cte tI llmiry in (he lg itt1 p lln t rn lnlftot il~ lf tspe iuUy in tlw initi 11 r luleuml )f cV IU[Icircon nf Ile ~oli ls W iU l 1 p(t)gr~s~ivlt il10middot~ shy
ment roward hvpok pho b G ll f ill~l Im lins l har dUflng (IN eWllLlfiu1 of 11Imh] co luumlgt i the l in t ot t l H~ gClyty Cegraven te l - 0 1 v llebed lxxli 5 r ro ject 1 seH fl r t side-ys and tlwn backlrcl bull thu~ p(0(1 lj n g a kyphQtlmg aet Il ln (h~ lu mhnr --PIl1 COftj tng
l l i tc Iugrave l lltl l( l rs1 tif s L -etllgt il l the lgirl11
1 Hl)
Ilu LE nI rIIY~Ic~L lXIlKISI 1 HI E TREhTMEtn OP JIU IDIOP llII C AD O USCUH O Ll Œl15 NEGR II
lLill tegt lre lenl1 ~I d ~fo rll1J[ ~ rhl recrSes the phyltiologiGII cmns of lh vine)
Accordlng () Dicion ~2 1 rtcluctio fl in the itgitttl CUIYtS combin l vi th a lueral Iviari n llltl ds t 1
mecban ism () ugravel~ta il ity in l he r rat r IllI1e which bVOf1i the unsd a nd i ncrea~e 0 1 co hlt1is (Fig 6 hiIf md Pl11jlbiJ Jl1eanwlt ile lt(udiecl lh e srnl ru t
orzyglpophySLs show ing t11 al ttleir 1I1tl rnic tl orienshytation f~I (jLi l~ltes aXIal ve rtegravebJl l rotllio ll in cun litluns lt f dorsal hypokrrhn Icirc tnd lum)H de i L lo IS
Tll t dat SLlgge 1 th t impOrfill ut pOitu res and l1lweil1 ) t Mudied in ord t r (CI mlIuml ntrlin or to reuwer fll e p llyslo lo~lCll ClIlye in lIe SlgJtta p lU)l Wlth the llm o t ch ~ kin~ rutltor in l~ bili ry7 AbC th ~e ~k-
1l11nL ~Irt del lnt [0 J jUc lt ftber l]kuti inrervenl ion vhich 1c)LJ k l IV - i(l ~ l compktl n l ililll on Il t c1 l shy-jel1 J11UVllT1ent IJ j o f 1uto-dOneacute(3tlon ( i e a -impk ld ion ) Iengtheni ng o f the pilleacute 011 a litlltl l aXl~ tll lt ((IT liJlI~rcdu e~ t lle ~---lJ linti- l lte ml-fkxj(l n h UI 11 - i llCrl I~t the plllH ](JgicJI dlt cr ~l S ( (1 k-yvllCiSh lIld O(ltOSh l o r c lch r1Iif n t a Ilew til(~ecirc dUuml llt Ilshy
si lflltl J ll1 u(~nlent iam ecl - 1l1t0- lIrfe rionmiddot7 4 llmshyp oed f Je-rura l iUIl cl middot-t1e- iltm lI1d ll1a intltnUlLe )( 5lg it d C Uf (gtS slig lll thltJrc i ypI1 tiZ) tIcircOI1 a nd lunugrave)ar 1()fdos i7~llion) sholild he esw b lb]HU 00 lb co
hl b oi hi p~l11il uU r -1Ir vlt Abo 111( e IlltUtl Chl lie o f purti n - a U vitk slJ1ultI h e )tuumlll ecl 1)] (1 n ldershy](ion r tl1i lt type for e upIe IilJ llyl)T S of repd shyiti( ml vemen prt n t in agonistK h)lnllltlSlks nI iIle kind f dlJ1ce C( uld he ([([r imentd
FmiddotO lllaljlallC and mobili ty of the SpIcircIlC
1 rd llo U 22 d L lm nrrare d lhlt in Illt fro nt a l pll ne
tilt 1 nge Clt 1)1lt vtment of tht scplit[i middot CU IY grcmr lIJ l il ~ d irectio n n f Lhe C ITelt tlO n tha n in tl le di re shyLion of pmgressi n l Fig 7 ) he IL o IS5err lJd tbat th15 mohiliry increac plrtil u la rly n apic [ cgcoeilts 1$ lh ~ ~c() li osb evolves Sragrm rJ 12 J ~ thus rigilt (0
VlI f n rller~p is ts Ilo t t) m o b uumliz - a sCtJl iu til curve w ilhout t [ uling ttwt tlle R lu tiOI o i til t ~a mt b fnlinruumln( 1hy l1tans o f ~I passic 01 1 rivE -uppnrt On tilt (ltllE r hand UgraveK d e iJlioJ1 in ease durill tlw tune 111 whicll tll C spmt i ~ not submjtrcd to correeshy( IV anl()n
j- Virh mi lei ol i b tlllt Upp i1n ill) lC tiol is d eveloped only lllmugil llClIf()mu$Cllbr f r llce thi ~
InegravelIl ~ thclcfo re tl1l[ inu eascgtt sp1J1all1extl)iity mua
11
Imiddotiumltgt 7-rurd illt Ir) 1 bull rdrilt I1 1 in tl lt frOlllll pbnlt- th( illl ge )r mOC llIeJlI o t the S-o UIIJC CUNe 1 supcrior in Ihlt diflt(l im ugrave( the n nKlIl thd n ll1 tllc dlrtcLion o f p rJ1(l( (llIl
be considrCtJ vntrl iJ)(l icltion and 1 undrli neocirc ab L a ~ubiljz~ILion 01 tilt spint pllss il)1y ohtl ll1td thrltJugll the stlengtlkl11ng o f the 1rltJgm vlt nonil lme shyCIC 111 illli orrant u bjcLliH- ln rhis r~f1 n sp u lllni lc tivitIumlLs sil uld lX tPI 10 dlegraveltl it l G lU t n w l1ik luring kine i Icircth lrr phyltical eXegraverci c~ tllat in ele
spinal m ot ilIcirclY sil nid 1e lt1 oid cdrt ~
Organ ie and psychologieal impainncuts and li islbi IiI le
A cgtI im lc pmi nr is moriOthl11 just 1 sp in and 1
compkt gt Ipp rnach to the gu in ad 1 ont i al~ shylute l e~se i t i11
[)a la 0 11[ [n ell lrom re semh pw tbat ome organi Iilnctiond cl fki ts suc]) as tlw clecrtiUe ut vild l tnd d fun ll l)Kity_orld ldly incrtJ k whil~ 0 shy[io s i -till in (1 miel q g of g JltlV ity ~ l ilI e 55 rtI lit
tllL pres e n ce )fl defidt Or Vi l~il Clp~1 - i~ ln one pIIiem in Ihr l ftectecl by 20 ICl 40 scoi stgt l ls~a r(h cunclutecl in tbe UA by Di Ruce- prod uegraveed an aaalo) u ll1lXimum 102 re u t in a group of Jd shyk 1ien t [(h sco llosls rang inF frum ) [0 1
Al10ther rudv bv rallt r m C chr111 lilcl NashycWrl1s( u 57 stlO eltt hil $(C 1 1 ui~ Ica js l( lllt cl (1 shy1prUlllI o f t1tgl lie bJd l imI in ~ul sct t1 t ltu b middot iects jlLltr l5 they are golng through ~I cltlici[e sllge in the fnm 1lt i n 01 tlWH o w n id uHitv t factor hit h Illy jeopmlize the cl velopme lit d ~ mIll lt lI1d htIshym cecl IWI sonalitr in Klulrhood
n RUI ~IEDl(( Ptl Y1-
ROU ltHmiddot PI [ I C~ 1 EXIRCIS]~ IN TI Il nW~JUNT OF SlllO lDIOP1HIC AI)C~ESΠ11 C(gt1[Oi 1S
This i why b IiCieacute ii is ~n imporrlIl t for p rcshyvegraveml e 1tLsr l tn en ou flge 1ari e nrs ~lfrecr(d by lIillcl middotu iosis ft) tlke p~l rt in portin -re rcatioluJ acrivitits Iha t 1eIU 10 L10 th r~1chophyinLl bull nd b~l )i 1l1o tur adlieem t n li 51Jmiddot2Even tlK)ugli [Dr bic mech~lnshy
ical mcl nellIUll10t 11 11 reltl ~ons lt r111 1gtomcrimes be l lefu l to ugg( ~t ne p rt in~ aCt iv ity r l h (gtr rll n anotlJer e th ink Ibal an exces~ ive IlHd icalizltion - Icirce l ll1posilion br plry~ilt i HlS nnejlor parents uf rh ry pe of po rt to lx p m lice 1 b Ule p 1Ucirc(Il L th1[ preshydLl ck l1 is fret clOice in lh ma tt r - -h II ll1 he avolc1ed wb 11 possLhle mainly for tlle i mport~ltll psyshyLb ) jogka l fe a SI)nS W( ha( ill ~ t nltntionegraved
Conclu ion
lbh ISsertegrave d t1H physkal tgtXtlci o is ) n fi ial whlIl practinu in order 10 ilnj rove the I11 llde
rœ nwh and tono C iral caplCiry and postu re o f the StOUO(I ~lIbj n II I nowkdge om ~ middotmg trom ci el1shyrlfi rls(~ Jrc li dJlJ accordl ng r the review 01 thE litshytirlture prnpo )td in t lli plpl r conflrm~ Ihe vuiclit ot th e -t ls ~rti ()ns
In l do l (ent Id iopl1il iC scoliuse il l n phee u i cl vk)pm e n t ( li tll iumlKh eXCC cl l g i en rhk thr hokl th e re i5 an und ubred need fn r l pprnpri 1tegrave (JJ1tOkJJe ~Ild Inr surgict1 therapics ill ortler 1) S l i p
the ( - Iuli on anugrave )JT~t~t UW ~pilll l dtlormities bull evshyerthtless in the illiti ~ll pl l~sC t ttlC c1iseLltc whcn the riS( r1 r euro )luli m is rtduced ocirc ~md tfle uifleal JOld threshold il ~ld flle po stural collai i reJcenw~ 43
JI l1 igh pllysicaJ egravexe rc ise - p revenc or r d llCe d i ~lh ilir ies o f [Iw ~ l() li )tic
p (iems R 28 J -6 5- 6 1 63
- f~KiHtare lh ( n utr ali711iCUl of postu m l d elicits tn produCel1 a coneql l nce J [)ti 0 I111)( or regre si -u lmiddotc 5middot Il 1 17 ~ M
-re 51udles U ~ n Ledecl tu con[mn or re jecr these conClLL i( 1 w l1 ich clerin-d frum 1l1 lIldytica l rcltw n f th e liter~iture appear r- ~Lo nlble Hnwecr Intil ne re ull are 31Iable wc should n r prevent our sroliotic patientmiddot trom tl ki ll p lt in s(loI1ing jshy
ir its pW1iada rly ltl t ~d1()o t () n til t c ntrHY -vith the l xcclrinn 01 gt[1 )11lt tIlat in rea-e t)1obility (tnU evc n thell oilly wh n progr~lgtion b p OSSibl) -uc h ~I( ucircvshyiUe -11 )ulu hl tIKoll w g ed The 11 S J ( rprOpriue kin (~irhe r~l Piuml to incr _~asc p()~tura l $llbil i ty is tl1egraveoretshyic tlly CiJUClt alttloughl more ~Iccu rtte aod deLli led ri k benefi rs anJlr~ is is netot1ed
Ria 1111tO
NIokl Mu d lle ftitYljJfu Jœl il 4IWr10UOifll S (JIvs i (1~1)Jshylidl ttno( cclIll le 11(11(1lt1 RCI fu lle ((lia LltfIt l1 I1I1i(i
LJ ci n s j(r3 pigt egrave li n IHUgru lkl di t rdz t fi sici pe e ft shytUlKm iluppno di un lisimerap15Ll rl lllcflt() 1 110 scopo di pnevirlt () fr en~lI 1-lgpwlllltnlcgt dclld lclonnitugrave o e il 5LOshy
Il i mi llon lt fH nugrave j (1 11ni dei co~e 1 lteIl I1J J nd ne ~Ii eifclti (()Tc rri udk s co lio si d i m e dia g rt iuuml ln que~ltlt
s rud i 30 llizzb mo i d ti cleU ric lca pel n ri Icare qJJ l lm 1 dis(imucirc x u le I[~ l z j-m i pro vna le da lla C gtl k A i json ere pr middote-nute () rk kl ducirc un~l rdeguCltl d nil cra pi lt di uJoseguerrnt Cjua li 1iU110 cli nbie tti 1 rcr lJ)tIId d~ fle)-UITC
n (- -fd7Io n~lcl)
Ut11claquo)si 1 lI tori htpnuuml )ludi-ttn I ~ cnntI1zttu fr Cq(in i idiJ)tic1 dbfl lOZ10l1 d d ~ leOla nelllOll1otoriO Lb un1I1cnUl 1n1l1i3 dcgli 111 lt1i ch DIJgt gtU l H crmU1 Nlch~mslt ( SIshygnaJ~l lerimiddot wo i esuemi -bletti d~ plt~e8lugraver- ne l pClZ le1lftgt scoliodcu kl s iluppo ddl ~ ~ uhjlil~ vertcbral~ lt o svilllp prJ Jdle JIl7 i() nl di ltCjuiljbrio Dng li studi sul lto lb( l~nlrale (OllddU i in pa rticdu d 1 DlIal-BeHJ (gtegraverl ~ P~II IId lI1 n~ llw - idente il v- m gtiu p eT il puientc clioti elgt di u n rnigb o t c)[ ro Ua sw mle dei radlldc onsegull o tramite il 11 fforzrlshyfl len to d e i l1luotoucirc l nllgr3ilri d e luOwo con crcbi ~Clltdr
in pOMltHJ corrctl e in va rie ~i[Jzioni s t llicb c c d inamIcirc tllt Dalle on sena d elb blOffiCcclIlicd tr idimlt n s io mlle d ei
r ~ chi Je ~oU()f icn ~Icirc ~videnuumll (l() ~llt tC p IYZIcircOSI ln(IiClZlfHicircl ~ 1I1shy
liumln fluenzt Je ll middote~rUrio tl SC) lgt lIi I rc pibull m i tldln sJlI71 Stl shygn~I I1 afferma che slI l p Ia no [11 middotccedilr~lk tre un œ rtlJ grado di l L1Liuuml IlC dclh vEltlh r1 apj(de le tu rœ mu SCltJ llri njtbc J n in $tJ ) t rodcfQfll1t1l1te PltJtantu b i r~it-~ r -lp il puugrave t~~
Ixnt-ftla solo nt Ile so )[j)~i Jl1Icirc na rl in qunnt ) ilon SlrM ntne )(l(Ofa tu soglb in caq ) co lltrLJIcircn l)lrilto llt~( i lJudotlsi di lfr~ lI1 C llg grVlmenl J 111 11 io lr riltd ll(17jOill leld rinlle 113 dimO~iumlrlto d llt nell o lin~l cl()~ li t th~oIOl))1 dri la defltgtrshymiti sul p iluO slfl iuale ~vohl lf1 (en5 ion~ sO lnm utto nd 1e bsi iniliali deWggrwm1Cnln mcn trl C a( lfLmn che occlleshyvoluzi ne dene = 110 i [ mhari IJ lin c l ki cen tri ch -1vi1( de i cp i CIt IJ rI Ji SI p m ittIl pnm l Iem lmeme e p o j pOS( shyrio fllwnte dtldnli mdv ( i un ziuuml ne ciloliz7nnl dd rlLtide lu mbJ œ ( lIlelttlaquo on NC n d d (gt11 uIdu m 1I1 Ilgt) cli r-Iure (0 eserClzi che IllUllengano 0 ltlUperifo le Clgt 6gt1 lo)iche sul pirluuml gilwlt Su l p iCl no fron itk Perdnulk il dlll1lt-trlto d1 lampkz-l d i LU ovimento amp111 lI rv Kolio ti ~ nd lt1 0 ddlJ cnrrc-LIcircQo i Ji gC 1 n lungl SUpegraveliltlrccedil 1M llS0 tlell 3ampIGI shyvamcnlo C che l~Jltmiddot mobiliti GlI mcnta co n l c lu7j o fle d l i) snAio i A ulln amplgrtJc1 ltllllmunjx~ i terlpGli nn n m obi shyUZ73It ma eutva coli ti0 1 1ct HsicVlfe nd tcmplt 11 1111nshyttllIcirc1nc n tc (k ll ~1 llu u zinnt n l1 un me77uuml d i sost l11( gt ln 0
e 11111ri b cle - Ilziunc egrave deorinatcl d l rlyarsi Snzcl la pr gtshy
liltlnl l i un() rtl~ i ptmiddot Jtl n(o 1S(Hl () (( ntJ() i ndit~tr i ~ Ii ISt (izi e l m iviL Illdlode ebe Hlmen tno laJlc ibiJii dcl rlc lide SCshy
li io) [n p articobre rune q lldl r C-I1 ich~ xlSiddcHe CUf t shyli ve ch~ iJllpi tgino e~rciii 01( biIi2 ZanUgrave HhnmL-trid () in tmiddot~t~nshy
sione kl fuchide O tne pure k- ~ttivit1 tnotoJII~ non prHi(~ llCcedil
in forma r k rel1tiva d Ie ~1I 11 rF~1l1( n otcol mcnlC 1 lll ubib Ll vcrteblmiddote (ad ~ flp j(l 11 n l) to L ginn ~Iilt Utl clkl rilshyC
mka la cli OT- tcc)
r1il to l~ _ I[Dl COlI rY IC~
NE olUNI
fillncr ( ni ((uuml(( n hIIo( rilclIO ~middothe k lln dtfidl fUr1z i shy
nlu CQll1~ la llcl llZIO 1e delb c apKJl ilde e della capacltl di 0170 mizianu luJndn le (OJ il~ gtna a nc r3 di m~i3 gmshy
v it ln G mlxl r i ~ gko Fl llslrom C dlllJ O e Nachcms(J h iU1I) dim lr JtQ che b o liosl p IOO C1 neUaduksœnr 10 SYil l1p pn d i lIniumlmn~gin nlt8Jliva de corpo in (o nridcnz di Ln ddic3w p ri d di f( m l lz i nlt deUa SUl idenritl condishyZltonc ch pOlrebh ~[I cubrmiddot ln vilu pp di un pe bull n nn lir m llur cd e quiJibfarn in t[C adulro TaU CO1DSCe nZe tvlde nshyZ[II)() la n ( middotess iti di ltimobre la plfte ip a7j0 r1e atl an ivi ll1ltHClr n gl b a li ltl h ~ di tlpO s pu rti middotu dl ittlrc nd gloani iCo lID ti i lirtugraveta z io ni llb vila di relazionc
ln concllliu fu la d tfoflll lL saliu iG egrave il sin l mo di lin) idrotnc C Il1pk 1 d e eoinvo l d middotmiddot= fu n (n i dd rgashynIcirc5H10 n Hi lhdli e lesenizjo fi 1lt0 se 1 Il indirill~t() pllO pr~cnin 0 odLf rgt t lli di fu nzlonicirc adlc s()Jj(bi 111Icircn(i rrHtatc CO ll nl1 cinesi rap i Quand l~ coli i ( n LS~middot iJ11 zia k il rischio evnluLIcircvo egrave lid [() mente no tcole 11 (ltlll asso p o lll shylal ltOtSltgllen7~1 _ ta cincsiterapia pc rslIk bidtlvi shyptutibulli d ubllIcirctIcirc vltnc brn1e di conrro llo )(JSu k d i 5IcirclupPQ d Ile rLlt ziofll d i eC[u ihb ugraveo dJ ftffr otZJH1 r1w dei IIl llJgtCili 1 11Icircshyg rdtarl in posru ra rrenu posslhile JnnalL in Illo lt i clsi l(j luucircun lt di lin ~c() li oi mi n rc ( ume [11 duumlnQstrIO la tinc~ jn~l el1lric ((1l1 ~rtlppi d i contnmiddotllo cnndnlt1 p nso i l entrt d e Massue di Li n nc da [ o llo n ~ Rodo l (1 986) Julndo il1vlce lIfU~ ho ~vutlJ tiVll 11lt1 1IjXIl to un dekrshyuina r o~itl di g rl vir~l bull a~-n lllull~nte n ec ~~uiu rlCUuml rf( ff dla tcrJpll rle si c a eo chirurg ica
1Ho le clllC ooliosi idjopHI 3 ttl1p ~ - E~er l zjo hsco shy11ln ~ I((fapil
l Bg 5 CUle Lo [la k ll oblems in tlu ll~ (U ni Cl) FrKUce CU ( )lIILr no 1 AllCPR lu b1lG1t10 11 middotCI 9()(iJ2 RockilJe MI) i)~Cr ~()f I [( al th all 1 () I ~Y 1(~Re~C~Hd ~gtutnlt Ilallb Srshy1ltC Cgt D~p(rulllnr CJf I Ilalil 11 1 HumlIl sen Lel 199-1
2 SI) lrzcf ( LcB I ~IIl( FE DupUb L ampkIll~ 1c ~ppro l c h ll tht rnent und mmgemlt-rlt ot ~ ct vlyrl~ led splnul (hs r)fder~ A monQglJph rr r d lll kic Re p o l1 or Ih Ou bcc TlSk Fu rcl 0 11 ipmd DIo rele Sp ine L9H LU) 59
) Clntino F 111i1 i(ll Ci nerte1H C Nou gltHhl C Kln(~Jl llBICII [lIe1 hmlln (Il dry rra ll1ltfll of QIil pa ll m log iC by l11e 1 lIb li 1le-llh laquorilC~ of ~ 10(lna 111 Jrc)Jcxli r~~ (of flle h l lntrnIUonll SVIll Illgt~iu tn - II 5lt Ik lIc lk0flllllic lu llln-I I r l III Fhhlt ri g 1092 -ltlIJ-7
i - ri of niii MA N()LJV II ~ mel h)ltks de kin ~~klk rlr k di lll J r~cdllclli (n d~s ~()li oes jn f ~tel r~1ruuml(ILI -lo s bl fl c sur IcIj cquishyl)œ~ Ik SOll ll l)(eacute Eli ror eetlfllS d )111 1~ 1)1-
5 iloll n G Ruumld(~ le s () I ~middotmiddots tnlcl l l1 I n in 1Ifc el kiwil~~ 1)11lt KillegraveSlthe ripJe SCleacutentlnlue lYl6 2 47 ~ 6
r) Feacuterr[ffgt en 1tsiero 5 Venlllfln A ll~~n () M MJglio nu N EfkUuml o r eXltClse tI~tl Yoj o n nild id iO rXllhlc iC() 1i()~ lrt~ lirnIcircIluy r sull Eur feltl lb)ii 1 1j34 Z5 -~ 1 NOilrill1 A Sbill P egn ni i Ll Linesilegraverpi l 1lt1 Itallllll~nlO
ddlJ soI K~ i llO 1 Orkl1Llllwnrl m efodoloil1c1 RbbilltlZiOllc Ot1(1 1 )29(1) 1l-~
8 Nli(rinl Nl(lr1n l A blll P LI rieduGlzione dl p llicml atflt rro (11 coli ns i idi opr lir1 l n SC(Um i le or h( JI 1rcLlIQn1 ~0Cl le Imc lI1etW)n11e de Recltcrchc ci 0 Ftude sm 1lt Radw jlt)(j S-71
gt Nftriruuml S SeJhrf U LI r i l bllh ~l liOlie dd plziecirc11te ulet1n 11 - r
lin Kllopd (1 In l1l Jgl L N eduoL Tf1It II d ll11e ji cln1 rJtbl IiIUvJ Milan) 1ltfddH~n(x~hl 2(1~111gt-1-PU ob L cllln t iRll p l nelLi rl tgtO llcui n~ dilt ~lio i - l rn~f- li ~iIa n 3efllnl -Kurflr 19-11
11 lIIra S lJll M EVtJltHlvugrave egraveI lt t rnrumel1t() d db S(oli - U r) surie doCum nUle fintgt 31 tIUUli Mibn SI rlin) KlIpf -r 199 2
L2 1 ~W I1l(IJ P _leacuteVia tio n I~lhra k~ du IlchlS ~- ( i( IoltS ccedil l r lI C1 l1 fl leq
Ene 1 l C hi r ApparctlIClCOn l~ ltll1 l ltx6lt (i W Er 20 j )7 l
U StrI tr d P Lcs 1) rm IlO du Hltlctli Parb ME n 115 li ~u n un_ l c- l ol lJn e~IL1roy JC EagtOllŒrio n sc lluocs
L cl middot Exp CO_fiL [-In 190 15 Xd BR llet13n) J Th ltJl-xwenc a l o-(l1 tUcn~kuud txer
C le re-glflW 1 lhe tfelmc nl o f id iopllhiC Collaraquo n lroc~-din) t Lhl 1 r 111(1ltli0 I111 Symf SiUl1l un 3-D Scl IiDliJ DclOfshymillelt ~k)J1[rlt u Gugtu l1Shltr Verbg 1lti t)L j32-t)
16 N1lh~Ir~il Al Peumlf r~o n LE Erree htJkmiddotmiddot~ n f t~U lt hfIl middot Ith J
hran in ~rls V ll ~ ttiVl ~HkJ k-nt IHuIXtthilaquo ic I) Li ~I~ts H t 1l1i JflIn t ~ j l~jl)5iuml7A(~)8Jj- 21 bull
17 M(jo n Y ( ullck J p ~ R A PrdulllnlIr rpurt 11 Iht e rt l f rnltJsu red 5l ren jl lh rrll nrl1 III ililleInr Hi rrt tllk scoJliagt
J lin1I IJisn rd 21 1 1)12) 102- - Hl Hunng CU[- -If p~lIll)~thc - Uonktd in -c h JI IL
c reacutetnl n~ ptnl l C)Q~ Z ) t 1 t(li-v 19 Kou )UrJKh L Glr~ k G KRI iJI G KLmiddotmiddotrnl kh g UlUI
) KrJ UkQULlk i~ ~l ~~ fl c+l l1ng ~t (w)j (h ildrcn frit ltt lmiddot( ti ~l~ 0 1 (he
isbnd of Cfdt J middotpin 1 Dior el 1 9J7 lIX( )middot i2 ~ middotl I i) SG IC1Iugrave lS r olle lCOS rh Zadrc C Ber E Xend s T A
ohool scr(l nin~ f r Loli rraquo pro~ p ah pidemlaIO)( Io Jl lUcJ ~middot In ncIfllwt~t~rll dncl Ctt1fLll Grttc J none 1cUlf ~)Ufg Arnl
19lt) ) JOJ )8-1)3 tl llunnd P n ohlecTln CfjtefO I1 f r SCCi II Ots t-CTctt1 lngJ BOIlt
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EUROP MIDI C Pli hIC
EDUCATIONMEETING SATURDAY 8thof APRIL 2006
(iSS
SEAS02 Scientific
Exercises Approach to Scoliosis
version 2002
G
S Negrini 1
EDUCATION MEETING SATURDAY8th of APRIL 2006
Neuromotor disfunctions
Neuromuscular disfunctions
11 Postural collapse
Postural collapse
Duval-Beaupegravere
Flexibility of scoliotic curve
f---I--- I Postural element
-------1 Structural element
S Negrini 2
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Postural collapse
Duval-Beaupegravere
It is a value related to muscular tone and to flexibil ity of convex side tissues
Post ural collapse
Bunch e Patwardhan
Critical load
Load threshold beyond wh ich a spine begins buckling
JI~~Wt1lW~flfthtlJlœJtAr ~ J~It- l~l - IMS
Postu ral collapse
Bunch e Patwardhan
If a curve reduces there is an increase of the deformation threshold
~~~NW~-damaoc~IIIMf ~~ J~Iv JaJ-I7I9sect
S Negrini 3
EDUCATION MEETING SATURDAY 8th of APRIL2006
Postural collapse
Torrel e Nachemson ~
Scolioses below 20deg ~ ~ lt~
have a high ~ ~ percentage of ~ ~
~postural collapse (on u~
average 75) ~~ 2i~
CU~VE O EG~EE S WHllE SUPlti e
~laquotd~c6b ____lPffI1wtt1t~
$ww J(t ~~7 JM5
Postural collapse
Minor scolioses 7
Antigravity musc es strengthening D
Reduces postural collapse -G
Increases the critical threshold of deformation
G
Neuromotor disfunetions
Stagnara
If we admit that one of the causes of idiopathie scoliosis is a disfunction in balance systems it is logical to orientate physical exercises toward this direction
s Negrini 4
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Neuromotor disfunctions
Dubousset
Idiopathie seoliosis results fram alterations in praprioeeption centres and deformation is a natural compensation to restore postural balance
etattJtitIK ypothfQj~S ___~ own_ oJ)HQr lar 1t-1( r
Neuromotor disfunctions
Nachemson Initial idiopathie scoliosis
+ Goood spine stability
Neutralization of postural deficits
D Static curve
Neuromotor disfunctions
Therapeutic aims
c) Development of spine stability
C) Development of balance reactions
G
S Negrini 5
EDUCATION MEETING SATURDAY 8thof APRIL 2006
Biomechanical disfunctions
j Horizontal r-Ian
i Sagi ttal plan
Frontal plan
Frontal plan
q Frontal plan disfunetions
Fronta l plan
Perdriolle Movement magnitude
gt in the direction of lt in the direction of correction progression
S Negrini 6
EDUCATION MEETING SATURDAY8th of APRIL 2006
Frontal plan
Stagnara
Never mobilize a scoliotic curve without ensuring reduction maintenance over time otherwise a greater mobility favours scoliosis progression
Frontal plan
Ducongeacute~ research
On a group of adolescent idiopathie scolioses treated with
Meacuteziegraveres gymnastics
D After 1 year the mean angle of
curves increased from 18deg to 29deg
Frontal plan
Scoliosis without brace
D Greater spine
flexibility D-
Risk of progression
S Negrini 7
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Frontal plan
Mobilization is useful
D In preparation to
brace
D With brace
Sagittal plan
QSagittal plan disfunctions
Sagittal plan r middot _J o
Perdriolle scouos B CJ aDeformation of D
thoracic and thoraco-Iumbar curves evolves in extension
S Negrini 8
EDUCATION MEETING SATURDAY8th of APRIL 2006
Sagittal plan
Graf
The line of gravity centres in the vertebral bodies o s c oUOSt
projects itself firstly laterally and then fi
o
posteriorly lJ ~~ ~~ ~ ~~-_J-D ~nI~
Sagittal plan
Therapeutic a ims
D Maintain or
retrieve physiological curves on the sagittal plan
Horizontal plan
QHorizontal plan disfunctions
S Negnni 9
EDUCATION MEETINGSATURDAY 8th of APRIL 2006
Horizontal plan
Stagnara The forces applied ta the spi ne act in a autoshydeforming sense
Horizontal plan
Dimnet Rotation gt 200
ampII~ (
D The actions of concave and convex side
muscles become
agonistic
~ItJrOnrIIiItdllfUClltlluumlll~~tI ~1JIf1laJ
Horizontal plan
Minor scolioses never exceed these autoshy
deformation thresholds
S Negrini 10
EDUCATION MEETING SATURDAY8th of APRIL 2006
Disfunctions at a biological organic and psychological
lever
Oisfunclions at a biological organlc and psychologlcal lever
Cheng
Bane density in scoliotic teenagers is lower than in normal subjects
~~~~middotA~IIlUtIy ~7œl 1d l
Oisfunctions at a blologlcal organic and psychologicallevel
A significant reduction of vital capacity and V02max in teenagers with a medium severity scoliosis
S Negrini 11
li
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Disfunctions at a biological organic and psychologicallevel
Disorders in the development of body image that the teenager has of himherself
Disfunctions at a blologlca l organlc and psychologicallevel
Therapeutic aims
cJ Activate cardioshyrespiratory function
cJ Favour bone density increase
cJ Develop a positive image of the body
Disfunctions at il biological organi and psydlologicallevel
Stagnara
Sport
D The active side of
kinesitherapy
S Negrini 12
EDUCATION MEETING SATURDAY 8thof APRIL 2006
Disfunctions at a biological organic and psychological
level
Distunctions at a biologlcal organlc and psychologicallevel
Cheng
Bone density in scoliotic teenagers is lower than in normal subjects
~n~IIIvpWr~middotA~stWy s- XXJl M J
Disfunctions at a biological organic and psychologicallevel
A significant reduction of vital capacity and V02max in teenagers with a medium severity scoliosis
G
S Negrini 11
EDUCATIONMEETING SATURDAY 8th of APRIL 2006
Kinesitherapy on the scoliotic subject
q Postural control
q Axial stability
q Muscular trophism
q Balance
q Respiratory function
The limits of kinesitherapy
There is a threshold beyond which
rehabilitation alone is not enough
sssr
Kinesitherapy in scoliosis treatment with brace
Therapeutic aims
S Negrini 13
6
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Therapeutic aims Srace kinesitherapy
With brace
il Postural corrections and
vertebral stability are obtained by the brace
Therapeutic aims Srace kinesitherapy
In preparation to the brace
il Mobilize spine on ail plans
Therapeutic aims Srace kinesitherapy
With brace D
Maintain a normal spine elasticity
~ Maintain a good muscular toneshy
trophism
C Model the hump with kyphotizating
exercises
S Negrini 14
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Exercises and their methodologies can vary accord ing to learning and individual sensibility of the single rehabilitator that proposes the m provided that they stay within the
Iimits of fixed therapeutic objectives
li
Therapeutic modalities
(Exercises)
QAuto-correction
QRespiratory education
QErgonomie education
QMuscular strengthening
QDevelopment of balance reactions
WNeuromotor integration
ci Vertebral mobiJization
QSpecifie modalities in brace treatment
S Negrini 15
EDUCATION MEETING SATURDAY 8th of APRIL 2006
The protocol of kinesitherapic
treatment
G
QChoice and dosage of exercises
Variatiosn of the work program every 2 - 3 months
Q Execute e)(ercises on an individual base or in a small group
Q Frequency not less than 2 times 1 week
Involve and awaken the family
G
S Negrini 16
EDUCATION MEETINGSATURDAY 8thof APRIL 2006
Q Determine the action and the localization of auto-correction
QAuto-correction must be associated to ail exercises
QAt the end of treatment ergonomy lesson
Auto-correction didactics
G
SCOLIOSI DORSALE---- shy ----
r
S Negrini 17
EDUCATION MEETING SATURDAY8thof APRIL 2006
SCOLIOS OORSOLOMBARE
shy
SCOLIOSI OOIlSALE 011 bull LOMBARE S1I--shy
SCOLIOSI LOMBARE
il --~_-
S Negrini 18
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Scoliotic patients are not radiographs
middotSeoliotie Mtients are not ndiographs but hum beings with a vertebral deviation-
Slagnara
Metha For the physieian Cobb angle is of utmost
importance For the patient it is body deformity t hat eounts most rib hump a protruding seapula or hip We are in a situation in whieh today dodors eure the radiographie deformity but what the patient really desires is to get rid of clinieal deformity and of ensuing psyehologieal distress
CIIQItIo shDuIdtucirc lM WIld tJw~~ I~~M~~~~ J9f~
S Negrini 19
- Poznan_workshop_Physiotherapy
- physio2
- physio3pdf
- physio4
- physio5
- physio6
- physio7
- physio8
- physio9
- physio10
-
ZcDli~ny w zakresie kla rolaei osiowe krfgu sezytowego
sknywienia w wyniku prowadzonej kinezyterapii wg Dobosiewicz w grupie progrcsywnych skolioz dwulukowyell shy
n=74 (C7lS obserwacji ad 6 do 45 miesi~q srednia 211 plusmn 111 miesiqcR)
oddnek Th odcinek L
Grupa skoliozjednoillkowycll 0 kqcie Cobba lt 40deg - leaeni wyhCznie kinezyterapil wg Dobo~icwicz (n=44) (czas obserwacji od 5 do JI mi~ifCY ~redllia t 18plusmn604 mie-ihco)
tnnl qICIiIl fMtt[ IoooI ~)I l~Illli 1IqIlt00401 IftmiddotI-I llJ
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Obserwowmo i ~totn~l korclacjt pomittuzy POZiUllllm opilnowilnia Illctody przcz chorych i cZccedilsloscj stosowaniu kjnc7ytcrapii a wiclkoscuuml rcgre~ji 7~niilnw zakrcsic kta Cubha i rutltjl OSIOWCJ krccedilgu szczytuwtgo skrz)wienia - wspOlczynnik Ptarsona wynusil Odpllwicdnio 016 i D53
Grupa skoliol dWlllu koovyeh 0 kItac Cobba lt3(jl
typ IV wg Ponltetiego - skrrywienia pienvotnie podw6le - piersitJwe pFlWosrUlII i lccedildiwi()we Iwostrow
-Ieczeni wylcznie kiDezyterapi~ wg Dobosiewicz (0=10) (nli obsrrvLcjicirc od ~ do 24 miesifCY _~ n~dllia 12453 micsi~ca)
Sndni ~~( Cobbl na pmltltu (ugraveurulJpii
wynosil
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W oddnku L-17deg
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W odcinku Th shy 1J7deg
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Zmiany w zakresie k(ill rotllcji osiowej kr~gll szqytowego sfmyiellilllV wyniku prowadzonej kinezylerapii wg Dobosiewicz
w grupie progresywnvch skoliozjedllollkowycll - 0=124 (CZB5 ObSrrwRcji od 6 do 58 mielli~cy irednia 197plusmn1185 miesiqca)
Grupa skoiozjedllolukowych typ 1 wg Ponseliego - skrzywienia Th dx - leczeni kintZ) terapill wg Dobosiewicz
(11=74 aas ubscrwacji od 6 do 45 mieiIcircccedilcy srednin 211plusmnII 1 miesiJtcft)
Zmiany w zakresie kqta CoMa IV wyniku prowadzoDej kinezy tera pii wg Dobosicwiu w grupie
progresvwon h skolUgraveIl dWlllllkowych - 0=74 (ons ubs~rwacji od 6 do 45 mil3Icircccedilcy sredni3 211 plusmn 1J1 micii il cn)
Ddcil1t~ Tb oddnek L
7
Zmiany w zaknsie kIta rotacji osiowej krfgu szczytoweg() sG-z~vienin W wylliku prowaagravezonej kinezyterapii
wg Dobosicwicz w grupi~ progrzs)wnvcb skolioz dWlUcircuk()wJcll shyn=74
(cras obscnvacji od 6 do 45 miesifC)j srednio ZI I1 JI I micsilfca)
oddnek Th udciollk L
Grupa skoliozjednolukowych 0 kqcie Cobba lt 40deg - JeCJeni wyl~7ltie lunezyterapil wg Dobo~il-Wicz (n=44) (nl3 obstrwllcji od 5 do 31 mhticcedilcy sndui 1I8plusmn6U4 miesiacn)
Obs~rwowano istolm korclacj( pomiccediltlzy poziull1lll1 upmowlIniu mctody przcz chorych 1 czccedilstosti stosowilniu kine7ylerapii il wi~lklJseii rewcsji zmian w Zakrcsil kta Cob l13 i ro tacjl osiowcj kr~1u SZCzylowcgu skrzywienia - wspolczynnik PeanlOniJ wjnusil uJpowiedniu 016 i D53 -
Grupa skolioz dWlllukowych 0 kflfch Cobbf lt30 Iyp 11 wg POllsetiego - jknywienia pienvotnie podwojle
- piersimve prflwv~middottrolle i lccedildiwilJwe ltKJoslrotme -Ieezeni wyl4eznie kinzyterapi~ wg Dobosiewicz (0=10)
(nu obenvacji ad 5 do 2 mlcsiccedilcy ~r~clnil 124plusmn51 micii~cll)
Sredui k~1 Cubba na )uclltlll I~lerpi
wy nosil
w udcinku Th-17o
w odcinkll L - 170
Sn=dui kql Cubb aJu liugrave~tyIcTUpij wynosil
W odcinku Th shy 137deg Y udcinku L shy lJ20
4) 1)IIIIcirc w Jlm ~llIWiob_ l~ rlllW
JIIIIm-lollUcirciaftq jtQ0 1 t~~010
UpIJI~r~
8
9
Po 5 i 10 miesieacutecach
C- 18 R-S C-12 R-S C-S R-Q
10
Po 9 miesilcach
11
BP
Il rz
Th
Cmiddot 12
R-3
L
C-16
R-7
PoDP 7 mies 10 rz_
C-9 C-20 R-OR-2
--__ _ _----------shy
12
DP
8 ri
111 C-26 R-2
L C- 17
R-]
bull Metoda asymetrycznej trojplaszczyznowej mobilizacji kr~gostupa ma znaczeumllCV wptyw na zahamowanie progresji
w skoliozach idiopatycznych szybko post~pujqcych
bull Mobilizacja strony wkl~s~ej skrzywienia i osiowa derotacja kr~gu szczytowego zwi~ksza korektywnoseacute skolioz zmniejsza garb i ebrowy poprawia obj~toseacute klatki piersiowej i zwi~ksza wydolnoseacute oddechowq plue
13
bull Przedstawiona metoda jest
stosowana samodzielnie lub
w pO~qczeniu z ortezq Checircneau
a takie jako przygotowanie do
leczenia operacyjnego
Ocena progresywnosci w badaniu elektrofizjologicznym
odruchu z odci~zenia
i~middotmiddot ~=~-~ shy1 _--==shyocirc
14
EUT S pine J (1997) () 93-97 copy S pringer-Verl ag lY07 ORIGINAL ARTICLE
K Dobosiewicz Neurophysiological mechanism of the unloading reflex as a prognostic factor in the early stages of idiopathie adolescent scoliosis
Rcceivcd 29 M arch 1996 Revised 16 August 1996 Acccp tcd 10 Septem ber 1996
Absfract This paper presents a new nc urophy iologila1 methougrave of e valushyati ng the risk o f p rogression in ill ioshy
mo t important factors in the eva luashytion of progress ive id io pathie scolioshysis The met hod can be lIsed to deshy
pathie scoliosis in th early stages uf tll( progre jve idiopath ie scolios is the dis ase by illY middottigating tll e unshy in lhe early s tages of the d isease loading refl ex in paraspinal muscles T he high sensi livi ty of ilie method The study incl uded 394 pat ients wilh means il can be used as a basis un seo liosis and 70 hcalt y chil dre n which to take an earl y dcc ision to
K D obosicwicz Depuumll1 mel1 l of Rchabi lilu lioll Si lesilln Medical Academ y 42-604 Tamo wskie G6ry 4
Lmenty of the unloacli ng retle x and repeatabi li ty o f Ihe rcbound and silent period were anal ysed for eaeh reflex evoked Prolonged latency and
p rimiddotom1 surgery
Key words Id iopathie seoli o is Unloadi ng rcnex Re bound
Katowice Polaml minima1 numbe o f cycles are the Larency Si ent period
T he ai m of this sludy was to evaJ uate the use of the unshyIntroduction load ing Dex for octcction of prog ressive id iopath ie adoshy
le cem oIios is in its carl s tages in onl r to lake a dccishyProg ress io n of id iopatJl ic scolios is bas been the su bject of
sion ta perfo nn surgcry as soon as pussible many clin ical radiological and elecrromyographic in ve~ shy
tigalions T here is ho wellcr no sim ple quantita ti ve or qual itati ve pro noslic methoo [hat can be em ployed in the
Materials and melhodsearly ~tHges of the disease Monitoring of lhe unloading rc felx in paraspinal m llsck appcars 10 be a reliable Inv gtsi lgnlions were carricd uut 011 394 pa tie nt with adolescent method o f discriminating bctwcen diffcrcn l fomls of Cushy ~c li ed J ild 70 hCldr hy children The scoli osis group consisted of Iios is T he un loa ing re n cx can be evokcd in ail the 31 1 g irl s and 83 boys aged 9-1 8 year~ (mean age 125 ycars) The
ske lelal muscles through a suegrave den shortening of o luntary contro ls wcre 0 girl s and 10 boys aged tO-1 7 y~ar (rncan age 128 cars ) Imong Ihe stlbjeclS tudied wcre 9 patien l w ith cershyinnervated muscle l2~J When a musc le is unloaJ ed vico-thoilc i seo liosi s mean Cobb ang le 22 7deg 121 with Ihoracic
rapidly durin g an isomerric con trac tion Ihe norm al reacshy scolios is mean Cobb nngle 309deg I 1 w ith thoraco-Iurnbar seolioshylion is an eleclrically silent pe riod fo llowed by a burs t o f s is rne ~n Co bb ang le 26~g o 63 with lumbar cotlos is mean Cobb action potentials called rebmmd The pause in d ischarge ang le 279deg and 90 w ir h doubh major curve sc o Ii() ~ i s meull o bb
nng le 292deg and 28 5deg The sludy group includcd 231 right -s ided can be observed only when a certai n h reshold va lue of and 163 left-sided 5col iouumlc patien ls There were 112 patients w ith
acceJcration flnd shortening of he muscle is exceeded progress ive id iopath ie scoliosi (76 ri g hHidtd and 36 Ic 1t-s ided) an tl il occues wilh constant latcncy correspond ing to that 182 with no n-progressive idjopa thic scoliosis (1 13 ri ght- sided and of the propriocepti ve nflcx (9 18 20] T he rebound ufter 6 le rt-sided) M d 100 w ith pe lvic tilt (statie) scolios is (42 rightshy
s ided anp 58 l eft -~ i(kd )the silent period in the unloaugraveing re felx rcsul ts from ae lishySC9 1ios is is consIcircdered progressive if the Cobb Jngle inshyvalio n of a pool of motone urons aIl o f which fClt1ch lhe
creltseacutes by more lhan 6 in 1 yen r aile middotnl1 n-progrcssive if the anshyfiring thres hold simultancously afte r prcviou~ si lenœ [l nua i increase is less thll n (i The Cobb angle ranged lrom 8deg to 77deg 1 4 201 in Ihe palicnls w ilh progress ive scoliosis (mean 361 ) [rom 30 ta
lI f R (on- f Rt tt1IY 1lIfl pflla 1 )(~ r(Jnu n t shy
fI) _ ~
Pathomechanic basics of conservative treatment of progressive idiopathic scoliosIcircs
according ta Dobosiewicz method based upon radiologie evaluation
Kryslyna DobosiewlcZ Jacek Dunnala Kny ztof Czemicki Hanna Jcndf7cjek
Deparmem of Rellabtlifatoll Mediw Uninrsity ofSiltsia KatOllice Poand 40-635 Katowice fil ZiUCl 3537 POL4ND
e-mail relwbilitacjt1s11mfoctaonetpl
Abstract Conscralivc IrcalrnCnI of Idiopathie scoht)~1 espcclall y kinc ilhcrapy i ~
nOI widcly apprccilllcd due 10 Ils suspectccl low dfcCIIcircvcnc 5 in relalion [ (1 a urglcal Irc[llment ACter long-ycar il ses ment of palomcchanic f scolio icirc in Dcpanmenl of Rchnhllilallon f Mclii al Unlcrsi ly of Sile bull a concTvallvc mcthod ()f IrCtllmenl asymmclric Irunk mobili7alion in lnclly ymmelm po~itions WIS
de el ped_Thi mClh d enablc 10 delain pTogression f scol iosis or ccn de middotrca~c laIerai urvalurc of a spi ne and angle of rOlllion assummg adequate () perallon f palicnl and ilS famil)
J Introduction
Idiopathie scoliosi OS) is a thrccdimensonal dcfonnation of il vertebral col lmm an- cntire trunk Afler many years of extensive rescarchcs the cause of idiopathie coliosIcircs $ i remaIcircns unknown It is possible Ihat idiopathie scoliosis devel ps and progress on a baslS 0- ~
multifactor disorder perhaps diffcrent for curve initiation and curve progressi 11 Fion poss ible pathologie factors nervous system dysfunctIcircons affecting postural tquili brium ar proprioceptive control seem to be espc ially important [ l 2 6 JI Pro_ ression f iS could bot delermincd by vertcbrac remodeling under eccent ri c loading created by axia lly ce gravitational forces in presence of muscular imbalancc in the trunk [2 J The verte rai colwrz unde r scoliotic conditions 15 an unstable system with tcndency to fu rther tune dcvelopment fl2] Lateral bending of a vertebral column visible in X-ray examination L
only a two-dimensional prcstntation of a complex dcformity consisting of patho logica axi rota ti on torsion and othcr deformations of vertebrae [7 8 10 II 14J ln fS physiolog~ curvatures of vcrtebra l column are disturbed Total Icngth of an anterior column of a spi n~
consi ting of vertebral bodies and intcrvertebral dises bccomcs grcater lhan length of l posterior colwnn - vertebral arches and proccsses [11 15 J h is apparent that phy iologi ~
thoracic kyphosis in rcgion of a scoliotIcircC curve diminishes Each vcrtebra of a stru tu ~
urve of coliosis is oricntatcd in hypercxtcnsion in relation t adjacent vcrtcbrae [7 l resulting
1 n B Uri middota I l 11
H srut ft illtf j tI) t li orf1Hli d
IDS Prt ts 21)2
Influence of method of asymmetric trunk mobilization on shaping of a physiological
thoracic kyphosis in children and youth suffering from progressive idiopathie scoliosis
Krystyna Dobo icwicz Jacek Dunnala Hanna Jendrzejck Krzysztof Czernicki
Deparrment of Rehabilitation Medical University ofSilesia KaloKce Poand 40-635 Katowice ut Ziolowa 3537 POLAND
e-mail rehabiliracjas(u1poCmiddottaollelpl
Abslract Idiopathie scoliosis (lS) which i sub 1 ntially l threeshydimen ional derormation or a pine cau e nOl only laler l curvalurc and axial rotation of vertebral column but al lordoti allon of VCr1cbrac in structural curve eXl nsion ln an effect physiological thoracic kypho j diminishc or cvcn dbappears Method of a ymlllctric lrunk mobilisation in strictly symmetric po iljon according [ Do () lewicz not only dcteriorme progre ion of IS or evcn reduces lalera] curvalure but also significmtly rebuild physiological thoracic kyphosis Icircn cases of lS accompanicd by lraight baclc
1 Introduction
Despitc Ion year researchc etiology of IS is nOl yel resol ed Significant problem re laled lO morphology of IS apar1 from lateral bending and ax i 1 r tati n i deviation of shape of a spine in sagittal axis affecting physiologi al curvatu re of vertebral coJumn [3 5 6 8 9 J 0 1t 12 Lcngth of anLerior col umn of a pin constitutcd by venebral hafls anugrave intcrvencbral dises dominate ovcr Jength of po terier c lurnn buill from vertebral arches and processes [lOJ This condition uring scol io i progress ion and growth of a child effect in hallowing or even disappearing of phy iological Lhoracic kyphosis in scoliotic region It i well know n lhar cn~brae of structu ral Jaleral curve are positioncd in hyperextension - lordotisation [5 6] which in Lhoracic region Icad (0 reduction of kyphosi or to true lordo middotis Such kind of venebrae relation in thoracic region cau es ilS destabicirclisatIcircon whi h in u sociation with eccentricircc gfilvitali nal load fa pinc duc to muscu lar icircmbalance [21 pOdbly produces r tationaJ lordo is [56 Il] and further development of symptomatic scoHose ft ha becn proven [12J tha strengthening of the erector spinac muscle aggravates nce initialcd deform tion and deteriorates coliotic process Hyperextension and uxial rotati n a s clatcd with
357 Th B Grivas (Ed) Research inro Spinal Defoml ilis 4 lOS Press 2002
Exercise efficiency of girls with idiopathie
seoliosis based on the ventilatory anaerobie threshold
Jacek Durmala Krystyna Dobosiewicz Hanna Jendrzejek Wieslaw Pius
Department ofRehabililation Medical University ofSiiesiaa Katowice Poand 40-635 Katowice m ZioJowa 4547 POLAND
e-mail durmalaiacekyocztaonetpl Department ofPhysiology Academy ofPhysical Education Katowice Poand
Abslract The aim of the study was to estimate the exercise efficiency in the group of
girls with idiopathie scol iosis based on the venlilatory anaerobic threshold (V AT)
Material and method The investigation comprised 58 gi rls wilh idiopathie scoliosis
aged 10--6 years 32 girls (55200 ) wilh double major scolioSiS and 26 girls (448)
with single scotiosis The girls were eonservatively treated using Dobosiewiagrave
method The control group consisted of 3 1 healthy girls aged 10-1 6 years The
cxercise test was performed using eycle ergometer During the exercise the gas
exehange parameters wcre reeorded (minute expiralory venlilation minute oxygen
consumption earbon dioxide production) On the basis of recorded paramcters V AT
has been computcd using V -si ope method Results The following V AT values were
obtained in the group with scoliosis 207+305 ml 02minlkg bm in control group
219+350 ml 02minlkg bm The differences belween girls with idiopathie scoliosis
and control group were nol SLaliSlically significant Conclusions I The exercise
effieieney of girls with idiopathie scoliosis conservalively treated using Dobosiewicz
melhod is normal 2 Such high level of the exercise cfficiency of the studied group
probably was due to intensive 3-D respiratory exercises of these girls
1 Introduction
In practice there are researched useful efficiency rates which on base of laboratory tests results possible easy without using of the relatively hard or long exercise tests would give the belter forsighting of the range of homeostasis disturbances and rapidi ty of increase of
physical fatigue during varied workloads [1] The best known rate of trus kind is the maximal
minute oxygen consumption [2345] During progressive physical effort minute oxygen
consumption increases proportionally to workload The reaching of real maximal minute
oxygen consumption in time of progressive effort is iodicaled by minute oxygen consumption plateau [5 61 This result is rarely registered in children The progressive exercise test is most commonly used in children until physicaJ exhaustion and the highest registered minute
oxygen consumption is treated as maximal minute oxygen consu mption or so-called
symplomatic limited maximal minute oxygen consumption [678J Sorne authors regard
Orto-dlet Trau malaogis Roha b ilitacjaARTlKUL ORIGINALNY ORIGINAL ARTICLE Vol 5 Nr 1 2003 80-85
Jacek Durmala l Krystyna Dobosiewicz l Tomasz Kotwicki Hanna Jendrzejek 1
Katedra i Klinika Rehabilitacji Slqska Akadenia Medyczna Katowice Katedra i Klinika Ortopedii Dzieci~cej Akademia Medyczna PoznQll
Wplyw asymetrycznej mobilizacji tulowia na wartoseacute k~ta Cobba i rotacji w przypadkach skolioz idiopatycznych u dzieci i mlodzieZy
Influence ofasyn1n1etrie 111obilisation of the trunk on the Cobb angle and rotation in idiopathie seoliosisin
children and adolescents Slnwu kluce ac eJJic Cl chOlIU) Ice SKoio= idj)PO Imiddot(~I7tmiddot
K~Jmiddot w()rus consrieI ve I (OtlHelif idiopathie HUW JS
SUMlvfARY
BackgrouId The aim ofthe stldy Vas Ihe radiological evaluation ofthe treatllJent ofthe idiopathic scolioshysis utilising as)mmetric trunk mobilisation in the strict~ll I)mmetric illitial position
Material ([fJ(f lIIellOds Presented stud) lOS based IIpon J36 cases (13 oovs oged FOf11 ocirc la 6 lcars (lild
rn girls aged frum 6 la S pears) trealed due to the idiopathie sCuliosis ((rom Novell1her 999 0 F enflfUn 200) Among 48 ch idrcn sllfJering from dOlfble-major scoios is 6 cases wcre infoll scaliusis JOjuvel7lle und 22 adolescent Among 88 sillgle scoliosis 6 lere infw7t 33 juvenile and 49 adolescent
Radiological exami71ation 1as condueed always in the repeataole technical cOlldiions RadlOglOlI1 lier evaluated oy the same physician Radiologica analysis oIthe scolios is incuded value ofthe Coho al1gle ongle ofaxial rotaion
ReSIils ln double-major scoliosis observed dlring one year period in Ihe thoracic segmenl Cobb angle decreased inll l increased 1395 and in 292 Il OS 111changed Axial lolation angle in 167 (~rcascs
decreased in 354 incrcased and rernainM the sorne in 479 In Ihe llllnba segmenl Cobb ang le clccrcscucirc il1 354 increased in 39 6 remained in 5 Angle ofaxial rotation deceoscd in3 ofca es incrcuscd in 29 and persisted in 48
ln single scolio is Cobb angle decreased in 386 incrcased in 353 and in 261 was lInchonged Axiol rotarion angle in 216 ofcases deceased in 295 increased and rell1aincd the sallie in 489
CondlsioJ Asymmetrie mobilisation of the tf1f17k in strictly syl7111elric initial positions is a 1Clhod of choice in the cOl7senJalive treatment ofthe idiopathic seoiosis
STRESZCZENIE
WS~p Celem pracy jest radiologiezla ocena Icczenia skoiloz idiopaf)cznych metoda asvmetrycznejl7lOoili shyzocji tllowia w sciSe symetlyczl7ych pozycjach lV)jscio wych
M aterial i metody Przeprowadono retrospektYlIl7q analizri 136 przypadkeacuteM dzieci (13 chlopcow i 123 dziellshyczqt w wieku 6- 18 lat) z bocznym idiop atycnylll skrYll ieniem krrgoslupa leczonych zachowawczo w Klinice
1
Ortopedla TliJumatoogia RehlblllagraveeJa ARTYKUL POOL1 DOWY OPINION ARTICLE Vol 7 Nf 1 2005 49-$11
Krystyna Dobosiewicz Jacek Durmala Tomasz KotwickP
Katedra i Klinika Rehabilitacji SIAM Katowice 2 Katedra i Klinika Orlopedii Dziecircej AM Pozncrlz
Biodynamiczna metoda tr6jplaszczyznowej korekcji skolioz idiopatycznych - opis metody Biodynamic method for 3-D correction of idiopathie
scoliosis a description ofthe method
SIOWQ kluczowe leezenie zachowawcze skoliozy idiopatyczne korekeja tr6jplaszczyznowa Key words conservative treament idiopathie scoliosis 3-D correction
SUMMARY
The biodynamic method of hree-dfmensional carreeion of idiopathie scoliosis is based on Ihe palhomeshychanics of idiopathie scolioiiiii and consiss in aClive segmental three-dimensional correction ofspinal cllrshyvatlre The course of action focuses in the viciniy ofthe apical vertebra Proprioceptive facilitation is applied on Ihe concave side ofthe curvaJure and exteroceplivefacilitation on the convex side Correction likewise proshyprio- or exteroceplive facilitation is phase-oclœd with asymmetric respirarory movemenr as weil as wilh parshyticular phases of the respiratory cycle ln Ihe course ofexercises three-planar movement is generated opposite to the direction in which scoliosis Is progressing This method is in accordance with the stale ofthe art ofscoshyIiasis pathomechanics The method requires detaied training and can Ihen con be applied at home under periodic control by a physician and a physiolherapist The method con be applied in landem with a Cheneau brace as weil as in surgical pretreatment A elaUed description of Ihe method of three-dimensional scoliosis trealment will be presented in Ihis article
STRESZCZENIE
ISlofa biadynamicznej mefody Ir6jplaszczyznowej korekcji skoioz idiopatycmych oparlaj est na patomechashynice iikolioz idiopatycznych - poega ana na czynnej segmentanlej tr6jplaszczymowej korekcji skrzywienia Dzialanie koncentruj e siccedil w pobitu Icrllgll szczytowego sknywienia Stosowane iest bodicowanie propiocepshytywne po stronie wklllsej oraz eksteroceptywne po stronie wypuldej Korekcja i slosowanie bodicocircw propioshyi eksteroceprywnych zsynchronizowane j esl z asymetrycznym torem oddechowym oraz z poszczeg61nymi fazashymi oddechu W trakcie eacutewiczen powstaje odwrotny do lrierurzku rozwoju scoliozy tr6jplaszczyznowy ruch IcrFtshygoslupa Melodajesl zgodna z aktualnym stanem wiedzy na lemat patomechanizmu scoiozy nymaga szczegocircshy100-lego instniktaZu po clorym mote byeacute wykonywana w warunkach domowych Z olcresowq kontrolq przez leshycana i fizj oterapeutll Metoda mote byeacute stosowana r6wnolegle z leczeniem gorsetem korekcyjnym Cheneau a talcte w przygotowaniu do leczenia operacyjnego slcolioz W pracy przedslawiony zostal szczeg6owy apis meshytody leczenia
Skoliozy idlopatyczne stanowili znieksztalcenia patycznej rozwija siccedil poprzez przemieszczenie kr~gu tr6j~aszczyznowe charakteryzujltce siccedil wyboczeshy szczytowego w stosunku do krccedilgu g6mego j dolnego niem rotacjltt krccedilg6w klatki piersiowej i miednicy z r6wnoczesolljego rotacjl zgodnie z ruchem wskashyoraz zmianami w fizjologicznych krzywiznach kr~ z6wek zegara dia skrzywienia prawostronnego oraz goslupa w plaszczyinie slrzalkoweJ [ 123] przeciwnie do wskaz6wek zegara dIa skrzywienia leshy
Z punklu widz nia patomechaniki tr6jplaszczyshy wostronnego Koncepcja rozwoju skoliozy jako rotashyznowe znieksztalcenie krccedilgoslupa w skoliozie idio- cja i kontrotacja sugeruje ze sily korekcyjne powinshy
49
EDUCATION MEETING SATURDAY 8th of APRIL 2006
- CARDJOPULMONARY EXERCIS E
TEST IN GIRLS WITH
CONSERVA TIVEL Y TREA TED
IDIOPATHIC SCOLIOSIS
Jacek DURMALA Krystyna DOBOSIEWICZ
Department of Rehabilitation Medical University of Silesia
Katowice Poland jdurmalaqcmpl
The aim of the study was
to estimate the influence the conservative treatment (asymmetric mobilization of the trunk by Dobosiewicz) on physical efficiency in the group of girls with idiopathie scoliosis
Material
bull 87 girls with idiopathie scoliosis
aged 1 0-17 years
(mean age 135 years SO 161)
J Durmala K Dobosiewicz 1
EDUCATION MEETING SATURDAY8thof APRIL 2006
Material
bull 38 girls (437) with double major scol iosis (thoracic segment - Cobb angle 18-42deg mean 30deg SO 82 angle of axial rotation 4-32deg mean 21 deg SD 107 lumbar segment - Cobb angle 11 shy48deg mean 31deg SO 128 angle of axial rotation 5shy30deg mean 13deg SO 85)
bull 49 girls (563) with single scoliosis (Cobb angle 11-75deg mean 33deg SO 155 angle of axial rotat ion 5-30deg mean 14deg SD 83)
TIoracic kyphosis of the invesllgated group was 5-39deg mean 23deg SO 86 and lumbar lordosis 16-41middot mean 30 50 65)
Material
bull The 64 girls aged 10-17 years (m ean age 131
years SD 132) were conservat ively Ireated
using Dobosiewiczs method
bull Treatment period ranged from 5 months 10 3
years (mean 148 months SD 902)
Material The 23 girls aged 10-17 years (mean age 136 years SO 108) were treated u sing symmetric exercises - treatment period ranged from 4 months to 3 years (mean 161 months SO 1019)
bull 26 of ail g irls (18 girls earlier treated using Dobosiewiczs m ethod and 8 gi rls earlier treated using symmetric exercises) aged 10-17 years (mean age 134 years SO 108) were twice tested - at first and last day of Intensive hospital rehabilitation (asymmetnc mobllization of the trunk by Oobosiewicz) - mean hospitalization period 20 days (range 18-26 days)
i rf~8f6~~ or~~n~= ~~r~1~r~icircJ~~tb~~~~ mean 17-4 1deg meatl~(I SO 74 R n~le ofax 1 rotatIon 5-25ot mC3 111 3laquo S0 6icircl Ilnd 1 99t1S~ ~~~~I~~~~~$ruo~ras~ ~ocirc~~a~e~~~~~~~5euml1 9middotn~ tUfllbar Iord05ts 16-4 1deg mean 311 SO 68)
J Durmala K Dobosiewicz 2
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Material
The control group consisted of 77 healthy
girls aged 6-17 years (mean age 12
years SD 31)
Material
The examined girls participated in school
only in scheduled physical education
lessons and have not been enrolled in
other sporting activity
METHOD
The exercise cycle
ergometer test was
performed
J Durmala K Dobosiewicz 3
EDUCATION MEETING SATURDAY 8th of APRIL 2006
METHOD
The Incrementai exercise test has been applied
We have found that tests ln whlch the Incrementai part of the protocol ln completed between 8 -12 minutes duration glve the
bullhighest maximum VOz in normal subjects
METHOD
The workload was Increased stepwlse
bull by 10 Watt every minute - ln chlldren
with high ~ 135 cm
bull by 15 Watt every minute ln chlldren
with high gt 135 cm
METHOD
The test had been contlnued untll refusai of the patient or exceeding the pulse Ilmit
Durlng the exerclse the gas exchange parameters were recorded by Jaeger device model Oxycon Alfa uslng direct breath-byshybreath rnethod (with face mask)
J Durmala K Dobosewlcz 4
EDUCATION MEETING SATURDAY 8th of APRIL 2006
METHOD ~ ~~ r 3 min 3 min 8 - 12 min 6 min -~
_ 0 rpiYJ 0 rpm 60 rpm ~1 30 rpm
_ t o~w=att~o~~na ~~ att__~ tl~~S~~ l ad l ~~~~~r o~w= Hlcremenlal t
pedaillog i i ~
~ ilt ~I~-----tl-~ I t ~ i ~ lOSt sffortivB
lW r resututlon r rm-u middot 1 - bullA~cremen tal ~~ ~ ~ ifr- ~ VtI 1 ~i ~ tllng _
METHOD
On the basis of recorded parameters VAT
has been individually computed for each
child using V-slope method by
Wasserman
METHOD
For assesment of physical capacity
the maximal minute oxygen o
consumption (V02max) ventilatory
anaerobic threshold (VAT) and
maximal workload was used
J Durmala K Dobosiewicz 5
EDUCATION MEETING SATURDAY 8thof APRIL 2006
RESULTS
Ali girls with 18 have been classified
within normal range of predicted
values of
bull maximal minute oxygen uptake
bull VAT and
bull maximal workload
RESULTS
The differences between group of girls
treated using Dobosiewicz s method and
group of girl s treated using symmetric
exercises were statistically significant
Lower exercise efficiency of girls treated
using sym metric exercises has been
observed
RESULTS Girls wilh IS Irealed using
N=87 p value
Dobosiewlczs method N64
symmetJic oxor-ci Nz23
Perœnlage of predicled vaJue of
maximal minute oxygen uptake
98 905 0033
Percenlage of predicled value of
VAT 97 933 0049
Percenlage 01 predided value ni
maximal workload 101 939 0038
J Durmala K Dobosiewicz 6
EDUCATION MEETING SATURDAY8th of APRIL 2006
RESULTS 26 girl s twice tested - at fi rst and last day of intensive hospital rehabilitation
The value of ventilatory anaerobic threshold increased during intensive hospital rehabilitation (asymmetric mobilization of the trunk by Oobosiewicz) statistically significantly (p=00019)
2047 ml O2 minkg (SO 268)
vs 2239 ml O2 minkg (SO 232)
Conclusions
1 The exerc ise eff iciency of girls with IS treated by asymmetric exerc ises of Oobosiewicz is norm al
2 Such high level of the exercise efficiency of thIcircs group resulted fram using of Oobosiewiczs method
r
J Durmala K Dobosiewicz 7
REVIEWS
Role of physical exercise in tbe treattnent of mild idiopathie adolescent scoliosis
Revicw of th- literature
A NECRlNl N VElWNL s PARZI 1 A NEGRINJ 5 NEClU NI
P1t~silillxlrd~ Ihcrapy (or klucgtlttlwrlpyl i pro shy-tJm of physka] cXlrd-cs ipcci I(a~ (IJcloJgtcd hy l li trIWlltl phrslollwrapbt wilh tb m~ln a1mor pl shyVCnI in lhe ilAAfIVltilH1 llf the ucirccfonuity III mild IgtC )
Lil1Si bclpin~ thebm ( aocl co uaufllclilIg ils ~jd- clf IS in nlOdlJmiddotnh-culiosis Th middotalillofthi paper ito r (W
Ille Ii lc ram r 1 a-ccrulin wh kh of Ih bull Lu[Jalmlcrus Ind (Lb hili til~ CLlLt-cd br scnli()si- clluld bl pl Y nlcd or r d uccd hl phylolld LXtmiddotrdsi n Il p--to-da le knowl Uuml~l nr tIll~C aspcc[~ i ne bulled in oruer 10 dndc whclh~r 11Rf blLl adcqlmtt Ib(uuml n middotlicaJ balis fo r ora)aini l Ihe US4~ of lUgravellgtitlerap) wltcllj(r or fln l th e prtl1iœ of kimiddot ~lre IUlll poNjn~ a t iil ies ~bould h allowtcI II uuml middot c enliaI toltlentlf)wh k lu alClor ie - lf pl lr~kiJl -c rmiddot d gtlt- (Ic rnnhi UzJ( inn ni (t hl HrJltlon [ rtn~hcll iJl ~ or 1i1J(IChIumlJlJt etc) Sh llU Ld be TolullllCcluse ulemiddot l onld b- clclIimcntalancl wukh sho ll ld he IJlI-n~ifl~d I~~a l lhc (o uld h 11lfu 1 Know k dg CJnc1in t (wIn SeiCIImiddot Hlk rCS([lflt h daw ccordinll to Ih bull llVit w o f tIlt iii 111 1( plop(lsltd in (h i papcr lmiddotonllmJ l lnl plLyi 11 cxcr(j$( pn (nti or (tmiddotduce dhlblli t ic 1 ~lt Il Jj ll(k pl ti Jlt fadl j w(~ the nlIIIrl li7alinn n f poMural dd shylitS tu p n xJ llc aSl COIlMqnen c(middot 1 all )llal) or r(tn~ shys i middot middotlIrve Tilt u~c (I f appn1priattmiddot kincsiuuml wrlpy 0 in rcns polttllcal swhiIHy Icirc IIHmiddotorc Illta ll y (0 r 1(lt1 lllho UAh mon ltlccurlltc 1Ut dl1alkd -rLk l(lWfils 111111 )11 h Jlccdt(
11) wurcJlt 0 lit)-IcircS (Iumpy - x rcLs P()lun
n rllt lT(ltnklf u f COll1tlK H (rtd) I 1i plfho l og l ~$I rUlglng tr m low tmiddot k Pl 1l1 to IdiOpath ie SCUIshy
Submitt(oJ [or PUhltCl l1 011 uly Tt 2001 Acc~pttJ ugu - ~2 1(t-1l
Addre rltj-xlfll telt~I(middotb If) - grinl Flt(1(bziurllt r )(m Ofl ()(Cl1I shy Lt middotqlltœlll ro () - 1u I4t agravehLIlKil ta IYIL-lTt ilSllltp lfllmiddot ~ 1l1uumldull
CelII ~ (niiOS I I~ middot ann (1) IfUh middot lIlfU di louhilll(tymi ( Nlmiddot ~iI rli -ilIIUmiddotltlfl
Nlti(ir 1( ) il r() (ltbullagt1
lt vLL_ l IiII no 1ftfI
jS ) we are a IUil ly tJc ing n1n) ltblll lS 1 k l1 b ~J)w in~ tl~ t S Jfll l approad llt - l1n til hy on ielshyertd ~tan lard ugraveJuld ln m any ~1~ he lI ~t les i if Ilot dange r )ll lt rhlS is lrut of reil l lnw 1gtlt1lt1 pa in l ~ or 5urgi c ll lrea lmltnl5 in dbc r lmiddot ll Sc - 2
ln tlle cj-e ut ~ t lll(tlWtl i( li p l ll1JC luuml- I ~ middottnl ~() shyliosis phys cal ((_lt1(( is emr1uved ltI t()fIl1 0 lh~rtrv
lo ly in cel1l in L)lllllde (nluumlnlr in tilt Lltlll middotorkl i e Iw l) r llt t Srain hUI IIgt() 111 Gert11lny 5- 1~1 in other reg lOl1 wbere thi I-incl qf tre l tm e rll 1 p~ 1 pmiddot t 1( cI il Jws Ixen cri ri cilld md rel -cltd Lw m~lI1 1 11 Jlu~ Fue Fnlny r ~lrs thio middot15 a lsgt(ru( f ~rth r -~ltc rrJtf))~ ll t vit11 br1Cltcgt b r II1 ([C Llt n ClW grmvlng 1lt1 0 L Sti g
gcsti n the lIsefulnes- u r Ih is form o t treatm n t 1
Hmiddotu]rs have nerged jn El or uf pll y~ iLd eegraverdse eacute 00[ 1 but tlw are nUl yel 11 11 t llu i vIC~11 and r hi ~
f rm of trt ~ltmenr IS stiJ l Ul1 ckf ckhate FfI t Jt 111 il i 11t (eltary td 1I iFy 11umbtr ot
b l sic COI ceP rlJ lf w ill he cIh tt d in t hi pap r
Scollosis
DCijIrI iriolls
ScnUoSlS is Irlircc c1 lme nsIcircltnal (I(gt i l cj on ot tht spinc thar cau C a CU 1 lh lt ca n h e $ t~en ln (1 me1Sshy
ured ultinF Coh) lll ltllCXI o n HI anreu middot p rtc rilt r
EUJlOI -1 lœDICOPHYSlc~ IR
NECRI Nl
110
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FigJ----jllph ot DlI w l-lkaupegraverel) The agloimvltltinn Or idio r lrhlc 50gt1iflll~ IS rpiJ bel~ en th e- [l0 IH P (l)ltg tnntll lol (JI PUllcmiddotny) mtl 1 ( f( lS-er sigll paiilivltecirc lt Dlt(i I1 11illg r the iti l 1Kgt n n t rll icirclicH a ) 111lt m omal prebulled the mno rche md ociks with lll I)ttlx flal gr Ih pll fl
rlcljoprdphLi 1 hl merl prestIK ~ of this curvt c10es n t autom~l ritllJy indi ate the pn$CI1(t of a defurshyTnitv (SlllKtUrd (Unel
It i~ possible tu clil1e ren tute a struCnlt t CI1tve fruIn a pogt urll 011e by identifyi og the hum]) du ring AdIlns tesr I~OQ looklng tra m beh lnd at the p atient w ho b benchng fUfward il is p -- ible ta d d~ct 1l1 eh ucirc n of o ne liidlt 0 1 the trunk usually n n the (onvex ~ jde ul tbe radiographie CUfve Ugrave1lr C Ul be mlt~I Slred lISin~
BUlln els S o liomere( 1 ~ l This h Uf1lp is du(- lO (Ile pregravegtecircn ~ of vertel ra i rolltion 1c1 Ollt tn tic f~YJ tllre o f the def trrnit tli [ c m be seen and measurc(i v ith Perddolles lb lsLometer on an amero-Ix)iferior radioshygrapb ~2
Seven ry pel cent o f li Ises a re conid 1lt 1tO be idiopa thie 1 bull ia l-nosilt in this CI$C is b exdlls i ~ n as idinpa thlc me-us t11H wc do n()[ know rJw origio of lheacute curvc [n othe] ~Ie$ it b Ix )~i ble ro ide nrify a dieak (bat CHl jusrify the c1etgtnniry slIch a rna lfo rshymar i ns I1(gtufol Ig ic~ l or genlttic cl iscas s Glnclt~r trauma etc )
[dicirc)parhk S(oliosis has been divicled ~(corcling (0
the ~Ie of tlie patient egrave1l the tiJ1ll of d~[ccli n of the condil ion into ti) ur t ypei ln fanUlc jU nik ltldolesshyccnt lnd aduh Til l m n st cnnunon (VPC IS the acloshylescegravenr o licirceacute I1IJctenzec1 hy 1 sud le l1 tggrH3l ion uuml uring the grow tll Spllrt (Hg 1)2
lhile p tu 1l sco liosi i5 Ycry lomnw n thl pre shy~Iknct ra te f r adole ent icuumlop~lthic structural CU IY~S in sch )o chilclren are 18middot20
- 10 Co bb d~grels o r m on l -lil
- 2) ~ohh dtgreclt or mort O 2~j - bull () (obb d gre -s )1 mOfeacute ()ll 2
Clin iltI [ d e isio ns lfl IXlSed 111 an lccu r~He pregshynosi which obt inccl in eJch pa ti nt mainly o n the basi of the nsidu~ll p()tlnllltl l of TH1h and the result s of 1 rh clin 1 1 ~l1d tadiogmpl i exlminashyti(ln12ll c noieq uentlya d inica ] la sifiou io n o f the ing le pHient tn -ome estent co incic1 ing w irh the
D diographic one c l n lw SLlIl1H1arizeci 1 1 folIcJ - mikl lc~ (1)(n 20 C bh de~r es - moderJt l betwlen ln md 15 ohh de~ rtes - StV re 111( gt1lt rh n ~J) )bh (kgf s
On the 1) lsis of [hi - dinic d d a lfic t i n (Vith l1l il el lrb tiOI ~ o f the ir b() und~ri e ) in Itllt l cente rS Of SCOtiO LS ITe ltlllent in the Lltin odcl (i rJ Ital lnmct md PI iJ Ugrave tre tmtnt i s plmmcd a fo lltJw 8l
- mild kineslth e (~1fw ~1Il (1 luok-ou t - Hl demte IJragravecegrave 1111101 c(~r md k i rws ithe lJpy - ~cven surgery
Physical exe rcL~e for S(ol iosis
Defi t tiOl l S
PhyS i 11 nU b lIKrlttp middot (or kines ithcIa Pl) i a p rvgrlill or plt~i Gl l (xeriltecircS ~1ci fi ( llJ y ltk ~ loped
y a -11 [ru ine 1pll yslo ther3pisr wirh th e m 10 Hllll
- pre (~ n tit1g tlc aggraaLion of the cl I )flnily in rnild bullcoUm is
- helping tlk Il ld Ct ~lOd ounter~lCtjng its skie elfects in III de rltegrave sc li sis
Tn tl1i_ feSpec1 kinesitl1ert py f JI s oliosis is tonshysider l a o on of peciticcedil training and s genecirc tltllly proposelt in sessions 0 1 4~ ro 60 minute IW) t) tour limes 1 Cee PhysiGtl exerci es can aLo ll v o ther auumlns 1S it oill he dise Issed in this plper
Ir 15 Ilot possib le to cl escribe a single progrlIT1 o r exerc ise a5 pro nrams ale USLIJUy p fgt nll ized ( ( lt
EUH PA ~illDI (DP1I YS IC~ 182
ROlL UF P l 1YSICAL lXl 1lt 1~E IN l IlE 11 ~l) IEd If IlU) l[)VP 1HI AIJ() J)~Cl~ r COl ~I NlG1W il
f)( 15 egraved ( )Il the nee L- 01 indi iuua l pJl itnts) al l l10ugh Lheacute) C l n h t 11 plicd o n a WOU p hJ~js (-1 (0 () pnients PC[ ~l ()lI r)middot lugrave reQCf lhese 1 10 grl lll frequt ml~ V IIT
hnm on in middotituk w allClthltJmiddot -Ill Jnv L l~egrave at Wc w Ht ~huw in lhis lyl peJ it i~ 111 n u -eII1 tu id e ntilv kirK itheJapturlc aims w hitl l ucircrr~spnd LO ugravelt~lil1 DUtshy
g X ir ur ph -s ici l lxtTi~l I~llhe r thln ln dj( us- indishyiJ u1 1progr-lfll
Aduumll l lxUl kisure time ~lOd h )u] Sp u lllll8 ~Ilttishy
i lt egrave~ i middotomm )Ly s iven lel mJ ing ro w hlf ~ Iuumlnsidshyer~d usdul or il lrmfu l in t1 lt rruning (lI tJw ptliJicirct ln tl1bplper Ugrave1 gent ltl l t rl ll bull p lwsiCUgrave lttG iviUes is rl ktll 10 JllI1ltlCc hOlll gtpOlt mJ kIJ1lsIcircl hc lJ l f
i ve lUen tloneumld )bo C on lv ine n dul( re Ull~ 1t~1 t s far Ilten publislt d f I~ mJ I(i noltgtithltl rgt is 11 11 a su h jel lnI deacutehate CJitk haltlt t llltit m itn ltl of l ny lorm o t p l1 ySiClI lxrcL e as a Itwr1 [ J- fo r i liopa tb il jcoJL~b un iL ()ri gin~ initial1) it WIS Ille r rOmiddotUumlK lt brgdv u f p l~lt titu gtllergt w h ) intervenecl hutll tc llcrl ll (mon as cltl HtilJ nic in terventi n man Jgt
1 t lltrJp utl t one 1 md rC j fkll l~ on rhe h sh lf som uni cOen I1v pn t I1cgts wt ldl hll ltl enl1 JI~ haLl nu na l scicnt lfic baisYmiddot HOlh tlle$( trr t peu shy to rh ~rl py tt nJecI to l~~rJ tte C Ih tk CUf -~ pnnshyclr~tll y as a f tsul t of lilo h llIzatio ll of tn imdqultdy ~u pp rt(d S pln eacute 7~ 12 to re-t1 r rI ltrl 1$ l l1C k o f WH llt~~rdl 10 I ndt~-dll()urnah tnd 11( on1 p~l per u suaJly Cl tc([ IS n prelimmtrf lll d 3 ln tt li w ay man (l rrlKpt(Hc H lf O iS Inll ph ~i C U l ~ d vi ~ cI nllog scnliotl pa t le nL~ 3gainst holll ph lca l egravexershyclc and p()rt~1
It m u st t~ n tfd [hat pllyknl txerc j~ tJe~ltm(nls t1iHer 1 lJ rd il1g r rhe rherlpcu tlC litTl~ on lllc h tJ rgt ap p lolc il l the IXlltent lncl hi im r IIIllHnt i- 1 (1(1 rI - 5lt1J lC igt tIl l ( f phJllIlllolopJ al rrea tmln ls Ihith cllffc r 1lt œQlfd- rhe m C cculc u ~t(l luI thl p al 1t n
~mc l 11i (lbE~e Tt i ~ P ~il k tlwreI[middote thll wuumlk ltlll t kin 1or ph~ i Clt1 1 lX r(j~ 1I 111~ t bc loidvd by t h~ Lo iurie IxujCJ1l al1ulhcr a dl ~IS nJI h~ iOg (1 11shygerols llugJr in racr le (wi ller d I ~fJIII ~ I ml thlls re(nl1l rn ndc(1
fn n UI cel1ll r we In(~ hccf) using 1 ) 1 1111 11 ve ) 1 (J p lw l icd ex(r(i~e (0 J ( 1I l tt i~ tlh aITt ~ l~d Ilv m ikl tru cflumiddott1 adokscltnt (cl ioj arh lC icoli is11 2)
ina the f U~ t rc-gt uJrs IefC pu b lishe - the pJ( )grd m 11lt1lt l1te n PWltllk d in fa c t deel()pnlln l~ in th t l itshy OlL1Ii in tl1 r b t ~() ycal f ha ve iclemi fiecl niO l l
m d 111 ur impl rnHm s md d i s )h ilir i (gt~ lue t idlo p lthk amp()lio -i ~ t Jll CIII he 1UO(l if Icirc 1by phyict1 egrave xert iSlgt l fe t rrncllt
l illl
111e aim of t l1JS r~l per ii tmiddot (tv iew tl1( l iterat urt to a(errl ln v llic ll of th~ impa irm 1t~ and Liit hil it il i GllIltec hy ~ o l i()gtj s -o ull he ll nt x or re middotlu celt1 Ili pl1ysical xerclse An u p-to-da te knOvkdge o f tl lt Lgtpecl-gt i necckC1 in rJeumlr) d -oek
- whetll~r there h ltl n adLtIIl ) l tht()d ical bbh fur or JqIIcirclb l l l1 Il( ) f k irt llit herlpy
- h N I)(1 ( 1 Dm tlle p r l c tIcirc(( o f Jebur tiJne )pOfung lcli v l ti ~ IIOU lci he tllf) -d o
II J U V f h 1 I11~ c~~lb li hed Ihe usefuhlLss 01 k il1 shyc ~thtrpy il i aIle dy l nsi 1([(( -r-tI Llleu i n )I11 plJt~ ut the wJrld ir ilt ecircS~nl i 1 I( id n Iv w l1i li ( 1shy
gories 0 1 pl1Vtl( 1excrClgtegt te D)bilI7it ric 1n (Ir st shylliuumlZltio f) lttlt tlgtbltn ing ni trcrccedilh ing erc) hn Id be
vnlcled he tll rhe nuld be lerrillldll1 1 md whidl s tlQu1d be inreœ jf ic(1 IJeClU~l tlley cOli lel Je LI ~ful
Ncuro1llotor impainncnts
Imv aUl llOr~ 11 lt1lt ~tlKlteJ lhe cltlndatiotl bd Ween tl UC1UmiddotIt t l ol(~C t nt id iopml je -nll ~J~ and cli~l l shyler~ lr 1tH lest ihuLIr yt 1 _ 13 ~ 311 D uhoussct 1
1-- ITS tln l ldiopath k s(o lio-L L cll -c d l J l hmgt in th terl tltr f prop li l l pu n md 1I1ar th e detrshyn Hi n i~ na tural 1 ~ronse to ril e need tu ts tu re p()tun ltlluilib riu Ul HcrmJJ1 31~ 11 () d tllat icliupathic ( liCl5j h l it re5u lt Ot1 rw nltuf mot r l ~ltelV
[Id )fcl 3 nI] ~1ltJ U Sr1lle nr to dtorders in centJtI lO~Cl shyIOIDNur) md 1xi~tI moro (Ul1lfOl syt( llI (Fig _l
N htIll -of) H1c S uumll h( rll1 ( ~ l( w ing JI t11 (oshyI-ie on the l l lO]ugy o b doll (nt Rl iu]icirc tlili- middot()lioL m unt fil t-hltll rhl ugravedcmnilV L th e fl5 ult o f 1 (k btcl 11lIFll llI ion nf som t11(WUgravetltnl md pO~ lur( (tnic l~ l licirc1 tl1lt if l p OgtlbJt b C 1l rlw sta l i lin 0f 11 1 Sf llle j lt g )tx l Tt) ohtil n a ))Cli U 1ILzltl I o f p ~llIr~il d l~flo [ in l1litkd ~J)llnSIS me CI Igt(middotqucnr J ~ a ~tmicirc ()nlly or regle Ie Llive
Ali th- 11yp ) tlw~es rd ~lte tr d irtl Itn t pnl1tlt o f [11 v hole ~piltm It11[ controls postu re ~nd mrw shyment lrre pell ic of tlh po int a d lI~ llv inH llYegraved il i ~ ll 1 nnable tCl aSUilll ri 1l tr l ll1 lo g thi ~ys ttm ( Qu it le 1I middoteli tl
lt ch ugt nlt~(S f rullliIl thil i nlomwtion th at p tlmiddot shyiCil J(tl iIies nw gt Il lInport~n t rr le to pbv [11Icircgt role ca n 1)lt slI i11l1lariztd ln lWO the ptu li ain Llt
- d elopmll1 l of p uumlltl St1 b Hlt ) - c1e veuml IOpm 1)[ o f bhll1ltc _
(k llhUl)lOr S Cll orr
ontrot oic whan-lt
------+ 1 ~ il lnll ugrave r AINnl
Cllnlr1
T bflt~ r
fltL1 tlli
lMini
l
~sary ~J-frlllen i )f
~ 1 ocirctnl
~UcirclllIJJlW Ll
AXl ~l1 n uumll l) r sy 5t ~nl
middoticoltoq ~ Fig 2-AcFgtrdong lU He-mutl 21 il is Fi)5~ ib1e rD prolXgtSlt l -oo ie1 mnd 1 ((if ~ elio egrave middotAhltr~d l)Qdy-p ati~ I I i u d) uren ttllOn k td LO In ~ory reHTt I1 eDi tn l al ) JdrnlV~ pn)4~ e l u r~o(Ofe 0-c1 eptunl dvstil t1 ctlon sltŒ(ry icircltu nu11t ilwnt [ ~mC ~ted tl l1 ce Ill trpntlshyUumlfJJl nd IKnle~ r~dibl jtugrave)n of -I) m tlosen Ir ~ig nj tl (I1vying ln fornll1U n (lI an ereltl ~piJl e Mmor aJJ r--a t ~) n ltgtf ti lt aXljl mowr plem iHUC Wh ~fl Ille 6ubjeco m uumlntl Icircn (1oJifitd perccpfLlI l ~na l ysilt of p n)lnocepti Icircnfu rnlaquol ti desnibJOS ~n t tecr spin A IICW motor co nrro l Ira I gy t adopt resu ltin~ in the ~tr ltctltr 1 ckformh y lf IdiopathirL scollos i=i Ht lrftU1uc nltnt l ISll I1lJy h1e- ~ I pro()und elkn on bralO Sfem flJll ct i(lnn~lLhu modifyRll Ille nltulltgtshytl10 ) 1 1111 Uu l-lHoror control 5~Shnl$ shy
As Srtgn1lt1 l ~ ltlssert~ if wc l C -Cp t 111 1 un o f the G IiC s oliosls L l tisorckr oi th e ltquilibrilltn sys t ~ms it is lagical to oriegravenrate physlCl l exercis( lherap y ln th is d ir(gtCli()[1
11lclte goals Cul tl lfOUgil ditrercn t modes 01 action be Olchic(-c1 witJ1 phykal accivit ie
- po rt ive Cll ities p ro ct LJ e aIl UgravelClltrtsc in 6lte nshyel ll )o rd in~lti n pinai pr0prinup ti_)[J nLi mOVeshyment control 0 vio lls iy ln thh repect ome lCtivshylites aœ pre um~I I)y lXrter tllln ntil crs
- kinrl lira py using pedJil exerCisocirc specially developecl lith th est 1101 5 in mind illVuuml VC I lllore prccilt( ll1d InC1 li zed cri n on rhe spiJw focusing
a90
1 ~~
lg -lNheJo ~1l l1 t r~l g rld in 1 1) h i(~ IImiddot ct r rHienl w i ll idlllhic _It ~i ~ _ iri s plt ~I le II find Jit ltH vlllleuml ~l Cgtbl tn~ ks III d il fef lt p ~ lt ihnS nu v~tl middot B ~a~pt u Il C middotl)Icircd ~(t l l11 C dlfkrCnl middot- hdween slllndi1g Uline nu nllt1Xinul oorrec ri nI t chied Vith Ct (J ) und tfdincJ ne lot es o UIine 1 fo llnVs middotIJfl tfi ni( - ltlrshy
reltiK)n ~ Ikexibiliry st3nucircing - -pirte - f ur~1 1IbjISC ltupin - ltorrcaion - - r~luci()il ll ymiddot For flmpllt in J npK l1 pH k1J il
plt1SSlhlc ln obtai n 10 u1 511ndlt)l [YLo lion yr ln Slt p ille rlOlgt itlugraven om l J ~ in ( gttf(C rigtIl lIex lbuil 15 i (r-l l=22deg pol lltl ~~J IIlpraquo is IcircO~-V- I t1 l nd tucircu(Ugrave) ilil) I~ 3laquoJO- IH-12
r ln Ugravel e abilit jl of tluuml [m e llu to co ntro l irse lr in ~ pac
fuld l oftlles uumlllelve ntio ns can presum1b1r incn~~ Ih enl ac )1 the orller and lHitlll r of Ille rn - 11 )ltd h e lllldenl lu EJ3)4il
Posl1l1-t collapse lnd slabilizariotl
lIle concept u fplt st lUal c(l lJap~e l l~t Iwen detin 61 by DlI II-T3e~tupegrave rL t Ac oJdin)j tu tl1i- ~ll1thor il [ nec(sary ~- l Hn Cv-tlualing th tleihility o f a col shylo tIcircC CUJVL (0 clistingu ih bt tVeen the re du ihil [ty index (th - li iffer gt le bet ~middot Il ~I r~tcli()grJph ie ~xnmshyinltio n of the iI111 pHienr in supine po ition m(i
ROte OF Pl rnmL EŒIlCISE IN THE TREAT-ŒNT OP ~I IJD IDIOPAnnC OOU~GEm seou SIS EltJRINI
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il 1~ 0
Dtl-Lmiddot ~ lttj l r~ UIltltlHt
f g 1 -TI1 u ilictf 1ld ( ii 11- ugraveu-sh) ld IX~ O 1d wllich ltJdnrshymII Il nf the pilll 1 ~tln~1 of th e -o lioti( spinc n IG~nI(J II IIIshytt) lhe iJeuml grl-e o f ~ ()Ii ti c (u rvH Il 1 w dcpc-nlknrly o l l he 10 111shy
P01(nl (pntt l ~ 1 1 nr ffll wrJ I) ln w hilth Ihe n i 1gt( ~ duc nL~ grlphs fm I h~lt 111lt hi~hr Iht Col h ~Ilu t (l f Lite ~Ul Ihe m Ol CI il y th t s(uumlJotil middotpin~ ~111 he ~middotJg gr~lVH(~(1
m mJxiTIt corrttt ion wll iJl i~ lIllCd to Ih - xt 1shy
lti Oilil y Jf tl1lt t Ut JO rl1t cdnUc idt md p OS shy
tU ll cul lapse ( th t ltHill enct b-tten l lUdioL) 1lphic egraveltamJl1ltlti OI1 J t th e ~lme pa tient in Sl il tl cling lOJ lline fX-sitiutl ) Wll ic h correb lc- onl wil ll fhe abilt ty of lllt p tu rl l gt s tem to C( lunternct lIk luree o r grl viry )cco d ing rv D lfVd- f3egraveLIprc po st li r t1 lt01shyIlDse is d ue to the Jnus -u lar ton a nd 11ll ex rCrIshy i) i itv of rhe tissus n the ( O IW-) si it (If the (01shyjl ti (~JtVe (Fi~ 3 L Pu~t llr1 C lltpstl lu lcl l ~~ reduc l-lt by llwans o f pl1ysica l cxerCles specitkally s tuclled ruuml i rnprove tIlus--ubr fOHt md lU pr )cllI Ct 1 ~11 hi shy
lizing ffCd
PararcL n tll CIJ cl the cr iti ca l (3 c1 thlsho ld beQ ld Il ich defol1J lHU n of the i pinlt 1 e~ in~ ne dtlllontr~1t _cl (1l ll t grclrf r mg] o f rllt C II in a qa m bng pos ition corn pOil 15 t l lowcr detormashytion lhnsllold (Fig 1) ie to ~11l Ulne3Se t the risk of pr ogr t~ lu n There t rh eJef re l J ea r l)iuuml 1itshycJ l ~ll1 l l(tl a 1 tnr tg ro b ohwined by d -cr t l ~ illg ilmiddot pU~lUrll cull lpse ptJcelJtge w bich lccording t i)
h llTd tnd ~l(heJ1l ~on 1~ b inde cl 1X llt icularly luumlgh Ugravel mllcl c Iio~ i (bdow 2( 0 ) (F ig 5 J
Fin a Il III ch iS respect lllljl hl and b um l 01 m linmiddot
ii iI 1 l _ _~ _ ___I ___ ___ __L ___ _ ___ ___J______ ___ 1 ___
li 1 1 1 1 i 1
1 i ___--____---___----__-_---_~- _ _--_ ___-+----
i
1
i -- ~- -- ---~-----_-~-_-_--_1-~
l ~
i
+----r--------t-------t------f-- J
Fj~ ~-Ac(XjJlin(Q luuml T O rIcd ~lnd Na(h(ln~ n i () dl( pCG w rd (rTIshy
POO ll is hiherin cu rvegt in wh ilt l1lh ~1flILWrd cII1I Olk l1t IS le- pr(v~knt ln th e grtph Ih t PogttJlJ I ugtnq) Ot1 -J1l j elfltS-e J tlt 1l1t obb dirr remc rlLIv obu incu f roll l the Cohb atl( 0 1stlI1dtJ1g IId gtupinc rldo~raf115 Ih Ille lt) [1l1t1 (i lndnl I pine) 511pille the ~(nlClu tJ1 compo l1lnt U rlk CU Y _VeJily I~ ltx p rlt 1 L1v UpUlt (obh Illeturo Ih t si _b Cct rtJeSIm l fie -ltn J trd Ugraveltuuml shyuumlo n A~-i)rding LP 11(lt uuta o n l ( r1I~( in ~I 2JQ sup itlt curvt 1hi C(]l)b ddhccno l l f lO is -J-lultt( thc s ldnd inr tnla Ol1l t lS wi Q) whil 11) 1 1)401 ~llp lne ClHVC If ~ 1Omiddot ( tcl Lhe ttnd trl~ nlca~ I(t I ~ ~I)
tli n ll w l lllE cq lin ti spin h~ i ng mo r ~ Llnt~II) 1 tlun the nOftl111 one n Cll l gr(lk ( (cU ve tl1u n da r u p shy
po rt in o r k r 10 m linrl in tht 1xi11po tuf_ n th ha__i of th egt onideratl lr1S it f(lll() rhJt
ph rH (~Uuml e erd es ulukl h u - ul iiuml tbeacuteY ~U-L lm cl 1l (It-d o pmg p05111 td C Jl1twl lS fuumlrnll~ rly d ccrll1td ln an Ql St if i imr ol1111 t ru t(( - tht m(d in C JI shy
r t t r sture fO Ir -ngthen tlll m u ck-gt of the spint mainl) in (11erl antig r3ilrl tIcirclt l]lli fun ctin ll U hy meU15 dl i )ll1 t trk ~ lhJ cl( -ll tlt C)nlr~lUions ~llld no l IdOshy
1l)llic d YIltll1k lt l jAJ lktic t) I1 ) II 11)t 111 hd posibleacute t lcluuml ee postura l io nrro and stfh ili lllllt IJI
w i thout food T1lw(ull r d I( Lf(11 Ibk t m ucircnuin Ihe c()rf ~ct [ ()S tu re for cl gtu ifKi IH lLl1gth 0f ti l11 ~
This i-l ddl usl a typl 11 dnmnin (tf k inesllh rap) in 11 (lt-11 [[k - p~d fk lnr in lng f u l1a in llllliCk is poss ihle lI sing ctrtain Idncl fJ l (lt) 11111 liun S p Ul in tb is Cl c is ulttful ooly sa I~tr 1~ il Iw lps t1w lxltknt 1 becuJl)t 1gtlt ltlt-I a ClJu~l inred irl ilL ntllru l o~ i cll
and I1lll~lJhl r-keJc LIl [rll-llIn~ middot etlt(wrs JI the int e rmiddot vlnrion
[J ROPA MfJ) I()Wf-I YSJ IR
1
ICR 1 1-1
r
1 shy ~
- shy
11 o-llrfOlhe5l~ o t Ih 1O~(1dity i n h ~ r ~ ll nr pbl1 l of ~ Spl11 in 111011 _llti1Gt l lPt f ltlJUCWJtl ( ~l Ihe Ir t 1 1gt illbll W Ilh LtltrJ1dlion Vln lbe rigronl middotUII~ l(I Dko n12 lIll h lumshydlanie1 1 [ nul 1 M hl whtrc M - gt) lnIUI1g 111laquo111laquo1 1 1 c rtJCshytjC~ f fce d -d Lill l1~ o f enr niI pUll spnmcl1y 1~ 111 mldlll1lt (n the fl1ur t 1 = tor~ of f(ward Ileuuml l = ughtel1lng fmiddotr p 1shynOf stn lClU= Alaquo rdtllg 1raquo Ihl~ - lin hull th l1ltgtllugrave ot tller1l lUr~Jtllrc F the ~pin t -ilh rlu1i tf Ihl 1 1Ibulll n lrlt InltT1 1
rbc prJI 3IJi l1ty d qrlOIJ~ n bull JI t IlJIII Hm lA the v=ltd gtc e lu-ing J 5lnK1ura i ltfnnity
Dioal e ch anicll itllp~lir J11 c nt
Ihrcemiddotdimcllgtional mc-cbal1in of the s pioc
~f Ikmiddot i t i nly l(œ ntly tlHr llk pr-5tnœ or nc ushy1 lnlo tnr impairment in Idiopttlllc s-ol ii IXl tknt liuml J$ heen h i- ll licircghlcJ hy re$eJ rh tll e preit ilegravee h inm b nIcirc Ji d lJutg~ lt hl ~ 1 ng t o n dO Ulll urcel 1 i5 (l lreldv well umlersrood H(j-ev~r nev lbt un h iomcrhankal im l) ion nI h1c rectm ly onk l n tIlt tre and p r~dou in f n rmtinn hou t pl1ykd (~fcl5( in t 11 0 tl1I _ltgt pbne of spact 1115 Im trqlt-u 1rom J i-[) v ing unclcrsrmdlng ot th l lmc -dim nshy~ilnl l l11 ~ hmk f the cO]jO[lC pln( ~2middot ) ) Ve- w ill )iI xnl t l1 d at lcL-orcltng tUl cl sif iol t lOn blsed o n gtolllt lricd h uumlCJ ) p lane
- b() rJzU[1tl ln th i pla n ~ th t 1o rm ll sp ine present no CUlye- w ll ile Uumll(~ ltc U Hic spLnc clevelops one of ir haracterls(Icircc deFo rm tiCs v elt tbrd ln lashytio n vh icl1 pJ()VcA~ theacute hw 11
- lgitltl in th llulJe U l(~ nonmll spIcirclle pl SenL kypl lOSis ~nd l dooi~ in tb lXI1 lhese [(Hu rts Vere m)( til ught [ 0 he relattd tlle scolkJtlc ( lI r Vegrave
- front l in hi pleme tht ncrmal p ine preseuron t no curYegrave whil thl ~11li tic p in ugravetI I ()~ icircl~ charshyad t Ilt I CU1C
Il Jri fJIIt palic
~l+I~na ra 3 r inr lut th l[ ber ll1d a œl1~lU1 degr 1
l f r()la tJo u lllu (lILa r forcKl ltxert ltJn tl ldefnmuumlng 1 tkllJ [J i1u a re- lhlt tll cly 11 [1 1 UI b y Olm ner w bn ~lh uiJwd tl egrave ro t1tic) l1 Ilm it ti lt p ica] lf shy
rhrl r() be (P (the Uma bevond Wl1iltJl th lCOJlb of [11( ~pmaJ musd ~ dthc COnCIt and nm ex ~l le btconk (t O li~[)
r ~l 18 ~1Il N lu t( ren i9 lun lu ted rlseurlt h in tlt ) tilt lULodeumlformipg1 tlo n ot tIH_ sc laquoJrle rh ox ercallkren lk 1l1~H li d11r once thl Il i ~ r tld1t5 [he lhrth ld f 111 JlIcirc lIi of tlle dnrlclc hurnp tlk
lI bslt Il l nt rlet()rlll lIcircon 01 the it l ()I~ C ( (ylm der (- sustalnecl by an H1tmi cforming aCOOIl
J1Ji h V hl rhyiical f~ f Ise CI 01 h spr n llnd kin middot ith ccedilrapJ my lX damlg ing vll e n l pplild as flle
igt Jk Iller ln SCC1IJ ~IS lllc lJ fxceed l auto in middot crca~ i n g lhrllgthuld [1 sh (~u Id ahn be j ofed that Ilw relscd pre sun 1l1111i insiugrave l fe pil1r inn) 1 mlshylt
- j Il- ( w atff 1 (nh ~1l 1(e Il10 utoldrml ng li1eCh~lI1 1sm
in flc l Geyer ~w tcd th1 t rm m 1 hI l)1ecircch1O lla1 puilll 0 l I C~ sw m mim t Ieuroamp no purpo t for cu lshyim le pllilt t1 s (weumlO middott r it is l~Jl(gtWl1 rhn in iculio r[ paULnl -iJl11T1ill~ doe_gt nor Il ~lp to i ncrt~SL n eur(1shym tor co mfU
(1irai p an (
Jerdnn lle 11 showecl thal ill CSl~ o f t10rLC IC 1i lUgrave
tllo lacolulllhil it lio_1 tlle cte tI llmiry in (he lg itt1 p lln t rn lnlftot il~ lf tspe iuUy in tlw initi 11 r luleuml )f cV IU[Icircon nf Ile ~oli ls W iU l 1 p(t)gr~s~ivlt il10middot~ shy
ment roward hvpok pho b G ll f ill~l Im lins l har dUflng (IN eWllLlfiu1 of 11Imh] co luumlgt i the l in t ot t l H~ gClyty Cegraven te l - 0 1 v llebed lxxli 5 r ro ject 1 seH fl r t side-ys and tlwn backlrcl bull thu~ p(0(1 lj n g a kyphQtlmg aet Il ln (h~ lu mhnr --PIl1 COftj tng
l l i tc Iugrave l lltl l( l rs1 tif s L -etllgt il l the lgirl11
1 Hl)
Ilu LE nI rIIY~Ic~L lXIlKISI 1 HI E TREhTMEtn OP JIU IDIOP llII C AD O USCUH O Ll Œl15 NEGR II
lLill tegt lre lenl1 ~I d ~fo rll1J[ ~ rhl recrSes the phyltiologiGII cmns of lh vine)
Accordlng () Dicion ~2 1 rtcluctio fl in the itgitttl CUIYtS combin l vi th a lueral Iviari n llltl ds t 1
mecban ism () ugravel~ta il ity in l he r rat r IllI1e which bVOf1i the unsd a nd i ncrea~e 0 1 co hlt1is (Fig 6 hiIf md Pl11jlbiJ Jl1eanwlt ile lt(udiecl lh e srnl ru t
orzyglpophySLs show ing t11 al ttleir 1I1tl rnic tl orienshytation f~I (jLi l~ltes aXIal ve rtegravebJl l rotllio ll in cun litluns lt f dorsal hypokrrhn Icirc tnd lum)H de i L lo IS
Tll t dat SLlgge 1 th t impOrfill ut pOitu res and l1lweil1 ) t Mudied in ord t r (CI mlIuml ntrlin or to reuwer fll e p llyslo lo~lCll ClIlye in lIe SlgJtta p lU)l Wlth the llm o t ch ~ kin~ rutltor in l~ bili ry7 AbC th ~e ~k-
1l11nL ~Irt del lnt [0 J jUc lt ftber l]kuti inrervenl ion vhich 1c)LJ k l IV - i(l ~ l compktl n l ililll on Il t c1 l shy-jel1 J11UVllT1ent IJ j o f 1uto-dOneacute(3tlon ( i e a -impk ld ion ) Iengtheni ng o f the pilleacute 011 a litlltl l aXl~ tll lt ((IT liJlI~rcdu e~ t lle ~---lJ linti- l lte ml-fkxj(l n h UI 11 - i llCrl I~t the plllH ](JgicJI dlt cr ~l S ( (1 k-yvllCiSh lIld O(ltOSh l o r c lch r1Iif n t a Ilew til(~ecirc dUuml llt Ilshy
si lflltl J ll1 u(~nlent iam ecl - 1l1t0- lIrfe rionmiddot7 4 llmshyp oed f Je-rura l iUIl cl middot-t1e- iltm lI1d ll1a intltnUlLe )( 5lg it d C Uf (gtS slig lll thltJrc i ypI1 tiZ) tIcircOI1 a nd lunugrave)ar 1()fdos i7~llion) sholild he esw b lb]HU 00 lb co
hl b oi hi p~l11il uU r -1Ir vlt Abo 111( e IlltUtl Chl lie o f purti n - a U vitk slJ1ultI h e )tuumlll ecl 1)] (1 n ldershy](ion r tl1i lt type for e upIe IilJ llyl)T S of repd shyiti( ml vemen prt n t in agonistK h)lnllltlSlks nI iIle kind f dlJ1ce C( uld he ([([r imentd
FmiddotO lllaljlallC and mobili ty of the SpIcircIlC
1 rd llo U 22 d L lm nrrare d lhlt in Illt fro nt a l pll ne
tilt 1 nge Clt 1)1lt vtment of tht scplit[i middot CU IY grcmr lIJ l il ~ d irectio n n f Lhe C ITelt tlO n tha n in tl le di re shyLion of pmgressi n l Fig 7 ) he IL o IS5err lJd tbat th15 mohiliry increac plrtil u la rly n apic [ cgcoeilts 1$ lh ~ ~c() li osb evolves Sragrm rJ 12 J ~ thus rigilt (0
VlI f n rller~p is ts Ilo t t) m o b uumliz - a sCtJl iu til curve w ilhout t [ uling ttwt tlle R lu tiOI o i til t ~a mt b fnlinruumln( 1hy l1tans o f ~I passic 01 1 rivE -uppnrt On tilt (ltllE r hand UgraveK d e iJlioJ1 in ease durill tlw tune 111 whicll tll C spmt i ~ not submjtrcd to correeshy( IV anl()n
j- Virh mi lei ol i b tlllt Upp i1n ill) lC tiol is d eveloped only lllmugil llClIf()mu$Cllbr f r llce thi ~
InegravelIl ~ thclcfo re tl1l[ inu eascgtt sp1J1all1extl)iity mua
11
Imiddotiumltgt 7-rurd illt Ir) 1 bull rdrilt I1 1 in tl lt frOlllll pbnlt- th( illl ge )r mOC llIeJlI o t the S-o UIIJC CUNe 1 supcrior in Ihlt diflt(l im ugrave( the n nKlIl thd n ll1 tllc dlrtcLion o f p rJ1(l( (llIl
be considrCtJ vntrl iJ)(l icltion and 1 undrli neocirc ab L a ~ubiljz~ILion 01 tilt spint pllss il)1y ohtl ll1td thrltJugll the stlengtlkl11ng o f the 1rltJgm vlt nonil lme shyCIC 111 illli orrant u bjcLliH- ln rhis r~f1 n sp u lllni lc tivitIumlLs sil uld lX tPI 10 dlegraveltl it l G lU t n w l1ik luring kine i Icircth lrr phyltical eXegraverci c~ tllat in ele
spinal m ot ilIcirclY sil nid 1e lt1 oid cdrt ~
Organ ie and psychologieal impainncuts and li islbi IiI le
A cgtI im lc pmi nr is moriOthl11 just 1 sp in and 1
compkt gt Ipp rnach to the gu in ad 1 ont i al~ shylute l e~se i t i11
[)a la 0 11[ [n ell lrom re semh pw tbat ome organi Iilnctiond cl fki ts suc]) as tlw clecrtiUe ut vild l tnd d fun ll l)Kity_orld ldly incrtJ k whil~ 0 shy[io s i -till in (1 miel q g of g JltlV ity ~ l ilI e 55 rtI lit
tllL pres e n ce )fl defidt Or Vi l~il Clp~1 - i~ ln one pIIiem in Ihr l ftectecl by 20 ICl 40 scoi stgt l ls~a r(h cunclutecl in tbe UA by Di Ruce- prod uegraveed an aaalo) u ll1lXimum 102 re u t in a group of Jd shyk 1ien t [(h sco llosls rang inF frum ) [0 1
Al10ther rudv bv rallt r m C chr111 lilcl NashycWrl1s( u 57 stlO eltt hil $(C 1 1 ui~ Ica js l( lllt cl (1 shy1prUlllI o f t1tgl lie bJd l imI in ~ul sct t1 t ltu b middot iects jlLltr l5 they are golng through ~I cltlici[e sllge in the fnm 1lt i n 01 tlWH o w n id uHitv t factor hit h Illy jeopmlize the cl velopme lit d ~ mIll lt lI1d htIshym cecl IWI sonalitr in Klulrhood
n RUI ~IEDl(( Ptl Y1-
ROU ltHmiddot PI [ I C~ 1 EXIRCIS]~ IN TI Il nW~JUNT OF SlllO lDIOP1HIC AI)C~ESΠ11 C(gt1[Oi 1S
This i why b IiCieacute ii is ~n imporrlIl t for p rcshyvegraveml e 1tLsr l tn en ou flge 1ari e nrs ~lfrecr(d by lIillcl middotu iosis ft) tlke p~l rt in portin -re rcatioluJ acrivitits Iha t 1eIU 10 L10 th r~1chophyinLl bull nd b~l )i 1l1o tur adlieem t n li 51Jmiddot2Even tlK)ugli [Dr bic mech~lnshy
ical mcl nellIUll10t 11 11 reltl ~ons lt r111 1gtomcrimes be l lefu l to ugg( ~t ne p rt in~ aCt iv ity r l h (gtr rll n anotlJer e th ink Ibal an exces~ ive IlHd icalizltion - Icirce l ll1posilion br plry~ilt i HlS nnejlor parents uf rh ry pe of po rt to lx p m lice 1 b Ule p 1Ucirc(Il L th1[ preshydLl ck l1 is fret clOice in lh ma tt r - -h II ll1 he avolc1ed wb 11 possLhle mainly for tlle i mport~ltll psyshyLb ) jogka l fe a SI)nS W( ha( ill ~ t nltntionegraved
Conclu ion
lbh ISsertegrave d t1H physkal tgtXtlci o is ) n fi ial whlIl practinu in order 10 ilnj rove the I11 llde
rœ nwh and tono C iral caplCiry and postu re o f the StOUO(I ~lIbj n II I nowkdge om ~ middotmg trom ci el1shyrlfi rls(~ Jrc li dJlJ accordl ng r the review 01 thE litshytirlture prnpo )td in t lli plpl r conflrm~ Ihe vuiclit ot th e -t ls ~rti ()ns
In l do l (ent Id iopl1il iC scoliuse il l n phee u i cl vk)pm e n t ( li tll iumlKh eXCC cl l g i en rhk thr hokl th e re i5 an und ubred need fn r l pprnpri 1tegrave (JJ1tOkJJe ~Ild Inr surgict1 therapics ill ortler 1) S l i p
the ( - Iuli on anugrave )JT~t~t UW ~pilll l dtlormities bull evshyerthtless in the illiti ~ll pl l~sC t ttlC c1iseLltc whcn the riS( r1 r euro )luli m is rtduced ocirc ~md tfle uifleal JOld threshold il ~ld flle po stural collai i reJcenw~ 43
JI l1 igh pllysicaJ egravexe rc ise - p revenc or r d llCe d i ~lh ilir ies o f [Iw ~ l() li )tic
p (iems R 28 J -6 5- 6 1 63
- f~KiHtare lh ( n utr ali711iCUl of postu m l d elicits tn produCel1 a coneql l nce J [)ti 0 I111)( or regre si -u lmiddotc 5middot Il 1 17 ~ M
-re 51udles U ~ n Ledecl tu con[mn or re jecr these conClLL i( 1 w l1 ich clerin-d frum 1l1 lIldytica l rcltw n f th e liter~iture appear r- ~Lo nlble Hnwecr Intil ne re ull are 31Iable wc should n r prevent our sroliotic patientmiddot trom tl ki ll p lt in s(loI1ing jshy
ir its pW1iada rly ltl t ~d1()o t () n til t c ntrHY -vith the l xcclrinn 01 gt[1 )11lt tIlat in rea-e t)1obility (tnU evc n thell oilly wh n progr~lgtion b p OSSibl) -uc h ~I( ucircvshyiUe -11 )ulu hl tIKoll w g ed The 11 S J ( rprOpriue kin (~irhe r~l Piuml to incr _~asc p()~tura l $llbil i ty is tl1egraveoretshyic tlly CiJUClt alttloughl more ~Iccu rtte aod deLli led ri k benefi rs anJlr~ is is netot1ed
Ria 1111tO
NIokl Mu d lle ftitYljJfu Jœl il 4IWr10UOifll S (JIvs i (1~1)Jshylidl ttno( cclIll le 11(11(1lt1 RCI fu lle ((lia LltfIt l1 I1I1i(i
LJ ci n s j(r3 pigt egrave li n IHUgru lkl di t rdz t fi sici pe e ft shytUlKm iluppno di un lisimerap15Ll rl lllcflt() 1 110 scopo di pnevirlt () fr en~lI 1-lgpwlllltnlcgt dclld lclonnitugrave o e il 5LOshy
Il i mi llon lt fH nugrave j (1 11ni dei co~e 1 lteIl I1J J nd ne ~Ii eifclti (()Tc rri udk s co lio si d i m e dia g rt iuuml ln que~ltlt
s rud i 30 llizzb mo i d ti cleU ric lca pel n ri Icare qJJ l lm 1 dis(imucirc x u le I[~ l z j-m i pro vna le da lla C gtl k A i json ere pr middote-nute () rk kl ducirc un~l rdeguCltl d nil cra pi lt di uJoseguerrnt Cjua li 1iU110 cli nbie tti 1 rcr lJ)tIId d~ fle)-UITC
n (- -fd7Io n~lcl)
Ut11claquo)si 1 lI tori htpnuuml )ludi-ttn I ~ cnntI1zttu fr Cq(in i idiJ)tic1 dbfl lOZ10l1 d d ~ leOla nelllOll1otoriO Lb un1I1cnUl 1n1l1i3 dcgli 111 lt1i ch DIJgt gtU l H crmU1 Nlch~mslt ( SIshygnaJ~l lerimiddot wo i esuemi -bletti d~ plt~e8lugraver- ne l pClZ le1lftgt scoliodcu kl s iluppo ddl ~ ~ uhjlil~ vertcbral~ lt o svilllp prJ Jdle JIl7 i() nl di ltCjuiljbrio Dng li studi sul lto lb( l~nlrale (OllddU i in pa rticdu d 1 DlIal-BeHJ (gtegraverl ~ P~II IId lI1 n~ llw - idente il v- m gtiu p eT il puientc clioti elgt di u n rnigb o t c)[ ro Ua sw mle dei radlldc onsegull o tramite il 11 fforzrlshyfl len to d e i l1luotoucirc l nllgr3ilri d e luOwo con crcbi ~Clltdr
in pOMltHJ corrctl e in va rie ~i[Jzioni s t llicb c c d inamIcirc tllt Dalle on sena d elb blOffiCcclIlicd tr idimlt n s io mlle d ei
r ~ chi Je ~oU()f icn ~Icirc ~videnuumll (l() ~llt tC p IYZIcircOSI ln(IiClZlfHicircl ~ 1I1shy
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EUROP MIDI C Pli hIC
EDUCATIONMEETING SATURDAY 8thof APRIL 2006
(iSS
SEAS02 Scientific
Exercises Approach to Scoliosis
version 2002
G
S Negrini 1
EDUCATION MEETING SATURDAY8th of APRIL 2006
Neuromotor disfunctions
Neuromuscular disfunctions
11 Postural collapse
Postural collapse
Duval-Beaupegravere
Flexibility of scoliotic curve
f---I--- I Postural element
-------1 Structural element
S Negrini 2
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Postural collapse
Duval-Beaupegravere
It is a value related to muscular tone and to flexibil ity of convex side tissues
Post ural collapse
Bunch e Patwardhan
Critical load
Load threshold beyond wh ich a spine begins buckling
JI~~Wt1lW~flfthtlJlœJtAr ~ J~It- l~l - IMS
Postu ral collapse
Bunch e Patwardhan
If a curve reduces there is an increase of the deformation threshold
~~~NW~-damaoc~IIIMf ~~ J~Iv JaJ-I7I9sect
S Negrini 3
EDUCATION MEETING SATURDAY 8th of APRIL2006
Postural collapse
Torrel e Nachemson ~
Scolioses below 20deg ~ ~ lt~
have a high ~ ~ percentage of ~ ~
~postural collapse (on u~
average 75) ~~ 2i~
CU~VE O EG~EE S WHllE SUPlti e
~laquotd~c6b ____lPffI1wtt1t~
$ww J(t ~~7 JM5
Postural collapse
Minor scolioses 7
Antigravity musc es strengthening D
Reduces postural collapse -G
Increases the critical threshold of deformation
G
Neuromotor disfunetions
Stagnara
If we admit that one of the causes of idiopathie scoliosis is a disfunction in balance systems it is logical to orientate physical exercises toward this direction
s Negrini 4
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Neuromotor disfunctions
Dubousset
Idiopathie seoliosis results fram alterations in praprioeeption centres and deformation is a natural compensation to restore postural balance
etattJtitIK ypothfQj~S ___~ own_ oJ)HQr lar 1t-1( r
Neuromotor disfunctions
Nachemson Initial idiopathie scoliosis
+ Goood spine stability
Neutralization of postural deficits
D Static curve
Neuromotor disfunctions
Therapeutic aims
c) Development of spine stability
C) Development of balance reactions
G
S Negrini 5
EDUCATION MEETING SATURDAY 8thof APRIL 2006
Biomechanical disfunctions
j Horizontal r-Ian
i Sagi ttal plan
Frontal plan
Frontal plan
q Frontal plan disfunetions
Fronta l plan
Perdriolle Movement magnitude
gt in the direction of lt in the direction of correction progression
S Negrini 6
EDUCATION MEETING SATURDAY8th of APRIL 2006
Frontal plan
Stagnara
Never mobilize a scoliotic curve without ensuring reduction maintenance over time otherwise a greater mobility favours scoliosis progression
Frontal plan
Ducongeacute~ research
On a group of adolescent idiopathie scolioses treated with
Meacuteziegraveres gymnastics
D After 1 year the mean angle of
curves increased from 18deg to 29deg
Frontal plan
Scoliosis without brace
D Greater spine
flexibility D-
Risk of progression
S Negrini 7
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Frontal plan
Mobilization is useful
D In preparation to
brace
D With brace
Sagittal plan
QSagittal plan disfunctions
Sagittal plan r middot _J o
Perdriolle scouos B CJ aDeformation of D
thoracic and thoraco-Iumbar curves evolves in extension
S Negrini 8
EDUCATION MEETING SATURDAY8th of APRIL 2006
Sagittal plan
Graf
The line of gravity centres in the vertebral bodies o s c oUOSt
projects itself firstly laterally and then fi
o
posteriorly lJ ~~ ~~ ~ ~~-_J-D ~nI~
Sagittal plan
Therapeutic a ims
D Maintain or
retrieve physiological curves on the sagittal plan
Horizontal plan
QHorizontal plan disfunctions
S Negnni 9
EDUCATION MEETINGSATURDAY 8th of APRIL 2006
Horizontal plan
Stagnara The forces applied ta the spi ne act in a autoshydeforming sense
Horizontal plan
Dimnet Rotation gt 200
ampII~ (
D The actions of concave and convex side
muscles become
agonistic
~ItJrOnrIIiItdllfUClltlluumlll~~tI ~1JIf1laJ
Horizontal plan
Minor scolioses never exceed these autoshy
deformation thresholds
S Negrini 10
EDUCATION MEETING SATURDAY8th of APRIL 2006
Disfunctions at a biological organic and psychological
lever
Oisfunclions at a biological organlc and psychologlcal lever
Cheng
Bane density in scoliotic teenagers is lower than in normal subjects
~~~~middotA~IIlUtIy ~7œl 1d l
Oisfunctions at a blologlcal organic and psychologicallevel
A significant reduction of vital capacity and V02max in teenagers with a medium severity scoliosis
S Negrini 11
li
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Disfunctions at a biological organic and psychologicallevel
Disorders in the development of body image that the teenager has of himherself
Disfunctions at a blologlca l organlc and psychologicallevel
Therapeutic aims
cJ Activate cardioshyrespiratory function
cJ Favour bone density increase
cJ Develop a positive image of the body
Disfunctions at il biological organi and psydlologicallevel
Stagnara
Sport
D The active side of
kinesitherapy
S Negrini 12
EDUCATION MEETING SATURDAY 8thof APRIL 2006
Disfunctions at a biological organic and psychological
level
Distunctions at a biologlcal organlc and psychologicallevel
Cheng
Bone density in scoliotic teenagers is lower than in normal subjects
~n~IIIvpWr~middotA~stWy s- XXJl M J
Disfunctions at a biological organic and psychologicallevel
A significant reduction of vital capacity and V02max in teenagers with a medium severity scoliosis
G
S Negrini 11
EDUCATIONMEETING SATURDAY 8th of APRIL 2006
Kinesitherapy on the scoliotic subject
q Postural control
q Axial stability
q Muscular trophism
q Balance
q Respiratory function
The limits of kinesitherapy
There is a threshold beyond which
rehabilitation alone is not enough
sssr
Kinesitherapy in scoliosis treatment with brace
Therapeutic aims
S Negrini 13
6
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Therapeutic aims Srace kinesitherapy
With brace
il Postural corrections and
vertebral stability are obtained by the brace
Therapeutic aims Srace kinesitherapy
In preparation to the brace
il Mobilize spine on ail plans
Therapeutic aims Srace kinesitherapy
With brace D
Maintain a normal spine elasticity
~ Maintain a good muscular toneshy
trophism
C Model the hump with kyphotizating
exercises
S Negrini 14
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Exercises and their methodologies can vary accord ing to learning and individual sensibility of the single rehabilitator that proposes the m provided that they stay within the
Iimits of fixed therapeutic objectives
li
Therapeutic modalities
(Exercises)
QAuto-correction
QRespiratory education
QErgonomie education
QMuscular strengthening
QDevelopment of balance reactions
WNeuromotor integration
ci Vertebral mobiJization
QSpecifie modalities in brace treatment
S Negrini 15
EDUCATION MEETING SATURDAY 8th of APRIL 2006
The protocol of kinesitherapic
treatment
G
QChoice and dosage of exercises
Variatiosn of the work program every 2 - 3 months
Q Execute e)(ercises on an individual base or in a small group
Q Frequency not less than 2 times 1 week
Involve and awaken the family
G
S Negrini 16
EDUCATION MEETINGSATURDAY 8thof APRIL 2006
Q Determine the action and the localization of auto-correction
QAuto-correction must be associated to ail exercises
QAt the end of treatment ergonomy lesson
Auto-correction didactics
G
SCOLIOSI DORSALE---- shy ----
r
S Negrini 17
EDUCATION MEETING SATURDAY8thof APRIL 2006
SCOLIOS OORSOLOMBARE
shy
SCOLIOSI OOIlSALE 011 bull LOMBARE S1I--shy
SCOLIOSI LOMBARE
il --~_-
S Negrini 18
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Scoliotic patients are not radiographs
middotSeoliotie Mtients are not ndiographs but hum beings with a vertebral deviation-
Slagnara
Metha For the physieian Cobb angle is of utmost
importance For the patient it is body deformity t hat eounts most rib hump a protruding seapula or hip We are in a situation in whieh today dodors eure the radiographie deformity but what the patient really desires is to get rid of clinieal deformity and of ensuing psyehologieal distress
CIIQItIo shDuIdtucirc lM WIld tJw~~ I~~M~~~~ J9f~
S Negrini 19
- Poznan_workshop_Physiotherapy
- physio2
- physio3pdf
- physio4
- physio5
- physio6
- physio7
- physio8
- physio9
- physio10
-
Zmiany w zakresie k(ill rotllcji osiowej kr~gll szqytowego sfmyiellilllV wyniku prowadzonej kinezylerapii wg Dobosiewicz
w grupie progresywnvch skoliozjedllollkowycll - 0=124 (CZB5 ObSrrwRcji od 6 do 58 mielli~cy irednia 197plusmn1185 miesiqca)
Grupa skoiozjedllolukowych typ 1 wg Ponseliego - skrzywienia Th dx - leczeni kintZ) terapill wg Dobosiewicz
(11=74 aas ubscrwacji od 6 do 45 mieiIcircccedilcy srednin 211plusmnII 1 miesiJtcft)
Zmiany w zakresie kqta CoMa IV wyniku prowadzoDej kinezy tera pii wg Dobosicwiu w grupie
progresvwon h skolUgraveIl dWlllllkowych - 0=74 (ons ubs~rwacji od 6 do 45 mil3Icircccedilcy sredni3 211 plusmn 1J1 micii il cn)
Ddcil1t~ Tb oddnek L
7
Zmiany w zaknsie kIta rotacji osiowej krfgu szczytoweg() sG-z~vienin W wylliku prowaagravezonej kinezyterapii
wg Dobosicwicz w grupi~ progrzs)wnvcb skolioz dWlUcircuk()wJcll shyn=74
(cras obscnvacji od 6 do 45 miesifC)j srednio ZI I1 JI I micsilfca)
oddnek Th udciollk L
Grupa skoliozjednolukowych 0 kqcie Cobba lt 40deg - JeCJeni wyl~7ltie lunezyterapil wg Dobo~il-Wicz (n=44) (nl3 obstrwllcji od 5 do 31 mhticcedilcy sndui 1I8plusmn6U4 miesiacn)
Obs~rwowano istolm korclacj( pomiccediltlzy poziull1lll1 upmowlIniu mctody przcz chorych 1 czccedilstosti stosowilniu kine7ylerapii il wi~lklJseii rewcsji zmian w Zakrcsil kta Cob l13 i ro tacjl osiowcj kr~1u SZCzylowcgu skrzywienia - wspolczynnik PeanlOniJ wjnusil uJpowiedniu 016 i D53 -
Grupa skolioz dWlllukowych 0 kflfch Cobbf lt30 Iyp 11 wg POllsetiego - jknywienia pienvotnie podwojle
- piersimve prflwv~middottrolle i lccedildiwilJwe ltKJoslrotme -Ieezeni wyl4eznie kinzyterapi~ wg Dobosiewicz (0=10)
(nu obenvacji ad 5 do 2 mlcsiccedilcy ~r~clnil 124plusmn51 micii~cll)
Sredui k~1 Cubba na )uclltlll I~lerpi
wy nosil
w udcinku Th-17o
w odcinkll L - 170
Sn=dui kql Cubb aJu liugrave~tyIcTUpij wynosil
W odcinku Th shy 137deg Y udcinku L shy lJ20
4) 1)IIIIcirc w Jlm ~llIWiob_ l~ rlllW
JIIIIm-lollUcirciaftq jtQ0 1 t~~010
UpIJI~r~
8
9
Po 5 i 10 miesieacutecach
C- 18 R-S C-12 R-S C-S R-Q
10
Po 9 miesilcach
11
BP
Il rz
Th
Cmiddot 12
R-3
L
C-16
R-7
PoDP 7 mies 10 rz_
C-9 C-20 R-OR-2
--__ _ _----------shy
12
DP
8 ri
111 C-26 R-2
L C- 17
R-]
bull Metoda asymetrycznej trojplaszczyznowej mobilizacji kr~gostupa ma znaczeumllCV wptyw na zahamowanie progresji
w skoliozach idiopatycznych szybko post~pujqcych
bull Mobilizacja strony wkl~s~ej skrzywienia i osiowa derotacja kr~gu szczytowego zwi~ksza korektywnoseacute skolioz zmniejsza garb i ebrowy poprawia obj~toseacute klatki piersiowej i zwi~ksza wydolnoseacute oddechowq plue
13
bull Przedstawiona metoda jest
stosowana samodzielnie lub
w pO~qczeniu z ortezq Checircneau
a takie jako przygotowanie do
leczenia operacyjnego
Ocena progresywnosci w badaniu elektrofizjologicznym
odruchu z odci~zenia
i~middotmiddot ~=~-~ shy1 _--==shyocirc
14
EUT S pine J (1997) () 93-97 copy S pringer-Verl ag lY07 ORIGINAL ARTICLE
K Dobosiewicz Neurophysiological mechanism of the unloading reflex as a prognostic factor in the early stages of idiopathie adolescent scoliosis
Rcceivcd 29 M arch 1996 Revised 16 August 1996 Acccp tcd 10 Septem ber 1996
Absfract This paper presents a new nc urophy iologila1 methougrave of e valushyati ng the risk o f p rogression in ill ioshy
mo t important factors in the eva luashytion of progress ive id io pathie scolioshysis The met hod can be lIsed to deshy
pathie scoliosis in th early stages uf tll( progre jve idiopath ie scolios is the dis ase by illY middottigating tll e unshy in lhe early s tages of the d isease loading refl ex in paraspinal muscles T he high sensi livi ty of ilie method The study incl uded 394 pat ients wilh means il can be used as a basis un seo liosis and 70 hcalt y chil dre n which to take an earl y dcc ision to
K D obosicwicz Depuumll1 mel1 l of Rchabi lilu lioll Si lesilln Medical Academ y 42-604 Tamo wskie G6ry 4
Lmenty of the unloacli ng retle x and repeatabi li ty o f Ihe rcbound and silent period were anal ysed for eaeh reflex evoked Prolonged latency and
p rimiddotom1 surgery
Key words Id iopathie seoli o is Unloadi ng rcnex Re bound
Katowice Polaml minima1 numbe o f cycles are the Larency Si ent period
T he ai m of this sludy was to evaJ uate the use of the unshyIntroduction load ing Dex for octcction of prog ressive id iopath ie adoshy
le cem oIios is in its carl s tages in onl r to lake a dccishyProg ress io n of id iopatJl ic scolios is bas been the su bject of
sion ta perfo nn surgcry as soon as pussible many clin ical radiological and elecrromyographic in ve~ shy
tigalions T here is ho wellcr no sim ple quantita ti ve or qual itati ve pro noslic methoo [hat can be em ployed in the
Materials and melhodsearly ~tHges of the disease Monitoring of lhe unloading rc felx in paraspinal m llsck appcars 10 be a reliable Inv gtsi lgnlions were carricd uut 011 394 pa tie nt with adolescent method o f discriminating bctwcen diffcrcn l fomls of Cushy ~c li ed J ild 70 hCldr hy children The scoli osis group consisted of Iios is T he un loa ing re n cx can be evokcd in ail the 31 1 g irl s and 83 boys aged 9-1 8 year~ (mean age 125 ycars) The
ske lelal muscles through a suegrave den shortening of o luntary contro ls wcre 0 girl s and 10 boys aged tO-1 7 y~ar (rncan age 128 cars ) Imong Ihe stlbjeclS tudied wcre 9 patien l w ith cershyinnervated muscle l2~J When a musc le is unloaJ ed vico-thoilc i seo liosi s mean Cobb ang le 22 7deg 121 with Ihoracic
rapidly durin g an isomerric con trac tion Ihe norm al reacshy scolios is mean Cobb nngle 309deg I 1 w ith thoraco-Iurnbar seolioshylion is an eleclrically silent pe riod fo llowed by a burs t o f s is rne ~n Co bb ang le 26~g o 63 with lumbar cotlos is mean Cobb action potentials called rebmmd The pause in d ischarge ang le 279deg and 90 w ir h doubh major curve sc o Ii() ~ i s meull o bb
nng le 292deg and 28 5deg The sludy group includcd 231 right -s ided can be observed only when a certai n h reshold va lue of and 163 left-sided 5col iouumlc patien ls There were 112 patients w ith
acceJcration flnd shortening of he muscle is exceeded progress ive id iopath ie scoliosi (76 ri g hHidtd and 36 Ic 1t-s ided) an tl il occues wilh constant latcncy correspond ing to that 182 with no n-progressive idjopa thic scoliosis (1 13 ri ght- sided and of the propriocepti ve nflcx (9 18 20] T he rebound ufter 6 le rt-sided) M d 100 w ith pe lvic tilt (statie) scolios is (42 rightshy
s ided anp 58 l eft -~ i(kd )the silent period in the unloaugraveing re felx rcsul ts from ae lishySC9 1ios is is consIcircdered progressive if the Cobb Jngle inshyvalio n of a pool of motone urons aIl o f which fClt1ch lhe
creltseacutes by more lhan 6 in 1 yen r aile middotnl1 n-progrcssive if the anshyfiring thres hold simultancously afte r prcviou~ si lenœ [l nua i increase is less thll n (i The Cobb angle ranged lrom 8deg to 77deg 1 4 201 in Ihe palicnls w ilh progress ive scoliosis (mean 361 ) [rom 30 ta
lI f R (on- f Rt tt1IY 1lIfl pflla 1 )(~ r(Jnu n t shy
fI) _ ~
Pathomechanic basics of conservative treatment of progressive idiopathic scoliosIcircs
according ta Dobosiewicz method based upon radiologie evaluation
Kryslyna DobosiewlcZ Jacek Dunnala Kny ztof Czemicki Hanna Jcndf7cjek
Deparmem of Rellabtlifatoll Mediw Uninrsity ofSiltsia KatOllice Poand 40-635 Katowice fil ZiUCl 3537 POL4ND
e-mail relwbilitacjt1s11mfoctaonetpl
Abstract Conscralivc IrcalrnCnI of Idiopathie scoht)~1 espcclall y kinc ilhcrapy i ~
nOI widcly apprccilllcd due 10 Ils suspectccl low dfcCIIcircvcnc 5 in relalion [ (1 a urglcal Irc[llment ACter long-ycar il ses ment of palomcchanic f scolio icirc in Dcpanmenl of Rchnhllilallon f Mclii al Unlcrsi ly of Sile bull a concTvallvc mcthod ()f IrCtllmenl asymmclric Irunk mobili7alion in lnclly ymmelm po~itions WIS
de el ped_Thi mClh d enablc 10 delain pTogression f scol iosis or ccn de middotrca~c laIerai urvalurc of a spi ne and angle of rOlllion assummg adequate () perallon f palicnl and ilS famil)
J Introduction
Idiopathie scoliosi OS) is a thrccdimensonal dcfonnation of il vertebral col lmm an- cntire trunk Afler many years of extensive rescarchcs the cause of idiopathie coliosIcircs $ i remaIcircns unknown It is possible Ihat idiopathie scoliosis devel ps and progress on a baslS 0- ~
multifactor disorder perhaps diffcrent for curve initiation and curve progressi 11 Fion poss ible pathologie factors nervous system dysfunctIcircons affecting postural tquili brium ar proprioceptive control seem to be espc ially important [ l 2 6 JI Pro_ ression f iS could bot delermincd by vertcbrac remodeling under eccent ri c loading created by axia lly ce gravitational forces in presence of muscular imbalancc in the trunk [2 J The verte rai colwrz unde r scoliotic conditions 15 an unstable system with tcndency to fu rther tune dcvelopment fl2] Lateral bending of a vertebral column visible in X-ray examination L
only a two-dimensional prcstntation of a complex dcformity consisting of patho logica axi rota ti on torsion and othcr deformations of vertebrae [7 8 10 II 14J ln fS physiolog~ curvatures of vcrtebra l column are disturbed Total Icngth of an anterior column of a spi n~
consi ting of vertebral bodies and intcrvertebral dises bccomcs grcater lhan length of l posterior colwnn - vertebral arches and proccsses [11 15 J h is apparent that phy iologi ~
thoracic kyphosis in rcgion of a scoliotIcircC curve diminishes Each vcrtebra of a stru tu ~
urve of coliosis is oricntatcd in hypercxtcnsion in relation t adjacent vcrtcbrae [7 l resulting
1 n B Uri middota I l 11
H srut ft illtf j tI) t li orf1Hli d
IDS Prt ts 21)2
Influence of method of asymmetric trunk mobilization on shaping of a physiological
thoracic kyphosis in children and youth suffering from progressive idiopathie scoliosis
Krystyna Dobo icwicz Jacek Dunnala Hanna Jendrzejck Krzysztof Czernicki
Deparrment of Rehabilitation Medical University ofSilesia KaloKce Poand 40-635 Katowice ut Ziolowa 3537 POLAND
e-mail rehabiliracjas(u1poCmiddottaollelpl
Abslract Idiopathie scoliosis (lS) which i sub 1 ntially l threeshydimen ional derormation or a pine cau e nOl only laler l curvalurc and axial rotation of vertebral column but al lordoti allon of VCr1cbrac in structural curve eXl nsion ln an effect physiological thoracic kypho j diminishc or cvcn dbappears Method of a ymlllctric lrunk mobilisation in strictly symmetric po iljon according [ Do () lewicz not only dcteriorme progre ion of IS or evcn reduces lalera] curvalure but also significmtly rebuild physiological thoracic kyphosis Icircn cases of lS accompanicd by lraight baclc
1 Introduction
Despitc Ion year researchc etiology of IS is nOl yel resol ed Significant problem re laled lO morphology of IS apar1 from lateral bending and ax i 1 r tati n i deviation of shape of a spine in sagittal axis affecting physiologi al curvatu re of vertebral coJumn [3 5 6 8 9 J 0 1t 12 Lcngth of anLerior col umn of a pin constitutcd by venebral hafls anugrave intcrvencbral dises dominate ovcr Jength of po terier c lurnn buill from vertebral arches and processes [lOJ This condition uring scol io i progress ion and growth of a child effect in hallowing or even disappearing of phy iological Lhoracic kyphosis in scoliotic region It i well know n lhar cn~brae of structu ral Jaleral curve are positioncd in hyperextension - lordotisation [5 6] which in Lhoracic region Icad (0 reduction of kyphosi or to true lordo middotis Such kind of venebrae relation in thoracic region cau es ilS destabicirclisatIcircon whi h in u sociation with eccentricircc gfilvitali nal load fa pinc duc to muscu lar icircmbalance [21 pOdbly produces r tationaJ lordo is [56 Il] and further development of symptomatic scoHose ft ha becn proven [12J tha strengthening of the erector spinac muscle aggravates nce initialcd deform tion and deteriorates coliotic process Hyperextension and uxial rotati n a s clatcd with
357 Th B Grivas (Ed) Research inro Spinal Defoml ilis 4 lOS Press 2002
Exercise efficiency of girls with idiopathie
seoliosis based on the ventilatory anaerobie threshold
Jacek Durmala Krystyna Dobosiewicz Hanna Jendrzejek Wieslaw Pius
Department ofRehabililation Medical University ofSiiesiaa Katowice Poand 40-635 Katowice m ZioJowa 4547 POLAND
e-mail durmalaiacekyocztaonetpl Department ofPhysiology Academy ofPhysical Education Katowice Poand
Abslract The aim of the study was to estimate the exercise efficiency in the group of
girls with idiopathie scol iosis based on the venlilatory anaerobic threshold (V AT)
Material and method The investigation comprised 58 gi rls wilh idiopathie scoliosis
aged 10--6 years 32 girls (55200 ) wilh double major scolioSiS and 26 girls (448)
with single scotiosis The girls were eonservatively treated using Dobosiewiagrave
method The control group consisted of 3 1 healthy girls aged 10-1 6 years The
cxercise test was performed using eycle ergometer During the exercise the gas
exehange parameters wcre reeorded (minute expiralory venlilation minute oxygen
consumption earbon dioxide production) On the basis of recorded paramcters V AT
has been computcd using V -si ope method Results The following V AT values were
obtained in the group with scoliosis 207+305 ml 02minlkg bm in control group
219+350 ml 02minlkg bm The differences belween girls with idiopathie scoliosis
and control group were nol SLaliSlically significant Conclusions I The exercise
effieieney of girls with idiopathie scoliosis conservalively treated using Dobosiewicz
melhod is normal 2 Such high level of the exercise cfficiency of the studied group
probably was due to intensive 3-D respiratory exercises of these girls
1 Introduction
In practice there are researched useful efficiency rates which on base of laboratory tests results possible easy without using of the relatively hard or long exercise tests would give the belter forsighting of the range of homeostasis disturbances and rapidi ty of increase of
physical fatigue during varied workloads [1] The best known rate of trus kind is the maximal
minute oxygen consumption [2345] During progressive physical effort minute oxygen
consumption increases proportionally to workload The reaching of real maximal minute
oxygen consumption in time of progressive effort is iodicaled by minute oxygen consumption plateau [5 61 This result is rarely registered in children The progressive exercise test is most commonly used in children until physicaJ exhaustion and the highest registered minute
oxygen consumption is treated as maximal minute oxygen consu mption or so-called
symplomatic limited maximal minute oxygen consumption [678J Sorne authors regard
Orto-dlet Trau malaogis Roha b ilitacjaARTlKUL ORIGINALNY ORIGINAL ARTICLE Vol 5 Nr 1 2003 80-85
Jacek Durmala l Krystyna Dobosiewicz l Tomasz Kotwicki Hanna Jendrzejek 1
Katedra i Klinika Rehabilitacji Slqska Akadenia Medyczna Katowice Katedra i Klinika Ortopedii Dzieci~cej Akademia Medyczna PoznQll
Wplyw asymetrycznej mobilizacji tulowia na wartoseacute k~ta Cobba i rotacji w przypadkach skolioz idiopatycznych u dzieci i mlodzieZy
Influence ofasyn1n1etrie 111obilisation of the trunk on the Cobb angle and rotation in idiopathie seoliosisin
children and adolescents Slnwu kluce ac eJJic Cl chOlIU) Ice SKoio= idj)PO Imiddot(~I7tmiddot
K~Jmiddot w()rus consrieI ve I (OtlHelif idiopathie HUW JS
SUMlvfARY
BackgrouId The aim ofthe stldy Vas Ihe radiological evaluation ofthe treatllJent ofthe idiopathic scolioshysis utilising as)mmetric trunk mobilisation in the strict~ll I)mmetric illitial position
Material ([fJ(f lIIellOds Presented stud) lOS based IIpon J36 cases (13 oovs oged FOf11 ocirc la 6 lcars (lild
rn girls aged frum 6 la S pears) trealed due to the idiopathie sCuliosis ((rom Novell1her 999 0 F enflfUn 200) Among 48 ch idrcn sllfJering from dOlfble-major scoios is 6 cases wcre infoll scaliusis JOjuvel7lle und 22 adolescent Among 88 sillgle scoliosis 6 lere infw7t 33 juvenile and 49 adolescent
Radiological exami71ation 1as condueed always in the repeataole technical cOlldiions RadlOglOlI1 lier evaluated oy the same physician Radiologica analysis oIthe scolios is incuded value ofthe Coho al1gle ongle ofaxial rotaion
ReSIils ln double-major scoliosis observed dlring one year period in Ihe thoracic segmenl Cobb angle decreased inll l increased 1395 and in 292 Il OS 111changed Axial lolation angle in 167 (~rcascs
decreased in 354 incrcased and rernainM the sorne in 479 In Ihe llllnba segmenl Cobb ang le clccrcscucirc il1 354 increased in 39 6 remained in 5 Angle ofaxial rotation deceoscd in3 ofca es incrcuscd in 29 and persisted in 48
ln single scolio is Cobb angle decreased in 386 incrcased in 353 and in 261 was lInchonged Axiol rotarion angle in 216 ofcases deceased in 295 increased and rell1aincd the sallie in 489
CondlsioJ Asymmetrie mobilisation of the tf1f17k in strictly syl7111elric initial positions is a 1Clhod of choice in the cOl7senJalive treatment ofthe idiopathic seoiosis
STRESZCZENIE
WS~p Celem pracy jest radiologiezla ocena Icczenia skoiloz idiopaf)cznych metoda asvmetrycznejl7lOoili shyzocji tllowia w sciSe symetlyczl7ych pozycjach lV)jscio wych
M aterial i metody Przeprowadono retrospektYlIl7q analizri 136 przypadkeacuteM dzieci (13 chlopcow i 123 dziellshyczqt w wieku 6- 18 lat) z bocznym idiop atycnylll skrYll ieniem krrgoslupa leczonych zachowawczo w Klinice
1
Ortopedla TliJumatoogia RehlblllagraveeJa ARTYKUL POOL1 DOWY OPINION ARTICLE Vol 7 Nf 1 2005 49-$11
Krystyna Dobosiewicz Jacek Durmala Tomasz KotwickP
Katedra i Klinika Rehabilitacji SIAM Katowice 2 Katedra i Klinika Orlopedii Dziecircej AM Pozncrlz
Biodynamiczna metoda tr6jplaszczyznowej korekcji skolioz idiopatycznych - opis metody Biodynamic method for 3-D correction of idiopathie
scoliosis a description ofthe method
SIOWQ kluczowe leezenie zachowawcze skoliozy idiopatyczne korekeja tr6jplaszczyznowa Key words conservative treament idiopathie scoliosis 3-D correction
SUMMARY
The biodynamic method of hree-dfmensional carreeion of idiopathie scoliosis is based on Ihe palhomeshychanics of idiopathie scolioiiiii and consiss in aClive segmental three-dimensional correction ofspinal cllrshyvatlre The course of action focuses in the viciniy ofthe apical vertebra Proprioceptive facilitation is applied on Ihe concave side ofthe curvaJure and exteroceplivefacilitation on the convex side Correction likewise proshyprio- or exteroceplive facilitation is phase-oclœd with asymmetric respirarory movemenr as weil as wilh parshyticular phases of the respiratory cycle ln Ihe course ofexercises three-planar movement is generated opposite to the direction in which scoliosis Is progressing This method is in accordance with the stale ofthe art ofscoshyIiasis pathomechanics The method requires detaied training and can Ihen con be applied at home under periodic control by a physician and a physiolherapist The method con be applied in landem with a Cheneau brace as weil as in surgical pretreatment A elaUed description of Ihe method of three-dimensional scoliosis trealment will be presented in Ihis article
STRESZCZENIE
ISlofa biadynamicznej mefody Ir6jplaszczyznowej korekcji skoioz idiopatycmych oparlaj est na patomechashynice iikolioz idiopatycznych - poega ana na czynnej segmentanlej tr6jplaszczymowej korekcji skrzywienia Dzialanie koncentruj e siccedil w pobitu Icrllgll szczytowego sknywienia Stosowane iest bodicowanie propiocepshytywne po stronie wklllsej oraz eksteroceptywne po stronie wypuldej Korekcja i slosowanie bodicocircw propioshyi eksteroceprywnych zsynchronizowane j esl z asymetrycznym torem oddechowym oraz z poszczeg61nymi fazashymi oddechu W trakcie eacutewiczen powstaje odwrotny do lrierurzku rozwoju scoliozy tr6jplaszczyznowy ruch IcrFtshygoslupa Melodajesl zgodna z aktualnym stanem wiedzy na lemat patomechanizmu scoiozy nymaga szczegocircshy100-lego instniktaZu po clorym mote byeacute wykonywana w warunkach domowych Z olcresowq kontrolq przez leshycana i fizj oterapeutll Metoda mote byeacute stosowana r6wnolegle z leczeniem gorsetem korekcyjnym Cheneau a talcte w przygotowaniu do leczenia operacyjnego slcolioz W pracy przedslawiony zostal szczeg6owy apis meshytody leczenia
Skoliozy idlopatyczne stanowili znieksztalcenia patycznej rozwija siccedil poprzez przemieszczenie kr~gu tr6j~aszczyznowe charakteryzujltce siccedil wyboczeshy szczytowego w stosunku do krccedilgu g6mego j dolnego niem rotacjltt krccedilg6w klatki piersiowej i miednicy z r6wnoczesolljego rotacjl zgodnie z ruchem wskashyoraz zmianami w fizjologicznych krzywiznach kr~ z6wek zegara dia skrzywienia prawostronnego oraz goslupa w plaszczyinie slrzalkoweJ [ 123] przeciwnie do wskaz6wek zegara dIa skrzywienia leshy
Z punklu widz nia patomechaniki tr6jplaszczyshy wostronnego Koncepcja rozwoju skoliozy jako rotashyznowe znieksztalcenie krccedilgoslupa w skoliozie idio- cja i kontrotacja sugeruje ze sily korekcyjne powinshy
49
EDUCATION MEETING SATURDAY 8th of APRIL 2006
- CARDJOPULMONARY EXERCIS E
TEST IN GIRLS WITH
CONSERVA TIVEL Y TREA TED
IDIOPATHIC SCOLIOSIS
Jacek DURMALA Krystyna DOBOSIEWICZ
Department of Rehabilitation Medical University of Silesia
Katowice Poland jdurmalaqcmpl
The aim of the study was
to estimate the influence the conservative treatment (asymmetric mobilization of the trunk by Dobosiewicz) on physical efficiency in the group of girls with idiopathie scoliosis
Material
bull 87 girls with idiopathie scoliosis
aged 1 0-17 years
(mean age 135 years SO 161)
J Durmala K Dobosiewicz 1
EDUCATION MEETING SATURDAY8thof APRIL 2006
Material
bull 38 girls (437) with double major scol iosis (thoracic segment - Cobb angle 18-42deg mean 30deg SO 82 angle of axial rotation 4-32deg mean 21 deg SD 107 lumbar segment - Cobb angle 11 shy48deg mean 31deg SO 128 angle of axial rotation 5shy30deg mean 13deg SO 85)
bull 49 girls (563) with single scoliosis (Cobb angle 11-75deg mean 33deg SO 155 angle of axial rotat ion 5-30deg mean 14deg SD 83)
TIoracic kyphosis of the invesllgated group was 5-39deg mean 23deg SO 86 and lumbar lordosis 16-41middot mean 30 50 65)
Material
bull The 64 girls aged 10-17 years (m ean age 131
years SD 132) were conservat ively Ireated
using Dobosiewiczs method
bull Treatment period ranged from 5 months 10 3
years (mean 148 months SD 902)
Material The 23 girls aged 10-17 years (mean age 136 years SO 108) were treated u sing symmetric exercises - treatment period ranged from 4 months to 3 years (mean 161 months SO 1019)
bull 26 of ail g irls (18 girls earlier treated using Dobosiewiczs m ethod and 8 gi rls earlier treated using symmetric exercises) aged 10-17 years (mean age 134 years SO 108) were twice tested - at first and last day of Intensive hospital rehabilitation (asymmetnc mobllization of the trunk by Oobosiewicz) - mean hospitalization period 20 days (range 18-26 days)
i rf~8f6~~ or~~n~= ~~r~1~r~icircJ~~tb~~~~ mean 17-4 1deg meatl~(I SO 74 R n~le ofax 1 rotatIon 5-25ot mC3 111 3laquo S0 6icircl Ilnd 1 99t1S~ ~~~~I~~~~~$ruo~ras~ ~ocirc~~a~e~~~~~~~5euml1 9middotn~ tUfllbar Iord05ts 16-4 1deg mean 311 SO 68)
J Durmala K Dobosiewicz 2
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Material
The control group consisted of 77 healthy
girls aged 6-17 years (mean age 12
years SD 31)
Material
The examined girls participated in school
only in scheduled physical education
lessons and have not been enrolled in
other sporting activity
METHOD
The exercise cycle
ergometer test was
performed
J Durmala K Dobosiewicz 3
EDUCATION MEETING SATURDAY 8th of APRIL 2006
METHOD
The Incrementai exercise test has been applied
We have found that tests ln whlch the Incrementai part of the protocol ln completed between 8 -12 minutes duration glve the
bullhighest maximum VOz in normal subjects
METHOD
The workload was Increased stepwlse
bull by 10 Watt every minute - ln chlldren
with high ~ 135 cm
bull by 15 Watt every minute ln chlldren
with high gt 135 cm
METHOD
The test had been contlnued untll refusai of the patient or exceeding the pulse Ilmit
Durlng the exerclse the gas exchange parameters were recorded by Jaeger device model Oxycon Alfa uslng direct breath-byshybreath rnethod (with face mask)
J Durmala K Dobosewlcz 4
EDUCATION MEETING SATURDAY 8th of APRIL 2006
METHOD ~ ~~ r 3 min 3 min 8 - 12 min 6 min -~
_ 0 rpiYJ 0 rpm 60 rpm ~1 30 rpm
_ t o~w=att~o~~na ~~ att__~ tl~~S~~ l ad l ~~~~~r o~w= Hlcremenlal t
pedaillog i i ~
~ ilt ~I~-----tl-~ I t ~ i ~ lOSt sffortivB
lW r resututlon r rm-u middot 1 - bullA~cremen tal ~~ ~ ~ ifr- ~ VtI 1 ~i ~ tllng _
METHOD
On the basis of recorded parameters VAT
has been individually computed for each
child using V-slope method by
Wasserman
METHOD
For assesment of physical capacity
the maximal minute oxygen o
consumption (V02max) ventilatory
anaerobic threshold (VAT) and
maximal workload was used
J Durmala K Dobosiewicz 5
EDUCATION MEETING SATURDAY 8thof APRIL 2006
RESULTS
Ali girls with 18 have been classified
within normal range of predicted
values of
bull maximal minute oxygen uptake
bull VAT and
bull maximal workload
RESULTS
The differences between group of girls
treated using Dobosiewicz s method and
group of girl s treated using symmetric
exercises were statistically significant
Lower exercise efficiency of girls treated
using sym metric exercises has been
observed
RESULTS Girls wilh IS Irealed using
N=87 p value
Dobosiewlczs method N64
symmetJic oxor-ci Nz23
Perœnlage of predicled vaJue of
maximal minute oxygen uptake
98 905 0033
Percenlage of predicled value of
VAT 97 933 0049
Percenlage 01 predided value ni
maximal workload 101 939 0038
J Durmala K Dobosiewicz 6
EDUCATION MEETING SATURDAY8th of APRIL 2006
RESULTS 26 girl s twice tested - at fi rst and last day of intensive hospital rehabilitation
The value of ventilatory anaerobic threshold increased during intensive hospital rehabilitation (asymmetric mobilization of the trunk by Oobosiewicz) statistically significantly (p=00019)
2047 ml O2 minkg (SO 268)
vs 2239 ml O2 minkg (SO 232)
Conclusions
1 The exerc ise eff iciency of girls with IS treated by asymmetric exerc ises of Oobosiewicz is norm al
2 Such high level of the exercise efficiency of thIcircs group resulted fram using of Oobosiewiczs method
r
J Durmala K Dobosiewicz 7
REVIEWS
Role of physical exercise in tbe treattnent of mild idiopathie adolescent scoliosis
Revicw of th- literature
A NECRlNl N VElWNL s PARZI 1 A NEGRINJ 5 NEClU NI
P1t~silillxlrd~ Ihcrapy (or klucgtlttlwrlpyl i pro shy-tJm of physka] cXlrd-cs ipcci I(a~ (IJcloJgtcd hy l li trIWlltl phrslollwrapbt wilh tb m~ln a1mor pl shyVCnI in lhe ilAAfIVltilH1 llf the ucirccfonuity III mild IgtC )
Lil1Si bclpin~ thebm ( aocl co uaufllclilIg ils ~jd- clf IS in nlOdlJmiddotnh-culiosis Th middotalillofthi paper ito r (W
Ille Ii lc ram r 1 a-ccrulin wh kh of Ih bull Lu[Jalmlcrus Ind (Lb hili til~ CLlLt-cd br scnli()si- clluld bl pl Y nlcd or r d uccd hl phylolld LXtmiddotrdsi n Il p--to-da le knowl Uuml~l nr tIll~C aspcc[~ i ne bulled in oruer 10 dndc whclh~r 11Rf blLl adcqlmtt Ib(uuml n middotlicaJ balis fo r ora)aini l Ihe US4~ of lUgravellgtitlerap) wltcllj(r or fln l th e prtl1iœ of kimiddot ~lre IUlll poNjn~ a t iil ies ~bould h allowtcI II uuml middot c enliaI toltlentlf)wh k lu alClor ie - lf pl lr~kiJl -c rmiddot d gtlt- (Ic rnnhi UzJ( inn ni (t hl HrJltlon [ rtn~hcll iJl ~ or 1i1J(IChIumlJlJt etc) Sh llU Ld be TolullllCcluse ulemiddot l onld b- clclIimcntalancl wukh sho ll ld he IJlI-n~ifl~d I~~a l lhc (o uld h 11lfu 1 Know k dg CJnc1in t (wIn SeiCIImiddot Hlk rCS([lflt h daw ccordinll to Ih bull llVit w o f tIlt iii 111 1( plop(lsltd in (h i papcr lmiddotonllmJ l lnl plLyi 11 cxcr(j$( pn (nti or (tmiddotduce dhlblli t ic 1 ~lt Il Jj ll(k pl ti Jlt fadl j w(~ the nlIIIrl li7alinn n f poMural dd shylitS tu p n xJ llc aSl COIlMqnen c(middot 1 all )llal) or r(tn~ shys i middot middotlIrve Tilt u~c (I f appn1priattmiddot kincsiuuml wrlpy 0 in rcns polttllcal swhiIHy Icirc IIHmiddotorc Illta ll y (0 r 1(lt1 lllho UAh mon ltlccurlltc 1Ut dl1alkd -rLk l(lWfils 111111 )11 h Jlccdt(
11) wurcJlt 0 lit)-IcircS (Iumpy - x rcLs P()lun
n rllt lT(ltnklf u f COll1tlK H (rtd) I 1i plfho l og l ~$I rUlglng tr m low tmiddot k Pl 1l1 to IdiOpath ie SCUIshy
Submitt(oJ [or PUhltCl l1 011 uly Tt 2001 Acc~pttJ ugu - ~2 1(t-1l
Addre rltj-xlfll telt~I(middotb If) - grinl Flt(1(bziurllt r )(m Ofl ()(Cl1I shy Lt middotqlltœlll ro () - 1u I4t agravehLIlKil ta IYIL-lTt ilSllltp lfllmiddot ~ 1l1uumldull
CelII ~ (niiOS I I~ middot ann (1) IfUh middot lIlfU di louhilll(tymi ( Nlmiddot ~iI rli -ilIIUmiddotltlfl
Nlti(ir 1( ) il r() (ltbullagt1
lt vLL_ l IiII no 1ftfI
jS ) we are a IUil ly tJc ing n1n) ltblll lS 1 k l1 b ~J)w in~ tl~ t S Jfll l approad llt - l1n til hy on ielshyertd ~tan lard ugraveJuld ln m any ~1~ he lI ~t les i if Ilot dange r )ll lt rhlS is lrut of reil l lnw 1gtlt1lt1 pa in l ~ or 5urgi c ll lrea lmltnl5 in dbc r lmiddot ll Sc - 2
ln tlle cj-e ut ~ t lll(tlWtl i( li p l ll1JC luuml- I ~ middottnl ~() shyliosis phys cal ((_lt1(( is emr1uved ltI t()fIl1 0 lh~rtrv
lo ly in cel1l in L)lllllde (nluumlnlr in tilt Lltlll middotorkl i e Iw l) r llt t Srain hUI IIgt() 111 Gert11lny 5- 1~1 in other reg lOl1 wbere thi I-incl qf tre l tm e rll 1 p~ 1 pmiddot t 1( cI il Jws Ixen cri ri cilld md rel -cltd Lw m~lI1 1 11 Jlu~ Fue Fnlny r ~lrs thio middot15 a lsgt(ru( f ~rth r -~ltc rrJtf))~ ll t vit11 br1Cltcgt b r II1 ([C Llt n ClW grmvlng 1lt1 0 L Sti g
gcsti n the lIsefulnes- u r Ih is form o t treatm n t 1
Hmiddotu]rs have nerged jn El or uf pll y~ iLd eegraverdse eacute 00[ 1 but tlw are nUl yel 11 11 t llu i vIC~11 and r hi ~
f rm of trt ~ltmenr IS stiJ l Ul1 ckf ckhate FfI t Jt 111 il i 11t (eltary td 1I iFy 11umbtr ot
b l sic COI ceP rlJ lf w ill he cIh tt d in t hi pap r
Scollosis
DCijIrI iriolls
ScnUoSlS is Irlircc c1 lme nsIcircltnal (I(gt i l cj on ot tht spinc thar cau C a CU 1 lh lt ca n h e $ t~en ln (1 me1Sshy
ured ultinF Coh) lll ltllCXI o n HI anreu middot p rtc rilt r
EUJlOI -1 lœDICOPHYSlc~ IR
NECRI Nl
110
f)i)
1 7J
amp aS g 5li - 0 v
V
31
10
(1 1) Il 15
-tc i ytjtr~)
FigJ----jllph ot DlI w l-lkaupegraverel) The agloimvltltinn Or idio r lrhlc 50gt1iflll~ IS rpiJ bel~ en th e- [l0 IH P (l)ltg tnntll lol (JI PUllcmiddotny) mtl 1 ( f( lS-er sigll paiilivltecirc lt Dlt(i I1 11illg r the iti l 1Kgt n n t rll icirclicH a ) 111lt m omal prebulled the mno rche md ociks with lll I)ttlx flal gr Ih pll fl
rlcljoprdphLi 1 hl merl prestIK ~ of this curvt c10es n t autom~l ritllJy indi ate the pn$CI1(t of a defurshyTnitv (SlllKtUrd (Unel
It i~ possible tu clil1e ren tute a struCnlt t CI1tve fruIn a pogt urll 011e by identifyi og the hum]) du ring AdIlns tesr I~OQ looklng tra m beh lnd at the p atient w ho b benchng fUfward il is p -- ible ta d d~ct 1l1 eh ucirc n of o ne liidlt 0 1 the trunk usually n n the (onvex ~ jde ul tbe radiographie CUfve Ugrave1lr C Ul be mlt~I Slred lISin~
BUlln els S o liomere( 1 ~ l This h Uf1lp is du(- lO (Ile pregravegtecircn ~ of vertel ra i rolltion 1c1 Ollt tn tic f~YJ tllre o f the def trrnit tli [ c m be seen and measurc(i v ith Perddolles lb lsLometer on an amero-Ix)iferior radioshygrapb ~2
Seven ry pel cent o f li Ises a re conid 1lt 1tO be idiopa thie 1 bull ia l-nosilt in this CI$C is b exdlls i ~ n as idinpa thlc me-us t11H wc do n()[ know rJw origio of lheacute curvc [n othe] ~Ie$ it b Ix )~i ble ro ide nrify a dieak (bat CHl jusrify the c1etgtnniry slIch a rna lfo rshymar i ns I1(gtufol Ig ic~ l or genlttic cl iscas s Glnclt~r trauma etc )
[dicirc)parhk S(oliosis has been divicled ~(corcling (0
the ~Ie of tlie patient egrave1l the tiJ1ll of d~[ccli n of the condil ion into ti) ur t ypei ln fanUlc jU nik ltldolesshyccnt lnd aduh Til l m n st cnnunon (VPC IS the acloshylescegravenr o licirceacute I1IJctenzec1 hy 1 sud le l1 tggrH3l ion uuml uring the grow tll Spllrt (Hg 1)2
lhile p tu 1l sco liosi i5 Ycry lomnw n thl pre shy~Iknct ra te f r adole ent icuumlop~lthic structural CU IY~S in sch )o chilclren are 18middot20
- 10 Co bb d~grels o r m on l -lil
- 2) ~ohh dtgreclt or mort O 2~j - bull () (obb d gre -s )1 mOfeacute ()ll 2
Clin iltI [ d e isio ns lfl IXlSed 111 an lccu r~He pregshynosi which obt inccl in eJch pa ti nt mainly o n the basi of the nsidu~ll p()tlnllltl l of TH1h and the result s of 1 rh clin 1 1 ~l1d tadiogmpl i exlminashyti(ln12ll c noieq uentlya d inica ] la sifiou io n o f the ing le pHient tn -ome estent co incic1 ing w irh the
D diographic one c l n lw SLlIl1H1arizeci 1 1 folIcJ - mikl lc~ (1)(n 20 C bh de~r es - moderJt l betwlen ln md 15 ohh de~ rtes - StV re 111( gt1lt rh n ~J) )bh (kgf s
On the 1) lsis of [hi - dinic d d a lfic t i n (Vith l1l il el lrb tiOI ~ o f the ir b() und~ri e ) in Itllt l cente rS Of SCOtiO LS ITe ltlllent in the Lltin odcl (i rJ Ital lnmct md PI iJ Ugrave tre tmtnt i s plmmcd a fo lltJw 8l
- mild kineslth e (~1fw ~1Il (1 luok-ou t - Hl demte IJragravecegrave 1111101 c(~r md k i rws ithe lJpy - ~cven surgery
Physical exe rcL~e for S(ol iosis
Defi t tiOl l S
PhyS i 11 nU b lIKrlttp middot (or kines ithcIa Pl) i a p rvgrlill or plt~i Gl l (xeriltecircS ~1ci fi ( llJ y ltk ~ loped
y a -11 [ru ine 1pll yslo ther3pisr wirh th e m 10 Hllll
- pre (~ n tit1g tlc aggraaLion of the cl I )flnily in rnild bullcoUm is
- helping tlk Il ld Ct ~lOd ounter~lCtjng its skie elfects in III de rltegrave sc li sis
Tn tl1i_ feSpec1 kinesitl1ert py f JI s oliosis is tonshysider l a o on of peciticcedil training and s genecirc tltllly proposelt in sessions 0 1 4~ ro 60 minute IW) t) tour limes 1 Cee PhysiGtl exerci es can aLo ll v o ther auumlns 1S it oill he dise Issed in this plper
Ir 15 Ilot possib le to cl escribe a single progrlIT1 o r exerc ise a5 pro nrams ale USLIJUy p fgt nll ized ( ( lt
EUH PA ~illDI (DP1I YS IC~ 182
ROlL UF P l 1YSICAL lXl 1lt 1~E IN l IlE 11 ~l) IEd If IlU) l[)VP 1HI AIJ() J)~Cl~ r COl ~I NlG1W il
f)( 15 egraved ( )Il the nee L- 01 indi iuua l pJl itnts) al l l10ugh Lheacute) C l n h t 11 plicd o n a WOU p hJ~js (-1 (0 () pnients PC[ ~l ()lI r)middot lugrave reQCf lhese 1 10 grl lll frequt ml~ V IIT
hnm on in middotituk w allClthltJmiddot -Ill Jnv L l~egrave at Wc w Ht ~huw in lhis lyl peJ it i~ 111 n u -eII1 tu id e ntilv kirK itheJapturlc aims w hitl l ucircrr~spnd LO ugravelt~lil1 DUtshy
g X ir ur ph -s ici l lxtTi~l I~llhe r thln ln dj( us- indishyiJ u1 1progr-lfll
Aduumll l lxUl kisure time ~lOd h )u] Sp u lllll8 ~Ilttishy
i lt egrave~ i middotomm )Ly s iven lel mJ ing ro w hlf ~ Iuumlnsidshyer~d usdul or il lrmfu l in t1 lt rruning (lI tJw ptliJicirct ln tl1bplper Ugrave1 gent ltl l t rl ll bull p lwsiCUgrave lttG iviUes is rl ktll 10 JllI1ltlCc hOlll gtpOlt mJ kIJ1lsIcircl hc lJ l f
i ve lUen tloneumld )bo C on lv ine n dul( re Ull~ 1t~1 t s far Ilten publislt d f I~ mJ I(i noltgtithltl rgt is 11 11 a su h jel lnI deacutehate CJitk haltlt t llltit m itn ltl of l ny lorm o t p l1 ySiClI lxrcL e as a Itwr1 [ J- fo r i liopa tb il jcoJL~b un iL ()ri gin~ initial1) it WIS Ille r rOmiddotUumlK lt brgdv u f p l~lt titu gtllergt w h ) intervenecl hutll tc llcrl ll (mon as cltl HtilJ nic in terventi n man Jgt
1 t lltrJp utl t one 1 md rC j fkll l~ on rhe h sh lf som uni cOen I1v pn t I1cgts wt ldl hll ltl enl1 JI~ haLl nu na l scicnt lfic baisYmiddot HOlh tlle$( trr t peu shy to rh ~rl py tt nJecI to l~~rJ tte C Ih tk CUf -~ pnnshyclr~tll y as a f tsul t of lilo h llIzatio ll of tn imdqultdy ~u pp rt(d S pln eacute 7~ 12 to re-t1 r rI ltrl 1$ l l1C k o f WH llt~~rdl 10 I ndt~-dll()urnah tnd 11( on1 p~l per u suaJly Cl tc([ IS n prelimmtrf lll d 3 ln tt li w ay man (l rrlKpt(Hc H lf O iS Inll ph ~i C U l ~ d vi ~ cI nllog scnliotl pa t le nL~ 3gainst holll ph lca l egravexershyclc and p()rt~1
It m u st t~ n tfd [hat pllyknl txerc j~ tJe~ltm(nls t1iHer 1 lJ rd il1g r rhe rherlpcu tlC litTl~ on lllc h tJ rgt ap p lolc il l the IXlltent lncl hi im r IIIllHnt i- 1 (1(1 rI - 5lt1J lC igt tIl l ( f phJllIlllolopJ al rrea tmln ls Ihith cllffc r 1lt œQlfd- rhe m C cculc u ~t(l luI thl p al 1t n
~mc l 11i (lbE~e Tt i ~ P ~il k tlwreI[middote thll wuumlk ltlll t kin 1or ph~ i Clt1 1 lX r(j~ 1I 111~ t bc loidvd by t h~ Lo iurie IxujCJ1l al1ulhcr a dl ~IS nJI h~ iOg (1 11shygerols llugJr in racr le (wi ller d I ~fJIII ~ I ml thlls re(nl1l rn ndc(1
fn n UI cel1ll r we In(~ hccf) using 1 ) 1 1111 11 ve ) 1 (J p lw l icd ex(r(i~e (0 J ( 1I l tt i~ tlh aITt ~ l~d Ilv m ikl tru cflumiddott1 adokscltnt (cl ioj arh lC icoli is11 2)
ina the f U~ t rc-gt uJrs IefC pu b lishe - the pJ( )grd m 11lt1lt l1te n PWltllk d in fa c t deel()pnlln l~ in th t l itshy OlL1Ii in tl1 r b t ~() ycal f ha ve iclemi fiecl niO l l
m d 111 ur impl rnHm s md d i s )h ilir i (gt~ lue t idlo p lthk amp()lio -i ~ t Jll CIII he 1UO(l if Icirc 1by phyict1 egrave xert iSlgt l fe t rrncllt
l illl
111e aim of t l1JS r~l per ii tmiddot (tv iew tl1( l iterat urt to a(errl ln v llic ll of th~ impa irm 1t~ and Liit hil it il i GllIltec hy ~ o l i()gtj s -o ull he ll nt x or re middotlu celt1 Ili pl1ysical xerclse An u p-to-da te knOvkdge o f tl lt Lgtpecl-gt i necckC1 in rJeumlr) d -oek
- whetll~r there h ltl n adLtIIl ) l tht()d ical bbh fur or JqIIcirclb l l l1 Il( ) f k irt llit herlpy
- h N I)(1 ( 1 Dm tlle p r l c tIcirc(( o f Jebur tiJne )pOfung lcli v l ti ~ IIOU lci he tllf) -d o
II J U V f h 1 I11~ c~~lb li hed Ihe usefuhlLss 01 k il1 shyc ~thtrpy il i aIle dy l nsi 1([(( -r-tI Llleu i n )I11 plJt~ ut the wJrld ir ilt ecircS~nl i 1 I( id n Iv w l1i li ( 1shy
gories 0 1 pl1Vtl( 1excrClgtegt te D)bilI7it ric 1n (Ir st shylliuumlZltio f) lttlt tlgtbltn ing ni trcrccedilh ing erc) hn Id be
vnlcled he tll rhe nuld be lerrillldll1 1 md whidl s tlQu1d be inreœ jf ic(1 IJeClU~l tlley cOli lel Je LI ~ful
Ncuro1llotor impainncnts
Imv aUl llOr~ 11 lt1lt ~tlKlteJ lhe cltlndatiotl bd Ween tl UC1UmiddotIt t l ol(~C t nt id iopml je -nll ~J~ and cli~l l shyler~ lr 1tH lest ihuLIr yt 1 _ 13 ~ 311 D uhoussct 1
1-- ITS tln l ldiopath k s(o lio-L L cll -c d l J l hmgt in th terl tltr f prop li l l pu n md 1I1ar th e detrshyn Hi n i~ na tural 1 ~ronse to ril e need tu ts tu re p()tun ltlluilib riu Ul HcrmJJ1 31~ 11 () d tllat icliupathic ( liCl5j h l it re5u lt Ot1 rw nltuf mot r l ~ltelV
[Id )fcl 3 nI] ~1ltJ U Sr1lle nr to dtorders in centJtI lO~Cl shyIOIDNur) md 1xi~tI moro (Ul1lfOl syt( llI (Fig _l
N htIll -of) H1c S uumll h( rll1 ( ~ l( w ing JI t11 (oshyI-ie on the l l lO]ugy o b doll (nt Rl iu]icirc tlili- middot()lioL m unt fil t-hltll rhl ugravedcmnilV L th e fl5 ult o f 1 (k btcl 11lIFll llI ion nf som t11(WUgravetltnl md pO~ lur( (tnic l~ l licirc1 tl1lt if l p OgtlbJt b C 1l rlw sta l i lin 0f 11 1 Sf llle j lt g )tx l Tt) ohtil n a ))Cli U 1ILzltl I o f p ~llIr~il d l~flo [ in l1litkd ~J)llnSIS me CI Igt(middotqucnr J ~ a ~tmicirc ()nlly or regle Ie Llive
Ali th- 11yp ) tlw~es rd ~lte tr d irtl Itn t pnl1tlt o f [11 v hole ~piltm It11[ controls postu re ~nd mrw shyment lrre pell ic of tlh po int a d lI~ llv inH llYegraved il i ~ ll 1 nnable tCl aSUilll ri 1l tr l ll1 lo g thi ~ys ttm ( Qu it le 1I middoteli tl
lt ch ugt nlt~(S f rullliIl thil i nlomwtion th at p tlmiddot shyiCil J(tl iIies nw gt Il lInport~n t rr le to pbv [11Icircgt role ca n 1)lt slI i11l1lariztd ln lWO the ptu li ain Llt
- d elopmll1 l of p uumlltl St1 b Hlt ) - c1e veuml IOpm 1)[ o f bhll1ltc _
(k llhUl)lOr S Cll orr
ontrot oic whan-lt
------+ 1 ~ il lnll ugrave r AINnl
Cllnlr1
T bflt~ r
fltL1 tlli
lMini
l
~sary ~J-frlllen i )f
~ 1 ocirctnl
~UcirclllIJJlW Ll
AXl ~l1 n uumll l) r sy 5t ~nl
middoticoltoq ~ Fig 2-AcFgtrdong lU He-mutl 21 il is Fi)5~ ib1e rD prolXgtSlt l -oo ie1 mnd 1 ((if ~ elio egrave middotAhltr~d l)Qdy-p ati~ I I i u d) uren ttllOn k td LO In ~ory reHTt I1 eDi tn l al ) JdrnlV~ pn)4~ e l u r~o(Ofe 0-c1 eptunl dvstil t1 ctlon sltŒ(ry icircltu nu11t ilwnt [ ~mC ~ted tl l1 ce Ill trpntlshyUumlfJJl nd IKnle~ r~dibl jtugrave)n of -I) m tlosen Ir ~ig nj tl (I1vying ln fornll1U n (lI an ereltl ~piJl e Mmor aJJ r--a t ~) n ltgtf ti lt aXljl mowr plem iHUC Wh ~fl Ille 6ubjeco m uumlntl Icircn (1oJifitd perccpfLlI l ~na l ysilt of p n)lnocepti Icircnfu rnlaquol ti desnibJOS ~n t tecr spin A IICW motor co nrro l Ira I gy t adopt resu ltin~ in the ~tr ltctltr 1 ckformh y lf IdiopathirL scollos i=i Ht lrftU1uc nltnt l ISll I1lJy h1e- ~ I pro()und elkn on bralO Sfem flJll ct i(lnn~lLhu modifyRll Ille nltulltgtshytl10 ) 1 1111 Uu l-lHoror control 5~Shnl$ shy
As Srtgn1lt1 l ~ ltlssert~ if wc l C -Cp t 111 1 un o f the G IiC s oliosls L l tisorckr oi th e ltquilibrilltn sys t ~ms it is lagical to oriegravenrate physlCl l exercis( lherap y ln th is d ir(gtCli()[1
11lclte goals Cul tl lfOUgil ditrercn t modes 01 action be Olchic(-c1 witJ1 phykal accivit ie
- po rt ive Cll ities p ro ct LJ e aIl UgravelClltrtsc in 6lte nshyel ll )o rd in~lti n pinai pr0prinup ti_)[J nLi mOVeshyment control 0 vio lls iy ln thh repect ome lCtivshylites aœ pre um~I I)y lXrter tllln ntil crs
- kinrl lira py using pedJil exerCisocirc specially developecl lith th est 1101 5 in mind illVuuml VC I lllore prccilt( ll1d InC1 li zed cri n on rhe spiJw focusing
a90
1 ~~
lg -lNheJo ~1l l1 t r~l g rld in 1 1) h i(~ IImiddot ct r rHienl w i ll idlllhic _It ~i ~ _ iri s plt ~I le II find Jit ltH vlllleuml ~l Cgtbl tn~ ks III d il fef lt p ~ lt ihnS nu v~tl middot B ~a~pt u Il C middotl)Icircd ~(t l l11 C dlfkrCnl middot- hdween slllndi1g Uline nu nllt1Xinul oorrec ri nI t chied Vith Ct (J ) und tfdincJ ne lot es o UIine 1 fo llnVs middotIJfl tfi ni( - ltlrshy
reltiK)n ~ Ikexibiliry st3nucircing - -pirte - f ur~1 1IbjISC ltupin - ltorrcaion - - r~luci()il ll ymiddot For flmpllt in J npK l1 pH k1J il
plt1SSlhlc ln obtai n 10 u1 511ndlt)l [YLo lion yr ln Slt p ille rlOlgt itlugraven om l J ~ in ( gttf(C rigtIl lIex lbuil 15 i (r-l l=22deg pol lltl ~~J IIlpraquo is IcircO~-V- I t1 l nd tucircu(Ugrave) ilil) I~ 3laquoJO- IH-12
r ln Ugravel e abilit jl of tluuml [m e llu to co ntro l irse lr in ~ pac
fuld l oftlles uumlllelve ntio ns can presum1b1r incn~~ Ih enl ac )1 the orller and lHitlll r of Ille rn - 11 )ltd h e lllldenl lu EJ3)4il
Posl1l1-t collapse lnd slabilizariotl
lIle concept u fplt st lUal c(l lJap~e l l~t Iwen detin 61 by DlI II-T3e~tupegrave rL t Ac oJdin)j tu tl1i- ~ll1thor il [ nec(sary ~- l Hn Cv-tlualing th tleihility o f a col shylo tIcircC CUJVL (0 clistingu ih bt tVeen the re du ihil [ty index (th - li iffer gt le bet ~middot Il ~I r~tcli()grJph ie ~xnmshyinltio n of the iI111 pHienr in supine po ition m(i
ROte OF Pl rnmL EŒIlCISE IN THE TREAT-ŒNT OP ~I IJD IDIOPAnnC OOU~GEm seou SIS EltJRINI
I (~)-----------------------~
__ _~ _____ _~ __ __ L ___~ ________1 ____ _ __ ____ ___ ___ _____L___ _____ l___ ----------L ______ _
1 ~
1
-- ------- --1---- ---- ]---r --- -----_----t- ---- --- ---shy__ ______~---- __ ____ 1________ __ _1_ __ ____ __shy
~ (1 J
1
8 =~~=r=middotmiddotmiddotmiddoti~=-middotl--- middotmiddotmiddotshy--------------t----------~- -------- - ------__shy
~---- --- -- -~ -------------r---- -- -- ~-- - -------- --shy----i-------r-- - ---- ~~-shy
il 1~ 0
Dtl-Lmiddot ~ lttj l r~ UIltltlHt
f g 1 -TI1 u ilictf 1ld ( ii 11- ugraveu-sh) ld IX~ O 1d wllich ltJdnrshymII Il nf the pilll 1 ~tln~1 of th e -o lioti( spinc n IG~nI(J II IIIshytt) lhe iJeuml grl-e o f ~ ()Ii ti c (u rvH Il 1 w dcpc-nlknrly o l l he 10 111shy
P01(nl (pntt l ~ 1 1 nr ffll wrJ I) ln w hilth Ihe n i 1gt( ~ duc nL~ grlphs fm I h~lt 111lt hi~hr Iht Col h ~Ilu t (l f Lite ~Ul Ihe m Ol CI il y th t s(uumlJotil middotpin~ ~111 he ~middotJg gr~lVH(~(1
m mJxiTIt corrttt ion wll iJl i~ lIllCd to Ih - xt 1shy
lti Oilil y Jf tl1lt t Ut JO rl1t cdnUc idt md p OS shy
tU ll cul lapse ( th t ltHill enct b-tten l lUdioL) 1lphic egraveltamJl1ltlti OI1 J t th e ~lme pa tient in Sl il tl cling lOJ lline fX-sitiutl ) Wll ic h correb lc- onl wil ll fhe abilt ty of lllt p tu rl l gt s tem to C( lunternct lIk luree o r grl viry )cco d ing rv D lfVd- f3egraveLIprc po st li r t1 lt01shyIlDse is d ue to the Jnus -u lar ton a nd 11ll ex rCrIshy i) i itv of rhe tissus n the ( O IW-) si it (If the (01shyjl ti (~JtVe (Fi~ 3 L Pu~t llr1 C lltpstl lu lcl l ~~ reduc l-lt by llwans o f pl1ysica l cxerCles specitkally s tuclled ruuml i rnprove tIlus--ubr fOHt md lU pr )cllI Ct 1 ~11 hi shy
lizing ffCd
PararcL n tll CIJ cl the cr iti ca l (3 c1 thlsho ld beQ ld Il ich defol1J lHU n of the i pinlt 1 e~ in~ ne dtlllontr~1t _cl (1l ll t grclrf r mg] o f rllt C II in a qa m bng pos ition corn pOil 15 t l lowcr detormashytion lhnsllold (Fig 1) ie to ~11l Ulne3Se t the risk of pr ogr t~ lu n There t rh eJef re l J ea r l)iuuml 1itshycJ l ~ll1 l l(tl a 1 tnr tg ro b ohwined by d -cr t l ~ illg ilmiddot pU~lUrll cull lpse ptJcelJtge w bich lccording t i)
h llTd tnd ~l(heJ1l ~on 1~ b inde cl 1X llt icularly luumlgh Ugravel mllcl c Iio~ i (bdow 2( 0 ) (F ig 5 J
Fin a Il III ch iS respect lllljl hl and b um l 01 m linmiddot
ii iI 1 l _ _~ _ ___I ___ ___ __L ___ _ ___ ___J______ ___ 1 ___
li 1 1 1 1 i 1
1 i ___--____---___----__-_---_~- _ _--_ ___-+----
i
1
i -- ~- -- ---~-----_-~-_-_--_1-~
l ~
i
+----r--------t-------t------f-- J
Fj~ ~-Ac(XjJlin(Q luuml T O rIcd ~lnd Na(h(ln~ n i () dl( pCG w rd (rTIshy
POO ll is hiherin cu rvegt in wh ilt l1lh ~1flILWrd cII1I Olk l1t IS le- pr(v~knt ln th e grtph Ih t PogttJlJ I ugtnq) Ot1 -J1l j elfltS-e J tlt 1l1t obb dirr remc rlLIv obu incu f roll l the Cohb atl( 0 1stlI1dtJ1g IId gtupinc rldo~raf115 Ih Ille lt) [1l1t1 (i lndnl I pine) 511pille the ~(nlClu tJ1 compo l1lnt U rlk CU Y _VeJily I~ ltx p rlt 1 L1v UpUlt (obh Illeturo Ih t si _b Cct rtJeSIm l fie -ltn J trd Ugraveltuuml shyuumlo n A~-i)rding LP 11(lt uuta o n l ( r1I~( in ~I 2JQ sup itlt curvt 1hi C(]l)b ddhccno l l f lO is -J-lultt( thc s ldnd inr tnla Ol1l t lS wi Q) whil 11) 1 1)401 ~llp lne ClHVC If ~ 1Omiddot ( tcl Lhe ttnd trl~ nlca~ I(t I ~ ~I)
tli n ll w l lllE cq lin ti spin h~ i ng mo r ~ Llnt~II) 1 tlun the nOftl111 one n Cll l gr(lk ( (cU ve tl1u n da r u p shy
po rt in o r k r 10 m linrl in tht 1xi11po tuf_ n th ha__i of th egt onideratl lr1S it f(lll() rhJt
ph rH (~Uuml e erd es ulukl h u - ul iiuml tbeacuteY ~U-L lm cl 1l (It-d o pmg p05111 td C Jl1twl lS fuumlrnll~ rly d ccrll1td ln an Ql St if i imr ol1111 t ru t(( - tht m(d in C JI shy
r t t r sture fO Ir -ngthen tlll m u ck-gt of the spint mainl) in (11erl antig r3ilrl tIcirclt l]lli fun ctin ll U hy meU15 dl i )ll1 t trk ~ lhJ cl( -ll tlt C)nlr~lUions ~llld no l IdOshy
1l)llic d YIltll1k lt l jAJ lktic t) I1 ) II 11)t 111 hd posibleacute t lcluuml ee postura l io nrro and stfh ili lllllt IJI
w i thout food T1lw(ull r d I( Lf(11 Ibk t m ucircnuin Ihe c()rf ~ct [ ()S tu re for cl gtu ifKi IH lLl1gth 0f ti l11 ~
This i-l ddl usl a typl 11 dnmnin (tf k inesllh rap) in 11 (lt-11 [[k - p~d fk lnr in lng f u l1a in llllliCk is poss ihle lI sing ctrtain Idncl fJ l (lt) 11111 liun S p Ul in tb is Cl c is ulttful ooly sa I~tr 1~ il Iw lps t1w lxltknt 1 becuJl)t 1gtlt ltlt-I a ClJu~l inred irl ilL ntllru l o~ i cll
and I1lll~lJhl r-keJc LIl [rll-llIn~ middot etlt(wrs JI the int e rmiddot vlnrion
[J ROPA MfJ) I()Wf-I YSJ IR
1
ICR 1 1-1
r
1 shy ~
- shy
11 o-llrfOlhe5l~ o t Ih 1O~(1dity i n h ~ r ~ ll nr pbl1 l of ~ Spl11 in 111011 _llti1Gt l lPt f ltlJUCWJtl ( ~l Ihe Ir t 1 1gt illbll W Ilh LtltrJ1dlion Vln lbe rigronl middotUII~ l(I Dko n12 lIll h lumshydlanie1 1 [ nul 1 M hl whtrc M - gt) lnIUI1g 111laquo111laquo1 1 1 c rtJCshytjC~ f fce d -d Lill l1~ o f enr niI pUll spnmcl1y 1~ 111 mldlll1lt (n the fl1ur t 1 = tor~ of f(ward Ileuuml l = ughtel1lng fmiddotr p 1shynOf stn lClU= Alaquo rdtllg 1raquo Ihl~ - lin hull th l1ltgtllugrave ot tller1l lUr~Jtllrc F the ~pin t -ilh rlu1i tf Ihl 1 1Ibulll n lrlt InltT1 1
rbc prJI 3IJi l1ty d qrlOIJ~ n bull JI t IlJIII Hm lA the v=ltd gtc e lu-ing J 5lnK1ura i ltfnnity
Dioal e ch anicll itllp~lir J11 c nt
Ihrcemiddotdimcllgtional mc-cbal1in of the s pioc
~f Ikmiddot i t i nly l(œ ntly tlHr llk pr-5tnœ or nc ushy1 lnlo tnr impairment in Idiopttlllc s-ol ii IXl tknt liuml J$ heen h i- ll licircghlcJ hy re$eJ rh tll e preit ilegravee h inm b nIcirc Ji d lJutg~ lt hl ~ 1 ng t o n dO Ulll urcel 1 i5 (l lreldv well umlersrood H(j-ev~r nev lbt un h iomcrhankal im l) ion nI h1c rectm ly onk l n tIlt tre and p r~dou in f n rmtinn hou t pl1ykd (~fcl5( in t 11 0 tl1I _ltgt pbne of spact 1115 Im trqlt-u 1rom J i-[) v ing unclcrsrmdlng ot th l lmc -dim nshy~ilnl l l11 ~ hmk f the cO]jO[lC pln( ~2middot ) ) Ve- w ill )iI xnl t l1 d at lcL-orcltng tUl cl sif iol t lOn blsed o n gtolllt lricd h uumlCJ ) p lane
- b() rJzU[1tl ln th i pla n ~ th t 1o rm ll sp ine present no CUlye- w ll ile Uumll(~ ltc U Hic spLnc clevelops one of ir haracterls(Icircc deFo rm tiCs v elt tbrd ln lashytio n vh icl1 pJ()VcA~ theacute hw 11
- lgitltl in th llulJe U l(~ nonmll spIcirclle pl SenL kypl lOSis ~nd l dooi~ in tb lXI1 lhese [(Hu rts Vere m)( til ught [ 0 he relattd tlle scolkJtlc ( lI r Vegrave
- front l in hi pleme tht ncrmal p ine preseuron t no curYegrave whil thl ~11li tic p in ugravetI I ()~ icircl~ charshyad t Ilt I CU1C
Il Jri fJIIt palic
~l+I~na ra 3 r inr lut th l[ ber ll1d a œl1~lU1 degr 1
l f r()la tJo u lllu (lILa r forcKl ltxert ltJn tl ldefnmuumlng 1 tkllJ [J i1u a re- lhlt tll cly 11 [1 1 UI b y Olm ner w bn ~lh uiJwd tl egrave ro t1tic) l1 Ilm it ti lt p ica] lf shy
rhrl r() be (P (the Uma bevond Wl1iltJl th lCOJlb of [11( ~pmaJ musd ~ dthc COnCIt and nm ex ~l le btconk (t O li~[)
r ~l 18 ~1Il N lu t( ren i9 lun lu ted rlseurlt h in tlt ) tilt lULodeumlformipg1 tlo n ot tIH_ sc laquoJrle rh ox ercallkren lk 1l1~H li d11r once thl Il i ~ r tld1t5 [he lhrth ld f 111 JlIcirc lIi of tlle dnrlclc hurnp tlk
lI bslt Il l nt rlet()rlll lIcircon 01 the it l ()I~ C ( (ylm der (- sustalnecl by an H1tmi cforming aCOOIl
J1Ji h V hl rhyiical f~ f Ise CI 01 h spr n llnd kin middot ith ccedilrapJ my lX damlg ing vll e n l pplild as flle
igt Jk Iller ln SCC1IJ ~IS lllc lJ fxceed l auto in middot crca~ i n g lhrllgthuld [1 sh (~u Id ahn be j ofed that Ilw relscd pre sun 1l1111i insiugrave l fe pil1r inn) 1 mlshylt
- j Il- ( w atff 1 (nh ~1l 1(e Il10 utoldrml ng li1eCh~lI1 1sm
in flc l Geyer ~w tcd th1 t rm m 1 hI l)1ecircch1O lla1 puilll 0 l I C~ sw m mim t Ieuroamp no purpo t for cu lshyim le pllilt t1 s (weumlO middott r it is l~Jl(gtWl1 rhn in iculio r[ paULnl -iJl11T1ill~ doe_gt nor Il ~lp to i ncrt~SL n eur(1shym tor co mfU
(1irai p an (
Jerdnn lle 11 showecl thal ill CSl~ o f t10rLC IC 1i lUgrave
tllo lacolulllhil it lio_1 tlle cte tI llmiry in (he lg itt1 p lln t rn lnlftot il~ lf tspe iuUy in tlw initi 11 r luleuml )f cV IU[Icircon nf Ile ~oli ls W iU l 1 p(t)gr~s~ivlt il10middot~ shy
ment roward hvpok pho b G ll f ill~l Im lins l har dUflng (IN eWllLlfiu1 of 11Imh] co luumlgt i the l in t ot t l H~ gClyty Cegraven te l - 0 1 v llebed lxxli 5 r ro ject 1 seH fl r t side-ys and tlwn backlrcl bull thu~ p(0(1 lj n g a kyphQtlmg aet Il ln (h~ lu mhnr --PIl1 COftj tng
l l i tc Iugrave l lltl l( l rs1 tif s L -etllgt il l the lgirl11
1 Hl)
Ilu LE nI rIIY~Ic~L lXIlKISI 1 HI E TREhTMEtn OP JIU IDIOP llII C AD O USCUH O Ll Œl15 NEGR II
lLill tegt lre lenl1 ~I d ~fo rll1J[ ~ rhl recrSes the phyltiologiGII cmns of lh vine)
Accordlng () Dicion ~2 1 rtcluctio fl in the itgitttl CUIYtS combin l vi th a lueral Iviari n llltl ds t 1
mecban ism () ugravel~ta il ity in l he r rat r IllI1e which bVOf1i the unsd a nd i ncrea~e 0 1 co hlt1is (Fig 6 hiIf md Pl11jlbiJ Jl1eanwlt ile lt(udiecl lh e srnl ru t
orzyglpophySLs show ing t11 al ttleir 1I1tl rnic tl orienshytation f~I (jLi l~ltes aXIal ve rtegravebJl l rotllio ll in cun litluns lt f dorsal hypokrrhn Icirc tnd lum)H de i L lo IS
Tll t dat SLlgge 1 th t impOrfill ut pOitu res and l1lweil1 ) t Mudied in ord t r (CI mlIuml ntrlin or to reuwer fll e p llyslo lo~lCll ClIlye in lIe SlgJtta p lU)l Wlth the llm o t ch ~ kin~ rutltor in l~ bili ry7 AbC th ~e ~k-
1l11nL ~Irt del lnt [0 J jUc lt ftber l]kuti inrervenl ion vhich 1c)LJ k l IV - i(l ~ l compktl n l ililll on Il t c1 l shy-jel1 J11UVllT1ent IJ j o f 1uto-dOneacute(3tlon ( i e a -impk ld ion ) Iengtheni ng o f the pilleacute 011 a litlltl l aXl~ tll lt ((IT liJlI~rcdu e~ t lle ~---lJ linti- l lte ml-fkxj(l n h UI 11 - i llCrl I~t the plllH ](JgicJI dlt cr ~l S ( (1 k-yvllCiSh lIld O(ltOSh l o r c lch r1Iif n t a Ilew til(~ecirc dUuml llt Ilshy
si lflltl J ll1 u(~nlent iam ecl - 1l1t0- lIrfe rionmiddot7 4 llmshyp oed f Je-rura l iUIl cl middot-t1e- iltm lI1d ll1a intltnUlLe )( 5lg it d C Uf (gtS slig lll thltJrc i ypI1 tiZ) tIcircOI1 a nd lunugrave)ar 1()fdos i7~llion) sholild he esw b lb]HU 00 lb co
hl b oi hi p~l11il uU r -1Ir vlt Abo 111( e IlltUtl Chl lie o f purti n - a U vitk slJ1ultI h e )tuumlll ecl 1)] (1 n ldershy](ion r tl1i lt type for e upIe IilJ llyl)T S of repd shyiti( ml vemen prt n t in agonistK h)lnllltlSlks nI iIle kind f dlJ1ce C( uld he ([([r imentd
FmiddotO lllaljlallC and mobili ty of the SpIcircIlC
1 rd llo U 22 d L lm nrrare d lhlt in Illt fro nt a l pll ne
tilt 1 nge Clt 1)1lt vtment of tht scplit[i middot CU IY grcmr lIJ l il ~ d irectio n n f Lhe C ITelt tlO n tha n in tl le di re shyLion of pmgressi n l Fig 7 ) he IL o IS5err lJd tbat th15 mohiliry increac plrtil u la rly n apic [ cgcoeilts 1$ lh ~ ~c() li osb evolves Sragrm rJ 12 J ~ thus rigilt (0
VlI f n rller~p is ts Ilo t t) m o b uumliz - a sCtJl iu til curve w ilhout t [ uling ttwt tlle R lu tiOI o i til t ~a mt b fnlinruumln( 1hy l1tans o f ~I passic 01 1 rivE -uppnrt On tilt (ltllE r hand UgraveK d e iJlioJ1 in ease durill tlw tune 111 whicll tll C spmt i ~ not submjtrcd to correeshy( IV anl()n
j- Virh mi lei ol i b tlllt Upp i1n ill) lC tiol is d eveloped only lllmugil llClIf()mu$Cllbr f r llce thi ~
InegravelIl ~ thclcfo re tl1l[ inu eascgtt sp1J1all1extl)iity mua
11
Imiddotiumltgt 7-rurd illt Ir) 1 bull rdrilt I1 1 in tl lt frOlllll pbnlt- th( illl ge )r mOC llIeJlI o t the S-o UIIJC CUNe 1 supcrior in Ihlt diflt(l im ugrave( the n nKlIl thd n ll1 tllc dlrtcLion o f p rJ1(l( (llIl
be considrCtJ vntrl iJ)(l icltion and 1 undrli neocirc ab L a ~ubiljz~ILion 01 tilt spint pllss il)1y ohtl ll1td thrltJugll the stlengtlkl11ng o f the 1rltJgm vlt nonil lme shyCIC 111 illli orrant u bjcLliH- ln rhis r~f1 n sp u lllni lc tivitIumlLs sil uld lX tPI 10 dlegraveltl it l G lU t n w l1ik luring kine i Icircth lrr phyltical eXegraverci c~ tllat in ele
spinal m ot ilIcirclY sil nid 1e lt1 oid cdrt ~
Organ ie and psychologieal impainncuts and li islbi IiI le
A cgtI im lc pmi nr is moriOthl11 just 1 sp in and 1
compkt gt Ipp rnach to the gu in ad 1 ont i al~ shylute l e~se i t i11
[)a la 0 11[ [n ell lrom re semh pw tbat ome organi Iilnctiond cl fki ts suc]) as tlw clecrtiUe ut vild l tnd d fun ll l)Kity_orld ldly incrtJ k whil~ 0 shy[io s i -till in (1 miel q g of g JltlV ity ~ l ilI e 55 rtI lit
tllL pres e n ce )fl defidt Or Vi l~il Clp~1 - i~ ln one pIIiem in Ihr l ftectecl by 20 ICl 40 scoi stgt l ls~a r(h cunclutecl in tbe UA by Di Ruce- prod uegraveed an aaalo) u ll1lXimum 102 re u t in a group of Jd shyk 1ien t [(h sco llosls rang inF frum ) [0 1
Al10ther rudv bv rallt r m C chr111 lilcl NashycWrl1s( u 57 stlO eltt hil $(C 1 1 ui~ Ica js l( lllt cl (1 shy1prUlllI o f t1tgl lie bJd l imI in ~ul sct t1 t ltu b middot iects jlLltr l5 they are golng through ~I cltlici[e sllge in the fnm 1lt i n 01 tlWH o w n id uHitv t factor hit h Illy jeopmlize the cl velopme lit d ~ mIll lt lI1d htIshym cecl IWI sonalitr in Klulrhood
n RUI ~IEDl(( Ptl Y1-
ROU ltHmiddot PI [ I C~ 1 EXIRCIS]~ IN TI Il nW~JUNT OF SlllO lDIOP1HIC AI)C~ESΠ11 C(gt1[Oi 1S
This i why b IiCieacute ii is ~n imporrlIl t for p rcshyvegraveml e 1tLsr l tn en ou flge 1ari e nrs ~lfrecr(d by lIillcl middotu iosis ft) tlke p~l rt in portin -re rcatioluJ acrivitits Iha t 1eIU 10 L10 th r~1chophyinLl bull nd b~l )i 1l1o tur adlieem t n li 51Jmiddot2Even tlK)ugli [Dr bic mech~lnshy
ical mcl nellIUll10t 11 11 reltl ~ons lt r111 1gtomcrimes be l lefu l to ugg( ~t ne p rt in~ aCt iv ity r l h (gtr rll n anotlJer e th ink Ibal an exces~ ive IlHd icalizltion - Icirce l ll1posilion br plry~ilt i HlS nnejlor parents uf rh ry pe of po rt to lx p m lice 1 b Ule p 1Ucirc(Il L th1[ preshydLl ck l1 is fret clOice in lh ma tt r - -h II ll1 he avolc1ed wb 11 possLhle mainly for tlle i mport~ltll psyshyLb ) jogka l fe a SI)nS W( ha( ill ~ t nltntionegraved
Conclu ion
lbh ISsertegrave d t1H physkal tgtXtlci o is ) n fi ial whlIl practinu in order 10 ilnj rove the I11 llde
rœ nwh and tono C iral caplCiry and postu re o f the StOUO(I ~lIbj n II I nowkdge om ~ middotmg trom ci el1shyrlfi rls(~ Jrc li dJlJ accordl ng r the review 01 thE litshytirlture prnpo )td in t lli plpl r conflrm~ Ihe vuiclit ot th e -t ls ~rti ()ns
In l do l (ent Id iopl1il iC scoliuse il l n phee u i cl vk)pm e n t ( li tll iumlKh eXCC cl l g i en rhk thr hokl th e re i5 an und ubred need fn r l pprnpri 1tegrave (JJ1tOkJJe ~Ild Inr surgict1 therapics ill ortler 1) S l i p
the ( - Iuli on anugrave )JT~t~t UW ~pilll l dtlormities bull evshyerthtless in the illiti ~ll pl l~sC t ttlC c1iseLltc whcn the riS( r1 r euro )luli m is rtduced ocirc ~md tfle uifleal JOld threshold il ~ld flle po stural collai i reJcenw~ 43
JI l1 igh pllysicaJ egravexe rc ise - p revenc or r d llCe d i ~lh ilir ies o f [Iw ~ l() li )tic
p (iems R 28 J -6 5- 6 1 63
- f~KiHtare lh ( n utr ali711iCUl of postu m l d elicits tn produCel1 a coneql l nce J [)ti 0 I111)( or regre si -u lmiddotc 5middot Il 1 17 ~ M
-re 51udles U ~ n Ledecl tu con[mn or re jecr these conClLL i( 1 w l1 ich clerin-d frum 1l1 lIldytica l rcltw n f th e liter~iture appear r- ~Lo nlble Hnwecr Intil ne re ull are 31Iable wc should n r prevent our sroliotic patientmiddot trom tl ki ll p lt in s(loI1ing jshy
ir its pW1iada rly ltl t ~d1()o t () n til t c ntrHY -vith the l xcclrinn 01 gt[1 )11lt tIlat in rea-e t)1obility (tnU evc n thell oilly wh n progr~lgtion b p OSSibl) -uc h ~I( ucircvshyiUe -11 )ulu hl tIKoll w g ed The 11 S J ( rprOpriue kin (~irhe r~l Piuml to incr _~asc p()~tura l $llbil i ty is tl1egraveoretshyic tlly CiJUClt alttloughl more ~Iccu rtte aod deLli led ri k benefi rs anJlr~ is is netot1ed
Ria 1111tO
NIokl Mu d lle ftitYljJfu Jœl il 4IWr10UOifll S (JIvs i (1~1)Jshylidl ttno( cclIll le 11(11(1lt1 RCI fu lle ((lia LltfIt l1 I1I1i(i
LJ ci n s j(r3 pigt egrave li n IHUgru lkl di t rdz t fi sici pe e ft shytUlKm iluppno di un lisimerap15Ll rl lllcflt() 1 110 scopo di pnevirlt () fr en~lI 1-lgpwlllltnlcgt dclld lclonnitugrave o e il 5LOshy
Il i mi llon lt fH nugrave j (1 11ni dei co~e 1 lteIl I1J J nd ne ~Ii eifclti (()Tc rri udk s co lio si d i m e dia g rt iuuml ln que~ltlt
s rud i 30 llizzb mo i d ti cleU ric lca pel n ri Icare qJJ l lm 1 dis(imucirc x u le I[~ l z j-m i pro vna le da lla C gtl k A i json ere pr middote-nute () rk kl ducirc un~l rdeguCltl d nil cra pi lt di uJoseguerrnt Cjua li 1iU110 cli nbie tti 1 rcr lJ)tIId d~ fle)-UITC
n (- -fd7Io n~lcl)
Ut11claquo)si 1 lI tori htpnuuml )ludi-ttn I ~ cnntI1zttu fr Cq(in i idiJ)tic1 dbfl lOZ10l1 d d ~ leOla nelllOll1otoriO Lb un1I1cnUl 1n1l1i3 dcgli 111 lt1i ch DIJgt gtU l H crmU1 Nlch~mslt ( SIshygnaJ~l lerimiddot wo i esuemi -bletti d~ plt~e8lugraver- ne l pClZ le1lftgt scoliodcu kl s iluppo ddl ~ ~ uhjlil~ vertcbral~ lt o svilllp prJ Jdle JIl7 i() nl di ltCjuiljbrio Dng li studi sul lto lb( l~nlrale (OllddU i in pa rticdu d 1 DlIal-BeHJ (gtegraverl ~ P~II IId lI1 n~ llw - idente il v- m gtiu p eT il puientc clioti elgt di u n rnigb o t c)[ ro Ua sw mle dei radlldc onsegull o tramite il 11 fforzrlshyfl len to d e i l1luotoucirc l nllgr3ilri d e luOwo con crcbi ~Clltdr
in pOMltHJ corrctl e in va rie ~i[Jzioni s t llicb c c d inamIcirc tllt Dalle on sena d elb blOffiCcclIlicd tr idimlt n s io mlle d ei
r ~ chi Je ~oU()f icn ~Icirc ~videnuumll (l() ~llt tC p IYZIcircOSI ln(IiClZlfHicircl ~ 1I1shy
liumln fluenzt Je ll middote~rUrio tl SC) lgt lIi I rc pibull m i tldln sJlI71 Stl shygn~I I1 afferma che slI l p Ia no [11 middotccedilr~lk tre un œ rtlJ grado di l L1Liuuml IlC dclh vEltlh r1 apj(de le tu rœ mu SCltJ llri njtbc J n in $tJ ) t rodcfQfll1t1l1te PltJtantu b i r~it-~ r -lp il puugrave t~~
Ixnt-ftla solo nt Ile so )[j)~i Jl1Icirc na rl in qunnt ) ilon SlrM ntne )(l(Ofa tu soglb in caq ) co lltrLJIcircn l)lrilto llt~( i lJudotlsi di lfr~ lI1 C llg grVlmenl J 111 11 io lr riltd ll(17jOill leld rinlle 113 dimO~iumlrlto d llt nell o lin~l cl()~ li t th~oIOl))1 dri la defltgtrshymiti sul p iluO slfl iuale ~vohl lf1 (en5 ion~ sO lnm utto nd 1e bsi iniliali deWggrwm1Cnln mcn trl C a( lfLmn che occlleshyvoluzi ne dene = 110 i [ mhari IJ lin c l ki cen tri ch -1vi1( de i cp i CIt IJ rI Ji SI p m ittIl pnm l Iem lmeme e p o j pOS( shyrio fllwnte dtldnli mdv ( i un ziuuml ne ciloliz7nnl dd rlLtide lu mbJ œ ( lIlelttlaquo on NC n d d (gt11 uIdu m 1I1 Ilgt) cli r-Iure (0 eserClzi che IllUllengano 0 ltlUperifo le Clgt 6gt1 lo)iche sul pirluuml gilwlt Su l p iCl no fron itk Perdnulk il dlll1lt-trlto d1 lampkz-l d i LU ovimento amp111 lI rv Kolio ti ~ nd lt1 0 ddlJ cnrrc-LIcircQo i Ji gC 1 n lungl SUpegraveliltlrccedil 1M llS0 tlell 3ampIGI shyvamcnlo C che l~Jltmiddot mobiliti GlI mcnta co n l c lu7j o fle d l i) snAio i A ulln amplgrtJc1 ltllllmunjx~ i terlpGli nn n m obi shyUZ73It ma eutva coli ti0 1 1ct HsicVlfe nd tcmplt 11 1111nshyttllIcirc1nc n tc (k ll ~1 llu u zinnt n l1 un me77uuml d i sost l11( gt ln 0
e 11111ri b cle - Ilziunc egrave deorinatcl d l rlyarsi Snzcl la pr gtshy
liltlnl l i un() rtl~ i ptmiddot Jtl n(o 1S(Hl () (( ntJ() i ndit~tr i ~ Ii ISt (izi e l m iviL Illdlode ebe Hlmen tno laJlc ibiJii dcl rlc lide SCshy
li io) [n p articobre rune q lldl r C-I1 ich~ xlSiddcHe CUf t shyli ve ch~ iJllpi tgino e~rciii 01( biIi2 ZanUgrave HhnmL-trid () in tmiddot~t~nshy
sione kl fuchide O tne pure k- ~ttivit1 tnotoJII~ non prHi(~ llCcedil
in forma r k rel1tiva d Ie ~1I 11 rF~1l1( n otcol mcnlC 1 lll ubib Ll vcrteblmiddote (ad ~ flp j(l 11 n l) to L ginn ~Iilt Utl clkl rilshyC
mka la cli OT- tcc)
r1il to l~ _ I[Dl COlI rY IC~
NE olUNI
fillncr ( ni ((uuml(( n hIIo( rilclIO ~middothe k lln dtfidl fUr1z i shy
nlu CQll1~ la llcl llZIO 1e delb c apKJl ilde e della capacltl di 0170 mizianu luJndn le (OJ il~ gtna a nc r3 di m~i3 gmshy
v it ln G mlxl r i ~ gko Fl llslrom C dlllJ O e Nachcms(J h iU1I) dim lr JtQ che b o liosl p IOO C1 neUaduksœnr 10 SYil l1p pn d i lIniumlmn~gin nlt8Jliva de corpo in (o nridcnz di Ln ddic3w p ri d di f( m l lz i nlt deUa SUl idenritl condishyZltonc ch pOlrebh ~[I cubrmiddot ln vilu pp di un pe bull n nn lir m llur cd e quiJibfarn in t[C adulro TaU CO1DSCe nZe tvlde nshyZ[II)() la n ( middotess iti di ltimobre la plfte ip a7j0 r1e atl an ivi ll1ltHClr n gl b a li ltl h ~ di tlpO s pu rti middotu dl ittlrc nd gloani iCo lID ti i lirtugraveta z io ni llb vila di relazionc
ln concllliu fu la d tfoflll lL saliu iG egrave il sin l mo di lin) idrotnc C Il1pk 1 d e eoinvo l d middotmiddot= fu n (n i dd rgashynIcirc5H10 n Hi lhdli e lesenizjo fi 1lt0 se 1 Il indirill~t() pllO pr~cnin 0 odLf rgt t lli di fu nzlonicirc adlc s()Jj(bi 111Icircn(i rrHtatc CO ll nl1 cinesi rap i Quand l~ coli i ( n LS~middot iJ11 zia k il rischio evnluLIcircvo egrave lid [() mente no tcole 11 (ltlll asso p o lll shylal ltOtSltgllen7~1 _ ta cincsiterapia pc rslIk bidtlvi shyptutibulli d ubllIcirctIcirc vltnc brn1e di conrro llo )(JSu k d i 5IcirclupPQ d Ile rLlt ziofll d i eC[u ihb ugraveo dJ ftffr otZJH1 r1w dei IIl llJgtCili 1 11Icircshyg rdtarl in posru ra rrenu posslhile JnnalL in Illo lt i clsi l(j luucircun lt di lin ~c() li oi mi n rc ( ume [11 duumlnQstrIO la tinc~ jn~l el1lric ((1l1 ~rtlppi d i contnmiddotllo cnndnlt1 p nso i l entrt d e Massue di Li n nc da [ o llo n ~ Rodo l (1 986) Julndo il1vlce lIfU~ ho ~vutlJ tiVll 11lt1 1IjXIl to un dekrshyuina r o~itl di g rl vir~l bull a~-n lllull~nte n ec ~~uiu rlCUuml rf( ff dla tcrJpll rle si c a eo chirurg ica
1Ho le clllC ooliosi idjopHI 3 ttl1p ~ - E~er l zjo hsco shy11ln ~ I((fapil
l Bg 5 CUle Lo [la k ll oblems in tlu ll~ (U ni Cl) FrKUce CU ( )lIILr no 1 AllCPR lu b1lG1t10 11 middotCI 9()(iJ2 RockilJe MI) i)~Cr ~()f I [( al th all 1 () I ~Y 1(~Re~C~Hd ~gtutnlt Ilallb Srshy1ltC Cgt D~p(rulllnr CJf I Ilalil 11 1 HumlIl sen Lel 199-1
2 SI) lrzcf ( LcB I ~IIl( FE DupUb L ampkIll~ 1c ~ppro l c h ll tht rnent und mmgemlt-rlt ot ~ ct vlyrl~ led splnul (hs r)fder~ A monQglJph rr r d lll kic Re p o l1 or Ih Ou bcc TlSk Fu rcl 0 11 ipmd DIo rele Sp ine L9H LU) 59
) Clntino F 111i1 i(ll Ci nerte1H C Nou gltHhl C Kln(~Jl llBICII [lIe1 hmlln (Il dry rra ll1ltfll of QIil pa ll m log iC by l11e 1 lIb li 1le-llh laquorilC~ of ~ 10(lna 111 Jrc)Jcxli r~~ (of flle h l lntrnIUonll SVIll Illgt~iu tn - II 5lt Ik lIc lk0flllllic lu llln-I I r l III Fhhlt ri g 1092 -ltlIJ-7
i - ri of niii MA N()LJV II ~ mel h)ltks de kin ~~klk rlr k di lll J r~cdllclli (n d~s ~()li oes jn f ~tel r~1ruuml(ILI -lo s bl fl c sur IcIj cquishyl)œ~ Ik SOll ll l)(eacute Eli ror eetlfllS d )111 1~ 1)1-
5 iloll n G Ruumld(~ le s () I ~middotmiddots tnlcl l l1 I n in 1Ifc el kiwil~~ 1)11lt KillegraveSlthe ripJe SCleacutentlnlue lYl6 2 47 ~ 6
r) Feacuterr[ffgt en 1tsiero 5 Venlllfln A ll~~n () M MJglio nu N EfkUuml o r eXltClse tI~tl Yoj o n nild id iO rXllhlc iC() 1i()~ lrt~ lirnIcircIluy r sull Eur feltl lb)ii 1 1j34 Z5 -~ 1 NOilrill1 A Sbill P egn ni i Ll Linesilegraverpi l 1lt1 Itallllll~nlO
ddlJ soI K~ i llO 1 Orkl1Llllwnrl m efodoloil1c1 RbbilltlZiOllc Ot1(1 1 )29(1) 1l-~
8 Nli(rinl Nl(lr1n l A blll P LI rieduGlzione dl p llicml atflt rro (11 coli ns i idi opr lir1 l n SC(Um i le or h( JI 1rcLlIQn1 ~0Cl le Imc lI1etW)n11e de Recltcrchc ci 0 Ftude sm 1lt Radw jlt)(j S-71
gt Nftriruuml S SeJhrf U LI r i l bllh ~l liOlie dd plziecirc11te ulet1n 11 - r
lin Kllopd (1 In l1l Jgl L N eduoL Tf1It II d ll11e ji cln1 rJtbl IiIUvJ Milan) 1ltfddH~n(x~hl 2(1~111gt-1-PU ob L cllln t iRll p l nelLi rl tgtO llcui n~ dilt ~lio i - l rn~f- li ~iIa n 3efllnl -Kurflr 19-11
11 lIIra S lJll M EVtJltHlvugrave egraveI lt t rnrumel1t() d db S(oli - U r) surie doCum nUle fintgt 31 tIUUli Mibn SI rlin) KlIpf -r 199 2
L2 1 ~W I1l(IJ P _leacuteVia tio n I~lhra k~ du IlchlS ~- ( i( IoltS ccedil l r lI C1 l1 fl leq
Ene 1 l C hi r ApparctlIClCOn l~ ltll1 l ltx6lt (i W Er 20 j )7 l
U StrI tr d P Lcs 1) rm IlO du Hltlctli Parb ME n 115 li ~u n un_ l c- l ol lJn e~IL1roy JC EagtOllŒrio n sc lluocs
L cl middot Exp CO_fiL [-In 190 15 Xd BR llet13n) J Th ltJl-xwenc a l o-(l1 tUcn~kuud txer
C le re-glflW 1 lhe tfelmc nl o f id iopllhiC Collaraquo n lroc~-din) t Lhl 1 r 111(1ltli0 I111 Symf SiUl1l un 3-D Scl IiDliJ DclOfshymillelt ~k)J1[rlt u Gugtu l1Shltr Verbg 1lti t)L j32-t)
16 N1lh~Ir~il Al Peumlf r~o n LE Erree htJkmiddotmiddot~ n f t~U lt hfIl middot Ith J
hran in ~rls V ll ~ ttiVl ~HkJ k-nt IHuIXtthilaquo ic I) Li ~I~ts H t 1l1i JflIn t ~ j l~jl)5iuml7A(~)8Jj- 21 bull
17 M(jo n Y ( ullck J p ~ R A PrdulllnlIr rpurt 11 Iht e rt l f rnltJsu red 5l ren jl lh rrll nrl1 III ililleInr Hi rrt tllk scoJliagt
J lin1I IJisn rd 21 1 1)12) 102- - Hl Hunng CU[- -If p~lIll)~thc - Uonktd in -c h JI IL
c reacutetnl n~ ptnl l C)Q~ Z ) t 1 t(li-v 19 Kou )UrJKh L Glr~ k G KRI iJI G KLmiddotmiddotrnl kh g UlUI
) KrJ UkQULlk i~ ~l ~~ fl c+l l1ng ~t (w)j (h ildrcn frit ltt lmiddot( ti ~l~ 0 1 (he
isbnd of Cfdt J middotpin 1 Dior el 1 9J7 lIX( )middot i2 ~ middotl I i) SG IC1Iugrave lS r olle lCOS rh Zadrc C Ber E Xend s T A
ohool scr(l nin~ f r Loli rraquo pro~ p ah pidemlaIO)( Io Jl lUcJ ~middot In ncIfllwt~t~rll dncl Ctt1fLll Grttc J none 1cUlf ~)Ufg Arnl
19lt) ) JOJ )8-1)3 tl llunnd P n ohlecTln CfjtefO I1 f r SCCi II Ots t-CTctt1 lngJ BOIlt
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EUROP MIDI C Pli hIC
EDUCATIONMEETING SATURDAY 8thof APRIL 2006
(iSS
SEAS02 Scientific
Exercises Approach to Scoliosis
version 2002
G
S Negrini 1
EDUCATION MEETING SATURDAY8th of APRIL 2006
Neuromotor disfunctions
Neuromuscular disfunctions
11 Postural collapse
Postural collapse
Duval-Beaupegravere
Flexibility of scoliotic curve
f---I--- I Postural element
-------1 Structural element
S Negrini 2
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Postural collapse
Duval-Beaupegravere
It is a value related to muscular tone and to flexibil ity of convex side tissues
Post ural collapse
Bunch e Patwardhan
Critical load
Load threshold beyond wh ich a spine begins buckling
JI~~Wt1lW~flfthtlJlœJtAr ~ J~It- l~l - IMS
Postu ral collapse
Bunch e Patwardhan
If a curve reduces there is an increase of the deformation threshold
~~~NW~-damaoc~IIIMf ~~ J~Iv JaJ-I7I9sect
S Negrini 3
EDUCATION MEETING SATURDAY 8th of APRIL2006
Postural collapse
Torrel e Nachemson ~
Scolioses below 20deg ~ ~ lt~
have a high ~ ~ percentage of ~ ~
~postural collapse (on u~
average 75) ~~ 2i~
CU~VE O EG~EE S WHllE SUPlti e
~laquotd~c6b ____lPffI1wtt1t~
$ww J(t ~~7 JM5
Postural collapse
Minor scolioses 7
Antigravity musc es strengthening D
Reduces postural collapse -G
Increases the critical threshold of deformation
G
Neuromotor disfunetions
Stagnara
If we admit that one of the causes of idiopathie scoliosis is a disfunction in balance systems it is logical to orientate physical exercises toward this direction
s Negrini 4
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Neuromotor disfunctions
Dubousset
Idiopathie seoliosis results fram alterations in praprioeeption centres and deformation is a natural compensation to restore postural balance
etattJtitIK ypothfQj~S ___~ own_ oJ)HQr lar 1t-1( r
Neuromotor disfunctions
Nachemson Initial idiopathie scoliosis
+ Goood spine stability
Neutralization of postural deficits
D Static curve
Neuromotor disfunctions
Therapeutic aims
c) Development of spine stability
C) Development of balance reactions
G
S Negrini 5
EDUCATION MEETING SATURDAY 8thof APRIL 2006
Biomechanical disfunctions
j Horizontal r-Ian
i Sagi ttal plan
Frontal plan
Frontal plan
q Frontal plan disfunetions
Fronta l plan
Perdriolle Movement magnitude
gt in the direction of lt in the direction of correction progression
S Negrini 6
EDUCATION MEETING SATURDAY8th of APRIL 2006
Frontal plan
Stagnara
Never mobilize a scoliotic curve without ensuring reduction maintenance over time otherwise a greater mobility favours scoliosis progression
Frontal plan
Ducongeacute~ research
On a group of adolescent idiopathie scolioses treated with
Meacuteziegraveres gymnastics
D After 1 year the mean angle of
curves increased from 18deg to 29deg
Frontal plan
Scoliosis without brace
D Greater spine
flexibility D-
Risk of progression
S Negrini 7
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Frontal plan
Mobilization is useful
D In preparation to
brace
D With brace
Sagittal plan
QSagittal plan disfunctions
Sagittal plan r middot _J o
Perdriolle scouos B CJ aDeformation of D
thoracic and thoraco-Iumbar curves evolves in extension
S Negrini 8
EDUCATION MEETING SATURDAY8th of APRIL 2006
Sagittal plan
Graf
The line of gravity centres in the vertebral bodies o s c oUOSt
projects itself firstly laterally and then fi
o
posteriorly lJ ~~ ~~ ~ ~~-_J-D ~nI~
Sagittal plan
Therapeutic a ims
D Maintain or
retrieve physiological curves on the sagittal plan
Horizontal plan
QHorizontal plan disfunctions
S Negnni 9
EDUCATION MEETINGSATURDAY 8th of APRIL 2006
Horizontal plan
Stagnara The forces applied ta the spi ne act in a autoshydeforming sense
Horizontal plan
Dimnet Rotation gt 200
ampII~ (
D The actions of concave and convex side
muscles become
agonistic
~ItJrOnrIIiItdllfUClltlluumlll~~tI ~1JIf1laJ
Horizontal plan
Minor scolioses never exceed these autoshy
deformation thresholds
S Negrini 10
EDUCATION MEETING SATURDAY8th of APRIL 2006
Disfunctions at a biological organic and psychological
lever
Oisfunclions at a biological organlc and psychologlcal lever
Cheng
Bane density in scoliotic teenagers is lower than in normal subjects
~~~~middotA~IIlUtIy ~7œl 1d l
Oisfunctions at a blologlcal organic and psychologicallevel
A significant reduction of vital capacity and V02max in teenagers with a medium severity scoliosis
S Negrini 11
li
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Disfunctions at a biological organic and psychologicallevel
Disorders in the development of body image that the teenager has of himherself
Disfunctions at a blologlca l organlc and psychologicallevel
Therapeutic aims
cJ Activate cardioshyrespiratory function
cJ Favour bone density increase
cJ Develop a positive image of the body
Disfunctions at il biological organi and psydlologicallevel
Stagnara
Sport
D The active side of
kinesitherapy
S Negrini 12
EDUCATION MEETING SATURDAY 8thof APRIL 2006
Disfunctions at a biological organic and psychological
level
Distunctions at a biologlcal organlc and psychologicallevel
Cheng
Bone density in scoliotic teenagers is lower than in normal subjects
~n~IIIvpWr~middotA~stWy s- XXJl M J
Disfunctions at a biological organic and psychologicallevel
A significant reduction of vital capacity and V02max in teenagers with a medium severity scoliosis
G
S Negrini 11
EDUCATIONMEETING SATURDAY 8th of APRIL 2006
Kinesitherapy on the scoliotic subject
q Postural control
q Axial stability
q Muscular trophism
q Balance
q Respiratory function
The limits of kinesitherapy
There is a threshold beyond which
rehabilitation alone is not enough
sssr
Kinesitherapy in scoliosis treatment with brace
Therapeutic aims
S Negrini 13
6
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Therapeutic aims Srace kinesitherapy
With brace
il Postural corrections and
vertebral stability are obtained by the brace
Therapeutic aims Srace kinesitherapy
In preparation to the brace
il Mobilize spine on ail plans
Therapeutic aims Srace kinesitherapy
With brace D
Maintain a normal spine elasticity
~ Maintain a good muscular toneshy
trophism
C Model the hump with kyphotizating
exercises
S Negrini 14
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Exercises and their methodologies can vary accord ing to learning and individual sensibility of the single rehabilitator that proposes the m provided that they stay within the
Iimits of fixed therapeutic objectives
li
Therapeutic modalities
(Exercises)
QAuto-correction
QRespiratory education
QErgonomie education
QMuscular strengthening
QDevelopment of balance reactions
WNeuromotor integration
ci Vertebral mobiJization
QSpecifie modalities in brace treatment
S Negrini 15
EDUCATION MEETING SATURDAY 8th of APRIL 2006
The protocol of kinesitherapic
treatment
G
QChoice and dosage of exercises
Variatiosn of the work program every 2 - 3 months
Q Execute e)(ercises on an individual base or in a small group
Q Frequency not less than 2 times 1 week
Involve and awaken the family
G
S Negrini 16
EDUCATION MEETINGSATURDAY 8thof APRIL 2006
Q Determine the action and the localization of auto-correction
QAuto-correction must be associated to ail exercises
QAt the end of treatment ergonomy lesson
Auto-correction didactics
G
SCOLIOSI DORSALE---- shy ----
r
S Negrini 17
EDUCATION MEETING SATURDAY8thof APRIL 2006
SCOLIOS OORSOLOMBARE
shy
SCOLIOSI OOIlSALE 011 bull LOMBARE S1I--shy
SCOLIOSI LOMBARE
il --~_-
S Negrini 18
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Scoliotic patients are not radiographs
middotSeoliotie Mtients are not ndiographs but hum beings with a vertebral deviation-
Slagnara
Metha For the physieian Cobb angle is of utmost
importance For the patient it is body deformity t hat eounts most rib hump a protruding seapula or hip We are in a situation in whieh today dodors eure the radiographie deformity but what the patient really desires is to get rid of clinieal deformity and of ensuing psyehologieal distress
CIIQItIo shDuIdtucirc lM WIld tJw~~ I~~M~~~~ J9f~
S Negrini 19
- Poznan_workshop_Physiotherapy
- physio2
- physio3pdf
- physio4
- physio5
- physio6
- physio7
- physio8
- physio9
- physio10
-
Zmiany w zaknsie kIta rotacji osiowej krfgu szczytoweg() sG-z~vienin W wylliku prowaagravezonej kinezyterapii
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(cras obscnvacji od 6 do 45 miesifC)j srednio ZI I1 JI I micsilfca)
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Grupa skolioz dWlllukowych 0 kflfch Cobbf lt30 Iyp 11 wg POllsetiego - jknywienia pienvotnie podwojle
- piersimve prflwv~middottrolle i lccedildiwilJwe ltKJoslrotme -Ieezeni wyl4eznie kinzyterapi~ wg Dobosiewicz (0=10)
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bull Metoda asymetrycznej trojplaszczyznowej mobilizacji kr~gostupa ma znaczeumllCV wptyw na zahamowanie progresji
w skoliozach idiopatycznych szybko post~pujqcych
bull Mobilizacja strony wkl~s~ej skrzywienia i osiowa derotacja kr~gu szczytowego zwi~ksza korektywnoseacute skolioz zmniejsza garb i ebrowy poprawia obj~toseacute klatki piersiowej i zwi~ksza wydolnoseacute oddechowq plue
13
bull Przedstawiona metoda jest
stosowana samodzielnie lub
w pO~qczeniu z ortezq Checircneau
a takie jako przygotowanie do
leczenia operacyjnego
Ocena progresywnosci w badaniu elektrofizjologicznym
odruchu z odci~zenia
i~middotmiddot ~=~-~ shy1 _--==shyocirc
14
EUT S pine J (1997) () 93-97 copy S pringer-Verl ag lY07 ORIGINAL ARTICLE
K Dobosiewicz Neurophysiological mechanism of the unloading reflex as a prognostic factor in the early stages of idiopathie adolescent scoliosis
Rcceivcd 29 M arch 1996 Revised 16 August 1996 Acccp tcd 10 Septem ber 1996
Absfract This paper presents a new nc urophy iologila1 methougrave of e valushyati ng the risk o f p rogression in ill ioshy
mo t important factors in the eva luashytion of progress ive id io pathie scolioshysis The met hod can be lIsed to deshy
pathie scoliosis in th early stages uf tll( progre jve idiopath ie scolios is the dis ase by illY middottigating tll e unshy in lhe early s tages of the d isease loading refl ex in paraspinal muscles T he high sensi livi ty of ilie method The study incl uded 394 pat ients wilh means il can be used as a basis un seo liosis and 70 hcalt y chil dre n which to take an earl y dcc ision to
K D obosicwicz Depuumll1 mel1 l of Rchabi lilu lioll Si lesilln Medical Academ y 42-604 Tamo wskie G6ry 4
Lmenty of the unloacli ng retle x and repeatabi li ty o f Ihe rcbound and silent period were anal ysed for eaeh reflex evoked Prolonged latency and
p rimiddotom1 surgery
Key words Id iopathie seoli o is Unloadi ng rcnex Re bound
Katowice Polaml minima1 numbe o f cycles are the Larency Si ent period
T he ai m of this sludy was to evaJ uate the use of the unshyIntroduction load ing Dex for octcction of prog ressive id iopath ie adoshy
le cem oIios is in its carl s tages in onl r to lake a dccishyProg ress io n of id iopatJl ic scolios is bas been the su bject of
sion ta perfo nn surgcry as soon as pussible many clin ical radiological and elecrromyographic in ve~ shy
tigalions T here is ho wellcr no sim ple quantita ti ve or qual itati ve pro noslic methoo [hat can be em ployed in the
Materials and melhodsearly ~tHges of the disease Monitoring of lhe unloading rc felx in paraspinal m llsck appcars 10 be a reliable Inv gtsi lgnlions were carricd uut 011 394 pa tie nt with adolescent method o f discriminating bctwcen diffcrcn l fomls of Cushy ~c li ed J ild 70 hCldr hy children The scoli osis group consisted of Iios is T he un loa ing re n cx can be evokcd in ail the 31 1 g irl s and 83 boys aged 9-1 8 year~ (mean age 125 ycars) The
ske lelal muscles through a suegrave den shortening of o luntary contro ls wcre 0 girl s and 10 boys aged tO-1 7 y~ar (rncan age 128 cars ) Imong Ihe stlbjeclS tudied wcre 9 patien l w ith cershyinnervated muscle l2~J When a musc le is unloaJ ed vico-thoilc i seo liosi s mean Cobb ang le 22 7deg 121 with Ihoracic
rapidly durin g an isomerric con trac tion Ihe norm al reacshy scolios is mean Cobb nngle 309deg I 1 w ith thoraco-Iurnbar seolioshylion is an eleclrically silent pe riod fo llowed by a burs t o f s is rne ~n Co bb ang le 26~g o 63 with lumbar cotlos is mean Cobb action potentials called rebmmd The pause in d ischarge ang le 279deg and 90 w ir h doubh major curve sc o Ii() ~ i s meull o bb
nng le 292deg and 28 5deg The sludy group includcd 231 right -s ided can be observed only when a certai n h reshold va lue of and 163 left-sided 5col iouumlc patien ls There were 112 patients w ith
acceJcration flnd shortening of he muscle is exceeded progress ive id iopath ie scoliosi (76 ri g hHidtd and 36 Ic 1t-s ided) an tl il occues wilh constant latcncy correspond ing to that 182 with no n-progressive idjopa thic scoliosis (1 13 ri ght- sided and of the propriocepti ve nflcx (9 18 20] T he rebound ufter 6 le rt-sided) M d 100 w ith pe lvic tilt (statie) scolios is (42 rightshy
s ided anp 58 l eft -~ i(kd )the silent period in the unloaugraveing re felx rcsul ts from ae lishySC9 1ios is is consIcircdered progressive if the Cobb Jngle inshyvalio n of a pool of motone urons aIl o f which fClt1ch lhe
creltseacutes by more lhan 6 in 1 yen r aile middotnl1 n-progrcssive if the anshyfiring thres hold simultancously afte r prcviou~ si lenœ [l nua i increase is less thll n (i The Cobb angle ranged lrom 8deg to 77deg 1 4 201 in Ihe palicnls w ilh progress ive scoliosis (mean 361 ) [rom 30 ta
lI f R (on- f Rt tt1IY 1lIfl pflla 1 )(~ r(Jnu n t shy
fI) _ ~
Pathomechanic basics of conservative treatment of progressive idiopathic scoliosIcircs
according ta Dobosiewicz method based upon radiologie evaluation
Kryslyna DobosiewlcZ Jacek Dunnala Kny ztof Czemicki Hanna Jcndf7cjek
Deparmem of Rellabtlifatoll Mediw Uninrsity ofSiltsia KatOllice Poand 40-635 Katowice fil ZiUCl 3537 POL4ND
e-mail relwbilitacjt1s11mfoctaonetpl
Abstract Conscralivc IrcalrnCnI of Idiopathie scoht)~1 espcclall y kinc ilhcrapy i ~
nOI widcly apprccilllcd due 10 Ils suspectccl low dfcCIIcircvcnc 5 in relalion [ (1 a urglcal Irc[llment ACter long-ycar il ses ment of palomcchanic f scolio icirc in Dcpanmenl of Rchnhllilallon f Mclii al Unlcrsi ly of Sile bull a concTvallvc mcthod ()f IrCtllmenl asymmclric Irunk mobili7alion in lnclly ymmelm po~itions WIS
de el ped_Thi mClh d enablc 10 delain pTogression f scol iosis or ccn de middotrca~c laIerai urvalurc of a spi ne and angle of rOlllion assummg adequate () perallon f palicnl and ilS famil)
J Introduction
Idiopathie scoliosi OS) is a thrccdimensonal dcfonnation of il vertebral col lmm an- cntire trunk Afler many years of extensive rescarchcs the cause of idiopathie coliosIcircs $ i remaIcircns unknown It is possible Ihat idiopathie scoliosis devel ps and progress on a baslS 0- ~
multifactor disorder perhaps diffcrent for curve initiation and curve progressi 11 Fion poss ible pathologie factors nervous system dysfunctIcircons affecting postural tquili brium ar proprioceptive control seem to be espc ially important [ l 2 6 JI Pro_ ression f iS could bot delermincd by vertcbrac remodeling under eccent ri c loading created by axia lly ce gravitational forces in presence of muscular imbalancc in the trunk [2 J The verte rai colwrz unde r scoliotic conditions 15 an unstable system with tcndency to fu rther tune dcvelopment fl2] Lateral bending of a vertebral column visible in X-ray examination L
only a two-dimensional prcstntation of a complex dcformity consisting of patho logica axi rota ti on torsion and othcr deformations of vertebrae [7 8 10 II 14J ln fS physiolog~ curvatures of vcrtebra l column are disturbed Total Icngth of an anterior column of a spi n~
consi ting of vertebral bodies and intcrvertebral dises bccomcs grcater lhan length of l posterior colwnn - vertebral arches and proccsses [11 15 J h is apparent that phy iologi ~
thoracic kyphosis in rcgion of a scoliotIcircC curve diminishes Each vcrtebra of a stru tu ~
urve of coliosis is oricntatcd in hypercxtcnsion in relation t adjacent vcrtcbrae [7 l resulting
1 n B Uri middota I l 11
H srut ft illtf j tI) t li orf1Hli d
IDS Prt ts 21)2
Influence of method of asymmetric trunk mobilization on shaping of a physiological
thoracic kyphosis in children and youth suffering from progressive idiopathie scoliosis
Krystyna Dobo icwicz Jacek Dunnala Hanna Jendrzejck Krzysztof Czernicki
Deparrment of Rehabilitation Medical University ofSilesia KaloKce Poand 40-635 Katowice ut Ziolowa 3537 POLAND
e-mail rehabiliracjas(u1poCmiddottaollelpl
Abslract Idiopathie scoliosis (lS) which i sub 1 ntially l threeshydimen ional derormation or a pine cau e nOl only laler l curvalurc and axial rotation of vertebral column but al lordoti allon of VCr1cbrac in structural curve eXl nsion ln an effect physiological thoracic kypho j diminishc or cvcn dbappears Method of a ymlllctric lrunk mobilisation in strictly symmetric po iljon according [ Do () lewicz not only dcteriorme progre ion of IS or evcn reduces lalera] curvalure but also significmtly rebuild physiological thoracic kyphosis Icircn cases of lS accompanicd by lraight baclc
1 Introduction
Despitc Ion year researchc etiology of IS is nOl yel resol ed Significant problem re laled lO morphology of IS apar1 from lateral bending and ax i 1 r tati n i deviation of shape of a spine in sagittal axis affecting physiologi al curvatu re of vertebral coJumn [3 5 6 8 9 J 0 1t 12 Lcngth of anLerior col umn of a pin constitutcd by venebral hafls anugrave intcrvencbral dises dominate ovcr Jength of po terier c lurnn buill from vertebral arches and processes [lOJ This condition uring scol io i progress ion and growth of a child effect in hallowing or even disappearing of phy iological Lhoracic kyphosis in scoliotic region It i well know n lhar cn~brae of structu ral Jaleral curve are positioncd in hyperextension - lordotisation [5 6] which in Lhoracic region Icad (0 reduction of kyphosi or to true lordo middotis Such kind of venebrae relation in thoracic region cau es ilS destabicirclisatIcircon whi h in u sociation with eccentricircc gfilvitali nal load fa pinc duc to muscu lar icircmbalance [21 pOdbly produces r tationaJ lordo is [56 Il] and further development of symptomatic scoHose ft ha becn proven [12J tha strengthening of the erector spinac muscle aggravates nce initialcd deform tion and deteriorates coliotic process Hyperextension and uxial rotati n a s clatcd with
357 Th B Grivas (Ed) Research inro Spinal Defoml ilis 4 lOS Press 2002
Exercise efficiency of girls with idiopathie
seoliosis based on the ventilatory anaerobie threshold
Jacek Durmala Krystyna Dobosiewicz Hanna Jendrzejek Wieslaw Pius
Department ofRehabililation Medical University ofSiiesiaa Katowice Poand 40-635 Katowice m ZioJowa 4547 POLAND
e-mail durmalaiacekyocztaonetpl Department ofPhysiology Academy ofPhysical Education Katowice Poand
Abslract The aim of the study was to estimate the exercise efficiency in the group of
girls with idiopathie scol iosis based on the venlilatory anaerobic threshold (V AT)
Material and method The investigation comprised 58 gi rls wilh idiopathie scoliosis
aged 10--6 years 32 girls (55200 ) wilh double major scolioSiS and 26 girls (448)
with single scotiosis The girls were eonservatively treated using Dobosiewiagrave
method The control group consisted of 3 1 healthy girls aged 10-1 6 years The
cxercise test was performed using eycle ergometer During the exercise the gas
exehange parameters wcre reeorded (minute expiralory venlilation minute oxygen
consumption earbon dioxide production) On the basis of recorded paramcters V AT
has been computcd using V -si ope method Results The following V AT values were
obtained in the group with scoliosis 207+305 ml 02minlkg bm in control group
219+350 ml 02minlkg bm The differences belween girls with idiopathie scoliosis
and control group were nol SLaliSlically significant Conclusions I The exercise
effieieney of girls with idiopathie scoliosis conservalively treated using Dobosiewicz
melhod is normal 2 Such high level of the exercise cfficiency of the studied group
probably was due to intensive 3-D respiratory exercises of these girls
1 Introduction
In practice there are researched useful efficiency rates which on base of laboratory tests results possible easy without using of the relatively hard or long exercise tests would give the belter forsighting of the range of homeostasis disturbances and rapidi ty of increase of
physical fatigue during varied workloads [1] The best known rate of trus kind is the maximal
minute oxygen consumption [2345] During progressive physical effort minute oxygen
consumption increases proportionally to workload The reaching of real maximal minute
oxygen consumption in time of progressive effort is iodicaled by minute oxygen consumption plateau [5 61 This result is rarely registered in children The progressive exercise test is most commonly used in children until physicaJ exhaustion and the highest registered minute
oxygen consumption is treated as maximal minute oxygen consu mption or so-called
symplomatic limited maximal minute oxygen consumption [678J Sorne authors regard
Orto-dlet Trau malaogis Roha b ilitacjaARTlKUL ORIGINALNY ORIGINAL ARTICLE Vol 5 Nr 1 2003 80-85
Jacek Durmala l Krystyna Dobosiewicz l Tomasz Kotwicki Hanna Jendrzejek 1
Katedra i Klinika Rehabilitacji Slqska Akadenia Medyczna Katowice Katedra i Klinika Ortopedii Dzieci~cej Akademia Medyczna PoznQll
Wplyw asymetrycznej mobilizacji tulowia na wartoseacute k~ta Cobba i rotacji w przypadkach skolioz idiopatycznych u dzieci i mlodzieZy
Influence ofasyn1n1etrie 111obilisation of the trunk on the Cobb angle and rotation in idiopathie seoliosisin
children and adolescents Slnwu kluce ac eJJic Cl chOlIU) Ice SKoio= idj)PO Imiddot(~I7tmiddot
K~Jmiddot w()rus consrieI ve I (OtlHelif idiopathie HUW JS
SUMlvfARY
BackgrouId The aim ofthe stldy Vas Ihe radiological evaluation ofthe treatllJent ofthe idiopathic scolioshysis utilising as)mmetric trunk mobilisation in the strict~ll I)mmetric illitial position
Material ([fJ(f lIIellOds Presented stud) lOS based IIpon J36 cases (13 oovs oged FOf11 ocirc la 6 lcars (lild
rn girls aged frum 6 la S pears) trealed due to the idiopathie sCuliosis ((rom Novell1her 999 0 F enflfUn 200) Among 48 ch idrcn sllfJering from dOlfble-major scoios is 6 cases wcre infoll scaliusis JOjuvel7lle und 22 adolescent Among 88 sillgle scoliosis 6 lere infw7t 33 juvenile and 49 adolescent
Radiological exami71ation 1as condueed always in the repeataole technical cOlldiions RadlOglOlI1 lier evaluated oy the same physician Radiologica analysis oIthe scolios is incuded value ofthe Coho al1gle ongle ofaxial rotaion
ReSIils ln double-major scoliosis observed dlring one year period in Ihe thoracic segmenl Cobb angle decreased inll l increased 1395 and in 292 Il OS 111changed Axial lolation angle in 167 (~rcascs
decreased in 354 incrcased and rernainM the sorne in 479 In Ihe llllnba segmenl Cobb ang le clccrcscucirc il1 354 increased in 39 6 remained in 5 Angle ofaxial rotation deceoscd in3 ofca es incrcuscd in 29 and persisted in 48
ln single scolio is Cobb angle decreased in 386 incrcased in 353 and in 261 was lInchonged Axiol rotarion angle in 216 ofcases deceased in 295 increased and rell1aincd the sallie in 489
CondlsioJ Asymmetrie mobilisation of the tf1f17k in strictly syl7111elric initial positions is a 1Clhod of choice in the cOl7senJalive treatment ofthe idiopathic seoiosis
STRESZCZENIE
WS~p Celem pracy jest radiologiezla ocena Icczenia skoiloz idiopaf)cznych metoda asvmetrycznejl7lOoili shyzocji tllowia w sciSe symetlyczl7ych pozycjach lV)jscio wych
M aterial i metody Przeprowadono retrospektYlIl7q analizri 136 przypadkeacuteM dzieci (13 chlopcow i 123 dziellshyczqt w wieku 6- 18 lat) z bocznym idiop atycnylll skrYll ieniem krrgoslupa leczonych zachowawczo w Klinice
1
Ortopedla TliJumatoogia RehlblllagraveeJa ARTYKUL POOL1 DOWY OPINION ARTICLE Vol 7 Nf 1 2005 49-$11
Krystyna Dobosiewicz Jacek Durmala Tomasz KotwickP
Katedra i Klinika Rehabilitacji SIAM Katowice 2 Katedra i Klinika Orlopedii Dziecircej AM Pozncrlz
Biodynamiczna metoda tr6jplaszczyznowej korekcji skolioz idiopatycznych - opis metody Biodynamic method for 3-D correction of idiopathie
scoliosis a description ofthe method
SIOWQ kluczowe leezenie zachowawcze skoliozy idiopatyczne korekeja tr6jplaszczyznowa Key words conservative treament idiopathie scoliosis 3-D correction
SUMMARY
The biodynamic method of hree-dfmensional carreeion of idiopathie scoliosis is based on Ihe palhomeshychanics of idiopathie scolioiiiii and consiss in aClive segmental three-dimensional correction ofspinal cllrshyvatlre The course of action focuses in the viciniy ofthe apical vertebra Proprioceptive facilitation is applied on Ihe concave side ofthe curvaJure and exteroceplivefacilitation on the convex side Correction likewise proshyprio- or exteroceplive facilitation is phase-oclœd with asymmetric respirarory movemenr as weil as wilh parshyticular phases of the respiratory cycle ln Ihe course ofexercises three-planar movement is generated opposite to the direction in which scoliosis Is progressing This method is in accordance with the stale ofthe art ofscoshyIiasis pathomechanics The method requires detaied training and can Ihen con be applied at home under periodic control by a physician and a physiolherapist The method con be applied in landem with a Cheneau brace as weil as in surgical pretreatment A elaUed description of Ihe method of three-dimensional scoliosis trealment will be presented in Ihis article
STRESZCZENIE
ISlofa biadynamicznej mefody Ir6jplaszczyznowej korekcji skoioz idiopatycmych oparlaj est na patomechashynice iikolioz idiopatycznych - poega ana na czynnej segmentanlej tr6jplaszczymowej korekcji skrzywienia Dzialanie koncentruj e siccedil w pobitu Icrllgll szczytowego sknywienia Stosowane iest bodicowanie propiocepshytywne po stronie wklllsej oraz eksteroceptywne po stronie wypuldej Korekcja i slosowanie bodicocircw propioshyi eksteroceprywnych zsynchronizowane j esl z asymetrycznym torem oddechowym oraz z poszczeg61nymi fazashymi oddechu W trakcie eacutewiczen powstaje odwrotny do lrierurzku rozwoju scoliozy tr6jplaszczyznowy ruch IcrFtshygoslupa Melodajesl zgodna z aktualnym stanem wiedzy na lemat patomechanizmu scoiozy nymaga szczegocircshy100-lego instniktaZu po clorym mote byeacute wykonywana w warunkach domowych Z olcresowq kontrolq przez leshycana i fizj oterapeutll Metoda mote byeacute stosowana r6wnolegle z leczeniem gorsetem korekcyjnym Cheneau a talcte w przygotowaniu do leczenia operacyjnego slcolioz W pracy przedslawiony zostal szczeg6owy apis meshytody leczenia
Skoliozy idlopatyczne stanowili znieksztalcenia patycznej rozwija siccedil poprzez przemieszczenie kr~gu tr6j~aszczyznowe charakteryzujltce siccedil wyboczeshy szczytowego w stosunku do krccedilgu g6mego j dolnego niem rotacjltt krccedilg6w klatki piersiowej i miednicy z r6wnoczesolljego rotacjl zgodnie z ruchem wskashyoraz zmianami w fizjologicznych krzywiznach kr~ z6wek zegara dia skrzywienia prawostronnego oraz goslupa w plaszczyinie slrzalkoweJ [ 123] przeciwnie do wskaz6wek zegara dIa skrzywienia leshy
Z punklu widz nia patomechaniki tr6jplaszczyshy wostronnego Koncepcja rozwoju skoliozy jako rotashyznowe znieksztalcenie krccedilgoslupa w skoliozie idio- cja i kontrotacja sugeruje ze sily korekcyjne powinshy
49
EDUCATION MEETING SATURDAY 8th of APRIL 2006
- CARDJOPULMONARY EXERCIS E
TEST IN GIRLS WITH
CONSERVA TIVEL Y TREA TED
IDIOPATHIC SCOLIOSIS
Jacek DURMALA Krystyna DOBOSIEWICZ
Department of Rehabilitation Medical University of Silesia
Katowice Poland jdurmalaqcmpl
The aim of the study was
to estimate the influence the conservative treatment (asymmetric mobilization of the trunk by Dobosiewicz) on physical efficiency in the group of girls with idiopathie scoliosis
Material
bull 87 girls with idiopathie scoliosis
aged 1 0-17 years
(mean age 135 years SO 161)
J Durmala K Dobosiewicz 1
EDUCATION MEETING SATURDAY8thof APRIL 2006
Material
bull 38 girls (437) with double major scol iosis (thoracic segment - Cobb angle 18-42deg mean 30deg SO 82 angle of axial rotation 4-32deg mean 21 deg SD 107 lumbar segment - Cobb angle 11 shy48deg mean 31deg SO 128 angle of axial rotation 5shy30deg mean 13deg SO 85)
bull 49 girls (563) with single scoliosis (Cobb angle 11-75deg mean 33deg SO 155 angle of axial rotat ion 5-30deg mean 14deg SD 83)
TIoracic kyphosis of the invesllgated group was 5-39deg mean 23deg SO 86 and lumbar lordosis 16-41middot mean 30 50 65)
Material
bull The 64 girls aged 10-17 years (m ean age 131
years SD 132) were conservat ively Ireated
using Dobosiewiczs method
bull Treatment period ranged from 5 months 10 3
years (mean 148 months SD 902)
Material The 23 girls aged 10-17 years (mean age 136 years SO 108) were treated u sing symmetric exercises - treatment period ranged from 4 months to 3 years (mean 161 months SO 1019)
bull 26 of ail g irls (18 girls earlier treated using Dobosiewiczs m ethod and 8 gi rls earlier treated using symmetric exercises) aged 10-17 years (mean age 134 years SO 108) were twice tested - at first and last day of Intensive hospital rehabilitation (asymmetnc mobllization of the trunk by Oobosiewicz) - mean hospitalization period 20 days (range 18-26 days)
i rf~8f6~~ or~~n~= ~~r~1~r~icircJ~~tb~~~~ mean 17-4 1deg meatl~(I SO 74 R n~le ofax 1 rotatIon 5-25ot mC3 111 3laquo S0 6icircl Ilnd 1 99t1S~ ~~~~I~~~~~$ruo~ras~ ~ocirc~~a~e~~~~~~~5euml1 9middotn~ tUfllbar Iord05ts 16-4 1deg mean 311 SO 68)
J Durmala K Dobosiewicz 2
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Material
The control group consisted of 77 healthy
girls aged 6-17 years (mean age 12
years SD 31)
Material
The examined girls participated in school
only in scheduled physical education
lessons and have not been enrolled in
other sporting activity
METHOD
The exercise cycle
ergometer test was
performed
J Durmala K Dobosiewicz 3
EDUCATION MEETING SATURDAY 8th of APRIL 2006
METHOD
The Incrementai exercise test has been applied
We have found that tests ln whlch the Incrementai part of the protocol ln completed between 8 -12 minutes duration glve the
bullhighest maximum VOz in normal subjects
METHOD
The workload was Increased stepwlse
bull by 10 Watt every minute - ln chlldren
with high ~ 135 cm
bull by 15 Watt every minute ln chlldren
with high gt 135 cm
METHOD
The test had been contlnued untll refusai of the patient or exceeding the pulse Ilmit
Durlng the exerclse the gas exchange parameters were recorded by Jaeger device model Oxycon Alfa uslng direct breath-byshybreath rnethod (with face mask)
J Durmala K Dobosewlcz 4
EDUCATION MEETING SATURDAY 8th of APRIL 2006
METHOD ~ ~~ r 3 min 3 min 8 - 12 min 6 min -~
_ 0 rpiYJ 0 rpm 60 rpm ~1 30 rpm
_ t o~w=att~o~~na ~~ att__~ tl~~S~~ l ad l ~~~~~r o~w= Hlcremenlal t
pedaillog i i ~
~ ilt ~I~-----tl-~ I t ~ i ~ lOSt sffortivB
lW r resututlon r rm-u middot 1 - bullA~cremen tal ~~ ~ ~ ifr- ~ VtI 1 ~i ~ tllng _
METHOD
On the basis of recorded parameters VAT
has been individually computed for each
child using V-slope method by
Wasserman
METHOD
For assesment of physical capacity
the maximal minute oxygen o
consumption (V02max) ventilatory
anaerobic threshold (VAT) and
maximal workload was used
J Durmala K Dobosiewicz 5
EDUCATION MEETING SATURDAY 8thof APRIL 2006
RESULTS
Ali girls with 18 have been classified
within normal range of predicted
values of
bull maximal minute oxygen uptake
bull VAT and
bull maximal workload
RESULTS
The differences between group of girls
treated using Dobosiewicz s method and
group of girl s treated using symmetric
exercises were statistically significant
Lower exercise efficiency of girls treated
using sym metric exercises has been
observed
RESULTS Girls wilh IS Irealed using
N=87 p value
Dobosiewlczs method N64
symmetJic oxor-ci Nz23
Perœnlage of predicled vaJue of
maximal minute oxygen uptake
98 905 0033
Percenlage of predicled value of
VAT 97 933 0049
Percenlage 01 predided value ni
maximal workload 101 939 0038
J Durmala K Dobosiewicz 6
EDUCATION MEETING SATURDAY8th of APRIL 2006
RESULTS 26 girl s twice tested - at fi rst and last day of intensive hospital rehabilitation
The value of ventilatory anaerobic threshold increased during intensive hospital rehabilitation (asymmetric mobilization of the trunk by Oobosiewicz) statistically significantly (p=00019)
2047 ml O2 minkg (SO 268)
vs 2239 ml O2 minkg (SO 232)
Conclusions
1 The exerc ise eff iciency of girls with IS treated by asymmetric exerc ises of Oobosiewicz is norm al
2 Such high level of the exercise efficiency of thIcircs group resulted fram using of Oobosiewiczs method
r
J Durmala K Dobosiewicz 7
REVIEWS
Role of physical exercise in tbe treattnent of mild idiopathie adolescent scoliosis
Revicw of th- literature
A NECRlNl N VElWNL s PARZI 1 A NEGRINJ 5 NEClU NI
P1t~silillxlrd~ Ihcrapy (or klucgtlttlwrlpyl i pro shy-tJm of physka] cXlrd-cs ipcci I(a~ (IJcloJgtcd hy l li trIWlltl phrslollwrapbt wilh tb m~ln a1mor pl shyVCnI in lhe ilAAfIVltilH1 llf the ucirccfonuity III mild IgtC )
Lil1Si bclpin~ thebm ( aocl co uaufllclilIg ils ~jd- clf IS in nlOdlJmiddotnh-culiosis Th middotalillofthi paper ito r (W
Ille Ii lc ram r 1 a-ccrulin wh kh of Ih bull Lu[Jalmlcrus Ind (Lb hili til~ CLlLt-cd br scnli()si- clluld bl pl Y nlcd or r d uccd hl phylolld LXtmiddotrdsi n Il p--to-da le knowl Uuml~l nr tIll~C aspcc[~ i ne bulled in oruer 10 dndc whclh~r 11Rf blLl adcqlmtt Ib(uuml n middotlicaJ balis fo r ora)aini l Ihe US4~ of lUgravellgtitlerap) wltcllj(r or fln l th e prtl1iœ of kimiddot ~lre IUlll poNjn~ a t iil ies ~bould h allowtcI II uuml middot c enliaI toltlentlf)wh k lu alClor ie - lf pl lr~kiJl -c rmiddot d gtlt- (Ic rnnhi UzJ( inn ni (t hl HrJltlon [ rtn~hcll iJl ~ or 1i1J(IChIumlJlJt etc) Sh llU Ld be TolullllCcluse ulemiddot l onld b- clclIimcntalancl wukh sho ll ld he IJlI-n~ifl~d I~~a l lhc (o uld h 11lfu 1 Know k dg CJnc1in t (wIn SeiCIImiddot Hlk rCS([lflt h daw ccordinll to Ih bull llVit w o f tIlt iii 111 1( plop(lsltd in (h i papcr lmiddotonllmJ l lnl plLyi 11 cxcr(j$( pn (nti or (tmiddotduce dhlblli t ic 1 ~lt Il Jj ll(k pl ti Jlt fadl j w(~ the nlIIIrl li7alinn n f poMural dd shylitS tu p n xJ llc aSl COIlMqnen c(middot 1 all )llal) or r(tn~ shys i middot middotlIrve Tilt u~c (I f appn1priattmiddot kincsiuuml wrlpy 0 in rcns polttllcal swhiIHy Icirc IIHmiddotorc Illta ll y (0 r 1(lt1 lllho UAh mon ltlccurlltc 1Ut dl1alkd -rLk l(lWfils 111111 )11 h Jlccdt(
11) wurcJlt 0 lit)-IcircS (Iumpy - x rcLs P()lun
n rllt lT(ltnklf u f COll1tlK H (rtd) I 1i plfho l og l ~$I rUlglng tr m low tmiddot k Pl 1l1 to IdiOpath ie SCUIshy
Submitt(oJ [or PUhltCl l1 011 uly Tt 2001 Acc~pttJ ugu - ~2 1(t-1l
Addre rltj-xlfll telt~I(middotb If) - grinl Flt(1(bziurllt r )(m Ofl ()(Cl1I shy Lt middotqlltœlll ro () - 1u I4t agravehLIlKil ta IYIL-lTt ilSllltp lfllmiddot ~ 1l1uumldull
CelII ~ (niiOS I I~ middot ann (1) IfUh middot lIlfU di louhilll(tymi ( Nlmiddot ~iI rli -ilIIUmiddotltlfl
Nlti(ir 1( ) il r() (ltbullagt1
lt vLL_ l IiII no 1ftfI
jS ) we are a IUil ly tJc ing n1n) ltblll lS 1 k l1 b ~J)w in~ tl~ t S Jfll l approad llt - l1n til hy on ielshyertd ~tan lard ugraveJuld ln m any ~1~ he lI ~t les i if Ilot dange r )ll lt rhlS is lrut of reil l lnw 1gtlt1lt1 pa in l ~ or 5urgi c ll lrea lmltnl5 in dbc r lmiddot ll Sc - 2
ln tlle cj-e ut ~ t lll(tlWtl i( li p l ll1JC luuml- I ~ middottnl ~() shyliosis phys cal ((_lt1(( is emr1uved ltI t()fIl1 0 lh~rtrv
lo ly in cel1l in L)lllllde (nluumlnlr in tilt Lltlll middotorkl i e Iw l) r llt t Srain hUI IIgt() 111 Gert11lny 5- 1~1 in other reg lOl1 wbere thi I-incl qf tre l tm e rll 1 p~ 1 pmiddot t 1( cI il Jws Ixen cri ri cilld md rel -cltd Lw m~lI1 1 11 Jlu~ Fue Fnlny r ~lrs thio middot15 a lsgt(ru( f ~rth r -~ltc rrJtf))~ ll t vit11 br1Cltcgt b r II1 ([C Llt n ClW grmvlng 1lt1 0 L Sti g
gcsti n the lIsefulnes- u r Ih is form o t treatm n t 1
Hmiddotu]rs have nerged jn El or uf pll y~ iLd eegraverdse eacute 00[ 1 but tlw are nUl yel 11 11 t llu i vIC~11 and r hi ~
f rm of trt ~ltmenr IS stiJ l Ul1 ckf ckhate FfI t Jt 111 il i 11t (eltary td 1I iFy 11umbtr ot
b l sic COI ceP rlJ lf w ill he cIh tt d in t hi pap r
Scollosis
DCijIrI iriolls
ScnUoSlS is Irlircc c1 lme nsIcircltnal (I(gt i l cj on ot tht spinc thar cau C a CU 1 lh lt ca n h e $ t~en ln (1 me1Sshy
ured ultinF Coh) lll ltllCXI o n HI anreu middot p rtc rilt r
EUJlOI -1 lœDICOPHYSlc~ IR
NECRI Nl
110
f)i)
1 7J
amp aS g 5li - 0 v
V
31
10
(1 1) Il 15
-tc i ytjtr~)
FigJ----jllph ot DlI w l-lkaupegraverel) The agloimvltltinn Or idio r lrhlc 50gt1iflll~ IS rpiJ bel~ en th e- [l0 IH P (l)ltg tnntll lol (JI PUllcmiddotny) mtl 1 ( f( lS-er sigll paiilivltecirc lt Dlt(i I1 11illg r the iti l 1Kgt n n t rll icirclicH a ) 111lt m omal prebulled the mno rche md ociks with lll I)ttlx flal gr Ih pll fl
rlcljoprdphLi 1 hl merl prestIK ~ of this curvt c10es n t autom~l ritllJy indi ate the pn$CI1(t of a defurshyTnitv (SlllKtUrd (Unel
It i~ possible tu clil1e ren tute a struCnlt t CI1tve fruIn a pogt urll 011e by identifyi og the hum]) du ring AdIlns tesr I~OQ looklng tra m beh lnd at the p atient w ho b benchng fUfward il is p -- ible ta d d~ct 1l1 eh ucirc n of o ne liidlt 0 1 the trunk usually n n the (onvex ~ jde ul tbe radiographie CUfve Ugrave1lr C Ul be mlt~I Slred lISin~
BUlln els S o liomere( 1 ~ l This h Uf1lp is du(- lO (Ile pregravegtecircn ~ of vertel ra i rolltion 1c1 Ollt tn tic f~YJ tllre o f the def trrnit tli [ c m be seen and measurc(i v ith Perddolles lb lsLometer on an amero-Ix)iferior radioshygrapb ~2
Seven ry pel cent o f li Ises a re conid 1lt 1tO be idiopa thie 1 bull ia l-nosilt in this CI$C is b exdlls i ~ n as idinpa thlc me-us t11H wc do n()[ know rJw origio of lheacute curvc [n othe] ~Ie$ it b Ix )~i ble ro ide nrify a dieak (bat CHl jusrify the c1etgtnniry slIch a rna lfo rshymar i ns I1(gtufol Ig ic~ l or genlttic cl iscas s Glnclt~r trauma etc )
[dicirc)parhk S(oliosis has been divicled ~(corcling (0
the ~Ie of tlie patient egrave1l the tiJ1ll of d~[ccli n of the condil ion into ti) ur t ypei ln fanUlc jU nik ltldolesshyccnt lnd aduh Til l m n st cnnunon (VPC IS the acloshylescegravenr o licirceacute I1IJctenzec1 hy 1 sud le l1 tggrH3l ion uuml uring the grow tll Spllrt (Hg 1)2
lhile p tu 1l sco liosi i5 Ycry lomnw n thl pre shy~Iknct ra te f r adole ent icuumlop~lthic structural CU IY~S in sch )o chilclren are 18middot20
- 10 Co bb d~grels o r m on l -lil
- 2) ~ohh dtgreclt or mort O 2~j - bull () (obb d gre -s )1 mOfeacute ()ll 2
Clin iltI [ d e isio ns lfl IXlSed 111 an lccu r~He pregshynosi which obt inccl in eJch pa ti nt mainly o n the basi of the nsidu~ll p()tlnllltl l of TH1h and the result s of 1 rh clin 1 1 ~l1d tadiogmpl i exlminashyti(ln12ll c noieq uentlya d inica ] la sifiou io n o f the ing le pHient tn -ome estent co incic1 ing w irh the
D diographic one c l n lw SLlIl1H1arizeci 1 1 folIcJ - mikl lc~ (1)(n 20 C bh de~r es - moderJt l betwlen ln md 15 ohh de~ rtes - StV re 111( gt1lt rh n ~J) )bh (kgf s
On the 1) lsis of [hi - dinic d d a lfic t i n (Vith l1l il el lrb tiOI ~ o f the ir b() und~ri e ) in Itllt l cente rS Of SCOtiO LS ITe ltlllent in the Lltin odcl (i rJ Ital lnmct md PI iJ Ugrave tre tmtnt i s plmmcd a fo lltJw 8l
- mild kineslth e (~1fw ~1Il (1 luok-ou t - Hl demte IJragravecegrave 1111101 c(~r md k i rws ithe lJpy - ~cven surgery
Physical exe rcL~e for S(ol iosis
Defi t tiOl l S
PhyS i 11 nU b lIKrlttp middot (or kines ithcIa Pl) i a p rvgrlill or plt~i Gl l (xeriltecircS ~1ci fi ( llJ y ltk ~ loped
y a -11 [ru ine 1pll yslo ther3pisr wirh th e m 10 Hllll
- pre (~ n tit1g tlc aggraaLion of the cl I )flnily in rnild bullcoUm is
- helping tlk Il ld Ct ~lOd ounter~lCtjng its skie elfects in III de rltegrave sc li sis
Tn tl1i_ feSpec1 kinesitl1ert py f JI s oliosis is tonshysider l a o on of peciticcedil training and s genecirc tltllly proposelt in sessions 0 1 4~ ro 60 minute IW) t) tour limes 1 Cee PhysiGtl exerci es can aLo ll v o ther auumlns 1S it oill he dise Issed in this plper
Ir 15 Ilot possib le to cl escribe a single progrlIT1 o r exerc ise a5 pro nrams ale USLIJUy p fgt nll ized ( ( lt
EUH PA ~illDI (DP1I YS IC~ 182
ROlL UF P l 1YSICAL lXl 1lt 1~E IN l IlE 11 ~l) IEd If IlU) l[)VP 1HI AIJ() J)~Cl~ r COl ~I NlG1W il
f)( 15 egraved ( )Il the nee L- 01 indi iuua l pJl itnts) al l l10ugh Lheacute) C l n h t 11 plicd o n a WOU p hJ~js (-1 (0 () pnients PC[ ~l ()lI r)middot lugrave reQCf lhese 1 10 grl lll frequt ml~ V IIT
hnm on in middotituk w allClthltJmiddot -Ill Jnv L l~egrave at Wc w Ht ~huw in lhis lyl peJ it i~ 111 n u -eII1 tu id e ntilv kirK itheJapturlc aims w hitl l ucircrr~spnd LO ugravelt~lil1 DUtshy
g X ir ur ph -s ici l lxtTi~l I~llhe r thln ln dj( us- indishyiJ u1 1progr-lfll
Aduumll l lxUl kisure time ~lOd h )u] Sp u lllll8 ~Ilttishy
i lt egrave~ i middotomm )Ly s iven lel mJ ing ro w hlf ~ Iuumlnsidshyer~d usdul or il lrmfu l in t1 lt rruning (lI tJw ptliJicirct ln tl1bplper Ugrave1 gent ltl l t rl ll bull p lwsiCUgrave lttG iviUes is rl ktll 10 JllI1ltlCc hOlll gtpOlt mJ kIJ1lsIcircl hc lJ l f
i ve lUen tloneumld )bo C on lv ine n dul( re Ull~ 1t~1 t s far Ilten publislt d f I~ mJ I(i noltgtithltl rgt is 11 11 a su h jel lnI deacutehate CJitk haltlt t llltit m itn ltl of l ny lorm o t p l1 ySiClI lxrcL e as a Itwr1 [ J- fo r i liopa tb il jcoJL~b un iL ()ri gin~ initial1) it WIS Ille r rOmiddotUumlK lt brgdv u f p l~lt titu gtllergt w h ) intervenecl hutll tc llcrl ll (mon as cltl HtilJ nic in terventi n man Jgt
1 t lltrJp utl t one 1 md rC j fkll l~ on rhe h sh lf som uni cOen I1v pn t I1cgts wt ldl hll ltl enl1 JI~ haLl nu na l scicnt lfic baisYmiddot HOlh tlle$( trr t peu shy to rh ~rl py tt nJecI to l~~rJ tte C Ih tk CUf -~ pnnshyclr~tll y as a f tsul t of lilo h llIzatio ll of tn imdqultdy ~u pp rt(d S pln eacute 7~ 12 to re-t1 r rI ltrl 1$ l l1C k o f WH llt~~rdl 10 I ndt~-dll()urnah tnd 11( on1 p~l per u suaJly Cl tc([ IS n prelimmtrf lll d 3 ln tt li w ay man (l rrlKpt(Hc H lf O iS Inll ph ~i C U l ~ d vi ~ cI nllog scnliotl pa t le nL~ 3gainst holll ph lca l egravexershyclc and p()rt~1
It m u st t~ n tfd [hat pllyknl txerc j~ tJe~ltm(nls t1iHer 1 lJ rd il1g r rhe rherlpcu tlC litTl~ on lllc h tJ rgt ap p lolc il l the IXlltent lncl hi im r IIIllHnt i- 1 (1(1 rI - 5lt1J lC igt tIl l ( f phJllIlllolopJ al rrea tmln ls Ihith cllffc r 1lt œQlfd- rhe m C cculc u ~t(l luI thl p al 1t n
~mc l 11i (lbE~e Tt i ~ P ~il k tlwreI[middote thll wuumlk ltlll t kin 1or ph~ i Clt1 1 lX r(j~ 1I 111~ t bc loidvd by t h~ Lo iurie IxujCJ1l al1ulhcr a dl ~IS nJI h~ iOg (1 11shygerols llugJr in racr le (wi ller d I ~fJIII ~ I ml thlls re(nl1l rn ndc(1
fn n UI cel1ll r we In(~ hccf) using 1 ) 1 1111 11 ve ) 1 (J p lw l icd ex(r(i~e (0 J ( 1I l tt i~ tlh aITt ~ l~d Ilv m ikl tru cflumiddott1 adokscltnt (cl ioj arh lC icoli is11 2)
ina the f U~ t rc-gt uJrs IefC pu b lishe - the pJ( )grd m 11lt1lt l1te n PWltllk d in fa c t deel()pnlln l~ in th t l itshy OlL1Ii in tl1 r b t ~() ycal f ha ve iclemi fiecl niO l l
m d 111 ur impl rnHm s md d i s )h ilir i (gt~ lue t idlo p lthk amp()lio -i ~ t Jll CIII he 1UO(l if Icirc 1by phyict1 egrave xert iSlgt l fe t rrncllt
l illl
111e aim of t l1JS r~l per ii tmiddot (tv iew tl1( l iterat urt to a(errl ln v llic ll of th~ impa irm 1t~ and Liit hil it il i GllIltec hy ~ o l i()gtj s -o ull he ll nt x or re middotlu celt1 Ili pl1ysical xerclse An u p-to-da te knOvkdge o f tl lt Lgtpecl-gt i necckC1 in rJeumlr) d -oek
- whetll~r there h ltl n adLtIIl ) l tht()d ical bbh fur or JqIIcirclb l l l1 Il( ) f k irt llit herlpy
- h N I)(1 ( 1 Dm tlle p r l c tIcirc(( o f Jebur tiJne )pOfung lcli v l ti ~ IIOU lci he tllf) -d o
II J U V f h 1 I11~ c~~lb li hed Ihe usefuhlLss 01 k il1 shyc ~thtrpy il i aIle dy l nsi 1([(( -r-tI Llleu i n )I11 plJt~ ut the wJrld ir ilt ecircS~nl i 1 I( id n Iv w l1i li ( 1shy
gories 0 1 pl1Vtl( 1excrClgtegt te D)bilI7it ric 1n (Ir st shylliuumlZltio f) lttlt tlgtbltn ing ni trcrccedilh ing erc) hn Id be
vnlcled he tll rhe nuld be lerrillldll1 1 md whidl s tlQu1d be inreœ jf ic(1 IJeClU~l tlley cOli lel Je LI ~ful
Ncuro1llotor impainncnts
Imv aUl llOr~ 11 lt1lt ~tlKlteJ lhe cltlndatiotl bd Ween tl UC1UmiddotIt t l ol(~C t nt id iopml je -nll ~J~ and cli~l l shyler~ lr 1tH lest ihuLIr yt 1 _ 13 ~ 311 D uhoussct 1
1-- ITS tln l ldiopath k s(o lio-L L cll -c d l J l hmgt in th terl tltr f prop li l l pu n md 1I1ar th e detrshyn Hi n i~ na tural 1 ~ronse to ril e need tu ts tu re p()tun ltlluilib riu Ul HcrmJJ1 31~ 11 () d tllat icliupathic ( liCl5j h l it re5u lt Ot1 rw nltuf mot r l ~ltelV
[Id )fcl 3 nI] ~1ltJ U Sr1lle nr to dtorders in centJtI lO~Cl shyIOIDNur) md 1xi~tI moro (Ul1lfOl syt( llI (Fig _l
N htIll -of) H1c S uumll h( rll1 ( ~ l( w ing JI t11 (oshyI-ie on the l l lO]ugy o b doll (nt Rl iu]icirc tlili- middot()lioL m unt fil t-hltll rhl ugravedcmnilV L th e fl5 ult o f 1 (k btcl 11lIFll llI ion nf som t11(WUgravetltnl md pO~ lur( (tnic l~ l licirc1 tl1lt if l p OgtlbJt b C 1l rlw sta l i lin 0f 11 1 Sf llle j lt g )tx l Tt) ohtil n a ))Cli U 1ILzltl I o f p ~llIr~il d l~flo [ in l1litkd ~J)llnSIS me CI Igt(middotqucnr J ~ a ~tmicirc ()nlly or regle Ie Llive
Ali th- 11yp ) tlw~es rd ~lte tr d irtl Itn t pnl1tlt o f [11 v hole ~piltm It11[ controls postu re ~nd mrw shyment lrre pell ic of tlh po int a d lI~ llv inH llYegraved il i ~ ll 1 nnable tCl aSUilll ri 1l tr l ll1 lo g thi ~ys ttm ( Qu it le 1I middoteli tl
lt ch ugt nlt~(S f rullliIl thil i nlomwtion th at p tlmiddot shyiCil J(tl iIies nw gt Il lInport~n t rr le to pbv [11Icircgt role ca n 1)lt slI i11l1lariztd ln lWO the ptu li ain Llt
- d elopmll1 l of p uumlltl St1 b Hlt ) - c1e veuml IOpm 1)[ o f bhll1ltc _
(k llhUl)lOr S Cll orr
ontrot oic whan-lt
------+ 1 ~ il lnll ugrave r AINnl
Cllnlr1
T bflt~ r
fltL1 tlli
lMini
l
~sary ~J-frlllen i )f
~ 1 ocirctnl
~UcirclllIJJlW Ll
AXl ~l1 n uumll l) r sy 5t ~nl
middoticoltoq ~ Fig 2-AcFgtrdong lU He-mutl 21 il is Fi)5~ ib1e rD prolXgtSlt l -oo ie1 mnd 1 ((if ~ elio egrave middotAhltr~d l)Qdy-p ati~ I I i u d) uren ttllOn k td LO In ~ory reHTt I1 eDi tn l al ) JdrnlV~ pn)4~ e l u r~o(Ofe 0-c1 eptunl dvstil t1 ctlon sltŒ(ry icircltu nu11t ilwnt [ ~mC ~ted tl l1 ce Ill trpntlshyUumlfJJl nd IKnle~ r~dibl jtugrave)n of -I) m tlosen Ir ~ig nj tl (I1vying ln fornll1U n (lI an ereltl ~piJl e Mmor aJJ r--a t ~) n ltgtf ti lt aXljl mowr plem iHUC Wh ~fl Ille 6ubjeco m uumlntl Icircn (1oJifitd perccpfLlI l ~na l ysilt of p n)lnocepti Icircnfu rnlaquol ti desnibJOS ~n t tecr spin A IICW motor co nrro l Ira I gy t adopt resu ltin~ in the ~tr ltctltr 1 ckformh y lf IdiopathirL scollos i=i Ht lrftU1uc nltnt l ISll I1lJy h1e- ~ I pro()und elkn on bralO Sfem flJll ct i(lnn~lLhu modifyRll Ille nltulltgtshytl10 ) 1 1111 Uu l-lHoror control 5~Shnl$ shy
As Srtgn1lt1 l ~ ltlssert~ if wc l C -Cp t 111 1 un o f the G IiC s oliosls L l tisorckr oi th e ltquilibrilltn sys t ~ms it is lagical to oriegravenrate physlCl l exercis( lherap y ln th is d ir(gtCli()[1
11lclte goals Cul tl lfOUgil ditrercn t modes 01 action be Olchic(-c1 witJ1 phykal accivit ie
- po rt ive Cll ities p ro ct LJ e aIl UgravelClltrtsc in 6lte nshyel ll )o rd in~lti n pinai pr0prinup ti_)[J nLi mOVeshyment control 0 vio lls iy ln thh repect ome lCtivshylites aœ pre um~I I)y lXrter tllln ntil crs
- kinrl lira py using pedJil exerCisocirc specially developecl lith th est 1101 5 in mind illVuuml VC I lllore prccilt( ll1d InC1 li zed cri n on rhe spiJw focusing
a90
1 ~~
lg -lNheJo ~1l l1 t r~l g rld in 1 1) h i(~ IImiddot ct r rHienl w i ll idlllhic _It ~i ~ _ iri s plt ~I le II find Jit ltH vlllleuml ~l Cgtbl tn~ ks III d il fef lt p ~ lt ihnS nu v~tl middot B ~a~pt u Il C middotl)Icircd ~(t l l11 C dlfkrCnl middot- hdween slllndi1g Uline nu nllt1Xinul oorrec ri nI t chied Vith Ct (J ) und tfdincJ ne lot es o UIine 1 fo llnVs middotIJfl tfi ni( - ltlrshy
reltiK)n ~ Ikexibiliry st3nucircing - -pirte - f ur~1 1IbjISC ltupin - ltorrcaion - - r~luci()il ll ymiddot For flmpllt in J npK l1 pH k1J il
plt1SSlhlc ln obtai n 10 u1 511ndlt)l [YLo lion yr ln Slt p ille rlOlgt itlugraven om l J ~ in ( gttf(C rigtIl lIex lbuil 15 i (r-l l=22deg pol lltl ~~J IIlpraquo is IcircO~-V- I t1 l nd tucircu(Ugrave) ilil) I~ 3laquoJO- IH-12
r ln Ugravel e abilit jl of tluuml [m e llu to co ntro l irse lr in ~ pac
fuld l oftlles uumlllelve ntio ns can presum1b1r incn~~ Ih enl ac )1 the orller and lHitlll r of Ille rn - 11 )ltd h e lllldenl lu EJ3)4il
Posl1l1-t collapse lnd slabilizariotl
lIle concept u fplt st lUal c(l lJap~e l l~t Iwen detin 61 by DlI II-T3e~tupegrave rL t Ac oJdin)j tu tl1i- ~ll1thor il [ nec(sary ~- l Hn Cv-tlualing th tleihility o f a col shylo tIcircC CUJVL (0 clistingu ih bt tVeen the re du ihil [ty index (th - li iffer gt le bet ~middot Il ~I r~tcli()grJph ie ~xnmshyinltio n of the iI111 pHienr in supine po ition m(i
ROte OF Pl rnmL EŒIlCISE IN THE TREAT-ŒNT OP ~I IJD IDIOPAnnC OOU~GEm seou SIS EltJRINI
I (~)-----------------------~
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8 =~~=r=middotmiddotmiddotmiddoti~=-middotl--- middotmiddotmiddotshy--------------t----------~- -------- - ------__shy
~---- --- -- -~ -------------r---- -- -- ~-- - -------- --shy----i-------r-- - ---- ~~-shy
il 1~ 0
Dtl-Lmiddot ~ lttj l r~ UIltltlHt
f g 1 -TI1 u ilictf 1ld ( ii 11- ugraveu-sh) ld IX~ O 1d wllich ltJdnrshymII Il nf the pilll 1 ~tln~1 of th e -o lioti( spinc n IG~nI(J II IIIshytt) lhe iJeuml grl-e o f ~ ()Ii ti c (u rvH Il 1 w dcpc-nlknrly o l l he 10 111shy
P01(nl (pntt l ~ 1 1 nr ffll wrJ I) ln w hilth Ihe n i 1gt( ~ duc nL~ grlphs fm I h~lt 111lt hi~hr Iht Col h ~Ilu t (l f Lite ~Ul Ihe m Ol CI il y th t s(uumlJotil middotpin~ ~111 he ~middotJg gr~lVH(~(1
m mJxiTIt corrttt ion wll iJl i~ lIllCd to Ih - xt 1shy
lti Oilil y Jf tl1lt t Ut JO rl1t cdnUc idt md p OS shy
tU ll cul lapse ( th t ltHill enct b-tten l lUdioL) 1lphic egraveltamJl1ltlti OI1 J t th e ~lme pa tient in Sl il tl cling lOJ lline fX-sitiutl ) Wll ic h correb lc- onl wil ll fhe abilt ty of lllt p tu rl l gt s tem to C( lunternct lIk luree o r grl viry )cco d ing rv D lfVd- f3egraveLIprc po st li r t1 lt01shyIlDse is d ue to the Jnus -u lar ton a nd 11ll ex rCrIshy i) i itv of rhe tissus n the ( O IW-) si it (If the (01shyjl ti (~JtVe (Fi~ 3 L Pu~t llr1 C lltpstl lu lcl l ~~ reduc l-lt by llwans o f pl1ysica l cxerCles specitkally s tuclled ruuml i rnprove tIlus--ubr fOHt md lU pr )cllI Ct 1 ~11 hi shy
lizing ffCd
PararcL n tll CIJ cl the cr iti ca l (3 c1 thlsho ld beQ ld Il ich defol1J lHU n of the i pinlt 1 e~ in~ ne dtlllontr~1t _cl (1l ll t grclrf r mg] o f rllt C II in a qa m bng pos ition corn pOil 15 t l lowcr detormashytion lhnsllold (Fig 1) ie to ~11l Ulne3Se t the risk of pr ogr t~ lu n There t rh eJef re l J ea r l)iuuml 1itshycJ l ~ll1 l l(tl a 1 tnr tg ro b ohwined by d -cr t l ~ illg ilmiddot pU~lUrll cull lpse ptJcelJtge w bich lccording t i)
h llTd tnd ~l(heJ1l ~on 1~ b inde cl 1X llt icularly luumlgh Ugravel mllcl c Iio~ i (bdow 2( 0 ) (F ig 5 J
Fin a Il III ch iS respect lllljl hl and b um l 01 m linmiddot
ii iI 1 l _ _~ _ ___I ___ ___ __L ___ _ ___ ___J______ ___ 1 ___
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i
+----r--------t-------t------f-- J
Fj~ ~-Ac(XjJlin(Q luuml T O rIcd ~lnd Na(h(ln~ n i () dl( pCG w rd (rTIshy
POO ll is hiherin cu rvegt in wh ilt l1lh ~1flILWrd cII1I Olk l1t IS le- pr(v~knt ln th e grtph Ih t PogttJlJ I ugtnq) Ot1 -J1l j elfltS-e J tlt 1l1t obb dirr remc rlLIv obu incu f roll l the Cohb atl( 0 1stlI1dtJ1g IId gtupinc rldo~raf115 Ih Ille lt) [1l1t1 (i lndnl I pine) 511pille the ~(nlClu tJ1 compo l1lnt U rlk CU Y _VeJily I~ ltx p rlt 1 L1v UpUlt (obh Illeturo Ih t si _b Cct rtJeSIm l fie -ltn J trd Ugraveltuuml shyuumlo n A~-i)rding LP 11(lt uuta o n l ( r1I~( in ~I 2JQ sup itlt curvt 1hi C(]l)b ddhccno l l f lO is -J-lultt( thc s ldnd inr tnla Ol1l t lS wi Q) whil 11) 1 1)401 ~llp lne ClHVC If ~ 1Omiddot ( tcl Lhe ttnd trl~ nlca~ I(t I ~ ~I)
tli n ll w l lllE cq lin ti spin h~ i ng mo r ~ Llnt~II) 1 tlun the nOftl111 one n Cll l gr(lk ( (cU ve tl1u n da r u p shy
po rt in o r k r 10 m linrl in tht 1xi11po tuf_ n th ha__i of th egt onideratl lr1S it f(lll() rhJt
ph rH (~Uuml e erd es ulukl h u - ul iiuml tbeacuteY ~U-L lm cl 1l (It-d o pmg p05111 td C Jl1twl lS fuumlrnll~ rly d ccrll1td ln an Ql St if i imr ol1111 t ru t(( - tht m(d in C JI shy
r t t r sture fO Ir -ngthen tlll m u ck-gt of the spint mainl) in (11erl antig r3ilrl tIcirclt l]lli fun ctin ll U hy meU15 dl i )ll1 t trk ~ lhJ cl( -ll tlt C)nlr~lUions ~llld no l IdOshy
1l)llic d YIltll1k lt l jAJ lktic t) I1 ) II 11)t 111 hd posibleacute t lcluuml ee postura l io nrro and stfh ili lllllt IJI
w i thout food T1lw(ull r d I( Lf(11 Ibk t m ucircnuin Ihe c()rf ~ct [ ()S tu re for cl gtu ifKi IH lLl1gth 0f ti l11 ~
This i-l ddl usl a typl 11 dnmnin (tf k inesllh rap) in 11 (lt-11 [[k - p~d fk lnr in lng f u l1a in llllliCk is poss ihle lI sing ctrtain Idncl fJ l (lt) 11111 liun S p Ul in tb is Cl c is ulttful ooly sa I~tr 1~ il Iw lps t1w lxltknt 1 becuJl)t 1gtlt ltlt-I a ClJu~l inred irl ilL ntllru l o~ i cll
and I1lll~lJhl r-keJc LIl [rll-llIn~ middot etlt(wrs JI the int e rmiddot vlnrion
[J ROPA MfJ) I()Wf-I YSJ IR
1
ICR 1 1-1
r
1 shy ~
- shy
11 o-llrfOlhe5l~ o t Ih 1O~(1dity i n h ~ r ~ ll nr pbl1 l of ~ Spl11 in 111011 _llti1Gt l lPt f ltlJUCWJtl ( ~l Ihe Ir t 1 1gt illbll W Ilh LtltrJ1dlion Vln lbe rigronl middotUII~ l(I Dko n12 lIll h lumshydlanie1 1 [ nul 1 M hl whtrc M - gt) lnIUI1g 111laquo111laquo1 1 1 c rtJCshytjC~ f fce d -d Lill l1~ o f enr niI pUll spnmcl1y 1~ 111 mldlll1lt (n the fl1ur t 1 = tor~ of f(ward Ileuuml l = ughtel1lng fmiddotr p 1shynOf stn lClU= Alaquo rdtllg 1raquo Ihl~ - lin hull th l1ltgtllugrave ot tller1l lUr~Jtllrc F the ~pin t -ilh rlu1i tf Ihl 1 1Ibulll n lrlt InltT1 1
rbc prJI 3IJi l1ty d qrlOIJ~ n bull JI t IlJIII Hm lA the v=ltd gtc e lu-ing J 5lnK1ura i ltfnnity
Dioal e ch anicll itllp~lir J11 c nt
Ihrcemiddotdimcllgtional mc-cbal1in of the s pioc
~f Ikmiddot i t i nly l(œ ntly tlHr llk pr-5tnœ or nc ushy1 lnlo tnr impairment in Idiopttlllc s-ol ii IXl tknt liuml J$ heen h i- ll licircghlcJ hy re$eJ rh tll e preit ilegravee h inm b nIcirc Ji d lJutg~ lt hl ~ 1 ng t o n dO Ulll urcel 1 i5 (l lreldv well umlersrood H(j-ev~r nev lbt un h iomcrhankal im l) ion nI h1c rectm ly onk l n tIlt tre and p r~dou in f n rmtinn hou t pl1ykd (~fcl5( in t 11 0 tl1I _ltgt pbne of spact 1115 Im trqlt-u 1rom J i-[) v ing unclcrsrmdlng ot th l lmc -dim nshy~ilnl l l11 ~ hmk f the cO]jO[lC pln( ~2middot ) ) Ve- w ill )iI xnl t l1 d at lcL-orcltng tUl cl sif iol t lOn blsed o n gtolllt lricd h uumlCJ ) p lane
- b() rJzU[1tl ln th i pla n ~ th t 1o rm ll sp ine present no CUlye- w ll ile Uumll(~ ltc U Hic spLnc clevelops one of ir haracterls(Icircc deFo rm tiCs v elt tbrd ln lashytio n vh icl1 pJ()VcA~ theacute hw 11
- lgitltl in th llulJe U l(~ nonmll spIcirclle pl SenL kypl lOSis ~nd l dooi~ in tb lXI1 lhese [(Hu rts Vere m)( til ught [ 0 he relattd tlle scolkJtlc ( lI r Vegrave
- front l in hi pleme tht ncrmal p ine preseuron t no curYegrave whil thl ~11li tic p in ugravetI I ()~ icircl~ charshyad t Ilt I CU1C
Il Jri fJIIt palic
~l+I~na ra 3 r inr lut th l[ ber ll1d a œl1~lU1 degr 1
l f r()la tJo u lllu (lILa r forcKl ltxert ltJn tl ldefnmuumlng 1 tkllJ [J i1u a re- lhlt tll cly 11 [1 1 UI b y Olm ner w bn ~lh uiJwd tl egrave ro t1tic) l1 Ilm it ti lt p ica] lf shy
rhrl r() be (P (the Uma bevond Wl1iltJl th lCOJlb of [11( ~pmaJ musd ~ dthc COnCIt and nm ex ~l le btconk (t O li~[)
r ~l 18 ~1Il N lu t( ren i9 lun lu ted rlseurlt h in tlt ) tilt lULodeumlformipg1 tlo n ot tIH_ sc laquoJrle rh ox ercallkren lk 1l1~H li d11r once thl Il i ~ r tld1t5 [he lhrth ld f 111 JlIcirc lIi of tlle dnrlclc hurnp tlk
lI bslt Il l nt rlet()rlll lIcircon 01 the it l ()I~ C ( (ylm der (- sustalnecl by an H1tmi cforming aCOOIl
J1Ji h V hl rhyiical f~ f Ise CI 01 h spr n llnd kin middot ith ccedilrapJ my lX damlg ing vll e n l pplild as flle
igt Jk Iller ln SCC1IJ ~IS lllc lJ fxceed l auto in middot crca~ i n g lhrllgthuld [1 sh (~u Id ahn be j ofed that Ilw relscd pre sun 1l1111i insiugrave l fe pil1r inn) 1 mlshylt
- j Il- ( w atff 1 (nh ~1l 1(e Il10 utoldrml ng li1eCh~lI1 1sm
in flc l Geyer ~w tcd th1 t rm m 1 hI l)1ecircch1O lla1 puilll 0 l I C~ sw m mim t Ieuroamp no purpo t for cu lshyim le pllilt t1 s (weumlO middott r it is l~Jl(gtWl1 rhn in iculio r[ paULnl -iJl11T1ill~ doe_gt nor Il ~lp to i ncrt~SL n eur(1shym tor co mfU
(1irai p an (
Jerdnn lle 11 showecl thal ill CSl~ o f t10rLC IC 1i lUgrave
tllo lacolulllhil it lio_1 tlle cte tI llmiry in (he lg itt1 p lln t rn lnlftot il~ lf tspe iuUy in tlw initi 11 r luleuml )f cV IU[Icircon nf Ile ~oli ls W iU l 1 p(t)gr~s~ivlt il10middot~ shy
ment roward hvpok pho b G ll f ill~l Im lins l har dUflng (IN eWllLlfiu1 of 11Imh] co luumlgt i the l in t ot t l H~ gClyty Cegraven te l - 0 1 v llebed lxxli 5 r ro ject 1 seH fl r t side-ys and tlwn backlrcl bull thu~ p(0(1 lj n g a kyphQtlmg aet Il ln (h~ lu mhnr --PIl1 COftj tng
l l i tc Iugrave l lltl l( l rs1 tif s L -etllgt il l the lgirl11
1 Hl)
Ilu LE nI rIIY~Ic~L lXIlKISI 1 HI E TREhTMEtn OP JIU IDIOP llII C AD O USCUH O Ll Œl15 NEGR II
lLill tegt lre lenl1 ~I d ~fo rll1J[ ~ rhl recrSes the phyltiologiGII cmns of lh vine)
Accordlng () Dicion ~2 1 rtcluctio fl in the itgitttl CUIYtS combin l vi th a lueral Iviari n llltl ds t 1
mecban ism () ugravel~ta il ity in l he r rat r IllI1e which bVOf1i the unsd a nd i ncrea~e 0 1 co hlt1is (Fig 6 hiIf md Pl11jlbiJ Jl1eanwlt ile lt(udiecl lh e srnl ru t
orzyglpophySLs show ing t11 al ttleir 1I1tl rnic tl orienshytation f~I (jLi l~ltes aXIal ve rtegravebJl l rotllio ll in cun litluns lt f dorsal hypokrrhn Icirc tnd lum)H de i L lo IS
Tll t dat SLlgge 1 th t impOrfill ut pOitu res and l1lweil1 ) t Mudied in ord t r (CI mlIuml ntrlin or to reuwer fll e p llyslo lo~lCll ClIlye in lIe SlgJtta p lU)l Wlth the llm o t ch ~ kin~ rutltor in l~ bili ry7 AbC th ~e ~k-
1l11nL ~Irt del lnt [0 J jUc lt ftber l]kuti inrervenl ion vhich 1c)LJ k l IV - i(l ~ l compktl n l ililll on Il t c1 l shy-jel1 J11UVllT1ent IJ j o f 1uto-dOneacute(3tlon ( i e a -impk ld ion ) Iengtheni ng o f the pilleacute 011 a litlltl l aXl~ tll lt ((IT liJlI~rcdu e~ t lle ~---lJ linti- l lte ml-fkxj(l n h UI 11 - i llCrl I~t the plllH ](JgicJI dlt cr ~l S ( (1 k-yvllCiSh lIld O(ltOSh l o r c lch r1Iif n t a Ilew til(~ecirc dUuml llt Ilshy
si lflltl J ll1 u(~nlent iam ecl - 1l1t0- lIrfe rionmiddot7 4 llmshyp oed f Je-rura l iUIl cl middot-t1e- iltm lI1d ll1a intltnUlLe )( 5lg it d C Uf (gtS slig lll thltJrc i ypI1 tiZ) tIcircOI1 a nd lunugrave)ar 1()fdos i7~llion) sholild he esw b lb]HU 00 lb co
hl b oi hi p~l11il uU r -1Ir vlt Abo 111( e IlltUtl Chl lie o f purti n - a U vitk slJ1ultI h e )tuumlll ecl 1)] (1 n ldershy](ion r tl1i lt type for e upIe IilJ llyl)T S of repd shyiti( ml vemen prt n t in agonistK h)lnllltlSlks nI iIle kind f dlJ1ce C( uld he ([([r imentd
FmiddotO lllaljlallC and mobili ty of the SpIcircIlC
1 rd llo U 22 d L lm nrrare d lhlt in Illt fro nt a l pll ne
tilt 1 nge Clt 1)1lt vtment of tht scplit[i middot CU IY grcmr lIJ l il ~ d irectio n n f Lhe C ITelt tlO n tha n in tl le di re shyLion of pmgressi n l Fig 7 ) he IL o IS5err lJd tbat th15 mohiliry increac plrtil u la rly n apic [ cgcoeilts 1$ lh ~ ~c() li osb evolves Sragrm rJ 12 J ~ thus rigilt (0
VlI f n rller~p is ts Ilo t t) m o b uumliz - a sCtJl iu til curve w ilhout t [ uling ttwt tlle R lu tiOI o i til t ~a mt b fnlinruumln( 1hy l1tans o f ~I passic 01 1 rivE -uppnrt On tilt (ltllE r hand UgraveK d e iJlioJ1 in ease durill tlw tune 111 whicll tll C spmt i ~ not submjtrcd to correeshy( IV anl()n
j- Virh mi lei ol i b tlllt Upp i1n ill) lC tiol is d eveloped only lllmugil llClIf()mu$Cllbr f r llce thi ~
InegravelIl ~ thclcfo re tl1l[ inu eascgtt sp1J1all1extl)iity mua
11
Imiddotiumltgt 7-rurd illt Ir) 1 bull rdrilt I1 1 in tl lt frOlllll pbnlt- th( illl ge )r mOC llIeJlI o t the S-o UIIJC CUNe 1 supcrior in Ihlt diflt(l im ugrave( the n nKlIl thd n ll1 tllc dlrtcLion o f p rJ1(l( (llIl
be considrCtJ vntrl iJ)(l icltion and 1 undrli neocirc ab L a ~ubiljz~ILion 01 tilt spint pllss il)1y ohtl ll1td thrltJugll the stlengtlkl11ng o f the 1rltJgm vlt nonil lme shyCIC 111 illli orrant u bjcLliH- ln rhis r~f1 n sp u lllni lc tivitIumlLs sil uld lX tPI 10 dlegraveltl it l G lU t n w l1ik luring kine i Icircth lrr phyltical eXegraverci c~ tllat in ele
spinal m ot ilIcirclY sil nid 1e lt1 oid cdrt ~
Organ ie and psychologieal impainncuts and li islbi IiI le
A cgtI im lc pmi nr is moriOthl11 just 1 sp in and 1
compkt gt Ipp rnach to the gu in ad 1 ont i al~ shylute l e~se i t i11
[)a la 0 11[ [n ell lrom re semh pw tbat ome organi Iilnctiond cl fki ts suc]) as tlw clecrtiUe ut vild l tnd d fun ll l)Kity_orld ldly incrtJ k whil~ 0 shy[io s i -till in (1 miel q g of g JltlV ity ~ l ilI e 55 rtI lit
tllL pres e n ce )fl defidt Or Vi l~il Clp~1 - i~ ln one pIIiem in Ihr l ftectecl by 20 ICl 40 scoi stgt l ls~a r(h cunclutecl in tbe UA by Di Ruce- prod uegraveed an aaalo) u ll1lXimum 102 re u t in a group of Jd shyk 1ien t [(h sco llosls rang inF frum ) [0 1
Al10ther rudv bv rallt r m C chr111 lilcl NashycWrl1s( u 57 stlO eltt hil $(C 1 1 ui~ Ica js l( lllt cl (1 shy1prUlllI o f t1tgl lie bJd l imI in ~ul sct t1 t ltu b middot iects jlLltr l5 they are golng through ~I cltlici[e sllge in the fnm 1lt i n 01 tlWH o w n id uHitv t factor hit h Illy jeopmlize the cl velopme lit d ~ mIll lt lI1d htIshym cecl IWI sonalitr in Klulrhood
n RUI ~IEDl(( Ptl Y1-
ROU ltHmiddot PI [ I C~ 1 EXIRCIS]~ IN TI Il nW~JUNT OF SlllO lDIOP1HIC AI)C~ESΠ11 C(gt1[Oi 1S
This i why b IiCieacute ii is ~n imporrlIl t for p rcshyvegraveml e 1tLsr l tn en ou flge 1ari e nrs ~lfrecr(d by lIillcl middotu iosis ft) tlke p~l rt in portin -re rcatioluJ acrivitits Iha t 1eIU 10 L10 th r~1chophyinLl bull nd b~l )i 1l1o tur adlieem t n li 51Jmiddot2Even tlK)ugli [Dr bic mech~lnshy
ical mcl nellIUll10t 11 11 reltl ~ons lt r111 1gtomcrimes be l lefu l to ugg( ~t ne p rt in~ aCt iv ity r l h (gtr rll n anotlJer e th ink Ibal an exces~ ive IlHd icalizltion - Icirce l ll1posilion br plry~ilt i HlS nnejlor parents uf rh ry pe of po rt to lx p m lice 1 b Ule p 1Ucirc(Il L th1[ preshydLl ck l1 is fret clOice in lh ma tt r - -h II ll1 he avolc1ed wb 11 possLhle mainly for tlle i mport~ltll psyshyLb ) jogka l fe a SI)nS W( ha( ill ~ t nltntionegraved
Conclu ion
lbh ISsertegrave d t1H physkal tgtXtlci o is ) n fi ial whlIl practinu in order 10 ilnj rove the I11 llde
rœ nwh and tono C iral caplCiry and postu re o f the StOUO(I ~lIbj n II I nowkdge om ~ middotmg trom ci el1shyrlfi rls(~ Jrc li dJlJ accordl ng r the review 01 thE litshytirlture prnpo )td in t lli plpl r conflrm~ Ihe vuiclit ot th e -t ls ~rti ()ns
In l do l (ent Id iopl1il iC scoliuse il l n phee u i cl vk)pm e n t ( li tll iumlKh eXCC cl l g i en rhk thr hokl th e re i5 an und ubred need fn r l pprnpri 1tegrave (JJ1tOkJJe ~Ild Inr surgict1 therapics ill ortler 1) S l i p
the ( - Iuli on anugrave )JT~t~t UW ~pilll l dtlormities bull evshyerthtless in the illiti ~ll pl l~sC t ttlC c1iseLltc whcn the riS( r1 r euro )luli m is rtduced ocirc ~md tfle uifleal JOld threshold il ~ld flle po stural collai i reJcenw~ 43
JI l1 igh pllysicaJ egravexe rc ise - p revenc or r d llCe d i ~lh ilir ies o f [Iw ~ l() li )tic
p (iems R 28 J -6 5- 6 1 63
- f~KiHtare lh ( n utr ali711iCUl of postu m l d elicits tn produCel1 a coneql l nce J [)ti 0 I111)( or regre si -u lmiddotc 5middot Il 1 17 ~ M
-re 51udles U ~ n Ledecl tu con[mn or re jecr these conClLL i( 1 w l1 ich clerin-d frum 1l1 lIldytica l rcltw n f th e liter~iture appear r- ~Lo nlble Hnwecr Intil ne re ull are 31Iable wc should n r prevent our sroliotic patientmiddot trom tl ki ll p lt in s(loI1ing jshy
ir its pW1iada rly ltl t ~d1()o t () n til t c ntrHY -vith the l xcclrinn 01 gt[1 )11lt tIlat in rea-e t)1obility (tnU evc n thell oilly wh n progr~lgtion b p OSSibl) -uc h ~I( ucircvshyiUe -11 )ulu hl tIKoll w g ed The 11 S J ( rprOpriue kin (~irhe r~l Piuml to incr _~asc p()~tura l $llbil i ty is tl1egraveoretshyic tlly CiJUClt alttloughl more ~Iccu rtte aod deLli led ri k benefi rs anJlr~ is is netot1ed
Ria 1111tO
NIokl Mu d lle ftitYljJfu Jœl il 4IWr10UOifll S (JIvs i (1~1)Jshylidl ttno( cclIll le 11(11(1lt1 RCI fu lle ((lia LltfIt l1 I1I1i(i
LJ ci n s j(r3 pigt egrave li n IHUgru lkl di t rdz t fi sici pe e ft shytUlKm iluppno di un lisimerap15Ll rl lllcflt() 1 110 scopo di pnevirlt () fr en~lI 1-lgpwlllltnlcgt dclld lclonnitugrave o e il 5LOshy
Il i mi llon lt fH nugrave j (1 11ni dei co~e 1 lteIl I1J J nd ne ~Ii eifclti (()Tc rri udk s co lio si d i m e dia g rt iuuml ln que~ltlt
s rud i 30 llizzb mo i d ti cleU ric lca pel n ri Icare qJJ l lm 1 dis(imucirc x u le I[~ l z j-m i pro vna le da lla C gtl k A i json ere pr middote-nute () rk kl ducirc un~l rdeguCltl d nil cra pi lt di uJoseguerrnt Cjua li 1iU110 cli nbie tti 1 rcr lJ)tIId d~ fle)-UITC
n (- -fd7Io n~lcl)
Ut11claquo)si 1 lI tori htpnuuml )ludi-ttn I ~ cnntI1zttu fr Cq(in i idiJ)tic1 dbfl lOZ10l1 d d ~ leOla nelllOll1otoriO Lb un1I1cnUl 1n1l1i3 dcgli 111 lt1i ch DIJgt gtU l H crmU1 Nlch~mslt ( SIshygnaJ~l lerimiddot wo i esuemi -bletti d~ plt~e8lugraver- ne l pClZ le1lftgt scoliodcu kl s iluppo ddl ~ ~ uhjlil~ vertcbral~ lt o svilllp prJ Jdle JIl7 i() nl di ltCjuiljbrio Dng li studi sul lto lb( l~nlrale (OllddU i in pa rticdu d 1 DlIal-BeHJ (gtegraverl ~ P~II IId lI1 n~ llw - idente il v- m gtiu p eT il puientc clioti elgt di u n rnigb o t c)[ ro Ua sw mle dei radlldc onsegull o tramite il 11 fforzrlshyfl len to d e i l1luotoucirc l nllgr3ilri d e luOwo con crcbi ~Clltdr
in pOMltHJ corrctl e in va rie ~i[Jzioni s t llicb c c d inamIcirc tllt Dalle on sena d elb blOffiCcclIlicd tr idimlt n s io mlle d ei
r ~ chi Je ~oU()f icn ~Icirc ~videnuumll (l() ~llt tC p IYZIcircOSI ln(IiClZlfHicircl ~ 1I1shy
liumln fluenzt Je ll middote~rUrio tl SC) lgt lIi I rc pibull m i tldln sJlI71 Stl shygn~I I1 afferma che slI l p Ia no [11 middotccedilr~lk tre un œ rtlJ grado di l L1Liuuml IlC dclh vEltlh r1 apj(de le tu rœ mu SCltJ llri njtbc J n in $tJ ) t rodcfQfll1t1l1te PltJtantu b i r~it-~ r -lp il puugrave t~~
Ixnt-ftla solo nt Ile so )[j)~i Jl1Icirc na rl in qunnt ) ilon SlrM ntne )(l(Ofa tu soglb in caq ) co lltrLJIcircn l)lrilto llt~( i lJudotlsi di lfr~ lI1 C llg grVlmenl J 111 11 io lr riltd ll(17jOill leld rinlle 113 dimO~iumlrlto d llt nell o lin~l cl()~ li t th~oIOl))1 dri la defltgtrshymiti sul p iluO slfl iuale ~vohl lf1 (en5 ion~ sO lnm utto nd 1e bsi iniliali deWggrwm1Cnln mcn trl C a( lfLmn che occlleshyvoluzi ne dene = 110 i [ mhari IJ lin c l ki cen tri ch -1vi1( de i cp i CIt IJ rI Ji SI p m ittIl pnm l Iem lmeme e p o j pOS( shyrio fllwnte dtldnli mdv ( i un ziuuml ne ciloliz7nnl dd rlLtide lu mbJ œ ( lIlelttlaquo on NC n d d (gt11 uIdu m 1I1 Ilgt) cli r-Iure (0 eserClzi che IllUllengano 0 ltlUperifo le Clgt 6gt1 lo)iche sul pirluuml gilwlt Su l p iCl no fron itk Perdnulk il dlll1lt-trlto d1 lampkz-l d i LU ovimento amp111 lI rv Kolio ti ~ nd lt1 0 ddlJ cnrrc-LIcircQo i Ji gC 1 n lungl SUpegraveliltlrccedil 1M llS0 tlell 3ampIGI shyvamcnlo C che l~Jltmiddot mobiliti GlI mcnta co n l c lu7j o fle d l i) snAio i A ulln amplgrtJc1 ltllllmunjx~ i terlpGli nn n m obi shyUZ73It ma eutva coli ti0 1 1ct HsicVlfe nd tcmplt 11 1111nshyttllIcirc1nc n tc (k ll ~1 llu u zinnt n l1 un me77uuml d i sost l11( gt ln 0
e 11111ri b cle - Ilziunc egrave deorinatcl d l rlyarsi Snzcl la pr gtshy
liltlnl l i un() rtl~ i ptmiddot Jtl n(o 1S(Hl () (( ntJ() i ndit~tr i ~ Ii ISt (izi e l m iviL Illdlode ebe Hlmen tno laJlc ibiJii dcl rlc lide SCshy
li io) [n p articobre rune q lldl r C-I1 ich~ xlSiddcHe CUf t shyli ve ch~ iJllpi tgino e~rciii 01( biIi2 ZanUgrave HhnmL-trid () in tmiddot~t~nshy
sione kl fuchide O tne pure k- ~ttivit1 tnotoJII~ non prHi(~ llCcedil
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EUROP MIDI C Pli hIC
EDUCATIONMEETING SATURDAY 8thof APRIL 2006
(iSS
SEAS02 Scientific
Exercises Approach to Scoliosis
version 2002
G
S Negrini 1
EDUCATION MEETING SATURDAY8th of APRIL 2006
Neuromotor disfunctions
Neuromuscular disfunctions
11 Postural collapse
Postural collapse
Duval-Beaupegravere
Flexibility of scoliotic curve
f---I--- I Postural element
-------1 Structural element
S Negrini 2
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Postural collapse
Duval-Beaupegravere
It is a value related to muscular tone and to flexibil ity of convex side tissues
Post ural collapse
Bunch e Patwardhan
Critical load
Load threshold beyond wh ich a spine begins buckling
JI~~Wt1lW~flfthtlJlœJtAr ~ J~It- l~l - IMS
Postu ral collapse
Bunch e Patwardhan
If a curve reduces there is an increase of the deformation threshold
~~~NW~-damaoc~IIIMf ~~ J~Iv JaJ-I7I9sect
S Negrini 3
EDUCATION MEETING SATURDAY 8th of APRIL2006
Postural collapse
Torrel e Nachemson ~
Scolioses below 20deg ~ ~ lt~
have a high ~ ~ percentage of ~ ~
~postural collapse (on u~
average 75) ~~ 2i~
CU~VE O EG~EE S WHllE SUPlti e
~laquotd~c6b ____lPffI1wtt1t~
$ww J(t ~~7 JM5
Postural collapse
Minor scolioses 7
Antigravity musc es strengthening D
Reduces postural collapse -G
Increases the critical threshold of deformation
G
Neuromotor disfunetions
Stagnara
If we admit that one of the causes of idiopathie scoliosis is a disfunction in balance systems it is logical to orientate physical exercises toward this direction
s Negrini 4
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Neuromotor disfunctions
Dubousset
Idiopathie seoliosis results fram alterations in praprioeeption centres and deformation is a natural compensation to restore postural balance
etattJtitIK ypothfQj~S ___~ own_ oJ)HQr lar 1t-1( r
Neuromotor disfunctions
Nachemson Initial idiopathie scoliosis
+ Goood spine stability
Neutralization of postural deficits
D Static curve
Neuromotor disfunctions
Therapeutic aims
c) Development of spine stability
C) Development of balance reactions
G
S Negrini 5
EDUCATION MEETING SATURDAY 8thof APRIL 2006
Biomechanical disfunctions
j Horizontal r-Ian
i Sagi ttal plan
Frontal plan
Frontal plan
q Frontal plan disfunetions
Fronta l plan
Perdriolle Movement magnitude
gt in the direction of lt in the direction of correction progression
S Negrini 6
EDUCATION MEETING SATURDAY8th of APRIL 2006
Frontal plan
Stagnara
Never mobilize a scoliotic curve without ensuring reduction maintenance over time otherwise a greater mobility favours scoliosis progression
Frontal plan
Ducongeacute~ research
On a group of adolescent idiopathie scolioses treated with
Meacuteziegraveres gymnastics
D After 1 year the mean angle of
curves increased from 18deg to 29deg
Frontal plan
Scoliosis without brace
D Greater spine
flexibility D-
Risk of progression
S Negrini 7
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Frontal plan
Mobilization is useful
D In preparation to
brace
D With brace
Sagittal plan
QSagittal plan disfunctions
Sagittal plan r middot _J o
Perdriolle scouos B CJ aDeformation of D
thoracic and thoraco-Iumbar curves evolves in extension
S Negrini 8
EDUCATION MEETING SATURDAY8th of APRIL 2006
Sagittal plan
Graf
The line of gravity centres in the vertebral bodies o s c oUOSt
projects itself firstly laterally and then fi
o
posteriorly lJ ~~ ~~ ~ ~~-_J-D ~nI~
Sagittal plan
Therapeutic a ims
D Maintain or
retrieve physiological curves on the sagittal plan
Horizontal plan
QHorizontal plan disfunctions
S Negnni 9
EDUCATION MEETINGSATURDAY 8th of APRIL 2006
Horizontal plan
Stagnara The forces applied ta the spi ne act in a autoshydeforming sense
Horizontal plan
Dimnet Rotation gt 200
ampII~ (
D The actions of concave and convex side
muscles become
agonistic
~ItJrOnrIIiItdllfUClltlluumlll~~tI ~1JIf1laJ
Horizontal plan
Minor scolioses never exceed these autoshy
deformation thresholds
S Negrini 10
EDUCATION MEETING SATURDAY8th of APRIL 2006
Disfunctions at a biological organic and psychological
lever
Oisfunclions at a biological organlc and psychologlcal lever
Cheng
Bane density in scoliotic teenagers is lower than in normal subjects
~~~~middotA~IIlUtIy ~7œl 1d l
Oisfunctions at a blologlcal organic and psychologicallevel
A significant reduction of vital capacity and V02max in teenagers with a medium severity scoliosis
S Negrini 11
li
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Disfunctions at a biological organic and psychologicallevel
Disorders in the development of body image that the teenager has of himherself
Disfunctions at a blologlca l organlc and psychologicallevel
Therapeutic aims
cJ Activate cardioshyrespiratory function
cJ Favour bone density increase
cJ Develop a positive image of the body
Disfunctions at il biological organi and psydlologicallevel
Stagnara
Sport
D The active side of
kinesitherapy
S Negrini 12
EDUCATION MEETING SATURDAY 8thof APRIL 2006
Disfunctions at a biological organic and psychological
level
Distunctions at a biologlcal organlc and psychologicallevel
Cheng
Bone density in scoliotic teenagers is lower than in normal subjects
~n~IIIvpWr~middotA~stWy s- XXJl M J
Disfunctions at a biological organic and psychologicallevel
A significant reduction of vital capacity and V02max in teenagers with a medium severity scoliosis
G
S Negrini 11
EDUCATIONMEETING SATURDAY 8th of APRIL 2006
Kinesitherapy on the scoliotic subject
q Postural control
q Axial stability
q Muscular trophism
q Balance
q Respiratory function
The limits of kinesitherapy
There is a threshold beyond which
rehabilitation alone is not enough
sssr
Kinesitherapy in scoliosis treatment with brace
Therapeutic aims
S Negrini 13
6
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Therapeutic aims Srace kinesitherapy
With brace
il Postural corrections and
vertebral stability are obtained by the brace
Therapeutic aims Srace kinesitherapy
In preparation to the brace
il Mobilize spine on ail plans
Therapeutic aims Srace kinesitherapy
With brace D
Maintain a normal spine elasticity
~ Maintain a good muscular toneshy
trophism
C Model the hump with kyphotizating
exercises
S Negrini 14
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Exercises and their methodologies can vary accord ing to learning and individual sensibility of the single rehabilitator that proposes the m provided that they stay within the
Iimits of fixed therapeutic objectives
li
Therapeutic modalities
(Exercises)
QAuto-correction
QRespiratory education
QErgonomie education
QMuscular strengthening
QDevelopment of balance reactions
WNeuromotor integration
ci Vertebral mobiJization
QSpecifie modalities in brace treatment
S Negrini 15
EDUCATION MEETING SATURDAY 8th of APRIL 2006
The protocol of kinesitherapic
treatment
G
QChoice and dosage of exercises
Variatiosn of the work program every 2 - 3 months
Q Execute e)(ercises on an individual base or in a small group
Q Frequency not less than 2 times 1 week
Involve and awaken the family
G
S Negrini 16
EDUCATION MEETINGSATURDAY 8thof APRIL 2006
Q Determine the action and the localization of auto-correction
QAuto-correction must be associated to ail exercises
QAt the end of treatment ergonomy lesson
Auto-correction didactics
G
SCOLIOSI DORSALE---- shy ----
r
S Negrini 17
EDUCATION MEETING SATURDAY8thof APRIL 2006
SCOLIOS OORSOLOMBARE
shy
SCOLIOSI OOIlSALE 011 bull LOMBARE S1I--shy
SCOLIOSI LOMBARE
il --~_-
S Negrini 18
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Scoliotic patients are not radiographs
middotSeoliotie Mtients are not ndiographs but hum beings with a vertebral deviation-
Slagnara
Metha For the physieian Cobb angle is of utmost
importance For the patient it is body deformity t hat eounts most rib hump a protruding seapula or hip We are in a situation in whieh today dodors eure the radiographie deformity but what the patient really desires is to get rid of clinieal deformity and of ensuing psyehologieal distress
CIIQItIo shDuIdtucirc lM WIld tJw~~ I~~M~~~~ J9f~
S Negrini 19
- Poznan_workshop_Physiotherapy
- physio2
- physio3pdf
- physio4
- physio5
- physio6
- physio7
- physio8
- physio9
- physio10
-
9
Po 5 i 10 miesieacutecach
C- 18 R-S C-12 R-S C-S R-Q
10
Po 9 miesilcach
11
BP
Il rz
Th
Cmiddot 12
R-3
L
C-16
R-7
PoDP 7 mies 10 rz_
C-9 C-20 R-OR-2
--__ _ _----------shy
12
DP
8 ri
111 C-26 R-2
L C- 17
R-]
bull Metoda asymetrycznej trojplaszczyznowej mobilizacji kr~gostupa ma znaczeumllCV wptyw na zahamowanie progresji
w skoliozach idiopatycznych szybko post~pujqcych
bull Mobilizacja strony wkl~s~ej skrzywienia i osiowa derotacja kr~gu szczytowego zwi~ksza korektywnoseacute skolioz zmniejsza garb i ebrowy poprawia obj~toseacute klatki piersiowej i zwi~ksza wydolnoseacute oddechowq plue
13
bull Przedstawiona metoda jest
stosowana samodzielnie lub
w pO~qczeniu z ortezq Checircneau
a takie jako przygotowanie do
leczenia operacyjnego
Ocena progresywnosci w badaniu elektrofizjologicznym
odruchu z odci~zenia
i~middotmiddot ~=~-~ shy1 _--==shyocirc
14
EUT S pine J (1997) () 93-97 copy S pringer-Verl ag lY07 ORIGINAL ARTICLE
K Dobosiewicz Neurophysiological mechanism of the unloading reflex as a prognostic factor in the early stages of idiopathie adolescent scoliosis
Rcceivcd 29 M arch 1996 Revised 16 August 1996 Acccp tcd 10 Septem ber 1996
Absfract This paper presents a new nc urophy iologila1 methougrave of e valushyati ng the risk o f p rogression in ill ioshy
mo t important factors in the eva luashytion of progress ive id io pathie scolioshysis The met hod can be lIsed to deshy
pathie scoliosis in th early stages uf tll( progre jve idiopath ie scolios is the dis ase by illY middottigating tll e unshy in lhe early s tages of the d isease loading refl ex in paraspinal muscles T he high sensi livi ty of ilie method The study incl uded 394 pat ients wilh means il can be used as a basis un seo liosis and 70 hcalt y chil dre n which to take an earl y dcc ision to
K D obosicwicz Depuumll1 mel1 l of Rchabi lilu lioll Si lesilln Medical Academ y 42-604 Tamo wskie G6ry 4
Lmenty of the unloacli ng retle x and repeatabi li ty o f Ihe rcbound and silent period were anal ysed for eaeh reflex evoked Prolonged latency and
p rimiddotom1 surgery
Key words Id iopathie seoli o is Unloadi ng rcnex Re bound
Katowice Polaml minima1 numbe o f cycles are the Larency Si ent period
T he ai m of this sludy was to evaJ uate the use of the unshyIntroduction load ing Dex for octcction of prog ressive id iopath ie adoshy
le cem oIios is in its carl s tages in onl r to lake a dccishyProg ress io n of id iopatJl ic scolios is bas been the su bject of
sion ta perfo nn surgcry as soon as pussible many clin ical radiological and elecrromyographic in ve~ shy
tigalions T here is ho wellcr no sim ple quantita ti ve or qual itati ve pro noslic methoo [hat can be em ployed in the
Materials and melhodsearly ~tHges of the disease Monitoring of lhe unloading rc felx in paraspinal m llsck appcars 10 be a reliable Inv gtsi lgnlions were carricd uut 011 394 pa tie nt with adolescent method o f discriminating bctwcen diffcrcn l fomls of Cushy ~c li ed J ild 70 hCldr hy children The scoli osis group consisted of Iios is T he un loa ing re n cx can be evokcd in ail the 31 1 g irl s and 83 boys aged 9-1 8 year~ (mean age 125 ycars) The
ske lelal muscles through a suegrave den shortening of o luntary contro ls wcre 0 girl s and 10 boys aged tO-1 7 y~ar (rncan age 128 cars ) Imong Ihe stlbjeclS tudied wcre 9 patien l w ith cershyinnervated muscle l2~J When a musc le is unloaJ ed vico-thoilc i seo liosi s mean Cobb ang le 22 7deg 121 with Ihoracic
rapidly durin g an isomerric con trac tion Ihe norm al reacshy scolios is mean Cobb nngle 309deg I 1 w ith thoraco-Iurnbar seolioshylion is an eleclrically silent pe riod fo llowed by a burs t o f s is rne ~n Co bb ang le 26~g o 63 with lumbar cotlos is mean Cobb action potentials called rebmmd The pause in d ischarge ang le 279deg and 90 w ir h doubh major curve sc o Ii() ~ i s meull o bb
nng le 292deg and 28 5deg The sludy group includcd 231 right -s ided can be observed only when a certai n h reshold va lue of and 163 left-sided 5col iouumlc patien ls There were 112 patients w ith
acceJcration flnd shortening of he muscle is exceeded progress ive id iopath ie scoliosi (76 ri g hHidtd and 36 Ic 1t-s ided) an tl il occues wilh constant latcncy correspond ing to that 182 with no n-progressive idjopa thic scoliosis (1 13 ri ght- sided and of the propriocepti ve nflcx (9 18 20] T he rebound ufter 6 le rt-sided) M d 100 w ith pe lvic tilt (statie) scolios is (42 rightshy
s ided anp 58 l eft -~ i(kd )the silent period in the unloaugraveing re felx rcsul ts from ae lishySC9 1ios is is consIcircdered progressive if the Cobb Jngle inshyvalio n of a pool of motone urons aIl o f which fClt1ch lhe
creltseacutes by more lhan 6 in 1 yen r aile middotnl1 n-progrcssive if the anshyfiring thres hold simultancously afte r prcviou~ si lenœ [l nua i increase is less thll n (i The Cobb angle ranged lrom 8deg to 77deg 1 4 201 in Ihe palicnls w ilh progress ive scoliosis (mean 361 ) [rom 30 ta
lI f R (on- f Rt tt1IY 1lIfl pflla 1 )(~ r(Jnu n t shy
fI) _ ~
Pathomechanic basics of conservative treatment of progressive idiopathic scoliosIcircs
according ta Dobosiewicz method based upon radiologie evaluation
Kryslyna DobosiewlcZ Jacek Dunnala Kny ztof Czemicki Hanna Jcndf7cjek
Deparmem of Rellabtlifatoll Mediw Uninrsity ofSiltsia KatOllice Poand 40-635 Katowice fil ZiUCl 3537 POL4ND
e-mail relwbilitacjt1s11mfoctaonetpl
Abstract Conscralivc IrcalrnCnI of Idiopathie scoht)~1 espcclall y kinc ilhcrapy i ~
nOI widcly apprccilllcd due 10 Ils suspectccl low dfcCIIcircvcnc 5 in relalion [ (1 a urglcal Irc[llment ACter long-ycar il ses ment of palomcchanic f scolio icirc in Dcpanmenl of Rchnhllilallon f Mclii al Unlcrsi ly of Sile bull a concTvallvc mcthod ()f IrCtllmenl asymmclric Irunk mobili7alion in lnclly ymmelm po~itions WIS
de el ped_Thi mClh d enablc 10 delain pTogression f scol iosis or ccn de middotrca~c laIerai urvalurc of a spi ne and angle of rOlllion assummg adequate () perallon f palicnl and ilS famil)
J Introduction
Idiopathie scoliosi OS) is a thrccdimensonal dcfonnation of il vertebral col lmm an- cntire trunk Afler many years of extensive rescarchcs the cause of idiopathie coliosIcircs $ i remaIcircns unknown It is possible Ihat idiopathie scoliosis devel ps and progress on a baslS 0- ~
multifactor disorder perhaps diffcrent for curve initiation and curve progressi 11 Fion poss ible pathologie factors nervous system dysfunctIcircons affecting postural tquili brium ar proprioceptive control seem to be espc ially important [ l 2 6 JI Pro_ ression f iS could bot delermincd by vertcbrac remodeling under eccent ri c loading created by axia lly ce gravitational forces in presence of muscular imbalancc in the trunk [2 J The verte rai colwrz unde r scoliotic conditions 15 an unstable system with tcndency to fu rther tune dcvelopment fl2] Lateral bending of a vertebral column visible in X-ray examination L
only a two-dimensional prcstntation of a complex dcformity consisting of patho logica axi rota ti on torsion and othcr deformations of vertebrae [7 8 10 II 14J ln fS physiolog~ curvatures of vcrtebra l column are disturbed Total Icngth of an anterior column of a spi n~
consi ting of vertebral bodies and intcrvertebral dises bccomcs grcater lhan length of l posterior colwnn - vertebral arches and proccsses [11 15 J h is apparent that phy iologi ~
thoracic kyphosis in rcgion of a scoliotIcircC curve diminishes Each vcrtebra of a stru tu ~
urve of coliosis is oricntatcd in hypercxtcnsion in relation t adjacent vcrtcbrae [7 l resulting
1 n B Uri middota I l 11
H srut ft illtf j tI) t li orf1Hli d
IDS Prt ts 21)2
Influence of method of asymmetric trunk mobilization on shaping of a physiological
thoracic kyphosis in children and youth suffering from progressive idiopathie scoliosis
Krystyna Dobo icwicz Jacek Dunnala Hanna Jendrzejck Krzysztof Czernicki
Deparrment of Rehabilitation Medical University ofSilesia KaloKce Poand 40-635 Katowice ut Ziolowa 3537 POLAND
e-mail rehabiliracjas(u1poCmiddottaollelpl
Abslract Idiopathie scoliosis (lS) which i sub 1 ntially l threeshydimen ional derormation or a pine cau e nOl only laler l curvalurc and axial rotation of vertebral column but al lordoti allon of VCr1cbrac in structural curve eXl nsion ln an effect physiological thoracic kypho j diminishc or cvcn dbappears Method of a ymlllctric lrunk mobilisation in strictly symmetric po iljon according [ Do () lewicz not only dcteriorme progre ion of IS or evcn reduces lalera] curvalure but also significmtly rebuild physiological thoracic kyphosis Icircn cases of lS accompanicd by lraight baclc
1 Introduction
Despitc Ion year researchc etiology of IS is nOl yel resol ed Significant problem re laled lO morphology of IS apar1 from lateral bending and ax i 1 r tati n i deviation of shape of a spine in sagittal axis affecting physiologi al curvatu re of vertebral coJumn [3 5 6 8 9 J 0 1t 12 Lcngth of anLerior col umn of a pin constitutcd by venebral hafls anugrave intcrvencbral dises dominate ovcr Jength of po terier c lurnn buill from vertebral arches and processes [lOJ This condition uring scol io i progress ion and growth of a child effect in hallowing or even disappearing of phy iological Lhoracic kyphosis in scoliotic region It i well know n lhar cn~brae of structu ral Jaleral curve are positioncd in hyperextension - lordotisation [5 6] which in Lhoracic region Icad (0 reduction of kyphosi or to true lordo middotis Such kind of venebrae relation in thoracic region cau es ilS destabicirclisatIcircon whi h in u sociation with eccentricircc gfilvitali nal load fa pinc duc to muscu lar icircmbalance [21 pOdbly produces r tationaJ lordo is [56 Il] and further development of symptomatic scoHose ft ha becn proven [12J tha strengthening of the erector spinac muscle aggravates nce initialcd deform tion and deteriorates coliotic process Hyperextension and uxial rotati n a s clatcd with
357 Th B Grivas (Ed) Research inro Spinal Defoml ilis 4 lOS Press 2002
Exercise efficiency of girls with idiopathie
seoliosis based on the ventilatory anaerobie threshold
Jacek Durmala Krystyna Dobosiewicz Hanna Jendrzejek Wieslaw Pius
Department ofRehabililation Medical University ofSiiesiaa Katowice Poand 40-635 Katowice m ZioJowa 4547 POLAND
e-mail durmalaiacekyocztaonetpl Department ofPhysiology Academy ofPhysical Education Katowice Poand
Abslract The aim of the study was to estimate the exercise efficiency in the group of
girls with idiopathie scol iosis based on the venlilatory anaerobic threshold (V AT)
Material and method The investigation comprised 58 gi rls wilh idiopathie scoliosis
aged 10--6 years 32 girls (55200 ) wilh double major scolioSiS and 26 girls (448)
with single scotiosis The girls were eonservatively treated using Dobosiewiagrave
method The control group consisted of 3 1 healthy girls aged 10-1 6 years The
cxercise test was performed using eycle ergometer During the exercise the gas
exehange parameters wcre reeorded (minute expiralory venlilation minute oxygen
consumption earbon dioxide production) On the basis of recorded paramcters V AT
has been computcd using V -si ope method Results The following V AT values were
obtained in the group with scoliosis 207+305 ml 02minlkg bm in control group
219+350 ml 02minlkg bm The differences belween girls with idiopathie scoliosis
and control group were nol SLaliSlically significant Conclusions I The exercise
effieieney of girls with idiopathie scoliosis conservalively treated using Dobosiewicz
melhod is normal 2 Such high level of the exercise cfficiency of the studied group
probably was due to intensive 3-D respiratory exercises of these girls
1 Introduction
In practice there are researched useful efficiency rates which on base of laboratory tests results possible easy without using of the relatively hard or long exercise tests would give the belter forsighting of the range of homeostasis disturbances and rapidi ty of increase of
physical fatigue during varied workloads [1] The best known rate of trus kind is the maximal
minute oxygen consumption [2345] During progressive physical effort minute oxygen
consumption increases proportionally to workload The reaching of real maximal minute
oxygen consumption in time of progressive effort is iodicaled by minute oxygen consumption plateau [5 61 This result is rarely registered in children The progressive exercise test is most commonly used in children until physicaJ exhaustion and the highest registered minute
oxygen consumption is treated as maximal minute oxygen consu mption or so-called
symplomatic limited maximal minute oxygen consumption [678J Sorne authors regard
Orto-dlet Trau malaogis Roha b ilitacjaARTlKUL ORIGINALNY ORIGINAL ARTICLE Vol 5 Nr 1 2003 80-85
Jacek Durmala l Krystyna Dobosiewicz l Tomasz Kotwicki Hanna Jendrzejek 1
Katedra i Klinika Rehabilitacji Slqska Akadenia Medyczna Katowice Katedra i Klinika Ortopedii Dzieci~cej Akademia Medyczna PoznQll
Wplyw asymetrycznej mobilizacji tulowia na wartoseacute k~ta Cobba i rotacji w przypadkach skolioz idiopatycznych u dzieci i mlodzieZy
Influence ofasyn1n1etrie 111obilisation of the trunk on the Cobb angle and rotation in idiopathie seoliosisin
children and adolescents Slnwu kluce ac eJJic Cl chOlIU) Ice SKoio= idj)PO Imiddot(~I7tmiddot
K~Jmiddot w()rus consrieI ve I (OtlHelif idiopathie HUW JS
SUMlvfARY
BackgrouId The aim ofthe stldy Vas Ihe radiological evaluation ofthe treatllJent ofthe idiopathic scolioshysis utilising as)mmetric trunk mobilisation in the strict~ll I)mmetric illitial position
Material ([fJ(f lIIellOds Presented stud) lOS based IIpon J36 cases (13 oovs oged FOf11 ocirc la 6 lcars (lild
rn girls aged frum 6 la S pears) trealed due to the idiopathie sCuliosis ((rom Novell1her 999 0 F enflfUn 200) Among 48 ch idrcn sllfJering from dOlfble-major scoios is 6 cases wcre infoll scaliusis JOjuvel7lle und 22 adolescent Among 88 sillgle scoliosis 6 lere infw7t 33 juvenile and 49 adolescent
Radiological exami71ation 1as condueed always in the repeataole technical cOlldiions RadlOglOlI1 lier evaluated oy the same physician Radiologica analysis oIthe scolios is incuded value ofthe Coho al1gle ongle ofaxial rotaion
ReSIils ln double-major scoliosis observed dlring one year period in Ihe thoracic segmenl Cobb angle decreased inll l increased 1395 and in 292 Il OS 111changed Axial lolation angle in 167 (~rcascs
decreased in 354 incrcased and rernainM the sorne in 479 In Ihe llllnba segmenl Cobb ang le clccrcscucirc il1 354 increased in 39 6 remained in 5 Angle ofaxial rotation deceoscd in3 ofca es incrcuscd in 29 and persisted in 48
ln single scolio is Cobb angle decreased in 386 incrcased in 353 and in 261 was lInchonged Axiol rotarion angle in 216 ofcases deceased in 295 increased and rell1aincd the sallie in 489
CondlsioJ Asymmetrie mobilisation of the tf1f17k in strictly syl7111elric initial positions is a 1Clhod of choice in the cOl7senJalive treatment ofthe idiopathic seoiosis
STRESZCZENIE
WS~p Celem pracy jest radiologiezla ocena Icczenia skoiloz idiopaf)cznych metoda asvmetrycznejl7lOoili shyzocji tllowia w sciSe symetlyczl7ych pozycjach lV)jscio wych
M aterial i metody Przeprowadono retrospektYlIl7q analizri 136 przypadkeacuteM dzieci (13 chlopcow i 123 dziellshyczqt w wieku 6- 18 lat) z bocznym idiop atycnylll skrYll ieniem krrgoslupa leczonych zachowawczo w Klinice
1
Ortopedla TliJumatoogia RehlblllagraveeJa ARTYKUL POOL1 DOWY OPINION ARTICLE Vol 7 Nf 1 2005 49-$11
Krystyna Dobosiewicz Jacek Durmala Tomasz KotwickP
Katedra i Klinika Rehabilitacji SIAM Katowice 2 Katedra i Klinika Orlopedii Dziecircej AM Pozncrlz
Biodynamiczna metoda tr6jplaszczyznowej korekcji skolioz idiopatycznych - opis metody Biodynamic method for 3-D correction of idiopathie
scoliosis a description ofthe method
SIOWQ kluczowe leezenie zachowawcze skoliozy idiopatyczne korekeja tr6jplaszczyznowa Key words conservative treament idiopathie scoliosis 3-D correction
SUMMARY
The biodynamic method of hree-dfmensional carreeion of idiopathie scoliosis is based on Ihe palhomeshychanics of idiopathie scolioiiiii and consiss in aClive segmental three-dimensional correction ofspinal cllrshyvatlre The course of action focuses in the viciniy ofthe apical vertebra Proprioceptive facilitation is applied on Ihe concave side ofthe curvaJure and exteroceplivefacilitation on the convex side Correction likewise proshyprio- or exteroceplive facilitation is phase-oclœd with asymmetric respirarory movemenr as weil as wilh parshyticular phases of the respiratory cycle ln Ihe course ofexercises three-planar movement is generated opposite to the direction in which scoliosis Is progressing This method is in accordance with the stale ofthe art ofscoshyIiasis pathomechanics The method requires detaied training and can Ihen con be applied at home under periodic control by a physician and a physiolherapist The method con be applied in landem with a Cheneau brace as weil as in surgical pretreatment A elaUed description of Ihe method of three-dimensional scoliosis trealment will be presented in Ihis article
STRESZCZENIE
ISlofa biadynamicznej mefody Ir6jplaszczyznowej korekcji skoioz idiopatycmych oparlaj est na patomechashynice iikolioz idiopatycznych - poega ana na czynnej segmentanlej tr6jplaszczymowej korekcji skrzywienia Dzialanie koncentruj e siccedil w pobitu Icrllgll szczytowego sknywienia Stosowane iest bodicowanie propiocepshytywne po stronie wklllsej oraz eksteroceptywne po stronie wypuldej Korekcja i slosowanie bodicocircw propioshyi eksteroceprywnych zsynchronizowane j esl z asymetrycznym torem oddechowym oraz z poszczeg61nymi fazashymi oddechu W trakcie eacutewiczen powstaje odwrotny do lrierurzku rozwoju scoliozy tr6jplaszczyznowy ruch IcrFtshygoslupa Melodajesl zgodna z aktualnym stanem wiedzy na lemat patomechanizmu scoiozy nymaga szczegocircshy100-lego instniktaZu po clorym mote byeacute wykonywana w warunkach domowych Z olcresowq kontrolq przez leshycana i fizj oterapeutll Metoda mote byeacute stosowana r6wnolegle z leczeniem gorsetem korekcyjnym Cheneau a talcte w przygotowaniu do leczenia operacyjnego slcolioz W pracy przedslawiony zostal szczeg6owy apis meshytody leczenia
Skoliozy idlopatyczne stanowili znieksztalcenia patycznej rozwija siccedil poprzez przemieszczenie kr~gu tr6j~aszczyznowe charakteryzujltce siccedil wyboczeshy szczytowego w stosunku do krccedilgu g6mego j dolnego niem rotacjltt krccedilg6w klatki piersiowej i miednicy z r6wnoczesolljego rotacjl zgodnie z ruchem wskashyoraz zmianami w fizjologicznych krzywiznach kr~ z6wek zegara dia skrzywienia prawostronnego oraz goslupa w plaszczyinie slrzalkoweJ [ 123] przeciwnie do wskaz6wek zegara dIa skrzywienia leshy
Z punklu widz nia patomechaniki tr6jplaszczyshy wostronnego Koncepcja rozwoju skoliozy jako rotashyznowe znieksztalcenie krccedilgoslupa w skoliozie idio- cja i kontrotacja sugeruje ze sily korekcyjne powinshy
49
EDUCATION MEETING SATURDAY 8th of APRIL 2006
- CARDJOPULMONARY EXERCIS E
TEST IN GIRLS WITH
CONSERVA TIVEL Y TREA TED
IDIOPATHIC SCOLIOSIS
Jacek DURMALA Krystyna DOBOSIEWICZ
Department of Rehabilitation Medical University of Silesia
Katowice Poland jdurmalaqcmpl
The aim of the study was
to estimate the influence the conservative treatment (asymmetric mobilization of the trunk by Dobosiewicz) on physical efficiency in the group of girls with idiopathie scoliosis
Material
bull 87 girls with idiopathie scoliosis
aged 1 0-17 years
(mean age 135 years SO 161)
J Durmala K Dobosiewicz 1
EDUCATION MEETING SATURDAY8thof APRIL 2006
Material
bull 38 girls (437) with double major scol iosis (thoracic segment - Cobb angle 18-42deg mean 30deg SO 82 angle of axial rotation 4-32deg mean 21 deg SD 107 lumbar segment - Cobb angle 11 shy48deg mean 31deg SO 128 angle of axial rotation 5shy30deg mean 13deg SO 85)
bull 49 girls (563) with single scoliosis (Cobb angle 11-75deg mean 33deg SO 155 angle of axial rotat ion 5-30deg mean 14deg SD 83)
TIoracic kyphosis of the invesllgated group was 5-39deg mean 23deg SO 86 and lumbar lordosis 16-41middot mean 30 50 65)
Material
bull The 64 girls aged 10-17 years (m ean age 131
years SD 132) were conservat ively Ireated
using Dobosiewiczs method
bull Treatment period ranged from 5 months 10 3
years (mean 148 months SD 902)
Material The 23 girls aged 10-17 years (mean age 136 years SO 108) were treated u sing symmetric exercises - treatment period ranged from 4 months to 3 years (mean 161 months SO 1019)
bull 26 of ail g irls (18 girls earlier treated using Dobosiewiczs m ethod and 8 gi rls earlier treated using symmetric exercises) aged 10-17 years (mean age 134 years SO 108) were twice tested - at first and last day of Intensive hospital rehabilitation (asymmetnc mobllization of the trunk by Oobosiewicz) - mean hospitalization period 20 days (range 18-26 days)
i rf~8f6~~ or~~n~= ~~r~1~r~icircJ~~tb~~~~ mean 17-4 1deg meatl~(I SO 74 R n~le ofax 1 rotatIon 5-25ot mC3 111 3laquo S0 6icircl Ilnd 1 99t1S~ ~~~~I~~~~~$ruo~ras~ ~ocirc~~a~e~~~~~~~5euml1 9middotn~ tUfllbar Iord05ts 16-4 1deg mean 311 SO 68)
J Durmala K Dobosiewicz 2
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Material
The control group consisted of 77 healthy
girls aged 6-17 years (mean age 12
years SD 31)
Material
The examined girls participated in school
only in scheduled physical education
lessons and have not been enrolled in
other sporting activity
METHOD
The exercise cycle
ergometer test was
performed
J Durmala K Dobosiewicz 3
EDUCATION MEETING SATURDAY 8th of APRIL 2006
METHOD
The Incrementai exercise test has been applied
We have found that tests ln whlch the Incrementai part of the protocol ln completed between 8 -12 minutes duration glve the
bullhighest maximum VOz in normal subjects
METHOD
The workload was Increased stepwlse
bull by 10 Watt every minute - ln chlldren
with high ~ 135 cm
bull by 15 Watt every minute ln chlldren
with high gt 135 cm
METHOD
The test had been contlnued untll refusai of the patient or exceeding the pulse Ilmit
Durlng the exerclse the gas exchange parameters were recorded by Jaeger device model Oxycon Alfa uslng direct breath-byshybreath rnethod (with face mask)
J Durmala K Dobosewlcz 4
EDUCATION MEETING SATURDAY 8th of APRIL 2006
METHOD ~ ~~ r 3 min 3 min 8 - 12 min 6 min -~
_ 0 rpiYJ 0 rpm 60 rpm ~1 30 rpm
_ t o~w=att~o~~na ~~ att__~ tl~~S~~ l ad l ~~~~~r o~w= Hlcremenlal t
pedaillog i i ~
~ ilt ~I~-----tl-~ I t ~ i ~ lOSt sffortivB
lW r resututlon r rm-u middot 1 - bullA~cremen tal ~~ ~ ~ ifr- ~ VtI 1 ~i ~ tllng _
METHOD
On the basis of recorded parameters VAT
has been individually computed for each
child using V-slope method by
Wasserman
METHOD
For assesment of physical capacity
the maximal minute oxygen o
consumption (V02max) ventilatory
anaerobic threshold (VAT) and
maximal workload was used
J Durmala K Dobosiewicz 5
EDUCATION MEETING SATURDAY 8thof APRIL 2006
RESULTS
Ali girls with 18 have been classified
within normal range of predicted
values of
bull maximal minute oxygen uptake
bull VAT and
bull maximal workload
RESULTS
The differences between group of girls
treated using Dobosiewicz s method and
group of girl s treated using symmetric
exercises were statistically significant
Lower exercise efficiency of girls treated
using sym metric exercises has been
observed
RESULTS Girls wilh IS Irealed using
N=87 p value
Dobosiewlczs method N64
symmetJic oxor-ci Nz23
Perœnlage of predicled vaJue of
maximal minute oxygen uptake
98 905 0033
Percenlage of predicled value of
VAT 97 933 0049
Percenlage 01 predided value ni
maximal workload 101 939 0038
J Durmala K Dobosiewicz 6
EDUCATION MEETING SATURDAY8th of APRIL 2006
RESULTS 26 girl s twice tested - at fi rst and last day of intensive hospital rehabilitation
The value of ventilatory anaerobic threshold increased during intensive hospital rehabilitation (asymmetric mobilization of the trunk by Oobosiewicz) statistically significantly (p=00019)
2047 ml O2 minkg (SO 268)
vs 2239 ml O2 minkg (SO 232)
Conclusions
1 The exerc ise eff iciency of girls with IS treated by asymmetric exerc ises of Oobosiewicz is norm al
2 Such high level of the exercise efficiency of thIcircs group resulted fram using of Oobosiewiczs method
r
J Durmala K Dobosiewicz 7
REVIEWS
Role of physical exercise in tbe treattnent of mild idiopathie adolescent scoliosis
Revicw of th- literature
A NECRlNl N VElWNL s PARZI 1 A NEGRINJ 5 NEClU NI
P1t~silillxlrd~ Ihcrapy (or klucgtlttlwrlpyl i pro shy-tJm of physka] cXlrd-cs ipcci I(a~ (IJcloJgtcd hy l li trIWlltl phrslollwrapbt wilh tb m~ln a1mor pl shyVCnI in lhe ilAAfIVltilH1 llf the ucirccfonuity III mild IgtC )
Lil1Si bclpin~ thebm ( aocl co uaufllclilIg ils ~jd- clf IS in nlOdlJmiddotnh-culiosis Th middotalillofthi paper ito r (W
Ille Ii lc ram r 1 a-ccrulin wh kh of Ih bull Lu[Jalmlcrus Ind (Lb hili til~ CLlLt-cd br scnli()si- clluld bl pl Y nlcd or r d uccd hl phylolld LXtmiddotrdsi n Il p--to-da le knowl Uuml~l nr tIll~C aspcc[~ i ne bulled in oruer 10 dndc whclh~r 11Rf blLl adcqlmtt Ib(uuml n middotlicaJ balis fo r ora)aini l Ihe US4~ of lUgravellgtitlerap) wltcllj(r or fln l th e prtl1iœ of kimiddot ~lre IUlll poNjn~ a t iil ies ~bould h allowtcI II uuml middot c enliaI toltlentlf)wh k lu alClor ie - lf pl lr~kiJl -c rmiddot d gtlt- (Ic rnnhi UzJ( inn ni (t hl HrJltlon [ rtn~hcll iJl ~ or 1i1J(IChIumlJlJt etc) Sh llU Ld be TolullllCcluse ulemiddot l onld b- clclIimcntalancl wukh sho ll ld he IJlI-n~ifl~d I~~a l lhc (o uld h 11lfu 1 Know k dg CJnc1in t (wIn SeiCIImiddot Hlk rCS([lflt h daw ccordinll to Ih bull llVit w o f tIlt iii 111 1( plop(lsltd in (h i papcr lmiddotonllmJ l lnl plLyi 11 cxcr(j$( pn (nti or (tmiddotduce dhlblli t ic 1 ~lt Il Jj ll(k pl ti Jlt fadl j w(~ the nlIIIrl li7alinn n f poMural dd shylitS tu p n xJ llc aSl COIlMqnen c(middot 1 all )llal) or r(tn~ shys i middot middotlIrve Tilt u~c (I f appn1priattmiddot kincsiuuml wrlpy 0 in rcns polttllcal swhiIHy Icirc IIHmiddotorc Illta ll y (0 r 1(lt1 lllho UAh mon ltlccurlltc 1Ut dl1alkd -rLk l(lWfils 111111 )11 h Jlccdt(
11) wurcJlt 0 lit)-IcircS (Iumpy - x rcLs P()lun
n rllt lT(ltnklf u f COll1tlK H (rtd) I 1i plfho l og l ~$I rUlglng tr m low tmiddot k Pl 1l1 to IdiOpath ie SCUIshy
Submitt(oJ [or PUhltCl l1 011 uly Tt 2001 Acc~pttJ ugu - ~2 1(t-1l
Addre rltj-xlfll telt~I(middotb If) - grinl Flt(1(bziurllt r )(m Ofl ()(Cl1I shy Lt middotqlltœlll ro () - 1u I4t agravehLIlKil ta IYIL-lTt ilSllltp lfllmiddot ~ 1l1uumldull
CelII ~ (niiOS I I~ middot ann (1) IfUh middot lIlfU di louhilll(tymi ( Nlmiddot ~iI rli -ilIIUmiddotltlfl
Nlti(ir 1( ) il r() (ltbullagt1
lt vLL_ l IiII no 1ftfI
jS ) we are a IUil ly tJc ing n1n) ltblll lS 1 k l1 b ~J)w in~ tl~ t S Jfll l approad llt - l1n til hy on ielshyertd ~tan lard ugraveJuld ln m any ~1~ he lI ~t les i if Ilot dange r )ll lt rhlS is lrut of reil l lnw 1gtlt1lt1 pa in l ~ or 5urgi c ll lrea lmltnl5 in dbc r lmiddot ll Sc - 2
ln tlle cj-e ut ~ t lll(tlWtl i( li p l ll1JC luuml- I ~ middottnl ~() shyliosis phys cal ((_lt1(( is emr1uved ltI t()fIl1 0 lh~rtrv
lo ly in cel1l in L)lllllde (nluumlnlr in tilt Lltlll middotorkl i e Iw l) r llt t Srain hUI IIgt() 111 Gert11lny 5- 1~1 in other reg lOl1 wbere thi I-incl qf tre l tm e rll 1 p~ 1 pmiddot t 1( cI il Jws Ixen cri ri cilld md rel -cltd Lw m~lI1 1 11 Jlu~ Fue Fnlny r ~lrs thio middot15 a lsgt(ru( f ~rth r -~ltc rrJtf))~ ll t vit11 br1Cltcgt b r II1 ([C Llt n ClW grmvlng 1lt1 0 L Sti g
gcsti n the lIsefulnes- u r Ih is form o t treatm n t 1
Hmiddotu]rs have nerged jn El or uf pll y~ iLd eegraverdse eacute 00[ 1 but tlw are nUl yel 11 11 t llu i vIC~11 and r hi ~
f rm of trt ~ltmenr IS stiJ l Ul1 ckf ckhate FfI t Jt 111 il i 11t (eltary td 1I iFy 11umbtr ot
b l sic COI ceP rlJ lf w ill he cIh tt d in t hi pap r
Scollosis
DCijIrI iriolls
ScnUoSlS is Irlircc c1 lme nsIcircltnal (I(gt i l cj on ot tht spinc thar cau C a CU 1 lh lt ca n h e $ t~en ln (1 me1Sshy
ured ultinF Coh) lll ltllCXI o n HI anreu middot p rtc rilt r
EUJlOI -1 lœDICOPHYSlc~ IR
NECRI Nl
110
f)i)
1 7J
amp aS g 5li - 0 v
V
31
10
(1 1) Il 15
-tc i ytjtr~)
FigJ----jllph ot DlI w l-lkaupegraverel) The agloimvltltinn Or idio r lrhlc 50gt1iflll~ IS rpiJ bel~ en th e- [l0 IH P (l)ltg tnntll lol (JI PUllcmiddotny) mtl 1 ( f( lS-er sigll paiilivltecirc lt Dlt(i I1 11illg r the iti l 1Kgt n n t rll icirclicH a ) 111lt m omal prebulled the mno rche md ociks with lll I)ttlx flal gr Ih pll fl
rlcljoprdphLi 1 hl merl prestIK ~ of this curvt c10es n t autom~l ritllJy indi ate the pn$CI1(t of a defurshyTnitv (SlllKtUrd (Unel
It i~ possible tu clil1e ren tute a struCnlt t CI1tve fruIn a pogt urll 011e by identifyi og the hum]) du ring AdIlns tesr I~OQ looklng tra m beh lnd at the p atient w ho b benchng fUfward il is p -- ible ta d d~ct 1l1 eh ucirc n of o ne liidlt 0 1 the trunk usually n n the (onvex ~ jde ul tbe radiographie CUfve Ugrave1lr C Ul be mlt~I Slred lISin~
BUlln els S o liomere( 1 ~ l This h Uf1lp is du(- lO (Ile pregravegtecircn ~ of vertel ra i rolltion 1c1 Ollt tn tic f~YJ tllre o f the def trrnit tli [ c m be seen and measurc(i v ith Perddolles lb lsLometer on an amero-Ix)iferior radioshygrapb ~2
Seven ry pel cent o f li Ises a re conid 1lt 1tO be idiopa thie 1 bull ia l-nosilt in this CI$C is b exdlls i ~ n as idinpa thlc me-us t11H wc do n()[ know rJw origio of lheacute curvc [n othe] ~Ie$ it b Ix )~i ble ro ide nrify a dieak (bat CHl jusrify the c1etgtnniry slIch a rna lfo rshymar i ns I1(gtufol Ig ic~ l or genlttic cl iscas s Glnclt~r trauma etc )
[dicirc)parhk S(oliosis has been divicled ~(corcling (0
the ~Ie of tlie patient egrave1l the tiJ1ll of d~[ccli n of the condil ion into ti) ur t ypei ln fanUlc jU nik ltldolesshyccnt lnd aduh Til l m n st cnnunon (VPC IS the acloshylescegravenr o licirceacute I1IJctenzec1 hy 1 sud le l1 tggrH3l ion uuml uring the grow tll Spllrt (Hg 1)2
lhile p tu 1l sco liosi i5 Ycry lomnw n thl pre shy~Iknct ra te f r adole ent icuumlop~lthic structural CU IY~S in sch )o chilclren are 18middot20
- 10 Co bb d~grels o r m on l -lil
- 2) ~ohh dtgreclt or mort O 2~j - bull () (obb d gre -s )1 mOfeacute ()ll 2
Clin iltI [ d e isio ns lfl IXlSed 111 an lccu r~He pregshynosi which obt inccl in eJch pa ti nt mainly o n the basi of the nsidu~ll p()tlnllltl l of TH1h and the result s of 1 rh clin 1 1 ~l1d tadiogmpl i exlminashyti(ln12ll c noieq uentlya d inica ] la sifiou io n o f the ing le pHient tn -ome estent co incic1 ing w irh the
D diographic one c l n lw SLlIl1H1arizeci 1 1 folIcJ - mikl lc~ (1)(n 20 C bh de~r es - moderJt l betwlen ln md 15 ohh de~ rtes - StV re 111( gt1lt rh n ~J) )bh (kgf s
On the 1) lsis of [hi - dinic d d a lfic t i n (Vith l1l il el lrb tiOI ~ o f the ir b() und~ri e ) in Itllt l cente rS Of SCOtiO LS ITe ltlllent in the Lltin odcl (i rJ Ital lnmct md PI iJ Ugrave tre tmtnt i s plmmcd a fo lltJw 8l
- mild kineslth e (~1fw ~1Il (1 luok-ou t - Hl demte IJragravecegrave 1111101 c(~r md k i rws ithe lJpy - ~cven surgery
Physical exe rcL~e for S(ol iosis
Defi t tiOl l S
PhyS i 11 nU b lIKrlttp middot (or kines ithcIa Pl) i a p rvgrlill or plt~i Gl l (xeriltecircS ~1ci fi ( llJ y ltk ~ loped
y a -11 [ru ine 1pll yslo ther3pisr wirh th e m 10 Hllll
- pre (~ n tit1g tlc aggraaLion of the cl I )flnily in rnild bullcoUm is
- helping tlk Il ld Ct ~lOd ounter~lCtjng its skie elfects in III de rltegrave sc li sis
Tn tl1i_ feSpec1 kinesitl1ert py f JI s oliosis is tonshysider l a o on of peciticcedil training and s genecirc tltllly proposelt in sessions 0 1 4~ ro 60 minute IW) t) tour limes 1 Cee PhysiGtl exerci es can aLo ll v o ther auumlns 1S it oill he dise Issed in this plper
Ir 15 Ilot possib le to cl escribe a single progrlIT1 o r exerc ise a5 pro nrams ale USLIJUy p fgt nll ized ( ( lt
EUH PA ~illDI (DP1I YS IC~ 182
ROlL UF P l 1YSICAL lXl 1lt 1~E IN l IlE 11 ~l) IEd If IlU) l[)VP 1HI AIJ() J)~Cl~ r COl ~I NlG1W il
f)( 15 egraved ( )Il the nee L- 01 indi iuua l pJl itnts) al l l10ugh Lheacute) C l n h t 11 plicd o n a WOU p hJ~js (-1 (0 () pnients PC[ ~l ()lI r)middot lugrave reQCf lhese 1 10 grl lll frequt ml~ V IIT
hnm on in middotituk w allClthltJmiddot -Ill Jnv L l~egrave at Wc w Ht ~huw in lhis lyl peJ it i~ 111 n u -eII1 tu id e ntilv kirK itheJapturlc aims w hitl l ucircrr~spnd LO ugravelt~lil1 DUtshy
g X ir ur ph -s ici l lxtTi~l I~llhe r thln ln dj( us- indishyiJ u1 1progr-lfll
Aduumll l lxUl kisure time ~lOd h )u] Sp u lllll8 ~Ilttishy
i lt egrave~ i middotomm )Ly s iven lel mJ ing ro w hlf ~ Iuumlnsidshyer~d usdul or il lrmfu l in t1 lt rruning (lI tJw ptliJicirct ln tl1bplper Ugrave1 gent ltl l t rl ll bull p lwsiCUgrave lttG iviUes is rl ktll 10 JllI1ltlCc hOlll gtpOlt mJ kIJ1lsIcircl hc lJ l f
i ve lUen tloneumld )bo C on lv ine n dul( re Ull~ 1t~1 t s far Ilten publislt d f I~ mJ I(i noltgtithltl rgt is 11 11 a su h jel lnI deacutehate CJitk haltlt t llltit m itn ltl of l ny lorm o t p l1 ySiClI lxrcL e as a Itwr1 [ J- fo r i liopa tb il jcoJL~b un iL ()ri gin~ initial1) it WIS Ille r rOmiddotUumlK lt brgdv u f p l~lt titu gtllergt w h ) intervenecl hutll tc llcrl ll (mon as cltl HtilJ nic in terventi n man Jgt
1 t lltrJp utl t one 1 md rC j fkll l~ on rhe h sh lf som uni cOen I1v pn t I1cgts wt ldl hll ltl enl1 JI~ haLl nu na l scicnt lfic baisYmiddot HOlh tlle$( trr t peu shy to rh ~rl py tt nJecI to l~~rJ tte C Ih tk CUf -~ pnnshyclr~tll y as a f tsul t of lilo h llIzatio ll of tn imdqultdy ~u pp rt(d S pln eacute 7~ 12 to re-t1 r rI ltrl 1$ l l1C k o f WH llt~~rdl 10 I ndt~-dll()urnah tnd 11( on1 p~l per u suaJly Cl tc([ IS n prelimmtrf lll d 3 ln tt li w ay man (l rrlKpt(Hc H lf O iS Inll ph ~i C U l ~ d vi ~ cI nllog scnliotl pa t le nL~ 3gainst holll ph lca l egravexershyclc and p()rt~1
It m u st t~ n tfd [hat pllyknl txerc j~ tJe~ltm(nls t1iHer 1 lJ rd il1g r rhe rherlpcu tlC litTl~ on lllc h tJ rgt ap p lolc il l the IXlltent lncl hi im r IIIllHnt i- 1 (1(1 rI - 5lt1J lC igt tIl l ( f phJllIlllolopJ al rrea tmln ls Ihith cllffc r 1lt œQlfd- rhe m C cculc u ~t(l luI thl p al 1t n
~mc l 11i (lbE~e Tt i ~ P ~il k tlwreI[middote thll wuumlk ltlll t kin 1or ph~ i Clt1 1 lX r(j~ 1I 111~ t bc loidvd by t h~ Lo iurie IxujCJ1l al1ulhcr a dl ~IS nJI h~ iOg (1 11shygerols llugJr in racr le (wi ller d I ~fJIII ~ I ml thlls re(nl1l rn ndc(1
fn n UI cel1ll r we In(~ hccf) using 1 ) 1 1111 11 ve ) 1 (J p lw l icd ex(r(i~e (0 J ( 1I l tt i~ tlh aITt ~ l~d Ilv m ikl tru cflumiddott1 adokscltnt (cl ioj arh lC icoli is11 2)
ina the f U~ t rc-gt uJrs IefC pu b lishe - the pJ( )grd m 11lt1lt l1te n PWltllk d in fa c t deel()pnlln l~ in th t l itshy OlL1Ii in tl1 r b t ~() ycal f ha ve iclemi fiecl niO l l
m d 111 ur impl rnHm s md d i s )h ilir i (gt~ lue t idlo p lthk amp()lio -i ~ t Jll CIII he 1UO(l if Icirc 1by phyict1 egrave xert iSlgt l fe t rrncllt
l illl
111e aim of t l1JS r~l per ii tmiddot (tv iew tl1( l iterat urt to a(errl ln v llic ll of th~ impa irm 1t~ and Liit hil it il i GllIltec hy ~ o l i()gtj s -o ull he ll nt x or re middotlu celt1 Ili pl1ysical xerclse An u p-to-da te knOvkdge o f tl lt Lgtpecl-gt i necckC1 in rJeumlr) d -oek
- whetll~r there h ltl n adLtIIl ) l tht()d ical bbh fur or JqIIcirclb l l l1 Il( ) f k irt llit herlpy
- h N I)(1 ( 1 Dm tlle p r l c tIcirc(( o f Jebur tiJne )pOfung lcli v l ti ~ IIOU lci he tllf) -d o
II J U V f h 1 I11~ c~~lb li hed Ihe usefuhlLss 01 k il1 shyc ~thtrpy il i aIle dy l nsi 1([(( -r-tI Llleu i n )I11 plJt~ ut the wJrld ir ilt ecircS~nl i 1 I( id n Iv w l1i li ( 1shy
gories 0 1 pl1Vtl( 1excrClgtegt te D)bilI7it ric 1n (Ir st shylliuumlZltio f) lttlt tlgtbltn ing ni trcrccedilh ing erc) hn Id be
vnlcled he tll rhe nuld be lerrillldll1 1 md whidl s tlQu1d be inreœ jf ic(1 IJeClU~l tlley cOli lel Je LI ~ful
Ncuro1llotor impainncnts
Imv aUl llOr~ 11 lt1lt ~tlKlteJ lhe cltlndatiotl bd Ween tl UC1UmiddotIt t l ol(~C t nt id iopml je -nll ~J~ and cli~l l shyler~ lr 1tH lest ihuLIr yt 1 _ 13 ~ 311 D uhoussct 1
1-- ITS tln l ldiopath k s(o lio-L L cll -c d l J l hmgt in th terl tltr f prop li l l pu n md 1I1ar th e detrshyn Hi n i~ na tural 1 ~ronse to ril e need tu ts tu re p()tun ltlluilib riu Ul HcrmJJ1 31~ 11 () d tllat icliupathic ( liCl5j h l it re5u lt Ot1 rw nltuf mot r l ~ltelV
[Id )fcl 3 nI] ~1ltJ U Sr1lle nr to dtorders in centJtI lO~Cl shyIOIDNur) md 1xi~tI moro (Ul1lfOl syt( llI (Fig _l
N htIll -of) H1c S uumll h( rll1 ( ~ l( w ing JI t11 (oshyI-ie on the l l lO]ugy o b doll (nt Rl iu]icirc tlili- middot()lioL m unt fil t-hltll rhl ugravedcmnilV L th e fl5 ult o f 1 (k btcl 11lIFll llI ion nf som t11(WUgravetltnl md pO~ lur( (tnic l~ l licirc1 tl1lt if l p OgtlbJt b C 1l rlw sta l i lin 0f 11 1 Sf llle j lt g )tx l Tt) ohtil n a ))Cli U 1ILzltl I o f p ~llIr~il d l~flo [ in l1litkd ~J)llnSIS me CI Igt(middotqucnr J ~ a ~tmicirc ()nlly or regle Ie Llive
Ali th- 11yp ) tlw~es rd ~lte tr d irtl Itn t pnl1tlt o f [11 v hole ~piltm It11[ controls postu re ~nd mrw shyment lrre pell ic of tlh po int a d lI~ llv inH llYegraved il i ~ ll 1 nnable tCl aSUilll ri 1l tr l ll1 lo g thi ~ys ttm ( Qu it le 1I middoteli tl
lt ch ugt nlt~(S f rullliIl thil i nlomwtion th at p tlmiddot shyiCil J(tl iIies nw gt Il lInport~n t rr le to pbv [11Icircgt role ca n 1)lt slI i11l1lariztd ln lWO the ptu li ain Llt
- d elopmll1 l of p uumlltl St1 b Hlt ) - c1e veuml IOpm 1)[ o f bhll1ltc _
(k llhUl)lOr S Cll orr
ontrot oic whan-lt
------+ 1 ~ il lnll ugrave r AINnl
Cllnlr1
T bflt~ r
fltL1 tlli
lMini
l
~sary ~J-frlllen i )f
~ 1 ocirctnl
~UcirclllIJJlW Ll
AXl ~l1 n uumll l) r sy 5t ~nl
middoticoltoq ~ Fig 2-AcFgtrdong lU He-mutl 21 il is Fi)5~ ib1e rD prolXgtSlt l -oo ie1 mnd 1 ((if ~ elio egrave middotAhltr~d l)Qdy-p ati~ I I i u d) uren ttllOn k td LO In ~ory reHTt I1 eDi tn l al ) JdrnlV~ pn)4~ e l u r~o(Ofe 0-c1 eptunl dvstil t1 ctlon sltŒ(ry icircltu nu11t ilwnt [ ~mC ~ted tl l1 ce Ill trpntlshyUumlfJJl nd IKnle~ r~dibl jtugrave)n of -I) m tlosen Ir ~ig nj tl (I1vying ln fornll1U n (lI an ereltl ~piJl e Mmor aJJ r--a t ~) n ltgtf ti lt aXljl mowr plem iHUC Wh ~fl Ille 6ubjeco m uumlntl Icircn (1oJifitd perccpfLlI l ~na l ysilt of p n)lnocepti Icircnfu rnlaquol ti desnibJOS ~n t tecr spin A IICW motor co nrro l Ira I gy t adopt resu ltin~ in the ~tr ltctltr 1 ckformh y lf IdiopathirL scollos i=i Ht lrftU1uc nltnt l ISll I1lJy h1e- ~ I pro()und elkn on bralO Sfem flJll ct i(lnn~lLhu modifyRll Ille nltulltgtshytl10 ) 1 1111 Uu l-lHoror control 5~Shnl$ shy
As Srtgn1lt1 l ~ ltlssert~ if wc l C -Cp t 111 1 un o f the G IiC s oliosls L l tisorckr oi th e ltquilibrilltn sys t ~ms it is lagical to oriegravenrate physlCl l exercis( lherap y ln th is d ir(gtCli()[1
11lclte goals Cul tl lfOUgil ditrercn t modes 01 action be Olchic(-c1 witJ1 phykal accivit ie
- po rt ive Cll ities p ro ct LJ e aIl UgravelClltrtsc in 6lte nshyel ll )o rd in~lti n pinai pr0prinup ti_)[J nLi mOVeshyment control 0 vio lls iy ln thh repect ome lCtivshylites aœ pre um~I I)y lXrter tllln ntil crs
- kinrl lira py using pedJil exerCisocirc specially developecl lith th est 1101 5 in mind illVuuml VC I lllore prccilt( ll1d InC1 li zed cri n on rhe spiJw focusing
a90
1 ~~
lg -lNheJo ~1l l1 t r~l g rld in 1 1) h i(~ IImiddot ct r rHienl w i ll idlllhic _It ~i ~ _ iri s plt ~I le II find Jit ltH vlllleuml ~l Cgtbl tn~ ks III d il fef lt p ~ lt ihnS nu v~tl middot B ~a~pt u Il C middotl)Icircd ~(t l l11 C dlfkrCnl middot- hdween slllndi1g Uline nu nllt1Xinul oorrec ri nI t chied Vith Ct (J ) und tfdincJ ne lot es o UIine 1 fo llnVs middotIJfl tfi ni( - ltlrshy
reltiK)n ~ Ikexibiliry st3nucircing - -pirte - f ur~1 1IbjISC ltupin - ltorrcaion - - r~luci()il ll ymiddot For flmpllt in J npK l1 pH k1J il
plt1SSlhlc ln obtai n 10 u1 511ndlt)l [YLo lion yr ln Slt p ille rlOlgt itlugraven om l J ~ in ( gttf(C rigtIl lIex lbuil 15 i (r-l l=22deg pol lltl ~~J IIlpraquo is IcircO~-V- I t1 l nd tucircu(Ugrave) ilil) I~ 3laquoJO- IH-12
r ln Ugravel e abilit jl of tluuml [m e llu to co ntro l irse lr in ~ pac
fuld l oftlles uumlllelve ntio ns can presum1b1r incn~~ Ih enl ac )1 the orller and lHitlll r of Ille rn - 11 )ltd h e lllldenl lu EJ3)4il
Posl1l1-t collapse lnd slabilizariotl
lIle concept u fplt st lUal c(l lJap~e l l~t Iwen detin 61 by DlI II-T3e~tupegrave rL t Ac oJdin)j tu tl1i- ~ll1thor il [ nec(sary ~- l Hn Cv-tlualing th tleihility o f a col shylo tIcircC CUJVL (0 clistingu ih bt tVeen the re du ihil [ty index (th - li iffer gt le bet ~middot Il ~I r~tcli()grJph ie ~xnmshyinltio n of the iI111 pHienr in supine po ition m(i
ROte OF Pl rnmL EŒIlCISE IN THE TREAT-ŒNT OP ~I IJD IDIOPAnnC OOU~GEm seou SIS EltJRINI
I (~)-----------------------~
__ _~ _____ _~ __ __ L ___~ ________1 ____ _ __ ____ ___ ___ _____L___ _____ l___ ----------L ______ _
1 ~
1
-- ------- --1---- ---- ]---r --- -----_----t- ---- --- ---shy__ ______~---- __ ____ 1________ __ _1_ __ ____ __shy
~ (1 J
1
8 =~~=r=middotmiddotmiddotmiddoti~=-middotl--- middotmiddotmiddotshy--------------t----------~- -------- - ------__shy
~---- --- -- -~ -------------r---- -- -- ~-- - -------- --shy----i-------r-- - ---- ~~-shy
il 1~ 0
Dtl-Lmiddot ~ lttj l r~ UIltltlHt
f g 1 -TI1 u ilictf 1ld ( ii 11- ugraveu-sh) ld IX~ O 1d wllich ltJdnrshymII Il nf the pilll 1 ~tln~1 of th e -o lioti( spinc n IG~nI(J II IIIshytt) lhe iJeuml grl-e o f ~ ()Ii ti c (u rvH Il 1 w dcpc-nlknrly o l l he 10 111shy
P01(nl (pntt l ~ 1 1 nr ffll wrJ I) ln w hilth Ihe n i 1gt( ~ duc nL~ grlphs fm I h~lt 111lt hi~hr Iht Col h ~Ilu t (l f Lite ~Ul Ihe m Ol CI il y th t s(uumlJotil middotpin~ ~111 he ~middotJg gr~lVH(~(1
m mJxiTIt corrttt ion wll iJl i~ lIllCd to Ih - xt 1shy
lti Oilil y Jf tl1lt t Ut JO rl1t cdnUc idt md p OS shy
tU ll cul lapse ( th t ltHill enct b-tten l lUdioL) 1lphic egraveltamJl1ltlti OI1 J t th e ~lme pa tient in Sl il tl cling lOJ lline fX-sitiutl ) Wll ic h correb lc- onl wil ll fhe abilt ty of lllt p tu rl l gt s tem to C( lunternct lIk luree o r grl viry )cco d ing rv D lfVd- f3egraveLIprc po st li r t1 lt01shyIlDse is d ue to the Jnus -u lar ton a nd 11ll ex rCrIshy i) i itv of rhe tissus n the ( O IW-) si it (If the (01shyjl ti (~JtVe (Fi~ 3 L Pu~t llr1 C lltpstl lu lcl l ~~ reduc l-lt by llwans o f pl1ysica l cxerCles specitkally s tuclled ruuml i rnprove tIlus--ubr fOHt md lU pr )cllI Ct 1 ~11 hi shy
lizing ffCd
PararcL n tll CIJ cl the cr iti ca l (3 c1 thlsho ld beQ ld Il ich defol1J lHU n of the i pinlt 1 e~ in~ ne dtlllontr~1t _cl (1l ll t grclrf r mg] o f rllt C II in a qa m bng pos ition corn pOil 15 t l lowcr detormashytion lhnsllold (Fig 1) ie to ~11l Ulne3Se t the risk of pr ogr t~ lu n There t rh eJef re l J ea r l)iuuml 1itshycJ l ~ll1 l l(tl a 1 tnr tg ro b ohwined by d -cr t l ~ illg ilmiddot pU~lUrll cull lpse ptJcelJtge w bich lccording t i)
h llTd tnd ~l(heJ1l ~on 1~ b inde cl 1X llt icularly luumlgh Ugravel mllcl c Iio~ i (bdow 2( 0 ) (F ig 5 J
Fin a Il III ch iS respect lllljl hl and b um l 01 m linmiddot
ii iI 1 l _ _~ _ ___I ___ ___ __L ___ _ ___ ___J______ ___ 1 ___
li 1 1 1 1 i 1
1 i ___--____---___----__-_---_~- _ _--_ ___-+----
i
1
i -- ~- -- ---~-----_-~-_-_--_1-~
l ~
i
+----r--------t-------t------f-- J
Fj~ ~-Ac(XjJlin(Q luuml T O rIcd ~lnd Na(h(ln~ n i () dl( pCG w rd (rTIshy
POO ll is hiherin cu rvegt in wh ilt l1lh ~1flILWrd cII1I Olk l1t IS le- pr(v~knt ln th e grtph Ih t PogttJlJ I ugtnq) Ot1 -J1l j elfltS-e J tlt 1l1t obb dirr remc rlLIv obu incu f roll l the Cohb atl( 0 1stlI1dtJ1g IId gtupinc rldo~raf115 Ih Ille lt) [1l1t1 (i lndnl I pine) 511pille the ~(nlClu tJ1 compo l1lnt U rlk CU Y _VeJily I~ ltx p rlt 1 L1v UpUlt (obh Illeturo Ih t si _b Cct rtJeSIm l fie -ltn J trd Ugraveltuuml shyuumlo n A~-i)rding LP 11(lt uuta o n l ( r1I~( in ~I 2JQ sup itlt curvt 1hi C(]l)b ddhccno l l f lO is -J-lultt( thc s ldnd inr tnla Ol1l t lS wi Q) whil 11) 1 1)401 ~llp lne ClHVC If ~ 1Omiddot ( tcl Lhe ttnd trl~ nlca~ I(t I ~ ~I)
tli n ll w l lllE cq lin ti spin h~ i ng mo r ~ Llnt~II) 1 tlun the nOftl111 one n Cll l gr(lk ( (cU ve tl1u n da r u p shy
po rt in o r k r 10 m linrl in tht 1xi11po tuf_ n th ha__i of th egt onideratl lr1S it f(lll() rhJt
ph rH (~Uuml e erd es ulukl h u - ul iiuml tbeacuteY ~U-L lm cl 1l (It-d o pmg p05111 td C Jl1twl lS fuumlrnll~ rly d ccrll1td ln an Ql St if i imr ol1111 t ru t(( - tht m(d in C JI shy
r t t r sture fO Ir -ngthen tlll m u ck-gt of the spint mainl) in (11erl antig r3ilrl tIcirclt l]lli fun ctin ll U hy meU15 dl i )ll1 t trk ~ lhJ cl( -ll tlt C)nlr~lUions ~llld no l IdOshy
1l)llic d YIltll1k lt l jAJ lktic t) I1 ) II 11)t 111 hd posibleacute t lcluuml ee postura l io nrro and stfh ili lllllt IJI
w i thout food T1lw(ull r d I( Lf(11 Ibk t m ucircnuin Ihe c()rf ~ct [ ()S tu re for cl gtu ifKi IH lLl1gth 0f ti l11 ~
This i-l ddl usl a typl 11 dnmnin (tf k inesllh rap) in 11 (lt-11 [[k - p~d fk lnr in lng f u l1a in llllliCk is poss ihle lI sing ctrtain Idncl fJ l (lt) 11111 liun S p Ul in tb is Cl c is ulttful ooly sa I~tr 1~ il Iw lps t1w lxltknt 1 becuJl)t 1gtlt ltlt-I a ClJu~l inred irl ilL ntllru l o~ i cll
and I1lll~lJhl r-keJc LIl [rll-llIn~ middot etlt(wrs JI the int e rmiddot vlnrion
[J ROPA MfJ) I()Wf-I YSJ IR
1
ICR 1 1-1
r
1 shy ~
- shy
11 o-llrfOlhe5l~ o t Ih 1O~(1dity i n h ~ r ~ ll nr pbl1 l of ~ Spl11 in 111011 _llti1Gt l lPt f ltlJUCWJtl ( ~l Ihe Ir t 1 1gt illbll W Ilh LtltrJ1dlion Vln lbe rigronl middotUII~ l(I Dko n12 lIll h lumshydlanie1 1 [ nul 1 M hl whtrc M - gt) lnIUI1g 111laquo111laquo1 1 1 c rtJCshytjC~ f fce d -d Lill l1~ o f enr niI pUll spnmcl1y 1~ 111 mldlll1lt (n the fl1ur t 1 = tor~ of f(ward Ileuuml l = ughtel1lng fmiddotr p 1shynOf stn lClU= Alaquo rdtllg 1raquo Ihl~ - lin hull th l1ltgtllugrave ot tller1l lUr~Jtllrc F the ~pin t -ilh rlu1i tf Ihl 1 1Ibulll n lrlt InltT1 1
rbc prJI 3IJi l1ty d qrlOIJ~ n bull JI t IlJIII Hm lA the v=ltd gtc e lu-ing J 5lnK1ura i ltfnnity
Dioal e ch anicll itllp~lir J11 c nt
Ihrcemiddotdimcllgtional mc-cbal1in of the s pioc
~f Ikmiddot i t i nly l(œ ntly tlHr llk pr-5tnœ or nc ushy1 lnlo tnr impairment in Idiopttlllc s-ol ii IXl tknt liuml J$ heen h i- ll licircghlcJ hy re$eJ rh tll e preit ilegravee h inm b nIcirc Ji d lJutg~ lt hl ~ 1 ng t o n dO Ulll urcel 1 i5 (l lreldv well umlersrood H(j-ev~r nev lbt un h iomcrhankal im l) ion nI h1c rectm ly onk l n tIlt tre and p r~dou in f n rmtinn hou t pl1ykd (~fcl5( in t 11 0 tl1I _ltgt pbne of spact 1115 Im trqlt-u 1rom J i-[) v ing unclcrsrmdlng ot th l lmc -dim nshy~ilnl l l11 ~ hmk f the cO]jO[lC pln( ~2middot ) ) Ve- w ill )iI xnl t l1 d at lcL-orcltng tUl cl sif iol t lOn blsed o n gtolllt lricd h uumlCJ ) p lane
- b() rJzU[1tl ln th i pla n ~ th t 1o rm ll sp ine present no CUlye- w ll ile Uumll(~ ltc U Hic spLnc clevelops one of ir haracterls(Icircc deFo rm tiCs v elt tbrd ln lashytio n vh icl1 pJ()VcA~ theacute hw 11
- lgitltl in th llulJe U l(~ nonmll spIcirclle pl SenL kypl lOSis ~nd l dooi~ in tb lXI1 lhese [(Hu rts Vere m)( til ught [ 0 he relattd tlle scolkJtlc ( lI r Vegrave
- front l in hi pleme tht ncrmal p ine preseuron t no curYegrave whil thl ~11li tic p in ugravetI I ()~ icircl~ charshyad t Ilt I CU1C
Il Jri fJIIt palic
~l+I~na ra 3 r inr lut th l[ ber ll1d a œl1~lU1 degr 1
l f r()la tJo u lllu (lILa r forcKl ltxert ltJn tl ldefnmuumlng 1 tkllJ [J i1u a re- lhlt tll cly 11 [1 1 UI b y Olm ner w bn ~lh uiJwd tl egrave ro t1tic) l1 Ilm it ti lt p ica] lf shy
rhrl r() be (P (the Uma bevond Wl1iltJl th lCOJlb of [11( ~pmaJ musd ~ dthc COnCIt and nm ex ~l le btconk (t O li~[)
r ~l 18 ~1Il N lu t( ren i9 lun lu ted rlseurlt h in tlt ) tilt lULodeumlformipg1 tlo n ot tIH_ sc laquoJrle rh ox ercallkren lk 1l1~H li d11r once thl Il i ~ r tld1t5 [he lhrth ld f 111 JlIcirc lIi of tlle dnrlclc hurnp tlk
lI bslt Il l nt rlet()rlll lIcircon 01 the it l ()I~ C ( (ylm der (- sustalnecl by an H1tmi cforming aCOOIl
J1Ji h V hl rhyiical f~ f Ise CI 01 h spr n llnd kin middot ith ccedilrapJ my lX damlg ing vll e n l pplild as flle
igt Jk Iller ln SCC1IJ ~IS lllc lJ fxceed l auto in middot crca~ i n g lhrllgthuld [1 sh (~u Id ahn be j ofed that Ilw relscd pre sun 1l1111i insiugrave l fe pil1r inn) 1 mlshylt
- j Il- ( w atff 1 (nh ~1l 1(e Il10 utoldrml ng li1eCh~lI1 1sm
in flc l Geyer ~w tcd th1 t rm m 1 hI l)1ecircch1O lla1 puilll 0 l I C~ sw m mim t Ieuroamp no purpo t for cu lshyim le pllilt t1 s (weumlO middott r it is l~Jl(gtWl1 rhn in iculio r[ paULnl -iJl11T1ill~ doe_gt nor Il ~lp to i ncrt~SL n eur(1shym tor co mfU
(1irai p an (
Jerdnn lle 11 showecl thal ill CSl~ o f t10rLC IC 1i lUgrave
tllo lacolulllhil it lio_1 tlle cte tI llmiry in (he lg itt1 p lln t rn lnlftot il~ lf tspe iuUy in tlw initi 11 r luleuml )f cV IU[Icircon nf Ile ~oli ls W iU l 1 p(t)gr~s~ivlt il10middot~ shy
ment roward hvpok pho b G ll f ill~l Im lins l har dUflng (IN eWllLlfiu1 of 11Imh] co luumlgt i the l in t ot t l H~ gClyty Cegraven te l - 0 1 v llebed lxxli 5 r ro ject 1 seH fl r t side-ys and tlwn backlrcl bull thu~ p(0(1 lj n g a kyphQtlmg aet Il ln (h~ lu mhnr --PIl1 COftj tng
l l i tc Iugrave l lltl l( l rs1 tif s L -etllgt il l the lgirl11
1 Hl)
Ilu LE nI rIIY~Ic~L lXIlKISI 1 HI E TREhTMEtn OP JIU IDIOP llII C AD O USCUH O Ll Œl15 NEGR II
lLill tegt lre lenl1 ~I d ~fo rll1J[ ~ rhl recrSes the phyltiologiGII cmns of lh vine)
Accordlng () Dicion ~2 1 rtcluctio fl in the itgitttl CUIYtS combin l vi th a lueral Iviari n llltl ds t 1
mecban ism () ugravel~ta il ity in l he r rat r IllI1e which bVOf1i the unsd a nd i ncrea~e 0 1 co hlt1is (Fig 6 hiIf md Pl11jlbiJ Jl1eanwlt ile lt(udiecl lh e srnl ru t
orzyglpophySLs show ing t11 al ttleir 1I1tl rnic tl orienshytation f~I (jLi l~ltes aXIal ve rtegravebJl l rotllio ll in cun litluns lt f dorsal hypokrrhn Icirc tnd lum)H de i L lo IS
Tll t dat SLlgge 1 th t impOrfill ut pOitu res and l1lweil1 ) t Mudied in ord t r (CI mlIuml ntrlin or to reuwer fll e p llyslo lo~lCll ClIlye in lIe SlgJtta p lU)l Wlth the llm o t ch ~ kin~ rutltor in l~ bili ry7 AbC th ~e ~k-
1l11nL ~Irt del lnt [0 J jUc lt ftber l]kuti inrervenl ion vhich 1c)LJ k l IV - i(l ~ l compktl n l ililll on Il t c1 l shy-jel1 J11UVllT1ent IJ j o f 1uto-dOneacute(3tlon ( i e a -impk ld ion ) Iengtheni ng o f the pilleacute 011 a litlltl l aXl~ tll lt ((IT liJlI~rcdu e~ t lle ~---lJ linti- l lte ml-fkxj(l n h UI 11 - i llCrl I~t the plllH ](JgicJI dlt cr ~l S ( (1 k-yvllCiSh lIld O(ltOSh l o r c lch r1Iif n t a Ilew til(~ecirc dUuml llt Ilshy
si lflltl J ll1 u(~nlent iam ecl - 1l1t0- lIrfe rionmiddot7 4 llmshyp oed f Je-rura l iUIl cl middot-t1e- iltm lI1d ll1a intltnUlLe )( 5lg it d C Uf (gtS slig lll thltJrc i ypI1 tiZ) tIcircOI1 a nd lunugrave)ar 1()fdos i7~llion) sholild he esw b lb]HU 00 lb co
hl b oi hi p~l11il uU r -1Ir vlt Abo 111( e IlltUtl Chl lie o f purti n - a U vitk slJ1ultI h e )tuumlll ecl 1)] (1 n ldershy](ion r tl1i lt type for e upIe IilJ llyl)T S of repd shyiti( ml vemen prt n t in agonistK h)lnllltlSlks nI iIle kind f dlJ1ce C( uld he ([([r imentd
FmiddotO lllaljlallC and mobili ty of the SpIcircIlC
1 rd llo U 22 d L lm nrrare d lhlt in Illt fro nt a l pll ne
tilt 1 nge Clt 1)1lt vtment of tht scplit[i middot CU IY grcmr lIJ l il ~ d irectio n n f Lhe C ITelt tlO n tha n in tl le di re shyLion of pmgressi n l Fig 7 ) he IL o IS5err lJd tbat th15 mohiliry increac plrtil u la rly n apic [ cgcoeilts 1$ lh ~ ~c() li osb evolves Sragrm rJ 12 J ~ thus rigilt (0
VlI f n rller~p is ts Ilo t t) m o b uumliz - a sCtJl iu til curve w ilhout t [ uling ttwt tlle R lu tiOI o i til t ~a mt b fnlinruumln( 1hy l1tans o f ~I passic 01 1 rivE -uppnrt On tilt (ltllE r hand UgraveK d e iJlioJ1 in ease durill tlw tune 111 whicll tll C spmt i ~ not submjtrcd to correeshy( IV anl()n
j- Virh mi lei ol i b tlllt Upp i1n ill) lC tiol is d eveloped only lllmugil llClIf()mu$Cllbr f r llce thi ~
InegravelIl ~ thclcfo re tl1l[ inu eascgtt sp1J1all1extl)iity mua
11
Imiddotiumltgt 7-rurd illt Ir) 1 bull rdrilt I1 1 in tl lt frOlllll pbnlt- th( illl ge )r mOC llIeJlI o t the S-o UIIJC CUNe 1 supcrior in Ihlt diflt(l im ugrave( the n nKlIl thd n ll1 tllc dlrtcLion o f p rJ1(l( (llIl
be considrCtJ vntrl iJ)(l icltion and 1 undrli neocirc ab L a ~ubiljz~ILion 01 tilt spint pllss il)1y ohtl ll1td thrltJugll the stlengtlkl11ng o f the 1rltJgm vlt nonil lme shyCIC 111 illli orrant u bjcLliH- ln rhis r~f1 n sp u lllni lc tivitIumlLs sil uld lX tPI 10 dlegraveltl it l G lU t n w l1ik luring kine i Icircth lrr phyltical eXegraverci c~ tllat in ele
spinal m ot ilIcirclY sil nid 1e lt1 oid cdrt ~
Organ ie and psychologieal impainncuts and li islbi IiI le
A cgtI im lc pmi nr is moriOthl11 just 1 sp in and 1
compkt gt Ipp rnach to the gu in ad 1 ont i al~ shylute l e~se i t i11
[)a la 0 11[ [n ell lrom re semh pw tbat ome organi Iilnctiond cl fki ts suc]) as tlw clecrtiUe ut vild l tnd d fun ll l)Kity_orld ldly incrtJ k whil~ 0 shy[io s i -till in (1 miel q g of g JltlV ity ~ l ilI e 55 rtI lit
tllL pres e n ce )fl defidt Or Vi l~il Clp~1 - i~ ln one pIIiem in Ihr l ftectecl by 20 ICl 40 scoi stgt l ls~a r(h cunclutecl in tbe UA by Di Ruce- prod uegraveed an aaalo) u ll1lXimum 102 re u t in a group of Jd shyk 1ien t [(h sco llosls rang inF frum ) [0 1
Al10ther rudv bv rallt r m C chr111 lilcl NashycWrl1s( u 57 stlO eltt hil $(C 1 1 ui~ Ica js l( lllt cl (1 shy1prUlllI o f t1tgl lie bJd l imI in ~ul sct t1 t ltu b middot iects jlLltr l5 they are golng through ~I cltlici[e sllge in the fnm 1lt i n 01 tlWH o w n id uHitv t factor hit h Illy jeopmlize the cl velopme lit d ~ mIll lt lI1d htIshym cecl IWI sonalitr in Klulrhood
n RUI ~IEDl(( Ptl Y1-
ROU ltHmiddot PI [ I C~ 1 EXIRCIS]~ IN TI Il nW~JUNT OF SlllO lDIOP1HIC AI)C~ESΠ11 C(gt1[Oi 1S
This i why b IiCieacute ii is ~n imporrlIl t for p rcshyvegraveml e 1tLsr l tn en ou flge 1ari e nrs ~lfrecr(d by lIillcl middotu iosis ft) tlke p~l rt in portin -re rcatioluJ acrivitits Iha t 1eIU 10 L10 th r~1chophyinLl bull nd b~l )i 1l1o tur adlieem t n li 51Jmiddot2Even tlK)ugli [Dr bic mech~lnshy
ical mcl nellIUll10t 11 11 reltl ~ons lt r111 1gtomcrimes be l lefu l to ugg( ~t ne p rt in~ aCt iv ity r l h (gtr rll n anotlJer e th ink Ibal an exces~ ive IlHd icalizltion - Icirce l ll1posilion br plry~ilt i HlS nnejlor parents uf rh ry pe of po rt to lx p m lice 1 b Ule p 1Ucirc(Il L th1[ preshydLl ck l1 is fret clOice in lh ma tt r - -h II ll1 he avolc1ed wb 11 possLhle mainly for tlle i mport~ltll psyshyLb ) jogka l fe a SI)nS W( ha( ill ~ t nltntionegraved
Conclu ion
lbh ISsertegrave d t1H physkal tgtXtlci o is ) n fi ial whlIl practinu in order 10 ilnj rove the I11 llde
rœ nwh and tono C iral caplCiry and postu re o f the StOUO(I ~lIbj n II I nowkdge om ~ middotmg trom ci el1shyrlfi rls(~ Jrc li dJlJ accordl ng r the review 01 thE litshytirlture prnpo )td in t lli plpl r conflrm~ Ihe vuiclit ot th e -t ls ~rti ()ns
In l do l (ent Id iopl1il iC scoliuse il l n phee u i cl vk)pm e n t ( li tll iumlKh eXCC cl l g i en rhk thr hokl th e re i5 an und ubred need fn r l pprnpri 1tegrave (JJ1tOkJJe ~Ild Inr surgict1 therapics ill ortler 1) S l i p
the ( - Iuli on anugrave )JT~t~t UW ~pilll l dtlormities bull evshyerthtless in the illiti ~ll pl l~sC t ttlC c1iseLltc whcn the riS( r1 r euro )luli m is rtduced ocirc ~md tfle uifleal JOld threshold il ~ld flle po stural collai i reJcenw~ 43
JI l1 igh pllysicaJ egravexe rc ise - p revenc or r d llCe d i ~lh ilir ies o f [Iw ~ l() li )tic
p (iems R 28 J -6 5- 6 1 63
- f~KiHtare lh ( n utr ali711iCUl of postu m l d elicits tn produCel1 a coneql l nce J [)ti 0 I111)( or regre si -u lmiddotc 5middot Il 1 17 ~ M
-re 51udles U ~ n Ledecl tu con[mn or re jecr these conClLL i( 1 w l1 ich clerin-d frum 1l1 lIldytica l rcltw n f th e liter~iture appear r- ~Lo nlble Hnwecr Intil ne re ull are 31Iable wc should n r prevent our sroliotic patientmiddot trom tl ki ll p lt in s(loI1ing jshy
ir its pW1iada rly ltl t ~d1()o t () n til t c ntrHY -vith the l xcclrinn 01 gt[1 )11lt tIlat in rea-e t)1obility (tnU evc n thell oilly wh n progr~lgtion b p OSSibl) -uc h ~I( ucircvshyiUe -11 )ulu hl tIKoll w g ed The 11 S J ( rprOpriue kin (~irhe r~l Piuml to incr _~asc p()~tura l $llbil i ty is tl1egraveoretshyic tlly CiJUClt alttloughl more ~Iccu rtte aod deLli led ri k benefi rs anJlr~ is is netot1ed
Ria 1111tO
NIokl Mu d lle ftitYljJfu Jœl il 4IWr10UOifll S (JIvs i (1~1)Jshylidl ttno( cclIll le 11(11(1lt1 RCI fu lle ((lia LltfIt l1 I1I1i(i
LJ ci n s j(r3 pigt egrave li n IHUgru lkl di t rdz t fi sici pe e ft shytUlKm iluppno di un lisimerap15Ll rl lllcflt() 1 110 scopo di pnevirlt () fr en~lI 1-lgpwlllltnlcgt dclld lclonnitugrave o e il 5LOshy
Il i mi llon lt fH nugrave j (1 11ni dei co~e 1 lteIl I1J J nd ne ~Ii eifclti (()Tc rri udk s co lio si d i m e dia g rt iuuml ln que~ltlt
s rud i 30 llizzb mo i d ti cleU ric lca pel n ri Icare qJJ l lm 1 dis(imucirc x u le I[~ l z j-m i pro vna le da lla C gtl k A i json ere pr middote-nute () rk kl ducirc un~l rdeguCltl d nil cra pi lt di uJoseguerrnt Cjua li 1iU110 cli nbie tti 1 rcr lJ)tIId d~ fle)-UITC
n (- -fd7Io n~lcl)
Ut11claquo)si 1 lI tori htpnuuml )ludi-ttn I ~ cnntI1zttu fr Cq(in i idiJ)tic1 dbfl lOZ10l1 d d ~ leOla nelllOll1otoriO Lb un1I1cnUl 1n1l1i3 dcgli 111 lt1i ch DIJgt gtU l H crmU1 Nlch~mslt ( SIshygnaJ~l lerimiddot wo i esuemi -bletti d~ plt~e8lugraver- ne l pClZ le1lftgt scoliodcu kl s iluppo ddl ~ ~ uhjlil~ vertcbral~ lt o svilllp prJ Jdle JIl7 i() nl di ltCjuiljbrio Dng li studi sul lto lb( l~nlrale (OllddU i in pa rticdu d 1 DlIal-BeHJ (gtegraverl ~ P~II IId lI1 n~ llw - idente il v- m gtiu p eT il puientc clioti elgt di u n rnigb o t c)[ ro Ua sw mle dei radlldc onsegull o tramite il 11 fforzrlshyfl len to d e i l1luotoucirc l nllgr3ilri d e luOwo con crcbi ~Clltdr
in pOMltHJ corrctl e in va rie ~i[Jzioni s t llicb c c d inamIcirc tllt Dalle on sena d elb blOffiCcclIlicd tr idimlt n s io mlle d ei
r ~ chi Je ~oU()f icn ~Icirc ~videnuumll (l() ~llt tC p IYZIcircOSI ln(IiClZlfHicircl ~ 1I1shy
liumln fluenzt Je ll middote~rUrio tl SC) lgt lIi I rc pibull m i tldln sJlI71 Stl shygn~I I1 afferma che slI l p Ia no [11 middotccedilr~lk tre un œ rtlJ grado di l L1Liuuml IlC dclh vEltlh r1 apj(de le tu rœ mu SCltJ llri njtbc J n in $tJ ) t rodcfQfll1t1l1te PltJtantu b i r~it-~ r -lp il puugrave t~~
Ixnt-ftla solo nt Ile so )[j)~i Jl1Icirc na rl in qunnt ) ilon SlrM ntne )(l(Ofa tu soglb in caq ) co lltrLJIcircn l)lrilto llt~( i lJudotlsi di lfr~ lI1 C llg grVlmenl J 111 11 io lr riltd ll(17jOill leld rinlle 113 dimO~iumlrlto d llt nell o lin~l cl()~ li t th~oIOl))1 dri la defltgtrshymiti sul p iluO slfl iuale ~vohl lf1 (en5 ion~ sO lnm utto nd 1e bsi iniliali deWggrwm1Cnln mcn trl C a( lfLmn che occlleshyvoluzi ne dene = 110 i [ mhari IJ lin c l ki cen tri ch -1vi1( de i cp i CIt IJ rI Ji SI p m ittIl pnm l Iem lmeme e p o j pOS( shyrio fllwnte dtldnli mdv ( i un ziuuml ne ciloliz7nnl dd rlLtide lu mbJ œ ( lIlelttlaquo on NC n d d (gt11 uIdu m 1I1 Ilgt) cli r-Iure (0 eserClzi che IllUllengano 0 ltlUperifo le Clgt 6gt1 lo)iche sul pirluuml gilwlt Su l p iCl no fron itk Perdnulk il dlll1lt-trlto d1 lampkz-l d i LU ovimento amp111 lI rv Kolio ti ~ nd lt1 0 ddlJ cnrrc-LIcircQo i Ji gC 1 n lungl SUpegraveliltlrccedil 1M llS0 tlell 3ampIGI shyvamcnlo C che l~Jltmiddot mobiliti GlI mcnta co n l c lu7j o fle d l i) snAio i A ulln amplgrtJc1 ltllllmunjx~ i terlpGli nn n m obi shyUZ73It ma eutva coli ti0 1 1ct HsicVlfe nd tcmplt 11 1111nshyttllIcirc1nc n tc (k ll ~1 llu u zinnt n l1 un me77uuml d i sost l11( gt ln 0
e 11111ri b cle - Ilziunc egrave deorinatcl d l rlyarsi Snzcl la pr gtshy
liltlnl l i un() rtl~ i ptmiddot Jtl n(o 1S(Hl () (( ntJ() i ndit~tr i ~ Ii ISt (izi e l m iviL Illdlode ebe Hlmen tno laJlc ibiJii dcl rlc lide SCshy
li io) [n p articobre rune q lldl r C-I1 ich~ xlSiddcHe CUf t shyli ve ch~ iJllpi tgino e~rciii 01( biIi2 ZanUgrave HhnmL-trid () in tmiddot~t~nshy
sione kl fuchide O tne pure k- ~ttivit1 tnotoJII~ non prHi(~ llCcedil
in forma r k rel1tiva d Ie ~1I 11 rF~1l1( n otcol mcnlC 1 lll ubib Ll vcrteblmiddote (ad ~ flp j(l 11 n l) to L ginn ~Iilt Utl clkl rilshyC
mka la cli OT- tcc)
r1il to l~ _ I[Dl COlI rY IC~
NE olUNI
fillncr ( ni ((uuml(( n hIIo( rilclIO ~middothe k lln dtfidl fUr1z i shy
nlu CQll1~ la llcl llZIO 1e delb c apKJl ilde e della capacltl di 0170 mizianu luJndn le (OJ il~ gtna a nc r3 di m~i3 gmshy
v it ln G mlxl r i ~ gko Fl llslrom C dlllJ O e Nachcms(J h iU1I) dim lr JtQ che b o liosl p IOO C1 neUaduksœnr 10 SYil l1p pn d i lIniumlmn~gin nlt8Jliva de corpo in (o nridcnz di Ln ddic3w p ri d di f( m l lz i nlt deUa SUl idenritl condishyZltonc ch pOlrebh ~[I cubrmiddot ln vilu pp di un pe bull n nn lir m llur cd e quiJibfarn in t[C adulro TaU CO1DSCe nZe tvlde nshyZ[II)() la n ( middotess iti di ltimobre la plfte ip a7j0 r1e atl an ivi ll1ltHClr n gl b a li ltl h ~ di tlpO s pu rti middotu dl ittlrc nd gloani iCo lID ti i lirtugraveta z io ni llb vila di relazionc
ln concllliu fu la d tfoflll lL saliu iG egrave il sin l mo di lin) idrotnc C Il1pk 1 d e eoinvo l d middotmiddot= fu n (n i dd rgashynIcirc5H10 n Hi lhdli e lesenizjo fi 1lt0 se 1 Il indirill~t() pllO pr~cnin 0 odLf rgt t lli di fu nzlonicirc adlc s()Jj(bi 111Icircn(i rrHtatc CO ll nl1 cinesi rap i Quand l~ coli i ( n LS~middot iJ11 zia k il rischio evnluLIcircvo egrave lid [() mente no tcole 11 (ltlll asso p o lll shylal ltOtSltgllen7~1 _ ta cincsiterapia pc rslIk bidtlvi shyptutibulli d ubllIcirctIcirc vltnc brn1e di conrro llo )(JSu k d i 5IcirclupPQ d Ile rLlt ziofll d i eC[u ihb ugraveo dJ ftffr otZJH1 r1w dei IIl llJgtCili 1 11Icircshyg rdtarl in posru ra rrenu posslhile JnnalL in Illo lt i clsi l(j luucircun lt di lin ~c() li oi mi n rc ( ume [11 duumlnQstrIO la tinc~ jn~l el1lric ((1l1 ~rtlppi d i contnmiddotllo cnndnlt1 p nso i l entrt d e Massue di Li n nc da [ o llo n ~ Rodo l (1 986) Julndo il1vlce lIfU~ ho ~vutlJ tiVll 11lt1 1IjXIl to un dekrshyuina r o~itl di g rl vir~l bull a~-n lllull~nte n ec ~~uiu rlCUuml rf( ff dla tcrJpll rle si c a eo chirurg ica
1Ho le clllC ooliosi idjopHI 3 ttl1p ~ - E~er l zjo hsco shy11ln ~ I((fapil
l Bg 5 CUle Lo [la k ll oblems in tlu ll~ (U ni Cl) FrKUce CU ( )lIILr no 1 AllCPR lu b1lG1t10 11 middotCI 9()(iJ2 RockilJe MI) i)~Cr ~()f I [( al th all 1 () I ~Y 1(~Re~C~Hd ~gtutnlt Ilallb Srshy1ltC Cgt D~p(rulllnr CJf I Ilalil 11 1 HumlIl sen Lel 199-1
2 SI) lrzcf ( LcB I ~IIl( FE DupUb L ampkIll~ 1c ~ppro l c h ll tht rnent und mmgemlt-rlt ot ~ ct vlyrl~ led splnul (hs r)fder~ A monQglJph rr r d lll kic Re p o l1 or Ih Ou bcc TlSk Fu rcl 0 11 ipmd DIo rele Sp ine L9H LU) 59
) Clntino F 111i1 i(ll Ci nerte1H C Nou gltHhl C Kln(~Jl llBICII [lIe1 hmlln (Il dry rra ll1ltfll of QIil pa ll m log iC by l11e 1 lIb li 1le-llh laquorilC~ of ~ 10(lna 111 Jrc)Jcxli r~~ (of flle h l lntrnIUonll SVIll Illgt~iu tn - II 5lt Ik lIc lk0flllllic lu llln-I I r l III Fhhlt ri g 1092 -ltlIJ-7
i - ri of niii MA N()LJV II ~ mel h)ltks de kin ~~klk rlr k di lll J r~cdllclli (n d~s ~()li oes jn f ~tel r~1ruuml(ILI -lo s bl fl c sur IcIj cquishyl)œ~ Ik SOll ll l)(eacute Eli ror eetlfllS d )111 1~ 1)1-
5 iloll n G Ruumld(~ le s () I ~middotmiddots tnlcl l l1 I n in 1Ifc el kiwil~~ 1)11lt KillegraveSlthe ripJe SCleacutentlnlue lYl6 2 47 ~ 6
r) Feacuterr[ffgt en 1tsiero 5 Venlllfln A ll~~n () M MJglio nu N EfkUuml o r eXltClse tI~tl Yoj o n nild id iO rXllhlc iC() 1i()~ lrt~ lirnIcircIluy r sull Eur feltl lb)ii 1 1j34 Z5 -~ 1 NOilrill1 A Sbill P egn ni i Ll Linesilegraverpi l 1lt1 Itallllll~nlO
ddlJ soI K~ i llO 1 Orkl1Llllwnrl m efodoloil1c1 RbbilltlZiOllc Ot1(1 1 )29(1) 1l-~
8 Nli(rinl Nl(lr1n l A blll P LI rieduGlzione dl p llicml atflt rro (11 coli ns i idi opr lir1 l n SC(Um i le or h( JI 1rcLlIQn1 ~0Cl le Imc lI1etW)n11e de Recltcrchc ci 0 Ftude sm 1lt Radw jlt)(j S-71
gt Nftriruuml S SeJhrf U LI r i l bllh ~l liOlie dd plziecirc11te ulet1n 11 - r
lin Kllopd (1 In l1l Jgl L N eduoL Tf1It II d ll11e ji cln1 rJtbl IiIUvJ Milan) 1ltfddH~n(x~hl 2(1~111gt-1-PU ob L cllln t iRll p l nelLi rl tgtO llcui n~ dilt ~lio i - l rn~f- li ~iIa n 3efllnl -Kurflr 19-11
11 lIIra S lJll M EVtJltHlvugrave egraveI lt t rnrumel1t() d db S(oli - U r) surie doCum nUle fintgt 31 tIUUli Mibn SI rlin) KlIpf -r 199 2
L2 1 ~W I1l(IJ P _leacuteVia tio n I~lhra k~ du IlchlS ~- ( i( IoltS ccedil l r lI C1 l1 fl leq
Ene 1 l C hi r ApparctlIClCOn l~ ltll1 l ltx6lt (i W Er 20 j )7 l
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16 N1lh~Ir~il Al Peumlf r~o n LE Erree htJkmiddotmiddot~ n f t~U lt hfIl middot Ith J
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17 M(jo n Y ( ullck J p ~ R A PrdulllnlIr rpurt 11 Iht e rt l f rnltJsu red 5l ren jl lh rrll nrl1 III ililleInr Hi rrt tllk scoJliagt
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EUROP MIDI C Pli hIC
EDUCATIONMEETING SATURDAY 8thof APRIL 2006
(iSS
SEAS02 Scientific
Exercises Approach to Scoliosis
version 2002
G
S Negrini 1
EDUCATION MEETING SATURDAY8th of APRIL 2006
Neuromotor disfunctions
Neuromuscular disfunctions
11 Postural collapse
Postural collapse
Duval-Beaupegravere
Flexibility of scoliotic curve
f---I--- I Postural element
-------1 Structural element
S Negrini 2
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Postural collapse
Duval-Beaupegravere
It is a value related to muscular tone and to flexibil ity of convex side tissues
Post ural collapse
Bunch e Patwardhan
Critical load
Load threshold beyond wh ich a spine begins buckling
JI~~Wt1lW~flfthtlJlœJtAr ~ J~It- l~l - IMS
Postu ral collapse
Bunch e Patwardhan
If a curve reduces there is an increase of the deformation threshold
~~~NW~-damaoc~IIIMf ~~ J~Iv JaJ-I7I9sect
S Negrini 3
EDUCATION MEETING SATURDAY 8th of APRIL2006
Postural collapse
Torrel e Nachemson ~
Scolioses below 20deg ~ ~ lt~
have a high ~ ~ percentage of ~ ~
~postural collapse (on u~
average 75) ~~ 2i~
CU~VE O EG~EE S WHllE SUPlti e
~laquotd~c6b ____lPffI1wtt1t~
$ww J(t ~~7 JM5
Postural collapse
Minor scolioses 7
Antigravity musc es strengthening D
Reduces postural collapse -G
Increases the critical threshold of deformation
G
Neuromotor disfunetions
Stagnara
If we admit that one of the causes of idiopathie scoliosis is a disfunction in balance systems it is logical to orientate physical exercises toward this direction
s Negrini 4
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Neuromotor disfunctions
Dubousset
Idiopathie seoliosis results fram alterations in praprioeeption centres and deformation is a natural compensation to restore postural balance
etattJtitIK ypothfQj~S ___~ own_ oJ)HQr lar 1t-1( r
Neuromotor disfunctions
Nachemson Initial idiopathie scoliosis
+ Goood spine stability
Neutralization of postural deficits
D Static curve
Neuromotor disfunctions
Therapeutic aims
c) Development of spine stability
C) Development of balance reactions
G
S Negrini 5
EDUCATION MEETING SATURDAY 8thof APRIL 2006
Biomechanical disfunctions
j Horizontal r-Ian
i Sagi ttal plan
Frontal plan
Frontal plan
q Frontal plan disfunetions
Fronta l plan
Perdriolle Movement magnitude
gt in the direction of lt in the direction of correction progression
S Negrini 6
EDUCATION MEETING SATURDAY8th of APRIL 2006
Frontal plan
Stagnara
Never mobilize a scoliotic curve without ensuring reduction maintenance over time otherwise a greater mobility favours scoliosis progression
Frontal plan
Ducongeacute~ research
On a group of adolescent idiopathie scolioses treated with
Meacuteziegraveres gymnastics
D After 1 year the mean angle of
curves increased from 18deg to 29deg
Frontal plan
Scoliosis without brace
D Greater spine
flexibility D-
Risk of progression
S Negrini 7
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Frontal plan
Mobilization is useful
D In preparation to
brace
D With brace
Sagittal plan
QSagittal plan disfunctions
Sagittal plan r middot _J o
Perdriolle scouos B CJ aDeformation of D
thoracic and thoraco-Iumbar curves evolves in extension
S Negrini 8
EDUCATION MEETING SATURDAY8th of APRIL 2006
Sagittal plan
Graf
The line of gravity centres in the vertebral bodies o s c oUOSt
projects itself firstly laterally and then fi
o
posteriorly lJ ~~ ~~ ~ ~~-_J-D ~nI~
Sagittal plan
Therapeutic a ims
D Maintain or
retrieve physiological curves on the sagittal plan
Horizontal plan
QHorizontal plan disfunctions
S Negnni 9
EDUCATION MEETINGSATURDAY 8th of APRIL 2006
Horizontal plan
Stagnara The forces applied ta the spi ne act in a autoshydeforming sense
Horizontal plan
Dimnet Rotation gt 200
ampII~ (
D The actions of concave and convex side
muscles become
agonistic
~ItJrOnrIIiItdllfUClltlluumlll~~tI ~1JIf1laJ
Horizontal plan
Minor scolioses never exceed these autoshy
deformation thresholds
S Negrini 10
EDUCATION MEETING SATURDAY8th of APRIL 2006
Disfunctions at a biological organic and psychological
lever
Oisfunclions at a biological organlc and psychologlcal lever
Cheng
Bane density in scoliotic teenagers is lower than in normal subjects
~~~~middotA~IIlUtIy ~7œl 1d l
Oisfunctions at a blologlcal organic and psychologicallevel
A significant reduction of vital capacity and V02max in teenagers with a medium severity scoliosis
S Negrini 11
li
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Disfunctions at a biological organic and psychologicallevel
Disorders in the development of body image that the teenager has of himherself
Disfunctions at a blologlca l organlc and psychologicallevel
Therapeutic aims
cJ Activate cardioshyrespiratory function
cJ Favour bone density increase
cJ Develop a positive image of the body
Disfunctions at il biological organi and psydlologicallevel
Stagnara
Sport
D The active side of
kinesitherapy
S Negrini 12
EDUCATION MEETING SATURDAY 8thof APRIL 2006
Disfunctions at a biological organic and psychological
level
Distunctions at a biologlcal organlc and psychologicallevel
Cheng
Bone density in scoliotic teenagers is lower than in normal subjects
~n~IIIvpWr~middotA~stWy s- XXJl M J
Disfunctions at a biological organic and psychologicallevel
A significant reduction of vital capacity and V02max in teenagers with a medium severity scoliosis
G
S Negrini 11
EDUCATIONMEETING SATURDAY 8th of APRIL 2006
Kinesitherapy on the scoliotic subject
q Postural control
q Axial stability
q Muscular trophism
q Balance
q Respiratory function
The limits of kinesitherapy
There is a threshold beyond which
rehabilitation alone is not enough
sssr
Kinesitherapy in scoliosis treatment with brace
Therapeutic aims
S Negrini 13
6
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Therapeutic aims Srace kinesitherapy
With brace
il Postural corrections and
vertebral stability are obtained by the brace
Therapeutic aims Srace kinesitherapy
In preparation to the brace
il Mobilize spine on ail plans
Therapeutic aims Srace kinesitherapy
With brace D
Maintain a normal spine elasticity
~ Maintain a good muscular toneshy
trophism
C Model the hump with kyphotizating
exercises
S Negrini 14
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Exercises and their methodologies can vary accord ing to learning and individual sensibility of the single rehabilitator that proposes the m provided that they stay within the
Iimits of fixed therapeutic objectives
li
Therapeutic modalities
(Exercises)
QAuto-correction
QRespiratory education
QErgonomie education
QMuscular strengthening
QDevelopment of balance reactions
WNeuromotor integration
ci Vertebral mobiJization
QSpecifie modalities in brace treatment
S Negrini 15
EDUCATION MEETING SATURDAY 8th of APRIL 2006
The protocol of kinesitherapic
treatment
G
QChoice and dosage of exercises
Variatiosn of the work program every 2 - 3 months
Q Execute e)(ercises on an individual base or in a small group
Q Frequency not less than 2 times 1 week
Involve and awaken the family
G
S Negrini 16
EDUCATION MEETINGSATURDAY 8thof APRIL 2006
Q Determine the action and the localization of auto-correction
QAuto-correction must be associated to ail exercises
QAt the end of treatment ergonomy lesson
Auto-correction didactics
G
SCOLIOSI DORSALE---- shy ----
r
S Negrini 17
EDUCATION MEETING SATURDAY8thof APRIL 2006
SCOLIOS OORSOLOMBARE
shy
SCOLIOSI OOIlSALE 011 bull LOMBARE S1I--shy
SCOLIOSI LOMBARE
il --~_-
S Negrini 18
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Scoliotic patients are not radiographs
middotSeoliotie Mtients are not ndiographs but hum beings with a vertebral deviation-
Slagnara
Metha For the physieian Cobb angle is of utmost
importance For the patient it is body deformity t hat eounts most rib hump a protruding seapula or hip We are in a situation in whieh today dodors eure the radiographie deformity but what the patient really desires is to get rid of clinieal deformity and of ensuing psyehologieal distress
CIIQItIo shDuIdtucirc lM WIld tJw~~ I~~M~~~~ J9f~
S Negrini 19
- Poznan_workshop_Physiotherapy
- physio2
- physio3pdf
- physio4
- physio5
- physio6
- physio7
- physio8
- physio9
- physio10
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bull Metoda asymetrycznej trojplaszczyznowej mobilizacji kr~gostupa ma znaczeumllCV wptyw na zahamowanie progresji
w skoliozach idiopatycznych szybko post~pujqcych
bull Mobilizacja strony wkl~s~ej skrzywienia i osiowa derotacja kr~gu szczytowego zwi~ksza korektywnoseacute skolioz zmniejsza garb i ebrowy poprawia obj~toseacute klatki piersiowej i zwi~ksza wydolnoseacute oddechowq plue
13
bull Przedstawiona metoda jest
stosowana samodzielnie lub
w pO~qczeniu z ortezq Checircneau
a takie jako przygotowanie do
leczenia operacyjnego
Ocena progresywnosci w badaniu elektrofizjologicznym
odruchu z odci~zenia
i~middotmiddot ~=~-~ shy1 _--==shyocirc
14
EUT S pine J (1997) () 93-97 copy S pringer-Verl ag lY07 ORIGINAL ARTICLE
K Dobosiewicz Neurophysiological mechanism of the unloading reflex as a prognostic factor in the early stages of idiopathie adolescent scoliosis
Rcceivcd 29 M arch 1996 Revised 16 August 1996 Acccp tcd 10 Septem ber 1996
Absfract This paper presents a new nc urophy iologila1 methougrave of e valushyati ng the risk o f p rogression in ill ioshy
mo t important factors in the eva luashytion of progress ive id io pathie scolioshysis The met hod can be lIsed to deshy
pathie scoliosis in th early stages uf tll( progre jve idiopath ie scolios is the dis ase by illY middottigating tll e unshy in lhe early s tages of the d isease loading refl ex in paraspinal muscles T he high sensi livi ty of ilie method The study incl uded 394 pat ients wilh means il can be used as a basis un seo liosis and 70 hcalt y chil dre n which to take an earl y dcc ision to
K D obosicwicz Depuumll1 mel1 l of Rchabi lilu lioll Si lesilln Medical Academ y 42-604 Tamo wskie G6ry 4
Lmenty of the unloacli ng retle x and repeatabi li ty o f Ihe rcbound and silent period were anal ysed for eaeh reflex evoked Prolonged latency and
p rimiddotom1 surgery
Key words Id iopathie seoli o is Unloadi ng rcnex Re bound
Katowice Polaml minima1 numbe o f cycles are the Larency Si ent period
T he ai m of this sludy was to evaJ uate the use of the unshyIntroduction load ing Dex for octcction of prog ressive id iopath ie adoshy
le cem oIios is in its carl s tages in onl r to lake a dccishyProg ress io n of id iopatJl ic scolios is bas been the su bject of
sion ta perfo nn surgcry as soon as pussible many clin ical radiological and elecrromyographic in ve~ shy
tigalions T here is ho wellcr no sim ple quantita ti ve or qual itati ve pro noslic methoo [hat can be em ployed in the
Materials and melhodsearly ~tHges of the disease Monitoring of lhe unloading rc felx in paraspinal m llsck appcars 10 be a reliable Inv gtsi lgnlions were carricd uut 011 394 pa tie nt with adolescent method o f discriminating bctwcen diffcrcn l fomls of Cushy ~c li ed J ild 70 hCldr hy children The scoli osis group consisted of Iios is T he un loa ing re n cx can be evokcd in ail the 31 1 g irl s and 83 boys aged 9-1 8 year~ (mean age 125 ycars) The
ske lelal muscles through a suegrave den shortening of o luntary contro ls wcre 0 girl s and 10 boys aged tO-1 7 y~ar (rncan age 128 cars ) Imong Ihe stlbjeclS tudied wcre 9 patien l w ith cershyinnervated muscle l2~J When a musc le is unloaJ ed vico-thoilc i seo liosi s mean Cobb ang le 22 7deg 121 with Ihoracic
rapidly durin g an isomerric con trac tion Ihe norm al reacshy scolios is mean Cobb nngle 309deg I 1 w ith thoraco-Iurnbar seolioshylion is an eleclrically silent pe riod fo llowed by a burs t o f s is rne ~n Co bb ang le 26~g o 63 with lumbar cotlos is mean Cobb action potentials called rebmmd The pause in d ischarge ang le 279deg and 90 w ir h doubh major curve sc o Ii() ~ i s meull o bb
nng le 292deg and 28 5deg The sludy group includcd 231 right -s ided can be observed only when a certai n h reshold va lue of and 163 left-sided 5col iouumlc patien ls There were 112 patients w ith
acceJcration flnd shortening of he muscle is exceeded progress ive id iopath ie scoliosi (76 ri g hHidtd and 36 Ic 1t-s ided) an tl il occues wilh constant latcncy correspond ing to that 182 with no n-progressive idjopa thic scoliosis (1 13 ri ght- sided and of the propriocepti ve nflcx (9 18 20] T he rebound ufter 6 le rt-sided) M d 100 w ith pe lvic tilt (statie) scolios is (42 rightshy
s ided anp 58 l eft -~ i(kd )the silent period in the unloaugraveing re felx rcsul ts from ae lishySC9 1ios is is consIcircdered progressive if the Cobb Jngle inshyvalio n of a pool of motone urons aIl o f which fClt1ch lhe
creltseacutes by more lhan 6 in 1 yen r aile middotnl1 n-progrcssive if the anshyfiring thres hold simultancously afte r prcviou~ si lenœ [l nua i increase is less thll n (i The Cobb angle ranged lrom 8deg to 77deg 1 4 201 in Ihe palicnls w ilh progress ive scoliosis (mean 361 ) [rom 30 ta
lI f R (on- f Rt tt1IY 1lIfl pflla 1 )(~ r(Jnu n t shy
fI) _ ~
Pathomechanic basics of conservative treatment of progressive idiopathic scoliosIcircs
according ta Dobosiewicz method based upon radiologie evaluation
Kryslyna DobosiewlcZ Jacek Dunnala Kny ztof Czemicki Hanna Jcndf7cjek
Deparmem of Rellabtlifatoll Mediw Uninrsity ofSiltsia KatOllice Poand 40-635 Katowice fil ZiUCl 3537 POL4ND
e-mail relwbilitacjt1s11mfoctaonetpl
Abstract Conscralivc IrcalrnCnI of Idiopathie scoht)~1 espcclall y kinc ilhcrapy i ~
nOI widcly apprccilllcd due 10 Ils suspectccl low dfcCIIcircvcnc 5 in relalion [ (1 a urglcal Irc[llment ACter long-ycar il ses ment of palomcchanic f scolio icirc in Dcpanmenl of Rchnhllilallon f Mclii al Unlcrsi ly of Sile bull a concTvallvc mcthod ()f IrCtllmenl asymmclric Irunk mobili7alion in lnclly ymmelm po~itions WIS
de el ped_Thi mClh d enablc 10 delain pTogression f scol iosis or ccn de middotrca~c laIerai urvalurc of a spi ne and angle of rOlllion assummg adequate () perallon f palicnl and ilS famil)
J Introduction
Idiopathie scoliosi OS) is a thrccdimensonal dcfonnation of il vertebral col lmm an- cntire trunk Afler many years of extensive rescarchcs the cause of idiopathie coliosIcircs $ i remaIcircns unknown It is possible Ihat idiopathie scoliosis devel ps and progress on a baslS 0- ~
multifactor disorder perhaps diffcrent for curve initiation and curve progressi 11 Fion poss ible pathologie factors nervous system dysfunctIcircons affecting postural tquili brium ar proprioceptive control seem to be espc ially important [ l 2 6 JI Pro_ ression f iS could bot delermincd by vertcbrac remodeling under eccent ri c loading created by axia lly ce gravitational forces in presence of muscular imbalancc in the trunk [2 J The verte rai colwrz unde r scoliotic conditions 15 an unstable system with tcndency to fu rther tune dcvelopment fl2] Lateral bending of a vertebral column visible in X-ray examination L
only a two-dimensional prcstntation of a complex dcformity consisting of patho logica axi rota ti on torsion and othcr deformations of vertebrae [7 8 10 II 14J ln fS physiolog~ curvatures of vcrtebra l column are disturbed Total Icngth of an anterior column of a spi n~
consi ting of vertebral bodies and intcrvertebral dises bccomcs grcater lhan length of l posterior colwnn - vertebral arches and proccsses [11 15 J h is apparent that phy iologi ~
thoracic kyphosis in rcgion of a scoliotIcircC curve diminishes Each vcrtebra of a stru tu ~
urve of coliosis is oricntatcd in hypercxtcnsion in relation t adjacent vcrtcbrae [7 l resulting
1 n B Uri middota I l 11
H srut ft illtf j tI) t li orf1Hli d
IDS Prt ts 21)2
Influence of method of asymmetric trunk mobilization on shaping of a physiological
thoracic kyphosis in children and youth suffering from progressive idiopathie scoliosis
Krystyna Dobo icwicz Jacek Dunnala Hanna Jendrzejck Krzysztof Czernicki
Deparrment of Rehabilitation Medical University ofSilesia KaloKce Poand 40-635 Katowice ut Ziolowa 3537 POLAND
e-mail rehabiliracjas(u1poCmiddottaollelpl
Abslract Idiopathie scoliosis (lS) which i sub 1 ntially l threeshydimen ional derormation or a pine cau e nOl only laler l curvalurc and axial rotation of vertebral column but al lordoti allon of VCr1cbrac in structural curve eXl nsion ln an effect physiological thoracic kypho j diminishc or cvcn dbappears Method of a ymlllctric lrunk mobilisation in strictly symmetric po iljon according [ Do () lewicz not only dcteriorme progre ion of IS or evcn reduces lalera] curvalure but also significmtly rebuild physiological thoracic kyphosis Icircn cases of lS accompanicd by lraight baclc
1 Introduction
Despitc Ion year researchc etiology of IS is nOl yel resol ed Significant problem re laled lO morphology of IS apar1 from lateral bending and ax i 1 r tati n i deviation of shape of a spine in sagittal axis affecting physiologi al curvatu re of vertebral coJumn [3 5 6 8 9 J 0 1t 12 Lcngth of anLerior col umn of a pin constitutcd by venebral hafls anugrave intcrvencbral dises dominate ovcr Jength of po terier c lurnn buill from vertebral arches and processes [lOJ This condition uring scol io i progress ion and growth of a child effect in hallowing or even disappearing of phy iological Lhoracic kyphosis in scoliotic region It i well know n lhar cn~brae of structu ral Jaleral curve are positioncd in hyperextension - lordotisation [5 6] which in Lhoracic region Icad (0 reduction of kyphosi or to true lordo middotis Such kind of venebrae relation in thoracic region cau es ilS destabicirclisatIcircon whi h in u sociation with eccentricircc gfilvitali nal load fa pinc duc to muscu lar icircmbalance [21 pOdbly produces r tationaJ lordo is [56 Il] and further development of symptomatic scoHose ft ha becn proven [12J tha strengthening of the erector spinac muscle aggravates nce initialcd deform tion and deteriorates coliotic process Hyperextension and uxial rotati n a s clatcd with
357 Th B Grivas (Ed) Research inro Spinal Defoml ilis 4 lOS Press 2002
Exercise efficiency of girls with idiopathie
seoliosis based on the ventilatory anaerobie threshold
Jacek Durmala Krystyna Dobosiewicz Hanna Jendrzejek Wieslaw Pius
Department ofRehabililation Medical University ofSiiesiaa Katowice Poand 40-635 Katowice m ZioJowa 4547 POLAND
e-mail durmalaiacekyocztaonetpl Department ofPhysiology Academy ofPhysical Education Katowice Poand
Abslract The aim of the study was to estimate the exercise efficiency in the group of
girls with idiopathie scol iosis based on the venlilatory anaerobic threshold (V AT)
Material and method The investigation comprised 58 gi rls wilh idiopathie scoliosis
aged 10--6 years 32 girls (55200 ) wilh double major scolioSiS and 26 girls (448)
with single scotiosis The girls were eonservatively treated using Dobosiewiagrave
method The control group consisted of 3 1 healthy girls aged 10-1 6 years The
cxercise test was performed using eycle ergometer During the exercise the gas
exehange parameters wcre reeorded (minute expiralory venlilation minute oxygen
consumption earbon dioxide production) On the basis of recorded paramcters V AT
has been computcd using V -si ope method Results The following V AT values were
obtained in the group with scoliosis 207+305 ml 02minlkg bm in control group
219+350 ml 02minlkg bm The differences belween girls with idiopathie scoliosis
and control group were nol SLaliSlically significant Conclusions I The exercise
effieieney of girls with idiopathie scoliosis conservalively treated using Dobosiewicz
melhod is normal 2 Such high level of the exercise cfficiency of the studied group
probably was due to intensive 3-D respiratory exercises of these girls
1 Introduction
In practice there are researched useful efficiency rates which on base of laboratory tests results possible easy without using of the relatively hard or long exercise tests would give the belter forsighting of the range of homeostasis disturbances and rapidi ty of increase of
physical fatigue during varied workloads [1] The best known rate of trus kind is the maximal
minute oxygen consumption [2345] During progressive physical effort minute oxygen
consumption increases proportionally to workload The reaching of real maximal minute
oxygen consumption in time of progressive effort is iodicaled by minute oxygen consumption plateau [5 61 This result is rarely registered in children The progressive exercise test is most commonly used in children until physicaJ exhaustion and the highest registered minute
oxygen consumption is treated as maximal minute oxygen consu mption or so-called
symplomatic limited maximal minute oxygen consumption [678J Sorne authors regard
Orto-dlet Trau malaogis Roha b ilitacjaARTlKUL ORIGINALNY ORIGINAL ARTICLE Vol 5 Nr 1 2003 80-85
Jacek Durmala l Krystyna Dobosiewicz l Tomasz Kotwicki Hanna Jendrzejek 1
Katedra i Klinika Rehabilitacji Slqska Akadenia Medyczna Katowice Katedra i Klinika Ortopedii Dzieci~cej Akademia Medyczna PoznQll
Wplyw asymetrycznej mobilizacji tulowia na wartoseacute k~ta Cobba i rotacji w przypadkach skolioz idiopatycznych u dzieci i mlodzieZy
Influence ofasyn1n1etrie 111obilisation of the trunk on the Cobb angle and rotation in idiopathie seoliosisin
children and adolescents Slnwu kluce ac eJJic Cl chOlIU) Ice SKoio= idj)PO Imiddot(~I7tmiddot
K~Jmiddot w()rus consrieI ve I (OtlHelif idiopathie HUW JS
SUMlvfARY
BackgrouId The aim ofthe stldy Vas Ihe radiological evaluation ofthe treatllJent ofthe idiopathic scolioshysis utilising as)mmetric trunk mobilisation in the strict~ll I)mmetric illitial position
Material ([fJ(f lIIellOds Presented stud) lOS based IIpon J36 cases (13 oovs oged FOf11 ocirc la 6 lcars (lild
rn girls aged frum 6 la S pears) trealed due to the idiopathie sCuliosis ((rom Novell1her 999 0 F enflfUn 200) Among 48 ch idrcn sllfJering from dOlfble-major scoios is 6 cases wcre infoll scaliusis JOjuvel7lle und 22 adolescent Among 88 sillgle scoliosis 6 lere infw7t 33 juvenile and 49 adolescent
Radiological exami71ation 1as condueed always in the repeataole technical cOlldiions RadlOglOlI1 lier evaluated oy the same physician Radiologica analysis oIthe scolios is incuded value ofthe Coho al1gle ongle ofaxial rotaion
ReSIils ln double-major scoliosis observed dlring one year period in Ihe thoracic segmenl Cobb angle decreased inll l increased 1395 and in 292 Il OS 111changed Axial lolation angle in 167 (~rcascs
decreased in 354 incrcased and rernainM the sorne in 479 In Ihe llllnba segmenl Cobb ang le clccrcscucirc il1 354 increased in 39 6 remained in 5 Angle ofaxial rotation deceoscd in3 ofca es incrcuscd in 29 and persisted in 48
ln single scolio is Cobb angle decreased in 386 incrcased in 353 and in 261 was lInchonged Axiol rotarion angle in 216 ofcases deceased in 295 increased and rell1aincd the sallie in 489
CondlsioJ Asymmetrie mobilisation of the tf1f17k in strictly syl7111elric initial positions is a 1Clhod of choice in the cOl7senJalive treatment ofthe idiopathic seoiosis
STRESZCZENIE
WS~p Celem pracy jest radiologiezla ocena Icczenia skoiloz idiopaf)cznych metoda asvmetrycznejl7lOoili shyzocji tllowia w sciSe symetlyczl7ych pozycjach lV)jscio wych
M aterial i metody Przeprowadono retrospektYlIl7q analizri 136 przypadkeacuteM dzieci (13 chlopcow i 123 dziellshyczqt w wieku 6- 18 lat) z bocznym idiop atycnylll skrYll ieniem krrgoslupa leczonych zachowawczo w Klinice
1
Ortopedla TliJumatoogia RehlblllagraveeJa ARTYKUL POOL1 DOWY OPINION ARTICLE Vol 7 Nf 1 2005 49-$11
Krystyna Dobosiewicz Jacek Durmala Tomasz KotwickP
Katedra i Klinika Rehabilitacji SIAM Katowice 2 Katedra i Klinika Orlopedii Dziecircej AM Pozncrlz
Biodynamiczna metoda tr6jplaszczyznowej korekcji skolioz idiopatycznych - opis metody Biodynamic method for 3-D correction of idiopathie
scoliosis a description ofthe method
SIOWQ kluczowe leezenie zachowawcze skoliozy idiopatyczne korekeja tr6jplaszczyznowa Key words conservative treament idiopathie scoliosis 3-D correction
SUMMARY
The biodynamic method of hree-dfmensional carreeion of idiopathie scoliosis is based on Ihe palhomeshychanics of idiopathie scolioiiiii and consiss in aClive segmental three-dimensional correction ofspinal cllrshyvatlre The course of action focuses in the viciniy ofthe apical vertebra Proprioceptive facilitation is applied on Ihe concave side ofthe curvaJure and exteroceplivefacilitation on the convex side Correction likewise proshyprio- or exteroceplive facilitation is phase-oclœd with asymmetric respirarory movemenr as weil as wilh parshyticular phases of the respiratory cycle ln Ihe course ofexercises three-planar movement is generated opposite to the direction in which scoliosis Is progressing This method is in accordance with the stale ofthe art ofscoshyIiasis pathomechanics The method requires detaied training and can Ihen con be applied at home under periodic control by a physician and a physiolherapist The method con be applied in landem with a Cheneau brace as weil as in surgical pretreatment A elaUed description of Ihe method of three-dimensional scoliosis trealment will be presented in Ihis article
STRESZCZENIE
ISlofa biadynamicznej mefody Ir6jplaszczyznowej korekcji skoioz idiopatycmych oparlaj est na patomechashynice iikolioz idiopatycznych - poega ana na czynnej segmentanlej tr6jplaszczymowej korekcji skrzywienia Dzialanie koncentruj e siccedil w pobitu Icrllgll szczytowego sknywienia Stosowane iest bodicowanie propiocepshytywne po stronie wklllsej oraz eksteroceptywne po stronie wypuldej Korekcja i slosowanie bodicocircw propioshyi eksteroceprywnych zsynchronizowane j esl z asymetrycznym torem oddechowym oraz z poszczeg61nymi fazashymi oddechu W trakcie eacutewiczen powstaje odwrotny do lrierurzku rozwoju scoliozy tr6jplaszczyznowy ruch IcrFtshygoslupa Melodajesl zgodna z aktualnym stanem wiedzy na lemat patomechanizmu scoiozy nymaga szczegocircshy100-lego instniktaZu po clorym mote byeacute wykonywana w warunkach domowych Z olcresowq kontrolq przez leshycana i fizj oterapeutll Metoda mote byeacute stosowana r6wnolegle z leczeniem gorsetem korekcyjnym Cheneau a talcte w przygotowaniu do leczenia operacyjnego slcolioz W pracy przedslawiony zostal szczeg6owy apis meshytody leczenia
Skoliozy idlopatyczne stanowili znieksztalcenia patycznej rozwija siccedil poprzez przemieszczenie kr~gu tr6j~aszczyznowe charakteryzujltce siccedil wyboczeshy szczytowego w stosunku do krccedilgu g6mego j dolnego niem rotacjltt krccedilg6w klatki piersiowej i miednicy z r6wnoczesolljego rotacjl zgodnie z ruchem wskashyoraz zmianami w fizjologicznych krzywiznach kr~ z6wek zegara dia skrzywienia prawostronnego oraz goslupa w plaszczyinie slrzalkoweJ [ 123] przeciwnie do wskaz6wek zegara dIa skrzywienia leshy
Z punklu widz nia patomechaniki tr6jplaszczyshy wostronnego Koncepcja rozwoju skoliozy jako rotashyznowe znieksztalcenie krccedilgoslupa w skoliozie idio- cja i kontrotacja sugeruje ze sily korekcyjne powinshy
49
EDUCATION MEETING SATURDAY 8th of APRIL 2006
- CARDJOPULMONARY EXERCIS E
TEST IN GIRLS WITH
CONSERVA TIVEL Y TREA TED
IDIOPATHIC SCOLIOSIS
Jacek DURMALA Krystyna DOBOSIEWICZ
Department of Rehabilitation Medical University of Silesia
Katowice Poland jdurmalaqcmpl
The aim of the study was
to estimate the influence the conservative treatment (asymmetric mobilization of the trunk by Dobosiewicz) on physical efficiency in the group of girls with idiopathie scoliosis
Material
bull 87 girls with idiopathie scoliosis
aged 1 0-17 years
(mean age 135 years SO 161)
J Durmala K Dobosiewicz 1
EDUCATION MEETING SATURDAY8thof APRIL 2006
Material
bull 38 girls (437) with double major scol iosis (thoracic segment - Cobb angle 18-42deg mean 30deg SO 82 angle of axial rotation 4-32deg mean 21 deg SD 107 lumbar segment - Cobb angle 11 shy48deg mean 31deg SO 128 angle of axial rotation 5shy30deg mean 13deg SO 85)
bull 49 girls (563) with single scoliosis (Cobb angle 11-75deg mean 33deg SO 155 angle of axial rotat ion 5-30deg mean 14deg SD 83)
TIoracic kyphosis of the invesllgated group was 5-39deg mean 23deg SO 86 and lumbar lordosis 16-41middot mean 30 50 65)
Material
bull The 64 girls aged 10-17 years (m ean age 131
years SD 132) were conservat ively Ireated
using Dobosiewiczs method
bull Treatment period ranged from 5 months 10 3
years (mean 148 months SD 902)
Material The 23 girls aged 10-17 years (mean age 136 years SO 108) were treated u sing symmetric exercises - treatment period ranged from 4 months to 3 years (mean 161 months SO 1019)
bull 26 of ail g irls (18 girls earlier treated using Dobosiewiczs m ethod and 8 gi rls earlier treated using symmetric exercises) aged 10-17 years (mean age 134 years SO 108) were twice tested - at first and last day of Intensive hospital rehabilitation (asymmetnc mobllization of the trunk by Oobosiewicz) - mean hospitalization period 20 days (range 18-26 days)
i rf~8f6~~ or~~n~= ~~r~1~r~icircJ~~tb~~~~ mean 17-4 1deg meatl~(I SO 74 R n~le ofax 1 rotatIon 5-25ot mC3 111 3laquo S0 6icircl Ilnd 1 99t1S~ ~~~~I~~~~~$ruo~ras~ ~ocirc~~a~e~~~~~~~5euml1 9middotn~ tUfllbar Iord05ts 16-4 1deg mean 311 SO 68)
J Durmala K Dobosiewicz 2
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Material
The control group consisted of 77 healthy
girls aged 6-17 years (mean age 12
years SD 31)
Material
The examined girls participated in school
only in scheduled physical education
lessons and have not been enrolled in
other sporting activity
METHOD
The exercise cycle
ergometer test was
performed
J Durmala K Dobosiewicz 3
EDUCATION MEETING SATURDAY 8th of APRIL 2006
METHOD
The Incrementai exercise test has been applied
We have found that tests ln whlch the Incrementai part of the protocol ln completed between 8 -12 minutes duration glve the
bullhighest maximum VOz in normal subjects
METHOD
The workload was Increased stepwlse
bull by 10 Watt every minute - ln chlldren
with high ~ 135 cm
bull by 15 Watt every minute ln chlldren
with high gt 135 cm
METHOD
The test had been contlnued untll refusai of the patient or exceeding the pulse Ilmit
Durlng the exerclse the gas exchange parameters were recorded by Jaeger device model Oxycon Alfa uslng direct breath-byshybreath rnethod (with face mask)
J Durmala K Dobosewlcz 4
EDUCATION MEETING SATURDAY 8th of APRIL 2006
METHOD ~ ~~ r 3 min 3 min 8 - 12 min 6 min -~
_ 0 rpiYJ 0 rpm 60 rpm ~1 30 rpm
_ t o~w=att~o~~na ~~ att__~ tl~~S~~ l ad l ~~~~~r o~w= Hlcremenlal t
pedaillog i i ~
~ ilt ~I~-----tl-~ I t ~ i ~ lOSt sffortivB
lW r resututlon r rm-u middot 1 - bullA~cremen tal ~~ ~ ~ ifr- ~ VtI 1 ~i ~ tllng _
METHOD
On the basis of recorded parameters VAT
has been individually computed for each
child using V-slope method by
Wasserman
METHOD
For assesment of physical capacity
the maximal minute oxygen o
consumption (V02max) ventilatory
anaerobic threshold (VAT) and
maximal workload was used
J Durmala K Dobosiewicz 5
EDUCATION MEETING SATURDAY 8thof APRIL 2006
RESULTS
Ali girls with 18 have been classified
within normal range of predicted
values of
bull maximal minute oxygen uptake
bull VAT and
bull maximal workload
RESULTS
The differences between group of girls
treated using Dobosiewicz s method and
group of girl s treated using symmetric
exercises were statistically significant
Lower exercise efficiency of girls treated
using sym metric exercises has been
observed
RESULTS Girls wilh IS Irealed using
N=87 p value
Dobosiewlczs method N64
symmetJic oxor-ci Nz23
Perœnlage of predicled vaJue of
maximal minute oxygen uptake
98 905 0033
Percenlage of predicled value of
VAT 97 933 0049
Percenlage 01 predided value ni
maximal workload 101 939 0038
J Durmala K Dobosiewicz 6
EDUCATION MEETING SATURDAY8th of APRIL 2006
RESULTS 26 girl s twice tested - at fi rst and last day of intensive hospital rehabilitation
The value of ventilatory anaerobic threshold increased during intensive hospital rehabilitation (asymmetric mobilization of the trunk by Oobosiewicz) statistically significantly (p=00019)
2047 ml O2 minkg (SO 268)
vs 2239 ml O2 minkg (SO 232)
Conclusions
1 The exerc ise eff iciency of girls with IS treated by asymmetric exerc ises of Oobosiewicz is norm al
2 Such high level of the exercise efficiency of thIcircs group resulted fram using of Oobosiewiczs method
r
J Durmala K Dobosiewicz 7
REVIEWS
Role of physical exercise in tbe treattnent of mild idiopathie adolescent scoliosis
Revicw of th- literature
A NECRlNl N VElWNL s PARZI 1 A NEGRINJ 5 NEClU NI
P1t~silillxlrd~ Ihcrapy (or klucgtlttlwrlpyl i pro shy-tJm of physka] cXlrd-cs ipcci I(a~ (IJcloJgtcd hy l li trIWlltl phrslollwrapbt wilh tb m~ln a1mor pl shyVCnI in lhe ilAAfIVltilH1 llf the ucirccfonuity III mild IgtC )
Lil1Si bclpin~ thebm ( aocl co uaufllclilIg ils ~jd- clf IS in nlOdlJmiddotnh-culiosis Th middotalillofthi paper ito r (W
Ille Ii lc ram r 1 a-ccrulin wh kh of Ih bull Lu[Jalmlcrus Ind (Lb hili til~ CLlLt-cd br scnli()si- clluld bl pl Y nlcd or r d uccd hl phylolld LXtmiddotrdsi n Il p--to-da le knowl Uuml~l nr tIll~C aspcc[~ i ne bulled in oruer 10 dndc whclh~r 11Rf blLl adcqlmtt Ib(uuml n middotlicaJ balis fo r ora)aini l Ihe US4~ of lUgravellgtitlerap) wltcllj(r or fln l th e prtl1iœ of kimiddot ~lre IUlll poNjn~ a t iil ies ~bould h allowtcI II uuml middot c enliaI toltlentlf)wh k lu alClor ie - lf pl lr~kiJl -c rmiddot d gtlt- (Ic rnnhi UzJ( inn ni (t hl HrJltlon [ rtn~hcll iJl ~ or 1i1J(IChIumlJlJt etc) Sh llU Ld be TolullllCcluse ulemiddot l onld b- clclIimcntalancl wukh sho ll ld he IJlI-n~ifl~d I~~a l lhc (o uld h 11lfu 1 Know k dg CJnc1in t (wIn SeiCIImiddot Hlk rCS([lflt h daw ccordinll to Ih bull llVit w o f tIlt iii 111 1( plop(lsltd in (h i papcr lmiddotonllmJ l lnl plLyi 11 cxcr(j$( pn (nti or (tmiddotduce dhlblli t ic 1 ~lt Il Jj ll(k pl ti Jlt fadl j w(~ the nlIIIrl li7alinn n f poMural dd shylitS tu p n xJ llc aSl COIlMqnen c(middot 1 all )llal) or r(tn~ shys i middot middotlIrve Tilt u~c (I f appn1priattmiddot kincsiuuml wrlpy 0 in rcns polttllcal swhiIHy Icirc IIHmiddotorc Illta ll y (0 r 1(lt1 lllho UAh mon ltlccurlltc 1Ut dl1alkd -rLk l(lWfils 111111 )11 h Jlccdt(
11) wurcJlt 0 lit)-IcircS (Iumpy - x rcLs P()lun
n rllt lT(ltnklf u f COll1tlK H (rtd) I 1i plfho l og l ~$I rUlglng tr m low tmiddot k Pl 1l1 to IdiOpath ie SCUIshy
Submitt(oJ [or PUhltCl l1 011 uly Tt 2001 Acc~pttJ ugu - ~2 1(t-1l
Addre rltj-xlfll telt~I(middotb If) - grinl Flt(1(bziurllt r )(m Ofl ()(Cl1I shy Lt middotqlltœlll ro () - 1u I4t agravehLIlKil ta IYIL-lTt ilSllltp lfllmiddot ~ 1l1uumldull
CelII ~ (niiOS I I~ middot ann (1) IfUh middot lIlfU di louhilll(tymi ( Nlmiddot ~iI rli -ilIIUmiddotltlfl
Nlti(ir 1( ) il r() (ltbullagt1
lt vLL_ l IiII no 1ftfI
jS ) we are a IUil ly tJc ing n1n) ltblll lS 1 k l1 b ~J)w in~ tl~ t S Jfll l approad llt - l1n til hy on ielshyertd ~tan lard ugraveJuld ln m any ~1~ he lI ~t les i if Ilot dange r )ll lt rhlS is lrut of reil l lnw 1gtlt1lt1 pa in l ~ or 5urgi c ll lrea lmltnl5 in dbc r lmiddot ll Sc - 2
ln tlle cj-e ut ~ t lll(tlWtl i( li p l ll1JC luuml- I ~ middottnl ~() shyliosis phys cal ((_lt1(( is emr1uved ltI t()fIl1 0 lh~rtrv
lo ly in cel1l in L)lllllde (nluumlnlr in tilt Lltlll middotorkl i e Iw l) r llt t Srain hUI IIgt() 111 Gert11lny 5- 1~1 in other reg lOl1 wbere thi I-incl qf tre l tm e rll 1 p~ 1 pmiddot t 1( cI il Jws Ixen cri ri cilld md rel -cltd Lw m~lI1 1 11 Jlu~ Fue Fnlny r ~lrs thio middot15 a lsgt(ru( f ~rth r -~ltc rrJtf))~ ll t vit11 br1Cltcgt b r II1 ([C Llt n ClW grmvlng 1lt1 0 L Sti g
gcsti n the lIsefulnes- u r Ih is form o t treatm n t 1
Hmiddotu]rs have nerged jn El or uf pll y~ iLd eegraverdse eacute 00[ 1 but tlw are nUl yel 11 11 t llu i vIC~11 and r hi ~
f rm of trt ~ltmenr IS stiJ l Ul1 ckf ckhate FfI t Jt 111 il i 11t (eltary td 1I iFy 11umbtr ot
b l sic COI ceP rlJ lf w ill he cIh tt d in t hi pap r
Scollosis
DCijIrI iriolls
ScnUoSlS is Irlircc c1 lme nsIcircltnal (I(gt i l cj on ot tht spinc thar cau C a CU 1 lh lt ca n h e $ t~en ln (1 me1Sshy
ured ultinF Coh) lll ltllCXI o n HI anreu middot p rtc rilt r
EUJlOI -1 lœDICOPHYSlc~ IR
NECRI Nl
110
f)i)
1 7J
amp aS g 5li - 0 v
V
31
10
(1 1) Il 15
-tc i ytjtr~)
FigJ----jllph ot DlI w l-lkaupegraverel) The agloimvltltinn Or idio r lrhlc 50gt1iflll~ IS rpiJ bel~ en th e- [l0 IH P (l)ltg tnntll lol (JI PUllcmiddotny) mtl 1 ( f( lS-er sigll paiilivltecirc lt Dlt(i I1 11illg r the iti l 1Kgt n n t rll icirclicH a ) 111lt m omal prebulled the mno rche md ociks with lll I)ttlx flal gr Ih pll fl
rlcljoprdphLi 1 hl merl prestIK ~ of this curvt c10es n t autom~l ritllJy indi ate the pn$CI1(t of a defurshyTnitv (SlllKtUrd (Unel
It i~ possible tu clil1e ren tute a struCnlt t CI1tve fruIn a pogt urll 011e by identifyi og the hum]) du ring AdIlns tesr I~OQ looklng tra m beh lnd at the p atient w ho b benchng fUfward il is p -- ible ta d d~ct 1l1 eh ucirc n of o ne liidlt 0 1 the trunk usually n n the (onvex ~ jde ul tbe radiographie CUfve Ugrave1lr C Ul be mlt~I Slred lISin~
BUlln els S o liomere( 1 ~ l This h Uf1lp is du(- lO (Ile pregravegtecircn ~ of vertel ra i rolltion 1c1 Ollt tn tic f~YJ tllre o f the def trrnit tli [ c m be seen and measurc(i v ith Perddolles lb lsLometer on an amero-Ix)iferior radioshygrapb ~2
Seven ry pel cent o f li Ises a re conid 1lt 1tO be idiopa thie 1 bull ia l-nosilt in this CI$C is b exdlls i ~ n as idinpa thlc me-us t11H wc do n()[ know rJw origio of lheacute curvc [n othe] ~Ie$ it b Ix )~i ble ro ide nrify a dieak (bat CHl jusrify the c1etgtnniry slIch a rna lfo rshymar i ns I1(gtufol Ig ic~ l or genlttic cl iscas s Glnclt~r trauma etc )
[dicirc)parhk S(oliosis has been divicled ~(corcling (0
the ~Ie of tlie patient egrave1l the tiJ1ll of d~[ccli n of the condil ion into ti) ur t ypei ln fanUlc jU nik ltldolesshyccnt lnd aduh Til l m n st cnnunon (VPC IS the acloshylescegravenr o licirceacute I1IJctenzec1 hy 1 sud le l1 tggrH3l ion uuml uring the grow tll Spllrt (Hg 1)2
lhile p tu 1l sco liosi i5 Ycry lomnw n thl pre shy~Iknct ra te f r adole ent icuumlop~lthic structural CU IY~S in sch )o chilclren are 18middot20
- 10 Co bb d~grels o r m on l -lil
- 2) ~ohh dtgreclt or mort O 2~j - bull () (obb d gre -s )1 mOfeacute ()ll 2
Clin iltI [ d e isio ns lfl IXlSed 111 an lccu r~He pregshynosi which obt inccl in eJch pa ti nt mainly o n the basi of the nsidu~ll p()tlnllltl l of TH1h and the result s of 1 rh clin 1 1 ~l1d tadiogmpl i exlminashyti(ln12ll c noieq uentlya d inica ] la sifiou io n o f the ing le pHient tn -ome estent co incic1 ing w irh the
D diographic one c l n lw SLlIl1H1arizeci 1 1 folIcJ - mikl lc~ (1)(n 20 C bh de~r es - moderJt l betwlen ln md 15 ohh de~ rtes - StV re 111( gt1lt rh n ~J) )bh (kgf s
On the 1) lsis of [hi - dinic d d a lfic t i n (Vith l1l il el lrb tiOI ~ o f the ir b() und~ri e ) in Itllt l cente rS Of SCOtiO LS ITe ltlllent in the Lltin odcl (i rJ Ital lnmct md PI iJ Ugrave tre tmtnt i s plmmcd a fo lltJw 8l
- mild kineslth e (~1fw ~1Il (1 luok-ou t - Hl demte IJragravecegrave 1111101 c(~r md k i rws ithe lJpy - ~cven surgery
Physical exe rcL~e for S(ol iosis
Defi t tiOl l S
PhyS i 11 nU b lIKrlttp middot (or kines ithcIa Pl) i a p rvgrlill or plt~i Gl l (xeriltecircS ~1ci fi ( llJ y ltk ~ loped
y a -11 [ru ine 1pll yslo ther3pisr wirh th e m 10 Hllll
- pre (~ n tit1g tlc aggraaLion of the cl I )flnily in rnild bullcoUm is
- helping tlk Il ld Ct ~lOd ounter~lCtjng its skie elfects in III de rltegrave sc li sis
Tn tl1i_ feSpec1 kinesitl1ert py f JI s oliosis is tonshysider l a o on of peciticcedil training and s genecirc tltllly proposelt in sessions 0 1 4~ ro 60 minute IW) t) tour limes 1 Cee PhysiGtl exerci es can aLo ll v o ther auumlns 1S it oill he dise Issed in this plper
Ir 15 Ilot possib le to cl escribe a single progrlIT1 o r exerc ise a5 pro nrams ale USLIJUy p fgt nll ized ( ( lt
EUH PA ~illDI (DP1I YS IC~ 182
ROlL UF P l 1YSICAL lXl 1lt 1~E IN l IlE 11 ~l) IEd If IlU) l[)VP 1HI AIJ() J)~Cl~ r COl ~I NlG1W il
f)( 15 egraved ( )Il the nee L- 01 indi iuua l pJl itnts) al l l10ugh Lheacute) C l n h t 11 plicd o n a WOU p hJ~js (-1 (0 () pnients PC[ ~l ()lI r)middot lugrave reQCf lhese 1 10 grl lll frequt ml~ V IIT
hnm on in middotituk w allClthltJmiddot -Ill Jnv L l~egrave at Wc w Ht ~huw in lhis lyl peJ it i~ 111 n u -eII1 tu id e ntilv kirK itheJapturlc aims w hitl l ucircrr~spnd LO ugravelt~lil1 DUtshy
g X ir ur ph -s ici l lxtTi~l I~llhe r thln ln dj( us- indishyiJ u1 1progr-lfll
Aduumll l lxUl kisure time ~lOd h )u] Sp u lllll8 ~Ilttishy
i lt egrave~ i middotomm )Ly s iven lel mJ ing ro w hlf ~ Iuumlnsidshyer~d usdul or il lrmfu l in t1 lt rruning (lI tJw ptliJicirct ln tl1bplper Ugrave1 gent ltl l t rl ll bull p lwsiCUgrave lttG iviUes is rl ktll 10 JllI1ltlCc hOlll gtpOlt mJ kIJ1lsIcircl hc lJ l f
i ve lUen tloneumld )bo C on lv ine n dul( re Ull~ 1t~1 t s far Ilten publislt d f I~ mJ I(i noltgtithltl rgt is 11 11 a su h jel lnI deacutehate CJitk haltlt t llltit m itn ltl of l ny lorm o t p l1 ySiClI lxrcL e as a Itwr1 [ J- fo r i liopa tb il jcoJL~b un iL ()ri gin~ initial1) it WIS Ille r rOmiddotUumlK lt brgdv u f p l~lt titu gtllergt w h ) intervenecl hutll tc llcrl ll (mon as cltl HtilJ nic in terventi n man Jgt
1 t lltrJp utl t one 1 md rC j fkll l~ on rhe h sh lf som uni cOen I1v pn t I1cgts wt ldl hll ltl enl1 JI~ haLl nu na l scicnt lfic baisYmiddot HOlh tlle$( trr t peu shy to rh ~rl py tt nJecI to l~~rJ tte C Ih tk CUf -~ pnnshyclr~tll y as a f tsul t of lilo h llIzatio ll of tn imdqultdy ~u pp rt(d S pln eacute 7~ 12 to re-t1 r rI ltrl 1$ l l1C k o f WH llt~~rdl 10 I ndt~-dll()urnah tnd 11( on1 p~l per u suaJly Cl tc([ IS n prelimmtrf lll d 3 ln tt li w ay man (l rrlKpt(Hc H lf O iS Inll ph ~i C U l ~ d vi ~ cI nllog scnliotl pa t le nL~ 3gainst holll ph lca l egravexershyclc and p()rt~1
It m u st t~ n tfd [hat pllyknl txerc j~ tJe~ltm(nls t1iHer 1 lJ rd il1g r rhe rherlpcu tlC litTl~ on lllc h tJ rgt ap p lolc il l the IXlltent lncl hi im r IIIllHnt i- 1 (1(1 rI - 5lt1J lC igt tIl l ( f phJllIlllolopJ al rrea tmln ls Ihith cllffc r 1lt œQlfd- rhe m C cculc u ~t(l luI thl p al 1t n
~mc l 11i (lbE~e Tt i ~ P ~il k tlwreI[middote thll wuumlk ltlll t kin 1or ph~ i Clt1 1 lX r(j~ 1I 111~ t bc loidvd by t h~ Lo iurie IxujCJ1l al1ulhcr a dl ~IS nJI h~ iOg (1 11shygerols llugJr in racr le (wi ller d I ~fJIII ~ I ml thlls re(nl1l rn ndc(1
fn n UI cel1ll r we In(~ hccf) using 1 ) 1 1111 11 ve ) 1 (J p lw l icd ex(r(i~e (0 J ( 1I l tt i~ tlh aITt ~ l~d Ilv m ikl tru cflumiddott1 adokscltnt (cl ioj arh lC icoli is11 2)
ina the f U~ t rc-gt uJrs IefC pu b lishe - the pJ( )grd m 11lt1lt l1te n PWltllk d in fa c t deel()pnlln l~ in th t l itshy OlL1Ii in tl1 r b t ~() ycal f ha ve iclemi fiecl niO l l
m d 111 ur impl rnHm s md d i s )h ilir i (gt~ lue t idlo p lthk amp()lio -i ~ t Jll CIII he 1UO(l if Icirc 1by phyict1 egrave xert iSlgt l fe t rrncllt
l illl
111e aim of t l1JS r~l per ii tmiddot (tv iew tl1( l iterat urt to a(errl ln v llic ll of th~ impa irm 1t~ and Liit hil it il i GllIltec hy ~ o l i()gtj s -o ull he ll nt x or re middotlu celt1 Ili pl1ysical xerclse An u p-to-da te knOvkdge o f tl lt Lgtpecl-gt i necckC1 in rJeumlr) d -oek
- whetll~r there h ltl n adLtIIl ) l tht()d ical bbh fur or JqIIcirclb l l l1 Il( ) f k irt llit herlpy
- h N I)(1 ( 1 Dm tlle p r l c tIcirc(( o f Jebur tiJne )pOfung lcli v l ti ~ IIOU lci he tllf) -d o
II J U V f h 1 I11~ c~~lb li hed Ihe usefuhlLss 01 k il1 shyc ~thtrpy il i aIle dy l nsi 1([(( -r-tI Llleu i n )I11 plJt~ ut the wJrld ir ilt ecircS~nl i 1 I( id n Iv w l1i li ( 1shy
gories 0 1 pl1Vtl( 1excrClgtegt te D)bilI7it ric 1n (Ir st shylliuumlZltio f) lttlt tlgtbltn ing ni trcrccedilh ing erc) hn Id be
vnlcled he tll rhe nuld be lerrillldll1 1 md whidl s tlQu1d be inreœ jf ic(1 IJeClU~l tlley cOli lel Je LI ~ful
Ncuro1llotor impainncnts
Imv aUl llOr~ 11 lt1lt ~tlKlteJ lhe cltlndatiotl bd Ween tl UC1UmiddotIt t l ol(~C t nt id iopml je -nll ~J~ and cli~l l shyler~ lr 1tH lest ihuLIr yt 1 _ 13 ~ 311 D uhoussct 1
1-- ITS tln l ldiopath k s(o lio-L L cll -c d l J l hmgt in th terl tltr f prop li l l pu n md 1I1ar th e detrshyn Hi n i~ na tural 1 ~ronse to ril e need tu ts tu re p()tun ltlluilib riu Ul HcrmJJ1 31~ 11 () d tllat icliupathic ( liCl5j h l it re5u lt Ot1 rw nltuf mot r l ~ltelV
[Id )fcl 3 nI] ~1ltJ U Sr1lle nr to dtorders in centJtI lO~Cl shyIOIDNur) md 1xi~tI moro (Ul1lfOl syt( llI (Fig _l
N htIll -of) H1c S uumll h( rll1 ( ~ l( w ing JI t11 (oshyI-ie on the l l lO]ugy o b doll (nt Rl iu]icirc tlili- middot()lioL m unt fil t-hltll rhl ugravedcmnilV L th e fl5 ult o f 1 (k btcl 11lIFll llI ion nf som t11(WUgravetltnl md pO~ lur( (tnic l~ l licirc1 tl1lt if l p OgtlbJt b C 1l rlw sta l i lin 0f 11 1 Sf llle j lt g )tx l Tt) ohtil n a ))Cli U 1ILzltl I o f p ~llIr~il d l~flo [ in l1litkd ~J)llnSIS me CI Igt(middotqucnr J ~ a ~tmicirc ()nlly or regle Ie Llive
Ali th- 11yp ) tlw~es rd ~lte tr d irtl Itn t pnl1tlt o f [11 v hole ~piltm It11[ controls postu re ~nd mrw shyment lrre pell ic of tlh po int a d lI~ llv inH llYegraved il i ~ ll 1 nnable tCl aSUilll ri 1l tr l ll1 lo g thi ~ys ttm ( Qu it le 1I middoteli tl
lt ch ugt nlt~(S f rullliIl thil i nlomwtion th at p tlmiddot shyiCil J(tl iIies nw gt Il lInport~n t rr le to pbv [11Icircgt role ca n 1)lt slI i11l1lariztd ln lWO the ptu li ain Llt
- d elopmll1 l of p uumlltl St1 b Hlt ) - c1e veuml IOpm 1)[ o f bhll1ltc _
(k llhUl)lOr S Cll orr
ontrot oic whan-lt
------+ 1 ~ il lnll ugrave r AINnl
Cllnlr1
T bflt~ r
fltL1 tlli
lMini
l
~sary ~J-frlllen i )f
~ 1 ocirctnl
~UcirclllIJJlW Ll
AXl ~l1 n uumll l) r sy 5t ~nl
middoticoltoq ~ Fig 2-AcFgtrdong lU He-mutl 21 il is Fi)5~ ib1e rD prolXgtSlt l -oo ie1 mnd 1 ((if ~ elio egrave middotAhltr~d l)Qdy-p ati~ I I i u d) uren ttllOn k td LO In ~ory reHTt I1 eDi tn l al ) JdrnlV~ pn)4~ e l u r~o(Ofe 0-c1 eptunl dvstil t1 ctlon sltŒ(ry icircltu nu11t ilwnt [ ~mC ~ted tl l1 ce Ill trpntlshyUumlfJJl nd IKnle~ r~dibl jtugrave)n of -I) m tlosen Ir ~ig nj tl (I1vying ln fornll1U n (lI an ereltl ~piJl e Mmor aJJ r--a t ~) n ltgtf ti lt aXljl mowr plem iHUC Wh ~fl Ille 6ubjeco m uumlntl Icircn (1oJifitd perccpfLlI l ~na l ysilt of p n)lnocepti Icircnfu rnlaquol ti desnibJOS ~n t tecr spin A IICW motor co nrro l Ira I gy t adopt resu ltin~ in the ~tr ltctltr 1 ckformh y lf IdiopathirL scollos i=i Ht lrftU1uc nltnt l ISll I1lJy h1e- ~ I pro()und elkn on bralO Sfem flJll ct i(lnn~lLhu modifyRll Ille nltulltgtshytl10 ) 1 1111 Uu l-lHoror control 5~Shnl$ shy
As Srtgn1lt1 l ~ ltlssert~ if wc l C -Cp t 111 1 un o f the G IiC s oliosls L l tisorckr oi th e ltquilibrilltn sys t ~ms it is lagical to oriegravenrate physlCl l exercis( lherap y ln th is d ir(gtCli()[1
11lclte goals Cul tl lfOUgil ditrercn t modes 01 action be Olchic(-c1 witJ1 phykal accivit ie
- po rt ive Cll ities p ro ct LJ e aIl UgravelClltrtsc in 6lte nshyel ll )o rd in~lti n pinai pr0prinup ti_)[J nLi mOVeshyment control 0 vio lls iy ln thh repect ome lCtivshylites aœ pre um~I I)y lXrter tllln ntil crs
- kinrl lira py using pedJil exerCisocirc specially developecl lith th est 1101 5 in mind illVuuml VC I lllore prccilt( ll1d InC1 li zed cri n on rhe spiJw focusing
a90
1 ~~
lg -lNheJo ~1l l1 t r~l g rld in 1 1) h i(~ IImiddot ct r rHienl w i ll idlllhic _It ~i ~ _ iri s plt ~I le II find Jit ltH vlllleuml ~l Cgtbl tn~ ks III d il fef lt p ~ lt ihnS nu v~tl middot B ~a~pt u Il C middotl)Icircd ~(t l l11 C dlfkrCnl middot- hdween slllndi1g Uline nu nllt1Xinul oorrec ri nI t chied Vith Ct (J ) und tfdincJ ne lot es o UIine 1 fo llnVs middotIJfl tfi ni( - ltlrshy
reltiK)n ~ Ikexibiliry st3nucircing - -pirte - f ur~1 1IbjISC ltupin - ltorrcaion - - r~luci()il ll ymiddot For flmpllt in J npK l1 pH k1J il
plt1SSlhlc ln obtai n 10 u1 511ndlt)l [YLo lion yr ln Slt p ille rlOlgt itlugraven om l J ~ in ( gttf(C rigtIl lIex lbuil 15 i (r-l l=22deg pol lltl ~~J IIlpraquo is IcircO~-V- I t1 l nd tucircu(Ugrave) ilil) I~ 3laquoJO- IH-12
r ln Ugravel e abilit jl of tluuml [m e llu to co ntro l irse lr in ~ pac
fuld l oftlles uumlllelve ntio ns can presum1b1r incn~~ Ih enl ac )1 the orller and lHitlll r of Ille rn - 11 )ltd h e lllldenl lu EJ3)4il
Posl1l1-t collapse lnd slabilizariotl
lIle concept u fplt st lUal c(l lJap~e l l~t Iwen detin 61 by DlI II-T3e~tupegrave rL t Ac oJdin)j tu tl1i- ~ll1thor il [ nec(sary ~- l Hn Cv-tlualing th tleihility o f a col shylo tIcircC CUJVL (0 clistingu ih bt tVeen the re du ihil [ty index (th - li iffer gt le bet ~middot Il ~I r~tcli()grJph ie ~xnmshyinltio n of the iI111 pHienr in supine po ition m(i
ROte OF Pl rnmL EŒIlCISE IN THE TREAT-ŒNT OP ~I IJD IDIOPAnnC OOU~GEm seou SIS EltJRINI
I (~)-----------------------~
__ _~ _____ _~ __ __ L ___~ ________1 ____ _ __ ____ ___ ___ _____L___ _____ l___ ----------L ______ _
1 ~
1
-- ------- --1---- ---- ]---r --- -----_----t- ---- --- ---shy__ ______~---- __ ____ 1________ __ _1_ __ ____ __shy
~ (1 J
1
8 =~~=r=middotmiddotmiddotmiddoti~=-middotl--- middotmiddotmiddotshy--------------t----------~- -------- - ------__shy
~---- --- -- -~ -------------r---- -- -- ~-- - -------- --shy----i-------r-- - ---- ~~-shy
il 1~ 0
Dtl-Lmiddot ~ lttj l r~ UIltltlHt
f g 1 -TI1 u ilictf 1ld ( ii 11- ugraveu-sh) ld IX~ O 1d wllich ltJdnrshymII Il nf the pilll 1 ~tln~1 of th e -o lioti( spinc n IG~nI(J II IIIshytt) lhe iJeuml grl-e o f ~ ()Ii ti c (u rvH Il 1 w dcpc-nlknrly o l l he 10 111shy
P01(nl (pntt l ~ 1 1 nr ffll wrJ I) ln w hilth Ihe n i 1gt( ~ duc nL~ grlphs fm I h~lt 111lt hi~hr Iht Col h ~Ilu t (l f Lite ~Ul Ihe m Ol CI il y th t s(uumlJotil middotpin~ ~111 he ~middotJg gr~lVH(~(1
m mJxiTIt corrttt ion wll iJl i~ lIllCd to Ih - xt 1shy
lti Oilil y Jf tl1lt t Ut JO rl1t cdnUc idt md p OS shy
tU ll cul lapse ( th t ltHill enct b-tten l lUdioL) 1lphic egraveltamJl1ltlti OI1 J t th e ~lme pa tient in Sl il tl cling lOJ lline fX-sitiutl ) Wll ic h correb lc- onl wil ll fhe abilt ty of lllt p tu rl l gt s tem to C( lunternct lIk luree o r grl viry )cco d ing rv D lfVd- f3egraveLIprc po st li r t1 lt01shyIlDse is d ue to the Jnus -u lar ton a nd 11ll ex rCrIshy i) i itv of rhe tissus n the ( O IW-) si it (If the (01shyjl ti (~JtVe (Fi~ 3 L Pu~t llr1 C lltpstl lu lcl l ~~ reduc l-lt by llwans o f pl1ysica l cxerCles specitkally s tuclled ruuml i rnprove tIlus--ubr fOHt md lU pr )cllI Ct 1 ~11 hi shy
lizing ffCd
PararcL n tll CIJ cl the cr iti ca l (3 c1 thlsho ld beQ ld Il ich defol1J lHU n of the i pinlt 1 e~ in~ ne dtlllontr~1t _cl (1l ll t grclrf r mg] o f rllt C II in a qa m bng pos ition corn pOil 15 t l lowcr detormashytion lhnsllold (Fig 1) ie to ~11l Ulne3Se t the risk of pr ogr t~ lu n There t rh eJef re l J ea r l)iuuml 1itshycJ l ~ll1 l l(tl a 1 tnr tg ro b ohwined by d -cr t l ~ illg ilmiddot pU~lUrll cull lpse ptJcelJtge w bich lccording t i)
h llTd tnd ~l(heJ1l ~on 1~ b inde cl 1X llt icularly luumlgh Ugravel mllcl c Iio~ i (bdow 2( 0 ) (F ig 5 J
Fin a Il III ch iS respect lllljl hl and b um l 01 m linmiddot
ii iI 1 l _ _~ _ ___I ___ ___ __L ___ _ ___ ___J______ ___ 1 ___
li 1 1 1 1 i 1
1 i ___--____---___----__-_---_~- _ _--_ ___-+----
i
1
i -- ~- -- ---~-----_-~-_-_--_1-~
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i
+----r--------t-------t------f-- J
Fj~ ~-Ac(XjJlin(Q luuml T O rIcd ~lnd Na(h(ln~ n i () dl( pCG w rd (rTIshy
POO ll is hiherin cu rvegt in wh ilt l1lh ~1flILWrd cII1I Olk l1t IS le- pr(v~knt ln th e grtph Ih t PogttJlJ I ugtnq) Ot1 -J1l j elfltS-e J tlt 1l1t obb dirr remc rlLIv obu incu f roll l the Cohb atl( 0 1stlI1dtJ1g IId gtupinc rldo~raf115 Ih Ille lt) [1l1t1 (i lndnl I pine) 511pille the ~(nlClu tJ1 compo l1lnt U rlk CU Y _VeJily I~ ltx p rlt 1 L1v UpUlt (obh Illeturo Ih t si _b Cct rtJeSIm l fie -ltn J trd Ugraveltuuml shyuumlo n A~-i)rding LP 11(lt uuta o n l ( r1I~( in ~I 2JQ sup itlt curvt 1hi C(]l)b ddhccno l l f lO is -J-lultt( thc s ldnd inr tnla Ol1l t lS wi Q) whil 11) 1 1)401 ~llp lne ClHVC If ~ 1Omiddot ( tcl Lhe ttnd trl~ nlca~ I(t I ~ ~I)
tli n ll w l lllE cq lin ti spin h~ i ng mo r ~ Llnt~II) 1 tlun the nOftl111 one n Cll l gr(lk ( (cU ve tl1u n da r u p shy
po rt in o r k r 10 m linrl in tht 1xi11po tuf_ n th ha__i of th egt onideratl lr1S it f(lll() rhJt
ph rH (~Uuml e erd es ulukl h u - ul iiuml tbeacuteY ~U-L lm cl 1l (It-d o pmg p05111 td C Jl1twl lS fuumlrnll~ rly d ccrll1td ln an Ql St if i imr ol1111 t ru t(( - tht m(d in C JI shy
r t t r sture fO Ir -ngthen tlll m u ck-gt of the spint mainl) in (11erl antig r3ilrl tIcirclt l]lli fun ctin ll U hy meU15 dl i )ll1 t trk ~ lhJ cl( -ll tlt C)nlr~lUions ~llld no l IdOshy
1l)llic d YIltll1k lt l jAJ lktic t) I1 ) II 11)t 111 hd posibleacute t lcluuml ee postura l io nrro and stfh ili lllllt IJI
w i thout food T1lw(ull r d I( Lf(11 Ibk t m ucircnuin Ihe c()rf ~ct [ ()S tu re for cl gtu ifKi IH lLl1gth 0f ti l11 ~
This i-l ddl usl a typl 11 dnmnin (tf k inesllh rap) in 11 (lt-11 [[k - p~d fk lnr in lng f u l1a in llllliCk is poss ihle lI sing ctrtain Idncl fJ l (lt) 11111 liun S p Ul in tb is Cl c is ulttful ooly sa I~tr 1~ il Iw lps t1w lxltknt 1 becuJl)t 1gtlt ltlt-I a ClJu~l inred irl ilL ntllru l o~ i cll
and I1lll~lJhl r-keJc LIl [rll-llIn~ middot etlt(wrs JI the int e rmiddot vlnrion
[J ROPA MfJ) I()Wf-I YSJ IR
1
ICR 1 1-1
r
1 shy ~
- shy
11 o-llrfOlhe5l~ o t Ih 1O~(1dity i n h ~ r ~ ll nr pbl1 l of ~ Spl11 in 111011 _llti1Gt l lPt f ltlJUCWJtl ( ~l Ihe Ir t 1 1gt illbll W Ilh LtltrJ1dlion Vln lbe rigronl middotUII~ l(I Dko n12 lIll h lumshydlanie1 1 [ nul 1 M hl whtrc M - gt) lnIUI1g 111laquo111laquo1 1 1 c rtJCshytjC~ f fce d -d Lill l1~ o f enr niI pUll spnmcl1y 1~ 111 mldlll1lt (n the fl1ur t 1 = tor~ of f(ward Ileuuml l = ughtel1lng fmiddotr p 1shynOf stn lClU= Alaquo rdtllg 1raquo Ihl~ - lin hull th l1ltgtllugrave ot tller1l lUr~Jtllrc F the ~pin t -ilh rlu1i tf Ihl 1 1Ibulll n lrlt InltT1 1
rbc prJI 3IJi l1ty d qrlOIJ~ n bull JI t IlJIII Hm lA the v=ltd gtc e lu-ing J 5lnK1ura i ltfnnity
Dioal e ch anicll itllp~lir J11 c nt
Ihrcemiddotdimcllgtional mc-cbal1in of the s pioc
~f Ikmiddot i t i nly l(œ ntly tlHr llk pr-5tnœ or nc ushy1 lnlo tnr impairment in Idiopttlllc s-ol ii IXl tknt liuml J$ heen h i- ll licircghlcJ hy re$eJ rh tll e preit ilegravee h inm b nIcirc Ji d lJutg~ lt hl ~ 1 ng t o n dO Ulll urcel 1 i5 (l lreldv well umlersrood H(j-ev~r nev lbt un h iomcrhankal im l) ion nI h1c rectm ly onk l n tIlt tre and p r~dou in f n rmtinn hou t pl1ykd (~fcl5( in t 11 0 tl1I _ltgt pbne of spact 1115 Im trqlt-u 1rom J i-[) v ing unclcrsrmdlng ot th l lmc -dim nshy~ilnl l l11 ~ hmk f the cO]jO[lC pln( ~2middot ) ) Ve- w ill )iI xnl t l1 d at lcL-orcltng tUl cl sif iol t lOn blsed o n gtolllt lricd h uumlCJ ) p lane
- b() rJzU[1tl ln th i pla n ~ th t 1o rm ll sp ine present no CUlye- w ll ile Uumll(~ ltc U Hic spLnc clevelops one of ir haracterls(Icircc deFo rm tiCs v elt tbrd ln lashytio n vh icl1 pJ()VcA~ theacute hw 11
- lgitltl in th llulJe U l(~ nonmll spIcirclle pl SenL kypl lOSis ~nd l dooi~ in tb lXI1 lhese [(Hu rts Vere m)( til ught [ 0 he relattd tlle scolkJtlc ( lI r Vegrave
- front l in hi pleme tht ncrmal p ine preseuron t no curYegrave whil thl ~11li tic p in ugravetI I ()~ icircl~ charshyad t Ilt I CU1C
Il Jri fJIIt palic
~l+I~na ra 3 r inr lut th l[ ber ll1d a œl1~lU1 degr 1
l f r()la tJo u lllu (lILa r forcKl ltxert ltJn tl ldefnmuumlng 1 tkllJ [J i1u a re- lhlt tll cly 11 [1 1 UI b y Olm ner w bn ~lh uiJwd tl egrave ro t1tic) l1 Ilm it ti lt p ica] lf shy
rhrl r() be (P (the Uma bevond Wl1iltJl th lCOJlb of [11( ~pmaJ musd ~ dthc COnCIt and nm ex ~l le btconk (t O li~[)
r ~l 18 ~1Il N lu t( ren i9 lun lu ted rlseurlt h in tlt ) tilt lULodeumlformipg1 tlo n ot tIH_ sc laquoJrle rh ox ercallkren lk 1l1~H li d11r once thl Il i ~ r tld1t5 [he lhrth ld f 111 JlIcirc lIi of tlle dnrlclc hurnp tlk
lI bslt Il l nt rlet()rlll lIcircon 01 the it l ()I~ C ( (ylm der (- sustalnecl by an H1tmi cforming aCOOIl
J1Ji h V hl rhyiical f~ f Ise CI 01 h spr n llnd kin middot ith ccedilrapJ my lX damlg ing vll e n l pplild as flle
igt Jk Iller ln SCC1IJ ~IS lllc lJ fxceed l auto in middot crca~ i n g lhrllgthuld [1 sh (~u Id ahn be j ofed that Ilw relscd pre sun 1l1111i insiugrave l fe pil1r inn) 1 mlshylt
- j Il- ( w atff 1 (nh ~1l 1(e Il10 utoldrml ng li1eCh~lI1 1sm
in flc l Geyer ~w tcd th1 t rm m 1 hI l)1ecircch1O lla1 puilll 0 l I C~ sw m mim t Ieuroamp no purpo t for cu lshyim le pllilt t1 s (weumlO middott r it is l~Jl(gtWl1 rhn in iculio r[ paULnl -iJl11T1ill~ doe_gt nor Il ~lp to i ncrt~SL n eur(1shym tor co mfU
(1irai p an (
Jerdnn lle 11 showecl thal ill CSl~ o f t10rLC IC 1i lUgrave
tllo lacolulllhil it lio_1 tlle cte tI llmiry in (he lg itt1 p lln t rn lnlftot il~ lf tspe iuUy in tlw initi 11 r luleuml )f cV IU[Icircon nf Ile ~oli ls W iU l 1 p(t)gr~s~ivlt il10middot~ shy
ment roward hvpok pho b G ll f ill~l Im lins l har dUflng (IN eWllLlfiu1 of 11Imh] co luumlgt i the l in t ot t l H~ gClyty Cegraven te l - 0 1 v llebed lxxli 5 r ro ject 1 seH fl r t side-ys and tlwn backlrcl bull thu~ p(0(1 lj n g a kyphQtlmg aet Il ln (h~ lu mhnr --PIl1 COftj tng
l l i tc Iugrave l lltl l( l rs1 tif s L -etllgt il l the lgirl11
1 Hl)
Ilu LE nI rIIY~Ic~L lXIlKISI 1 HI E TREhTMEtn OP JIU IDIOP llII C AD O USCUH O Ll Œl15 NEGR II
lLill tegt lre lenl1 ~I d ~fo rll1J[ ~ rhl recrSes the phyltiologiGII cmns of lh vine)
Accordlng () Dicion ~2 1 rtcluctio fl in the itgitttl CUIYtS combin l vi th a lueral Iviari n llltl ds t 1
mecban ism () ugravel~ta il ity in l he r rat r IllI1e which bVOf1i the unsd a nd i ncrea~e 0 1 co hlt1is (Fig 6 hiIf md Pl11jlbiJ Jl1eanwlt ile lt(udiecl lh e srnl ru t
orzyglpophySLs show ing t11 al ttleir 1I1tl rnic tl orienshytation f~I (jLi l~ltes aXIal ve rtegravebJl l rotllio ll in cun litluns lt f dorsal hypokrrhn Icirc tnd lum)H de i L lo IS
Tll t dat SLlgge 1 th t impOrfill ut pOitu res and l1lweil1 ) t Mudied in ord t r (CI mlIuml ntrlin or to reuwer fll e p llyslo lo~lCll ClIlye in lIe SlgJtta p lU)l Wlth the llm o t ch ~ kin~ rutltor in l~ bili ry7 AbC th ~e ~k-
1l11nL ~Irt del lnt [0 J jUc lt ftber l]kuti inrervenl ion vhich 1c)LJ k l IV - i(l ~ l compktl n l ililll on Il t c1 l shy-jel1 J11UVllT1ent IJ j o f 1uto-dOneacute(3tlon ( i e a -impk ld ion ) Iengtheni ng o f the pilleacute 011 a litlltl l aXl~ tll lt ((IT liJlI~rcdu e~ t lle ~---lJ linti- l lte ml-fkxj(l n h UI 11 - i llCrl I~t the plllH ](JgicJI dlt cr ~l S ( (1 k-yvllCiSh lIld O(ltOSh l o r c lch r1Iif n t a Ilew til(~ecirc dUuml llt Ilshy
si lflltl J ll1 u(~nlent iam ecl - 1l1t0- lIrfe rionmiddot7 4 llmshyp oed f Je-rura l iUIl cl middot-t1e- iltm lI1d ll1a intltnUlLe )( 5lg it d C Uf (gtS slig lll thltJrc i ypI1 tiZ) tIcircOI1 a nd lunugrave)ar 1()fdos i7~llion) sholild he esw b lb]HU 00 lb co
hl b oi hi p~l11il uU r -1Ir vlt Abo 111( e IlltUtl Chl lie o f purti n - a U vitk slJ1ultI h e )tuumlll ecl 1)] (1 n ldershy](ion r tl1i lt type for e upIe IilJ llyl)T S of repd shyiti( ml vemen prt n t in agonistK h)lnllltlSlks nI iIle kind f dlJ1ce C( uld he ([([r imentd
FmiddotO lllaljlallC and mobili ty of the SpIcircIlC
1 rd llo U 22 d L lm nrrare d lhlt in Illt fro nt a l pll ne
tilt 1 nge Clt 1)1lt vtment of tht scplit[i middot CU IY grcmr lIJ l il ~ d irectio n n f Lhe C ITelt tlO n tha n in tl le di re shyLion of pmgressi n l Fig 7 ) he IL o IS5err lJd tbat th15 mohiliry increac plrtil u la rly n apic [ cgcoeilts 1$ lh ~ ~c() li osb evolves Sragrm rJ 12 J ~ thus rigilt (0
VlI f n rller~p is ts Ilo t t) m o b uumliz - a sCtJl iu til curve w ilhout t [ uling ttwt tlle R lu tiOI o i til t ~a mt b fnlinruumln( 1hy l1tans o f ~I passic 01 1 rivE -uppnrt On tilt (ltllE r hand UgraveK d e iJlioJ1 in ease durill tlw tune 111 whicll tll C spmt i ~ not submjtrcd to correeshy( IV anl()n
j- Virh mi lei ol i b tlllt Upp i1n ill) lC tiol is d eveloped only lllmugil llClIf()mu$Cllbr f r llce thi ~
InegravelIl ~ thclcfo re tl1l[ inu eascgtt sp1J1all1extl)iity mua
11
Imiddotiumltgt 7-rurd illt Ir) 1 bull rdrilt I1 1 in tl lt frOlllll pbnlt- th( illl ge )r mOC llIeJlI o t the S-o UIIJC CUNe 1 supcrior in Ihlt diflt(l im ugrave( the n nKlIl thd n ll1 tllc dlrtcLion o f p rJ1(l( (llIl
be considrCtJ vntrl iJ)(l icltion and 1 undrli neocirc ab L a ~ubiljz~ILion 01 tilt spint pllss il)1y ohtl ll1td thrltJugll the stlengtlkl11ng o f the 1rltJgm vlt nonil lme shyCIC 111 illli orrant u bjcLliH- ln rhis r~f1 n sp u lllni lc tivitIumlLs sil uld lX tPI 10 dlegraveltl it l G lU t n w l1ik luring kine i Icircth lrr phyltical eXegraverci c~ tllat in ele
spinal m ot ilIcirclY sil nid 1e lt1 oid cdrt ~
Organ ie and psychologieal impainncuts and li islbi IiI le
A cgtI im lc pmi nr is moriOthl11 just 1 sp in and 1
compkt gt Ipp rnach to the gu in ad 1 ont i al~ shylute l e~se i t i11
[)a la 0 11[ [n ell lrom re semh pw tbat ome organi Iilnctiond cl fki ts suc]) as tlw clecrtiUe ut vild l tnd d fun ll l)Kity_orld ldly incrtJ k whil~ 0 shy[io s i -till in (1 miel q g of g JltlV ity ~ l ilI e 55 rtI lit
tllL pres e n ce )fl defidt Or Vi l~il Clp~1 - i~ ln one pIIiem in Ihr l ftectecl by 20 ICl 40 scoi stgt l ls~a r(h cunclutecl in tbe UA by Di Ruce- prod uegraveed an aaalo) u ll1lXimum 102 re u t in a group of Jd shyk 1ien t [(h sco llosls rang inF frum ) [0 1
Al10ther rudv bv rallt r m C chr111 lilcl NashycWrl1s( u 57 stlO eltt hil $(C 1 1 ui~ Ica js l( lllt cl (1 shy1prUlllI o f t1tgl lie bJd l imI in ~ul sct t1 t ltu b middot iects jlLltr l5 they are golng through ~I cltlici[e sllge in the fnm 1lt i n 01 tlWH o w n id uHitv t factor hit h Illy jeopmlize the cl velopme lit d ~ mIll lt lI1d htIshym cecl IWI sonalitr in Klulrhood
n RUI ~IEDl(( Ptl Y1-
ROU ltHmiddot PI [ I C~ 1 EXIRCIS]~ IN TI Il nW~JUNT OF SlllO lDIOP1HIC AI)C~ESΠ11 C(gt1[Oi 1S
This i why b IiCieacute ii is ~n imporrlIl t for p rcshyvegraveml e 1tLsr l tn en ou flge 1ari e nrs ~lfrecr(d by lIillcl middotu iosis ft) tlke p~l rt in portin -re rcatioluJ acrivitits Iha t 1eIU 10 L10 th r~1chophyinLl bull nd b~l )i 1l1o tur adlieem t n li 51Jmiddot2Even tlK)ugli [Dr bic mech~lnshy
ical mcl nellIUll10t 11 11 reltl ~ons lt r111 1gtomcrimes be l lefu l to ugg( ~t ne p rt in~ aCt iv ity r l h (gtr rll n anotlJer e th ink Ibal an exces~ ive IlHd icalizltion - Icirce l ll1posilion br plry~ilt i HlS nnejlor parents uf rh ry pe of po rt to lx p m lice 1 b Ule p 1Ucirc(Il L th1[ preshydLl ck l1 is fret clOice in lh ma tt r - -h II ll1 he avolc1ed wb 11 possLhle mainly for tlle i mport~ltll psyshyLb ) jogka l fe a SI)nS W( ha( ill ~ t nltntionegraved
Conclu ion
lbh ISsertegrave d t1H physkal tgtXtlci o is ) n fi ial whlIl practinu in order 10 ilnj rove the I11 llde
rœ nwh and tono C iral caplCiry and postu re o f the StOUO(I ~lIbj n II I nowkdge om ~ middotmg trom ci el1shyrlfi rls(~ Jrc li dJlJ accordl ng r the review 01 thE litshytirlture prnpo )td in t lli plpl r conflrm~ Ihe vuiclit ot th e -t ls ~rti ()ns
In l do l (ent Id iopl1il iC scoliuse il l n phee u i cl vk)pm e n t ( li tll iumlKh eXCC cl l g i en rhk thr hokl th e re i5 an und ubred need fn r l pprnpri 1tegrave (JJ1tOkJJe ~Ild Inr surgict1 therapics ill ortler 1) S l i p
the ( - Iuli on anugrave )JT~t~t UW ~pilll l dtlormities bull evshyerthtless in the illiti ~ll pl l~sC t ttlC c1iseLltc whcn the riS( r1 r euro )luli m is rtduced ocirc ~md tfle uifleal JOld threshold il ~ld flle po stural collai i reJcenw~ 43
JI l1 igh pllysicaJ egravexe rc ise - p revenc or r d llCe d i ~lh ilir ies o f [Iw ~ l() li )tic
p (iems R 28 J -6 5- 6 1 63
- f~KiHtare lh ( n utr ali711iCUl of postu m l d elicits tn produCel1 a coneql l nce J [)ti 0 I111)( or regre si -u lmiddotc 5middot Il 1 17 ~ M
-re 51udles U ~ n Ledecl tu con[mn or re jecr these conClLL i( 1 w l1 ich clerin-d frum 1l1 lIldytica l rcltw n f th e liter~iture appear r- ~Lo nlble Hnwecr Intil ne re ull are 31Iable wc should n r prevent our sroliotic patientmiddot trom tl ki ll p lt in s(loI1ing jshy
ir its pW1iada rly ltl t ~d1()o t () n til t c ntrHY -vith the l xcclrinn 01 gt[1 )11lt tIlat in rea-e t)1obility (tnU evc n thell oilly wh n progr~lgtion b p OSSibl) -uc h ~I( ucircvshyiUe -11 )ulu hl tIKoll w g ed The 11 S J ( rprOpriue kin (~irhe r~l Piuml to incr _~asc p()~tura l $llbil i ty is tl1egraveoretshyic tlly CiJUClt alttloughl more ~Iccu rtte aod deLli led ri k benefi rs anJlr~ is is netot1ed
Ria 1111tO
NIokl Mu d lle ftitYljJfu Jœl il 4IWr10UOifll S (JIvs i (1~1)Jshylidl ttno( cclIll le 11(11(1lt1 RCI fu lle ((lia LltfIt l1 I1I1i(i
LJ ci n s j(r3 pigt egrave li n IHUgru lkl di t rdz t fi sici pe e ft shytUlKm iluppno di un lisimerap15Ll rl lllcflt() 1 110 scopo di pnevirlt () fr en~lI 1-lgpwlllltnlcgt dclld lclonnitugrave o e il 5LOshy
Il i mi llon lt fH nugrave j (1 11ni dei co~e 1 lteIl I1J J nd ne ~Ii eifclti (()Tc rri udk s co lio si d i m e dia g rt iuuml ln que~ltlt
s rud i 30 llizzb mo i d ti cleU ric lca pel n ri Icare qJJ l lm 1 dis(imucirc x u le I[~ l z j-m i pro vna le da lla C gtl k A i json ere pr middote-nute () rk kl ducirc un~l rdeguCltl d nil cra pi lt di uJoseguerrnt Cjua li 1iU110 cli nbie tti 1 rcr lJ)tIId d~ fle)-UITC
n (- -fd7Io n~lcl)
Ut11claquo)si 1 lI tori htpnuuml )ludi-ttn I ~ cnntI1zttu fr Cq(in i idiJ)tic1 dbfl lOZ10l1 d d ~ leOla nelllOll1otoriO Lb un1I1cnUl 1n1l1i3 dcgli 111 lt1i ch DIJgt gtU l H crmU1 Nlch~mslt ( SIshygnaJ~l lerimiddot wo i esuemi -bletti d~ plt~e8lugraver- ne l pClZ le1lftgt scoliodcu kl s iluppo ddl ~ ~ uhjlil~ vertcbral~ lt o svilllp prJ Jdle JIl7 i() nl di ltCjuiljbrio Dng li studi sul lto lb( l~nlrale (OllddU i in pa rticdu d 1 DlIal-BeHJ (gtegraverl ~ P~II IId lI1 n~ llw - idente il v- m gtiu p eT il puientc clioti elgt di u n rnigb o t c)[ ro Ua sw mle dei radlldc onsegull o tramite il 11 fforzrlshyfl len to d e i l1luotoucirc l nllgr3ilri d e luOwo con crcbi ~Clltdr
in pOMltHJ corrctl e in va rie ~i[Jzioni s t llicb c c d inamIcirc tllt Dalle on sena d elb blOffiCcclIlicd tr idimlt n s io mlle d ei
r ~ chi Je ~oU()f icn ~Icirc ~videnuumll (l() ~llt tC p IYZIcircOSI ln(IiClZlfHicircl ~ 1I1shy
liumln fluenzt Je ll middote~rUrio tl SC) lgt lIi I rc pibull m i tldln sJlI71 Stl shygn~I I1 afferma che slI l p Ia no [11 middotccedilr~lk tre un œ rtlJ grado di l L1Liuuml IlC dclh vEltlh r1 apj(de le tu rœ mu SCltJ llri njtbc J n in $tJ ) t rodcfQfll1t1l1te PltJtantu b i r~it-~ r -lp il puugrave t~~
Ixnt-ftla solo nt Ile so )[j)~i Jl1Icirc na rl in qunnt ) ilon SlrM ntne )(l(Ofa tu soglb in caq ) co lltrLJIcircn l)lrilto llt~( i lJudotlsi di lfr~ lI1 C llg grVlmenl J 111 11 io lr riltd ll(17jOill leld rinlle 113 dimO~iumlrlto d llt nell o lin~l cl()~ li t th~oIOl))1 dri la defltgtrshymiti sul p iluO slfl iuale ~vohl lf1 (en5 ion~ sO lnm utto nd 1e bsi iniliali deWggrwm1Cnln mcn trl C a( lfLmn che occlleshyvoluzi ne dene = 110 i [ mhari IJ lin c l ki cen tri ch -1vi1( de i cp i CIt IJ rI Ji SI p m ittIl pnm l Iem lmeme e p o j pOS( shyrio fllwnte dtldnli mdv ( i un ziuuml ne ciloliz7nnl dd rlLtide lu mbJ œ ( lIlelttlaquo on NC n d d (gt11 uIdu m 1I1 Ilgt) cli r-Iure (0 eserClzi che IllUllengano 0 ltlUperifo le Clgt 6gt1 lo)iche sul pirluuml gilwlt Su l p iCl no fron itk Perdnulk il dlll1lt-trlto d1 lampkz-l d i LU ovimento amp111 lI rv Kolio ti ~ nd lt1 0 ddlJ cnrrc-LIcircQo i Ji gC 1 n lungl SUpegraveliltlrccedil 1M llS0 tlell 3ampIGI shyvamcnlo C che l~Jltmiddot mobiliti GlI mcnta co n l c lu7j o fle d l i) snAio i A ulln amplgrtJc1 ltllllmunjx~ i terlpGli nn n m obi shyUZ73It ma eutva coli ti0 1 1ct HsicVlfe nd tcmplt 11 1111nshyttllIcirc1nc n tc (k ll ~1 llu u zinnt n l1 un me77uuml d i sost l11( gt ln 0
e 11111ri b cle - Ilziunc egrave deorinatcl d l rlyarsi Snzcl la pr gtshy
liltlnl l i un() rtl~ i ptmiddot Jtl n(o 1S(Hl () (( ntJ() i ndit~tr i ~ Ii ISt (izi e l m iviL Illdlode ebe Hlmen tno laJlc ibiJii dcl rlc lide SCshy
li io) [n p articobre rune q lldl r C-I1 ich~ xlSiddcHe CUf t shyli ve ch~ iJllpi tgino e~rciii 01( biIi2 ZanUgrave HhnmL-trid () in tmiddot~t~nshy
sione kl fuchide O tne pure k- ~ttivit1 tnotoJII~ non prHi(~ llCcedil
in forma r k rel1tiva d Ie ~1I 11 rF~1l1( n otcol mcnlC 1 lll ubib Ll vcrteblmiddote (ad ~ flp j(l 11 n l) to L ginn ~Iilt Utl clkl rilshyC
mka la cli OT- tcc)
r1il to l~ _ I[Dl COlI rY IC~
NE olUNI
fillncr ( ni ((uuml(( n hIIo( rilclIO ~middothe k lln dtfidl fUr1z i shy
nlu CQll1~ la llcl llZIO 1e delb c apKJl ilde e della capacltl di 0170 mizianu luJndn le (OJ il~ gtna a nc r3 di m~i3 gmshy
v it ln G mlxl r i ~ gko Fl llslrom C dlllJ O e Nachcms(J h iU1I) dim lr JtQ che b o liosl p IOO C1 neUaduksœnr 10 SYil l1p pn d i lIniumlmn~gin nlt8Jliva de corpo in (o nridcnz di Ln ddic3w p ri d di f( m l lz i nlt deUa SUl idenritl condishyZltonc ch pOlrebh ~[I cubrmiddot ln vilu pp di un pe bull n nn lir m llur cd e quiJibfarn in t[C adulro TaU CO1DSCe nZe tvlde nshyZ[II)() la n ( middotess iti di ltimobre la plfte ip a7j0 r1e atl an ivi ll1ltHClr n gl b a li ltl h ~ di tlpO s pu rti middotu dl ittlrc nd gloani iCo lID ti i lirtugraveta z io ni llb vila di relazionc
ln concllliu fu la d tfoflll lL saliu iG egrave il sin l mo di lin) idrotnc C Il1pk 1 d e eoinvo l d middotmiddot= fu n (n i dd rgashynIcirc5H10 n Hi lhdli e lesenizjo fi 1lt0 se 1 Il indirill~t() pllO pr~cnin 0 odLf rgt t lli di fu nzlonicirc adlc s()Jj(bi 111Icircn(i rrHtatc CO ll nl1 cinesi rap i Quand l~ coli i ( n LS~middot iJ11 zia k il rischio evnluLIcircvo egrave lid [() mente no tcole 11 (ltlll asso p o lll shylal ltOtSltgllen7~1 _ ta cincsiterapia pc rslIk bidtlvi shyptutibulli d ubllIcirctIcirc vltnc brn1e di conrro llo )(JSu k d i 5IcirclupPQ d Ile rLlt ziofll d i eC[u ihb ugraveo dJ ftffr otZJH1 r1w dei IIl llJgtCili 1 11Icircshyg rdtarl in posru ra rrenu posslhile JnnalL in Illo lt i clsi l(j luucircun lt di lin ~c() li oi mi n rc ( ume [11 duumlnQstrIO la tinc~ jn~l el1lric ((1l1 ~rtlppi d i contnmiddotllo cnndnlt1 p nso i l entrt d e Massue di Li n nc da [ o llo n ~ Rodo l (1 986) Julndo il1vlce lIfU~ ho ~vutlJ tiVll 11lt1 1IjXIl to un dekrshyuina r o~itl di g rl vir~l bull a~-n lllull~nte n ec ~~uiu rlCUuml rf( ff dla tcrJpll rle si c a eo chirurg ica
1Ho le clllC ooliosi idjopHI 3 ttl1p ~ - E~er l zjo hsco shy11ln ~ I((fapil
l Bg 5 CUle Lo [la k ll oblems in tlu ll~ (U ni Cl) FrKUce CU ( )lIILr no 1 AllCPR lu b1lG1t10 11 middotCI 9()(iJ2 RockilJe MI) i)~Cr ~()f I [( al th all 1 () I ~Y 1(~Re~C~Hd ~gtutnlt Ilallb Srshy1ltC Cgt D~p(rulllnr CJf I Ilalil 11 1 HumlIl sen Lel 199-1
2 SI) lrzcf ( LcB I ~IIl( FE DupUb L ampkIll~ 1c ~ppro l c h ll tht rnent und mmgemlt-rlt ot ~ ct vlyrl~ led splnul (hs r)fder~ A monQglJph rr r d lll kic Re p o l1 or Ih Ou bcc TlSk Fu rcl 0 11 ipmd DIo rele Sp ine L9H LU) 59
) Clntino F 111i1 i(ll Ci nerte1H C Nou gltHhl C Kln(~Jl llBICII [lIe1 hmlln (Il dry rra ll1ltfll of QIil pa ll m log iC by l11e 1 lIb li 1le-llh laquorilC~ of ~ 10(lna 111 Jrc)Jcxli r~~ (of flle h l lntrnIUonll SVIll Illgt~iu tn - II 5lt Ik lIc lk0flllllic lu llln-I I r l III Fhhlt ri g 1092 -ltlIJ-7
i - ri of niii MA N()LJV II ~ mel h)ltks de kin ~~klk rlr k di lll J r~cdllclli (n d~s ~()li oes jn f ~tel r~1ruuml(ILI -lo s bl fl c sur IcIj cquishyl)œ~ Ik SOll ll l)(eacute Eli ror eetlfllS d )111 1~ 1)1-
5 iloll n G Ruumld(~ le s () I ~middotmiddots tnlcl l l1 I n in 1Ifc el kiwil~~ 1)11lt KillegraveSlthe ripJe SCleacutentlnlue lYl6 2 47 ~ 6
r) Feacuterr[ffgt en 1tsiero 5 Venlllfln A ll~~n () M MJglio nu N EfkUuml o r eXltClse tI~tl Yoj o n nild id iO rXllhlc iC() 1i()~ lrt~ lirnIcircIluy r sull Eur feltl lb)ii 1 1j34 Z5 -~ 1 NOilrill1 A Sbill P egn ni i Ll Linesilegraverpi l 1lt1 Itallllll~nlO
ddlJ soI K~ i llO 1 Orkl1Llllwnrl m efodoloil1c1 RbbilltlZiOllc Ot1(1 1 )29(1) 1l-~
8 Nli(rinl Nl(lr1n l A blll P LI rieduGlzione dl p llicml atflt rro (11 coli ns i idi opr lir1 l n SC(Um i le or h( JI 1rcLlIQn1 ~0Cl le Imc lI1etW)n11e de Recltcrchc ci 0 Ftude sm 1lt Radw jlt)(j S-71
gt Nftriruuml S SeJhrf U LI r i l bllh ~l liOlie dd plziecirc11te ulet1n 11 - r
lin Kllopd (1 In l1l Jgl L N eduoL Tf1It II d ll11e ji cln1 rJtbl IiIUvJ Milan) 1ltfddH~n(x~hl 2(1~111gt-1-PU ob L cllln t iRll p l nelLi rl tgtO llcui n~ dilt ~lio i - l rn~f- li ~iIa n 3efllnl -Kurflr 19-11
11 lIIra S lJll M EVtJltHlvugrave egraveI lt t rnrumel1t() d db S(oli - U r) surie doCum nUle fintgt 31 tIUUli Mibn SI rlin) KlIpf -r 199 2
L2 1 ~W I1l(IJ P _leacuteVia tio n I~lhra k~ du IlchlS ~- ( i( IoltS ccedil l r lI C1 l1 fl leq
Ene 1 l C hi r ApparctlIClCOn l~ ltll1 l ltx6lt (i W Er 20 j )7 l
U StrI tr d P Lcs 1) rm IlO du Hltlctli Parb ME n 115 li ~u n un_ l c- l ol lJn e~IL1roy JC EagtOllŒrio n sc lluocs
L cl middot Exp CO_fiL [-In 190 15 Xd BR llet13n) J Th ltJl-xwenc a l o-(l1 tUcn~kuud txer
C le re-glflW 1 lhe tfelmc nl o f id iopllhiC Collaraquo n lroc~-din) t Lhl 1 r 111(1ltli0 I111 Symf SiUl1l un 3-D Scl IiDliJ DclOfshymillelt ~k)J1[rlt u Gugtu l1Shltr Verbg 1lti t)L j32-t)
16 N1lh~Ir~il Al Peumlf r~o n LE Erree htJkmiddotmiddot~ n f t~U lt hfIl middot Ith J
hran in ~rls V ll ~ ttiVl ~HkJ k-nt IHuIXtthilaquo ic I) Li ~I~ts H t 1l1i JflIn t ~ j l~jl)5iuml7A(~)8Jj- 21 bull
17 M(jo n Y ( ullck J p ~ R A PrdulllnlIr rpurt 11 Iht e rt l f rnltJsu red 5l ren jl lh rrll nrl1 III ililleInr Hi rrt tllk scoJliagt
J lin1I IJisn rd 21 1 1)12) 102- - Hl Hunng CU[- -If p~lIll)~thc - Uonktd in -c h JI IL
c reacutetnl n~ ptnl l C)Q~ Z ) t 1 t(li-v 19 Kou )UrJKh L Glr~ k G KRI iJI G KLmiddotmiddotrnl kh g UlUI
) KrJ UkQULlk i~ ~l ~~ fl c+l l1ng ~t (w)j (h ildrcn frit ltt lmiddot( ti ~l~ 0 1 (he
isbnd of Cfdt J middotpin 1 Dior el 1 9J7 lIX( )middot i2 ~ middotl I i) SG IC1Iugrave lS r olle lCOS rh Zadrc C Ber E Xend s T A
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EUROP MIDI C Pli hIC
EDUCATIONMEETING SATURDAY 8thof APRIL 2006
(iSS
SEAS02 Scientific
Exercises Approach to Scoliosis
version 2002
G
S Negrini 1
EDUCATION MEETING SATURDAY8th of APRIL 2006
Neuromotor disfunctions
Neuromuscular disfunctions
11 Postural collapse
Postural collapse
Duval-Beaupegravere
Flexibility of scoliotic curve
f---I--- I Postural element
-------1 Structural element
S Negrini 2
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Postural collapse
Duval-Beaupegravere
It is a value related to muscular tone and to flexibil ity of convex side tissues
Post ural collapse
Bunch e Patwardhan
Critical load
Load threshold beyond wh ich a spine begins buckling
JI~~Wt1lW~flfthtlJlœJtAr ~ J~It- l~l - IMS
Postu ral collapse
Bunch e Patwardhan
If a curve reduces there is an increase of the deformation threshold
~~~NW~-damaoc~IIIMf ~~ J~Iv JaJ-I7I9sect
S Negrini 3
EDUCATION MEETING SATURDAY 8th of APRIL2006
Postural collapse
Torrel e Nachemson ~
Scolioses below 20deg ~ ~ lt~
have a high ~ ~ percentage of ~ ~
~postural collapse (on u~
average 75) ~~ 2i~
CU~VE O EG~EE S WHllE SUPlti e
~laquotd~c6b ____lPffI1wtt1t~
$ww J(t ~~7 JM5
Postural collapse
Minor scolioses 7
Antigravity musc es strengthening D
Reduces postural collapse -G
Increases the critical threshold of deformation
G
Neuromotor disfunetions
Stagnara
If we admit that one of the causes of idiopathie scoliosis is a disfunction in balance systems it is logical to orientate physical exercises toward this direction
s Negrini 4
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Neuromotor disfunctions
Dubousset
Idiopathie seoliosis results fram alterations in praprioeeption centres and deformation is a natural compensation to restore postural balance
etattJtitIK ypothfQj~S ___~ own_ oJ)HQr lar 1t-1( r
Neuromotor disfunctions
Nachemson Initial idiopathie scoliosis
+ Goood spine stability
Neutralization of postural deficits
D Static curve
Neuromotor disfunctions
Therapeutic aims
c) Development of spine stability
C) Development of balance reactions
G
S Negrini 5
EDUCATION MEETING SATURDAY 8thof APRIL 2006
Biomechanical disfunctions
j Horizontal r-Ian
i Sagi ttal plan
Frontal plan
Frontal plan
q Frontal plan disfunetions
Fronta l plan
Perdriolle Movement magnitude
gt in the direction of lt in the direction of correction progression
S Negrini 6
EDUCATION MEETING SATURDAY8th of APRIL 2006
Frontal plan
Stagnara
Never mobilize a scoliotic curve without ensuring reduction maintenance over time otherwise a greater mobility favours scoliosis progression
Frontal plan
Ducongeacute~ research
On a group of adolescent idiopathie scolioses treated with
Meacuteziegraveres gymnastics
D After 1 year the mean angle of
curves increased from 18deg to 29deg
Frontal plan
Scoliosis without brace
D Greater spine
flexibility D-
Risk of progression
S Negrini 7
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Frontal plan
Mobilization is useful
D In preparation to
brace
D With brace
Sagittal plan
QSagittal plan disfunctions
Sagittal plan r middot _J o
Perdriolle scouos B CJ aDeformation of D
thoracic and thoraco-Iumbar curves evolves in extension
S Negrini 8
EDUCATION MEETING SATURDAY8th of APRIL 2006
Sagittal plan
Graf
The line of gravity centres in the vertebral bodies o s c oUOSt
projects itself firstly laterally and then fi
o
posteriorly lJ ~~ ~~ ~ ~~-_J-D ~nI~
Sagittal plan
Therapeutic a ims
D Maintain or
retrieve physiological curves on the sagittal plan
Horizontal plan
QHorizontal plan disfunctions
S Negnni 9
EDUCATION MEETINGSATURDAY 8th of APRIL 2006
Horizontal plan
Stagnara The forces applied ta the spi ne act in a autoshydeforming sense
Horizontal plan
Dimnet Rotation gt 200
ampII~ (
D The actions of concave and convex side
muscles become
agonistic
~ItJrOnrIIiItdllfUClltlluumlll~~tI ~1JIf1laJ
Horizontal plan
Minor scolioses never exceed these autoshy
deformation thresholds
S Negrini 10
EDUCATION MEETING SATURDAY8th of APRIL 2006
Disfunctions at a biological organic and psychological
lever
Oisfunclions at a biological organlc and psychologlcal lever
Cheng
Bane density in scoliotic teenagers is lower than in normal subjects
~~~~middotA~IIlUtIy ~7œl 1d l
Oisfunctions at a blologlcal organic and psychologicallevel
A significant reduction of vital capacity and V02max in teenagers with a medium severity scoliosis
S Negrini 11
li
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Disfunctions at a biological organic and psychologicallevel
Disorders in the development of body image that the teenager has of himherself
Disfunctions at a blologlca l organlc and psychologicallevel
Therapeutic aims
cJ Activate cardioshyrespiratory function
cJ Favour bone density increase
cJ Develop a positive image of the body
Disfunctions at il biological organi and psydlologicallevel
Stagnara
Sport
D The active side of
kinesitherapy
S Negrini 12
EDUCATION MEETING SATURDAY 8thof APRIL 2006
Disfunctions at a biological organic and psychological
level
Distunctions at a biologlcal organlc and psychologicallevel
Cheng
Bone density in scoliotic teenagers is lower than in normal subjects
~n~IIIvpWr~middotA~stWy s- XXJl M J
Disfunctions at a biological organic and psychologicallevel
A significant reduction of vital capacity and V02max in teenagers with a medium severity scoliosis
G
S Negrini 11
EDUCATIONMEETING SATURDAY 8th of APRIL 2006
Kinesitherapy on the scoliotic subject
q Postural control
q Axial stability
q Muscular trophism
q Balance
q Respiratory function
The limits of kinesitherapy
There is a threshold beyond which
rehabilitation alone is not enough
sssr
Kinesitherapy in scoliosis treatment with brace
Therapeutic aims
S Negrini 13
6
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Therapeutic aims Srace kinesitherapy
With brace
il Postural corrections and
vertebral stability are obtained by the brace
Therapeutic aims Srace kinesitherapy
In preparation to the brace
il Mobilize spine on ail plans
Therapeutic aims Srace kinesitherapy
With brace D
Maintain a normal spine elasticity
~ Maintain a good muscular toneshy
trophism
C Model the hump with kyphotizating
exercises
S Negrini 14
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Exercises and their methodologies can vary accord ing to learning and individual sensibility of the single rehabilitator that proposes the m provided that they stay within the
Iimits of fixed therapeutic objectives
li
Therapeutic modalities
(Exercises)
QAuto-correction
QRespiratory education
QErgonomie education
QMuscular strengthening
QDevelopment of balance reactions
WNeuromotor integration
ci Vertebral mobiJization
QSpecifie modalities in brace treatment
S Negrini 15
EDUCATION MEETING SATURDAY 8th of APRIL 2006
The protocol of kinesitherapic
treatment
G
QChoice and dosage of exercises
Variatiosn of the work program every 2 - 3 months
Q Execute e)(ercises on an individual base or in a small group
Q Frequency not less than 2 times 1 week
Involve and awaken the family
G
S Negrini 16
EDUCATION MEETINGSATURDAY 8thof APRIL 2006
Q Determine the action and the localization of auto-correction
QAuto-correction must be associated to ail exercises
QAt the end of treatment ergonomy lesson
Auto-correction didactics
G
SCOLIOSI DORSALE---- shy ----
r
S Negrini 17
EDUCATION MEETING SATURDAY8thof APRIL 2006
SCOLIOS OORSOLOMBARE
shy
SCOLIOSI OOIlSALE 011 bull LOMBARE S1I--shy
SCOLIOSI LOMBARE
il --~_-
S Negrini 18
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Scoliotic patients are not radiographs
middotSeoliotie Mtients are not ndiographs but hum beings with a vertebral deviation-
Slagnara
Metha For the physieian Cobb angle is of utmost
importance For the patient it is body deformity t hat eounts most rib hump a protruding seapula or hip We are in a situation in whieh today dodors eure the radiographie deformity but what the patient really desires is to get rid of clinieal deformity and of ensuing psyehologieal distress
CIIQItIo shDuIdtucirc lM WIld tJw~~ I~~M~~~~ J9f~
S Negrini 19
- Poznan_workshop_Physiotherapy
- physio2
- physio3pdf
- physio4
- physio5
- physio6
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- physio10
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bull Metoda asymetrycznej trojplaszczyznowej mobilizacji kr~gostupa ma znaczeumllCV wptyw na zahamowanie progresji
w skoliozach idiopatycznych szybko post~pujqcych
bull Mobilizacja strony wkl~s~ej skrzywienia i osiowa derotacja kr~gu szczytowego zwi~ksza korektywnoseacute skolioz zmniejsza garb i ebrowy poprawia obj~toseacute klatki piersiowej i zwi~ksza wydolnoseacute oddechowq plue
13
bull Przedstawiona metoda jest
stosowana samodzielnie lub
w pO~qczeniu z ortezq Checircneau
a takie jako przygotowanie do
leczenia operacyjnego
Ocena progresywnosci w badaniu elektrofizjologicznym
odruchu z odci~zenia
i~middotmiddot ~=~-~ shy1 _--==shyocirc
14
EUT S pine J (1997) () 93-97 copy S pringer-Verl ag lY07 ORIGINAL ARTICLE
K Dobosiewicz Neurophysiological mechanism of the unloading reflex as a prognostic factor in the early stages of idiopathie adolescent scoliosis
Rcceivcd 29 M arch 1996 Revised 16 August 1996 Acccp tcd 10 Septem ber 1996
Absfract This paper presents a new nc urophy iologila1 methougrave of e valushyati ng the risk o f p rogression in ill ioshy
mo t important factors in the eva luashytion of progress ive id io pathie scolioshysis The met hod can be lIsed to deshy
pathie scoliosis in th early stages uf tll( progre jve idiopath ie scolios is the dis ase by illY middottigating tll e unshy in lhe early s tages of the d isease loading refl ex in paraspinal muscles T he high sensi livi ty of ilie method The study incl uded 394 pat ients wilh means il can be used as a basis un seo liosis and 70 hcalt y chil dre n which to take an earl y dcc ision to
K D obosicwicz Depuumll1 mel1 l of Rchabi lilu lioll Si lesilln Medical Academ y 42-604 Tamo wskie G6ry 4
Lmenty of the unloacli ng retle x and repeatabi li ty o f Ihe rcbound and silent period were anal ysed for eaeh reflex evoked Prolonged latency and
p rimiddotom1 surgery
Key words Id iopathie seoli o is Unloadi ng rcnex Re bound
Katowice Polaml minima1 numbe o f cycles are the Larency Si ent period
T he ai m of this sludy was to evaJ uate the use of the unshyIntroduction load ing Dex for octcction of prog ressive id iopath ie adoshy
le cem oIios is in its carl s tages in onl r to lake a dccishyProg ress io n of id iopatJl ic scolios is bas been the su bject of
sion ta perfo nn surgcry as soon as pussible many clin ical radiological and elecrromyographic in ve~ shy
tigalions T here is ho wellcr no sim ple quantita ti ve or qual itati ve pro noslic methoo [hat can be em ployed in the
Materials and melhodsearly ~tHges of the disease Monitoring of lhe unloading rc felx in paraspinal m llsck appcars 10 be a reliable Inv gtsi lgnlions were carricd uut 011 394 pa tie nt with adolescent method o f discriminating bctwcen diffcrcn l fomls of Cushy ~c li ed J ild 70 hCldr hy children The scoli osis group consisted of Iios is T he un loa ing re n cx can be evokcd in ail the 31 1 g irl s and 83 boys aged 9-1 8 year~ (mean age 125 ycars) The
ske lelal muscles through a suegrave den shortening of o luntary contro ls wcre 0 girl s and 10 boys aged tO-1 7 y~ar (rncan age 128 cars ) Imong Ihe stlbjeclS tudied wcre 9 patien l w ith cershyinnervated muscle l2~J When a musc le is unloaJ ed vico-thoilc i seo liosi s mean Cobb ang le 22 7deg 121 with Ihoracic
rapidly durin g an isomerric con trac tion Ihe norm al reacshy scolios is mean Cobb nngle 309deg I 1 w ith thoraco-Iurnbar seolioshylion is an eleclrically silent pe riod fo llowed by a burs t o f s is rne ~n Co bb ang le 26~g o 63 with lumbar cotlos is mean Cobb action potentials called rebmmd The pause in d ischarge ang le 279deg and 90 w ir h doubh major curve sc o Ii() ~ i s meull o bb
nng le 292deg and 28 5deg The sludy group includcd 231 right -s ided can be observed only when a certai n h reshold va lue of and 163 left-sided 5col iouumlc patien ls There were 112 patients w ith
acceJcration flnd shortening of he muscle is exceeded progress ive id iopath ie scoliosi (76 ri g hHidtd and 36 Ic 1t-s ided) an tl il occues wilh constant latcncy correspond ing to that 182 with no n-progressive idjopa thic scoliosis (1 13 ri ght- sided and of the propriocepti ve nflcx (9 18 20] T he rebound ufter 6 le rt-sided) M d 100 w ith pe lvic tilt (statie) scolios is (42 rightshy
s ided anp 58 l eft -~ i(kd )the silent period in the unloaugraveing re felx rcsul ts from ae lishySC9 1ios is is consIcircdered progressive if the Cobb Jngle inshyvalio n of a pool of motone urons aIl o f which fClt1ch lhe
creltseacutes by more lhan 6 in 1 yen r aile middotnl1 n-progrcssive if the anshyfiring thres hold simultancously afte r prcviou~ si lenœ [l nua i increase is less thll n (i The Cobb angle ranged lrom 8deg to 77deg 1 4 201 in Ihe palicnls w ilh progress ive scoliosis (mean 361 ) [rom 30 ta
lI f R (on- f Rt tt1IY 1lIfl pflla 1 )(~ r(Jnu n t shy
fI) _ ~
Pathomechanic basics of conservative treatment of progressive idiopathic scoliosIcircs
according ta Dobosiewicz method based upon radiologie evaluation
Kryslyna DobosiewlcZ Jacek Dunnala Kny ztof Czemicki Hanna Jcndf7cjek
Deparmem of Rellabtlifatoll Mediw Uninrsity ofSiltsia KatOllice Poand 40-635 Katowice fil ZiUCl 3537 POL4ND
e-mail relwbilitacjt1s11mfoctaonetpl
Abstract Conscralivc IrcalrnCnI of Idiopathie scoht)~1 espcclall y kinc ilhcrapy i ~
nOI widcly apprccilllcd due 10 Ils suspectccl low dfcCIIcircvcnc 5 in relalion [ (1 a urglcal Irc[llment ACter long-ycar il ses ment of palomcchanic f scolio icirc in Dcpanmenl of Rchnhllilallon f Mclii al Unlcrsi ly of Sile bull a concTvallvc mcthod ()f IrCtllmenl asymmclric Irunk mobili7alion in lnclly ymmelm po~itions WIS
de el ped_Thi mClh d enablc 10 delain pTogression f scol iosis or ccn de middotrca~c laIerai urvalurc of a spi ne and angle of rOlllion assummg adequate () perallon f palicnl and ilS famil)
J Introduction
Idiopathie scoliosi OS) is a thrccdimensonal dcfonnation of il vertebral col lmm an- cntire trunk Afler many years of extensive rescarchcs the cause of idiopathie coliosIcircs $ i remaIcircns unknown It is possible Ihat idiopathie scoliosis devel ps and progress on a baslS 0- ~
multifactor disorder perhaps diffcrent for curve initiation and curve progressi 11 Fion poss ible pathologie factors nervous system dysfunctIcircons affecting postural tquili brium ar proprioceptive control seem to be espc ially important [ l 2 6 JI Pro_ ression f iS could bot delermincd by vertcbrac remodeling under eccent ri c loading created by axia lly ce gravitational forces in presence of muscular imbalancc in the trunk [2 J The verte rai colwrz unde r scoliotic conditions 15 an unstable system with tcndency to fu rther tune dcvelopment fl2] Lateral bending of a vertebral column visible in X-ray examination L
only a two-dimensional prcstntation of a complex dcformity consisting of patho logica axi rota ti on torsion and othcr deformations of vertebrae [7 8 10 II 14J ln fS physiolog~ curvatures of vcrtebra l column are disturbed Total Icngth of an anterior column of a spi n~
consi ting of vertebral bodies and intcrvertebral dises bccomcs grcater lhan length of l posterior colwnn - vertebral arches and proccsses [11 15 J h is apparent that phy iologi ~
thoracic kyphosis in rcgion of a scoliotIcircC curve diminishes Each vcrtebra of a stru tu ~
urve of coliosis is oricntatcd in hypercxtcnsion in relation t adjacent vcrtcbrae [7 l resulting
1 n B Uri middota I l 11
H srut ft illtf j tI) t li orf1Hli d
IDS Prt ts 21)2
Influence of method of asymmetric trunk mobilization on shaping of a physiological
thoracic kyphosis in children and youth suffering from progressive idiopathie scoliosis
Krystyna Dobo icwicz Jacek Dunnala Hanna Jendrzejck Krzysztof Czernicki
Deparrment of Rehabilitation Medical University ofSilesia KaloKce Poand 40-635 Katowice ut Ziolowa 3537 POLAND
e-mail rehabiliracjas(u1poCmiddottaollelpl
Abslract Idiopathie scoliosis (lS) which i sub 1 ntially l threeshydimen ional derormation or a pine cau e nOl only laler l curvalurc and axial rotation of vertebral column but al lordoti allon of VCr1cbrac in structural curve eXl nsion ln an effect physiological thoracic kypho j diminishc or cvcn dbappears Method of a ymlllctric lrunk mobilisation in strictly symmetric po iljon according [ Do () lewicz not only dcteriorme progre ion of IS or evcn reduces lalera] curvalure but also significmtly rebuild physiological thoracic kyphosis Icircn cases of lS accompanicd by lraight baclc
1 Introduction
Despitc Ion year researchc etiology of IS is nOl yel resol ed Significant problem re laled lO morphology of IS apar1 from lateral bending and ax i 1 r tati n i deviation of shape of a spine in sagittal axis affecting physiologi al curvatu re of vertebral coJumn [3 5 6 8 9 J 0 1t 12 Lcngth of anLerior col umn of a pin constitutcd by venebral hafls anugrave intcrvencbral dises dominate ovcr Jength of po terier c lurnn buill from vertebral arches and processes [lOJ This condition uring scol io i progress ion and growth of a child effect in hallowing or even disappearing of phy iological Lhoracic kyphosis in scoliotic region It i well know n lhar cn~brae of structu ral Jaleral curve are positioncd in hyperextension - lordotisation [5 6] which in Lhoracic region Icad (0 reduction of kyphosi or to true lordo middotis Such kind of venebrae relation in thoracic region cau es ilS destabicirclisatIcircon whi h in u sociation with eccentricircc gfilvitali nal load fa pinc duc to muscu lar icircmbalance [21 pOdbly produces r tationaJ lordo is [56 Il] and further development of symptomatic scoHose ft ha becn proven [12J tha strengthening of the erector spinac muscle aggravates nce initialcd deform tion and deteriorates coliotic process Hyperextension and uxial rotati n a s clatcd with
357 Th B Grivas (Ed) Research inro Spinal Defoml ilis 4 lOS Press 2002
Exercise efficiency of girls with idiopathie
seoliosis based on the ventilatory anaerobie threshold
Jacek Durmala Krystyna Dobosiewicz Hanna Jendrzejek Wieslaw Pius
Department ofRehabililation Medical University ofSiiesiaa Katowice Poand 40-635 Katowice m ZioJowa 4547 POLAND
e-mail durmalaiacekyocztaonetpl Department ofPhysiology Academy ofPhysical Education Katowice Poand
Abslract The aim of the study was to estimate the exercise efficiency in the group of
girls with idiopathie scol iosis based on the venlilatory anaerobic threshold (V AT)
Material and method The investigation comprised 58 gi rls wilh idiopathie scoliosis
aged 10--6 years 32 girls (55200 ) wilh double major scolioSiS and 26 girls (448)
with single scotiosis The girls were eonservatively treated using Dobosiewiagrave
method The control group consisted of 3 1 healthy girls aged 10-1 6 years The
cxercise test was performed using eycle ergometer During the exercise the gas
exehange parameters wcre reeorded (minute expiralory venlilation minute oxygen
consumption earbon dioxide production) On the basis of recorded paramcters V AT
has been computcd using V -si ope method Results The following V AT values were
obtained in the group with scoliosis 207+305 ml 02minlkg bm in control group
219+350 ml 02minlkg bm The differences belween girls with idiopathie scoliosis
and control group were nol SLaliSlically significant Conclusions I The exercise
effieieney of girls with idiopathie scoliosis conservalively treated using Dobosiewicz
melhod is normal 2 Such high level of the exercise cfficiency of the studied group
probably was due to intensive 3-D respiratory exercises of these girls
1 Introduction
In practice there are researched useful efficiency rates which on base of laboratory tests results possible easy without using of the relatively hard or long exercise tests would give the belter forsighting of the range of homeostasis disturbances and rapidi ty of increase of
physical fatigue during varied workloads [1] The best known rate of trus kind is the maximal
minute oxygen consumption [2345] During progressive physical effort minute oxygen
consumption increases proportionally to workload The reaching of real maximal minute
oxygen consumption in time of progressive effort is iodicaled by minute oxygen consumption plateau [5 61 This result is rarely registered in children The progressive exercise test is most commonly used in children until physicaJ exhaustion and the highest registered minute
oxygen consumption is treated as maximal minute oxygen consu mption or so-called
symplomatic limited maximal minute oxygen consumption [678J Sorne authors regard
Orto-dlet Trau malaogis Roha b ilitacjaARTlKUL ORIGINALNY ORIGINAL ARTICLE Vol 5 Nr 1 2003 80-85
Jacek Durmala l Krystyna Dobosiewicz l Tomasz Kotwicki Hanna Jendrzejek 1
Katedra i Klinika Rehabilitacji Slqska Akadenia Medyczna Katowice Katedra i Klinika Ortopedii Dzieci~cej Akademia Medyczna PoznQll
Wplyw asymetrycznej mobilizacji tulowia na wartoseacute k~ta Cobba i rotacji w przypadkach skolioz idiopatycznych u dzieci i mlodzieZy
Influence ofasyn1n1etrie 111obilisation of the trunk on the Cobb angle and rotation in idiopathie seoliosisin
children and adolescents Slnwu kluce ac eJJic Cl chOlIU) Ice SKoio= idj)PO Imiddot(~I7tmiddot
K~Jmiddot w()rus consrieI ve I (OtlHelif idiopathie HUW JS
SUMlvfARY
BackgrouId The aim ofthe stldy Vas Ihe radiological evaluation ofthe treatllJent ofthe idiopathic scolioshysis utilising as)mmetric trunk mobilisation in the strict~ll I)mmetric illitial position
Material ([fJ(f lIIellOds Presented stud) lOS based IIpon J36 cases (13 oovs oged FOf11 ocirc la 6 lcars (lild
rn girls aged frum 6 la S pears) trealed due to the idiopathie sCuliosis ((rom Novell1her 999 0 F enflfUn 200) Among 48 ch idrcn sllfJering from dOlfble-major scoios is 6 cases wcre infoll scaliusis JOjuvel7lle und 22 adolescent Among 88 sillgle scoliosis 6 lere infw7t 33 juvenile and 49 adolescent
Radiological exami71ation 1as condueed always in the repeataole technical cOlldiions RadlOglOlI1 lier evaluated oy the same physician Radiologica analysis oIthe scolios is incuded value ofthe Coho al1gle ongle ofaxial rotaion
ReSIils ln double-major scoliosis observed dlring one year period in Ihe thoracic segmenl Cobb angle decreased inll l increased 1395 and in 292 Il OS 111changed Axial lolation angle in 167 (~rcascs
decreased in 354 incrcased and rernainM the sorne in 479 In Ihe llllnba segmenl Cobb ang le clccrcscucirc il1 354 increased in 39 6 remained in 5 Angle ofaxial rotation deceoscd in3 ofca es incrcuscd in 29 and persisted in 48
ln single scolio is Cobb angle decreased in 386 incrcased in 353 and in 261 was lInchonged Axiol rotarion angle in 216 ofcases deceased in 295 increased and rell1aincd the sallie in 489
CondlsioJ Asymmetrie mobilisation of the tf1f17k in strictly syl7111elric initial positions is a 1Clhod of choice in the cOl7senJalive treatment ofthe idiopathic seoiosis
STRESZCZENIE
WS~p Celem pracy jest radiologiezla ocena Icczenia skoiloz idiopaf)cznych metoda asvmetrycznejl7lOoili shyzocji tllowia w sciSe symetlyczl7ych pozycjach lV)jscio wych
M aterial i metody Przeprowadono retrospektYlIl7q analizri 136 przypadkeacuteM dzieci (13 chlopcow i 123 dziellshyczqt w wieku 6- 18 lat) z bocznym idiop atycnylll skrYll ieniem krrgoslupa leczonych zachowawczo w Klinice
1
Ortopedla TliJumatoogia RehlblllagraveeJa ARTYKUL POOL1 DOWY OPINION ARTICLE Vol 7 Nf 1 2005 49-$11
Krystyna Dobosiewicz Jacek Durmala Tomasz KotwickP
Katedra i Klinika Rehabilitacji SIAM Katowice 2 Katedra i Klinika Orlopedii Dziecircej AM Pozncrlz
Biodynamiczna metoda tr6jplaszczyznowej korekcji skolioz idiopatycznych - opis metody Biodynamic method for 3-D correction of idiopathie
scoliosis a description ofthe method
SIOWQ kluczowe leezenie zachowawcze skoliozy idiopatyczne korekeja tr6jplaszczyznowa Key words conservative treament idiopathie scoliosis 3-D correction
SUMMARY
The biodynamic method of hree-dfmensional carreeion of idiopathie scoliosis is based on Ihe palhomeshychanics of idiopathie scolioiiiii and consiss in aClive segmental three-dimensional correction ofspinal cllrshyvatlre The course of action focuses in the viciniy ofthe apical vertebra Proprioceptive facilitation is applied on Ihe concave side ofthe curvaJure and exteroceplivefacilitation on the convex side Correction likewise proshyprio- or exteroceplive facilitation is phase-oclœd with asymmetric respirarory movemenr as weil as wilh parshyticular phases of the respiratory cycle ln Ihe course ofexercises three-planar movement is generated opposite to the direction in which scoliosis Is progressing This method is in accordance with the stale ofthe art ofscoshyIiasis pathomechanics The method requires detaied training and can Ihen con be applied at home under periodic control by a physician and a physiolherapist The method con be applied in landem with a Cheneau brace as weil as in surgical pretreatment A elaUed description of Ihe method of three-dimensional scoliosis trealment will be presented in Ihis article
STRESZCZENIE
ISlofa biadynamicznej mefody Ir6jplaszczyznowej korekcji skoioz idiopatycmych oparlaj est na patomechashynice iikolioz idiopatycznych - poega ana na czynnej segmentanlej tr6jplaszczymowej korekcji skrzywienia Dzialanie koncentruj e siccedil w pobitu Icrllgll szczytowego sknywienia Stosowane iest bodicowanie propiocepshytywne po stronie wklllsej oraz eksteroceptywne po stronie wypuldej Korekcja i slosowanie bodicocircw propioshyi eksteroceprywnych zsynchronizowane j esl z asymetrycznym torem oddechowym oraz z poszczeg61nymi fazashymi oddechu W trakcie eacutewiczen powstaje odwrotny do lrierurzku rozwoju scoliozy tr6jplaszczyznowy ruch IcrFtshygoslupa Melodajesl zgodna z aktualnym stanem wiedzy na lemat patomechanizmu scoiozy nymaga szczegocircshy100-lego instniktaZu po clorym mote byeacute wykonywana w warunkach domowych Z olcresowq kontrolq przez leshycana i fizj oterapeutll Metoda mote byeacute stosowana r6wnolegle z leczeniem gorsetem korekcyjnym Cheneau a talcte w przygotowaniu do leczenia operacyjnego slcolioz W pracy przedslawiony zostal szczeg6owy apis meshytody leczenia
Skoliozy idlopatyczne stanowili znieksztalcenia patycznej rozwija siccedil poprzez przemieszczenie kr~gu tr6j~aszczyznowe charakteryzujltce siccedil wyboczeshy szczytowego w stosunku do krccedilgu g6mego j dolnego niem rotacjltt krccedilg6w klatki piersiowej i miednicy z r6wnoczesolljego rotacjl zgodnie z ruchem wskashyoraz zmianami w fizjologicznych krzywiznach kr~ z6wek zegara dia skrzywienia prawostronnego oraz goslupa w plaszczyinie slrzalkoweJ [ 123] przeciwnie do wskaz6wek zegara dIa skrzywienia leshy
Z punklu widz nia patomechaniki tr6jplaszczyshy wostronnego Koncepcja rozwoju skoliozy jako rotashyznowe znieksztalcenie krccedilgoslupa w skoliozie idio- cja i kontrotacja sugeruje ze sily korekcyjne powinshy
49
EDUCATION MEETING SATURDAY 8th of APRIL 2006
- CARDJOPULMONARY EXERCIS E
TEST IN GIRLS WITH
CONSERVA TIVEL Y TREA TED
IDIOPATHIC SCOLIOSIS
Jacek DURMALA Krystyna DOBOSIEWICZ
Department of Rehabilitation Medical University of Silesia
Katowice Poland jdurmalaqcmpl
The aim of the study was
to estimate the influence the conservative treatment (asymmetric mobilization of the trunk by Dobosiewicz) on physical efficiency in the group of girls with idiopathie scoliosis
Material
bull 87 girls with idiopathie scoliosis
aged 1 0-17 years
(mean age 135 years SO 161)
J Durmala K Dobosiewicz 1
EDUCATION MEETING SATURDAY8thof APRIL 2006
Material
bull 38 girls (437) with double major scol iosis (thoracic segment - Cobb angle 18-42deg mean 30deg SO 82 angle of axial rotation 4-32deg mean 21 deg SD 107 lumbar segment - Cobb angle 11 shy48deg mean 31deg SO 128 angle of axial rotation 5shy30deg mean 13deg SO 85)
bull 49 girls (563) with single scoliosis (Cobb angle 11-75deg mean 33deg SO 155 angle of axial rotat ion 5-30deg mean 14deg SD 83)
TIoracic kyphosis of the invesllgated group was 5-39deg mean 23deg SO 86 and lumbar lordosis 16-41middot mean 30 50 65)
Material
bull The 64 girls aged 10-17 years (m ean age 131
years SD 132) were conservat ively Ireated
using Dobosiewiczs method
bull Treatment period ranged from 5 months 10 3
years (mean 148 months SD 902)
Material The 23 girls aged 10-17 years (mean age 136 years SO 108) were treated u sing symmetric exercises - treatment period ranged from 4 months to 3 years (mean 161 months SO 1019)
bull 26 of ail g irls (18 girls earlier treated using Dobosiewiczs m ethod and 8 gi rls earlier treated using symmetric exercises) aged 10-17 years (mean age 134 years SO 108) were twice tested - at first and last day of Intensive hospital rehabilitation (asymmetnc mobllization of the trunk by Oobosiewicz) - mean hospitalization period 20 days (range 18-26 days)
i rf~8f6~~ or~~n~= ~~r~1~r~icircJ~~tb~~~~ mean 17-4 1deg meatl~(I SO 74 R n~le ofax 1 rotatIon 5-25ot mC3 111 3laquo S0 6icircl Ilnd 1 99t1S~ ~~~~I~~~~~$ruo~ras~ ~ocirc~~a~e~~~~~~~5euml1 9middotn~ tUfllbar Iord05ts 16-4 1deg mean 311 SO 68)
J Durmala K Dobosiewicz 2
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Material
The control group consisted of 77 healthy
girls aged 6-17 years (mean age 12
years SD 31)
Material
The examined girls participated in school
only in scheduled physical education
lessons and have not been enrolled in
other sporting activity
METHOD
The exercise cycle
ergometer test was
performed
J Durmala K Dobosiewicz 3
EDUCATION MEETING SATURDAY 8th of APRIL 2006
METHOD
The Incrementai exercise test has been applied
We have found that tests ln whlch the Incrementai part of the protocol ln completed between 8 -12 minutes duration glve the
bullhighest maximum VOz in normal subjects
METHOD
The workload was Increased stepwlse
bull by 10 Watt every minute - ln chlldren
with high ~ 135 cm
bull by 15 Watt every minute ln chlldren
with high gt 135 cm
METHOD
The test had been contlnued untll refusai of the patient or exceeding the pulse Ilmit
Durlng the exerclse the gas exchange parameters were recorded by Jaeger device model Oxycon Alfa uslng direct breath-byshybreath rnethod (with face mask)
J Durmala K Dobosewlcz 4
EDUCATION MEETING SATURDAY 8th of APRIL 2006
METHOD ~ ~~ r 3 min 3 min 8 - 12 min 6 min -~
_ 0 rpiYJ 0 rpm 60 rpm ~1 30 rpm
_ t o~w=att~o~~na ~~ att__~ tl~~S~~ l ad l ~~~~~r o~w= Hlcremenlal t
pedaillog i i ~
~ ilt ~I~-----tl-~ I t ~ i ~ lOSt sffortivB
lW r resututlon r rm-u middot 1 - bullA~cremen tal ~~ ~ ~ ifr- ~ VtI 1 ~i ~ tllng _
METHOD
On the basis of recorded parameters VAT
has been individually computed for each
child using V-slope method by
Wasserman
METHOD
For assesment of physical capacity
the maximal minute oxygen o
consumption (V02max) ventilatory
anaerobic threshold (VAT) and
maximal workload was used
J Durmala K Dobosiewicz 5
EDUCATION MEETING SATURDAY 8thof APRIL 2006
RESULTS
Ali girls with 18 have been classified
within normal range of predicted
values of
bull maximal minute oxygen uptake
bull VAT and
bull maximal workload
RESULTS
The differences between group of girls
treated using Dobosiewicz s method and
group of girl s treated using symmetric
exercises were statistically significant
Lower exercise efficiency of girls treated
using sym metric exercises has been
observed
RESULTS Girls wilh IS Irealed using
N=87 p value
Dobosiewlczs method N64
symmetJic oxor-ci Nz23
Perœnlage of predicled vaJue of
maximal minute oxygen uptake
98 905 0033
Percenlage of predicled value of
VAT 97 933 0049
Percenlage 01 predided value ni
maximal workload 101 939 0038
J Durmala K Dobosiewicz 6
EDUCATION MEETING SATURDAY8th of APRIL 2006
RESULTS 26 girl s twice tested - at fi rst and last day of intensive hospital rehabilitation
The value of ventilatory anaerobic threshold increased during intensive hospital rehabilitation (asymmetric mobilization of the trunk by Oobosiewicz) statistically significantly (p=00019)
2047 ml O2 minkg (SO 268)
vs 2239 ml O2 minkg (SO 232)
Conclusions
1 The exerc ise eff iciency of girls with IS treated by asymmetric exerc ises of Oobosiewicz is norm al
2 Such high level of the exercise efficiency of thIcircs group resulted fram using of Oobosiewiczs method
r
J Durmala K Dobosiewicz 7
REVIEWS
Role of physical exercise in tbe treattnent of mild idiopathie adolescent scoliosis
Revicw of th- literature
A NECRlNl N VElWNL s PARZI 1 A NEGRINJ 5 NEClU NI
P1t~silillxlrd~ Ihcrapy (or klucgtlttlwrlpyl i pro shy-tJm of physka] cXlrd-cs ipcci I(a~ (IJcloJgtcd hy l li trIWlltl phrslollwrapbt wilh tb m~ln a1mor pl shyVCnI in lhe ilAAfIVltilH1 llf the ucirccfonuity III mild IgtC )
Lil1Si bclpin~ thebm ( aocl co uaufllclilIg ils ~jd- clf IS in nlOdlJmiddotnh-culiosis Th middotalillofthi paper ito r (W
Ille Ii lc ram r 1 a-ccrulin wh kh of Ih bull Lu[Jalmlcrus Ind (Lb hili til~ CLlLt-cd br scnli()si- clluld bl pl Y nlcd or r d uccd hl phylolld LXtmiddotrdsi n Il p--to-da le knowl Uuml~l nr tIll~C aspcc[~ i ne bulled in oruer 10 dndc whclh~r 11Rf blLl adcqlmtt Ib(uuml n middotlicaJ balis fo r ora)aini l Ihe US4~ of lUgravellgtitlerap) wltcllj(r or fln l th e prtl1iœ of kimiddot ~lre IUlll poNjn~ a t iil ies ~bould h allowtcI II uuml middot c enliaI toltlentlf)wh k lu alClor ie - lf pl lr~kiJl -c rmiddot d gtlt- (Ic rnnhi UzJ( inn ni (t hl HrJltlon [ rtn~hcll iJl ~ or 1i1J(IChIumlJlJt etc) Sh llU Ld be TolullllCcluse ulemiddot l onld b- clclIimcntalancl wukh sho ll ld he IJlI-n~ifl~d I~~a l lhc (o uld h 11lfu 1 Know k dg CJnc1in t (wIn SeiCIImiddot Hlk rCS([lflt h daw ccordinll to Ih bull llVit w o f tIlt iii 111 1( plop(lsltd in (h i papcr lmiddotonllmJ l lnl plLyi 11 cxcr(j$( pn (nti or (tmiddotduce dhlblli t ic 1 ~lt Il Jj ll(k pl ti Jlt fadl j w(~ the nlIIIrl li7alinn n f poMural dd shylitS tu p n xJ llc aSl COIlMqnen c(middot 1 all )llal) or r(tn~ shys i middot middotlIrve Tilt u~c (I f appn1priattmiddot kincsiuuml wrlpy 0 in rcns polttllcal swhiIHy Icirc IIHmiddotorc Illta ll y (0 r 1(lt1 lllho UAh mon ltlccurlltc 1Ut dl1alkd -rLk l(lWfils 111111 )11 h Jlccdt(
11) wurcJlt 0 lit)-IcircS (Iumpy - x rcLs P()lun
n rllt lT(ltnklf u f COll1tlK H (rtd) I 1i plfho l og l ~$I rUlglng tr m low tmiddot k Pl 1l1 to IdiOpath ie SCUIshy
Submitt(oJ [or PUhltCl l1 011 uly Tt 2001 Acc~pttJ ugu - ~2 1(t-1l
Addre rltj-xlfll telt~I(middotb If) - grinl Flt(1(bziurllt r )(m Ofl ()(Cl1I shy Lt middotqlltœlll ro () - 1u I4t agravehLIlKil ta IYIL-lTt ilSllltp lfllmiddot ~ 1l1uumldull
CelII ~ (niiOS I I~ middot ann (1) IfUh middot lIlfU di louhilll(tymi ( Nlmiddot ~iI rli -ilIIUmiddotltlfl
Nlti(ir 1( ) il r() (ltbullagt1
lt vLL_ l IiII no 1ftfI
jS ) we are a IUil ly tJc ing n1n) ltblll lS 1 k l1 b ~J)w in~ tl~ t S Jfll l approad llt - l1n til hy on ielshyertd ~tan lard ugraveJuld ln m any ~1~ he lI ~t les i if Ilot dange r )ll lt rhlS is lrut of reil l lnw 1gtlt1lt1 pa in l ~ or 5urgi c ll lrea lmltnl5 in dbc r lmiddot ll Sc - 2
ln tlle cj-e ut ~ t lll(tlWtl i( li p l ll1JC luuml- I ~ middottnl ~() shyliosis phys cal ((_lt1(( is emr1uved ltI t()fIl1 0 lh~rtrv
lo ly in cel1l in L)lllllde (nluumlnlr in tilt Lltlll middotorkl i e Iw l) r llt t Srain hUI IIgt() 111 Gert11lny 5- 1~1 in other reg lOl1 wbere thi I-incl qf tre l tm e rll 1 p~ 1 pmiddot t 1( cI il Jws Ixen cri ri cilld md rel -cltd Lw m~lI1 1 11 Jlu~ Fue Fnlny r ~lrs thio middot15 a lsgt(ru( f ~rth r -~ltc rrJtf))~ ll t vit11 br1Cltcgt b r II1 ([C Llt n ClW grmvlng 1lt1 0 L Sti g
gcsti n the lIsefulnes- u r Ih is form o t treatm n t 1
Hmiddotu]rs have nerged jn El or uf pll y~ iLd eegraverdse eacute 00[ 1 but tlw are nUl yel 11 11 t llu i vIC~11 and r hi ~
f rm of trt ~ltmenr IS stiJ l Ul1 ckf ckhate FfI t Jt 111 il i 11t (eltary td 1I iFy 11umbtr ot
b l sic COI ceP rlJ lf w ill he cIh tt d in t hi pap r
Scollosis
DCijIrI iriolls
ScnUoSlS is Irlircc c1 lme nsIcircltnal (I(gt i l cj on ot tht spinc thar cau C a CU 1 lh lt ca n h e $ t~en ln (1 me1Sshy
ured ultinF Coh) lll ltllCXI o n HI anreu middot p rtc rilt r
EUJlOI -1 lœDICOPHYSlc~ IR
NECRI Nl
110
f)i)
1 7J
amp aS g 5li - 0 v
V
31
10
(1 1) Il 15
-tc i ytjtr~)
FigJ----jllph ot DlI w l-lkaupegraverel) The agloimvltltinn Or idio r lrhlc 50gt1iflll~ IS rpiJ bel~ en th e- [l0 IH P (l)ltg tnntll lol (JI PUllcmiddotny) mtl 1 ( f( lS-er sigll paiilivltecirc lt Dlt(i I1 11illg r the iti l 1Kgt n n t rll icirclicH a ) 111lt m omal prebulled the mno rche md ociks with lll I)ttlx flal gr Ih pll fl
rlcljoprdphLi 1 hl merl prestIK ~ of this curvt c10es n t autom~l ritllJy indi ate the pn$CI1(t of a defurshyTnitv (SlllKtUrd (Unel
It i~ possible tu clil1e ren tute a struCnlt t CI1tve fruIn a pogt urll 011e by identifyi og the hum]) du ring AdIlns tesr I~OQ looklng tra m beh lnd at the p atient w ho b benchng fUfward il is p -- ible ta d d~ct 1l1 eh ucirc n of o ne liidlt 0 1 the trunk usually n n the (onvex ~ jde ul tbe radiographie CUfve Ugrave1lr C Ul be mlt~I Slred lISin~
BUlln els S o liomere( 1 ~ l This h Uf1lp is du(- lO (Ile pregravegtecircn ~ of vertel ra i rolltion 1c1 Ollt tn tic f~YJ tllre o f the def trrnit tli [ c m be seen and measurc(i v ith Perddolles lb lsLometer on an amero-Ix)iferior radioshygrapb ~2
Seven ry pel cent o f li Ises a re conid 1lt 1tO be idiopa thie 1 bull ia l-nosilt in this CI$C is b exdlls i ~ n as idinpa thlc me-us t11H wc do n()[ know rJw origio of lheacute curvc [n othe] ~Ie$ it b Ix )~i ble ro ide nrify a dieak (bat CHl jusrify the c1etgtnniry slIch a rna lfo rshymar i ns I1(gtufol Ig ic~ l or genlttic cl iscas s Glnclt~r trauma etc )
[dicirc)parhk S(oliosis has been divicled ~(corcling (0
the ~Ie of tlie patient egrave1l the tiJ1ll of d~[ccli n of the condil ion into ti) ur t ypei ln fanUlc jU nik ltldolesshyccnt lnd aduh Til l m n st cnnunon (VPC IS the acloshylescegravenr o licirceacute I1IJctenzec1 hy 1 sud le l1 tggrH3l ion uuml uring the grow tll Spllrt (Hg 1)2
lhile p tu 1l sco liosi i5 Ycry lomnw n thl pre shy~Iknct ra te f r adole ent icuumlop~lthic structural CU IY~S in sch )o chilclren are 18middot20
- 10 Co bb d~grels o r m on l -lil
- 2) ~ohh dtgreclt or mort O 2~j - bull () (obb d gre -s )1 mOfeacute ()ll 2
Clin iltI [ d e isio ns lfl IXlSed 111 an lccu r~He pregshynosi which obt inccl in eJch pa ti nt mainly o n the basi of the nsidu~ll p()tlnllltl l of TH1h and the result s of 1 rh clin 1 1 ~l1d tadiogmpl i exlminashyti(ln12ll c noieq uentlya d inica ] la sifiou io n o f the ing le pHient tn -ome estent co incic1 ing w irh the
D diographic one c l n lw SLlIl1H1arizeci 1 1 folIcJ - mikl lc~ (1)(n 20 C bh de~r es - moderJt l betwlen ln md 15 ohh de~ rtes - StV re 111( gt1lt rh n ~J) )bh (kgf s
On the 1) lsis of [hi - dinic d d a lfic t i n (Vith l1l il el lrb tiOI ~ o f the ir b() und~ri e ) in Itllt l cente rS Of SCOtiO LS ITe ltlllent in the Lltin odcl (i rJ Ital lnmct md PI iJ Ugrave tre tmtnt i s plmmcd a fo lltJw 8l
- mild kineslth e (~1fw ~1Il (1 luok-ou t - Hl demte IJragravecegrave 1111101 c(~r md k i rws ithe lJpy - ~cven surgery
Physical exe rcL~e for S(ol iosis
Defi t tiOl l S
PhyS i 11 nU b lIKrlttp middot (or kines ithcIa Pl) i a p rvgrlill or plt~i Gl l (xeriltecircS ~1ci fi ( llJ y ltk ~ loped
y a -11 [ru ine 1pll yslo ther3pisr wirh th e m 10 Hllll
- pre (~ n tit1g tlc aggraaLion of the cl I )flnily in rnild bullcoUm is
- helping tlk Il ld Ct ~lOd ounter~lCtjng its skie elfects in III de rltegrave sc li sis
Tn tl1i_ feSpec1 kinesitl1ert py f JI s oliosis is tonshysider l a o on of peciticcedil training and s genecirc tltllly proposelt in sessions 0 1 4~ ro 60 minute IW) t) tour limes 1 Cee PhysiGtl exerci es can aLo ll v o ther auumlns 1S it oill he dise Issed in this plper
Ir 15 Ilot possib le to cl escribe a single progrlIT1 o r exerc ise a5 pro nrams ale USLIJUy p fgt nll ized ( ( lt
EUH PA ~illDI (DP1I YS IC~ 182
ROlL UF P l 1YSICAL lXl 1lt 1~E IN l IlE 11 ~l) IEd If IlU) l[)VP 1HI AIJ() J)~Cl~ r COl ~I NlG1W il
f)( 15 egraved ( )Il the nee L- 01 indi iuua l pJl itnts) al l l10ugh Lheacute) C l n h t 11 plicd o n a WOU p hJ~js (-1 (0 () pnients PC[ ~l ()lI r)middot lugrave reQCf lhese 1 10 grl lll frequt ml~ V IIT
hnm on in middotituk w allClthltJmiddot -Ill Jnv L l~egrave at Wc w Ht ~huw in lhis lyl peJ it i~ 111 n u -eII1 tu id e ntilv kirK itheJapturlc aims w hitl l ucircrr~spnd LO ugravelt~lil1 DUtshy
g X ir ur ph -s ici l lxtTi~l I~llhe r thln ln dj( us- indishyiJ u1 1progr-lfll
Aduumll l lxUl kisure time ~lOd h )u] Sp u lllll8 ~Ilttishy
i lt egrave~ i middotomm )Ly s iven lel mJ ing ro w hlf ~ Iuumlnsidshyer~d usdul or il lrmfu l in t1 lt rruning (lI tJw ptliJicirct ln tl1bplper Ugrave1 gent ltl l t rl ll bull p lwsiCUgrave lttG iviUes is rl ktll 10 JllI1ltlCc hOlll gtpOlt mJ kIJ1lsIcircl hc lJ l f
i ve lUen tloneumld )bo C on lv ine n dul( re Ull~ 1t~1 t s far Ilten publislt d f I~ mJ I(i noltgtithltl rgt is 11 11 a su h jel lnI deacutehate CJitk haltlt t llltit m itn ltl of l ny lorm o t p l1 ySiClI lxrcL e as a Itwr1 [ J- fo r i liopa tb il jcoJL~b un iL ()ri gin~ initial1) it WIS Ille r rOmiddotUumlK lt brgdv u f p l~lt titu gtllergt w h ) intervenecl hutll tc llcrl ll (mon as cltl HtilJ nic in terventi n man Jgt
1 t lltrJp utl t one 1 md rC j fkll l~ on rhe h sh lf som uni cOen I1v pn t I1cgts wt ldl hll ltl enl1 JI~ haLl nu na l scicnt lfic baisYmiddot HOlh tlle$( trr t peu shy to rh ~rl py tt nJecI to l~~rJ tte C Ih tk CUf -~ pnnshyclr~tll y as a f tsul t of lilo h llIzatio ll of tn imdqultdy ~u pp rt(d S pln eacute 7~ 12 to re-t1 r rI ltrl 1$ l l1C k o f WH llt~~rdl 10 I ndt~-dll()urnah tnd 11( on1 p~l per u suaJly Cl tc([ IS n prelimmtrf lll d 3 ln tt li w ay man (l rrlKpt(Hc H lf O iS Inll ph ~i C U l ~ d vi ~ cI nllog scnliotl pa t le nL~ 3gainst holll ph lca l egravexershyclc and p()rt~1
It m u st t~ n tfd [hat pllyknl txerc j~ tJe~ltm(nls t1iHer 1 lJ rd il1g r rhe rherlpcu tlC litTl~ on lllc h tJ rgt ap p lolc il l the IXlltent lncl hi im r IIIllHnt i- 1 (1(1 rI - 5lt1J lC igt tIl l ( f phJllIlllolopJ al rrea tmln ls Ihith cllffc r 1lt œQlfd- rhe m C cculc u ~t(l luI thl p al 1t n
~mc l 11i (lbE~e Tt i ~ P ~il k tlwreI[middote thll wuumlk ltlll t kin 1or ph~ i Clt1 1 lX r(j~ 1I 111~ t bc loidvd by t h~ Lo iurie IxujCJ1l al1ulhcr a dl ~IS nJI h~ iOg (1 11shygerols llugJr in racr le (wi ller d I ~fJIII ~ I ml thlls re(nl1l rn ndc(1
fn n UI cel1ll r we In(~ hccf) using 1 ) 1 1111 11 ve ) 1 (J p lw l icd ex(r(i~e (0 J ( 1I l tt i~ tlh aITt ~ l~d Ilv m ikl tru cflumiddott1 adokscltnt (cl ioj arh lC icoli is11 2)
ina the f U~ t rc-gt uJrs IefC pu b lishe - the pJ( )grd m 11lt1lt l1te n PWltllk d in fa c t deel()pnlln l~ in th t l itshy OlL1Ii in tl1 r b t ~() ycal f ha ve iclemi fiecl niO l l
m d 111 ur impl rnHm s md d i s )h ilir i (gt~ lue t idlo p lthk amp()lio -i ~ t Jll CIII he 1UO(l if Icirc 1by phyict1 egrave xert iSlgt l fe t rrncllt
l illl
111e aim of t l1JS r~l per ii tmiddot (tv iew tl1( l iterat urt to a(errl ln v llic ll of th~ impa irm 1t~ and Liit hil it il i GllIltec hy ~ o l i()gtj s -o ull he ll nt x or re middotlu celt1 Ili pl1ysical xerclse An u p-to-da te knOvkdge o f tl lt Lgtpecl-gt i necckC1 in rJeumlr) d -oek
- whetll~r there h ltl n adLtIIl ) l tht()d ical bbh fur or JqIIcirclb l l l1 Il( ) f k irt llit herlpy
- h N I)(1 ( 1 Dm tlle p r l c tIcirc(( o f Jebur tiJne )pOfung lcli v l ti ~ IIOU lci he tllf) -d o
II J U V f h 1 I11~ c~~lb li hed Ihe usefuhlLss 01 k il1 shyc ~thtrpy il i aIle dy l nsi 1([(( -r-tI Llleu i n )I11 plJt~ ut the wJrld ir ilt ecircS~nl i 1 I( id n Iv w l1i li ( 1shy
gories 0 1 pl1Vtl( 1excrClgtegt te D)bilI7it ric 1n (Ir st shylliuumlZltio f) lttlt tlgtbltn ing ni trcrccedilh ing erc) hn Id be
vnlcled he tll rhe nuld be lerrillldll1 1 md whidl s tlQu1d be inreœ jf ic(1 IJeClU~l tlley cOli lel Je LI ~ful
Ncuro1llotor impainncnts
Imv aUl llOr~ 11 lt1lt ~tlKlteJ lhe cltlndatiotl bd Ween tl UC1UmiddotIt t l ol(~C t nt id iopml je -nll ~J~ and cli~l l shyler~ lr 1tH lest ihuLIr yt 1 _ 13 ~ 311 D uhoussct 1
1-- ITS tln l ldiopath k s(o lio-L L cll -c d l J l hmgt in th terl tltr f prop li l l pu n md 1I1ar th e detrshyn Hi n i~ na tural 1 ~ronse to ril e need tu ts tu re p()tun ltlluilib riu Ul HcrmJJ1 31~ 11 () d tllat icliupathic ( liCl5j h l it re5u lt Ot1 rw nltuf mot r l ~ltelV
[Id )fcl 3 nI] ~1ltJ U Sr1lle nr to dtorders in centJtI lO~Cl shyIOIDNur) md 1xi~tI moro (Ul1lfOl syt( llI (Fig _l
N htIll -of) H1c S uumll h( rll1 ( ~ l( w ing JI t11 (oshyI-ie on the l l lO]ugy o b doll (nt Rl iu]icirc tlili- middot()lioL m unt fil t-hltll rhl ugravedcmnilV L th e fl5 ult o f 1 (k btcl 11lIFll llI ion nf som t11(WUgravetltnl md pO~ lur( (tnic l~ l licirc1 tl1lt if l p OgtlbJt b C 1l rlw sta l i lin 0f 11 1 Sf llle j lt g )tx l Tt) ohtil n a ))Cli U 1ILzltl I o f p ~llIr~il d l~flo [ in l1litkd ~J)llnSIS me CI Igt(middotqucnr J ~ a ~tmicirc ()nlly or regle Ie Llive
Ali th- 11yp ) tlw~es rd ~lte tr d irtl Itn t pnl1tlt o f [11 v hole ~piltm It11[ controls postu re ~nd mrw shyment lrre pell ic of tlh po int a d lI~ llv inH llYegraved il i ~ ll 1 nnable tCl aSUilll ri 1l tr l ll1 lo g thi ~ys ttm ( Qu it le 1I middoteli tl
lt ch ugt nlt~(S f rullliIl thil i nlomwtion th at p tlmiddot shyiCil J(tl iIies nw gt Il lInport~n t rr le to pbv [11Icircgt role ca n 1)lt slI i11l1lariztd ln lWO the ptu li ain Llt
- d elopmll1 l of p uumlltl St1 b Hlt ) - c1e veuml IOpm 1)[ o f bhll1ltc _
(k llhUl)lOr S Cll orr
ontrot oic whan-lt
------+ 1 ~ il lnll ugrave r AINnl
Cllnlr1
T bflt~ r
fltL1 tlli
lMini
l
~sary ~J-frlllen i )f
~ 1 ocirctnl
~UcirclllIJJlW Ll
AXl ~l1 n uumll l) r sy 5t ~nl
middoticoltoq ~ Fig 2-AcFgtrdong lU He-mutl 21 il is Fi)5~ ib1e rD prolXgtSlt l -oo ie1 mnd 1 ((if ~ elio egrave middotAhltr~d l)Qdy-p ati~ I I i u d) uren ttllOn k td LO In ~ory reHTt I1 eDi tn l al ) JdrnlV~ pn)4~ e l u r~o(Ofe 0-c1 eptunl dvstil t1 ctlon sltŒ(ry icircltu nu11t ilwnt [ ~mC ~ted tl l1 ce Ill trpntlshyUumlfJJl nd IKnle~ r~dibl jtugrave)n of -I) m tlosen Ir ~ig nj tl (I1vying ln fornll1U n (lI an ereltl ~piJl e Mmor aJJ r--a t ~) n ltgtf ti lt aXljl mowr plem iHUC Wh ~fl Ille 6ubjeco m uumlntl Icircn (1oJifitd perccpfLlI l ~na l ysilt of p n)lnocepti Icircnfu rnlaquol ti desnibJOS ~n t tecr spin A IICW motor co nrro l Ira I gy t adopt resu ltin~ in the ~tr ltctltr 1 ckformh y lf IdiopathirL scollos i=i Ht lrftU1uc nltnt l ISll I1lJy h1e- ~ I pro()und elkn on bralO Sfem flJll ct i(lnn~lLhu modifyRll Ille nltulltgtshytl10 ) 1 1111 Uu l-lHoror control 5~Shnl$ shy
As Srtgn1lt1 l ~ ltlssert~ if wc l C -Cp t 111 1 un o f the G IiC s oliosls L l tisorckr oi th e ltquilibrilltn sys t ~ms it is lagical to oriegravenrate physlCl l exercis( lherap y ln th is d ir(gtCli()[1
11lclte goals Cul tl lfOUgil ditrercn t modes 01 action be Olchic(-c1 witJ1 phykal accivit ie
- po rt ive Cll ities p ro ct LJ e aIl UgravelClltrtsc in 6lte nshyel ll )o rd in~lti n pinai pr0prinup ti_)[J nLi mOVeshyment control 0 vio lls iy ln thh repect ome lCtivshylites aœ pre um~I I)y lXrter tllln ntil crs
- kinrl lira py using pedJil exerCisocirc specially developecl lith th est 1101 5 in mind illVuuml VC I lllore prccilt( ll1d InC1 li zed cri n on rhe spiJw focusing
a90
1 ~~
lg -lNheJo ~1l l1 t r~l g rld in 1 1) h i(~ IImiddot ct r rHienl w i ll idlllhic _It ~i ~ _ iri s plt ~I le II find Jit ltH vlllleuml ~l Cgtbl tn~ ks III d il fef lt p ~ lt ihnS nu v~tl middot B ~a~pt u Il C middotl)Icircd ~(t l l11 C dlfkrCnl middot- hdween slllndi1g Uline nu nllt1Xinul oorrec ri nI t chied Vith Ct (J ) und tfdincJ ne lot es o UIine 1 fo llnVs middotIJfl tfi ni( - ltlrshy
reltiK)n ~ Ikexibiliry st3nucircing - -pirte - f ur~1 1IbjISC ltupin - ltorrcaion - - r~luci()il ll ymiddot For flmpllt in J npK l1 pH k1J il
plt1SSlhlc ln obtai n 10 u1 511ndlt)l [YLo lion yr ln Slt p ille rlOlgt itlugraven om l J ~ in ( gttf(C rigtIl lIex lbuil 15 i (r-l l=22deg pol lltl ~~J IIlpraquo is IcircO~-V- I t1 l nd tucircu(Ugrave) ilil) I~ 3laquoJO- IH-12
r ln Ugravel e abilit jl of tluuml [m e llu to co ntro l irse lr in ~ pac
fuld l oftlles uumlllelve ntio ns can presum1b1r incn~~ Ih enl ac )1 the orller and lHitlll r of Ille rn - 11 )ltd h e lllldenl lu EJ3)4il
Posl1l1-t collapse lnd slabilizariotl
lIle concept u fplt st lUal c(l lJap~e l l~t Iwen detin 61 by DlI II-T3e~tupegrave rL t Ac oJdin)j tu tl1i- ~ll1thor il [ nec(sary ~- l Hn Cv-tlualing th tleihility o f a col shylo tIcircC CUJVL (0 clistingu ih bt tVeen the re du ihil [ty index (th - li iffer gt le bet ~middot Il ~I r~tcli()grJph ie ~xnmshyinltio n of the iI111 pHienr in supine po ition m(i
ROte OF Pl rnmL EŒIlCISE IN THE TREAT-ŒNT OP ~I IJD IDIOPAnnC OOU~GEm seou SIS EltJRINI
I (~)-----------------------~
__ _~ _____ _~ __ __ L ___~ ________1 ____ _ __ ____ ___ ___ _____L___ _____ l___ ----------L ______ _
1 ~
1
-- ------- --1---- ---- ]---r --- -----_----t- ---- --- ---shy__ ______~---- __ ____ 1________ __ _1_ __ ____ __shy
~ (1 J
1
8 =~~=r=middotmiddotmiddotmiddoti~=-middotl--- middotmiddotmiddotshy--------------t----------~- -------- - ------__shy
~---- --- -- -~ -------------r---- -- -- ~-- - -------- --shy----i-------r-- - ---- ~~-shy
il 1~ 0
Dtl-Lmiddot ~ lttj l r~ UIltltlHt
f g 1 -TI1 u ilictf 1ld ( ii 11- ugraveu-sh) ld IX~ O 1d wllich ltJdnrshymII Il nf the pilll 1 ~tln~1 of th e -o lioti( spinc n IG~nI(J II IIIshytt) lhe iJeuml grl-e o f ~ ()Ii ti c (u rvH Il 1 w dcpc-nlknrly o l l he 10 111shy
P01(nl (pntt l ~ 1 1 nr ffll wrJ I) ln w hilth Ihe n i 1gt( ~ duc nL~ grlphs fm I h~lt 111lt hi~hr Iht Col h ~Ilu t (l f Lite ~Ul Ihe m Ol CI il y th t s(uumlJotil middotpin~ ~111 he ~middotJg gr~lVH(~(1
m mJxiTIt corrttt ion wll iJl i~ lIllCd to Ih - xt 1shy
lti Oilil y Jf tl1lt t Ut JO rl1t cdnUc idt md p OS shy
tU ll cul lapse ( th t ltHill enct b-tten l lUdioL) 1lphic egraveltamJl1ltlti OI1 J t th e ~lme pa tient in Sl il tl cling lOJ lline fX-sitiutl ) Wll ic h correb lc- onl wil ll fhe abilt ty of lllt p tu rl l gt s tem to C( lunternct lIk luree o r grl viry )cco d ing rv D lfVd- f3egraveLIprc po st li r t1 lt01shyIlDse is d ue to the Jnus -u lar ton a nd 11ll ex rCrIshy i) i itv of rhe tissus n the ( O IW-) si it (If the (01shyjl ti (~JtVe (Fi~ 3 L Pu~t llr1 C lltpstl lu lcl l ~~ reduc l-lt by llwans o f pl1ysica l cxerCles specitkally s tuclled ruuml i rnprove tIlus--ubr fOHt md lU pr )cllI Ct 1 ~11 hi shy
lizing ffCd
PararcL n tll CIJ cl the cr iti ca l (3 c1 thlsho ld beQ ld Il ich defol1J lHU n of the i pinlt 1 e~ in~ ne dtlllontr~1t _cl (1l ll t grclrf r mg] o f rllt C II in a qa m bng pos ition corn pOil 15 t l lowcr detormashytion lhnsllold (Fig 1) ie to ~11l Ulne3Se t the risk of pr ogr t~ lu n There t rh eJef re l J ea r l)iuuml 1itshycJ l ~ll1 l l(tl a 1 tnr tg ro b ohwined by d -cr t l ~ illg ilmiddot pU~lUrll cull lpse ptJcelJtge w bich lccording t i)
h llTd tnd ~l(heJ1l ~on 1~ b inde cl 1X llt icularly luumlgh Ugravel mllcl c Iio~ i (bdow 2( 0 ) (F ig 5 J
Fin a Il III ch iS respect lllljl hl and b um l 01 m linmiddot
ii iI 1 l _ _~ _ ___I ___ ___ __L ___ _ ___ ___J______ ___ 1 ___
li 1 1 1 1 i 1
1 i ___--____---___----__-_---_~- _ _--_ ___-+----
i
1
i -- ~- -- ---~-----_-~-_-_--_1-~
l ~
i
+----r--------t-------t------f-- J
Fj~ ~-Ac(XjJlin(Q luuml T O rIcd ~lnd Na(h(ln~ n i () dl( pCG w rd (rTIshy
POO ll is hiherin cu rvegt in wh ilt l1lh ~1flILWrd cII1I Olk l1t IS le- pr(v~knt ln th e grtph Ih t PogttJlJ I ugtnq) Ot1 -J1l j elfltS-e J tlt 1l1t obb dirr remc rlLIv obu incu f roll l the Cohb atl( 0 1stlI1dtJ1g IId gtupinc rldo~raf115 Ih Ille lt) [1l1t1 (i lndnl I pine) 511pille the ~(nlClu tJ1 compo l1lnt U rlk CU Y _VeJily I~ ltx p rlt 1 L1v UpUlt (obh Illeturo Ih t si _b Cct rtJeSIm l fie -ltn J trd Ugraveltuuml shyuumlo n A~-i)rding LP 11(lt uuta o n l ( r1I~( in ~I 2JQ sup itlt curvt 1hi C(]l)b ddhccno l l f lO is -J-lultt( thc s ldnd inr tnla Ol1l t lS wi Q) whil 11) 1 1)401 ~llp lne ClHVC If ~ 1Omiddot ( tcl Lhe ttnd trl~ nlca~ I(t I ~ ~I)
tli n ll w l lllE cq lin ti spin h~ i ng mo r ~ Llnt~II) 1 tlun the nOftl111 one n Cll l gr(lk ( (cU ve tl1u n da r u p shy
po rt in o r k r 10 m linrl in tht 1xi11po tuf_ n th ha__i of th egt onideratl lr1S it f(lll() rhJt
ph rH (~Uuml e erd es ulukl h u - ul iiuml tbeacuteY ~U-L lm cl 1l (It-d o pmg p05111 td C Jl1twl lS fuumlrnll~ rly d ccrll1td ln an Ql St if i imr ol1111 t ru t(( - tht m(d in C JI shy
r t t r sture fO Ir -ngthen tlll m u ck-gt of the spint mainl) in (11erl antig r3ilrl tIcirclt l]lli fun ctin ll U hy meU15 dl i )ll1 t trk ~ lhJ cl( -ll tlt C)nlr~lUions ~llld no l IdOshy
1l)llic d YIltll1k lt l jAJ lktic t) I1 ) II 11)t 111 hd posibleacute t lcluuml ee postura l io nrro and stfh ili lllllt IJI
w i thout food T1lw(ull r d I( Lf(11 Ibk t m ucircnuin Ihe c()rf ~ct [ ()S tu re for cl gtu ifKi IH lLl1gth 0f ti l11 ~
This i-l ddl usl a typl 11 dnmnin (tf k inesllh rap) in 11 (lt-11 [[k - p~d fk lnr in lng f u l1a in llllliCk is poss ihle lI sing ctrtain Idncl fJ l (lt) 11111 liun S p Ul in tb is Cl c is ulttful ooly sa I~tr 1~ il Iw lps t1w lxltknt 1 becuJl)t 1gtlt ltlt-I a ClJu~l inred irl ilL ntllru l o~ i cll
and I1lll~lJhl r-keJc LIl [rll-llIn~ middot etlt(wrs JI the int e rmiddot vlnrion
[J ROPA MfJ) I()Wf-I YSJ IR
1
ICR 1 1-1
r
1 shy ~
- shy
11 o-llrfOlhe5l~ o t Ih 1O~(1dity i n h ~ r ~ ll nr pbl1 l of ~ Spl11 in 111011 _llti1Gt l lPt f ltlJUCWJtl ( ~l Ihe Ir t 1 1gt illbll W Ilh LtltrJ1dlion Vln lbe rigronl middotUII~ l(I Dko n12 lIll h lumshydlanie1 1 [ nul 1 M hl whtrc M - gt) lnIUI1g 111laquo111laquo1 1 1 c rtJCshytjC~ f fce d -d Lill l1~ o f enr niI pUll spnmcl1y 1~ 111 mldlll1lt (n the fl1ur t 1 = tor~ of f(ward Ileuuml l = ughtel1lng fmiddotr p 1shynOf stn lClU= Alaquo rdtllg 1raquo Ihl~ - lin hull th l1ltgtllugrave ot tller1l lUr~Jtllrc F the ~pin t -ilh rlu1i tf Ihl 1 1Ibulll n lrlt InltT1 1
rbc prJI 3IJi l1ty d qrlOIJ~ n bull JI t IlJIII Hm lA the v=ltd gtc e lu-ing J 5lnK1ura i ltfnnity
Dioal e ch anicll itllp~lir J11 c nt
Ihrcemiddotdimcllgtional mc-cbal1in of the s pioc
~f Ikmiddot i t i nly l(œ ntly tlHr llk pr-5tnœ or nc ushy1 lnlo tnr impairment in Idiopttlllc s-ol ii IXl tknt liuml J$ heen h i- ll licircghlcJ hy re$eJ rh tll e preit ilegravee h inm b nIcirc Ji d lJutg~ lt hl ~ 1 ng t o n dO Ulll urcel 1 i5 (l lreldv well umlersrood H(j-ev~r nev lbt un h iomcrhankal im l) ion nI h1c rectm ly onk l n tIlt tre and p r~dou in f n rmtinn hou t pl1ykd (~fcl5( in t 11 0 tl1I _ltgt pbne of spact 1115 Im trqlt-u 1rom J i-[) v ing unclcrsrmdlng ot th l lmc -dim nshy~ilnl l l11 ~ hmk f the cO]jO[lC pln( ~2middot ) ) Ve- w ill )iI xnl t l1 d at lcL-orcltng tUl cl sif iol t lOn blsed o n gtolllt lricd h uumlCJ ) p lane
- b() rJzU[1tl ln th i pla n ~ th t 1o rm ll sp ine present no CUlye- w ll ile Uumll(~ ltc U Hic spLnc clevelops one of ir haracterls(Icircc deFo rm tiCs v elt tbrd ln lashytio n vh icl1 pJ()VcA~ theacute hw 11
- lgitltl in th llulJe U l(~ nonmll spIcirclle pl SenL kypl lOSis ~nd l dooi~ in tb lXI1 lhese [(Hu rts Vere m)( til ught [ 0 he relattd tlle scolkJtlc ( lI r Vegrave
- front l in hi pleme tht ncrmal p ine preseuron t no curYegrave whil thl ~11li tic p in ugravetI I ()~ icircl~ charshyad t Ilt I CU1C
Il Jri fJIIt palic
~l+I~na ra 3 r inr lut th l[ ber ll1d a œl1~lU1 degr 1
l f r()la tJo u lllu (lILa r forcKl ltxert ltJn tl ldefnmuumlng 1 tkllJ [J i1u a re- lhlt tll cly 11 [1 1 UI b y Olm ner w bn ~lh uiJwd tl egrave ro t1tic) l1 Ilm it ti lt p ica] lf shy
rhrl r() be (P (the Uma bevond Wl1iltJl th lCOJlb of [11( ~pmaJ musd ~ dthc COnCIt and nm ex ~l le btconk (t O li~[)
r ~l 18 ~1Il N lu t( ren i9 lun lu ted rlseurlt h in tlt ) tilt lULodeumlformipg1 tlo n ot tIH_ sc laquoJrle rh ox ercallkren lk 1l1~H li d11r once thl Il i ~ r tld1t5 [he lhrth ld f 111 JlIcirc lIi of tlle dnrlclc hurnp tlk
lI bslt Il l nt rlet()rlll lIcircon 01 the it l ()I~ C ( (ylm der (- sustalnecl by an H1tmi cforming aCOOIl
J1Ji h V hl rhyiical f~ f Ise CI 01 h spr n llnd kin middot ith ccedilrapJ my lX damlg ing vll e n l pplild as flle
igt Jk Iller ln SCC1IJ ~IS lllc lJ fxceed l auto in middot crca~ i n g lhrllgthuld [1 sh (~u Id ahn be j ofed that Ilw relscd pre sun 1l1111i insiugrave l fe pil1r inn) 1 mlshylt
- j Il- ( w atff 1 (nh ~1l 1(e Il10 utoldrml ng li1eCh~lI1 1sm
in flc l Geyer ~w tcd th1 t rm m 1 hI l)1ecircch1O lla1 puilll 0 l I C~ sw m mim t Ieuroamp no purpo t for cu lshyim le pllilt t1 s (weumlO middott r it is l~Jl(gtWl1 rhn in iculio r[ paULnl -iJl11T1ill~ doe_gt nor Il ~lp to i ncrt~SL n eur(1shym tor co mfU
(1irai p an (
Jerdnn lle 11 showecl thal ill CSl~ o f t10rLC IC 1i lUgrave
tllo lacolulllhil it lio_1 tlle cte tI llmiry in (he lg itt1 p lln t rn lnlftot il~ lf tspe iuUy in tlw initi 11 r luleuml )f cV IU[Icircon nf Ile ~oli ls W iU l 1 p(t)gr~s~ivlt il10middot~ shy
ment roward hvpok pho b G ll f ill~l Im lins l har dUflng (IN eWllLlfiu1 of 11Imh] co luumlgt i the l in t ot t l H~ gClyty Cegraven te l - 0 1 v llebed lxxli 5 r ro ject 1 seH fl r t side-ys and tlwn backlrcl bull thu~ p(0(1 lj n g a kyphQtlmg aet Il ln (h~ lu mhnr --PIl1 COftj tng
l l i tc Iugrave l lltl l( l rs1 tif s L -etllgt il l the lgirl11
1 Hl)
Ilu LE nI rIIY~Ic~L lXIlKISI 1 HI E TREhTMEtn OP JIU IDIOP llII C AD O USCUH O Ll Œl15 NEGR II
lLill tegt lre lenl1 ~I d ~fo rll1J[ ~ rhl recrSes the phyltiologiGII cmns of lh vine)
Accordlng () Dicion ~2 1 rtcluctio fl in the itgitttl CUIYtS combin l vi th a lueral Iviari n llltl ds t 1
mecban ism () ugravel~ta il ity in l he r rat r IllI1e which bVOf1i the unsd a nd i ncrea~e 0 1 co hlt1is (Fig 6 hiIf md Pl11jlbiJ Jl1eanwlt ile lt(udiecl lh e srnl ru t
orzyglpophySLs show ing t11 al ttleir 1I1tl rnic tl orienshytation f~I (jLi l~ltes aXIal ve rtegravebJl l rotllio ll in cun litluns lt f dorsal hypokrrhn Icirc tnd lum)H de i L lo IS
Tll t dat SLlgge 1 th t impOrfill ut pOitu res and l1lweil1 ) t Mudied in ord t r (CI mlIuml ntrlin or to reuwer fll e p llyslo lo~lCll ClIlye in lIe SlgJtta p lU)l Wlth the llm o t ch ~ kin~ rutltor in l~ bili ry7 AbC th ~e ~k-
1l11nL ~Irt del lnt [0 J jUc lt ftber l]kuti inrervenl ion vhich 1c)LJ k l IV - i(l ~ l compktl n l ililll on Il t c1 l shy-jel1 J11UVllT1ent IJ j o f 1uto-dOneacute(3tlon ( i e a -impk ld ion ) Iengtheni ng o f the pilleacute 011 a litlltl l aXl~ tll lt ((IT liJlI~rcdu e~ t lle ~---lJ linti- l lte ml-fkxj(l n h UI 11 - i llCrl I~t the plllH ](JgicJI dlt cr ~l S ( (1 k-yvllCiSh lIld O(ltOSh l o r c lch r1Iif n t a Ilew til(~ecirc dUuml llt Ilshy
si lflltl J ll1 u(~nlent iam ecl - 1l1t0- lIrfe rionmiddot7 4 llmshyp oed f Je-rura l iUIl cl middot-t1e- iltm lI1d ll1a intltnUlLe )( 5lg it d C Uf (gtS slig lll thltJrc i ypI1 tiZ) tIcircOI1 a nd lunugrave)ar 1()fdos i7~llion) sholild he esw b lb]HU 00 lb co
hl b oi hi p~l11il uU r -1Ir vlt Abo 111( e IlltUtl Chl lie o f purti n - a U vitk slJ1ultI h e )tuumlll ecl 1)] (1 n ldershy](ion r tl1i lt type for e upIe IilJ llyl)T S of repd shyiti( ml vemen prt n t in agonistK h)lnllltlSlks nI iIle kind f dlJ1ce C( uld he ([([r imentd
FmiddotO lllaljlallC and mobili ty of the SpIcircIlC
1 rd llo U 22 d L lm nrrare d lhlt in Illt fro nt a l pll ne
tilt 1 nge Clt 1)1lt vtment of tht scplit[i middot CU IY grcmr lIJ l il ~ d irectio n n f Lhe C ITelt tlO n tha n in tl le di re shyLion of pmgressi n l Fig 7 ) he IL o IS5err lJd tbat th15 mohiliry increac plrtil u la rly n apic [ cgcoeilts 1$ lh ~ ~c() li osb evolves Sragrm rJ 12 J ~ thus rigilt (0
VlI f n rller~p is ts Ilo t t) m o b uumliz - a sCtJl iu til curve w ilhout t [ uling ttwt tlle R lu tiOI o i til t ~a mt b fnlinruumln( 1hy l1tans o f ~I passic 01 1 rivE -uppnrt On tilt (ltllE r hand UgraveK d e iJlioJ1 in ease durill tlw tune 111 whicll tll C spmt i ~ not submjtrcd to correeshy( IV anl()n
j- Virh mi lei ol i b tlllt Upp i1n ill) lC tiol is d eveloped only lllmugil llClIf()mu$Cllbr f r llce thi ~
InegravelIl ~ thclcfo re tl1l[ inu eascgtt sp1J1all1extl)iity mua
11
Imiddotiumltgt 7-rurd illt Ir) 1 bull rdrilt I1 1 in tl lt frOlllll pbnlt- th( illl ge )r mOC llIeJlI o t the S-o UIIJC CUNe 1 supcrior in Ihlt diflt(l im ugrave( the n nKlIl thd n ll1 tllc dlrtcLion o f p rJ1(l( (llIl
be considrCtJ vntrl iJ)(l icltion and 1 undrli neocirc ab L a ~ubiljz~ILion 01 tilt spint pllss il)1y ohtl ll1td thrltJugll the stlengtlkl11ng o f the 1rltJgm vlt nonil lme shyCIC 111 illli orrant u bjcLliH- ln rhis r~f1 n sp u lllni lc tivitIumlLs sil uld lX tPI 10 dlegraveltl it l G lU t n w l1ik luring kine i Icircth lrr phyltical eXegraverci c~ tllat in ele
spinal m ot ilIcirclY sil nid 1e lt1 oid cdrt ~
Organ ie and psychologieal impainncuts and li islbi IiI le
A cgtI im lc pmi nr is moriOthl11 just 1 sp in and 1
compkt gt Ipp rnach to the gu in ad 1 ont i al~ shylute l e~se i t i11
[)a la 0 11[ [n ell lrom re semh pw tbat ome organi Iilnctiond cl fki ts suc]) as tlw clecrtiUe ut vild l tnd d fun ll l)Kity_orld ldly incrtJ k whil~ 0 shy[io s i -till in (1 miel q g of g JltlV ity ~ l ilI e 55 rtI lit
tllL pres e n ce )fl defidt Or Vi l~il Clp~1 - i~ ln one pIIiem in Ihr l ftectecl by 20 ICl 40 scoi stgt l ls~a r(h cunclutecl in tbe UA by Di Ruce- prod uegraveed an aaalo) u ll1lXimum 102 re u t in a group of Jd shyk 1ien t [(h sco llosls rang inF frum ) [0 1
Al10ther rudv bv rallt r m C chr111 lilcl NashycWrl1s( u 57 stlO eltt hil $(C 1 1 ui~ Ica js l( lllt cl (1 shy1prUlllI o f t1tgl lie bJd l imI in ~ul sct t1 t ltu b middot iects jlLltr l5 they are golng through ~I cltlici[e sllge in the fnm 1lt i n 01 tlWH o w n id uHitv t factor hit h Illy jeopmlize the cl velopme lit d ~ mIll lt lI1d htIshym cecl IWI sonalitr in Klulrhood
n RUI ~IEDl(( Ptl Y1-
ROU ltHmiddot PI [ I C~ 1 EXIRCIS]~ IN TI Il nW~JUNT OF SlllO lDIOP1HIC AI)C~ESΠ11 C(gt1[Oi 1S
This i why b IiCieacute ii is ~n imporrlIl t for p rcshyvegraveml e 1tLsr l tn en ou flge 1ari e nrs ~lfrecr(d by lIillcl middotu iosis ft) tlke p~l rt in portin -re rcatioluJ acrivitits Iha t 1eIU 10 L10 th r~1chophyinLl bull nd b~l )i 1l1o tur adlieem t n li 51Jmiddot2Even tlK)ugli [Dr bic mech~lnshy
ical mcl nellIUll10t 11 11 reltl ~ons lt r111 1gtomcrimes be l lefu l to ugg( ~t ne p rt in~ aCt iv ity r l h (gtr rll n anotlJer e th ink Ibal an exces~ ive IlHd icalizltion - Icirce l ll1posilion br plry~ilt i HlS nnejlor parents uf rh ry pe of po rt to lx p m lice 1 b Ule p 1Ucirc(Il L th1[ preshydLl ck l1 is fret clOice in lh ma tt r - -h II ll1 he avolc1ed wb 11 possLhle mainly for tlle i mport~ltll psyshyLb ) jogka l fe a SI)nS W( ha( ill ~ t nltntionegraved
Conclu ion
lbh ISsertegrave d t1H physkal tgtXtlci o is ) n fi ial whlIl practinu in order 10 ilnj rove the I11 llde
rœ nwh and tono C iral caplCiry and postu re o f the StOUO(I ~lIbj n II I nowkdge om ~ middotmg trom ci el1shyrlfi rls(~ Jrc li dJlJ accordl ng r the review 01 thE litshytirlture prnpo )td in t lli plpl r conflrm~ Ihe vuiclit ot th e -t ls ~rti ()ns
In l do l (ent Id iopl1il iC scoliuse il l n phee u i cl vk)pm e n t ( li tll iumlKh eXCC cl l g i en rhk thr hokl th e re i5 an und ubred need fn r l pprnpri 1tegrave (JJ1tOkJJe ~Ild Inr surgict1 therapics ill ortler 1) S l i p
the ( - Iuli on anugrave )JT~t~t UW ~pilll l dtlormities bull evshyerthtless in the illiti ~ll pl l~sC t ttlC c1iseLltc whcn the riS( r1 r euro )luli m is rtduced ocirc ~md tfle uifleal JOld threshold il ~ld flle po stural collai i reJcenw~ 43
JI l1 igh pllysicaJ egravexe rc ise - p revenc or r d llCe d i ~lh ilir ies o f [Iw ~ l() li )tic
p (iems R 28 J -6 5- 6 1 63
- f~KiHtare lh ( n utr ali711iCUl of postu m l d elicits tn produCel1 a coneql l nce J [)ti 0 I111)( or regre si -u lmiddotc 5middot Il 1 17 ~ M
-re 51udles U ~ n Ledecl tu con[mn or re jecr these conClLL i( 1 w l1 ich clerin-d frum 1l1 lIldytica l rcltw n f th e liter~iture appear r- ~Lo nlble Hnwecr Intil ne re ull are 31Iable wc should n r prevent our sroliotic patientmiddot trom tl ki ll p lt in s(loI1ing jshy
ir its pW1iada rly ltl t ~d1()o t () n til t c ntrHY -vith the l xcclrinn 01 gt[1 )11lt tIlat in rea-e t)1obility (tnU evc n thell oilly wh n progr~lgtion b p OSSibl) -uc h ~I( ucircvshyiUe -11 )ulu hl tIKoll w g ed The 11 S J ( rprOpriue kin (~irhe r~l Piuml to incr _~asc p()~tura l $llbil i ty is tl1egraveoretshyic tlly CiJUClt alttloughl more ~Iccu rtte aod deLli led ri k benefi rs anJlr~ is is netot1ed
Ria 1111tO
NIokl Mu d lle ftitYljJfu Jœl il 4IWr10UOifll S (JIvs i (1~1)Jshylidl ttno( cclIll le 11(11(1lt1 RCI fu lle ((lia LltfIt l1 I1I1i(i
LJ ci n s j(r3 pigt egrave li n IHUgru lkl di t rdz t fi sici pe e ft shytUlKm iluppno di un lisimerap15Ll rl lllcflt() 1 110 scopo di pnevirlt () fr en~lI 1-lgpwlllltnlcgt dclld lclonnitugrave o e il 5LOshy
Il i mi llon lt fH nugrave j (1 11ni dei co~e 1 lteIl I1J J nd ne ~Ii eifclti (()Tc rri udk s co lio si d i m e dia g rt iuuml ln que~ltlt
s rud i 30 llizzb mo i d ti cleU ric lca pel n ri Icare qJJ l lm 1 dis(imucirc x u le I[~ l z j-m i pro vna le da lla C gtl k A i json ere pr middote-nute () rk kl ducirc un~l rdeguCltl d nil cra pi lt di uJoseguerrnt Cjua li 1iU110 cli nbie tti 1 rcr lJ)tIId d~ fle)-UITC
n (- -fd7Io n~lcl)
Ut11claquo)si 1 lI tori htpnuuml )ludi-ttn I ~ cnntI1zttu fr Cq(in i idiJ)tic1 dbfl lOZ10l1 d d ~ leOla nelllOll1otoriO Lb un1I1cnUl 1n1l1i3 dcgli 111 lt1i ch DIJgt gtU l H crmU1 Nlch~mslt ( SIshygnaJ~l lerimiddot wo i esuemi -bletti d~ plt~e8lugraver- ne l pClZ le1lftgt scoliodcu kl s iluppo ddl ~ ~ uhjlil~ vertcbral~ lt o svilllp prJ Jdle JIl7 i() nl di ltCjuiljbrio Dng li studi sul lto lb( l~nlrale (OllddU i in pa rticdu d 1 DlIal-BeHJ (gtegraverl ~ P~II IId lI1 n~ llw - idente il v- m gtiu p eT il puientc clioti elgt di u n rnigb o t c)[ ro Ua sw mle dei radlldc onsegull o tramite il 11 fforzrlshyfl len to d e i l1luotoucirc l nllgr3ilri d e luOwo con crcbi ~Clltdr
in pOMltHJ corrctl e in va rie ~i[Jzioni s t llicb c c d inamIcirc tllt Dalle on sena d elb blOffiCcclIlicd tr idimlt n s io mlle d ei
r ~ chi Je ~oU()f icn ~Icirc ~videnuumll (l() ~llt tC p IYZIcircOSI ln(IiClZlfHicircl ~ 1I1shy
liumln fluenzt Je ll middote~rUrio tl SC) lgt lIi I rc pibull m i tldln sJlI71 Stl shygn~I I1 afferma che slI l p Ia no [11 middotccedilr~lk tre un œ rtlJ grado di l L1Liuuml IlC dclh vEltlh r1 apj(de le tu rœ mu SCltJ llri njtbc J n in $tJ ) t rodcfQfll1t1l1te PltJtantu b i r~it-~ r -lp il puugrave t~~
Ixnt-ftla solo nt Ile so )[j)~i Jl1Icirc na rl in qunnt ) ilon SlrM ntne )(l(Ofa tu soglb in caq ) co lltrLJIcircn l)lrilto llt~( i lJudotlsi di lfr~ lI1 C llg grVlmenl J 111 11 io lr riltd ll(17jOill leld rinlle 113 dimO~iumlrlto d llt nell o lin~l cl()~ li t th~oIOl))1 dri la defltgtrshymiti sul p iluO slfl iuale ~vohl lf1 (en5 ion~ sO lnm utto nd 1e bsi iniliali deWggrwm1Cnln mcn trl C a( lfLmn che occlleshyvoluzi ne dene = 110 i [ mhari IJ lin c l ki cen tri ch -1vi1( de i cp i CIt IJ rI Ji SI p m ittIl pnm l Iem lmeme e p o j pOS( shyrio fllwnte dtldnli mdv ( i un ziuuml ne ciloliz7nnl dd rlLtide lu mbJ œ ( lIlelttlaquo on NC n d d (gt11 uIdu m 1I1 Ilgt) cli r-Iure (0 eserClzi che IllUllengano 0 ltlUperifo le Clgt 6gt1 lo)iche sul pirluuml gilwlt Su l p iCl no fron itk Perdnulk il dlll1lt-trlto d1 lampkz-l d i LU ovimento amp111 lI rv Kolio ti ~ nd lt1 0 ddlJ cnrrc-LIcircQo i Ji gC 1 n lungl SUpegraveliltlrccedil 1M llS0 tlell 3ampIGI shyvamcnlo C che l~Jltmiddot mobiliti GlI mcnta co n l c lu7j o fle d l i) snAio i A ulln amplgrtJc1 ltllllmunjx~ i terlpGli nn n m obi shyUZ73It ma eutva coli ti0 1 1ct HsicVlfe nd tcmplt 11 1111nshyttllIcirc1nc n tc (k ll ~1 llu u zinnt n l1 un me77uuml d i sost l11( gt ln 0
e 11111ri b cle - Ilziunc egrave deorinatcl d l rlyarsi Snzcl la pr gtshy
liltlnl l i un() rtl~ i ptmiddot Jtl n(o 1S(Hl () (( ntJ() i ndit~tr i ~ Ii ISt (izi e l m iviL Illdlode ebe Hlmen tno laJlc ibiJii dcl rlc lide SCshy
li io) [n p articobre rune q lldl r C-I1 ich~ xlSiddcHe CUf t shyli ve ch~ iJllpi tgino e~rciii 01( biIi2 ZanUgrave HhnmL-trid () in tmiddot~t~nshy
sione kl fuchide O tne pure k- ~ttivit1 tnotoJII~ non prHi(~ llCcedil
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EUROP MIDI C Pli hIC
EDUCATIONMEETING SATURDAY 8thof APRIL 2006
(iSS
SEAS02 Scientific
Exercises Approach to Scoliosis
version 2002
G
S Negrini 1
EDUCATION MEETING SATURDAY8th of APRIL 2006
Neuromotor disfunctions
Neuromuscular disfunctions
11 Postural collapse
Postural collapse
Duval-Beaupegravere
Flexibility of scoliotic curve
f---I--- I Postural element
-------1 Structural element
S Negrini 2
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Postural collapse
Duval-Beaupegravere
It is a value related to muscular tone and to flexibil ity of convex side tissues
Post ural collapse
Bunch e Patwardhan
Critical load
Load threshold beyond wh ich a spine begins buckling
JI~~Wt1lW~flfthtlJlœJtAr ~ J~It- l~l - IMS
Postu ral collapse
Bunch e Patwardhan
If a curve reduces there is an increase of the deformation threshold
~~~NW~-damaoc~IIIMf ~~ J~Iv JaJ-I7I9sect
S Negrini 3
EDUCATION MEETING SATURDAY 8th of APRIL2006
Postural collapse
Torrel e Nachemson ~
Scolioses below 20deg ~ ~ lt~
have a high ~ ~ percentage of ~ ~
~postural collapse (on u~
average 75) ~~ 2i~
CU~VE O EG~EE S WHllE SUPlti e
~laquotd~c6b ____lPffI1wtt1t~
$ww J(t ~~7 JM5
Postural collapse
Minor scolioses 7
Antigravity musc es strengthening D
Reduces postural collapse -G
Increases the critical threshold of deformation
G
Neuromotor disfunetions
Stagnara
If we admit that one of the causes of idiopathie scoliosis is a disfunction in balance systems it is logical to orientate physical exercises toward this direction
s Negrini 4
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Neuromotor disfunctions
Dubousset
Idiopathie seoliosis results fram alterations in praprioeeption centres and deformation is a natural compensation to restore postural balance
etattJtitIK ypothfQj~S ___~ own_ oJ)HQr lar 1t-1( r
Neuromotor disfunctions
Nachemson Initial idiopathie scoliosis
+ Goood spine stability
Neutralization of postural deficits
D Static curve
Neuromotor disfunctions
Therapeutic aims
c) Development of spine stability
C) Development of balance reactions
G
S Negrini 5
EDUCATION MEETING SATURDAY 8thof APRIL 2006
Biomechanical disfunctions
j Horizontal r-Ian
i Sagi ttal plan
Frontal plan
Frontal plan
q Frontal plan disfunetions
Fronta l plan
Perdriolle Movement magnitude
gt in the direction of lt in the direction of correction progression
S Negrini 6
EDUCATION MEETING SATURDAY8th of APRIL 2006
Frontal plan
Stagnara
Never mobilize a scoliotic curve without ensuring reduction maintenance over time otherwise a greater mobility favours scoliosis progression
Frontal plan
Ducongeacute~ research
On a group of adolescent idiopathie scolioses treated with
Meacuteziegraveres gymnastics
D After 1 year the mean angle of
curves increased from 18deg to 29deg
Frontal plan
Scoliosis without brace
D Greater spine
flexibility D-
Risk of progression
S Negrini 7
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Frontal plan
Mobilization is useful
D In preparation to
brace
D With brace
Sagittal plan
QSagittal plan disfunctions
Sagittal plan r middot _J o
Perdriolle scouos B CJ aDeformation of D
thoracic and thoraco-Iumbar curves evolves in extension
S Negrini 8
EDUCATION MEETING SATURDAY8th of APRIL 2006
Sagittal plan
Graf
The line of gravity centres in the vertebral bodies o s c oUOSt
projects itself firstly laterally and then fi
o
posteriorly lJ ~~ ~~ ~ ~~-_J-D ~nI~
Sagittal plan
Therapeutic a ims
D Maintain or
retrieve physiological curves on the sagittal plan
Horizontal plan
QHorizontal plan disfunctions
S Negnni 9
EDUCATION MEETINGSATURDAY 8th of APRIL 2006
Horizontal plan
Stagnara The forces applied ta the spi ne act in a autoshydeforming sense
Horizontal plan
Dimnet Rotation gt 200
ampII~ (
D The actions of concave and convex side
muscles become
agonistic
~ItJrOnrIIiItdllfUClltlluumlll~~tI ~1JIf1laJ
Horizontal plan
Minor scolioses never exceed these autoshy
deformation thresholds
S Negrini 10
EDUCATION MEETING SATURDAY8th of APRIL 2006
Disfunctions at a biological organic and psychological
lever
Oisfunclions at a biological organlc and psychologlcal lever
Cheng
Bane density in scoliotic teenagers is lower than in normal subjects
~~~~middotA~IIlUtIy ~7œl 1d l
Oisfunctions at a blologlcal organic and psychologicallevel
A significant reduction of vital capacity and V02max in teenagers with a medium severity scoliosis
S Negrini 11
li
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Disfunctions at a biological organic and psychologicallevel
Disorders in the development of body image that the teenager has of himherself
Disfunctions at a blologlca l organlc and psychologicallevel
Therapeutic aims
cJ Activate cardioshyrespiratory function
cJ Favour bone density increase
cJ Develop a positive image of the body
Disfunctions at il biological organi and psydlologicallevel
Stagnara
Sport
D The active side of
kinesitherapy
S Negrini 12
EDUCATION MEETING SATURDAY 8thof APRIL 2006
Disfunctions at a biological organic and psychological
level
Distunctions at a biologlcal organlc and psychologicallevel
Cheng
Bone density in scoliotic teenagers is lower than in normal subjects
~n~IIIvpWr~middotA~stWy s- XXJl M J
Disfunctions at a biological organic and psychologicallevel
A significant reduction of vital capacity and V02max in teenagers with a medium severity scoliosis
G
S Negrini 11
EDUCATIONMEETING SATURDAY 8th of APRIL 2006
Kinesitherapy on the scoliotic subject
q Postural control
q Axial stability
q Muscular trophism
q Balance
q Respiratory function
The limits of kinesitherapy
There is a threshold beyond which
rehabilitation alone is not enough
sssr
Kinesitherapy in scoliosis treatment with brace
Therapeutic aims
S Negrini 13
6
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Therapeutic aims Srace kinesitherapy
With brace
il Postural corrections and
vertebral stability are obtained by the brace
Therapeutic aims Srace kinesitherapy
In preparation to the brace
il Mobilize spine on ail plans
Therapeutic aims Srace kinesitherapy
With brace D
Maintain a normal spine elasticity
~ Maintain a good muscular toneshy
trophism
C Model the hump with kyphotizating
exercises
S Negrini 14
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Exercises and their methodologies can vary accord ing to learning and individual sensibility of the single rehabilitator that proposes the m provided that they stay within the
Iimits of fixed therapeutic objectives
li
Therapeutic modalities
(Exercises)
QAuto-correction
QRespiratory education
QErgonomie education
QMuscular strengthening
QDevelopment of balance reactions
WNeuromotor integration
ci Vertebral mobiJization
QSpecifie modalities in brace treatment
S Negrini 15
EDUCATION MEETING SATURDAY 8th of APRIL 2006
The protocol of kinesitherapic
treatment
G
QChoice and dosage of exercises
Variatiosn of the work program every 2 - 3 months
Q Execute e)(ercises on an individual base or in a small group
Q Frequency not less than 2 times 1 week
Involve and awaken the family
G
S Negrini 16
EDUCATION MEETINGSATURDAY 8thof APRIL 2006
Q Determine the action and the localization of auto-correction
QAuto-correction must be associated to ail exercises
QAt the end of treatment ergonomy lesson
Auto-correction didactics
G
SCOLIOSI DORSALE---- shy ----
r
S Negrini 17
EDUCATION MEETING SATURDAY8thof APRIL 2006
SCOLIOS OORSOLOMBARE
shy
SCOLIOSI OOIlSALE 011 bull LOMBARE S1I--shy
SCOLIOSI LOMBARE
il --~_-
S Negrini 18
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Scoliotic patients are not radiographs
middotSeoliotie Mtients are not ndiographs but hum beings with a vertebral deviation-
Slagnara
Metha For the physieian Cobb angle is of utmost
importance For the patient it is body deformity t hat eounts most rib hump a protruding seapula or hip We are in a situation in whieh today dodors eure the radiographie deformity but what the patient really desires is to get rid of clinieal deformity and of ensuing psyehologieal distress
CIIQItIo shDuIdtucirc lM WIld tJw~~ I~~M~~~~ J9f~
S Negrini 19
- Poznan_workshop_Physiotherapy
- physio2
- physio3pdf
- physio4
- physio5
- physio6
- physio7
- physio8
- physio9
- physio10
-
BP
Il rz
Th
Cmiddot 12
R-3
L
C-16
R-7
PoDP 7 mies 10 rz_
C-9 C-20 R-OR-2
--__ _ _----------shy
12
DP
8 ri
111 C-26 R-2
L C- 17
R-]
bull Metoda asymetrycznej trojplaszczyznowej mobilizacji kr~gostupa ma znaczeumllCV wptyw na zahamowanie progresji
w skoliozach idiopatycznych szybko post~pujqcych
bull Mobilizacja strony wkl~s~ej skrzywienia i osiowa derotacja kr~gu szczytowego zwi~ksza korektywnoseacute skolioz zmniejsza garb i ebrowy poprawia obj~toseacute klatki piersiowej i zwi~ksza wydolnoseacute oddechowq plue
13
bull Przedstawiona metoda jest
stosowana samodzielnie lub
w pO~qczeniu z ortezq Checircneau
a takie jako przygotowanie do
leczenia operacyjnego
Ocena progresywnosci w badaniu elektrofizjologicznym
odruchu z odci~zenia
i~middotmiddot ~=~-~ shy1 _--==shyocirc
14
EUT S pine J (1997) () 93-97 copy S pringer-Verl ag lY07 ORIGINAL ARTICLE
K Dobosiewicz Neurophysiological mechanism of the unloading reflex as a prognostic factor in the early stages of idiopathie adolescent scoliosis
Rcceivcd 29 M arch 1996 Revised 16 August 1996 Acccp tcd 10 Septem ber 1996
Absfract This paper presents a new nc urophy iologila1 methougrave of e valushyati ng the risk o f p rogression in ill ioshy
mo t important factors in the eva luashytion of progress ive id io pathie scolioshysis The met hod can be lIsed to deshy
pathie scoliosis in th early stages uf tll( progre jve idiopath ie scolios is the dis ase by illY middottigating tll e unshy in lhe early s tages of the d isease loading refl ex in paraspinal muscles T he high sensi livi ty of ilie method The study incl uded 394 pat ients wilh means il can be used as a basis un seo liosis and 70 hcalt y chil dre n which to take an earl y dcc ision to
K D obosicwicz Depuumll1 mel1 l of Rchabi lilu lioll Si lesilln Medical Academ y 42-604 Tamo wskie G6ry 4
Lmenty of the unloacli ng retle x and repeatabi li ty o f Ihe rcbound and silent period were anal ysed for eaeh reflex evoked Prolonged latency and
p rimiddotom1 surgery
Key words Id iopathie seoli o is Unloadi ng rcnex Re bound
Katowice Polaml minima1 numbe o f cycles are the Larency Si ent period
T he ai m of this sludy was to evaJ uate the use of the unshyIntroduction load ing Dex for octcction of prog ressive id iopath ie adoshy
le cem oIios is in its carl s tages in onl r to lake a dccishyProg ress io n of id iopatJl ic scolios is bas been the su bject of
sion ta perfo nn surgcry as soon as pussible many clin ical radiological and elecrromyographic in ve~ shy
tigalions T here is ho wellcr no sim ple quantita ti ve or qual itati ve pro noslic methoo [hat can be em ployed in the
Materials and melhodsearly ~tHges of the disease Monitoring of lhe unloading rc felx in paraspinal m llsck appcars 10 be a reliable Inv gtsi lgnlions were carricd uut 011 394 pa tie nt with adolescent method o f discriminating bctwcen diffcrcn l fomls of Cushy ~c li ed J ild 70 hCldr hy children The scoli osis group consisted of Iios is T he un loa ing re n cx can be evokcd in ail the 31 1 g irl s and 83 boys aged 9-1 8 year~ (mean age 125 ycars) The
ske lelal muscles through a suegrave den shortening of o luntary contro ls wcre 0 girl s and 10 boys aged tO-1 7 y~ar (rncan age 128 cars ) Imong Ihe stlbjeclS tudied wcre 9 patien l w ith cershyinnervated muscle l2~J When a musc le is unloaJ ed vico-thoilc i seo liosi s mean Cobb ang le 22 7deg 121 with Ihoracic
rapidly durin g an isomerric con trac tion Ihe norm al reacshy scolios is mean Cobb nngle 309deg I 1 w ith thoraco-Iurnbar seolioshylion is an eleclrically silent pe riod fo llowed by a burs t o f s is rne ~n Co bb ang le 26~g o 63 with lumbar cotlos is mean Cobb action potentials called rebmmd The pause in d ischarge ang le 279deg and 90 w ir h doubh major curve sc o Ii() ~ i s meull o bb
nng le 292deg and 28 5deg The sludy group includcd 231 right -s ided can be observed only when a certai n h reshold va lue of and 163 left-sided 5col iouumlc patien ls There were 112 patients w ith
acceJcration flnd shortening of he muscle is exceeded progress ive id iopath ie scoliosi (76 ri g hHidtd and 36 Ic 1t-s ided) an tl il occues wilh constant latcncy correspond ing to that 182 with no n-progressive idjopa thic scoliosis (1 13 ri ght- sided and of the propriocepti ve nflcx (9 18 20] T he rebound ufter 6 le rt-sided) M d 100 w ith pe lvic tilt (statie) scolios is (42 rightshy
s ided anp 58 l eft -~ i(kd )the silent period in the unloaugraveing re felx rcsul ts from ae lishySC9 1ios is is consIcircdered progressive if the Cobb Jngle inshyvalio n of a pool of motone urons aIl o f which fClt1ch lhe
creltseacutes by more lhan 6 in 1 yen r aile middotnl1 n-progrcssive if the anshyfiring thres hold simultancously afte r prcviou~ si lenœ [l nua i increase is less thll n (i The Cobb angle ranged lrom 8deg to 77deg 1 4 201 in Ihe palicnls w ilh progress ive scoliosis (mean 361 ) [rom 30 ta
lI f R (on- f Rt tt1IY 1lIfl pflla 1 )(~ r(Jnu n t shy
fI) _ ~
Pathomechanic basics of conservative treatment of progressive idiopathic scoliosIcircs
according ta Dobosiewicz method based upon radiologie evaluation
Kryslyna DobosiewlcZ Jacek Dunnala Kny ztof Czemicki Hanna Jcndf7cjek
Deparmem of Rellabtlifatoll Mediw Uninrsity ofSiltsia KatOllice Poand 40-635 Katowice fil ZiUCl 3537 POL4ND
e-mail relwbilitacjt1s11mfoctaonetpl
Abstract Conscralivc IrcalrnCnI of Idiopathie scoht)~1 espcclall y kinc ilhcrapy i ~
nOI widcly apprccilllcd due 10 Ils suspectccl low dfcCIIcircvcnc 5 in relalion [ (1 a urglcal Irc[llment ACter long-ycar il ses ment of palomcchanic f scolio icirc in Dcpanmenl of Rchnhllilallon f Mclii al Unlcrsi ly of Sile bull a concTvallvc mcthod ()f IrCtllmenl asymmclric Irunk mobili7alion in lnclly ymmelm po~itions WIS
de el ped_Thi mClh d enablc 10 delain pTogression f scol iosis or ccn de middotrca~c laIerai urvalurc of a spi ne and angle of rOlllion assummg adequate () perallon f palicnl and ilS famil)
J Introduction
Idiopathie scoliosi OS) is a thrccdimensonal dcfonnation of il vertebral col lmm an- cntire trunk Afler many years of extensive rescarchcs the cause of idiopathie coliosIcircs $ i remaIcircns unknown It is possible Ihat idiopathie scoliosis devel ps and progress on a baslS 0- ~
multifactor disorder perhaps diffcrent for curve initiation and curve progressi 11 Fion poss ible pathologie factors nervous system dysfunctIcircons affecting postural tquili brium ar proprioceptive control seem to be espc ially important [ l 2 6 JI Pro_ ression f iS could bot delermincd by vertcbrac remodeling under eccent ri c loading created by axia lly ce gravitational forces in presence of muscular imbalancc in the trunk [2 J The verte rai colwrz unde r scoliotic conditions 15 an unstable system with tcndency to fu rther tune dcvelopment fl2] Lateral bending of a vertebral column visible in X-ray examination L
only a two-dimensional prcstntation of a complex dcformity consisting of patho logica axi rota ti on torsion and othcr deformations of vertebrae [7 8 10 II 14J ln fS physiolog~ curvatures of vcrtebra l column are disturbed Total Icngth of an anterior column of a spi n~
consi ting of vertebral bodies and intcrvertebral dises bccomcs grcater lhan length of l posterior colwnn - vertebral arches and proccsses [11 15 J h is apparent that phy iologi ~
thoracic kyphosis in rcgion of a scoliotIcircC curve diminishes Each vcrtebra of a stru tu ~
urve of coliosis is oricntatcd in hypercxtcnsion in relation t adjacent vcrtcbrae [7 l resulting
1 n B Uri middota I l 11
H srut ft illtf j tI) t li orf1Hli d
IDS Prt ts 21)2
Influence of method of asymmetric trunk mobilization on shaping of a physiological
thoracic kyphosis in children and youth suffering from progressive idiopathie scoliosis
Krystyna Dobo icwicz Jacek Dunnala Hanna Jendrzejck Krzysztof Czernicki
Deparrment of Rehabilitation Medical University ofSilesia KaloKce Poand 40-635 Katowice ut Ziolowa 3537 POLAND
e-mail rehabiliracjas(u1poCmiddottaollelpl
Abslract Idiopathie scoliosis (lS) which i sub 1 ntially l threeshydimen ional derormation or a pine cau e nOl only laler l curvalurc and axial rotation of vertebral column but al lordoti allon of VCr1cbrac in structural curve eXl nsion ln an effect physiological thoracic kypho j diminishc or cvcn dbappears Method of a ymlllctric lrunk mobilisation in strictly symmetric po iljon according [ Do () lewicz not only dcteriorme progre ion of IS or evcn reduces lalera] curvalure but also significmtly rebuild physiological thoracic kyphosis Icircn cases of lS accompanicd by lraight baclc
1 Introduction
Despitc Ion year researchc etiology of IS is nOl yel resol ed Significant problem re laled lO morphology of IS apar1 from lateral bending and ax i 1 r tati n i deviation of shape of a spine in sagittal axis affecting physiologi al curvatu re of vertebral coJumn [3 5 6 8 9 J 0 1t 12 Lcngth of anLerior col umn of a pin constitutcd by venebral hafls anugrave intcrvencbral dises dominate ovcr Jength of po terier c lurnn buill from vertebral arches and processes [lOJ This condition uring scol io i progress ion and growth of a child effect in hallowing or even disappearing of phy iological Lhoracic kyphosis in scoliotic region It i well know n lhar cn~brae of structu ral Jaleral curve are positioncd in hyperextension - lordotisation [5 6] which in Lhoracic region Icad (0 reduction of kyphosi or to true lordo middotis Such kind of venebrae relation in thoracic region cau es ilS destabicirclisatIcircon whi h in u sociation with eccentricircc gfilvitali nal load fa pinc duc to muscu lar icircmbalance [21 pOdbly produces r tationaJ lordo is [56 Il] and further development of symptomatic scoHose ft ha becn proven [12J tha strengthening of the erector spinac muscle aggravates nce initialcd deform tion and deteriorates coliotic process Hyperextension and uxial rotati n a s clatcd with
357 Th B Grivas (Ed) Research inro Spinal Defoml ilis 4 lOS Press 2002
Exercise efficiency of girls with idiopathie
seoliosis based on the ventilatory anaerobie threshold
Jacek Durmala Krystyna Dobosiewicz Hanna Jendrzejek Wieslaw Pius
Department ofRehabililation Medical University ofSiiesiaa Katowice Poand 40-635 Katowice m ZioJowa 4547 POLAND
e-mail durmalaiacekyocztaonetpl Department ofPhysiology Academy ofPhysical Education Katowice Poand
Abslract The aim of the study was to estimate the exercise efficiency in the group of
girls with idiopathie scol iosis based on the venlilatory anaerobic threshold (V AT)
Material and method The investigation comprised 58 gi rls wilh idiopathie scoliosis
aged 10--6 years 32 girls (55200 ) wilh double major scolioSiS and 26 girls (448)
with single scotiosis The girls were eonservatively treated using Dobosiewiagrave
method The control group consisted of 3 1 healthy girls aged 10-1 6 years The
cxercise test was performed using eycle ergometer During the exercise the gas
exehange parameters wcre reeorded (minute expiralory venlilation minute oxygen
consumption earbon dioxide production) On the basis of recorded paramcters V AT
has been computcd using V -si ope method Results The following V AT values were
obtained in the group with scoliosis 207+305 ml 02minlkg bm in control group
219+350 ml 02minlkg bm The differences belween girls with idiopathie scoliosis
and control group were nol SLaliSlically significant Conclusions I The exercise
effieieney of girls with idiopathie scoliosis conservalively treated using Dobosiewicz
melhod is normal 2 Such high level of the exercise cfficiency of the studied group
probably was due to intensive 3-D respiratory exercises of these girls
1 Introduction
In practice there are researched useful efficiency rates which on base of laboratory tests results possible easy without using of the relatively hard or long exercise tests would give the belter forsighting of the range of homeostasis disturbances and rapidi ty of increase of
physical fatigue during varied workloads [1] The best known rate of trus kind is the maximal
minute oxygen consumption [2345] During progressive physical effort minute oxygen
consumption increases proportionally to workload The reaching of real maximal minute
oxygen consumption in time of progressive effort is iodicaled by minute oxygen consumption plateau [5 61 This result is rarely registered in children The progressive exercise test is most commonly used in children until physicaJ exhaustion and the highest registered minute
oxygen consumption is treated as maximal minute oxygen consu mption or so-called
symplomatic limited maximal minute oxygen consumption [678J Sorne authors regard
Orto-dlet Trau malaogis Roha b ilitacjaARTlKUL ORIGINALNY ORIGINAL ARTICLE Vol 5 Nr 1 2003 80-85
Jacek Durmala l Krystyna Dobosiewicz l Tomasz Kotwicki Hanna Jendrzejek 1
Katedra i Klinika Rehabilitacji Slqska Akadenia Medyczna Katowice Katedra i Klinika Ortopedii Dzieci~cej Akademia Medyczna PoznQll
Wplyw asymetrycznej mobilizacji tulowia na wartoseacute k~ta Cobba i rotacji w przypadkach skolioz idiopatycznych u dzieci i mlodzieZy
Influence ofasyn1n1etrie 111obilisation of the trunk on the Cobb angle and rotation in idiopathie seoliosisin
children and adolescents Slnwu kluce ac eJJic Cl chOlIU) Ice SKoio= idj)PO Imiddot(~I7tmiddot
K~Jmiddot w()rus consrieI ve I (OtlHelif idiopathie HUW JS
SUMlvfARY
BackgrouId The aim ofthe stldy Vas Ihe radiological evaluation ofthe treatllJent ofthe idiopathic scolioshysis utilising as)mmetric trunk mobilisation in the strict~ll I)mmetric illitial position
Material ([fJ(f lIIellOds Presented stud) lOS based IIpon J36 cases (13 oovs oged FOf11 ocirc la 6 lcars (lild
rn girls aged frum 6 la S pears) trealed due to the idiopathie sCuliosis ((rom Novell1her 999 0 F enflfUn 200) Among 48 ch idrcn sllfJering from dOlfble-major scoios is 6 cases wcre infoll scaliusis JOjuvel7lle und 22 adolescent Among 88 sillgle scoliosis 6 lere infw7t 33 juvenile and 49 adolescent
Radiological exami71ation 1as condueed always in the repeataole technical cOlldiions RadlOglOlI1 lier evaluated oy the same physician Radiologica analysis oIthe scolios is incuded value ofthe Coho al1gle ongle ofaxial rotaion
ReSIils ln double-major scoliosis observed dlring one year period in Ihe thoracic segmenl Cobb angle decreased inll l increased 1395 and in 292 Il OS 111changed Axial lolation angle in 167 (~rcascs
decreased in 354 incrcased and rernainM the sorne in 479 In Ihe llllnba segmenl Cobb ang le clccrcscucirc il1 354 increased in 39 6 remained in 5 Angle ofaxial rotation deceoscd in3 ofca es incrcuscd in 29 and persisted in 48
ln single scolio is Cobb angle decreased in 386 incrcased in 353 and in 261 was lInchonged Axiol rotarion angle in 216 ofcases deceased in 295 increased and rell1aincd the sallie in 489
CondlsioJ Asymmetrie mobilisation of the tf1f17k in strictly syl7111elric initial positions is a 1Clhod of choice in the cOl7senJalive treatment ofthe idiopathic seoiosis
STRESZCZENIE
WS~p Celem pracy jest radiologiezla ocena Icczenia skoiloz idiopaf)cznych metoda asvmetrycznejl7lOoili shyzocji tllowia w sciSe symetlyczl7ych pozycjach lV)jscio wych
M aterial i metody Przeprowadono retrospektYlIl7q analizri 136 przypadkeacuteM dzieci (13 chlopcow i 123 dziellshyczqt w wieku 6- 18 lat) z bocznym idiop atycnylll skrYll ieniem krrgoslupa leczonych zachowawczo w Klinice
1
Ortopedla TliJumatoogia RehlblllagraveeJa ARTYKUL POOL1 DOWY OPINION ARTICLE Vol 7 Nf 1 2005 49-$11
Krystyna Dobosiewicz Jacek Durmala Tomasz KotwickP
Katedra i Klinika Rehabilitacji SIAM Katowice 2 Katedra i Klinika Orlopedii Dziecircej AM Pozncrlz
Biodynamiczna metoda tr6jplaszczyznowej korekcji skolioz idiopatycznych - opis metody Biodynamic method for 3-D correction of idiopathie
scoliosis a description ofthe method
SIOWQ kluczowe leezenie zachowawcze skoliozy idiopatyczne korekeja tr6jplaszczyznowa Key words conservative treament idiopathie scoliosis 3-D correction
SUMMARY
The biodynamic method of hree-dfmensional carreeion of idiopathie scoliosis is based on Ihe palhomeshychanics of idiopathie scolioiiiii and consiss in aClive segmental three-dimensional correction ofspinal cllrshyvatlre The course of action focuses in the viciniy ofthe apical vertebra Proprioceptive facilitation is applied on Ihe concave side ofthe curvaJure and exteroceplivefacilitation on the convex side Correction likewise proshyprio- or exteroceplive facilitation is phase-oclœd with asymmetric respirarory movemenr as weil as wilh parshyticular phases of the respiratory cycle ln Ihe course ofexercises three-planar movement is generated opposite to the direction in which scoliosis Is progressing This method is in accordance with the stale ofthe art ofscoshyIiasis pathomechanics The method requires detaied training and can Ihen con be applied at home under periodic control by a physician and a physiolherapist The method con be applied in landem with a Cheneau brace as weil as in surgical pretreatment A elaUed description of Ihe method of three-dimensional scoliosis trealment will be presented in Ihis article
STRESZCZENIE
ISlofa biadynamicznej mefody Ir6jplaszczyznowej korekcji skoioz idiopatycmych oparlaj est na patomechashynice iikolioz idiopatycznych - poega ana na czynnej segmentanlej tr6jplaszczymowej korekcji skrzywienia Dzialanie koncentruj e siccedil w pobitu Icrllgll szczytowego sknywienia Stosowane iest bodicowanie propiocepshytywne po stronie wklllsej oraz eksteroceptywne po stronie wypuldej Korekcja i slosowanie bodicocircw propioshyi eksteroceprywnych zsynchronizowane j esl z asymetrycznym torem oddechowym oraz z poszczeg61nymi fazashymi oddechu W trakcie eacutewiczen powstaje odwrotny do lrierurzku rozwoju scoliozy tr6jplaszczyznowy ruch IcrFtshygoslupa Melodajesl zgodna z aktualnym stanem wiedzy na lemat patomechanizmu scoiozy nymaga szczegocircshy100-lego instniktaZu po clorym mote byeacute wykonywana w warunkach domowych Z olcresowq kontrolq przez leshycana i fizj oterapeutll Metoda mote byeacute stosowana r6wnolegle z leczeniem gorsetem korekcyjnym Cheneau a talcte w przygotowaniu do leczenia operacyjnego slcolioz W pracy przedslawiony zostal szczeg6owy apis meshytody leczenia
Skoliozy idlopatyczne stanowili znieksztalcenia patycznej rozwija siccedil poprzez przemieszczenie kr~gu tr6j~aszczyznowe charakteryzujltce siccedil wyboczeshy szczytowego w stosunku do krccedilgu g6mego j dolnego niem rotacjltt krccedilg6w klatki piersiowej i miednicy z r6wnoczesolljego rotacjl zgodnie z ruchem wskashyoraz zmianami w fizjologicznych krzywiznach kr~ z6wek zegara dia skrzywienia prawostronnego oraz goslupa w plaszczyinie slrzalkoweJ [ 123] przeciwnie do wskaz6wek zegara dIa skrzywienia leshy
Z punklu widz nia patomechaniki tr6jplaszczyshy wostronnego Koncepcja rozwoju skoliozy jako rotashyznowe znieksztalcenie krccedilgoslupa w skoliozie idio- cja i kontrotacja sugeruje ze sily korekcyjne powinshy
49
EDUCATION MEETING SATURDAY 8th of APRIL 2006
- CARDJOPULMONARY EXERCIS E
TEST IN GIRLS WITH
CONSERVA TIVEL Y TREA TED
IDIOPATHIC SCOLIOSIS
Jacek DURMALA Krystyna DOBOSIEWICZ
Department of Rehabilitation Medical University of Silesia
Katowice Poland jdurmalaqcmpl
The aim of the study was
to estimate the influence the conservative treatment (asymmetric mobilization of the trunk by Dobosiewicz) on physical efficiency in the group of girls with idiopathie scoliosis
Material
bull 87 girls with idiopathie scoliosis
aged 1 0-17 years
(mean age 135 years SO 161)
J Durmala K Dobosiewicz 1
EDUCATION MEETING SATURDAY8thof APRIL 2006
Material
bull 38 girls (437) with double major scol iosis (thoracic segment - Cobb angle 18-42deg mean 30deg SO 82 angle of axial rotation 4-32deg mean 21 deg SD 107 lumbar segment - Cobb angle 11 shy48deg mean 31deg SO 128 angle of axial rotation 5shy30deg mean 13deg SO 85)
bull 49 girls (563) with single scoliosis (Cobb angle 11-75deg mean 33deg SO 155 angle of axial rotat ion 5-30deg mean 14deg SD 83)
TIoracic kyphosis of the invesllgated group was 5-39deg mean 23deg SO 86 and lumbar lordosis 16-41middot mean 30 50 65)
Material
bull The 64 girls aged 10-17 years (m ean age 131
years SD 132) were conservat ively Ireated
using Dobosiewiczs method
bull Treatment period ranged from 5 months 10 3
years (mean 148 months SD 902)
Material The 23 girls aged 10-17 years (mean age 136 years SO 108) were treated u sing symmetric exercises - treatment period ranged from 4 months to 3 years (mean 161 months SO 1019)
bull 26 of ail g irls (18 girls earlier treated using Dobosiewiczs m ethod and 8 gi rls earlier treated using symmetric exercises) aged 10-17 years (mean age 134 years SO 108) were twice tested - at first and last day of Intensive hospital rehabilitation (asymmetnc mobllization of the trunk by Oobosiewicz) - mean hospitalization period 20 days (range 18-26 days)
i rf~8f6~~ or~~n~= ~~r~1~r~icircJ~~tb~~~~ mean 17-4 1deg meatl~(I SO 74 R n~le ofax 1 rotatIon 5-25ot mC3 111 3laquo S0 6icircl Ilnd 1 99t1S~ ~~~~I~~~~~$ruo~ras~ ~ocirc~~a~e~~~~~~~5euml1 9middotn~ tUfllbar Iord05ts 16-4 1deg mean 311 SO 68)
J Durmala K Dobosiewicz 2
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Material
The control group consisted of 77 healthy
girls aged 6-17 years (mean age 12
years SD 31)
Material
The examined girls participated in school
only in scheduled physical education
lessons and have not been enrolled in
other sporting activity
METHOD
The exercise cycle
ergometer test was
performed
J Durmala K Dobosiewicz 3
EDUCATION MEETING SATURDAY 8th of APRIL 2006
METHOD
The Incrementai exercise test has been applied
We have found that tests ln whlch the Incrementai part of the protocol ln completed between 8 -12 minutes duration glve the
bullhighest maximum VOz in normal subjects
METHOD
The workload was Increased stepwlse
bull by 10 Watt every minute - ln chlldren
with high ~ 135 cm
bull by 15 Watt every minute ln chlldren
with high gt 135 cm
METHOD
The test had been contlnued untll refusai of the patient or exceeding the pulse Ilmit
Durlng the exerclse the gas exchange parameters were recorded by Jaeger device model Oxycon Alfa uslng direct breath-byshybreath rnethod (with face mask)
J Durmala K Dobosewlcz 4
EDUCATION MEETING SATURDAY 8th of APRIL 2006
METHOD ~ ~~ r 3 min 3 min 8 - 12 min 6 min -~
_ 0 rpiYJ 0 rpm 60 rpm ~1 30 rpm
_ t o~w=att~o~~na ~~ att__~ tl~~S~~ l ad l ~~~~~r o~w= Hlcremenlal t
pedaillog i i ~
~ ilt ~I~-----tl-~ I t ~ i ~ lOSt sffortivB
lW r resututlon r rm-u middot 1 - bullA~cremen tal ~~ ~ ~ ifr- ~ VtI 1 ~i ~ tllng _
METHOD
On the basis of recorded parameters VAT
has been individually computed for each
child using V-slope method by
Wasserman
METHOD
For assesment of physical capacity
the maximal minute oxygen o
consumption (V02max) ventilatory
anaerobic threshold (VAT) and
maximal workload was used
J Durmala K Dobosiewicz 5
EDUCATION MEETING SATURDAY 8thof APRIL 2006
RESULTS
Ali girls with 18 have been classified
within normal range of predicted
values of
bull maximal minute oxygen uptake
bull VAT and
bull maximal workload
RESULTS
The differences between group of girls
treated using Dobosiewicz s method and
group of girl s treated using symmetric
exercises were statistically significant
Lower exercise efficiency of girls treated
using sym metric exercises has been
observed
RESULTS Girls wilh IS Irealed using
N=87 p value
Dobosiewlczs method N64
symmetJic oxor-ci Nz23
Perœnlage of predicled vaJue of
maximal minute oxygen uptake
98 905 0033
Percenlage of predicled value of
VAT 97 933 0049
Percenlage 01 predided value ni
maximal workload 101 939 0038
J Durmala K Dobosiewicz 6
EDUCATION MEETING SATURDAY8th of APRIL 2006
RESULTS 26 girl s twice tested - at fi rst and last day of intensive hospital rehabilitation
The value of ventilatory anaerobic threshold increased during intensive hospital rehabilitation (asymmetric mobilization of the trunk by Oobosiewicz) statistically significantly (p=00019)
2047 ml O2 minkg (SO 268)
vs 2239 ml O2 minkg (SO 232)
Conclusions
1 The exerc ise eff iciency of girls with IS treated by asymmetric exerc ises of Oobosiewicz is norm al
2 Such high level of the exercise efficiency of thIcircs group resulted fram using of Oobosiewiczs method
r
J Durmala K Dobosiewicz 7
REVIEWS
Role of physical exercise in tbe treattnent of mild idiopathie adolescent scoliosis
Revicw of th- literature
A NECRlNl N VElWNL s PARZI 1 A NEGRINJ 5 NEClU NI
P1t~silillxlrd~ Ihcrapy (or klucgtlttlwrlpyl i pro shy-tJm of physka] cXlrd-cs ipcci I(a~ (IJcloJgtcd hy l li trIWlltl phrslollwrapbt wilh tb m~ln a1mor pl shyVCnI in lhe ilAAfIVltilH1 llf the ucirccfonuity III mild IgtC )
Lil1Si bclpin~ thebm ( aocl co uaufllclilIg ils ~jd- clf IS in nlOdlJmiddotnh-culiosis Th middotalillofthi paper ito r (W
Ille Ii lc ram r 1 a-ccrulin wh kh of Ih bull Lu[Jalmlcrus Ind (Lb hili til~ CLlLt-cd br scnli()si- clluld bl pl Y nlcd or r d uccd hl phylolld LXtmiddotrdsi n Il p--to-da le knowl Uuml~l nr tIll~C aspcc[~ i ne bulled in oruer 10 dndc whclh~r 11Rf blLl adcqlmtt Ib(uuml n middotlicaJ balis fo r ora)aini l Ihe US4~ of lUgravellgtitlerap) wltcllj(r or fln l th e prtl1iœ of kimiddot ~lre IUlll poNjn~ a t iil ies ~bould h allowtcI II uuml middot c enliaI toltlentlf)wh k lu alClor ie - lf pl lr~kiJl -c rmiddot d gtlt- (Ic rnnhi UzJ( inn ni (t hl HrJltlon [ rtn~hcll iJl ~ or 1i1J(IChIumlJlJt etc) Sh llU Ld be TolullllCcluse ulemiddot l onld b- clclIimcntalancl wukh sho ll ld he IJlI-n~ifl~d I~~a l lhc (o uld h 11lfu 1 Know k dg CJnc1in t (wIn SeiCIImiddot Hlk rCS([lflt h daw ccordinll to Ih bull llVit w o f tIlt iii 111 1( plop(lsltd in (h i papcr lmiddotonllmJ l lnl plLyi 11 cxcr(j$( pn (nti or (tmiddotduce dhlblli t ic 1 ~lt Il Jj ll(k pl ti Jlt fadl j w(~ the nlIIIrl li7alinn n f poMural dd shylitS tu p n xJ llc aSl COIlMqnen c(middot 1 all )llal) or r(tn~ shys i middot middotlIrve Tilt u~c (I f appn1priattmiddot kincsiuuml wrlpy 0 in rcns polttllcal swhiIHy Icirc IIHmiddotorc Illta ll y (0 r 1(lt1 lllho UAh mon ltlccurlltc 1Ut dl1alkd -rLk l(lWfils 111111 )11 h Jlccdt(
11) wurcJlt 0 lit)-IcircS (Iumpy - x rcLs P()lun
n rllt lT(ltnklf u f COll1tlK H (rtd) I 1i plfho l og l ~$I rUlglng tr m low tmiddot k Pl 1l1 to IdiOpath ie SCUIshy
Submitt(oJ [or PUhltCl l1 011 uly Tt 2001 Acc~pttJ ugu - ~2 1(t-1l
Addre rltj-xlfll telt~I(middotb If) - grinl Flt(1(bziurllt r )(m Ofl ()(Cl1I shy Lt middotqlltœlll ro () - 1u I4t agravehLIlKil ta IYIL-lTt ilSllltp lfllmiddot ~ 1l1uumldull
CelII ~ (niiOS I I~ middot ann (1) IfUh middot lIlfU di louhilll(tymi ( Nlmiddot ~iI rli -ilIIUmiddotltlfl
Nlti(ir 1( ) il r() (ltbullagt1
lt vLL_ l IiII no 1ftfI
jS ) we are a IUil ly tJc ing n1n) ltblll lS 1 k l1 b ~J)w in~ tl~ t S Jfll l approad llt - l1n til hy on ielshyertd ~tan lard ugraveJuld ln m any ~1~ he lI ~t les i if Ilot dange r )ll lt rhlS is lrut of reil l lnw 1gtlt1lt1 pa in l ~ or 5urgi c ll lrea lmltnl5 in dbc r lmiddot ll Sc - 2
ln tlle cj-e ut ~ t lll(tlWtl i( li p l ll1JC luuml- I ~ middottnl ~() shyliosis phys cal ((_lt1(( is emr1uved ltI t()fIl1 0 lh~rtrv
lo ly in cel1l in L)lllllde (nluumlnlr in tilt Lltlll middotorkl i e Iw l) r llt t Srain hUI IIgt() 111 Gert11lny 5- 1~1 in other reg lOl1 wbere thi I-incl qf tre l tm e rll 1 p~ 1 pmiddot t 1( cI il Jws Ixen cri ri cilld md rel -cltd Lw m~lI1 1 11 Jlu~ Fue Fnlny r ~lrs thio middot15 a lsgt(ru( f ~rth r -~ltc rrJtf))~ ll t vit11 br1Cltcgt b r II1 ([C Llt n ClW grmvlng 1lt1 0 L Sti g
gcsti n the lIsefulnes- u r Ih is form o t treatm n t 1
Hmiddotu]rs have nerged jn El or uf pll y~ iLd eegraverdse eacute 00[ 1 but tlw are nUl yel 11 11 t llu i vIC~11 and r hi ~
f rm of trt ~ltmenr IS stiJ l Ul1 ckf ckhate FfI t Jt 111 il i 11t (eltary td 1I iFy 11umbtr ot
b l sic COI ceP rlJ lf w ill he cIh tt d in t hi pap r
Scollosis
DCijIrI iriolls
ScnUoSlS is Irlircc c1 lme nsIcircltnal (I(gt i l cj on ot tht spinc thar cau C a CU 1 lh lt ca n h e $ t~en ln (1 me1Sshy
ured ultinF Coh) lll ltllCXI o n HI anreu middot p rtc rilt r
EUJlOI -1 lœDICOPHYSlc~ IR
NECRI Nl
110
f)i)
1 7J
amp aS g 5li - 0 v
V
31
10
(1 1) Il 15
-tc i ytjtr~)
FigJ----jllph ot DlI w l-lkaupegraverel) The agloimvltltinn Or idio r lrhlc 50gt1iflll~ IS rpiJ bel~ en th e- [l0 IH P (l)ltg tnntll lol (JI PUllcmiddotny) mtl 1 ( f( lS-er sigll paiilivltecirc lt Dlt(i I1 11illg r the iti l 1Kgt n n t rll icirclicH a ) 111lt m omal prebulled the mno rche md ociks with lll I)ttlx flal gr Ih pll fl
rlcljoprdphLi 1 hl merl prestIK ~ of this curvt c10es n t autom~l ritllJy indi ate the pn$CI1(t of a defurshyTnitv (SlllKtUrd (Unel
It i~ possible tu clil1e ren tute a struCnlt t CI1tve fruIn a pogt urll 011e by identifyi og the hum]) du ring AdIlns tesr I~OQ looklng tra m beh lnd at the p atient w ho b benchng fUfward il is p -- ible ta d d~ct 1l1 eh ucirc n of o ne liidlt 0 1 the trunk usually n n the (onvex ~ jde ul tbe radiographie CUfve Ugrave1lr C Ul be mlt~I Slred lISin~
BUlln els S o liomere( 1 ~ l This h Uf1lp is du(- lO (Ile pregravegtecircn ~ of vertel ra i rolltion 1c1 Ollt tn tic f~YJ tllre o f the def trrnit tli [ c m be seen and measurc(i v ith Perddolles lb lsLometer on an amero-Ix)iferior radioshygrapb ~2
Seven ry pel cent o f li Ises a re conid 1lt 1tO be idiopa thie 1 bull ia l-nosilt in this CI$C is b exdlls i ~ n as idinpa thlc me-us t11H wc do n()[ know rJw origio of lheacute curvc [n othe] ~Ie$ it b Ix )~i ble ro ide nrify a dieak (bat CHl jusrify the c1etgtnniry slIch a rna lfo rshymar i ns I1(gtufol Ig ic~ l or genlttic cl iscas s Glnclt~r trauma etc )
[dicirc)parhk S(oliosis has been divicled ~(corcling (0
the ~Ie of tlie patient egrave1l the tiJ1ll of d~[ccli n of the condil ion into ti) ur t ypei ln fanUlc jU nik ltldolesshyccnt lnd aduh Til l m n st cnnunon (VPC IS the acloshylescegravenr o licirceacute I1IJctenzec1 hy 1 sud le l1 tggrH3l ion uuml uring the grow tll Spllrt (Hg 1)2
lhile p tu 1l sco liosi i5 Ycry lomnw n thl pre shy~Iknct ra te f r adole ent icuumlop~lthic structural CU IY~S in sch )o chilclren are 18middot20
- 10 Co bb d~grels o r m on l -lil
- 2) ~ohh dtgreclt or mort O 2~j - bull () (obb d gre -s )1 mOfeacute ()ll 2
Clin iltI [ d e isio ns lfl IXlSed 111 an lccu r~He pregshynosi which obt inccl in eJch pa ti nt mainly o n the basi of the nsidu~ll p()tlnllltl l of TH1h and the result s of 1 rh clin 1 1 ~l1d tadiogmpl i exlminashyti(ln12ll c noieq uentlya d inica ] la sifiou io n o f the ing le pHient tn -ome estent co incic1 ing w irh the
D diographic one c l n lw SLlIl1H1arizeci 1 1 folIcJ - mikl lc~ (1)(n 20 C bh de~r es - moderJt l betwlen ln md 15 ohh de~ rtes - StV re 111( gt1lt rh n ~J) )bh (kgf s
On the 1) lsis of [hi - dinic d d a lfic t i n (Vith l1l il el lrb tiOI ~ o f the ir b() und~ri e ) in Itllt l cente rS Of SCOtiO LS ITe ltlllent in the Lltin odcl (i rJ Ital lnmct md PI iJ Ugrave tre tmtnt i s plmmcd a fo lltJw 8l
- mild kineslth e (~1fw ~1Il (1 luok-ou t - Hl demte IJragravecegrave 1111101 c(~r md k i rws ithe lJpy - ~cven surgery
Physical exe rcL~e for S(ol iosis
Defi t tiOl l S
PhyS i 11 nU b lIKrlttp middot (or kines ithcIa Pl) i a p rvgrlill or plt~i Gl l (xeriltecircS ~1ci fi ( llJ y ltk ~ loped
y a -11 [ru ine 1pll yslo ther3pisr wirh th e m 10 Hllll
- pre (~ n tit1g tlc aggraaLion of the cl I )flnily in rnild bullcoUm is
- helping tlk Il ld Ct ~lOd ounter~lCtjng its skie elfects in III de rltegrave sc li sis
Tn tl1i_ feSpec1 kinesitl1ert py f JI s oliosis is tonshysider l a o on of peciticcedil training and s genecirc tltllly proposelt in sessions 0 1 4~ ro 60 minute IW) t) tour limes 1 Cee PhysiGtl exerci es can aLo ll v o ther auumlns 1S it oill he dise Issed in this plper
Ir 15 Ilot possib le to cl escribe a single progrlIT1 o r exerc ise a5 pro nrams ale USLIJUy p fgt nll ized ( ( lt
EUH PA ~illDI (DP1I YS IC~ 182
ROlL UF P l 1YSICAL lXl 1lt 1~E IN l IlE 11 ~l) IEd If IlU) l[)VP 1HI AIJ() J)~Cl~ r COl ~I NlG1W il
f)( 15 egraved ( )Il the nee L- 01 indi iuua l pJl itnts) al l l10ugh Lheacute) C l n h t 11 plicd o n a WOU p hJ~js (-1 (0 () pnients PC[ ~l ()lI r)middot lugrave reQCf lhese 1 10 grl lll frequt ml~ V IIT
hnm on in middotituk w allClthltJmiddot -Ill Jnv L l~egrave at Wc w Ht ~huw in lhis lyl peJ it i~ 111 n u -eII1 tu id e ntilv kirK itheJapturlc aims w hitl l ucircrr~spnd LO ugravelt~lil1 DUtshy
g X ir ur ph -s ici l lxtTi~l I~llhe r thln ln dj( us- indishyiJ u1 1progr-lfll
Aduumll l lxUl kisure time ~lOd h )u] Sp u lllll8 ~Ilttishy
i lt egrave~ i middotomm )Ly s iven lel mJ ing ro w hlf ~ Iuumlnsidshyer~d usdul or il lrmfu l in t1 lt rruning (lI tJw ptliJicirct ln tl1bplper Ugrave1 gent ltl l t rl ll bull p lwsiCUgrave lttG iviUes is rl ktll 10 JllI1ltlCc hOlll gtpOlt mJ kIJ1lsIcircl hc lJ l f
i ve lUen tloneumld )bo C on lv ine n dul( re Ull~ 1t~1 t s far Ilten publislt d f I~ mJ I(i noltgtithltl rgt is 11 11 a su h jel lnI deacutehate CJitk haltlt t llltit m itn ltl of l ny lorm o t p l1 ySiClI lxrcL e as a Itwr1 [ J- fo r i liopa tb il jcoJL~b un iL ()ri gin~ initial1) it WIS Ille r rOmiddotUumlK lt brgdv u f p l~lt titu gtllergt w h ) intervenecl hutll tc llcrl ll (mon as cltl HtilJ nic in terventi n man Jgt
1 t lltrJp utl t one 1 md rC j fkll l~ on rhe h sh lf som uni cOen I1v pn t I1cgts wt ldl hll ltl enl1 JI~ haLl nu na l scicnt lfic baisYmiddot HOlh tlle$( trr t peu shy to rh ~rl py tt nJecI to l~~rJ tte C Ih tk CUf -~ pnnshyclr~tll y as a f tsul t of lilo h llIzatio ll of tn imdqultdy ~u pp rt(d S pln eacute 7~ 12 to re-t1 r rI ltrl 1$ l l1C k o f WH llt~~rdl 10 I ndt~-dll()urnah tnd 11( on1 p~l per u suaJly Cl tc([ IS n prelimmtrf lll d 3 ln tt li w ay man (l rrlKpt(Hc H lf O iS Inll ph ~i C U l ~ d vi ~ cI nllog scnliotl pa t le nL~ 3gainst holll ph lca l egravexershyclc and p()rt~1
It m u st t~ n tfd [hat pllyknl txerc j~ tJe~ltm(nls t1iHer 1 lJ rd il1g r rhe rherlpcu tlC litTl~ on lllc h tJ rgt ap p lolc il l the IXlltent lncl hi im r IIIllHnt i- 1 (1(1 rI - 5lt1J lC igt tIl l ( f phJllIlllolopJ al rrea tmln ls Ihith cllffc r 1lt œQlfd- rhe m C cculc u ~t(l luI thl p al 1t n
~mc l 11i (lbE~e Tt i ~ P ~il k tlwreI[middote thll wuumlk ltlll t kin 1or ph~ i Clt1 1 lX r(j~ 1I 111~ t bc loidvd by t h~ Lo iurie IxujCJ1l al1ulhcr a dl ~IS nJI h~ iOg (1 11shygerols llugJr in racr le (wi ller d I ~fJIII ~ I ml thlls re(nl1l rn ndc(1
fn n UI cel1ll r we In(~ hccf) using 1 ) 1 1111 11 ve ) 1 (J p lw l icd ex(r(i~e (0 J ( 1I l tt i~ tlh aITt ~ l~d Ilv m ikl tru cflumiddott1 adokscltnt (cl ioj arh lC icoli is11 2)
ina the f U~ t rc-gt uJrs IefC pu b lishe - the pJ( )grd m 11lt1lt l1te n PWltllk d in fa c t deel()pnlln l~ in th t l itshy OlL1Ii in tl1 r b t ~() ycal f ha ve iclemi fiecl niO l l
m d 111 ur impl rnHm s md d i s )h ilir i (gt~ lue t idlo p lthk amp()lio -i ~ t Jll CIII he 1UO(l if Icirc 1by phyict1 egrave xert iSlgt l fe t rrncllt
l illl
111e aim of t l1JS r~l per ii tmiddot (tv iew tl1( l iterat urt to a(errl ln v llic ll of th~ impa irm 1t~ and Liit hil it il i GllIltec hy ~ o l i()gtj s -o ull he ll nt x or re middotlu celt1 Ili pl1ysical xerclse An u p-to-da te knOvkdge o f tl lt Lgtpecl-gt i necckC1 in rJeumlr) d -oek
- whetll~r there h ltl n adLtIIl ) l tht()d ical bbh fur or JqIIcirclb l l l1 Il( ) f k irt llit herlpy
- h N I)(1 ( 1 Dm tlle p r l c tIcirc(( o f Jebur tiJne )pOfung lcli v l ti ~ IIOU lci he tllf) -d o
II J U V f h 1 I11~ c~~lb li hed Ihe usefuhlLss 01 k il1 shyc ~thtrpy il i aIle dy l nsi 1([(( -r-tI Llleu i n )I11 plJt~ ut the wJrld ir ilt ecircS~nl i 1 I( id n Iv w l1i li ( 1shy
gories 0 1 pl1Vtl( 1excrClgtegt te D)bilI7it ric 1n (Ir st shylliuumlZltio f) lttlt tlgtbltn ing ni trcrccedilh ing erc) hn Id be
vnlcled he tll rhe nuld be lerrillldll1 1 md whidl s tlQu1d be inreœ jf ic(1 IJeClU~l tlley cOli lel Je LI ~ful
Ncuro1llotor impainncnts
Imv aUl llOr~ 11 lt1lt ~tlKlteJ lhe cltlndatiotl bd Ween tl UC1UmiddotIt t l ol(~C t nt id iopml je -nll ~J~ and cli~l l shyler~ lr 1tH lest ihuLIr yt 1 _ 13 ~ 311 D uhoussct 1
1-- ITS tln l ldiopath k s(o lio-L L cll -c d l J l hmgt in th terl tltr f prop li l l pu n md 1I1ar th e detrshyn Hi n i~ na tural 1 ~ronse to ril e need tu ts tu re p()tun ltlluilib riu Ul HcrmJJ1 31~ 11 () d tllat icliupathic ( liCl5j h l it re5u lt Ot1 rw nltuf mot r l ~ltelV
[Id )fcl 3 nI] ~1ltJ U Sr1lle nr to dtorders in centJtI lO~Cl shyIOIDNur) md 1xi~tI moro (Ul1lfOl syt( llI (Fig _l
N htIll -of) H1c S uumll h( rll1 ( ~ l( w ing JI t11 (oshyI-ie on the l l lO]ugy o b doll (nt Rl iu]icirc tlili- middot()lioL m unt fil t-hltll rhl ugravedcmnilV L th e fl5 ult o f 1 (k btcl 11lIFll llI ion nf som t11(WUgravetltnl md pO~ lur( (tnic l~ l licirc1 tl1lt if l p OgtlbJt b C 1l rlw sta l i lin 0f 11 1 Sf llle j lt g )tx l Tt) ohtil n a ))Cli U 1ILzltl I o f p ~llIr~il d l~flo [ in l1litkd ~J)llnSIS me CI Igt(middotqucnr J ~ a ~tmicirc ()nlly or regle Ie Llive
Ali th- 11yp ) tlw~es rd ~lte tr d irtl Itn t pnl1tlt o f [11 v hole ~piltm It11[ controls postu re ~nd mrw shyment lrre pell ic of tlh po int a d lI~ llv inH llYegraved il i ~ ll 1 nnable tCl aSUilll ri 1l tr l ll1 lo g thi ~ys ttm ( Qu it le 1I middoteli tl
lt ch ugt nlt~(S f rullliIl thil i nlomwtion th at p tlmiddot shyiCil J(tl iIies nw gt Il lInport~n t rr le to pbv [11Icircgt role ca n 1)lt slI i11l1lariztd ln lWO the ptu li ain Llt
- d elopmll1 l of p uumlltl St1 b Hlt ) - c1e veuml IOpm 1)[ o f bhll1ltc _
(k llhUl)lOr S Cll orr
ontrot oic whan-lt
------+ 1 ~ il lnll ugrave r AINnl
Cllnlr1
T bflt~ r
fltL1 tlli
lMini
l
~sary ~J-frlllen i )f
~ 1 ocirctnl
~UcirclllIJJlW Ll
AXl ~l1 n uumll l) r sy 5t ~nl
middoticoltoq ~ Fig 2-AcFgtrdong lU He-mutl 21 il is Fi)5~ ib1e rD prolXgtSlt l -oo ie1 mnd 1 ((if ~ elio egrave middotAhltr~d l)Qdy-p ati~ I I i u d) uren ttllOn k td LO In ~ory reHTt I1 eDi tn l al ) JdrnlV~ pn)4~ e l u r~o(Ofe 0-c1 eptunl dvstil t1 ctlon sltŒ(ry icircltu nu11t ilwnt [ ~mC ~ted tl l1 ce Ill trpntlshyUumlfJJl nd IKnle~ r~dibl jtugrave)n of -I) m tlosen Ir ~ig nj tl (I1vying ln fornll1U n (lI an ereltl ~piJl e Mmor aJJ r--a t ~) n ltgtf ti lt aXljl mowr plem iHUC Wh ~fl Ille 6ubjeco m uumlntl Icircn (1oJifitd perccpfLlI l ~na l ysilt of p n)lnocepti Icircnfu rnlaquol ti desnibJOS ~n t tecr spin A IICW motor co nrro l Ira I gy t adopt resu ltin~ in the ~tr ltctltr 1 ckformh y lf IdiopathirL scollos i=i Ht lrftU1uc nltnt l ISll I1lJy h1e- ~ I pro()und elkn on bralO Sfem flJll ct i(lnn~lLhu modifyRll Ille nltulltgtshytl10 ) 1 1111 Uu l-lHoror control 5~Shnl$ shy
As Srtgn1lt1 l ~ ltlssert~ if wc l C -Cp t 111 1 un o f the G IiC s oliosls L l tisorckr oi th e ltquilibrilltn sys t ~ms it is lagical to oriegravenrate physlCl l exercis( lherap y ln th is d ir(gtCli()[1
11lclte goals Cul tl lfOUgil ditrercn t modes 01 action be Olchic(-c1 witJ1 phykal accivit ie
- po rt ive Cll ities p ro ct LJ e aIl UgravelClltrtsc in 6lte nshyel ll )o rd in~lti n pinai pr0prinup ti_)[J nLi mOVeshyment control 0 vio lls iy ln thh repect ome lCtivshylites aœ pre um~I I)y lXrter tllln ntil crs
- kinrl lira py using pedJil exerCisocirc specially developecl lith th est 1101 5 in mind illVuuml VC I lllore prccilt( ll1d InC1 li zed cri n on rhe spiJw focusing
a90
1 ~~
lg -lNheJo ~1l l1 t r~l g rld in 1 1) h i(~ IImiddot ct r rHienl w i ll idlllhic _It ~i ~ _ iri s plt ~I le II find Jit ltH vlllleuml ~l Cgtbl tn~ ks III d il fef lt p ~ lt ihnS nu v~tl middot B ~a~pt u Il C middotl)Icircd ~(t l l11 C dlfkrCnl middot- hdween slllndi1g Uline nu nllt1Xinul oorrec ri nI t chied Vith Ct (J ) und tfdincJ ne lot es o UIine 1 fo llnVs middotIJfl tfi ni( - ltlrshy
reltiK)n ~ Ikexibiliry st3nucircing - -pirte - f ur~1 1IbjISC ltupin - ltorrcaion - - r~luci()il ll ymiddot For flmpllt in J npK l1 pH k1J il
plt1SSlhlc ln obtai n 10 u1 511ndlt)l [YLo lion yr ln Slt p ille rlOlgt itlugraven om l J ~ in ( gttf(C rigtIl lIex lbuil 15 i (r-l l=22deg pol lltl ~~J IIlpraquo is IcircO~-V- I t1 l nd tucircu(Ugrave) ilil) I~ 3laquoJO- IH-12
r ln Ugravel e abilit jl of tluuml [m e llu to co ntro l irse lr in ~ pac
fuld l oftlles uumlllelve ntio ns can presum1b1r incn~~ Ih enl ac )1 the orller and lHitlll r of Ille rn - 11 )ltd h e lllldenl lu EJ3)4il
Posl1l1-t collapse lnd slabilizariotl
lIle concept u fplt st lUal c(l lJap~e l l~t Iwen detin 61 by DlI II-T3e~tupegrave rL t Ac oJdin)j tu tl1i- ~ll1thor il [ nec(sary ~- l Hn Cv-tlualing th tleihility o f a col shylo tIcircC CUJVL (0 clistingu ih bt tVeen the re du ihil [ty index (th - li iffer gt le bet ~middot Il ~I r~tcli()grJph ie ~xnmshyinltio n of the iI111 pHienr in supine po ition m(i
ROte OF Pl rnmL EŒIlCISE IN THE TREAT-ŒNT OP ~I IJD IDIOPAnnC OOU~GEm seou SIS EltJRINI
I (~)-----------------------~
__ _~ _____ _~ __ __ L ___~ ________1 ____ _ __ ____ ___ ___ _____L___ _____ l___ ----------L ______ _
1 ~
1
-- ------- --1---- ---- ]---r --- -----_----t- ---- --- ---shy__ ______~---- __ ____ 1________ __ _1_ __ ____ __shy
~ (1 J
1
8 =~~=r=middotmiddotmiddotmiddoti~=-middotl--- middotmiddotmiddotshy--------------t----------~- -------- - ------__shy
~---- --- -- -~ -------------r---- -- -- ~-- - -------- --shy----i-------r-- - ---- ~~-shy
il 1~ 0
Dtl-Lmiddot ~ lttj l r~ UIltltlHt
f g 1 -TI1 u ilictf 1ld ( ii 11- ugraveu-sh) ld IX~ O 1d wllich ltJdnrshymII Il nf the pilll 1 ~tln~1 of th e -o lioti( spinc n IG~nI(J II IIIshytt) lhe iJeuml grl-e o f ~ ()Ii ti c (u rvH Il 1 w dcpc-nlknrly o l l he 10 111shy
P01(nl (pntt l ~ 1 1 nr ffll wrJ I) ln w hilth Ihe n i 1gt( ~ duc nL~ grlphs fm I h~lt 111lt hi~hr Iht Col h ~Ilu t (l f Lite ~Ul Ihe m Ol CI il y th t s(uumlJotil middotpin~ ~111 he ~middotJg gr~lVH(~(1
m mJxiTIt corrttt ion wll iJl i~ lIllCd to Ih - xt 1shy
lti Oilil y Jf tl1lt t Ut JO rl1t cdnUc idt md p OS shy
tU ll cul lapse ( th t ltHill enct b-tten l lUdioL) 1lphic egraveltamJl1ltlti OI1 J t th e ~lme pa tient in Sl il tl cling lOJ lline fX-sitiutl ) Wll ic h correb lc- onl wil ll fhe abilt ty of lllt p tu rl l gt s tem to C( lunternct lIk luree o r grl viry )cco d ing rv D lfVd- f3egraveLIprc po st li r t1 lt01shyIlDse is d ue to the Jnus -u lar ton a nd 11ll ex rCrIshy i) i itv of rhe tissus n the ( O IW-) si it (If the (01shyjl ti (~JtVe (Fi~ 3 L Pu~t llr1 C lltpstl lu lcl l ~~ reduc l-lt by llwans o f pl1ysica l cxerCles specitkally s tuclled ruuml i rnprove tIlus--ubr fOHt md lU pr )cllI Ct 1 ~11 hi shy
lizing ffCd
PararcL n tll CIJ cl the cr iti ca l (3 c1 thlsho ld beQ ld Il ich defol1J lHU n of the i pinlt 1 e~ in~ ne dtlllontr~1t _cl (1l ll t grclrf r mg] o f rllt C II in a qa m bng pos ition corn pOil 15 t l lowcr detormashytion lhnsllold (Fig 1) ie to ~11l Ulne3Se t the risk of pr ogr t~ lu n There t rh eJef re l J ea r l)iuuml 1itshycJ l ~ll1 l l(tl a 1 tnr tg ro b ohwined by d -cr t l ~ illg ilmiddot pU~lUrll cull lpse ptJcelJtge w bich lccording t i)
h llTd tnd ~l(heJ1l ~on 1~ b inde cl 1X llt icularly luumlgh Ugravel mllcl c Iio~ i (bdow 2( 0 ) (F ig 5 J
Fin a Il III ch iS respect lllljl hl and b um l 01 m linmiddot
ii iI 1 l _ _~ _ ___I ___ ___ __L ___ _ ___ ___J______ ___ 1 ___
li 1 1 1 1 i 1
1 i ___--____---___----__-_---_~- _ _--_ ___-+----
i
1
i -- ~- -- ---~-----_-~-_-_--_1-~
l ~
i
+----r--------t-------t------f-- J
Fj~ ~-Ac(XjJlin(Q luuml T O rIcd ~lnd Na(h(ln~ n i () dl( pCG w rd (rTIshy
POO ll is hiherin cu rvegt in wh ilt l1lh ~1flILWrd cII1I Olk l1t IS le- pr(v~knt ln th e grtph Ih t PogttJlJ I ugtnq) Ot1 -J1l j elfltS-e J tlt 1l1t obb dirr remc rlLIv obu incu f roll l the Cohb atl( 0 1stlI1dtJ1g IId gtupinc rldo~raf115 Ih Ille lt) [1l1t1 (i lndnl I pine) 511pille the ~(nlClu tJ1 compo l1lnt U rlk CU Y _VeJily I~ ltx p rlt 1 L1v UpUlt (obh Illeturo Ih t si _b Cct rtJeSIm l fie -ltn J trd Ugraveltuuml shyuumlo n A~-i)rding LP 11(lt uuta o n l ( r1I~( in ~I 2JQ sup itlt curvt 1hi C(]l)b ddhccno l l f lO is -J-lultt( thc s ldnd inr tnla Ol1l t lS wi Q) whil 11) 1 1)401 ~llp lne ClHVC If ~ 1Omiddot ( tcl Lhe ttnd trl~ nlca~ I(t I ~ ~I)
tli n ll w l lllE cq lin ti spin h~ i ng mo r ~ Llnt~II) 1 tlun the nOftl111 one n Cll l gr(lk ( (cU ve tl1u n da r u p shy
po rt in o r k r 10 m linrl in tht 1xi11po tuf_ n th ha__i of th egt onideratl lr1S it f(lll() rhJt
ph rH (~Uuml e erd es ulukl h u - ul iiuml tbeacuteY ~U-L lm cl 1l (It-d o pmg p05111 td C Jl1twl lS fuumlrnll~ rly d ccrll1td ln an Ql St if i imr ol1111 t ru t(( - tht m(d in C JI shy
r t t r sture fO Ir -ngthen tlll m u ck-gt of the spint mainl) in (11erl antig r3ilrl tIcirclt l]lli fun ctin ll U hy meU15 dl i )ll1 t trk ~ lhJ cl( -ll tlt C)nlr~lUions ~llld no l IdOshy
1l)llic d YIltll1k lt l jAJ lktic t) I1 ) II 11)t 111 hd posibleacute t lcluuml ee postura l io nrro and stfh ili lllllt IJI
w i thout food T1lw(ull r d I( Lf(11 Ibk t m ucircnuin Ihe c()rf ~ct [ ()S tu re for cl gtu ifKi IH lLl1gth 0f ti l11 ~
This i-l ddl usl a typl 11 dnmnin (tf k inesllh rap) in 11 (lt-11 [[k - p~d fk lnr in lng f u l1a in llllliCk is poss ihle lI sing ctrtain Idncl fJ l (lt) 11111 liun S p Ul in tb is Cl c is ulttful ooly sa I~tr 1~ il Iw lps t1w lxltknt 1 becuJl)t 1gtlt ltlt-I a ClJu~l inred irl ilL ntllru l o~ i cll
and I1lll~lJhl r-keJc LIl [rll-llIn~ middot etlt(wrs JI the int e rmiddot vlnrion
[J ROPA MfJ) I()Wf-I YSJ IR
1
ICR 1 1-1
r
1 shy ~
- shy
11 o-llrfOlhe5l~ o t Ih 1O~(1dity i n h ~ r ~ ll nr pbl1 l of ~ Spl11 in 111011 _llti1Gt l lPt f ltlJUCWJtl ( ~l Ihe Ir t 1 1gt illbll W Ilh LtltrJ1dlion Vln lbe rigronl middotUII~ l(I Dko n12 lIll h lumshydlanie1 1 [ nul 1 M hl whtrc M - gt) lnIUI1g 111laquo111laquo1 1 1 c rtJCshytjC~ f fce d -d Lill l1~ o f enr niI pUll spnmcl1y 1~ 111 mldlll1lt (n the fl1ur t 1 = tor~ of f(ward Ileuuml l = ughtel1lng fmiddotr p 1shynOf stn lClU= Alaquo rdtllg 1raquo Ihl~ - lin hull th l1ltgtllugrave ot tller1l lUr~Jtllrc F the ~pin t -ilh rlu1i tf Ihl 1 1Ibulll n lrlt InltT1 1
rbc prJI 3IJi l1ty d qrlOIJ~ n bull JI t IlJIII Hm lA the v=ltd gtc e lu-ing J 5lnK1ura i ltfnnity
Dioal e ch anicll itllp~lir J11 c nt
Ihrcemiddotdimcllgtional mc-cbal1in of the s pioc
~f Ikmiddot i t i nly l(œ ntly tlHr llk pr-5tnœ or nc ushy1 lnlo tnr impairment in Idiopttlllc s-ol ii IXl tknt liuml J$ heen h i- ll licircghlcJ hy re$eJ rh tll e preit ilegravee h inm b nIcirc Ji d lJutg~ lt hl ~ 1 ng t o n dO Ulll urcel 1 i5 (l lreldv well umlersrood H(j-ev~r nev lbt un h iomcrhankal im l) ion nI h1c rectm ly onk l n tIlt tre and p r~dou in f n rmtinn hou t pl1ykd (~fcl5( in t 11 0 tl1I _ltgt pbne of spact 1115 Im trqlt-u 1rom J i-[) v ing unclcrsrmdlng ot th l lmc -dim nshy~ilnl l l11 ~ hmk f the cO]jO[lC pln( ~2middot ) ) Ve- w ill )iI xnl t l1 d at lcL-orcltng tUl cl sif iol t lOn blsed o n gtolllt lricd h uumlCJ ) p lane
- b() rJzU[1tl ln th i pla n ~ th t 1o rm ll sp ine present no CUlye- w ll ile Uumll(~ ltc U Hic spLnc clevelops one of ir haracterls(Icircc deFo rm tiCs v elt tbrd ln lashytio n vh icl1 pJ()VcA~ theacute hw 11
- lgitltl in th llulJe U l(~ nonmll spIcirclle pl SenL kypl lOSis ~nd l dooi~ in tb lXI1 lhese [(Hu rts Vere m)( til ught [ 0 he relattd tlle scolkJtlc ( lI r Vegrave
- front l in hi pleme tht ncrmal p ine preseuron t no curYegrave whil thl ~11li tic p in ugravetI I ()~ icircl~ charshyad t Ilt I CU1C
Il Jri fJIIt palic
~l+I~na ra 3 r inr lut th l[ ber ll1d a œl1~lU1 degr 1
l f r()la tJo u lllu (lILa r forcKl ltxert ltJn tl ldefnmuumlng 1 tkllJ [J i1u a re- lhlt tll cly 11 [1 1 UI b y Olm ner w bn ~lh uiJwd tl egrave ro t1tic) l1 Ilm it ti lt p ica] lf shy
rhrl r() be (P (the Uma bevond Wl1iltJl th lCOJlb of [11( ~pmaJ musd ~ dthc COnCIt and nm ex ~l le btconk (t O li~[)
r ~l 18 ~1Il N lu t( ren i9 lun lu ted rlseurlt h in tlt ) tilt lULodeumlformipg1 tlo n ot tIH_ sc laquoJrle rh ox ercallkren lk 1l1~H li d11r once thl Il i ~ r tld1t5 [he lhrth ld f 111 JlIcirc lIi of tlle dnrlclc hurnp tlk
lI bslt Il l nt rlet()rlll lIcircon 01 the it l ()I~ C ( (ylm der (- sustalnecl by an H1tmi cforming aCOOIl
J1Ji h V hl rhyiical f~ f Ise CI 01 h spr n llnd kin middot ith ccedilrapJ my lX damlg ing vll e n l pplild as flle
igt Jk Iller ln SCC1IJ ~IS lllc lJ fxceed l auto in middot crca~ i n g lhrllgthuld [1 sh (~u Id ahn be j ofed that Ilw relscd pre sun 1l1111i insiugrave l fe pil1r inn) 1 mlshylt
- j Il- ( w atff 1 (nh ~1l 1(e Il10 utoldrml ng li1eCh~lI1 1sm
in flc l Geyer ~w tcd th1 t rm m 1 hI l)1ecircch1O lla1 puilll 0 l I C~ sw m mim t Ieuroamp no purpo t for cu lshyim le pllilt t1 s (weumlO middott r it is l~Jl(gtWl1 rhn in iculio r[ paULnl -iJl11T1ill~ doe_gt nor Il ~lp to i ncrt~SL n eur(1shym tor co mfU
(1irai p an (
Jerdnn lle 11 showecl thal ill CSl~ o f t10rLC IC 1i lUgrave
tllo lacolulllhil it lio_1 tlle cte tI llmiry in (he lg itt1 p lln t rn lnlftot il~ lf tspe iuUy in tlw initi 11 r luleuml )f cV IU[Icircon nf Ile ~oli ls W iU l 1 p(t)gr~s~ivlt il10middot~ shy
ment roward hvpok pho b G ll f ill~l Im lins l har dUflng (IN eWllLlfiu1 of 11Imh] co luumlgt i the l in t ot t l H~ gClyty Cegraven te l - 0 1 v llebed lxxli 5 r ro ject 1 seH fl r t side-ys and tlwn backlrcl bull thu~ p(0(1 lj n g a kyphQtlmg aet Il ln (h~ lu mhnr --PIl1 COftj tng
l l i tc Iugrave l lltl l( l rs1 tif s L -etllgt il l the lgirl11
1 Hl)
Ilu LE nI rIIY~Ic~L lXIlKISI 1 HI E TREhTMEtn OP JIU IDIOP llII C AD O USCUH O Ll Œl15 NEGR II
lLill tegt lre lenl1 ~I d ~fo rll1J[ ~ rhl recrSes the phyltiologiGII cmns of lh vine)
Accordlng () Dicion ~2 1 rtcluctio fl in the itgitttl CUIYtS combin l vi th a lueral Iviari n llltl ds t 1
mecban ism () ugravel~ta il ity in l he r rat r IllI1e which bVOf1i the unsd a nd i ncrea~e 0 1 co hlt1is (Fig 6 hiIf md Pl11jlbiJ Jl1eanwlt ile lt(udiecl lh e srnl ru t
orzyglpophySLs show ing t11 al ttleir 1I1tl rnic tl orienshytation f~I (jLi l~ltes aXIal ve rtegravebJl l rotllio ll in cun litluns lt f dorsal hypokrrhn Icirc tnd lum)H de i L lo IS
Tll t dat SLlgge 1 th t impOrfill ut pOitu res and l1lweil1 ) t Mudied in ord t r (CI mlIuml ntrlin or to reuwer fll e p llyslo lo~lCll ClIlye in lIe SlgJtta p lU)l Wlth the llm o t ch ~ kin~ rutltor in l~ bili ry7 AbC th ~e ~k-
1l11nL ~Irt del lnt [0 J jUc lt ftber l]kuti inrervenl ion vhich 1c)LJ k l IV - i(l ~ l compktl n l ililll on Il t c1 l shy-jel1 J11UVllT1ent IJ j o f 1uto-dOneacute(3tlon ( i e a -impk ld ion ) Iengtheni ng o f the pilleacute 011 a litlltl l aXl~ tll lt ((IT liJlI~rcdu e~ t lle ~---lJ linti- l lte ml-fkxj(l n h UI 11 - i llCrl I~t the plllH ](JgicJI dlt cr ~l S ( (1 k-yvllCiSh lIld O(ltOSh l o r c lch r1Iif n t a Ilew til(~ecirc dUuml llt Ilshy
si lflltl J ll1 u(~nlent iam ecl - 1l1t0- lIrfe rionmiddot7 4 llmshyp oed f Je-rura l iUIl cl middot-t1e- iltm lI1d ll1a intltnUlLe )( 5lg it d C Uf (gtS slig lll thltJrc i ypI1 tiZ) tIcircOI1 a nd lunugrave)ar 1()fdos i7~llion) sholild he esw b lb]HU 00 lb co
hl b oi hi p~l11il uU r -1Ir vlt Abo 111( e IlltUtl Chl lie o f purti n - a U vitk slJ1ultI h e )tuumlll ecl 1)] (1 n ldershy](ion r tl1i lt type for e upIe IilJ llyl)T S of repd shyiti( ml vemen prt n t in agonistK h)lnllltlSlks nI iIle kind f dlJ1ce C( uld he ([([r imentd
FmiddotO lllaljlallC and mobili ty of the SpIcircIlC
1 rd llo U 22 d L lm nrrare d lhlt in Illt fro nt a l pll ne
tilt 1 nge Clt 1)1lt vtment of tht scplit[i middot CU IY grcmr lIJ l il ~ d irectio n n f Lhe C ITelt tlO n tha n in tl le di re shyLion of pmgressi n l Fig 7 ) he IL o IS5err lJd tbat th15 mohiliry increac plrtil u la rly n apic [ cgcoeilts 1$ lh ~ ~c() li osb evolves Sragrm rJ 12 J ~ thus rigilt (0
VlI f n rller~p is ts Ilo t t) m o b uumliz - a sCtJl iu til curve w ilhout t [ uling ttwt tlle R lu tiOI o i til t ~a mt b fnlinruumln( 1hy l1tans o f ~I passic 01 1 rivE -uppnrt On tilt (ltllE r hand UgraveK d e iJlioJ1 in ease durill tlw tune 111 whicll tll C spmt i ~ not submjtrcd to correeshy( IV anl()n
j- Virh mi lei ol i b tlllt Upp i1n ill) lC tiol is d eveloped only lllmugil llClIf()mu$Cllbr f r llce thi ~
InegravelIl ~ thclcfo re tl1l[ inu eascgtt sp1J1all1extl)iity mua
11
Imiddotiumltgt 7-rurd illt Ir) 1 bull rdrilt I1 1 in tl lt frOlllll pbnlt- th( illl ge )r mOC llIeJlI o t the S-o UIIJC CUNe 1 supcrior in Ihlt diflt(l im ugrave( the n nKlIl thd n ll1 tllc dlrtcLion o f p rJ1(l( (llIl
be considrCtJ vntrl iJ)(l icltion and 1 undrli neocirc ab L a ~ubiljz~ILion 01 tilt spint pllss il)1y ohtl ll1td thrltJugll the stlengtlkl11ng o f the 1rltJgm vlt nonil lme shyCIC 111 illli orrant u bjcLliH- ln rhis r~f1 n sp u lllni lc tivitIumlLs sil uld lX tPI 10 dlegraveltl it l G lU t n w l1ik luring kine i Icircth lrr phyltical eXegraverci c~ tllat in ele
spinal m ot ilIcirclY sil nid 1e lt1 oid cdrt ~
Organ ie and psychologieal impainncuts and li islbi IiI le
A cgtI im lc pmi nr is moriOthl11 just 1 sp in and 1
compkt gt Ipp rnach to the gu in ad 1 ont i al~ shylute l e~se i t i11
[)a la 0 11[ [n ell lrom re semh pw tbat ome organi Iilnctiond cl fki ts suc]) as tlw clecrtiUe ut vild l tnd d fun ll l)Kity_orld ldly incrtJ k whil~ 0 shy[io s i -till in (1 miel q g of g JltlV ity ~ l ilI e 55 rtI lit
tllL pres e n ce )fl defidt Or Vi l~il Clp~1 - i~ ln one pIIiem in Ihr l ftectecl by 20 ICl 40 scoi stgt l ls~a r(h cunclutecl in tbe UA by Di Ruce- prod uegraveed an aaalo) u ll1lXimum 102 re u t in a group of Jd shyk 1ien t [(h sco llosls rang inF frum ) [0 1
Al10ther rudv bv rallt r m C chr111 lilcl NashycWrl1s( u 57 stlO eltt hil $(C 1 1 ui~ Ica js l( lllt cl (1 shy1prUlllI o f t1tgl lie bJd l imI in ~ul sct t1 t ltu b middot iects jlLltr l5 they are golng through ~I cltlici[e sllge in the fnm 1lt i n 01 tlWH o w n id uHitv t factor hit h Illy jeopmlize the cl velopme lit d ~ mIll lt lI1d htIshym cecl IWI sonalitr in Klulrhood
n RUI ~IEDl(( Ptl Y1-
ROU ltHmiddot PI [ I C~ 1 EXIRCIS]~ IN TI Il nW~JUNT OF SlllO lDIOP1HIC AI)C~ESΠ11 C(gt1[Oi 1S
This i why b IiCieacute ii is ~n imporrlIl t for p rcshyvegraveml e 1tLsr l tn en ou flge 1ari e nrs ~lfrecr(d by lIillcl middotu iosis ft) tlke p~l rt in portin -re rcatioluJ acrivitits Iha t 1eIU 10 L10 th r~1chophyinLl bull nd b~l )i 1l1o tur adlieem t n li 51Jmiddot2Even tlK)ugli [Dr bic mech~lnshy
ical mcl nellIUll10t 11 11 reltl ~ons lt r111 1gtomcrimes be l lefu l to ugg( ~t ne p rt in~ aCt iv ity r l h (gtr rll n anotlJer e th ink Ibal an exces~ ive IlHd icalizltion - Icirce l ll1posilion br plry~ilt i HlS nnejlor parents uf rh ry pe of po rt to lx p m lice 1 b Ule p 1Ucirc(Il L th1[ preshydLl ck l1 is fret clOice in lh ma tt r - -h II ll1 he avolc1ed wb 11 possLhle mainly for tlle i mport~ltll psyshyLb ) jogka l fe a SI)nS W( ha( ill ~ t nltntionegraved
Conclu ion
lbh ISsertegrave d t1H physkal tgtXtlci o is ) n fi ial whlIl practinu in order 10 ilnj rove the I11 llde
rœ nwh and tono C iral caplCiry and postu re o f the StOUO(I ~lIbj n II I nowkdge om ~ middotmg trom ci el1shyrlfi rls(~ Jrc li dJlJ accordl ng r the review 01 thE litshytirlture prnpo )td in t lli plpl r conflrm~ Ihe vuiclit ot th e -t ls ~rti ()ns
In l do l (ent Id iopl1il iC scoliuse il l n phee u i cl vk)pm e n t ( li tll iumlKh eXCC cl l g i en rhk thr hokl th e re i5 an und ubred need fn r l pprnpri 1tegrave (JJ1tOkJJe ~Ild Inr surgict1 therapics ill ortler 1) S l i p
the ( - Iuli on anugrave )JT~t~t UW ~pilll l dtlormities bull evshyerthtless in the illiti ~ll pl l~sC t ttlC c1iseLltc whcn the riS( r1 r euro )luli m is rtduced ocirc ~md tfle uifleal JOld threshold il ~ld flle po stural collai i reJcenw~ 43
JI l1 igh pllysicaJ egravexe rc ise - p revenc or r d llCe d i ~lh ilir ies o f [Iw ~ l() li )tic
p (iems R 28 J -6 5- 6 1 63
- f~KiHtare lh ( n utr ali711iCUl of postu m l d elicits tn produCel1 a coneql l nce J [)ti 0 I111)( or regre si -u lmiddotc 5middot Il 1 17 ~ M
-re 51udles U ~ n Ledecl tu con[mn or re jecr these conClLL i( 1 w l1 ich clerin-d frum 1l1 lIldytica l rcltw n f th e liter~iture appear r- ~Lo nlble Hnwecr Intil ne re ull are 31Iable wc should n r prevent our sroliotic patientmiddot trom tl ki ll p lt in s(loI1ing jshy
ir its pW1iada rly ltl t ~d1()o t () n til t c ntrHY -vith the l xcclrinn 01 gt[1 )11lt tIlat in rea-e t)1obility (tnU evc n thell oilly wh n progr~lgtion b p OSSibl) -uc h ~I( ucircvshyiUe -11 )ulu hl tIKoll w g ed The 11 S J ( rprOpriue kin (~irhe r~l Piuml to incr _~asc p()~tura l $llbil i ty is tl1egraveoretshyic tlly CiJUClt alttloughl more ~Iccu rtte aod deLli led ri k benefi rs anJlr~ is is netot1ed
Ria 1111tO
NIokl Mu d lle ftitYljJfu Jœl il 4IWr10UOifll S (JIvs i (1~1)Jshylidl ttno( cclIll le 11(11(1lt1 RCI fu lle ((lia LltfIt l1 I1I1i(i
LJ ci n s j(r3 pigt egrave li n IHUgru lkl di t rdz t fi sici pe e ft shytUlKm iluppno di un lisimerap15Ll rl lllcflt() 1 110 scopo di pnevirlt () fr en~lI 1-lgpwlllltnlcgt dclld lclonnitugrave o e il 5LOshy
Il i mi llon lt fH nugrave j (1 11ni dei co~e 1 lteIl I1J J nd ne ~Ii eifclti (()Tc rri udk s co lio si d i m e dia g rt iuuml ln que~ltlt
s rud i 30 llizzb mo i d ti cleU ric lca pel n ri Icare qJJ l lm 1 dis(imucirc x u le I[~ l z j-m i pro vna le da lla C gtl k A i json ere pr middote-nute () rk kl ducirc un~l rdeguCltl d nil cra pi lt di uJoseguerrnt Cjua li 1iU110 cli nbie tti 1 rcr lJ)tIId d~ fle)-UITC
n (- -fd7Io n~lcl)
Ut11claquo)si 1 lI tori htpnuuml )ludi-ttn I ~ cnntI1zttu fr Cq(in i idiJ)tic1 dbfl lOZ10l1 d d ~ leOla nelllOll1otoriO Lb un1I1cnUl 1n1l1i3 dcgli 111 lt1i ch DIJgt gtU l H crmU1 Nlch~mslt ( SIshygnaJ~l lerimiddot wo i esuemi -bletti d~ plt~e8lugraver- ne l pClZ le1lftgt scoliodcu kl s iluppo ddl ~ ~ uhjlil~ vertcbral~ lt o svilllp prJ Jdle JIl7 i() nl di ltCjuiljbrio Dng li studi sul lto lb( l~nlrale (OllddU i in pa rticdu d 1 DlIal-BeHJ (gtegraverl ~ P~II IId lI1 n~ llw - idente il v- m gtiu p eT il puientc clioti elgt di u n rnigb o t c)[ ro Ua sw mle dei radlldc onsegull o tramite il 11 fforzrlshyfl len to d e i l1luotoucirc l nllgr3ilri d e luOwo con crcbi ~Clltdr
in pOMltHJ corrctl e in va rie ~i[Jzioni s t llicb c c d inamIcirc tllt Dalle on sena d elb blOffiCcclIlicd tr idimlt n s io mlle d ei
r ~ chi Je ~oU()f icn ~Icirc ~videnuumll (l() ~llt tC p IYZIcircOSI ln(IiClZlfHicircl ~ 1I1shy
liumln fluenzt Je ll middote~rUrio tl SC) lgt lIi I rc pibull m i tldln sJlI71 Stl shygn~I I1 afferma che slI l p Ia no [11 middotccedilr~lk tre un œ rtlJ grado di l L1Liuuml IlC dclh vEltlh r1 apj(de le tu rœ mu SCltJ llri njtbc J n in $tJ ) t rodcfQfll1t1l1te PltJtantu b i r~it-~ r -lp il puugrave t~~
Ixnt-ftla solo nt Ile so )[j)~i Jl1Icirc na rl in qunnt ) ilon SlrM ntne )(l(Ofa tu soglb in caq ) co lltrLJIcircn l)lrilto llt~( i lJudotlsi di lfr~ lI1 C llg grVlmenl J 111 11 io lr riltd ll(17jOill leld rinlle 113 dimO~iumlrlto d llt nell o lin~l cl()~ li t th~oIOl))1 dri la defltgtrshymiti sul p iluO slfl iuale ~vohl lf1 (en5 ion~ sO lnm utto nd 1e bsi iniliali deWggrwm1Cnln mcn trl C a( lfLmn che occlleshyvoluzi ne dene = 110 i [ mhari IJ lin c l ki cen tri ch -1vi1( de i cp i CIt IJ rI Ji SI p m ittIl pnm l Iem lmeme e p o j pOS( shyrio fllwnte dtldnli mdv ( i un ziuuml ne ciloliz7nnl dd rlLtide lu mbJ œ ( lIlelttlaquo on NC n d d (gt11 uIdu m 1I1 Ilgt) cli r-Iure (0 eserClzi che IllUllengano 0 ltlUperifo le Clgt 6gt1 lo)iche sul pirluuml gilwlt Su l p iCl no fron itk Perdnulk il dlll1lt-trlto d1 lampkz-l d i LU ovimento amp111 lI rv Kolio ti ~ nd lt1 0 ddlJ cnrrc-LIcircQo i Ji gC 1 n lungl SUpegraveliltlrccedil 1M llS0 tlell 3ampIGI shyvamcnlo C che l~Jltmiddot mobiliti GlI mcnta co n l c lu7j o fle d l i) snAio i A ulln amplgrtJc1 ltllllmunjx~ i terlpGli nn n m obi shyUZ73It ma eutva coli ti0 1 1ct HsicVlfe nd tcmplt 11 1111nshyttllIcirc1nc n tc (k ll ~1 llu u zinnt n l1 un me77uuml d i sost l11( gt ln 0
e 11111ri b cle - Ilziunc egrave deorinatcl d l rlyarsi Snzcl la pr gtshy
liltlnl l i un() rtl~ i ptmiddot Jtl n(o 1S(Hl () (( ntJ() i ndit~tr i ~ Ii ISt (izi e l m iviL Illdlode ebe Hlmen tno laJlc ibiJii dcl rlc lide SCshy
li io) [n p articobre rune q lldl r C-I1 ich~ xlSiddcHe CUf t shyli ve ch~ iJllpi tgino e~rciii 01( biIi2 ZanUgrave HhnmL-trid () in tmiddot~t~nshy
sione kl fuchide O tne pure k- ~ttivit1 tnotoJII~ non prHi(~ llCcedil
in forma r k rel1tiva d Ie ~1I 11 rF~1l1( n otcol mcnlC 1 lll ubib Ll vcrteblmiddote (ad ~ flp j(l 11 n l) to L ginn ~Iilt Utl clkl rilshyC
mka la cli OT- tcc)
r1il to l~ _ I[Dl COlI rY IC~
NE olUNI
fillncr ( ni ((uuml(( n hIIo( rilclIO ~middothe k lln dtfidl fUr1z i shy
nlu CQll1~ la llcl llZIO 1e delb c apKJl ilde e della capacltl di 0170 mizianu luJndn le (OJ il~ gtna a nc r3 di m~i3 gmshy
v it ln G mlxl r i ~ gko Fl llslrom C dlllJ O e Nachcms(J h iU1I) dim lr JtQ che b o liosl p IOO C1 neUaduksœnr 10 SYil l1p pn d i lIniumlmn~gin nlt8Jliva de corpo in (o nridcnz di Ln ddic3w p ri d di f( m l lz i nlt deUa SUl idenritl condishyZltonc ch pOlrebh ~[I cubrmiddot ln vilu pp di un pe bull n nn lir m llur cd e quiJibfarn in t[C adulro TaU CO1DSCe nZe tvlde nshyZ[II)() la n ( middotess iti di ltimobre la plfte ip a7j0 r1e atl an ivi ll1ltHClr n gl b a li ltl h ~ di tlpO s pu rti middotu dl ittlrc nd gloani iCo lID ti i lirtugraveta z io ni llb vila di relazionc
ln concllliu fu la d tfoflll lL saliu iG egrave il sin l mo di lin) idrotnc C Il1pk 1 d e eoinvo l d middotmiddot= fu n (n i dd rgashynIcirc5H10 n Hi lhdli e lesenizjo fi 1lt0 se 1 Il indirill~t() pllO pr~cnin 0 odLf rgt t lli di fu nzlonicirc adlc s()Jj(bi 111Icircn(i rrHtatc CO ll nl1 cinesi rap i Quand l~ coli i ( n LS~middot iJ11 zia k il rischio evnluLIcircvo egrave lid [() mente no tcole 11 (ltlll asso p o lll shylal ltOtSltgllen7~1 _ ta cincsiterapia pc rslIk bidtlvi shyptutibulli d ubllIcirctIcirc vltnc brn1e di conrro llo )(JSu k d i 5IcirclupPQ d Ile rLlt ziofll d i eC[u ihb ugraveo dJ ftffr otZJH1 r1w dei IIl llJgtCili 1 11Icircshyg rdtarl in posru ra rrenu posslhile JnnalL in Illo lt i clsi l(j luucircun lt di lin ~c() li oi mi n rc ( ume [11 duumlnQstrIO la tinc~ jn~l el1lric ((1l1 ~rtlppi d i contnmiddotllo cnndnlt1 p nso i l entrt d e Massue di Li n nc da [ o llo n ~ Rodo l (1 986) Julndo il1vlce lIfU~ ho ~vutlJ tiVll 11lt1 1IjXIl to un dekrshyuina r o~itl di g rl vir~l bull a~-n lllull~nte n ec ~~uiu rlCUuml rf( ff dla tcrJpll rle si c a eo chirurg ica
1Ho le clllC ooliosi idjopHI 3 ttl1p ~ - E~er l zjo hsco shy11ln ~ I((fapil
l Bg 5 CUle Lo [la k ll oblems in tlu ll~ (U ni Cl) FrKUce CU ( )lIILr no 1 AllCPR lu b1lG1t10 11 middotCI 9()(iJ2 RockilJe MI) i)~Cr ~()f I [( al th all 1 () I ~Y 1(~Re~C~Hd ~gtutnlt Ilallb Srshy1ltC Cgt D~p(rulllnr CJf I Ilalil 11 1 HumlIl sen Lel 199-1
2 SI) lrzcf ( LcB I ~IIl( FE DupUb L ampkIll~ 1c ~ppro l c h ll tht rnent und mmgemlt-rlt ot ~ ct vlyrl~ led splnul (hs r)fder~ A monQglJph rr r d lll kic Re p o l1 or Ih Ou bcc TlSk Fu rcl 0 11 ipmd DIo rele Sp ine L9H LU) 59
) Clntino F 111i1 i(ll Ci nerte1H C Nou gltHhl C Kln(~Jl llBICII [lIe1 hmlln (Il dry rra ll1ltfll of QIil pa ll m log iC by l11e 1 lIb li 1le-llh laquorilC~ of ~ 10(lna 111 Jrc)Jcxli r~~ (of flle h l lntrnIUonll SVIll Illgt~iu tn - II 5lt Ik lIc lk0flllllic lu llln-I I r l III Fhhlt ri g 1092 -ltlIJ-7
i - ri of niii MA N()LJV II ~ mel h)ltks de kin ~~klk rlr k di lll J r~cdllclli (n d~s ~()li oes jn f ~tel r~1ruuml(ILI -lo s bl fl c sur IcIj cquishyl)œ~ Ik SOll ll l)(eacute Eli ror eetlfllS d )111 1~ 1)1-
5 iloll n G Ruumld(~ le s () I ~middotmiddots tnlcl l l1 I n in 1Ifc el kiwil~~ 1)11lt KillegraveSlthe ripJe SCleacutentlnlue lYl6 2 47 ~ 6
r) Feacuterr[ffgt en 1tsiero 5 Venlllfln A ll~~n () M MJglio nu N EfkUuml o r eXltClse tI~tl Yoj o n nild id iO rXllhlc iC() 1i()~ lrt~ lirnIcircIluy r sull Eur feltl lb)ii 1 1j34 Z5 -~ 1 NOilrill1 A Sbill P egn ni i Ll Linesilegraverpi l 1lt1 Itallllll~nlO
ddlJ soI K~ i llO 1 Orkl1Llllwnrl m efodoloil1c1 RbbilltlZiOllc Ot1(1 1 )29(1) 1l-~
8 Nli(rinl Nl(lr1n l A blll P LI rieduGlzione dl p llicml atflt rro (11 coli ns i idi opr lir1 l n SC(Um i le or h( JI 1rcLlIQn1 ~0Cl le Imc lI1etW)n11e de Recltcrchc ci 0 Ftude sm 1lt Radw jlt)(j S-71
gt Nftriruuml S SeJhrf U LI r i l bllh ~l liOlie dd plziecirc11te ulet1n 11 - r
lin Kllopd (1 In l1l Jgl L N eduoL Tf1It II d ll11e ji cln1 rJtbl IiIUvJ Milan) 1ltfddH~n(x~hl 2(1~111gt-1-PU ob L cllln t iRll p l nelLi rl tgtO llcui n~ dilt ~lio i - l rn~f- li ~iIa n 3efllnl -Kurflr 19-11
11 lIIra S lJll M EVtJltHlvugrave egraveI lt t rnrumel1t() d db S(oli - U r) surie doCum nUle fintgt 31 tIUUli Mibn SI rlin) KlIpf -r 199 2
L2 1 ~W I1l(IJ P _leacuteVia tio n I~lhra k~ du IlchlS ~- ( i( IoltS ccedil l r lI C1 l1 fl leq
Ene 1 l C hi r ApparctlIClCOn l~ ltll1 l ltx6lt (i W Er 20 j )7 l
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16 N1lh~Ir~il Al Peumlf r~o n LE Erree htJkmiddotmiddot~ n f t~U lt hfIl middot Ith J
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17 M(jo n Y ( ullck J p ~ R A PrdulllnlIr rpurt 11 Iht e rt l f rnltJsu red 5l ren jl lh rrll nrl1 III ililleInr Hi rrt tllk scoJliagt
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EUROP MIDI C Pli hIC
EDUCATIONMEETING SATURDAY 8thof APRIL 2006
(iSS
SEAS02 Scientific
Exercises Approach to Scoliosis
version 2002
G
S Negrini 1
EDUCATION MEETING SATURDAY8th of APRIL 2006
Neuromotor disfunctions
Neuromuscular disfunctions
11 Postural collapse
Postural collapse
Duval-Beaupegravere
Flexibility of scoliotic curve
f---I--- I Postural element
-------1 Structural element
S Negrini 2
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Postural collapse
Duval-Beaupegravere
It is a value related to muscular tone and to flexibil ity of convex side tissues
Post ural collapse
Bunch e Patwardhan
Critical load
Load threshold beyond wh ich a spine begins buckling
JI~~Wt1lW~flfthtlJlœJtAr ~ J~It- l~l - IMS
Postu ral collapse
Bunch e Patwardhan
If a curve reduces there is an increase of the deformation threshold
~~~NW~-damaoc~IIIMf ~~ J~Iv JaJ-I7I9sect
S Negrini 3
EDUCATION MEETING SATURDAY 8th of APRIL2006
Postural collapse
Torrel e Nachemson ~
Scolioses below 20deg ~ ~ lt~
have a high ~ ~ percentage of ~ ~
~postural collapse (on u~
average 75) ~~ 2i~
CU~VE O EG~EE S WHllE SUPlti e
~laquotd~c6b ____lPffI1wtt1t~
$ww J(t ~~7 JM5
Postural collapse
Minor scolioses 7
Antigravity musc es strengthening D
Reduces postural collapse -G
Increases the critical threshold of deformation
G
Neuromotor disfunetions
Stagnara
If we admit that one of the causes of idiopathie scoliosis is a disfunction in balance systems it is logical to orientate physical exercises toward this direction
s Negrini 4
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Neuromotor disfunctions
Dubousset
Idiopathie seoliosis results fram alterations in praprioeeption centres and deformation is a natural compensation to restore postural balance
etattJtitIK ypothfQj~S ___~ own_ oJ)HQr lar 1t-1( r
Neuromotor disfunctions
Nachemson Initial idiopathie scoliosis
+ Goood spine stability
Neutralization of postural deficits
D Static curve
Neuromotor disfunctions
Therapeutic aims
c) Development of spine stability
C) Development of balance reactions
G
S Negrini 5
EDUCATION MEETING SATURDAY 8thof APRIL 2006
Biomechanical disfunctions
j Horizontal r-Ian
i Sagi ttal plan
Frontal plan
Frontal plan
q Frontal plan disfunetions
Fronta l plan
Perdriolle Movement magnitude
gt in the direction of lt in the direction of correction progression
S Negrini 6
EDUCATION MEETING SATURDAY8th of APRIL 2006
Frontal plan
Stagnara
Never mobilize a scoliotic curve without ensuring reduction maintenance over time otherwise a greater mobility favours scoliosis progression
Frontal plan
Ducongeacute~ research
On a group of adolescent idiopathie scolioses treated with
Meacuteziegraveres gymnastics
D After 1 year the mean angle of
curves increased from 18deg to 29deg
Frontal plan
Scoliosis without brace
D Greater spine
flexibility D-
Risk of progression
S Negrini 7
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Frontal plan
Mobilization is useful
D In preparation to
brace
D With brace
Sagittal plan
QSagittal plan disfunctions
Sagittal plan r middot _J o
Perdriolle scouos B CJ aDeformation of D
thoracic and thoraco-Iumbar curves evolves in extension
S Negrini 8
EDUCATION MEETING SATURDAY8th of APRIL 2006
Sagittal plan
Graf
The line of gravity centres in the vertebral bodies o s c oUOSt
projects itself firstly laterally and then fi
o
posteriorly lJ ~~ ~~ ~ ~~-_J-D ~nI~
Sagittal plan
Therapeutic a ims
D Maintain or
retrieve physiological curves on the sagittal plan
Horizontal plan
QHorizontal plan disfunctions
S Negnni 9
EDUCATION MEETINGSATURDAY 8th of APRIL 2006
Horizontal plan
Stagnara The forces applied ta the spi ne act in a autoshydeforming sense
Horizontal plan
Dimnet Rotation gt 200
ampII~ (
D The actions of concave and convex side
muscles become
agonistic
~ItJrOnrIIiItdllfUClltlluumlll~~tI ~1JIf1laJ
Horizontal plan
Minor scolioses never exceed these autoshy
deformation thresholds
S Negrini 10
EDUCATION MEETING SATURDAY8th of APRIL 2006
Disfunctions at a biological organic and psychological
lever
Oisfunclions at a biological organlc and psychologlcal lever
Cheng
Bane density in scoliotic teenagers is lower than in normal subjects
~~~~middotA~IIlUtIy ~7œl 1d l
Oisfunctions at a blologlcal organic and psychologicallevel
A significant reduction of vital capacity and V02max in teenagers with a medium severity scoliosis
S Negrini 11
li
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Disfunctions at a biological organic and psychologicallevel
Disorders in the development of body image that the teenager has of himherself
Disfunctions at a blologlca l organlc and psychologicallevel
Therapeutic aims
cJ Activate cardioshyrespiratory function
cJ Favour bone density increase
cJ Develop a positive image of the body
Disfunctions at il biological organi and psydlologicallevel
Stagnara
Sport
D The active side of
kinesitherapy
S Negrini 12
EDUCATION MEETING SATURDAY 8thof APRIL 2006
Disfunctions at a biological organic and psychological
level
Distunctions at a biologlcal organlc and psychologicallevel
Cheng
Bone density in scoliotic teenagers is lower than in normal subjects
~n~IIIvpWr~middotA~stWy s- XXJl M J
Disfunctions at a biological organic and psychologicallevel
A significant reduction of vital capacity and V02max in teenagers with a medium severity scoliosis
G
S Negrini 11
EDUCATIONMEETING SATURDAY 8th of APRIL 2006
Kinesitherapy on the scoliotic subject
q Postural control
q Axial stability
q Muscular trophism
q Balance
q Respiratory function
The limits of kinesitherapy
There is a threshold beyond which
rehabilitation alone is not enough
sssr
Kinesitherapy in scoliosis treatment with brace
Therapeutic aims
S Negrini 13
6
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Therapeutic aims Srace kinesitherapy
With brace
il Postural corrections and
vertebral stability are obtained by the brace
Therapeutic aims Srace kinesitherapy
In preparation to the brace
il Mobilize spine on ail plans
Therapeutic aims Srace kinesitherapy
With brace D
Maintain a normal spine elasticity
~ Maintain a good muscular toneshy
trophism
C Model the hump with kyphotizating
exercises
S Negrini 14
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Exercises and their methodologies can vary accord ing to learning and individual sensibility of the single rehabilitator that proposes the m provided that they stay within the
Iimits of fixed therapeutic objectives
li
Therapeutic modalities
(Exercises)
QAuto-correction
QRespiratory education
QErgonomie education
QMuscular strengthening
QDevelopment of balance reactions
WNeuromotor integration
ci Vertebral mobiJization
QSpecifie modalities in brace treatment
S Negrini 15
EDUCATION MEETING SATURDAY 8th of APRIL 2006
The protocol of kinesitherapic
treatment
G
QChoice and dosage of exercises
Variatiosn of the work program every 2 - 3 months
Q Execute e)(ercises on an individual base or in a small group
Q Frequency not less than 2 times 1 week
Involve and awaken the family
G
S Negrini 16
EDUCATION MEETINGSATURDAY 8thof APRIL 2006
Q Determine the action and the localization of auto-correction
QAuto-correction must be associated to ail exercises
QAt the end of treatment ergonomy lesson
Auto-correction didactics
G
SCOLIOSI DORSALE---- shy ----
r
S Negrini 17
EDUCATION MEETING SATURDAY8thof APRIL 2006
SCOLIOS OORSOLOMBARE
shy
SCOLIOSI OOIlSALE 011 bull LOMBARE S1I--shy
SCOLIOSI LOMBARE
il --~_-
S Negrini 18
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Scoliotic patients are not radiographs
middotSeoliotie Mtients are not ndiographs but hum beings with a vertebral deviation-
Slagnara
Metha For the physieian Cobb angle is of utmost
importance For the patient it is body deformity t hat eounts most rib hump a protruding seapula or hip We are in a situation in whieh today dodors eure the radiographie deformity but what the patient really desires is to get rid of clinieal deformity and of ensuing psyehologieal distress
CIIQItIo shDuIdtucirc lM WIld tJw~~ I~~M~~~~ J9f~
S Negrini 19
- Poznan_workshop_Physiotherapy
- physio2
- physio3pdf
- physio4
- physio5
- physio6
- physio7
- physio8
- physio9
- physio10
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bull Metoda asymetrycznej trojplaszczyznowej mobilizacji kr~gostupa ma znaczeumllCV wptyw na zahamowanie progresji
w skoliozach idiopatycznych szybko post~pujqcych
bull Mobilizacja strony wkl~s~ej skrzywienia i osiowa derotacja kr~gu szczytowego zwi~ksza korektywnoseacute skolioz zmniejsza garb i ebrowy poprawia obj~toseacute klatki piersiowej i zwi~ksza wydolnoseacute oddechowq plue
13
bull Przedstawiona metoda jest
stosowana samodzielnie lub
w pO~qczeniu z ortezq Checircneau
a takie jako przygotowanie do
leczenia operacyjnego
Ocena progresywnosci w badaniu elektrofizjologicznym
odruchu z odci~zenia
i~middotmiddot ~=~-~ shy1 _--==shyocirc
14
EUT S pine J (1997) () 93-97 copy S pringer-Verl ag lY07 ORIGINAL ARTICLE
K Dobosiewicz Neurophysiological mechanism of the unloading reflex as a prognostic factor in the early stages of idiopathie adolescent scoliosis
Rcceivcd 29 M arch 1996 Revised 16 August 1996 Acccp tcd 10 Septem ber 1996
Absfract This paper presents a new nc urophy iologila1 methougrave of e valushyati ng the risk o f p rogression in ill ioshy
mo t important factors in the eva luashytion of progress ive id io pathie scolioshysis The met hod can be lIsed to deshy
pathie scoliosis in th early stages uf tll( progre jve idiopath ie scolios is the dis ase by illY middottigating tll e unshy in lhe early s tages of the d isease loading refl ex in paraspinal muscles T he high sensi livi ty of ilie method The study incl uded 394 pat ients wilh means il can be used as a basis un seo liosis and 70 hcalt y chil dre n which to take an earl y dcc ision to
K D obosicwicz Depuumll1 mel1 l of Rchabi lilu lioll Si lesilln Medical Academ y 42-604 Tamo wskie G6ry 4
Lmenty of the unloacli ng retle x and repeatabi li ty o f Ihe rcbound and silent period were anal ysed for eaeh reflex evoked Prolonged latency and
p rimiddotom1 surgery
Key words Id iopathie seoli o is Unloadi ng rcnex Re bound
Katowice Polaml minima1 numbe o f cycles are the Larency Si ent period
T he ai m of this sludy was to evaJ uate the use of the unshyIntroduction load ing Dex for octcction of prog ressive id iopath ie adoshy
le cem oIios is in its carl s tages in onl r to lake a dccishyProg ress io n of id iopatJl ic scolios is bas been the su bject of
sion ta perfo nn surgcry as soon as pussible many clin ical radiological and elecrromyographic in ve~ shy
tigalions T here is ho wellcr no sim ple quantita ti ve or qual itati ve pro noslic methoo [hat can be em ployed in the
Materials and melhodsearly ~tHges of the disease Monitoring of lhe unloading rc felx in paraspinal m llsck appcars 10 be a reliable Inv gtsi lgnlions were carricd uut 011 394 pa tie nt with adolescent method o f discriminating bctwcen diffcrcn l fomls of Cushy ~c li ed J ild 70 hCldr hy children The scoli osis group consisted of Iios is T he un loa ing re n cx can be evokcd in ail the 31 1 g irl s and 83 boys aged 9-1 8 year~ (mean age 125 ycars) The
ske lelal muscles through a suegrave den shortening of o luntary contro ls wcre 0 girl s and 10 boys aged tO-1 7 y~ar (rncan age 128 cars ) Imong Ihe stlbjeclS tudied wcre 9 patien l w ith cershyinnervated muscle l2~J When a musc le is unloaJ ed vico-thoilc i seo liosi s mean Cobb ang le 22 7deg 121 with Ihoracic
rapidly durin g an isomerric con trac tion Ihe norm al reacshy scolios is mean Cobb nngle 309deg I 1 w ith thoraco-Iurnbar seolioshylion is an eleclrically silent pe riod fo llowed by a burs t o f s is rne ~n Co bb ang le 26~g o 63 with lumbar cotlos is mean Cobb action potentials called rebmmd The pause in d ischarge ang le 279deg and 90 w ir h doubh major curve sc o Ii() ~ i s meull o bb
nng le 292deg and 28 5deg The sludy group includcd 231 right -s ided can be observed only when a certai n h reshold va lue of and 163 left-sided 5col iouumlc patien ls There were 112 patients w ith
acceJcration flnd shortening of he muscle is exceeded progress ive id iopath ie scoliosi (76 ri g hHidtd and 36 Ic 1t-s ided) an tl il occues wilh constant latcncy correspond ing to that 182 with no n-progressive idjopa thic scoliosis (1 13 ri ght- sided and of the propriocepti ve nflcx (9 18 20] T he rebound ufter 6 le rt-sided) M d 100 w ith pe lvic tilt (statie) scolios is (42 rightshy
s ided anp 58 l eft -~ i(kd )the silent period in the unloaugraveing re felx rcsul ts from ae lishySC9 1ios is is consIcircdered progressive if the Cobb Jngle inshyvalio n of a pool of motone urons aIl o f which fClt1ch lhe
creltseacutes by more lhan 6 in 1 yen r aile middotnl1 n-progrcssive if the anshyfiring thres hold simultancously afte r prcviou~ si lenœ [l nua i increase is less thll n (i The Cobb angle ranged lrom 8deg to 77deg 1 4 201 in Ihe palicnls w ilh progress ive scoliosis (mean 361 ) [rom 30 ta
lI f R (on- f Rt tt1IY 1lIfl pflla 1 )(~ r(Jnu n t shy
fI) _ ~
Pathomechanic basics of conservative treatment of progressive idiopathic scoliosIcircs
according ta Dobosiewicz method based upon radiologie evaluation
Kryslyna DobosiewlcZ Jacek Dunnala Kny ztof Czemicki Hanna Jcndf7cjek
Deparmem of Rellabtlifatoll Mediw Uninrsity ofSiltsia KatOllice Poand 40-635 Katowice fil ZiUCl 3537 POL4ND
e-mail relwbilitacjt1s11mfoctaonetpl
Abstract Conscralivc IrcalrnCnI of Idiopathie scoht)~1 espcclall y kinc ilhcrapy i ~
nOI widcly apprccilllcd due 10 Ils suspectccl low dfcCIIcircvcnc 5 in relalion [ (1 a urglcal Irc[llment ACter long-ycar il ses ment of palomcchanic f scolio icirc in Dcpanmenl of Rchnhllilallon f Mclii al Unlcrsi ly of Sile bull a concTvallvc mcthod ()f IrCtllmenl asymmclric Irunk mobili7alion in lnclly ymmelm po~itions WIS
de el ped_Thi mClh d enablc 10 delain pTogression f scol iosis or ccn de middotrca~c laIerai urvalurc of a spi ne and angle of rOlllion assummg adequate () perallon f palicnl and ilS famil)
J Introduction
Idiopathie scoliosi OS) is a thrccdimensonal dcfonnation of il vertebral col lmm an- cntire trunk Afler many years of extensive rescarchcs the cause of idiopathie coliosIcircs $ i remaIcircns unknown It is possible Ihat idiopathie scoliosis devel ps and progress on a baslS 0- ~
multifactor disorder perhaps diffcrent for curve initiation and curve progressi 11 Fion poss ible pathologie factors nervous system dysfunctIcircons affecting postural tquili brium ar proprioceptive control seem to be espc ially important [ l 2 6 JI Pro_ ression f iS could bot delermincd by vertcbrac remodeling under eccent ri c loading created by axia lly ce gravitational forces in presence of muscular imbalancc in the trunk [2 J The verte rai colwrz unde r scoliotic conditions 15 an unstable system with tcndency to fu rther tune dcvelopment fl2] Lateral bending of a vertebral column visible in X-ray examination L
only a two-dimensional prcstntation of a complex dcformity consisting of patho logica axi rota ti on torsion and othcr deformations of vertebrae [7 8 10 II 14J ln fS physiolog~ curvatures of vcrtebra l column are disturbed Total Icngth of an anterior column of a spi n~
consi ting of vertebral bodies and intcrvertebral dises bccomcs grcater lhan length of l posterior colwnn - vertebral arches and proccsses [11 15 J h is apparent that phy iologi ~
thoracic kyphosis in rcgion of a scoliotIcircC curve diminishes Each vcrtebra of a stru tu ~
urve of coliosis is oricntatcd in hypercxtcnsion in relation t adjacent vcrtcbrae [7 l resulting
1 n B Uri middota I l 11
H srut ft illtf j tI) t li orf1Hli d
IDS Prt ts 21)2
Influence of method of asymmetric trunk mobilization on shaping of a physiological
thoracic kyphosis in children and youth suffering from progressive idiopathie scoliosis
Krystyna Dobo icwicz Jacek Dunnala Hanna Jendrzejck Krzysztof Czernicki
Deparrment of Rehabilitation Medical University ofSilesia KaloKce Poand 40-635 Katowice ut Ziolowa 3537 POLAND
e-mail rehabiliracjas(u1poCmiddottaollelpl
Abslract Idiopathie scoliosis (lS) which i sub 1 ntially l threeshydimen ional derormation or a pine cau e nOl only laler l curvalurc and axial rotation of vertebral column but al lordoti allon of VCr1cbrac in structural curve eXl nsion ln an effect physiological thoracic kypho j diminishc or cvcn dbappears Method of a ymlllctric lrunk mobilisation in strictly symmetric po iljon according [ Do () lewicz not only dcteriorme progre ion of IS or evcn reduces lalera] curvalure but also significmtly rebuild physiological thoracic kyphosis Icircn cases of lS accompanicd by lraight baclc
1 Introduction
Despitc Ion year researchc etiology of IS is nOl yel resol ed Significant problem re laled lO morphology of IS apar1 from lateral bending and ax i 1 r tati n i deviation of shape of a spine in sagittal axis affecting physiologi al curvatu re of vertebral coJumn [3 5 6 8 9 J 0 1t 12 Lcngth of anLerior col umn of a pin constitutcd by venebral hafls anugrave intcrvencbral dises dominate ovcr Jength of po terier c lurnn buill from vertebral arches and processes [lOJ This condition uring scol io i progress ion and growth of a child effect in hallowing or even disappearing of phy iological Lhoracic kyphosis in scoliotic region It i well know n lhar cn~brae of structu ral Jaleral curve are positioncd in hyperextension - lordotisation [5 6] which in Lhoracic region Icad (0 reduction of kyphosi or to true lordo middotis Such kind of venebrae relation in thoracic region cau es ilS destabicirclisatIcircon whi h in u sociation with eccentricircc gfilvitali nal load fa pinc duc to muscu lar icircmbalance [21 pOdbly produces r tationaJ lordo is [56 Il] and further development of symptomatic scoHose ft ha becn proven [12J tha strengthening of the erector spinac muscle aggravates nce initialcd deform tion and deteriorates coliotic process Hyperextension and uxial rotati n a s clatcd with
357 Th B Grivas (Ed) Research inro Spinal Defoml ilis 4 lOS Press 2002
Exercise efficiency of girls with idiopathie
seoliosis based on the ventilatory anaerobie threshold
Jacek Durmala Krystyna Dobosiewicz Hanna Jendrzejek Wieslaw Pius
Department ofRehabililation Medical University ofSiiesiaa Katowice Poand 40-635 Katowice m ZioJowa 4547 POLAND
e-mail durmalaiacekyocztaonetpl Department ofPhysiology Academy ofPhysical Education Katowice Poand
Abslract The aim of the study was to estimate the exercise efficiency in the group of
girls with idiopathie scol iosis based on the venlilatory anaerobic threshold (V AT)
Material and method The investigation comprised 58 gi rls wilh idiopathie scoliosis
aged 10--6 years 32 girls (55200 ) wilh double major scolioSiS and 26 girls (448)
with single scotiosis The girls were eonservatively treated using Dobosiewiagrave
method The control group consisted of 3 1 healthy girls aged 10-1 6 years The
cxercise test was performed using eycle ergometer During the exercise the gas
exehange parameters wcre reeorded (minute expiralory venlilation minute oxygen
consumption earbon dioxide production) On the basis of recorded paramcters V AT
has been computcd using V -si ope method Results The following V AT values were
obtained in the group with scoliosis 207+305 ml 02minlkg bm in control group
219+350 ml 02minlkg bm The differences belween girls with idiopathie scoliosis
and control group were nol SLaliSlically significant Conclusions I The exercise
effieieney of girls with idiopathie scoliosis conservalively treated using Dobosiewicz
melhod is normal 2 Such high level of the exercise cfficiency of the studied group
probably was due to intensive 3-D respiratory exercises of these girls
1 Introduction
In practice there are researched useful efficiency rates which on base of laboratory tests results possible easy without using of the relatively hard or long exercise tests would give the belter forsighting of the range of homeostasis disturbances and rapidi ty of increase of
physical fatigue during varied workloads [1] The best known rate of trus kind is the maximal
minute oxygen consumption [2345] During progressive physical effort minute oxygen
consumption increases proportionally to workload The reaching of real maximal minute
oxygen consumption in time of progressive effort is iodicaled by minute oxygen consumption plateau [5 61 This result is rarely registered in children The progressive exercise test is most commonly used in children until physicaJ exhaustion and the highest registered minute
oxygen consumption is treated as maximal minute oxygen consu mption or so-called
symplomatic limited maximal minute oxygen consumption [678J Sorne authors regard
Orto-dlet Trau malaogis Roha b ilitacjaARTlKUL ORIGINALNY ORIGINAL ARTICLE Vol 5 Nr 1 2003 80-85
Jacek Durmala l Krystyna Dobosiewicz l Tomasz Kotwicki Hanna Jendrzejek 1
Katedra i Klinika Rehabilitacji Slqska Akadenia Medyczna Katowice Katedra i Klinika Ortopedii Dzieci~cej Akademia Medyczna PoznQll
Wplyw asymetrycznej mobilizacji tulowia na wartoseacute k~ta Cobba i rotacji w przypadkach skolioz idiopatycznych u dzieci i mlodzieZy
Influence ofasyn1n1etrie 111obilisation of the trunk on the Cobb angle and rotation in idiopathie seoliosisin
children and adolescents Slnwu kluce ac eJJic Cl chOlIU) Ice SKoio= idj)PO Imiddot(~I7tmiddot
K~Jmiddot w()rus consrieI ve I (OtlHelif idiopathie HUW JS
SUMlvfARY
BackgrouId The aim ofthe stldy Vas Ihe radiological evaluation ofthe treatllJent ofthe idiopathic scolioshysis utilising as)mmetric trunk mobilisation in the strict~ll I)mmetric illitial position
Material ([fJ(f lIIellOds Presented stud) lOS based IIpon J36 cases (13 oovs oged FOf11 ocirc la 6 lcars (lild
rn girls aged frum 6 la S pears) trealed due to the idiopathie sCuliosis ((rom Novell1her 999 0 F enflfUn 200) Among 48 ch idrcn sllfJering from dOlfble-major scoios is 6 cases wcre infoll scaliusis JOjuvel7lle und 22 adolescent Among 88 sillgle scoliosis 6 lere infw7t 33 juvenile and 49 adolescent
Radiological exami71ation 1as condueed always in the repeataole technical cOlldiions RadlOglOlI1 lier evaluated oy the same physician Radiologica analysis oIthe scolios is incuded value ofthe Coho al1gle ongle ofaxial rotaion
ReSIils ln double-major scoliosis observed dlring one year period in Ihe thoracic segmenl Cobb angle decreased inll l increased 1395 and in 292 Il OS 111changed Axial lolation angle in 167 (~rcascs
decreased in 354 incrcased and rernainM the sorne in 479 In Ihe llllnba segmenl Cobb ang le clccrcscucirc il1 354 increased in 39 6 remained in 5 Angle ofaxial rotation deceoscd in3 ofca es incrcuscd in 29 and persisted in 48
ln single scolio is Cobb angle decreased in 386 incrcased in 353 and in 261 was lInchonged Axiol rotarion angle in 216 ofcases deceased in 295 increased and rell1aincd the sallie in 489
CondlsioJ Asymmetrie mobilisation of the tf1f17k in strictly syl7111elric initial positions is a 1Clhod of choice in the cOl7senJalive treatment ofthe idiopathic seoiosis
STRESZCZENIE
WS~p Celem pracy jest radiologiezla ocena Icczenia skoiloz idiopaf)cznych metoda asvmetrycznejl7lOoili shyzocji tllowia w sciSe symetlyczl7ych pozycjach lV)jscio wych
M aterial i metody Przeprowadono retrospektYlIl7q analizri 136 przypadkeacuteM dzieci (13 chlopcow i 123 dziellshyczqt w wieku 6- 18 lat) z bocznym idiop atycnylll skrYll ieniem krrgoslupa leczonych zachowawczo w Klinice
1
Ortopedla TliJumatoogia RehlblllagraveeJa ARTYKUL POOL1 DOWY OPINION ARTICLE Vol 7 Nf 1 2005 49-$11
Krystyna Dobosiewicz Jacek Durmala Tomasz KotwickP
Katedra i Klinika Rehabilitacji SIAM Katowice 2 Katedra i Klinika Orlopedii Dziecircej AM Pozncrlz
Biodynamiczna metoda tr6jplaszczyznowej korekcji skolioz idiopatycznych - opis metody Biodynamic method for 3-D correction of idiopathie
scoliosis a description ofthe method
SIOWQ kluczowe leezenie zachowawcze skoliozy idiopatyczne korekeja tr6jplaszczyznowa Key words conservative treament idiopathie scoliosis 3-D correction
SUMMARY
The biodynamic method of hree-dfmensional carreeion of idiopathie scoliosis is based on Ihe palhomeshychanics of idiopathie scolioiiiii and consiss in aClive segmental three-dimensional correction ofspinal cllrshyvatlre The course of action focuses in the viciniy ofthe apical vertebra Proprioceptive facilitation is applied on Ihe concave side ofthe curvaJure and exteroceplivefacilitation on the convex side Correction likewise proshyprio- or exteroceplive facilitation is phase-oclœd with asymmetric respirarory movemenr as weil as wilh parshyticular phases of the respiratory cycle ln Ihe course ofexercises three-planar movement is generated opposite to the direction in which scoliosis Is progressing This method is in accordance with the stale ofthe art ofscoshyIiasis pathomechanics The method requires detaied training and can Ihen con be applied at home under periodic control by a physician and a physiolherapist The method con be applied in landem with a Cheneau brace as weil as in surgical pretreatment A elaUed description of Ihe method of three-dimensional scoliosis trealment will be presented in Ihis article
STRESZCZENIE
ISlofa biadynamicznej mefody Ir6jplaszczyznowej korekcji skoioz idiopatycmych oparlaj est na patomechashynice iikolioz idiopatycznych - poega ana na czynnej segmentanlej tr6jplaszczymowej korekcji skrzywienia Dzialanie koncentruj e siccedil w pobitu Icrllgll szczytowego sknywienia Stosowane iest bodicowanie propiocepshytywne po stronie wklllsej oraz eksteroceptywne po stronie wypuldej Korekcja i slosowanie bodicocircw propioshyi eksteroceprywnych zsynchronizowane j esl z asymetrycznym torem oddechowym oraz z poszczeg61nymi fazashymi oddechu W trakcie eacutewiczen powstaje odwrotny do lrierurzku rozwoju scoliozy tr6jplaszczyznowy ruch IcrFtshygoslupa Melodajesl zgodna z aktualnym stanem wiedzy na lemat patomechanizmu scoiozy nymaga szczegocircshy100-lego instniktaZu po clorym mote byeacute wykonywana w warunkach domowych Z olcresowq kontrolq przez leshycana i fizj oterapeutll Metoda mote byeacute stosowana r6wnolegle z leczeniem gorsetem korekcyjnym Cheneau a talcte w przygotowaniu do leczenia operacyjnego slcolioz W pracy przedslawiony zostal szczeg6owy apis meshytody leczenia
Skoliozy idlopatyczne stanowili znieksztalcenia patycznej rozwija siccedil poprzez przemieszczenie kr~gu tr6j~aszczyznowe charakteryzujltce siccedil wyboczeshy szczytowego w stosunku do krccedilgu g6mego j dolnego niem rotacjltt krccedilg6w klatki piersiowej i miednicy z r6wnoczesolljego rotacjl zgodnie z ruchem wskashyoraz zmianami w fizjologicznych krzywiznach kr~ z6wek zegara dia skrzywienia prawostronnego oraz goslupa w plaszczyinie slrzalkoweJ [ 123] przeciwnie do wskaz6wek zegara dIa skrzywienia leshy
Z punklu widz nia patomechaniki tr6jplaszczyshy wostronnego Koncepcja rozwoju skoliozy jako rotashyznowe znieksztalcenie krccedilgoslupa w skoliozie idio- cja i kontrotacja sugeruje ze sily korekcyjne powinshy
49
EDUCATION MEETING SATURDAY 8th of APRIL 2006
- CARDJOPULMONARY EXERCIS E
TEST IN GIRLS WITH
CONSERVA TIVEL Y TREA TED
IDIOPATHIC SCOLIOSIS
Jacek DURMALA Krystyna DOBOSIEWICZ
Department of Rehabilitation Medical University of Silesia
Katowice Poland jdurmalaqcmpl
The aim of the study was
to estimate the influence the conservative treatment (asymmetric mobilization of the trunk by Dobosiewicz) on physical efficiency in the group of girls with idiopathie scoliosis
Material
bull 87 girls with idiopathie scoliosis
aged 1 0-17 years
(mean age 135 years SO 161)
J Durmala K Dobosiewicz 1
EDUCATION MEETING SATURDAY8thof APRIL 2006
Material
bull 38 girls (437) with double major scol iosis (thoracic segment - Cobb angle 18-42deg mean 30deg SO 82 angle of axial rotation 4-32deg mean 21 deg SD 107 lumbar segment - Cobb angle 11 shy48deg mean 31deg SO 128 angle of axial rotation 5shy30deg mean 13deg SO 85)
bull 49 girls (563) with single scoliosis (Cobb angle 11-75deg mean 33deg SO 155 angle of axial rotat ion 5-30deg mean 14deg SD 83)
TIoracic kyphosis of the invesllgated group was 5-39deg mean 23deg SO 86 and lumbar lordosis 16-41middot mean 30 50 65)
Material
bull The 64 girls aged 10-17 years (m ean age 131
years SD 132) were conservat ively Ireated
using Dobosiewiczs method
bull Treatment period ranged from 5 months 10 3
years (mean 148 months SD 902)
Material The 23 girls aged 10-17 years (mean age 136 years SO 108) were treated u sing symmetric exercises - treatment period ranged from 4 months to 3 years (mean 161 months SO 1019)
bull 26 of ail g irls (18 girls earlier treated using Dobosiewiczs m ethod and 8 gi rls earlier treated using symmetric exercises) aged 10-17 years (mean age 134 years SO 108) were twice tested - at first and last day of Intensive hospital rehabilitation (asymmetnc mobllization of the trunk by Oobosiewicz) - mean hospitalization period 20 days (range 18-26 days)
i rf~8f6~~ or~~n~= ~~r~1~r~icircJ~~tb~~~~ mean 17-4 1deg meatl~(I SO 74 R n~le ofax 1 rotatIon 5-25ot mC3 111 3laquo S0 6icircl Ilnd 1 99t1S~ ~~~~I~~~~~$ruo~ras~ ~ocirc~~a~e~~~~~~~5euml1 9middotn~ tUfllbar Iord05ts 16-4 1deg mean 311 SO 68)
J Durmala K Dobosiewicz 2
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Material
The control group consisted of 77 healthy
girls aged 6-17 years (mean age 12
years SD 31)
Material
The examined girls participated in school
only in scheduled physical education
lessons and have not been enrolled in
other sporting activity
METHOD
The exercise cycle
ergometer test was
performed
J Durmala K Dobosiewicz 3
EDUCATION MEETING SATURDAY 8th of APRIL 2006
METHOD
The Incrementai exercise test has been applied
We have found that tests ln whlch the Incrementai part of the protocol ln completed between 8 -12 minutes duration glve the
bullhighest maximum VOz in normal subjects
METHOD
The workload was Increased stepwlse
bull by 10 Watt every minute - ln chlldren
with high ~ 135 cm
bull by 15 Watt every minute ln chlldren
with high gt 135 cm
METHOD
The test had been contlnued untll refusai of the patient or exceeding the pulse Ilmit
Durlng the exerclse the gas exchange parameters were recorded by Jaeger device model Oxycon Alfa uslng direct breath-byshybreath rnethod (with face mask)
J Durmala K Dobosewlcz 4
EDUCATION MEETING SATURDAY 8th of APRIL 2006
METHOD ~ ~~ r 3 min 3 min 8 - 12 min 6 min -~
_ 0 rpiYJ 0 rpm 60 rpm ~1 30 rpm
_ t o~w=att~o~~na ~~ att__~ tl~~S~~ l ad l ~~~~~r o~w= Hlcremenlal t
pedaillog i i ~
~ ilt ~I~-----tl-~ I t ~ i ~ lOSt sffortivB
lW r resututlon r rm-u middot 1 - bullA~cremen tal ~~ ~ ~ ifr- ~ VtI 1 ~i ~ tllng _
METHOD
On the basis of recorded parameters VAT
has been individually computed for each
child using V-slope method by
Wasserman
METHOD
For assesment of physical capacity
the maximal minute oxygen o
consumption (V02max) ventilatory
anaerobic threshold (VAT) and
maximal workload was used
J Durmala K Dobosiewicz 5
EDUCATION MEETING SATURDAY 8thof APRIL 2006
RESULTS
Ali girls with 18 have been classified
within normal range of predicted
values of
bull maximal minute oxygen uptake
bull VAT and
bull maximal workload
RESULTS
The differences between group of girls
treated using Dobosiewicz s method and
group of girl s treated using symmetric
exercises were statistically significant
Lower exercise efficiency of girls treated
using sym metric exercises has been
observed
RESULTS Girls wilh IS Irealed using
N=87 p value
Dobosiewlczs method N64
symmetJic oxor-ci Nz23
Perœnlage of predicled vaJue of
maximal minute oxygen uptake
98 905 0033
Percenlage of predicled value of
VAT 97 933 0049
Percenlage 01 predided value ni
maximal workload 101 939 0038
J Durmala K Dobosiewicz 6
EDUCATION MEETING SATURDAY8th of APRIL 2006
RESULTS 26 girl s twice tested - at fi rst and last day of intensive hospital rehabilitation
The value of ventilatory anaerobic threshold increased during intensive hospital rehabilitation (asymmetric mobilization of the trunk by Oobosiewicz) statistically significantly (p=00019)
2047 ml O2 minkg (SO 268)
vs 2239 ml O2 minkg (SO 232)
Conclusions
1 The exerc ise eff iciency of girls with IS treated by asymmetric exerc ises of Oobosiewicz is norm al
2 Such high level of the exercise efficiency of thIcircs group resulted fram using of Oobosiewiczs method
r
J Durmala K Dobosiewicz 7
REVIEWS
Role of physical exercise in tbe treattnent of mild idiopathie adolescent scoliosis
Revicw of th- literature
A NECRlNl N VElWNL s PARZI 1 A NEGRINJ 5 NEClU NI
P1t~silillxlrd~ Ihcrapy (or klucgtlttlwrlpyl i pro shy-tJm of physka] cXlrd-cs ipcci I(a~ (IJcloJgtcd hy l li trIWlltl phrslollwrapbt wilh tb m~ln a1mor pl shyVCnI in lhe ilAAfIVltilH1 llf the ucirccfonuity III mild IgtC )
Lil1Si bclpin~ thebm ( aocl co uaufllclilIg ils ~jd- clf IS in nlOdlJmiddotnh-culiosis Th middotalillofthi paper ito r (W
Ille Ii lc ram r 1 a-ccrulin wh kh of Ih bull Lu[Jalmlcrus Ind (Lb hili til~ CLlLt-cd br scnli()si- clluld bl pl Y nlcd or r d uccd hl phylolld LXtmiddotrdsi n Il p--to-da le knowl Uuml~l nr tIll~C aspcc[~ i ne bulled in oruer 10 dndc whclh~r 11Rf blLl adcqlmtt Ib(uuml n middotlicaJ balis fo r ora)aini l Ihe US4~ of lUgravellgtitlerap) wltcllj(r or fln l th e prtl1iœ of kimiddot ~lre IUlll poNjn~ a t iil ies ~bould h allowtcI II uuml middot c enliaI toltlentlf)wh k lu alClor ie - lf pl lr~kiJl -c rmiddot d gtlt- (Ic rnnhi UzJ( inn ni (t hl HrJltlon [ rtn~hcll iJl ~ or 1i1J(IChIumlJlJt etc) Sh llU Ld be TolullllCcluse ulemiddot l onld b- clclIimcntalancl wukh sho ll ld he IJlI-n~ifl~d I~~a l lhc (o uld h 11lfu 1 Know k dg CJnc1in t (wIn SeiCIImiddot Hlk rCS([lflt h daw ccordinll to Ih bull llVit w o f tIlt iii 111 1( plop(lsltd in (h i papcr lmiddotonllmJ l lnl plLyi 11 cxcr(j$( pn (nti or (tmiddotduce dhlblli t ic 1 ~lt Il Jj ll(k pl ti Jlt fadl j w(~ the nlIIIrl li7alinn n f poMural dd shylitS tu p n xJ llc aSl COIlMqnen c(middot 1 all )llal) or r(tn~ shys i middot middotlIrve Tilt u~c (I f appn1priattmiddot kincsiuuml wrlpy 0 in rcns polttllcal swhiIHy Icirc IIHmiddotorc Illta ll y (0 r 1(lt1 lllho UAh mon ltlccurlltc 1Ut dl1alkd -rLk l(lWfils 111111 )11 h Jlccdt(
11) wurcJlt 0 lit)-IcircS (Iumpy - x rcLs P()lun
n rllt lT(ltnklf u f COll1tlK H (rtd) I 1i plfho l og l ~$I rUlglng tr m low tmiddot k Pl 1l1 to IdiOpath ie SCUIshy
Submitt(oJ [or PUhltCl l1 011 uly Tt 2001 Acc~pttJ ugu - ~2 1(t-1l
Addre rltj-xlfll telt~I(middotb If) - grinl Flt(1(bziurllt r )(m Ofl ()(Cl1I shy Lt middotqlltœlll ro () - 1u I4t agravehLIlKil ta IYIL-lTt ilSllltp lfllmiddot ~ 1l1uumldull
CelII ~ (niiOS I I~ middot ann (1) IfUh middot lIlfU di louhilll(tymi ( Nlmiddot ~iI rli -ilIIUmiddotltlfl
Nlti(ir 1( ) il r() (ltbullagt1
lt vLL_ l IiII no 1ftfI
jS ) we are a IUil ly tJc ing n1n) ltblll lS 1 k l1 b ~J)w in~ tl~ t S Jfll l approad llt - l1n til hy on ielshyertd ~tan lard ugraveJuld ln m any ~1~ he lI ~t les i if Ilot dange r )ll lt rhlS is lrut of reil l lnw 1gtlt1lt1 pa in l ~ or 5urgi c ll lrea lmltnl5 in dbc r lmiddot ll Sc - 2
ln tlle cj-e ut ~ t lll(tlWtl i( li p l ll1JC luuml- I ~ middottnl ~() shyliosis phys cal ((_lt1(( is emr1uved ltI t()fIl1 0 lh~rtrv
lo ly in cel1l in L)lllllde (nluumlnlr in tilt Lltlll middotorkl i e Iw l) r llt t Srain hUI IIgt() 111 Gert11lny 5- 1~1 in other reg lOl1 wbere thi I-incl qf tre l tm e rll 1 p~ 1 pmiddot t 1( cI il Jws Ixen cri ri cilld md rel -cltd Lw m~lI1 1 11 Jlu~ Fue Fnlny r ~lrs thio middot15 a lsgt(ru( f ~rth r -~ltc rrJtf))~ ll t vit11 br1Cltcgt b r II1 ([C Llt n ClW grmvlng 1lt1 0 L Sti g
gcsti n the lIsefulnes- u r Ih is form o t treatm n t 1
Hmiddotu]rs have nerged jn El or uf pll y~ iLd eegraverdse eacute 00[ 1 but tlw are nUl yel 11 11 t llu i vIC~11 and r hi ~
f rm of trt ~ltmenr IS stiJ l Ul1 ckf ckhate FfI t Jt 111 il i 11t (eltary td 1I iFy 11umbtr ot
b l sic COI ceP rlJ lf w ill he cIh tt d in t hi pap r
Scollosis
DCijIrI iriolls
ScnUoSlS is Irlircc c1 lme nsIcircltnal (I(gt i l cj on ot tht spinc thar cau C a CU 1 lh lt ca n h e $ t~en ln (1 me1Sshy
ured ultinF Coh) lll ltllCXI o n HI anreu middot p rtc rilt r
EUJlOI -1 lœDICOPHYSlc~ IR
NECRI Nl
110
f)i)
1 7J
amp aS g 5li - 0 v
V
31
10
(1 1) Il 15
-tc i ytjtr~)
FigJ----jllph ot DlI w l-lkaupegraverel) The agloimvltltinn Or idio r lrhlc 50gt1iflll~ IS rpiJ bel~ en th e- [l0 IH P (l)ltg tnntll lol (JI PUllcmiddotny) mtl 1 ( f( lS-er sigll paiilivltecirc lt Dlt(i I1 11illg r the iti l 1Kgt n n t rll icirclicH a ) 111lt m omal prebulled the mno rche md ociks with lll I)ttlx flal gr Ih pll fl
rlcljoprdphLi 1 hl merl prestIK ~ of this curvt c10es n t autom~l ritllJy indi ate the pn$CI1(t of a defurshyTnitv (SlllKtUrd (Unel
It i~ possible tu clil1e ren tute a struCnlt t CI1tve fruIn a pogt urll 011e by identifyi og the hum]) du ring AdIlns tesr I~OQ looklng tra m beh lnd at the p atient w ho b benchng fUfward il is p -- ible ta d d~ct 1l1 eh ucirc n of o ne liidlt 0 1 the trunk usually n n the (onvex ~ jde ul tbe radiographie CUfve Ugrave1lr C Ul be mlt~I Slred lISin~
BUlln els S o liomere( 1 ~ l This h Uf1lp is du(- lO (Ile pregravegtecircn ~ of vertel ra i rolltion 1c1 Ollt tn tic f~YJ tllre o f the def trrnit tli [ c m be seen and measurc(i v ith Perddolles lb lsLometer on an amero-Ix)iferior radioshygrapb ~2
Seven ry pel cent o f li Ises a re conid 1lt 1tO be idiopa thie 1 bull ia l-nosilt in this CI$C is b exdlls i ~ n as idinpa thlc me-us t11H wc do n()[ know rJw origio of lheacute curvc [n othe] ~Ie$ it b Ix )~i ble ro ide nrify a dieak (bat CHl jusrify the c1etgtnniry slIch a rna lfo rshymar i ns I1(gtufol Ig ic~ l or genlttic cl iscas s Glnclt~r trauma etc )
[dicirc)parhk S(oliosis has been divicled ~(corcling (0
the ~Ie of tlie patient egrave1l the tiJ1ll of d~[ccli n of the condil ion into ti) ur t ypei ln fanUlc jU nik ltldolesshyccnt lnd aduh Til l m n st cnnunon (VPC IS the acloshylescegravenr o licirceacute I1IJctenzec1 hy 1 sud le l1 tggrH3l ion uuml uring the grow tll Spllrt (Hg 1)2
lhile p tu 1l sco liosi i5 Ycry lomnw n thl pre shy~Iknct ra te f r adole ent icuumlop~lthic structural CU IY~S in sch )o chilclren are 18middot20
- 10 Co bb d~grels o r m on l -lil
- 2) ~ohh dtgreclt or mort O 2~j - bull () (obb d gre -s )1 mOfeacute ()ll 2
Clin iltI [ d e isio ns lfl IXlSed 111 an lccu r~He pregshynosi which obt inccl in eJch pa ti nt mainly o n the basi of the nsidu~ll p()tlnllltl l of TH1h and the result s of 1 rh clin 1 1 ~l1d tadiogmpl i exlminashyti(ln12ll c noieq uentlya d inica ] la sifiou io n o f the ing le pHient tn -ome estent co incic1 ing w irh the
D diographic one c l n lw SLlIl1H1arizeci 1 1 folIcJ - mikl lc~ (1)(n 20 C bh de~r es - moderJt l betwlen ln md 15 ohh de~ rtes - StV re 111( gt1lt rh n ~J) )bh (kgf s
On the 1) lsis of [hi - dinic d d a lfic t i n (Vith l1l il el lrb tiOI ~ o f the ir b() und~ri e ) in Itllt l cente rS Of SCOtiO LS ITe ltlllent in the Lltin odcl (i rJ Ital lnmct md PI iJ Ugrave tre tmtnt i s plmmcd a fo lltJw 8l
- mild kineslth e (~1fw ~1Il (1 luok-ou t - Hl demte IJragravecegrave 1111101 c(~r md k i rws ithe lJpy - ~cven surgery
Physical exe rcL~e for S(ol iosis
Defi t tiOl l S
PhyS i 11 nU b lIKrlttp middot (or kines ithcIa Pl) i a p rvgrlill or plt~i Gl l (xeriltecircS ~1ci fi ( llJ y ltk ~ loped
y a -11 [ru ine 1pll yslo ther3pisr wirh th e m 10 Hllll
- pre (~ n tit1g tlc aggraaLion of the cl I )flnily in rnild bullcoUm is
- helping tlk Il ld Ct ~lOd ounter~lCtjng its skie elfects in III de rltegrave sc li sis
Tn tl1i_ feSpec1 kinesitl1ert py f JI s oliosis is tonshysider l a o on of peciticcedil training and s genecirc tltllly proposelt in sessions 0 1 4~ ro 60 minute IW) t) tour limes 1 Cee PhysiGtl exerci es can aLo ll v o ther auumlns 1S it oill he dise Issed in this plper
Ir 15 Ilot possib le to cl escribe a single progrlIT1 o r exerc ise a5 pro nrams ale USLIJUy p fgt nll ized ( ( lt
EUH PA ~illDI (DP1I YS IC~ 182
ROlL UF P l 1YSICAL lXl 1lt 1~E IN l IlE 11 ~l) IEd If IlU) l[)VP 1HI AIJ() J)~Cl~ r COl ~I NlG1W il
f)( 15 egraved ( )Il the nee L- 01 indi iuua l pJl itnts) al l l10ugh Lheacute) C l n h t 11 plicd o n a WOU p hJ~js (-1 (0 () pnients PC[ ~l ()lI r)middot lugrave reQCf lhese 1 10 grl lll frequt ml~ V IIT
hnm on in middotituk w allClthltJmiddot -Ill Jnv L l~egrave at Wc w Ht ~huw in lhis lyl peJ it i~ 111 n u -eII1 tu id e ntilv kirK itheJapturlc aims w hitl l ucircrr~spnd LO ugravelt~lil1 DUtshy
g X ir ur ph -s ici l lxtTi~l I~llhe r thln ln dj( us- indishyiJ u1 1progr-lfll
Aduumll l lxUl kisure time ~lOd h )u] Sp u lllll8 ~Ilttishy
i lt egrave~ i middotomm )Ly s iven lel mJ ing ro w hlf ~ Iuumlnsidshyer~d usdul or il lrmfu l in t1 lt rruning (lI tJw ptliJicirct ln tl1bplper Ugrave1 gent ltl l t rl ll bull p lwsiCUgrave lttG iviUes is rl ktll 10 JllI1ltlCc hOlll gtpOlt mJ kIJ1lsIcircl hc lJ l f
i ve lUen tloneumld )bo C on lv ine n dul( re Ull~ 1t~1 t s far Ilten publislt d f I~ mJ I(i noltgtithltl rgt is 11 11 a su h jel lnI deacutehate CJitk haltlt t llltit m itn ltl of l ny lorm o t p l1 ySiClI lxrcL e as a Itwr1 [ J- fo r i liopa tb il jcoJL~b un iL ()ri gin~ initial1) it WIS Ille r rOmiddotUumlK lt brgdv u f p l~lt titu gtllergt w h ) intervenecl hutll tc llcrl ll (mon as cltl HtilJ nic in terventi n man Jgt
1 t lltrJp utl t one 1 md rC j fkll l~ on rhe h sh lf som uni cOen I1v pn t I1cgts wt ldl hll ltl enl1 JI~ haLl nu na l scicnt lfic baisYmiddot HOlh tlle$( trr t peu shy to rh ~rl py tt nJecI to l~~rJ tte C Ih tk CUf -~ pnnshyclr~tll y as a f tsul t of lilo h llIzatio ll of tn imdqultdy ~u pp rt(d S pln eacute 7~ 12 to re-t1 r rI ltrl 1$ l l1C k o f WH llt~~rdl 10 I ndt~-dll()urnah tnd 11( on1 p~l per u suaJly Cl tc([ IS n prelimmtrf lll d 3 ln tt li w ay man (l rrlKpt(Hc H lf O iS Inll ph ~i C U l ~ d vi ~ cI nllog scnliotl pa t le nL~ 3gainst holll ph lca l egravexershyclc and p()rt~1
It m u st t~ n tfd [hat pllyknl txerc j~ tJe~ltm(nls t1iHer 1 lJ rd il1g r rhe rherlpcu tlC litTl~ on lllc h tJ rgt ap p lolc il l the IXlltent lncl hi im r IIIllHnt i- 1 (1(1 rI - 5lt1J lC igt tIl l ( f phJllIlllolopJ al rrea tmln ls Ihith cllffc r 1lt œQlfd- rhe m C cculc u ~t(l luI thl p al 1t n
~mc l 11i (lbE~e Tt i ~ P ~il k tlwreI[middote thll wuumlk ltlll t kin 1or ph~ i Clt1 1 lX r(j~ 1I 111~ t bc loidvd by t h~ Lo iurie IxujCJ1l al1ulhcr a dl ~IS nJI h~ iOg (1 11shygerols llugJr in racr le (wi ller d I ~fJIII ~ I ml thlls re(nl1l rn ndc(1
fn n UI cel1ll r we In(~ hccf) using 1 ) 1 1111 11 ve ) 1 (J p lw l icd ex(r(i~e (0 J ( 1I l tt i~ tlh aITt ~ l~d Ilv m ikl tru cflumiddott1 adokscltnt (cl ioj arh lC icoli is11 2)
ina the f U~ t rc-gt uJrs IefC pu b lishe - the pJ( )grd m 11lt1lt l1te n PWltllk d in fa c t deel()pnlln l~ in th t l itshy OlL1Ii in tl1 r b t ~() ycal f ha ve iclemi fiecl niO l l
m d 111 ur impl rnHm s md d i s )h ilir i (gt~ lue t idlo p lthk amp()lio -i ~ t Jll CIII he 1UO(l if Icirc 1by phyict1 egrave xert iSlgt l fe t rrncllt
l illl
111e aim of t l1JS r~l per ii tmiddot (tv iew tl1( l iterat urt to a(errl ln v llic ll of th~ impa irm 1t~ and Liit hil it il i GllIltec hy ~ o l i()gtj s -o ull he ll nt x or re middotlu celt1 Ili pl1ysical xerclse An u p-to-da te knOvkdge o f tl lt Lgtpecl-gt i necckC1 in rJeumlr) d -oek
- whetll~r there h ltl n adLtIIl ) l tht()d ical bbh fur or JqIIcirclb l l l1 Il( ) f k irt llit herlpy
- h N I)(1 ( 1 Dm tlle p r l c tIcirc(( o f Jebur tiJne )pOfung lcli v l ti ~ IIOU lci he tllf) -d o
II J U V f h 1 I11~ c~~lb li hed Ihe usefuhlLss 01 k il1 shyc ~thtrpy il i aIle dy l nsi 1([(( -r-tI Llleu i n )I11 plJt~ ut the wJrld ir ilt ecircS~nl i 1 I( id n Iv w l1i li ( 1shy
gories 0 1 pl1Vtl( 1excrClgtegt te D)bilI7it ric 1n (Ir st shylliuumlZltio f) lttlt tlgtbltn ing ni trcrccedilh ing erc) hn Id be
vnlcled he tll rhe nuld be lerrillldll1 1 md whidl s tlQu1d be inreœ jf ic(1 IJeClU~l tlley cOli lel Je LI ~ful
Ncuro1llotor impainncnts
Imv aUl llOr~ 11 lt1lt ~tlKlteJ lhe cltlndatiotl bd Ween tl UC1UmiddotIt t l ol(~C t nt id iopml je -nll ~J~ and cli~l l shyler~ lr 1tH lest ihuLIr yt 1 _ 13 ~ 311 D uhoussct 1
1-- ITS tln l ldiopath k s(o lio-L L cll -c d l J l hmgt in th terl tltr f prop li l l pu n md 1I1ar th e detrshyn Hi n i~ na tural 1 ~ronse to ril e need tu ts tu re p()tun ltlluilib riu Ul HcrmJJ1 31~ 11 () d tllat icliupathic ( liCl5j h l it re5u lt Ot1 rw nltuf mot r l ~ltelV
[Id )fcl 3 nI] ~1ltJ U Sr1lle nr to dtorders in centJtI lO~Cl shyIOIDNur) md 1xi~tI moro (Ul1lfOl syt( llI (Fig _l
N htIll -of) H1c S uumll h( rll1 ( ~ l( w ing JI t11 (oshyI-ie on the l l lO]ugy o b doll (nt Rl iu]icirc tlili- middot()lioL m unt fil t-hltll rhl ugravedcmnilV L th e fl5 ult o f 1 (k btcl 11lIFll llI ion nf som t11(WUgravetltnl md pO~ lur( (tnic l~ l licirc1 tl1lt if l p OgtlbJt b C 1l rlw sta l i lin 0f 11 1 Sf llle j lt g )tx l Tt) ohtil n a ))Cli U 1ILzltl I o f p ~llIr~il d l~flo [ in l1litkd ~J)llnSIS me CI Igt(middotqucnr J ~ a ~tmicirc ()nlly or regle Ie Llive
Ali th- 11yp ) tlw~es rd ~lte tr d irtl Itn t pnl1tlt o f [11 v hole ~piltm It11[ controls postu re ~nd mrw shyment lrre pell ic of tlh po int a d lI~ llv inH llYegraved il i ~ ll 1 nnable tCl aSUilll ri 1l tr l ll1 lo g thi ~ys ttm ( Qu it le 1I middoteli tl
lt ch ugt nlt~(S f rullliIl thil i nlomwtion th at p tlmiddot shyiCil J(tl iIies nw gt Il lInport~n t rr le to pbv [11Icircgt role ca n 1)lt slI i11l1lariztd ln lWO the ptu li ain Llt
- d elopmll1 l of p uumlltl St1 b Hlt ) - c1e veuml IOpm 1)[ o f bhll1ltc _
(k llhUl)lOr S Cll orr
ontrot oic whan-lt
------+ 1 ~ il lnll ugrave r AINnl
Cllnlr1
T bflt~ r
fltL1 tlli
lMini
l
~sary ~J-frlllen i )f
~ 1 ocirctnl
~UcirclllIJJlW Ll
AXl ~l1 n uumll l) r sy 5t ~nl
middoticoltoq ~ Fig 2-AcFgtrdong lU He-mutl 21 il is Fi)5~ ib1e rD prolXgtSlt l -oo ie1 mnd 1 ((if ~ elio egrave middotAhltr~d l)Qdy-p ati~ I I i u d) uren ttllOn k td LO In ~ory reHTt I1 eDi tn l al ) JdrnlV~ pn)4~ e l u r~o(Ofe 0-c1 eptunl dvstil t1 ctlon sltŒ(ry icircltu nu11t ilwnt [ ~mC ~ted tl l1 ce Ill trpntlshyUumlfJJl nd IKnle~ r~dibl jtugrave)n of -I) m tlosen Ir ~ig nj tl (I1vying ln fornll1U n (lI an ereltl ~piJl e Mmor aJJ r--a t ~) n ltgtf ti lt aXljl mowr plem iHUC Wh ~fl Ille 6ubjeco m uumlntl Icircn (1oJifitd perccpfLlI l ~na l ysilt of p n)lnocepti Icircnfu rnlaquol ti desnibJOS ~n t tecr spin A IICW motor co nrro l Ira I gy t adopt resu ltin~ in the ~tr ltctltr 1 ckformh y lf IdiopathirL scollos i=i Ht lrftU1uc nltnt l ISll I1lJy h1e- ~ I pro()und elkn on bralO Sfem flJll ct i(lnn~lLhu modifyRll Ille nltulltgtshytl10 ) 1 1111 Uu l-lHoror control 5~Shnl$ shy
As Srtgn1lt1 l ~ ltlssert~ if wc l C -Cp t 111 1 un o f the G IiC s oliosls L l tisorckr oi th e ltquilibrilltn sys t ~ms it is lagical to oriegravenrate physlCl l exercis( lherap y ln th is d ir(gtCli()[1
11lclte goals Cul tl lfOUgil ditrercn t modes 01 action be Olchic(-c1 witJ1 phykal accivit ie
- po rt ive Cll ities p ro ct LJ e aIl UgravelClltrtsc in 6lte nshyel ll )o rd in~lti n pinai pr0prinup ti_)[J nLi mOVeshyment control 0 vio lls iy ln thh repect ome lCtivshylites aœ pre um~I I)y lXrter tllln ntil crs
- kinrl lira py using pedJil exerCisocirc specially developecl lith th est 1101 5 in mind illVuuml VC I lllore prccilt( ll1d InC1 li zed cri n on rhe spiJw focusing
a90
1 ~~
lg -lNheJo ~1l l1 t r~l g rld in 1 1) h i(~ IImiddot ct r rHienl w i ll idlllhic _It ~i ~ _ iri s plt ~I le II find Jit ltH vlllleuml ~l Cgtbl tn~ ks III d il fef lt p ~ lt ihnS nu v~tl middot B ~a~pt u Il C middotl)Icircd ~(t l l11 C dlfkrCnl middot- hdween slllndi1g Uline nu nllt1Xinul oorrec ri nI t chied Vith Ct (J ) und tfdincJ ne lot es o UIine 1 fo llnVs middotIJfl tfi ni( - ltlrshy
reltiK)n ~ Ikexibiliry st3nucircing - -pirte - f ur~1 1IbjISC ltupin - ltorrcaion - - r~luci()il ll ymiddot For flmpllt in J npK l1 pH k1J il
plt1SSlhlc ln obtai n 10 u1 511ndlt)l [YLo lion yr ln Slt p ille rlOlgt itlugraven om l J ~ in ( gttf(C rigtIl lIex lbuil 15 i (r-l l=22deg pol lltl ~~J IIlpraquo is IcircO~-V- I t1 l nd tucircu(Ugrave) ilil) I~ 3laquoJO- IH-12
r ln Ugravel e abilit jl of tluuml [m e llu to co ntro l irse lr in ~ pac
fuld l oftlles uumlllelve ntio ns can presum1b1r incn~~ Ih enl ac )1 the orller and lHitlll r of Ille rn - 11 )ltd h e lllldenl lu EJ3)4il
Posl1l1-t collapse lnd slabilizariotl
lIle concept u fplt st lUal c(l lJap~e l l~t Iwen detin 61 by DlI II-T3e~tupegrave rL t Ac oJdin)j tu tl1i- ~ll1thor il [ nec(sary ~- l Hn Cv-tlualing th tleihility o f a col shylo tIcircC CUJVL (0 clistingu ih bt tVeen the re du ihil [ty index (th - li iffer gt le bet ~middot Il ~I r~tcli()grJph ie ~xnmshyinltio n of the iI111 pHienr in supine po ition m(i
ROte OF Pl rnmL EŒIlCISE IN THE TREAT-ŒNT OP ~I IJD IDIOPAnnC OOU~GEm seou SIS EltJRINI
I (~)-----------------------~
__ _~ _____ _~ __ __ L ___~ ________1 ____ _ __ ____ ___ ___ _____L___ _____ l___ ----------L ______ _
1 ~
1
-- ------- --1---- ---- ]---r --- -----_----t- ---- --- ---shy__ ______~---- __ ____ 1________ __ _1_ __ ____ __shy
~ (1 J
1
8 =~~=r=middotmiddotmiddotmiddoti~=-middotl--- middotmiddotmiddotshy--------------t----------~- -------- - ------__shy
~---- --- -- -~ -------------r---- -- -- ~-- - -------- --shy----i-------r-- - ---- ~~-shy
il 1~ 0
Dtl-Lmiddot ~ lttj l r~ UIltltlHt
f g 1 -TI1 u ilictf 1ld ( ii 11- ugraveu-sh) ld IX~ O 1d wllich ltJdnrshymII Il nf the pilll 1 ~tln~1 of th e -o lioti( spinc n IG~nI(J II IIIshytt) lhe iJeuml grl-e o f ~ ()Ii ti c (u rvH Il 1 w dcpc-nlknrly o l l he 10 111shy
P01(nl (pntt l ~ 1 1 nr ffll wrJ I) ln w hilth Ihe n i 1gt( ~ duc nL~ grlphs fm I h~lt 111lt hi~hr Iht Col h ~Ilu t (l f Lite ~Ul Ihe m Ol CI il y th t s(uumlJotil middotpin~ ~111 he ~middotJg gr~lVH(~(1
m mJxiTIt corrttt ion wll iJl i~ lIllCd to Ih - xt 1shy
lti Oilil y Jf tl1lt t Ut JO rl1t cdnUc idt md p OS shy
tU ll cul lapse ( th t ltHill enct b-tten l lUdioL) 1lphic egraveltamJl1ltlti OI1 J t th e ~lme pa tient in Sl il tl cling lOJ lline fX-sitiutl ) Wll ic h correb lc- onl wil ll fhe abilt ty of lllt p tu rl l gt s tem to C( lunternct lIk luree o r grl viry )cco d ing rv D lfVd- f3egraveLIprc po st li r t1 lt01shyIlDse is d ue to the Jnus -u lar ton a nd 11ll ex rCrIshy i) i itv of rhe tissus n the ( O IW-) si it (If the (01shyjl ti (~JtVe (Fi~ 3 L Pu~t llr1 C lltpstl lu lcl l ~~ reduc l-lt by llwans o f pl1ysica l cxerCles specitkally s tuclled ruuml i rnprove tIlus--ubr fOHt md lU pr )cllI Ct 1 ~11 hi shy
lizing ffCd
PararcL n tll CIJ cl the cr iti ca l (3 c1 thlsho ld beQ ld Il ich defol1J lHU n of the i pinlt 1 e~ in~ ne dtlllontr~1t _cl (1l ll t grclrf r mg] o f rllt C II in a qa m bng pos ition corn pOil 15 t l lowcr detormashytion lhnsllold (Fig 1) ie to ~11l Ulne3Se t the risk of pr ogr t~ lu n There t rh eJef re l J ea r l)iuuml 1itshycJ l ~ll1 l l(tl a 1 tnr tg ro b ohwined by d -cr t l ~ illg ilmiddot pU~lUrll cull lpse ptJcelJtge w bich lccording t i)
h llTd tnd ~l(heJ1l ~on 1~ b inde cl 1X llt icularly luumlgh Ugravel mllcl c Iio~ i (bdow 2( 0 ) (F ig 5 J
Fin a Il III ch iS respect lllljl hl and b um l 01 m linmiddot
ii iI 1 l _ _~ _ ___I ___ ___ __L ___ _ ___ ___J______ ___ 1 ___
li 1 1 1 1 i 1
1 i ___--____---___----__-_---_~- _ _--_ ___-+----
i
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i -- ~- -- ---~-----_-~-_-_--_1-~
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+----r--------t-------t------f-- J
Fj~ ~-Ac(XjJlin(Q luuml T O rIcd ~lnd Na(h(ln~ n i () dl( pCG w rd (rTIshy
POO ll is hiherin cu rvegt in wh ilt l1lh ~1flILWrd cII1I Olk l1t IS le- pr(v~knt ln th e grtph Ih t PogttJlJ I ugtnq) Ot1 -J1l j elfltS-e J tlt 1l1t obb dirr remc rlLIv obu incu f roll l the Cohb atl( 0 1stlI1dtJ1g IId gtupinc rldo~raf115 Ih Ille lt) [1l1t1 (i lndnl I pine) 511pille the ~(nlClu tJ1 compo l1lnt U rlk CU Y _VeJily I~ ltx p rlt 1 L1v UpUlt (obh Illeturo Ih t si _b Cct rtJeSIm l fie -ltn J trd Ugraveltuuml shyuumlo n A~-i)rding LP 11(lt uuta o n l ( r1I~( in ~I 2JQ sup itlt curvt 1hi C(]l)b ddhccno l l f lO is -J-lultt( thc s ldnd inr tnla Ol1l t lS wi Q) whil 11) 1 1)401 ~llp lne ClHVC If ~ 1Omiddot ( tcl Lhe ttnd trl~ nlca~ I(t I ~ ~I)
tli n ll w l lllE cq lin ti spin h~ i ng mo r ~ Llnt~II) 1 tlun the nOftl111 one n Cll l gr(lk ( (cU ve tl1u n da r u p shy
po rt in o r k r 10 m linrl in tht 1xi11po tuf_ n th ha__i of th egt onideratl lr1S it f(lll() rhJt
ph rH (~Uuml e erd es ulukl h u - ul iiuml tbeacuteY ~U-L lm cl 1l (It-d o pmg p05111 td C Jl1twl lS fuumlrnll~ rly d ccrll1td ln an Ql St if i imr ol1111 t ru t(( - tht m(d in C JI shy
r t t r sture fO Ir -ngthen tlll m u ck-gt of the spint mainl) in (11erl antig r3ilrl tIcirclt l]lli fun ctin ll U hy meU15 dl i )ll1 t trk ~ lhJ cl( -ll tlt C)nlr~lUions ~llld no l IdOshy
1l)llic d YIltll1k lt l jAJ lktic t) I1 ) II 11)t 111 hd posibleacute t lcluuml ee postura l io nrro and stfh ili lllllt IJI
w i thout food T1lw(ull r d I( Lf(11 Ibk t m ucircnuin Ihe c()rf ~ct [ ()S tu re for cl gtu ifKi IH lLl1gth 0f ti l11 ~
This i-l ddl usl a typl 11 dnmnin (tf k inesllh rap) in 11 (lt-11 [[k - p~d fk lnr in lng f u l1a in llllliCk is poss ihle lI sing ctrtain Idncl fJ l (lt) 11111 liun S p Ul in tb is Cl c is ulttful ooly sa I~tr 1~ il Iw lps t1w lxltknt 1 becuJl)t 1gtlt ltlt-I a ClJu~l inred irl ilL ntllru l o~ i cll
and I1lll~lJhl r-keJc LIl [rll-llIn~ middot etlt(wrs JI the int e rmiddot vlnrion
[J ROPA MfJ) I()Wf-I YSJ IR
1
ICR 1 1-1
r
1 shy ~
- shy
11 o-llrfOlhe5l~ o t Ih 1O~(1dity i n h ~ r ~ ll nr pbl1 l of ~ Spl11 in 111011 _llti1Gt l lPt f ltlJUCWJtl ( ~l Ihe Ir t 1 1gt illbll W Ilh LtltrJ1dlion Vln lbe rigronl middotUII~ l(I Dko n12 lIll h lumshydlanie1 1 [ nul 1 M hl whtrc M - gt) lnIUI1g 111laquo111laquo1 1 1 c rtJCshytjC~ f fce d -d Lill l1~ o f enr niI pUll spnmcl1y 1~ 111 mldlll1lt (n the fl1ur t 1 = tor~ of f(ward Ileuuml l = ughtel1lng fmiddotr p 1shynOf stn lClU= Alaquo rdtllg 1raquo Ihl~ - lin hull th l1ltgtllugrave ot tller1l lUr~Jtllrc F the ~pin t -ilh rlu1i tf Ihl 1 1Ibulll n lrlt InltT1 1
rbc prJI 3IJi l1ty d qrlOIJ~ n bull JI t IlJIII Hm lA the v=ltd gtc e lu-ing J 5lnK1ura i ltfnnity
Dioal e ch anicll itllp~lir J11 c nt
Ihrcemiddotdimcllgtional mc-cbal1in of the s pioc
~f Ikmiddot i t i nly l(œ ntly tlHr llk pr-5tnœ or nc ushy1 lnlo tnr impairment in Idiopttlllc s-ol ii IXl tknt liuml J$ heen h i- ll licircghlcJ hy re$eJ rh tll e preit ilegravee h inm b nIcirc Ji d lJutg~ lt hl ~ 1 ng t o n dO Ulll urcel 1 i5 (l lreldv well umlersrood H(j-ev~r nev lbt un h iomcrhankal im l) ion nI h1c rectm ly onk l n tIlt tre and p r~dou in f n rmtinn hou t pl1ykd (~fcl5( in t 11 0 tl1I _ltgt pbne of spact 1115 Im trqlt-u 1rom J i-[) v ing unclcrsrmdlng ot th l lmc -dim nshy~ilnl l l11 ~ hmk f the cO]jO[lC pln( ~2middot ) ) Ve- w ill )iI xnl t l1 d at lcL-orcltng tUl cl sif iol t lOn blsed o n gtolllt lricd h uumlCJ ) p lane
- b() rJzU[1tl ln th i pla n ~ th t 1o rm ll sp ine present no CUlye- w ll ile Uumll(~ ltc U Hic spLnc clevelops one of ir haracterls(Icircc deFo rm tiCs v elt tbrd ln lashytio n vh icl1 pJ()VcA~ theacute hw 11
- lgitltl in th llulJe U l(~ nonmll spIcirclle pl SenL kypl lOSis ~nd l dooi~ in tb lXI1 lhese [(Hu rts Vere m)( til ught [ 0 he relattd tlle scolkJtlc ( lI r Vegrave
- front l in hi pleme tht ncrmal p ine preseuron t no curYegrave whil thl ~11li tic p in ugravetI I ()~ icircl~ charshyad t Ilt I CU1C
Il Jri fJIIt palic
~l+I~na ra 3 r inr lut th l[ ber ll1d a œl1~lU1 degr 1
l f r()la tJo u lllu (lILa r forcKl ltxert ltJn tl ldefnmuumlng 1 tkllJ [J i1u a re- lhlt tll cly 11 [1 1 UI b y Olm ner w bn ~lh uiJwd tl egrave ro t1tic) l1 Ilm it ti lt p ica] lf shy
rhrl r() be (P (the Uma bevond Wl1iltJl th lCOJlb of [11( ~pmaJ musd ~ dthc COnCIt and nm ex ~l le btconk (t O li~[)
r ~l 18 ~1Il N lu t( ren i9 lun lu ted rlseurlt h in tlt ) tilt lULodeumlformipg1 tlo n ot tIH_ sc laquoJrle rh ox ercallkren lk 1l1~H li d11r once thl Il i ~ r tld1t5 [he lhrth ld f 111 JlIcirc lIi of tlle dnrlclc hurnp tlk
lI bslt Il l nt rlet()rlll lIcircon 01 the it l ()I~ C ( (ylm der (- sustalnecl by an H1tmi cforming aCOOIl
J1Ji h V hl rhyiical f~ f Ise CI 01 h spr n llnd kin middot ith ccedilrapJ my lX damlg ing vll e n l pplild as flle
igt Jk Iller ln SCC1IJ ~IS lllc lJ fxceed l auto in middot crca~ i n g lhrllgthuld [1 sh (~u Id ahn be j ofed that Ilw relscd pre sun 1l1111i insiugrave l fe pil1r inn) 1 mlshylt
- j Il- ( w atff 1 (nh ~1l 1(e Il10 utoldrml ng li1eCh~lI1 1sm
in flc l Geyer ~w tcd th1 t rm m 1 hI l)1ecircch1O lla1 puilll 0 l I C~ sw m mim t Ieuroamp no purpo t for cu lshyim le pllilt t1 s (weumlO middott r it is l~Jl(gtWl1 rhn in iculio r[ paULnl -iJl11T1ill~ doe_gt nor Il ~lp to i ncrt~SL n eur(1shym tor co mfU
(1irai p an (
Jerdnn lle 11 showecl thal ill CSl~ o f t10rLC IC 1i lUgrave
tllo lacolulllhil it lio_1 tlle cte tI llmiry in (he lg itt1 p lln t rn lnlftot il~ lf tspe iuUy in tlw initi 11 r luleuml )f cV IU[Icircon nf Ile ~oli ls W iU l 1 p(t)gr~s~ivlt il10middot~ shy
ment roward hvpok pho b G ll f ill~l Im lins l har dUflng (IN eWllLlfiu1 of 11Imh] co luumlgt i the l in t ot t l H~ gClyty Cegraven te l - 0 1 v llebed lxxli 5 r ro ject 1 seH fl r t side-ys and tlwn backlrcl bull thu~ p(0(1 lj n g a kyphQtlmg aet Il ln (h~ lu mhnr --PIl1 COftj tng
l l i tc Iugrave l lltl l( l rs1 tif s L -etllgt il l the lgirl11
1 Hl)
Ilu LE nI rIIY~Ic~L lXIlKISI 1 HI E TREhTMEtn OP JIU IDIOP llII C AD O USCUH O Ll Œl15 NEGR II
lLill tegt lre lenl1 ~I d ~fo rll1J[ ~ rhl recrSes the phyltiologiGII cmns of lh vine)
Accordlng () Dicion ~2 1 rtcluctio fl in the itgitttl CUIYtS combin l vi th a lueral Iviari n llltl ds t 1
mecban ism () ugravel~ta il ity in l he r rat r IllI1e which bVOf1i the unsd a nd i ncrea~e 0 1 co hlt1is (Fig 6 hiIf md Pl11jlbiJ Jl1eanwlt ile lt(udiecl lh e srnl ru t
orzyglpophySLs show ing t11 al ttleir 1I1tl rnic tl orienshytation f~I (jLi l~ltes aXIal ve rtegravebJl l rotllio ll in cun litluns lt f dorsal hypokrrhn Icirc tnd lum)H de i L lo IS
Tll t dat SLlgge 1 th t impOrfill ut pOitu res and l1lweil1 ) t Mudied in ord t r (CI mlIuml ntrlin or to reuwer fll e p llyslo lo~lCll ClIlye in lIe SlgJtta p lU)l Wlth the llm o t ch ~ kin~ rutltor in l~ bili ry7 AbC th ~e ~k-
1l11nL ~Irt del lnt [0 J jUc lt ftber l]kuti inrervenl ion vhich 1c)LJ k l IV - i(l ~ l compktl n l ililll on Il t c1 l shy-jel1 J11UVllT1ent IJ j o f 1uto-dOneacute(3tlon ( i e a -impk ld ion ) Iengtheni ng o f the pilleacute 011 a litlltl l aXl~ tll lt ((IT liJlI~rcdu e~ t lle ~---lJ linti- l lte ml-fkxj(l n h UI 11 - i llCrl I~t the plllH ](JgicJI dlt cr ~l S ( (1 k-yvllCiSh lIld O(ltOSh l o r c lch r1Iif n t a Ilew til(~ecirc dUuml llt Ilshy
si lflltl J ll1 u(~nlent iam ecl - 1l1t0- lIrfe rionmiddot7 4 llmshyp oed f Je-rura l iUIl cl middot-t1e- iltm lI1d ll1a intltnUlLe )( 5lg it d C Uf (gtS slig lll thltJrc i ypI1 tiZ) tIcircOI1 a nd lunugrave)ar 1()fdos i7~llion) sholild he esw b lb]HU 00 lb co
hl b oi hi p~l11il uU r -1Ir vlt Abo 111( e IlltUtl Chl lie o f purti n - a U vitk slJ1ultI h e )tuumlll ecl 1)] (1 n ldershy](ion r tl1i lt type for e upIe IilJ llyl)T S of repd shyiti( ml vemen prt n t in agonistK h)lnllltlSlks nI iIle kind f dlJ1ce C( uld he ([([r imentd
FmiddotO lllaljlallC and mobili ty of the SpIcircIlC
1 rd llo U 22 d L lm nrrare d lhlt in Illt fro nt a l pll ne
tilt 1 nge Clt 1)1lt vtment of tht scplit[i middot CU IY grcmr lIJ l il ~ d irectio n n f Lhe C ITelt tlO n tha n in tl le di re shyLion of pmgressi n l Fig 7 ) he IL o IS5err lJd tbat th15 mohiliry increac plrtil u la rly n apic [ cgcoeilts 1$ lh ~ ~c() li osb evolves Sragrm rJ 12 J ~ thus rigilt (0
VlI f n rller~p is ts Ilo t t) m o b uumliz - a sCtJl iu til curve w ilhout t [ uling ttwt tlle R lu tiOI o i til t ~a mt b fnlinruumln( 1hy l1tans o f ~I passic 01 1 rivE -uppnrt On tilt (ltllE r hand UgraveK d e iJlioJ1 in ease durill tlw tune 111 whicll tll C spmt i ~ not submjtrcd to correeshy( IV anl()n
j- Virh mi lei ol i b tlllt Upp i1n ill) lC tiol is d eveloped only lllmugil llClIf()mu$Cllbr f r llce thi ~
InegravelIl ~ thclcfo re tl1l[ inu eascgtt sp1J1all1extl)iity mua
11
Imiddotiumltgt 7-rurd illt Ir) 1 bull rdrilt I1 1 in tl lt frOlllll pbnlt- th( illl ge )r mOC llIeJlI o t the S-o UIIJC CUNe 1 supcrior in Ihlt diflt(l im ugrave( the n nKlIl thd n ll1 tllc dlrtcLion o f p rJ1(l( (llIl
be considrCtJ vntrl iJ)(l icltion and 1 undrli neocirc ab L a ~ubiljz~ILion 01 tilt spint pllss il)1y ohtl ll1td thrltJugll the stlengtlkl11ng o f the 1rltJgm vlt nonil lme shyCIC 111 illli orrant u bjcLliH- ln rhis r~f1 n sp u lllni lc tivitIumlLs sil uld lX tPI 10 dlegraveltl it l G lU t n w l1ik luring kine i Icircth lrr phyltical eXegraverci c~ tllat in ele
spinal m ot ilIcirclY sil nid 1e lt1 oid cdrt ~
Organ ie and psychologieal impainncuts and li islbi IiI le
A cgtI im lc pmi nr is moriOthl11 just 1 sp in and 1
compkt gt Ipp rnach to the gu in ad 1 ont i al~ shylute l e~se i t i11
[)a la 0 11[ [n ell lrom re semh pw tbat ome organi Iilnctiond cl fki ts suc]) as tlw clecrtiUe ut vild l tnd d fun ll l)Kity_orld ldly incrtJ k whil~ 0 shy[io s i -till in (1 miel q g of g JltlV ity ~ l ilI e 55 rtI lit
tllL pres e n ce )fl defidt Or Vi l~il Clp~1 - i~ ln one pIIiem in Ihr l ftectecl by 20 ICl 40 scoi stgt l ls~a r(h cunclutecl in tbe UA by Di Ruce- prod uegraveed an aaalo) u ll1lXimum 102 re u t in a group of Jd shyk 1ien t [(h sco llosls rang inF frum ) [0 1
Al10ther rudv bv rallt r m C chr111 lilcl NashycWrl1s( u 57 stlO eltt hil $(C 1 1 ui~ Ica js l( lllt cl (1 shy1prUlllI o f t1tgl lie bJd l imI in ~ul sct t1 t ltu b middot iects jlLltr l5 they are golng through ~I cltlici[e sllge in the fnm 1lt i n 01 tlWH o w n id uHitv t factor hit h Illy jeopmlize the cl velopme lit d ~ mIll lt lI1d htIshym cecl IWI sonalitr in Klulrhood
n RUI ~IEDl(( Ptl Y1-
ROU ltHmiddot PI [ I C~ 1 EXIRCIS]~ IN TI Il nW~JUNT OF SlllO lDIOP1HIC AI)C~ESΠ11 C(gt1[Oi 1S
This i why b IiCieacute ii is ~n imporrlIl t for p rcshyvegraveml e 1tLsr l tn en ou flge 1ari e nrs ~lfrecr(d by lIillcl middotu iosis ft) tlke p~l rt in portin -re rcatioluJ acrivitits Iha t 1eIU 10 L10 th r~1chophyinLl bull nd b~l )i 1l1o tur adlieem t n li 51Jmiddot2Even tlK)ugli [Dr bic mech~lnshy
ical mcl nellIUll10t 11 11 reltl ~ons lt r111 1gtomcrimes be l lefu l to ugg( ~t ne p rt in~ aCt iv ity r l h (gtr rll n anotlJer e th ink Ibal an exces~ ive IlHd icalizltion - Icirce l ll1posilion br plry~ilt i HlS nnejlor parents uf rh ry pe of po rt to lx p m lice 1 b Ule p 1Ucirc(Il L th1[ preshydLl ck l1 is fret clOice in lh ma tt r - -h II ll1 he avolc1ed wb 11 possLhle mainly for tlle i mport~ltll psyshyLb ) jogka l fe a SI)nS W( ha( ill ~ t nltntionegraved
Conclu ion
lbh ISsertegrave d t1H physkal tgtXtlci o is ) n fi ial whlIl practinu in order 10 ilnj rove the I11 llde
rœ nwh and tono C iral caplCiry and postu re o f the StOUO(I ~lIbj n II I nowkdge om ~ middotmg trom ci el1shyrlfi rls(~ Jrc li dJlJ accordl ng r the review 01 thE litshytirlture prnpo )td in t lli plpl r conflrm~ Ihe vuiclit ot th e -t ls ~rti ()ns
In l do l (ent Id iopl1il iC scoliuse il l n phee u i cl vk)pm e n t ( li tll iumlKh eXCC cl l g i en rhk thr hokl th e re i5 an und ubred need fn r l pprnpri 1tegrave (JJ1tOkJJe ~Ild Inr surgict1 therapics ill ortler 1) S l i p
the ( - Iuli on anugrave )JT~t~t UW ~pilll l dtlormities bull evshyerthtless in the illiti ~ll pl l~sC t ttlC c1iseLltc whcn the riS( r1 r euro )luli m is rtduced ocirc ~md tfle uifleal JOld threshold il ~ld flle po stural collai i reJcenw~ 43
JI l1 igh pllysicaJ egravexe rc ise - p revenc or r d llCe d i ~lh ilir ies o f [Iw ~ l() li )tic
p (iems R 28 J -6 5- 6 1 63
- f~KiHtare lh ( n utr ali711iCUl of postu m l d elicits tn produCel1 a coneql l nce J [)ti 0 I111)( or regre si -u lmiddotc 5middot Il 1 17 ~ M
-re 51udles U ~ n Ledecl tu con[mn or re jecr these conClLL i( 1 w l1 ich clerin-d frum 1l1 lIldytica l rcltw n f th e liter~iture appear r- ~Lo nlble Hnwecr Intil ne re ull are 31Iable wc should n r prevent our sroliotic patientmiddot trom tl ki ll p lt in s(loI1ing jshy
ir its pW1iada rly ltl t ~d1()o t () n til t c ntrHY -vith the l xcclrinn 01 gt[1 )11lt tIlat in rea-e t)1obility (tnU evc n thell oilly wh n progr~lgtion b p OSSibl) -uc h ~I( ucircvshyiUe -11 )ulu hl tIKoll w g ed The 11 S J ( rprOpriue kin (~irhe r~l Piuml to incr _~asc p()~tura l $llbil i ty is tl1egraveoretshyic tlly CiJUClt alttloughl more ~Iccu rtte aod deLli led ri k benefi rs anJlr~ is is netot1ed
Ria 1111tO
NIokl Mu d lle ftitYljJfu Jœl il 4IWr10UOifll S (JIvs i (1~1)Jshylidl ttno( cclIll le 11(11(1lt1 RCI fu lle ((lia LltfIt l1 I1I1i(i
LJ ci n s j(r3 pigt egrave li n IHUgru lkl di t rdz t fi sici pe e ft shytUlKm iluppno di un lisimerap15Ll rl lllcflt() 1 110 scopo di pnevirlt () fr en~lI 1-lgpwlllltnlcgt dclld lclonnitugrave o e il 5LOshy
Il i mi llon lt fH nugrave j (1 11ni dei co~e 1 lteIl I1J J nd ne ~Ii eifclti (()Tc rri udk s co lio si d i m e dia g rt iuuml ln que~ltlt
s rud i 30 llizzb mo i d ti cleU ric lca pel n ri Icare qJJ l lm 1 dis(imucirc x u le I[~ l z j-m i pro vna le da lla C gtl k A i json ere pr middote-nute () rk kl ducirc un~l rdeguCltl d nil cra pi lt di uJoseguerrnt Cjua li 1iU110 cli nbie tti 1 rcr lJ)tIId d~ fle)-UITC
n (- -fd7Io n~lcl)
Ut11claquo)si 1 lI tori htpnuuml )ludi-ttn I ~ cnntI1zttu fr Cq(in i idiJ)tic1 dbfl lOZ10l1 d d ~ leOla nelllOll1otoriO Lb un1I1cnUl 1n1l1i3 dcgli 111 lt1i ch DIJgt gtU l H crmU1 Nlch~mslt ( SIshygnaJ~l lerimiddot wo i esuemi -bletti d~ plt~e8lugraver- ne l pClZ le1lftgt scoliodcu kl s iluppo ddl ~ ~ uhjlil~ vertcbral~ lt o svilllp prJ Jdle JIl7 i() nl di ltCjuiljbrio Dng li studi sul lto lb( l~nlrale (OllddU i in pa rticdu d 1 DlIal-BeHJ (gtegraverl ~ P~II IId lI1 n~ llw - idente il v- m gtiu p eT il puientc clioti elgt di u n rnigb o t c)[ ro Ua sw mle dei radlldc onsegull o tramite il 11 fforzrlshyfl len to d e i l1luotoucirc l nllgr3ilri d e luOwo con crcbi ~Clltdr
in pOMltHJ corrctl e in va rie ~i[Jzioni s t llicb c c d inamIcirc tllt Dalle on sena d elb blOffiCcclIlicd tr idimlt n s io mlle d ei
r ~ chi Je ~oU()f icn ~Icirc ~videnuumll (l() ~llt tC p IYZIcircOSI ln(IiClZlfHicircl ~ 1I1shy
liumln fluenzt Je ll middote~rUrio tl SC) lgt lIi I rc pibull m i tldln sJlI71 Stl shygn~I I1 afferma che slI l p Ia no [11 middotccedilr~lk tre un œ rtlJ grado di l L1Liuuml IlC dclh vEltlh r1 apj(de le tu rœ mu SCltJ llri njtbc J n in $tJ ) t rodcfQfll1t1l1te PltJtantu b i r~it-~ r -lp il puugrave t~~
Ixnt-ftla solo nt Ile so )[j)~i Jl1Icirc na rl in qunnt ) ilon SlrM ntne )(l(Ofa tu soglb in caq ) co lltrLJIcircn l)lrilto llt~( i lJudotlsi di lfr~ lI1 C llg grVlmenl J 111 11 io lr riltd ll(17jOill leld rinlle 113 dimO~iumlrlto d llt nell o lin~l cl()~ li t th~oIOl))1 dri la defltgtrshymiti sul p iluO slfl iuale ~vohl lf1 (en5 ion~ sO lnm utto nd 1e bsi iniliali deWggrwm1Cnln mcn trl C a( lfLmn che occlleshyvoluzi ne dene = 110 i [ mhari IJ lin c l ki cen tri ch -1vi1( de i cp i CIt IJ rI Ji SI p m ittIl pnm l Iem lmeme e p o j pOS( shyrio fllwnte dtldnli mdv ( i un ziuuml ne ciloliz7nnl dd rlLtide lu mbJ œ ( lIlelttlaquo on NC n d d (gt11 uIdu m 1I1 Ilgt) cli r-Iure (0 eserClzi che IllUllengano 0 ltlUperifo le Clgt 6gt1 lo)iche sul pirluuml gilwlt Su l p iCl no fron itk Perdnulk il dlll1lt-trlto d1 lampkz-l d i LU ovimento amp111 lI rv Kolio ti ~ nd lt1 0 ddlJ cnrrc-LIcircQo i Ji gC 1 n lungl SUpegraveliltlrccedil 1M llS0 tlell 3ampIGI shyvamcnlo C che l~Jltmiddot mobiliti GlI mcnta co n l c lu7j o fle d l i) snAio i A ulln amplgrtJc1 ltllllmunjx~ i terlpGli nn n m obi shyUZ73It ma eutva coli ti0 1 1ct HsicVlfe nd tcmplt 11 1111nshyttllIcirc1nc n tc (k ll ~1 llu u zinnt n l1 un me77uuml d i sost l11( gt ln 0
e 11111ri b cle - Ilziunc egrave deorinatcl d l rlyarsi Snzcl la pr gtshy
liltlnl l i un() rtl~ i ptmiddot Jtl n(o 1S(Hl () (( ntJ() i ndit~tr i ~ Ii ISt (izi e l m iviL Illdlode ebe Hlmen tno laJlc ibiJii dcl rlc lide SCshy
li io) [n p articobre rune q lldl r C-I1 ich~ xlSiddcHe CUf t shyli ve ch~ iJllpi tgino e~rciii 01( biIi2 ZanUgrave HhnmL-trid () in tmiddot~t~nshy
sione kl fuchide O tne pure k- ~ttivit1 tnotoJII~ non prHi(~ llCcedil
in forma r k rel1tiva d Ie ~1I 11 rF~1l1( n otcol mcnlC 1 lll ubib Ll vcrteblmiddote (ad ~ flp j(l 11 n l) to L ginn ~Iilt Utl clkl rilshyC
mka la cli OT- tcc)
r1il to l~ _ I[Dl COlI rY IC~
NE olUNI
fillncr ( ni ((uuml(( n hIIo( rilclIO ~middothe k lln dtfidl fUr1z i shy
nlu CQll1~ la llcl llZIO 1e delb c apKJl ilde e della capacltl di 0170 mizianu luJndn le (OJ il~ gtna a nc r3 di m~i3 gmshy
v it ln G mlxl r i ~ gko Fl llslrom C dlllJ O e Nachcms(J h iU1I) dim lr JtQ che b o liosl p IOO C1 neUaduksœnr 10 SYil l1p pn d i lIniumlmn~gin nlt8Jliva de corpo in (o nridcnz di Ln ddic3w p ri d di f( m l lz i nlt deUa SUl idenritl condishyZltonc ch pOlrebh ~[I cubrmiddot ln vilu pp di un pe bull n nn lir m llur cd e quiJibfarn in t[C adulro TaU CO1DSCe nZe tvlde nshyZ[II)() la n ( middotess iti di ltimobre la plfte ip a7j0 r1e atl an ivi ll1ltHClr n gl b a li ltl h ~ di tlpO s pu rti middotu dl ittlrc nd gloani iCo lID ti i lirtugraveta z io ni llb vila di relazionc
ln concllliu fu la d tfoflll lL saliu iG egrave il sin l mo di lin) idrotnc C Il1pk 1 d e eoinvo l d middotmiddot= fu n (n i dd rgashynIcirc5H10 n Hi lhdli e lesenizjo fi 1lt0 se 1 Il indirill~t() pllO pr~cnin 0 odLf rgt t lli di fu nzlonicirc adlc s()Jj(bi 111Icircn(i rrHtatc CO ll nl1 cinesi rap i Quand l~ coli i ( n LS~middot iJ11 zia k il rischio evnluLIcircvo egrave lid [() mente no tcole 11 (ltlll asso p o lll shylal ltOtSltgllen7~1 _ ta cincsiterapia pc rslIk bidtlvi shyptutibulli d ubllIcirctIcirc vltnc brn1e di conrro llo )(JSu k d i 5IcirclupPQ d Ile rLlt ziofll d i eC[u ihb ugraveo dJ ftffr otZJH1 r1w dei IIl llJgtCili 1 11Icircshyg rdtarl in posru ra rrenu posslhile JnnalL in Illo lt i clsi l(j luucircun lt di lin ~c() li oi mi n rc ( ume [11 duumlnQstrIO la tinc~ jn~l el1lric ((1l1 ~rtlppi d i contnmiddotllo cnndnlt1 p nso i l entrt d e Massue di Li n nc da [ o llo n ~ Rodo l (1 986) Julndo il1vlce lIfU~ ho ~vutlJ tiVll 11lt1 1IjXIl to un dekrshyuina r o~itl di g rl vir~l bull a~-n lllull~nte n ec ~~uiu rlCUuml rf( ff dla tcrJpll rle si c a eo chirurg ica
1Ho le clllC ooliosi idjopHI 3 ttl1p ~ - E~er l zjo hsco shy11ln ~ I((fapil
l Bg 5 CUle Lo [la k ll oblems in tlu ll~ (U ni Cl) FrKUce CU ( )lIILr no 1 AllCPR lu b1lG1t10 11 middotCI 9()(iJ2 RockilJe MI) i)~Cr ~()f I [( al th all 1 () I ~Y 1(~Re~C~Hd ~gtutnlt Ilallb Srshy1ltC Cgt D~p(rulllnr CJf I Ilalil 11 1 HumlIl sen Lel 199-1
2 SI) lrzcf ( LcB I ~IIl( FE DupUb L ampkIll~ 1c ~ppro l c h ll tht rnent und mmgemlt-rlt ot ~ ct vlyrl~ led splnul (hs r)fder~ A monQglJph rr r d lll kic Re p o l1 or Ih Ou bcc TlSk Fu rcl 0 11 ipmd DIo rele Sp ine L9H LU) 59
) Clntino F 111i1 i(ll Ci nerte1H C Nou gltHhl C Kln(~Jl llBICII [lIe1 hmlln (Il dry rra ll1ltfll of QIil pa ll m log iC by l11e 1 lIb li 1le-llh laquorilC~ of ~ 10(lna 111 Jrc)Jcxli r~~ (of flle h l lntrnIUonll SVIll Illgt~iu tn - II 5lt Ik lIc lk0flllllic lu llln-I I r l III Fhhlt ri g 1092 -ltlIJ-7
i - ri of niii MA N()LJV II ~ mel h)ltks de kin ~~klk rlr k di lll J r~cdllclli (n d~s ~()li oes jn f ~tel r~1ruuml(ILI -lo s bl fl c sur IcIj cquishyl)œ~ Ik SOll ll l)(eacute Eli ror eetlfllS d )111 1~ 1)1-
5 iloll n G Ruumld(~ le s () I ~middotmiddots tnlcl l l1 I n in 1Ifc el kiwil~~ 1)11lt KillegraveSlthe ripJe SCleacutentlnlue lYl6 2 47 ~ 6
r) Feacuterr[ffgt en 1tsiero 5 Venlllfln A ll~~n () M MJglio nu N EfkUuml o r eXltClse tI~tl Yoj o n nild id iO rXllhlc iC() 1i()~ lrt~ lirnIcircIluy r sull Eur feltl lb)ii 1 1j34 Z5 -~ 1 NOilrill1 A Sbill P egn ni i Ll Linesilegraverpi l 1lt1 Itallllll~nlO
ddlJ soI K~ i llO 1 Orkl1Llllwnrl m efodoloil1c1 RbbilltlZiOllc Ot1(1 1 )29(1) 1l-~
8 Nli(rinl Nl(lr1n l A blll P LI rieduGlzione dl p llicml atflt rro (11 coli ns i idi opr lir1 l n SC(Um i le or h( JI 1rcLlIQn1 ~0Cl le Imc lI1etW)n11e de Recltcrchc ci 0 Ftude sm 1lt Radw jlt)(j S-71
gt Nftriruuml S SeJhrf U LI r i l bllh ~l liOlie dd plziecirc11te ulet1n 11 - r
lin Kllopd (1 In l1l Jgl L N eduoL Tf1It II d ll11e ji cln1 rJtbl IiIUvJ Milan) 1ltfddH~n(x~hl 2(1~111gt-1-PU ob L cllln t iRll p l nelLi rl tgtO llcui n~ dilt ~lio i - l rn~f- li ~iIa n 3efllnl -Kurflr 19-11
11 lIIra S lJll M EVtJltHlvugrave egraveI lt t rnrumel1t() d db S(oli - U r) surie doCum nUle fintgt 31 tIUUli Mibn SI rlin) KlIpf -r 199 2
L2 1 ~W I1l(IJ P _leacuteVia tio n I~lhra k~ du IlchlS ~- ( i( IoltS ccedil l r lI C1 l1 fl leq
Ene 1 l C hi r ApparctlIClCOn l~ ltll1 l ltx6lt (i W Er 20 j )7 l
U StrI tr d P Lcs 1) rm IlO du Hltlctli Parb ME n 115 li ~u n un_ l c- l ol lJn e~IL1roy JC EagtOllŒrio n sc lluocs
L cl middot Exp CO_fiL [-In 190 15 Xd BR llet13n) J Th ltJl-xwenc a l o-(l1 tUcn~kuud txer
C le re-glflW 1 lhe tfelmc nl o f id iopllhiC Collaraquo n lroc~-din) t Lhl 1 r 111(1ltli0 I111 Symf SiUl1l un 3-D Scl IiDliJ DclOfshymillelt ~k)J1[rlt u Gugtu l1Shltr Verbg 1lti t)L j32-t)
16 N1lh~Ir~il Al Peumlf r~o n LE Erree htJkmiddotmiddot~ n f t~U lt hfIl middot Ith J
hran in ~rls V ll ~ ttiVl ~HkJ k-nt IHuIXtthilaquo ic I) Li ~I~ts H t 1l1i JflIn t ~ j l~jl)5iuml7A(~)8Jj- 21 bull
17 M(jo n Y ( ullck J p ~ R A PrdulllnlIr rpurt 11 Iht e rt l f rnltJsu red 5l ren jl lh rrll nrl1 III ililleInr Hi rrt tllk scoJliagt
J lin1I IJisn rd 21 1 1)12) 102- - Hl Hunng CU[- -If p~lIll)~thc - Uonktd in -c h JI IL
c reacutetnl n~ ptnl l C)Q~ Z ) t 1 t(li-v 19 Kou )UrJKh L Glr~ k G KRI iJI G KLmiddotmiddotrnl kh g UlUI
) KrJ UkQULlk i~ ~l ~~ fl c+l l1ng ~t (w)j (h ildrcn frit ltt lmiddot( ti ~l~ 0 1 (he
isbnd of Cfdt J middotpin 1 Dior el 1 9J7 lIX( )middot i2 ~ middotl I i) SG IC1Iugrave lS r olle lCOS rh Zadrc C Ber E Xend s T A
ohool scr(l nin~ f r Loli rraquo pro~ p ah pidemlaIO)( Io Jl lUcJ ~middot In ncIfllwt~t~rll dncl Ctt1fLll Grttc J none 1cUlf ~)Ufg Arnl
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EUROP MIDI C Pli hIC
EDUCATIONMEETING SATURDAY 8thof APRIL 2006
(iSS
SEAS02 Scientific
Exercises Approach to Scoliosis
version 2002
G
S Negrini 1
EDUCATION MEETING SATURDAY8th of APRIL 2006
Neuromotor disfunctions
Neuromuscular disfunctions
11 Postural collapse
Postural collapse
Duval-Beaupegravere
Flexibility of scoliotic curve
f---I--- I Postural element
-------1 Structural element
S Negrini 2
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Postural collapse
Duval-Beaupegravere
It is a value related to muscular tone and to flexibil ity of convex side tissues
Post ural collapse
Bunch e Patwardhan
Critical load
Load threshold beyond wh ich a spine begins buckling
JI~~Wt1lW~flfthtlJlœJtAr ~ J~It- l~l - IMS
Postu ral collapse
Bunch e Patwardhan
If a curve reduces there is an increase of the deformation threshold
~~~NW~-damaoc~IIIMf ~~ J~Iv JaJ-I7I9sect
S Negrini 3
EDUCATION MEETING SATURDAY 8th of APRIL2006
Postural collapse
Torrel e Nachemson ~
Scolioses below 20deg ~ ~ lt~
have a high ~ ~ percentage of ~ ~
~postural collapse (on u~
average 75) ~~ 2i~
CU~VE O EG~EE S WHllE SUPlti e
~laquotd~c6b ____lPffI1wtt1t~
$ww J(t ~~7 JM5
Postural collapse
Minor scolioses 7
Antigravity musc es strengthening D
Reduces postural collapse -G
Increases the critical threshold of deformation
G
Neuromotor disfunetions
Stagnara
If we admit that one of the causes of idiopathie scoliosis is a disfunction in balance systems it is logical to orientate physical exercises toward this direction
s Negrini 4
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Neuromotor disfunctions
Dubousset
Idiopathie seoliosis results fram alterations in praprioeeption centres and deformation is a natural compensation to restore postural balance
etattJtitIK ypothfQj~S ___~ own_ oJ)HQr lar 1t-1( r
Neuromotor disfunctions
Nachemson Initial idiopathie scoliosis
+ Goood spine stability
Neutralization of postural deficits
D Static curve
Neuromotor disfunctions
Therapeutic aims
c) Development of spine stability
C) Development of balance reactions
G
S Negrini 5
EDUCATION MEETING SATURDAY 8thof APRIL 2006
Biomechanical disfunctions
j Horizontal r-Ian
i Sagi ttal plan
Frontal plan
Frontal plan
q Frontal plan disfunetions
Fronta l plan
Perdriolle Movement magnitude
gt in the direction of lt in the direction of correction progression
S Negrini 6
EDUCATION MEETING SATURDAY8th of APRIL 2006
Frontal plan
Stagnara
Never mobilize a scoliotic curve without ensuring reduction maintenance over time otherwise a greater mobility favours scoliosis progression
Frontal plan
Ducongeacute~ research
On a group of adolescent idiopathie scolioses treated with
Meacuteziegraveres gymnastics
D After 1 year the mean angle of
curves increased from 18deg to 29deg
Frontal plan
Scoliosis without brace
D Greater spine
flexibility D-
Risk of progression
S Negrini 7
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Frontal plan
Mobilization is useful
D In preparation to
brace
D With brace
Sagittal plan
QSagittal plan disfunctions
Sagittal plan r middot _J o
Perdriolle scouos B CJ aDeformation of D
thoracic and thoraco-Iumbar curves evolves in extension
S Negrini 8
EDUCATION MEETING SATURDAY8th of APRIL 2006
Sagittal plan
Graf
The line of gravity centres in the vertebral bodies o s c oUOSt
projects itself firstly laterally and then fi
o
posteriorly lJ ~~ ~~ ~ ~~-_J-D ~nI~
Sagittal plan
Therapeutic a ims
D Maintain or
retrieve physiological curves on the sagittal plan
Horizontal plan
QHorizontal plan disfunctions
S Negnni 9
EDUCATION MEETINGSATURDAY 8th of APRIL 2006
Horizontal plan
Stagnara The forces applied ta the spi ne act in a autoshydeforming sense
Horizontal plan
Dimnet Rotation gt 200
ampII~ (
D The actions of concave and convex side
muscles become
agonistic
~ItJrOnrIIiItdllfUClltlluumlll~~tI ~1JIf1laJ
Horizontal plan
Minor scolioses never exceed these autoshy
deformation thresholds
S Negrini 10
EDUCATION MEETING SATURDAY8th of APRIL 2006
Disfunctions at a biological organic and psychological
lever
Oisfunclions at a biological organlc and psychologlcal lever
Cheng
Bane density in scoliotic teenagers is lower than in normal subjects
~~~~middotA~IIlUtIy ~7œl 1d l
Oisfunctions at a blologlcal organic and psychologicallevel
A significant reduction of vital capacity and V02max in teenagers with a medium severity scoliosis
S Negrini 11
li
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Disfunctions at a biological organic and psychologicallevel
Disorders in the development of body image that the teenager has of himherself
Disfunctions at a blologlca l organlc and psychologicallevel
Therapeutic aims
cJ Activate cardioshyrespiratory function
cJ Favour bone density increase
cJ Develop a positive image of the body
Disfunctions at il biological organi and psydlologicallevel
Stagnara
Sport
D The active side of
kinesitherapy
S Negrini 12
EDUCATION MEETING SATURDAY 8thof APRIL 2006
Disfunctions at a biological organic and psychological
level
Distunctions at a biologlcal organlc and psychologicallevel
Cheng
Bone density in scoliotic teenagers is lower than in normal subjects
~n~IIIvpWr~middotA~stWy s- XXJl M J
Disfunctions at a biological organic and psychologicallevel
A significant reduction of vital capacity and V02max in teenagers with a medium severity scoliosis
G
S Negrini 11
EDUCATIONMEETING SATURDAY 8th of APRIL 2006
Kinesitherapy on the scoliotic subject
q Postural control
q Axial stability
q Muscular trophism
q Balance
q Respiratory function
The limits of kinesitherapy
There is a threshold beyond which
rehabilitation alone is not enough
sssr
Kinesitherapy in scoliosis treatment with brace
Therapeutic aims
S Negrini 13
6
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Therapeutic aims Srace kinesitherapy
With brace
il Postural corrections and
vertebral stability are obtained by the brace
Therapeutic aims Srace kinesitherapy
In preparation to the brace
il Mobilize spine on ail plans
Therapeutic aims Srace kinesitherapy
With brace D
Maintain a normal spine elasticity
~ Maintain a good muscular toneshy
trophism
C Model the hump with kyphotizating
exercises
S Negrini 14
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Exercises and their methodologies can vary accord ing to learning and individual sensibility of the single rehabilitator that proposes the m provided that they stay within the
Iimits of fixed therapeutic objectives
li
Therapeutic modalities
(Exercises)
QAuto-correction
QRespiratory education
QErgonomie education
QMuscular strengthening
QDevelopment of balance reactions
WNeuromotor integration
ci Vertebral mobiJization
QSpecifie modalities in brace treatment
S Negrini 15
EDUCATION MEETING SATURDAY 8th of APRIL 2006
The protocol of kinesitherapic
treatment
G
QChoice and dosage of exercises
Variatiosn of the work program every 2 - 3 months
Q Execute e)(ercises on an individual base or in a small group
Q Frequency not less than 2 times 1 week
Involve and awaken the family
G
S Negrini 16
EDUCATION MEETINGSATURDAY 8thof APRIL 2006
Q Determine the action and the localization of auto-correction
QAuto-correction must be associated to ail exercises
QAt the end of treatment ergonomy lesson
Auto-correction didactics
G
SCOLIOSI DORSALE---- shy ----
r
S Negrini 17
EDUCATION MEETING SATURDAY8thof APRIL 2006
SCOLIOS OORSOLOMBARE
shy
SCOLIOSI OOIlSALE 011 bull LOMBARE S1I--shy
SCOLIOSI LOMBARE
il --~_-
S Negrini 18
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Scoliotic patients are not radiographs
middotSeoliotie Mtients are not ndiographs but hum beings with a vertebral deviation-
Slagnara
Metha For the physieian Cobb angle is of utmost
importance For the patient it is body deformity t hat eounts most rib hump a protruding seapula or hip We are in a situation in whieh today dodors eure the radiographie deformity but what the patient really desires is to get rid of clinieal deformity and of ensuing psyehologieal distress
CIIQItIo shDuIdtucirc lM WIld tJw~~ I~~M~~~~ J9f~
S Negrini 19
- Poznan_workshop_Physiotherapy
- physio2
- physio3pdf
- physio4
- physio5
- physio6
- physio7
- physio8
- physio9
- physio10
-
bull Przedstawiona metoda jest
stosowana samodzielnie lub
w pO~qczeniu z ortezq Checircneau
a takie jako przygotowanie do
leczenia operacyjnego
Ocena progresywnosci w badaniu elektrofizjologicznym
odruchu z odci~zenia
i~middotmiddot ~=~-~ shy1 _--==shyocirc
14
EUT S pine J (1997) () 93-97 copy S pringer-Verl ag lY07 ORIGINAL ARTICLE
K Dobosiewicz Neurophysiological mechanism of the unloading reflex as a prognostic factor in the early stages of idiopathie adolescent scoliosis
Rcceivcd 29 M arch 1996 Revised 16 August 1996 Acccp tcd 10 Septem ber 1996
Absfract This paper presents a new nc urophy iologila1 methougrave of e valushyati ng the risk o f p rogression in ill ioshy
mo t important factors in the eva luashytion of progress ive id io pathie scolioshysis The met hod can be lIsed to deshy
pathie scoliosis in th early stages uf tll( progre jve idiopath ie scolios is the dis ase by illY middottigating tll e unshy in lhe early s tages of the d isease loading refl ex in paraspinal muscles T he high sensi livi ty of ilie method The study incl uded 394 pat ients wilh means il can be used as a basis un seo liosis and 70 hcalt y chil dre n which to take an earl y dcc ision to
K D obosicwicz Depuumll1 mel1 l of Rchabi lilu lioll Si lesilln Medical Academ y 42-604 Tamo wskie G6ry 4
Lmenty of the unloacli ng retle x and repeatabi li ty o f Ihe rcbound and silent period were anal ysed for eaeh reflex evoked Prolonged latency and
p rimiddotom1 surgery
Key words Id iopathie seoli o is Unloadi ng rcnex Re bound
Katowice Polaml minima1 numbe o f cycles are the Larency Si ent period
T he ai m of this sludy was to evaJ uate the use of the unshyIntroduction load ing Dex for octcction of prog ressive id iopath ie adoshy
le cem oIios is in its carl s tages in onl r to lake a dccishyProg ress io n of id iopatJl ic scolios is bas been the su bject of
sion ta perfo nn surgcry as soon as pussible many clin ical radiological and elecrromyographic in ve~ shy
tigalions T here is ho wellcr no sim ple quantita ti ve or qual itati ve pro noslic methoo [hat can be em ployed in the
Materials and melhodsearly ~tHges of the disease Monitoring of lhe unloading rc felx in paraspinal m llsck appcars 10 be a reliable Inv gtsi lgnlions were carricd uut 011 394 pa tie nt with adolescent method o f discriminating bctwcen diffcrcn l fomls of Cushy ~c li ed J ild 70 hCldr hy children The scoli osis group consisted of Iios is T he un loa ing re n cx can be evokcd in ail the 31 1 g irl s and 83 boys aged 9-1 8 year~ (mean age 125 ycars) The
ske lelal muscles through a suegrave den shortening of o luntary contro ls wcre 0 girl s and 10 boys aged tO-1 7 y~ar (rncan age 128 cars ) Imong Ihe stlbjeclS tudied wcre 9 patien l w ith cershyinnervated muscle l2~J When a musc le is unloaJ ed vico-thoilc i seo liosi s mean Cobb ang le 22 7deg 121 with Ihoracic
rapidly durin g an isomerric con trac tion Ihe norm al reacshy scolios is mean Cobb nngle 309deg I 1 w ith thoraco-Iurnbar seolioshylion is an eleclrically silent pe riod fo llowed by a burs t o f s is rne ~n Co bb ang le 26~g o 63 with lumbar cotlos is mean Cobb action potentials called rebmmd The pause in d ischarge ang le 279deg and 90 w ir h doubh major curve sc o Ii() ~ i s meull o bb
nng le 292deg and 28 5deg The sludy group includcd 231 right -s ided can be observed only when a certai n h reshold va lue of and 163 left-sided 5col iouumlc patien ls There were 112 patients w ith
acceJcration flnd shortening of he muscle is exceeded progress ive id iopath ie scoliosi (76 ri g hHidtd and 36 Ic 1t-s ided) an tl il occues wilh constant latcncy correspond ing to that 182 with no n-progressive idjopa thic scoliosis (1 13 ri ght- sided and of the propriocepti ve nflcx (9 18 20] T he rebound ufter 6 le rt-sided) M d 100 w ith pe lvic tilt (statie) scolios is (42 rightshy
s ided anp 58 l eft -~ i(kd )the silent period in the unloaugraveing re felx rcsul ts from ae lishySC9 1ios is is consIcircdered progressive if the Cobb Jngle inshyvalio n of a pool of motone urons aIl o f which fClt1ch lhe
creltseacutes by more lhan 6 in 1 yen r aile middotnl1 n-progrcssive if the anshyfiring thres hold simultancously afte r prcviou~ si lenœ [l nua i increase is less thll n (i The Cobb angle ranged lrom 8deg to 77deg 1 4 201 in Ihe palicnls w ilh progress ive scoliosis (mean 361 ) [rom 30 ta
lI f R (on- f Rt tt1IY 1lIfl pflla 1 )(~ r(Jnu n t shy
fI) _ ~
Pathomechanic basics of conservative treatment of progressive idiopathic scoliosIcircs
according ta Dobosiewicz method based upon radiologie evaluation
Kryslyna DobosiewlcZ Jacek Dunnala Kny ztof Czemicki Hanna Jcndf7cjek
Deparmem of Rellabtlifatoll Mediw Uninrsity ofSiltsia KatOllice Poand 40-635 Katowice fil ZiUCl 3537 POL4ND
e-mail relwbilitacjt1s11mfoctaonetpl
Abstract Conscralivc IrcalrnCnI of Idiopathie scoht)~1 espcclall y kinc ilhcrapy i ~
nOI widcly apprccilllcd due 10 Ils suspectccl low dfcCIIcircvcnc 5 in relalion [ (1 a urglcal Irc[llment ACter long-ycar il ses ment of palomcchanic f scolio icirc in Dcpanmenl of Rchnhllilallon f Mclii al Unlcrsi ly of Sile bull a concTvallvc mcthod ()f IrCtllmenl asymmclric Irunk mobili7alion in lnclly ymmelm po~itions WIS
de el ped_Thi mClh d enablc 10 delain pTogression f scol iosis or ccn de middotrca~c laIerai urvalurc of a spi ne and angle of rOlllion assummg adequate () perallon f palicnl and ilS famil)
J Introduction
Idiopathie scoliosi OS) is a thrccdimensonal dcfonnation of il vertebral col lmm an- cntire trunk Afler many years of extensive rescarchcs the cause of idiopathie coliosIcircs $ i remaIcircns unknown It is possible Ihat idiopathie scoliosis devel ps and progress on a baslS 0- ~
multifactor disorder perhaps diffcrent for curve initiation and curve progressi 11 Fion poss ible pathologie factors nervous system dysfunctIcircons affecting postural tquili brium ar proprioceptive control seem to be espc ially important [ l 2 6 JI Pro_ ression f iS could bot delermincd by vertcbrac remodeling under eccent ri c loading created by axia lly ce gravitational forces in presence of muscular imbalancc in the trunk [2 J The verte rai colwrz unde r scoliotic conditions 15 an unstable system with tcndency to fu rther tune dcvelopment fl2] Lateral bending of a vertebral column visible in X-ray examination L
only a two-dimensional prcstntation of a complex dcformity consisting of patho logica axi rota ti on torsion and othcr deformations of vertebrae [7 8 10 II 14J ln fS physiolog~ curvatures of vcrtebra l column are disturbed Total Icngth of an anterior column of a spi n~
consi ting of vertebral bodies and intcrvertebral dises bccomcs grcater lhan length of l posterior colwnn - vertebral arches and proccsses [11 15 J h is apparent that phy iologi ~
thoracic kyphosis in rcgion of a scoliotIcircC curve diminishes Each vcrtebra of a stru tu ~
urve of coliosis is oricntatcd in hypercxtcnsion in relation t adjacent vcrtcbrae [7 l resulting
1 n B Uri middota I l 11
H srut ft illtf j tI) t li orf1Hli d
IDS Prt ts 21)2
Influence of method of asymmetric trunk mobilization on shaping of a physiological
thoracic kyphosis in children and youth suffering from progressive idiopathie scoliosis
Krystyna Dobo icwicz Jacek Dunnala Hanna Jendrzejck Krzysztof Czernicki
Deparrment of Rehabilitation Medical University ofSilesia KaloKce Poand 40-635 Katowice ut Ziolowa 3537 POLAND
e-mail rehabiliracjas(u1poCmiddottaollelpl
Abslract Idiopathie scoliosis (lS) which i sub 1 ntially l threeshydimen ional derormation or a pine cau e nOl only laler l curvalurc and axial rotation of vertebral column but al lordoti allon of VCr1cbrac in structural curve eXl nsion ln an effect physiological thoracic kypho j diminishc or cvcn dbappears Method of a ymlllctric lrunk mobilisation in strictly symmetric po iljon according [ Do () lewicz not only dcteriorme progre ion of IS or evcn reduces lalera] curvalure but also significmtly rebuild physiological thoracic kyphosis Icircn cases of lS accompanicd by lraight baclc
1 Introduction
Despitc Ion year researchc etiology of IS is nOl yel resol ed Significant problem re laled lO morphology of IS apar1 from lateral bending and ax i 1 r tati n i deviation of shape of a spine in sagittal axis affecting physiologi al curvatu re of vertebral coJumn [3 5 6 8 9 J 0 1t 12 Lcngth of anLerior col umn of a pin constitutcd by venebral hafls anugrave intcrvencbral dises dominate ovcr Jength of po terier c lurnn buill from vertebral arches and processes [lOJ This condition uring scol io i progress ion and growth of a child effect in hallowing or even disappearing of phy iological Lhoracic kyphosis in scoliotic region It i well know n lhar cn~brae of structu ral Jaleral curve are positioncd in hyperextension - lordotisation [5 6] which in Lhoracic region Icad (0 reduction of kyphosi or to true lordo middotis Such kind of venebrae relation in thoracic region cau es ilS destabicirclisatIcircon whi h in u sociation with eccentricircc gfilvitali nal load fa pinc duc to muscu lar icircmbalance [21 pOdbly produces r tationaJ lordo is [56 Il] and further development of symptomatic scoHose ft ha becn proven [12J tha strengthening of the erector spinac muscle aggravates nce initialcd deform tion and deteriorates coliotic process Hyperextension and uxial rotati n a s clatcd with
357 Th B Grivas (Ed) Research inro Spinal Defoml ilis 4 lOS Press 2002
Exercise efficiency of girls with idiopathie
seoliosis based on the ventilatory anaerobie threshold
Jacek Durmala Krystyna Dobosiewicz Hanna Jendrzejek Wieslaw Pius
Department ofRehabililation Medical University ofSiiesiaa Katowice Poand 40-635 Katowice m ZioJowa 4547 POLAND
e-mail durmalaiacekyocztaonetpl Department ofPhysiology Academy ofPhysical Education Katowice Poand
Abslract The aim of the study was to estimate the exercise efficiency in the group of
girls with idiopathie scol iosis based on the venlilatory anaerobic threshold (V AT)
Material and method The investigation comprised 58 gi rls wilh idiopathie scoliosis
aged 10--6 years 32 girls (55200 ) wilh double major scolioSiS and 26 girls (448)
with single scotiosis The girls were eonservatively treated using Dobosiewiagrave
method The control group consisted of 3 1 healthy girls aged 10-1 6 years The
cxercise test was performed using eycle ergometer During the exercise the gas
exehange parameters wcre reeorded (minute expiralory venlilation minute oxygen
consumption earbon dioxide production) On the basis of recorded paramcters V AT
has been computcd using V -si ope method Results The following V AT values were
obtained in the group with scoliosis 207+305 ml 02minlkg bm in control group
219+350 ml 02minlkg bm The differences belween girls with idiopathie scoliosis
and control group were nol SLaliSlically significant Conclusions I The exercise
effieieney of girls with idiopathie scoliosis conservalively treated using Dobosiewicz
melhod is normal 2 Such high level of the exercise cfficiency of the studied group
probably was due to intensive 3-D respiratory exercises of these girls
1 Introduction
In practice there are researched useful efficiency rates which on base of laboratory tests results possible easy without using of the relatively hard or long exercise tests would give the belter forsighting of the range of homeostasis disturbances and rapidi ty of increase of
physical fatigue during varied workloads [1] The best known rate of trus kind is the maximal
minute oxygen consumption [2345] During progressive physical effort minute oxygen
consumption increases proportionally to workload The reaching of real maximal minute
oxygen consumption in time of progressive effort is iodicaled by minute oxygen consumption plateau [5 61 This result is rarely registered in children The progressive exercise test is most commonly used in children until physicaJ exhaustion and the highest registered minute
oxygen consumption is treated as maximal minute oxygen consu mption or so-called
symplomatic limited maximal minute oxygen consumption [678J Sorne authors regard
Orto-dlet Trau malaogis Roha b ilitacjaARTlKUL ORIGINALNY ORIGINAL ARTICLE Vol 5 Nr 1 2003 80-85
Jacek Durmala l Krystyna Dobosiewicz l Tomasz Kotwicki Hanna Jendrzejek 1
Katedra i Klinika Rehabilitacji Slqska Akadenia Medyczna Katowice Katedra i Klinika Ortopedii Dzieci~cej Akademia Medyczna PoznQll
Wplyw asymetrycznej mobilizacji tulowia na wartoseacute k~ta Cobba i rotacji w przypadkach skolioz idiopatycznych u dzieci i mlodzieZy
Influence ofasyn1n1etrie 111obilisation of the trunk on the Cobb angle and rotation in idiopathie seoliosisin
children and adolescents Slnwu kluce ac eJJic Cl chOlIU) Ice SKoio= idj)PO Imiddot(~I7tmiddot
K~Jmiddot w()rus consrieI ve I (OtlHelif idiopathie HUW JS
SUMlvfARY
BackgrouId The aim ofthe stldy Vas Ihe radiological evaluation ofthe treatllJent ofthe idiopathic scolioshysis utilising as)mmetric trunk mobilisation in the strict~ll I)mmetric illitial position
Material ([fJ(f lIIellOds Presented stud) lOS based IIpon J36 cases (13 oovs oged FOf11 ocirc la 6 lcars (lild
rn girls aged frum 6 la S pears) trealed due to the idiopathie sCuliosis ((rom Novell1her 999 0 F enflfUn 200) Among 48 ch idrcn sllfJering from dOlfble-major scoios is 6 cases wcre infoll scaliusis JOjuvel7lle und 22 adolescent Among 88 sillgle scoliosis 6 lere infw7t 33 juvenile and 49 adolescent
Radiological exami71ation 1as condueed always in the repeataole technical cOlldiions RadlOglOlI1 lier evaluated oy the same physician Radiologica analysis oIthe scolios is incuded value ofthe Coho al1gle ongle ofaxial rotaion
ReSIils ln double-major scoliosis observed dlring one year period in Ihe thoracic segmenl Cobb angle decreased inll l increased 1395 and in 292 Il OS 111changed Axial lolation angle in 167 (~rcascs
decreased in 354 incrcased and rernainM the sorne in 479 In Ihe llllnba segmenl Cobb ang le clccrcscucirc il1 354 increased in 39 6 remained in 5 Angle ofaxial rotation deceoscd in3 ofca es incrcuscd in 29 and persisted in 48
ln single scolio is Cobb angle decreased in 386 incrcased in 353 and in 261 was lInchonged Axiol rotarion angle in 216 ofcases deceased in 295 increased and rell1aincd the sallie in 489
CondlsioJ Asymmetrie mobilisation of the tf1f17k in strictly syl7111elric initial positions is a 1Clhod of choice in the cOl7senJalive treatment ofthe idiopathic seoiosis
STRESZCZENIE
WS~p Celem pracy jest radiologiezla ocena Icczenia skoiloz idiopaf)cznych metoda asvmetrycznejl7lOoili shyzocji tllowia w sciSe symetlyczl7ych pozycjach lV)jscio wych
M aterial i metody Przeprowadono retrospektYlIl7q analizri 136 przypadkeacuteM dzieci (13 chlopcow i 123 dziellshyczqt w wieku 6- 18 lat) z bocznym idiop atycnylll skrYll ieniem krrgoslupa leczonych zachowawczo w Klinice
1
Ortopedla TliJumatoogia RehlblllagraveeJa ARTYKUL POOL1 DOWY OPINION ARTICLE Vol 7 Nf 1 2005 49-$11
Krystyna Dobosiewicz Jacek Durmala Tomasz KotwickP
Katedra i Klinika Rehabilitacji SIAM Katowice 2 Katedra i Klinika Orlopedii Dziecircej AM Pozncrlz
Biodynamiczna metoda tr6jplaszczyznowej korekcji skolioz idiopatycznych - opis metody Biodynamic method for 3-D correction of idiopathie
scoliosis a description ofthe method
SIOWQ kluczowe leezenie zachowawcze skoliozy idiopatyczne korekeja tr6jplaszczyznowa Key words conservative treament idiopathie scoliosis 3-D correction
SUMMARY
The biodynamic method of hree-dfmensional carreeion of idiopathie scoliosis is based on Ihe palhomeshychanics of idiopathie scolioiiiii and consiss in aClive segmental three-dimensional correction ofspinal cllrshyvatlre The course of action focuses in the viciniy ofthe apical vertebra Proprioceptive facilitation is applied on Ihe concave side ofthe curvaJure and exteroceplivefacilitation on the convex side Correction likewise proshyprio- or exteroceplive facilitation is phase-oclœd with asymmetric respirarory movemenr as weil as wilh parshyticular phases of the respiratory cycle ln Ihe course ofexercises three-planar movement is generated opposite to the direction in which scoliosis Is progressing This method is in accordance with the stale ofthe art ofscoshyIiasis pathomechanics The method requires detaied training and can Ihen con be applied at home under periodic control by a physician and a physiolherapist The method con be applied in landem with a Cheneau brace as weil as in surgical pretreatment A elaUed description of Ihe method of three-dimensional scoliosis trealment will be presented in Ihis article
STRESZCZENIE
ISlofa biadynamicznej mefody Ir6jplaszczyznowej korekcji skoioz idiopatycmych oparlaj est na patomechashynice iikolioz idiopatycznych - poega ana na czynnej segmentanlej tr6jplaszczymowej korekcji skrzywienia Dzialanie koncentruj e siccedil w pobitu Icrllgll szczytowego sknywienia Stosowane iest bodicowanie propiocepshytywne po stronie wklllsej oraz eksteroceptywne po stronie wypuldej Korekcja i slosowanie bodicocircw propioshyi eksteroceprywnych zsynchronizowane j esl z asymetrycznym torem oddechowym oraz z poszczeg61nymi fazashymi oddechu W trakcie eacutewiczen powstaje odwrotny do lrierurzku rozwoju scoliozy tr6jplaszczyznowy ruch IcrFtshygoslupa Melodajesl zgodna z aktualnym stanem wiedzy na lemat patomechanizmu scoiozy nymaga szczegocircshy100-lego instniktaZu po clorym mote byeacute wykonywana w warunkach domowych Z olcresowq kontrolq przez leshycana i fizj oterapeutll Metoda mote byeacute stosowana r6wnolegle z leczeniem gorsetem korekcyjnym Cheneau a talcte w przygotowaniu do leczenia operacyjnego slcolioz W pracy przedslawiony zostal szczeg6owy apis meshytody leczenia
Skoliozy idlopatyczne stanowili znieksztalcenia patycznej rozwija siccedil poprzez przemieszczenie kr~gu tr6j~aszczyznowe charakteryzujltce siccedil wyboczeshy szczytowego w stosunku do krccedilgu g6mego j dolnego niem rotacjltt krccedilg6w klatki piersiowej i miednicy z r6wnoczesolljego rotacjl zgodnie z ruchem wskashyoraz zmianami w fizjologicznych krzywiznach kr~ z6wek zegara dia skrzywienia prawostronnego oraz goslupa w plaszczyinie slrzalkoweJ [ 123] przeciwnie do wskaz6wek zegara dIa skrzywienia leshy
Z punklu widz nia patomechaniki tr6jplaszczyshy wostronnego Koncepcja rozwoju skoliozy jako rotashyznowe znieksztalcenie krccedilgoslupa w skoliozie idio- cja i kontrotacja sugeruje ze sily korekcyjne powinshy
49
EDUCATION MEETING SATURDAY 8th of APRIL 2006
- CARDJOPULMONARY EXERCIS E
TEST IN GIRLS WITH
CONSERVA TIVEL Y TREA TED
IDIOPATHIC SCOLIOSIS
Jacek DURMALA Krystyna DOBOSIEWICZ
Department of Rehabilitation Medical University of Silesia
Katowice Poland jdurmalaqcmpl
The aim of the study was
to estimate the influence the conservative treatment (asymmetric mobilization of the trunk by Dobosiewicz) on physical efficiency in the group of girls with idiopathie scoliosis
Material
bull 87 girls with idiopathie scoliosis
aged 1 0-17 years
(mean age 135 years SO 161)
J Durmala K Dobosiewicz 1
EDUCATION MEETING SATURDAY8thof APRIL 2006
Material
bull 38 girls (437) with double major scol iosis (thoracic segment - Cobb angle 18-42deg mean 30deg SO 82 angle of axial rotation 4-32deg mean 21 deg SD 107 lumbar segment - Cobb angle 11 shy48deg mean 31deg SO 128 angle of axial rotation 5shy30deg mean 13deg SO 85)
bull 49 girls (563) with single scoliosis (Cobb angle 11-75deg mean 33deg SO 155 angle of axial rotat ion 5-30deg mean 14deg SD 83)
TIoracic kyphosis of the invesllgated group was 5-39deg mean 23deg SO 86 and lumbar lordosis 16-41middot mean 30 50 65)
Material
bull The 64 girls aged 10-17 years (m ean age 131
years SD 132) were conservat ively Ireated
using Dobosiewiczs method
bull Treatment period ranged from 5 months 10 3
years (mean 148 months SD 902)
Material The 23 girls aged 10-17 years (mean age 136 years SO 108) were treated u sing symmetric exercises - treatment period ranged from 4 months to 3 years (mean 161 months SO 1019)
bull 26 of ail g irls (18 girls earlier treated using Dobosiewiczs m ethod and 8 gi rls earlier treated using symmetric exercises) aged 10-17 years (mean age 134 years SO 108) were twice tested - at first and last day of Intensive hospital rehabilitation (asymmetnc mobllization of the trunk by Oobosiewicz) - mean hospitalization period 20 days (range 18-26 days)
i rf~8f6~~ or~~n~= ~~r~1~r~icircJ~~tb~~~~ mean 17-4 1deg meatl~(I SO 74 R n~le ofax 1 rotatIon 5-25ot mC3 111 3laquo S0 6icircl Ilnd 1 99t1S~ ~~~~I~~~~~$ruo~ras~ ~ocirc~~a~e~~~~~~~5euml1 9middotn~ tUfllbar Iord05ts 16-4 1deg mean 311 SO 68)
J Durmala K Dobosiewicz 2
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Material
The control group consisted of 77 healthy
girls aged 6-17 years (mean age 12
years SD 31)
Material
The examined girls participated in school
only in scheduled physical education
lessons and have not been enrolled in
other sporting activity
METHOD
The exercise cycle
ergometer test was
performed
J Durmala K Dobosiewicz 3
EDUCATION MEETING SATURDAY 8th of APRIL 2006
METHOD
The Incrementai exercise test has been applied
We have found that tests ln whlch the Incrementai part of the protocol ln completed between 8 -12 minutes duration glve the
bullhighest maximum VOz in normal subjects
METHOD
The workload was Increased stepwlse
bull by 10 Watt every minute - ln chlldren
with high ~ 135 cm
bull by 15 Watt every minute ln chlldren
with high gt 135 cm
METHOD
The test had been contlnued untll refusai of the patient or exceeding the pulse Ilmit
Durlng the exerclse the gas exchange parameters were recorded by Jaeger device model Oxycon Alfa uslng direct breath-byshybreath rnethod (with face mask)
J Durmala K Dobosewlcz 4
EDUCATION MEETING SATURDAY 8th of APRIL 2006
METHOD ~ ~~ r 3 min 3 min 8 - 12 min 6 min -~
_ 0 rpiYJ 0 rpm 60 rpm ~1 30 rpm
_ t o~w=att~o~~na ~~ att__~ tl~~S~~ l ad l ~~~~~r o~w= Hlcremenlal t
pedaillog i i ~
~ ilt ~I~-----tl-~ I t ~ i ~ lOSt sffortivB
lW r resututlon r rm-u middot 1 - bullA~cremen tal ~~ ~ ~ ifr- ~ VtI 1 ~i ~ tllng _
METHOD
On the basis of recorded parameters VAT
has been individually computed for each
child using V-slope method by
Wasserman
METHOD
For assesment of physical capacity
the maximal minute oxygen o
consumption (V02max) ventilatory
anaerobic threshold (VAT) and
maximal workload was used
J Durmala K Dobosiewicz 5
EDUCATION MEETING SATURDAY 8thof APRIL 2006
RESULTS
Ali girls with 18 have been classified
within normal range of predicted
values of
bull maximal minute oxygen uptake
bull VAT and
bull maximal workload
RESULTS
The differences between group of girls
treated using Dobosiewicz s method and
group of girl s treated using symmetric
exercises were statistically significant
Lower exercise efficiency of girls treated
using sym metric exercises has been
observed
RESULTS Girls wilh IS Irealed using
N=87 p value
Dobosiewlczs method N64
symmetJic oxor-ci Nz23
Perœnlage of predicled vaJue of
maximal minute oxygen uptake
98 905 0033
Percenlage of predicled value of
VAT 97 933 0049
Percenlage 01 predided value ni
maximal workload 101 939 0038
J Durmala K Dobosiewicz 6
EDUCATION MEETING SATURDAY8th of APRIL 2006
RESULTS 26 girl s twice tested - at fi rst and last day of intensive hospital rehabilitation
The value of ventilatory anaerobic threshold increased during intensive hospital rehabilitation (asymmetric mobilization of the trunk by Oobosiewicz) statistically significantly (p=00019)
2047 ml O2 minkg (SO 268)
vs 2239 ml O2 minkg (SO 232)
Conclusions
1 The exerc ise eff iciency of girls with IS treated by asymmetric exerc ises of Oobosiewicz is norm al
2 Such high level of the exercise efficiency of thIcircs group resulted fram using of Oobosiewiczs method
r
J Durmala K Dobosiewicz 7
REVIEWS
Role of physical exercise in tbe treattnent of mild idiopathie adolescent scoliosis
Revicw of th- literature
A NECRlNl N VElWNL s PARZI 1 A NEGRINJ 5 NEClU NI
P1t~silillxlrd~ Ihcrapy (or klucgtlttlwrlpyl i pro shy-tJm of physka] cXlrd-cs ipcci I(a~ (IJcloJgtcd hy l li trIWlltl phrslollwrapbt wilh tb m~ln a1mor pl shyVCnI in lhe ilAAfIVltilH1 llf the ucirccfonuity III mild IgtC )
Lil1Si bclpin~ thebm ( aocl co uaufllclilIg ils ~jd- clf IS in nlOdlJmiddotnh-culiosis Th middotalillofthi paper ito r (W
Ille Ii lc ram r 1 a-ccrulin wh kh of Ih bull Lu[Jalmlcrus Ind (Lb hili til~ CLlLt-cd br scnli()si- clluld bl pl Y nlcd or r d uccd hl phylolld LXtmiddotrdsi n Il p--to-da le knowl Uuml~l nr tIll~C aspcc[~ i ne bulled in oruer 10 dndc whclh~r 11Rf blLl adcqlmtt Ib(uuml n middotlicaJ balis fo r ora)aini l Ihe US4~ of lUgravellgtitlerap) wltcllj(r or fln l th e prtl1iœ of kimiddot ~lre IUlll poNjn~ a t iil ies ~bould h allowtcI II uuml middot c enliaI toltlentlf)wh k lu alClor ie - lf pl lr~kiJl -c rmiddot d gtlt- (Ic rnnhi UzJ( inn ni (t hl HrJltlon [ rtn~hcll iJl ~ or 1i1J(IChIumlJlJt etc) Sh llU Ld be TolullllCcluse ulemiddot l onld b- clclIimcntalancl wukh sho ll ld he IJlI-n~ifl~d I~~a l lhc (o uld h 11lfu 1 Know k dg CJnc1in t (wIn SeiCIImiddot Hlk rCS([lflt h daw ccordinll to Ih bull llVit w o f tIlt iii 111 1( plop(lsltd in (h i papcr lmiddotonllmJ l lnl plLyi 11 cxcr(j$( pn (nti or (tmiddotduce dhlblli t ic 1 ~lt Il Jj ll(k pl ti Jlt fadl j w(~ the nlIIIrl li7alinn n f poMural dd shylitS tu p n xJ llc aSl COIlMqnen c(middot 1 all )llal) or r(tn~ shys i middot middotlIrve Tilt u~c (I f appn1priattmiddot kincsiuuml wrlpy 0 in rcns polttllcal swhiIHy Icirc IIHmiddotorc Illta ll y (0 r 1(lt1 lllho UAh mon ltlccurlltc 1Ut dl1alkd -rLk l(lWfils 111111 )11 h Jlccdt(
11) wurcJlt 0 lit)-IcircS (Iumpy - x rcLs P()lun
n rllt lT(ltnklf u f COll1tlK H (rtd) I 1i plfho l og l ~$I rUlglng tr m low tmiddot k Pl 1l1 to IdiOpath ie SCUIshy
Submitt(oJ [or PUhltCl l1 011 uly Tt 2001 Acc~pttJ ugu - ~2 1(t-1l
Addre rltj-xlfll telt~I(middotb If) - grinl Flt(1(bziurllt r )(m Ofl ()(Cl1I shy Lt middotqlltœlll ro () - 1u I4t agravehLIlKil ta IYIL-lTt ilSllltp lfllmiddot ~ 1l1uumldull
CelII ~ (niiOS I I~ middot ann (1) IfUh middot lIlfU di louhilll(tymi ( Nlmiddot ~iI rli -ilIIUmiddotltlfl
Nlti(ir 1( ) il r() (ltbullagt1
lt vLL_ l IiII no 1ftfI
jS ) we are a IUil ly tJc ing n1n) ltblll lS 1 k l1 b ~J)w in~ tl~ t S Jfll l approad llt - l1n til hy on ielshyertd ~tan lard ugraveJuld ln m any ~1~ he lI ~t les i if Ilot dange r )ll lt rhlS is lrut of reil l lnw 1gtlt1lt1 pa in l ~ or 5urgi c ll lrea lmltnl5 in dbc r lmiddot ll Sc - 2
ln tlle cj-e ut ~ t lll(tlWtl i( li p l ll1JC luuml- I ~ middottnl ~() shyliosis phys cal ((_lt1(( is emr1uved ltI t()fIl1 0 lh~rtrv
lo ly in cel1l in L)lllllde (nluumlnlr in tilt Lltlll middotorkl i e Iw l) r llt t Srain hUI IIgt() 111 Gert11lny 5- 1~1 in other reg lOl1 wbere thi I-incl qf tre l tm e rll 1 p~ 1 pmiddot t 1( cI il Jws Ixen cri ri cilld md rel -cltd Lw m~lI1 1 11 Jlu~ Fue Fnlny r ~lrs thio middot15 a lsgt(ru( f ~rth r -~ltc rrJtf))~ ll t vit11 br1Cltcgt b r II1 ([C Llt n ClW grmvlng 1lt1 0 L Sti g
gcsti n the lIsefulnes- u r Ih is form o t treatm n t 1
Hmiddotu]rs have nerged jn El or uf pll y~ iLd eegraverdse eacute 00[ 1 but tlw are nUl yel 11 11 t llu i vIC~11 and r hi ~
f rm of trt ~ltmenr IS stiJ l Ul1 ckf ckhate FfI t Jt 111 il i 11t (eltary td 1I iFy 11umbtr ot
b l sic COI ceP rlJ lf w ill he cIh tt d in t hi pap r
Scollosis
DCijIrI iriolls
ScnUoSlS is Irlircc c1 lme nsIcircltnal (I(gt i l cj on ot tht spinc thar cau C a CU 1 lh lt ca n h e $ t~en ln (1 me1Sshy
ured ultinF Coh) lll ltllCXI o n HI anreu middot p rtc rilt r
EUJlOI -1 lœDICOPHYSlc~ IR
NECRI Nl
110
f)i)
1 7J
amp aS g 5li - 0 v
V
31
10
(1 1) Il 15
-tc i ytjtr~)
FigJ----jllph ot DlI w l-lkaupegraverel) The agloimvltltinn Or idio r lrhlc 50gt1iflll~ IS rpiJ bel~ en th e- [l0 IH P (l)ltg tnntll lol (JI PUllcmiddotny) mtl 1 ( f( lS-er sigll paiilivltecirc lt Dlt(i I1 11illg r the iti l 1Kgt n n t rll icirclicH a ) 111lt m omal prebulled the mno rche md ociks with lll I)ttlx flal gr Ih pll fl
rlcljoprdphLi 1 hl merl prestIK ~ of this curvt c10es n t autom~l ritllJy indi ate the pn$CI1(t of a defurshyTnitv (SlllKtUrd (Unel
It i~ possible tu clil1e ren tute a struCnlt t CI1tve fruIn a pogt urll 011e by identifyi og the hum]) du ring AdIlns tesr I~OQ looklng tra m beh lnd at the p atient w ho b benchng fUfward il is p -- ible ta d d~ct 1l1 eh ucirc n of o ne liidlt 0 1 the trunk usually n n the (onvex ~ jde ul tbe radiographie CUfve Ugrave1lr C Ul be mlt~I Slred lISin~
BUlln els S o liomere( 1 ~ l This h Uf1lp is du(- lO (Ile pregravegtecircn ~ of vertel ra i rolltion 1c1 Ollt tn tic f~YJ tllre o f the def trrnit tli [ c m be seen and measurc(i v ith Perddolles lb lsLometer on an amero-Ix)iferior radioshygrapb ~2
Seven ry pel cent o f li Ises a re conid 1lt 1tO be idiopa thie 1 bull ia l-nosilt in this CI$C is b exdlls i ~ n as idinpa thlc me-us t11H wc do n()[ know rJw origio of lheacute curvc [n othe] ~Ie$ it b Ix )~i ble ro ide nrify a dieak (bat CHl jusrify the c1etgtnniry slIch a rna lfo rshymar i ns I1(gtufol Ig ic~ l or genlttic cl iscas s Glnclt~r trauma etc )
[dicirc)parhk S(oliosis has been divicled ~(corcling (0
the ~Ie of tlie patient egrave1l the tiJ1ll of d~[ccli n of the condil ion into ti) ur t ypei ln fanUlc jU nik ltldolesshyccnt lnd aduh Til l m n st cnnunon (VPC IS the acloshylescegravenr o licirceacute I1IJctenzec1 hy 1 sud le l1 tggrH3l ion uuml uring the grow tll Spllrt (Hg 1)2
lhile p tu 1l sco liosi i5 Ycry lomnw n thl pre shy~Iknct ra te f r adole ent icuumlop~lthic structural CU IY~S in sch )o chilclren are 18middot20
- 10 Co bb d~grels o r m on l -lil
- 2) ~ohh dtgreclt or mort O 2~j - bull () (obb d gre -s )1 mOfeacute ()ll 2
Clin iltI [ d e isio ns lfl IXlSed 111 an lccu r~He pregshynosi which obt inccl in eJch pa ti nt mainly o n the basi of the nsidu~ll p()tlnllltl l of TH1h and the result s of 1 rh clin 1 1 ~l1d tadiogmpl i exlminashyti(ln12ll c noieq uentlya d inica ] la sifiou io n o f the ing le pHient tn -ome estent co incic1 ing w irh the
D diographic one c l n lw SLlIl1H1arizeci 1 1 folIcJ - mikl lc~ (1)(n 20 C bh de~r es - moderJt l betwlen ln md 15 ohh de~ rtes - StV re 111( gt1lt rh n ~J) )bh (kgf s
On the 1) lsis of [hi - dinic d d a lfic t i n (Vith l1l il el lrb tiOI ~ o f the ir b() und~ri e ) in Itllt l cente rS Of SCOtiO LS ITe ltlllent in the Lltin odcl (i rJ Ital lnmct md PI iJ Ugrave tre tmtnt i s plmmcd a fo lltJw 8l
- mild kineslth e (~1fw ~1Il (1 luok-ou t - Hl demte IJragravecegrave 1111101 c(~r md k i rws ithe lJpy - ~cven surgery
Physical exe rcL~e for S(ol iosis
Defi t tiOl l S
PhyS i 11 nU b lIKrlttp middot (or kines ithcIa Pl) i a p rvgrlill or plt~i Gl l (xeriltecircS ~1ci fi ( llJ y ltk ~ loped
y a -11 [ru ine 1pll yslo ther3pisr wirh th e m 10 Hllll
- pre (~ n tit1g tlc aggraaLion of the cl I )flnily in rnild bullcoUm is
- helping tlk Il ld Ct ~lOd ounter~lCtjng its skie elfects in III de rltegrave sc li sis
Tn tl1i_ feSpec1 kinesitl1ert py f JI s oliosis is tonshysider l a o on of peciticcedil training and s genecirc tltllly proposelt in sessions 0 1 4~ ro 60 minute IW) t) tour limes 1 Cee PhysiGtl exerci es can aLo ll v o ther auumlns 1S it oill he dise Issed in this plper
Ir 15 Ilot possib le to cl escribe a single progrlIT1 o r exerc ise a5 pro nrams ale USLIJUy p fgt nll ized ( ( lt
EUH PA ~illDI (DP1I YS IC~ 182
ROlL UF P l 1YSICAL lXl 1lt 1~E IN l IlE 11 ~l) IEd If IlU) l[)VP 1HI AIJ() J)~Cl~ r COl ~I NlG1W il
f)( 15 egraved ( )Il the nee L- 01 indi iuua l pJl itnts) al l l10ugh Lheacute) C l n h t 11 plicd o n a WOU p hJ~js (-1 (0 () pnients PC[ ~l ()lI r)middot lugrave reQCf lhese 1 10 grl lll frequt ml~ V IIT
hnm on in middotituk w allClthltJmiddot -Ill Jnv L l~egrave at Wc w Ht ~huw in lhis lyl peJ it i~ 111 n u -eII1 tu id e ntilv kirK itheJapturlc aims w hitl l ucircrr~spnd LO ugravelt~lil1 DUtshy
g X ir ur ph -s ici l lxtTi~l I~llhe r thln ln dj( us- indishyiJ u1 1progr-lfll
Aduumll l lxUl kisure time ~lOd h )u] Sp u lllll8 ~Ilttishy
i lt egrave~ i middotomm )Ly s iven lel mJ ing ro w hlf ~ Iuumlnsidshyer~d usdul or il lrmfu l in t1 lt rruning (lI tJw ptliJicirct ln tl1bplper Ugrave1 gent ltl l t rl ll bull p lwsiCUgrave lttG iviUes is rl ktll 10 JllI1ltlCc hOlll gtpOlt mJ kIJ1lsIcircl hc lJ l f
i ve lUen tloneumld )bo C on lv ine n dul( re Ull~ 1t~1 t s far Ilten publislt d f I~ mJ I(i noltgtithltl rgt is 11 11 a su h jel lnI deacutehate CJitk haltlt t llltit m itn ltl of l ny lorm o t p l1 ySiClI lxrcL e as a Itwr1 [ J- fo r i liopa tb il jcoJL~b un iL ()ri gin~ initial1) it WIS Ille r rOmiddotUumlK lt brgdv u f p l~lt titu gtllergt w h ) intervenecl hutll tc llcrl ll (mon as cltl HtilJ nic in terventi n man Jgt
1 t lltrJp utl t one 1 md rC j fkll l~ on rhe h sh lf som uni cOen I1v pn t I1cgts wt ldl hll ltl enl1 JI~ haLl nu na l scicnt lfic baisYmiddot HOlh tlle$( trr t peu shy to rh ~rl py tt nJecI to l~~rJ tte C Ih tk CUf -~ pnnshyclr~tll y as a f tsul t of lilo h llIzatio ll of tn imdqultdy ~u pp rt(d S pln eacute 7~ 12 to re-t1 r rI ltrl 1$ l l1C k o f WH llt~~rdl 10 I ndt~-dll()urnah tnd 11( on1 p~l per u suaJly Cl tc([ IS n prelimmtrf lll d 3 ln tt li w ay man (l rrlKpt(Hc H lf O iS Inll ph ~i C U l ~ d vi ~ cI nllog scnliotl pa t le nL~ 3gainst holll ph lca l egravexershyclc and p()rt~1
It m u st t~ n tfd [hat pllyknl txerc j~ tJe~ltm(nls t1iHer 1 lJ rd il1g r rhe rherlpcu tlC litTl~ on lllc h tJ rgt ap p lolc il l the IXlltent lncl hi im r IIIllHnt i- 1 (1(1 rI - 5lt1J lC igt tIl l ( f phJllIlllolopJ al rrea tmln ls Ihith cllffc r 1lt œQlfd- rhe m C cculc u ~t(l luI thl p al 1t n
~mc l 11i (lbE~e Tt i ~ P ~il k tlwreI[middote thll wuumlk ltlll t kin 1or ph~ i Clt1 1 lX r(j~ 1I 111~ t bc loidvd by t h~ Lo iurie IxujCJ1l al1ulhcr a dl ~IS nJI h~ iOg (1 11shygerols llugJr in racr le (wi ller d I ~fJIII ~ I ml thlls re(nl1l rn ndc(1
fn n UI cel1ll r we In(~ hccf) using 1 ) 1 1111 11 ve ) 1 (J p lw l icd ex(r(i~e (0 J ( 1I l tt i~ tlh aITt ~ l~d Ilv m ikl tru cflumiddott1 adokscltnt (cl ioj arh lC icoli is11 2)
ina the f U~ t rc-gt uJrs IefC pu b lishe - the pJ( )grd m 11lt1lt l1te n PWltllk d in fa c t deel()pnlln l~ in th t l itshy OlL1Ii in tl1 r b t ~() ycal f ha ve iclemi fiecl niO l l
m d 111 ur impl rnHm s md d i s )h ilir i (gt~ lue t idlo p lthk amp()lio -i ~ t Jll CIII he 1UO(l if Icirc 1by phyict1 egrave xert iSlgt l fe t rrncllt
l illl
111e aim of t l1JS r~l per ii tmiddot (tv iew tl1( l iterat urt to a(errl ln v llic ll of th~ impa irm 1t~ and Liit hil it il i GllIltec hy ~ o l i()gtj s -o ull he ll nt x or re middotlu celt1 Ili pl1ysical xerclse An u p-to-da te knOvkdge o f tl lt Lgtpecl-gt i necckC1 in rJeumlr) d -oek
- whetll~r there h ltl n adLtIIl ) l tht()d ical bbh fur or JqIIcirclb l l l1 Il( ) f k irt llit herlpy
- h N I)(1 ( 1 Dm tlle p r l c tIcirc(( o f Jebur tiJne )pOfung lcli v l ti ~ IIOU lci he tllf) -d o
II J U V f h 1 I11~ c~~lb li hed Ihe usefuhlLss 01 k il1 shyc ~thtrpy il i aIle dy l nsi 1([(( -r-tI Llleu i n )I11 plJt~ ut the wJrld ir ilt ecircS~nl i 1 I( id n Iv w l1i li ( 1shy
gories 0 1 pl1Vtl( 1excrClgtegt te D)bilI7it ric 1n (Ir st shylliuumlZltio f) lttlt tlgtbltn ing ni trcrccedilh ing erc) hn Id be
vnlcled he tll rhe nuld be lerrillldll1 1 md whidl s tlQu1d be inreœ jf ic(1 IJeClU~l tlley cOli lel Je LI ~ful
Ncuro1llotor impainncnts
Imv aUl llOr~ 11 lt1lt ~tlKlteJ lhe cltlndatiotl bd Ween tl UC1UmiddotIt t l ol(~C t nt id iopml je -nll ~J~ and cli~l l shyler~ lr 1tH lest ihuLIr yt 1 _ 13 ~ 311 D uhoussct 1
1-- ITS tln l ldiopath k s(o lio-L L cll -c d l J l hmgt in th terl tltr f prop li l l pu n md 1I1ar th e detrshyn Hi n i~ na tural 1 ~ronse to ril e need tu ts tu re p()tun ltlluilib riu Ul HcrmJJ1 31~ 11 () d tllat icliupathic ( liCl5j h l it re5u lt Ot1 rw nltuf mot r l ~ltelV
[Id )fcl 3 nI] ~1ltJ U Sr1lle nr to dtorders in centJtI lO~Cl shyIOIDNur) md 1xi~tI moro (Ul1lfOl syt( llI (Fig _l
N htIll -of) H1c S uumll h( rll1 ( ~ l( w ing JI t11 (oshyI-ie on the l l lO]ugy o b doll (nt Rl iu]icirc tlili- middot()lioL m unt fil t-hltll rhl ugravedcmnilV L th e fl5 ult o f 1 (k btcl 11lIFll llI ion nf som t11(WUgravetltnl md pO~ lur( (tnic l~ l licirc1 tl1lt if l p OgtlbJt b C 1l rlw sta l i lin 0f 11 1 Sf llle j lt g )tx l Tt) ohtil n a ))Cli U 1ILzltl I o f p ~llIr~il d l~flo [ in l1litkd ~J)llnSIS me CI Igt(middotqucnr J ~ a ~tmicirc ()nlly or regle Ie Llive
Ali th- 11yp ) tlw~es rd ~lte tr d irtl Itn t pnl1tlt o f [11 v hole ~piltm It11[ controls postu re ~nd mrw shyment lrre pell ic of tlh po int a d lI~ llv inH llYegraved il i ~ ll 1 nnable tCl aSUilll ri 1l tr l ll1 lo g thi ~ys ttm ( Qu it le 1I middoteli tl
lt ch ugt nlt~(S f rullliIl thil i nlomwtion th at p tlmiddot shyiCil J(tl iIies nw gt Il lInport~n t rr le to pbv [11Icircgt role ca n 1)lt slI i11l1lariztd ln lWO the ptu li ain Llt
- d elopmll1 l of p uumlltl St1 b Hlt ) - c1e veuml IOpm 1)[ o f bhll1ltc _
(k llhUl)lOr S Cll orr
ontrot oic whan-lt
------+ 1 ~ il lnll ugrave r AINnl
Cllnlr1
T bflt~ r
fltL1 tlli
lMini
l
~sary ~J-frlllen i )f
~ 1 ocirctnl
~UcirclllIJJlW Ll
AXl ~l1 n uumll l) r sy 5t ~nl
middoticoltoq ~ Fig 2-AcFgtrdong lU He-mutl 21 il is Fi)5~ ib1e rD prolXgtSlt l -oo ie1 mnd 1 ((if ~ elio egrave middotAhltr~d l)Qdy-p ati~ I I i u d) uren ttllOn k td LO In ~ory reHTt I1 eDi tn l al ) JdrnlV~ pn)4~ e l u r~o(Ofe 0-c1 eptunl dvstil t1 ctlon sltŒ(ry icircltu nu11t ilwnt [ ~mC ~ted tl l1 ce Ill trpntlshyUumlfJJl nd IKnle~ r~dibl jtugrave)n of -I) m tlosen Ir ~ig nj tl (I1vying ln fornll1U n (lI an ereltl ~piJl e Mmor aJJ r--a t ~) n ltgtf ti lt aXljl mowr plem iHUC Wh ~fl Ille 6ubjeco m uumlntl Icircn (1oJifitd perccpfLlI l ~na l ysilt of p n)lnocepti Icircnfu rnlaquol ti desnibJOS ~n t tecr spin A IICW motor co nrro l Ira I gy t adopt resu ltin~ in the ~tr ltctltr 1 ckformh y lf IdiopathirL scollos i=i Ht lrftU1uc nltnt l ISll I1lJy h1e- ~ I pro()und elkn on bralO Sfem flJll ct i(lnn~lLhu modifyRll Ille nltulltgtshytl10 ) 1 1111 Uu l-lHoror control 5~Shnl$ shy
As Srtgn1lt1 l ~ ltlssert~ if wc l C -Cp t 111 1 un o f the G IiC s oliosls L l tisorckr oi th e ltquilibrilltn sys t ~ms it is lagical to oriegravenrate physlCl l exercis( lherap y ln th is d ir(gtCli()[1
11lclte goals Cul tl lfOUgil ditrercn t modes 01 action be Olchic(-c1 witJ1 phykal accivit ie
- po rt ive Cll ities p ro ct LJ e aIl UgravelClltrtsc in 6lte nshyel ll )o rd in~lti n pinai pr0prinup ti_)[J nLi mOVeshyment control 0 vio lls iy ln thh repect ome lCtivshylites aœ pre um~I I)y lXrter tllln ntil crs
- kinrl lira py using pedJil exerCisocirc specially developecl lith th est 1101 5 in mind illVuuml VC I lllore prccilt( ll1d InC1 li zed cri n on rhe spiJw focusing
a90
1 ~~
lg -lNheJo ~1l l1 t r~l g rld in 1 1) h i(~ IImiddot ct r rHienl w i ll idlllhic _It ~i ~ _ iri s plt ~I le II find Jit ltH vlllleuml ~l Cgtbl tn~ ks III d il fef lt p ~ lt ihnS nu v~tl middot B ~a~pt u Il C middotl)Icircd ~(t l l11 C dlfkrCnl middot- hdween slllndi1g Uline nu nllt1Xinul oorrec ri nI t chied Vith Ct (J ) und tfdincJ ne lot es o UIine 1 fo llnVs middotIJfl tfi ni( - ltlrshy
reltiK)n ~ Ikexibiliry st3nucircing - -pirte - f ur~1 1IbjISC ltupin - ltorrcaion - - r~luci()il ll ymiddot For flmpllt in J npK l1 pH k1J il
plt1SSlhlc ln obtai n 10 u1 511ndlt)l [YLo lion yr ln Slt p ille rlOlgt itlugraven om l J ~ in ( gttf(C rigtIl lIex lbuil 15 i (r-l l=22deg pol lltl ~~J IIlpraquo is IcircO~-V- I t1 l nd tucircu(Ugrave) ilil) I~ 3laquoJO- IH-12
r ln Ugravel e abilit jl of tluuml [m e llu to co ntro l irse lr in ~ pac
fuld l oftlles uumlllelve ntio ns can presum1b1r incn~~ Ih enl ac )1 the orller and lHitlll r of Ille rn - 11 )ltd h e lllldenl lu EJ3)4il
Posl1l1-t collapse lnd slabilizariotl
lIle concept u fplt st lUal c(l lJap~e l l~t Iwen detin 61 by DlI II-T3e~tupegrave rL t Ac oJdin)j tu tl1i- ~ll1thor il [ nec(sary ~- l Hn Cv-tlualing th tleihility o f a col shylo tIcircC CUJVL (0 clistingu ih bt tVeen the re du ihil [ty index (th - li iffer gt le bet ~middot Il ~I r~tcli()grJph ie ~xnmshyinltio n of the iI111 pHienr in supine po ition m(i
ROte OF Pl rnmL EŒIlCISE IN THE TREAT-ŒNT OP ~I IJD IDIOPAnnC OOU~GEm seou SIS EltJRINI
I (~)-----------------------~
__ _~ _____ _~ __ __ L ___~ ________1 ____ _ __ ____ ___ ___ _____L___ _____ l___ ----------L ______ _
1 ~
1
-- ------- --1---- ---- ]---r --- -----_----t- ---- --- ---shy__ ______~---- __ ____ 1________ __ _1_ __ ____ __shy
~ (1 J
1
8 =~~=r=middotmiddotmiddotmiddoti~=-middotl--- middotmiddotmiddotshy--------------t----------~- -------- - ------__shy
~---- --- -- -~ -------------r---- -- -- ~-- - -------- --shy----i-------r-- - ---- ~~-shy
il 1~ 0
Dtl-Lmiddot ~ lttj l r~ UIltltlHt
f g 1 -TI1 u ilictf 1ld ( ii 11- ugraveu-sh) ld IX~ O 1d wllich ltJdnrshymII Il nf the pilll 1 ~tln~1 of th e -o lioti( spinc n IG~nI(J II IIIshytt) lhe iJeuml grl-e o f ~ ()Ii ti c (u rvH Il 1 w dcpc-nlknrly o l l he 10 111shy
P01(nl (pntt l ~ 1 1 nr ffll wrJ I) ln w hilth Ihe n i 1gt( ~ duc nL~ grlphs fm I h~lt 111lt hi~hr Iht Col h ~Ilu t (l f Lite ~Ul Ihe m Ol CI il y th t s(uumlJotil middotpin~ ~111 he ~middotJg gr~lVH(~(1
m mJxiTIt corrttt ion wll iJl i~ lIllCd to Ih - xt 1shy
lti Oilil y Jf tl1lt t Ut JO rl1t cdnUc idt md p OS shy
tU ll cul lapse ( th t ltHill enct b-tten l lUdioL) 1lphic egraveltamJl1ltlti OI1 J t th e ~lme pa tient in Sl il tl cling lOJ lline fX-sitiutl ) Wll ic h correb lc- onl wil ll fhe abilt ty of lllt p tu rl l gt s tem to C( lunternct lIk luree o r grl viry )cco d ing rv D lfVd- f3egraveLIprc po st li r t1 lt01shyIlDse is d ue to the Jnus -u lar ton a nd 11ll ex rCrIshy i) i itv of rhe tissus n the ( O IW-) si it (If the (01shyjl ti (~JtVe (Fi~ 3 L Pu~t llr1 C lltpstl lu lcl l ~~ reduc l-lt by llwans o f pl1ysica l cxerCles specitkally s tuclled ruuml i rnprove tIlus--ubr fOHt md lU pr )cllI Ct 1 ~11 hi shy
lizing ffCd
PararcL n tll CIJ cl the cr iti ca l (3 c1 thlsho ld beQ ld Il ich defol1J lHU n of the i pinlt 1 e~ in~ ne dtlllontr~1t _cl (1l ll t grclrf r mg] o f rllt C II in a qa m bng pos ition corn pOil 15 t l lowcr detormashytion lhnsllold (Fig 1) ie to ~11l Ulne3Se t the risk of pr ogr t~ lu n There t rh eJef re l J ea r l)iuuml 1itshycJ l ~ll1 l l(tl a 1 tnr tg ro b ohwined by d -cr t l ~ illg ilmiddot pU~lUrll cull lpse ptJcelJtge w bich lccording t i)
h llTd tnd ~l(heJ1l ~on 1~ b inde cl 1X llt icularly luumlgh Ugravel mllcl c Iio~ i (bdow 2( 0 ) (F ig 5 J
Fin a Il III ch iS respect lllljl hl and b um l 01 m linmiddot
ii iI 1 l _ _~ _ ___I ___ ___ __L ___ _ ___ ___J______ ___ 1 ___
li 1 1 1 1 i 1
1 i ___--____---___----__-_---_~- _ _--_ ___-+----
i
1
i -- ~- -- ---~-----_-~-_-_--_1-~
l ~
i
+----r--------t-------t------f-- J
Fj~ ~-Ac(XjJlin(Q luuml T O rIcd ~lnd Na(h(ln~ n i () dl( pCG w rd (rTIshy
POO ll is hiherin cu rvegt in wh ilt l1lh ~1flILWrd cII1I Olk l1t IS le- pr(v~knt ln th e grtph Ih t PogttJlJ I ugtnq) Ot1 -J1l j elfltS-e J tlt 1l1t obb dirr remc rlLIv obu incu f roll l the Cohb atl( 0 1stlI1dtJ1g IId gtupinc rldo~raf115 Ih Ille lt) [1l1t1 (i lndnl I pine) 511pille the ~(nlClu tJ1 compo l1lnt U rlk CU Y _VeJily I~ ltx p rlt 1 L1v UpUlt (obh Illeturo Ih t si _b Cct rtJeSIm l fie -ltn J trd Ugraveltuuml shyuumlo n A~-i)rding LP 11(lt uuta o n l ( r1I~( in ~I 2JQ sup itlt curvt 1hi C(]l)b ddhccno l l f lO is -J-lultt( thc s ldnd inr tnla Ol1l t lS wi Q) whil 11) 1 1)401 ~llp lne ClHVC If ~ 1Omiddot ( tcl Lhe ttnd trl~ nlca~ I(t I ~ ~I)
tli n ll w l lllE cq lin ti spin h~ i ng mo r ~ Llnt~II) 1 tlun the nOftl111 one n Cll l gr(lk ( (cU ve tl1u n da r u p shy
po rt in o r k r 10 m linrl in tht 1xi11po tuf_ n th ha__i of th egt onideratl lr1S it f(lll() rhJt
ph rH (~Uuml e erd es ulukl h u - ul iiuml tbeacuteY ~U-L lm cl 1l (It-d o pmg p05111 td C Jl1twl lS fuumlrnll~ rly d ccrll1td ln an Ql St if i imr ol1111 t ru t(( - tht m(d in C JI shy
r t t r sture fO Ir -ngthen tlll m u ck-gt of the spint mainl) in (11erl antig r3ilrl tIcirclt l]lli fun ctin ll U hy meU15 dl i )ll1 t trk ~ lhJ cl( -ll tlt C)nlr~lUions ~llld no l IdOshy
1l)llic d YIltll1k lt l jAJ lktic t) I1 ) II 11)t 111 hd posibleacute t lcluuml ee postura l io nrro and stfh ili lllllt IJI
w i thout food T1lw(ull r d I( Lf(11 Ibk t m ucircnuin Ihe c()rf ~ct [ ()S tu re for cl gtu ifKi IH lLl1gth 0f ti l11 ~
This i-l ddl usl a typl 11 dnmnin (tf k inesllh rap) in 11 (lt-11 [[k - p~d fk lnr in lng f u l1a in llllliCk is poss ihle lI sing ctrtain Idncl fJ l (lt) 11111 liun S p Ul in tb is Cl c is ulttful ooly sa I~tr 1~ il Iw lps t1w lxltknt 1 becuJl)t 1gtlt ltlt-I a ClJu~l inred irl ilL ntllru l o~ i cll
and I1lll~lJhl r-keJc LIl [rll-llIn~ middot etlt(wrs JI the int e rmiddot vlnrion
[J ROPA MfJ) I()Wf-I YSJ IR
1
ICR 1 1-1
r
1 shy ~
- shy
11 o-llrfOlhe5l~ o t Ih 1O~(1dity i n h ~ r ~ ll nr pbl1 l of ~ Spl11 in 111011 _llti1Gt l lPt f ltlJUCWJtl ( ~l Ihe Ir t 1 1gt illbll W Ilh LtltrJ1dlion Vln lbe rigronl middotUII~ l(I Dko n12 lIll h lumshydlanie1 1 [ nul 1 M hl whtrc M - gt) lnIUI1g 111laquo111laquo1 1 1 c rtJCshytjC~ f fce d -d Lill l1~ o f enr niI pUll spnmcl1y 1~ 111 mldlll1lt (n the fl1ur t 1 = tor~ of f(ward Ileuuml l = ughtel1lng fmiddotr p 1shynOf stn lClU= Alaquo rdtllg 1raquo Ihl~ - lin hull th l1ltgtllugrave ot tller1l lUr~Jtllrc F the ~pin t -ilh rlu1i tf Ihl 1 1Ibulll n lrlt InltT1 1
rbc prJI 3IJi l1ty d qrlOIJ~ n bull JI t IlJIII Hm lA the v=ltd gtc e lu-ing J 5lnK1ura i ltfnnity
Dioal e ch anicll itllp~lir J11 c nt
Ihrcemiddotdimcllgtional mc-cbal1in of the s pioc
~f Ikmiddot i t i nly l(œ ntly tlHr llk pr-5tnœ or nc ushy1 lnlo tnr impairment in Idiopttlllc s-ol ii IXl tknt liuml J$ heen h i- ll licircghlcJ hy re$eJ rh tll e preit ilegravee h inm b nIcirc Ji d lJutg~ lt hl ~ 1 ng t o n dO Ulll urcel 1 i5 (l lreldv well umlersrood H(j-ev~r nev lbt un h iomcrhankal im l) ion nI h1c rectm ly onk l n tIlt tre and p r~dou in f n rmtinn hou t pl1ykd (~fcl5( in t 11 0 tl1I _ltgt pbne of spact 1115 Im trqlt-u 1rom J i-[) v ing unclcrsrmdlng ot th l lmc -dim nshy~ilnl l l11 ~ hmk f the cO]jO[lC pln( ~2middot ) ) Ve- w ill )iI xnl t l1 d at lcL-orcltng tUl cl sif iol t lOn blsed o n gtolllt lricd h uumlCJ ) p lane
- b() rJzU[1tl ln th i pla n ~ th t 1o rm ll sp ine present no CUlye- w ll ile Uumll(~ ltc U Hic spLnc clevelops one of ir haracterls(Icircc deFo rm tiCs v elt tbrd ln lashytio n vh icl1 pJ()VcA~ theacute hw 11
- lgitltl in th llulJe U l(~ nonmll spIcirclle pl SenL kypl lOSis ~nd l dooi~ in tb lXI1 lhese [(Hu rts Vere m)( til ught [ 0 he relattd tlle scolkJtlc ( lI r Vegrave
- front l in hi pleme tht ncrmal p ine preseuron t no curYegrave whil thl ~11li tic p in ugravetI I ()~ icircl~ charshyad t Ilt I CU1C
Il Jri fJIIt palic
~l+I~na ra 3 r inr lut th l[ ber ll1d a œl1~lU1 degr 1
l f r()la tJo u lllu (lILa r forcKl ltxert ltJn tl ldefnmuumlng 1 tkllJ [J i1u a re- lhlt tll cly 11 [1 1 UI b y Olm ner w bn ~lh uiJwd tl egrave ro t1tic) l1 Ilm it ti lt p ica] lf shy
rhrl r() be (P (the Uma bevond Wl1iltJl th lCOJlb of [11( ~pmaJ musd ~ dthc COnCIt and nm ex ~l le btconk (t O li~[)
r ~l 18 ~1Il N lu t( ren i9 lun lu ted rlseurlt h in tlt ) tilt lULodeumlformipg1 tlo n ot tIH_ sc laquoJrle rh ox ercallkren lk 1l1~H li d11r once thl Il i ~ r tld1t5 [he lhrth ld f 111 JlIcirc lIi of tlle dnrlclc hurnp tlk
lI bslt Il l nt rlet()rlll lIcircon 01 the it l ()I~ C ( (ylm der (- sustalnecl by an H1tmi cforming aCOOIl
J1Ji h V hl rhyiical f~ f Ise CI 01 h spr n llnd kin middot ith ccedilrapJ my lX damlg ing vll e n l pplild as flle
igt Jk Iller ln SCC1IJ ~IS lllc lJ fxceed l auto in middot crca~ i n g lhrllgthuld [1 sh (~u Id ahn be j ofed that Ilw relscd pre sun 1l1111i insiugrave l fe pil1r inn) 1 mlshylt
- j Il- ( w atff 1 (nh ~1l 1(e Il10 utoldrml ng li1eCh~lI1 1sm
in flc l Geyer ~w tcd th1 t rm m 1 hI l)1ecircch1O lla1 puilll 0 l I C~ sw m mim t Ieuroamp no purpo t for cu lshyim le pllilt t1 s (weumlO middott r it is l~Jl(gtWl1 rhn in iculio r[ paULnl -iJl11T1ill~ doe_gt nor Il ~lp to i ncrt~SL n eur(1shym tor co mfU
(1irai p an (
Jerdnn lle 11 showecl thal ill CSl~ o f t10rLC IC 1i lUgrave
tllo lacolulllhil it lio_1 tlle cte tI llmiry in (he lg itt1 p lln t rn lnlftot il~ lf tspe iuUy in tlw initi 11 r luleuml )f cV IU[Icircon nf Ile ~oli ls W iU l 1 p(t)gr~s~ivlt il10middot~ shy
ment roward hvpok pho b G ll f ill~l Im lins l har dUflng (IN eWllLlfiu1 of 11Imh] co luumlgt i the l in t ot t l H~ gClyty Cegraven te l - 0 1 v llebed lxxli 5 r ro ject 1 seH fl r t side-ys and tlwn backlrcl bull thu~ p(0(1 lj n g a kyphQtlmg aet Il ln (h~ lu mhnr --PIl1 COftj tng
l l i tc Iugrave l lltl l( l rs1 tif s L -etllgt il l the lgirl11
1 Hl)
Ilu LE nI rIIY~Ic~L lXIlKISI 1 HI E TREhTMEtn OP JIU IDIOP llII C AD O USCUH O Ll Œl15 NEGR II
lLill tegt lre lenl1 ~I d ~fo rll1J[ ~ rhl recrSes the phyltiologiGII cmns of lh vine)
Accordlng () Dicion ~2 1 rtcluctio fl in the itgitttl CUIYtS combin l vi th a lueral Iviari n llltl ds t 1
mecban ism () ugravel~ta il ity in l he r rat r IllI1e which bVOf1i the unsd a nd i ncrea~e 0 1 co hlt1is (Fig 6 hiIf md Pl11jlbiJ Jl1eanwlt ile lt(udiecl lh e srnl ru t
orzyglpophySLs show ing t11 al ttleir 1I1tl rnic tl orienshytation f~I (jLi l~ltes aXIal ve rtegravebJl l rotllio ll in cun litluns lt f dorsal hypokrrhn Icirc tnd lum)H de i L lo IS
Tll t dat SLlgge 1 th t impOrfill ut pOitu res and l1lweil1 ) t Mudied in ord t r (CI mlIuml ntrlin or to reuwer fll e p llyslo lo~lCll ClIlye in lIe SlgJtta p lU)l Wlth the llm o t ch ~ kin~ rutltor in l~ bili ry7 AbC th ~e ~k-
1l11nL ~Irt del lnt [0 J jUc lt ftber l]kuti inrervenl ion vhich 1c)LJ k l IV - i(l ~ l compktl n l ililll on Il t c1 l shy-jel1 J11UVllT1ent IJ j o f 1uto-dOneacute(3tlon ( i e a -impk ld ion ) Iengtheni ng o f the pilleacute 011 a litlltl l aXl~ tll lt ((IT liJlI~rcdu e~ t lle ~---lJ linti- l lte ml-fkxj(l n h UI 11 - i llCrl I~t the plllH ](JgicJI dlt cr ~l S ( (1 k-yvllCiSh lIld O(ltOSh l o r c lch r1Iif n t a Ilew til(~ecirc dUuml llt Ilshy
si lflltl J ll1 u(~nlent iam ecl - 1l1t0- lIrfe rionmiddot7 4 llmshyp oed f Je-rura l iUIl cl middot-t1e- iltm lI1d ll1a intltnUlLe )( 5lg it d C Uf (gtS slig lll thltJrc i ypI1 tiZ) tIcircOI1 a nd lunugrave)ar 1()fdos i7~llion) sholild he esw b lb]HU 00 lb co
hl b oi hi p~l11il uU r -1Ir vlt Abo 111( e IlltUtl Chl lie o f purti n - a U vitk slJ1ultI h e )tuumlll ecl 1)] (1 n ldershy](ion r tl1i lt type for e upIe IilJ llyl)T S of repd shyiti( ml vemen prt n t in agonistK h)lnllltlSlks nI iIle kind f dlJ1ce C( uld he ([([r imentd
FmiddotO lllaljlallC and mobili ty of the SpIcircIlC
1 rd llo U 22 d L lm nrrare d lhlt in Illt fro nt a l pll ne
tilt 1 nge Clt 1)1lt vtment of tht scplit[i middot CU IY grcmr lIJ l il ~ d irectio n n f Lhe C ITelt tlO n tha n in tl le di re shyLion of pmgressi n l Fig 7 ) he IL o IS5err lJd tbat th15 mohiliry increac plrtil u la rly n apic [ cgcoeilts 1$ lh ~ ~c() li osb evolves Sragrm rJ 12 J ~ thus rigilt (0
VlI f n rller~p is ts Ilo t t) m o b uumliz - a sCtJl iu til curve w ilhout t [ uling ttwt tlle R lu tiOI o i til t ~a mt b fnlinruumln( 1hy l1tans o f ~I passic 01 1 rivE -uppnrt On tilt (ltllE r hand UgraveK d e iJlioJ1 in ease durill tlw tune 111 whicll tll C spmt i ~ not submjtrcd to correeshy( IV anl()n
j- Virh mi lei ol i b tlllt Upp i1n ill) lC tiol is d eveloped only lllmugil llClIf()mu$Cllbr f r llce thi ~
InegravelIl ~ thclcfo re tl1l[ inu eascgtt sp1J1all1extl)iity mua
11
Imiddotiumltgt 7-rurd illt Ir) 1 bull rdrilt I1 1 in tl lt frOlllll pbnlt- th( illl ge )r mOC llIeJlI o t the S-o UIIJC CUNe 1 supcrior in Ihlt diflt(l im ugrave( the n nKlIl thd n ll1 tllc dlrtcLion o f p rJ1(l( (llIl
be considrCtJ vntrl iJ)(l icltion and 1 undrli neocirc ab L a ~ubiljz~ILion 01 tilt spint pllss il)1y ohtl ll1td thrltJugll the stlengtlkl11ng o f the 1rltJgm vlt nonil lme shyCIC 111 illli orrant u bjcLliH- ln rhis r~f1 n sp u lllni lc tivitIumlLs sil uld lX tPI 10 dlegraveltl it l G lU t n w l1ik luring kine i Icircth lrr phyltical eXegraverci c~ tllat in ele
spinal m ot ilIcirclY sil nid 1e lt1 oid cdrt ~
Organ ie and psychologieal impainncuts and li islbi IiI le
A cgtI im lc pmi nr is moriOthl11 just 1 sp in and 1
compkt gt Ipp rnach to the gu in ad 1 ont i al~ shylute l e~se i t i11
[)a la 0 11[ [n ell lrom re semh pw tbat ome organi Iilnctiond cl fki ts suc]) as tlw clecrtiUe ut vild l tnd d fun ll l)Kity_orld ldly incrtJ k whil~ 0 shy[io s i -till in (1 miel q g of g JltlV ity ~ l ilI e 55 rtI lit
tllL pres e n ce )fl defidt Or Vi l~il Clp~1 - i~ ln one pIIiem in Ihr l ftectecl by 20 ICl 40 scoi stgt l ls~a r(h cunclutecl in tbe UA by Di Ruce- prod uegraveed an aaalo) u ll1lXimum 102 re u t in a group of Jd shyk 1ien t [(h sco llosls rang inF frum ) [0 1
Al10ther rudv bv rallt r m C chr111 lilcl NashycWrl1s( u 57 stlO eltt hil $(C 1 1 ui~ Ica js l( lllt cl (1 shy1prUlllI o f t1tgl lie bJd l imI in ~ul sct t1 t ltu b middot iects jlLltr l5 they are golng through ~I cltlici[e sllge in the fnm 1lt i n 01 tlWH o w n id uHitv t factor hit h Illy jeopmlize the cl velopme lit d ~ mIll lt lI1d htIshym cecl IWI sonalitr in Klulrhood
n RUI ~IEDl(( Ptl Y1-
ROU ltHmiddot PI [ I C~ 1 EXIRCIS]~ IN TI Il nW~JUNT OF SlllO lDIOP1HIC AI)C~ESΠ11 C(gt1[Oi 1S
This i why b IiCieacute ii is ~n imporrlIl t for p rcshyvegraveml e 1tLsr l tn en ou flge 1ari e nrs ~lfrecr(d by lIillcl middotu iosis ft) tlke p~l rt in portin -re rcatioluJ acrivitits Iha t 1eIU 10 L10 th r~1chophyinLl bull nd b~l )i 1l1o tur adlieem t n li 51Jmiddot2Even tlK)ugli [Dr bic mech~lnshy
ical mcl nellIUll10t 11 11 reltl ~ons lt r111 1gtomcrimes be l lefu l to ugg( ~t ne p rt in~ aCt iv ity r l h (gtr rll n anotlJer e th ink Ibal an exces~ ive IlHd icalizltion - Icirce l ll1posilion br plry~ilt i HlS nnejlor parents uf rh ry pe of po rt to lx p m lice 1 b Ule p 1Ucirc(Il L th1[ preshydLl ck l1 is fret clOice in lh ma tt r - -h II ll1 he avolc1ed wb 11 possLhle mainly for tlle i mport~ltll psyshyLb ) jogka l fe a SI)nS W( ha( ill ~ t nltntionegraved
Conclu ion
lbh ISsertegrave d t1H physkal tgtXtlci o is ) n fi ial whlIl practinu in order 10 ilnj rove the I11 llde
rœ nwh and tono C iral caplCiry and postu re o f the StOUO(I ~lIbj n II I nowkdge om ~ middotmg trom ci el1shyrlfi rls(~ Jrc li dJlJ accordl ng r the review 01 thE litshytirlture prnpo )td in t lli plpl r conflrm~ Ihe vuiclit ot th e -t ls ~rti ()ns
In l do l (ent Id iopl1il iC scoliuse il l n phee u i cl vk)pm e n t ( li tll iumlKh eXCC cl l g i en rhk thr hokl th e re i5 an und ubred need fn r l pprnpri 1tegrave (JJ1tOkJJe ~Ild Inr surgict1 therapics ill ortler 1) S l i p
the ( - Iuli on anugrave )JT~t~t UW ~pilll l dtlormities bull evshyerthtless in the illiti ~ll pl l~sC t ttlC c1iseLltc whcn the riS( r1 r euro )luli m is rtduced ocirc ~md tfle uifleal JOld threshold il ~ld flle po stural collai i reJcenw~ 43
JI l1 igh pllysicaJ egravexe rc ise - p revenc or r d llCe d i ~lh ilir ies o f [Iw ~ l() li )tic
p (iems R 28 J -6 5- 6 1 63
- f~KiHtare lh ( n utr ali711iCUl of postu m l d elicits tn produCel1 a coneql l nce J [)ti 0 I111)( or regre si -u lmiddotc 5middot Il 1 17 ~ M
-re 51udles U ~ n Ledecl tu con[mn or re jecr these conClLL i( 1 w l1 ich clerin-d frum 1l1 lIldytica l rcltw n f th e liter~iture appear r- ~Lo nlble Hnwecr Intil ne re ull are 31Iable wc should n r prevent our sroliotic patientmiddot trom tl ki ll p lt in s(loI1ing jshy
ir its pW1iada rly ltl t ~d1()o t () n til t c ntrHY -vith the l xcclrinn 01 gt[1 )11lt tIlat in rea-e t)1obility (tnU evc n thell oilly wh n progr~lgtion b p OSSibl) -uc h ~I( ucircvshyiUe -11 )ulu hl tIKoll w g ed The 11 S J ( rprOpriue kin (~irhe r~l Piuml to incr _~asc p()~tura l $llbil i ty is tl1egraveoretshyic tlly CiJUClt alttloughl more ~Iccu rtte aod deLli led ri k benefi rs anJlr~ is is netot1ed
Ria 1111tO
NIokl Mu d lle ftitYljJfu Jœl il 4IWr10UOifll S (JIvs i (1~1)Jshylidl ttno( cclIll le 11(11(1lt1 RCI fu lle ((lia LltfIt l1 I1I1i(i
LJ ci n s j(r3 pigt egrave li n IHUgru lkl di t rdz t fi sici pe e ft shytUlKm iluppno di un lisimerap15Ll rl lllcflt() 1 110 scopo di pnevirlt () fr en~lI 1-lgpwlllltnlcgt dclld lclonnitugrave o e il 5LOshy
Il i mi llon lt fH nugrave j (1 11ni dei co~e 1 lteIl I1J J nd ne ~Ii eifclti (()Tc rri udk s co lio si d i m e dia g rt iuuml ln que~ltlt
s rud i 30 llizzb mo i d ti cleU ric lca pel n ri Icare qJJ l lm 1 dis(imucirc x u le I[~ l z j-m i pro vna le da lla C gtl k A i json ere pr middote-nute () rk kl ducirc un~l rdeguCltl d nil cra pi lt di uJoseguerrnt Cjua li 1iU110 cli nbie tti 1 rcr lJ)tIId d~ fle)-UITC
n (- -fd7Io n~lcl)
Ut11claquo)si 1 lI tori htpnuuml )ludi-ttn I ~ cnntI1zttu fr Cq(in i idiJ)tic1 dbfl lOZ10l1 d d ~ leOla nelllOll1otoriO Lb un1I1cnUl 1n1l1i3 dcgli 111 lt1i ch DIJgt gtU l H crmU1 Nlch~mslt ( SIshygnaJ~l lerimiddot wo i esuemi -bletti d~ plt~e8lugraver- ne l pClZ le1lftgt scoliodcu kl s iluppo ddl ~ ~ uhjlil~ vertcbral~ lt o svilllp prJ Jdle JIl7 i() nl di ltCjuiljbrio Dng li studi sul lto lb( l~nlrale (OllddU i in pa rticdu d 1 DlIal-BeHJ (gtegraverl ~ P~II IId lI1 n~ llw - idente il v- m gtiu p eT il puientc clioti elgt di u n rnigb o t c)[ ro Ua sw mle dei radlldc onsegull o tramite il 11 fforzrlshyfl len to d e i l1luotoucirc l nllgr3ilri d e luOwo con crcbi ~Clltdr
in pOMltHJ corrctl e in va rie ~i[Jzioni s t llicb c c d inamIcirc tllt Dalle on sena d elb blOffiCcclIlicd tr idimlt n s io mlle d ei
r ~ chi Je ~oU()f icn ~Icirc ~videnuumll (l() ~llt tC p IYZIcircOSI ln(IiClZlfHicircl ~ 1I1shy
liumln fluenzt Je ll middote~rUrio tl SC) lgt lIi I rc pibull m i tldln sJlI71 Stl shygn~I I1 afferma che slI l p Ia no [11 middotccedilr~lk tre un œ rtlJ grado di l L1Liuuml IlC dclh vEltlh r1 apj(de le tu rœ mu SCltJ llri njtbc J n in $tJ ) t rodcfQfll1t1l1te PltJtantu b i r~it-~ r -lp il puugrave t~~
Ixnt-ftla solo nt Ile so )[j)~i Jl1Icirc na rl in qunnt ) ilon SlrM ntne )(l(Ofa tu soglb in caq ) co lltrLJIcircn l)lrilto llt~( i lJudotlsi di lfr~ lI1 C llg grVlmenl J 111 11 io lr riltd ll(17jOill leld rinlle 113 dimO~iumlrlto d llt nell o lin~l cl()~ li t th~oIOl))1 dri la defltgtrshymiti sul p iluO slfl iuale ~vohl lf1 (en5 ion~ sO lnm utto nd 1e bsi iniliali deWggrwm1Cnln mcn trl C a( lfLmn che occlleshyvoluzi ne dene = 110 i [ mhari IJ lin c l ki cen tri ch -1vi1( de i cp i CIt IJ rI Ji SI p m ittIl pnm l Iem lmeme e p o j pOS( shyrio fllwnte dtldnli mdv ( i un ziuuml ne ciloliz7nnl dd rlLtide lu mbJ œ ( lIlelttlaquo on NC n d d (gt11 uIdu m 1I1 Ilgt) cli r-Iure (0 eserClzi che IllUllengano 0 ltlUperifo le Clgt 6gt1 lo)iche sul pirluuml gilwlt Su l p iCl no fron itk Perdnulk il dlll1lt-trlto d1 lampkz-l d i LU ovimento amp111 lI rv Kolio ti ~ nd lt1 0 ddlJ cnrrc-LIcircQo i Ji gC 1 n lungl SUpegraveliltlrccedil 1M llS0 tlell 3ampIGI shyvamcnlo C che l~Jltmiddot mobiliti GlI mcnta co n l c lu7j o fle d l i) snAio i A ulln amplgrtJc1 ltllllmunjx~ i terlpGli nn n m obi shyUZ73It ma eutva coli ti0 1 1ct HsicVlfe nd tcmplt 11 1111nshyttllIcirc1nc n tc (k ll ~1 llu u zinnt n l1 un me77uuml d i sost l11( gt ln 0
e 11111ri b cle - Ilziunc egrave deorinatcl d l rlyarsi Snzcl la pr gtshy
liltlnl l i un() rtl~ i ptmiddot Jtl n(o 1S(Hl () (( ntJ() i ndit~tr i ~ Ii ISt (izi e l m iviL Illdlode ebe Hlmen tno laJlc ibiJii dcl rlc lide SCshy
li io) [n p articobre rune q lldl r C-I1 ich~ xlSiddcHe CUf t shyli ve ch~ iJllpi tgino e~rciii 01( biIi2 ZanUgrave HhnmL-trid () in tmiddot~t~nshy
sione kl fuchide O tne pure k- ~ttivit1 tnotoJII~ non prHi(~ llCcedil
in forma r k rel1tiva d Ie ~1I 11 rF~1l1( n otcol mcnlC 1 lll ubib Ll vcrteblmiddote (ad ~ flp j(l 11 n l) to L ginn ~Iilt Utl clkl rilshyC
mka la cli OT- tcc)
r1il to l~ _ I[Dl COlI rY IC~
NE olUNI
fillncr ( ni ((uuml(( n hIIo( rilclIO ~middothe k lln dtfidl fUr1z i shy
nlu CQll1~ la llcl llZIO 1e delb c apKJl ilde e della capacltl di 0170 mizianu luJndn le (OJ il~ gtna a nc r3 di m~i3 gmshy
v it ln G mlxl r i ~ gko Fl llslrom C dlllJ O e Nachcms(J h iU1I) dim lr JtQ che b o liosl p IOO C1 neUaduksœnr 10 SYil l1p pn d i lIniumlmn~gin nlt8Jliva de corpo in (o nridcnz di Ln ddic3w p ri d di f( m l lz i nlt deUa SUl idenritl condishyZltonc ch pOlrebh ~[I cubrmiddot ln vilu pp di un pe bull n nn lir m llur cd e quiJibfarn in t[C adulro TaU CO1DSCe nZe tvlde nshyZ[II)() la n ( middotess iti di ltimobre la plfte ip a7j0 r1e atl an ivi ll1ltHClr n gl b a li ltl h ~ di tlpO s pu rti middotu dl ittlrc nd gloani iCo lID ti i lirtugraveta z io ni llb vila di relazionc
ln concllliu fu la d tfoflll lL saliu iG egrave il sin l mo di lin) idrotnc C Il1pk 1 d e eoinvo l d middotmiddot= fu n (n i dd rgashynIcirc5H10 n Hi lhdli e lesenizjo fi 1lt0 se 1 Il indirill~t() pllO pr~cnin 0 odLf rgt t lli di fu nzlonicirc adlc s()Jj(bi 111Icircn(i rrHtatc CO ll nl1 cinesi rap i Quand l~ coli i ( n LS~middot iJ11 zia k il rischio evnluLIcircvo egrave lid [() mente no tcole 11 (ltlll asso p o lll shylal ltOtSltgllen7~1 _ ta cincsiterapia pc rslIk bidtlvi shyptutibulli d ubllIcirctIcirc vltnc brn1e di conrro llo )(JSu k d i 5IcirclupPQ d Ile rLlt ziofll d i eC[u ihb ugraveo dJ ftffr otZJH1 r1w dei IIl llJgtCili 1 11Icircshyg rdtarl in posru ra rrenu posslhile JnnalL in Illo lt i clsi l(j luucircun lt di lin ~c() li oi mi n rc ( ume [11 duumlnQstrIO la tinc~ jn~l el1lric ((1l1 ~rtlppi d i contnmiddotllo cnndnlt1 p nso i l entrt d e Massue di Li n nc da [ o llo n ~ Rodo l (1 986) Julndo il1vlce lIfU~ ho ~vutlJ tiVll 11lt1 1IjXIl to un dekrshyuina r o~itl di g rl vir~l bull a~-n lllull~nte n ec ~~uiu rlCUuml rf( ff dla tcrJpll rle si c a eo chirurg ica
1Ho le clllC ooliosi idjopHI 3 ttl1p ~ - E~er l zjo hsco shy11ln ~ I((fapil
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EUROP MIDI C Pli hIC
EDUCATIONMEETING SATURDAY 8thof APRIL 2006
(iSS
SEAS02 Scientific
Exercises Approach to Scoliosis
version 2002
G
S Negrini 1
EDUCATION MEETING SATURDAY8th of APRIL 2006
Neuromotor disfunctions
Neuromuscular disfunctions
11 Postural collapse
Postural collapse
Duval-Beaupegravere
Flexibility of scoliotic curve
f---I--- I Postural element
-------1 Structural element
S Negrini 2
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Postural collapse
Duval-Beaupegravere
It is a value related to muscular tone and to flexibil ity of convex side tissues
Post ural collapse
Bunch e Patwardhan
Critical load
Load threshold beyond wh ich a spine begins buckling
JI~~Wt1lW~flfthtlJlœJtAr ~ J~It- l~l - IMS
Postu ral collapse
Bunch e Patwardhan
If a curve reduces there is an increase of the deformation threshold
~~~NW~-damaoc~IIIMf ~~ J~Iv JaJ-I7I9sect
S Negrini 3
EDUCATION MEETING SATURDAY 8th of APRIL2006
Postural collapse
Torrel e Nachemson ~
Scolioses below 20deg ~ ~ lt~
have a high ~ ~ percentage of ~ ~
~postural collapse (on u~
average 75) ~~ 2i~
CU~VE O EG~EE S WHllE SUPlti e
~laquotd~c6b ____lPffI1wtt1t~
$ww J(t ~~7 JM5
Postural collapse
Minor scolioses 7
Antigravity musc es strengthening D
Reduces postural collapse -G
Increases the critical threshold of deformation
G
Neuromotor disfunetions
Stagnara
If we admit that one of the causes of idiopathie scoliosis is a disfunction in balance systems it is logical to orientate physical exercises toward this direction
s Negrini 4
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Neuromotor disfunctions
Dubousset
Idiopathie seoliosis results fram alterations in praprioeeption centres and deformation is a natural compensation to restore postural balance
etattJtitIK ypothfQj~S ___~ own_ oJ)HQr lar 1t-1( r
Neuromotor disfunctions
Nachemson Initial idiopathie scoliosis
+ Goood spine stability
Neutralization of postural deficits
D Static curve
Neuromotor disfunctions
Therapeutic aims
c) Development of spine stability
C) Development of balance reactions
G
S Negrini 5
EDUCATION MEETING SATURDAY 8thof APRIL 2006
Biomechanical disfunctions
j Horizontal r-Ian
i Sagi ttal plan
Frontal plan
Frontal plan
q Frontal plan disfunetions
Fronta l plan
Perdriolle Movement magnitude
gt in the direction of lt in the direction of correction progression
S Negrini 6
EDUCATION MEETING SATURDAY8th of APRIL 2006
Frontal plan
Stagnara
Never mobilize a scoliotic curve without ensuring reduction maintenance over time otherwise a greater mobility favours scoliosis progression
Frontal plan
Ducongeacute~ research
On a group of adolescent idiopathie scolioses treated with
Meacuteziegraveres gymnastics
D After 1 year the mean angle of
curves increased from 18deg to 29deg
Frontal plan
Scoliosis without brace
D Greater spine
flexibility D-
Risk of progression
S Negrini 7
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Frontal plan
Mobilization is useful
D In preparation to
brace
D With brace
Sagittal plan
QSagittal plan disfunctions
Sagittal plan r middot _J o
Perdriolle scouos B CJ aDeformation of D
thoracic and thoraco-Iumbar curves evolves in extension
S Negrini 8
EDUCATION MEETING SATURDAY8th of APRIL 2006
Sagittal plan
Graf
The line of gravity centres in the vertebral bodies o s c oUOSt
projects itself firstly laterally and then fi
o
posteriorly lJ ~~ ~~ ~ ~~-_J-D ~nI~
Sagittal plan
Therapeutic a ims
D Maintain or
retrieve physiological curves on the sagittal plan
Horizontal plan
QHorizontal plan disfunctions
S Negnni 9
EDUCATION MEETINGSATURDAY 8th of APRIL 2006
Horizontal plan
Stagnara The forces applied ta the spi ne act in a autoshydeforming sense
Horizontal plan
Dimnet Rotation gt 200
ampII~ (
D The actions of concave and convex side
muscles become
agonistic
~ItJrOnrIIiItdllfUClltlluumlll~~tI ~1JIf1laJ
Horizontal plan
Minor scolioses never exceed these autoshy
deformation thresholds
S Negrini 10
EDUCATION MEETING SATURDAY8th of APRIL 2006
Disfunctions at a biological organic and psychological
lever
Oisfunclions at a biological organlc and psychologlcal lever
Cheng
Bane density in scoliotic teenagers is lower than in normal subjects
~~~~middotA~IIlUtIy ~7œl 1d l
Oisfunctions at a blologlcal organic and psychologicallevel
A significant reduction of vital capacity and V02max in teenagers with a medium severity scoliosis
S Negrini 11
li
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Disfunctions at a biological organic and psychologicallevel
Disorders in the development of body image that the teenager has of himherself
Disfunctions at a blologlca l organlc and psychologicallevel
Therapeutic aims
cJ Activate cardioshyrespiratory function
cJ Favour bone density increase
cJ Develop a positive image of the body
Disfunctions at il biological organi and psydlologicallevel
Stagnara
Sport
D The active side of
kinesitherapy
S Negrini 12
EDUCATION MEETING SATURDAY 8thof APRIL 2006
Disfunctions at a biological organic and psychological
level
Distunctions at a biologlcal organlc and psychologicallevel
Cheng
Bone density in scoliotic teenagers is lower than in normal subjects
~n~IIIvpWr~middotA~stWy s- XXJl M J
Disfunctions at a biological organic and psychologicallevel
A significant reduction of vital capacity and V02max in teenagers with a medium severity scoliosis
G
S Negrini 11
EDUCATIONMEETING SATURDAY 8th of APRIL 2006
Kinesitherapy on the scoliotic subject
q Postural control
q Axial stability
q Muscular trophism
q Balance
q Respiratory function
The limits of kinesitherapy
There is a threshold beyond which
rehabilitation alone is not enough
sssr
Kinesitherapy in scoliosis treatment with brace
Therapeutic aims
S Negrini 13
6
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Therapeutic aims Srace kinesitherapy
With brace
il Postural corrections and
vertebral stability are obtained by the brace
Therapeutic aims Srace kinesitherapy
In preparation to the brace
il Mobilize spine on ail plans
Therapeutic aims Srace kinesitherapy
With brace D
Maintain a normal spine elasticity
~ Maintain a good muscular toneshy
trophism
C Model the hump with kyphotizating
exercises
S Negrini 14
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Exercises and their methodologies can vary accord ing to learning and individual sensibility of the single rehabilitator that proposes the m provided that they stay within the
Iimits of fixed therapeutic objectives
li
Therapeutic modalities
(Exercises)
QAuto-correction
QRespiratory education
QErgonomie education
QMuscular strengthening
QDevelopment of balance reactions
WNeuromotor integration
ci Vertebral mobiJization
QSpecifie modalities in brace treatment
S Negrini 15
EDUCATION MEETING SATURDAY 8th of APRIL 2006
The protocol of kinesitherapic
treatment
G
QChoice and dosage of exercises
Variatiosn of the work program every 2 - 3 months
Q Execute e)(ercises on an individual base or in a small group
Q Frequency not less than 2 times 1 week
Involve and awaken the family
G
S Negrini 16
EDUCATION MEETINGSATURDAY 8thof APRIL 2006
Q Determine the action and the localization of auto-correction
QAuto-correction must be associated to ail exercises
QAt the end of treatment ergonomy lesson
Auto-correction didactics
G
SCOLIOSI DORSALE---- shy ----
r
S Negrini 17
EDUCATION MEETING SATURDAY8thof APRIL 2006
SCOLIOS OORSOLOMBARE
shy
SCOLIOSI OOIlSALE 011 bull LOMBARE S1I--shy
SCOLIOSI LOMBARE
il --~_-
S Negrini 18
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Scoliotic patients are not radiographs
middotSeoliotie Mtients are not ndiographs but hum beings with a vertebral deviation-
Slagnara
Metha For the physieian Cobb angle is of utmost
importance For the patient it is body deformity t hat eounts most rib hump a protruding seapula or hip We are in a situation in whieh today dodors eure the radiographie deformity but what the patient really desires is to get rid of clinieal deformity and of ensuing psyehologieal distress
CIIQItIo shDuIdtucirc lM WIld tJw~~ I~~M~~~~ J9f~
S Negrini 19
- Poznan_workshop_Physiotherapy
- physio2
- physio3pdf
- physio4
- physio5
- physio6
- physio7
- physio8
- physio9
- physio10
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EUT S pine J (1997) () 93-97 copy S pringer-Verl ag lY07 ORIGINAL ARTICLE
K Dobosiewicz Neurophysiological mechanism of the unloading reflex as a prognostic factor in the early stages of idiopathie adolescent scoliosis
Rcceivcd 29 M arch 1996 Revised 16 August 1996 Acccp tcd 10 Septem ber 1996
Absfract This paper presents a new nc urophy iologila1 methougrave of e valushyati ng the risk o f p rogression in ill ioshy
mo t important factors in the eva luashytion of progress ive id io pathie scolioshysis The met hod can be lIsed to deshy
pathie scoliosis in th early stages uf tll( progre jve idiopath ie scolios is the dis ase by illY middottigating tll e unshy in lhe early s tages of the d isease loading refl ex in paraspinal muscles T he high sensi livi ty of ilie method The study incl uded 394 pat ients wilh means il can be used as a basis un seo liosis and 70 hcalt y chil dre n which to take an earl y dcc ision to
K D obosicwicz Depuumll1 mel1 l of Rchabi lilu lioll Si lesilln Medical Academ y 42-604 Tamo wskie G6ry 4
Lmenty of the unloacli ng retle x and repeatabi li ty o f Ihe rcbound and silent period were anal ysed for eaeh reflex evoked Prolonged latency and
p rimiddotom1 surgery
Key words Id iopathie seoli o is Unloadi ng rcnex Re bound
Katowice Polaml minima1 numbe o f cycles are the Larency Si ent period
T he ai m of this sludy was to evaJ uate the use of the unshyIntroduction load ing Dex for octcction of prog ressive id iopath ie adoshy
le cem oIios is in its carl s tages in onl r to lake a dccishyProg ress io n of id iopatJl ic scolios is bas been the su bject of
sion ta perfo nn surgcry as soon as pussible many clin ical radiological and elecrromyographic in ve~ shy
tigalions T here is ho wellcr no sim ple quantita ti ve or qual itati ve pro noslic methoo [hat can be em ployed in the
Materials and melhodsearly ~tHges of the disease Monitoring of lhe unloading rc felx in paraspinal m llsck appcars 10 be a reliable Inv gtsi lgnlions were carricd uut 011 394 pa tie nt with adolescent method o f discriminating bctwcen diffcrcn l fomls of Cushy ~c li ed J ild 70 hCldr hy children The scoli osis group consisted of Iios is T he un loa ing re n cx can be evokcd in ail the 31 1 g irl s and 83 boys aged 9-1 8 year~ (mean age 125 ycars) The
ske lelal muscles through a suegrave den shortening of o luntary contro ls wcre 0 girl s and 10 boys aged tO-1 7 y~ar (rncan age 128 cars ) Imong Ihe stlbjeclS tudied wcre 9 patien l w ith cershyinnervated muscle l2~J When a musc le is unloaJ ed vico-thoilc i seo liosi s mean Cobb ang le 22 7deg 121 with Ihoracic
rapidly durin g an isomerric con trac tion Ihe norm al reacshy scolios is mean Cobb nngle 309deg I 1 w ith thoraco-Iurnbar seolioshylion is an eleclrically silent pe riod fo llowed by a burs t o f s is rne ~n Co bb ang le 26~g o 63 with lumbar cotlos is mean Cobb action potentials called rebmmd The pause in d ischarge ang le 279deg and 90 w ir h doubh major curve sc o Ii() ~ i s meull o bb
nng le 292deg and 28 5deg The sludy group includcd 231 right -s ided can be observed only when a certai n h reshold va lue of and 163 left-sided 5col iouumlc patien ls There were 112 patients w ith
acceJcration flnd shortening of he muscle is exceeded progress ive id iopath ie scoliosi (76 ri g hHidtd and 36 Ic 1t-s ided) an tl il occues wilh constant latcncy correspond ing to that 182 with no n-progressive idjopa thic scoliosis (1 13 ri ght- sided and of the propriocepti ve nflcx (9 18 20] T he rebound ufter 6 le rt-sided) M d 100 w ith pe lvic tilt (statie) scolios is (42 rightshy
s ided anp 58 l eft -~ i(kd )the silent period in the unloaugraveing re felx rcsul ts from ae lishySC9 1ios is is consIcircdered progressive if the Cobb Jngle inshyvalio n of a pool of motone urons aIl o f which fClt1ch lhe
creltseacutes by more lhan 6 in 1 yen r aile middotnl1 n-progrcssive if the anshyfiring thres hold simultancously afte r prcviou~ si lenœ [l nua i increase is less thll n (i The Cobb angle ranged lrom 8deg to 77deg 1 4 201 in Ihe palicnls w ilh progress ive scoliosis (mean 361 ) [rom 30 ta
lI f R (on- f Rt tt1IY 1lIfl pflla 1 )(~ r(Jnu n t shy
fI) _ ~
Pathomechanic basics of conservative treatment of progressive idiopathic scoliosIcircs
according ta Dobosiewicz method based upon radiologie evaluation
Kryslyna DobosiewlcZ Jacek Dunnala Kny ztof Czemicki Hanna Jcndf7cjek
Deparmem of Rellabtlifatoll Mediw Uninrsity ofSiltsia KatOllice Poand 40-635 Katowice fil ZiUCl 3537 POL4ND
e-mail relwbilitacjt1s11mfoctaonetpl
Abstract Conscralivc IrcalrnCnI of Idiopathie scoht)~1 espcclall y kinc ilhcrapy i ~
nOI widcly apprccilllcd due 10 Ils suspectccl low dfcCIIcircvcnc 5 in relalion [ (1 a urglcal Irc[llment ACter long-ycar il ses ment of palomcchanic f scolio icirc in Dcpanmenl of Rchnhllilallon f Mclii al Unlcrsi ly of Sile bull a concTvallvc mcthod ()f IrCtllmenl asymmclric Irunk mobili7alion in lnclly ymmelm po~itions WIS
de el ped_Thi mClh d enablc 10 delain pTogression f scol iosis or ccn de middotrca~c laIerai urvalurc of a spi ne and angle of rOlllion assummg adequate () perallon f palicnl and ilS famil)
J Introduction
Idiopathie scoliosi OS) is a thrccdimensonal dcfonnation of il vertebral col lmm an- cntire trunk Afler many years of extensive rescarchcs the cause of idiopathie coliosIcircs $ i remaIcircns unknown It is possible Ihat idiopathie scoliosis devel ps and progress on a baslS 0- ~
multifactor disorder perhaps diffcrent for curve initiation and curve progressi 11 Fion poss ible pathologie factors nervous system dysfunctIcircons affecting postural tquili brium ar proprioceptive control seem to be espc ially important [ l 2 6 JI Pro_ ression f iS could bot delermincd by vertcbrac remodeling under eccent ri c loading created by axia lly ce gravitational forces in presence of muscular imbalancc in the trunk [2 J The verte rai colwrz unde r scoliotic conditions 15 an unstable system with tcndency to fu rther tune dcvelopment fl2] Lateral bending of a vertebral column visible in X-ray examination L
only a two-dimensional prcstntation of a complex dcformity consisting of patho logica axi rota ti on torsion and othcr deformations of vertebrae [7 8 10 II 14J ln fS physiolog~ curvatures of vcrtebra l column are disturbed Total Icngth of an anterior column of a spi n~
consi ting of vertebral bodies and intcrvertebral dises bccomcs grcater lhan length of l posterior colwnn - vertebral arches and proccsses [11 15 J h is apparent that phy iologi ~
thoracic kyphosis in rcgion of a scoliotIcircC curve diminishes Each vcrtebra of a stru tu ~
urve of coliosis is oricntatcd in hypercxtcnsion in relation t adjacent vcrtcbrae [7 l resulting
1 n B Uri middota I l 11
H srut ft illtf j tI) t li orf1Hli d
IDS Prt ts 21)2
Influence of method of asymmetric trunk mobilization on shaping of a physiological
thoracic kyphosis in children and youth suffering from progressive idiopathie scoliosis
Krystyna Dobo icwicz Jacek Dunnala Hanna Jendrzejck Krzysztof Czernicki
Deparrment of Rehabilitation Medical University ofSilesia KaloKce Poand 40-635 Katowice ut Ziolowa 3537 POLAND
e-mail rehabiliracjas(u1poCmiddottaollelpl
Abslract Idiopathie scoliosis (lS) which i sub 1 ntially l threeshydimen ional derormation or a pine cau e nOl only laler l curvalurc and axial rotation of vertebral column but al lordoti allon of VCr1cbrac in structural curve eXl nsion ln an effect physiological thoracic kypho j diminishc or cvcn dbappears Method of a ymlllctric lrunk mobilisation in strictly symmetric po iljon according [ Do () lewicz not only dcteriorme progre ion of IS or evcn reduces lalera] curvalure but also significmtly rebuild physiological thoracic kyphosis Icircn cases of lS accompanicd by lraight baclc
1 Introduction
Despitc Ion year researchc etiology of IS is nOl yel resol ed Significant problem re laled lO morphology of IS apar1 from lateral bending and ax i 1 r tati n i deviation of shape of a spine in sagittal axis affecting physiologi al curvatu re of vertebral coJumn [3 5 6 8 9 J 0 1t 12 Lcngth of anLerior col umn of a pin constitutcd by venebral hafls anugrave intcrvencbral dises dominate ovcr Jength of po terier c lurnn buill from vertebral arches and processes [lOJ This condition uring scol io i progress ion and growth of a child effect in hallowing or even disappearing of phy iological Lhoracic kyphosis in scoliotic region It i well know n lhar cn~brae of structu ral Jaleral curve are positioncd in hyperextension - lordotisation [5 6] which in Lhoracic region Icad (0 reduction of kyphosi or to true lordo middotis Such kind of venebrae relation in thoracic region cau es ilS destabicirclisatIcircon whi h in u sociation with eccentricircc gfilvitali nal load fa pinc duc to muscu lar icircmbalance [21 pOdbly produces r tationaJ lordo is [56 Il] and further development of symptomatic scoHose ft ha becn proven [12J tha strengthening of the erector spinac muscle aggravates nce initialcd deform tion and deteriorates coliotic process Hyperextension and uxial rotati n a s clatcd with
357 Th B Grivas (Ed) Research inro Spinal Defoml ilis 4 lOS Press 2002
Exercise efficiency of girls with idiopathie
seoliosis based on the ventilatory anaerobie threshold
Jacek Durmala Krystyna Dobosiewicz Hanna Jendrzejek Wieslaw Pius
Department ofRehabililation Medical University ofSiiesiaa Katowice Poand 40-635 Katowice m ZioJowa 4547 POLAND
e-mail durmalaiacekyocztaonetpl Department ofPhysiology Academy ofPhysical Education Katowice Poand
Abslract The aim of the study was to estimate the exercise efficiency in the group of
girls with idiopathie scol iosis based on the venlilatory anaerobic threshold (V AT)
Material and method The investigation comprised 58 gi rls wilh idiopathie scoliosis
aged 10--6 years 32 girls (55200 ) wilh double major scolioSiS and 26 girls (448)
with single scotiosis The girls were eonservatively treated using Dobosiewiagrave
method The control group consisted of 3 1 healthy girls aged 10-1 6 years The
cxercise test was performed using eycle ergometer During the exercise the gas
exehange parameters wcre reeorded (minute expiralory venlilation minute oxygen
consumption earbon dioxide production) On the basis of recorded paramcters V AT
has been computcd using V -si ope method Results The following V AT values were
obtained in the group with scoliosis 207+305 ml 02minlkg bm in control group
219+350 ml 02minlkg bm The differences belween girls with idiopathie scoliosis
and control group were nol SLaliSlically significant Conclusions I The exercise
effieieney of girls with idiopathie scoliosis conservalively treated using Dobosiewicz
melhod is normal 2 Such high level of the exercise cfficiency of the studied group
probably was due to intensive 3-D respiratory exercises of these girls
1 Introduction
In practice there are researched useful efficiency rates which on base of laboratory tests results possible easy without using of the relatively hard or long exercise tests would give the belter forsighting of the range of homeostasis disturbances and rapidi ty of increase of
physical fatigue during varied workloads [1] The best known rate of trus kind is the maximal
minute oxygen consumption [2345] During progressive physical effort minute oxygen
consumption increases proportionally to workload The reaching of real maximal minute
oxygen consumption in time of progressive effort is iodicaled by minute oxygen consumption plateau [5 61 This result is rarely registered in children The progressive exercise test is most commonly used in children until physicaJ exhaustion and the highest registered minute
oxygen consumption is treated as maximal minute oxygen consu mption or so-called
symplomatic limited maximal minute oxygen consumption [678J Sorne authors regard
Orto-dlet Trau malaogis Roha b ilitacjaARTlKUL ORIGINALNY ORIGINAL ARTICLE Vol 5 Nr 1 2003 80-85
Jacek Durmala l Krystyna Dobosiewicz l Tomasz Kotwicki Hanna Jendrzejek 1
Katedra i Klinika Rehabilitacji Slqska Akadenia Medyczna Katowice Katedra i Klinika Ortopedii Dzieci~cej Akademia Medyczna PoznQll
Wplyw asymetrycznej mobilizacji tulowia na wartoseacute k~ta Cobba i rotacji w przypadkach skolioz idiopatycznych u dzieci i mlodzieZy
Influence ofasyn1n1etrie 111obilisation of the trunk on the Cobb angle and rotation in idiopathie seoliosisin
children and adolescents Slnwu kluce ac eJJic Cl chOlIU) Ice SKoio= idj)PO Imiddot(~I7tmiddot
K~Jmiddot w()rus consrieI ve I (OtlHelif idiopathie HUW JS
SUMlvfARY
BackgrouId The aim ofthe stldy Vas Ihe radiological evaluation ofthe treatllJent ofthe idiopathic scolioshysis utilising as)mmetric trunk mobilisation in the strict~ll I)mmetric illitial position
Material ([fJ(f lIIellOds Presented stud) lOS based IIpon J36 cases (13 oovs oged FOf11 ocirc la 6 lcars (lild
rn girls aged frum 6 la S pears) trealed due to the idiopathie sCuliosis ((rom Novell1her 999 0 F enflfUn 200) Among 48 ch idrcn sllfJering from dOlfble-major scoios is 6 cases wcre infoll scaliusis JOjuvel7lle und 22 adolescent Among 88 sillgle scoliosis 6 lere infw7t 33 juvenile and 49 adolescent
Radiological exami71ation 1as condueed always in the repeataole technical cOlldiions RadlOglOlI1 lier evaluated oy the same physician Radiologica analysis oIthe scolios is incuded value ofthe Coho al1gle ongle ofaxial rotaion
ReSIils ln double-major scoliosis observed dlring one year period in Ihe thoracic segmenl Cobb angle decreased inll l increased 1395 and in 292 Il OS 111changed Axial lolation angle in 167 (~rcascs
decreased in 354 incrcased and rernainM the sorne in 479 In Ihe llllnba segmenl Cobb ang le clccrcscucirc il1 354 increased in 39 6 remained in 5 Angle ofaxial rotation deceoscd in3 ofca es incrcuscd in 29 and persisted in 48
ln single scolio is Cobb angle decreased in 386 incrcased in 353 and in 261 was lInchonged Axiol rotarion angle in 216 ofcases deceased in 295 increased and rell1aincd the sallie in 489
CondlsioJ Asymmetrie mobilisation of the tf1f17k in strictly syl7111elric initial positions is a 1Clhod of choice in the cOl7senJalive treatment ofthe idiopathic seoiosis
STRESZCZENIE
WS~p Celem pracy jest radiologiezla ocena Icczenia skoiloz idiopaf)cznych metoda asvmetrycznejl7lOoili shyzocji tllowia w sciSe symetlyczl7ych pozycjach lV)jscio wych
M aterial i metody Przeprowadono retrospektYlIl7q analizri 136 przypadkeacuteM dzieci (13 chlopcow i 123 dziellshyczqt w wieku 6- 18 lat) z bocznym idiop atycnylll skrYll ieniem krrgoslupa leczonych zachowawczo w Klinice
1
Ortopedla TliJumatoogia RehlblllagraveeJa ARTYKUL POOL1 DOWY OPINION ARTICLE Vol 7 Nf 1 2005 49-$11
Krystyna Dobosiewicz Jacek Durmala Tomasz KotwickP
Katedra i Klinika Rehabilitacji SIAM Katowice 2 Katedra i Klinika Orlopedii Dziecircej AM Pozncrlz
Biodynamiczna metoda tr6jplaszczyznowej korekcji skolioz idiopatycznych - opis metody Biodynamic method for 3-D correction of idiopathie
scoliosis a description ofthe method
SIOWQ kluczowe leezenie zachowawcze skoliozy idiopatyczne korekeja tr6jplaszczyznowa Key words conservative treament idiopathie scoliosis 3-D correction
SUMMARY
The biodynamic method of hree-dfmensional carreeion of idiopathie scoliosis is based on Ihe palhomeshychanics of idiopathie scolioiiiii and consiss in aClive segmental three-dimensional correction ofspinal cllrshyvatlre The course of action focuses in the viciniy ofthe apical vertebra Proprioceptive facilitation is applied on Ihe concave side ofthe curvaJure and exteroceplivefacilitation on the convex side Correction likewise proshyprio- or exteroceplive facilitation is phase-oclœd with asymmetric respirarory movemenr as weil as wilh parshyticular phases of the respiratory cycle ln Ihe course ofexercises three-planar movement is generated opposite to the direction in which scoliosis Is progressing This method is in accordance with the stale ofthe art ofscoshyIiasis pathomechanics The method requires detaied training and can Ihen con be applied at home under periodic control by a physician and a physiolherapist The method con be applied in landem with a Cheneau brace as weil as in surgical pretreatment A elaUed description of Ihe method of three-dimensional scoliosis trealment will be presented in Ihis article
STRESZCZENIE
ISlofa biadynamicznej mefody Ir6jplaszczyznowej korekcji skoioz idiopatycmych oparlaj est na patomechashynice iikolioz idiopatycznych - poega ana na czynnej segmentanlej tr6jplaszczymowej korekcji skrzywienia Dzialanie koncentruj e siccedil w pobitu Icrllgll szczytowego sknywienia Stosowane iest bodicowanie propiocepshytywne po stronie wklllsej oraz eksteroceptywne po stronie wypuldej Korekcja i slosowanie bodicocircw propioshyi eksteroceprywnych zsynchronizowane j esl z asymetrycznym torem oddechowym oraz z poszczeg61nymi fazashymi oddechu W trakcie eacutewiczen powstaje odwrotny do lrierurzku rozwoju scoliozy tr6jplaszczyznowy ruch IcrFtshygoslupa Melodajesl zgodna z aktualnym stanem wiedzy na lemat patomechanizmu scoiozy nymaga szczegocircshy100-lego instniktaZu po clorym mote byeacute wykonywana w warunkach domowych Z olcresowq kontrolq przez leshycana i fizj oterapeutll Metoda mote byeacute stosowana r6wnolegle z leczeniem gorsetem korekcyjnym Cheneau a talcte w przygotowaniu do leczenia operacyjnego slcolioz W pracy przedslawiony zostal szczeg6owy apis meshytody leczenia
Skoliozy idlopatyczne stanowili znieksztalcenia patycznej rozwija siccedil poprzez przemieszczenie kr~gu tr6j~aszczyznowe charakteryzujltce siccedil wyboczeshy szczytowego w stosunku do krccedilgu g6mego j dolnego niem rotacjltt krccedilg6w klatki piersiowej i miednicy z r6wnoczesolljego rotacjl zgodnie z ruchem wskashyoraz zmianami w fizjologicznych krzywiznach kr~ z6wek zegara dia skrzywienia prawostronnego oraz goslupa w plaszczyinie slrzalkoweJ [ 123] przeciwnie do wskaz6wek zegara dIa skrzywienia leshy
Z punklu widz nia patomechaniki tr6jplaszczyshy wostronnego Koncepcja rozwoju skoliozy jako rotashyznowe znieksztalcenie krccedilgoslupa w skoliozie idio- cja i kontrotacja sugeruje ze sily korekcyjne powinshy
49
EDUCATION MEETING SATURDAY 8th of APRIL 2006
- CARDJOPULMONARY EXERCIS E
TEST IN GIRLS WITH
CONSERVA TIVEL Y TREA TED
IDIOPATHIC SCOLIOSIS
Jacek DURMALA Krystyna DOBOSIEWICZ
Department of Rehabilitation Medical University of Silesia
Katowice Poland jdurmalaqcmpl
The aim of the study was
to estimate the influence the conservative treatment (asymmetric mobilization of the trunk by Dobosiewicz) on physical efficiency in the group of girls with idiopathie scoliosis
Material
bull 87 girls with idiopathie scoliosis
aged 1 0-17 years
(mean age 135 years SO 161)
J Durmala K Dobosiewicz 1
EDUCATION MEETING SATURDAY8thof APRIL 2006
Material
bull 38 girls (437) with double major scol iosis (thoracic segment - Cobb angle 18-42deg mean 30deg SO 82 angle of axial rotation 4-32deg mean 21 deg SD 107 lumbar segment - Cobb angle 11 shy48deg mean 31deg SO 128 angle of axial rotation 5shy30deg mean 13deg SO 85)
bull 49 girls (563) with single scoliosis (Cobb angle 11-75deg mean 33deg SO 155 angle of axial rotat ion 5-30deg mean 14deg SD 83)
TIoracic kyphosis of the invesllgated group was 5-39deg mean 23deg SO 86 and lumbar lordosis 16-41middot mean 30 50 65)
Material
bull The 64 girls aged 10-17 years (m ean age 131
years SD 132) were conservat ively Ireated
using Dobosiewiczs method
bull Treatment period ranged from 5 months 10 3
years (mean 148 months SD 902)
Material The 23 girls aged 10-17 years (mean age 136 years SO 108) were treated u sing symmetric exercises - treatment period ranged from 4 months to 3 years (mean 161 months SO 1019)
bull 26 of ail g irls (18 girls earlier treated using Dobosiewiczs m ethod and 8 gi rls earlier treated using symmetric exercises) aged 10-17 years (mean age 134 years SO 108) were twice tested - at first and last day of Intensive hospital rehabilitation (asymmetnc mobllization of the trunk by Oobosiewicz) - mean hospitalization period 20 days (range 18-26 days)
i rf~8f6~~ or~~n~= ~~r~1~r~icircJ~~tb~~~~ mean 17-4 1deg meatl~(I SO 74 R n~le ofax 1 rotatIon 5-25ot mC3 111 3laquo S0 6icircl Ilnd 1 99t1S~ ~~~~I~~~~~$ruo~ras~ ~ocirc~~a~e~~~~~~~5euml1 9middotn~ tUfllbar Iord05ts 16-4 1deg mean 311 SO 68)
J Durmala K Dobosiewicz 2
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Material
The control group consisted of 77 healthy
girls aged 6-17 years (mean age 12
years SD 31)
Material
The examined girls participated in school
only in scheduled physical education
lessons and have not been enrolled in
other sporting activity
METHOD
The exercise cycle
ergometer test was
performed
J Durmala K Dobosiewicz 3
EDUCATION MEETING SATURDAY 8th of APRIL 2006
METHOD
The Incrementai exercise test has been applied
We have found that tests ln whlch the Incrementai part of the protocol ln completed between 8 -12 minutes duration glve the
bullhighest maximum VOz in normal subjects
METHOD
The workload was Increased stepwlse
bull by 10 Watt every minute - ln chlldren
with high ~ 135 cm
bull by 15 Watt every minute ln chlldren
with high gt 135 cm
METHOD
The test had been contlnued untll refusai of the patient or exceeding the pulse Ilmit
Durlng the exerclse the gas exchange parameters were recorded by Jaeger device model Oxycon Alfa uslng direct breath-byshybreath rnethod (with face mask)
J Durmala K Dobosewlcz 4
EDUCATION MEETING SATURDAY 8th of APRIL 2006
METHOD ~ ~~ r 3 min 3 min 8 - 12 min 6 min -~
_ 0 rpiYJ 0 rpm 60 rpm ~1 30 rpm
_ t o~w=att~o~~na ~~ att__~ tl~~S~~ l ad l ~~~~~r o~w= Hlcremenlal t
pedaillog i i ~
~ ilt ~I~-----tl-~ I t ~ i ~ lOSt sffortivB
lW r resututlon r rm-u middot 1 - bullA~cremen tal ~~ ~ ~ ifr- ~ VtI 1 ~i ~ tllng _
METHOD
On the basis of recorded parameters VAT
has been individually computed for each
child using V-slope method by
Wasserman
METHOD
For assesment of physical capacity
the maximal minute oxygen o
consumption (V02max) ventilatory
anaerobic threshold (VAT) and
maximal workload was used
J Durmala K Dobosiewicz 5
EDUCATION MEETING SATURDAY 8thof APRIL 2006
RESULTS
Ali girls with 18 have been classified
within normal range of predicted
values of
bull maximal minute oxygen uptake
bull VAT and
bull maximal workload
RESULTS
The differences between group of girls
treated using Dobosiewicz s method and
group of girl s treated using symmetric
exercises were statistically significant
Lower exercise efficiency of girls treated
using sym metric exercises has been
observed
RESULTS Girls wilh IS Irealed using
N=87 p value
Dobosiewlczs method N64
symmetJic oxor-ci Nz23
Perœnlage of predicled vaJue of
maximal minute oxygen uptake
98 905 0033
Percenlage of predicled value of
VAT 97 933 0049
Percenlage 01 predided value ni
maximal workload 101 939 0038
J Durmala K Dobosiewicz 6
EDUCATION MEETING SATURDAY8th of APRIL 2006
RESULTS 26 girl s twice tested - at fi rst and last day of intensive hospital rehabilitation
The value of ventilatory anaerobic threshold increased during intensive hospital rehabilitation (asymmetric mobilization of the trunk by Oobosiewicz) statistically significantly (p=00019)
2047 ml O2 minkg (SO 268)
vs 2239 ml O2 minkg (SO 232)
Conclusions
1 The exerc ise eff iciency of girls with IS treated by asymmetric exerc ises of Oobosiewicz is norm al
2 Such high level of the exercise efficiency of thIcircs group resulted fram using of Oobosiewiczs method
r
J Durmala K Dobosiewicz 7
REVIEWS
Role of physical exercise in tbe treattnent of mild idiopathie adolescent scoliosis
Revicw of th- literature
A NECRlNl N VElWNL s PARZI 1 A NEGRINJ 5 NEClU NI
P1t~silillxlrd~ Ihcrapy (or klucgtlttlwrlpyl i pro shy-tJm of physka] cXlrd-cs ipcci I(a~ (IJcloJgtcd hy l li trIWlltl phrslollwrapbt wilh tb m~ln a1mor pl shyVCnI in lhe ilAAfIVltilH1 llf the ucirccfonuity III mild IgtC )
Lil1Si bclpin~ thebm ( aocl co uaufllclilIg ils ~jd- clf IS in nlOdlJmiddotnh-culiosis Th middotalillofthi paper ito r (W
Ille Ii lc ram r 1 a-ccrulin wh kh of Ih bull Lu[Jalmlcrus Ind (Lb hili til~ CLlLt-cd br scnli()si- clluld bl pl Y nlcd or r d uccd hl phylolld LXtmiddotrdsi n Il p--to-da le knowl Uuml~l nr tIll~C aspcc[~ i ne bulled in oruer 10 dndc whclh~r 11Rf blLl adcqlmtt Ib(uuml n middotlicaJ balis fo r ora)aini l Ihe US4~ of lUgravellgtitlerap) wltcllj(r or fln l th e prtl1iœ of kimiddot ~lre IUlll poNjn~ a t iil ies ~bould h allowtcI II uuml middot c enliaI toltlentlf)wh k lu alClor ie - lf pl lr~kiJl -c rmiddot d gtlt- (Ic rnnhi UzJ( inn ni (t hl HrJltlon [ rtn~hcll iJl ~ or 1i1J(IChIumlJlJt etc) Sh llU Ld be TolullllCcluse ulemiddot l onld b- clclIimcntalancl wukh sho ll ld he IJlI-n~ifl~d I~~a l lhc (o uld h 11lfu 1 Know k dg CJnc1in t (wIn SeiCIImiddot Hlk rCS([lflt h daw ccordinll to Ih bull llVit w o f tIlt iii 111 1( plop(lsltd in (h i papcr lmiddotonllmJ l lnl plLyi 11 cxcr(j$( pn (nti or (tmiddotduce dhlblli t ic 1 ~lt Il Jj ll(k pl ti Jlt fadl j w(~ the nlIIIrl li7alinn n f poMural dd shylitS tu p n xJ llc aSl COIlMqnen c(middot 1 all )llal) or r(tn~ shys i middot middotlIrve Tilt u~c (I f appn1priattmiddot kincsiuuml wrlpy 0 in rcns polttllcal swhiIHy Icirc IIHmiddotorc Illta ll y (0 r 1(lt1 lllho UAh mon ltlccurlltc 1Ut dl1alkd -rLk l(lWfils 111111 )11 h Jlccdt(
11) wurcJlt 0 lit)-IcircS (Iumpy - x rcLs P()lun
n rllt lT(ltnklf u f COll1tlK H (rtd) I 1i plfho l og l ~$I rUlglng tr m low tmiddot k Pl 1l1 to IdiOpath ie SCUIshy
Submitt(oJ [or PUhltCl l1 011 uly Tt 2001 Acc~pttJ ugu - ~2 1(t-1l
Addre rltj-xlfll telt~I(middotb If) - grinl Flt(1(bziurllt r )(m Ofl ()(Cl1I shy Lt middotqlltœlll ro () - 1u I4t agravehLIlKil ta IYIL-lTt ilSllltp lfllmiddot ~ 1l1uumldull
CelII ~ (niiOS I I~ middot ann (1) IfUh middot lIlfU di louhilll(tymi ( Nlmiddot ~iI rli -ilIIUmiddotltlfl
Nlti(ir 1( ) il r() (ltbullagt1
lt vLL_ l IiII no 1ftfI
jS ) we are a IUil ly tJc ing n1n) ltblll lS 1 k l1 b ~J)w in~ tl~ t S Jfll l approad llt - l1n til hy on ielshyertd ~tan lard ugraveJuld ln m any ~1~ he lI ~t les i if Ilot dange r )ll lt rhlS is lrut of reil l lnw 1gtlt1lt1 pa in l ~ or 5urgi c ll lrea lmltnl5 in dbc r lmiddot ll Sc - 2
ln tlle cj-e ut ~ t lll(tlWtl i( li p l ll1JC luuml- I ~ middottnl ~() shyliosis phys cal ((_lt1(( is emr1uved ltI t()fIl1 0 lh~rtrv
lo ly in cel1l in L)lllllde (nluumlnlr in tilt Lltlll middotorkl i e Iw l) r llt t Srain hUI IIgt() 111 Gert11lny 5- 1~1 in other reg lOl1 wbere thi I-incl qf tre l tm e rll 1 p~ 1 pmiddot t 1( cI il Jws Ixen cri ri cilld md rel -cltd Lw m~lI1 1 11 Jlu~ Fue Fnlny r ~lrs thio middot15 a lsgt(ru( f ~rth r -~ltc rrJtf))~ ll t vit11 br1Cltcgt b r II1 ([C Llt n ClW grmvlng 1lt1 0 L Sti g
gcsti n the lIsefulnes- u r Ih is form o t treatm n t 1
Hmiddotu]rs have nerged jn El or uf pll y~ iLd eegraverdse eacute 00[ 1 but tlw are nUl yel 11 11 t llu i vIC~11 and r hi ~
f rm of trt ~ltmenr IS stiJ l Ul1 ckf ckhate FfI t Jt 111 il i 11t (eltary td 1I iFy 11umbtr ot
b l sic COI ceP rlJ lf w ill he cIh tt d in t hi pap r
Scollosis
DCijIrI iriolls
ScnUoSlS is Irlircc c1 lme nsIcircltnal (I(gt i l cj on ot tht spinc thar cau C a CU 1 lh lt ca n h e $ t~en ln (1 me1Sshy
ured ultinF Coh) lll ltllCXI o n HI anreu middot p rtc rilt r
EUJlOI -1 lœDICOPHYSlc~ IR
NECRI Nl
110
f)i)
1 7J
amp aS g 5li - 0 v
V
31
10
(1 1) Il 15
-tc i ytjtr~)
FigJ----jllph ot DlI w l-lkaupegraverel) The agloimvltltinn Or idio r lrhlc 50gt1iflll~ IS rpiJ bel~ en th e- [l0 IH P (l)ltg tnntll lol (JI PUllcmiddotny) mtl 1 ( f( lS-er sigll paiilivltecirc lt Dlt(i I1 11illg r the iti l 1Kgt n n t rll icirclicH a ) 111lt m omal prebulled the mno rche md ociks with lll I)ttlx flal gr Ih pll fl
rlcljoprdphLi 1 hl merl prestIK ~ of this curvt c10es n t autom~l ritllJy indi ate the pn$CI1(t of a defurshyTnitv (SlllKtUrd (Unel
It i~ possible tu clil1e ren tute a struCnlt t CI1tve fruIn a pogt urll 011e by identifyi og the hum]) du ring AdIlns tesr I~OQ looklng tra m beh lnd at the p atient w ho b benchng fUfward il is p -- ible ta d d~ct 1l1 eh ucirc n of o ne liidlt 0 1 the trunk usually n n the (onvex ~ jde ul tbe radiographie CUfve Ugrave1lr C Ul be mlt~I Slred lISin~
BUlln els S o liomere( 1 ~ l This h Uf1lp is du(- lO (Ile pregravegtecircn ~ of vertel ra i rolltion 1c1 Ollt tn tic f~YJ tllre o f the def trrnit tli [ c m be seen and measurc(i v ith Perddolles lb lsLometer on an amero-Ix)iferior radioshygrapb ~2
Seven ry pel cent o f li Ises a re conid 1lt 1tO be idiopa thie 1 bull ia l-nosilt in this CI$C is b exdlls i ~ n as idinpa thlc me-us t11H wc do n()[ know rJw origio of lheacute curvc [n othe] ~Ie$ it b Ix )~i ble ro ide nrify a dieak (bat CHl jusrify the c1etgtnniry slIch a rna lfo rshymar i ns I1(gtufol Ig ic~ l or genlttic cl iscas s Glnclt~r trauma etc )
[dicirc)parhk S(oliosis has been divicled ~(corcling (0
the ~Ie of tlie patient egrave1l the tiJ1ll of d~[ccli n of the condil ion into ti) ur t ypei ln fanUlc jU nik ltldolesshyccnt lnd aduh Til l m n st cnnunon (VPC IS the acloshylescegravenr o licirceacute I1IJctenzec1 hy 1 sud le l1 tggrH3l ion uuml uring the grow tll Spllrt (Hg 1)2
lhile p tu 1l sco liosi i5 Ycry lomnw n thl pre shy~Iknct ra te f r adole ent icuumlop~lthic structural CU IY~S in sch )o chilclren are 18middot20
- 10 Co bb d~grels o r m on l -lil
- 2) ~ohh dtgreclt or mort O 2~j - bull () (obb d gre -s )1 mOfeacute ()ll 2
Clin iltI [ d e isio ns lfl IXlSed 111 an lccu r~He pregshynosi which obt inccl in eJch pa ti nt mainly o n the basi of the nsidu~ll p()tlnllltl l of TH1h and the result s of 1 rh clin 1 1 ~l1d tadiogmpl i exlminashyti(ln12ll c noieq uentlya d inica ] la sifiou io n o f the ing le pHient tn -ome estent co incic1 ing w irh the
D diographic one c l n lw SLlIl1H1arizeci 1 1 folIcJ - mikl lc~ (1)(n 20 C bh de~r es - moderJt l betwlen ln md 15 ohh de~ rtes - StV re 111( gt1lt rh n ~J) )bh (kgf s
On the 1) lsis of [hi - dinic d d a lfic t i n (Vith l1l il el lrb tiOI ~ o f the ir b() und~ri e ) in Itllt l cente rS Of SCOtiO LS ITe ltlllent in the Lltin odcl (i rJ Ital lnmct md PI iJ Ugrave tre tmtnt i s plmmcd a fo lltJw 8l
- mild kineslth e (~1fw ~1Il (1 luok-ou t - Hl demte IJragravecegrave 1111101 c(~r md k i rws ithe lJpy - ~cven surgery
Physical exe rcL~e for S(ol iosis
Defi t tiOl l S
PhyS i 11 nU b lIKrlttp middot (or kines ithcIa Pl) i a p rvgrlill or plt~i Gl l (xeriltecircS ~1ci fi ( llJ y ltk ~ loped
y a -11 [ru ine 1pll yslo ther3pisr wirh th e m 10 Hllll
- pre (~ n tit1g tlc aggraaLion of the cl I )flnily in rnild bullcoUm is
- helping tlk Il ld Ct ~lOd ounter~lCtjng its skie elfects in III de rltegrave sc li sis
Tn tl1i_ feSpec1 kinesitl1ert py f JI s oliosis is tonshysider l a o on of peciticcedil training and s genecirc tltllly proposelt in sessions 0 1 4~ ro 60 minute IW) t) tour limes 1 Cee PhysiGtl exerci es can aLo ll v o ther auumlns 1S it oill he dise Issed in this plper
Ir 15 Ilot possib le to cl escribe a single progrlIT1 o r exerc ise a5 pro nrams ale USLIJUy p fgt nll ized ( ( lt
EUH PA ~illDI (DP1I YS IC~ 182
ROlL UF P l 1YSICAL lXl 1lt 1~E IN l IlE 11 ~l) IEd If IlU) l[)VP 1HI AIJ() J)~Cl~ r COl ~I NlG1W il
f)( 15 egraved ( )Il the nee L- 01 indi iuua l pJl itnts) al l l10ugh Lheacute) C l n h t 11 plicd o n a WOU p hJ~js (-1 (0 () pnients PC[ ~l ()lI r)middot lugrave reQCf lhese 1 10 grl lll frequt ml~ V IIT
hnm on in middotituk w allClthltJmiddot -Ill Jnv L l~egrave at Wc w Ht ~huw in lhis lyl peJ it i~ 111 n u -eII1 tu id e ntilv kirK itheJapturlc aims w hitl l ucircrr~spnd LO ugravelt~lil1 DUtshy
g X ir ur ph -s ici l lxtTi~l I~llhe r thln ln dj( us- indishyiJ u1 1progr-lfll
Aduumll l lxUl kisure time ~lOd h )u] Sp u lllll8 ~Ilttishy
i lt egrave~ i middotomm )Ly s iven lel mJ ing ro w hlf ~ Iuumlnsidshyer~d usdul or il lrmfu l in t1 lt rruning (lI tJw ptliJicirct ln tl1bplper Ugrave1 gent ltl l t rl ll bull p lwsiCUgrave lttG iviUes is rl ktll 10 JllI1ltlCc hOlll gtpOlt mJ kIJ1lsIcircl hc lJ l f
i ve lUen tloneumld )bo C on lv ine n dul( re Ull~ 1t~1 t s far Ilten publislt d f I~ mJ I(i noltgtithltl rgt is 11 11 a su h jel lnI deacutehate CJitk haltlt t llltit m itn ltl of l ny lorm o t p l1 ySiClI lxrcL e as a Itwr1 [ J- fo r i liopa tb il jcoJL~b un iL ()ri gin~ initial1) it WIS Ille r rOmiddotUumlK lt brgdv u f p l~lt titu gtllergt w h ) intervenecl hutll tc llcrl ll (mon as cltl HtilJ nic in terventi n man Jgt
1 t lltrJp utl t one 1 md rC j fkll l~ on rhe h sh lf som uni cOen I1v pn t I1cgts wt ldl hll ltl enl1 JI~ haLl nu na l scicnt lfic baisYmiddot HOlh tlle$( trr t peu shy to rh ~rl py tt nJecI to l~~rJ tte C Ih tk CUf -~ pnnshyclr~tll y as a f tsul t of lilo h llIzatio ll of tn imdqultdy ~u pp rt(d S pln eacute 7~ 12 to re-t1 r rI ltrl 1$ l l1C k o f WH llt~~rdl 10 I ndt~-dll()urnah tnd 11( on1 p~l per u suaJly Cl tc([ IS n prelimmtrf lll d 3 ln tt li w ay man (l rrlKpt(Hc H lf O iS Inll ph ~i C U l ~ d vi ~ cI nllog scnliotl pa t le nL~ 3gainst holll ph lca l egravexershyclc and p()rt~1
It m u st t~ n tfd [hat pllyknl txerc j~ tJe~ltm(nls t1iHer 1 lJ rd il1g r rhe rherlpcu tlC litTl~ on lllc h tJ rgt ap p lolc il l the IXlltent lncl hi im r IIIllHnt i- 1 (1(1 rI - 5lt1J lC igt tIl l ( f phJllIlllolopJ al rrea tmln ls Ihith cllffc r 1lt œQlfd- rhe m C cculc u ~t(l luI thl p al 1t n
~mc l 11i (lbE~e Tt i ~ P ~il k tlwreI[middote thll wuumlk ltlll t kin 1or ph~ i Clt1 1 lX r(j~ 1I 111~ t bc loidvd by t h~ Lo iurie IxujCJ1l al1ulhcr a dl ~IS nJI h~ iOg (1 11shygerols llugJr in racr le (wi ller d I ~fJIII ~ I ml thlls re(nl1l rn ndc(1
fn n UI cel1ll r we In(~ hccf) using 1 ) 1 1111 11 ve ) 1 (J p lw l icd ex(r(i~e (0 J ( 1I l tt i~ tlh aITt ~ l~d Ilv m ikl tru cflumiddott1 adokscltnt (cl ioj arh lC icoli is11 2)
ina the f U~ t rc-gt uJrs IefC pu b lishe - the pJ( )grd m 11lt1lt l1te n PWltllk d in fa c t deel()pnlln l~ in th t l itshy OlL1Ii in tl1 r b t ~() ycal f ha ve iclemi fiecl niO l l
m d 111 ur impl rnHm s md d i s )h ilir i (gt~ lue t idlo p lthk amp()lio -i ~ t Jll CIII he 1UO(l if Icirc 1by phyict1 egrave xert iSlgt l fe t rrncllt
l illl
111e aim of t l1JS r~l per ii tmiddot (tv iew tl1( l iterat urt to a(errl ln v llic ll of th~ impa irm 1t~ and Liit hil it il i GllIltec hy ~ o l i()gtj s -o ull he ll nt x or re middotlu celt1 Ili pl1ysical xerclse An u p-to-da te knOvkdge o f tl lt Lgtpecl-gt i necckC1 in rJeumlr) d -oek
- whetll~r there h ltl n adLtIIl ) l tht()d ical bbh fur or JqIIcirclb l l l1 Il( ) f k irt llit herlpy
- h N I)(1 ( 1 Dm tlle p r l c tIcirc(( o f Jebur tiJne )pOfung lcli v l ti ~ IIOU lci he tllf) -d o
II J U V f h 1 I11~ c~~lb li hed Ihe usefuhlLss 01 k il1 shyc ~thtrpy il i aIle dy l nsi 1([(( -r-tI Llleu i n )I11 plJt~ ut the wJrld ir ilt ecircS~nl i 1 I( id n Iv w l1i li ( 1shy
gories 0 1 pl1Vtl( 1excrClgtegt te D)bilI7it ric 1n (Ir st shylliuumlZltio f) lttlt tlgtbltn ing ni trcrccedilh ing erc) hn Id be
vnlcled he tll rhe nuld be lerrillldll1 1 md whidl s tlQu1d be inreœ jf ic(1 IJeClU~l tlley cOli lel Je LI ~ful
Ncuro1llotor impainncnts
Imv aUl llOr~ 11 lt1lt ~tlKlteJ lhe cltlndatiotl bd Ween tl UC1UmiddotIt t l ol(~C t nt id iopml je -nll ~J~ and cli~l l shyler~ lr 1tH lest ihuLIr yt 1 _ 13 ~ 311 D uhoussct 1
1-- ITS tln l ldiopath k s(o lio-L L cll -c d l J l hmgt in th terl tltr f prop li l l pu n md 1I1ar th e detrshyn Hi n i~ na tural 1 ~ronse to ril e need tu ts tu re p()tun ltlluilib riu Ul HcrmJJ1 31~ 11 () d tllat icliupathic ( liCl5j h l it re5u lt Ot1 rw nltuf mot r l ~ltelV
[Id )fcl 3 nI] ~1ltJ U Sr1lle nr to dtorders in centJtI lO~Cl shyIOIDNur) md 1xi~tI moro (Ul1lfOl syt( llI (Fig _l
N htIll -of) H1c S uumll h( rll1 ( ~ l( w ing JI t11 (oshyI-ie on the l l lO]ugy o b doll (nt Rl iu]icirc tlili- middot()lioL m unt fil t-hltll rhl ugravedcmnilV L th e fl5 ult o f 1 (k btcl 11lIFll llI ion nf som t11(WUgravetltnl md pO~ lur( (tnic l~ l licirc1 tl1lt if l p OgtlbJt b C 1l rlw sta l i lin 0f 11 1 Sf llle j lt g )tx l Tt) ohtil n a ))Cli U 1ILzltl I o f p ~llIr~il d l~flo [ in l1litkd ~J)llnSIS me CI Igt(middotqucnr J ~ a ~tmicirc ()nlly or regle Ie Llive
Ali th- 11yp ) tlw~es rd ~lte tr d irtl Itn t pnl1tlt o f [11 v hole ~piltm It11[ controls postu re ~nd mrw shyment lrre pell ic of tlh po int a d lI~ llv inH llYegraved il i ~ ll 1 nnable tCl aSUilll ri 1l tr l ll1 lo g thi ~ys ttm ( Qu it le 1I middoteli tl
lt ch ugt nlt~(S f rullliIl thil i nlomwtion th at p tlmiddot shyiCil J(tl iIies nw gt Il lInport~n t rr le to pbv [11Icircgt role ca n 1)lt slI i11l1lariztd ln lWO the ptu li ain Llt
- d elopmll1 l of p uumlltl St1 b Hlt ) - c1e veuml IOpm 1)[ o f bhll1ltc _
(k llhUl)lOr S Cll orr
ontrot oic whan-lt
------+ 1 ~ il lnll ugrave r AINnl
Cllnlr1
T bflt~ r
fltL1 tlli
lMini
l
~sary ~J-frlllen i )f
~ 1 ocirctnl
~UcirclllIJJlW Ll
AXl ~l1 n uumll l) r sy 5t ~nl
middoticoltoq ~ Fig 2-AcFgtrdong lU He-mutl 21 il is Fi)5~ ib1e rD prolXgtSlt l -oo ie1 mnd 1 ((if ~ elio egrave middotAhltr~d l)Qdy-p ati~ I I i u d) uren ttllOn k td LO In ~ory reHTt I1 eDi tn l al ) JdrnlV~ pn)4~ e l u r~o(Ofe 0-c1 eptunl dvstil t1 ctlon sltŒ(ry icircltu nu11t ilwnt [ ~mC ~ted tl l1 ce Ill trpntlshyUumlfJJl nd IKnle~ r~dibl jtugrave)n of -I) m tlosen Ir ~ig nj tl (I1vying ln fornll1U n (lI an ereltl ~piJl e Mmor aJJ r--a t ~) n ltgtf ti lt aXljl mowr plem iHUC Wh ~fl Ille 6ubjeco m uumlntl Icircn (1oJifitd perccpfLlI l ~na l ysilt of p n)lnocepti Icircnfu rnlaquol ti desnibJOS ~n t tecr spin A IICW motor co nrro l Ira I gy t adopt resu ltin~ in the ~tr ltctltr 1 ckformh y lf IdiopathirL scollos i=i Ht lrftU1uc nltnt l ISll I1lJy h1e- ~ I pro()und elkn on bralO Sfem flJll ct i(lnn~lLhu modifyRll Ille nltulltgtshytl10 ) 1 1111 Uu l-lHoror control 5~Shnl$ shy
As Srtgn1lt1 l ~ ltlssert~ if wc l C -Cp t 111 1 un o f the G IiC s oliosls L l tisorckr oi th e ltquilibrilltn sys t ~ms it is lagical to oriegravenrate physlCl l exercis( lherap y ln th is d ir(gtCli()[1
11lclte goals Cul tl lfOUgil ditrercn t modes 01 action be Olchic(-c1 witJ1 phykal accivit ie
- po rt ive Cll ities p ro ct LJ e aIl UgravelClltrtsc in 6lte nshyel ll )o rd in~lti n pinai pr0prinup ti_)[J nLi mOVeshyment control 0 vio lls iy ln thh repect ome lCtivshylites aœ pre um~I I)y lXrter tllln ntil crs
- kinrl lira py using pedJil exerCisocirc specially developecl lith th est 1101 5 in mind illVuuml VC I lllore prccilt( ll1d InC1 li zed cri n on rhe spiJw focusing
a90
1 ~~
lg -lNheJo ~1l l1 t r~l g rld in 1 1) h i(~ IImiddot ct r rHienl w i ll idlllhic _It ~i ~ _ iri s plt ~I le II find Jit ltH vlllleuml ~l Cgtbl tn~ ks III d il fef lt p ~ lt ihnS nu v~tl middot B ~a~pt u Il C middotl)Icircd ~(t l l11 C dlfkrCnl middot- hdween slllndi1g Uline nu nllt1Xinul oorrec ri nI t chied Vith Ct (J ) und tfdincJ ne lot es o UIine 1 fo llnVs middotIJfl tfi ni( - ltlrshy
reltiK)n ~ Ikexibiliry st3nucircing - -pirte - f ur~1 1IbjISC ltupin - ltorrcaion - - r~luci()il ll ymiddot For flmpllt in J npK l1 pH k1J il
plt1SSlhlc ln obtai n 10 u1 511ndlt)l [YLo lion yr ln Slt p ille rlOlgt itlugraven om l J ~ in ( gttf(C rigtIl lIex lbuil 15 i (r-l l=22deg pol lltl ~~J IIlpraquo is IcircO~-V- I t1 l nd tucircu(Ugrave) ilil) I~ 3laquoJO- IH-12
r ln Ugravel e abilit jl of tluuml [m e llu to co ntro l irse lr in ~ pac
fuld l oftlles uumlllelve ntio ns can presum1b1r incn~~ Ih enl ac )1 the orller and lHitlll r of Ille rn - 11 )ltd h e lllldenl lu EJ3)4il
Posl1l1-t collapse lnd slabilizariotl
lIle concept u fplt st lUal c(l lJap~e l l~t Iwen detin 61 by DlI II-T3e~tupegrave rL t Ac oJdin)j tu tl1i- ~ll1thor il [ nec(sary ~- l Hn Cv-tlualing th tleihility o f a col shylo tIcircC CUJVL (0 clistingu ih bt tVeen the re du ihil [ty index (th - li iffer gt le bet ~middot Il ~I r~tcli()grJph ie ~xnmshyinltio n of the iI111 pHienr in supine po ition m(i
ROte OF Pl rnmL EŒIlCISE IN THE TREAT-ŒNT OP ~I IJD IDIOPAnnC OOU~GEm seou SIS EltJRINI
I (~)-----------------------~
__ _~ _____ _~ __ __ L ___~ ________1 ____ _ __ ____ ___ ___ _____L___ _____ l___ ----------L ______ _
1 ~
1
-- ------- --1---- ---- ]---r --- -----_----t- ---- --- ---shy__ ______~---- __ ____ 1________ __ _1_ __ ____ __shy
~ (1 J
1
8 =~~=r=middotmiddotmiddotmiddoti~=-middotl--- middotmiddotmiddotshy--------------t----------~- -------- - ------__shy
~---- --- -- -~ -------------r---- -- -- ~-- - -------- --shy----i-------r-- - ---- ~~-shy
il 1~ 0
Dtl-Lmiddot ~ lttj l r~ UIltltlHt
f g 1 -TI1 u ilictf 1ld ( ii 11- ugraveu-sh) ld IX~ O 1d wllich ltJdnrshymII Il nf the pilll 1 ~tln~1 of th e -o lioti( spinc n IG~nI(J II IIIshytt) lhe iJeuml grl-e o f ~ ()Ii ti c (u rvH Il 1 w dcpc-nlknrly o l l he 10 111shy
P01(nl (pntt l ~ 1 1 nr ffll wrJ I) ln w hilth Ihe n i 1gt( ~ duc nL~ grlphs fm I h~lt 111lt hi~hr Iht Col h ~Ilu t (l f Lite ~Ul Ihe m Ol CI il y th t s(uumlJotil middotpin~ ~111 he ~middotJg gr~lVH(~(1
m mJxiTIt corrttt ion wll iJl i~ lIllCd to Ih - xt 1shy
lti Oilil y Jf tl1lt t Ut JO rl1t cdnUc idt md p OS shy
tU ll cul lapse ( th t ltHill enct b-tten l lUdioL) 1lphic egraveltamJl1ltlti OI1 J t th e ~lme pa tient in Sl il tl cling lOJ lline fX-sitiutl ) Wll ic h correb lc- onl wil ll fhe abilt ty of lllt p tu rl l gt s tem to C( lunternct lIk luree o r grl viry )cco d ing rv D lfVd- f3egraveLIprc po st li r t1 lt01shyIlDse is d ue to the Jnus -u lar ton a nd 11ll ex rCrIshy i) i itv of rhe tissus n the ( O IW-) si it (If the (01shyjl ti (~JtVe (Fi~ 3 L Pu~t llr1 C lltpstl lu lcl l ~~ reduc l-lt by llwans o f pl1ysica l cxerCles specitkally s tuclled ruuml i rnprove tIlus--ubr fOHt md lU pr )cllI Ct 1 ~11 hi shy
lizing ffCd
PararcL n tll CIJ cl the cr iti ca l (3 c1 thlsho ld beQ ld Il ich defol1J lHU n of the i pinlt 1 e~ in~ ne dtlllontr~1t _cl (1l ll t grclrf r mg] o f rllt C II in a qa m bng pos ition corn pOil 15 t l lowcr detormashytion lhnsllold (Fig 1) ie to ~11l Ulne3Se t the risk of pr ogr t~ lu n There t rh eJef re l J ea r l)iuuml 1itshycJ l ~ll1 l l(tl a 1 tnr tg ro b ohwined by d -cr t l ~ illg ilmiddot pU~lUrll cull lpse ptJcelJtge w bich lccording t i)
h llTd tnd ~l(heJ1l ~on 1~ b inde cl 1X llt icularly luumlgh Ugravel mllcl c Iio~ i (bdow 2( 0 ) (F ig 5 J
Fin a Il III ch iS respect lllljl hl and b um l 01 m linmiddot
ii iI 1 l _ _~ _ ___I ___ ___ __L ___ _ ___ ___J______ ___ 1 ___
li 1 1 1 1 i 1
1 i ___--____---___----__-_---_~- _ _--_ ___-+----
i
1
i -- ~- -- ---~-----_-~-_-_--_1-~
l ~
i
+----r--------t-------t------f-- J
Fj~ ~-Ac(XjJlin(Q luuml T O rIcd ~lnd Na(h(ln~ n i () dl( pCG w rd (rTIshy
POO ll is hiherin cu rvegt in wh ilt l1lh ~1flILWrd cII1I Olk l1t IS le- pr(v~knt ln th e grtph Ih t PogttJlJ I ugtnq) Ot1 -J1l j elfltS-e J tlt 1l1t obb dirr remc rlLIv obu incu f roll l the Cohb atl( 0 1stlI1dtJ1g IId gtupinc rldo~raf115 Ih Ille lt) [1l1t1 (i lndnl I pine) 511pille the ~(nlClu tJ1 compo l1lnt U rlk CU Y _VeJily I~ ltx p rlt 1 L1v UpUlt (obh Illeturo Ih t si _b Cct rtJeSIm l fie -ltn J trd Ugraveltuuml shyuumlo n A~-i)rding LP 11(lt uuta o n l ( r1I~( in ~I 2JQ sup itlt curvt 1hi C(]l)b ddhccno l l f lO is -J-lultt( thc s ldnd inr tnla Ol1l t lS wi Q) whil 11) 1 1)401 ~llp lne ClHVC If ~ 1Omiddot ( tcl Lhe ttnd trl~ nlca~ I(t I ~ ~I)
tli n ll w l lllE cq lin ti spin h~ i ng mo r ~ Llnt~II) 1 tlun the nOftl111 one n Cll l gr(lk ( (cU ve tl1u n da r u p shy
po rt in o r k r 10 m linrl in tht 1xi11po tuf_ n th ha__i of th egt onideratl lr1S it f(lll() rhJt
ph rH (~Uuml e erd es ulukl h u - ul iiuml tbeacuteY ~U-L lm cl 1l (It-d o pmg p05111 td C Jl1twl lS fuumlrnll~ rly d ccrll1td ln an Ql St if i imr ol1111 t ru t(( - tht m(d in C JI shy
r t t r sture fO Ir -ngthen tlll m u ck-gt of the spint mainl) in (11erl antig r3ilrl tIcirclt l]lli fun ctin ll U hy meU15 dl i )ll1 t trk ~ lhJ cl( -ll tlt C)nlr~lUions ~llld no l IdOshy
1l)llic d YIltll1k lt l jAJ lktic t) I1 ) II 11)t 111 hd posibleacute t lcluuml ee postura l io nrro and stfh ili lllllt IJI
w i thout food T1lw(ull r d I( Lf(11 Ibk t m ucircnuin Ihe c()rf ~ct [ ()S tu re for cl gtu ifKi IH lLl1gth 0f ti l11 ~
This i-l ddl usl a typl 11 dnmnin (tf k inesllh rap) in 11 (lt-11 [[k - p~d fk lnr in lng f u l1a in llllliCk is poss ihle lI sing ctrtain Idncl fJ l (lt) 11111 liun S p Ul in tb is Cl c is ulttful ooly sa I~tr 1~ il Iw lps t1w lxltknt 1 becuJl)t 1gtlt ltlt-I a ClJu~l inred irl ilL ntllru l o~ i cll
and I1lll~lJhl r-keJc LIl [rll-llIn~ middot etlt(wrs JI the int e rmiddot vlnrion
[J ROPA MfJ) I()Wf-I YSJ IR
1
ICR 1 1-1
r
1 shy ~
- shy
11 o-llrfOlhe5l~ o t Ih 1O~(1dity i n h ~ r ~ ll nr pbl1 l of ~ Spl11 in 111011 _llti1Gt l lPt f ltlJUCWJtl ( ~l Ihe Ir t 1 1gt illbll W Ilh LtltrJ1dlion Vln lbe rigronl middotUII~ l(I Dko n12 lIll h lumshydlanie1 1 [ nul 1 M hl whtrc M - gt) lnIUI1g 111laquo111laquo1 1 1 c rtJCshytjC~ f fce d -d Lill l1~ o f enr niI pUll spnmcl1y 1~ 111 mldlll1lt (n the fl1ur t 1 = tor~ of f(ward Ileuuml l = ughtel1lng fmiddotr p 1shynOf stn lClU= Alaquo rdtllg 1raquo Ihl~ - lin hull th l1ltgtllugrave ot tller1l lUr~Jtllrc F the ~pin t -ilh rlu1i tf Ihl 1 1Ibulll n lrlt InltT1 1
rbc prJI 3IJi l1ty d qrlOIJ~ n bull JI t IlJIII Hm lA the v=ltd gtc e lu-ing J 5lnK1ura i ltfnnity
Dioal e ch anicll itllp~lir J11 c nt
Ihrcemiddotdimcllgtional mc-cbal1in of the s pioc
~f Ikmiddot i t i nly l(œ ntly tlHr llk pr-5tnœ or nc ushy1 lnlo tnr impairment in Idiopttlllc s-ol ii IXl tknt liuml J$ heen h i- ll licircghlcJ hy re$eJ rh tll e preit ilegravee h inm b nIcirc Ji d lJutg~ lt hl ~ 1 ng t o n dO Ulll urcel 1 i5 (l lreldv well umlersrood H(j-ev~r nev lbt un h iomcrhankal im l) ion nI h1c rectm ly onk l n tIlt tre and p r~dou in f n rmtinn hou t pl1ykd (~fcl5( in t 11 0 tl1I _ltgt pbne of spact 1115 Im trqlt-u 1rom J i-[) v ing unclcrsrmdlng ot th l lmc -dim nshy~ilnl l l11 ~ hmk f the cO]jO[lC pln( ~2middot ) ) Ve- w ill )iI xnl t l1 d at lcL-orcltng tUl cl sif iol t lOn blsed o n gtolllt lricd h uumlCJ ) p lane
- b() rJzU[1tl ln th i pla n ~ th t 1o rm ll sp ine present no CUlye- w ll ile Uumll(~ ltc U Hic spLnc clevelops one of ir haracterls(Icircc deFo rm tiCs v elt tbrd ln lashytio n vh icl1 pJ()VcA~ theacute hw 11
- lgitltl in th llulJe U l(~ nonmll spIcirclle pl SenL kypl lOSis ~nd l dooi~ in tb lXI1 lhese [(Hu rts Vere m)( til ught [ 0 he relattd tlle scolkJtlc ( lI r Vegrave
- front l in hi pleme tht ncrmal p ine preseuron t no curYegrave whil thl ~11li tic p in ugravetI I ()~ icircl~ charshyad t Ilt I CU1C
Il Jri fJIIt palic
~l+I~na ra 3 r inr lut th l[ ber ll1d a œl1~lU1 degr 1
l f r()la tJo u lllu (lILa r forcKl ltxert ltJn tl ldefnmuumlng 1 tkllJ [J i1u a re- lhlt tll cly 11 [1 1 UI b y Olm ner w bn ~lh uiJwd tl egrave ro t1tic) l1 Ilm it ti lt p ica] lf shy
rhrl r() be (P (the Uma bevond Wl1iltJl th lCOJlb of [11( ~pmaJ musd ~ dthc COnCIt and nm ex ~l le btconk (t O li~[)
r ~l 18 ~1Il N lu t( ren i9 lun lu ted rlseurlt h in tlt ) tilt lULodeumlformipg1 tlo n ot tIH_ sc laquoJrle rh ox ercallkren lk 1l1~H li d11r once thl Il i ~ r tld1t5 [he lhrth ld f 111 JlIcirc lIi of tlle dnrlclc hurnp tlk
lI bslt Il l nt rlet()rlll lIcircon 01 the it l ()I~ C ( (ylm der (- sustalnecl by an H1tmi cforming aCOOIl
J1Ji h V hl rhyiical f~ f Ise CI 01 h spr n llnd kin middot ith ccedilrapJ my lX damlg ing vll e n l pplild as flle
igt Jk Iller ln SCC1IJ ~IS lllc lJ fxceed l auto in middot crca~ i n g lhrllgthuld [1 sh (~u Id ahn be j ofed that Ilw relscd pre sun 1l1111i insiugrave l fe pil1r inn) 1 mlshylt
- j Il- ( w atff 1 (nh ~1l 1(e Il10 utoldrml ng li1eCh~lI1 1sm
in flc l Geyer ~w tcd th1 t rm m 1 hI l)1ecircch1O lla1 puilll 0 l I C~ sw m mim t Ieuroamp no purpo t for cu lshyim le pllilt t1 s (weumlO middott r it is l~Jl(gtWl1 rhn in iculio r[ paULnl -iJl11T1ill~ doe_gt nor Il ~lp to i ncrt~SL n eur(1shym tor co mfU
(1irai p an (
Jerdnn lle 11 showecl thal ill CSl~ o f t10rLC IC 1i lUgrave
tllo lacolulllhil it lio_1 tlle cte tI llmiry in (he lg itt1 p lln t rn lnlftot il~ lf tspe iuUy in tlw initi 11 r luleuml )f cV IU[Icircon nf Ile ~oli ls W iU l 1 p(t)gr~s~ivlt il10middot~ shy
ment roward hvpok pho b G ll f ill~l Im lins l har dUflng (IN eWllLlfiu1 of 11Imh] co luumlgt i the l in t ot t l H~ gClyty Cegraven te l - 0 1 v llebed lxxli 5 r ro ject 1 seH fl r t side-ys and tlwn backlrcl bull thu~ p(0(1 lj n g a kyphQtlmg aet Il ln (h~ lu mhnr --PIl1 COftj tng
l l i tc Iugrave l lltl l( l rs1 tif s L -etllgt il l the lgirl11
1 Hl)
Ilu LE nI rIIY~Ic~L lXIlKISI 1 HI E TREhTMEtn OP JIU IDIOP llII C AD O USCUH O Ll Œl15 NEGR II
lLill tegt lre lenl1 ~I d ~fo rll1J[ ~ rhl recrSes the phyltiologiGII cmns of lh vine)
Accordlng () Dicion ~2 1 rtcluctio fl in the itgitttl CUIYtS combin l vi th a lueral Iviari n llltl ds t 1
mecban ism () ugravel~ta il ity in l he r rat r IllI1e which bVOf1i the unsd a nd i ncrea~e 0 1 co hlt1is (Fig 6 hiIf md Pl11jlbiJ Jl1eanwlt ile lt(udiecl lh e srnl ru t
orzyglpophySLs show ing t11 al ttleir 1I1tl rnic tl orienshytation f~I (jLi l~ltes aXIal ve rtegravebJl l rotllio ll in cun litluns lt f dorsal hypokrrhn Icirc tnd lum)H de i L lo IS
Tll t dat SLlgge 1 th t impOrfill ut pOitu res and l1lweil1 ) t Mudied in ord t r (CI mlIuml ntrlin or to reuwer fll e p llyslo lo~lCll ClIlye in lIe SlgJtta p lU)l Wlth the llm o t ch ~ kin~ rutltor in l~ bili ry7 AbC th ~e ~k-
1l11nL ~Irt del lnt [0 J jUc lt ftber l]kuti inrervenl ion vhich 1c)LJ k l IV - i(l ~ l compktl n l ililll on Il t c1 l shy-jel1 J11UVllT1ent IJ j o f 1uto-dOneacute(3tlon ( i e a -impk ld ion ) Iengtheni ng o f the pilleacute 011 a litlltl l aXl~ tll lt ((IT liJlI~rcdu e~ t lle ~---lJ linti- l lte ml-fkxj(l n h UI 11 - i llCrl I~t the plllH ](JgicJI dlt cr ~l S ( (1 k-yvllCiSh lIld O(ltOSh l o r c lch r1Iif n t a Ilew til(~ecirc dUuml llt Ilshy
si lflltl J ll1 u(~nlent iam ecl - 1l1t0- lIrfe rionmiddot7 4 llmshyp oed f Je-rura l iUIl cl middot-t1e- iltm lI1d ll1a intltnUlLe )( 5lg it d C Uf (gtS slig lll thltJrc i ypI1 tiZ) tIcircOI1 a nd lunugrave)ar 1()fdos i7~llion) sholild he esw b lb]HU 00 lb co
hl b oi hi p~l11il uU r -1Ir vlt Abo 111( e IlltUtl Chl lie o f purti n - a U vitk slJ1ultI h e )tuumlll ecl 1)] (1 n ldershy](ion r tl1i lt type for e upIe IilJ llyl)T S of repd shyiti( ml vemen prt n t in agonistK h)lnllltlSlks nI iIle kind f dlJ1ce C( uld he ([([r imentd
FmiddotO lllaljlallC and mobili ty of the SpIcircIlC
1 rd llo U 22 d L lm nrrare d lhlt in Illt fro nt a l pll ne
tilt 1 nge Clt 1)1lt vtment of tht scplit[i middot CU IY grcmr lIJ l il ~ d irectio n n f Lhe C ITelt tlO n tha n in tl le di re shyLion of pmgressi n l Fig 7 ) he IL o IS5err lJd tbat th15 mohiliry increac plrtil u la rly n apic [ cgcoeilts 1$ lh ~ ~c() li osb evolves Sragrm rJ 12 J ~ thus rigilt (0
VlI f n rller~p is ts Ilo t t) m o b uumliz - a sCtJl iu til curve w ilhout t [ uling ttwt tlle R lu tiOI o i til t ~a mt b fnlinruumln( 1hy l1tans o f ~I passic 01 1 rivE -uppnrt On tilt (ltllE r hand UgraveK d e iJlioJ1 in ease durill tlw tune 111 whicll tll C spmt i ~ not submjtrcd to correeshy( IV anl()n
j- Virh mi lei ol i b tlllt Upp i1n ill) lC tiol is d eveloped only lllmugil llClIf()mu$Cllbr f r llce thi ~
InegravelIl ~ thclcfo re tl1l[ inu eascgtt sp1J1all1extl)iity mua
11
Imiddotiumltgt 7-rurd illt Ir) 1 bull rdrilt I1 1 in tl lt frOlllll pbnlt- th( illl ge )r mOC llIeJlI o t the S-o UIIJC CUNe 1 supcrior in Ihlt diflt(l im ugrave( the n nKlIl thd n ll1 tllc dlrtcLion o f p rJ1(l( (llIl
be considrCtJ vntrl iJ)(l icltion and 1 undrli neocirc ab L a ~ubiljz~ILion 01 tilt spint pllss il)1y ohtl ll1td thrltJugll the stlengtlkl11ng o f the 1rltJgm vlt nonil lme shyCIC 111 illli orrant u bjcLliH- ln rhis r~f1 n sp u lllni lc tivitIumlLs sil uld lX tPI 10 dlegraveltl it l G lU t n w l1ik luring kine i Icircth lrr phyltical eXegraverci c~ tllat in ele
spinal m ot ilIcirclY sil nid 1e lt1 oid cdrt ~
Organ ie and psychologieal impainncuts and li islbi IiI le
A cgtI im lc pmi nr is moriOthl11 just 1 sp in and 1
compkt gt Ipp rnach to the gu in ad 1 ont i al~ shylute l e~se i t i11
[)a la 0 11[ [n ell lrom re semh pw tbat ome organi Iilnctiond cl fki ts suc]) as tlw clecrtiUe ut vild l tnd d fun ll l)Kity_orld ldly incrtJ k whil~ 0 shy[io s i -till in (1 miel q g of g JltlV ity ~ l ilI e 55 rtI lit
tllL pres e n ce )fl defidt Or Vi l~il Clp~1 - i~ ln one pIIiem in Ihr l ftectecl by 20 ICl 40 scoi stgt l ls~a r(h cunclutecl in tbe UA by Di Ruce- prod uegraveed an aaalo) u ll1lXimum 102 re u t in a group of Jd shyk 1ien t [(h sco llosls rang inF frum ) [0 1
Al10ther rudv bv rallt r m C chr111 lilcl NashycWrl1s( u 57 stlO eltt hil $(C 1 1 ui~ Ica js l( lllt cl (1 shy1prUlllI o f t1tgl lie bJd l imI in ~ul sct t1 t ltu b middot iects jlLltr l5 they are golng through ~I cltlici[e sllge in the fnm 1lt i n 01 tlWH o w n id uHitv t factor hit h Illy jeopmlize the cl velopme lit d ~ mIll lt lI1d htIshym cecl IWI sonalitr in Klulrhood
n RUI ~IEDl(( Ptl Y1-
ROU ltHmiddot PI [ I C~ 1 EXIRCIS]~ IN TI Il nW~JUNT OF SlllO lDIOP1HIC AI)C~ESΠ11 C(gt1[Oi 1S
This i why b IiCieacute ii is ~n imporrlIl t for p rcshyvegraveml e 1tLsr l tn en ou flge 1ari e nrs ~lfrecr(d by lIillcl middotu iosis ft) tlke p~l rt in portin -re rcatioluJ acrivitits Iha t 1eIU 10 L10 th r~1chophyinLl bull nd b~l )i 1l1o tur adlieem t n li 51Jmiddot2Even tlK)ugli [Dr bic mech~lnshy
ical mcl nellIUll10t 11 11 reltl ~ons lt r111 1gtomcrimes be l lefu l to ugg( ~t ne p rt in~ aCt iv ity r l h (gtr rll n anotlJer e th ink Ibal an exces~ ive IlHd icalizltion - Icirce l ll1posilion br plry~ilt i HlS nnejlor parents uf rh ry pe of po rt to lx p m lice 1 b Ule p 1Ucirc(Il L th1[ preshydLl ck l1 is fret clOice in lh ma tt r - -h II ll1 he avolc1ed wb 11 possLhle mainly for tlle i mport~ltll psyshyLb ) jogka l fe a SI)nS W( ha( ill ~ t nltntionegraved
Conclu ion
lbh ISsertegrave d t1H physkal tgtXtlci o is ) n fi ial whlIl practinu in order 10 ilnj rove the I11 llde
rœ nwh and tono C iral caplCiry and postu re o f the StOUO(I ~lIbj n II I nowkdge om ~ middotmg trom ci el1shyrlfi rls(~ Jrc li dJlJ accordl ng r the review 01 thE litshytirlture prnpo )td in t lli plpl r conflrm~ Ihe vuiclit ot th e -t ls ~rti ()ns
In l do l (ent Id iopl1il iC scoliuse il l n phee u i cl vk)pm e n t ( li tll iumlKh eXCC cl l g i en rhk thr hokl th e re i5 an und ubred need fn r l pprnpri 1tegrave (JJ1tOkJJe ~Ild Inr surgict1 therapics ill ortler 1) S l i p
the ( - Iuli on anugrave )JT~t~t UW ~pilll l dtlormities bull evshyerthtless in the illiti ~ll pl l~sC t ttlC c1iseLltc whcn the riS( r1 r euro )luli m is rtduced ocirc ~md tfle uifleal JOld threshold il ~ld flle po stural collai i reJcenw~ 43
JI l1 igh pllysicaJ egravexe rc ise - p revenc or r d llCe d i ~lh ilir ies o f [Iw ~ l() li )tic
p (iems R 28 J -6 5- 6 1 63
- f~KiHtare lh ( n utr ali711iCUl of postu m l d elicits tn produCel1 a coneql l nce J [)ti 0 I111)( or regre si -u lmiddotc 5middot Il 1 17 ~ M
-re 51udles U ~ n Ledecl tu con[mn or re jecr these conClLL i( 1 w l1 ich clerin-d frum 1l1 lIldytica l rcltw n f th e liter~iture appear r- ~Lo nlble Hnwecr Intil ne re ull are 31Iable wc should n r prevent our sroliotic patientmiddot trom tl ki ll p lt in s(loI1ing jshy
ir its pW1iada rly ltl t ~d1()o t () n til t c ntrHY -vith the l xcclrinn 01 gt[1 )11lt tIlat in rea-e t)1obility (tnU evc n thell oilly wh n progr~lgtion b p OSSibl) -uc h ~I( ucircvshyiUe -11 )ulu hl tIKoll w g ed The 11 S J ( rprOpriue kin (~irhe r~l Piuml to incr _~asc p()~tura l $llbil i ty is tl1egraveoretshyic tlly CiJUClt alttloughl more ~Iccu rtte aod deLli led ri k benefi rs anJlr~ is is netot1ed
Ria 1111tO
NIokl Mu d lle ftitYljJfu Jœl il 4IWr10UOifll S (JIvs i (1~1)Jshylidl ttno( cclIll le 11(11(1lt1 RCI fu lle ((lia LltfIt l1 I1I1i(i
LJ ci n s j(r3 pigt egrave li n IHUgru lkl di t rdz t fi sici pe e ft shytUlKm iluppno di un lisimerap15Ll rl lllcflt() 1 110 scopo di pnevirlt () fr en~lI 1-lgpwlllltnlcgt dclld lclonnitugrave o e il 5LOshy
Il i mi llon lt fH nugrave j (1 11ni dei co~e 1 lteIl I1J J nd ne ~Ii eifclti (()Tc rri udk s co lio si d i m e dia g rt iuuml ln que~ltlt
s rud i 30 llizzb mo i d ti cleU ric lca pel n ri Icare qJJ l lm 1 dis(imucirc x u le I[~ l z j-m i pro vna le da lla C gtl k A i json ere pr middote-nute () rk kl ducirc un~l rdeguCltl d nil cra pi lt di uJoseguerrnt Cjua li 1iU110 cli nbie tti 1 rcr lJ)tIId d~ fle)-UITC
n (- -fd7Io n~lcl)
Ut11claquo)si 1 lI tori htpnuuml )ludi-ttn I ~ cnntI1zttu fr Cq(in i idiJ)tic1 dbfl lOZ10l1 d d ~ leOla nelllOll1otoriO Lb un1I1cnUl 1n1l1i3 dcgli 111 lt1i ch DIJgt gtU l H crmU1 Nlch~mslt ( SIshygnaJ~l lerimiddot wo i esuemi -bletti d~ plt~e8lugraver- ne l pClZ le1lftgt scoliodcu kl s iluppo ddl ~ ~ uhjlil~ vertcbral~ lt o svilllp prJ Jdle JIl7 i() nl di ltCjuiljbrio Dng li studi sul lto lb( l~nlrale (OllddU i in pa rticdu d 1 DlIal-BeHJ (gtegraverl ~ P~II IId lI1 n~ llw - idente il v- m gtiu p eT il puientc clioti elgt di u n rnigb o t c)[ ro Ua sw mle dei radlldc onsegull o tramite il 11 fforzrlshyfl len to d e i l1luotoucirc l nllgr3ilri d e luOwo con crcbi ~Clltdr
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v it ln G mlxl r i ~ gko Fl llslrom C dlllJ O e Nachcms(J h iU1I) dim lr JtQ che b o liosl p IOO C1 neUaduksœnr 10 SYil l1p pn d i lIniumlmn~gin nlt8Jliva de corpo in (o nridcnz di Ln ddic3w p ri d di f( m l lz i nlt deUa SUl idenritl condishyZltonc ch pOlrebh ~[I cubrmiddot ln vilu pp di un pe bull n nn lir m llur cd e quiJibfarn in t[C adulro TaU CO1DSCe nZe tvlde nshyZ[II)() la n ( middotess iti di ltimobre la plfte ip a7j0 r1e atl an ivi ll1ltHClr n gl b a li ltl h ~ di tlpO s pu rti middotu dl ittlrc nd gloani iCo lID ti i lirtugraveta z io ni llb vila di relazionc
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(i OWgt1lC IC PiClT1 5 Y tuU 71tllll d lnla-lre tUll u l [ ral rlll l ltl)[i InltrlIenlO dh -Ii ltl 1[ r iJ1nL~ tk eda 1)3- ) 2 _middot1
EUROP MIDI C Pli hIC
EDUCATIONMEETING SATURDAY 8thof APRIL 2006
(iSS
SEAS02 Scientific
Exercises Approach to Scoliosis
version 2002
G
S Negrini 1
EDUCATION MEETING SATURDAY8th of APRIL 2006
Neuromotor disfunctions
Neuromuscular disfunctions
11 Postural collapse
Postural collapse
Duval-Beaupegravere
Flexibility of scoliotic curve
f---I--- I Postural element
-------1 Structural element
S Negrini 2
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Postural collapse
Duval-Beaupegravere
It is a value related to muscular tone and to flexibil ity of convex side tissues
Post ural collapse
Bunch e Patwardhan
Critical load
Load threshold beyond wh ich a spine begins buckling
JI~~Wt1lW~flfthtlJlœJtAr ~ J~It- l~l - IMS
Postu ral collapse
Bunch e Patwardhan
If a curve reduces there is an increase of the deformation threshold
~~~NW~-damaoc~IIIMf ~~ J~Iv JaJ-I7I9sect
S Negrini 3
EDUCATION MEETING SATURDAY 8th of APRIL2006
Postural collapse
Torrel e Nachemson ~
Scolioses below 20deg ~ ~ lt~
have a high ~ ~ percentage of ~ ~
~postural collapse (on u~
average 75) ~~ 2i~
CU~VE O EG~EE S WHllE SUPlti e
~laquotd~c6b ____lPffI1wtt1t~
$ww J(t ~~7 JM5
Postural collapse
Minor scolioses 7
Antigravity musc es strengthening D
Reduces postural collapse -G
Increases the critical threshold of deformation
G
Neuromotor disfunetions
Stagnara
If we admit that one of the causes of idiopathie scoliosis is a disfunction in balance systems it is logical to orientate physical exercises toward this direction
s Negrini 4
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Neuromotor disfunctions
Dubousset
Idiopathie seoliosis results fram alterations in praprioeeption centres and deformation is a natural compensation to restore postural balance
etattJtitIK ypothfQj~S ___~ own_ oJ)HQr lar 1t-1( r
Neuromotor disfunctions
Nachemson Initial idiopathie scoliosis
+ Goood spine stability
Neutralization of postural deficits
D Static curve
Neuromotor disfunctions
Therapeutic aims
c) Development of spine stability
C) Development of balance reactions
G
S Negrini 5
EDUCATION MEETING SATURDAY 8thof APRIL 2006
Biomechanical disfunctions
j Horizontal r-Ian
i Sagi ttal plan
Frontal plan
Frontal plan
q Frontal plan disfunetions
Fronta l plan
Perdriolle Movement magnitude
gt in the direction of lt in the direction of correction progression
S Negrini 6
EDUCATION MEETING SATURDAY8th of APRIL 2006
Frontal plan
Stagnara
Never mobilize a scoliotic curve without ensuring reduction maintenance over time otherwise a greater mobility favours scoliosis progression
Frontal plan
Ducongeacute~ research
On a group of adolescent idiopathie scolioses treated with
Meacuteziegraveres gymnastics
D After 1 year the mean angle of
curves increased from 18deg to 29deg
Frontal plan
Scoliosis without brace
D Greater spine
flexibility D-
Risk of progression
S Negrini 7
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Frontal plan
Mobilization is useful
D In preparation to
brace
D With brace
Sagittal plan
QSagittal plan disfunctions
Sagittal plan r middot _J o
Perdriolle scouos B CJ aDeformation of D
thoracic and thoraco-Iumbar curves evolves in extension
S Negrini 8
EDUCATION MEETING SATURDAY8th of APRIL 2006
Sagittal plan
Graf
The line of gravity centres in the vertebral bodies o s c oUOSt
projects itself firstly laterally and then fi
o
posteriorly lJ ~~ ~~ ~ ~~-_J-D ~nI~
Sagittal plan
Therapeutic a ims
D Maintain or
retrieve physiological curves on the sagittal plan
Horizontal plan
QHorizontal plan disfunctions
S Negnni 9
EDUCATION MEETINGSATURDAY 8th of APRIL 2006
Horizontal plan
Stagnara The forces applied ta the spi ne act in a autoshydeforming sense
Horizontal plan
Dimnet Rotation gt 200
ampII~ (
D The actions of concave and convex side
muscles become
agonistic
~ItJrOnrIIiItdllfUClltlluumlll~~tI ~1JIf1laJ
Horizontal plan
Minor scolioses never exceed these autoshy
deformation thresholds
S Negrini 10
EDUCATION MEETING SATURDAY8th of APRIL 2006
Disfunctions at a biological organic and psychological
lever
Oisfunclions at a biological organlc and psychologlcal lever
Cheng
Bane density in scoliotic teenagers is lower than in normal subjects
~~~~middotA~IIlUtIy ~7œl 1d l
Oisfunctions at a blologlcal organic and psychologicallevel
A significant reduction of vital capacity and V02max in teenagers with a medium severity scoliosis
S Negrini 11
li
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Disfunctions at a biological organic and psychologicallevel
Disorders in the development of body image that the teenager has of himherself
Disfunctions at a blologlca l organlc and psychologicallevel
Therapeutic aims
cJ Activate cardioshyrespiratory function
cJ Favour bone density increase
cJ Develop a positive image of the body
Disfunctions at il biological organi and psydlologicallevel
Stagnara
Sport
D The active side of
kinesitherapy
S Negrini 12
EDUCATION MEETING SATURDAY 8thof APRIL 2006
Disfunctions at a biological organic and psychological
level
Distunctions at a biologlcal organlc and psychologicallevel
Cheng
Bone density in scoliotic teenagers is lower than in normal subjects
~n~IIIvpWr~middotA~stWy s- XXJl M J
Disfunctions at a biological organic and psychologicallevel
A significant reduction of vital capacity and V02max in teenagers with a medium severity scoliosis
G
S Negrini 11
EDUCATIONMEETING SATURDAY 8th of APRIL 2006
Kinesitherapy on the scoliotic subject
q Postural control
q Axial stability
q Muscular trophism
q Balance
q Respiratory function
The limits of kinesitherapy
There is a threshold beyond which
rehabilitation alone is not enough
sssr
Kinesitherapy in scoliosis treatment with brace
Therapeutic aims
S Negrini 13
6
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Therapeutic aims Srace kinesitherapy
With brace
il Postural corrections and
vertebral stability are obtained by the brace
Therapeutic aims Srace kinesitherapy
In preparation to the brace
il Mobilize spine on ail plans
Therapeutic aims Srace kinesitherapy
With brace D
Maintain a normal spine elasticity
~ Maintain a good muscular toneshy
trophism
C Model the hump with kyphotizating
exercises
S Negrini 14
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Exercises and their methodologies can vary accord ing to learning and individual sensibility of the single rehabilitator that proposes the m provided that they stay within the
Iimits of fixed therapeutic objectives
li
Therapeutic modalities
(Exercises)
QAuto-correction
QRespiratory education
QErgonomie education
QMuscular strengthening
QDevelopment of balance reactions
WNeuromotor integration
ci Vertebral mobiJization
QSpecifie modalities in brace treatment
S Negrini 15
EDUCATION MEETING SATURDAY 8th of APRIL 2006
The protocol of kinesitherapic
treatment
G
QChoice and dosage of exercises
Variatiosn of the work program every 2 - 3 months
Q Execute e)(ercises on an individual base or in a small group
Q Frequency not less than 2 times 1 week
Involve and awaken the family
G
S Negrini 16
EDUCATION MEETINGSATURDAY 8thof APRIL 2006
Q Determine the action and the localization of auto-correction
QAuto-correction must be associated to ail exercises
QAt the end of treatment ergonomy lesson
Auto-correction didactics
G
SCOLIOSI DORSALE---- shy ----
r
S Negrini 17
EDUCATION MEETING SATURDAY8thof APRIL 2006
SCOLIOS OORSOLOMBARE
shy
SCOLIOSI OOIlSALE 011 bull LOMBARE S1I--shy
SCOLIOSI LOMBARE
il --~_-
S Negrini 18
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Scoliotic patients are not radiographs
middotSeoliotie Mtients are not ndiographs but hum beings with a vertebral deviation-
Slagnara
Metha For the physieian Cobb angle is of utmost
importance For the patient it is body deformity t hat eounts most rib hump a protruding seapula or hip We are in a situation in whieh today dodors eure the radiographie deformity but what the patient really desires is to get rid of clinieal deformity and of ensuing psyehologieal distress
CIIQItIo shDuIdtucirc lM WIld tJw~~ I~~M~~~~ J9f~
S Negrini 19
- Poznan_workshop_Physiotherapy
- physio2
- physio3pdf
- physio4
- physio5
- physio6
- physio7
- physio8
- physio9
- physio10
-
lI f R (on- f Rt tt1IY 1lIfl pflla 1 )(~ r(Jnu n t shy
fI) _ ~
Pathomechanic basics of conservative treatment of progressive idiopathic scoliosIcircs
according ta Dobosiewicz method based upon radiologie evaluation
Kryslyna DobosiewlcZ Jacek Dunnala Kny ztof Czemicki Hanna Jcndf7cjek
Deparmem of Rellabtlifatoll Mediw Uninrsity ofSiltsia KatOllice Poand 40-635 Katowice fil ZiUCl 3537 POL4ND
e-mail relwbilitacjt1s11mfoctaonetpl
Abstract Conscralivc IrcalrnCnI of Idiopathie scoht)~1 espcclall y kinc ilhcrapy i ~
nOI widcly apprccilllcd due 10 Ils suspectccl low dfcCIIcircvcnc 5 in relalion [ (1 a urglcal Irc[llment ACter long-ycar il ses ment of palomcchanic f scolio icirc in Dcpanmenl of Rchnhllilallon f Mclii al Unlcrsi ly of Sile bull a concTvallvc mcthod ()f IrCtllmenl asymmclric Irunk mobili7alion in lnclly ymmelm po~itions WIS
de el ped_Thi mClh d enablc 10 delain pTogression f scol iosis or ccn de middotrca~c laIerai urvalurc of a spi ne and angle of rOlllion assummg adequate () perallon f palicnl and ilS famil)
J Introduction
Idiopathie scoliosi OS) is a thrccdimensonal dcfonnation of il vertebral col lmm an- cntire trunk Afler many years of extensive rescarchcs the cause of idiopathie coliosIcircs $ i remaIcircns unknown It is possible Ihat idiopathie scoliosis devel ps and progress on a baslS 0- ~
multifactor disorder perhaps diffcrent for curve initiation and curve progressi 11 Fion poss ible pathologie factors nervous system dysfunctIcircons affecting postural tquili brium ar proprioceptive control seem to be espc ially important [ l 2 6 JI Pro_ ression f iS could bot delermincd by vertcbrac remodeling under eccent ri c loading created by axia lly ce gravitational forces in presence of muscular imbalancc in the trunk [2 J The verte rai colwrz unde r scoliotic conditions 15 an unstable system with tcndency to fu rther tune dcvelopment fl2] Lateral bending of a vertebral column visible in X-ray examination L
only a two-dimensional prcstntation of a complex dcformity consisting of patho logica axi rota ti on torsion and othcr deformations of vertebrae [7 8 10 II 14J ln fS physiolog~ curvatures of vcrtebra l column are disturbed Total Icngth of an anterior column of a spi n~
consi ting of vertebral bodies and intcrvertebral dises bccomcs grcater lhan length of l posterior colwnn - vertebral arches and proccsses [11 15 J h is apparent that phy iologi ~
thoracic kyphosis in rcgion of a scoliotIcircC curve diminishes Each vcrtebra of a stru tu ~
urve of coliosis is oricntatcd in hypercxtcnsion in relation t adjacent vcrtcbrae [7 l resulting
1 n B Uri middota I l 11
H srut ft illtf j tI) t li orf1Hli d
IDS Prt ts 21)2
Influence of method of asymmetric trunk mobilization on shaping of a physiological
thoracic kyphosis in children and youth suffering from progressive idiopathie scoliosis
Krystyna Dobo icwicz Jacek Dunnala Hanna Jendrzejck Krzysztof Czernicki
Deparrment of Rehabilitation Medical University ofSilesia KaloKce Poand 40-635 Katowice ut Ziolowa 3537 POLAND
e-mail rehabiliracjas(u1poCmiddottaollelpl
Abslract Idiopathie scoliosis (lS) which i sub 1 ntially l threeshydimen ional derormation or a pine cau e nOl only laler l curvalurc and axial rotation of vertebral column but al lordoti allon of VCr1cbrac in structural curve eXl nsion ln an effect physiological thoracic kypho j diminishc or cvcn dbappears Method of a ymlllctric lrunk mobilisation in strictly symmetric po iljon according [ Do () lewicz not only dcteriorme progre ion of IS or evcn reduces lalera] curvalure but also significmtly rebuild physiological thoracic kyphosis Icircn cases of lS accompanicd by lraight baclc
1 Introduction
Despitc Ion year researchc etiology of IS is nOl yel resol ed Significant problem re laled lO morphology of IS apar1 from lateral bending and ax i 1 r tati n i deviation of shape of a spine in sagittal axis affecting physiologi al curvatu re of vertebral coJumn [3 5 6 8 9 J 0 1t 12 Lcngth of anLerior col umn of a pin constitutcd by venebral hafls anugrave intcrvencbral dises dominate ovcr Jength of po terier c lurnn buill from vertebral arches and processes [lOJ This condition uring scol io i progress ion and growth of a child effect in hallowing or even disappearing of phy iological Lhoracic kyphosis in scoliotic region It i well know n lhar cn~brae of structu ral Jaleral curve are positioncd in hyperextension - lordotisation [5 6] which in Lhoracic region Icad (0 reduction of kyphosi or to true lordo middotis Such kind of venebrae relation in thoracic region cau es ilS destabicirclisatIcircon whi h in u sociation with eccentricircc gfilvitali nal load fa pinc duc to muscu lar icircmbalance [21 pOdbly produces r tationaJ lordo is [56 Il] and further development of symptomatic scoHose ft ha becn proven [12J tha strengthening of the erector spinac muscle aggravates nce initialcd deform tion and deteriorates coliotic process Hyperextension and uxial rotati n a s clatcd with
357 Th B Grivas (Ed) Research inro Spinal Defoml ilis 4 lOS Press 2002
Exercise efficiency of girls with idiopathie
seoliosis based on the ventilatory anaerobie threshold
Jacek Durmala Krystyna Dobosiewicz Hanna Jendrzejek Wieslaw Pius
Department ofRehabililation Medical University ofSiiesiaa Katowice Poand 40-635 Katowice m ZioJowa 4547 POLAND
e-mail durmalaiacekyocztaonetpl Department ofPhysiology Academy ofPhysical Education Katowice Poand
Abslract The aim of the study was to estimate the exercise efficiency in the group of
girls with idiopathie scol iosis based on the venlilatory anaerobic threshold (V AT)
Material and method The investigation comprised 58 gi rls wilh idiopathie scoliosis
aged 10--6 years 32 girls (55200 ) wilh double major scolioSiS and 26 girls (448)
with single scotiosis The girls were eonservatively treated using Dobosiewiagrave
method The control group consisted of 3 1 healthy girls aged 10-1 6 years The
cxercise test was performed using eycle ergometer During the exercise the gas
exehange parameters wcre reeorded (minute expiralory venlilation minute oxygen
consumption earbon dioxide production) On the basis of recorded paramcters V AT
has been computcd using V -si ope method Results The following V AT values were
obtained in the group with scoliosis 207+305 ml 02minlkg bm in control group
219+350 ml 02minlkg bm The differences belween girls with idiopathie scoliosis
and control group were nol SLaliSlically significant Conclusions I The exercise
effieieney of girls with idiopathie scoliosis conservalively treated using Dobosiewicz
melhod is normal 2 Such high level of the exercise cfficiency of the studied group
probably was due to intensive 3-D respiratory exercises of these girls
1 Introduction
In practice there are researched useful efficiency rates which on base of laboratory tests results possible easy without using of the relatively hard or long exercise tests would give the belter forsighting of the range of homeostasis disturbances and rapidi ty of increase of
physical fatigue during varied workloads [1] The best known rate of trus kind is the maximal
minute oxygen consumption [2345] During progressive physical effort minute oxygen
consumption increases proportionally to workload The reaching of real maximal minute
oxygen consumption in time of progressive effort is iodicaled by minute oxygen consumption plateau [5 61 This result is rarely registered in children The progressive exercise test is most commonly used in children until physicaJ exhaustion and the highest registered minute
oxygen consumption is treated as maximal minute oxygen consu mption or so-called
symplomatic limited maximal minute oxygen consumption [678J Sorne authors regard
Orto-dlet Trau malaogis Roha b ilitacjaARTlKUL ORIGINALNY ORIGINAL ARTICLE Vol 5 Nr 1 2003 80-85
Jacek Durmala l Krystyna Dobosiewicz l Tomasz Kotwicki Hanna Jendrzejek 1
Katedra i Klinika Rehabilitacji Slqska Akadenia Medyczna Katowice Katedra i Klinika Ortopedii Dzieci~cej Akademia Medyczna PoznQll
Wplyw asymetrycznej mobilizacji tulowia na wartoseacute k~ta Cobba i rotacji w przypadkach skolioz idiopatycznych u dzieci i mlodzieZy
Influence ofasyn1n1etrie 111obilisation of the trunk on the Cobb angle and rotation in idiopathie seoliosisin
children and adolescents Slnwu kluce ac eJJic Cl chOlIU) Ice SKoio= idj)PO Imiddot(~I7tmiddot
K~Jmiddot w()rus consrieI ve I (OtlHelif idiopathie HUW JS
SUMlvfARY
BackgrouId The aim ofthe stldy Vas Ihe radiological evaluation ofthe treatllJent ofthe idiopathic scolioshysis utilising as)mmetric trunk mobilisation in the strict~ll I)mmetric illitial position
Material ([fJ(f lIIellOds Presented stud) lOS based IIpon J36 cases (13 oovs oged FOf11 ocirc la 6 lcars (lild
rn girls aged frum 6 la S pears) trealed due to the idiopathie sCuliosis ((rom Novell1her 999 0 F enflfUn 200) Among 48 ch idrcn sllfJering from dOlfble-major scoios is 6 cases wcre infoll scaliusis JOjuvel7lle und 22 adolescent Among 88 sillgle scoliosis 6 lere infw7t 33 juvenile and 49 adolescent
Radiological exami71ation 1as condueed always in the repeataole technical cOlldiions RadlOglOlI1 lier evaluated oy the same physician Radiologica analysis oIthe scolios is incuded value ofthe Coho al1gle ongle ofaxial rotaion
ReSIils ln double-major scoliosis observed dlring one year period in Ihe thoracic segmenl Cobb angle decreased inll l increased 1395 and in 292 Il OS 111changed Axial lolation angle in 167 (~rcascs
decreased in 354 incrcased and rernainM the sorne in 479 In Ihe llllnba segmenl Cobb ang le clccrcscucirc il1 354 increased in 39 6 remained in 5 Angle ofaxial rotation deceoscd in3 ofca es incrcuscd in 29 and persisted in 48
ln single scolio is Cobb angle decreased in 386 incrcased in 353 and in 261 was lInchonged Axiol rotarion angle in 216 ofcases deceased in 295 increased and rell1aincd the sallie in 489
CondlsioJ Asymmetrie mobilisation of the tf1f17k in strictly syl7111elric initial positions is a 1Clhod of choice in the cOl7senJalive treatment ofthe idiopathic seoiosis
STRESZCZENIE
WS~p Celem pracy jest radiologiezla ocena Icczenia skoiloz idiopaf)cznych metoda asvmetrycznejl7lOoili shyzocji tllowia w sciSe symetlyczl7ych pozycjach lV)jscio wych
M aterial i metody Przeprowadono retrospektYlIl7q analizri 136 przypadkeacuteM dzieci (13 chlopcow i 123 dziellshyczqt w wieku 6- 18 lat) z bocznym idiop atycnylll skrYll ieniem krrgoslupa leczonych zachowawczo w Klinice
1
Ortopedla TliJumatoogia RehlblllagraveeJa ARTYKUL POOL1 DOWY OPINION ARTICLE Vol 7 Nf 1 2005 49-$11
Krystyna Dobosiewicz Jacek Durmala Tomasz KotwickP
Katedra i Klinika Rehabilitacji SIAM Katowice 2 Katedra i Klinika Orlopedii Dziecircej AM Pozncrlz
Biodynamiczna metoda tr6jplaszczyznowej korekcji skolioz idiopatycznych - opis metody Biodynamic method for 3-D correction of idiopathie
scoliosis a description ofthe method
SIOWQ kluczowe leezenie zachowawcze skoliozy idiopatyczne korekeja tr6jplaszczyznowa Key words conservative treament idiopathie scoliosis 3-D correction
SUMMARY
The biodynamic method of hree-dfmensional carreeion of idiopathie scoliosis is based on Ihe palhomeshychanics of idiopathie scolioiiiii and consiss in aClive segmental three-dimensional correction ofspinal cllrshyvatlre The course of action focuses in the viciniy ofthe apical vertebra Proprioceptive facilitation is applied on Ihe concave side ofthe curvaJure and exteroceplivefacilitation on the convex side Correction likewise proshyprio- or exteroceplive facilitation is phase-oclœd with asymmetric respirarory movemenr as weil as wilh parshyticular phases of the respiratory cycle ln Ihe course ofexercises three-planar movement is generated opposite to the direction in which scoliosis Is progressing This method is in accordance with the stale ofthe art ofscoshyIiasis pathomechanics The method requires detaied training and can Ihen con be applied at home under periodic control by a physician and a physiolherapist The method con be applied in landem with a Cheneau brace as weil as in surgical pretreatment A elaUed description of Ihe method of three-dimensional scoliosis trealment will be presented in Ihis article
STRESZCZENIE
ISlofa biadynamicznej mefody Ir6jplaszczyznowej korekcji skoioz idiopatycmych oparlaj est na patomechashynice iikolioz idiopatycznych - poega ana na czynnej segmentanlej tr6jplaszczymowej korekcji skrzywienia Dzialanie koncentruj e siccedil w pobitu Icrllgll szczytowego sknywienia Stosowane iest bodicowanie propiocepshytywne po stronie wklllsej oraz eksteroceptywne po stronie wypuldej Korekcja i slosowanie bodicocircw propioshyi eksteroceprywnych zsynchronizowane j esl z asymetrycznym torem oddechowym oraz z poszczeg61nymi fazashymi oddechu W trakcie eacutewiczen powstaje odwrotny do lrierurzku rozwoju scoliozy tr6jplaszczyznowy ruch IcrFtshygoslupa Melodajesl zgodna z aktualnym stanem wiedzy na lemat patomechanizmu scoiozy nymaga szczegocircshy100-lego instniktaZu po clorym mote byeacute wykonywana w warunkach domowych Z olcresowq kontrolq przez leshycana i fizj oterapeutll Metoda mote byeacute stosowana r6wnolegle z leczeniem gorsetem korekcyjnym Cheneau a talcte w przygotowaniu do leczenia operacyjnego slcolioz W pracy przedslawiony zostal szczeg6owy apis meshytody leczenia
Skoliozy idlopatyczne stanowili znieksztalcenia patycznej rozwija siccedil poprzez przemieszczenie kr~gu tr6j~aszczyznowe charakteryzujltce siccedil wyboczeshy szczytowego w stosunku do krccedilgu g6mego j dolnego niem rotacjltt krccedilg6w klatki piersiowej i miednicy z r6wnoczesolljego rotacjl zgodnie z ruchem wskashyoraz zmianami w fizjologicznych krzywiznach kr~ z6wek zegara dia skrzywienia prawostronnego oraz goslupa w plaszczyinie slrzalkoweJ [ 123] przeciwnie do wskaz6wek zegara dIa skrzywienia leshy
Z punklu widz nia patomechaniki tr6jplaszczyshy wostronnego Koncepcja rozwoju skoliozy jako rotashyznowe znieksztalcenie krccedilgoslupa w skoliozie idio- cja i kontrotacja sugeruje ze sily korekcyjne powinshy
49
EDUCATION MEETING SATURDAY 8th of APRIL 2006
- CARDJOPULMONARY EXERCIS E
TEST IN GIRLS WITH
CONSERVA TIVEL Y TREA TED
IDIOPATHIC SCOLIOSIS
Jacek DURMALA Krystyna DOBOSIEWICZ
Department of Rehabilitation Medical University of Silesia
Katowice Poland jdurmalaqcmpl
The aim of the study was
to estimate the influence the conservative treatment (asymmetric mobilization of the trunk by Dobosiewicz) on physical efficiency in the group of girls with idiopathie scoliosis
Material
bull 87 girls with idiopathie scoliosis
aged 1 0-17 years
(mean age 135 years SO 161)
J Durmala K Dobosiewicz 1
EDUCATION MEETING SATURDAY8thof APRIL 2006
Material
bull 38 girls (437) with double major scol iosis (thoracic segment - Cobb angle 18-42deg mean 30deg SO 82 angle of axial rotation 4-32deg mean 21 deg SD 107 lumbar segment - Cobb angle 11 shy48deg mean 31deg SO 128 angle of axial rotation 5shy30deg mean 13deg SO 85)
bull 49 girls (563) with single scoliosis (Cobb angle 11-75deg mean 33deg SO 155 angle of axial rotat ion 5-30deg mean 14deg SD 83)
TIoracic kyphosis of the invesllgated group was 5-39deg mean 23deg SO 86 and lumbar lordosis 16-41middot mean 30 50 65)
Material
bull The 64 girls aged 10-17 years (m ean age 131
years SD 132) were conservat ively Ireated
using Dobosiewiczs method
bull Treatment period ranged from 5 months 10 3
years (mean 148 months SD 902)
Material The 23 girls aged 10-17 years (mean age 136 years SO 108) were treated u sing symmetric exercises - treatment period ranged from 4 months to 3 years (mean 161 months SO 1019)
bull 26 of ail g irls (18 girls earlier treated using Dobosiewiczs m ethod and 8 gi rls earlier treated using symmetric exercises) aged 10-17 years (mean age 134 years SO 108) were twice tested - at first and last day of Intensive hospital rehabilitation (asymmetnc mobllization of the trunk by Oobosiewicz) - mean hospitalization period 20 days (range 18-26 days)
i rf~8f6~~ or~~n~= ~~r~1~r~icircJ~~tb~~~~ mean 17-4 1deg meatl~(I SO 74 R n~le ofax 1 rotatIon 5-25ot mC3 111 3laquo S0 6icircl Ilnd 1 99t1S~ ~~~~I~~~~~$ruo~ras~ ~ocirc~~a~e~~~~~~~5euml1 9middotn~ tUfllbar Iord05ts 16-4 1deg mean 311 SO 68)
J Durmala K Dobosiewicz 2
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Material
The control group consisted of 77 healthy
girls aged 6-17 years (mean age 12
years SD 31)
Material
The examined girls participated in school
only in scheduled physical education
lessons and have not been enrolled in
other sporting activity
METHOD
The exercise cycle
ergometer test was
performed
J Durmala K Dobosiewicz 3
EDUCATION MEETING SATURDAY 8th of APRIL 2006
METHOD
The Incrementai exercise test has been applied
We have found that tests ln whlch the Incrementai part of the protocol ln completed between 8 -12 minutes duration glve the
bullhighest maximum VOz in normal subjects
METHOD
The workload was Increased stepwlse
bull by 10 Watt every minute - ln chlldren
with high ~ 135 cm
bull by 15 Watt every minute ln chlldren
with high gt 135 cm
METHOD
The test had been contlnued untll refusai of the patient or exceeding the pulse Ilmit
Durlng the exerclse the gas exchange parameters were recorded by Jaeger device model Oxycon Alfa uslng direct breath-byshybreath rnethod (with face mask)
J Durmala K Dobosewlcz 4
EDUCATION MEETING SATURDAY 8th of APRIL 2006
METHOD ~ ~~ r 3 min 3 min 8 - 12 min 6 min -~
_ 0 rpiYJ 0 rpm 60 rpm ~1 30 rpm
_ t o~w=att~o~~na ~~ att__~ tl~~S~~ l ad l ~~~~~r o~w= Hlcremenlal t
pedaillog i i ~
~ ilt ~I~-----tl-~ I t ~ i ~ lOSt sffortivB
lW r resututlon r rm-u middot 1 - bullA~cremen tal ~~ ~ ~ ifr- ~ VtI 1 ~i ~ tllng _
METHOD
On the basis of recorded parameters VAT
has been individually computed for each
child using V-slope method by
Wasserman
METHOD
For assesment of physical capacity
the maximal minute oxygen o
consumption (V02max) ventilatory
anaerobic threshold (VAT) and
maximal workload was used
J Durmala K Dobosiewicz 5
EDUCATION MEETING SATURDAY 8thof APRIL 2006
RESULTS
Ali girls with 18 have been classified
within normal range of predicted
values of
bull maximal minute oxygen uptake
bull VAT and
bull maximal workload
RESULTS
The differences between group of girls
treated using Dobosiewicz s method and
group of girl s treated using symmetric
exercises were statistically significant
Lower exercise efficiency of girls treated
using sym metric exercises has been
observed
RESULTS Girls wilh IS Irealed using
N=87 p value
Dobosiewlczs method N64
symmetJic oxor-ci Nz23
Perœnlage of predicled vaJue of
maximal minute oxygen uptake
98 905 0033
Percenlage of predicled value of
VAT 97 933 0049
Percenlage 01 predided value ni
maximal workload 101 939 0038
J Durmala K Dobosiewicz 6
EDUCATION MEETING SATURDAY8th of APRIL 2006
RESULTS 26 girl s twice tested - at fi rst and last day of intensive hospital rehabilitation
The value of ventilatory anaerobic threshold increased during intensive hospital rehabilitation (asymmetric mobilization of the trunk by Oobosiewicz) statistically significantly (p=00019)
2047 ml O2 minkg (SO 268)
vs 2239 ml O2 minkg (SO 232)
Conclusions
1 The exerc ise eff iciency of girls with IS treated by asymmetric exerc ises of Oobosiewicz is norm al
2 Such high level of the exercise efficiency of thIcircs group resulted fram using of Oobosiewiczs method
r
J Durmala K Dobosiewicz 7
REVIEWS
Role of physical exercise in tbe treattnent of mild idiopathie adolescent scoliosis
Revicw of th- literature
A NECRlNl N VElWNL s PARZI 1 A NEGRINJ 5 NEClU NI
P1t~silillxlrd~ Ihcrapy (or klucgtlttlwrlpyl i pro shy-tJm of physka] cXlrd-cs ipcci I(a~ (IJcloJgtcd hy l li trIWlltl phrslollwrapbt wilh tb m~ln a1mor pl shyVCnI in lhe ilAAfIVltilH1 llf the ucirccfonuity III mild IgtC )
Lil1Si bclpin~ thebm ( aocl co uaufllclilIg ils ~jd- clf IS in nlOdlJmiddotnh-culiosis Th middotalillofthi paper ito r (W
Ille Ii lc ram r 1 a-ccrulin wh kh of Ih bull Lu[Jalmlcrus Ind (Lb hili til~ CLlLt-cd br scnli()si- clluld bl pl Y nlcd or r d uccd hl phylolld LXtmiddotrdsi n Il p--to-da le knowl Uuml~l nr tIll~C aspcc[~ i ne bulled in oruer 10 dndc whclh~r 11Rf blLl adcqlmtt Ib(uuml n middotlicaJ balis fo r ora)aini l Ihe US4~ of lUgravellgtitlerap) wltcllj(r or fln l th e prtl1iœ of kimiddot ~lre IUlll poNjn~ a t iil ies ~bould h allowtcI II uuml middot c enliaI toltlentlf)wh k lu alClor ie - lf pl lr~kiJl -c rmiddot d gtlt- (Ic rnnhi UzJ( inn ni (t hl HrJltlon [ rtn~hcll iJl ~ or 1i1J(IChIumlJlJt etc) Sh llU Ld be TolullllCcluse ulemiddot l onld b- clclIimcntalancl wukh sho ll ld he IJlI-n~ifl~d I~~a l lhc (o uld h 11lfu 1 Know k dg CJnc1in t (wIn SeiCIImiddot Hlk rCS([lflt h daw ccordinll to Ih bull llVit w o f tIlt iii 111 1( plop(lsltd in (h i papcr lmiddotonllmJ l lnl plLyi 11 cxcr(j$( pn (nti or (tmiddotduce dhlblli t ic 1 ~lt Il Jj ll(k pl ti Jlt fadl j w(~ the nlIIIrl li7alinn n f poMural dd shylitS tu p n xJ llc aSl COIlMqnen c(middot 1 all )llal) or r(tn~ shys i middot middotlIrve Tilt u~c (I f appn1priattmiddot kincsiuuml wrlpy 0 in rcns polttllcal swhiIHy Icirc IIHmiddotorc Illta ll y (0 r 1(lt1 lllho UAh mon ltlccurlltc 1Ut dl1alkd -rLk l(lWfils 111111 )11 h Jlccdt(
11) wurcJlt 0 lit)-IcircS (Iumpy - x rcLs P()lun
n rllt lT(ltnklf u f COll1tlK H (rtd) I 1i plfho l og l ~$I rUlglng tr m low tmiddot k Pl 1l1 to IdiOpath ie SCUIshy
Submitt(oJ [or PUhltCl l1 011 uly Tt 2001 Acc~pttJ ugu - ~2 1(t-1l
Addre rltj-xlfll telt~I(middotb If) - grinl Flt(1(bziurllt r )(m Ofl ()(Cl1I shy Lt middotqlltœlll ro () - 1u I4t agravehLIlKil ta IYIL-lTt ilSllltp lfllmiddot ~ 1l1uumldull
CelII ~ (niiOS I I~ middot ann (1) IfUh middot lIlfU di louhilll(tymi ( Nlmiddot ~iI rli -ilIIUmiddotltlfl
Nlti(ir 1( ) il r() (ltbullagt1
lt vLL_ l IiII no 1ftfI
jS ) we are a IUil ly tJc ing n1n) ltblll lS 1 k l1 b ~J)w in~ tl~ t S Jfll l approad llt - l1n til hy on ielshyertd ~tan lard ugraveJuld ln m any ~1~ he lI ~t les i if Ilot dange r )ll lt rhlS is lrut of reil l lnw 1gtlt1lt1 pa in l ~ or 5urgi c ll lrea lmltnl5 in dbc r lmiddot ll Sc - 2
ln tlle cj-e ut ~ t lll(tlWtl i( li p l ll1JC luuml- I ~ middottnl ~() shyliosis phys cal ((_lt1(( is emr1uved ltI t()fIl1 0 lh~rtrv
lo ly in cel1l in L)lllllde (nluumlnlr in tilt Lltlll middotorkl i e Iw l) r llt t Srain hUI IIgt() 111 Gert11lny 5- 1~1 in other reg lOl1 wbere thi I-incl qf tre l tm e rll 1 p~ 1 pmiddot t 1( cI il Jws Ixen cri ri cilld md rel -cltd Lw m~lI1 1 11 Jlu~ Fue Fnlny r ~lrs thio middot15 a lsgt(ru( f ~rth r -~ltc rrJtf))~ ll t vit11 br1Cltcgt b r II1 ([C Llt n ClW grmvlng 1lt1 0 L Sti g
gcsti n the lIsefulnes- u r Ih is form o t treatm n t 1
Hmiddotu]rs have nerged jn El or uf pll y~ iLd eegraverdse eacute 00[ 1 but tlw are nUl yel 11 11 t llu i vIC~11 and r hi ~
f rm of trt ~ltmenr IS stiJ l Ul1 ckf ckhate FfI t Jt 111 il i 11t (eltary td 1I iFy 11umbtr ot
b l sic COI ceP rlJ lf w ill he cIh tt d in t hi pap r
Scollosis
DCijIrI iriolls
ScnUoSlS is Irlircc c1 lme nsIcircltnal (I(gt i l cj on ot tht spinc thar cau C a CU 1 lh lt ca n h e $ t~en ln (1 me1Sshy
ured ultinF Coh) lll ltllCXI o n HI anreu middot p rtc rilt r
EUJlOI -1 lœDICOPHYSlc~ IR
NECRI Nl
110
f)i)
1 7J
amp aS g 5li - 0 v
V
31
10
(1 1) Il 15
-tc i ytjtr~)
FigJ----jllph ot DlI w l-lkaupegraverel) The agloimvltltinn Or idio r lrhlc 50gt1iflll~ IS rpiJ bel~ en th e- [l0 IH P (l)ltg tnntll lol (JI PUllcmiddotny) mtl 1 ( f( lS-er sigll paiilivltecirc lt Dlt(i I1 11illg r the iti l 1Kgt n n t rll icirclicH a ) 111lt m omal prebulled the mno rche md ociks with lll I)ttlx flal gr Ih pll fl
rlcljoprdphLi 1 hl merl prestIK ~ of this curvt c10es n t autom~l ritllJy indi ate the pn$CI1(t of a defurshyTnitv (SlllKtUrd (Unel
It i~ possible tu clil1e ren tute a struCnlt t CI1tve fruIn a pogt urll 011e by identifyi og the hum]) du ring AdIlns tesr I~OQ looklng tra m beh lnd at the p atient w ho b benchng fUfward il is p -- ible ta d d~ct 1l1 eh ucirc n of o ne liidlt 0 1 the trunk usually n n the (onvex ~ jde ul tbe radiographie CUfve Ugrave1lr C Ul be mlt~I Slred lISin~
BUlln els S o liomere( 1 ~ l This h Uf1lp is du(- lO (Ile pregravegtecircn ~ of vertel ra i rolltion 1c1 Ollt tn tic f~YJ tllre o f the def trrnit tli [ c m be seen and measurc(i v ith Perddolles lb lsLometer on an amero-Ix)iferior radioshygrapb ~2
Seven ry pel cent o f li Ises a re conid 1lt 1tO be idiopa thie 1 bull ia l-nosilt in this CI$C is b exdlls i ~ n as idinpa thlc me-us t11H wc do n()[ know rJw origio of lheacute curvc [n othe] ~Ie$ it b Ix )~i ble ro ide nrify a dieak (bat CHl jusrify the c1etgtnniry slIch a rna lfo rshymar i ns I1(gtufol Ig ic~ l or genlttic cl iscas s Glnclt~r trauma etc )
[dicirc)parhk S(oliosis has been divicled ~(corcling (0
the ~Ie of tlie patient egrave1l the tiJ1ll of d~[ccli n of the condil ion into ti) ur t ypei ln fanUlc jU nik ltldolesshyccnt lnd aduh Til l m n st cnnunon (VPC IS the acloshylescegravenr o licirceacute I1IJctenzec1 hy 1 sud le l1 tggrH3l ion uuml uring the grow tll Spllrt (Hg 1)2
lhile p tu 1l sco liosi i5 Ycry lomnw n thl pre shy~Iknct ra te f r adole ent icuumlop~lthic structural CU IY~S in sch )o chilclren are 18middot20
- 10 Co bb d~grels o r m on l -lil
- 2) ~ohh dtgreclt or mort O 2~j - bull () (obb d gre -s )1 mOfeacute ()ll 2
Clin iltI [ d e isio ns lfl IXlSed 111 an lccu r~He pregshynosi which obt inccl in eJch pa ti nt mainly o n the basi of the nsidu~ll p()tlnllltl l of TH1h and the result s of 1 rh clin 1 1 ~l1d tadiogmpl i exlminashyti(ln12ll c noieq uentlya d inica ] la sifiou io n o f the ing le pHient tn -ome estent co incic1 ing w irh the
D diographic one c l n lw SLlIl1H1arizeci 1 1 folIcJ - mikl lc~ (1)(n 20 C bh de~r es - moderJt l betwlen ln md 15 ohh de~ rtes - StV re 111( gt1lt rh n ~J) )bh (kgf s
On the 1) lsis of [hi - dinic d d a lfic t i n (Vith l1l il el lrb tiOI ~ o f the ir b() und~ri e ) in Itllt l cente rS Of SCOtiO LS ITe ltlllent in the Lltin odcl (i rJ Ital lnmct md PI iJ Ugrave tre tmtnt i s plmmcd a fo lltJw 8l
- mild kineslth e (~1fw ~1Il (1 luok-ou t - Hl demte IJragravecegrave 1111101 c(~r md k i rws ithe lJpy - ~cven surgery
Physical exe rcL~e for S(ol iosis
Defi t tiOl l S
PhyS i 11 nU b lIKrlttp middot (or kines ithcIa Pl) i a p rvgrlill or plt~i Gl l (xeriltecircS ~1ci fi ( llJ y ltk ~ loped
y a -11 [ru ine 1pll yslo ther3pisr wirh th e m 10 Hllll
- pre (~ n tit1g tlc aggraaLion of the cl I )flnily in rnild bullcoUm is
- helping tlk Il ld Ct ~lOd ounter~lCtjng its skie elfects in III de rltegrave sc li sis
Tn tl1i_ feSpec1 kinesitl1ert py f JI s oliosis is tonshysider l a o on of peciticcedil training and s genecirc tltllly proposelt in sessions 0 1 4~ ro 60 minute IW) t) tour limes 1 Cee PhysiGtl exerci es can aLo ll v o ther auumlns 1S it oill he dise Issed in this plper
Ir 15 Ilot possib le to cl escribe a single progrlIT1 o r exerc ise a5 pro nrams ale USLIJUy p fgt nll ized ( ( lt
EUH PA ~illDI (DP1I YS IC~ 182
ROlL UF P l 1YSICAL lXl 1lt 1~E IN l IlE 11 ~l) IEd If IlU) l[)VP 1HI AIJ() J)~Cl~ r COl ~I NlG1W il
f)( 15 egraved ( )Il the nee L- 01 indi iuua l pJl itnts) al l l10ugh Lheacute) C l n h t 11 plicd o n a WOU p hJ~js (-1 (0 () pnients PC[ ~l ()lI r)middot lugrave reQCf lhese 1 10 grl lll frequt ml~ V IIT
hnm on in middotituk w allClthltJmiddot -Ill Jnv L l~egrave at Wc w Ht ~huw in lhis lyl peJ it i~ 111 n u -eII1 tu id e ntilv kirK itheJapturlc aims w hitl l ucircrr~spnd LO ugravelt~lil1 DUtshy
g X ir ur ph -s ici l lxtTi~l I~llhe r thln ln dj( us- indishyiJ u1 1progr-lfll
Aduumll l lxUl kisure time ~lOd h )u] Sp u lllll8 ~Ilttishy
i lt egrave~ i middotomm )Ly s iven lel mJ ing ro w hlf ~ Iuumlnsidshyer~d usdul or il lrmfu l in t1 lt rruning (lI tJw ptliJicirct ln tl1bplper Ugrave1 gent ltl l t rl ll bull p lwsiCUgrave lttG iviUes is rl ktll 10 JllI1ltlCc hOlll gtpOlt mJ kIJ1lsIcircl hc lJ l f
i ve lUen tloneumld )bo C on lv ine n dul( re Ull~ 1t~1 t s far Ilten publislt d f I~ mJ I(i noltgtithltl rgt is 11 11 a su h jel lnI deacutehate CJitk haltlt t llltit m itn ltl of l ny lorm o t p l1 ySiClI lxrcL e as a Itwr1 [ J- fo r i liopa tb il jcoJL~b un iL ()ri gin~ initial1) it WIS Ille r rOmiddotUumlK lt brgdv u f p l~lt titu gtllergt w h ) intervenecl hutll tc llcrl ll (mon as cltl HtilJ nic in terventi n man Jgt
1 t lltrJp utl t one 1 md rC j fkll l~ on rhe h sh lf som uni cOen I1v pn t I1cgts wt ldl hll ltl enl1 JI~ haLl nu na l scicnt lfic baisYmiddot HOlh tlle$( trr t peu shy to rh ~rl py tt nJecI to l~~rJ tte C Ih tk CUf -~ pnnshyclr~tll y as a f tsul t of lilo h llIzatio ll of tn imdqultdy ~u pp rt(d S pln eacute 7~ 12 to re-t1 r rI ltrl 1$ l l1C k o f WH llt~~rdl 10 I ndt~-dll()urnah tnd 11( on1 p~l per u suaJly Cl tc([ IS n prelimmtrf lll d 3 ln tt li w ay man (l rrlKpt(Hc H lf O iS Inll ph ~i C U l ~ d vi ~ cI nllog scnliotl pa t le nL~ 3gainst holll ph lca l egravexershyclc and p()rt~1
It m u st t~ n tfd [hat pllyknl txerc j~ tJe~ltm(nls t1iHer 1 lJ rd il1g r rhe rherlpcu tlC litTl~ on lllc h tJ rgt ap p lolc il l the IXlltent lncl hi im r IIIllHnt i- 1 (1(1 rI - 5lt1J lC igt tIl l ( f phJllIlllolopJ al rrea tmln ls Ihith cllffc r 1lt œQlfd- rhe m C cculc u ~t(l luI thl p al 1t n
~mc l 11i (lbE~e Tt i ~ P ~il k tlwreI[middote thll wuumlk ltlll t kin 1or ph~ i Clt1 1 lX r(j~ 1I 111~ t bc loidvd by t h~ Lo iurie IxujCJ1l al1ulhcr a dl ~IS nJI h~ iOg (1 11shygerols llugJr in racr le (wi ller d I ~fJIII ~ I ml thlls re(nl1l rn ndc(1
fn n UI cel1ll r we In(~ hccf) using 1 ) 1 1111 11 ve ) 1 (J p lw l icd ex(r(i~e (0 J ( 1I l tt i~ tlh aITt ~ l~d Ilv m ikl tru cflumiddott1 adokscltnt (cl ioj arh lC icoli is11 2)
ina the f U~ t rc-gt uJrs IefC pu b lishe - the pJ( )grd m 11lt1lt l1te n PWltllk d in fa c t deel()pnlln l~ in th t l itshy OlL1Ii in tl1 r b t ~() ycal f ha ve iclemi fiecl niO l l
m d 111 ur impl rnHm s md d i s )h ilir i (gt~ lue t idlo p lthk amp()lio -i ~ t Jll CIII he 1UO(l if Icirc 1by phyict1 egrave xert iSlgt l fe t rrncllt
l illl
111e aim of t l1JS r~l per ii tmiddot (tv iew tl1( l iterat urt to a(errl ln v llic ll of th~ impa irm 1t~ and Liit hil it il i GllIltec hy ~ o l i()gtj s -o ull he ll nt x or re middotlu celt1 Ili pl1ysical xerclse An u p-to-da te knOvkdge o f tl lt Lgtpecl-gt i necckC1 in rJeumlr) d -oek
- whetll~r there h ltl n adLtIIl ) l tht()d ical bbh fur or JqIIcirclb l l l1 Il( ) f k irt llit herlpy
- h N I)(1 ( 1 Dm tlle p r l c tIcirc(( o f Jebur tiJne )pOfung lcli v l ti ~ IIOU lci he tllf) -d o
II J U V f h 1 I11~ c~~lb li hed Ihe usefuhlLss 01 k il1 shyc ~thtrpy il i aIle dy l nsi 1([(( -r-tI Llleu i n )I11 plJt~ ut the wJrld ir ilt ecircS~nl i 1 I( id n Iv w l1i li ( 1shy
gories 0 1 pl1Vtl( 1excrClgtegt te D)bilI7it ric 1n (Ir st shylliuumlZltio f) lttlt tlgtbltn ing ni trcrccedilh ing erc) hn Id be
vnlcled he tll rhe nuld be lerrillldll1 1 md whidl s tlQu1d be inreœ jf ic(1 IJeClU~l tlley cOli lel Je LI ~ful
Ncuro1llotor impainncnts
Imv aUl llOr~ 11 lt1lt ~tlKlteJ lhe cltlndatiotl bd Ween tl UC1UmiddotIt t l ol(~C t nt id iopml je -nll ~J~ and cli~l l shyler~ lr 1tH lest ihuLIr yt 1 _ 13 ~ 311 D uhoussct 1
1-- ITS tln l ldiopath k s(o lio-L L cll -c d l J l hmgt in th terl tltr f prop li l l pu n md 1I1ar th e detrshyn Hi n i~ na tural 1 ~ronse to ril e need tu ts tu re p()tun ltlluilib riu Ul HcrmJJ1 31~ 11 () d tllat icliupathic ( liCl5j h l it re5u lt Ot1 rw nltuf mot r l ~ltelV
[Id )fcl 3 nI] ~1ltJ U Sr1lle nr to dtorders in centJtI lO~Cl shyIOIDNur) md 1xi~tI moro (Ul1lfOl syt( llI (Fig _l
N htIll -of) H1c S uumll h( rll1 ( ~ l( w ing JI t11 (oshyI-ie on the l l lO]ugy o b doll (nt Rl iu]icirc tlili- middot()lioL m unt fil t-hltll rhl ugravedcmnilV L th e fl5 ult o f 1 (k btcl 11lIFll llI ion nf som t11(WUgravetltnl md pO~ lur( (tnic l~ l licirc1 tl1lt if l p OgtlbJt b C 1l rlw sta l i lin 0f 11 1 Sf llle j lt g )tx l Tt) ohtil n a ))Cli U 1ILzltl I o f p ~llIr~il d l~flo [ in l1litkd ~J)llnSIS me CI Igt(middotqucnr J ~ a ~tmicirc ()nlly or regle Ie Llive
Ali th- 11yp ) tlw~es rd ~lte tr d irtl Itn t pnl1tlt o f [11 v hole ~piltm It11[ controls postu re ~nd mrw shyment lrre pell ic of tlh po int a d lI~ llv inH llYegraved il i ~ ll 1 nnable tCl aSUilll ri 1l tr l ll1 lo g thi ~ys ttm ( Qu it le 1I middoteli tl
lt ch ugt nlt~(S f rullliIl thil i nlomwtion th at p tlmiddot shyiCil J(tl iIies nw gt Il lInport~n t rr le to pbv [11Icircgt role ca n 1)lt slI i11l1lariztd ln lWO the ptu li ain Llt
- d elopmll1 l of p uumlltl St1 b Hlt ) - c1e veuml IOpm 1)[ o f bhll1ltc _
(k llhUl)lOr S Cll orr
ontrot oic whan-lt
------+ 1 ~ il lnll ugrave r AINnl
Cllnlr1
T bflt~ r
fltL1 tlli
lMini
l
~sary ~J-frlllen i )f
~ 1 ocirctnl
~UcirclllIJJlW Ll
AXl ~l1 n uumll l) r sy 5t ~nl
middoticoltoq ~ Fig 2-AcFgtrdong lU He-mutl 21 il is Fi)5~ ib1e rD prolXgtSlt l -oo ie1 mnd 1 ((if ~ elio egrave middotAhltr~d l)Qdy-p ati~ I I i u d) uren ttllOn k td LO In ~ory reHTt I1 eDi tn l al ) JdrnlV~ pn)4~ e l u r~o(Ofe 0-c1 eptunl dvstil t1 ctlon sltŒ(ry icircltu nu11t ilwnt [ ~mC ~ted tl l1 ce Ill trpntlshyUumlfJJl nd IKnle~ r~dibl jtugrave)n of -I) m tlosen Ir ~ig nj tl (I1vying ln fornll1U n (lI an ereltl ~piJl e Mmor aJJ r--a t ~) n ltgtf ti lt aXljl mowr plem iHUC Wh ~fl Ille 6ubjeco m uumlntl Icircn (1oJifitd perccpfLlI l ~na l ysilt of p n)lnocepti Icircnfu rnlaquol ti desnibJOS ~n t tecr spin A IICW motor co nrro l Ira I gy t adopt resu ltin~ in the ~tr ltctltr 1 ckformh y lf IdiopathirL scollos i=i Ht lrftU1uc nltnt l ISll I1lJy h1e- ~ I pro()und elkn on bralO Sfem flJll ct i(lnn~lLhu modifyRll Ille nltulltgtshytl10 ) 1 1111 Uu l-lHoror control 5~Shnl$ shy
As Srtgn1lt1 l ~ ltlssert~ if wc l C -Cp t 111 1 un o f the G IiC s oliosls L l tisorckr oi th e ltquilibrilltn sys t ~ms it is lagical to oriegravenrate physlCl l exercis( lherap y ln th is d ir(gtCli()[1
11lclte goals Cul tl lfOUgil ditrercn t modes 01 action be Olchic(-c1 witJ1 phykal accivit ie
- po rt ive Cll ities p ro ct LJ e aIl UgravelClltrtsc in 6lte nshyel ll )o rd in~lti n pinai pr0prinup ti_)[J nLi mOVeshyment control 0 vio lls iy ln thh repect ome lCtivshylites aœ pre um~I I)y lXrter tllln ntil crs
- kinrl lira py using pedJil exerCisocirc specially developecl lith th est 1101 5 in mind illVuuml VC I lllore prccilt( ll1d InC1 li zed cri n on rhe spiJw focusing
a90
1 ~~
lg -lNheJo ~1l l1 t r~l g rld in 1 1) h i(~ IImiddot ct r rHienl w i ll idlllhic _It ~i ~ _ iri s plt ~I le II find Jit ltH vlllleuml ~l Cgtbl tn~ ks III d il fef lt p ~ lt ihnS nu v~tl middot B ~a~pt u Il C middotl)Icircd ~(t l l11 C dlfkrCnl middot- hdween slllndi1g Uline nu nllt1Xinul oorrec ri nI t chied Vith Ct (J ) und tfdincJ ne lot es o UIine 1 fo llnVs middotIJfl tfi ni( - ltlrshy
reltiK)n ~ Ikexibiliry st3nucircing - -pirte - f ur~1 1IbjISC ltupin - ltorrcaion - - r~luci()il ll ymiddot For flmpllt in J npK l1 pH k1J il
plt1SSlhlc ln obtai n 10 u1 511ndlt)l [YLo lion yr ln Slt p ille rlOlgt itlugraven om l J ~ in ( gttf(C rigtIl lIex lbuil 15 i (r-l l=22deg pol lltl ~~J IIlpraquo is IcircO~-V- I t1 l nd tucircu(Ugrave) ilil) I~ 3laquoJO- IH-12
r ln Ugravel e abilit jl of tluuml [m e llu to co ntro l irse lr in ~ pac
fuld l oftlles uumlllelve ntio ns can presum1b1r incn~~ Ih enl ac )1 the orller and lHitlll r of Ille rn - 11 )ltd h e lllldenl lu EJ3)4il
Posl1l1-t collapse lnd slabilizariotl
lIle concept u fplt st lUal c(l lJap~e l l~t Iwen detin 61 by DlI II-T3e~tupegrave rL t Ac oJdin)j tu tl1i- ~ll1thor il [ nec(sary ~- l Hn Cv-tlualing th tleihility o f a col shylo tIcircC CUJVL (0 clistingu ih bt tVeen the re du ihil [ty index (th - li iffer gt le bet ~middot Il ~I r~tcli()grJph ie ~xnmshyinltio n of the iI111 pHienr in supine po ition m(i
ROte OF Pl rnmL EŒIlCISE IN THE TREAT-ŒNT OP ~I IJD IDIOPAnnC OOU~GEm seou SIS EltJRINI
I (~)-----------------------~
__ _~ _____ _~ __ __ L ___~ ________1 ____ _ __ ____ ___ ___ _____L___ _____ l___ ----------L ______ _
1 ~
1
-- ------- --1---- ---- ]---r --- -----_----t- ---- --- ---shy__ ______~---- __ ____ 1________ __ _1_ __ ____ __shy
~ (1 J
1
8 =~~=r=middotmiddotmiddotmiddoti~=-middotl--- middotmiddotmiddotshy--------------t----------~- -------- - ------__shy
~---- --- -- -~ -------------r---- -- -- ~-- - -------- --shy----i-------r-- - ---- ~~-shy
il 1~ 0
Dtl-Lmiddot ~ lttj l r~ UIltltlHt
f g 1 -TI1 u ilictf 1ld ( ii 11- ugraveu-sh) ld IX~ O 1d wllich ltJdnrshymII Il nf the pilll 1 ~tln~1 of th e -o lioti( spinc n IG~nI(J II IIIshytt) lhe iJeuml grl-e o f ~ ()Ii ti c (u rvH Il 1 w dcpc-nlknrly o l l he 10 111shy
P01(nl (pntt l ~ 1 1 nr ffll wrJ I) ln w hilth Ihe n i 1gt( ~ duc nL~ grlphs fm I h~lt 111lt hi~hr Iht Col h ~Ilu t (l f Lite ~Ul Ihe m Ol CI il y th t s(uumlJotil middotpin~ ~111 he ~middotJg gr~lVH(~(1
m mJxiTIt corrttt ion wll iJl i~ lIllCd to Ih - xt 1shy
lti Oilil y Jf tl1lt t Ut JO rl1t cdnUc idt md p OS shy
tU ll cul lapse ( th t ltHill enct b-tten l lUdioL) 1lphic egraveltamJl1ltlti OI1 J t th e ~lme pa tient in Sl il tl cling lOJ lline fX-sitiutl ) Wll ic h correb lc- onl wil ll fhe abilt ty of lllt p tu rl l gt s tem to C( lunternct lIk luree o r grl viry )cco d ing rv D lfVd- f3egraveLIprc po st li r t1 lt01shyIlDse is d ue to the Jnus -u lar ton a nd 11ll ex rCrIshy i) i itv of rhe tissus n the ( O IW-) si it (If the (01shyjl ti (~JtVe (Fi~ 3 L Pu~t llr1 C lltpstl lu lcl l ~~ reduc l-lt by llwans o f pl1ysica l cxerCles specitkally s tuclled ruuml i rnprove tIlus--ubr fOHt md lU pr )cllI Ct 1 ~11 hi shy
lizing ffCd
PararcL n tll CIJ cl the cr iti ca l (3 c1 thlsho ld beQ ld Il ich defol1J lHU n of the i pinlt 1 e~ in~ ne dtlllontr~1t _cl (1l ll t grclrf r mg] o f rllt C II in a qa m bng pos ition corn pOil 15 t l lowcr detormashytion lhnsllold (Fig 1) ie to ~11l Ulne3Se t the risk of pr ogr t~ lu n There t rh eJef re l J ea r l)iuuml 1itshycJ l ~ll1 l l(tl a 1 tnr tg ro b ohwined by d -cr t l ~ illg ilmiddot pU~lUrll cull lpse ptJcelJtge w bich lccording t i)
h llTd tnd ~l(heJ1l ~on 1~ b inde cl 1X llt icularly luumlgh Ugravel mllcl c Iio~ i (bdow 2( 0 ) (F ig 5 J
Fin a Il III ch iS respect lllljl hl and b um l 01 m linmiddot
ii iI 1 l _ _~ _ ___I ___ ___ __L ___ _ ___ ___J______ ___ 1 ___
li 1 1 1 1 i 1
1 i ___--____---___----__-_---_~- _ _--_ ___-+----
i
1
i -- ~- -- ---~-----_-~-_-_--_1-~
l ~
i
+----r--------t-------t------f-- J
Fj~ ~-Ac(XjJlin(Q luuml T O rIcd ~lnd Na(h(ln~ n i () dl( pCG w rd (rTIshy
POO ll is hiherin cu rvegt in wh ilt l1lh ~1flILWrd cII1I Olk l1t IS le- pr(v~knt ln th e grtph Ih t PogttJlJ I ugtnq) Ot1 -J1l j elfltS-e J tlt 1l1t obb dirr remc rlLIv obu incu f roll l the Cohb atl( 0 1stlI1dtJ1g IId gtupinc rldo~raf115 Ih Ille lt) [1l1t1 (i lndnl I pine) 511pille the ~(nlClu tJ1 compo l1lnt U rlk CU Y _VeJily I~ ltx p rlt 1 L1v UpUlt (obh Illeturo Ih t si _b Cct rtJeSIm l fie -ltn J trd Ugraveltuuml shyuumlo n A~-i)rding LP 11(lt uuta o n l ( r1I~( in ~I 2JQ sup itlt curvt 1hi C(]l)b ddhccno l l f lO is -J-lultt( thc s ldnd inr tnla Ol1l t lS wi Q) whil 11) 1 1)401 ~llp lne ClHVC If ~ 1Omiddot ( tcl Lhe ttnd trl~ nlca~ I(t I ~ ~I)
tli n ll w l lllE cq lin ti spin h~ i ng mo r ~ Llnt~II) 1 tlun the nOftl111 one n Cll l gr(lk ( (cU ve tl1u n da r u p shy
po rt in o r k r 10 m linrl in tht 1xi11po tuf_ n th ha__i of th egt onideratl lr1S it f(lll() rhJt
ph rH (~Uuml e erd es ulukl h u - ul iiuml tbeacuteY ~U-L lm cl 1l (It-d o pmg p05111 td C Jl1twl lS fuumlrnll~ rly d ccrll1td ln an Ql St if i imr ol1111 t ru t(( - tht m(d in C JI shy
r t t r sture fO Ir -ngthen tlll m u ck-gt of the spint mainl) in (11erl antig r3ilrl tIcirclt l]lli fun ctin ll U hy meU15 dl i )ll1 t trk ~ lhJ cl( -ll tlt C)nlr~lUions ~llld no l IdOshy
1l)llic d YIltll1k lt l jAJ lktic t) I1 ) II 11)t 111 hd posibleacute t lcluuml ee postura l io nrro and stfh ili lllllt IJI
w i thout food T1lw(ull r d I( Lf(11 Ibk t m ucircnuin Ihe c()rf ~ct [ ()S tu re for cl gtu ifKi IH lLl1gth 0f ti l11 ~
This i-l ddl usl a typl 11 dnmnin (tf k inesllh rap) in 11 (lt-11 [[k - p~d fk lnr in lng f u l1a in llllliCk is poss ihle lI sing ctrtain Idncl fJ l (lt) 11111 liun S p Ul in tb is Cl c is ulttful ooly sa I~tr 1~ il Iw lps t1w lxltknt 1 becuJl)t 1gtlt ltlt-I a ClJu~l inred irl ilL ntllru l o~ i cll
and I1lll~lJhl r-keJc LIl [rll-llIn~ middot etlt(wrs JI the int e rmiddot vlnrion
[J ROPA MfJ) I()Wf-I YSJ IR
1
ICR 1 1-1
r
1 shy ~
- shy
11 o-llrfOlhe5l~ o t Ih 1O~(1dity i n h ~ r ~ ll nr pbl1 l of ~ Spl11 in 111011 _llti1Gt l lPt f ltlJUCWJtl ( ~l Ihe Ir t 1 1gt illbll W Ilh LtltrJ1dlion Vln lbe rigronl middotUII~ l(I Dko n12 lIll h lumshydlanie1 1 [ nul 1 M hl whtrc M - gt) lnIUI1g 111laquo111laquo1 1 1 c rtJCshytjC~ f fce d -d Lill l1~ o f enr niI pUll spnmcl1y 1~ 111 mldlll1lt (n the fl1ur t 1 = tor~ of f(ward Ileuuml l = ughtel1lng fmiddotr p 1shynOf stn lClU= Alaquo rdtllg 1raquo Ihl~ - lin hull th l1ltgtllugrave ot tller1l lUr~Jtllrc F the ~pin t -ilh rlu1i tf Ihl 1 1Ibulll n lrlt InltT1 1
rbc prJI 3IJi l1ty d qrlOIJ~ n bull JI t IlJIII Hm lA the v=ltd gtc e lu-ing J 5lnK1ura i ltfnnity
Dioal e ch anicll itllp~lir J11 c nt
Ihrcemiddotdimcllgtional mc-cbal1in of the s pioc
~f Ikmiddot i t i nly l(œ ntly tlHr llk pr-5tnœ or nc ushy1 lnlo tnr impairment in Idiopttlllc s-ol ii IXl tknt liuml J$ heen h i- ll licircghlcJ hy re$eJ rh tll e preit ilegravee h inm b nIcirc Ji d lJutg~ lt hl ~ 1 ng t o n dO Ulll urcel 1 i5 (l lreldv well umlersrood H(j-ev~r nev lbt un h iomcrhankal im l) ion nI h1c rectm ly onk l n tIlt tre and p r~dou in f n rmtinn hou t pl1ykd (~fcl5( in t 11 0 tl1I _ltgt pbne of spact 1115 Im trqlt-u 1rom J i-[) v ing unclcrsrmdlng ot th l lmc -dim nshy~ilnl l l11 ~ hmk f the cO]jO[lC pln( ~2middot ) ) Ve- w ill )iI xnl t l1 d at lcL-orcltng tUl cl sif iol t lOn blsed o n gtolllt lricd h uumlCJ ) p lane
- b() rJzU[1tl ln th i pla n ~ th t 1o rm ll sp ine present no CUlye- w ll ile Uumll(~ ltc U Hic spLnc clevelops one of ir haracterls(Icircc deFo rm tiCs v elt tbrd ln lashytio n vh icl1 pJ()VcA~ theacute hw 11
- lgitltl in th llulJe U l(~ nonmll spIcirclle pl SenL kypl lOSis ~nd l dooi~ in tb lXI1 lhese [(Hu rts Vere m)( til ught [ 0 he relattd tlle scolkJtlc ( lI r Vegrave
- front l in hi pleme tht ncrmal p ine preseuron t no curYegrave whil thl ~11li tic p in ugravetI I ()~ icircl~ charshyad t Ilt I CU1C
Il Jri fJIIt palic
~l+I~na ra 3 r inr lut th l[ ber ll1d a œl1~lU1 degr 1
l f r()la tJo u lllu (lILa r forcKl ltxert ltJn tl ldefnmuumlng 1 tkllJ [J i1u a re- lhlt tll cly 11 [1 1 UI b y Olm ner w bn ~lh uiJwd tl egrave ro t1tic) l1 Ilm it ti lt p ica] lf shy
rhrl r() be (P (the Uma bevond Wl1iltJl th lCOJlb of [11( ~pmaJ musd ~ dthc COnCIt and nm ex ~l le btconk (t O li~[)
r ~l 18 ~1Il N lu t( ren i9 lun lu ted rlseurlt h in tlt ) tilt lULodeumlformipg1 tlo n ot tIH_ sc laquoJrle rh ox ercallkren lk 1l1~H li d11r once thl Il i ~ r tld1t5 [he lhrth ld f 111 JlIcirc lIi of tlle dnrlclc hurnp tlk
lI bslt Il l nt rlet()rlll lIcircon 01 the it l ()I~ C ( (ylm der (- sustalnecl by an H1tmi cforming aCOOIl
J1Ji h V hl rhyiical f~ f Ise CI 01 h spr n llnd kin middot ith ccedilrapJ my lX damlg ing vll e n l pplild as flle
igt Jk Iller ln SCC1IJ ~IS lllc lJ fxceed l auto in middot crca~ i n g lhrllgthuld [1 sh (~u Id ahn be j ofed that Ilw relscd pre sun 1l1111i insiugrave l fe pil1r inn) 1 mlshylt
- j Il- ( w atff 1 (nh ~1l 1(e Il10 utoldrml ng li1eCh~lI1 1sm
in flc l Geyer ~w tcd th1 t rm m 1 hI l)1ecircch1O lla1 puilll 0 l I C~ sw m mim t Ieuroamp no purpo t for cu lshyim le pllilt t1 s (weumlO middott r it is l~Jl(gtWl1 rhn in iculio r[ paULnl -iJl11T1ill~ doe_gt nor Il ~lp to i ncrt~SL n eur(1shym tor co mfU
(1irai p an (
Jerdnn lle 11 showecl thal ill CSl~ o f t10rLC IC 1i lUgrave
tllo lacolulllhil it lio_1 tlle cte tI llmiry in (he lg itt1 p lln t rn lnlftot il~ lf tspe iuUy in tlw initi 11 r luleuml )f cV IU[Icircon nf Ile ~oli ls W iU l 1 p(t)gr~s~ivlt il10middot~ shy
ment roward hvpok pho b G ll f ill~l Im lins l har dUflng (IN eWllLlfiu1 of 11Imh] co luumlgt i the l in t ot t l H~ gClyty Cegraven te l - 0 1 v llebed lxxli 5 r ro ject 1 seH fl r t side-ys and tlwn backlrcl bull thu~ p(0(1 lj n g a kyphQtlmg aet Il ln (h~ lu mhnr --PIl1 COftj tng
l l i tc Iugrave l lltl l( l rs1 tif s L -etllgt il l the lgirl11
1 Hl)
Ilu LE nI rIIY~Ic~L lXIlKISI 1 HI E TREhTMEtn OP JIU IDIOP llII C AD O USCUH O Ll Œl15 NEGR II
lLill tegt lre lenl1 ~I d ~fo rll1J[ ~ rhl recrSes the phyltiologiGII cmns of lh vine)
Accordlng () Dicion ~2 1 rtcluctio fl in the itgitttl CUIYtS combin l vi th a lueral Iviari n llltl ds t 1
mecban ism () ugravel~ta il ity in l he r rat r IllI1e which bVOf1i the unsd a nd i ncrea~e 0 1 co hlt1is (Fig 6 hiIf md Pl11jlbiJ Jl1eanwlt ile lt(udiecl lh e srnl ru t
orzyglpophySLs show ing t11 al ttleir 1I1tl rnic tl orienshytation f~I (jLi l~ltes aXIal ve rtegravebJl l rotllio ll in cun litluns lt f dorsal hypokrrhn Icirc tnd lum)H de i L lo IS
Tll t dat SLlgge 1 th t impOrfill ut pOitu res and l1lweil1 ) t Mudied in ord t r (CI mlIuml ntrlin or to reuwer fll e p llyslo lo~lCll ClIlye in lIe SlgJtta p lU)l Wlth the llm o t ch ~ kin~ rutltor in l~ bili ry7 AbC th ~e ~k-
1l11nL ~Irt del lnt [0 J jUc lt ftber l]kuti inrervenl ion vhich 1c)LJ k l IV - i(l ~ l compktl n l ililll on Il t c1 l shy-jel1 J11UVllT1ent IJ j o f 1uto-dOneacute(3tlon ( i e a -impk ld ion ) Iengtheni ng o f the pilleacute 011 a litlltl l aXl~ tll lt ((IT liJlI~rcdu e~ t lle ~---lJ linti- l lte ml-fkxj(l n h UI 11 - i llCrl I~t the plllH ](JgicJI dlt cr ~l S ( (1 k-yvllCiSh lIld O(ltOSh l o r c lch r1Iif n t a Ilew til(~ecirc dUuml llt Ilshy
si lflltl J ll1 u(~nlent iam ecl - 1l1t0- lIrfe rionmiddot7 4 llmshyp oed f Je-rura l iUIl cl middot-t1e- iltm lI1d ll1a intltnUlLe )( 5lg it d C Uf (gtS slig lll thltJrc i ypI1 tiZ) tIcircOI1 a nd lunugrave)ar 1()fdos i7~llion) sholild he esw b lb]HU 00 lb co
hl b oi hi p~l11il uU r -1Ir vlt Abo 111( e IlltUtl Chl lie o f purti n - a U vitk slJ1ultI h e )tuumlll ecl 1)] (1 n ldershy](ion r tl1i lt type for e upIe IilJ llyl)T S of repd shyiti( ml vemen prt n t in agonistK h)lnllltlSlks nI iIle kind f dlJ1ce C( uld he ([([r imentd
FmiddotO lllaljlallC and mobili ty of the SpIcircIlC
1 rd llo U 22 d L lm nrrare d lhlt in Illt fro nt a l pll ne
tilt 1 nge Clt 1)1lt vtment of tht scplit[i middot CU IY grcmr lIJ l il ~ d irectio n n f Lhe C ITelt tlO n tha n in tl le di re shyLion of pmgressi n l Fig 7 ) he IL o IS5err lJd tbat th15 mohiliry increac plrtil u la rly n apic [ cgcoeilts 1$ lh ~ ~c() li osb evolves Sragrm rJ 12 J ~ thus rigilt (0
VlI f n rller~p is ts Ilo t t) m o b uumliz - a sCtJl iu til curve w ilhout t [ uling ttwt tlle R lu tiOI o i til t ~a mt b fnlinruumln( 1hy l1tans o f ~I passic 01 1 rivE -uppnrt On tilt (ltllE r hand UgraveK d e iJlioJ1 in ease durill tlw tune 111 whicll tll C spmt i ~ not submjtrcd to correeshy( IV anl()n
j- Virh mi lei ol i b tlllt Upp i1n ill) lC tiol is d eveloped only lllmugil llClIf()mu$Cllbr f r llce thi ~
InegravelIl ~ thclcfo re tl1l[ inu eascgtt sp1J1all1extl)iity mua
11
Imiddotiumltgt 7-rurd illt Ir) 1 bull rdrilt I1 1 in tl lt frOlllll pbnlt- th( illl ge )r mOC llIeJlI o t the S-o UIIJC CUNe 1 supcrior in Ihlt diflt(l im ugrave( the n nKlIl thd n ll1 tllc dlrtcLion o f p rJ1(l( (llIl
be considrCtJ vntrl iJ)(l icltion and 1 undrli neocirc ab L a ~ubiljz~ILion 01 tilt spint pllss il)1y ohtl ll1td thrltJugll the stlengtlkl11ng o f the 1rltJgm vlt nonil lme shyCIC 111 illli orrant u bjcLliH- ln rhis r~f1 n sp u lllni lc tivitIumlLs sil uld lX tPI 10 dlegraveltl it l G lU t n w l1ik luring kine i Icircth lrr phyltical eXegraverci c~ tllat in ele
spinal m ot ilIcirclY sil nid 1e lt1 oid cdrt ~
Organ ie and psychologieal impainncuts and li islbi IiI le
A cgtI im lc pmi nr is moriOthl11 just 1 sp in and 1
compkt gt Ipp rnach to the gu in ad 1 ont i al~ shylute l e~se i t i11
[)a la 0 11[ [n ell lrom re semh pw tbat ome organi Iilnctiond cl fki ts suc]) as tlw clecrtiUe ut vild l tnd d fun ll l)Kity_orld ldly incrtJ k whil~ 0 shy[io s i -till in (1 miel q g of g JltlV ity ~ l ilI e 55 rtI lit
tllL pres e n ce )fl defidt Or Vi l~il Clp~1 - i~ ln one pIIiem in Ihr l ftectecl by 20 ICl 40 scoi stgt l ls~a r(h cunclutecl in tbe UA by Di Ruce- prod uegraveed an aaalo) u ll1lXimum 102 re u t in a group of Jd shyk 1ien t [(h sco llosls rang inF frum ) [0 1
Al10ther rudv bv rallt r m C chr111 lilcl NashycWrl1s( u 57 stlO eltt hil $(C 1 1 ui~ Ica js l( lllt cl (1 shy1prUlllI o f t1tgl lie bJd l imI in ~ul sct t1 t ltu b middot iects jlLltr l5 they are golng through ~I cltlici[e sllge in the fnm 1lt i n 01 tlWH o w n id uHitv t factor hit h Illy jeopmlize the cl velopme lit d ~ mIll lt lI1d htIshym cecl IWI sonalitr in Klulrhood
n RUI ~IEDl(( Ptl Y1-
ROU ltHmiddot PI [ I C~ 1 EXIRCIS]~ IN TI Il nW~JUNT OF SlllO lDIOP1HIC AI)C~ESΠ11 C(gt1[Oi 1S
This i why b IiCieacute ii is ~n imporrlIl t for p rcshyvegraveml e 1tLsr l tn en ou flge 1ari e nrs ~lfrecr(d by lIillcl middotu iosis ft) tlke p~l rt in portin -re rcatioluJ acrivitits Iha t 1eIU 10 L10 th r~1chophyinLl bull nd b~l )i 1l1o tur adlieem t n li 51Jmiddot2Even tlK)ugli [Dr bic mech~lnshy
ical mcl nellIUll10t 11 11 reltl ~ons lt r111 1gtomcrimes be l lefu l to ugg( ~t ne p rt in~ aCt iv ity r l h (gtr rll n anotlJer e th ink Ibal an exces~ ive IlHd icalizltion - Icirce l ll1posilion br plry~ilt i HlS nnejlor parents uf rh ry pe of po rt to lx p m lice 1 b Ule p 1Ucirc(Il L th1[ preshydLl ck l1 is fret clOice in lh ma tt r - -h II ll1 he avolc1ed wb 11 possLhle mainly for tlle i mport~ltll psyshyLb ) jogka l fe a SI)nS W( ha( ill ~ t nltntionegraved
Conclu ion
lbh ISsertegrave d t1H physkal tgtXtlci o is ) n fi ial whlIl practinu in order 10 ilnj rove the I11 llde
rœ nwh and tono C iral caplCiry and postu re o f the StOUO(I ~lIbj n II I nowkdge om ~ middotmg trom ci el1shyrlfi rls(~ Jrc li dJlJ accordl ng r the review 01 thE litshytirlture prnpo )td in t lli plpl r conflrm~ Ihe vuiclit ot th e -t ls ~rti ()ns
In l do l (ent Id iopl1il iC scoliuse il l n phee u i cl vk)pm e n t ( li tll iumlKh eXCC cl l g i en rhk thr hokl th e re i5 an und ubred need fn r l pprnpri 1tegrave (JJ1tOkJJe ~Ild Inr surgict1 therapics ill ortler 1) S l i p
the ( - Iuli on anugrave )JT~t~t UW ~pilll l dtlormities bull evshyerthtless in the illiti ~ll pl l~sC t ttlC c1iseLltc whcn the riS( r1 r euro )luli m is rtduced ocirc ~md tfle uifleal JOld threshold il ~ld flle po stural collai i reJcenw~ 43
JI l1 igh pllysicaJ egravexe rc ise - p revenc or r d llCe d i ~lh ilir ies o f [Iw ~ l() li )tic
p (iems R 28 J -6 5- 6 1 63
- f~KiHtare lh ( n utr ali711iCUl of postu m l d elicits tn produCel1 a coneql l nce J [)ti 0 I111)( or regre si -u lmiddotc 5middot Il 1 17 ~ M
-re 51udles U ~ n Ledecl tu con[mn or re jecr these conClLL i( 1 w l1 ich clerin-d frum 1l1 lIldytica l rcltw n f th e liter~iture appear r- ~Lo nlble Hnwecr Intil ne re ull are 31Iable wc should n r prevent our sroliotic patientmiddot trom tl ki ll p lt in s(loI1ing jshy
ir its pW1iada rly ltl t ~d1()o t () n til t c ntrHY -vith the l xcclrinn 01 gt[1 )11lt tIlat in rea-e t)1obility (tnU evc n thell oilly wh n progr~lgtion b p OSSibl) -uc h ~I( ucircvshyiUe -11 )ulu hl tIKoll w g ed The 11 S J ( rprOpriue kin (~irhe r~l Piuml to incr _~asc p()~tura l $llbil i ty is tl1egraveoretshyic tlly CiJUClt alttloughl more ~Iccu rtte aod deLli led ri k benefi rs anJlr~ is is netot1ed
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EUROP MIDI C Pli hIC
EDUCATIONMEETING SATURDAY 8thof APRIL 2006
(iSS
SEAS02 Scientific
Exercises Approach to Scoliosis
version 2002
G
S Negrini 1
EDUCATION MEETING SATURDAY8th of APRIL 2006
Neuromotor disfunctions
Neuromuscular disfunctions
11 Postural collapse
Postural collapse
Duval-Beaupegravere
Flexibility of scoliotic curve
f---I--- I Postural element
-------1 Structural element
S Negrini 2
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Postural collapse
Duval-Beaupegravere
It is a value related to muscular tone and to flexibil ity of convex side tissues
Post ural collapse
Bunch e Patwardhan
Critical load
Load threshold beyond wh ich a spine begins buckling
JI~~Wt1lW~flfthtlJlœJtAr ~ J~It- l~l - IMS
Postu ral collapse
Bunch e Patwardhan
If a curve reduces there is an increase of the deformation threshold
~~~NW~-damaoc~IIIMf ~~ J~Iv JaJ-I7I9sect
S Negrini 3
EDUCATION MEETING SATURDAY 8th of APRIL2006
Postural collapse
Torrel e Nachemson ~
Scolioses below 20deg ~ ~ lt~
have a high ~ ~ percentage of ~ ~
~postural collapse (on u~
average 75) ~~ 2i~
CU~VE O EG~EE S WHllE SUPlti e
~laquotd~c6b ____lPffI1wtt1t~
$ww J(t ~~7 JM5
Postural collapse
Minor scolioses 7
Antigravity musc es strengthening D
Reduces postural collapse -G
Increases the critical threshold of deformation
G
Neuromotor disfunetions
Stagnara
If we admit that one of the causes of idiopathie scoliosis is a disfunction in balance systems it is logical to orientate physical exercises toward this direction
s Negrini 4
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Neuromotor disfunctions
Dubousset
Idiopathie seoliosis results fram alterations in praprioeeption centres and deformation is a natural compensation to restore postural balance
etattJtitIK ypothfQj~S ___~ own_ oJ)HQr lar 1t-1( r
Neuromotor disfunctions
Nachemson Initial idiopathie scoliosis
+ Goood spine stability
Neutralization of postural deficits
D Static curve
Neuromotor disfunctions
Therapeutic aims
c) Development of spine stability
C) Development of balance reactions
G
S Negrini 5
EDUCATION MEETING SATURDAY 8thof APRIL 2006
Biomechanical disfunctions
j Horizontal r-Ian
i Sagi ttal plan
Frontal plan
Frontal plan
q Frontal plan disfunetions
Fronta l plan
Perdriolle Movement magnitude
gt in the direction of lt in the direction of correction progression
S Negrini 6
EDUCATION MEETING SATURDAY8th of APRIL 2006
Frontal plan
Stagnara
Never mobilize a scoliotic curve without ensuring reduction maintenance over time otherwise a greater mobility favours scoliosis progression
Frontal plan
Ducongeacute~ research
On a group of adolescent idiopathie scolioses treated with
Meacuteziegraveres gymnastics
D After 1 year the mean angle of
curves increased from 18deg to 29deg
Frontal plan
Scoliosis without brace
D Greater spine
flexibility D-
Risk of progression
S Negrini 7
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Frontal plan
Mobilization is useful
D In preparation to
brace
D With brace
Sagittal plan
QSagittal plan disfunctions
Sagittal plan r middot _J o
Perdriolle scouos B CJ aDeformation of D
thoracic and thoraco-Iumbar curves evolves in extension
S Negrini 8
EDUCATION MEETING SATURDAY8th of APRIL 2006
Sagittal plan
Graf
The line of gravity centres in the vertebral bodies o s c oUOSt
projects itself firstly laterally and then fi
o
posteriorly lJ ~~ ~~ ~ ~~-_J-D ~nI~
Sagittal plan
Therapeutic a ims
D Maintain or
retrieve physiological curves on the sagittal plan
Horizontal plan
QHorizontal plan disfunctions
S Negnni 9
EDUCATION MEETINGSATURDAY 8th of APRIL 2006
Horizontal plan
Stagnara The forces applied ta the spi ne act in a autoshydeforming sense
Horizontal plan
Dimnet Rotation gt 200
ampII~ (
D The actions of concave and convex side
muscles become
agonistic
~ItJrOnrIIiItdllfUClltlluumlll~~tI ~1JIf1laJ
Horizontal plan
Minor scolioses never exceed these autoshy
deformation thresholds
S Negrini 10
EDUCATION MEETING SATURDAY8th of APRIL 2006
Disfunctions at a biological organic and psychological
lever
Oisfunclions at a biological organlc and psychologlcal lever
Cheng
Bane density in scoliotic teenagers is lower than in normal subjects
~~~~middotA~IIlUtIy ~7œl 1d l
Oisfunctions at a blologlcal organic and psychologicallevel
A significant reduction of vital capacity and V02max in teenagers with a medium severity scoliosis
S Negrini 11
li
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Disfunctions at a biological organic and psychologicallevel
Disorders in the development of body image that the teenager has of himherself
Disfunctions at a blologlca l organlc and psychologicallevel
Therapeutic aims
cJ Activate cardioshyrespiratory function
cJ Favour bone density increase
cJ Develop a positive image of the body
Disfunctions at il biological organi and psydlologicallevel
Stagnara
Sport
D The active side of
kinesitherapy
S Negrini 12
EDUCATION MEETING SATURDAY 8thof APRIL 2006
Disfunctions at a biological organic and psychological
level
Distunctions at a biologlcal organlc and psychologicallevel
Cheng
Bone density in scoliotic teenagers is lower than in normal subjects
~n~IIIvpWr~middotA~stWy s- XXJl M J
Disfunctions at a biological organic and psychologicallevel
A significant reduction of vital capacity and V02max in teenagers with a medium severity scoliosis
G
S Negrini 11
EDUCATIONMEETING SATURDAY 8th of APRIL 2006
Kinesitherapy on the scoliotic subject
q Postural control
q Axial stability
q Muscular trophism
q Balance
q Respiratory function
The limits of kinesitherapy
There is a threshold beyond which
rehabilitation alone is not enough
sssr
Kinesitherapy in scoliosis treatment with brace
Therapeutic aims
S Negrini 13
6
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Therapeutic aims Srace kinesitherapy
With brace
il Postural corrections and
vertebral stability are obtained by the brace
Therapeutic aims Srace kinesitherapy
In preparation to the brace
il Mobilize spine on ail plans
Therapeutic aims Srace kinesitherapy
With brace D
Maintain a normal spine elasticity
~ Maintain a good muscular toneshy
trophism
C Model the hump with kyphotizating
exercises
S Negrini 14
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Exercises and their methodologies can vary accord ing to learning and individual sensibility of the single rehabilitator that proposes the m provided that they stay within the
Iimits of fixed therapeutic objectives
li
Therapeutic modalities
(Exercises)
QAuto-correction
QRespiratory education
QErgonomie education
QMuscular strengthening
QDevelopment of balance reactions
WNeuromotor integration
ci Vertebral mobiJization
QSpecifie modalities in brace treatment
S Negrini 15
EDUCATION MEETING SATURDAY 8th of APRIL 2006
The protocol of kinesitherapic
treatment
G
QChoice and dosage of exercises
Variatiosn of the work program every 2 - 3 months
Q Execute e)(ercises on an individual base or in a small group
Q Frequency not less than 2 times 1 week
Involve and awaken the family
G
S Negrini 16
EDUCATION MEETINGSATURDAY 8thof APRIL 2006
Q Determine the action and the localization of auto-correction
QAuto-correction must be associated to ail exercises
QAt the end of treatment ergonomy lesson
Auto-correction didactics
G
SCOLIOSI DORSALE---- shy ----
r
S Negrini 17
EDUCATION MEETING SATURDAY8thof APRIL 2006
SCOLIOS OORSOLOMBARE
shy
SCOLIOSI OOIlSALE 011 bull LOMBARE S1I--shy
SCOLIOSI LOMBARE
il --~_-
S Negrini 18
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Scoliotic patients are not radiographs
middotSeoliotie Mtients are not ndiographs but hum beings with a vertebral deviation-
Slagnara
Metha For the physieian Cobb angle is of utmost
importance For the patient it is body deformity t hat eounts most rib hump a protruding seapula or hip We are in a situation in whieh today dodors eure the radiographie deformity but what the patient really desires is to get rid of clinieal deformity and of ensuing psyehologieal distress
CIIQItIo shDuIdtucirc lM WIld tJw~~ I~~M~~~~ J9f~
S Negrini 19
- Poznan_workshop_Physiotherapy
- physio2
- physio3pdf
- physio4
- physio5
- physio6
- physio7
- physio8
- physio9
- physio10
-
1 n B Uri middota I l 11
H srut ft illtf j tI) t li orf1Hli d
IDS Prt ts 21)2
Influence of method of asymmetric trunk mobilization on shaping of a physiological
thoracic kyphosis in children and youth suffering from progressive idiopathie scoliosis
Krystyna Dobo icwicz Jacek Dunnala Hanna Jendrzejck Krzysztof Czernicki
Deparrment of Rehabilitation Medical University ofSilesia KaloKce Poand 40-635 Katowice ut Ziolowa 3537 POLAND
e-mail rehabiliracjas(u1poCmiddottaollelpl
Abslract Idiopathie scoliosis (lS) which i sub 1 ntially l threeshydimen ional derormation or a pine cau e nOl only laler l curvalurc and axial rotation of vertebral column but al lordoti allon of VCr1cbrac in structural curve eXl nsion ln an effect physiological thoracic kypho j diminishc or cvcn dbappears Method of a ymlllctric lrunk mobilisation in strictly symmetric po iljon according [ Do () lewicz not only dcteriorme progre ion of IS or evcn reduces lalera] curvalure but also significmtly rebuild physiological thoracic kyphosis Icircn cases of lS accompanicd by lraight baclc
1 Introduction
Despitc Ion year researchc etiology of IS is nOl yel resol ed Significant problem re laled lO morphology of IS apar1 from lateral bending and ax i 1 r tati n i deviation of shape of a spine in sagittal axis affecting physiologi al curvatu re of vertebral coJumn [3 5 6 8 9 J 0 1t 12 Lcngth of anLerior col umn of a pin constitutcd by venebral hafls anugrave intcrvencbral dises dominate ovcr Jength of po terier c lurnn buill from vertebral arches and processes [lOJ This condition uring scol io i progress ion and growth of a child effect in hallowing or even disappearing of phy iological Lhoracic kyphosis in scoliotic region It i well know n lhar cn~brae of structu ral Jaleral curve are positioncd in hyperextension - lordotisation [5 6] which in Lhoracic region Icad (0 reduction of kyphosi or to true lordo middotis Such kind of venebrae relation in thoracic region cau es ilS destabicirclisatIcircon whi h in u sociation with eccentricircc gfilvitali nal load fa pinc duc to muscu lar icircmbalance [21 pOdbly produces r tationaJ lordo is [56 Il] and further development of symptomatic scoHose ft ha becn proven [12J tha strengthening of the erector spinac muscle aggravates nce initialcd deform tion and deteriorates coliotic process Hyperextension and uxial rotati n a s clatcd with
357 Th B Grivas (Ed) Research inro Spinal Defoml ilis 4 lOS Press 2002
Exercise efficiency of girls with idiopathie
seoliosis based on the ventilatory anaerobie threshold
Jacek Durmala Krystyna Dobosiewicz Hanna Jendrzejek Wieslaw Pius
Department ofRehabililation Medical University ofSiiesiaa Katowice Poand 40-635 Katowice m ZioJowa 4547 POLAND
e-mail durmalaiacekyocztaonetpl Department ofPhysiology Academy ofPhysical Education Katowice Poand
Abslract The aim of the study was to estimate the exercise efficiency in the group of
girls with idiopathie scol iosis based on the venlilatory anaerobic threshold (V AT)
Material and method The investigation comprised 58 gi rls wilh idiopathie scoliosis
aged 10--6 years 32 girls (55200 ) wilh double major scolioSiS and 26 girls (448)
with single scotiosis The girls were eonservatively treated using Dobosiewiagrave
method The control group consisted of 3 1 healthy girls aged 10-1 6 years The
cxercise test was performed using eycle ergometer During the exercise the gas
exehange parameters wcre reeorded (minute expiralory venlilation minute oxygen
consumption earbon dioxide production) On the basis of recorded paramcters V AT
has been computcd using V -si ope method Results The following V AT values were
obtained in the group with scoliosis 207+305 ml 02minlkg bm in control group
219+350 ml 02minlkg bm The differences belween girls with idiopathie scoliosis
and control group were nol SLaliSlically significant Conclusions I The exercise
effieieney of girls with idiopathie scoliosis conservalively treated using Dobosiewicz
melhod is normal 2 Such high level of the exercise cfficiency of the studied group
probably was due to intensive 3-D respiratory exercises of these girls
1 Introduction
In practice there are researched useful efficiency rates which on base of laboratory tests results possible easy without using of the relatively hard or long exercise tests would give the belter forsighting of the range of homeostasis disturbances and rapidi ty of increase of
physical fatigue during varied workloads [1] The best known rate of trus kind is the maximal
minute oxygen consumption [2345] During progressive physical effort minute oxygen
consumption increases proportionally to workload The reaching of real maximal minute
oxygen consumption in time of progressive effort is iodicaled by minute oxygen consumption plateau [5 61 This result is rarely registered in children The progressive exercise test is most commonly used in children until physicaJ exhaustion and the highest registered minute
oxygen consumption is treated as maximal minute oxygen consu mption or so-called
symplomatic limited maximal minute oxygen consumption [678J Sorne authors regard
Orto-dlet Trau malaogis Roha b ilitacjaARTlKUL ORIGINALNY ORIGINAL ARTICLE Vol 5 Nr 1 2003 80-85
Jacek Durmala l Krystyna Dobosiewicz l Tomasz Kotwicki Hanna Jendrzejek 1
Katedra i Klinika Rehabilitacji Slqska Akadenia Medyczna Katowice Katedra i Klinika Ortopedii Dzieci~cej Akademia Medyczna PoznQll
Wplyw asymetrycznej mobilizacji tulowia na wartoseacute k~ta Cobba i rotacji w przypadkach skolioz idiopatycznych u dzieci i mlodzieZy
Influence ofasyn1n1etrie 111obilisation of the trunk on the Cobb angle and rotation in idiopathie seoliosisin
children and adolescents Slnwu kluce ac eJJic Cl chOlIU) Ice SKoio= idj)PO Imiddot(~I7tmiddot
K~Jmiddot w()rus consrieI ve I (OtlHelif idiopathie HUW JS
SUMlvfARY
BackgrouId The aim ofthe stldy Vas Ihe radiological evaluation ofthe treatllJent ofthe idiopathic scolioshysis utilising as)mmetric trunk mobilisation in the strict~ll I)mmetric illitial position
Material ([fJ(f lIIellOds Presented stud) lOS based IIpon J36 cases (13 oovs oged FOf11 ocirc la 6 lcars (lild
rn girls aged frum 6 la S pears) trealed due to the idiopathie sCuliosis ((rom Novell1her 999 0 F enflfUn 200) Among 48 ch idrcn sllfJering from dOlfble-major scoios is 6 cases wcre infoll scaliusis JOjuvel7lle und 22 adolescent Among 88 sillgle scoliosis 6 lere infw7t 33 juvenile and 49 adolescent
Radiological exami71ation 1as condueed always in the repeataole technical cOlldiions RadlOglOlI1 lier evaluated oy the same physician Radiologica analysis oIthe scolios is incuded value ofthe Coho al1gle ongle ofaxial rotaion
ReSIils ln double-major scoliosis observed dlring one year period in Ihe thoracic segmenl Cobb angle decreased inll l increased 1395 and in 292 Il OS 111changed Axial lolation angle in 167 (~rcascs
decreased in 354 incrcased and rernainM the sorne in 479 In Ihe llllnba segmenl Cobb ang le clccrcscucirc il1 354 increased in 39 6 remained in 5 Angle ofaxial rotation deceoscd in3 ofca es incrcuscd in 29 and persisted in 48
ln single scolio is Cobb angle decreased in 386 incrcased in 353 and in 261 was lInchonged Axiol rotarion angle in 216 ofcases deceased in 295 increased and rell1aincd the sallie in 489
CondlsioJ Asymmetrie mobilisation of the tf1f17k in strictly syl7111elric initial positions is a 1Clhod of choice in the cOl7senJalive treatment ofthe idiopathic seoiosis
STRESZCZENIE
WS~p Celem pracy jest radiologiezla ocena Icczenia skoiloz idiopaf)cznych metoda asvmetrycznejl7lOoili shyzocji tllowia w sciSe symetlyczl7ych pozycjach lV)jscio wych
M aterial i metody Przeprowadono retrospektYlIl7q analizri 136 przypadkeacuteM dzieci (13 chlopcow i 123 dziellshyczqt w wieku 6- 18 lat) z bocznym idiop atycnylll skrYll ieniem krrgoslupa leczonych zachowawczo w Klinice
1
Ortopedla TliJumatoogia RehlblllagraveeJa ARTYKUL POOL1 DOWY OPINION ARTICLE Vol 7 Nf 1 2005 49-$11
Krystyna Dobosiewicz Jacek Durmala Tomasz KotwickP
Katedra i Klinika Rehabilitacji SIAM Katowice 2 Katedra i Klinika Orlopedii Dziecircej AM Pozncrlz
Biodynamiczna metoda tr6jplaszczyznowej korekcji skolioz idiopatycznych - opis metody Biodynamic method for 3-D correction of idiopathie
scoliosis a description ofthe method
SIOWQ kluczowe leezenie zachowawcze skoliozy idiopatyczne korekeja tr6jplaszczyznowa Key words conservative treament idiopathie scoliosis 3-D correction
SUMMARY
The biodynamic method of hree-dfmensional carreeion of idiopathie scoliosis is based on Ihe palhomeshychanics of idiopathie scolioiiiii and consiss in aClive segmental three-dimensional correction ofspinal cllrshyvatlre The course of action focuses in the viciniy ofthe apical vertebra Proprioceptive facilitation is applied on Ihe concave side ofthe curvaJure and exteroceplivefacilitation on the convex side Correction likewise proshyprio- or exteroceplive facilitation is phase-oclœd with asymmetric respirarory movemenr as weil as wilh parshyticular phases of the respiratory cycle ln Ihe course ofexercises three-planar movement is generated opposite to the direction in which scoliosis Is progressing This method is in accordance with the stale ofthe art ofscoshyIiasis pathomechanics The method requires detaied training and can Ihen con be applied at home under periodic control by a physician and a physiolherapist The method con be applied in landem with a Cheneau brace as weil as in surgical pretreatment A elaUed description of Ihe method of three-dimensional scoliosis trealment will be presented in Ihis article
STRESZCZENIE
ISlofa biadynamicznej mefody Ir6jplaszczyznowej korekcji skoioz idiopatycmych oparlaj est na patomechashynice iikolioz idiopatycznych - poega ana na czynnej segmentanlej tr6jplaszczymowej korekcji skrzywienia Dzialanie koncentruj e siccedil w pobitu Icrllgll szczytowego sknywienia Stosowane iest bodicowanie propiocepshytywne po stronie wklllsej oraz eksteroceptywne po stronie wypuldej Korekcja i slosowanie bodicocircw propioshyi eksteroceprywnych zsynchronizowane j esl z asymetrycznym torem oddechowym oraz z poszczeg61nymi fazashymi oddechu W trakcie eacutewiczen powstaje odwrotny do lrierurzku rozwoju scoliozy tr6jplaszczyznowy ruch IcrFtshygoslupa Melodajesl zgodna z aktualnym stanem wiedzy na lemat patomechanizmu scoiozy nymaga szczegocircshy100-lego instniktaZu po clorym mote byeacute wykonywana w warunkach domowych Z olcresowq kontrolq przez leshycana i fizj oterapeutll Metoda mote byeacute stosowana r6wnolegle z leczeniem gorsetem korekcyjnym Cheneau a talcte w przygotowaniu do leczenia operacyjnego slcolioz W pracy przedslawiony zostal szczeg6owy apis meshytody leczenia
Skoliozy idlopatyczne stanowili znieksztalcenia patycznej rozwija siccedil poprzez przemieszczenie kr~gu tr6j~aszczyznowe charakteryzujltce siccedil wyboczeshy szczytowego w stosunku do krccedilgu g6mego j dolnego niem rotacjltt krccedilg6w klatki piersiowej i miednicy z r6wnoczesolljego rotacjl zgodnie z ruchem wskashyoraz zmianami w fizjologicznych krzywiznach kr~ z6wek zegara dia skrzywienia prawostronnego oraz goslupa w plaszczyinie slrzalkoweJ [ 123] przeciwnie do wskaz6wek zegara dIa skrzywienia leshy
Z punklu widz nia patomechaniki tr6jplaszczyshy wostronnego Koncepcja rozwoju skoliozy jako rotashyznowe znieksztalcenie krccedilgoslupa w skoliozie idio- cja i kontrotacja sugeruje ze sily korekcyjne powinshy
49
EDUCATION MEETING SATURDAY 8th of APRIL 2006
- CARDJOPULMONARY EXERCIS E
TEST IN GIRLS WITH
CONSERVA TIVEL Y TREA TED
IDIOPATHIC SCOLIOSIS
Jacek DURMALA Krystyna DOBOSIEWICZ
Department of Rehabilitation Medical University of Silesia
Katowice Poland jdurmalaqcmpl
The aim of the study was
to estimate the influence the conservative treatment (asymmetric mobilization of the trunk by Dobosiewicz) on physical efficiency in the group of girls with idiopathie scoliosis
Material
bull 87 girls with idiopathie scoliosis
aged 1 0-17 years
(mean age 135 years SO 161)
J Durmala K Dobosiewicz 1
EDUCATION MEETING SATURDAY8thof APRIL 2006
Material
bull 38 girls (437) with double major scol iosis (thoracic segment - Cobb angle 18-42deg mean 30deg SO 82 angle of axial rotation 4-32deg mean 21 deg SD 107 lumbar segment - Cobb angle 11 shy48deg mean 31deg SO 128 angle of axial rotation 5shy30deg mean 13deg SO 85)
bull 49 girls (563) with single scoliosis (Cobb angle 11-75deg mean 33deg SO 155 angle of axial rotat ion 5-30deg mean 14deg SD 83)
TIoracic kyphosis of the invesllgated group was 5-39deg mean 23deg SO 86 and lumbar lordosis 16-41middot mean 30 50 65)
Material
bull The 64 girls aged 10-17 years (m ean age 131
years SD 132) were conservat ively Ireated
using Dobosiewiczs method
bull Treatment period ranged from 5 months 10 3
years (mean 148 months SD 902)
Material The 23 girls aged 10-17 years (mean age 136 years SO 108) were treated u sing symmetric exercises - treatment period ranged from 4 months to 3 years (mean 161 months SO 1019)
bull 26 of ail g irls (18 girls earlier treated using Dobosiewiczs m ethod and 8 gi rls earlier treated using symmetric exercises) aged 10-17 years (mean age 134 years SO 108) were twice tested - at first and last day of Intensive hospital rehabilitation (asymmetnc mobllization of the trunk by Oobosiewicz) - mean hospitalization period 20 days (range 18-26 days)
i rf~8f6~~ or~~n~= ~~r~1~r~icircJ~~tb~~~~ mean 17-4 1deg meatl~(I SO 74 R n~le ofax 1 rotatIon 5-25ot mC3 111 3laquo S0 6icircl Ilnd 1 99t1S~ ~~~~I~~~~~$ruo~ras~ ~ocirc~~a~e~~~~~~~5euml1 9middotn~ tUfllbar Iord05ts 16-4 1deg mean 311 SO 68)
J Durmala K Dobosiewicz 2
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Material
The control group consisted of 77 healthy
girls aged 6-17 years (mean age 12
years SD 31)
Material
The examined girls participated in school
only in scheduled physical education
lessons and have not been enrolled in
other sporting activity
METHOD
The exercise cycle
ergometer test was
performed
J Durmala K Dobosiewicz 3
EDUCATION MEETING SATURDAY 8th of APRIL 2006
METHOD
The Incrementai exercise test has been applied
We have found that tests ln whlch the Incrementai part of the protocol ln completed between 8 -12 minutes duration glve the
bullhighest maximum VOz in normal subjects
METHOD
The workload was Increased stepwlse
bull by 10 Watt every minute - ln chlldren
with high ~ 135 cm
bull by 15 Watt every minute ln chlldren
with high gt 135 cm
METHOD
The test had been contlnued untll refusai of the patient or exceeding the pulse Ilmit
Durlng the exerclse the gas exchange parameters were recorded by Jaeger device model Oxycon Alfa uslng direct breath-byshybreath rnethod (with face mask)
J Durmala K Dobosewlcz 4
EDUCATION MEETING SATURDAY 8th of APRIL 2006
METHOD ~ ~~ r 3 min 3 min 8 - 12 min 6 min -~
_ 0 rpiYJ 0 rpm 60 rpm ~1 30 rpm
_ t o~w=att~o~~na ~~ att__~ tl~~S~~ l ad l ~~~~~r o~w= Hlcremenlal t
pedaillog i i ~
~ ilt ~I~-----tl-~ I t ~ i ~ lOSt sffortivB
lW r resututlon r rm-u middot 1 - bullA~cremen tal ~~ ~ ~ ifr- ~ VtI 1 ~i ~ tllng _
METHOD
On the basis of recorded parameters VAT
has been individually computed for each
child using V-slope method by
Wasserman
METHOD
For assesment of physical capacity
the maximal minute oxygen o
consumption (V02max) ventilatory
anaerobic threshold (VAT) and
maximal workload was used
J Durmala K Dobosiewicz 5
EDUCATION MEETING SATURDAY 8thof APRIL 2006
RESULTS
Ali girls with 18 have been classified
within normal range of predicted
values of
bull maximal minute oxygen uptake
bull VAT and
bull maximal workload
RESULTS
The differences between group of girls
treated using Dobosiewicz s method and
group of girl s treated using symmetric
exercises were statistically significant
Lower exercise efficiency of girls treated
using sym metric exercises has been
observed
RESULTS Girls wilh IS Irealed using
N=87 p value
Dobosiewlczs method N64
symmetJic oxor-ci Nz23
Perœnlage of predicled vaJue of
maximal minute oxygen uptake
98 905 0033
Percenlage of predicled value of
VAT 97 933 0049
Percenlage 01 predided value ni
maximal workload 101 939 0038
J Durmala K Dobosiewicz 6
EDUCATION MEETING SATURDAY8th of APRIL 2006
RESULTS 26 girl s twice tested - at fi rst and last day of intensive hospital rehabilitation
The value of ventilatory anaerobic threshold increased during intensive hospital rehabilitation (asymmetric mobilization of the trunk by Oobosiewicz) statistically significantly (p=00019)
2047 ml O2 minkg (SO 268)
vs 2239 ml O2 minkg (SO 232)
Conclusions
1 The exerc ise eff iciency of girls with IS treated by asymmetric exerc ises of Oobosiewicz is norm al
2 Such high level of the exercise efficiency of thIcircs group resulted fram using of Oobosiewiczs method
r
J Durmala K Dobosiewicz 7
REVIEWS
Role of physical exercise in tbe treattnent of mild idiopathie adolescent scoliosis
Revicw of th- literature
A NECRlNl N VElWNL s PARZI 1 A NEGRINJ 5 NEClU NI
P1t~silillxlrd~ Ihcrapy (or klucgtlttlwrlpyl i pro shy-tJm of physka] cXlrd-cs ipcci I(a~ (IJcloJgtcd hy l li trIWlltl phrslollwrapbt wilh tb m~ln a1mor pl shyVCnI in lhe ilAAfIVltilH1 llf the ucirccfonuity III mild IgtC )
Lil1Si bclpin~ thebm ( aocl co uaufllclilIg ils ~jd- clf IS in nlOdlJmiddotnh-culiosis Th middotalillofthi paper ito r (W
Ille Ii lc ram r 1 a-ccrulin wh kh of Ih bull Lu[Jalmlcrus Ind (Lb hili til~ CLlLt-cd br scnli()si- clluld bl pl Y nlcd or r d uccd hl phylolld LXtmiddotrdsi n Il p--to-da le knowl Uuml~l nr tIll~C aspcc[~ i ne bulled in oruer 10 dndc whclh~r 11Rf blLl adcqlmtt Ib(uuml n middotlicaJ balis fo r ora)aini l Ihe US4~ of lUgravellgtitlerap) wltcllj(r or fln l th e prtl1iœ of kimiddot ~lre IUlll poNjn~ a t iil ies ~bould h allowtcI II uuml middot c enliaI toltlentlf)wh k lu alClor ie - lf pl lr~kiJl -c rmiddot d gtlt- (Ic rnnhi UzJ( inn ni (t hl HrJltlon [ rtn~hcll iJl ~ or 1i1J(IChIumlJlJt etc) Sh llU Ld be TolullllCcluse ulemiddot l onld b- clclIimcntalancl wukh sho ll ld he IJlI-n~ifl~d I~~a l lhc (o uld h 11lfu 1 Know k dg CJnc1in t (wIn SeiCIImiddot Hlk rCS([lflt h daw ccordinll to Ih bull llVit w o f tIlt iii 111 1( plop(lsltd in (h i papcr lmiddotonllmJ l lnl plLyi 11 cxcr(j$( pn (nti or (tmiddotduce dhlblli t ic 1 ~lt Il Jj ll(k pl ti Jlt fadl j w(~ the nlIIIrl li7alinn n f poMural dd shylitS tu p n xJ llc aSl COIlMqnen c(middot 1 all )llal) or r(tn~ shys i middot middotlIrve Tilt u~c (I f appn1priattmiddot kincsiuuml wrlpy 0 in rcns polttllcal swhiIHy Icirc IIHmiddotorc Illta ll y (0 r 1(lt1 lllho UAh mon ltlccurlltc 1Ut dl1alkd -rLk l(lWfils 111111 )11 h Jlccdt(
11) wurcJlt 0 lit)-IcircS (Iumpy - x rcLs P()lun
n rllt lT(ltnklf u f COll1tlK H (rtd) I 1i plfho l og l ~$I rUlglng tr m low tmiddot k Pl 1l1 to IdiOpath ie SCUIshy
Submitt(oJ [or PUhltCl l1 011 uly Tt 2001 Acc~pttJ ugu - ~2 1(t-1l
Addre rltj-xlfll telt~I(middotb If) - grinl Flt(1(bziurllt r )(m Ofl ()(Cl1I shy Lt middotqlltœlll ro () - 1u I4t agravehLIlKil ta IYIL-lTt ilSllltp lfllmiddot ~ 1l1uumldull
CelII ~ (niiOS I I~ middot ann (1) IfUh middot lIlfU di louhilll(tymi ( Nlmiddot ~iI rli -ilIIUmiddotltlfl
Nlti(ir 1( ) il r() (ltbullagt1
lt vLL_ l IiII no 1ftfI
jS ) we are a IUil ly tJc ing n1n) ltblll lS 1 k l1 b ~J)w in~ tl~ t S Jfll l approad llt - l1n til hy on ielshyertd ~tan lard ugraveJuld ln m any ~1~ he lI ~t les i if Ilot dange r )ll lt rhlS is lrut of reil l lnw 1gtlt1lt1 pa in l ~ or 5urgi c ll lrea lmltnl5 in dbc r lmiddot ll Sc - 2
ln tlle cj-e ut ~ t lll(tlWtl i( li p l ll1JC luuml- I ~ middottnl ~() shyliosis phys cal ((_lt1(( is emr1uved ltI t()fIl1 0 lh~rtrv
lo ly in cel1l in L)lllllde (nluumlnlr in tilt Lltlll middotorkl i e Iw l) r llt t Srain hUI IIgt() 111 Gert11lny 5- 1~1 in other reg lOl1 wbere thi I-incl qf tre l tm e rll 1 p~ 1 pmiddot t 1( cI il Jws Ixen cri ri cilld md rel -cltd Lw m~lI1 1 11 Jlu~ Fue Fnlny r ~lrs thio middot15 a lsgt(ru( f ~rth r -~ltc rrJtf))~ ll t vit11 br1Cltcgt b r II1 ([C Llt n ClW grmvlng 1lt1 0 L Sti g
gcsti n the lIsefulnes- u r Ih is form o t treatm n t 1
Hmiddotu]rs have nerged jn El or uf pll y~ iLd eegraverdse eacute 00[ 1 but tlw are nUl yel 11 11 t llu i vIC~11 and r hi ~
f rm of trt ~ltmenr IS stiJ l Ul1 ckf ckhate FfI t Jt 111 il i 11t (eltary td 1I iFy 11umbtr ot
b l sic COI ceP rlJ lf w ill he cIh tt d in t hi pap r
Scollosis
DCijIrI iriolls
ScnUoSlS is Irlircc c1 lme nsIcircltnal (I(gt i l cj on ot tht spinc thar cau C a CU 1 lh lt ca n h e $ t~en ln (1 me1Sshy
ured ultinF Coh) lll ltllCXI o n HI anreu middot p rtc rilt r
EUJlOI -1 lœDICOPHYSlc~ IR
NECRI Nl
110
f)i)
1 7J
amp aS g 5li - 0 v
V
31
10
(1 1) Il 15
-tc i ytjtr~)
FigJ----jllph ot DlI w l-lkaupegraverel) The agloimvltltinn Or idio r lrhlc 50gt1iflll~ IS rpiJ bel~ en th e- [l0 IH P (l)ltg tnntll lol (JI PUllcmiddotny) mtl 1 ( f( lS-er sigll paiilivltecirc lt Dlt(i I1 11illg r the iti l 1Kgt n n t rll icirclicH a ) 111lt m omal prebulled the mno rche md ociks with lll I)ttlx flal gr Ih pll fl
rlcljoprdphLi 1 hl merl prestIK ~ of this curvt c10es n t autom~l ritllJy indi ate the pn$CI1(t of a defurshyTnitv (SlllKtUrd (Unel
It i~ possible tu clil1e ren tute a struCnlt t CI1tve fruIn a pogt urll 011e by identifyi og the hum]) du ring AdIlns tesr I~OQ looklng tra m beh lnd at the p atient w ho b benchng fUfward il is p -- ible ta d d~ct 1l1 eh ucirc n of o ne liidlt 0 1 the trunk usually n n the (onvex ~ jde ul tbe radiographie CUfve Ugrave1lr C Ul be mlt~I Slred lISin~
BUlln els S o liomere( 1 ~ l This h Uf1lp is du(- lO (Ile pregravegtecircn ~ of vertel ra i rolltion 1c1 Ollt tn tic f~YJ tllre o f the def trrnit tli [ c m be seen and measurc(i v ith Perddolles lb lsLometer on an amero-Ix)iferior radioshygrapb ~2
Seven ry pel cent o f li Ises a re conid 1lt 1tO be idiopa thie 1 bull ia l-nosilt in this CI$C is b exdlls i ~ n as idinpa thlc me-us t11H wc do n()[ know rJw origio of lheacute curvc [n othe] ~Ie$ it b Ix )~i ble ro ide nrify a dieak (bat CHl jusrify the c1etgtnniry slIch a rna lfo rshymar i ns I1(gtufol Ig ic~ l or genlttic cl iscas s Glnclt~r trauma etc )
[dicirc)parhk S(oliosis has been divicled ~(corcling (0
the ~Ie of tlie patient egrave1l the tiJ1ll of d~[ccli n of the condil ion into ti) ur t ypei ln fanUlc jU nik ltldolesshyccnt lnd aduh Til l m n st cnnunon (VPC IS the acloshylescegravenr o licirceacute I1IJctenzec1 hy 1 sud le l1 tggrH3l ion uuml uring the grow tll Spllrt (Hg 1)2
lhile p tu 1l sco liosi i5 Ycry lomnw n thl pre shy~Iknct ra te f r adole ent icuumlop~lthic structural CU IY~S in sch )o chilclren are 18middot20
- 10 Co bb d~grels o r m on l -lil
- 2) ~ohh dtgreclt or mort O 2~j - bull () (obb d gre -s )1 mOfeacute ()ll 2
Clin iltI [ d e isio ns lfl IXlSed 111 an lccu r~He pregshynosi which obt inccl in eJch pa ti nt mainly o n the basi of the nsidu~ll p()tlnllltl l of TH1h and the result s of 1 rh clin 1 1 ~l1d tadiogmpl i exlminashyti(ln12ll c noieq uentlya d inica ] la sifiou io n o f the ing le pHient tn -ome estent co incic1 ing w irh the
D diographic one c l n lw SLlIl1H1arizeci 1 1 folIcJ - mikl lc~ (1)(n 20 C bh de~r es - moderJt l betwlen ln md 15 ohh de~ rtes - StV re 111( gt1lt rh n ~J) )bh (kgf s
On the 1) lsis of [hi - dinic d d a lfic t i n (Vith l1l il el lrb tiOI ~ o f the ir b() und~ri e ) in Itllt l cente rS Of SCOtiO LS ITe ltlllent in the Lltin odcl (i rJ Ital lnmct md PI iJ Ugrave tre tmtnt i s plmmcd a fo lltJw 8l
- mild kineslth e (~1fw ~1Il (1 luok-ou t - Hl demte IJragravecegrave 1111101 c(~r md k i rws ithe lJpy - ~cven surgery
Physical exe rcL~e for S(ol iosis
Defi t tiOl l S
PhyS i 11 nU b lIKrlttp middot (or kines ithcIa Pl) i a p rvgrlill or plt~i Gl l (xeriltecircS ~1ci fi ( llJ y ltk ~ loped
y a -11 [ru ine 1pll yslo ther3pisr wirh th e m 10 Hllll
- pre (~ n tit1g tlc aggraaLion of the cl I )flnily in rnild bullcoUm is
- helping tlk Il ld Ct ~lOd ounter~lCtjng its skie elfects in III de rltegrave sc li sis
Tn tl1i_ feSpec1 kinesitl1ert py f JI s oliosis is tonshysider l a o on of peciticcedil training and s genecirc tltllly proposelt in sessions 0 1 4~ ro 60 minute IW) t) tour limes 1 Cee PhysiGtl exerci es can aLo ll v o ther auumlns 1S it oill he dise Issed in this plper
Ir 15 Ilot possib le to cl escribe a single progrlIT1 o r exerc ise a5 pro nrams ale USLIJUy p fgt nll ized ( ( lt
EUH PA ~illDI (DP1I YS IC~ 182
ROlL UF P l 1YSICAL lXl 1lt 1~E IN l IlE 11 ~l) IEd If IlU) l[)VP 1HI AIJ() J)~Cl~ r COl ~I NlG1W il
f)( 15 egraved ( )Il the nee L- 01 indi iuua l pJl itnts) al l l10ugh Lheacute) C l n h t 11 plicd o n a WOU p hJ~js (-1 (0 () pnients PC[ ~l ()lI r)middot lugrave reQCf lhese 1 10 grl lll frequt ml~ V IIT
hnm on in middotituk w allClthltJmiddot -Ill Jnv L l~egrave at Wc w Ht ~huw in lhis lyl peJ it i~ 111 n u -eII1 tu id e ntilv kirK itheJapturlc aims w hitl l ucircrr~spnd LO ugravelt~lil1 DUtshy
g X ir ur ph -s ici l lxtTi~l I~llhe r thln ln dj( us- indishyiJ u1 1progr-lfll
Aduumll l lxUl kisure time ~lOd h )u] Sp u lllll8 ~Ilttishy
i lt egrave~ i middotomm )Ly s iven lel mJ ing ro w hlf ~ Iuumlnsidshyer~d usdul or il lrmfu l in t1 lt rruning (lI tJw ptliJicirct ln tl1bplper Ugrave1 gent ltl l t rl ll bull p lwsiCUgrave lttG iviUes is rl ktll 10 JllI1ltlCc hOlll gtpOlt mJ kIJ1lsIcircl hc lJ l f
i ve lUen tloneumld )bo C on lv ine n dul( re Ull~ 1t~1 t s far Ilten publislt d f I~ mJ I(i noltgtithltl rgt is 11 11 a su h jel lnI deacutehate CJitk haltlt t llltit m itn ltl of l ny lorm o t p l1 ySiClI lxrcL e as a Itwr1 [ J- fo r i liopa tb il jcoJL~b un iL ()ri gin~ initial1) it WIS Ille r rOmiddotUumlK lt brgdv u f p l~lt titu gtllergt w h ) intervenecl hutll tc llcrl ll (mon as cltl HtilJ nic in terventi n man Jgt
1 t lltrJp utl t one 1 md rC j fkll l~ on rhe h sh lf som uni cOen I1v pn t I1cgts wt ldl hll ltl enl1 JI~ haLl nu na l scicnt lfic baisYmiddot HOlh tlle$( trr t peu shy to rh ~rl py tt nJecI to l~~rJ tte C Ih tk CUf -~ pnnshyclr~tll y as a f tsul t of lilo h llIzatio ll of tn imdqultdy ~u pp rt(d S pln eacute 7~ 12 to re-t1 r rI ltrl 1$ l l1C k o f WH llt~~rdl 10 I ndt~-dll()urnah tnd 11( on1 p~l per u suaJly Cl tc([ IS n prelimmtrf lll d 3 ln tt li w ay man (l rrlKpt(Hc H lf O iS Inll ph ~i C U l ~ d vi ~ cI nllog scnliotl pa t le nL~ 3gainst holll ph lca l egravexershyclc and p()rt~1
It m u st t~ n tfd [hat pllyknl txerc j~ tJe~ltm(nls t1iHer 1 lJ rd il1g r rhe rherlpcu tlC litTl~ on lllc h tJ rgt ap p lolc il l the IXlltent lncl hi im r IIIllHnt i- 1 (1(1 rI - 5lt1J lC igt tIl l ( f phJllIlllolopJ al rrea tmln ls Ihith cllffc r 1lt œQlfd- rhe m C cculc u ~t(l luI thl p al 1t n
~mc l 11i (lbE~e Tt i ~ P ~il k tlwreI[middote thll wuumlk ltlll t kin 1or ph~ i Clt1 1 lX r(j~ 1I 111~ t bc loidvd by t h~ Lo iurie IxujCJ1l al1ulhcr a dl ~IS nJI h~ iOg (1 11shygerols llugJr in racr le (wi ller d I ~fJIII ~ I ml thlls re(nl1l rn ndc(1
fn n UI cel1ll r we In(~ hccf) using 1 ) 1 1111 11 ve ) 1 (J p lw l icd ex(r(i~e (0 J ( 1I l tt i~ tlh aITt ~ l~d Ilv m ikl tru cflumiddott1 adokscltnt (cl ioj arh lC icoli is11 2)
ina the f U~ t rc-gt uJrs IefC pu b lishe - the pJ( )grd m 11lt1lt l1te n PWltllk d in fa c t deel()pnlln l~ in th t l itshy OlL1Ii in tl1 r b t ~() ycal f ha ve iclemi fiecl niO l l
m d 111 ur impl rnHm s md d i s )h ilir i (gt~ lue t idlo p lthk amp()lio -i ~ t Jll CIII he 1UO(l if Icirc 1by phyict1 egrave xert iSlgt l fe t rrncllt
l illl
111e aim of t l1JS r~l per ii tmiddot (tv iew tl1( l iterat urt to a(errl ln v llic ll of th~ impa irm 1t~ and Liit hil it il i GllIltec hy ~ o l i()gtj s -o ull he ll nt x or re middotlu celt1 Ili pl1ysical xerclse An u p-to-da te knOvkdge o f tl lt Lgtpecl-gt i necckC1 in rJeumlr) d -oek
- whetll~r there h ltl n adLtIIl ) l tht()d ical bbh fur or JqIIcirclb l l l1 Il( ) f k irt llit herlpy
- h N I)(1 ( 1 Dm tlle p r l c tIcirc(( o f Jebur tiJne )pOfung lcli v l ti ~ IIOU lci he tllf) -d o
II J U V f h 1 I11~ c~~lb li hed Ihe usefuhlLss 01 k il1 shyc ~thtrpy il i aIle dy l nsi 1([(( -r-tI Llleu i n )I11 plJt~ ut the wJrld ir ilt ecircS~nl i 1 I( id n Iv w l1i li ( 1shy
gories 0 1 pl1Vtl( 1excrClgtegt te D)bilI7it ric 1n (Ir st shylliuumlZltio f) lttlt tlgtbltn ing ni trcrccedilh ing erc) hn Id be
vnlcled he tll rhe nuld be lerrillldll1 1 md whidl s tlQu1d be inreœ jf ic(1 IJeClU~l tlley cOli lel Je LI ~ful
Ncuro1llotor impainncnts
Imv aUl llOr~ 11 lt1lt ~tlKlteJ lhe cltlndatiotl bd Ween tl UC1UmiddotIt t l ol(~C t nt id iopml je -nll ~J~ and cli~l l shyler~ lr 1tH lest ihuLIr yt 1 _ 13 ~ 311 D uhoussct 1
1-- ITS tln l ldiopath k s(o lio-L L cll -c d l J l hmgt in th terl tltr f prop li l l pu n md 1I1ar th e detrshyn Hi n i~ na tural 1 ~ronse to ril e need tu ts tu re p()tun ltlluilib riu Ul HcrmJJ1 31~ 11 () d tllat icliupathic ( liCl5j h l it re5u lt Ot1 rw nltuf mot r l ~ltelV
[Id )fcl 3 nI] ~1ltJ U Sr1lle nr to dtorders in centJtI lO~Cl shyIOIDNur) md 1xi~tI moro (Ul1lfOl syt( llI (Fig _l
N htIll -of) H1c S uumll h( rll1 ( ~ l( w ing JI t11 (oshyI-ie on the l l lO]ugy o b doll (nt Rl iu]icirc tlili- middot()lioL m unt fil t-hltll rhl ugravedcmnilV L th e fl5 ult o f 1 (k btcl 11lIFll llI ion nf som t11(WUgravetltnl md pO~ lur( (tnic l~ l licirc1 tl1lt if l p OgtlbJt b C 1l rlw sta l i lin 0f 11 1 Sf llle j lt g )tx l Tt) ohtil n a ))Cli U 1ILzltl I o f p ~llIr~il d l~flo [ in l1litkd ~J)llnSIS me CI Igt(middotqucnr J ~ a ~tmicirc ()nlly or regle Ie Llive
Ali th- 11yp ) tlw~es rd ~lte tr d irtl Itn t pnl1tlt o f [11 v hole ~piltm It11[ controls postu re ~nd mrw shyment lrre pell ic of tlh po int a d lI~ llv inH llYegraved il i ~ ll 1 nnable tCl aSUilll ri 1l tr l ll1 lo g thi ~ys ttm ( Qu it le 1I middoteli tl
lt ch ugt nlt~(S f rullliIl thil i nlomwtion th at p tlmiddot shyiCil J(tl iIies nw gt Il lInport~n t rr le to pbv [11Icircgt role ca n 1)lt slI i11l1lariztd ln lWO the ptu li ain Llt
- d elopmll1 l of p uumlltl St1 b Hlt ) - c1e veuml IOpm 1)[ o f bhll1ltc _
(k llhUl)lOr S Cll orr
ontrot oic whan-lt
------+ 1 ~ il lnll ugrave r AINnl
Cllnlr1
T bflt~ r
fltL1 tlli
lMini
l
~sary ~J-frlllen i )f
~ 1 ocirctnl
~UcirclllIJJlW Ll
AXl ~l1 n uumll l) r sy 5t ~nl
middoticoltoq ~ Fig 2-AcFgtrdong lU He-mutl 21 il is Fi)5~ ib1e rD prolXgtSlt l -oo ie1 mnd 1 ((if ~ elio egrave middotAhltr~d l)Qdy-p ati~ I I i u d) uren ttllOn k td LO In ~ory reHTt I1 eDi tn l al ) JdrnlV~ pn)4~ e l u r~o(Ofe 0-c1 eptunl dvstil t1 ctlon sltŒ(ry icircltu nu11t ilwnt [ ~mC ~ted tl l1 ce Ill trpntlshyUumlfJJl nd IKnle~ r~dibl jtugrave)n of -I) m tlosen Ir ~ig nj tl (I1vying ln fornll1U n (lI an ereltl ~piJl e Mmor aJJ r--a t ~) n ltgtf ti lt aXljl mowr plem iHUC Wh ~fl Ille 6ubjeco m uumlntl Icircn (1oJifitd perccpfLlI l ~na l ysilt of p n)lnocepti Icircnfu rnlaquol ti desnibJOS ~n t tecr spin A IICW motor co nrro l Ira I gy t adopt resu ltin~ in the ~tr ltctltr 1 ckformh y lf IdiopathirL scollos i=i Ht lrftU1uc nltnt l ISll I1lJy h1e- ~ I pro()und elkn on bralO Sfem flJll ct i(lnn~lLhu modifyRll Ille nltulltgtshytl10 ) 1 1111 Uu l-lHoror control 5~Shnl$ shy
As Srtgn1lt1 l ~ ltlssert~ if wc l C -Cp t 111 1 un o f the G IiC s oliosls L l tisorckr oi th e ltquilibrilltn sys t ~ms it is lagical to oriegravenrate physlCl l exercis( lherap y ln th is d ir(gtCli()[1
11lclte goals Cul tl lfOUgil ditrercn t modes 01 action be Olchic(-c1 witJ1 phykal accivit ie
- po rt ive Cll ities p ro ct LJ e aIl UgravelClltrtsc in 6lte nshyel ll )o rd in~lti n pinai pr0prinup ti_)[J nLi mOVeshyment control 0 vio lls iy ln thh repect ome lCtivshylites aœ pre um~I I)y lXrter tllln ntil crs
- kinrl lira py using pedJil exerCisocirc specially developecl lith th est 1101 5 in mind illVuuml VC I lllore prccilt( ll1d InC1 li zed cri n on rhe spiJw focusing
a90
1 ~~
lg -lNheJo ~1l l1 t r~l g rld in 1 1) h i(~ IImiddot ct r rHienl w i ll idlllhic _It ~i ~ _ iri s plt ~I le II find Jit ltH vlllleuml ~l Cgtbl tn~ ks III d il fef lt p ~ lt ihnS nu v~tl middot B ~a~pt u Il C middotl)Icircd ~(t l l11 C dlfkrCnl middot- hdween slllndi1g Uline nu nllt1Xinul oorrec ri nI t chied Vith Ct (J ) und tfdincJ ne lot es o UIine 1 fo llnVs middotIJfl tfi ni( - ltlrshy
reltiK)n ~ Ikexibiliry st3nucircing - -pirte - f ur~1 1IbjISC ltupin - ltorrcaion - - r~luci()il ll ymiddot For flmpllt in J npK l1 pH k1J il
plt1SSlhlc ln obtai n 10 u1 511ndlt)l [YLo lion yr ln Slt p ille rlOlgt itlugraven om l J ~ in ( gttf(C rigtIl lIex lbuil 15 i (r-l l=22deg pol lltl ~~J IIlpraquo is IcircO~-V- I t1 l nd tucircu(Ugrave) ilil) I~ 3laquoJO- IH-12
r ln Ugravel e abilit jl of tluuml [m e llu to co ntro l irse lr in ~ pac
fuld l oftlles uumlllelve ntio ns can presum1b1r incn~~ Ih enl ac )1 the orller and lHitlll r of Ille rn - 11 )ltd h e lllldenl lu EJ3)4il
Posl1l1-t collapse lnd slabilizariotl
lIle concept u fplt st lUal c(l lJap~e l l~t Iwen detin 61 by DlI II-T3e~tupegrave rL t Ac oJdin)j tu tl1i- ~ll1thor il [ nec(sary ~- l Hn Cv-tlualing th tleihility o f a col shylo tIcircC CUJVL (0 clistingu ih bt tVeen the re du ihil [ty index (th - li iffer gt le bet ~middot Il ~I r~tcli()grJph ie ~xnmshyinltio n of the iI111 pHienr in supine po ition m(i
ROte OF Pl rnmL EŒIlCISE IN THE TREAT-ŒNT OP ~I IJD IDIOPAnnC OOU~GEm seou SIS EltJRINI
I (~)-----------------------~
__ _~ _____ _~ __ __ L ___~ ________1 ____ _ __ ____ ___ ___ _____L___ _____ l___ ----------L ______ _
1 ~
1
-- ------- --1---- ---- ]---r --- -----_----t- ---- --- ---shy__ ______~---- __ ____ 1________ __ _1_ __ ____ __shy
~ (1 J
1
8 =~~=r=middotmiddotmiddotmiddoti~=-middotl--- middotmiddotmiddotshy--------------t----------~- -------- - ------__shy
~---- --- -- -~ -------------r---- -- -- ~-- - -------- --shy----i-------r-- - ---- ~~-shy
il 1~ 0
Dtl-Lmiddot ~ lttj l r~ UIltltlHt
f g 1 -TI1 u ilictf 1ld ( ii 11- ugraveu-sh) ld IX~ O 1d wllich ltJdnrshymII Il nf the pilll 1 ~tln~1 of th e -o lioti( spinc n IG~nI(J II IIIshytt) lhe iJeuml grl-e o f ~ ()Ii ti c (u rvH Il 1 w dcpc-nlknrly o l l he 10 111shy
P01(nl (pntt l ~ 1 1 nr ffll wrJ I) ln w hilth Ihe n i 1gt( ~ duc nL~ grlphs fm I h~lt 111lt hi~hr Iht Col h ~Ilu t (l f Lite ~Ul Ihe m Ol CI il y th t s(uumlJotil middotpin~ ~111 he ~middotJg gr~lVH(~(1
m mJxiTIt corrttt ion wll iJl i~ lIllCd to Ih - xt 1shy
lti Oilil y Jf tl1lt t Ut JO rl1t cdnUc idt md p OS shy
tU ll cul lapse ( th t ltHill enct b-tten l lUdioL) 1lphic egraveltamJl1ltlti OI1 J t th e ~lme pa tient in Sl il tl cling lOJ lline fX-sitiutl ) Wll ic h correb lc- onl wil ll fhe abilt ty of lllt p tu rl l gt s tem to C( lunternct lIk luree o r grl viry )cco d ing rv D lfVd- f3egraveLIprc po st li r t1 lt01shyIlDse is d ue to the Jnus -u lar ton a nd 11ll ex rCrIshy i) i itv of rhe tissus n the ( O IW-) si it (If the (01shyjl ti (~JtVe (Fi~ 3 L Pu~t llr1 C lltpstl lu lcl l ~~ reduc l-lt by llwans o f pl1ysica l cxerCles specitkally s tuclled ruuml i rnprove tIlus--ubr fOHt md lU pr )cllI Ct 1 ~11 hi shy
lizing ffCd
PararcL n tll CIJ cl the cr iti ca l (3 c1 thlsho ld beQ ld Il ich defol1J lHU n of the i pinlt 1 e~ in~ ne dtlllontr~1t _cl (1l ll t grclrf r mg] o f rllt C II in a qa m bng pos ition corn pOil 15 t l lowcr detormashytion lhnsllold (Fig 1) ie to ~11l Ulne3Se t the risk of pr ogr t~ lu n There t rh eJef re l J ea r l)iuuml 1itshycJ l ~ll1 l l(tl a 1 tnr tg ro b ohwined by d -cr t l ~ illg ilmiddot pU~lUrll cull lpse ptJcelJtge w bich lccording t i)
h llTd tnd ~l(heJ1l ~on 1~ b inde cl 1X llt icularly luumlgh Ugravel mllcl c Iio~ i (bdow 2( 0 ) (F ig 5 J
Fin a Il III ch iS respect lllljl hl and b um l 01 m linmiddot
ii iI 1 l _ _~ _ ___I ___ ___ __L ___ _ ___ ___J______ ___ 1 ___
li 1 1 1 1 i 1
1 i ___--____---___----__-_---_~- _ _--_ ___-+----
i
1
i -- ~- -- ---~-----_-~-_-_--_1-~
l ~
i
+----r--------t-------t------f-- J
Fj~ ~-Ac(XjJlin(Q luuml T O rIcd ~lnd Na(h(ln~ n i () dl( pCG w rd (rTIshy
POO ll is hiherin cu rvegt in wh ilt l1lh ~1flILWrd cII1I Olk l1t IS le- pr(v~knt ln th e grtph Ih t PogttJlJ I ugtnq) Ot1 -J1l j elfltS-e J tlt 1l1t obb dirr remc rlLIv obu incu f roll l the Cohb atl( 0 1stlI1dtJ1g IId gtupinc rldo~raf115 Ih Ille lt) [1l1t1 (i lndnl I pine) 511pille the ~(nlClu tJ1 compo l1lnt U rlk CU Y _VeJily I~ ltx p rlt 1 L1v UpUlt (obh Illeturo Ih t si _b Cct rtJeSIm l fie -ltn J trd Ugraveltuuml shyuumlo n A~-i)rding LP 11(lt uuta o n l ( r1I~( in ~I 2JQ sup itlt curvt 1hi C(]l)b ddhccno l l f lO is -J-lultt( thc s ldnd inr tnla Ol1l t lS wi Q) whil 11) 1 1)401 ~llp lne ClHVC If ~ 1Omiddot ( tcl Lhe ttnd trl~ nlca~ I(t I ~ ~I)
tli n ll w l lllE cq lin ti spin h~ i ng mo r ~ Llnt~II) 1 tlun the nOftl111 one n Cll l gr(lk ( (cU ve tl1u n da r u p shy
po rt in o r k r 10 m linrl in tht 1xi11po tuf_ n th ha__i of th egt onideratl lr1S it f(lll() rhJt
ph rH (~Uuml e erd es ulukl h u - ul iiuml tbeacuteY ~U-L lm cl 1l (It-d o pmg p05111 td C Jl1twl lS fuumlrnll~ rly d ccrll1td ln an Ql St if i imr ol1111 t ru t(( - tht m(d in C JI shy
r t t r sture fO Ir -ngthen tlll m u ck-gt of the spint mainl) in (11erl antig r3ilrl tIcirclt l]lli fun ctin ll U hy meU15 dl i )ll1 t trk ~ lhJ cl( -ll tlt C)nlr~lUions ~llld no l IdOshy
1l)llic d YIltll1k lt l jAJ lktic t) I1 ) II 11)t 111 hd posibleacute t lcluuml ee postura l io nrro and stfh ili lllllt IJI
w i thout food T1lw(ull r d I( Lf(11 Ibk t m ucircnuin Ihe c()rf ~ct [ ()S tu re for cl gtu ifKi IH lLl1gth 0f ti l11 ~
This i-l ddl usl a typl 11 dnmnin (tf k inesllh rap) in 11 (lt-11 [[k - p~d fk lnr in lng f u l1a in llllliCk is poss ihle lI sing ctrtain Idncl fJ l (lt) 11111 liun S p Ul in tb is Cl c is ulttful ooly sa I~tr 1~ il Iw lps t1w lxltknt 1 becuJl)t 1gtlt ltlt-I a ClJu~l inred irl ilL ntllru l o~ i cll
and I1lll~lJhl r-keJc LIl [rll-llIn~ middot etlt(wrs JI the int e rmiddot vlnrion
[J ROPA MfJ) I()Wf-I YSJ IR
1
ICR 1 1-1
r
1 shy ~
- shy
11 o-llrfOlhe5l~ o t Ih 1O~(1dity i n h ~ r ~ ll nr pbl1 l of ~ Spl11 in 111011 _llti1Gt l lPt f ltlJUCWJtl ( ~l Ihe Ir t 1 1gt illbll W Ilh LtltrJ1dlion Vln lbe rigronl middotUII~ l(I Dko n12 lIll h lumshydlanie1 1 [ nul 1 M hl whtrc M - gt) lnIUI1g 111laquo111laquo1 1 1 c rtJCshytjC~ f fce d -d Lill l1~ o f enr niI pUll spnmcl1y 1~ 111 mldlll1lt (n the fl1ur t 1 = tor~ of f(ward Ileuuml l = ughtel1lng fmiddotr p 1shynOf stn lClU= Alaquo rdtllg 1raquo Ihl~ - lin hull th l1ltgtllugrave ot tller1l lUr~Jtllrc F the ~pin t -ilh rlu1i tf Ihl 1 1Ibulll n lrlt InltT1 1
rbc prJI 3IJi l1ty d qrlOIJ~ n bull JI t IlJIII Hm lA the v=ltd gtc e lu-ing J 5lnK1ura i ltfnnity
Dioal e ch anicll itllp~lir J11 c nt
Ihrcemiddotdimcllgtional mc-cbal1in of the s pioc
~f Ikmiddot i t i nly l(œ ntly tlHr llk pr-5tnœ or nc ushy1 lnlo tnr impairment in Idiopttlllc s-ol ii IXl tknt liuml J$ heen h i- ll licircghlcJ hy re$eJ rh tll e preit ilegravee h inm b nIcirc Ji d lJutg~ lt hl ~ 1 ng t o n dO Ulll urcel 1 i5 (l lreldv well umlersrood H(j-ev~r nev lbt un h iomcrhankal im l) ion nI h1c rectm ly onk l n tIlt tre and p r~dou in f n rmtinn hou t pl1ykd (~fcl5( in t 11 0 tl1I _ltgt pbne of spact 1115 Im trqlt-u 1rom J i-[) v ing unclcrsrmdlng ot th l lmc -dim nshy~ilnl l l11 ~ hmk f the cO]jO[lC pln( ~2middot ) ) Ve- w ill )iI xnl t l1 d at lcL-orcltng tUl cl sif iol t lOn blsed o n gtolllt lricd h uumlCJ ) p lane
- b() rJzU[1tl ln th i pla n ~ th t 1o rm ll sp ine present no CUlye- w ll ile Uumll(~ ltc U Hic spLnc clevelops one of ir haracterls(Icircc deFo rm tiCs v elt tbrd ln lashytio n vh icl1 pJ()VcA~ theacute hw 11
- lgitltl in th llulJe U l(~ nonmll spIcirclle pl SenL kypl lOSis ~nd l dooi~ in tb lXI1 lhese [(Hu rts Vere m)( til ught [ 0 he relattd tlle scolkJtlc ( lI r Vegrave
- front l in hi pleme tht ncrmal p ine preseuron t no curYegrave whil thl ~11li tic p in ugravetI I ()~ icircl~ charshyad t Ilt I CU1C
Il Jri fJIIt palic
~l+I~na ra 3 r inr lut th l[ ber ll1d a œl1~lU1 degr 1
l f r()la tJo u lllu (lILa r forcKl ltxert ltJn tl ldefnmuumlng 1 tkllJ [J i1u a re- lhlt tll cly 11 [1 1 UI b y Olm ner w bn ~lh uiJwd tl egrave ro t1tic) l1 Ilm it ti lt p ica] lf shy
rhrl r() be (P (the Uma bevond Wl1iltJl th lCOJlb of [11( ~pmaJ musd ~ dthc COnCIt and nm ex ~l le btconk (t O li~[)
r ~l 18 ~1Il N lu t( ren i9 lun lu ted rlseurlt h in tlt ) tilt lULodeumlformipg1 tlo n ot tIH_ sc laquoJrle rh ox ercallkren lk 1l1~H li d11r once thl Il i ~ r tld1t5 [he lhrth ld f 111 JlIcirc lIi of tlle dnrlclc hurnp tlk
lI bslt Il l nt rlet()rlll lIcircon 01 the it l ()I~ C ( (ylm der (- sustalnecl by an H1tmi cforming aCOOIl
J1Ji h V hl rhyiical f~ f Ise CI 01 h spr n llnd kin middot ith ccedilrapJ my lX damlg ing vll e n l pplild as flle
igt Jk Iller ln SCC1IJ ~IS lllc lJ fxceed l auto in middot crca~ i n g lhrllgthuld [1 sh (~u Id ahn be j ofed that Ilw relscd pre sun 1l1111i insiugrave l fe pil1r inn) 1 mlshylt
- j Il- ( w atff 1 (nh ~1l 1(e Il10 utoldrml ng li1eCh~lI1 1sm
in flc l Geyer ~w tcd th1 t rm m 1 hI l)1ecircch1O lla1 puilll 0 l I C~ sw m mim t Ieuroamp no purpo t for cu lshyim le pllilt t1 s (weumlO middott r it is l~Jl(gtWl1 rhn in iculio r[ paULnl -iJl11T1ill~ doe_gt nor Il ~lp to i ncrt~SL n eur(1shym tor co mfU
(1irai p an (
Jerdnn lle 11 showecl thal ill CSl~ o f t10rLC IC 1i lUgrave
tllo lacolulllhil it lio_1 tlle cte tI llmiry in (he lg itt1 p lln t rn lnlftot il~ lf tspe iuUy in tlw initi 11 r luleuml )f cV IU[Icircon nf Ile ~oli ls W iU l 1 p(t)gr~s~ivlt il10middot~ shy
ment roward hvpok pho b G ll f ill~l Im lins l har dUflng (IN eWllLlfiu1 of 11Imh] co luumlgt i the l in t ot t l H~ gClyty Cegraven te l - 0 1 v llebed lxxli 5 r ro ject 1 seH fl r t side-ys and tlwn backlrcl bull thu~ p(0(1 lj n g a kyphQtlmg aet Il ln (h~ lu mhnr --PIl1 COftj tng
l l i tc Iugrave l lltl l( l rs1 tif s L -etllgt il l the lgirl11
1 Hl)
Ilu LE nI rIIY~Ic~L lXIlKISI 1 HI E TREhTMEtn OP JIU IDIOP llII C AD O USCUH O Ll Œl15 NEGR II
lLill tegt lre lenl1 ~I d ~fo rll1J[ ~ rhl recrSes the phyltiologiGII cmns of lh vine)
Accordlng () Dicion ~2 1 rtcluctio fl in the itgitttl CUIYtS combin l vi th a lueral Iviari n llltl ds t 1
mecban ism () ugravel~ta il ity in l he r rat r IllI1e which bVOf1i the unsd a nd i ncrea~e 0 1 co hlt1is (Fig 6 hiIf md Pl11jlbiJ Jl1eanwlt ile lt(udiecl lh e srnl ru t
orzyglpophySLs show ing t11 al ttleir 1I1tl rnic tl orienshytation f~I (jLi l~ltes aXIal ve rtegravebJl l rotllio ll in cun litluns lt f dorsal hypokrrhn Icirc tnd lum)H de i L lo IS
Tll t dat SLlgge 1 th t impOrfill ut pOitu res and l1lweil1 ) t Mudied in ord t r (CI mlIuml ntrlin or to reuwer fll e p llyslo lo~lCll ClIlye in lIe SlgJtta p lU)l Wlth the llm o t ch ~ kin~ rutltor in l~ bili ry7 AbC th ~e ~k-
1l11nL ~Irt del lnt [0 J jUc lt ftber l]kuti inrervenl ion vhich 1c)LJ k l IV - i(l ~ l compktl n l ililll on Il t c1 l shy-jel1 J11UVllT1ent IJ j o f 1uto-dOneacute(3tlon ( i e a -impk ld ion ) Iengtheni ng o f the pilleacute 011 a litlltl l aXl~ tll lt ((IT liJlI~rcdu e~ t lle ~---lJ linti- l lte ml-fkxj(l n h UI 11 - i llCrl I~t the plllH ](JgicJI dlt cr ~l S ( (1 k-yvllCiSh lIld O(ltOSh l o r c lch r1Iif n t a Ilew til(~ecirc dUuml llt Ilshy
si lflltl J ll1 u(~nlent iam ecl - 1l1t0- lIrfe rionmiddot7 4 llmshyp oed f Je-rura l iUIl cl middot-t1e- iltm lI1d ll1a intltnUlLe )( 5lg it d C Uf (gtS slig lll thltJrc i ypI1 tiZ) tIcircOI1 a nd lunugrave)ar 1()fdos i7~llion) sholild he esw b lb]HU 00 lb co
hl b oi hi p~l11il uU r -1Ir vlt Abo 111( e IlltUtl Chl lie o f purti n - a U vitk slJ1ultI h e )tuumlll ecl 1)] (1 n ldershy](ion r tl1i lt type for e upIe IilJ llyl)T S of repd shyiti( ml vemen prt n t in agonistK h)lnllltlSlks nI iIle kind f dlJ1ce C( uld he ([([r imentd
FmiddotO lllaljlallC and mobili ty of the SpIcircIlC
1 rd llo U 22 d L lm nrrare d lhlt in Illt fro nt a l pll ne
tilt 1 nge Clt 1)1lt vtment of tht scplit[i middot CU IY grcmr lIJ l il ~ d irectio n n f Lhe C ITelt tlO n tha n in tl le di re shyLion of pmgressi n l Fig 7 ) he IL o IS5err lJd tbat th15 mohiliry increac plrtil u la rly n apic [ cgcoeilts 1$ lh ~ ~c() li osb evolves Sragrm rJ 12 J ~ thus rigilt (0
VlI f n rller~p is ts Ilo t t) m o b uumliz - a sCtJl iu til curve w ilhout t [ uling ttwt tlle R lu tiOI o i til t ~a mt b fnlinruumln( 1hy l1tans o f ~I passic 01 1 rivE -uppnrt On tilt (ltllE r hand UgraveK d e iJlioJ1 in ease durill tlw tune 111 whicll tll C spmt i ~ not submjtrcd to correeshy( IV anl()n
j- Virh mi lei ol i b tlllt Upp i1n ill) lC tiol is d eveloped only lllmugil llClIf()mu$Cllbr f r llce thi ~
InegravelIl ~ thclcfo re tl1l[ inu eascgtt sp1J1all1extl)iity mua
11
Imiddotiumltgt 7-rurd illt Ir) 1 bull rdrilt I1 1 in tl lt frOlllll pbnlt- th( illl ge )r mOC llIeJlI o t the S-o UIIJC CUNe 1 supcrior in Ihlt diflt(l im ugrave( the n nKlIl thd n ll1 tllc dlrtcLion o f p rJ1(l( (llIl
be considrCtJ vntrl iJ)(l icltion and 1 undrli neocirc ab L a ~ubiljz~ILion 01 tilt spint pllss il)1y ohtl ll1td thrltJugll the stlengtlkl11ng o f the 1rltJgm vlt nonil lme shyCIC 111 illli orrant u bjcLliH- ln rhis r~f1 n sp u lllni lc tivitIumlLs sil uld lX tPI 10 dlegraveltl it l G lU t n w l1ik luring kine i Icircth lrr phyltical eXegraverci c~ tllat in ele
spinal m ot ilIcirclY sil nid 1e lt1 oid cdrt ~
Organ ie and psychologieal impainncuts and li islbi IiI le
A cgtI im lc pmi nr is moriOthl11 just 1 sp in and 1
compkt gt Ipp rnach to the gu in ad 1 ont i al~ shylute l e~se i t i11
[)a la 0 11[ [n ell lrom re semh pw tbat ome organi Iilnctiond cl fki ts suc]) as tlw clecrtiUe ut vild l tnd d fun ll l)Kity_orld ldly incrtJ k whil~ 0 shy[io s i -till in (1 miel q g of g JltlV ity ~ l ilI e 55 rtI lit
tllL pres e n ce )fl defidt Or Vi l~il Clp~1 - i~ ln one pIIiem in Ihr l ftectecl by 20 ICl 40 scoi stgt l ls~a r(h cunclutecl in tbe UA by Di Ruce- prod uegraveed an aaalo) u ll1lXimum 102 re u t in a group of Jd shyk 1ien t [(h sco llosls rang inF frum ) [0 1
Al10ther rudv bv rallt r m C chr111 lilcl NashycWrl1s( u 57 stlO eltt hil $(C 1 1 ui~ Ica js l( lllt cl (1 shy1prUlllI o f t1tgl lie bJd l imI in ~ul sct t1 t ltu b middot iects jlLltr l5 they are golng through ~I cltlici[e sllge in the fnm 1lt i n 01 tlWH o w n id uHitv t factor hit h Illy jeopmlize the cl velopme lit d ~ mIll lt lI1d htIshym cecl IWI sonalitr in Klulrhood
n RUI ~IEDl(( Ptl Y1-
ROU ltHmiddot PI [ I C~ 1 EXIRCIS]~ IN TI Il nW~JUNT OF SlllO lDIOP1HIC AI)C~ESΠ11 C(gt1[Oi 1S
This i why b IiCieacute ii is ~n imporrlIl t for p rcshyvegraveml e 1tLsr l tn en ou flge 1ari e nrs ~lfrecr(d by lIillcl middotu iosis ft) tlke p~l rt in portin -re rcatioluJ acrivitits Iha t 1eIU 10 L10 th r~1chophyinLl bull nd b~l )i 1l1o tur adlieem t n li 51Jmiddot2Even tlK)ugli [Dr bic mech~lnshy
ical mcl nellIUll10t 11 11 reltl ~ons lt r111 1gtomcrimes be l lefu l to ugg( ~t ne p rt in~ aCt iv ity r l h (gtr rll n anotlJer e th ink Ibal an exces~ ive IlHd icalizltion - Icirce l ll1posilion br plry~ilt i HlS nnejlor parents uf rh ry pe of po rt to lx p m lice 1 b Ule p 1Ucirc(Il L th1[ preshydLl ck l1 is fret clOice in lh ma tt r - -h II ll1 he avolc1ed wb 11 possLhle mainly for tlle i mport~ltll psyshyLb ) jogka l fe a SI)nS W( ha( ill ~ t nltntionegraved
Conclu ion
lbh ISsertegrave d t1H physkal tgtXtlci o is ) n fi ial whlIl practinu in order 10 ilnj rove the I11 llde
rœ nwh and tono C iral caplCiry and postu re o f the StOUO(I ~lIbj n II I nowkdge om ~ middotmg trom ci el1shyrlfi rls(~ Jrc li dJlJ accordl ng r the review 01 thE litshytirlture prnpo )td in t lli plpl r conflrm~ Ihe vuiclit ot th e -t ls ~rti ()ns
In l do l (ent Id iopl1il iC scoliuse il l n phee u i cl vk)pm e n t ( li tll iumlKh eXCC cl l g i en rhk thr hokl th e re i5 an und ubred need fn r l pprnpri 1tegrave (JJ1tOkJJe ~Ild Inr surgict1 therapics ill ortler 1) S l i p
the ( - Iuli on anugrave )JT~t~t UW ~pilll l dtlormities bull evshyerthtless in the illiti ~ll pl l~sC t ttlC c1iseLltc whcn the riS( r1 r euro )luli m is rtduced ocirc ~md tfle uifleal JOld threshold il ~ld flle po stural collai i reJcenw~ 43
JI l1 igh pllysicaJ egravexe rc ise - p revenc or r d llCe d i ~lh ilir ies o f [Iw ~ l() li )tic
p (iems R 28 J -6 5- 6 1 63
- f~KiHtare lh ( n utr ali711iCUl of postu m l d elicits tn produCel1 a coneql l nce J [)ti 0 I111)( or regre si -u lmiddotc 5middot Il 1 17 ~ M
-re 51udles U ~ n Ledecl tu con[mn or re jecr these conClLL i( 1 w l1 ich clerin-d frum 1l1 lIldytica l rcltw n f th e liter~iture appear r- ~Lo nlble Hnwecr Intil ne re ull are 31Iable wc should n r prevent our sroliotic patientmiddot trom tl ki ll p lt in s(loI1ing jshy
ir its pW1iada rly ltl t ~d1()o t () n til t c ntrHY -vith the l xcclrinn 01 gt[1 )11lt tIlat in rea-e t)1obility (tnU evc n thell oilly wh n progr~lgtion b p OSSibl) -uc h ~I( ucircvshyiUe -11 )ulu hl tIKoll w g ed The 11 S J ( rprOpriue kin (~irhe r~l Piuml to incr _~asc p()~tura l $llbil i ty is tl1egraveoretshyic tlly CiJUClt alttloughl more ~Iccu rtte aod deLli led ri k benefi rs anJlr~ is is netot1ed
Ria 1111tO
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EUROP MIDI C Pli hIC
EDUCATIONMEETING SATURDAY 8thof APRIL 2006
(iSS
SEAS02 Scientific
Exercises Approach to Scoliosis
version 2002
G
S Negrini 1
EDUCATION MEETING SATURDAY8th of APRIL 2006
Neuromotor disfunctions
Neuromuscular disfunctions
11 Postural collapse
Postural collapse
Duval-Beaupegravere
Flexibility of scoliotic curve
f---I--- I Postural element
-------1 Structural element
S Negrini 2
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Postural collapse
Duval-Beaupegravere
It is a value related to muscular tone and to flexibil ity of convex side tissues
Post ural collapse
Bunch e Patwardhan
Critical load
Load threshold beyond wh ich a spine begins buckling
JI~~Wt1lW~flfthtlJlœJtAr ~ J~It- l~l - IMS
Postu ral collapse
Bunch e Patwardhan
If a curve reduces there is an increase of the deformation threshold
~~~NW~-damaoc~IIIMf ~~ J~Iv JaJ-I7I9sect
S Negrini 3
EDUCATION MEETING SATURDAY 8th of APRIL2006
Postural collapse
Torrel e Nachemson ~
Scolioses below 20deg ~ ~ lt~
have a high ~ ~ percentage of ~ ~
~postural collapse (on u~
average 75) ~~ 2i~
CU~VE O EG~EE S WHllE SUPlti e
~laquotd~c6b ____lPffI1wtt1t~
$ww J(t ~~7 JM5
Postural collapse
Minor scolioses 7
Antigravity musc es strengthening D
Reduces postural collapse -G
Increases the critical threshold of deformation
G
Neuromotor disfunetions
Stagnara
If we admit that one of the causes of idiopathie scoliosis is a disfunction in balance systems it is logical to orientate physical exercises toward this direction
s Negrini 4
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Neuromotor disfunctions
Dubousset
Idiopathie seoliosis results fram alterations in praprioeeption centres and deformation is a natural compensation to restore postural balance
etattJtitIK ypothfQj~S ___~ own_ oJ)HQr lar 1t-1( r
Neuromotor disfunctions
Nachemson Initial idiopathie scoliosis
+ Goood spine stability
Neutralization of postural deficits
D Static curve
Neuromotor disfunctions
Therapeutic aims
c) Development of spine stability
C) Development of balance reactions
G
S Negrini 5
EDUCATION MEETING SATURDAY 8thof APRIL 2006
Biomechanical disfunctions
j Horizontal r-Ian
i Sagi ttal plan
Frontal plan
Frontal plan
q Frontal plan disfunetions
Fronta l plan
Perdriolle Movement magnitude
gt in the direction of lt in the direction of correction progression
S Negrini 6
EDUCATION MEETING SATURDAY8th of APRIL 2006
Frontal plan
Stagnara
Never mobilize a scoliotic curve without ensuring reduction maintenance over time otherwise a greater mobility favours scoliosis progression
Frontal plan
Ducongeacute~ research
On a group of adolescent idiopathie scolioses treated with
Meacuteziegraveres gymnastics
D After 1 year the mean angle of
curves increased from 18deg to 29deg
Frontal plan
Scoliosis without brace
D Greater spine
flexibility D-
Risk of progression
S Negrini 7
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Frontal plan
Mobilization is useful
D In preparation to
brace
D With brace
Sagittal plan
QSagittal plan disfunctions
Sagittal plan r middot _J o
Perdriolle scouos B CJ aDeformation of D
thoracic and thoraco-Iumbar curves evolves in extension
S Negrini 8
EDUCATION MEETING SATURDAY8th of APRIL 2006
Sagittal plan
Graf
The line of gravity centres in the vertebral bodies o s c oUOSt
projects itself firstly laterally and then fi
o
posteriorly lJ ~~ ~~ ~ ~~-_J-D ~nI~
Sagittal plan
Therapeutic a ims
D Maintain or
retrieve physiological curves on the sagittal plan
Horizontal plan
QHorizontal plan disfunctions
S Negnni 9
EDUCATION MEETINGSATURDAY 8th of APRIL 2006
Horizontal plan
Stagnara The forces applied ta the spi ne act in a autoshydeforming sense
Horizontal plan
Dimnet Rotation gt 200
ampII~ (
D The actions of concave and convex side
muscles become
agonistic
~ItJrOnrIIiItdllfUClltlluumlll~~tI ~1JIf1laJ
Horizontal plan
Minor scolioses never exceed these autoshy
deformation thresholds
S Negrini 10
EDUCATION MEETING SATURDAY8th of APRIL 2006
Disfunctions at a biological organic and psychological
lever
Oisfunclions at a biological organlc and psychologlcal lever
Cheng
Bane density in scoliotic teenagers is lower than in normal subjects
~~~~middotA~IIlUtIy ~7œl 1d l
Oisfunctions at a blologlcal organic and psychologicallevel
A significant reduction of vital capacity and V02max in teenagers with a medium severity scoliosis
S Negrini 11
li
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Disfunctions at a biological organic and psychologicallevel
Disorders in the development of body image that the teenager has of himherself
Disfunctions at a blologlca l organlc and psychologicallevel
Therapeutic aims
cJ Activate cardioshyrespiratory function
cJ Favour bone density increase
cJ Develop a positive image of the body
Disfunctions at il biological organi and psydlologicallevel
Stagnara
Sport
D The active side of
kinesitherapy
S Negrini 12
EDUCATION MEETING SATURDAY 8thof APRIL 2006
Disfunctions at a biological organic and psychological
level
Distunctions at a biologlcal organlc and psychologicallevel
Cheng
Bone density in scoliotic teenagers is lower than in normal subjects
~n~IIIvpWr~middotA~stWy s- XXJl M J
Disfunctions at a biological organic and psychologicallevel
A significant reduction of vital capacity and V02max in teenagers with a medium severity scoliosis
G
S Negrini 11
EDUCATIONMEETING SATURDAY 8th of APRIL 2006
Kinesitherapy on the scoliotic subject
q Postural control
q Axial stability
q Muscular trophism
q Balance
q Respiratory function
The limits of kinesitherapy
There is a threshold beyond which
rehabilitation alone is not enough
sssr
Kinesitherapy in scoliosis treatment with brace
Therapeutic aims
S Negrini 13
6
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Therapeutic aims Srace kinesitherapy
With brace
il Postural corrections and
vertebral stability are obtained by the brace
Therapeutic aims Srace kinesitherapy
In preparation to the brace
il Mobilize spine on ail plans
Therapeutic aims Srace kinesitherapy
With brace D
Maintain a normal spine elasticity
~ Maintain a good muscular toneshy
trophism
C Model the hump with kyphotizating
exercises
S Negrini 14
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Exercises and their methodologies can vary accord ing to learning and individual sensibility of the single rehabilitator that proposes the m provided that they stay within the
Iimits of fixed therapeutic objectives
li
Therapeutic modalities
(Exercises)
QAuto-correction
QRespiratory education
QErgonomie education
QMuscular strengthening
QDevelopment of balance reactions
WNeuromotor integration
ci Vertebral mobiJization
QSpecifie modalities in brace treatment
S Negrini 15
EDUCATION MEETING SATURDAY 8th of APRIL 2006
The protocol of kinesitherapic
treatment
G
QChoice and dosage of exercises
Variatiosn of the work program every 2 - 3 months
Q Execute e)(ercises on an individual base or in a small group
Q Frequency not less than 2 times 1 week
Involve and awaken the family
G
S Negrini 16
EDUCATION MEETINGSATURDAY 8thof APRIL 2006
Q Determine the action and the localization of auto-correction
QAuto-correction must be associated to ail exercises
QAt the end of treatment ergonomy lesson
Auto-correction didactics
G
SCOLIOSI DORSALE---- shy ----
r
S Negrini 17
EDUCATION MEETING SATURDAY8thof APRIL 2006
SCOLIOS OORSOLOMBARE
shy
SCOLIOSI OOIlSALE 011 bull LOMBARE S1I--shy
SCOLIOSI LOMBARE
il --~_-
S Negrini 18
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Scoliotic patients are not radiographs
middotSeoliotie Mtients are not ndiographs but hum beings with a vertebral deviation-
Slagnara
Metha For the physieian Cobb angle is of utmost
importance For the patient it is body deformity t hat eounts most rib hump a protruding seapula or hip We are in a situation in whieh today dodors eure the radiographie deformity but what the patient really desires is to get rid of clinieal deformity and of ensuing psyehologieal distress
CIIQItIo shDuIdtucirc lM WIld tJw~~ I~~M~~~~ J9f~
S Negrini 19
- Poznan_workshop_Physiotherapy
- physio2
- physio3pdf
- physio4
- physio5
- physio6
- physio7
- physio8
- physio9
- physio10
-
357 Th B Grivas (Ed) Research inro Spinal Defoml ilis 4 lOS Press 2002
Exercise efficiency of girls with idiopathie
seoliosis based on the ventilatory anaerobie threshold
Jacek Durmala Krystyna Dobosiewicz Hanna Jendrzejek Wieslaw Pius
Department ofRehabililation Medical University ofSiiesiaa Katowice Poand 40-635 Katowice m ZioJowa 4547 POLAND
e-mail durmalaiacekyocztaonetpl Department ofPhysiology Academy ofPhysical Education Katowice Poand
Abslract The aim of the study was to estimate the exercise efficiency in the group of
girls with idiopathie scol iosis based on the venlilatory anaerobic threshold (V AT)
Material and method The investigation comprised 58 gi rls wilh idiopathie scoliosis
aged 10--6 years 32 girls (55200 ) wilh double major scolioSiS and 26 girls (448)
with single scotiosis The girls were eonservatively treated using Dobosiewiagrave
method The control group consisted of 3 1 healthy girls aged 10-1 6 years The
cxercise test was performed using eycle ergometer During the exercise the gas
exehange parameters wcre reeorded (minute expiralory venlilation minute oxygen
consumption earbon dioxide production) On the basis of recorded paramcters V AT
has been computcd using V -si ope method Results The following V AT values were
obtained in the group with scoliosis 207+305 ml 02minlkg bm in control group
219+350 ml 02minlkg bm The differences belween girls with idiopathie scoliosis
and control group were nol SLaliSlically significant Conclusions I The exercise
effieieney of girls with idiopathie scoliosis conservalively treated using Dobosiewicz
melhod is normal 2 Such high level of the exercise cfficiency of the studied group
probably was due to intensive 3-D respiratory exercises of these girls
1 Introduction
In practice there are researched useful efficiency rates which on base of laboratory tests results possible easy without using of the relatively hard or long exercise tests would give the belter forsighting of the range of homeostasis disturbances and rapidi ty of increase of
physical fatigue during varied workloads [1] The best known rate of trus kind is the maximal
minute oxygen consumption [2345] During progressive physical effort minute oxygen
consumption increases proportionally to workload The reaching of real maximal minute
oxygen consumption in time of progressive effort is iodicaled by minute oxygen consumption plateau [5 61 This result is rarely registered in children The progressive exercise test is most commonly used in children until physicaJ exhaustion and the highest registered minute
oxygen consumption is treated as maximal minute oxygen consu mption or so-called
symplomatic limited maximal minute oxygen consumption [678J Sorne authors regard
Orto-dlet Trau malaogis Roha b ilitacjaARTlKUL ORIGINALNY ORIGINAL ARTICLE Vol 5 Nr 1 2003 80-85
Jacek Durmala l Krystyna Dobosiewicz l Tomasz Kotwicki Hanna Jendrzejek 1
Katedra i Klinika Rehabilitacji Slqska Akadenia Medyczna Katowice Katedra i Klinika Ortopedii Dzieci~cej Akademia Medyczna PoznQll
Wplyw asymetrycznej mobilizacji tulowia na wartoseacute k~ta Cobba i rotacji w przypadkach skolioz idiopatycznych u dzieci i mlodzieZy
Influence ofasyn1n1etrie 111obilisation of the trunk on the Cobb angle and rotation in idiopathie seoliosisin
children and adolescents Slnwu kluce ac eJJic Cl chOlIU) Ice SKoio= idj)PO Imiddot(~I7tmiddot
K~Jmiddot w()rus consrieI ve I (OtlHelif idiopathie HUW JS
SUMlvfARY
BackgrouId The aim ofthe stldy Vas Ihe radiological evaluation ofthe treatllJent ofthe idiopathic scolioshysis utilising as)mmetric trunk mobilisation in the strict~ll I)mmetric illitial position
Material ([fJ(f lIIellOds Presented stud) lOS based IIpon J36 cases (13 oovs oged FOf11 ocirc la 6 lcars (lild
rn girls aged frum 6 la S pears) trealed due to the idiopathie sCuliosis ((rom Novell1her 999 0 F enflfUn 200) Among 48 ch idrcn sllfJering from dOlfble-major scoios is 6 cases wcre infoll scaliusis JOjuvel7lle und 22 adolescent Among 88 sillgle scoliosis 6 lere infw7t 33 juvenile and 49 adolescent
Radiological exami71ation 1as condueed always in the repeataole technical cOlldiions RadlOglOlI1 lier evaluated oy the same physician Radiologica analysis oIthe scolios is incuded value ofthe Coho al1gle ongle ofaxial rotaion
ReSIils ln double-major scoliosis observed dlring one year period in Ihe thoracic segmenl Cobb angle decreased inll l increased 1395 and in 292 Il OS 111changed Axial lolation angle in 167 (~rcascs
decreased in 354 incrcased and rernainM the sorne in 479 In Ihe llllnba segmenl Cobb ang le clccrcscucirc il1 354 increased in 39 6 remained in 5 Angle ofaxial rotation deceoscd in3 ofca es incrcuscd in 29 and persisted in 48
ln single scolio is Cobb angle decreased in 386 incrcased in 353 and in 261 was lInchonged Axiol rotarion angle in 216 ofcases deceased in 295 increased and rell1aincd the sallie in 489
CondlsioJ Asymmetrie mobilisation of the tf1f17k in strictly syl7111elric initial positions is a 1Clhod of choice in the cOl7senJalive treatment ofthe idiopathic seoiosis
STRESZCZENIE
WS~p Celem pracy jest radiologiezla ocena Icczenia skoiloz idiopaf)cznych metoda asvmetrycznejl7lOoili shyzocji tllowia w sciSe symetlyczl7ych pozycjach lV)jscio wych
M aterial i metody Przeprowadono retrospektYlIl7q analizri 136 przypadkeacuteM dzieci (13 chlopcow i 123 dziellshyczqt w wieku 6- 18 lat) z bocznym idiop atycnylll skrYll ieniem krrgoslupa leczonych zachowawczo w Klinice
1
Ortopedla TliJumatoogia RehlblllagraveeJa ARTYKUL POOL1 DOWY OPINION ARTICLE Vol 7 Nf 1 2005 49-$11
Krystyna Dobosiewicz Jacek Durmala Tomasz KotwickP
Katedra i Klinika Rehabilitacji SIAM Katowice 2 Katedra i Klinika Orlopedii Dziecircej AM Pozncrlz
Biodynamiczna metoda tr6jplaszczyznowej korekcji skolioz idiopatycznych - opis metody Biodynamic method for 3-D correction of idiopathie
scoliosis a description ofthe method
SIOWQ kluczowe leezenie zachowawcze skoliozy idiopatyczne korekeja tr6jplaszczyznowa Key words conservative treament idiopathie scoliosis 3-D correction
SUMMARY
The biodynamic method of hree-dfmensional carreeion of idiopathie scoliosis is based on Ihe palhomeshychanics of idiopathie scolioiiiii and consiss in aClive segmental three-dimensional correction ofspinal cllrshyvatlre The course of action focuses in the viciniy ofthe apical vertebra Proprioceptive facilitation is applied on Ihe concave side ofthe curvaJure and exteroceplivefacilitation on the convex side Correction likewise proshyprio- or exteroceplive facilitation is phase-oclœd with asymmetric respirarory movemenr as weil as wilh parshyticular phases of the respiratory cycle ln Ihe course ofexercises three-planar movement is generated opposite to the direction in which scoliosis Is progressing This method is in accordance with the stale ofthe art ofscoshyIiasis pathomechanics The method requires detaied training and can Ihen con be applied at home under periodic control by a physician and a physiolherapist The method con be applied in landem with a Cheneau brace as weil as in surgical pretreatment A elaUed description of Ihe method of three-dimensional scoliosis trealment will be presented in Ihis article
STRESZCZENIE
ISlofa biadynamicznej mefody Ir6jplaszczyznowej korekcji skoioz idiopatycmych oparlaj est na patomechashynice iikolioz idiopatycznych - poega ana na czynnej segmentanlej tr6jplaszczymowej korekcji skrzywienia Dzialanie koncentruj e siccedil w pobitu Icrllgll szczytowego sknywienia Stosowane iest bodicowanie propiocepshytywne po stronie wklllsej oraz eksteroceptywne po stronie wypuldej Korekcja i slosowanie bodicocircw propioshyi eksteroceprywnych zsynchronizowane j esl z asymetrycznym torem oddechowym oraz z poszczeg61nymi fazashymi oddechu W trakcie eacutewiczen powstaje odwrotny do lrierurzku rozwoju scoliozy tr6jplaszczyznowy ruch IcrFtshygoslupa Melodajesl zgodna z aktualnym stanem wiedzy na lemat patomechanizmu scoiozy nymaga szczegocircshy100-lego instniktaZu po clorym mote byeacute wykonywana w warunkach domowych Z olcresowq kontrolq przez leshycana i fizj oterapeutll Metoda mote byeacute stosowana r6wnolegle z leczeniem gorsetem korekcyjnym Cheneau a talcte w przygotowaniu do leczenia operacyjnego slcolioz W pracy przedslawiony zostal szczeg6owy apis meshytody leczenia
Skoliozy idlopatyczne stanowili znieksztalcenia patycznej rozwija siccedil poprzez przemieszczenie kr~gu tr6j~aszczyznowe charakteryzujltce siccedil wyboczeshy szczytowego w stosunku do krccedilgu g6mego j dolnego niem rotacjltt krccedilg6w klatki piersiowej i miednicy z r6wnoczesolljego rotacjl zgodnie z ruchem wskashyoraz zmianami w fizjologicznych krzywiznach kr~ z6wek zegara dia skrzywienia prawostronnego oraz goslupa w plaszczyinie slrzalkoweJ [ 123] przeciwnie do wskaz6wek zegara dIa skrzywienia leshy
Z punklu widz nia patomechaniki tr6jplaszczyshy wostronnego Koncepcja rozwoju skoliozy jako rotashyznowe znieksztalcenie krccedilgoslupa w skoliozie idio- cja i kontrotacja sugeruje ze sily korekcyjne powinshy
49
EDUCATION MEETING SATURDAY 8th of APRIL 2006
- CARDJOPULMONARY EXERCIS E
TEST IN GIRLS WITH
CONSERVA TIVEL Y TREA TED
IDIOPATHIC SCOLIOSIS
Jacek DURMALA Krystyna DOBOSIEWICZ
Department of Rehabilitation Medical University of Silesia
Katowice Poland jdurmalaqcmpl
The aim of the study was
to estimate the influence the conservative treatment (asymmetric mobilization of the trunk by Dobosiewicz) on physical efficiency in the group of girls with idiopathie scoliosis
Material
bull 87 girls with idiopathie scoliosis
aged 1 0-17 years
(mean age 135 years SO 161)
J Durmala K Dobosiewicz 1
EDUCATION MEETING SATURDAY8thof APRIL 2006
Material
bull 38 girls (437) with double major scol iosis (thoracic segment - Cobb angle 18-42deg mean 30deg SO 82 angle of axial rotation 4-32deg mean 21 deg SD 107 lumbar segment - Cobb angle 11 shy48deg mean 31deg SO 128 angle of axial rotation 5shy30deg mean 13deg SO 85)
bull 49 girls (563) with single scoliosis (Cobb angle 11-75deg mean 33deg SO 155 angle of axial rotat ion 5-30deg mean 14deg SD 83)
TIoracic kyphosis of the invesllgated group was 5-39deg mean 23deg SO 86 and lumbar lordosis 16-41middot mean 30 50 65)
Material
bull The 64 girls aged 10-17 years (m ean age 131
years SD 132) were conservat ively Ireated
using Dobosiewiczs method
bull Treatment period ranged from 5 months 10 3
years (mean 148 months SD 902)
Material The 23 girls aged 10-17 years (mean age 136 years SO 108) were treated u sing symmetric exercises - treatment period ranged from 4 months to 3 years (mean 161 months SO 1019)
bull 26 of ail g irls (18 girls earlier treated using Dobosiewiczs m ethod and 8 gi rls earlier treated using symmetric exercises) aged 10-17 years (mean age 134 years SO 108) were twice tested - at first and last day of Intensive hospital rehabilitation (asymmetnc mobllization of the trunk by Oobosiewicz) - mean hospitalization period 20 days (range 18-26 days)
i rf~8f6~~ or~~n~= ~~r~1~r~icircJ~~tb~~~~ mean 17-4 1deg meatl~(I SO 74 R n~le ofax 1 rotatIon 5-25ot mC3 111 3laquo S0 6icircl Ilnd 1 99t1S~ ~~~~I~~~~~$ruo~ras~ ~ocirc~~a~e~~~~~~~5euml1 9middotn~ tUfllbar Iord05ts 16-4 1deg mean 311 SO 68)
J Durmala K Dobosiewicz 2
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Material
The control group consisted of 77 healthy
girls aged 6-17 years (mean age 12
years SD 31)
Material
The examined girls participated in school
only in scheduled physical education
lessons and have not been enrolled in
other sporting activity
METHOD
The exercise cycle
ergometer test was
performed
J Durmala K Dobosiewicz 3
EDUCATION MEETING SATURDAY 8th of APRIL 2006
METHOD
The Incrementai exercise test has been applied
We have found that tests ln whlch the Incrementai part of the protocol ln completed between 8 -12 minutes duration glve the
bullhighest maximum VOz in normal subjects
METHOD
The workload was Increased stepwlse
bull by 10 Watt every minute - ln chlldren
with high ~ 135 cm
bull by 15 Watt every minute ln chlldren
with high gt 135 cm
METHOD
The test had been contlnued untll refusai of the patient or exceeding the pulse Ilmit
Durlng the exerclse the gas exchange parameters were recorded by Jaeger device model Oxycon Alfa uslng direct breath-byshybreath rnethod (with face mask)
J Durmala K Dobosewlcz 4
EDUCATION MEETING SATURDAY 8th of APRIL 2006
METHOD ~ ~~ r 3 min 3 min 8 - 12 min 6 min -~
_ 0 rpiYJ 0 rpm 60 rpm ~1 30 rpm
_ t o~w=att~o~~na ~~ att__~ tl~~S~~ l ad l ~~~~~r o~w= Hlcremenlal t
pedaillog i i ~
~ ilt ~I~-----tl-~ I t ~ i ~ lOSt sffortivB
lW r resututlon r rm-u middot 1 - bullA~cremen tal ~~ ~ ~ ifr- ~ VtI 1 ~i ~ tllng _
METHOD
On the basis of recorded parameters VAT
has been individually computed for each
child using V-slope method by
Wasserman
METHOD
For assesment of physical capacity
the maximal minute oxygen o
consumption (V02max) ventilatory
anaerobic threshold (VAT) and
maximal workload was used
J Durmala K Dobosiewicz 5
EDUCATION MEETING SATURDAY 8thof APRIL 2006
RESULTS
Ali girls with 18 have been classified
within normal range of predicted
values of
bull maximal minute oxygen uptake
bull VAT and
bull maximal workload
RESULTS
The differences between group of girls
treated using Dobosiewicz s method and
group of girl s treated using symmetric
exercises were statistically significant
Lower exercise efficiency of girls treated
using sym metric exercises has been
observed
RESULTS Girls wilh IS Irealed using
N=87 p value
Dobosiewlczs method N64
symmetJic oxor-ci Nz23
Perœnlage of predicled vaJue of
maximal minute oxygen uptake
98 905 0033
Percenlage of predicled value of
VAT 97 933 0049
Percenlage 01 predided value ni
maximal workload 101 939 0038
J Durmala K Dobosiewicz 6
EDUCATION MEETING SATURDAY8th of APRIL 2006
RESULTS 26 girl s twice tested - at fi rst and last day of intensive hospital rehabilitation
The value of ventilatory anaerobic threshold increased during intensive hospital rehabilitation (asymmetric mobilization of the trunk by Oobosiewicz) statistically significantly (p=00019)
2047 ml O2 minkg (SO 268)
vs 2239 ml O2 minkg (SO 232)
Conclusions
1 The exerc ise eff iciency of girls with IS treated by asymmetric exerc ises of Oobosiewicz is norm al
2 Such high level of the exercise efficiency of thIcircs group resulted fram using of Oobosiewiczs method
r
J Durmala K Dobosiewicz 7
REVIEWS
Role of physical exercise in tbe treattnent of mild idiopathie adolescent scoliosis
Revicw of th- literature
A NECRlNl N VElWNL s PARZI 1 A NEGRINJ 5 NEClU NI
P1t~silillxlrd~ Ihcrapy (or klucgtlttlwrlpyl i pro shy-tJm of physka] cXlrd-cs ipcci I(a~ (IJcloJgtcd hy l li trIWlltl phrslollwrapbt wilh tb m~ln a1mor pl shyVCnI in lhe ilAAfIVltilH1 llf the ucirccfonuity III mild IgtC )
Lil1Si bclpin~ thebm ( aocl co uaufllclilIg ils ~jd- clf IS in nlOdlJmiddotnh-culiosis Th middotalillofthi paper ito r (W
Ille Ii lc ram r 1 a-ccrulin wh kh of Ih bull Lu[Jalmlcrus Ind (Lb hili til~ CLlLt-cd br scnli()si- clluld bl pl Y nlcd or r d uccd hl phylolld LXtmiddotrdsi n Il p--to-da le knowl Uuml~l nr tIll~C aspcc[~ i ne bulled in oruer 10 dndc whclh~r 11Rf blLl adcqlmtt Ib(uuml n middotlicaJ balis fo r ora)aini l Ihe US4~ of lUgravellgtitlerap) wltcllj(r or fln l th e prtl1iœ of kimiddot ~lre IUlll poNjn~ a t iil ies ~bould h allowtcI II uuml middot c enliaI toltlentlf)wh k lu alClor ie - lf pl lr~kiJl -c rmiddot d gtlt- (Ic rnnhi UzJ( inn ni (t hl HrJltlon [ rtn~hcll iJl ~ or 1i1J(IChIumlJlJt etc) Sh llU Ld be TolullllCcluse ulemiddot l onld b- clclIimcntalancl wukh sho ll ld he IJlI-n~ifl~d I~~a l lhc (o uld h 11lfu 1 Know k dg CJnc1in t (wIn SeiCIImiddot Hlk rCS([lflt h daw ccordinll to Ih bull llVit w o f tIlt iii 111 1( plop(lsltd in (h i papcr lmiddotonllmJ l lnl plLyi 11 cxcr(j$( pn (nti or (tmiddotduce dhlblli t ic 1 ~lt Il Jj ll(k pl ti Jlt fadl j w(~ the nlIIIrl li7alinn n f poMural dd shylitS tu p n xJ llc aSl COIlMqnen c(middot 1 all )llal) or r(tn~ shys i middot middotlIrve Tilt u~c (I f appn1priattmiddot kincsiuuml wrlpy 0 in rcns polttllcal swhiIHy Icirc IIHmiddotorc Illta ll y (0 r 1(lt1 lllho UAh mon ltlccurlltc 1Ut dl1alkd -rLk l(lWfils 111111 )11 h Jlccdt(
11) wurcJlt 0 lit)-IcircS (Iumpy - x rcLs P()lun
n rllt lT(ltnklf u f COll1tlK H (rtd) I 1i plfho l og l ~$I rUlglng tr m low tmiddot k Pl 1l1 to IdiOpath ie SCUIshy
Submitt(oJ [or PUhltCl l1 011 uly Tt 2001 Acc~pttJ ugu - ~2 1(t-1l
Addre rltj-xlfll telt~I(middotb If) - grinl Flt(1(bziurllt r )(m Ofl ()(Cl1I shy Lt middotqlltœlll ro () - 1u I4t agravehLIlKil ta IYIL-lTt ilSllltp lfllmiddot ~ 1l1uumldull
CelII ~ (niiOS I I~ middot ann (1) IfUh middot lIlfU di louhilll(tymi ( Nlmiddot ~iI rli -ilIIUmiddotltlfl
Nlti(ir 1( ) il r() (ltbullagt1
lt vLL_ l IiII no 1ftfI
jS ) we are a IUil ly tJc ing n1n) ltblll lS 1 k l1 b ~J)w in~ tl~ t S Jfll l approad llt - l1n til hy on ielshyertd ~tan lard ugraveJuld ln m any ~1~ he lI ~t les i if Ilot dange r )ll lt rhlS is lrut of reil l lnw 1gtlt1lt1 pa in l ~ or 5urgi c ll lrea lmltnl5 in dbc r lmiddot ll Sc - 2
ln tlle cj-e ut ~ t lll(tlWtl i( li p l ll1JC luuml- I ~ middottnl ~() shyliosis phys cal ((_lt1(( is emr1uved ltI t()fIl1 0 lh~rtrv
lo ly in cel1l in L)lllllde (nluumlnlr in tilt Lltlll middotorkl i e Iw l) r llt t Srain hUI IIgt() 111 Gert11lny 5- 1~1 in other reg lOl1 wbere thi I-incl qf tre l tm e rll 1 p~ 1 pmiddot t 1( cI il Jws Ixen cri ri cilld md rel -cltd Lw m~lI1 1 11 Jlu~ Fue Fnlny r ~lrs thio middot15 a lsgt(ru( f ~rth r -~ltc rrJtf))~ ll t vit11 br1Cltcgt b r II1 ([C Llt n ClW grmvlng 1lt1 0 L Sti g
gcsti n the lIsefulnes- u r Ih is form o t treatm n t 1
Hmiddotu]rs have nerged jn El or uf pll y~ iLd eegraverdse eacute 00[ 1 but tlw are nUl yel 11 11 t llu i vIC~11 and r hi ~
f rm of trt ~ltmenr IS stiJ l Ul1 ckf ckhate FfI t Jt 111 il i 11t (eltary td 1I iFy 11umbtr ot
b l sic COI ceP rlJ lf w ill he cIh tt d in t hi pap r
Scollosis
DCijIrI iriolls
ScnUoSlS is Irlircc c1 lme nsIcircltnal (I(gt i l cj on ot tht spinc thar cau C a CU 1 lh lt ca n h e $ t~en ln (1 me1Sshy
ured ultinF Coh) lll ltllCXI o n HI anreu middot p rtc rilt r
EUJlOI -1 lœDICOPHYSlc~ IR
NECRI Nl
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FigJ----jllph ot DlI w l-lkaupegraverel) The agloimvltltinn Or idio r lrhlc 50gt1iflll~ IS rpiJ bel~ en th e- [l0 IH P (l)ltg tnntll lol (JI PUllcmiddotny) mtl 1 ( f( lS-er sigll paiilivltecirc lt Dlt(i I1 11illg r the iti l 1Kgt n n t rll icirclicH a ) 111lt m omal prebulled the mno rche md ociks with lll I)ttlx flal gr Ih pll fl
rlcljoprdphLi 1 hl merl prestIK ~ of this curvt c10es n t autom~l ritllJy indi ate the pn$CI1(t of a defurshyTnitv (SlllKtUrd (Unel
It i~ possible tu clil1e ren tute a struCnlt t CI1tve fruIn a pogt urll 011e by identifyi og the hum]) du ring AdIlns tesr I~OQ looklng tra m beh lnd at the p atient w ho b benchng fUfward il is p -- ible ta d d~ct 1l1 eh ucirc n of o ne liidlt 0 1 the trunk usually n n the (onvex ~ jde ul tbe radiographie CUfve Ugrave1lr C Ul be mlt~I Slred lISin~
BUlln els S o liomere( 1 ~ l This h Uf1lp is du(- lO (Ile pregravegtecircn ~ of vertel ra i rolltion 1c1 Ollt tn tic f~YJ tllre o f the def trrnit tli [ c m be seen and measurc(i v ith Perddolles lb lsLometer on an amero-Ix)iferior radioshygrapb ~2
Seven ry pel cent o f li Ises a re conid 1lt 1tO be idiopa thie 1 bull ia l-nosilt in this CI$C is b exdlls i ~ n as idinpa thlc me-us t11H wc do n()[ know rJw origio of lheacute curvc [n othe] ~Ie$ it b Ix )~i ble ro ide nrify a dieak (bat CHl jusrify the c1etgtnniry slIch a rna lfo rshymar i ns I1(gtufol Ig ic~ l or genlttic cl iscas s Glnclt~r trauma etc )
[dicirc)parhk S(oliosis has been divicled ~(corcling (0
the ~Ie of tlie patient egrave1l the tiJ1ll of d~[ccli n of the condil ion into ti) ur t ypei ln fanUlc jU nik ltldolesshyccnt lnd aduh Til l m n st cnnunon (VPC IS the acloshylescegravenr o licirceacute I1IJctenzec1 hy 1 sud le l1 tggrH3l ion uuml uring the grow tll Spllrt (Hg 1)2
lhile p tu 1l sco liosi i5 Ycry lomnw n thl pre shy~Iknct ra te f r adole ent icuumlop~lthic structural CU IY~S in sch )o chilclren are 18middot20
- 10 Co bb d~grels o r m on l -lil
- 2) ~ohh dtgreclt or mort O 2~j - bull () (obb d gre -s )1 mOfeacute ()ll 2
Clin iltI [ d e isio ns lfl IXlSed 111 an lccu r~He pregshynosi which obt inccl in eJch pa ti nt mainly o n the basi of the nsidu~ll p()tlnllltl l of TH1h and the result s of 1 rh clin 1 1 ~l1d tadiogmpl i exlminashyti(ln12ll c noieq uentlya d inica ] la sifiou io n o f the ing le pHient tn -ome estent co incic1 ing w irh the
D diographic one c l n lw SLlIl1H1arizeci 1 1 folIcJ - mikl lc~ (1)(n 20 C bh de~r es - moderJt l betwlen ln md 15 ohh de~ rtes - StV re 111( gt1lt rh n ~J) )bh (kgf s
On the 1) lsis of [hi - dinic d d a lfic t i n (Vith l1l il el lrb tiOI ~ o f the ir b() und~ri e ) in Itllt l cente rS Of SCOtiO LS ITe ltlllent in the Lltin odcl (i rJ Ital lnmct md PI iJ Ugrave tre tmtnt i s plmmcd a fo lltJw 8l
- mild kineslth e (~1fw ~1Il (1 luok-ou t - Hl demte IJragravecegrave 1111101 c(~r md k i rws ithe lJpy - ~cven surgery
Physical exe rcL~e for S(ol iosis
Defi t tiOl l S
PhyS i 11 nU b lIKrlttp middot (or kines ithcIa Pl) i a p rvgrlill or plt~i Gl l (xeriltecircS ~1ci fi ( llJ y ltk ~ loped
y a -11 [ru ine 1pll yslo ther3pisr wirh th e m 10 Hllll
- pre (~ n tit1g tlc aggraaLion of the cl I )flnily in rnild bullcoUm is
- helping tlk Il ld Ct ~lOd ounter~lCtjng its skie elfects in III de rltegrave sc li sis
Tn tl1i_ feSpec1 kinesitl1ert py f JI s oliosis is tonshysider l a o on of peciticcedil training and s genecirc tltllly proposelt in sessions 0 1 4~ ro 60 minute IW) t) tour limes 1 Cee PhysiGtl exerci es can aLo ll v o ther auumlns 1S it oill he dise Issed in this plper
Ir 15 Ilot possib le to cl escribe a single progrlIT1 o r exerc ise a5 pro nrams ale USLIJUy p fgt nll ized ( ( lt
EUH PA ~illDI (DP1I YS IC~ 182
ROlL UF P l 1YSICAL lXl 1lt 1~E IN l IlE 11 ~l) IEd If IlU) l[)VP 1HI AIJ() J)~Cl~ r COl ~I NlG1W il
f)( 15 egraved ( )Il the nee L- 01 indi iuua l pJl itnts) al l l10ugh Lheacute) C l n h t 11 plicd o n a WOU p hJ~js (-1 (0 () pnients PC[ ~l ()lI r)middot lugrave reQCf lhese 1 10 grl lll frequt ml~ V IIT
hnm on in middotituk w allClthltJmiddot -Ill Jnv L l~egrave at Wc w Ht ~huw in lhis lyl peJ it i~ 111 n u -eII1 tu id e ntilv kirK itheJapturlc aims w hitl l ucircrr~spnd LO ugravelt~lil1 DUtshy
g X ir ur ph -s ici l lxtTi~l I~llhe r thln ln dj( us- indishyiJ u1 1progr-lfll
Aduumll l lxUl kisure time ~lOd h )u] Sp u lllll8 ~Ilttishy
i lt egrave~ i middotomm )Ly s iven lel mJ ing ro w hlf ~ Iuumlnsidshyer~d usdul or il lrmfu l in t1 lt rruning (lI tJw ptliJicirct ln tl1bplper Ugrave1 gent ltl l t rl ll bull p lwsiCUgrave lttG iviUes is rl ktll 10 JllI1ltlCc hOlll gtpOlt mJ kIJ1lsIcircl hc lJ l f
i ve lUen tloneumld )bo C on lv ine n dul( re Ull~ 1t~1 t s far Ilten publislt d f I~ mJ I(i noltgtithltl rgt is 11 11 a su h jel lnI deacutehate CJitk haltlt t llltit m itn ltl of l ny lorm o t p l1 ySiClI lxrcL e as a Itwr1 [ J- fo r i liopa tb il jcoJL~b un iL ()ri gin~ initial1) it WIS Ille r rOmiddotUumlK lt brgdv u f p l~lt titu gtllergt w h ) intervenecl hutll tc llcrl ll (mon as cltl HtilJ nic in terventi n man Jgt
1 t lltrJp utl t one 1 md rC j fkll l~ on rhe h sh lf som uni cOen I1v pn t I1cgts wt ldl hll ltl enl1 JI~ haLl nu na l scicnt lfic baisYmiddot HOlh tlle$( trr t peu shy to rh ~rl py tt nJecI to l~~rJ tte C Ih tk CUf -~ pnnshyclr~tll y as a f tsul t of lilo h llIzatio ll of tn imdqultdy ~u pp rt(d S pln eacute 7~ 12 to re-t1 r rI ltrl 1$ l l1C k o f WH llt~~rdl 10 I ndt~-dll()urnah tnd 11( on1 p~l per u suaJly Cl tc([ IS n prelimmtrf lll d 3 ln tt li w ay man (l rrlKpt(Hc H lf O iS Inll ph ~i C U l ~ d vi ~ cI nllog scnliotl pa t le nL~ 3gainst holll ph lca l egravexershyclc and p()rt~1
It m u st t~ n tfd [hat pllyknl txerc j~ tJe~ltm(nls t1iHer 1 lJ rd il1g r rhe rherlpcu tlC litTl~ on lllc h tJ rgt ap p lolc il l the IXlltent lncl hi im r IIIllHnt i- 1 (1(1 rI - 5lt1J lC igt tIl l ( f phJllIlllolopJ al rrea tmln ls Ihith cllffc r 1lt œQlfd- rhe m C cculc u ~t(l luI thl p al 1t n
~mc l 11i (lbE~e Tt i ~ P ~il k tlwreI[middote thll wuumlk ltlll t kin 1or ph~ i Clt1 1 lX r(j~ 1I 111~ t bc loidvd by t h~ Lo iurie IxujCJ1l al1ulhcr a dl ~IS nJI h~ iOg (1 11shygerols llugJr in racr le (wi ller d I ~fJIII ~ I ml thlls re(nl1l rn ndc(1
fn n UI cel1ll r we In(~ hccf) using 1 ) 1 1111 11 ve ) 1 (J p lw l icd ex(r(i~e (0 J ( 1I l tt i~ tlh aITt ~ l~d Ilv m ikl tru cflumiddott1 adokscltnt (cl ioj arh lC icoli is11 2)
ina the f U~ t rc-gt uJrs IefC pu b lishe - the pJ( )grd m 11lt1lt l1te n PWltllk d in fa c t deel()pnlln l~ in th t l itshy OlL1Ii in tl1 r b t ~() ycal f ha ve iclemi fiecl niO l l
m d 111 ur impl rnHm s md d i s )h ilir i (gt~ lue t idlo p lthk amp()lio -i ~ t Jll CIII he 1UO(l if Icirc 1by phyict1 egrave xert iSlgt l fe t rrncllt
l illl
111e aim of t l1JS r~l per ii tmiddot (tv iew tl1( l iterat urt to a(errl ln v llic ll of th~ impa irm 1t~ and Liit hil it il i GllIltec hy ~ o l i()gtj s -o ull he ll nt x or re middotlu celt1 Ili pl1ysical xerclse An u p-to-da te knOvkdge o f tl lt Lgtpecl-gt i necckC1 in rJeumlr) d -oek
- whetll~r there h ltl n adLtIIl ) l tht()d ical bbh fur or JqIIcirclb l l l1 Il( ) f k irt llit herlpy
- h N I)(1 ( 1 Dm tlle p r l c tIcirc(( o f Jebur tiJne )pOfung lcli v l ti ~ IIOU lci he tllf) -d o
II J U V f h 1 I11~ c~~lb li hed Ihe usefuhlLss 01 k il1 shyc ~thtrpy il i aIle dy l nsi 1([(( -r-tI Llleu i n )I11 plJt~ ut the wJrld ir ilt ecircS~nl i 1 I( id n Iv w l1i li ( 1shy
gories 0 1 pl1Vtl( 1excrClgtegt te D)bilI7it ric 1n (Ir st shylliuumlZltio f) lttlt tlgtbltn ing ni trcrccedilh ing erc) hn Id be
vnlcled he tll rhe nuld be lerrillldll1 1 md whidl s tlQu1d be inreœ jf ic(1 IJeClU~l tlley cOli lel Je LI ~ful
Ncuro1llotor impainncnts
Imv aUl llOr~ 11 lt1lt ~tlKlteJ lhe cltlndatiotl bd Ween tl UC1UmiddotIt t l ol(~C t nt id iopml je -nll ~J~ and cli~l l shyler~ lr 1tH lest ihuLIr yt 1 _ 13 ~ 311 D uhoussct 1
1-- ITS tln l ldiopath k s(o lio-L L cll -c d l J l hmgt in th terl tltr f prop li l l pu n md 1I1ar th e detrshyn Hi n i~ na tural 1 ~ronse to ril e need tu ts tu re p()tun ltlluilib riu Ul HcrmJJ1 31~ 11 () d tllat icliupathic ( liCl5j h l it re5u lt Ot1 rw nltuf mot r l ~ltelV
[Id )fcl 3 nI] ~1ltJ U Sr1lle nr to dtorders in centJtI lO~Cl shyIOIDNur) md 1xi~tI moro (Ul1lfOl syt( llI (Fig _l
N htIll -of) H1c S uumll h( rll1 ( ~ l( w ing JI t11 (oshyI-ie on the l l lO]ugy o b doll (nt Rl iu]icirc tlili- middot()lioL m unt fil t-hltll rhl ugravedcmnilV L th e fl5 ult o f 1 (k btcl 11lIFll llI ion nf som t11(WUgravetltnl md pO~ lur( (tnic l~ l licirc1 tl1lt if l p OgtlbJt b C 1l rlw sta l i lin 0f 11 1 Sf llle j lt g )tx l Tt) ohtil n a ))Cli U 1ILzltl I o f p ~llIr~il d l~flo [ in l1litkd ~J)llnSIS me CI Igt(middotqucnr J ~ a ~tmicirc ()nlly or regle Ie Llive
Ali th- 11yp ) tlw~es rd ~lte tr d irtl Itn t pnl1tlt o f [11 v hole ~piltm It11[ controls postu re ~nd mrw shyment lrre pell ic of tlh po int a d lI~ llv inH llYegraved il i ~ ll 1 nnable tCl aSUilll ri 1l tr l ll1 lo g thi ~ys ttm ( Qu it le 1I middoteli tl
lt ch ugt nlt~(S f rullliIl thil i nlomwtion th at p tlmiddot shyiCil J(tl iIies nw gt Il lInport~n t rr le to pbv [11Icircgt role ca n 1)lt slI i11l1lariztd ln lWO the ptu li ain Llt
- d elopmll1 l of p uumlltl St1 b Hlt ) - c1e veuml IOpm 1)[ o f bhll1ltc _
(k llhUl)lOr S Cll orr
ontrot oic whan-lt
------+ 1 ~ il lnll ugrave r AINnl
Cllnlr1
T bflt~ r
fltL1 tlli
lMini
l
~sary ~J-frlllen i )f
~ 1 ocirctnl
~UcirclllIJJlW Ll
AXl ~l1 n uumll l) r sy 5t ~nl
middoticoltoq ~ Fig 2-AcFgtrdong lU He-mutl 21 il is Fi)5~ ib1e rD prolXgtSlt l -oo ie1 mnd 1 ((if ~ elio egrave middotAhltr~d l)Qdy-p ati~ I I i u d) uren ttllOn k td LO In ~ory reHTt I1 eDi tn l al ) JdrnlV~ pn)4~ e l u r~o(Ofe 0-c1 eptunl dvstil t1 ctlon sltŒ(ry icircltu nu11t ilwnt [ ~mC ~ted tl l1 ce Ill trpntlshyUumlfJJl nd IKnle~ r~dibl jtugrave)n of -I) m tlosen Ir ~ig nj tl (I1vying ln fornll1U n (lI an ereltl ~piJl e Mmor aJJ r--a t ~) n ltgtf ti lt aXljl mowr plem iHUC Wh ~fl Ille 6ubjeco m uumlntl Icircn (1oJifitd perccpfLlI l ~na l ysilt of p n)lnocepti Icircnfu rnlaquol ti desnibJOS ~n t tecr spin A IICW motor co nrro l Ira I gy t adopt resu ltin~ in the ~tr ltctltr 1 ckformh y lf IdiopathirL scollos i=i Ht lrftU1uc nltnt l ISll I1lJy h1e- ~ I pro()und elkn on bralO Sfem flJll ct i(lnn~lLhu modifyRll Ille nltulltgtshytl10 ) 1 1111 Uu l-lHoror control 5~Shnl$ shy
As Srtgn1lt1 l ~ ltlssert~ if wc l C -Cp t 111 1 un o f the G IiC s oliosls L l tisorckr oi th e ltquilibrilltn sys t ~ms it is lagical to oriegravenrate physlCl l exercis( lherap y ln th is d ir(gtCli()[1
11lclte goals Cul tl lfOUgil ditrercn t modes 01 action be Olchic(-c1 witJ1 phykal accivit ie
- po rt ive Cll ities p ro ct LJ e aIl UgravelClltrtsc in 6lte nshyel ll )o rd in~lti n pinai pr0prinup ti_)[J nLi mOVeshyment control 0 vio lls iy ln thh repect ome lCtivshylites aœ pre um~I I)y lXrter tllln ntil crs
- kinrl lira py using pedJil exerCisocirc specially developecl lith th est 1101 5 in mind illVuuml VC I lllore prccilt( ll1d InC1 li zed cri n on rhe spiJw focusing
a90
1 ~~
lg -lNheJo ~1l l1 t r~l g rld in 1 1) h i(~ IImiddot ct r rHienl w i ll idlllhic _It ~i ~ _ iri s plt ~I le II find Jit ltH vlllleuml ~l Cgtbl tn~ ks III d il fef lt p ~ lt ihnS nu v~tl middot B ~a~pt u Il C middotl)Icircd ~(t l l11 C dlfkrCnl middot- hdween slllndi1g Uline nu nllt1Xinul oorrec ri nI t chied Vith Ct (J ) und tfdincJ ne lot es o UIine 1 fo llnVs middotIJfl tfi ni( - ltlrshy
reltiK)n ~ Ikexibiliry st3nucircing - -pirte - f ur~1 1IbjISC ltupin - ltorrcaion - - r~luci()il ll ymiddot For flmpllt in J npK l1 pH k1J il
plt1SSlhlc ln obtai n 10 u1 511ndlt)l [YLo lion yr ln Slt p ille rlOlgt itlugraven om l J ~ in ( gttf(C rigtIl lIex lbuil 15 i (r-l l=22deg pol lltl ~~J IIlpraquo is IcircO~-V- I t1 l nd tucircu(Ugrave) ilil) I~ 3laquoJO- IH-12
r ln Ugravel e abilit jl of tluuml [m e llu to co ntro l irse lr in ~ pac
fuld l oftlles uumlllelve ntio ns can presum1b1r incn~~ Ih enl ac )1 the orller and lHitlll r of Ille rn - 11 )ltd h e lllldenl lu EJ3)4il
Posl1l1-t collapse lnd slabilizariotl
lIle concept u fplt st lUal c(l lJap~e l l~t Iwen detin 61 by DlI II-T3e~tupegrave rL t Ac oJdin)j tu tl1i- ~ll1thor il [ nec(sary ~- l Hn Cv-tlualing th tleihility o f a col shylo tIcircC CUJVL (0 clistingu ih bt tVeen the re du ihil [ty index (th - li iffer gt le bet ~middot Il ~I r~tcli()grJph ie ~xnmshyinltio n of the iI111 pHienr in supine po ition m(i
ROte OF Pl rnmL EŒIlCISE IN THE TREAT-ŒNT OP ~I IJD IDIOPAnnC OOU~GEm seou SIS EltJRINI
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8 =~~=r=middotmiddotmiddotmiddoti~=-middotl--- middotmiddotmiddotshy--------------t----------~- -------- - ------__shy
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il 1~ 0
Dtl-Lmiddot ~ lttj l r~ UIltltlHt
f g 1 -TI1 u ilictf 1ld ( ii 11- ugraveu-sh) ld IX~ O 1d wllich ltJdnrshymII Il nf the pilll 1 ~tln~1 of th e -o lioti( spinc n IG~nI(J II IIIshytt) lhe iJeuml grl-e o f ~ ()Ii ti c (u rvH Il 1 w dcpc-nlknrly o l l he 10 111shy
P01(nl (pntt l ~ 1 1 nr ffll wrJ I) ln w hilth Ihe n i 1gt( ~ duc nL~ grlphs fm I h~lt 111lt hi~hr Iht Col h ~Ilu t (l f Lite ~Ul Ihe m Ol CI il y th t s(uumlJotil middotpin~ ~111 he ~middotJg gr~lVH(~(1
m mJxiTIt corrttt ion wll iJl i~ lIllCd to Ih - xt 1shy
lti Oilil y Jf tl1lt t Ut JO rl1t cdnUc idt md p OS shy
tU ll cul lapse ( th t ltHill enct b-tten l lUdioL) 1lphic egraveltamJl1ltlti OI1 J t th e ~lme pa tient in Sl il tl cling lOJ lline fX-sitiutl ) Wll ic h correb lc- onl wil ll fhe abilt ty of lllt p tu rl l gt s tem to C( lunternct lIk luree o r grl viry )cco d ing rv D lfVd- f3egraveLIprc po st li r t1 lt01shyIlDse is d ue to the Jnus -u lar ton a nd 11ll ex rCrIshy i) i itv of rhe tissus n the ( O IW-) si it (If the (01shyjl ti (~JtVe (Fi~ 3 L Pu~t llr1 C lltpstl lu lcl l ~~ reduc l-lt by llwans o f pl1ysica l cxerCles specitkally s tuclled ruuml i rnprove tIlus--ubr fOHt md lU pr )cllI Ct 1 ~11 hi shy
lizing ffCd
PararcL n tll CIJ cl the cr iti ca l (3 c1 thlsho ld beQ ld Il ich defol1J lHU n of the i pinlt 1 e~ in~ ne dtlllontr~1t _cl (1l ll t grclrf r mg] o f rllt C II in a qa m bng pos ition corn pOil 15 t l lowcr detormashytion lhnsllold (Fig 1) ie to ~11l Ulne3Se t the risk of pr ogr t~ lu n There t rh eJef re l J ea r l)iuuml 1itshycJ l ~ll1 l l(tl a 1 tnr tg ro b ohwined by d -cr t l ~ illg ilmiddot pU~lUrll cull lpse ptJcelJtge w bich lccording t i)
h llTd tnd ~l(heJ1l ~on 1~ b inde cl 1X llt icularly luumlgh Ugravel mllcl c Iio~ i (bdow 2( 0 ) (F ig 5 J
Fin a Il III ch iS respect lllljl hl and b um l 01 m linmiddot
ii iI 1 l _ _~ _ ___I ___ ___ __L ___ _ ___ ___J______ ___ 1 ___
li 1 1 1 1 i 1
1 i ___--____---___----__-_---_~- _ _--_ ___-+----
i
1
i -- ~- -- ---~-----_-~-_-_--_1-~
l ~
i
+----r--------t-------t------f-- J
Fj~ ~-Ac(XjJlin(Q luuml T O rIcd ~lnd Na(h(ln~ n i () dl( pCG w rd (rTIshy
POO ll is hiherin cu rvegt in wh ilt l1lh ~1flILWrd cII1I Olk l1t IS le- pr(v~knt ln th e grtph Ih t PogttJlJ I ugtnq) Ot1 -J1l j elfltS-e J tlt 1l1t obb dirr remc rlLIv obu incu f roll l the Cohb atl( 0 1stlI1dtJ1g IId gtupinc rldo~raf115 Ih Ille lt) [1l1t1 (i lndnl I pine) 511pille the ~(nlClu tJ1 compo l1lnt U rlk CU Y _VeJily I~ ltx p rlt 1 L1v UpUlt (obh Illeturo Ih t si _b Cct rtJeSIm l fie -ltn J trd Ugraveltuuml shyuumlo n A~-i)rding LP 11(lt uuta o n l ( r1I~( in ~I 2JQ sup itlt curvt 1hi C(]l)b ddhccno l l f lO is -J-lultt( thc s ldnd inr tnla Ol1l t lS wi Q) whil 11) 1 1)401 ~llp lne ClHVC If ~ 1Omiddot ( tcl Lhe ttnd trl~ nlca~ I(t I ~ ~I)
tli n ll w l lllE cq lin ti spin h~ i ng mo r ~ Llnt~II) 1 tlun the nOftl111 one n Cll l gr(lk ( (cU ve tl1u n da r u p shy
po rt in o r k r 10 m linrl in tht 1xi11po tuf_ n th ha__i of th egt onideratl lr1S it f(lll() rhJt
ph rH (~Uuml e erd es ulukl h u - ul iiuml tbeacuteY ~U-L lm cl 1l (It-d o pmg p05111 td C Jl1twl lS fuumlrnll~ rly d ccrll1td ln an Ql St if i imr ol1111 t ru t(( - tht m(d in C JI shy
r t t r sture fO Ir -ngthen tlll m u ck-gt of the spint mainl) in (11erl antig r3ilrl tIcirclt l]lli fun ctin ll U hy meU15 dl i )ll1 t trk ~ lhJ cl( -ll tlt C)nlr~lUions ~llld no l IdOshy
1l)llic d YIltll1k lt l jAJ lktic t) I1 ) II 11)t 111 hd posibleacute t lcluuml ee postura l io nrro and stfh ili lllllt IJI
w i thout food T1lw(ull r d I( Lf(11 Ibk t m ucircnuin Ihe c()rf ~ct [ ()S tu re for cl gtu ifKi IH lLl1gth 0f ti l11 ~
This i-l ddl usl a typl 11 dnmnin (tf k inesllh rap) in 11 (lt-11 [[k - p~d fk lnr in lng f u l1a in llllliCk is poss ihle lI sing ctrtain Idncl fJ l (lt) 11111 liun S p Ul in tb is Cl c is ulttful ooly sa I~tr 1~ il Iw lps t1w lxltknt 1 becuJl)t 1gtlt ltlt-I a ClJu~l inred irl ilL ntllru l o~ i cll
and I1lll~lJhl r-keJc LIl [rll-llIn~ middot etlt(wrs JI the int e rmiddot vlnrion
[J ROPA MfJ) I()Wf-I YSJ IR
1
ICR 1 1-1
r
1 shy ~
- shy
11 o-llrfOlhe5l~ o t Ih 1O~(1dity i n h ~ r ~ ll nr pbl1 l of ~ Spl11 in 111011 _llti1Gt l lPt f ltlJUCWJtl ( ~l Ihe Ir t 1 1gt illbll W Ilh LtltrJ1dlion Vln lbe rigronl middotUII~ l(I Dko n12 lIll h lumshydlanie1 1 [ nul 1 M hl whtrc M - gt) lnIUI1g 111laquo111laquo1 1 1 c rtJCshytjC~ f fce d -d Lill l1~ o f enr niI pUll spnmcl1y 1~ 111 mldlll1lt (n the fl1ur t 1 = tor~ of f(ward Ileuuml l = ughtel1lng fmiddotr p 1shynOf stn lClU= Alaquo rdtllg 1raquo Ihl~ - lin hull th l1ltgtllugrave ot tller1l lUr~Jtllrc F the ~pin t -ilh rlu1i tf Ihl 1 1Ibulll n lrlt InltT1 1
rbc prJI 3IJi l1ty d qrlOIJ~ n bull JI t IlJIII Hm lA the v=ltd gtc e lu-ing J 5lnK1ura i ltfnnity
Dioal e ch anicll itllp~lir J11 c nt
Ihrcemiddotdimcllgtional mc-cbal1in of the s pioc
~f Ikmiddot i t i nly l(œ ntly tlHr llk pr-5tnœ or nc ushy1 lnlo tnr impairment in Idiopttlllc s-ol ii IXl tknt liuml J$ heen h i- ll licircghlcJ hy re$eJ rh tll e preit ilegravee h inm b nIcirc Ji d lJutg~ lt hl ~ 1 ng t o n dO Ulll urcel 1 i5 (l lreldv well umlersrood H(j-ev~r nev lbt un h iomcrhankal im l) ion nI h1c rectm ly onk l n tIlt tre and p r~dou in f n rmtinn hou t pl1ykd (~fcl5( in t 11 0 tl1I _ltgt pbne of spact 1115 Im trqlt-u 1rom J i-[) v ing unclcrsrmdlng ot th l lmc -dim nshy~ilnl l l11 ~ hmk f the cO]jO[lC pln( ~2middot ) ) Ve- w ill )iI xnl t l1 d at lcL-orcltng tUl cl sif iol t lOn blsed o n gtolllt lricd h uumlCJ ) p lane
- b() rJzU[1tl ln th i pla n ~ th t 1o rm ll sp ine present no CUlye- w ll ile Uumll(~ ltc U Hic spLnc clevelops one of ir haracterls(Icircc deFo rm tiCs v elt tbrd ln lashytio n vh icl1 pJ()VcA~ theacute hw 11
- lgitltl in th llulJe U l(~ nonmll spIcirclle pl SenL kypl lOSis ~nd l dooi~ in tb lXI1 lhese [(Hu rts Vere m)( til ught [ 0 he relattd tlle scolkJtlc ( lI r Vegrave
- front l in hi pleme tht ncrmal p ine preseuron t no curYegrave whil thl ~11li tic p in ugravetI I ()~ icircl~ charshyad t Ilt I CU1C
Il Jri fJIIt palic
~l+I~na ra 3 r inr lut th l[ ber ll1d a œl1~lU1 degr 1
l f r()la tJo u lllu (lILa r forcKl ltxert ltJn tl ldefnmuumlng 1 tkllJ [J i1u a re- lhlt tll cly 11 [1 1 UI b y Olm ner w bn ~lh uiJwd tl egrave ro t1tic) l1 Ilm it ti lt p ica] lf shy
rhrl r() be (P (the Uma bevond Wl1iltJl th lCOJlb of [11( ~pmaJ musd ~ dthc COnCIt and nm ex ~l le btconk (t O li~[)
r ~l 18 ~1Il N lu t( ren i9 lun lu ted rlseurlt h in tlt ) tilt lULodeumlformipg1 tlo n ot tIH_ sc laquoJrle rh ox ercallkren lk 1l1~H li d11r once thl Il i ~ r tld1t5 [he lhrth ld f 111 JlIcirc lIi of tlle dnrlclc hurnp tlk
lI bslt Il l nt rlet()rlll lIcircon 01 the it l ()I~ C ( (ylm der (- sustalnecl by an H1tmi cforming aCOOIl
J1Ji h V hl rhyiical f~ f Ise CI 01 h spr n llnd kin middot ith ccedilrapJ my lX damlg ing vll e n l pplild as flle
igt Jk Iller ln SCC1IJ ~IS lllc lJ fxceed l auto in middot crca~ i n g lhrllgthuld [1 sh (~u Id ahn be j ofed that Ilw relscd pre sun 1l1111i insiugrave l fe pil1r inn) 1 mlshylt
- j Il- ( w atff 1 (nh ~1l 1(e Il10 utoldrml ng li1eCh~lI1 1sm
in flc l Geyer ~w tcd th1 t rm m 1 hI l)1ecircch1O lla1 puilll 0 l I C~ sw m mim t Ieuroamp no purpo t for cu lshyim le pllilt t1 s (weumlO middott r it is l~Jl(gtWl1 rhn in iculio r[ paULnl -iJl11T1ill~ doe_gt nor Il ~lp to i ncrt~SL n eur(1shym tor co mfU
(1irai p an (
Jerdnn lle 11 showecl thal ill CSl~ o f t10rLC IC 1i lUgrave
tllo lacolulllhil it lio_1 tlle cte tI llmiry in (he lg itt1 p lln t rn lnlftot il~ lf tspe iuUy in tlw initi 11 r luleuml )f cV IU[Icircon nf Ile ~oli ls W iU l 1 p(t)gr~s~ivlt il10middot~ shy
ment roward hvpok pho b G ll f ill~l Im lins l har dUflng (IN eWllLlfiu1 of 11Imh] co luumlgt i the l in t ot t l H~ gClyty Cegraven te l - 0 1 v llebed lxxli 5 r ro ject 1 seH fl r t side-ys and tlwn backlrcl bull thu~ p(0(1 lj n g a kyphQtlmg aet Il ln (h~ lu mhnr --PIl1 COftj tng
l l i tc Iugrave l lltl l( l rs1 tif s L -etllgt il l the lgirl11
1 Hl)
Ilu LE nI rIIY~Ic~L lXIlKISI 1 HI E TREhTMEtn OP JIU IDIOP llII C AD O USCUH O Ll Œl15 NEGR II
lLill tegt lre lenl1 ~I d ~fo rll1J[ ~ rhl recrSes the phyltiologiGII cmns of lh vine)
Accordlng () Dicion ~2 1 rtcluctio fl in the itgitttl CUIYtS combin l vi th a lueral Iviari n llltl ds t 1
mecban ism () ugravel~ta il ity in l he r rat r IllI1e which bVOf1i the unsd a nd i ncrea~e 0 1 co hlt1is (Fig 6 hiIf md Pl11jlbiJ Jl1eanwlt ile lt(udiecl lh e srnl ru t
orzyglpophySLs show ing t11 al ttleir 1I1tl rnic tl orienshytation f~I (jLi l~ltes aXIal ve rtegravebJl l rotllio ll in cun litluns lt f dorsal hypokrrhn Icirc tnd lum)H de i L lo IS
Tll t dat SLlgge 1 th t impOrfill ut pOitu res and l1lweil1 ) t Mudied in ord t r (CI mlIuml ntrlin or to reuwer fll e p llyslo lo~lCll ClIlye in lIe SlgJtta p lU)l Wlth the llm o t ch ~ kin~ rutltor in l~ bili ry7 AbC th ~e ~k-
1l11nL ~Irt del lnt [0 J jUc lt ftber l]kuti inrervenl ion vhich 1c)LJ k l IV - i(l ~ l compktl n l ililll on Il t c1 l shy-jel1 J11UVllT1ent IJ j o f 1uto-dOneacute(3tlon ( i e a -impk ld ion ) Iengtheni ng o f the pilleacute 011 a litlltl l aXl~ tll lt ((IT liJlI~rcdu e~ t lle ~---lJ linti- l lte ml-fkxj(l n h UI 11 - i llCrl I~t the plllH ](JgicJI dlt cr ~l S ( (1 k-yvllCiSh lIld O(ltOSh l o r c lch r1Iif n t a Ilew til(~ecirc dUuml llt Ilshy
si lflltl J ll1 u(~nlent iam ecl - 1l1t0- lIrfe rionmiddot7 4 llmshyp oed f Je-rura l iUIl cl middot-t1e- iltm lI1d ll1a intltnUlLe )( 5lg it d C Uf (gtS slig lll thltJrc i ypI1 tiZ) tIcircOI1 a nd lunugrave)ar 1()fdos i7~llion) sholild he esw b lb]HU 00 lb co
hl b oi hi p~l11il uU r -1Ir vlt Abo 111( e IlltUtl Chl lie o f purti n - a U vitk slJ1ultI h e )tuumlll ecl 1)] (1 n ldershy](ion r tl1i lt type for e upIe IilJ llyl)T S of repd shyiti( ml vemen prt n t in agonistK h)lnllltlSlks nI iIle kind f dlJ1ce C( uld he ([([r imentd
FmiddotO lllaljlallC and mobili ty of the SpIcircIlC
1 rd llo U 22 d L lm nrrare d lhlt in Illt fro nt a l pll ne
tilt 1 nge Clt 1)1lt vtment of tht scplit[i middot CU IY grcmr lIJ l il ~ d irectio n n f Lhe C ITelt tlO n tha n in tl le di re shyLion of pmgressi n l Fig 7 ) he IL o IS5err lJd tbat th15 mohiliry increac plrtil u la rly n apic [ cgcoeilts 1$ lh ~ ~c() li osb evolves Sragrm rJ 12 J ~ thus rigilt (0
VlI f n rller~p is ts Ilo t t) m o b uumliz - a sCtJl iu til curve w ilhout t [ uling ttwt tlle R lu tiOI o i til t ~a mt b fnlinruumln( 1hy l1tans o f ~I passic 01 1 rivE -uppnrt On tilt (ltllE r hand UgraveK d e iJlioJ1 in ease durill tlw tune 111 whicll tll C spmt i ~ not submjtrcd to correeshy( IV anl()n
j- Virh mi lei ol i b tlllt Upp i1n ill) lC tiol is d eveloped only lllmugil llClIf()mu$Cllbr f r llce thi ~
InegravelIl ~ thclcfo re tl1l[ inu eascgtt sp1J1all1extl)iity mua
11
Imiddotiumltgt 7-rurd illt Ir) 1 bull rdrilt I1 1 in tl lt frOlllll pbnlt- th( illl ge )r mOC llIeJlI o t the S-o UIIJC CUNe 1 supcrior in Ihlt diflt(l im ugrave( the n nKlIl thd n ll1 tllc dlrtcLion o f p rJ1(l( (llIl
be considrCtJ vntrl iJ)(l icltion and 1 undrli neocirc ab L a ~ubiljz~ILion 01 tilt spint pllss il)1y ohtl ll1td thrltJugll the stlengtlkl11ng o f the 1rltJgm vlt nonil lme shyCIC 111 illli orrant u bjcLliH- ln rhis r~f1 n sp u lllni lc tivitIumlLs sil uld lX tPI 10 dlegraveltl it l G lU t n w l1ik luring kine i Icircth lrr phyltical eXegraverci c~ tllat in ele
spinal m ot ilIcirclY sil nid 1e lt1 oid cdrt ~
Organ ie and psychologieal impainncuts and li islbi IiI le
A cgtI im lc pmi nr is moriOthl11 just 1 sp in and 1
compkt gt Ipp rnach to the gu in ad 1 ont i al~ shylute l e~se i t i11
[)a la 0 11[ [n ell lrom re semh pw tbat ome organi Iilnctiond cl fki ts suc]) as tlw clecrtiUe ut vild l tnd d fun ll l)Kity_orld ldly incrtJ k whil~ 0 shy[io s i -till in (1 miel q g of g JltlV ity ~ l ilI e 55 rtI lit
tllL pres e n ce )fl defidt Or Vi l~il Clp~1 - i~ ln one pIIiem in Ihr l ftectecl by 20 ICl 40 scoi stgt l ls~a r(h cunclutecl in tbe UA by Di Ruce- prod uegraveed an aaalo) u ll1lXimum 102 re u t in a group of Jd shyk 1ien t [(h sco llosls rang inF frum ) [0 1
Al10ther rudv bv rallt r m C chr111 lilcl NashycWrl1s( u 57 stlO eltt hil $(C 1 1 ui~ Ica js l( lllt cl (1 shy1prUlllI o f t1tgl lie bJd l imI in ~ul sct t1 t ltu b middot iects jlLltr l5 they are golng through ~I cltlici[e sllge in the fnm 1lt i n 01 tlWH o w n id uHitv t factor hit h Illy jeopmlize the cl velopme lit d ~ mIll lt lI1d htIshym cecl IWI sonalitr in Klulrhood
n RUI ~IEDl(( Ptl Y1-
ROU ltHmiddot PI [ I C~ 1 EXIRCIS]~ IN TI Il nW~JUNT OF SlllO lDIOP1HIC AI)C~ESΠ11 C(gt1[Oi 1S
This i why b IiCieacute ii is ~n imporrlIl t for p rcshyvegraveml e 1tLsr l tn en ou flge 1ari e nrs ~lfrecr(d by lIillcl middotu iosis ft) tlke p~l rt in portin -re rcatioluJ acrivitits Iha t 1eIU 10 L10 th r~1chophyinLl bull nd b~l )i 1l1o tur adlieem t n li 51Jmiddot2Even tlK)ugli [Dr bic mech~lnshy
ical mcl nellIUll10t 11 11 reltl ~ons lt r111 1gtomcrimes be l lefu l to ugg( ~t ne p rt in~ aCt iv ity r l h (gtr rll n anotlJer e th ink Ibal an exces~ ive IlHd icalizltion - Icirce l ll1posilion br plry~ilt i HlS nnejlor parents uf rh ry pe of po rt to lx p m lice 1 b Ule p 1Ucirc(Il L th1[ preshydLl ck l1 is fret clOice in lh ma tt r - -h II ll1 he avolc1ed wb 11 possLhle mainly for tlle i mport~ltll psyshyLb ) jogka l fe a SI)nS W( ha( ill ~ t nltntionegraved
Conclu ion
lbh ISsertegrave d t1H physkal tgtXtlci o is ) n fi ial whlIl practinu in order 10 ilnj rove the I11 llde
rœ nwh and tono C iral caplCiry and postu re o f the StOUO(I ~lIbj n II I nowkdge om ~ middotmg trom ci el1shyrlfi rls(~ Jrc li dJlJ accordl ng r the review 01 thE litshytirlture prnpo )td in t lli plpl r conflrm~ Ihe vuiclit ot th e -t ls ~rti ()ns
In l do l (ent Id iopl1il iC scoliuse il l n phee u i cl vk)pm e n t ( li tll iumlKh eXCC cl l g i en rhk thr hokl th e re i5 an und ubred need fn r l pprnpri 1tegrave (JJ1tOkJJe ~Ild Inr surgict1 therapics ill ortler 1) S l i p
the ( - Iuli on anugrave )JT~t~t UW ~pilll l dtlormities bull evshyerthtless in the illiti ~ll pl l~sC t ttlC c1iseLltc whcn the riS( r1 r euro )luli m is rtduced ocirc ~md tfle uifleal JOld threshold il ~ld flle po stural collai i reJcenw~ 43
JI l1 igh pllysicaJ egravexe rc ise - p revenc or r d llCe d i ~lh ilir ies o f [Iw ~ l() li )tic
p (iems R 28 J -6 5- 6 1 63
- f~KiHtare lh ( n utr ali711iCUl of postu m l d elicits tn produCel1 a coneql l nce J [)ti 0 I111)( or regre si -u lmiddotc 5middot Il 1 17 ~ M
-re 51udles U ~ n Ledecl tu con[mn or re jecr these conClLL i( 1 w l1 ich clerin-d frum 1l1 lIldytica l rcltw n f th e liter~iture appear r- ~Lo nlble Hnwecr Intil ne re ull are 31Iable wc should n r prevent our sroliotic patientmiddot trom tl ki ll p lt in s(loI1ing jshy
ir its pW1iada rly ltl t ~d1()o t () n til t c ntrHY -vith the l xcclrinn 01 gt[1 )11lt tIlat in rea-e t)1obility (tnU evc n thell oilly wh n progr~lgtion b p OSSibl) -uc h ~I( ucircvshyiUe -11 )ulu hl tIKoll w g ed The 11 S J ( rprOpriue kin (~irhe r~l Piuml to incr _~asc p()~tura l $llbil i ty is tl1egraveoretshyic tlly CiJUClt alttloughl more ~Iccu rtte aod deLli led ri k benefi rs anJlr~ is is netot1ed
Ria 1111tO
NIokl Mu d lle ftitYljJfu Jœl il 4IWr10UOifll S (JIvs i (1~1)Jshylidl ttno( cclIll le 11(11(1lt1 RCI fu lle ((lia LltfIt l1 I1I1i(i
LJ ci n s j(r3 pigt egrave li n IHUgru lkl di t rdz t fi sici pe e ft shytUlKm iluppno di un lisimerap15Ll rl lllcflt() 1 110 scopo di pnevirlt () fr en~lI 1-lgpwlllltnlcgt dclld lclonnitugrave o e il 5LOshy
Il i mi llon lt fH nugrave j (1 11ni dei co~e 1 lteIl I1J J nd ne ~Ii eifclti (()Tc rri udk s co lio si d i m e dia g rt iuuml ln que~ltlt
s rud i 30 llizzb mo i d ti cleU ric lca pel n ri Icare qJJ l lm 1 dis(imucirc x u le I[~ l z j-m i pro vna le da lla C gtl k A i json ere pr middote-nute () rk kl ducirc un~l rdeguCltl d nil cra pi lt di uJoseguerrnt Cjua li 1iU110 cli nbie tti 1 rcr lJ)tIId d~ fle)-UITC
n (- -fd7Io n~lcl)
Ut11claquo)si 1 lI tori htpnuuml )ludi-ttn I ~ cnntI1zttu fr Cq(in i idiJ)tic1 dbfl lOZ10l1 d d ~ leOla nelllOll1otoriO Lb un1I1cnUl 1n1l1i3 dcgli 111 lt1i ch DIJgt gtU l H crmU1 Nlch~mslt ( SIshygnaJ~l lerimiddot wo i esuemi -bletti d~ plt~e8lugraver- ne l pClZ le1lftgt scoliodcu kl s iluppo ddl ~ ~ uhjlil~ vertcbral~ lt o svilllp prJ Jdle JIl7 i() nl di ltCjuiljbrio Dng li studi sul lto lb( l~nlrale (OllddU i in pa rticdu d 1 DlIal-BeHJ (gtegraverl ~ P~II IId lI1 n~ llw - idente il v- m gtiu p eT il puientc clioti elgt di u n rnigb o t c)[ ro Ua sw mle dei radlldc onsegull o tramite il 11 fforzrlshyfl len to d e i l1luotoucirc l nllgr3ilri d e luOwo con crcbi ~Clltdr
in pOMltHJ corrctl e in va rie ~i[Jzioni s t llicb c c d inamIcirc tllt Dalle on sena d elb blOffiCcclIlicd tr idimlt n s io mlle d ei
r ~ chi Je ~oU()f icn ~Icirc ~videnuumll (l() ~llt tC p IYZIcircOSI ln(IiClZlfHicircl ~ 1I1shy
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EUROP MIDI C Pli hIC
EDUCATIONMEETING SATURDAY 8thof APRIL 2006
(iSS
SEAS02 Scientific
Exercises Approach to Scoliosis
version 2002
G
S Negrini 1
EDUCATION MEETING SATURDAY8th of APRIL 2006
Neuromotor disfunctions
Neuromuscular disfunctions
11 Postural collapse
Postural collapse
Duval-Beaupegravere
Flexibility of scoliotic curve
f---I--- I Postural element
-------1 Structural element
S Negrini 2
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Postural collapse
Duval-Beaupegravere
It is a value related to muscular tone and to flexibil ity of convex side tissues
Post ural collapse
Bunch e Patwardhan
Critical load
Load threshold beyond wh ich a spine begins buckling
JI~~Wt1lW~flfthtlJlœJtAr ~ J~It- l~l - IMS
Postu ral collapse
Bunch e Patwardhan
If a curve reduces there is an increase of the deformation threshold
~~~NW~-damaoc~IIIMf ~~ J~Iv JaJ-I7I9sect
S Negrini 3
EDUCATION MEETING SATURDAY 8th of APRIL2006
Postural collapse
Torrel e Nachemson ~
Scolioses below 20deg ~ ~ lt~
have a high ~ ~ percentage of ~ ~
~postural collapse (on u~
average 75) ~~ 2i~
CU~VE O EG~EE S WHllE SUPlti e
~laquotd~c6b ____lPffI1wtt1t~
$ww J(t ~~7 JM5
Postural collapse
Minor scolioses 7
Antigravity musc es strengthening D
Reduces postural collapse -G
Increases the critical threshold of deformation
G
Neuromotor disfunetions
Stagnara
If we admit that one of the causes of idiopathie scoliosis is a disfunction in balance systems it is logical to orientate physical exercises toward this direction
s Negrini 4
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Neuromotor disfunctions
Dubousset
Idiopathie seoliosis results fram alterations in praprioeeption centres and deformation is a natural compensation to restore postural balance
etattJtitIK ypothfQj~S ___~ own_ oJ)HQr lar 1t-1( r
Neuromotor disfunctions
Nachemson Initial idiopathie scoliosis
+ Goood spine stability
Neutralization of postural deficits
D Static curve
Neuromotor disfunctions
Therapeutic aims
c) Development of spine stability
C) Development of balance reactions
G
S Negrini 5
EDUCATION MEETING SATURDAY 8thof APRIL 2006
Biomechanical disfunctions
j Horizontal r-Ian
i Sagi ttal plan
Frontal plan
Frontal plan
q Frontal plan disfunetions
Fronta l plan
Perdriolle Movement magnitude
gt in the direction of lt in the direction of correction progression
S Negrini 6
EDUCATION MEETING SATURDAY8th of APRIL 2006
Frontal plan
Stagnara
Never mobilize a scoliotic curve without ensuring reduction maintenance over time otherwise a greater mobility favours scoliosis progression
Frontal plan
Ducongeacute~ research
On a group of adolescent idiopathie scolioses treated with
Meacuteziegraveres gymnastics
D After 1 year the mean angle of
curves increased from 18deg to 29deg
Frontal plan
Scoliosis without brace
D Greater spine
flexibility D-
Risk of progression
S Negrini 7
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Frontal plan
Mobilization is useful
D In preparation to
brace
D With brace
Sagittal plan
QSagittal plan disfunctions
Sagittal plan r middot _J o
Perdriolle scouos B CJ aDeformation of D
thoracic and thoraco-Iumbar curves evolves in extension
S Negrini 8
EDUCATION MEETING SATURDAY8th of APRIL 2006
Sagittal plan
Graf
The line of gravity centres in the vertebral bodies o s c oUOSt
projects itself firstly laterally and then fi
o
posteriorly lJ ~~ ~~ ~ ~~-_J-D ~nI~
Sagittal plan
Therapeutic a ims
D Maintain or
retrieve physiological curves on the sagittal plan
Horizontal plan
QHorizontal plan disfunctions
S Negnni 9
EDUCATION MEETINGSATURDAY 8th of APRIL 2006
Horizontal plan
Stagnara The forces applied ta the spi ne act in a autoshydeforming sense
Horizontal plan
Dimnet Rotation gt 200
ampII~ (
D The actions of concave and convex side
muscles become
agonistic
~ItJrOnrIIiItdllfUClltlluumlll~~tI ~1JIf1laJ
Horizontal plan
Minor scolioses never exceed these autoshy
deformation thresholds
S Negrini 10
EDUCATION MEETING SATURDAY8th of APRIL 2006
Disfunctions at a biological organic and psychological
lever
Oisfunclions at a biological organlc and psychologlcal lever
Cheng
Bane density in scoliotic teenagers is lower than in normal subjects
~~~~middotA~IIlUtIy ~7œl 1d l
Oisfunctions at a blologlcal organic and psychologicallevel
A significant reduction of vital capacity and V02max in teenagers with a medium severity scoliosis
S Negrini 11
li
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Disfunctions at a biological organic and psychologicallevel
Disorders in the development of body image that the teenager has of himherself
Disfunctions at a blologlca l organlc and psychologicallevel
Therapeutic aims
cJ Activate cardioshyrespiratory function
cJ Favour bone density increase
cJ Develop a positive image of the body
Disfunctions at il biological organi and psydlologicallevel
Stagnara
Sport
D The active side of
kinesitherapy
S Negrini 12
EDUCATION MEETING SATURDAY 8thof APRIL 2006
Disfunctions at a biological organic and psychological
level
Distunctions at a biologlcal organlc and psychologicallevel
Cheng
Bone density in scoliotic teenagers is lower than in normal subjects
~n~IIIvpWr~middotA~stWy s- XXJl M J
Disfunctions at a biological organic and psychologicallevel
A significant reduction of vital capacity and V02max in teenagers with a medium severity scoliosis
G
S Negrini 11
EDUCATIONMEETING SATURDAY 8th of APRIL 2006
Kinesitherapy on the scoliotic subject
q Postural control
q Axial stability
q Muscular trophism
q Balance
q Respiratory function
The limits of kinesitherapy
There is a threshold beyond which
rehabilitation alone is not enough
sssr
Kinesitherapy in scoliosis treatment with brace
Therapeutic aims
S Negrini 13
6
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Therapeutic aims Srace kinesitherapy
With brace
il Postural corrections and
vertebral stability are obtained by the brace
Therapeutic aims Srace kinesitherapy
In preparation to the brace
il Mobilize spine on ail plans
Therapeutic aims Srace kinesitherapy
With brace D
Maintain a normal spine elasticity
~ Maintain a good muscular toneshy
trophism
C Model the hump with kyphotizating
exercises
S Negrini 14
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Exercises and their methodologies can vary accord ing to learning and individual sensibility of the single rehabilitator that proposes the m provided that they stay within the
Iimits of fixed therapeutic objectives
li
Therapeutic modalities
(Exercises)
QAuto-correction
QRespiratory education
QErgonomie education
QMuscular strengthening
QDevelopment of balance reactions
WNeuromotor integration
ci Vertebral mobiJization
QSpecifie modalities in brace treatment
S Negrini 15
EDUCATION MEETING SATURDAY 8th of APRIL 2006
The protocol of kinesitherapic
treatment
G
QChoice and dosage of exercises
Variatiosn of the work program every 2 - 3 months
Q Execute e)(ercises on an individual base or in a small group
Q Frequency not less than 2 times 1 week
Involve and awaken the family
G
S Negrini 16
EDUCATION MEETINGSATURDAY 8thof APRIL 2006
Q Determine the action and the localization of auto-correction
QAuto-correction must be associated to ail exercises
QAt the end of treatment ergonomy lesson
Auto-correction didactics
G
SCOLIOSI DORSALE---- shy ----
r
S Negrini 17
EDUCATION MEETING SATURDAY8thof APRIL 2006
SCOLIOS OORSOLOMBARE
shy
SCOLIOSI OOIlSALE 011 bull LOMBARE S1I--shy
SCOLIOSI LOMBARE
il --~_-
S Negrini 18
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Scoliotic patients are not radiographs
middotSeoliotie Mtients are not ndiographs but hum beings with a vertebral deviation-
Slagnara
Metha For the physieian Cobb angle is of utmost
importance For the patient it is body deformity t hat eounts most rib hump a protruding seapula or hip We are in a situation in whieh today dodors eure the radiographie deformity but what the patient really desires is to get rid of clinieal deformity and of ensuing psyehologieal distress
CIIQItIo shDuIdtucirc lM WIld tJw~~ I~~M~~~~ J9f~
S Negrini 19
- Poznan_workshop_Physiotherapy
- physio2
- physio3pdf
- physio4
- physio5
- physio6
- physio7
- physio8
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- physio10
-
Orto-dlet Trau malaogis Roha b ilitacjaARTlKUL ORIGINALNY ORIGINAL ARTICLE Vol 5 Nr 1 2003 80-85
Jacek Durmala l Krystyna Dobosiewicz l Tomasz Kotwicki Hanna Jendrzejek 1
Katedra i Klinika Rehabilitacji Slqska Akadenia Medyczna Katowice Katedra i Klinika Ortopedii Dzieci~cej Akademia Medyczna PoznQll
Wplyw asymetrycznej mobilizacji tulowia na wartoseacute k~ta Cobba i rotacji w przypadkach skolioz idiopatycznych u dzieci i mlodzieZy
Influence ofasyn1n1etrie 111obilisation of the trunk on the Cobb angle and rotation in idiopathie seoliosisin
children and adolescents Slnwu kluce ac eJJic Cl chOlIU) Ice SKoio= idj)PO Imiddot(~I7tmiddot
K~Jmiddot w()rus consrieI ve I (OtlHelif idiopathie HUW JS
SUMlvfARY
BackgrouId The aim ofthe stldy Vas Ihe radiological evaluation ofthe treatllJent ofthe idiopathic scolioshysis utilising as)mmetric trunk mobilisation in the strict~ll I)mmetric illitial position
Material ([fJ(f lIIellOds Presented stud) lOS based IIpon J36 cases (13 oovs oged FOf11 ocirc la 6 lcars (lild
rn girls aged frum 6 la S pears) trealed due to the idiopathie sCuliosis ((rom Novell1her 999 0 F enflfUn 200) Among 48 ch idrcn sllfJering from dOlfble-major scoios is 6 cases wcre infoll scaliusis JOjuvel7lle und 22 adolescent Among 88 sillgle scoliosis 6 lere infw7t 33 juvenile and 49 adolescent
Radiological exami71ation 1as condueed always in the repeataole technical cOlldiions RadlOglOlI1 lier evaluated oy the same physician Radiologica analysis oIthe scolios is incuded value ofthe Coho al1gle ongle ofaxial rotaion
ReSIils ln double-major scoliosis observed dlring one year period in Ihe thoracic segmenl Cobb angle decreased inll l increased 1395 and in 292 Il OS 111changed Axial lolation angle in 167 (~rcascs
decreased in 354 incrcased and rernainM the sorne in 479 In Ihe llllnba segmenl Cobb ang le clccrcscucirc il1 354 increased in 39 6 remained in 5 Angle ofaxial rotation deceoscd in3 ofca es incrcuscd in 29 and persisted in 48
ln single scolio is Cobb angle decreased in 386 incrcased in 353 and in 261 was lInchonged Axiol rotarion angle in 216 ofcases deceased in 295 increased and rell1aincd the sallie in 489
CondlsioJ Asymmetrie mobilisation of the tf1f17k in strictly syl7111elric initial positions is a 1Clhod of choice in the cOl7senJalive treatment ofthe idiopathic seoiosis
STRESZCZENIE
WS~p Celem pracy jest radiologiezla ocena Icczenia skoiloz idiopaf)cznych metoda asvmetrycznejl7lOoili shyzocji tllowia w sciSe symetlyczl7ych pozycjach lV)jscio wych
M aterial i metody Przeprowadono retrospektYlIl7q analizri 136 przypadkeacuteM dzieci (13 chlopcow i 123 dziellshyczqt w wieku 6- 18 lat) z bocznym idiop atycnylll skrYll ieniem krrgoslupa leczonych zachowawczo w Klinice
1
Ortopedla TliJumatoogia RehlblllagraveeJa ARTYKUL POOL1 DOWY OPINION ARTICLE Vol 7 Nf 1 2005 49-$11
Krystyna Dobosiewicz Jacek Durmala Tomasz KotwickP
Katedra i Klinika Rehabilitacji SIAM Katowice 2 Katedra i Klinika Orlopedii Dziecircej AM Pozncrlz
Biodynamiczna metoda tr6jplaszczyznowej korekcji skolioz idiopatycznych - opis metody Biodynamic method for 3-D correction of idiopathie
scoliosis a description ofthe method
SIOWQ kluczowe leezenie zachowawcze skoliozy idiopatyczne korekeja tr6jplaszczyznowa Key words conservative treament idiopathie scoliosis 3-D correction
SUMMARY
The biodynamic method of hree-dfmensional carreeion of idiopathie scoliosis is based on Ihe palhomeshychanics of idiopathie scolioiiiii and consiss in aClive segmental three-dimensional correction ofspinal cllrshyvatlre The course of action focuses in the viciniy ofthe apical vertebra Proprioceptive facilitation is applied on Ihe concave side ofthe curvaJure and exteroceplivefacilitation on the convex side Correction likewise proshyprio- or exteroceplive facilitation is phase-oclœd with asymmetric respirarory movemenr as weil as wilh parshyticular phases of the respiratory cycle ln Ihe course ofexercises three-planar movement is generated opposite to the direction in which scoliosis Is progressing This method is in accordance with the stale ofthe art ofscoshyIiasis pathomechanics The method requires detaied training and can Ihen con be applied at home under periodic control by a physician and a physiolherapist The method con be applied in landem with a Cheneau brace as weil as in surgical pretreatment A elaUed description of Ihe method of three-dimensional scoliosis trealment will be presented in Ihis article
STRESZCZENIE
ISlofa biadynamicznej mefody Ir6jplaszczyznowej korekcji skoioz idiopatycmych oparlaj est na patomechashynice iikolioz idiopatycznych - poega ana na czynnej segmentanlej tr6jplaszczymowej korekcji skrzywienia Dzialanie koncentruj e siccedil w pobitu Icrllgll szczytowego sknywienia Stosowane iest bodicowanie propiocepshytywne po stronie wklllsej oraz eksteroceptywne po stronie wypuldej Korekcja i slosowanie bodicocircw propioshyi eksteroceprywnych zsynchronizowane j esl z asymetrycznym torem oddechowym oraz z poszczeg61nymi fazashymi oddechu W trakcie eacutewiczen powstaje odwrotny do lrierurzku rozwoju scoliozy tr6jplaszczyznowy ruch IcrFtshygoslupa Melodajesl zgodna z aktualnym stanem wiedzy na lemat patomechanizmu scoiozy nymaga szczegocircshy100-lego instniktaZu po clorym mote byeacute wykonywana w warunkach domowych Z olcresowq kontrolq przez leshycana i fizj oterapeutll Metoda mote byeacute stosowana r6wnolegle z leczeniem gorsetem korekcyjnym Cheneau a talcte w przygotowaniu do leczenia operacyjnego slcolioz W pracy przedslawiony zostal szczeg6owy apis meshytody leczenia
Skoliozy idlopatyczne stanowili znieksztalcenia patycznej rozwija siccedil poprzez przemieszczenie kr~gu tr6j~aszczyznowe charakteryzujltce siccedil wyboczeshy szczytowego w stosunku do krccedilgu g6mego j dolnego niem rotacjltt krccedilg6w klatki piersiowej i miednicy z r6wnoczesolljego rotacjl zgodnie z ruchem wskashyoraz zmianami w fizjologicznych krzywiznach kr~ z6wek zegara dia skrzywienia prawostronnego oraz goslupa w plaszczyinie slrzalkoweJ [ 123] przeciwnie do wskaz6wek zegara dIa skrzywienia leshy
Z punklu widz nia patomechaniki tr6jplaszczyshy wostronnego Koncepcja rozwoju skoliozy jako rotashyznowe znieksztalcenie krccedilgoslupa w skoliozie idio- cja i kontrotacja sugeruje ze sily korekcyjne powinshy
49
EDUCATION MEETING SATURDAY 8th of APRIL 2006
- CARDJOPULMONARY EXERCIS E
TEST IN GIRLS WITH
CONSERVA TIVEL Y TREA TED
IDIOPATHIC SCOLIOSIS
Jacek DURMALA Krystyna DOBOSIEWICZ
Department of Rehabilitation Medical University of Silesia
Katowice Poland jdurmalaqcmpl
The aim of the study was
to estimate the influence the conservative treatment (asymmetric mobilization of the trunk by Dobosiewicz) on physical efficiency in the group of girls with idiopathie scoliosis
Material
bull 87 girls with idiopathie scoliosis
aged 1 0-17 years
(mean age 135 years SO 161)
J Durmala K Dobosiewicz 1
EDUCATION MEETING SATURDAY8thof APRIL 2006
Material
bull 38 girls (437) with double major scol iosis (thoracic segment - Cobb angle 18-42deg mean 30deg SO 82 angle of axial rotation 4-32deg mean 21 deg SD 107 lumbar segment - Cobb angle 11 shy48deg mean 31deg SO 128 angle of axial rotation 5shy30deg mean 13deg SO 85)
bull 49 girls (563) with single scoliosis (Cobb angle 11-75deg mean 33deg SO 155 angle of axial rotat ion 5-30deg mean 14deg SD 83)
TIoracic kyphosis of the invesllgated group was 5-39deg mean 23deg SO 86 and lumbar lordosis 16-41middot mean 30 50 65)
Material
bull The 64 girls aged 10-17 years (m ean age 131
years SD 132) were conservat ively Ireated
using Dobosiewiczs method
bull Treatment period ranged from 5 months 10 3
years (mean 148 months SD 902)
Material The 23 girls aged 10-17 years (mean age 136 years SO 108) were treated u sing symmetric exercises - treatment period ranged from 4 months to 3 years (mean 161 months SO 1019)
bull 26 of ail g irls (18 girls earlier treated using Dobosiewiczs m ethod and 8 gi rls earlier treated using symmetric exercises) aged 10-17 years (mean age 134 years SO 108) were twice tested - at first and last day of Intensive hospital rehabilitation (asymmetnc mobllization of the trunk by Oobosiewicz) - mean hospitalization period 20 days (range 18-26 days)
i rf~8f6~~ or~~n~= ~~r~1~r~icircJ~~tb~~~~ mean 17-4 1deg meatl~(I SO 74 R n~le ofax 1 rotatIon 5-25ot mC3 111 3laquo S0 6icircl Ilnd 1 99t1S~ ~~~~I~~~~~$ruo~ras~ ~ocirc~~a~e~~~~~~~5euml1 9middotn~ tUfllbar Iord05ts 16-4 1deg mean 311 SO 68)
J Durmala K Dobosiewicz 2
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Material
The control group consisted of 77 healthy
girls aged 6-17 years (mean age 12
years SD 31)
Material
The examined girls participated in school
only in scheduled physical education
lessons and have not been enrolled in
other sporting activity
METHOD
The exercise cycle
ergometer test was
performed
J Durmala K Dobosiewicz 3
EDUCATION MEETING SATURDAY 8th of APRIL 2006
METHOD
The Incrementai exercise test has been applied
We have found that tests ln whlch the Incrementai part of the protocol ln completed between 8 -12 minutes duration glve the
bullhighest maximum VOz in normal subjects
METHOD
The workload was Increased stepwlse
bull by 10 Watt every minute - ln chlldren
with high ~ 135 cm
bull by 15 Watt every minute ln chlldren
with high gt 135 cm
METHOD
The test had been contlnued untll refusai of the patient or exceeding the pulse Ilmit
Durlng the exerclse the gas exchange parameters were recorded by Jaeger device model Oxycon Alfa uslng direct breath-byshybreath rnethod (with face mask)
J Durmala K Dobosewlcz 4
EDUCATION MEETING SATURDAY 8th of APRIL 2006
METHOD ~ ~~ r 3 min 3 min 8 - 12 min 6 min -~
_ 0 rpiYJ 0 rpm 60 rpm ~1 30 rpm
_ t o~w=att~o~~na ~~ att__~ tl~~S~~ l ad l ~~~~~r o~w= Hlcremenlal t
pedaillog i i ~
~ ilt ~I~-----tl-~ I t ~ i ~ lOSt sffortivB
lW r resututlon r rm-u middot 1 - bullA~cremen tal ~~ ~ ~ ifr- ~ VtI 1 ~i ~ tllng _
METHOD
On the basis of recorded parameters VAT
has been individually computed for each
child using V-slope method by
Wasserman
METHOD
For assesment of physical capacity
the maximal minute oxygen o
consumption (V02max) ventilatory
anaerobic threshold (VAT) and
maximal workload was used
J Durmala K Dobosiewicz 5
EDUCATION MEETING SATURDAY 8thof APRIL 2006
RESULTS
Ali girls with 18 have been classified
within normal range of predicted
values of
bull maximal minute oxygen uptake
bull VAT and
bull maximal workload
RESULTS
The differences between group of girls
treated using Dobosiewicz s method and
group of girl s treated using symmetric
exercises were statistically significant
Lower exercise efficiency of girls treated
using sym metric exercises has been
observed
RESULTS Girls wilh IS Irealed using
N=87 p value
Dobosiewlczs method N64
symmetJic oxor-ci Nz23
Perœnlage of predicled vaJue of
maximal minute oxygen uptake
98 905 0033
Percenlage of predicled value of
VAT 97 933 0049
Percenlage 01 predided value ni
maximal workload 101 939 0038
J Durmala K Dobosiewicz 6
EDUCATION MEETING SATURDAY8th of APRIL 2006
RESULTS 26 girl s twice tested - at fi rst and last day of intensive hospital rehabilitation
The value of ventilatory anaerobic threshold increased during intensive hospital rehabilitation (asymmetric mobilization of the trunk by Oobosiewicz) statistically significantly (p=00019)
2047 ml O2 minkg (SO 268)
vs 2239 ml O2 minkg (SO 232)
Conclusions
1 The exerc ise eff iciency of girls with IS treated by asymmetric exerc ises of Oobosiewicz is norm al
2 Such high level of the exercise efficiency of thIcircs group resulted fram using of Oobosiewiczs method
r
J Durmala K Dobosiewicz 7
REVIEWS
Role of physical exercise in tbe treattnent of mild idiopathie adolescent scoliosis
Revicw of th- literature
A NECRlNl N VElWNL s PARZI 1 A NEGRINJ 5 NEClU NI
P1t~silillxlrd~ Ihcrapy (or klucgtlttlwrlpyl i pro shy-tJm of physka] cXlrd-cs ipcci I(a~ (IJcloJgtcd hy l li trIWlltl phrslollwrapbt wilh tb m~ln a1mor pl shyVCnI in lhe ilAAfIVltilH1 llf the ucirccfonuity III mild IgtC )
Lil1Si bclpin~ thebm ( aocl co uaufllclilIg ils ~jd- clf IS in nlOdlJmiddotnh-culiosis Th middotalillofthi paper ito r (W
Ille Ii lc ram r 1 a-ccrulin wh kh of Ih bull Lu[Jalmlcrus Ind (Lb hili til~ CLlLt-cd br scnli()si- clluld bl pl Y nlcd or r d uccd hl phylolld LXtmiddotrdsi n Il p--to-da le knowl Uuml~l nr tIll~C aspcc[~ i ne bulled in oruer 10 dndc whclh~r 11Rf blLl adcqlmtt Ib(uuml n middotlicaJ balis fo r ora)aini l Ihe US4~ of lUgravellgtitlerap) wltcllj(r or fln l th e prtl1iœ of kimiddot ~lre IUlll poNjn~ a t iil ies ~bould h allowtcI II uuml middot c enliaI toltlentlf)wh k lu alClor ie - lf pl lr~kiJl -c rmiddot d gtlt- (Ic rnnhi UzJ( inn ni (t hl HrJltlon [ rtn~hcll iJl ~ or 1i1J(IChIumlJlJt etc) Sh llU Ld be TolullllCcluse ulemiddot l onld b- clclIimcntalancl wukh sho ll ld he IJlI-n~ifl~d I~~a l lhc (o uld h 11lfu 1 Know k dg CJnc1in t (wIn SeiCIImiddot Hlk rCS([lflt h daw ccordinll to Ih bull llVit w o f tIlt iii 111 1( plop(lsltd in (h i papcr lmiddotonllmJ l lnl plLyi 11 cxcr(j$( pn (nti or (tmiddotduce dhlblli t ic 1 ~lt Il Jj ll(k pl ti Jlt fadl j w(~ the nlIIIrl li7alinn n f poMural dd shylitS tu p n xJ llc aSl COIlMqnen c(middot 1 all )llal) or r(tn~ shys i middot middotlIrve Tilt u~c (I f appn1priattmiddot kincsiuuml wrlpy 0 in rcns polttllcal swhiIHy Icirc IIHmiddotorc Illta ll y (0 r 1(lt1 lllho UAh mon ltlccurlltc 1Ut dl1alkd -rLk l(lWfils 111111 )11 h Jlccdt(
11) wurcJlt 0 lit)-IcircS (Iumpy - x rcLs P()lun
n rllt lT(ltnklf u f COll1tlK H (rtd) I 1i plfho l og l ~$I rUlglng tr m low tmiddot k Pl 1l1 to IdiOpath ie SCUIshy
Submitt(oJ [or PUhltCl l1 011 uly Tt 2001 Acc~pttJ ugu - ~2 1(t-1l
Addre rltj-xlfll telt~I(middotb If) - grinl Flt(1(bziurllt r )(m Ofl ()(Cl1I shy Lt middotqlltœlll ro () - 1u I4t agravehLIlKil ta IYIL-lTt ilSllltp lfllmiddot ~ 1l1uumldull
CelII ~ (niiOS I I~ middot ann (1) IfUh middot lIlfU di louhilll(tymi ( Nlmiddot ~iI rli -ilIIUmiddotltlfl
Nlti(ir 1( ) il r() (ltbullagt1
lt vLL_ l IiII no 1ftfI
jS ) we are a IUil ly tJc ing n1n) ltblll lS 1 k l1 b ~J)w in~ tl~ t S Jfll l approad llt - l1n til hy on ielshyertd ~tan lard ugraveJuld ln m any ~1~ he lI ~t les i if Ilot dange r )ll lt rhlS is lrut of reil l lnw 1gtlt1lt1 pa in l ~ or 5urgi c ll lrea lmltnl5 in dbc r lmiddot ll Sc - 2
ln tlle cj-e ut ~ t lll(tlWtl i( li p l ll1JC luuml- I ~ middottnl ~() shyliosis phys cal ((_lt1(( is emr1uved ltI t()fIl1 0 lh~rtrv
lo ly in cel1l in L)lllllde (nluumlnlr in tilt Lltlll middotorkl i e Iw l) r llt t Srain hUI IIgt() 111 Gert11lny 5- 1~1 in other reg lOl1 wbere thi I-incl qf tre l tm e rll 1 p~ 1 pmiddot t 1( cI il Jws Ixen cri ri cilld md rel -cltd Lw m~lI1 1 11 Jlu~ Fue Fnlny r ~lrs thio middot15 a lsgt(ru( f ~rth r -~ltc rrJtf))~ ll t vit11 br1Cltcgt b r II1 ([C Llt n ClW grmvlng 1lt1 0 L Sti g
gcsti n the lIsefulnes- u r Ih is form o t treatm n t 1
Hmiddotu]rs have nerged jn El or uf pll y~ iLd eegraverdse eacute 00[ 1 but tlw are nUl yel 11 11 t llu i vIC~11 and r hi ~
f rm of trt ~ltmenr IS stiJ l Ul1 ckf ckhate FfI t Jt 111 il i 11t (eltary td 1I iFy 11umbtr ot
b l sic COI ceP rlJ lf w ill he cIh tt d in t hi pap r
Scollosis
DCijIrI iriolls
ScnUoSlS is Irlircc c1 lme nsIcircltnal (I(gt i l cj on ot tht spinc thar cau C a CU 1 lh lt ca n h e $ t~en ln (1 me1Sshy
ured ultinF Coh) lll ltllCXI o n HI anreu middot p rtc rilt r
EUJlOI -1 lœDICOPHYSlc~ IR
NECRI Nl
110
f)i)
1 7J
amp aS g 5li - 0 v
V
31
10
(1 1) Il 15
-tc i ytjtr~)
FigJ----jllph ot DlI w l-lkaupegraverel) The agloimvltltinn Or idio r lrhlc 50gt1iflll~ IS rpiJ bel~ en th e- [l0 IH P (l)ltg tnntll lol (JI PUllcmiddotny) mtl 1 ( f( lS-er sigll paiilivltecirc lt Dlt(i I1 11illg r the iti l 1Kgt n n t rll icirclicH a ) 111lt m omal prebulled the mno rche md ociks with lll I)ttlx flal gr Ih pll fl
rlcljoprdphLi 1 hl merl prestIK ~ of this curvt c10es n t autom~l ritllJy indi ate the pn$CI1(t of a defurshyTnitv (SlllKtUrd (Unel
It i~ possible tu clil1e ren tute a struCnlt t CI1tve fruIn a pogt urll 011e by identifyi og the hum]) du ring AdIlns tesr I~OQ looklng tra m beh lnd at the p atient w ho b benchng fUfward il is p -- ible ta d d~ct 1l1 eh ucirc n of o ne liidlt 0 1 the trunk usually n n the (onvex ~ jde ul tbe radiographie CUfve Ugrave1lr C Ul be mlt~I Slred lISin~
BUlln els S o liomere( 1 ~ l This h Uf1lp is du(- lO (Ile pregravegtecircn ~ of vertel ra i rolltion 1c1 Ollt tn tic f~YJ tllre o f the def trrnit tli [ c m be seen and measurc(i v ith Perddolles lb lsLometer on an amero-Ix)iferior radioshygrapb ~2
Seven ry pel cent o f li Ises a re conid 1lt 1tO be idiopa thie 1 bull ia l-nosilt in this CI$C is b exdlls i ~ n as idinpa thlc me-us t11H wc do n()[ know rJw origio of lheacute curvc [n othe] ~Ie$ it b Ix )~i ble ro ide nrify a dieak (bat CHl jusrify the c1etgtnniry slIch a rna lfo rshymar i ns I1(gtufol Ig ic~ l or genlttic cl iscas s Glnclt~r trauma etc )
[dicirc)parhk S(oliosis has been divicled ~(corcling (0
the ~Ie of tlie patient egrave1l the tiJ1ll of d~[ccli n of the condil ion into ti) ur t ypei ln fanUlc jU nik ltldolesshyccnt lnd aduh Til l m n st cnnunon (VPC IS the acloshylescegravenr o licirceacute I1IJctenzec1 hy 1 sud le l1 tggrH3l ion uuml uring the grow tll Spllrt (Hg 1)2
lhile p tu 1l sco liosi i5 Ycry lomnw n thl pre shy~Iknct ra te f r adole ent icuumlop~lthic structural CU IY~S in sch )o chilclren are 18middot20
- 10 Co bb d~grels o r m on l -lil
- 2) ~ohh dtgreclt or mort O 2~j - bull () (obb d gre -s )1 mOfeacute ()ll 2
Clin iltI [ d e isio ns lfl IXlSed 111 an lccu r~He pregshynosi which obt inccl in eJch pa ti nt mainly o n the basi of the nsidu~ll p()tlnllltl l of TH1h and the result s of 1 rh clin 1 1 ~l1d tadiogmpl i exlminashyti(ln12ll c noieq uentlya d inica ] la sifiou io n o f the ing le pHient tn -ome estent co incic1 ing w irh the
D diographic one c l n lw SLlIl1H1arizeci 1 1 folIcJ - mikl lc~ (1)(n 20 C bh de~r es - moderJt l betwlen ln md 15 ohh de~ rtes - StV re 111( gt1lt rh n ~J) )bh (kgf s
On the 1) lsis of [hi - dinic d d a lfic t i n (Vith l1l il el lrb tiOI ~ o f the ir b() und~ri e ) in Itllt l cente rS Of SCOtiO LS ITe ltlllent in the Lltin odcl (i rJ Ital lnmct md PI iJ Ugrave tre tmtnt i s plmmcd a fo lltJw 8l
- mild kineslth e (~1fw ~1Il (1 luok-ou t - Hl demte IJragravecegrave 1111101 c(~r md k i rws ithe lJpy - ~cven surgery
Physical exe rcL~e for S(ol iosis
Defi t tiOl l S
PhyS i 11 nU b lIKrlttp middot (or kines ithcIa Pl) i a p rvgrlill or plt~i Gl l (xeriltecircS ~1ci fi ( llJ y ltk ~ loped
y a -11 [ru ine 1pll yslo ther3pisr wirh th e m 10 Hllll
- pre (~ n tit1g tlc aggraaLion of the cl I )flnily in rnild bullcoUm is
- helping tlk Il ld Ct ~lOd ounter~lCtjng its skie elfects in III de rltegrave sc li sis
Tn tl1i_ feSpec1 kinesitl1ert py f JI s oliosis is tonshysider l a o on of peciticcedil training and s genecirc tltllly proposelt in sessions 0 1 4~ ro 60 minute IW) t) tour limes 1 Cee PhysiGtl exerci es can aLo ll v o ther auumlns 1S it oill he dise Issed in this plper
Ir 15 Ilot possib le to cl escribe a single progrlIT1 o r exerc ise a5 pro nrams ale USLIJUy p fgt nll ized ( ( lt
EUH PA ~illDI (DP1I YS IC~ 182
ROlL UF P l 1YSICAL lXl 1lt 1~E IN l IlE 11 ~l) IEd If IlU) l[)VP 1HI AIJ() J)~Cl~ r COl ~I NlG1W il
f)( 15 egraved ( )Il the nee L- 01 indi iuua l pJl itnts) al l l10ugh Lheacute) C l n h t 11 plicd o n a WOU p hJ~js (-1 (0 () pnients PC[ ~l ()lI r)middot lugrave reQCf lhese 1 10 grl lll frequt ml~ V IIT
hnm on in middotituk w allClthltJmiddot -Ill Jnv L l~egrave at Wc w Ht ~huw in lhis lyl peJ it i~ 111 n u -eII1 tu id e ntilv kirK itheJapturlc aims w hitl l ucircrr~spnd LO ugravelt~lil1 DUtshy
g X ir ur ph -s ici l lxtTi~l I~llhe r thln ln dj( us- indishyiJ u1 1progr-lfll
Aduumll l lxUl kisure time ~lOd h )u] Sp u lllll8 ~Ilttishy
i lt egrave~ i middotomm )Ly s iven lel mJ ing ro w hlf ~ Iuumlnsidshyer~d usdul or il lrmfu l in t1 lt rruning (lI tJw ptliJicirct ln tl1bplper Ugrave1 gent ltl l t rl ll bull p lwsiCUgrave lttG iviUes is rl ktll 10 JllI1ltlCc hOlll gtpOlt mJ kIJ1lsIcircl hc lJ l f
i ve lUen tloneumld )bo C on lv ine n dul( re Ull~ 1t~1 t s far Ilten publislt d f I~ mJ I(i noltgtithltl rgt is 11 11 a su h jel lnI deacutehate CJitk haltlt t llltit m itn ltl of l ny lorm o t p l1 ySiClI lxrcL e as a Itwr1 [ J- fo r i liopa tb il jcoJL~b un iL ()ri gin~ initial1) it WIS Ille r rOmiddotUumlK lt brgdv u f p l~lt titu gtllergt w h ) intervenecl hutll tc llcrl ll (mon as cltl HtilJ nic in terventi n man Jgt
1 t lltrJp utl t one 1 md rC j fkll l~ on rhe h sh lf som uni cOen I1v pn t I1cgts wt ldl hll ltl enl1 JI~ haLl nu na l scicnt lfic baisYmiddot HOlh tlle$( trr t peu shy to rh ~rl py tt nJecI to l~~rJ tte C Ih tk CUf -~ pnnshyclr~tll y as a f tsul t of lilo h llIzatio ll of tn imdqultdy ~u pp rt(d S pln eacute 7~ 12 to re-t1 r rI ltrl 1$ l l1C k o f WH llt~~rdl 10 I ndt~-dll()urnah tnd 11( on1 p~l per u suaJly Cl tc([ IS n prelimmtrf lll d 3 ln tt li w ay man (l rrlKpt(Hc H lf O iS Inll ph ~i C U l ~ d vi ~ cI nllog scnliotl pa t le nL~ 3gainst holll ph lca l egravexershyclc and p()rt~1
It m u st t~ n tfd [hat pllyknl txerc j~ tJe~ltm(nls t1iHer 1 lJ rd il1g r rhe rherlpcu tlC litTl~ on lllc h tJ rgt ap p lolc il l the IXlltent lncl hi im r IIIllHnt i- 1 (1(1 rI - 5lt1J lC igt tIl l ( f phJllIlllolopJ al rrea tmln ls Ihith cllffc r 1lt œQlfd- rhe m C cculc u ~t(l luI thl p al 1t n
~mc l 11i (lbE~e Tt i ~ P ~il k tlwreI[middote thll wuumlk ltlll t kin 1or ph~ i Clt1 1 lX r(j~ 1I 111~ t bc loidvd by t h~ Lo iurie IxujCJ1l al1ulhcr a dl ~IS nJI h~ iOg (1 11shygerols llugJr in racr le (wi ller d I ~fJIII ~ I ml thlls re(nl1l rn ndc(1
fn n UI cel1ll r we In(~ hccf) using 1 ) 1 1111 11 ve ) 1 (J p lw l icd ex(r(i~e (0 J ( 1I l tt i~ tlh aITt ~ l~d Ilv m ikl tru cflumiddott1 adokscltnt (cl ioj arh lC icoli is11 2)
ina the f U~ t rc-gt uJrs IefC pu b lishe - the pJ( )grd m 11lt1lt l1te n PWltllk d in fa c t deel()pnlln l~ in th t l itshy OlL1Ii in tl1 r b t ~() ycal f ha ve iclemi fiecl niO l l
m d 111 ur impl rnHm s md d i s )h ilir i (gt~ lue t idlo p lthk amp()lio -i ~ t Jll CIII he 1UO(l if Icirc 1by phyict1 egrave xert iSlgt l fe t rrncllt
l illl
111e aim of t l1JS r~l per ii tmiddot (tv iew tl1( l iterat urt to a(errl ln v llic ll of th~ impa irm 1t~ and Liit hil it il i GllIltec hy ~ o l i()gtj s -o ull he ll nt x or re middotlu celt1 Ili pl1ysical xerclse An u p-to-da te knOvkdge o f tl lt Lgtpecl-gt i necckC1 in rJeumlr) d -oek
- whetll~r there h ltl n adLtIIl ) l tht()d ical bbh fur or JqIIcirclb l l l1 Il( ) f k irt llit herlpy
- h N I)(1 ( 1 Dm tlle p r l c tIcirc(( o f Jebur tiJne )pOfung lcli v l ti ~ IIOU lci he tllf) -d o
II J U V f h 1 I11~ c~~lb li hed Ihe usefuhlLss 01 k il1 shyc ~thtrpy il i aIle dy l nsi 1([(( -r-tI Llleu i n )I11 plJt~ ut the wJrld ir ilt ecircS~nl i 1 I( id n Iv w l1i li ( 1shy
gories 0 1 pl1Vtl( 1excrClgtegt te D)bilI7it ric 1n (Ir st shylliuumlZltio f) lttlt tlgtbltn ing ni trcrccedilh ing erc) hn Id be
vnlcled he tll rhe nuld be lerrillldll1 1 md whidl s tlQu1d be inreœ jf ic(1 IJeClU~l tlley cOli lel Je LI ~ful
Ncuro1llotor impainncnts
Imv aUl llOr~ 11 lt1lt ~tlKlteJ lhe cltlndatiotl bd Ween tl UC1UmiddotIt t l ol(~C t nt id iopml je -nll ~J~ and cli~l l shyler~ lr 1tH lest ihuLIr yt 1 _ 13 ~ 311 D uhoussct 1
1-- ITS tln l ldiopath k s(o lio-L L cll -c d l J l hmgt in th terl tltr f prop li l l pu n md 1I1ar th e detrshyn Hi n i~ na tural 1 ~ronse to ril e need tu ts tu re p()tun ltlluilib riu Ul HcrmJJ1 31~ 11 () d tllat icliupathic ( liCl5j h l it re5u lt Ot1 rw nltuf mot r l ~ltelV
[Id )fcl 3 nI] ~1ltJ U Sr1lle nr to dtorders in centJtI lO~Cl shyIOIDNur) md 1xi~tI moro (Ul1lfOl syt( llI (Fig _l
N htIll -of) H1c S uumll h( rll1 ( ~ l( w ing JI t11 (oshyI-ie on the l l lO]ugy o b doll (nt Rl iu]icirc tlili- middot()lioL m unt fil t-hltll rhl ugravedcmnilV L th e fl5 ult o f 1 (k btcl 11lIFll llI ion nf som t11(WUgravetltnl md pO~ lur( (tnic l~ l licirc1 tl1lt if l p OgtlbJt b C 1l rlw sta l i lin 0f 11 1 Sf llle j lt g )tx l Tt) ohtil n a ))Cli U 1ILzltl I o f p ~llIr~il d l~flo [ in l1litkd ~J)llnSIS me CI Igt(middotqucnr J ~ a ~tmicirc ()nlly or regle Ie Llive
Ali th- 11yp ) tlw~es rd ~lte tr d irtl Itn t pnl1tlt o f [11 v hole ~piltm It11[ controls postu re ~nd mrw shyment lrre pell ic of tlh po int a d lI~ llv inH llYegraved il i ~ ll 1 nnable tCl aSUilll ri 1l tr l ll1 lo g thi ~ys ttm ( Qu it le 1I middoteli tl
lt ch ugt nlt~(S f rullliIl thil i nlomwtion th at p tlmiddot shyiCil J(tl iIies nw gt Il lInport~n t rr le to pbv [11Icircgt role ca n 1)lt slI i11l1lariztd ln lWO the ptu li ain Llt
- d elopmll1 l of p uumlltl St1 b Hlt ) - c1e veuml IOpm 1)[ o f bhll1ltc _
(k llhUl)lOr S Cll orr
ontrot oic whan-lt
------+ 1 ~ il lnll ugrave r AINnl
Cllnlr1
T bflt~ r
fltL1 tlli
lMini
l
~sary ~J-frlllen i )f
~ 1 ocirctnl
~UcirclllIJJlW Ll
AXl ~l1 n uumll l) r sy 5t ~nl
middoticoltoq ~ Fig 2-AcFgtrdong lU He-mutl 21 il is Fi)5~ ib1e rD prolXgtSlt l -oo ie1 mnd 1 ((if ~ elio egrave middotAhltr~d l)Qdy-p ati~ I I i u d) uren ttllOn k td LO In ~ory reHTt I1 eDi tn l al ) JdrnlV~ pn)4~ e l u r~o(Ofe 0-c1 eptunl dvstil t1 ctlon sltŒ(ry icircltu nu11t ilwnt [ ~mC ~ted tl l1 ce Ill trpntlshyUumlfJJl nd IKnle~ r~dibl jtugrave)n of -I) m tlosen Ir ~ig nj tl (I1vying ln fornll1U n (lI an ereltl ~piJl e Mmor aJJ r--a t ~) n ltgtf ti lt aXljl mowr plem iHUC Wh ~fl Ille 6ubjeco m uumlntl Icircn (1oJifitd perccpfLlI l ~na l ysilt of p n)lnocepti Icircnfu rnlaquol ti desnibJOS ~n t tecr spin A IICW motor co nrro l Ira I gy t adopt resu ltin~ in the ~tr ltctltr 1 ckformh y lf IdiopathirL scollos i=i Ht lrftU1uc nltnt l ISll I1lJy h1e- ~ I pro()und elkn on bralO Sfem flJll ct i(lnn~lLhu modifyRll Ille nltulltgtshytl10 ) 1 1111 Uu l-lHoror control 5~Shnl$ shy
As Srtgn1lt1 l ~ ltlssert~ if wc l C -Cp t 111 1 un o f the G IiC s oliosls L l tisorckr oi th e ltquilibrilltn sys t ~ms it is lagical to oriegravenrate physlCl l exercis( lherap y ln th is d ir(gtCli()[1
11lclte goals Cul tl lfOUgil ditrercn t modes 01 action be Olchic(-c1 witJ1 phykal accivit ie
- po rt ive Cll ities p ro ct LJ e aIl UgravelClltrtsc in 6lte nshyel ll )o rd in~lti n pinai pr0prinup ti_)[J nLi mOVeshyment control 0 vio lls iy ln thh repect ome lCtivshylites aœ pre um~I I)y lXrter tllln ntil crs
- kinrl lira py using pedJil exerCisocirc specially developecl lith th est 1101 5 in mind illVuuml VC I lllore prccilt( ll1d InC1 li zed cri n on rhe spiJw focusing
a90
1 ~~
lg -lNheJo ~1l l1 t r~l g rld in 1 1) h i(~ IImiddot ct r rHienl w i ll idlllhic _It ~i ~ _ iri s plt ~I le II find Jit ltH vlllleuml ~l Cgtbl tn~ ks III d il fef lt p ~ lt ihnS nu v~tl middot B ~a~pt u Il C middotl)Icircd ~(t l l11 C dlfkrCnl middot- hdween slllndi1g Uline nu nllt1Xinul oorrec ri nI t chied Vith Ct (J ) und tfdincJ ne lot es o UIine 1 fo llnVs middotIJfl tfi ni( - ltlrshy
reltiK)n ~ Ikexibiliry st3nucircing - -pirte - f ur~1 1IbjISC ltupin - ltorrcaion - - r~luci()il ll ymiddot For flmpllt in J npK l1 pH k1J il
plt1SSlhlc ln obtai n 10 u1 511ndlt)l [YLo lion yr ln Slt p ille rlOlgt itlugraven om l J ~ in ( gttf(C rigtIl lIex lbuil 15 i (r-l l=22deg pol lltl ~~J IIlpraquo is IcircO~-V- I t1 l nd tucircu(Ugrave) ilil) I~ 3laquoJO- IH-12
r ln Ugravel e abilit jl of tluuml [m e llu to co ntro l irse lr in ~ pac
fuld l oftlles uumlllelve ntio ns can presum1b1r incn~~ Ih enl ac )1 the orller and lHitlll r of Ille rn - 11 )ltd h e lllldenl lu EJ3)4il
Posl1l1-t collapse lnd slabilizariotl
lIle concept u fplt st lUal c(l lJap~e l l~t Iwen detin 61 by DlI II-T3e~tupegrave rL t Ac oJdin)j tu tl1i- ~ll1thor il [ nec(sary ~- l Hn Cv-tlualing th tleihility o f a col shylo tIcircC CUJVL (0 clistingu ih bt tVeen the re du ihil [ty index (th - li iffer gt le bet ~middot Il ~I r~tcli()grJph ie ~xnmshyinltio n of the iI111 pHienr in supine po ition m(i
ROte OF Pl rnmL EŒIlCISE IN THE TREAT-ŒNT OP ~I IJD IDIOPAnnC OOU~GEm seou SIS EltJRINI
I (~)-----------------------~
__ _~ _____ _~ __ __ L ___~ ________1 ____ _ __ ____ ___ ___ _____L___ _____ l___ ----------L ______ _
1 ~
1
-- ------- --1---- ---- ]---r --- -----_----t- ---- --- ---shy__ ______~---- __ ____ 1________ __ _1_ __ ____ __shy
~ (1 J
1
8 =~~=r=middotmiddotmiddotmiddoti~=-middotl--- middotmiddotmiddotshy--------------t----------~- -------- - ------__shy
~---- --- -- -~ -------------r---- -- -- ~-- - -------- --shy----i-------r-- - ---- ~~-shy
il 1~ 0
Dtl-Lmiddot ~ lttj l r~ UIltltlHt
f g 1 -TI1 u ilictf 1ld ( ii 11- ugraveu-sh) ld IX~ O 1d wllich ltJdnrshymII Il nf the pilll 1 ~tln~1 of th e -o lioti( spinc n IG~nI(J II IIIshytt) lhe iJeuml grl-e o f ~ ()Ii ti c (u rvH Il 1 w dcpc-nlknrly o l l he 10 111shy
P01(nl (pntt l ~ 1 1 nr ffll wrJ I) ln w hilth Ihe n i 1gt( ~ duc nL~ grlphs fm I h~lt 111lt hi~hr Iht Col h ~Ilu t (l f Lite ~Ul Ihe m Ol CI il y th t s(uumlJotil middotpin~ ~111 he ~middotJg gr~lVH(~(1
m mJxiTIt corrttt ion wll iJl i~ lIllCd to Ih - xt 1shy
lti Oilil y Jf tl1lt t Ut JO rl1t cdnUc idt md p OS shy
tU ll cul lapse ( th t ltHill enct b-tten l lUdioL) 1lphic egraveltamJl1ltlti OI1 J t th e ~lme pa tient in Sl il tl cling lOJ lline fX-sitiutl ) Wll ic h correb lc- onl wil ll fhe abilt ty of lllt p tu rl l gt s tem to C( lunternct lIk luree o r grl viry )cco d ing rv D lfVd- f3egraveLIprc po st li r t1 lt01shyIlDse is d ue to the Jnus -u lar ton a nd 11ll ex rCrIshy i) i itv of rhe tissus n the ( O IW-) si it (If the (01shyjl ti (~JtVe (Fi~ 3 L Pu~t llr1 C lltpstl lu lcl l ~~ reduc l-lt by llwans o f pl1ysica l cxerCles specitkally s tuclled ruuml i rnprove tIlus--ubr fOHt md lU pr )cllI Ct 1 ~11 hi shy
lizing ffCd
PararcL n tll CIJ cl the cr iti ca l (3 c1 thlsho ld beQ ld Il ich defol1J lHU n of the i pinlt 1 e~ in~ ne dtlllontr~1t _cl (1l ll t grclrf r mg] o f rllt C II in a qa m bng pos ition corn pOil 15 t l lowcr detormashytion lhnsllold (Fig 1) ie to ~11l Ulne3Se t the risk of pr ogr t~ lu n There t rh eJef re l J ea r l)iuuml 1itshycJ l ~ll1 l l(tl a 1 tnr tg ro b ohwined by d -cr t l ~ illg ilmiddot pU~lUrll cull lpse ptJcelJtge w bich lccording t i)
h llTd tnd ~l(heJ1l ~on 1~ b inde cl 1X llt icularly luumlgh Ugravel mllcl c Iio~ i (bdow 2( 0 ) (F ig 5 J
Fin a Il III ch iS respect lllljl hl and b um l 01 m linmiddot
ii iI 1 l _ _~ _ ___I ___ ___ __L ___ _ ___ ___J______ ___ 1 ___
li 1 1 1 1 i 1
1 i ___--____---___----__-_---_~- _ _--_ ___-+----
i
1
i -- ~- -- ---~-----_-~-_-_--_1-~
l ~
i
+----r--------t-------t------f-- J
Fj~ ~-Ac(XjJlin(Q luuml T O rIcd ~lnd Na(h(ln~ n i () dl( pCG w rd (rTIshy
POO ll is hiherin cu rvegt in wh ilt l1lh ~1flILWrd cII1I Olk l1t IS le- pr(v~knt ln th e grtph Ih t PogttJlJ I ugtnq) Ot1 -J1l j elfltS-e J tlt 1l1t obb dirr remc rlLIv obu incu f roll l the Cohb atl( 0 1stlI1dtJ1g IId gtupinc rldo~raf115 Ih Ille lt) [1l1t1 (i lndnl I pine) 511pille the ~(nlClu tJ1 compo l1lnt U rlk CU Y _VeJily I~ ltx p rlt 1 L1v UpUlt (obh Illeturo Ih t si _b Cct rtJeSIm l fie -ltn J trd Ugraveltuuml shyuumlo n A~-i)rding LP 11(lt uuta o n l ( r1I~( in ~I 2JQ sup itlt curvt 1hi C(]l)b ddhccno l l f lO is -J-lultt( thc s ldnd inr tnla Ol1l t lS wi Q) whil 11) 1 1)401 ~llp lne ClHVC If ~ 1Omiddot ( tcl Lhe ttnd trl~ nlca~ I(t I ~ ~I)
tli n ll w l lllE cq lin ti spin h~ i ng mo r ~ Llnt~II) 1 tlun the nOftl111 one n Cll l gr(lk ( (cU ve tl1u n da r u p shy
po rt in o r k r 10 m linrl in tht 1xi11po tuf_ n th ha__i of th egt onideratl lr1S it f(lll() rhJt
ph rH (~Uuml e erd es ulukl h u - ul iiuml tbeacuteY ~U-L lm cl 1l (It-d o pmg p05111 td C Jl1twl lS fuumlrnll~ rly d ccrll1td ln an Ql St if i imr ol1111 t ru t(( - tht m(d in C JI shy
r t t r sture fO Ir -ngthen tlll m u ck-gt of the spint mainl) in (11erl antig r3ilrl tIcirclt l]lli fun ctin ll U hy meU15 dl i )ll1 t trk ~ lhJ cl( -ll tlt C)nlr~lUions ~llld no l IdOshy
1l)llic d YIltll1k lt l jAJ lktic t) I1 ) II 11)t 111 hd posibleacute t lcluuml ee postura l io nrro and stfh ili lllllt IJI
w i thout food T1lw(ull r d I( Lf(11 Ibk t m ucircnuin Ihe c()rf ~ct [ ()S tu re for cl gtu ifKi IH lLl1gth 0f ti l11 ~
This i-l ddl usl a typl 11 dnmnin (tf k inesllh rap) in 11 (lt-11 [[k - p~d fk lnr in lng f u l1a in llllliCk is poss ihle lI sing ctrtain Idncl fJ l (lt) 11111 liun S p Ul in tb is Cl c is ulttful ooly sa I~tr 1~ il Iw lps t1w lxltknt 1 becuJl)t 1gtlt ltlt-I a ClJu~l inred irl ilL ntllru l o~ i cll
and I1lll~lJhl r-keJc LIl [rll-llIn~ middot etlt(wrs JI the int e rmiddot vlnrion
[J ROPA MfJ) I()Wf-I YSJ IR
1
ICR 1 1-1
r
1 shy ~
- shy
11 o-llrfOlhe5l~ o t Ih 1O~(1dity i n h ~ r ~ ll nr pbl1 l of ~ Spl11 in 111011 _llti1Gt l lPt f ltlJUCWJtl ( ~l Ihe Ir t 1 1gt illbll W Ilh LtltrJ1dlion Vln lbe rigronl middotUII~ l(I Dko n12 lIll h lumshydlanie1 1 [ nul 1 M hl whtrc M - gt) lnIUI1g 111laquo111laquo1 1 1 c rtJCshytjC~ f fce d -d Lill l1~ o f enr niI pUll spnmcl1y 1~ 111 mldlll1lt (n the fl1ur t 1 = tor~ of f(ward Ileuuml l = ughtel1lng fmiddotr p 1shynOf stn lClU= Alaquo rdtllg 1raquo Ihl~ - lin hull th l1ltgtllugrave ot tller1l lUr~Jtllrc F the ~pin t -ilh rlu1i tf Ihl 1 1Ibulll n lrlt InltT1 1
rbc prJI 3IJi l1ty d qrlOIJ~ n bull JI t IlJIII Hm lA the v=ltd gtc e lu-ing J 5lnK1ura i ltfnnity
Dioal e ch anicll itllp~lir J11 c nt
Ihrcemiddotdimcllgtional mc-cbal1in of the s pioc
~f Ikmiddot i t i nly l(œ ntly tlHr llk pr-5tnœ or nc ushy1 lnlo tnr impairment in Idiopttlllc s-ol ii IXl tknt liuml J$ heen h i- ll licircghlcJ hy re$eJ rh tll e preit ilegravee h inm b nIcirc Ji d lJutg~ lt hl ~ 1 ng t o n dO Ulll urcel 1 i5 (l lreldv well umlersrood H(j-ev~r nev lbt un h iomcrhankal im l) ion nI h1c rectm ly onk l n tIlt tre and p r~dou in f n rmtinn hou t pl1ykd (~fcl5( in t 11 0 tl1I _ltgt pbne of spact 1115 Im trqlt-u 1rom J i-[) v ing unclcrsrmdlng ot th l lmc -dim nshy~ilnl l l11 ~ hmk f the cO]jO[lC pln( ~2middot ) ) Ve- w ill )iI xnl t l1 d at lcL-orcltng tUl cl sif iol t lOn blsed o n gtolllt lricd h uumlCJ ) p lane
- b() rJzU[1tl ln th i pla n ~ th t 1o rm ll sp ine present no CUlye- w ll ile Uumll(~ ltc U Hic spLnc clevelops one of ir haracterls(Icircc deFo rm tiCs v elt tbrd ln lashytio n vh icl1 pJ()VcA~ theacute hw 11
- lgitltl in th llulJe U l(~ nonmll spIcirclle pl SenL kypl lOSis ~nd l dooi~ in tb lXI1 lhese [(Hu rts Vere m)( til ught [ 0 he relattd tlle scolkJtlc ( lI r Vegrave
- front l in hi pleme tht ncrmal p ine preseuron t no curYegrave whil thl ~11li tic p in ugravetI I ()~ icircl~ charshyad t Ilt I CU1C
Il Jri fJIIt palic
~l+I~na ra 3 r inr lut th l[ ber ll1d a œl1~lU1 degr 1
l f r()la tJo u lllu (lILa r forcKl ltxert ltJn tl ldefnmuumlng 1 tkllJ [J i1u a re- lhlt tll cly 11 [1 1 UI b y Olm ner w bn ~lh uiJwd tl egrave ro t1tic) l1 Ilm it ti lt p ica] lf shy
rhrl r() be (P (the Uma bevond Wl1iltJl th lCOJlb of [11( ~pmaJ musd ~ dthc COnCIt and nm ex ~l le btconk (t O li~[)
r ~l 18 ~1Il N lu t( ren i9 lun lu ted rlseurlt h in tlt ) tilt lULodeumlformipg1 tlo n ot tIH_ sc laquoJrle rh ox ercallkren lk 1l1~H li d11r once thl Il i ~ r tld1t5 [he lhrth ld f 111 JlIcirc lIi of tlle dnrlclc hurnp tlk
lI bslt Il l nt rlet()rlll lIcircon 01 the it l ()I~ C ( (ylm der (- sustalnecl by an H1tmi cforming aCOOIl
J1Ji h V hl rhyiical f~ f Ise CI 01 h spr n llnd kin middot ith ccedilrapJ my lX damlg ing vll e n l pplild as flle
igt Jk Iller ln SCC1IJ ~IS lllc lJ fxceed l auto in middot crca~ i n g lhrllgthuld [1 sh (~u Id ahn be j ofed that Ilw relscd pre sun 1l1111i insiugrave l fe pil1r inn) 1 mlshylt
- j Il- ( w atff 1 (nh ~1l 1(e Il10 utoldrml ng li1eCh~lI1 1sm
in flc l Geyer ~w tcd th1 t rm m 1 hI l)1ecircch1O lla1 puilll 0 l I C~ sw m mim t Ieuroamp no purpo t for cu lshyim le pllilt t1 s (weumlO middott r it is l~Jl(gtWl1 rhn in iculio r[ paULnl -iJl11T1ill~ doe_gt nor Il ~lp to i ncrt~SL n eur(1shym tor co mfU
(1irai p an (
Jerdnn lle 11 showecl thal ill CSl~ o f t10rLC IC 1i lUgrave
tllo lacolulllhil it lio_1 tlle cte tI llmiry in (he lg itt1 p lln t rn lnlftot il~ lf tspe iuUy in tlw initi 11 r luleuml )f cV IU[Icircon nf Ile ~oli ls W iU l 1 p(t)gr~s~ivlt il10middot~ shy
ment roward hvpok pho b G ll f ill~l Im lins l har dUflng (IN eWllLlfiu1 of 11Imh] co luumlgt i the l in t ot t l H~ gClyty Cegraven te l - 0 1 v llebed lxxli 5 r ro ject 1 seH fl r t side-ys and tlwn backlrcl bull thu~ p(0(1 lj n g a kyphQtlmg aet Il ln (h~ lu mhnr --PIl1 COftj tng
l l i tc Iugrave l lltl l( l rs1 tif s L -etllgt il l the lgirl11
1 Hl)
Ilu LE nI rIIY~Ic~L lXIlKISI 1 HI E TREhTMEtn OP JIU IDIOP llII C AD O USCUH O Ll Œl15 NEGR II
lLill tegt lre lenl1 ~I d ~fo rll1J[ ~ rhl recrSes the phyltiologiGII cmns of lh vine)
Accordlng () Dicion ~2 1 rtcluctio fl in the itgitttl CUIYtS combin l vi th a lueral Iviari n llltl ds t 1
mecban ism () ugravel~ta il ity in l he r rat r IllI1e which bVOf1i the unsd a nd i ncrea~e 0 1 co hlt1is (Fig 6 hiIf md Pl11jlbiJ Jl1eanwlt ile lt(udiecl lh e srnl ru t
orzyglpophySLs show ing t11 al ttleir 1I1tl rnic tl orienshytation f~I (jLi l~ltes aXIal ve rtegravebJl l rotllio ll in cun litluns lt f dorsal hypokrrhn Icirc tnd lum)H de i L lo IS
Tll t dat SLlgge 1 th t impOrfill ut pOitu res and l1lweil1 ) t Mudied in ord t r (CI mlIuml ntrlin or to reuwer fll e p llyslo lo~lCll ClIlye in lIe SlgJtta p lU)l Wlth the llm o t ch ~ kin~ rutltor in l~ bili ry7 AbC th ~e ~k-
1l11nL ~Irt del lnt [0 J jUc lt ftber l]kuti inrervenl ion vhich 1c)LJ k l IV - i(l ~ l compktl n l ililll on Il t c1 l shy-jel1 J11UVllT1ent IJ j o f 1uto-dOneacute(3tlon ( i e a -impk ld ion ) Iengtheni ng o f the pilleacute 011 a litlltl l aXl~ tll lt ((IT liJlI~rcdu e~ t lle ~---lJ linti- l lte ml-fkxj(l n h UI 11 - i llCrl I~t the plllH ](JgicJI dlt cr ~l S ( (1 k-yvllCiSh lIld O(ltOSh l o r c lch r1Iif n t a Ilew til(~ecirc dUuml llt Ilshy
si lflltl J ll1 u(~nlent iam ecl - 1l1t0- lIrfe rionmiddot7 4 llmshyp oed f Je-rura l iUIl cl middot-t1e- iltm lI1d ll1a intltnUlLe )( 5lg it d C Uf (gtS slig lll thltJrc i ypI1 tiZ) tIcircOI1 a nd lunugrave)ar 1()fdos i7~llion) sholild he esw b lb]HU 00 lb co
hl b oi hi p~l11il uU r -1Ir vlt Abo 111( e IlltUtl Chl lie o f purti n - a U vitk slJ1ultI h e )tuumlll ecl 1)] (1 n ldershy](ion r tl1i lt type for e upIe IilJ llyl)T S of repd shyiti( ml vemen prt n t in agonistK h)lnllltlSlks nI iIle kind f dlJ1ce C( uld he ([([r imentd
FmiddotO lllaljlallC and mobili ty of the SpIcircIlC
1 rd llo U 22 d L lm nrrare d lhlt in Illt fro nt a l pll ne
tilt 1 nge Clt 1)1lt vtment of tht scplit[i middot CU IY grcmr lIJ l il ~ d irectio n n f Lhe C ITelt tlO n tha n in tl le di re shyLion of pmgressi n l Fig 7 ) he IL o IS5err lJd tbat th15 mohiliry increac plrtil u la rly n apic [ cgcoeilts 1$ lh ~ ~c() li osb evolves Sragrm rJ 12 J ~ thus rigilt (0
VlI f n rller~p is ts Ilo t t) m o b uumliz - a sCtJl iu til curve w ilhout t [ uling ttwt tlle R lu tiOI o i til t ~a mt b fnlinruumln( 1hy l1tans o f ~I passic 01 1 rivE -uppnrt On tilt (ltllE r hand UgraveK d e iJlioJ1 in ease durill tlw tune 111 whicll tll C spmt i ~ not submjtrcd to correeshy( IV anl()n
j- Virh mi lei ol i b tlllt Upp i1n ill) lC tiol is d eveloped only lllmugil llClIf()mu$Cllbr f r llce thi ~
InegravelIl ~ thclcfo re tl1l[ inu eascgtt sp1J1all1extl)iity mua
11
Imiddotiumltgt 7-rurd illt Ir) 1 bull rdrilt I1 1 in tl lt frOlllll pbnlt- th( illl ge )r mOC llIeJlI o t the S-o UIIJC CUNe 1 supcrior in Ihlt diflt(l im ugrave( the n nKlIl thd n ll1 tllc dlrtcLion o f p rJ1(l( (llIl
be considrCtJ vntrl iJ)(l icltion and 1 undrli neocirc ab L a ~ubiljz~ILion 01 tilt spint pllss il)1y ohtl ll1td thrltJugll the stlengtlkl11ng o f the 1rltJgm vlt nonil lme shyCIC 111 illli orrant u bjcLliH- ln rhis r~f1 n sp u lllni lc tivitIumlLs sil uld lX tPI 10 dlegraveltl it l G lU t n w l1ik luring kine i Icircth lrr phyltical eXegraverci c~ tllat in ele
spinal m ot ilIcirclY sil nid 1e lt1 oid cdrt ~
Organ ie and psychologieal impainncuts and li islbi IiI le
A cgtI im lc pmi nr is moriOthl11 just 1 sp in and 1
compkt gt Ipp rnach to the gu in ad 1 ont i al~ shylute l e~se i t i11
[)a la 0 11[ [n ell lrom re semh pw tbat ome organi Iilnctiond cl fki ts suc]) as tlw clecrtiUe ut vild l tnd d fun ll l)Kity_orld ldly incrtJ k whil~ 0 shy[io s i -till in (1 miel q g of g JltlV ity ~ l ilI e 55 rtI lit
tllL pres e n ce )fl defidt Or Vi l~il Clp~1 - i~ ln one pIIiem in Ihr l ftectecl by 20 ICl 40 scoi stgt l ls~a r(h cunclutecl in tbe UA by Di Ruce- prod uegraveed an aaalo) u ll1lXimum 102 re u t in a group of Jd shyk 1ien t [(h sco llosls rang inF frum ) [0 1
Al10ther rudv bv rallt r m C chr111 lilcl NashycWrl1s( u 57 stlO eltt hil $(C 1 1 ui~ Ica js l( lllt cl (1 shy1prUlllI o f t1tgl lie bJd l imI in ~ul sct t1 t ltu b middot iects jlLltr l5 they are golng through ~I cltlici[e sllge in the fnm 1lt i n 01 tlWH o w n id uHitv t factor hit h Illy jeopmlize the cl velopme lit d ~ mIll lt lI1d htIshym cecl IWI sonalitr in Klulrhood
n RUI ~IEDl(( Ptl Y1-
ROU ltHmiddot PI [ I C~ 1 EXIRCIS]~ IN TI Il nW~JUNT OF SlllO lDIOP1HIC AI)C~ESΠ11 C(gt1[Oi 1S
This i why b IiCieacute ii is ~n imporrlIl t for p rcshyvegraveml e 1tLsr l tn en ou flge 1ari e nrs ~lfrecr(d by lIillcl middotu iosis ft) tlke p~l rt in portin -re rcatioluJ acrivitits Iha t 1eIU 10 L10 th r~1chophyinLl bull nd b~l )i 1l1o tur adlieem t n li 51Jmiddot2Even tlK)ugli [Dr bic mech~lnshy
ical mcl nellIUll10t 11 11 reltl ~ons lt r111 1gtomcrimes be l lefu l to ugg( ~t ne p rt in~ aCt iv ity r l h (gtr rll n anotlJer e th ink Ibal an exces~ ive IlHd icalizltion - Icirce l ll1posilion br plry~ilt i HlS nnejlor parents uf rh ry pe of po rt to lx p m lice 1 b Ule p 1Ucirc(Il L th1[ preshydLl ck l1 is fret clOice in lh ma tt r - -h II ll1 he avolc1ed wb 11 possLhle mainly for tlle i mport~ltll psyshyLb ) jogka l fe a SI)nS W( ha( ill ~ t nltntionegraved
Conclu ion
lbh ISsertegrave d t1H physkal tgtXtlci o is ) n fi ial whlIl practinu in order 10 ilnj rove the I11 llde
rœ nwh and tono C iral caplCiry and postu re o f the StOUO(I ~lIbj n II I nowkdge om ~ middotmg trom ci el1shyrlfi rls(~ Jrc li dJlJ accordl ng r the review 01 thE litshytirlture prnpo )td in t lli plpl r conflrm~ Ihe vuiclit ot th e -t ls ~rti ()ns
In l do l (ent Id iopl1il iC scoliuse il l n phee u i cl vk)pm e n t ( li tll iumlKh eXCC cl l g i en rhk thr hokl th e re i5 an und ubred need fn r l pprnpri 1tegrave (JJ1tOkJJe ~Ild Inr surgict1 therapics ill ortler 1) S l i p
the ( - Iuli on anugrave )JT~t~t UW ~pilll l dtlormities bull evshyerthtless in the illiti ~ll pl l~sC t ttlC c1iseLltc whcn the riS( r1 r euro )luli m is rtduced ocirc ~md tfle uifleal JOld threshold il ~ld flle po stural collai i reJcenw~ 43
JI l1 igh pllysicaJ egravexe rc ise - p revenc or r d llCe d i ~lh ilir ies o f [Iw ~ l() li )tic
p (iems R 28 J -6 5- 6 1 63
- f~KiHtare lh ( n utr ali711iCUl of postu m l d elicits tn produCel1 a coneql l nce J [)ti 0 I111)( or regre si -u lmiddotc 5middot Il 1 17 ~ M
-re 51udles U ~ n Ledecl tu con[mn or re jecr these conClLL i( 1 w l1 ich clerin-d frum 1l1 lIldytica l rcltw n f th e liter~iture appear r- ~Lo nlble Hnwecr Intil ne re ull are 31Iable wc should n r prevent our sroliotic patientmiddot trom tl ki ll p lt in s(loI1ing jshy
ir its pW1iada rly ltl t ~d1()o t () n til t c ntrHY -vith the l xcclrinn 01 gt[1 )11lt tIlat in rea-e t)1obility (tnU evc n thell oilly wh n progr~lgtion b p OSSibl) -uc h ~I( ucircvshyiUe -11 )ulu hl tIKoll w g ed The 11 S J ( rprOpriue kin (~irhe r~l Piuml to incr _~asc p()~tura l $llbil i ty is tl1egraveoretshyic tlly CiJUClt alttloughl more ~Iccu rtte aod deLli led ri k benefi rs anJlr~ is is netot1ed
Ria 1111tO
NIokl Mu d lle ftitYljJfu Jœl il 4IWr10UOifll S (JIvs i (1~1)Jshylidl ttno( cclIll le 11(11(1lt1 RCI fu lle ((lia LltfIt l1 I1I1i(i
LJ ci n s j(r3 pigt egrave li n IHUgru lkl di t rdz t fi sici pe e ft shytUlKm iluppno di un lisimerap15Ll rl lllcflt() 1 110 scopo di pnevirlt () fr en~lI 1-lgpwlllltnlcgt dclld lclonnitugrave o e il 5LOshy
Il i mi llon lt fH nugrave j (1 11ni dei co~e 1 lteIl I1J J nd ne ~Ii eifclti (()Tc rri udk s co lio si d i m e dia g rt iuuml ln que~ltlt
s rud i 30 llizzb mo i d ti cleU ric lca pel n ri Icare qJJ l lm 1 dis(imucirc x u le I[~ l z j-m i pro vna le da lla C gtl k A i json ere pr middote-nute () rk kl ducirc un~l rdeguCltl d nil cra pi lt di uJoseguerrnt Cjua li 1iU110 cli nbie tti 1 rcr lJ)tIId d~ fle)-UITC
n (- -fd7Io n~lcl)
Ut11claquo)si 1 lI tori htpnuuml )ludi-ttn I ~ cnntI1zttu fr Cq(in i idiJ)tic1 dbfl lOZ10l1 d d ~ leOla nelllOll1otoriO Lb un1I1cnUl 1n1l1i3 dcgli 111 lt1i ch DIJgt gtU l H crmU1 Nlch~mslt ( SIshygnaJ~l lerimiddot wo i esuemi -bletti d~ plt~e8lugraver- ne l pClZ le1lftgt scoliodcu kl s iluppo ddl ~ ~ uhjlil~ vertcbral~ lt o svilllp prJ Jdle JIl7 i() nl di ltCjuiljbrio Dng li studi sul lto lb( l~nlrale (OllddU i in pa rticdu d 1 DlIal-BeHJ (gtegraverl ~ P~II IId lI1 n~ llw - idente il v- m gtiu p eT il puientc clioti elgt di u n rnigb o t c)[ ro Ua sw mle dei radlldc onsegull o tramite il 11 fforzrlshyfl len to d e i l1luotoucirc l nllgr3ilri d e luOwo con crcbi ~Clltdr
in pOMltHJ corrctl e in va rie ~i[Jzioni s t llicb c c d inamIcirc tllt Dalle on sena d elb blOffiCcclIlicd tr idimlt n s io mlle d ei
r ~ chi Je ~oU()f icn ~Icirc ~videnuumll (l() ~llt tC p IYZIcircOSI ln(IiClZlfHicircl ~ 1I1shy
liumln fluenzt Je ll middote~rUrio tl SC) lgt lIi I rc pibull m i tldln sJlI71 Stl shygn~I I1 afferma che slI l p Ia no [11 middotccedilr~lk tre un œ rtlJ grado di l L1Liuuml IlC dclh vEltlh r1 apj(de le tu rœ mu SCltJ llri njtbc J n in $tJ ) t rodcfQfll1t1l1te PltJtantu b i r~it-~ r -lp il puugrave t~~
Ixnt-ftla solo nt Ile so )[j)~i Jl1Icirc na rl in qunnt ) ilon SlrM ntne )(l(Ofa tu soglb in caq ) co lltrLJIcircn l)lrilto llt~( i lJudotlsi di lfr~ lI1 C llg grVlmenl J 111 11 io lr riltd ll(17jOill leld rinlle 113 dimO~iumlrlto d llt nell o lin~l cl()~ li t th~oIOl))1 dri la defltgtrshymiti sul p iluO slfl iuale ~vohl lf1 (en5 ion~ sO lnm utto nd 1e bsi iniliali deWggrwm1Cnln mcn trl C a( lfLmn che occlleshyvoluzi ne dene = 110 i [ mhari IJ lin c l ki cen tri ch -1vi1( de i cp i CIt IJ rI Ji SI p m ittIl pnm l Iem lmeme e p o j pOS( shyrio fllwnte dtldnli mdv ( i un ziuuml ne ciloliz7nnl dd rlLtide lu mbJ œ ( lIlelttlaquo on NC n d d (gt11 uIdu m 1I1 Ilgt) cli r-Iure (0 eserClzi che IllUllengano 0 ltlUperifo le Clgt 6gt1 lo)iche sul pirluuml gilwlt Su l p iCl no fron itk Perdnulk il dlll1lt-trlto d1 lampkz-l d i LU ovimento amp111 lI rv Kolio ti ~ nd lt1 0 ddlJ cnrrc-LIcircQo i Ji gC 1 n lungl SUpegraveliltlrccedil 1M llS0 tlell 3ampIGI shyvamcnlo C che l~Jltmiddot mobiliti GlI mcnta co n l c lu7j o fle d l i) snAio i A ulln amplgrtJc1 ltllllmunjx~ i terlpGli nn n m obi shyUZ73It ma eutva coli ti0 1 1ct HsicVlfe nd tcmplt 11 1111nshyttllIcirc1nc n tc (k ll ~1 llu u zinnt n l1 un me77uuml d i sost l11( gt ln 0
e 11111ri b cle - Ilziunc egrave deorinatcl d l rlyarsi Snzcl la pr gtshy
liltlnl l i un() rtl~ i ptmiddot Jtl n(o 1S(Hl () (( ntJ() i ndit~tr i ~ Ii ISt (izi e l m iviL Illdlode ebe Hlmen tno laJlc ibiJii dcl rlc lide SCshy
li io) [n p articobre rune q lldl r C-I1 ich~ xlSiddcHe CUf t shyli ve ch~ iJllpi tgino e~rciii 01( biIi2 ZanUgrave HhnmL-trid () in tmiddot~t~nshy
sione kl fuchide O tne pure k- ~ttivit1 tnotoJII~ non prHi(~ llCcedil
in forma r k rel1tiva d Ie ~1I 11 rF~1l1( n otcol mcnlC 1 lll ubib Ll vcrteblmiddote (ad ~ flp j(l 11 n l) to L ginn ~Iilt Utl clkl rilshyC
mka la cli OT- tcc)
r1il to l~ _ I[Dl COlI rY IC~
NE olUNI
fillncr ( ni ((uuml(( n hIIo( rilclIO ~middothe k lln dtfidl fUr1z i shy
nlu CQll1~ la llcl llZIO 1e delb c apKJl ilde e della capacltl di 0170 mizianu luJndn le (OJ il~ gtna a nc r3 di m~i3 gmshy
v it ln G mlxl r i ~ gko Fl llslrom C dlllJ O e Nachcms(J h iU1I) dim lr JtQ che b o liosl p IOO C1 neUaduksœnr 10 SYil l1p pn d i lIniumlmn~gin nlt8Jliva de corpo in (o nridcnz di Ln ddic3w p ri d di f( m l lz i nlt deUa SUl idenritl condishyZltonc ch pOlrebh ~[I cubrmiddot ln vilu pp di un pe bull n nn lir m llur cd e quiJibfarn in t[C adulro TaU CO1DSCe nZe tvlde nshyZ[II)() la n ( middotess iti di ltimobre la plfte ip a7j0 r1e atl an ivi ll1ltHClr n gl b a li ltl h ~ di tlpO s pu rti middotu dl ittlrc nd gloani iCo lID ti i lirtugraveta z io ni llb vila di relazionc
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EUROP MIDI C Pli hIC
EDUCATIONMEETING SATURDAY 8thof APRIL 2006
(iSS
SEAS02 Scientific
Exercises Approach to Scoliosis
version 2002
G
S Negrini 1
EDUCATION MEETING SATURDAY8th of APRIL 2006
Neuromotor disfunctions
Neuromuscular disfunctions
11 Postural collapse
Postural collapse
Duval-Beaupegravere
Flexibility of scoliotic curve
f---I--- I Postural element
-------1 Structural element
S Negrini 2
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Postural collapse
Duval-Beaupegravere
It is a value related to muscular tone and to flexibil ity of convex side tissues
Post ural collapse
Bunch e Patwardhan
Critical load
Load threshold beyond wh ich a spine begins buckling
JI~~Wt1lW~flfthtlJlœJtAr ~ J~It- l~l - IMS
Postu ral collapse
Bunch e Patwardhan
If a curve reduces there is an increase of the deformation threshold
~~~NW~-damaoc~IIIMf ~~ J~Iv JaJ-I7I9sect
S Negrini 3
EDUCATION MEETING SATURDAY 8th of APRIL2006
Postural collapse
Torrel e Nachemson ~
Scolioses below 20deg ~ ~ lt~
have a high ~ ~ percentage of ~ ~
~postural collapse (on u~
average 75) ~~ 2i~
CU~VE O EG~EE S WHllE SUPlti e
~laquotd~c6b ____lPffI1wtt1t~
$ww J(t ~~7 JM5
Postural collapse
Minor scolioses 7
Antigravity musc es strengthening D
Reduces postural collapse -G
Increases the critical threshold of deformation
G
Neuromotor disfunetions
Stagnara
If we admit that one of the causes of idiopathie scoliosis is a disfunction in balance systems it is logical to orientate physical exercises toward this direction
s Negrini 4
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Neuromotor disfunctions
Dubousset
Idiopathie seoliosis results fram alterations in praprioeeption centres and deformation is a natural compensation to restore postural balance
etattJtitIK ypothfQj~S ___~ own_ oJ)HQr lar 1t-1( r
Neuromotor disfunctions
Nachemson Initial idiopathie scoliosis
+ Goood spine stability
Neutralization of postural deficits
D Static curve
Neuromotor disfunctions
Therapeutic aims
c) Development of spine stability
C) Development of balance reactions
G
S Negrini 5
EDUCATION MEETING SATURDAY 8thof APRIL 2006
Biomechanical disfunctions
j Horizontal r-Ian
i Sagi ttal plan
Frontal plan
Frontal plan
q Frontal plan disfunetions
Fronta l plan
Perdriolle Movement magnitude
gt in the direction of lt in the direction of correction progression
S Negrini 6
EDUCATION MEETING SATURDAY8th of APRIL 2006
Frontal plan
Stagnara
Never mobilize a scoliotic curve without ensuring reduction maintenance over time otherwise a greater mobility favours scoliosis progression
Frontal plan
Ducongeacute~ research
On a group of adolescent idiopathie scolioses treated with
Meacuteziegraveres gymnastics
D After 1 year the mean angle of
curves increased from 18deg to 29deg
Frontal plan
Scoliosis without brace
D Greater spine
flexibility D-
Risk of progression
S Negrini 7
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Frontal plan
Mobilization is useful
D In preparation to
brace
D With brace
Sagittal plan
QSagittal plan disfunctions
Sagittal plan r middot _J o
Perdriolle scouos B CJ aDeformation of D
thoracic and thoraco-Iumbar curves evolves in extension
S Negrini 8
EDUCATION MEETING SATURDAY8th of APRIL 2006
Sagittal plan
Graf
The line of gravity centres in the vertebral bodies o s c oUOSt
projects itself firstly laterally and then fi
o
posteriorly lJ ~~ ~~ ~ ~~-_J-D ~nI~
Sagittal plan
Therapeutic a ims
D Maintain or
retrieve physiological curves on the sagittal plan
Horizontal plan
QHorizontal plan disfunctions
S Negnni 9
EDUCATION MEETINGSATURDAY 8th of APRIL 2006
Horizontal plan
Stagnara The forces applied ta the spi ne act in a autoshydeforming sense
Horizontal plan
Dimnet Rotation gt 200
ampII~ (
D The actions of concave and convex side
muscles become
agonistic
~ItJrOnrIIiItdllfUClltlluumlll~~tI ~1JIf1laJ
Horizontal plan
Minor scolioses never exceed these autoshy
deformation thresholds
S Negrini 10
EDUCATION MEETING SATURDAY8th of APRIL 2006
Disfunctions at a biological organic and psychological
lever
Oisfunclions at a biological organlc and psychologlcal lever
Cheng
Bane density in scoliotic teenagers is lower than in normal subjects
~~~~middotA~IIlUtIy ~7œl 1d l
Oisfunctions at a blologlcal organic and psychologicallevel
A significant reduction of vital capacity and V02max in teenagers with a medium severity scoliosis
S Negrini 11
li
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Disfunctions at a biological organic and psychologicallevel
Disorders in the development of body image that the teenager has of himherself
Disfunctions at a blologlca l organlc and psychologicallevel
Therapeutic aims
cJ Activate cardioshyrespiratory function
cJ Favour bone density increase
cJ Develop a positive image of the body
Disfunctions at il biological organi and psydlologicallevel
Stagnara
Sport
D The active side of
kinesitherapy
S Negrini 12
EDUCATION MEETING SATURDAY 8thof APRIL 2006
Disfunctions at a biological organic and psychological
level
Distunctions at a biologlcal organlc and psychologicallevel
Cheng
Bone density in scoliotic teenagers is lower than in normal subjects
~n~IIIvpWr~middotA~stWy s- XXJl M J
Disfunctions at a biological organic and psychologicallevel
A significant reduction of vital capacity and V02max in teenagers with a medium severity scoliosis
G
S Negrini 11
EDUCATIONMEETING SATURDAY 8th of APRIL 2006
Kinesitherapy on the scoliotic subject
q Postural control
q Axial stability
q Muscular trophism
q Balance
q Respiratory function
The limits of kinesitherapy
There is a threshold beyond which
rehabilitation alone is not enough
sssr
Kinesitherapy in scoliosis treatment with brace
Therapeutic aims
S Negrini 13
6
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Therapeutic aims Srace kinesitherapy
With brace
il Postural corrections and
vertebral stability are obtained by the brace
Therapeutic aims Srace kinesitherapy
In preparation to the brace
il Mobilize spine on ail plans
Therapeutic aims Srace kinesitherapy
With brace D
Maintain a normal spine elasticity
~ Maintain a good muscular toneshy
trophism
C Model the hump with kyphotizating
exercises
S Negrini 14
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Exercises and their methodologies can vary accord ing to learning and individual sensibility of the single rehabilitator that proposes the m provided that they stay within the
Iimits of fixed therapeutic objectives
li
Therapeutic modalities
(Exercises)
QAuto-correction
QRespiratory education
QErgonomie education
QMuscular strengthening
QDevelopment of balance reactions
WNeuromotor integration
ci Vertebral mobiJization
QSpecifie modalities in brace treatment
S Negrini 15
EDUCATION MEETING SATURDAY 8th of APRIL 2006
The protocol of kinesitherapic
treatment
G
QChoice and dosage of exercises
Variatiosn of the work program every 2 - 3 months
Q Execute e)(ercises on an individual base or in a small group
Q Frequency not less than 2 times 1 week
Involve and awaken the family
G
S Negrini 16
EDUCATION MEETINGSATURDAY 8thof APRIL 2006
Q Determine the action and the localization of auto-correction
QAuto-correction must be associated to ail exercises
QAt the end of treatment ergonomy lesson
Auto-correction didactics
G
SCOLIOSI DORSALE---- shy ----
r
S Negrini 17
EDUCATION MEETING SATURDAY8thof APRIL 2006
SCOLIOS OORSOLOMBARE
shy
SCOLIOSI OOIlSALE 011 bull LOMBARE S1I--shy
SCOLIOSI LOMBARE
il --~_-
S Negrini 18
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Scoliotic patients are not radiographs
middotSeoliotie Mtients are not ndiographs but hum beings with a vertebral deviation-
Slagnara
Metha For the physieian Cobb angle is of utmost
importance For the patient it is body deformity t hat eounts most rib hump a protruding seapula or hip We are in a situation in whieh today dodors eure the radiographie deformity but what the patient really desires is to get rid of clinieal deformity and of ensuing psyehologieal distress
CIIQItIo shDuIdtucirc lM WIld tJw~~ I~~M~~~~ J9f~
S Negrini 19
- Poznan_workshop_Physiotherapy
- physio2
- physio3pdf
- physio4
- physio5
- physio6
- physio7
- physio8
- physio9
- physio10
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1
Ortopedla TliJumatoogia RehlblllagraveeJa ARTYKUL POOL1 DOWY OPINION ARTICLE Vol 7 Nf 1 2005 49-$11
Krystyna Dobosiewicz Jacek Durmala Tomasz KotwickP
Katedra i Klinika Rehabilitacji SIAM Katowice 2 Katedra i Klinika Orlopedii Dziecircej AM Pozncrlz
Biodynamiczna metoda tr6jplaszczyznowej korekcji skolioz idiopatycznych - opis metody Biodynamic method for 3-D correction of idiopathie
scoliosis a description ofthe method
SIOWQ kluczowe leezenie zachowawcze skoliozy idiopatyczne korekeja tr6jplaszczyznowa Key words conservative treament idiopathie scoliosis 3-D correction
SUMMARY
The biodynamic method of hree-dfmensional carreeion of idiopathie scoliosis is based on Ihe palhomeshychanics of idiopathie scolioiiiii and consiss in aClive segmental three-dimensional correction ofspinal cllrshyvatlre The course of action focuses in the viciniy ofthe apical vertebra Proprioceptive facilitation is applied on Ihe concave side ofthe curvaJure and exteroceplivefacilitation on the convex side Correction likewise proshyprio- or exteroceplive facilitation is phase-oclœd with asymmetric respirarory movemenr as weil as wilh parshyticular phases of the respiratory cycle ln Ihe course ofexercises three-planar movement is generated opposite to the direction in which scoliosis Is progressing This method is in accordance with the stale ofthe art ofscoshyIiasis pathomechanics The method requires detaied training and can Ihen con be applied at home under periodic control by a physician and a physiolherapist The method con be applied in landem with a Cheneau brace as weil as in surgical pretreatment A elaUed description of Ihe method of three-dimensional scoliosis trealment will be presented in Ihis article
STRESZCZENIE
ISlofa biadynamicznej mefody Ir6jplaszczyznowej korekcji skoioz idiopatycmych oparlaj est na patomechashynice iikolioz idiopatycznych - poega ana na czynnej segmentanlej tr6jplaszczymowej korekcji skrzywienia Dzialanie koncentruj e siccedil w pobitu Icrllgll szczytowego sknywienia Stosowane iest bodicowanie propiocepshytywne po stronie wklllsej oraz eksteroceptywne po stronie wypuldej Korekcja i slosowanie bodicocircw propioshyi eksteroceprywnych zsynchronizowane j esl z asymetrycznym torem oddechowym oraz z poszczeg61nymi fazashymi oddechu W trakcie eacutewiczen powstaje odwrotny do lrierurzku rozwoju scoliozy tr6jplaszczyznowy ruch IcrFtshygoslupa Melodajesl zgodna z aktualnym stanem wiedzy na lemat patomechanizmu scoiozy nymaga szczegocircshy100-lego instniktaZu po clorym mote byeacute wykonywana w warunkach domowych Z olcresowq kontrolq przez leshycana i fizj oterapeutll Metoda mote byeacute stosowana r6wnolegle z leczeniem gorsetem korekcyjnym Cheneau a talcte w przygotowaniu do leczenia operacyjnego slcolioz W pracy przedslawiony zostal szczeg6owy apis meshytody leczenia
Skoliozy idlopatyczne stanowili znieksztalcenia patycznej rozwija siccedil poprzez przemieszczenie kr~gu tr6j~aszczyznowe charakteryzujltce siccedil wyboczeshy szczytowego w stosunku do krccedilgu g6mego j dolnego niem rotacjltt krccedilg6w klatki piersiowej i miednicy z r6wnoczesolljego rotacjl zgodnie z ruchem wskashyoraz zmianami w fizjologicznych krzywiznach kr~ z6wek zegara dia skrzywienia prawostronnego oraz goslupa w plaszczyinie slrzalkoweJ [ 123] przeciwnie do wskaz6wek zegara dIa skrzywienia leshy
Z punklu widz nia patomechaniki tr6jplaszczyshy wostronnego Koncepcja rozwoju skoliozy jako rotashyznowe znieksztalcenie krccedilgoslupa w skoliozie idio- cja i kontrotacja sugeruje ze sily korekcyjne powinshy
49
EDUCATION MEETING SATURDAY 8th of APRIL 2006
- CARDJOPULMONARY EXERCIS E
TEST IN GIRLS WITH
CONSERVA TIVEL Y TREA TED
IDIOPATHIC SCOLIOSIS
Jacek DURMALA Krystyna DOBOSIEWICZ
Department of Rehabilitation Medical University of Silesia
Katowice Poland jdurmalaqcmpl
The aim of the study was
to estimate the influence the conservative treatment (asymmetric mobilization of the trunk by Dobosiewicz) on physical efficiency in the group of girls with idiopathie scoliosis
Material
bull 87 girls with idiopathie scoliosis
aged 1 0-17 years
(mean age 135 years SO 161)
J Durmala K Dobosiewicz 1
EDUCATION MEETING SATURDAY8thof APRIL 2006
Material
bull 38 girls (437) with double major scol iosis (thoracic segment - Cobb angle 18-42deg mean 30deg SO 82 angle of axial rotation 4-32deg mean 21 deg SD 107 lumbar segment - Cobb angle 11 shy48deg mean 31deg SO 128 angle of axial rotation 5shy30deg mean 13deg SO 85)
bull 49 girls (563) with single scoliosis (Cobb angle 11-75deg mean 33deg SO 155 angle of axial rotat ion 5-30deg mean 14deg SD 83)
TIoracic kyphosis of the invesllgated group was 5-39deg mean 23deg SO 86 and lumbar lordosis 16-41middot mean 30 50 65)
Material
bull The 64 girls aged 10-17 years (m ean age 131
years SD 132) were conservat ively Ireated
using Dobosiewiczs method
bull Treatment period ranged from 5 months 10 3
years (mean 148 months SD 902)
Material The 23 girls aged 10-17 years (mean age 136 years SO 108) were treated u sing symmetric exercises - treatment period ranged from 4 months to 3 years (mean 161 months SO 1019)
bull 26 of ail g irls (18 girls earlier treated using Dobosiewiczs m ethod and 8 gi rls earlier treated using symmetric exercises) aged 10-17 years (mean age 134 years SO 108) were twice tested - at first and last day of Intensive hospital rehabilitation (asymmetnc mobllization of the trunk by Oobosiewicz) - mean hospitalization period 20 days (range 18-26 days)
i rf~8f6~~ or~~n~= ~~r~1~r~icircJ~~tb~~~~ mean 17-4 1deg meatl~(I SO 74 R n~le ofax 1 rotatIon 5-25ot mC3 111 3laquo S0 6icircl Ilnd 1 99t1S~ ~~~~I~~~~~$ruo~ras~ ~ocirc~~a~e~~~~~~~5euml1 9middotn~ tUfllbar Iord05ts 16-4 1deg mean 311 SO 68)
J Durmala K Dobosiewicz 2
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Material
The control group consisted of 77 healthy
girls aged 6-17 years (mean age 12
years SD 31)
Material
The examined girls participated in school
only in scheduled physical education
lessons and have not been enrolled in
other sporting activity
METHOD
The exercise cycle
ergometer test was
performed
J Durmala K Dobosiewicz 3
EDUCATION MEETING SATURDAY 8th of APRIL 2006
METHOD
The Incrementai exercise test has been applied
We have found that tests ln whlch the Incrementai part of the protocol ln completed between 8 -12 minutes duration glve the
bullhighest maximum VOz in normal subjects
METHOD
The workload was Increased stepwlse
bull by 10 Watt every minute - ln chlldren
with high ~ 135 cm
bull by 15 Watt every minute ln chlldren
with high gt 135 cm
METHOD
The test had been contlnued untll refusai of the patient or exceeding the pulse Ilmit
Durlng the exerclse the gas exchange parameters were recorded by Jaeger device model Oxycon Alfa uslng direct breath-byshybreath rnethod (with face mask)
J Durmala K Dobosewlcz 4
EDUCATION MEETING SATURDAY 8th of APRIL 2006
METHOD ~ ~~ r 3 min 3 min 8 - 12 min 6 min -~
_ 0 rpiYJ 0 rpm 60 rpm ~1 30 rpm
_ t o~w=att~o~~na ~~ att__~ tl~~S~~ l ad l ~~~~~r o~w= Hlcremenlal t
pedaillog i i ~
~ ilt ~I~-----tl-~ I t ~ i ~ lOSt sffortivB
lW r resututlon r rm-u middot 1 - bullA~cremen tal ~~ ~ ~ ifr- ~ VtI 1 ~i ~ tllng _
METHOD
On the basis of recorded parameters VAT
has been individually computed for each
child using V-slope method by
Wasserman
METHOD
For assesment of physical capacity
the maximal minute oxygen o
consumption (V02max) ventilatory
anaerobic threshold (VAT) and
maximal workload was used
J Durmala K Dobosiewicz 5
EDUCATION MEETING SATURDAY 8thof APRIL 2006
RESULTS
Ali girls with 18 have been classified
within normal range of predicted
values of
bull maximal minute oxygen uptake
bull VAT and
bull maximal workload
RESULTS
The differences between group of girls
treated using Dobosiewicz s method and
group of girl s treated using symmetric
exercises were statistically significant
Lower exercise efficiency of girls treated
using sym metric exercises has been
observed
RESULTS Girls wilh IS Irealed using
N=87 p value
Dobosiewlczs method N64
symmetJic oxor-ci Nz23
Perœnlage of predicled vaJue of
maximal minute oxygen uptake
98 905 0033
Percenlage of predicled value of
VAT 97 933 0049
Percenlage 01 predided value ni
maximal workload 101 939 0038
J Durmala K Dobosiewicz 6
EDUCATION MEETING SATURDAY8th of APRIL 2006
RESULTS 26 girl s twice tested - at fi rst and last day of intensive hospital rehabilitation
The value of ventilatory anaerobic threshold increased during intensive hospital rehabilitation (asymmetric mobilization of the trunk by Oobosiewicz) statistically significantly (p=00019)
2047 ml O2 minkg (SO 268)
vs 2239 ml O2 minkg (SO 232)
Conclusions
1 The exerc ise eff iciency of girls with IS treated by asymmetric exerc ises of Oobosiewicz is norm al
2 Such high level of the exercise efficiency of thIcircs group resulted fram using of Oobosiewiczs method
r
J Durmala K Dobosiewicz 7
REVIEWS
Role of physical exercise in tbe treattnent of mild idiopathie adolescent scoliosis
Revicw of th- literature
A NECRlNl N VElWNL s PARZI 1 A NEGRINJ 5 NEClU NI
P1t~silillxlrd~ Ihcrapy (or klucgtlttlwrlpyl i pro shy-tJm of physka] cXlrd-cs ipcci I(a~ (IJcloJgtcd hy l li trIWlltl phrslollwrapbt wilh tb m~ln a1mor pl shyVCnI in lhe ilAAfIVltilH1 llf the ucirccfonuity III mild IgtC )
Lil1Si bclpin~ thebm ( aocl co uaufllclilIg ils ~jd- clf IS in nlOdlJmiddotnh-culiosis Th middotalillofthi paper ito r (W
Ille Ii lc ram r 1 a-ccrulin wh kh of Ih bull Lu[Jalmlcrus Ind (Lb hili til~ CLlLt-cd br scnli()si- clluld bl pl Y nlcd or r d uccd hl phylolld LXtmiddotrdsi n Il p--to-da le knowl Uuml~l nr tIll~C aspcc[~ i ne bulled in oruer 10 dndc whclh~r 11Rf blLl adcqlmtt Ib(uuml n middotlicaJ balis fo r ora)aini l Ihe US4~ of lUgravellgtitlerap) wltcllj(r or fln l th e prtl1iœ of kimiddot ~lre IUlll poNjn~ a t iil ies ~bould h allowtcI II uuml middot c enliaI toltlentlf)wh k lu alClor ie - lf pl lr~kiJl -c rmiddot d gtlt- (Ic rnnhi UzJ( inn ni (t hl HrJltlon [ rtn~hcll iJl ~ or 1i1J(IChIumlJlJt etc) Sh llU Ld be TolullllCcluse ulemiddot l onld b- clclIimcntalancl wukh sho ll ld he IJlI-n~ifl~d I~~a l lhc (o uld h 11lfu 1 Know k dg CJnc1in t (wIn SeiCIImiddot Hlk rCS([lflt h daw ccordinll to Ih bull llVit w o f tIlt iii 111 1( plop(lsltd in (h i papcr lmiddotonllmJ l lnl plLyi 11 cxcr(j$( pn (nti or (tmiddotduce dhlblli t ic 1 ~lt Il Jj ll(k pl ti Jlt fadl j w(~ the nlIIIrl li7alinn n f poMural dd shylitS tu p n xJ llc aSl COIlMqnen c(middot 1 all )llal) or r(tn~ shys i middot middotlIrve Tilt u~c (I f appn1priattmiddot kincsiuuml wrlpy 0 in rcns polttllcal swhiIHy Icirc IIHmiddotorc Illta ll y (0 r 1(lt1 lllho UAh mon ltlccurlltc 1Ut dl1alkd -rLk l(lWfils 111111 )11 h Jlccdt(
11) wurcJlt 0 lit)-IcircS (Iumpy - x rcLs P()lun
n rllt lT(ltnklf u f COll1tlK H (rtd) I 1i plfho l og l ~$I rUlglng tr m low tmiddot k Pl 1l1 to IdiOpath ie SCUIshy
Submitt(oJ [or PUhltCl l1 011 uly Tt 2001 Acc~pttJ ugu - ~2 1(t-1l
Addre rltj-xlfll telt~I(middotb If) - grinl Flt(1(bziurllt r )(m Ofl ()(Cl1I shy Lt middotqlltœlll ro () - 1u I4t agravehLIlKil ta IYIL-lTt ilSllltp lfllmiddot ~ 1l1uumldull
CelII ~ (niiOS I I~ middot ann (1) IfUh middot lIlfU di louhilll(tymi ( Nlmiddot ~iI rli -ilIIUmiddotltlfl
Nlti(ir 1( ) il r() (ltbullagt1
lt vLL_ l IiII no 1ftfI
jS ) we are a IUil ly tJc ing n1n) ltblll lS 1 k l1 b ~J)w in~ tl~ t S Jfll l approad llt - l1n til hy on ielshyertd ~tan lard ugraveJuld ln m any ~1~ he lI ~t les i if Ilot dange r )ll lt rhlS is lrut of reil l lnw 1gtlt1lt1 pa in l ~ or 5urgi c ll lrea lmltnl5 in dbc r lmiddot ll Sc - 2
ln tlle cj-e ut ~ t lll(tlWtl i( li p l ll1JC luuml- I ~ middottnl ~() shyliosis phys cal ((_lt1(( is emr1uved ltI t()fIl1 0 lh~rtrv
lo ly in cel1l in L)lllllde (nluumlnlr in tilt Lltlll middotorkl i e Iw l) r llt t Srain hUI IIgt() 111 Gert11lny 5- 1~1 in other reg lOl1 wbere thi I-incl qf tre l tm e rll 1 p~ 1 pmiddot t 1( cI il Jws Ixen cri ri cilld md rel -cltd Lw m~lI1 1 11 Jlu~ Fue Fnlny r ~lrs thio middot15 a lsgt(ru( f ~rth r -~ltc rrJtf))~ ll t vit11 br1Cltcgt b r II1 ([C Llt n ClW grmvlng 1lt1 0 L Sti g
gcsti n the lIsefulnes- u r Ih is form o t treatm n t 1
Hmiddotu]rs have nerged jn El or uf pll y~ iLd eegraverdse eacute 00[ 1 but tlw are nUl yel 11 11 t llu i vIC~11 and r hi ~
f rm of trt ~ltmenr IS stiJ l Ul1 ckf ckhate FfI t Jt 111 il i 11t (eltary td 1I iFy 11umbtr ot
b l sic COI ceP rlJ lf w ill he cIh tt d in t hi pap r
Scollosis
DCijIrI iriolls
ScnUoSlS is Irlircc c1 lme nsIcircltnal (I(gt i l cj on ot tht spinc thar cau C a CU 1 lh lt ca n h e $ t~en ln (1 me1Sshy
ured ultinF Coh) lll ltllCXI o n HI anreu middot p rtc rilt r
EUJlOI -1 lœDICOPHYSlc~ IR
NECRI Nl
110
f)i)
1 7J
amp aS g 5li - 0 v
V
31
10
(1 1) Il 15
-tc i ytjtr~)
FigJ----jllph ot DlI w l-lkaupegraverel) The agloimvltltinn Or idio r lrhlc 50gt1iflll~ IS rpiJ bel~ en th e- [l0 IH P (l)ltg tnntll lol (JI PUllcmiddotny) mtl 1 ( f( lS-er sigll paiilivltecirc lt Dlt(i I1 11illg r the iti l 1Kgt n n t rll icirclicH a ) 111lt m omal prebulled the mno rche md ociks with lll I)ttlx flal gr Ih pll fl
rlcljoprdphLi 1 hl merl prestIK ~ of this curvt c10es n t autom~l ritllJy indi ate the pn$CI1(t of a defurshyTnitv (SlllKtUrd (Unel
It i~ possible tu clil1e ren tute a struCnlt t CI1tve fruIn a pogt urll 011e by identifyi og the hum]) du ring AdIlns tesr I~OQ looklng tra m beh lnd at the p atient w ho b benchng fUfward il is p -- ible ta d d~ct 1l1 eh ucirc n of o ne liidlt 0 1 the trunk usually n n the (onvex ~ jde ul tbe radiographie CUfve Ugrave1lr C Ul be mlt~I Slred lISin~
BUlln els S o liomere( 1 ~ l This h Uf1lp is du(- lO (Ile pregravegtecircn ~ of vertel ra i rolltion 1c1 Ollt tn tic f~YJ tllre o f the def trrnit tli [ c m be seen and measurc(i v ith Perddolles lb lsLometer on an amero-Ix)iferior radioshygrapb ~2
Seven ry pel cent o f li Ises a re conid 1lt 1tO be idiopa thie 1 bull ia l-nosilt in this CI$C is b exdlls i ~ n as idinpa thlc me-us t11H wc do n()[ know rJw origio of lheacute curvc [n othe] ~Ie$ it b Ix )~i ble ro ide nrify a dieak (bat CHl jusrify the c1etgtnniry slIch a rna lfo rshymar i ns I1(gtufol Ig ic~ l or genlttic cl iscas s Glnclt~r trauma etc )
[dicirc)parhk S(oliosis has been divicled ~(corcling (0
the ~Ie of tlie patient egrave1l the tiJ1ll of d~[ccli n of the condil ion into ti) ur t ypei ln fanUlc jU nik ltldolesshyccnt lnd aduh Til l m n st cnnunon (VPC IS the acloshylescegravenr o licirceacute I1IJctenzec1 hy 1 sud le l1 tggrH3l ion uuml uring the grow tll Spllrt (Hg 1)2
lhile p tu 1l sco liosi i5 Ycry lomnw n thl pre shy~Iknct ra te f r adole ent icuumlop~lthic structural CU IY~S in sch )o chilclren are 18middot20
- 10 Co bb d~grels o r m on l -lil
- 2) ~ohh dtgreclt or mort O 2~j - bull () (obb d gre -s )1 mOfeacute ()ll 2
Clin iltI [ d e isio ns lfl IXlSed 111 an lccu r~He pregshynosi which obt inccl in eJch pa ti nt mainly o n the basi of the nsidu~ll p()tlnllltl l of TH1h and the result s of 1 rh clin 1 1 ~l1d tadiogmpl i exlminashyti(ln12ll c noieq uentlya d inica ] la sifiou io n o f the ing le pHient tn -ome estent co incic1 ing w irh the
D diographic one c l n lw SLlIl1H1arizeci 1 1 folIcJ - mikl lc~ (1)(n 20 C bh de~r es - moderJt l betwlen ln md 15 ohh de~ rtes - StV re 111( gt1lt rh n ~J) )bh (kgf s
On the 1) lsis of [hi - dinic d d a lfic t i n (Vith l1l il el lrb tiOI ~ o f the ir b() und~ri e ) in Itllt l cente rS Of SCOtiO LS ITe ltlllent in the Lltin odcl (i rJ Ital lnmct md PI iJ Ugrave tre tmtnt i s plmmcd a fo lltJw 8l
- mild kineslth e (~1fw ~1Il (1 luok-ou t - Hl demte IJragravecegrave 1111101 c(~r md k i rws ithe lJpy - ~cven surgery
Physical exe rcL~e for S(ol iosis
Defi t tiOl l S
PhyS i 11 nU b lIKrlttp middot (or kines ithcIa Pl) i a p rvgrlill or plt~i Gl l (xeriltecircS ~1ci fi ( llJ y ltk ~ loped
y a -11 [ru ine 1pll yslo ther3pisr wirh th e m 10 Hllll
- pre (~ n tit1g tlc aggraaLion of the cl I )flnily in rnild bullcoUm is
- helping tlk Il ld Ct ~lOd ounter~lCtjng its skie elfects in III de rltegrave sc li sis
Tn tl1i_ feSpec1 kinesitl1ert py f JI s oliosis is tonshysider l a o on of peciticcedil training and s genecirc tltllly proposelt in sessions 0 1 4~ ro 60 minute IW) t) tour limes 1 Cee PhysiGtl exerci es can aLo ll v o ther auumlns 1S it oill he dise Issed in this plper
Ir 15 Ilot possib le to cl escribe a single progrlIT1 o r exerc ise a5 pro nrams ale USLIJUy p fgt nll ized ( ( lt
EUH PA ~illDI (DP1I YS IC~ 182
ROlL UF P l 1YSICAL lXl 1lt 1~E IN l IlE 11 ~l) IEd If IlU) l[)VP 1HI AIJ() J)~Cl~ r COl ~I NlG1W il
f)( 15 egraved ( )Il the nee L- 01 indi iuua l pJl itnts) al l l10ugh Lheacute) C l n h t 11 plicd o n a WOU p hJ~js (-1 (0 () pnients PC[ ~l ()lI r)middot lugrave reQCf lhese 1 10 grl lll frequt ml~ V IIT
hnm on in middotituk w allClthltJmiddot -Ill Jnv L l~egrave at Wc w Ht ~huw in lhis lyl peJ it i~ 111 n u -eII1 tu id e ntilv kirK itheJapturlc aims w hitl l ucircrr~spnd LO ugravelt~lil1 DUtshy
g X ir ur ph -s ici l lxtTi~l I~llhe r thln ln dj( us- indishyiJ u1 1progr-lfll
Aduumll l lxUl kisure time ~lOd h )u] Sp u lllll8 ~Ilttishy
i lt egrave~ i middotomm )Ly s iven lel mJ ing ro w hlf ~ Iuumlnsidshyer~d usdul or il lrmfu l in t1 lt rruning (lI tJw ptliJicirct ln tl1bplper Ugrave1 gent ltl l t rl ll bull p lwsiCUgrave lttG iviUes is rl ktll 10 JllI1ltlCc hOlll gtpOlt mJ kIJ1lsIcircl hc lJ l f
i ve lUen tloneumld )bo C on lv ine n dul( re Ull~ 1t~1 t s far Ilten publislt d f I~ mJ I(i noltgtithltl rgt is 11 11 a su h jel lnI deacutehate CJitk haltlt t llltit m itn ltl of l ny lorm o t p l1 ySiClI lxrcL e as a Itwr1 [ J- fo r i liopa tb il jcoJL~b un iL ()ri gin~ initial1) it WIS Ille r rOmiddotUumlK lt brgdv u f p l~lt titu gtllergt w h ) intervenecl hutll tc llcrl ll (mon as cltl HtilJ nic in terventi n man Jgt
1 t lltrJp utl t one 1 md rC j fkll l~ on rhe h sh lf som uni cOen I1v pn t I1cgts wt ldl hll ltl enl1 JI~ haLl nu na l scicnt lfic baisYmiddot HOlh tlle$( trr t peu shy to rh ~rl py tt nJecI to l~~rJ tte C Ih tk CUf -~ pnnshyclr~tll y as a f tsul t of lilo h llIzatio ll of tn imdqultdy ~u pp rt(d S pln eacute 7~ 12 to re-t1 r rI ltrl 1$ l l1C k o f WH llt~~rdl 10 I ndt~-dll()urnah tnd 11( on1 p~l per u suaJly Cl tc([ IS n prelimmtrf lll d 3 ln tt li w ay man (l rrlKpt(Hc H lf O iS Inll ph ~i C U l ~ d vi ~ cI nllog scnliotl pa t le nL~ 3gainst holll ph lca l egravexershyclc and p()rt~1
It m u st t~ n tfd [hat pllyknl txerc j~ tJe~ltm(nls t1iHer 1 lJ rd il1g r rhe rherlpcu tlC litTl~ on lllc h tJ rgt ap p lolc il l the IXlltent lncl hi im r IIIllHnt i- 1 (1(1 rI - 5lt1J lC igt tIl l ( f phJllIlllolopJ al rrea tmln ls Ihith cllffc r 1lt œQlfd- rhe m C cculc u ~t(l luI thl p al 1t n
~mc l 11i (lbE~e Tt i ~ P ~il k tlwreI[middote thll wuumlk ltlll t kin 1or ph~ i Clt1 1 lX r(j~ 1I 111~ t bc loidvd by t h~ Lo iurie IxujCJ1l al1ulhcr a dl ~IS nJI h~ iOg (1 11shygerols llugJr in racr le (wi ller d I ~fJIII ~ I ml thlls re(nl1l rn ndc(1
fn n UI cel1ll r we In(~ hccf) using 1 ) 1 1111 11 ve ) 1 (J p lw l icd ex(r(i~e (0 J ( 1I l tt i~ tlh aITt ~ l~d Ilv m ikl tru cflumiddott1 adokscltnt (cl ioj arh lC icoli is11 2)
ina the f U~ t rc-gt uJrs IefC pu b lishe - the pJ( )grd m 11lt1lt l1te n PWltllk d in fa c t deel()pnlln l~ in th t l itshy OlL1Ii in tl1 r b t ~() ycal f ha ve iclemi fiecl niO l l
m d 111 ur impl rnHm s md d i s )h ilir i (gt~ lue t idlo p lthk amp()lio -i ~ t Jll CIII he 1UO(l if Icirc 1by phyict1 egrave xert iSlgt l fe t rrncllt
l illl
111e aim of t l1JS r~l per ii tmiddot (tv iew tl1( l iterat urt to a(errl ln v llic ll of th~ impa irm 1t~ and Liit hil it il i GllIltec hy ~ o l i()gtj s -o ull he ll nt x or re middotlu celt1 Ili pl1ysical xerclse An u p-to-da te knOvkdge o f tl lt Lgtpecl-gt i necckC1 in rJeumlr) d -oek
- whetll~r there h ltl n adLtIIl ) l tht()d ical bbh fur or JqIIcirclb l l l1 Il( ) f k irt llit herlpy
- h N I)(1 ( 1 Dm tlle p r l c tIcirc(( o f Jebur tiJne )pOfung lcli v l ti ~ IIOU lci he tllf) -d o
II J U V f h 1 I11~ c~~lb li hed Ihe usefuhlLss 01 k il1 shyc ~thtrpy il i aIle dy l nsi 1([(( -r-tI Llleu i n )I11 plJt~ ut the wJrld ir ilt ecircS~nl i 1 I( id n Iv w l1i li ( 1shy
gories 0 1 pl1Vtl( 1excrClgtegt te D)bilI7it ric 1n (Ir st shylliuumlZltio f) lttlt tlgtbltn ing ni trcrccedilh ing erc) hn Id be
vnlcled he tll rhe nuld be lerrillldll1 1 md whidl s tlQu1d be inreœ jf ic(1 IJeClU~l tlley cOli lel Je LI ~ful
Ncuro1llotor impainncnts
Imv aUl llOr~ 11 lt1lt ~tlKlteJ lhe cltlndatiotl bd Ween tl UC1UmiddotIt t l ol(~C t nt id iopml je -nll ~J~ and cli~l l shyler~ lr 1tH lest ihuLIr yt 1 _ 13 ~ 311 D uhoussct 1
1-- ITS tln l ldiopath k s(o lio-L L cll -c d l J l hmgt in th terl tltr f prop li l l pu n md 1I1ar th e detrshyn Hi n i~ na tural 1 ~ronse to ril e need tu ts tu re p()tun ltlluilib riu Ul HcrmJJ1 31~ 11 () d tllat icliupathic ( liCl5j h l it re5u lt Ot1 rw nltuf mot r l ~ltelV
[Id )fcl 3 nI] ~1ltJ U Sr1lle nr to dtorders in centJtI lO~Cl shyIOIDNur) md 1xi~tI moro (Ul1lfOl syt( llI (Fig _l
N htIll -of) H1c S uumll h( rll1 ( ~ l( w ing JI t11 (oshyI-ie on the l l lO]ugy o b doll (nt Rl iu]icirc tlili- middot()lioL m unt fil t-hltll rhl ugravedcmnilV L th e fl5 ult o f 1 (k btcl 11lIFll llI ion nf som t11(WUgravetltnl md pO~ lur( (tnic l~ l licirc1 tl1lt if l p OgtlbJt b C 1l rlw sta l i lin 0f 11 1 Sf llle j lt g )tx l Tt) ohtil n a ))Cli U 1ILzltl I o f p ~llIr~il d l~flo [ in l1litkd ~J)llnSIS me CI Igt(middotqucnr J ~ a ~tmicirc ()nlly or regle Ie Llive
Ali th- 11yp ) tlw~es rd ~lte tr d irtl Itn t pnl1tlt o f [11 v hole ~piltm It11[ controls postu re ~nd mrw shyment lrre pell ic of tlh po int a d lI~ llv inH llYegraved il i ~ ll 1 nnable tCl aSUilll ri 1l tr l ll1 lo g thi ~ys ttm ( Qu it le 1I middoteli tl
lt ch ugt nlt~(S f rullliIl thil i nlomwtion th at p tlmiddot shyiCil J(tl iIies nw gt Il lInport~n t rr le to pbv [11Icircgt role ca n 1)lt slI i11l1lariztd ln lWO the ptu li ain Llt
- d elopmll1 l of p uumlltl St1 b Hlt ) - c1e veuml IOpm 1)[ o f bhll1ltc _
(k llhUl)lOr S Cll orr
ontrot oic whan-lt
------+ 1 ~ il lnll ugrave r AINnl
Cllnlr1
T bflt~ r
fltL1 tlli
lMini
l
~sary ~J-frlllen i )f
~ 1 ocirctnl
~UcirclllIJJlW Ll
AXl ~l1 n uumll l) r sy 5t ~nl
middoticoltoq ~ Fig 2-AcFgtrdong lU He-mutl 21 il is Fi)5~ ib1e rD prolXgtSlt l -oo ie1 mnd 1 ((if ~ elio egrave middotAhltr~d l)Qdy-p ati~ I I i u d) uren ttllOn k td LO In ~ory reHTt I1 eDi tn l al ) JdrnlV~ pn)4~ e l u r~o(Ofe 0-c1 eptunl dvstil t1 ctlon sltŒ(ry icircltu nu11t ilwnt [ ~mC ~ted tl l1 ce Ill trpntlshyUumlfJJl nd IKnle~ r~dibl jtugrave)n of -I) m tlosen Ir ~ig nj tl (I1vying ln fornll1U n (lI an ereltl ~piJl e Mmor aJJ r--a t ~) n ltgtf ti lt aXljl mowr plem iHUC Wh ~fl Ille 6ubjeco m uumlntl Icircn (1oJifitd perccpfLlI l ~na l ysilt of p n)lnocepti Icircnfu rnlaquol ti desnibJOS ~n t tecr spin A IICW motor co nrro l Ira I gy t adopt resu ltin~ in the ~tr ltctltr 1 ckformh y lf IdiopathirL scollos i=i Ht lrftU1uc nltnt l ISll I1lJy h1e- ~ I pro()und elkn on bralO Sfem flJll ct i(lnn~lLhu modifyRll Ille nltulltgtshytl10 ) 1 1111 Uu l-lHoror control 5~Shnl$ shy
As Srtgn1lt1 l ~ ltlssert~ if wc l C -Cp t 111 1 un o f the G IiC s oliosls L l tisorckr oi th e ltquilibrilltn sys t ~ms it is lagical to oriegravenrate physlCl l exercis( lherap y ln th is d ir(gtCli()[1
11lclte goals Cul tl lfOUgil ditrercn t modes 01 action be Olchic(-c1 witJ1 phykal accivit ie
- po rt ive Cll ities p ro ct LJ e aIl UgravelClltrtsc in 6lte nshyel ll )o rd in~lti n pinai pr0prinup ti_)[J nLi mOVeshyment control 0 vio lls iy ln thh repect ome lCtivshylites aœ pre um~I I)y lXrter tllln ntil crs
- kinrl lira py using pedJil exerCisocirc specially developecl lith th est 1101 5 in mind illVuuml VC I lllore prccilt( ll1d InC1 li zed cri n on rhe spiJw focusing
a90
1 ~~
lg -lNheJo ~1l l1 t r~l g rld in 1 1) h i(~ IImiddot ct r rHienl w i ll idlllhic _It ~i ~ _ iri s plt ~I le II find Jit ltH vlllleuml ~l Cgtbl tn~ ks III d il fef lt p ~ lt ihnS nu v~tl middot B ~a~pt u Il C middotl)Icircd ~(t l l11 C dlfkrCnl middot- hdween slllndi1g Uline nu nllt1Xinul oorrec ri nI t chied Vith Ct (J ) und tfdincJ ne lot es o UIine 1 fo llnVs middotIJfl tfi ni( - ltlrshy
reltiK)n ~ Ikexibiliry st3nucircing - -pirte - f ur~1 1IbjISC ltupin - ltorrcaion - - r~luci()il ll ymiddot For flmpllt in J npK l1 pH k1J il
plt1SSlhlc ln obtai n 10 u1 511ndlt)l [YLo lion yr ln Slt p ille rlOlgt itlugraven om l J ~ in ( gttf(C rigtIl lIex lbuil 15 i (r-l l=22deg pol lltl ~~J IIlpraquo is IcircO~-V- I t1 l nd tucircu(Ugrave) ilil) I~ 3laquoJO- IH-12
r ln Ugravel e abilit jl of tluuml [m e llu to co ntro l irse lr in ~ pac
fuld l oftlles uumlllelve ntio ns can presum1b1r incn~~ Ih enl ac )1 the orller and lHitlll r of Ille rn - 11 )ltd h e lllldenl lu EJ3)4il
Posl1l1-t collapse lnd slabilizariotl
lIle concept u fplt st lUal c(l lJap~e l l~t Iwen detin 61 by DlI II-T3e~tupegrave rL t Ac oJdin)j tu tl1i- ~ll1thor il [ nec(sary ~- l Hn Cv-tlualing th tleihility o f a col shylo tIcircC CUJVL (0 clistingu ih bt tVeen the re du ihil [ty index (th - li iffer gt le bet ~middot Il ~I r~tcli()grJph ie ~xnmshyinltio n of the iI111 pHienr in supine po ition m(i
ROte OF Pl rnmL EŒIlCISE IN THE TREAT-ŒNT OP ~I IJD IDIOPAnnC OOU~GEm seou SIS EltJRINI
I (~)-----------------------~
__ _~ _____ _~ __ __ L ___~ ________1 ____ _ __ ____ ___ ___ _____L___ _____ l___ ----------L ______ _
1 ~
1
-- ------- --1---- ---- ]---r --- -----_----t- ---- --- ---shy__ ______~---- __ ____ 1________ __ _1_ __ ____ __shy
~ (1 J
1
8 =~~=r=middotmiddotmiddotmiddoti~=-middotl--- middotmiddotmiddotshy--------------t----------~- -------- - ------__shy
~---- --- -- -~ -------------r---- -- -- ~-- - -------- --shy----i-------r-- - ---- ~~-shy
il 1~ 0
Dtl-Lmiddot ~ lttj l r~ UIltltlHt
f g 1 -TI1 u ilictf 1ld ( ii 11- ugraveu-sh) ld IX~ O 1d wllich ltJdnrshymII Il nf the pilll 1 ~tln~1 of th e -o lioti( spinc n IG~nI(J II IIIshytt) lhe iJeuml grl-e o f ~ ()Ii ti c (u rvH Il 1 w dcpc-nlknrly o l l he 10 111shy
P01(nl (pntt l ~ 1 1 nr ffll wrJ I) ln w hilth Ihe n i 1gt( ~ duc nL~ grlphs fm I h~lt 111lt hi~hr Iht Col h ~Ilu t (l f Lite ~Ul Ihe m Ol CI il y th t s(uumlJotil middotpin~ ~111 he ~middotJg gr~lVH(~(1
m mJxiTIt corrttt ion wll iJl i~ lIllCd to Ih - xt 1shy
lti Oilil y Jf tl1lt t Ut JO rl1t cdnUc idt md p OS shy
tU ll cul lapse ( th t ltHill enct b-tten l lUdioL) 1lphic egraveltamJl1ltlti OI1 J t th e ~lme pa tient in Sl il tl cling lOJ lline fX-sitiutl ) Wll ic h correb lc- onl wil ll fhe abilt ty of lllt p tu rl l gt s tem to C( lunternct lIk luree o r grl viry )cco d ing rv D lfVd- f3egraveLIprc po st li r t1 lt01shyIlDse is d ue to the Jnus -u lar ton a nd 11ll ex rCrIshy i) i itv of rhe tissus n the ( O IW-) si it (If the (01shyjl ti (~JtVe (Fi~ 3 L Pu~t llr1 C lltpstl lu lcl l ~~ reduc l-lt by llwans o f pl1ysica l cxerCles specitkally s tuclled ruuml i rnprove tIlus--ubr fOHt md lU pr )cllI Ct 1 ~11 hi shy
lizing ffCd
PararcL n tll CIJ cl the cr iti ca l (3 c1 thlsho ld beQ ld Il ich defol1J lHU n of the i pinlt 1 e~ in~ ne dtlllontr~1t _cl (1l ll t grclrf r mg] o f rllt C II in a qa m bng pos ition corn pOil 15 t l lowcr detormashytion lhnsllold (Fig 1) ie to ~11l Ulne3Se t the risk of pr ogr t~ lu n There t rh eJef re l J ea r l)iuuml 1itshycJ l ~ll1 l l(tl a 1 tnr tg ro b ohwined by d -cr t l ~ illg ilmiddot pU~lUrll cull lpse ptJcelJtge w bich lccording t i)
h llTd tnd ~l(heJ1l ~on 1~ b inde cl 1X llt icularly luumlgh Ugravel mllcl c Iio~ i (bdow 2( 0 ) (F ig 5 J
Fin a Il III ch iS respect lllljl hl and b um l 01 m linmiddot
ii iI 1 l _ _~ _ ___I ___ ___ __L ___ _ ___ ___J______ ___ 1 ___
li 1 1 1 1 i 1
1 i ___--____---___----__-_---_~- _ _--_ ___-+----
i
1
i -- ~- -- ---~-----_-~-_-_--_1-~
l ~
i
+----r--------t-------t------f-- J
Fj~ ~-Ac(XjJlin(Q luuml T O rIcd ~lnd Na(h(ln~ n i () dl( pCG w rd (rTIshy
POO ll is hiherin cu rvegt in wh ilt l1lh ~1flILWrd cII1I Olk l1t IS le- pr(v~knt ln th e grtph Ih t PogttJlJ I ugtnq) Ot1 -J1l j elfltS-e J tlt 1l1t obb dirr remc rlLIv obu incu f roll l the Cohb atl( 0 1stlI1dtJ1g IId gtupinc rldo~raf115 Ih Ille lt) [1l1t1 (i lndnl I pine) 511pille the ~(nlClu tJ1 compo l1lnt U rlk CU Y _VeJily I~ ltx p rlt 1 L1v UpUlt (obh Illeturo Ih t si _b Cct rtJeSIm l fie -ltn J trd Ugraveltuuml shyuumlo n A~-i)rding LP 11(lt uuta o n l ( r1I~( in ~I 2JQ sup itlt curvt 1hi C(]l)b ddhccno l l f lO is -J-lultt( thc s ldnd inr tnla Ol1l t lS wi Q) whil 11) 1 1)401 ~llp lne ClHVC If ~ 1Omiddot ( tcl Lhe ttnd trl~ nlca~ I(t I ~ ~I)
tli n ll w l lllE cq lin ti spin h~ i ng mo r ~ Llnt~II) 1 tlun the nOftl111 one n Cll l gr(lk ( (cU ve tl1u n da r u p shy
po rt in o r k r 10 m linrl in tht 1xi11po tuf_ n th ha__i of th egt onideratl lr1S it f(lll() rhJt
ph rH (~Uuml e erd es ulukl h u - ul iiuml tbeacuteY ~U-L lm cl 1l (It-d o pmg p05111 td C Jl1twl lS fuumlrnll~ rly d ccrll1td ln an Ql St if i imr ol1111 t ru t(( - tht m(d in C JI shy
r t t r sture fO Ir -ngthen tlll m u ck-gt of the spint mainl) in (11erl antig r3ilrl tIcirclt l]lli fun ctin ll U hy meU15 dl i )ll1 t trk ~ lhJ cl( -ll tlt C)nlr~lUions ~llld no l IdOshy
1l)llic d YIltll1k lt l jAJ lktic t) I1 ) II 11)t 111 hd posibleacute t lcluuml ee postura l io nrro and stfh ili lllllt IJI
w i thout food T1lw(ull r d I( Lf(11 Ibk t m ucircnuin Ihe c()rf ~ct [ ()S tu re for cl gtu ifKi IH lLl1gth 0f ti l11 ~
This i-l ddl usl a typl 11 dnmnin (tf k inesllh rap) in 11 (lt-11 [[k - p~d fk lnr in lng f u l1a in llllliCk is poss ihle lI sing ctrtain Idncl fJ l (lt) 11111 liun S p Ul in tb is Cl c is ulttful ooly sa I~tr 1~ il Iw lps t1w lxltknt 1 becuJl)t 1gtlt ltlt-I a ClJu~l inred irl ilL ntllru l o~ i cll
and I1lll~lJhl r-keJc LIl [rll-llIn~ middot etlt(wrs JI the int e rmiddot vlnrion
[J ROPA MfJ) I()Wf-I YSJ IR
1
ICR 1 1-1
r
1 shy ~
- shy
11 o-llrfOlhe5l~ o t Ih 1O~(1dity i n h ~ r ~ ll nr pbl1 l of ~ Spl11 in 111011 _llti1Gt l lPt f ltlJUCWJtl ( ~l Ihe Ir t 1 1gt illbll W Ilh LtltrJ1dlion Vln lbe rigronl middotUII~ l(I Dko n12 lIll h lumshydlanie1 1 [ nul 1 M hl whtrc M - gt) lnIUI1g 111laquo111laquo1 1 1 c rtJCshytjC~ f fce d -d Lill l1~ o f enr niI pUll spnmcl1y 1~ 111 mldlll1lt (n the fl1ur t 1 = tor~ of f(ward Ileuuml l = ughtel1lng fmiddotr p 1shynOf stn lClU= Alaquo rdtllg 1raquo Ihl~ - lin hull th l1ltgtllugrave ot tller1l lUr~Jtllrc F the ~pin t -ilh rlu1i tf Ihl 1 1Ibulll n lrlt InltT1 1
rbc prJI 3IJi l1ty d qrlOIJ~ n bull JI t IlJIII Hm lA the v=ltd gtc e lu-ing J 5lnK1ura i ltfnnity
Dioal e ch anicll itllp~lir J11 c nt
Ihrcemiddotdimcllgtional mc-cbal1in of the s pioc
~f Ikmiddot i t i nly l(œ ntly tlHr llk pr-5tnœ or nc ushy1 lnlo tnr impairment in Idiopttlllc s-ol ii IXl tknt liuml J$ heen h i- ll licircghlcJ hy re$eJ rh tll e preit ilegravee h inm b nIcirc Ji d lJutg~ lt hl ~ 1 ng t o n dO Ulll urcel 1 i5 (l lreldv well umlersrood H(j-ev~r nev lbt un h iomcrhankal im l) ion nI h1c rectm ly onk l n tIlt tre and p r~dou in f n rmtinn hou t pl1ykd (~fcl5( in t 11 0 tl1I _ltgt pbne of spact 1115 Im trqlt-u 1rom J i-[) v ing unclcrsrmdlng ot th l lmc -dim nshy~ilnl l l11 ~ hmk f the cO]jO[lC pln( ~2middot ) ) Ve- w ill )iI xnl t l1 d at lcL-orcltng tUl cl sif iol t lOn blsed o n gtolllt lricd h uumlCJ ) p lane
- b() rJzU[1tl ln th i pla n ~ th t 1o rm ll sp ine present no CUlye- w ll ile Uumll(~ ltc U Hic spLnc clevelops one of ir haracterls(Icircc deFo rm tiCs v elt tbrd ln lashytio n vh icl1 pJ()VcA~ theacute hw 11
- lgitltl in th llulJe U l(~ nonmll spIcirclle pl SenL kypl lOSis ~nd l dooi~ in tb lXI1 lhese [(Hu rts Vere m)( til ught [ 0 he relattd tlle scolkJtlc ( lI r Vegrave
- front l in hi pleme tht ncrmal p ine preseuron t no curYegrave whil thl ~11li tic p in ugravetI I ()~ icircl~ charshyad t Ilt I CU1C
Il Jri fJIIt palic
~l+I~na ra 3 r inr lut th l[ ber ll1d a œl1~lU1 degr 1
l f r()la tJo u lllu (lILa r forcKl ltxert ltJn tl ldefnmuumlng 1 tkllJ [J i1u a re- lhlt tll cly 11 [1 1 UI b y Olm ner w bn ~lh uiJwd tl egrave ro t1tic) l1 Ilm it ti lt p ica] lf shy
rhrl r() be (P (the Uma bevond Wl1iltJl th lCOJlb of [11( ~pmaJ musd ~ dthc COnCIt and nm ex ~l le btconk (t O li~[)
r ~l 18 ~1Il N lu t( ren i9 lun lu ted rlseurlt h in tlt ) tilt lULodeumlformipg1 tlo n ot tIH_ sc laquoJrle rh ox ercallkren lk 1l1~H li d11r once thl Il i ~ r tld1t5 [he lhrth ld f 111 JlIcirc lIi of tlle dnrlclc hurnp tlk
lI bslt Il l nt rlet()rlll lIcircon 01 the it l ()I~ C ( (ylm der (- sustalnecl by an H1tmi cforming aCOOIl
J1Ji h V hl rhyiical f~ f Ise CI 01 h spr n llnd kin middot ith ccedilrapJ my lX damlg ing vll e n l pplild as flle
igt Jk Iller ln SCC1IJ ~IS lllc lJ fxceed l auto in middot crca~ i n g lhrllgthuld [1 sh (~u Id ahn be j ofed that Ilw relscd pre sun 1l1111i insiugrave l fe pil1r inn) 1 mlshylt
- j Il- ( w atff 1 (nh ~1l 1(e Il10 utoldrml ng li1eCh~lI1 1sm
in flc l Geyer ~w tcd th1 t rm m 1 hI l)1ecircch1O lla1 puilll 0 l I C~ sw m mim t Ieuroamp no purpo t for cu lshyim le pllilt t1 s (weumlO middott r it is l~Jl(gtWl1 rhn in iculio r[ paULnl -iJl11T1ill~ doe_gt nor Il ~lp to i ncrt~SL n eur(1shym tor co mfU
(1irai p an (
Jerdnn lle 11 showecl thal ill CSl~ o f t10rLC IC 1i lUgrave
tllo lacolulllhil it lio_1 tlle cte tI llmiry in (he lg itt1 p lln t rn lnlftot il~ lf tspe iuUy in tlw initi 11 r luleuml )f cV IU[Icircon nf Ile ~oli ls W iU l 1 p(t)gr~s~ivlt il10middot~ shy
ment roward hvpok pho b G ll f ill~l Im lins l har dUflng (IN eWllLlfiu1 of 11Imh] co luumlgt i the l in t ot t l H~ gClyty Cegraven te l - 0 1 v llebed lxxli 5 r ro ject 1 seH fl r t side-ys and tlwn backlrcl bull thu~ p(0(1 lj n g a kyphQtlmg aet Il ln (h~ lu mhnr --PIl1 COftj tng
l l i tc Iugrave l lltl l( l rs1 tif s L -etllgt il l the lgirl11
1 Hl)
Ilu LE nI rIIY~Ic~L lXIlKISI 1 HI E TREhTMEtn OP JIU IDIOP llII C AD O USCUH O Ll Œl15 NEGR II
lLill tegt lre lenl1 ~I d ~fo rll1J[ ~ rhl recrSes the phyltiologiGII cmns of lh vine)
Accordlng () Dicion ~2 1 rtcluctio fl in the itgitttl CUIYtS combin l vi th a lueral Iviari n llltl ds t 1
mecban ism () ugravel~ta il ity in l he r rat r IllI1e which bVOf1i the unsd a nd i ncrea~e 0 1 co hlt1is (Fig 6 hiIf md Pl11jlbiJ Jl1eanwlt ile lt(udiecl lh e srnl ru t
orzyglpophySLs show ing t11 al ttleir 1I1tl rnic tl orienshytation f~I (jLi l~ltes aXIal ve rtegravebJl l rotllio ll in cun litluns lt f dorsal hypokrrhn Icirc tnd lum)H de i L lo IS
Tll t dat SLlgge 1 th t impOrfill ut pOitu res and l1lweil1 ) t Mudied in ord t r (CI mlIuml ntrlin or to reuwer fll e p llyslo lo~lCll ClIlye in lIe SlgJtta p lU)l Wlth the llm o t ch ~ kin~ rutltor in l~ bili ry7 AbC th ~e ~k-
1l11nL ~Irt del lnt [0 J jUc lt ftber l]kuti inrervenl ion vhich 1c)LJ k l IV - i(l ~ l compktl n l ililll on Il t c1 l shy-jel1 J11UVllT1ent IJ j o f 1uto-dOneacute(3tlon ( i e a -impk ld ion ) Iengtheni ng o f the pilleacute 011 a litlltl l aXl~ tll lt ((IT liJlI~rcdu e~ t lle ~---lJ linti- l lte ml-fkxj(l n h UI 11 - i llCrl I~t the plllH ](JgicJI dlt cr ~l S ( (1 k-yvllCiSh lIld O(ltOSh l o r c lch r1Iif n t a Ilew til(~ecirc dUuml llt Ilshy
si lflltl J ll1 u(~nlent iam ecl - 1l1t0- lIrfe rionmiddot7 4 llmshyp oed f Je-rura l iUIl cl middot-t1e- iltm lI1d ll1a intltnUlLe )( 5lg it d C Uf (gtS slig lll thltJrc i ypI1 tiZ) tIcircOI1 a nd lunugrave)ar 1()fdos i7~llion) sholild he esw b lb]HU 00 lb co
hl b oi hi p~l11il uU r -1Ir vlt Abo 111( e IlltUtl Chl lie o f purti n - a U vitk slJ1ultI h e )tuumlll ecl 1)] (1 n ldershy](ion r tl1i lt type for e upIe IilJ llyl)T S of repd shyiti( ml vemen prt n t in agonistK h)lnllltlSlks nI iIle kind f dlJ1ce C( uld he ([([r imentd
FmiddotO lllaljlallC and mobili ty of the SpIcircIlC
1 rd llo U 22 d L lm nrrare d lhlt in Illt fro nt a l pll ne
tilt 1 nge Clt 1)1lt vtment of tht scplit[i middot CU IY grcmr lIJ l il ~ d irectio n n f Lhe C ITelt tlO n tha n in tl le di re shyLion of pmgressi n l Fig 7 ) he IL o IS5err lJd tbat th15 mohiliry increac plrtil u la rly n apic [ cgcoeilts 1$ lh ~ ~c() li osb evolves Sragrm rJ 12 J ~ thus rigilt (0
VlI f n rller~p is ts Ilo t t) m o b uumliz - a sCtJl iu til curve w ilhout t [ uling ttwt tlle R lu tiOI o i til t ~a mt b fnlinruumln( 1hy l1tans o f ~I passic 01 1 rivE -uppnrt On tilt (ltllE r hand UgraveK d e iJlioJ1 in ease durill tlw tune 111 whicll tll C spmt i ~ not submjtrcd to correeshy( IV anl()n
j- Virh mi lei ol i b tlllt Upp i1n ill) lC tiol is d eveloped only lllmugil llClIf()mu$Cllbr f r llce thi ~
InegravelIl ~ thclcfo re tl1l[ inu eascgtt sp1J1all1extl)iity mua
11
Imiddotiumltgt 7-rurd illt Ir) 1 bull rdrilt I1 1 in tl lt frOlllll pbnlt- th( illl ge )r mOC llIeJlI o t the S-o UIIJC CUNe 1 supcrior in Ihlt diflt(l im ugrave( the n nKlIl thd n ll1 tllc dlrtcLion o f p rJ1(l( (llIl
be considrCtJ vntrl iJ)(l icltion and 1 undrli neocirc ab L a ~ubiljz~ILion 01 tilt spint pllss il)1y ohtl ll1td thrltJugll the stlengtlkl11ng o f the 1rltJgm vlt nonil lme shyCIC 111 illli orrant u bjcLliH- ln rhis r~f1 n sp u lllni lc tivitIumlLs sil uld lX tPI 10 dlegraveltl it l G lU t n w l1ik luring kine i Icircth lrr phyltical eXegraverci c~ tllat in ele
spinal m ot ilIcirclY sil nid 1e lt1 oid cdrt ~
Organ ie and psychologieal impainncuts and li islbi IiI le
A cgtI im lc pmi nr is moriOthl11 just 1 sp in and 1
compkt gt Ipp rnach to the gu in ad 1 ont i al~ shylute l e~se i t i11
[)a la 0 11[ [n ell lrom re semh pw tbat ome organi Iilnctiond cl fki ts suc]) as tlw clecrtiUe ut vild l tnd d fun ll l)Kity_orld ldly incrtJ k whil~ 0 shy[io s i -till in (1 miel q g of g JltlV ity ~ l ilI e 55 rtI lit
tllL pres e n ce )fl defidt Or Vi l~il Clp~1 - i~ ln one pIIiem in Ihr l ftectecl by 20 ICl 40 scoi stgt l ls~a r(h cunclutecl in tbe UA by Di Ruce- prod uegraveed an aaalo) u ll1lXimum 102 re u t in a group of Jd shyk 1ien t [(h sco llosls rang inF frum ) [0 1
Al10ther rudv bv rallt r m C chr111 lilcl NashycWrl1s( u 57 stlO eltt hil $(C 1 1 ui~ Ica js l( lllt cl (1 shy1prUlllI o f t1tgl lie bJd l imI in ~ul sct t1 t ltu b middot iects jlLltr l5 they are golng through ~I cltlici[e sllge in the fnm 1lt i n 01 tlWH o w n id uHitv t factor hit h Illy jeopmlize the cl velopme lit d ~ mIll lt lI1d htIshym cecl IWI sonalitr in Klulrhood
n RUI ~IEDl(( Ptl Y1-
ROU ltHmiddot PI [ I C~ 1 EXIRCIS]~ IN TI Il nW~JUNT OF SlllO lDIOP1HIC AI)C~ESΠ11 C(gt1[Oi 1S
This i why b IiCieacute ii is ~n imporrlIl t for p rcshyvegraveml e 1tLsr l tn en ou flge 1ari e nrs ~lfrecr(d by lIillcl middotu iosis ft) tlke p~l rt in portin -re rcatioluJ acrivitits Iha t 1eIU 10 L10 th r~1chophyinLl bull nd b~l )i 1l1o tur adlieem t n li 51Jmiddot2Even tlK)ugli [Dr bic mech~lnshy
ical mcl nellIUll10t 11 11 reltl ~ons lt r111 1gtomcrimes be l lefu l to ugg( ~t ne p rt in~ aCt iv ity r l h (gtr rll n anotlJer e th ink Ibal an exces~ ive IlHd icalizltion - Icirce l ll1posilion br plry~ilt i HlS nnejlor parents uf rh ry pe of po rt to lx p m lice 1 b Ule p 1Ucirc(Il L th1[ preshydLl ck l1 is fret clOice in lh ma tt r - -h II ll1 he avolc1ed wb 11 possLhle mainly for tlle i mport~ltll psyshyLb ) jogka l fe a SI)nS W( ha( ill ~ t nltntionegraved
Conclu ion
lbh ISsertegrave d t1H physkal tgtXtlci o is ) n fi ial whlIl practinu in order 10 ilnj rove the I11 llde
rœ nwh and tono C iral caplCiry and postu re o f the StOUO(I ~lIbj n II I nowkdge om ~ middotmg trom ci el1shyrlfi rls(~ Jrc li dJlJ accordl ng r the review 01 thE litshytirlture prnpo )td in t lli plpl r conflrm~ Ihe vuiclit ot th e -t ls ~rti ()ns
In l do l (ent Id iopl1il iC scoliuse il l n phee u i cl vk)pm e n t ( li tll iumlKh eXCC cl l g i en rhk thr hokl th e re i5 an und ubred need fn r l pprnpri 1tegrave (JJ1tOkJJe ~Ild Inr surgict1 therapics ill ortler 1) S l i p
the ( - Iuli on anugrave )JT~t~t UW ~pilll l dtlormities bull evshyerthtless in the illiti ~ll pl l~sC t ttlC c1iseLltc whcn the riS( r1 r euro )luli m is rtduced ocirc ~md tfle uifleal JOld threshold il ~ld flle po stural collai i reJcenw~ 43
JI l1 igh pllysicaJ egravexe rc ise - p revenc or r d llCe d i ~lh ilir ies o f [Iw ~ l() li )tic
p (iems R 28 J -6 5- 6 1 63
- f~KiHtare lh ( n utr ali711iCUl of postu m l d elicits tn produCel1 a coneql l nce J [)ti 0 I111)( or regre si -u lmiddotc 5middot Il 1 17 ~ M
-re 51udles U ~ n Ledecl tu con[mn or re jecr these conClLL i( 1 w l1 ich clerin-d frum 1l1 lIldytica l rcltw n f th e liter~iture appear r- ~Lo nlble Hnwecr Intil ne re ull are 31Iable wc should n r prevent our sroliotic patientmiddot trom tl ki ll p lt in s(loI1ing jshy
ir its pW1iada rly ltl t ~d1()o t () n til t c ntrHY -vith the l xcclrinn 01 gt[1 )11lt tIlat in rea-e t)1obility (tnU evc n thell oilly wh n progr~lgtion b p OSSibl) -uc h ~I( ucircvshyiUe -11 )ulu hl tIKoll w g ed The 11 S J ( rprOpriue kin (~irhe r~l Piuml to incr _~asc p()~tura l $llbil i ty is tl1egraveoretshyic tlly CiJUClt alttloughl more ~Iccu rtte aod deLli led ri k benefi rs anJlr~ is is netot1ed
Ria 1111tO
NIokl Mu d lle ftitYljJfu Jœl il 4IWr10UOifll S (JIvs i (1~1)Jshylidl ttno( cclIll le 11(11(1lt1 RCI fu lle ((lia LltfIt l1 I1I1i(i
LJ ci n s j(r3 pigt egrave li n IHUgru lkl di t rdz t fi sici pe e ft shytUlKm iluppno di un lisimerap15Ll rl lllcflt() 1 110 scopo di pnevirlt () fr en~lI 1-lgpwlllltnlcgt dclld lclonnitugrave o e il 5LOshy
Il i mi llon lt fH nugrave j (1 11ni dei co~e 1 lteIl I1J J nd ne ~Ii eifclti (()Tc rri udk s co lio si d i m e dia g rt iuuml ln que~ltlt
s rud i 30 llizzb mo i d ti cleU ric lca pel n ri Icare qJJ l lm 1 dis(imucirc x u le I[~ l z j-m i pro vna le da lla C gtl k A i json ere pr middote-nute () rk kl ducirc un~l rdeguCltl d nil cra pi lt di uJoseguerrnt Cjua li 1iU110 cli nbie tti 1 rcr lJ)tIId d~ fle)-UITC
n (- -fd7Io n~lcl)
Ut11claquo)si 1 lI tori htpnuuml )ludi-ttn I ~ cnntI1zttu fr Cq(in i idiJ)tic1 dbfl lOZ10l1 d d ~ leOla nelllOll1otoriO Lb un1I1cnUl 1n1l1i3 dcgli 111 lt1i ch DIJgt gtU l H crmU1 Nlch~mslt ( SIshygnaJ~l lerimiddot wo i esuemi -bletti d~ plt~e8lugraver- ne l pClZ le1lftgt scoliodcu kl s iluppo ddl ~ ~ uhjlil~ vertcbral~ lt o svilllp prJ Jdle JIl7 i() nl di ltCjuiljbrio Dng li studi sul lto lb( l~nlrale (OllddU i in pa rticdu d 1 DlIal-BeHJ (gtegraverl ~ P~II IId lI1 n~ llw - idente il v- m gtiu p eT il puientc clioti elgt di u n rnigb o t c)[ ro Ua sw mle dei radlldc onsegull o tramite il 11 fforzrlshyfl len to d e i l1luotoucirc l nllgr3ilri d e luOwo con crcbi ~Clltdr
in pOMltHJ corrctl e in va rie ~i[Jzioni s t llicb c c d inamIcirc tllt Dalle on sena d elb blOffiCcclIlicd tr idimlt n s io mlle d ei
r ~ chi Je ~oU()f icn ~Icirc ~videnuumll (l() ~llt tC p IYZIcircOSI ln(IiClZlfHicircl ~ 1I1shy
liumln fluenzt Je ll middote~rUrio tl SC) lgt lIi I rc pibull m i tldln sJlI71 Stl shygn~I I1 afferma che slI l p Ia no [11 middotccedilr~lk tre un œ rtlJ grado di l L1Liuuml IlC dclh vEltlh r1 apj(de le tu rœ mu SCltJ llri njtbc J n in $tJ ) t rodcfQfll1t1l1te PltJtantu b i r~it-~ r -lp il puugrave t~~
Ixnt-ftla solo nt Ile so )[j)~i Jl1Icirc na rl in qunnt ) ilon SlrM ntne )(l(Ofa tu soglb in caq ) co lltrLJIcircn l)lrilto llt~( i lJudotlsi di lfr~ lI1 C llg grVlmenl J 111 11 io lr riltd ll(17jOill leld rinlle 113 dimO~iumlrlto d llt nell o lin~l cl()~ li t th~oIOl))1 dri la defltgtrshymiti sul p iluO slfl iuale ~vohl lf1 (en5 ion~ sO lnm utto nd 1e bsi iniliali deWggrwm1Cnln mcn trl C a( lfLmn che occlleshyvoluzi ne dene = 110 i [ mhari IJ lin c l ki cen tri ch -1vi1( de i cp i CIt IJ rI Ji SI p m ittIl pnm l Iem lmeme e p o j pOS( shyrio fllwnte dtldnli mdv ( i un ziuuml ne ciloliz7nnl dd rlLtide lu mbJ œ ( lIlelttlaquo on NC n d d (gt11 uIdu m 1I1 Ilgt) cli r-Iure (0 eserClzi che IllUllengano 0 ltlUperifo le Clgt 6gt1 lo)iche sul pirluuml gilwlt Su l p iCl no fron itk Perdnulk il dlll1lt-trlto d1 lampkz-l d i LU ovimento amp111 lI rv Kolio ti ~ nd lt1 0 ddlJ cnrrc-LIcircQo i Ji gC 1 n lungl SUpegraveliltlrccedil 1M llS0 tlell 3ampIGI shyvamcnlo C che l~Jltmiddot mobiliti GlI mcnta co n l c lu7j o fle d l i) snAio i A ulln amplgrtJc1 ltllllmunjx~ i terlpGli nn n m obi shyUZ73It ma eutva coli ti0 1 1ct HsicVlfe nd tcmplt 11 1111nshyttllIcirc1nc n tc (k ll ~1 llu u zinnt n l1 un me77uuml d i sost l11( gt ln 0
e 11111ri b cle - Ilziunc egrave deorinatcl d l rlyarsi Snzcl la pr gtshy
liltlnl l i un() rtl~ i ptmiddot Jtl n(o 1S(Hl () (( ntJ() i ndit~tr i ~ Ii ISt (izi e l m iviL Illdlode ebe Hlmen tno laJlc ibiJii dcl rlc lide SCshy
li io) [n p articobre rune q lldl r C-I1 ich~ xlSiddcHe CUf t shyli ve ch~ iJllpi tgino e~rciii 01( biIi2 ZanUgrave HhnmL-trid () in tmiddot~t~nshy
sione kl fuchide O tne pure k- ~ttivit1 tnotoJII~ non prHi(~ llCcedil
in forma r k rel1tiva d Ie ~1I 11 rF~1l1( n otcol mcnlC 1 lll ubib Ll vcrteblmiddote (ad ~ flp j(l 11 n l) to L ginn ~Iilt Utl clkl rilshyC
mka la cli OT- tcc)
r1il to l~ _ I[Dl COlI rY IC~
NE olUNI
fillncr ( ni ((uuml(( n hIIo( rilclIO ~middothe k lln dtfidl fUr1z i shy
nlu CQll1~ la llcl llZIO 1e delb c apKJl ilde e della capacltl di 0170 mizianu luJndn le (OJ il~ gtna a nc r3 di m~i3 gmshy
v it ln G mlxl r i ~ gko Fl llslrom C dlllJ O e Nachcms(J h iU1I) dim lr JtQ che b o liosl p IOO C1 neUaduksœnr 10 SYil l1p pn d i lIniumlmn~gin nlt8Jliva de corpo in (o nridcnz di Ln ddic3w p ri d di f( m l lz i nlt deUa SUl idenritl condishyZltonc ch pOlrebh ~[I cubrmiddot ln vilu pp di un pe bull n nn lir m llur cd e quiJibfarn in t[C adulro TaU CO1DSCe nZe tvlde nshyZ[II)() la n ( middotess iti di ltimobre la plfte ip a7j0 r1e atl an ivi ll1ltHClr n gl b a li ltl h ~ di tlpO s pu rti middotu dl ittlrc nd gloani iCo lID ti i lirtugraveta z io ni llb vila di relazionc
ln concllliu fu la d tfoflll lL saliu iG egrave il sin l mo di lin) idrotnc C Il1pk 1 d e eoinvo l d middotmiddot= fu n (n i dd rgashynIcirc5H10 n Hi lhdli e lesenizjo fi 1lt0 se 1 Il indirill~t() pllO pr~cnin 0 odLf rgt t lli di fu nzlonicirc adlc s()Jj(bi 111Icircn(i rrHtatc CO ll nl1 cinesi rap i Quand l~ coli i ( n LS~middot iJ11 zia k il rischio evnluLIcircvo egrave lid [() mente no tcole 11 (ltlll asso p o lll shylal ltOtSltgllen7~1 _ ta cincsiterapia pc rslIk bidtlvi shyptutibulli d ubllIcirctIcirc vltnc brn1e di conrro llo )(JSu k d i 5IcirclupPQ d Ile rLlt ziofll d i eC[u ihb ugraveo dJ ftffr otZJH1 r1w dei IIl llJgtCili 1 11Icircshyg rdtarl in posru ra rrenu posslhile JnnalL in Illo lt i clsi l(j luucircun lt di lin ~c() li oi mi n rc ( ume [11 duumlnQstrIO la tinc~ jn~l el1lric ((1l1 ~rtlppi d i contnmiddotllo cnndnlt1 p nso i l entrt d e Massue di Li n nc da [ o llo n ~ Rodo l (1 986) Julndo il1vlce lIfU~ ho ~vutlJ tiVll 11lt1 1IjXIl to un dekrshyuina r o~itl di g rl vir~l bull a~-n lllull~nte n ec ~~uiu rlCUuml rf( ff dla tcrJpll rle si c a eo chirurg ica
1Ho le clllC ooliosi idjopHI 3 ttl1p ~ - E~er l zjo hsco shy11ln ~ I((fapil
l Bg 5 CUle Lo [la k ll oblems in tlu ll~ (U ni Cl) FrKUce CU ( )lIILr no 1 AllCPR lu b1lG1t10 11 middotCI 9()(iJ2 RockilJe MI) i)~Cr ~()f I [( al th all 1 () I ~Y 1(~Re~C~Hd ~gtutnlt Ilallb Srshy1ltC Cgt D~p(rulllnr CJf I Ilalil 11 1 HumlIl sen Lel 199-1
2 SI) lrzcf ( LcB I ~IIl( FE DupUb L ampkIll~ 1c ~ppro l c h ll tht rnent und mmgemlt-rlt ot ~ ct vlyrl~ led splnul (hs r)fder~ A monQglJph rr r d lll kic Re p o l1 or Ih Ou bcc TlSk Fu rcl 0 11 ipmd DIo rele Sp ine L9H LU) 59
) Clntino F 111i1 i(ll Ci nerte1H C Nou gltHhl C Kln(~Jl llBICII [lIe1 hmlln (Il dry rra ll1ltfll of QIil pa ll m log iC by l11e 1 lIb li 1le-llh laquorilC~ of ~ 10(lna 111 Jrc)Jcxli r~~ (of flle h l lntrnIUonll SVIll Illgt~iu tn - II 5lt Ik lIc lk0flllllic lu llln-I I r l III Fhhlt ri g 1092 -ltlIJ-7
i - ri of niii MA N()LJV II ~ mel h)ltks de kin ~~klk rlr k di lll J r~cdllclli (n d~s ~()li oes jn f ~tel r~1ruuml(ILI -lo s bl fl c sur IcIj cquishyl)œ~ Ik SOll ll l)(eacute Eli ror eetlfllS d )111 1~ 1)1-
5 iloll n G Ruumld(~ le s () I ~middotmiddots tnlcl l l1 I n in 1Ifc el kiwil~~ 1)11lt KillegraveSlthe ripJe SCleacutentlnlue lYl6 2 47 ~ 6
r) Feacuterr[ffgt en 1tsiero 5 Venlllfln A ll~~n () M MJglio nu N EfkUuml o r eXltClse tI~tl Yoj o n nild id iO rXllhlc iC() 1i()~ lrt~ lirnIcircIluy r sull Eur feltl lb)ii 1 1j34 Z5 -~ 1 NOilrill1 A Sbill P egn ni i Ll Linesilegraverpi l 1lt1 Itallllll~nlO
ddlJ soI K~ i llO 1 Orkl1Llllwnrl m efodoloil1c1 RbbilltlZiOllc Ot1(1 1 )29(1) 1l-~
8 Nli(rinl Nl(lr1n l A blll P LI rieduGlzione dl p llicml atflt rro (11 coli ns i idi opr lir1 l n SC(Um i le or h( JI 1rcLlIQn1 ~0Cl le Imc lI1etW)n11e de Recltcrchc ci 0 Ftude sm 1lt Radw jlt)(j S-71
gt Nftriruuml S SeJhrf U LI r i l bllh ~l liOlie dd plziecirc11te ulet1n 11 - r
lin Kllopd (1 In l1l Jgl L N eduoL Tf1It II d ll11e ji cln1 rJtbl IiIUvJ Milan) 1ltfddH~n(x~hl 2(1~111gt-1-PU ob L cllln t iRll p l nelLi rl tgtO llcui n~ dilt ~lio i - l rn~f- li ~iIa n 3efllnl -Kurflr 19-11
11 lIIra S lJll M EVtJltHlvugrave egraveI lt t rnrumel1t() d db S(oli - U r) surie doCum nUle fintgt 31 tIUUli Mibn SI rlin) KlIpf -r 199 2
L2 1 ~W I1l(IJ P _leacuteVia tio n I~lhra k~ du IlchlS ~- ( i( IoltS ccedil l r lI C1 l1 fl leq
Ene 1 l C hi r ApparctlIClCOn l~ ltll1 l ltx6lt (i W Er 20 j )7 l
U StrI tr d P Lcs 1) rm IlO du Hltlctli Parb ME n 115 li ~u n un_ l c- l ol lJn e~IL1roy JC EagtOllŒrio n sc lluocs
L cl middot Exp CO_fiL [-In 190 15 Xd BR llet13n) J Th ltJl-xwenc a l o-(l1 tUcn~kuud txer
C le re-glflW 1 lhe tfelmc nl o f id iopllhiC Collaraquo n lroc~-din) t Lhl 1 r 111(1ltli0 I111 Symf SiUl1l un 3-D Scl IiDliJ DclOfshymillelt ~k)J1[rlt u Gugtu l1Shltr Verbg 1lti t)L j32-t)
16 N1lh~Ir~il Al Peumlf r~o n LE Erree htJkmiddotmiddot~ n f t~U lt hfIl middot Ith J
hran in ~rls V ll ~ ttiVl ~HkJ k-nt IHuIXtthilaquo ic I) Li ~I~ts H t 1l1i JflIn t ~ j l~jl)5iuml7A(~)8Jj- 21 bull
17 M(jo n Y ( ullck J p ~ R A PrdulllnlIr rpurt 11 Iht e rt l f rnltJsu red 5l ren jl lh rrll nrl1 III ililleInr Hi rrt tllk scoJliagt
J lin1I IJisn rd 21 1 1)12) 102- - Hl Hunng CU[- -If p~lIll)~thc - Uonktd in -c h JI IL
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EUROP MIDI C Pli hIC
EDUCATIONMEETING SATURDAY 8thof APRIL 2006
(iSS
SEAS02 Scientific
Exercises Approach to Scoliosis
version 2002
G
S Negrini 1
EDUCATION MEETING SATURDAY8th of APRIL 2006
Neuromotor disfunctions
Neuromuscular disfunctions
11 Postural collapse
Postural collapse
Duval-Beaupegravere
Flexibility of scoliotic curve
f---I--- I Postural element
-------1 Structural element
S Negrini 2
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Postural collapse
Duval-Beaupegravere
It is a value related to muscular tone and to flexibil ity of convex side tissues
Post ural collapse
Bunch e Patwardhan
Critical load
Load threshold beyond wh ich a spine begins buckling
JI~~Wt1lW~flfthtlJlœJtAr ~ J~It- l~l - IMS
Postu ral collapse
Bunch e Patwardhan
If a curve reduces there is an increase of the deformation threshold
~~~NW~-damaoc~IIIMf ~~ J~Iv JaJ-I7I9sect
S Negrini 3
EDUCATION MEETING SATURDAY 8th of APRIL2006
Postural collapse
Torrel e Nachemson ~
Scolioses below 20deg ~ ~ lt~
have a high ~ ~ percentage of ~ ~
~postural collapse (on u~
average 75) ~~ 2i~
CU~VE O EG~EE S WHllE SUPlti e
~laquotd~c6b ____lPffI1wtt1t~
$ww J(t ~~7 JM5
Postural collapse
Minor scolioses 7
Antigravity musc es strengthening D
Reduces postural collapse -G
Increases the critical threshold of deformation
G
Neuromotor disfunetions
Stagnara
If we admit that one of the causes of idiopathie scoliosis is a disfunction in balance systems it is logical to orientate physical exercises toward this direction
s Negrini 4
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Neuromotor disfunctions
Dubousset
Idiopathie seoliosis results fram alterations in praprioeeption centres and deformation is a natural compensation to restore postural balance
etattJtitIK ypothfQj~S ___~ own_ oJ)HQr lar 1t-1( r
Neuromotor disfunctions
Nachemson Initial idiopathie scoliosis
+ Goood spine stability
Neutralization of postural deficits
D Static curve
Neuromotor disfunctions
Therapeutic aims
c) Development of spine stability
C) Development of balance reactions
G
S Negrini 5
EDUCATION MEETING SATURDAY 8thof APRIL 2006
Biomechanical disfunctions
j Horizontal r-Ian
i Sagi ttal plan
Frontal plan
Frontal plan
q Frontal plan disfunetions
Fronta l plan
Perdriolle Movement magnitude
gt in the direction of lt in the direction of correction progression
S Negrini 6
EDUCATION MEETING SATURDAY8th of APRIL 2006
Frontal plan
Stagnara
Never mobilize a scoliotic curve without ensuring reduction maintenance over time otherwise a greater mobility favours scoliosis progression
Frontal plan
Ducongeacute~ research
On a group of adolescent idiopathie scolioses treated with
Meacuteziegraveres gymnastics
D After 1 year the mean angle of
curves increased from 18deg to 29deg
Frontal plan
Scoliosis without brace
D Greater spine
flexibility D-
Risk of progression
S Negrini 7
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Frontal plan
Mobilization is useful
D In preparation to
brace
D With brace
Sagittal plan
QSagittal plan disfunctions
Sagittal plan r middot _J o
Perdriolle scouos B CJ aDeformation of D
thoracic and thoraco-Iumbar curves evolves in extension
S Negrini 8
EDUCATION MEETING SATURDAY8th of APRIL 2006
Sagittal plan
Graf
The line of gravity centres in the vertebral bodies o s c oUOSt
projects itself firstly laterally and then fi
o
posteriorly lJ ~~ ~~ ~ ~~-_J-D ~nI~
Sagittal plan
Therapeutic a ims
D Maintain or
retrieve physiological curves on the sagittal plan
Horizontal plan
QHorizontal plan disfunctions
S Negnni 9
EDUCATION MEETINGSATURDAY 8th of APRIL 2006
Horizontal plan
Stagnara The forces applied ta the spi ne act in a autoshydeforming sense
Horizontal plan
Dimnet Rotation gt 200
ampII~ (
D The actions of concave and convex side
muscles become
agonistic
~ItJrOnrIIiItdllfUClltlluumlll~~tI ~1JIf1laJ
Horizontal plan
Minor scolioses never exceed these autoshy
deformation thresholds
S Negrini 10
EDUCATION MEETING SATURDAY8th of APRIL 2006
Disfunctions at a biological organic and psychological
lever
Oisfunclions at a biological organlc and psychologlcal lever
Cheng
Bane density in scoliotic teenagers is lower than in normal subjects
~~~~middotA~IIlUtIy ~7œl 1d l
Oisfunctions at a blologlcal organic and psychologicallevel
A significant reduction of vital capacity and V02max in teenagers with a medium severity scoliosis
S Negrini 11
li
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Disfunctions at a biological organic and psychologicallevel
Disorders in the development of body image that the teenager has of himherself
Disfunctions at a blologlca l organlc and psychologicallevel
Therapeutic aims
cJ Activate cardioshyrespiratory function
cJ Favour bone density increase
cJ Develop a positive image of the body
Disfunctions at il biological organi and psydlologicallevel
Stagnara
Sport
D The active side of
kinesitherapy
S Negrini 12
EDUCATION MEETING SATURDAY 8thof APRIL 2006
Disfunctions at a biological organic and psychological
level
Distunctions at a biologlcal organlc and psychologicallevel
Cheng
Bone density in scoliotic teenagers is lower than in normal subjects
~n~IIIvpWr~middotA~stWy s- XXJl M J
Disfunctions at a biological organic and psychologicallevel
A significant reduction of vital capacity and V02max in teenagers with a medium severity scoliosis
G
S Negrini 11
EDUCATIONMEETING SATURDAY 8th of APRIL 2006
Kinesitherapy on the scoliotic subject
q Postural control
q Axial stability
q Muscular trophism
q Balance
q Respiratory function
The limits of kinesitherapy
There is a threshold beyond which
rehabilitation alone is not enough
sssr
Kinesitherapy in scoliosis treatment with brace
Therapeutic aims
S Negrini 13
6
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Therapeutic aims Srace kinesitherapy
With brace
il Postural corrections and
vertebral stability are obtained by the brace
Therapeutic aims Srace kinesitherapy
In preparation to the brace
il Mobilize spine on ail plans
Therapeutic aims Srace kinesitherapy
With brace D
Maintain a normal spine elasticity
~ Maintain a good muscular toneshy
trophism
C Model the hump with kyphotizating
exercises
S Negrini 14
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Exercises and their methodologies can vary accord ing to learning and individual sensibility of the single rehabilitator that proposes the m provided that they stay within the
Iimits of fixed therapeutic objectives
li
Therapeutic modalities
(Exercises)
QAuto-correction
QRespiratory education
QErgonomie education
QMuscular strengthening
QDevelopment of balance reactions
WNeuromotor integration
ci Vertebral mobiJization
QSpecifie modalities in brace treatment
S Negrini 15
EDUCATION MEETING SATURDAY 8th of APRIL 2006
The protocol of kinesitherapic
treatment
G
QChoice and dosage of exercises
Variatiosn of the work program every 2 - 3 months
Q Execute e)(ercises on an individual base or in a small group
Q Frequency not less than 2 times 1 week
Involve and awaken the family
G
S Negrini 16
EDUCATION MEETINGSATURDAY 8thof APRIL 2006
Q Determine the action and the localization of auto-correction
QAuto-correction must be associated to ail exercises
QAt the end of treatment ergonomy lesson
Auto-correction didactics
G
SCOLIOSI DORSALE---- shy ----
r
S Negrini 17
EDUCATION MEETING SATURDAY8thof APRIL 2006
SCOLIOS OORSOLOMBARE
shy
SCOLIOSI OOIlSALE 011 bull LOMBARE S1I--shy
SCOLIOSI LOMBARE
il --~_-
S Negrini 18
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Scoliotic patients are not radiographs
middotSeoliotie Mtients are not ndiographs but hum beings with a vertebral deviation-
Slagnara
Metha For the physieian Cobb angle is of utmost
importance For the patient it is body deformity t hat eounts most rib hump a protruding seapula or hip We are in a situation in whieh today dodors eure the radiographie deformity but what the patient really desires is to get rid of clinieal deformity and of ensuing psyehologieal distress
CIIQItIo shDuIdtucirc lM WIld tJw~~ I~~M~~~~ J9f~
S Negrini 19
- Poznan_workshop_Physiotherapy
- physio2
- physio3pdf
- physio4
- physio5
- physio6
- physio7
- physio8
- physio9
- physio10
-
EDUCATION MEETING SATURDAY 8th of APRIL 2006
- CARDJOPULMONARY EXERCIS E
TEST IN GIRLS WITH
CONSERVA TIVEL Y TREA TED
IDIOPATHIC SCOLIOSIS
Jacek DURMALA Krystyna DOBOSIEWICZ
Department of Rehabilitation Medical University of Silesia
Katowice Poland jdurmalaqcmpl
The aim of the study was
to estimate the influence the conservative treatment (asymmetric mobilization of the trunk by Dobosiewicz) on physical efficiency in the group of girls with idiopathie scoliosis
Material
bull 87 girls with idiopathie scoliosis
aged 1 0-17 years
(mean age 135 years SO 161)
J Durmala K Dobosiewicz 1
EDUCATION MEETING SATURDAY8thof APRIL 2006
Material
bull 38 girls (437) with double major scol iosis (thoracic segment - Cobb angle 18-42deg mean 30deg SO 82 angle of axial rotation 4-32deg mean 21 deg SD 107 lumbar segment - Cobb angle 11 shy48deg mean 31deg SO 128 angle of axial rotation 5shy30deg mean 13deg SO 85)
bull 49 girls (563) with single scoliosis (Cobb angle 11-75deg mean 33deg SO 155 angle of axial rotat ion 5-30deg mean 14deg SD 83)
TIoracic kyphosis of the invesllgated group was 5-39deg mean 23deg SO 86 and lumbar lordosis 16-41middot mean 30 50 65)
Material
bull The 64 girls aged 10-17 years (m ean age 131
years SD 132) were conservat ively Ireated
using Dobosiewiczs method
bull Treatment period ranged from 5 months 10 3
years (mean 148 months SD 902)
Material The 23 girls aged 10-17 years (mean age 136 years SO 108) were treated u sing symmetric exercises - treatment period ranged from 4 months to 3 years (mean 161 months SO 1019)
bull 26 of ail g irls (18 girls earlier treated using Dobosiewiczs m ethod and 8 gi rls earlier treated using symmetric exercises) aged 10-17 years (mean age 134 years SO 108) were twice tested - at first and last day of Intensive hospital rehabilitation (asymmetnc mobllization of the trunk by Oobosiewicz) - mean hospitalization period 20 days (range 18-26 days)
i rf~8f6~~ or~~n~= ~~r~1~r~icircJ~~tb~~~~ mean 17-4 1deg meatl~(I SO 74 R n~le ofax 1 rotatIon 5-25ot mC3 111 3laquo S0 6icircl Ilnd 1 99t1S~ ~~~~I~~~~~$ruo~ras~ ~ocirc~~a~e~~~~~~~5euml1 9middotn~ tUfllbar Iord05ts 16-4 1deg mean 311 SO 68)
J Durmala K Dobosiewicz 2
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Material
The control group consisted of 77 healthy
girls aged 6-17 years (mean age 12
years SD 31)
Material
The examined girls participated in school
only in scheduled physical education
lessons and have not been enrolled in
other sporting activity
METHOD
The exercise cycle
ergometer test was
performed
J Durmala K Dobosiewicz 3
EDUCATION MEETING SATURDAY 8th of APRIL 2006
METHOD
The Incrementai exercise test has been applied
We have found that tests ln whlch the Incrementai part of the protocol ln completed between 8 -12 minutes duration glve the
bullhighest maximum VOz in normal subjects
METHOD
The workload was Increased stepwlse
bull by 10 Watt every minute - ln chlldren
with high ~ 135 cm
bull by 15 Watt every minute ln chlldren
with high gt 135 cm
METHOD
The test had been contlnued untll refusai of the patient or exceeding the pulse Ilmit
Durlng the exerclse the gas exchange parameters were recorded by Jaeger device model Oxycon Alfa uslng direct breath-byshybreath rnethod (with face mask)
J Durmala K Dobosewlcz 4
EDUCATION MEETING SATURDAY 8th of APRIL 2006
METHOD ~ ~~ r 3 min 3 min 8 - 12 min 6 min -~
_ 0 rpiYJ 0 rpm 60 rpm ~1 30 rpm
_ t o~w=att~o~~na ~~ att__~ tl~~S~~ l ad l ~~~~~r o~w= Hlcremenlal t
pedaillog i i ~
~ ilt ~I~-----tl-~ I t ~ i ~ lOSt sffortivB
lW r resututlon r rm-u middot 1 - bullA~cremen tal ~~ ~ ~ ifr- ~ VtI 1 ~i ~ tllng _
METHOD
On the basis of recorded parameters VAT
has been individually computed for each
child using V-slope method by
Wasserman
METHOD
For assesment of physical capacity
the maximal minute oxygen o
consumption (V02max) ventilatory
anaerobic threshold (VAT) and
maximal workload was used
J Durmala K Dobosiewicz 5
EDUCATION MEETING SATURDAY 8thof APRIL 2006
RESULTS
Ali girls with 18 have been classified
within normal range of predicted
values of
bull maximal minute oxygen uptake
bull VAT and
bull maximal workload
RESULTS
The differences between group of girls
treated using Dobosiewicz s method and
group of girl s treated using symmetric
exercises were statistically significant
Lower exercise efficiency of girls treated
using sym metric exercises has been
observed
RESULTS Girls wilh IS Irealed using
N=87 p value
Dobosiewlczs method N64
symmetJic oxor-ci Nz23
Perœnlage of predicled vaJue of
maximal minute oxygen uptake
98 905 0033
Percenlage of predicled value of
VAT 97 933 0049
Percenlage 01 predided value ni
maximal workload 101 939 0038
J Durmala K Dobosiewicz 6
EDUCATION MEETING SATURDAY8th of APRIL 2006
RESULTS 26 girl s twice tested - at fi rst and last day of intensive hospital rehabilitation
The value of ventilatory anaerobic threshold increased during intensive hospital rehabilitation (asymmetric mobilization of the trunk by Oobosiewicz) statistically significantly (p=00019)
2047 ml O2 minkg (SO 268)
vs 2239 ml O2 minkg (SO 232)
Conclusions
1 The exerc ise eff iciency of girls with IS treated by asymmetric exerc ises of Oobosiewicz is norm al
2 Such high level of the exercise efficiency of thIcircs group resulted fram using of Oobosiewiczs method
r
J Durmala K Dobosiewicz 7
REVIEWS
Role of physical exercise in tbe treattnent of mild idiopathie adolescent scoliosis
Revicw of th- literature
A NECRlNl N VElWNL s PARZI 1 A NEGRINJ 5 NEClU NI
P1t~silillxlrd~ Ihcrapy (or klucgtlttlwrlpyl i pro shy-tJm of physka] cXlrd-cs ipcci I(a~ (IJcloJgtcd hy l li trIWlltl phrslollwrapbt wilh tb m~ln a1mor pl shyVCnI in lhe ilAAfIVltilH1 llf the ucirccfonuity III mild IgtC )
Lil1Si bclpin~ thebm ( aocl co uaufllclilIg ils ~jd- clf IS in nlOdlJmiddotnh-culiosis Th middotalillofthi paper ito r (W
Ille Ii lc ram r 1 a-ccrulin wh kh of Ih bull Lu[Jalmlcrus Ind (Lb hili til~ CLlLt-cd br scnli()si- clluld bl pl Y nlcd or r d uccd hl phylolld LXtmiddotrdsi n Il p--to-da le knowl Uuml~l nr tIll~C aspcc[~ i ne bulled in oruer 10 dndc whclh~r 11Rf blLl adcqlmtt Ib(uuml n middotlicaJ balis fo r ora)aini l Ihe US4~ of lUgravellgtitlerap) wltcllj(r or fln l th e prtl1iœ of kimiddot ~lre IUlll poNjn~ a t iil ies ~bould h allowtcI II uuml middot c enliaI toltlentlf)wh k lu alClor ie - lf pl lr~kiJl -c rmiddot d gtlt- (Ic rnnhi UzJ( inn ni (t hl HrJltlon [ rtn~hcll iJl ~ or 1i1J(IChIumlJlJt etc) Sh llU Ld be TolullllCcluse ulemiddot l onld b- clclIimcntalancl wukh sho ll ld he IJlI-n~ifl~d I~~a l lhc (o uld h 11lfu 1 Know k dg CJnc1in t (wIn SeiCIImiddot Hlk rCS([lflt h daw ccordinll to Ih bull llVit w o f tIlt iii 111 1( plop(lsltd in (h i papcr lmiddotonllmJ l lnl plLyi 11 cxcr(j$( pn (nti or (tmiddotduce dhlblli t ic 1 ~lt Il Jj ll(k pl ti Jlt fadl j w(~ the nlIIIrl li7alinn n f poMural dd shylitS tu p n xJ llc aSl COIlMqnen c(middot 1 all )llal) or r(tn~ shys i middot middotlIrve Tilt u~c (I f appn1priattmiddot kincsiuuml wrlpy 0 in rcns polttllcal swhiIHy Icirc IIHmiddotorc Illta ll y (0 r 1(lt1 lllho UAh mon ltlccurlltc 1Ut dl1alkd -rLk l(lWfils 111111 )11 h Jlccdt(
11) wurcJlt 0 lit)-IcircS (Iumpy - x rcLs P()lun
n rllt lT(ltnklf u f COll1tlK H (rtd) I 1i plfho l og l ~$I rUlglng tr m low tmiddot k Pl 1l1 to IdiOpath ie SCUIshy
Submitt(oJ [or PUhltCl l1 011 uly Tt 2001 Acc~pttJ ugu - ~2 1(t-1l
Addre rltj-xlfll telt~I(middotb If) - grinl Flt(1(bziurllt r )(m Ofl ()(Cl1I shy Lt middotqlltœlll ro () - 1u I4t agravehLIlKil ta IYIL-lTt ilSllltp lfllmiddot ~ 1l1uumldull
CelII ~ (niiOS I I~ middot ann (1) IfUh middot lIlfU di louhilll(tymi ( Nlmiddot ~iI rli -ilIIUmiddotltlfl
Nlti(ir 1( ) il r() (ltbullagt1
lt vLL_ l IiII no 1ftfI
jS ) we are a IUil ly tJc ing n1n) ltblll lS 1 k l1 b ~J)w in~ tl~ t S Jfll l approad llt - l1n til hy on ielshyertd ~tan lard ugraveJuld ln m any ~1~ he lI ~t les i if Ilot dange r )ll lt rhlS is lrut of reil l lnw 1gtlt1lt1 pa in l ~ or 5urgi c ll lrea lmltnl5 in dbc r lmiddot ll Sc - 2
ln tlle cj-e ut ~ t lll(tlWtl i( li p l ll1JC luuml- I ~ middottnl ~() shyliosis phys cal ((_lt1(( is emr1uved ltI t()fIl1 0 lh~rtrv
lo ly in cel1l in L)lllllde (nluumlnlr in tilt Lltlll middotorkl i e Iw l) r llt t Srain hUI IIgt() 111 Gert11lny 5- 1~1 in other reg lOl1 wbere thi I-incl qf tre l tm e rll 1 p~ 1 pmiddot t 1( cI il Jws Ixen cri ri cilld md rel -cltd Lw m~lI1 1 11 Jlu~ Fue Fnlny r ~lrs thio middot15 a lsgt(ru( f ~rth r -~ltc rrJtf))~ ll t vit11 br1Cltcgt b r II1 ([C Llt n ClW grmvlng 1lt1 0 L Sti g
gcsti n the lIsefulnes- u r Ih is form o t treatm n t 1
Hmiddotu]rs have nerged jn El or uf pll y~ iLd eegraverdse eacute 00[ 1 but tlw are nUl yel 11 11 t llu i vIC~11 and r hi ~
f rm of trt ~ltmenr IS stiJ l Ul1 ckf ckhate FfI t Jt 111 il i 11t (eltary td 1I iFy 11umbtr ot
b l sic COI ceP rlJ lf w ill he cIh tt d in t hi pap r
Scollosis
DCijIrI iriolls
ScnUoSlS is Irlircc c1 lme nsIcircltnal (I(gt i l cj on ot tht spinc thar cau C a CU 1 lh lt ca n h e $ t~en ln (1 me1Sshy
ured ultinF Coh) lll ltllCXI o n HI anreu middot p rtc rilt r
EUJlOI -1 lœDICOPHYSlc~ IR
NECRI Nl
110
f)i)
1 7J
amp aS g 5li - 0 v
V
31
10
(1 1) Il 15
-tc i ytjtr~)
FigJ----jllph ot DlI w l-lkaupegraverel) The agloimvltltinn Or idio r lrhlc 50gt1iflll~ IS rpiJ bel~ en th e- [l0 IH P (l)ltg tnntll lol (JI PUllcmiddotny) mtl 1 ( f( lS-er sigll paiilivltecirc lt Dlt(i I1 11illg r the iti l 1Kgt n n t rll icirclicH a ) 111lt m omal prebulled the mno rche md ociks with lll I)ttlx flal gr Ih pll fl
rlcljoprdphLi 1 hl merl prestIK ~ of this curvt c10es n t autom~l ritllJy indi ate the pn$CI1(t of a defurshyTnitv (SlllKtUrd (Unel
It i~ possible tu clil1e ren tute a struCnlt t CI1tve fruIn a pogt urll 011e by identifyi og the hum]) du ring AdIlns tesr I~OQ looklng tra m beh lnd at the p atient w ho b benchng fUfward il is p -- ible ta d d~ct 1l1 eh ucirc n of o ne liidlt 0 1 the trunk usually n n the (onvex ~ jde ul tbe radiographie CUfve Ugrave1lr C Ul be mlt~I Slred lISin~
BUlln els S o liomere( 1 ~ l This h Uf1lp is du(- lO (Ile pregravegtecircn ~ of vertel ra i rolltion 1c1 Ollt tn tic f~YJ tllre o f the def trrnit tli [ c m be seen and measurc(i v ith Perddolles lb lsLometer on an amero-Ix)iferior radioshygrapb ~2
Seven ry pel cent o f li Ises a re conid 1lt 1tO be idiopa thie 1 bull ia l-nosilt in this CI$C is b exdlls i ~ n as idinpa thlc me-us t11H wc do n()[ know rJw origio of lheacute curvc [n othe] ~Ie$ it b Ix )~i ble ro ide nrify a dieak (bat CHl jusrify the c1etgtnniry slIch a rna lfo rshymar i ns I1(gtufol Ig ic~ l or genlttic cl iscas s Glnclt~r trauma etc )
[dicirc)parhk S(oliosis has been divicled ~(corcling (0
the ~Ie of tlie patient egrave1l the tiJ1ll of d~[ccli n of the condil ion into ti) ur t ypei ln fanUlc jU nik ltldolesshyccnt lnd aduh Til l m n st cnnunon (VPC IS the acloshylescegravenr o licirceacute I1IJctenzec1 hy 1 sud le l1 tggrH3l ion uuml uring the grow tll Spllrt (Hg 1)2
lhile p tu 1l sco liosi i5 Ycry lomnw n thl pre shy~Iknct ra te f r adole ent icuumlop~lthic structural CU IY~S in sch )o chilclren are 18middot20
- 10 Co bb d~grels o r m on l -lil
- 2) ~ohh dtgreclt or mort O 2~j - bull () (obb d gre -s )1 mOfeacute ()ll 2
Clin iltI [ d e isio ns lfl IXlSed 111 an lccu r~He pregshynosi which obt inccl in eJch pa ti nt mainly o n the basi of the nsidu~ll p()tlnllltl l of TH1h and the result s of 1 rh clin 1 1 ~l1d tadiogmpl i exlminashyti(ln12ll c noieq uentlya d inica ] la sifiou io n o f the ing le pHient tn -ome estent co incic1 ing w irh the
D diographic one c l n lw SLlIl1H1arizeci 1 1 folIcJ - mikl lc~ (1)(n 20 C bh de~r es - moderJt l betwlen ln md 15 ohh de~ rtes - StV re 111( gt1lt rh n ~J) )bh (kgf s
On the 1) lsis of [hi - dinic d d a lfic t i n (Vith l1l il el lrb tiOI ~ o f the ir b() und~ri e ) in Itllt l cente rS Of SCOtiO LS ITe ltlllent in the Lltin odcl (i rJ Ital lnmct md PI iJ Ugrave tre tmtnt i s plmmcd a fo lltJw 8l
- mild kineslth e (~1fw ~1Il (1 luok-ou t - Hl demte IJragravecegrave 1111101 c(~r md k i rws ithe lJpy - ~cven surgery
Physical exe rcL~e for S(ol iosis
Defi t tiOl l S
PhyS i 11 nU b lIKrlttp middot (or kines ithcIa Pl) i a p rvgrlill or plt~i Gl l (xeriltecircS ~1ci fi ( llJ y ltk ~ loped
y a -11 [ru ine 1pll yslo ther3pisr wirh th e m 10 Hllll
- pre (~ n tit1g tlc aggraaLion of the cl I )flnily in rnild bullcoUm is
- helping tlk Il ld Ct ~lOd ounter~lCtjng its skie elfects in III de rltegrave sc li sis
Tn tl1i_ feSpec1 kinesitl1ert py f JI s oliosis is tonshysider l a o on of peciticcedil training and s genecirc tltllly proposelt in sessions 0 1 4~ ro 60 minute IW) t) tour limes 1 Cee PhysiGtl exerci es can aLo ll v o ther auumlns 1S it oill he dise Issed in this plper
Ir 15 Ilot possib le to cl escribe a single progrlIT1 o r exerc ise a5 pro nrams ale USLIJUy p fgt nll ized ( ( lt
EUH PA ~illDI (DP1I YS IC~ 182
ROlL UF P l 1YSICAL lXl 1lt 1~E IN l IlE 11 ~l) IEd If IlU) l[)VP 1HI AIJ() J)~Cl~ r COl ~I NlG1W il
f)( 15 egraved ( )Il the nee L- 01 indi iuua l pJl itnts) al l l10ugh Lheacute) C l n h t 11 plicd o n a WOU p hJ~js (-1 (0 () pnients PC[ ~l ()lI r)middot lugrave reQCf lhese 1 10 grl lll frequt ml~ V IIT
hnm on in middotituk w allClthltJmiddot -Ill Jnv L l~egrave at Wc w Ht ~huw in lhis lyl peJ it i~ 111 n u -eII1 tu id e ntilv kirK itheJapturlc aims w hitl l ucircrr~spnd LO ugravelt~lil1 DUtshy
g X ir ur ph -s ici l lxtTi~l I~llhe r thln ln dj( us- indishyiJ u1 1progr-lfll
Aduumll l lxUl kisure time ~lOd h )u] Sp u lllll8 ~Ilttishy
i lt egrave~ i middotomm )Ly s iven lel mJ ing ro w hlf ~ Iuumlnsidshyer~d usdul or il lrmfu l in t1 lt rruning (lI tJw ptliJicirct ln tl1bplper Ugrave1 gent ltl l t rl ll bull p lwsiCUgrave lttG iviUes is rl ktll 10 JllI1ltlCc hOlll gtpOlt mJ kIJ1lsIcircl hc lJ l f
i ve lUen tloneumld )bo C on lv ine n dul( re Ull~ 1t~1 t s far Ilten publislt d f I~ mJ I(i noltgtithltl rgt is 11 11 a su h jel lnI deacutehate CJitk haltlt t llltit m itn ltl of l ny lorm o t p l1 ySiClI lxrcL e as a Itwr1 [ J- fo r i liopa tb il jcoJL~b un iL ()ri gin~ initial1) it WIS Ille r rOmiddotUumlK lt brgdv u f p l~lt titu gtllergt w h ) intervenecl hutll tc llcrl ll (mon as cltl HtilJ nic in terventi n man Jgt
1 t lltrJp utl t one 1 md rC j fkll l~ on rhe h sh lf som uni cOen I1v pn t I1cgts wt ldl hll ltl enl1 JI~ haLl nu na l scicnt lfic baisYmiddot HOlh tlle$( trr t peu shy to rh ~rl py tt nJecI to l~~rJ tte C Ih tk CUf -~ pnnshyclr~tll y as a f tsul t of lilo h llIzatio ll of tn imdqultdy ~u pp rt(d S pln eacute 7~ 12 to re-t1 r rI ltrl 1$ l l1C k o f WH llt~~rdl 10 I ndt~-dll()urnah tnd 11( on1 p~l per u suaJly Cl tc([ IS n prelimmtrf lll d 3 ln tt li w ay man (l rrlKpt(Hc H lf O iS Inll ph ~i C U l ~ d vi ~ cI nllog scnliotl pa t le nL~ 3gainst holll ph lca l egravexershyclc and p()rt~1
It m u st t~ n tfd [hat pllyknl txerc j~ tJe~ltm(nls t1iHer 1 lJ rd il1g r rhe rherlpcu tlC litTl~ on lllc h tJ rgt ap p lolc il l the IXlltent lncl hi im r IIIllHnt i- 1 (1(1 rI - 5lt1J lC igt tIl l ( f phJllIlllolopJ al rrea tmln ls Ihith cllffc r 1lt œQlfd- rhe m C cculc u ~t(l luI thl p al 1t n
~mc l 11i (lbE~e Tt i ~ P ~il k tlwreI[middote thll wuumlk ltlll t kin 1or ph~ i Clt1 1 lX r(j~ 1I 111~ t bc loidvd by t h~ Lo iurie IxujCJ1l al1ulhcr a dl ~IS nJI h~ iOg (1 11shygerols llugJr in racr le (wi ller d I ~fJIII ~ I ml thlls re(nl1l rn ndc(1
fn n UI cel1ll r we In(~ hccf) using 1 ) 1 1111 11 ve ) 1 (J p lw l icd ex(r(i~e (0 J ( 1I l tt i~ tlh aITt ~ l~d Ilv m ikl tru cflumiddott1 adokscltnt (cl ioj arh lC icoli is11 2)
ina the f U~ t rc-gt uJrs IefC pu b lishe - the pJ( )grd m 11lt1lt l1te n PWltllk d in fa c t deel()pnlln l~ in th t l itshy OlL1Ii in tl1 r b t ~() ycal f ha ve iclemi fiecl niO l l
m d 111 ur impl rnHm s md d i s )h ilir i (gt~ lue t idlo p lthk amp()lio -i ~ t Jll CIII he 1UO(l if Icirc 1by phyict1 egrave xert iSlgt l fe t rrncllt
l illl
111e aim of t l1JS r~l per ii tmiddot (tv iew tl1( l iterat urt to a(errl ln v llic ll of th~ impa irm 1t~ and Liit hil it il i GllIltec hy ~ o l i()gtj s -o ull he ll nt x or re middotlu celt1 Ili pl1ysical xerclse An u p-to-da te knOvkdge o f tl lt Lgtpecl-gt i necckC1 in rJeumlr) d -oek
- whetll~r there h ltl n adLtIIl ) l tht()d ical bbh fur or JqIIcirclb l l l1 Il( ) f k irt llit herlpy
- h N I)(1 ( 1 Dm tlle p r l c tIcirc(( o f Jebur tiJne )pOfung lcli v l ti ~ IIOU lci he tllf) -d o
II J U V f h 1 I11~ c~~lb li hed Ihe usefuhlLss 01 k il1 shyc ~thtrpy il i aIle dy l nsi 1([(( -r-tI Llleu i n )I11 plJt~ ut the wJrld ir ilt ecircS~nl i 1 I( id n Iv w l1i li ( 1shy
gories 0 1 pl1Vtl( 1excrClgtegt te D)bilI7it ric 1n (Ir st shylliuumlZltio f) lttlt tlgtbltn ing ni trcrccedilh ing erc) hn Id be
vnlcled he tll rhe nuld be lerrillldll1 1 md whidl s tlQu1d be inreœ jf ic(1 IJeClU~l tlley cOli lel Je LI ~ful
Ncuro1llotor impainncnts
Imv aUl llOr~ 11 lt1lt ~tlKlteJ lhe cltlndatiotl bd Ween tl UC1UmiddotIt t l ol(~C t nt id iopml je -nll ~J~ and cli~l l shyler~ lr 1tH lest ihuLIr yt 1 _ 13 ~ 311 D uhoussct 1
1-- ITS tln l ldiopath k s(o lio-L L cll -c d l J l hmgt in th terl tltr f prop li l l pu n md 1I1ar th e detrshyn Hi n i~ na tural 1 ~ronse to ril e need tu ts tu re p()tun ltlluilib riu Ul HcrmJJ1 31~ 11 () d tllat icliupathic ( liCl5j h l it re5u lt Ot1 rw nltuf mot r l ~ltelV
[Id )fcl 3 nI] ~1ltJ U Sr1lle nr to dtorders in centJtI lO~Cl shyIOIDNur) md 1xi~tI moro (Ul1lfOl syt( llI (Fig _l
N htIll -of) H1c S uumll h( rll1 ( ~ l( w ing JI t11 (oshyI-ie on the l l lO]ugy o b doll (nt Rl iu]icirc tlili- middot()lioL m unt fil t-hltll rhl ugravedcmnilV L th e fl5 ult o f 1 (k btcl 11lIFll llI ion nf som t11(WUgravetltnl md pO~ lur( (tnic l~ l licirc1 tl1lt if l p OgtlbJt b C 1l rlw sta l i lin 0f 11 1 Sf llle j lt g )tx l Tt) ohtil n a ))Cli U 1ILzltl I o f p ~llIr~il d l~flo [ in l1litkd ~J)llnSIS me CI Igt(middotqucnr J ~ a ~tmicirc ()nlly or regle Ie Llive
Ali th- 11yp ) tlw~es rd ~lte tr d irtl Itn t pnl1tlt o f [11 v hole ~piltm It11[ controls postu re ~nd mrw shyment lrre pell ic of tlh po int a d lI~ llv inH llYegraved il i ~ ll 1 nnable tCl aSUilll ri 1l tr l ll1 lo g thi ~ys ttm ( Qu it le 1I middoteli tl
lt ch ugt nlt~(S f rullliIl thil i nlomwtion th at p tlmiddot shyiCil J(tl iIies nw gt Il lInport~n t rr le to pbv [11Icircgt role ca n 1)lt slI i11l1lariztd ln lWO the ptu li ain Llt
- d elopmll1 l of p uumlltl St1 b Hlt ) - c1e veuml IOpm 1)[ o f bhll1ltc _
(k llhUl)lOr S Cll orr
ontrot oic whan-lt
------+ 1 ~ il lnll ugrave r AINnl
Cllnlr1
T bflt~ r
fltL1 tlli
lMini
l
~sary ~J-frlllen i )f
~ 1 ocirctnl
~UcirclllIJJlW Ll
AXl ~l1 n uumll l) r sy 5t ~nl
middoticoltoq ~ Fig 2-AcFgtrdong lU He-mutl 21 il is Fi)5~ ib1e rD prolXgtSlt l -oo ie1 mnd 1 ((if ~ elio egrave middotAhltr~d l)Qdy-p ati~ I I i u d) uren ttllOn k td LO In ~ory reHTt I1 eDi tn l al ) JdrnlV~ pn)4~ e l u r~o(Ofe 0-c1 eptunl dvstil t1 ctlon sltŒ(ry icircltu nu11t ilwnt [ ~mC ~ted tl l1 ce Ill trpntlshyUumlfJJl nd IKnle~ r~dibl jtugrave)n of -I) m tlosen Ir ~ig nj tl (I1vying ln fornll1U n (lI an ereltl ~piJl e Mmor aJJ r--a t ~) n ltgtf ti lt aXljl mowr plem iHUC Wh ~fl Ille 6ubjeco m uumlntl Icircn (1oJifitd perccpfLlI l ~na l ysilt of p n)lnocepti Icircnfu rnlaquol ti desnibJOS ~n t tecr spin A IICW motor co nrro l Ira I gy t adopt resu ltin~ in the ~tr ltctltr 1 ckformh y lf IdiopathirL scollos i=i Ht lrftU1uc nltnt l ISll I1lJy h1e- ~ I pro()und elkn on bralO Sfem flJll ct i(lnn~lLhu modifyRll Ille nltulltgtshytl10 ) 1 1111 Uu l-lHoror control 5~Shnl$ shy
As Srtgn1lt1 l ~ ltlssert~ if wc l C -Cp t 111 1 un o f the G IiC s oliosls L l tisorckr oi th e ltquilibrilltn sys t ~ms it is lagical to oriegravenrate physlCl l exercis( lherap y ln th is d ir(gtCli()[1
11lclte goals Cul tl lfOUgil ditrercn t modes 01 action be Olchic(-c1 witJ1 phykal accivit ie
- po rt ive Cll ities p ro ct LJ e aIl UgravelClltrtsc in 6lte nshyel ll )o rd in~lti n pinai pr0prinup ti_)[J nLi mOVeshyment control 0 vio lls iy ln thh repect ome lCtivshylites aœ pre um~I I)y lXrter tllln ntil crs
- kinrl lira py using pedJil exerCisocirc specially developecl lith th est 1101 5 in mind illVuuml VC I lllore prccilt( ll1d InC1 li zed cri n on rhe spiJw focusing
a90
1 ~~
lg -lNheJo ~1l l1 t r~l g rld in 1 1) h i(~ IImiddot ct r rHienl w i ll idlllhic _It ~i ~ _ iri s plt ~I le II find Jit ltH vlllleuml ~l Cgtbl tn~ ks III d il fef lt p ~ lt ihnS nu v~tl middot B ~a~pt u Il C middotl)Icircd ~(t l l11 C dlfkrCnl middot- hdween slllndi1g Uline nu nllt1Xinul oorrec ri nI t chied Vith Ct (J ) und tfdincJ ne lot es o UIine 1 fo llnVs middotIJfl tfi ni( - ltlrshy
reltiK)n ~ Ikexibiliry st3nucircing - -pirte - f ur~1 1IbjISC ltupin - ltorrcaion - - r~luci()il ll ymiddot For flmpllt in J npK l1 pH k1J il
plt1SSlhlc ln obtai n 10 u1 511ndlt)l [YLo lion yr ln Slt p ille rlOlgt itlugraven om l J ~ in ( gttf(C rigtIl lIex lbuil 15 i (r-l l=22deg pol lltl ~~J IIlpraquo is IcircO~-V- I t1 l nd tucircu(Ugrave) ilil) I~ 3laquoJO- IH-12
r ln Ugravel e abilit jl of tluuml [m e llu to co ntro l irse lr in ~ pac
fuld l oftlles uumlllelve ntio ns can presum1b1r incn~~ Ih enl ac )1 the orller and lHitlll r of Ille rn - 11 )ltd h e lllldenl lu EJ3)4il
Posl1l1-t collapse lnd slabilizariotl
lIle concept u fplt st lUal c(l lJap~e l l~t Iwen detin 61 by DlI II-T3e~tupegrave rL t Ac oJdin)j tu tl1i- ~ll1thor il [ nec(sary ~- l Hn Cv-tlualing th tleihility o f a col shylo tIcircC CUJVL (0 clistingu ih bt tVeen the re du ihil [ty index (th - li iffer gt le bet ~middot Il ~I r~tcli()grJph ie ~xnmshyinltio n of the iI111 pHienr in supine po ition m(i
ROte OF Pl rnmL EŒIlCISE IN THE TREAT-ŒNT OP ~I IJD IDIOPAnnC OOU~GEm seou SIS EltJRINI
I (~)-----------------------~
__ _~ _____ _~ __ __ L ___~ ________1 ____ _ __ ____ ___ ___ _____L___ _____ l___ ----------L ______ _
1 ~
1
-- ------- --1---- ---- ]---r --- -----_----t- ---- --- ---shy__ ______~---- __ ____ 1________ __ _1_ __ ____ __shy
~ (1 J
1
8 =~~=r=middotmiddotmiddotmiddoti~=-middotl--- middotmiddotmiddotshy--------------t----------~- -------- - ------__shy
~---- --- -- -~ -------------r---- -- -- ~-- - -------- --shy----i-------r-- - ---- ~~-shy
il 1~ 0
Dtl-Lmiddot ~ lttj l r~ UIltltlHt
f g 1 -TI1 u ilictf 1ld ( ii 11- ugraveu-sh) ld IX~ O 1d wllich ltJdnrshymII Il nf the pilll 1 ~tln~1 of th e -o lioti( spinc n IG~nI(J II IIIshytt) lhe iJeuml grl-e o f ~ ()Ii ti c (u rvH Il 1 w dcpc-nlknrly o l l he 10 111shy
P01(nl (pntt l ~ 1 1 nr ffll wrJ I) ln w hilth Ihe n i 1gt( ~ duc nL~ grlphs fm I h~lt 111lt hi~hr Iht Col h ~Ilu t (l f Lite ~Ul Ihe m Ol CI il y th t s(uumlJotil middotpin~ ~111 he ~middotJg gr~lVH(~(1
m mJxiTIt corrttt ion wll iJl i~ lIllCd to Ih - xt 1shy
lti Oilil y Jf tl1lt t Ut JO rl1t cdnUc idt md p OS shy
tU ll cul lapse ( th t ltHill enct b-tten l lUdioL) 1lphic egraveltamJl1ltlti OI1 J t th e ~lme pa tient in Sl il tl cling lOJ lline fX-sitiutl ) Wll ic h correb lc- onl wil ll fhe abilt ty of lllt p tu rl l gt s tem to C( lunternct lIk luree o r grl viry )cco d ing rv D lfVd- f3egraveLIprc po st li r t1 lt01shyIlDse is d ue to the Jnus -u lar ton a nd 11ll ex rCrIshy i) i itv of rhe tissus n the ( O IW-) si it (If the (01shyjl ti (~JtVe (Fi~ 3 L Pu~t llr1 C lltpstl lu lcl l ~~ reduc l-lt by llwans o f pl1ysica l cxerCles specitkally s tuclled ruuml i rnprove tIlus--ubr fOHt md lU pr )cllI Ct 1 ~11 hi shy
lizing ffCd
PararcL n tll CIJ cl the cr iti ca l (3 c1 thlsho ld beQ ld Il ich defol1J lHU n of the i pinlt 1 e~ in~ ne dtlllontr~1t _cl (1l ll t grclrf r mg] o f rllt C II in a qa m bng pos ition corn pOil 15 t l lowcr detormashytion lhnsllold (Fig 1) ie to ~11l Ulne3Se t the risk of pr ogr t~ lu n There t rh eJef re l J ea r l)iuuml 1itshycJ l ~ll1 l l(tl a 1 tnr tg ro b ohwined by d -cr t l ~ illg ilmiddot pU~lUrll cull lpse ptJcelJtge w bich lccording t i)
h llTd tnd ~l(heJ1l ~on 1~ b inde cl 1X llt icularly luumlgh Ugravel mllcl c Iio~ i (bdow 2( 0 ) (F ig 5 J
Fin a Il III ch iS respect lllljl hl and b um l 01 m linmiddot
ii iI 1 l _ _~ _ ___I ___ ___ __L ___ _ ___ ___J______ ___ 1 ___
li 1 1 1 1 i 1
1 i ___--____---___----__-_---_~- _ _--_ ___-+----
i
1
i -- ~- -- ---~-----_-~-_-_--_1-~
l ~
i
+----r--------t-------t------f-- J
Fj~ ~-Ac(XjJlin(Q luuml T O rIcd ~lnd Na(h(ln~ n i () dl( pCG w rd (rTIshy
POO ll is hiherin cu rvegt in wh ilt l1lh ~1flILWrd cII1I Olk l1t IS le- pr(v~knt ln th e grtph Ih t PogttJlJ I ugtnq) Ot1 -J1l j elfltS-e J tlt 1l1t obb dirr remc rlLIv obu incu f roll l the Cohb atl( 0 1stlI1dtJ1g IId gtupinc rldo~raf115 Ih Ille lt) [1l1t1 (i lndnl I pine) 511pille the ~(nlClu tJ1 compo l1lnt U rlk CU Y _VeJily I~ ltx p rlt 1 L1v UpUlt (obh Illeturo Ih t si _b Cct rtJeSIm l fie -ltn J trd Ugraveltuuml shyuumlo n A~-i)rding LP 11(lt uuta o n l ( r1I~( in ~I 2JQ sup itlt curvt 1hi C(]l)b ddhccno l l f lO is -J-lultt( thc s ldnd inr tnla Ol1l t lS wi Q) whil 11) 1 1)401 ~llp lne ClHVC If ~ 1Omiddot ( tcl Lhe ttnd trl~ nlca~ I(t I ~ ~I)
tli n ll w l lllE cq lin ti spin h~ i ng mo r ~ Llnt~II) 1 tlun the nOftl111 one n Cll l gr(lk ( (cU ve tl1u n da r u p shy
po rt in o r k r 10 m linrl in tht 1xi11po tuf_ n th ha__i of th egt onideratl lr1S it f(lll() rhJt
ph rH (~Uuml e erd es ulukl h u - ul iiuml tbeacuteY ~U-L lm cl 1l (It-d o pmg p05111 td C Jl1twl lS fuumlrnll~ rly d ccrll1td ln an Ql St if i imr ol1111 t ru t(( - tht m(d in C JI shy
r t t r sture fO Ir -ngthen tlll m u ck-gt of the spint mainl) in (11erl antig r3ilrl tIcirclt l]lli fun ctin ll U hy meU15 dl i )ll1 t trk ~ lhJ cl( -ll tlt C)nlr~lUions ~llld no l IdOshy
1l)llic d YIltll1k lt l jAJ lktic t) I1 ) II 11)t 111 hd posibleacute t lcluuml ee postura l io nrro and stfh ili lllllt IJI
w i thout food T1lw(ull r d I( Lf(11 Ibk t m ucircnuin Ihe c()rf ~ct [ ()S tu re for cl gtu ifKi IH lLl1gth 0f ti l11 ~
This i-l ddl usl a typl 11 dnmnin (tf k inesllh rap) in 11 (lt-11 [[k - p~d fk lnr in lng f u l1a in llllliCk is poss ihle lI sing ctrtain Idncl fJ l (lt) 11111 liun S p Ul in tb is Cl c is ulttful ooly sa I~tr 1~ il Iw lps t1w lxltknt 1 becuJl)t 1gtlt ltlt-I a ClJu~l inred irl ilL ntllru l o~ i cll
and I1lll~lJhl r-keJc LIl [rll-llIn~ middot etlt(wrs JI the int e rmiddot vlnrion
[J ROPA MfJ) I()Wf-I YSJ IR
1
ICR 1 1-1
r
1 shy ~
- shy
11 o-llrfOlhe5l~ o t Ih 1O~(1dity i n h ~ r ~ ll nr pbl1 l of ~ Spl11 in 111011 _llti1Gt l lPt f ltlJUCWJtl ( ~l Ihe Ir t 1 1gt illbll W Ilh LtltrJ1dlion Vln lbe rigronl middotUII~ l(I Dko n12 lIll h lumshydlanie1 1 [ nul 1 M hl whtrc M - gt) lnIUI1g 111laquo111laquo1 1 1 c rtJCshytjC~ f fce d -d Lill l1~ o f enr niI pUll spnmcl1y 1~ 111 mldlll1lt (n the fl1ur t 1 = tor~ of f(ward Ileuuml l = ughtel1lng fmiddotr p 1shynOf stn lClU= Alaquo rdtllg 1raquo Ihl~ - lin hull th l1ltgtllugrave ot tller1l lUr~Jtllrc F the ~pin t -ilh rlu1i tf Ihl 1 1Ibulll n lrlt InltT1 1
rbc prJI 3IJi l1ty d qrlOIJ~ n bull JI t IlJIII Hm lA the v=ltd gtc e lu-ing J 5lnK1ura i ltfnnity
Dioal e ch anicll itllp~lir J11 c nt
Ihrcemiddotdimcllgtional mc-cbal1in of the s pioc
~f Ikmiddot i t i nly l(œ ntly tlHr llk pr-5tnœ or nc ushy1 lnlo tnr impairment in Idiopttlllc s-ol ii IXl tknt liuml J$ heen h i- ll licircghlcJ hy re$eJ rh tll e preit ilegravee h inm b nIcirc Ji d lJutg~ lt hl ~ 1 ng t o n dO Ulll urcel 1 i5 (l lreldv well umlersrood H(j-ev~r nev lbt un h iomcrhankal im l) ion nI h1c rectm ly onk l n tIlt tre and p r~dou in f n rmtinn hou t pl1ykd (~fcl5( in t 11 0 tl1I _ltgt pbne of spact 1115 Im trqlt-u 1rom J i-[) v ing unclcrsrmdlng ot th l lmc -dim nshy~ilnl l l11 ~ hmk f the cO]jO[lC pln( ~2middot ) ) Ve- w ill )iI xnl t l1 d at lcL-orcltng tUl cl sif iol t lOn blsed o n gtolllt lricd h uumlCJ ) p lane
- b() rJzU[1tl ln th i pla n ~ th t 1o rm ll sp ine present no CUlye- w ll ile Uumll(~ ltc U Hic spLnc clevelops one of ir haracterls(Icircc deFo rm tiCs v elt tbrd ln lashytio n vh icl1 pJ()VcA~ theacute hw 11
- lgitltl in th llulJe U l(~ nonmll spIcirclle pl SenL kypl lOSis ~nd l dooi~ in tb lXI1 lhese [(Hu rts Vere m)( til ught [ 0 he relattd tlle scolkJtlc ( lI r Vegrave
- front l in hi pleme tht ncrmal p ine preseuron t no curYegrave whil thl ~11li tic p in ugravetI I ()~ icircl~ charshyad t Ilt I CU1C
Il Jri fJIIt palic
~l+I~na ra 3 r inr lut th l[ ber ll1d a œl1~lU1 degr 1
l f r()la tJo u lllu (lILa r forcKl ltxert ltJn tl ldefnmuumlng 1 tkllJ [J i1u a re- lhlt tll cly 11 [1 1 UI b y Olm ner w bn ~lh uiJwd tl egrave ro t1tic) l1 Ilm it ti lt p ica] lf shy
rhrl r() be (P (the Uma bevond Wl1iltJl th lCOJlb of [11( ~pmaJ musd ~ dthc COnCIt and nm ex ~l le btconk (t O li~[)
r ~l 18 ~1Il N lu t( ren i9 lun lu ted rlseurlt h in tlt ) tilt lULodeumlformipg1 tlo n ot tIH_ sc laquoJrle rh ox ercallkren lk 1l1~H li d11r once thl Il i ~ r tld1t5 [he lhrth ld f 111 JlIcirc lIi of tlle dnrlclc hurnp tlk
lI bslt Il l nt rlet()rlll lIcircon 01 the it l ()I~ C ( (ylm der (- sustalnecl by an H1tmi cforming aCOOIl
J1Ji h V hl rhyiical f~ f Ise CI 01 h spr n llnd kin middot ith ccedilrapJ my lX damlg ing vll e n l pplild as flle
igt Jk Iller ln SCC1IJ ~IS lllc lJ fxceed l auto in middot crca~ i n g lhrllgthuld [1 sh (~u Id ahn be j ofed that Ilw relscd pre sun 1l1111i insiugrave l fe pil1r inn) 1 mlshylt
- j Il- ( w atff 1 (nh ~1l 1(e Il10 utoldrml ng li1eCh~lI1 1sm
in flc l Geyer ~w tcd th1 t rm m 1 hI l)1ecircch1O lla1 puilll 0 l I C~ sw m mim t Ieuroamp no purpo t for cu lshyim le pllilt t1 s (weumlO middott r it is l~Jl(gtWl1 rhn in iculio r[ paULnl -iJl11T1ill~ doe_gt nor Il ~lp to i ncrt~SL n eur(1shym tor co mfU
(1irai p an (
Jerdnn lle 11 showecl thal ill CSl~ o f t10rLC IC 1i lUgrave
tllo lacolulllhil it lio_1 tlle cte tI llmiry in (he lg itt1 p lln t rn lnlftot il~ lf tspe iuUy in tlw initi 11 r luleuml )f cV IU[Icircon nf Ile ~oli ls W iU l 1 p(t)gr~s~ivlt il10middot~ shy
ment roward hvpok pho b G ll f ill~l Im lins l har dUflng (IN eWllLlfiu1 of 11Imh] co luumlgt i the l in t ot t l H~ gClyty Cegraven te l - 0 1 v llebed lxxli 5 r ro ject 1 seH fl r t side-ys and tlwn backlrcl bull thu~ p(0(1 lj n g a kyphQtlmg aet Il ln (h~ lu mhnr --PIl1 COftj tng
l l i tc Iugrave l lltl l( l rs1 tif s L -etllgt il l the lgirl11
1 Hl)
Ilu LE nI rIIY~Ic~L lXIlKISI 1 HI E TREhTMEtn OP JIU IDIOP llII C AD O USCUH O Ll Œl15 NEGR II
lLill tegt lre lenl1 ~I d ~fo rll1J[ ~ rhl recrSes the phyltiologiGII cmns of lh vine)
Accordlng () Dicion ~2 1 rtcluctio fl in the itgitttl CUIYtS combin l vi th a lueral Iviari n llltl ds t 1
mecban ism () ugravel~ta il ity in l he r rat r IllI1e which bVOf1i the unsd a nd i ncrea~e 0 1 co hlt1is (Fig 6 hiIf md Pl11jlbiJ Jl1eanwlt ile lt(udiecl lh e srnl ru t
orzyglpophySLs show ing t11 al ttleir 1I1tl rnic tl orienshytation f~I (jLi l~ltes aXIal ve rtegravebJl l rotllio ll in cun litluns lt f dorsal hypokrrhn Icirc tnd lum)H de i L lo IS
Tll t dat SLlgge 1 th t impOrfill ut pOitu res and l1lweil1 ) t Mudied in ord t r (CI mlIuml ntrlin or to reuwer fll e p llyslo lo~lCll ClIlye in lIe SlgJtta p lU)l Wlth the llm o t ch ~ kin~ rutltor in l~ bili ry7 AbC th ~e ~k-
1l11nL ~Irt del lnt [0 J jUc lt ftber l]kuti inrervenl ion vhich 1c)LJ k l IV - i(l ~ l compktl n l ililll on Il t c1 l shy-jel1 J11UVllT1ent IJ j o f 1uto-dOneacute(3tlon ( i e a -impk ld ion ) Iengtheni ng o f the pilleacute 011 a litlltl l aXl~ tll lt ((IT liJlI~rcdu e~ t lle ~---lJ linti- l lte ml-fkxj(l n h UI 11 - i llCrl I~t the plllH ](JgicJI dlt cr ~l S ( (1 k-yvllCiSh lIld O(ltOSh l o r c lch r1Iif n t a Ilew til(~ecirc dUuml llt Ilshy
si lflltl J ll1 u(~nlent iam ecl - 1l1t0- lIrfe rionmiddot7 4 llmshyp oed f Je-rura l iUIl cl middot-t1e- iltm lI1d ll1a intltnUlLe )( 5lg it d C Uf (gtS slig lll thltJrc i ypI1 tiZ) tIcircOI1 a nd lunugrave)ar 1()fdos i7~llion) sholild he esw b lb]HU 00 lb co
hl b oi hi p~l11il uU r -1Ir vlt Abo 111( e IlltUtl Chl lie o f purti n - a U vitk slJ1ultI h e )tuumlll ecl 1)] (1 n ldershy](ion r tl1i lt type for e upIe IilJ llyl)T S of repd shyiti( ml vemen prt n t in agonistK h)lnllltlSlks nI iIle kind f dlJ1ce C( uld he ([([r imentd
FmiddotO lllaljlallC and mobili ty of the SpIcircIlC
1 rd llo U 22 d L lm nrrare d lhlt in Illt fro nt a l pll ne
tilt 1 nge Clt 1)1lt vtment of tht scplit[i middot CU IY grcmr lIJ l il ~ d irectio n n f Lhe C ITelt tlO n tha n in tl le di re shyLion of pmgressi n l Fig 7 ) he IL o IS5err lJd tbat th15 mohiliry increac plrtil u la rly n apic [ cgcoeilts 1$ lh ~ ~c() li osb evolves Sragrm rJ 12 J ~ thus rigilt (0
VlI f n rller~p is ts Ilo t t) m o b uumliz - a sCtJl iu til curve w ilhout t [ uling ttwt tlle R lu tiOI o i til t ~a mt b fnlinruumln( 1hy l1tans o f ~I passic 01 1 rivE -uppnrt On tilt (ltllE r hand UgraveK d e iJlioJ1 in ease durill tlw tune 111 whicll tll C spmt i ~ not submjtrcd to correeshy( IV anl()n
j- Virh mi lei ol i b tlllt Upp i1n ill) lC tiol is d eveloped only lllmugil llClIf()mu$Cllbr f r llce thi ~
InegravelIl ~ thclcfo re tl1l[ inu eascgtt sp1J1all1extl)iity mua
11
Imiddotiumltgt 7-rurd illt Ir) 1 bull rdrilt I1 1 in tl lt frOlllll pbnlt- th( illl ge )r mOC llIeJlI o t the S-o UIIJC CUNe 1 supcrior in Ihlt diflt(l im ugrave( the n nKlIl thd n ll1 tllc dlrtcLion o f p rJ1(l( (llIl
be considrCtJ vntrl iJ)(l icltion and 1 undrli neocirc ab L a ~ubiljz~ILion 01 tilt spint pllss il)1y ohtl ll1td thrltJugll the stlengtlkl11ng o f the 1rltJgm vlt nonil lme shyCIC 111 illli orrant u bjcLliH- ln rhis r~f1 n sp u lllni lc tivitIumlLs sil uld lX tPI 10 dlegraveltl it l G lU t n w l1ik luring kine i Icircth lrr phyltical eXegraverci c~ tllat in ele
spinal m ot ilIcirclY sil nid 1e lt1 oid cdrt ~
Organ ie and psychologieal impainncuts and li islbi IiI le
A cgtI im lc pmi nr is moriOthl11 just 1 sp in and 1
compkt gt Ipp rnach to the gu in ad 1 ont i al~ shylute l e~se i t i11
[)a la 0 11[ [n ell lrom re semh pw tbat ome organi Iilnctiond cl fki ts suc]) as tlw clecrtiUe ut vild l tnd d fun ll l)Kity_orld ldly incrtJ k whil~ 0 shy[io s i -till in (1 miel q g of g JltlV ity ~ l ilI e 55 rtI lit
tllL pres e n ce )fl defidt Or Vi l~il Clp~1 - i~ ln one pIIiem in Ihr l ftectecl by 20 ICl 40 scoi stgt l ls~a r(h cunclutecl in tbe UA by Di Ruce- prod uegraveed an aaalo) u ll1lXimum 102 re u t in a group of Jd shyk 1ien t [(h sco llosls rang inF frum ) [0 1
Al10ther rudv bv rallt r m C chr111 lilcl NashycWrl1s( u 57 stlO eltt hil $(C 1 1 ui~ Ica js l( lllt cl (1 shy1prUlllI o f t1tgl lie bJd l imI in ~ul sct t1 t ltu b middot iects jlLltr l5 they are golng through ~I cltlici[e sllge in the fnm 1lt i n 01 tlWH o w n id uHitv t factor hit h Illy jeopmlize the cl velopme lit d ~ mIll lt lI1d htIshym cecl IWI sonalitr in Klulrhood
n RUI ~IEDl(( Ptl Y1-
ROU ltHmiddot PI [ I C~ 1 EXIRCIS]~ IN TI Il nW~JUNT OF SlllO lDIOP1HIC AI)C~ESΠ11 C(gt1[Oi 1S
This i why b IiCieacute ii is ~n imporrlIl t for p rcshyvegraveml e 1tLsr l tn en ou flge 1ari e nrs ~lfrecr(d by lIillcl middotu iosis ft) tlke p~l rt in portin -re rcatioluJ acrivitits Iha t 1eIU 10 L10 th r~1chophyinLl bull nd b~l )i 1l1o tur adlieem t n li 51Jmiddot2Even tlK)ugli [Dr bic mech~lnshy
ical mcl nellIUll10t 11 11 reltl ~ons lt r111 1gtomcrimes be l lefu l to ugg( ~t ne p rt in~ aCt iv ity r l h (gtr rll n anotlJer e th ink Ibal an exces~ ive IlHd icalizltion - Icirce l ll1posilion br plry~ilt i HlS nnejlor parents uf rh ry pe of po rt to lx p m lice 1 b Ule p 1Ucirc(Il L th1[ preshydLl ck l1 is fret clOice in lh ma tt r - -h II ll1 he avolc1ed wb 11 possLhle mainly for tlle i mport~ltll psyshyLb ) jogka l fe a SI)nS W( ha( ill ~ t nltntionegraved
Conclu ion
lbh ISsertegrave d t1H physkal tgtXtlci o is ) n fi ial whlIl practinu in order 10 ilnj rove the I11 llde
rœ nwh and tono C iral caplCiry and postu re o f the StOUO(I ~lIbj n II I nowkdge om ~ middotmg trom ci el1shyrlfi rls(~ Jrc li dJlJ accordl ng r the review 01 thE litshytirlture prnpo )td in t lli plpl r conflrm~ Ihe vuiclit ot th e -t ls ~rti ()ns
In l do l (ent Id iopl1il iC scoliuse il l n phee u i cl vk)pm e n t ( li tll iumlKh eXCC cl l g i en rhk thr hokl th e re i5 an und ubred need fn r l pprnpri 1tegrave (JJ1tOkJJe ~Ild Inr surgict1 therapics ill ortler 1) S l i p
the ( - Iuli on anugrave )JT~t~t UW ~pilll l dtlormities bull evshyerthtless in the illiti ~ll pl l~sC t ttlC c1iseLltc whcn the riS( r1 r euro )luli m is rtduced ocirc ~md tfle uifleal JOld threshold il ~ld flle po stural collai i reJcenw~ 43
JI l1 igh pllysicaJ egravexe rc ise - p revenc or r d llCe d i ~lh ilir ies o f [Iw ~ l() li )tic
p (iems R 28 J -6 5- 6 1 63
- f~KiHtare lh ( n utr ali711iCUl of postu m l d elicits tn produCel1 a coneql l nce J [)ti 0 I111)( or regre si -u lmiddotc 5middot Il 1 17 ~ M
-re 51udles U ~ n Ledecl tu con[mn or re jecr these conClLL i( 1 w l1 ich clerin-d frum 1l1 lIldytica l rcltw n f th e liter~iture appear r- ~Lo nlble Hnwecr Intil ne re ull are 31Iable wc should n r prevent our sroliotic patientmiddot trom tl ki ll p lt in s(loI1ing jshy
ir its pW1iada rly ltl t ~d1()o t () n til t c ntrHY -vith the l xcclrinn 01 gt[1 )11lt tIlat in rea-e t)1obility (tnU evc n thell oilly wh n progr~lgtion b p OSSibl) -uc h ~I( ucircvshyiUe -11 )ulu hl tIKoll w g ed The 11 S J ( rprOpriue kin (~irhe r~l Piuml to incr _~asc p()~tura l $llbil i ty is tl1egraveoretshyic tlly CiJUClt alttloughl more ~Iccu rtte aod deLli led ri k benefi rs anJlr~ is is netot1ed
Ria 1111tO
NIokl Mu d lle ftitYljJfu Jœl il 4IWr10UOifll S (JIvs i (1~1)Jshylidl ttno( cclIll le 11(11(1lt1 RCI fu lle ((lia LltfIt l1 I1I1i(i
LJ ci n s j(r3 pigt egrave li n IHUgru lkl di t rdz t fi sici pe e ft shytUlKm iluppno di un lisimerap15Ll rl lllcflt() 1 110 scopo di pnevirlt () fr en~lI 1-lgpwlllltnlcgt dclld lclonnitugrave o e il 5LOshy
Il i mi llon lt fH nugrave j (1 11ni dei co~e 1 lteIl I1J J nd ne ~Ii eifclti (()Tc rri udk s co lio si d i m e dia g rt iuuml ln que~ltlt
s rud i 30 llizzb mo i d ti cleU ric lca pel n ri Icare qJJ l lm 1 dis(imucirc x u le I[~ l z j-m i pro vna le da lla C gtl k A i json ere pr middote-nute () rk kl ducirc un~l rdeguCltl d nil cra pi lt di uJoseguerrnt Cjua li 1iU110 cli nbie tti 1 rcr lJ)tIId d~ fle)-UITC
n (- -fd7Io n~lcl)
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EUROP MIDI C Pli hIC
EDUCATIONMEETING SATURDAY 8thof APRIL 2006
(iSS
SEAS02 Scientific
Exercises Approach to Scoliosis
version 2002
G
S Negrini 1
EDUCATION MEETING SATURDAY8th of APRIL 2006
Neuromotor disfunctions
Neuromuscular disfunctions
11 Postural collapse
Postural collapse
Duval-Beaupegravere
Flexibility of scoliotic curve
f---I--- I Postural element
-------1 Structural element
S Negrini 2
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Postural collapse
Duval-Beaupegravere
It is a value related to muscular tone and to flexibil ity of convex side tissues
Post ural collapse
Bunch e Patwardhan
Critical load
Load threshold beyond wh ich a spine begins buckling
JI~~Wt1lW~flfthtlJlœJtAr ~ J~It- l~l - IMS
Postu ral collapse
Bunch e Patwardhan
If a curve reduces there is an increase of the deformation threshold
~~~NW~-damaoc~IIIMf ~~ J~Iv JaJ-I7I9sect
S Negrini 3
EDUCATION MEETING SATURDAY 8th of APRIL2006
Postural collapse
Torrel e Nachemson ~
Scolioses below 20deg ~ ~ lt~
have a high ~ ~ percentage of ~ ~
~postural collapse (on u~
average 75) ~~ 2i~
CU~VE O EG~EE S WHllE SUPlti e
~laquotd~c6b ____lPffI1wtt1t~
$ww J(t ~~7 JM5
Postural collapse
Minor scolioses 7
Antigravity musc es strengthening D
Reduces postural collapse -G
Increases the critical threshold of deformation
G
Neuromotor disfunetions
Stagnara
If we admit that one of the causes of idiopathie scoliosis is a disfunction in balance systems it is logical to orientate physical exercises toward this direction
s Negrini 4
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Neuromotor disfunctions
Dubousset
Idiopathie seoliosis results fram alterations in praprioeeption centres and deformation is a natural compensation to restore postural balance
etattJtitIK ypothfQj~S ___~ own_ oJ)HQr lar 1t-1( r
Neuromotor disfunctions
Nachemson Initial idiopathie scoliosis
+ Goood spine stability
Neutralization of postural deficits
D Static curve
Neuromotor disfunctions
Therapeutic aims
c) Development of spine stability
C) Development of balance reactions
G
S Negrini 5
EDUCATION MEETING SATURDAY 8thof APRIL 2006
Biomechanical disfunctions
j Horizontal r-Ian
i Sagi ttal plan
Frontal plan
Frontal plan
q Frontal plan disfunetions
Fronta l plan
Perdriolle Movement magnitude
gt in the direction of lt in the direction of correction progression
S Negrini 6
EDUCATION MEETING SATURDAY8th of APRIL 2006
Frontal plan
Stagnara
Never mobilize a scoliotic curve without ensuring reduction maintenance over time otherwise a greater mobility favours scoliosis progression
Frontal plan
Ducongeacute~ research
On a group of adolescent idiopathie scolioses treated with
Meacuteziegraveres gymnastics
D After 1 year the mean angle of
curves increased from 18deg to 29deg
Frontal plan
Scoliosis without brace
D Greater spine
flexibility D-
Risk of progression
S Negrini 7
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Frontal plan
Mobilization is useful
D In preparation to
brace
D With brace
Sagittal plan
QSagittal plan disfunctions
Sagittal plan r middot _J o
Perdriolle scouos B CJ aDeformation of D
thoracic and thoraco-Iumbar curves evolves in extension
S Negrini 8
EDUCATION MEETING SATURDAY8th of APRIL 2006
Sagittal plan
Graf
The line of gravity centres in the vertebral bodies o s c oUOSt
projects itself firstly laterally and then fi
o
posteriorly lJ ~~ ~~ ~ ~~-_J-D ~nI~
Sagittal plan
Therapeutic a ims
D Maintain or
retrieve physiological curves on the sagittal plan
Horizontal plan
QHorizontal plan disfunctions
S Negnni 9
EDUCATION MEETINGSATURDAY 8th of APRIL 2006
Horizontal plan
Stagnara The forces applied ta the spi ne act in a autoshydeforming sense
Horizontal plan
Dimnet Rotation gt 200
ampII~ (
D The actions of concave and convex side
muscles become
agonistic
~ItJrOnrIIiItdllfUClltlluumlll~~tI ~1JIf1laJ
Horizontal plan
Minor scolioses never exceed these autoshy
deformation thresholds
S Negrini 10
EDUCATION MEETING SATURDAY8th of APRIL 2006
Disfunctions at a biological organic and psychological
lever
Oisfunclions at a biological organlc and psychologlcal lever
Cheng
Bane density in scoliotic teenagers is lower than in normal subjects
~~~~middotA~IIlUtIy ~7œl 1d l
Oisfunctions at a blologlcal organic and psychologicallevel
A significant reduction of vital capacity and V02max in teenagers with a medium severity scoliosis
S Negrini 11
li
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Disfunctions at a biological organic and psychologicallevel
Disorders in the development of body image that the teenager has of himherself
Disfunctions at a blologlca l organlc and psychologicallevel
Therapeutic aims
cJ Activate cardioshyrespiratory function
cJ Favour bone density increase
cJ Develop a positive image of the body
Disfunctions at il biological organi and psydlologicallevel
Stagnara
Sport
D The active side of
kinesitherapy
S Negrini 12
EDUCATION MEETING SATURDAY 8thof APRIL 2006
Disfunctions at a biological organic and psychological
level
Distunctions at a biologlcal organlc and psychologicallevel
Cheng
Bone density in scoliotic teenagers is lower than in normal subjects
~n~IIIvpWr~middotA~stWy s- XXJl M J
Disfunctions at a biological organic and psychologicallevel
A significant reduction of vital capacity and V02max in teenagers with a medium severity scoliosis
G
S Negrini 11
EDUCATIONMEETING SATURDAY 8th of APRIL 2006
Kinesitherapy on the scoliotic subject
q Postural control
q Axial stability
q Muscular trophism
q Balance
q Respiratory function
The limits of kinesitherapy
There is a threshold beyond which
rehabilitation alone is not enough
sssr
Kinesitherapy in scoliosis treatment with brace
Therapeutic aims
S Negrini 13
6
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Therapeutic aims Srace kinesitherapy
With brace
il Postural corrections and
vertebral stability are obtained by the brace
Therapeutic aims Srace kinesitherapy
In preparation to the brace
il Mobilize spine on ail plans
Therapeutic aims Srace kinesitherapy
With brace D
Maintain a normal spine elasticity
~ Maintain a good muscular toneshy
trophism
C Model the hump with kyphotizating
exercises
S Negrini 14
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Exercises and their methodologies can vary accord ing to learning and individual sensibility of the single rehabilitator that proposes the m provided that they stay within the
Iimits of fixed therapeutic objectives
li
Therapeutic modalities
(Exercises)
QAuto-correction
QRespiratory education
QErgonomie education
QMuscular strengthening
QDevelopment of balance reactions
WNeuromotor integration
ci Vertebral mobiJization
QSpecifie modalities in brace treatment
S Negrini 15
EDUCATION MEETING SATURDAY 8th of APRIL 2006
The protocol of kinesitherapic
treatment
G
QChoice and dosage of exercises
Variatiosn of the work program every 2 - 3 months
Q Execute e)(ercises on an individual base or in a small group
Q Frequency not less than 2 times 1 week
Involve and awaken the family
G
S Negrini 16
EDUCATION MEETINGSATURDAY 8thof APRIL 2006
Q Determine the action and the localization of auto-correction
QAuto-correction must be associated to ail exercises
QAt the end of treatment ergonomy lesson
Auto-correction didactics
G
SCOLIOSI DORSALE---- shy ----
r
S Negrini 17
EDUCATION MEETING SATURDAY8thof APRIL 2006
SCOLIOS OORSOLOMBARE
shy
SCOLIOSI OOIlSALE 011 bull LOMBARE S1I--shy
SCOLIOSI LOMBARE
il --~_-
S Negrini 18
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Scoliotic patients are not radiographs
middotSeoliotie Mtients are not ndiographs but hum beings with a vertebral deviation-
Slagnara
Metha For the physieian Cobb angle is of utmost
importance For the patient it is body deformity t hat eounts most rib hump a protruding seapula or hip We are in a situation in whieh today dodors eure the radiographie deformity but what the patient really desires is to get rid of clinieal deformity and of ensuing psyehologieal distress
CIIQItIo shDuIdtucirc lM WIld tJw~~ I~~M~~~~ J9f~
S Negrini 19
- Poznan_workshop_Physiotherapy
- physio2
- physio3pdf
- physio4
- physio5
- physio6
- physio7
- physio8
- physio9
- physio10
-
EDUCATION MEETING SATURDAY8thof APRIL 2006
Material
bull 38 girls (437) with double major scol iosis (thoracic segment - Cobb angle 18-42deg mean 30deg SO 82 angle of axial rotation 4-32deg mean 21 deg SD 107 lumbar segment - Cobb angle 11 shy48deg mean 31deg SO 128 angle of axial rotation 5shy30deg mean 13deg SO 85)
bull 49 girls (563) with single scoliosis (Cobb angle 11-75deg mean 33deg SO 155 angle of axial rotat ion 5-30deg mean 14deg SD 83)
TIoracic kyphosis of the invesllgated group was 5-39deg mean 23deg SO 86 and lumbar lordosis 16-41middot mean 30 50 65)
Material
bull The 64 girls aged 10-17 years (m ean age 131
years SD 132) were conservat ively Ireated
using Dobosiewiczs method
bull Treatment period ranged from 5 months 10 3
years (mean 148 months SD 902)
Material The 23 girls aged 10-17 years (mean age 136 years SO 108) were treated u sing symmetric exercises - treatment period ranged from 4 months to 3 years (mean 161 months SO 1019)
bull 26 of ail g irls (18 girls earlier treated using Dobosiewiczs m ethod and 8 gi rls earlier treated using symmetric exercises) aged 10-17 years (mean age 134 years SO 108) were twice tested - at first and last day of Intensive hospital rehabilitation (asymmetnc mobllization of the trunk by Oobosiewicz) - mean hospitalization period 20 days (range 18-26 days)
i rf~8f6~~ or~~n~= ~~r~1~r~icircJ~~tb~~~~ mean 17-4 1deg meatl~(I SO 74 R n~le ofax 1 rotatIon 5-25ot mC3 111 3laquo S0 6icircl Ilnd 1 99t1S~ ~~~~I~~~~~$ruo~ras~ ~ocirc~~a~e~~~~~~~5euml1 9middotn~ tUfllbar Iord05ts 16-4 1deg mean 311 SO 68)
J Durmala K Dobosiewicz 2
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Material
The control group consisted of 77 healthy
girls aged 6-17 years (mean age 12
years SD 31)
Material
The examined girls participated in school
only in scheduled physical education
lessons and have not been enrolled in
other sporting activity
METHOD
The exercise cycle
ergometer test was
performed
J Durmala K Dobosiewicz 3
EDUCATION MEETING SATURDAY 8th of APRIL 2006
METHOD
The Incrementai exercise test has been applied
We have found that tests ln whlch the Incrementai part of the protocol ln completed between 8 -12 minutes duration glve the
bullhighest maximum VOz in normal subjects
METHOD
The workload was Increased stepwlse
bull by 10 Watt every minute - ln chlldren
with high ~ 135 cm
bull by 15 Watt every minute ln chlldren
with high gt 135 cm
METHOD
The test had been contlnued untll refusai of the patient or exceeding the pulse Ilmit
Durlng the exerclse the gas exchange parameters were recorded by Jaeger device model Oxycon Alfa uslng direct breath-byshybreath rnethod (with face mask)
J Durmala K Dobosewlcz 4
EDUCATION MEETING SATURDAY 8th of APRIL 2006
METHOD ~ ~~ r 3 min 3 min 8 - 12 min 6 min -~
_ 0 rpiYJ 0 rpm 60 rpm ~1 30 rpm
_ t o~w=att~o~~na ~~ att__~ tl~~S~~ l ad l ~~~~~r o~w= Hlcremenlal t
pedaillog i i ~
~ ilt ~I~-----tl-~ I t ~ i ~ lOSt sffortivB
lW r resututlon r rm-u middot 1 - bullA~cremen tal ~~ ~ ~ ifr- ~ VtI 1 ~i ~ tllng _
METHOD
On the basis of recorded parameters VAT
has been individually computed for each
child using V-slope method by
Wasserman
METHOD
For assesment of physical capacity
the maximal minute oxygen o
consumption (V02max) ventilatory
anaerobic threshold (VAT) and
maximal workload was used
J Durmala K Dobosiewicz 5
EDUCATION MEETING SATURDAY 8thof APRIL 2006
RESULTS
Ali girls with 18 have been classified
within normal range of predicted
values of
bull maximal minute oxygen uptake
bull VAT and
bull maximal workload
RESULTS
The differences between group of girls
treated using Dobosiewicz s method and
group of girl s treated using symmetric
exercises were statistically significant
Lower exercise efficiency of girls treated
using sym metric exercises has been
observed
RESULTS Girls wilh IS Irealed using
N=87 p value
Dobosiewlczs method N64
symmetJic oxor-ci Nz23
Perœnlage of predicled vaJue of
maximal minute oxygen uptake
98 905 0033
Percenlage of predicled value of
VAT 97 933 0049
Percenlage 01 predided value ni
maximal workload 101 939 0038
J Durmala K Dobosiewicz 6
EDUCATION MEETING SATURDAY8th of APRIL 2006
RESULTS 26 girl s twice tested - at fi rst and last day of intensive hospital rehabilitation
The value of ventilatory anaerobic threshold increased during intensive hospital rehabilitation (asymmetric mobilization of the trunk by Oobosiewicz) statistically significantly (p=00019)
2047 ml O2 minkg (SO 268)
vs 2239 ml O2 minkg (SO 232)
Conclusions
1 The exerc ise eff iciency of girls with IS treated by asymmetric exerc ises of Oobosiewicz is norm al
2 Such high level of the exercise efficiency of thIcircs group resulted fram using of Oobosiewiczs method
r
J Durmala K Dobosiewicz 7
REVIEWS
Role of physical exercise in tbe treattnent of mild idiopathie adolescent scoliosis
Revicw of th- literature
A NECRlNl N VElWNL s PARZI 1 A NEGRINJ 5 NEClU NI
P1t~silillxlrd~ Ihcrapy (or klucgtlttlwrlpyl i pro shy-tJm of physka] cXlrd-cs ipcci I(a~ (IJcloJgtcd hy l li trIWlltl phrslollwrapbt wilh tb m~ln a1mor pl shyVCnI in lhe ilAAfIVltilH1 llf the ucirccfonuity III mild IgtC )
Lil1Si bclpin~ thebm ( aocl co uaufllclilIg ils ~jd- clf IS in nlOdlJmiddotnh-culiosis Th middotalillofthi paper ito r (W
Ille Ii lc ram r 1 a-ccrulin wh kh of Ih bull Lu[Jalmlcrus Ind (Lb hili til~ CLlLt-cd br scnli()si- clluld bl pl Y nlcd or r d uccd hl phylolld LXtmiddotrdsi n Il p--to-da le knowl Uuml~l nr tIll~C aspcc[~ i ne bulled in oruer 10 dndc whclh~r 11Rf blLl adcqlmtt Ib(uuml n middotlicaJ balis fo r ora)aini l Ihe US4~ of lUgravellgtitlerap) wltcllj(r or fln l th e prtl1iœ of kimiddot ~lre IUlll poNjn~ a t iil ies ~bould h allowtcI II uuml middot c enliaI toltlentlf)wh k lu alClor ie - lf pl lr~kiJl -c rmiddot d gtlt- (Ic rnnhi UzJ( inn ni (t hl HrJltlon [ rtn~hcll iJl ~ or 1i1J(IChIumlJlJt etc) Sh llU Ld be TolullllCcluse ulemiddot l onld b- clclIimcntalancl wukh sho ll ld he IJlI-n~ifl~d I~~a l lhc (o uld h 11lfu 1 Know k dg CJnc1in t (wIn SeiCIImiddot Hlk rCS([lflt h daw ccordinll to Ih bull llVit w o f tIlt iii 111 1( plop(lsltd in (h i papcr lmiddotonllmJ l lnl plLyi 11 cxcr(j$( pn (nti or (tmiddotduce dhlblli t ic 1 ~lt Il Jj ll(k pl ti Jlt fadl j w(~ the nlIIIrl li7alinn n f poMural dd shylitS tu p n xJ llc aSl COIlMqnen c(middot 1 all )llal) or r(tn~ shys i middot middotlIrve Tilt u~c (I f appn1priattmiddot kincsiuuml wrlpy 0 in rcns polttllcal swhiIHy Icirc IIHmiddotorc Illta ll y (0 r 1(lt1 lllho UAh mon ltlccurlltc 1Ut dl1alkd -rLk l(lWfils 111111 )11 h Jlccdt(
11) wurcJlt 0 lit)-IcircS (Iumpy - x rcLs P()lun
n rllt lT(ltnklf u f COll1tlK H (rtd) I 1i plfho l og l ~$I rUlglng tr m low tmiddot k Pl 1l1 to IdiOpath ie SCUIshy
Submitt(oJ [or PUhltCl l1 011 uly Tt 2001 Acc~pttJ ugu - ~2 1(t-1l
Addre rltj-xlfll telt~I(middotb If) - grinl Flt(1(bziurllt r )(m Ofl ()(Cl1I shy Lt middotqlltœlll ro () - 1u I4t agravehLIlKil ta IYIL-lTt ilSllltp lfllmiddot ~ 1l1uumldull
CelII ~ (niiOS I I~ middot ann (1) IfUh middot lIlfU di louhilll(tymi ( Nlmiddot ~iI rli -ilIIUmiddotltlfl
Nlti(ir 1( ) il r() (ltbullagt1
lt vLL_ l IiII no 1ftfI
jS ) we are a IUil ly tJc ing n1n) ltblll lS 1 k l1 b ~J)w in~ tl~ t S Jfll l approad llt - l1n til hy on ielshyertd ~tan lard ugraveJuld ln m any ~1~ he lI ~t les i if Ilot dange r )ll lt rhlS is lrut of reil l lnw 1gtlt1lt1 pa in l ~ or 5urgi c ll lrea lmltnl5 in dbc r lmiddot ll Sc - 2
ln tlle cj-e ut ~ t lll(tlWtl i( li p l ll1JC luuml- I ~ middottnl ~() shyliosis phys cal ((_lt1(( is emr1uved ltI t()fIl1 0 lh~rtrv
lo ly in cel1l in L)lllllde (nluumlnlr in tilt Lltlll middotorkl i e Iw l) r llt t Srain hUI IIgt() 111 Gert11lny 5- 1~1 in other reg lOl1 wbere thi I-incl qf tre l tm e rll 1 p~ 1 pmiddot t 1( cI il Jws Ixen cri ri cilld md rel -cltd Lw m~lI1 1 11 Jlu~ Fue Fnlny r ~lrs thio middot15 a lsgt(ru( f ~rth r -~ltc rrJtf))~ ll t vit11 br1Cltcgt b r II1 ([C Llt n ClW grmvlng 1lt1 0 L Sti g
gcsti n the lIsefulnes- u r Ih is form o t treatm n t 1
Hmiddotu]rs have nerged jn El or uf pll y~ iLd eegraverdse eacute 00[ 1 but tlw are nUl yel 11 11 t llu i vIC~11 and r hi ~
f rm of trt ~ltmenr IS stiJ l Ul1 ckf ckhate FfI t Jt 111 il i 11t (eltary td 1I iFy 11umbtr ot
b l sic COI ceP rlJ lf w ill he cIh tt d in t hi pap r
Scollosis
DCijIrI iriolls
ScnUoSlS is Irlircc c1 lme nsIcircltnal (I(gt i l cj on ot tht spinc thar cau C a CU 1 lh lt ca n h e $ t~en ln (1 me1Sshy
ured ultinF Coh) lll ltllCXI o n HI anreu middot p rtc rilt r
EUJlOI -1 lœDICOPHYSlc~ IR
NECRI Nl
110
f)i)
1 7J
amp aS g 5li - 0 v
V
31
10
(1 1) Il 15
-tc i ytjtr~)
FigJ----jllph ot DlI w l-lkaupegraverel) The agloimvltltinn Or idio r lrhlc 50gt1iflll~ IS rpiJ bel~ en th e- [l0 IH P (l)ltg tnntll lol (JI PUllcmiddotny) mtl 1 ( f( lS-er sigll paiilivltecirc lt Dlt(i I1 11illg r the iti l 1Kgt n n t rll icirclicH a ) 111lt m omal prebulled the mno rche md ociks with lll I)ttlx flal gr Ih pll fl
rlcljoprdphLi 1 hl merl prestIK ~ of this curvt c10es n t autom~l ritllJy indi ate the pn$CI1(t of a defurshyTnitv (SlllKtUrd (Unel
It i~ possible tu clil1e ren tute a struCnlt t CI1tve fruIn a pogt urll 011e by identifyi og the hum]) du ring AdIlns tesr I~OQ looklng tra m beh lnd at the p atient w ho b benchng fUfward il is p -- ible ta d d~ct 1l1 eh ucirc n of o ne liidlt 0 1 the trunk usually n n the (onvex ~ jde ul tbe radiographie CUfve Ugrave1lr C Ul be mlt~I Slred lISin~
BUlln els S o liomere( 1 ~ l This h Uf1lp is du(- lO (Ile pregravegtecircn ~ of vertel ra i rolltion 1c1 Ollt tn tic f~YJ tllre o f the def trrnit tli [ c m be seen and measurc(i v ith Perddolles lb lsLometer on an amero-Ix)iferior radioshygrapb ~2
Seven ry pel cent o f li Ises a re conid 1lt 1tO be idiopa thie 1 bull ia l-nosilt in this CI$C is b exdlls i ~ n as idinpa thlc me-us t11H wc do n()[ know rJw origio of lheacute curvc [n othe] ~Ie$ it b Ix )~i ble ro ide nrify a dieak (bat CHl jusrify the c1etgtnniry slIch a rna lfo rshymar i ns I1(gtufol Ig ic~ l or genlttic cl iscas s Glnclt~r trauma etc )
[dicirc)parhk S(oliosis has been divicled ~(corcling (0
the ~Ie of tlie patient egrave1l the tiJ1ll of d~[ccli n of the condil ion into ti) ur t ypei ln fanUlc jU nik ltldolesshyccnt lnd aduh Til l m n st cnnunon (VPC IS the acloshylescegravenr o licirceacute I1IJctenzec1 hy 1 sud le l1 tggrH3l ion uuml uring the grow tll Spllrt (Hg 1)2
lhile p tu 1l sco liosi i5 Ycry lomnw n thl pre shy~Iknct ra te f r adole ent icuumlop~lthic structural CU IY~S in sch )o chilclren are 18middot20
- 10 Co bb d~grels o r m on l -lil
- 2) ~ohh dtgreclt or mort O 2~j - bull () (obb d gre -s )1 mOfeacute ()ll 2
Clin iltI [ d e isio ns lfl IXlSed 111 an lccu r~He pregshynosi which obt inccl in eJch pa ti nt mainly o n the basi of the nsidu~ll p()tlnllltl l of TH1h and the result s of 1 rh clin 1 1 ~l1d tadiogmpl i exlminashyti(ln12ll c noieq uentlya d inica ] la sifiou io n o f the ing le pHient tn -ome estent co incic1 ing w irh the
D diographic one c l n lw SLlIl1H1arizeci 1 1 folIcJ - mikl lc~ (1)(n 20 C bh de~r es - moderJt l betwlen ln md 15 ohh de~ rtes - StV re 111( gt1lt rh n ~J) )bh (kgf s
On the 1) lsis of [hi - dinic d d a lfic t i n (Vith l1l il el lrb tiOI ~ o f the ir b() und~ri e ) in Itllt l cente rS Of SCOtiO LS ITe ltlllent in the Lltin odcl (i rJ Ital lnmct md PI iJ Ugrave tre tmtnt i s plmmcd a fo lltJw 8l
- mild kineslth e (~1fw ~1Il (1 luok-ou t - Hl demte IJragravecegrave 1111101 c(~r md k i rws ithe lJpy - ~cven surgery
Physical exe rcL~e for S(ol iosis
Defi t tiOl l S
PhyS i 11 nU b lIKrlttp middot (or kines ithcIa Pl) i a p rvgrlill or plt~i Gl l (xeriltecircS ~1ci fi ( llJ y ltk ~ loped
y a -11 [ru ine 1pll yslo ther3pisr wirh th e m 10 Hllll
- pre (~ n tit1g tlc aggraaLion of the cl I )flnily in rnild bullcoUm is
- helping tlk Il ld Ct ~lOd ounter~lCtjng its skie elfects in III de rltegrave sc li sis
Tn tl1i_ feSpec1 kinesitl1ert py f JI s oliosis is tonshysider l a o on of peciticcedil training and s genecirc tltllly proposelt in sessions 0 1 4~ ro 60 minute IW) t) tour limes 1 Cee PhysiGtl exerci es can aLo ll v o ther auumlns 1S it oill he dise Issed in this plper
Ir 15 Ilot possib le to cl escribe a single progrlIT1 o r exerc ise a5 pro nrams ale USLIJUy p fgt nll ized ( ( lt
EUH PA ~illDI (DP1I YS IC~ 182
ROlL UF P l 1YSICAL lXl 1lt 1~E IN l IlE 11 ~l) IEd If IlU) l[)VP 1HI AIJ() J)~Cl~ r COl ~I NlG1W il
f)( 15 egraved ( )Il the nee L- 01 indi iuua l pJl itnts) al l l10ugh Lheacute) C l n h t 11 plicd o n a WOU p hJ~js (-1 (0 () pnients PC[ ~l ()lI r)middot lugrave reQCf lhese 1 10 grl lll frequt ml~ V IIT
hnm on in middotituk w allClthltJmiddot -Ill Jnv L l~egrave at Wc w Ht ~huw in lhis lyl peJ it i~ 111 n u -eII1 tu id e ntilv kirK itheJapturlc aims w hitl l ucircrr~spnd LO ugravelt~lil1 DUtshy
g X ir ur ph -s ici l lxtTi~l I~llhe r thln ln dj( us- indishyiJ u1 1progr-lfll
Aduumll l lxUl kisure time ~lOd h )u] Sp u lllll8 ~Ilttishy
i lt egrave~ i middotomm )Ly s iven lel mJ ing ro w hlf ~ Iuumlnsidshyer~d usdul or il lrmfu l in t1 lt rruning (lI tJw ptliJicirct ln tl1bplper Ugrave1 gent ltl l t rl ll bull p lwsiCUgrave lttG iviUes is rl ktll 10 JllI1ltlCc hOlll gtpOlt mJ kIJ1lsIcircl hc lJ l f
i ve lUen tloneumld )bo C on lv ine n dul( re Ull~ 1t~1 t s far Ilten publislt d f I~ mJ I(i noltgtithltl rgt is 11 11 a su h jel lnI deacutehate CJitk haltlt t llltit m itn ltl of l ny lorm o t p l1 ySiClI lxrcL e as a Itwr1 [ J- fo r i liopa tb il jcoJL~b un iL ()ri gin~ initial1) it WIS Ille r rOmiddotUumlK lt brgdv u f p l~lt titu gtllergt w h ) intervenecl hutll tc llcrl ll (mon as cltl HtilJ nic in terventi n man Jgt
1 t lltrJp utl t one 1 md rC j fkll l~ on rhe h sh lf som uni cOen I1v pn t I1cgts wt ldl hll ltl enl1 JI~ haLl nu na l scicnt lfic baisYmiddot HOlh tlle$( trr t peu shy to rh ~rl py tt nJecI to l~~rJ tte C Ih tk CUf -~ pnnshyclr~tll y as a f tsul t of lilo h llIzatio ll of tn imdqultdy ~u pp rt(d S pln eacute 7~ 12 to re-t1 r rI ltrl 1$ l l1C k o f WH llt~~rdl 10 I ndt~-dll()urnah tnd 11( on1 p~l per u suaJly Cl tc([ IS n prelimmtrf lll d 3 ln tt li w ay man (l rrlKpt(Hc H lf O iS Inll ph ~i C U l ~ d vi ~ cI nllog scnliotl pa t le nL~ 3gainst holll ph lca l egravexershyclc and p()rt~1
It m u st t~ n tfd [hat pllyknl txerc j~ tJe~ltm(nls t1iHer 1 lJ rd il1g r rhe rherlpcu tlC litTl~ on lllc h tJ rgt ap p lolc il l the IXlltent lncl hi im r IIIllHnt i- 1 (1(1 rI - 5lt1J lC igt tIl l ( f phJllIlllolopJ al rrea tmln ls Ihith cllffc r 1lt œQlfd- rhe m C cculc u ~t(l luI thl p al 1t n
~mc l 11i (lbE~e Tt i ~ P ~il k tlwreI[middote thll wuumlk ltlll t kin 1or ph~ i Clt1 1 lX r(j~ 1I 111~ t bc loidvd by t h~ Lo iurie IxujCJ1l al1ulhcr a dl ~IS nJI h~ iOg (1 11shygerols llugJr in racr le (wi ller d I ~fJIII ~ I ml thlls re(nl1l rn ndc(1
fn n UI cel1ll r we In(~ hccf) using 1 ) 1 1111 11 ve ) 1 (J p lw l icd ex(r(i~e (0 J ( 1I l tt i~ tlh aITt ~ l~d Ilv m ikl tru cflumiddott1 adokscltnt (cl ioj arh lC icoli is11 2)
ina the f U~ t rc-gt uJrs IefC pu b lishe - the pJ( )grd m 11lt1lt l1te n PWltllk d in fa c t deel()pnlln l~ in th t l itshy OlL1Ii in tl1 r b t ~() ycal f ha ve iclemi fiecl niO l l
m d 111 ur impl rnHm s md d i s )h ilir i (gt~ lue t idlo p lthk amp()lio -i ~ t Jll CIII he 1UO(l if Icirc 1by phyict1 egrave xert iSlgt l fe t rrncllt
l illl
111e aim of t l1JS r~l per ii tmiddot (tv iew tl1( l iterat urt to a(errl ln v llic ll of th~ impa irm 1t~ and Liit hil it il i GllIltec hy ~ o l i()gtj s -o ull he ll nt x or re middotlu celt1 Ili pl1ysical xerclse An u p-to-da te knOvkdge o f tl lt Lgtpecl-gt i necckC1 in rJeumlr) d -oek
- whetll~r there h ltl n adLtIIl ) l tht()d ical bbh fur or JqIIcirclb l l l1 Il( ) f k irt llit herlpy
- h N I)(1 ( 1 Dm tlle p r l c tIcirc(( o f Jebur tiJne )pOfung lcli v l ti ~ IIOU lci he tllf) -d o
II J U V f h 1 I11~ c~~lb li hed Ihe usefuhlLss 01 k il1 shyc ~thtrpy il i aIle dy l nsi 1([(( -r-tI Llleu i n )I11 plJt~ ut the wJrld ir ilt ecircS~nl i 1 I( id n Iv w l1i li ( 1shy
gories 0 1 pl1Vtl( 1excrClgtegt te D)bilI7it ric 1n (Ir st shylliuumlZltio f) lttlt tlgtbltn ing ni trcrccedilh ing erc) hn Id be
vnlcled he tll rhe nuld be lerrillldll1 1 md whidl s tlQu1d be inreœ jf ic(1 IJeClU~l tlley cOli lel Je LI ~ful
Ncuro1llotor impainncnts
Imv aUl llOr~ 11 lt1lt ~tlKlteJ lhe cltlndatiotl bd Ween tl UC1UmiddotIt t l ol(~C t nt id iopml je -nll ~J~ and cli~l l shyler~ lr 1tH lest ihuLIr yt 1 _ 13 ~ 311 D uhoussct 1
1-- ITS tln l ldiopath k s(o lio-L L cll -c d l J l hmgt in th terl tltr f prop li l l pu n md 1I1ar th e detrshyn Hi n i~ na tural 1 ~ronse to ril e need tu ts tu re p()tun ltlluilib riu Ul HcrmJJ1 31~ 11 () d tllat icliupathic ( liCl5j h l it re5u lt Ot1 rw nltuf mot r l ~ltelV
[Id )fcl 3 nI] ~1ltJ U Sr1lle nr to dtorders in centJtI lO~Cl shyIOIDNur) md 1xi~tI moro (Ul1lfOl syt( llI (Fig _l
N htIll -of) H1c S uumll h( rll1 ( ~ l( w ing JI t11 (oshyI-ie on the l l lO]ugy o b doll (nt Rl iu]icirc tlili- middot()lioL m unt fil t-hltll rhl ugravedcmnilV L th e fl5 ult o f 1 (k btcl 11lIFll llI ion nf som t11(WUgravetltnl md pO~ lur( (tnic l~ l licirc1 tl1lt if l p OgtlbJt b C 1l rlw sta l i lin 0f 11 1 Sf llle j lt g )tx l Tt) ohtil n a ))Cli U 1ILzltl I o f p ~llIr~il d l~flo [ in l1litkd ~J)llnSIS me CI Igt(middotqucnr J ~ a ~tmicirc ()nlly or regle Ie Llive
Ali th- 11yp ) tlw~es rd ~lte tr d irtl Itn t pnl1tlt o f [11 v hole ~piltm It11[ controls postu re ~nd mrw shyment lrre pell ic of tlh po int a d lI~ llv inH llYegraved il i ~ ll 1 nnable tCl aSUilll ri 1l tr l ll1 lo g thi ~ys ttm ( Qu it le 1I middoteli tl
lt ch ugt nlt~(S f rullliIl thil i nlomwtion th at p tlmiddot shyiCil J(tl iIies nw gt Il lInport~n t rr le to pbv [11Icircgt role ca n 1)lt slI i11l1lariztd ln lWO the ptu li ain Llt
- d elopmll1 l of p uumlltl St1 b Hlt ) - c1e veuml IOpm 1)[ o f bhll1ltc _
(k llhUl)lOr S Cll orr
ontrot oic whan-lt
------+ 1 ~ il lnll ugrave r AINnl
Cllnlr1
T bflt~ r
fltL1 tlli
lMini
l
~sary ~J-frlllen i )f
~ 1 ocirctnl
~UcirclllIJJlW Ll
AXl ~l1 n uumll l) r sy 5t ~nl
middoticoltoq ~ Fig 2-AcFgtrdong lU He-mutl 21 il is Fi)5~ ib1e rD prolXgtSlt l -oo ie1 mnd 1 ((if ~ elio egrave middotAhltr~d l)Qdy-p ati~ I I i u d) uren ttllOn k td LO In ~ory reHTt I1 eDi tn l al ) JdrnlV~ pn)4~ e l u r~o(Ofe 0-c1 eptunl dvstil t1 ctlon sltŒ(ry icircltu nu11t ilwnt [ ~mC ~ted tl l1 ce Ill trpntlshyUumlfJJl nd IKnle~ r~dibl jtugrave)n of -I) m tlosen Ir ~ig nj tl (I1vying ln fornll1U n (lI an ereltl ~piJl e Mmor aJJ r--a t ~) n ltgtf ti lt aXljl mowr plem iHUC Wh ~fl Ille 6ubjeco m uumlntl Icircn (1oJifitd perccpfLlI l ~na l ysilt of p n)lnocepti Icircnfu rnlaquol ti desnibJOS ~n t tecr spin A IICW motor co nrro l Ira I gy t adopt resu ltin~ in the ~tr ltctltr 1 ckformh y lf IdiopathirL scollos i=i Ht lrftU1uc nltnt l ISll I1lJy h1e- ~ I pro()und elkn on bralO Sfem flJll ct i(lnn~lLhu modifyRll Ille nltulltgtshytl10 ) 1 1111 Uu l-lHoror control 5~Shnl$ shy
As Srtgn1lt1 l ~ ltlssert~ if wc l C -Cp t 111 1 un o f the G IiC s oliosls L l tisorckr oi th e ltquilibrilltn sys t ~ms it is lagical to oriegravenrate physlCl l exercis( lherap y ln th is d ir(gtCli()[1
11lclte goals Cul tl lfOUgil ditrercn t modes 01 action be Olchic(-c1 witJ1 phykal accivit ie
- po rt ive Cll ities p ro ct LJ e aIl UgravelClltrtsc in 6lte nshyel ll )o rd in~lti n pinai pr0prinup ti_)[J nLi mOVeshyment control 0 vio lls iy ln thh repect ome lCtivshylites aœ pre um~I I)y lXrter tllln ntil crs
- kinrl lira py using pedJil exerCisocirc specially developecl lith th est 1101 5 in mind illVuuml VC I lllore prccilt( ll1d InC1 li zed cri n on rhe spiJw focusing
a90
1 ~~
lg -lNheJo ~1l l1 t r~l g rld in 1 1) h i(~ IImiddot ct r rHienl w i ll idlllhic _It ~i ~ _ iri s plt ~I le II find Jit ltH vlllleuml ~l Cgtbl tn~ ks III d il fef lt p ~ lt ihnS nu v~tl middot B ~a~pt u Il C middotl)Icircd ~(t l l11 C dlfkrCnl middot- hdween slllndi1g Uline nu nllt1Xinul oorrec ri nI t chied Vith Ct (J ) und tfdincJ ne lot es o UIine 1 fo llnVs middotIJfl tfi ni( - ltlrshy
reltiK)n ~ Ikexibiliry st3nucircing - -pirte - f ur~1 1IbjISC ltupin - ltorrcaion - - r~luci()il ll ymiddot For flmpllt in J npK l1 pH k1J il
plt1SSlhlc ln obtai n 10 u1 511ndlt)l [YLo lion yr ln Slt p ille rlOlgt itlugraven om l J ~ in ( gttf(C rigtIl lIex lbuil 15 i (r-l l=22deg pol lltl ~~J IIlpraquo is IcircO~-V- I t1 l nd tucircu(Ugrave) ilil) I~ 3laquoJO- IH-12
r ln Ugravel e abilit jl of tluuml [m e llu to co ntro l irse lr in ~ pac
fuld l oftlles uumlllelve ntio ns can presum1b1r incn~~ Ih enl ac )1 the orller and lHitlll r of Ille rn - 11 )ltd h e lllldenl lu EJ3)4il
Posl1l1-t collapse lnd slabilizariotl
lIle concept u fplt st lUal c(l lJap~e l l~t Iwen detin 61 by DlI II-T3e~tupegrave rL t Ac oJdin)j tu tl1i- ~ll1thor il [ nec(sary ~- l Hn Cv-tlualing th tleihility o f a col shylo tIcircC CUJVL (0 clistingu ih bt tVeen the re du ihil [ty index (th - li iffer gt le bet ~middot Il ~I r~tcli()grJph ie ~xnmshyinltio n of the iI111 pHienr in supine po ition m(i
ROte OF Pl rnmL EŒIlCISE IN THE TREAT-ŒNT OP ~I IJD IDIOPAnnC OOU~GEm seou SIS EltJRINI
I (~)-----------------------~
__ _~ _____ _~ __ __ L ___~ ________1 ____ _ __ ____ ___ ___ _____L___ _____ l___ ----------L ______ _
1 ~
1
-- ------- --1---- ---- ]---r --- -----_----t- ---- --- ---shy__ ______~---- __ ____ 1________ __ _1_ __ ____ __shy
~ (1 J
1
8 =~~=r=middotmiddotmiddotmiddoti~=-middotl--- middotmiddotmiddotshy--------------t----------~- -------- - ------__shy
~---- --- -- -~ -------------r---- -- -- ~-- - -------- --shy----i-------r-- - ---- ~~-shy
il 1~ 0
Dtl-Lmiddot ~ lttj l r~ UIltltlHt
f g 1 -TI1 u ilictf 1ld ( ii 11- ugraveu-sh) ld IX~ O 1d wllich ltJdnrshymII Il nf the pilll 1 ~tln~1 of th e -o lioti( spinc n IG~nI(J II IIIshytt) lhe iJeuml grl-e o f ~ ()Ii ti c (u rvH Il 1 w dcpc-nlknrly o l l he 10 111shy
P01(nl (pntt l ~ 1 1 nr ffll wrJ I) ln w hilth Ihe n i 1gt( ~ duc nL~ grlphs fm I h~lt 111lt hi~hr Iht Col h ~Ilu t (l f Lite ~Ul Ihe m Ol CI il y th t s(uumlJotil middotpin~ ~111 he ~middotJg gr~lVH(~(1
m mJxiTIt corrttt ion wll iJl i~ lIllCd to Ih - xt 1shy
lti Oilil y Jf tl1lt t Ut JO rl1t cdnUc idt md p OS shy
tU ll cul lapse ( th t ltHill enct b-tten l lUdioL) 1lphic egraveltamJl1ltlti OI1 J t th e ~lme pa tient in Sl il tl cling lOJ lline fX-sitiutl ) Wll ic h correb lc- onl wil ll fhe abilt ty of lllt p tu rl l gt s tem to C( lunternct lIk luree o r grl viry )cco d ing rv D lfVd- f3egraveLIprc po st li r t1 lt01shyIlDse is d ue to the Jnus -u lar ton a nd 11ll ex rCrIshy i) i itv of rhe tissus n the ( O IW-) si it (If the (01shyjl ti (~JtVe (Fi~ 3 L Pu~t llr1 C lltpstl lu lcl l ~~ reduc l-lt by llwans o f pl1ysica l cxerCles specitkally s tuclled ruuml i rnprove tIlus--ubr fOHt md lU pr )cllI Ct 1 ~11 hi shy
lizing ffCd
PararcL n tll CIJ cl the cr iti ca l (3 c1 thlsho ld beQ ld Il ich defol1J lHU n of the i pinlt 1 e~ in~ ne dtlllontr~1t _cl (1l ll t grclrf r mg] o f rllt C II in a qa m bng pos ition corn pOil 15 t l lowcr detormashytion lhnsllold (Fig 1) ie to ~11l Ulne3Se t the risk of pr ogr t~ lu n There t rh eJef re l J ea r l)iuuml 1itshycJ l ~ll1 l l(tl a 1 tnr tg ro b ohwined by d -cr t l ~ illg ilmiddot pU~lUrll cull lpse ptJcelJtge w bich lccording t i)
h llTd tnd ~l(heJ1l ~on 1~ b inde cl 1X llt icularly luumlgh Ugravel mllcl c Iio~ i (bdow 2( 0 ) (F ig 5 J
Fin a Il III ch iS respect lllljl hl and b um l 01 m linmiddot
ii iI 1 l _ _~ _ ___I ___ ___ __L ___ _ ___ ___J______ ___ 1 ___
li 1 1 1 1 i 1
1 i ___--____---___----__-_---_~- _ _--_ ___-+----
i
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+----r--------t-------t------f-- J
Fj~ ~-Ac(XjJlin(Q luuml T O rIcd ~lnd Na(h(ln~ n i () dl( pCG w rd (rTIshy
POO ll is hiherin cu rvegt in wh ilt l1lh ~1flILWrd cII1I Olk l1t IS le- pr(v~knt ln th e grtph Ih t PogttJlJ I ugtnq) Ot1 -J1l j elfltS-e J tlt 1l1t obb dirr remc rlLIv obu incu f roll l the Cohb atl( 0 1stlI1dtJ1g IId gtupinc rldo~raf115 Ih Ille lt) [1l1t1 (i lndnl I pine) 511pille the ~(nlClu tJ1 compo l1lnt U rlk CU Y _VeJily I~ ltx p rlt 1 L1v UpUlt (obh Illeturo Ih t si _b Cct rtJeSIm l fie -ltn J trd Ugraveltuuml shyuumlo n A~-i)rding LP 11(lt uuta o n l ( r1I~( in ~I 2JQ sup itlt curvt 1hi C(]l)b ddhccno l l f lO is -J-lultt( thc s ldnd inr tnla Ol1l t lS wi Q) whil 11) 1 1)401 ~llp lne ClHVC If ~ 1Omiddot ( tcl Lhe ttnd trl~ nlca~ I(t I ~ ~I)
tli n ll w l lllE cq lin ti spin h~ i ng mo r ~ Llnt~II) 1 tlun the nOftl111 one n Cll l gr(lk ( (cU ve tl1u n da r u p shy
po rt in o r k r 10 m linrl in tht 1xi11po tuf_ n th ha__i of th egt onideratl lr1S it f(lll() rhJt
ph rH (~Uuml e erd es ulukl h u - ul iiuml tbeacuteY ~U-L lm cl 1l (It-d o pmg p05111 td C Jl1twl lS fuumlrnll~ rly d ccrll1td ln an Ql St if i imr ol1111 t ru t(( - tht m(d in C JI shy
r t t r sture fO Ir -ngthen tlll m u ck-gt of the spint mainl) in (11erl antig r3ilrl tIcirclt l]lli fun ctin ll U hy meU15 dl i )ll1 t trk ~ lhJ cl( -ll tlt C)nlr~lUions ~llld no l IdOshy
1l)llic d YIltll1k lt l jAJ lktic t) I1 ) II 11)t 111 hd posibleacute t lcluuml ee postura l io nrro and stfh ili lllllt IJI
w i thout food T1lw(ull r d I( Lf(11 Ibk t m ucircnuin Ihe c()rf ~ct [ ()S tu re for cl gtu ifKi IH lLl1gth 0f ti l11 ~
This i-l ddl usl a typl 11 dnmnin (tf k inesllh rap) in 11 (lt-11 [[k - p~d fk lnr in lng f u l1a in llllliCk is poss ihle lI sing ctrtain Idncl fJ l (lt) 11111 liun S p Ul in tb is Cl c is ulttful ooly sa I~tr 1~ il Iw lps t1w lxltknt 1 becuJl)t 1gtlt ltlt-I a ClJu~l inred irl ilL ntllru l o~ i cll
and I1lll~lJhl r-keJc LIl [rll-llIn~ middot etlt(wrs JI the int e rmiddot vlnrion
[J ROPA MfJ) I()Wf-I YSJ IR
1
ICR 1 1-1
r
1 shy ~
- shy
11 o-llrfOlhe5l~ o t Ih 1O~(1dity i n h ~ r ~ ll nr pbl1 l of ~ Spl11 in 111011 _llti1Gt l lPt f ltlJUCWJtl ( ~l Ihe Ir t 1 1gt illbll W Ilh LtltrJ1dlion Vln lbe rigronl middotUII~ l(I Dko n12 lIll h lumshydlanie1 1 [ nul 1 M hl whtrc M - gt) lnIUI1g 111laquo111laquo1 1 1 c rtJCshytjC~ f fce d -d Lill l1~ o f enr niI pUll spnmcl1y 1~ 111 mldlll1lt (n the fl1ur t 1 = tor~ of f(ward Ileuuml l = ughtel1lng fmiddotr p 1shynOf stn lClU= Alaquo rdtllg 1raquo Ihl~ - lin hull th l1ltgtllugrave ot tller1l lUr~Jtllrc F the ~pin t -ilh rlu1i tf Ihl 1 1Ibulll n lrlt InltT1 1
rbc prJI 3IJi l1ty d qrlOIJ~ n bull JI t IlJIII Hm lA the v=ltd gtc e lu-ing J 5lnK1ura i ltfnnity
Dioal e ch anicll itllp~lir J11 c nt
Ihrcemiddotdimcllgtional mc-cbal1in of the s pioc
~f Ikmiddot i t i nly l(œ ntly tlHr llk pr-5tnœ or nc ushy1 lnlo tnr impairment in Idiopttlllc s-ol ii IXl tknt liuml J$ heen h i- ll licircghlcJ hy re$eJ rh tll e preit ilegravee h inm b nIcirc Ji d lJutg~ lt hl ~ 1 ng t o n dO Ulll urcel 1 i5 (l lreldv well umlersrood H(j-ev~r nev lbt un h iomcrhankal im l) ion nI h1c rectm ly onk l n tIlt tre and p r~dou in f n rmtinn hou t pl1ykd (~fcl5( in t 11 0 tl1I _ltgt pbne of spact 1115 Im trqlt-u 1rom J i-[) v ing unclcrsrmdlng ot th l lmc -dim nshy~ilnl l l11 ~ hmk f the cO]jO[lC pln( ~2middot ) ) Ve- w ill )iI xnl t l1 d at lcL-orcltng tUl cl sif iol t lOn blsed o n gtolllt lricd h uumlCJ ) p lane
- b() rJzU[1tl ln th i pla n ~ th t 1o rm ll sp ine present no CUlye- w ll ile Uumll(~ ltc U Hic spLnc clevelops one of ir haracterls(Icircc deFo rm tiCs v elt tbrd ln lashytio n vh icl1 pJ()VcA~ theacute hw 11
- lgitltl in th llulJe U l(~ nonmll spIcirclle pl SenL kypl lOSis ~nd l dooi~ in tb lXI1 lhese [(Hu rts Vere m)( til ught [ 0 he relattd tlle scolkJtlc ( lI r Vegrave
- front l in hi pleme tht ncrmal p ine preseuron t no curYegrave whil thl ~11li tic p in ugravetI I ()~ icircl~ charshyad t Ilt I CU1C
Il Jri fJIIt palic
~l+I~na ra 3 r inr lut th l[ ber ll1d a œl1~lU1 degr 1
l f r()la tJo u lllu (lILa r forcKl ltxert ltJn tl ldefnmuumlng 1 tkllJ [J i1u a re- lhlt tll cly 11 [1 1 UI b y Olm ner w bn ~lh uiJwd tl egrave ro t1tic) l1 Ilm it ti lt p ica] lf shy
rhrl r() be (P (the Uma bevond Wl1iltJl th lCOJlb of [11( ~pmaJ musd ~ dthc COnCIt and nm ex ~l le btconk (t O li~[)
r ~l 18 ~1Il N lu t( ren i9 lun lu ted rlseurlt h in tlt ) tilt lULodeumlformipg1 tlo n ot tIH_ sc laquoJrle rh ox ercallkren lk 1l1~H li d11r once thl Il i ~ r tld1t5 [he lhrth ld f 111 JlIcirc lIi of tlle dnrlclc hurnp tlk
lI bslt Il l nt rlet()rlll lIcircon 01 the it l ()I~ C ( (ylm der (- sustalnecl by an H1tmi cforming aCOOIl
J1Ji h V hl rhyiical f~ f Ise CI 01 h spr n llnd kin middot ith ccedilrapJ my lX damlg ing vll e n l pplild as flle
igt Jk Iller ln SCC1IJ ~IS lllc lJ fxceed l auto in middot crca~ i n g lhrllgthuld [1 sh (~u Id ahn be j ofed that Ilw relscd pre sun 1l1111i insiugrave l fe pil1r inn) 1 mlshylt
- j Il- ( w atff 1 (nh ~1l 1(e Il10 utoldrml ng li1eCh~lI1 1sm
in flc l Geyer ~w tcd th1 t rm m 1 hI l)1ecircch1O lla1 puilll 0 l I C~ sw m mim t Ieuroamp no purpo t for cu lshyim le pllilt t1 s (weumlO middott r it is l~Jl(gtWl1 rhn in iculio r[ paULnl -iJl11T1ill~ doe_gt nor Il ~lp to i ncrt~SL n eur(1shym tor co mfU
(1irai p an (
Jerdnn lle 11 showecl thal ill CSl~ o f t10rLC IC 1i lUgrave
tllo lacolulllhil it lio_1 tlle cte tI llmiry in (he lg itt1 p lln t rn lnlftot il~ lf tspe iuUy in tlw initi 11 r luleuml )f cV IU[Icircon nf Ile ~oli ls W iU l 1 p(t)gr~s~ivlt il10middot~ shy
ment roward hvpok pho b G ll f ill~l Im lins l har dUflng (IN eWllLlfiu1 of 11Imh] co luumlgt i the l in t ot t l H~ gClyty Cegraven te l - 0 1 v llebed lxxli 5 r ro ject 1 seH fl r t side-ys and tlwn backlrcl bull thu~ p(0(1 lj n g a kyphQtlmg aet Il ln (h~ lu mhnr --PIl1 COftj tng
l l i tc Iugrave l lltl l( l rs1 tif s L -etllgt il l the lgirl11
1 Hl)
Ilu LE nI rIIY~Ic~L lXIlKISI 1 HI E TREhTMEtn OP JIU IDIOP llII C AD O USCUH O Ll Œl15 NEGR II
lLill tegt lre lenl1 ~I d ~fo rll1J[ ~ rhl recrSes the phyltiologiGII cmns of lh vine)
Accordlng () Dicion ~2 1 rtcluctio fl in the itgitttl CUIYtS combin l vi th a lueral Iviari n llltl ds t 1
mecban ism () ugravel~ta il ity in l he r rat r IllI1e which bVOf1i the unsd a nd i ncrea~e 0 1 co hlt1is (Fig 6 hiIf md Pl11jlbiJ Jl1eanwlt ile lt(udiecl lh e srnl ru t
orzyglpophySLs show ing t11 al ttleir 1I1tl rnic tl orienshytation f~I (jLi l~ltes aXIal ve rtegravebJl l rotllio ll in cun litluns lt f dorsal hypokrrhn Icirc tnd lum)H de i L lo IS
Tll t dat SLlgge 1 th t impOrfill ut pOitu res and l1lweil1 ) t Mudied in ord t r (CI mlIuml ntrlin or to reuwer fll e p llyslo lo~lCll ClIlye in lIe SlgJtta p lU)l Wlth the llm o t ch ~ kin~ rutltor in l~ bili ry7 AbC th ~e ~k-
1l11nL ~Irt del lnt [0 J jUc lt ftber l]kuti inrervenl ion vhich 1c)LJ k l IV - i(l ~ l compktl n l ililll on Il t c1 l shy-jel1 J11UVllT1ent IJ j o f 1uto-dOneacute(3tlon ( i e a -impk ld ion ) Iengtheni ng o f the pilleacute 011 a litlltl l aXl~ tll lt ((IT liJlI~rcdu e~ t lle ~---lJ linti- l lte ml-fkxj(l n h UI 11 - i llCrl I~t the plllH ](JgicJI dlt cr ~l S ( (1 k-yvllCiSh lIld O(ltOSh l o r c lch r1Iif n t a Ilew til(~ecirc dUuml llt Ilshy
si lflltl J ll1 u(~nlent iam ecl - 1l1t0- lIrfe rionmiddot7 4 llmshyp oed f Je-rura l iUIl cl middot-t1e- iltm lI1d ll1a intltnUlLe )( 5lg it d C Uf (gtS slig lll thltJrc i ypI1 tiZ) tIcircOI1 a nd lunugrave)ar 1()fdos i7~llion) sholild he esw b lb]HU 00 lb co
hl b oi hi p~l11il uU r -1Ir vlt Abo 111( e IlltUtl Chl lie o f purti n - a U vitk slJ1ultI h e )tuumlll ecl 1)] (1 n ldershy](ion r tl1i lt type for e upIe IilJ llyl)T S of repd shyiti( ml vemen prt n t in agonistK h)lnllltlSlks nI iIle kind f dlJ1ce C( uld he ([([r imentd
FmiddotO lllaljlallC and mobili ty of the SpIcircIlC
1 rd llo U 22 d L lm nrrare d lhlt in Illt fro nt a l pll ne
tilt 1 nge Clt 1)1lt vtment of tht scplit[i middot CU IY grcmr lIJ l il ~ d irectio n n f Lhe C ITelt tlO n tha n in tl le di re shyLion of pmgressi n l Fig 7 ) he IL o IS5err lJd tbat th15 mohiliry increac plrtil u la rly n apic [ cgcoeilts 1$ lh ~ ~c() li osb evolves Sragrm rJ 12 J ~ thus rigilt (0
VlI f n rller~p is ts Ilo t t) m o b uumliz - a sCtJl iu til curve w ilhout t [ uling ttwt tlle R lu tiOI o i til t ~a mt b fnlinruumln( 1hy l1tans o f ~I passic 01 1 rivE -uppnrt On tilt (ltllE r hand UgraveK d e iJlioJ1 in ease durill tlw tune 111 whicll tll C spmt i ~ not submjtrcd to correeshy( IV anl()n
j- Virh mi lei ol i b tlllt Upp i1n ill) lC tiol is d eveloped only lllmugil llClIf()mu$Cllbr f r llce thi ~
InegravelIl ~ thclcfo re tl1l[ inu eascgtt sp1J1all1extl)iity mua
11
Imiddotiumltgt 7-rurd illt Ir) 1 bull rdrilt I1 1 in tl lt frOlllll pbnlt- th( illl ge )r mOC llIeJlI o t the S-o UIIJC CUNe 1 supcrior in Ihlt diflt(l im ugrave( the n nKlIl thd n ll1 tllc dlrtcLion o f p rJ1(l( (llIl
be considrCtJ vntrl iJ)(l icltion and 1 undrli neocirc ab L a ~ubiljz~ILion 01 tilt spint pllss il)1y ohtl ll1td thrltJugll the stlengtlkl11ng o f the 1rltJgm vlt nonil lme shyCIC 111 illli orrant u bjcLliH- ln rhis r~f1 n sp u lllni lc tivitIumlLs sil uld lX tPI 10 dlegraveltl it l G lU t n w l1ik luring kine i Icircth lrr phyltical eXegraverci c~ tllat in ele
spinal m ot ilIcirclY sil nid 1e lt1 oid cdrt ~
Organ ie and psychologieal impainncuts and li islbi IiI le
A cgtI im lc pmi nr is moriOthl11 just 1 sp in and 1
compkt gt Ipp rnach to the gu in ad 1 ont i al~ shylute l e~se i t i11
[)a la 0 11[ [n ell lrom re semh pw tbat ome organi Iilnctiond cl fki ts suc]) as tlw clecrtiUe ut vild l tnd d fun ll l)Kity_orld ldly incrtJ k whil~ 0 shy[io s i -till in (1 miel q g of g JltlV ity ~ l ilI e 55 rtI lit
tllL pres e n ce )fl defidt Or Vi l~il Clp~1 - i~ ln one pIIiem in Ihr l ftectecl by 20 ICl 40 scoi stgt l ls~a r(h cunclutecl in tbe UA by Di Ruce- prod uegraveed an aaalo) u ll1lXimum 102 re u t in a group of Jd shyk 1ien t [(h sco llosls rang inF frum ) [0 1
Al10ther rudv bv rallt r m C chr111 lilcl NashycWrl1s( u 57 stlO eltt hil $(C 1 1 ui~ Ica js l( lllt cl (1 shy1prUlllI o f t1tgl lie bJd l imI in ~ul sct t1 t ltu b middot iects jlLltr l5 they are golng through ~I cltlici[e sllge in the fnm 1lt i n 01 tlWH o w n id uHitv t factor hit h Illy jeopmlize the cl velopme lit d ~ mIll lt lI1d htIshym cecl IWI sonalitr in Klulrhood
n RUI ~IEDl(( Ptl Y1-
ROU ltHmiddot PI [ I C~ 1 EXIRCIS]~ IN TI Il nW~JUNT OF SlllO lDIOP1HIC AI)C~ESΠ11 C(gt1[Oi 1S
This i why b IiCieacute ii is ~n imporrlIl t for p rcshyvegraveml e 1tLsr l tn en ou flge 1ari e nrs ~lfrecr(d by lIillcl middotu iosis ft) tlke p~l rt in portin -re rcatioluJ acrivitits Iha t 1eIU 10 L10 th r~1chophyinLl bull nd b~l )i 1l1o tur adlieem t n li 51Jmiddot2Even tlK)ugli [Dr bic mech~lnshy
ical mcl nellIUll10t 11 11 reltl ~ons lt r111 1gtomcrimes be l lefu l to ugg( ~t ne p rt in~ aCt iv ity r l h (gtr rll n anotlJer e th ink Ibal an exces~ ive IlHd icalizltion - Icirce l ll1posilion br plry~ilt i HlS nnejlor parents uf rh ry pe of po rt to lx p m lice 1 b Ule p 1Ucirc(Il L th1[ preshydLl ck l1 is fret clOice in lh ma tt r - -h II ll1 he avolc1ed wb 11 possLhle mainly for tlle i mport~ltll psyshyLb ) jogka l fe a SI)nS W( ha( ill ~ t nltntionegraved
Conclu ion
lbh ISsertegrave d t1H physkal tgtXtlci o is ) n fi ial whlIl practinu in order 10 ilnj rove the I11 llde
rœ nwh and tono C iral caplCiry and postu re o f the StOUO(I ~lIbj n II I nowkdge om ~ middotmg trom ci el1shyrlfi rls(~ Jrc li dJlJ accordl ng r the review 01 thE litshytirlture prnpo )td in t lli plpl r conflrm~ Ihe vuiclit ot th e -t ls ~rti ()ns
In l do l (ent Id iopl1il iC scoliuse il l n phee u i cl vk)pm e n t ( li tll iumlKh eXCC cl l g i en rhk thr hokl th e re i5 an und ubred need fn r l pprnpri 1tegrave (JJ1tOkJJe ~Ild Inr surgict1 therapics ill ortler 1) S l i p
the ( - Iuli on anugrave )JT~t~t UW ~pilll l dtlormities bull evshyerthtless in the illiti ~ll pl l~sC t ttlC c1iseLltc whcn the riS( r1 r euro )luli m is rtduced ocirc ~md tfle uifleal JOld threshold il ~ld flle po stural collai i reJcenw~ 43
JI l1 igh pllysicaJ egravexe rc ise - p revenc or r d llCe d i ~lh ilir ies o f [Iw ~ l() li )tic
p (iems R 28 J -6 5- 6 1 63
- f~KiHtare lh ( n utr ali711iCUl of postu m l d elicits tn produCel1 a coneql l nce J [)ti 0 I111)( or regre si -u lmiddotc 5middot Il 1 17 ~ M
-re 51udles U ~ n Ledecl tu con[mn or re jecr these conClLL i( 1 w l1 ich clerin-d frum 1l1 lIldytica l rcltw n f th e liter~iture appear r- ~Lo nlble Hnwecr Intil ne re ull are 31Iable wc should n r prevent our sroliotic patientmiddot trom tl ki ll p lt in s(loI1ing jshy
ir its pW1iada rly ltl t ~d1()o t () n til t c ntrHY -vith the l xcclrinn 01 gt[1 )11lt tIlat in rea-e t)1obility (tnU evc n thell oilly wh n progr~lgtion b p OSSibl) -uc h ~I( ucircvshyiUe -11 )ulu hl tIKoll w g ed The 11 S J ( rprOpriue kin (~irhe r~l Piuml to incr _~asc p()~tura l $llbil i ty is tl1egraveoretshyic tlly CiJUClt alttloughl more ~Iccu rtte aod deLli led ri k benefi rs anJlr~ is is netot1ed
Ria 1111tO
NIokl Mu d lle ftitYljJfu Jœl il 4IWr10UOifll S (JIvs i (1~1)Jshylidl ttno( cclIll le 11(11(1lt1 RCI fu lle ((lia LltfIt l1 I1I1i(i
LJ ci n s j(r3 pigt egrave li n IHUgru lkl di t rdz t fi sici pe e ft shytUlKm iluppno di un lisimerap15Ll rl lllcflt() 1 110 scopo di pnevirlt () fr en~lI 1-lgpwlllltnlcgt dclld lclonnitugrave o e il 5LOshy
Il i mi llon lt fH nugrave j (1 11ni dei co~e 1 lteIl I1J J nd ne ~Ii eifclti (()Tc rri udk s co lio si d i m e dia g rt iuuml ln que~ltlt
s rud i 30 llizzb mo i d ti cleU ric lca pel n ri Icare qJJ l lm 1 dis(imucirc x u le I[~ l z j-m i pro vna le da lla C gtl k A i json ere pr middote-nute () rk kl ducirc un~l rdeguCltl d nil cra pi lt di uJoseguerrnt Cjua li 1iU110 cli nbie tti 1 rcr lJ)tIId d~ fle)-UITC
n (- -fd7Io n~lcl)
Ut11claquo)si 1 lI tori htpnuuml )ludi-ttn I ~ cnntI1zttu fr Cq(in i idiJ)tic1 dbfl lOZ10l1 d d ~ leOla nelllOll1otoriO Lb un1I1cnUl 1n1l1i3 dcgli 111 lt1i ch DIJgt gtU l H crmU1 Nlch~mslt ( SIshygnaJ~l lerimiddot wo i esuemi -bletti d~ plt~e8lugraver- ne l pClZ le1lftgt scoliodcu kl s iluppo ddl ~ ~ uhjlil~ vertcbral~ lt o svilllp prJ Jdle JIl7 i() nl di ltCjuiljbrio Dng li studi sul lto lb( l~nlrale (OllddU i in pa rticdu d 1 DlIal-BeHJ (gtegraverl ~ P~II IId lI1 n~ llw - idente il v- m gtiu p eT il puientc clioti elgt di u n rnigb o t c)[ ro Ua sw mle dei radlldc onsegull o tramite il 11 fforzrlshyfl len to d e i l1luotoucirc l nllgr3ilri d e luOwo con crcbi ~Clltdr
in pOMltHJ corrctl e in va rie ~i[Jzioni s t llicb c c d inamIcirc tllt Dalle on sena d elb blOffiCcclIlicd tr idimlt n s io mlle d ei
r ~ chi Je ~oU()f icn ~Icirc ~videnuumll (l() ~llt tC p IYZIcircOSI ln(IiClZlfHicircl ~ 1I1shy
liumln fluenzt Je ll middote~rUrio tl SC) lgt lIi I rc pibull m i tldln sJlI71 Stl shygn~I I1 afferma che slI l p Ia no [11 middotccedilr~lk tre un œ rtlJ grado di l L1Liuuml IlC dclh vEltlh r1 apj(de le tu rœ mu SCltJ llri njtbc J n in $tJ ) t rodcfQfll1t1l1te PltJtantu b i r~it-~ r -lp il puugrave t~~
Ixnt-ftla solo nt Ile so )[j)~i Jl1Icirc na rl in qunnt ) ilon SlrM ntne )(l(Ofa tu soglb in caq ) co lltrLJIcircn l)lrilto llt~( i lJudotlsi di lfr~ lI1 C llg grVlmenl J 111 11 io lr riltd ll(17jOill leld rinlle 113 dimO~iumlrlto d llt nell o lin~l cl()~ li t th~oIOl))1 dri la defltgtrshymiti sul p iluO slfl iuale ~vohl lf1 (en5 ion~ sO lnm utto nd 1e bsi iniliali deWggrwm1Cnln mcn trl C a( lfLmn che occlleshyvoluzi ne dene = 110 i [ mhari IJ lin c l ki cen tri ch -1vi1( de i cp i CIt IJ rI Ji SI p m ittIl pnm l Iem lmeme e p o j pOS( shyrio fllwnte dtldnli mdv ( i un ziuuml ne ciloliz7nnl dd rlLtide lu mbJ œ ( lIlelttlaquo on NC n d d (gt11 uIdu m 1I1 Ilgt) cli r-Iure (0 eserClzi che IllUllengano 0 ltlUperifo le Clgt 6gt1 lo)iche sul pirluuml gilwlt Su l p iCl no fron itk Perdnulk il dlll1lt-trlto d1 lampkz-l d i LU ovimento amp111 lI rv Kolio ti ~ nd lt1 0 ddlJ cnrrc-LIcircQo i Ji gC 1 n lungl SUpegraveliltlrccedil 1M llS0 tlell 3ampIGI shyvamcnlo C che l~Jltmiddot mobiliti GlI mcnta co n l c lu7j o fle d l i) snAio i A ulln amplgrtJc1 ltllllmunjx~ i terlpGli nn n m obi shyUZ73It ma eutva coli ti0 1 1ct HsicVlfe nd tcmplt 11 1111nshyttllIcirc1nc n tc (k ll ~1 llu u zinnt n l1 un me77uuml d i sost l11( gt ln 0
e 11111ri b cle - Ilziunc egrave deorinatcl d l rlyarsi Snzcl la pr gtshy
liltlnl l i un() rtl~ i ptmiddot Jtl n(o 1S(Hl () (( ntJ() i ndit~tr i ~ Ii ISt (izi e l m iviL Illdlode ebe Hlmen tno laJlc ibiJii dcl rlc lide SCshy
li io) [n p articobre rune q lldl r C-I1 ich~ xlSiddcHe CUf t shyli ve ch~ iJllpi tgino e~rciii 01( biIi2 ZanUgrave HhnmL-trid () in tmiddot~t~nshy
sione kl fuchide O tne pure k- ~ttivit1 tnotoJII~ non prHi(~ llCcedil
in forma r k rel1tiva d Ie ~1I 11 rF~1l1( n otcol mcnlC 1 lll ubib Ll vcrteblmiddote (ad ~ flp j(l 11 n l) to L ginn ~Iilt Utl clkl rilshyC
mka la cli OT- tcc)
r1il to l~ _ I[Dl COlI rY IC~
NE olUNI
fillncr ( ni ((uuml(( n hIIo( rilclIO ~middothe k lln dtfidl fUr1z i shy
nlu CQll1~ la llcl llZIO 1e delb c apKJl ilde e della capacltl di 0170 mizianu luJndn le (OJ il~ gtna a nc r3 di m~i3 gmshy
v it ln G mlxl r i ~ gko Fl llslrom C dlllJ O e Nachcms(J h iU1I) dim lr JtQ che b o liosl p IOO C1 neUaduksœnr 10 SYil l1p pn d i lIniumlmn~gin nlt8Jliva de corpo in (o nridcnz di Ln ddic3w p ri d di f( m l lz i nlt deUa SUl idenritl condishyZltonc ch pOlrebh ~[I cubrmiddot ln vilu pp di un pe bull n nn lir m llur cd e quiJibfarn in t[C adulro TaU CO1DSCe nZe tvlde nshyZ[II)() la n ( middotess iti di ltimobre la plfte ip a7j0 r1e atl an ivi ll1ltHClr n gl b a li ltl h ~ di tlpO s pu rti middotu dl ittlrc nd gloani iCo lID ti i lirtugraveta z io ni llb vila di relazionc
ln concllliu fu la d tfoflll lL saliu iG egrave il sin l mo di lin) idrotnc C Il1pk 1 d e eoinvo l d middotmiddot= fu n (n i dd rgashynIcirc5H10 n Hi lhdli e lesenizjo fi 1lt0 se 1 Il indirill~t() pllO pr~cnin 0 odLf rgt t lli di fu nzlonicirc adlc s()Jj(bi 111Icircn(i rrHtatc CO ll nl1 cinesi rap i Quand l~ coli i ( n LS~middot iJ11 zia k il rischio evnluLIcircvo egrave lid [() mente no tcole 11 (ltlll asso p o lll shylal ltOtSltgllen7~1 _ ta cincsiterapia pc rslIk bidtlvi shyptutibulli d ubllIcirctIcirc vltnc brn1e di conrro llo )(JSu k d i 5IcirclupPQ d Ile rLlt ziofll d i eC[u ihb ugraveo dJ ftffr otZJH1 r1w dei IIl llJgtCili 1 11Icircshyg rdtarl in posru ra rrenu posslhile JnnalL in Illo lt i clsi l(j luucircun lt di lin ~c() li oi mi n rc ( ume [11 duumlnQstrIO la tinc~ jn~l el1lric ((1l1 ~rtlppi d i contnmiddotllo cnndnlt1 p nso i l entrt d e Massue di Li n nc da [ o llo n ~ Rodo l (1 986) Julndo il1vlce lIfU~ ho ~vutlJ tiVll 11lt1 1IjXIl to un dekrshyuina r o~itl di g rl vir~l bull a~-n lllull~nte n ec ~~uiu rlCUuml rf( ff dla tcrJpll rle si c a eo chirurg ica
1Ho le clllC ooliosi idjopHI 3 ttl1p ~ - E~er l zjo hsco shy11ln ~ I((fapil
l Bg 5 CUle Lo [la k ll oblems in tlu ll~ (U ni Cl) FrKUce CU ( )lIILr no 1 AllCPR lu b1lG1t10 11 middotCI 9()(iJ2 RockilJe MI) i)~Cr ~()f I [( al th all 1 () I ~Y 1(~Re~C~Hd ~gtutnlt Ilallb Srshy1ltC Cgt D~p(rulllnr CJf I Ilalil 11 1 HumlIl sen Lel 199-1
2 SI) lrzcf ( LcB I ~IIl( FE DupUb L ampkIll~ 1c ~ppro l c h ll tht rnent und mmgemlt-rlt ot ~ ct vlyrl~ led splnul (hs r)fder~ A monQglJph rr r d lll kic Re p o l1 or Ih Ou bcc TlSk Fu rcl 0 11 ipmd DIo rele Sp ine L9H LU) 59
) Clntino F 111i1 i(ll Ci nerte1H C Nou gltHhl C Kln(~Jl llBICII [lIe1 hmlln (Il dry rra ll1ltfll of QIil pa ll m log iC by l11e 1 lIb li 1le-llh laquorilC~ of ~ 10(lna 111 Jrc)Jcxli r~~ (of flle h l lntrnIUonll SVIll Illgt~iu tn - II 5lt Ik lIc lk0flllllic lu llln-I I r l III Fhhlt ri g 1092 -ltlIJ-7
i - ri of niii MA N()LJV II ~ mel h)ltks de kin ~~klk rlr k di lll J r~cdllclli (n d~s ~()li oes jn f ~tel r~1ruuml(ILI -lo s bl fl c sur IcIj cquishyl)œ~ Ik SOll ll l)(eacute Eli ror eetlfllS d )111 1~ 1)1-
5 iloll n G Ruumld(~ le s () I ~middotmiddots tnlcl l l1 I n in 1Ifc el kiwil~~ 1)11lt KillegraveSlthe ripJe SCleacutentlnlue lYl6 2 47 ~ 6
r) Feacuterr[ffgt en 1tsiero 5 Venlllfln A ll~~n () M MJglio nu N EfkUuml o r eXltClse tI~tl Yoj o n nild id iO rXllhlc iC() 1i()~ lrt~ lirnIcircIluy r sull Eur feltl lb)ii 1 1j34 Z5 -~ 1 NOilrill1 A Sbill P egn ni i Ll Linesilegraverpi l 1lt1 Itallllll~nlO
ddlJ soI K~ i llO 1 Orkl1Llllwnrl m efodoloil1c1 RbbilltlZiOllc Ot1(1 1 )29(1) 1l-~
8 Nli(rinl Nl(lr1n l A blll P LI rieduGlzione dl p llicml atflt rro (11 coli ns i idi opr lir1 l n SC(Um i le or h( JI 1rcLlIQn1 ~0Cl le Imc lI1etW)n11e de Recltcrchc ci 0 Ftude sm 1lt Radw jlt)(j S-71
gt Nftriruuml S SeJhrf U LI r i l bllh ~l liOlie dd plziecirc11te ulet1n 11 - r
lin Kllopd (1 In l1l Jgl L N eduoL Tf1It II d ll11e ji cln1 rJtbl IiIUvJ Milan) 1ltfddH~n(x~hl 2(1~111gt-1-PU ob L cllln t iRll p l nelLi rl tgtO llcui n~ dilt ~lio i - l rn~f- li ~iIa n 3efllnl -Kurflr 19-11
11 lIIra S lJll M EVtJltHlvugrave egraveI lt t rnrumel1t() d db S(oli - U r) surie doCum nUle fintgt 31 tIUUli Mibn SI rlin) KlIpf -r 199 2
L2 1 ~W I1l(IJ P _leacuteVia tio n I~lhra k~ du IlchlS ~- ( i( IoltS ccedil l r lI C1 l1 fl leq
Ene 1 l C hi r ApparctlIClCOn l~ ltll1 l ltx6lt (i W Er 20 j )7 l
U StrI tr d P Lcs 1) rm IlO du Hltlctli Parb ME n 115 li ~u n un_ l c- l ol lJn e~IL1roy JC EagtOllŒrio n sc lluocs
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EUROP MIDI C Pli hIC
EDUCATIONMEETING SATURDAY 8thof APRIL 2006
(iSS
SEAS02 Scientific
Exercises Approach to Scoliosis
version 2002
G
S Negrini 1
EDUCATION MEETING SATURDAY8th of APRIL 2006
Neuromotor disfunctions
Neuromuscular disfunctions
11 Postural collapse
Postural collapse
Duval-Beaupegravere
Flexibility of scoliotic curve
f---I--- I Postural element
-------1 Structural element
S Negrini 2
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Postural collapse
Duval-Beaupegravere
It is a value related to muscular tone and to flexibil ity of convex side tissues
Post ural collapse
Bunch e Patwardhan
Critical load
Load threshold beyond wh ich a spine begins buckling
JI~~Wt1lW~flfthtlJlœJtAr ~ J~It- l~l - IMS
Postu ral collapse
Bunch e Patwardhan
If a curve reduces there is an increase of the deformation threshold
~~~NW~-damaoc~IIIMf ~~ J~Iv JaJ-I7I9sect
S Negrini 3
EDUCATION MEETING SATURDAY 8th of APRIL2006
Postural collapse
Torrel e Nachemson ~
Scolioses below 20deg ~ ~ lt~
have a high ~ ~ percentage of ~ ~
~postural collapse (on u~
average 75) ~~ 2i~
CU~VE O EG~EE S WHllE SUPlti e
~laquotd~c6b ____lPffI1wtt1t~
$ww J(t ~~7 JM5
Postural collapse
Minor scolioses 7
Antigravity musc es strengthening D
Reduces postural collapse -G
Increases the critical threshold of deformation
G
Neuromotor disfunetions
Stagnara
If we admit that one of the causes of idiopathie scoliosis is a disfunction in balance systems it is logical to orientate physical exercises toward this direction
s Negrini 4
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Neuromotor disfunctions
Dubousset
Idiopathie seoliosis results fram alterations in praprioeeption centres and deformation is a natural compensation to restore postural balance
etattJtitIK ypothfQj~S ___~ own_ oJ)HQr lar 1t-1( r
Neuromotor disfunctions
Nachemson Initial idiopathie scoliosis
+ Goood spine stability
Neutralization of postural deficits
D Static curve
Neuromotor disfunctions
Therapeutic aims
c) Development of spine stability
C) Development of balance reactions
G
S Negrini 5
EDUCATION MEETING SATURDAY 8thof APRIL 2006
Biomechanical disfunctions
j Horizontal r-Ian
i Sagi ttal plan
Frontal plan
Frontal plan
q Frontal plan disfunetions
Fronta l plan
Perdriolle Movement magnitude
gt in the direction of lt in the direction of correction progression
S Negrini 6
EDUCATION MEETING SATURDAY8th of APRIL 2006
Frontal plan
Stagnara
Never mobilize a scoliotic curve without ensuring reduction maintenance over time otherwise a greater mobility favours scoliosis progression
Frontal plan
Ducongeacute~ research
On a group of adolescent idiopathie scolioses treated with
Meacuteziegraveres gymnastics
D After 1 year the mean angle of
curves increased from 18deg to 29deg
Frontal plan
Scoliosis without brace
D Greater spine
flexibility D-
Risk of progression
S Negrini 7
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Frontal plan
Mobilization is useful
D In preparation to
brace
D With brace
Sagittal plan
QSagittal plan disfunctions
Sagittal plan r middot _J o
Perdriolle scouos B CJ aDeformation of D
thoracic and thoraco-Iumbar curves evolves in extension
S Negrini 8
EDUCATION MEETING SATURDAY8th of APRIL 2006
Sagittal plan
Graf
The line of gravity centres in the vertebral bodies o s c oUOSt
projects itself firstly laterally and then fi
o
posteriorly lJ ~~ ~~ ~ ~~-_J-D ~nI~
Sagittal plan
Therapeutic a ims
D Maintain or
retrieve physiological curves on the sagittal plan
Horizontal plan
QHorizontal plan disfunctions
S Negnni 9
EDUCATION MEETINGSATURDAY 8th of APRIL 2006
Horizontal plan
Stagnara The forces applied ta the spi ne act in a autoshydeforming sense
Horizontal plan
Dimnet Rotation gt 200
ampII~ (
D The actions of concave and convex side
muscles become
agonistic
~ItJrOnrIIiItdllfUClltlluumlll~~tI ~1JIf1laJ
Horizontal plan
Minor scolioses never exceed these autoshy
deformation thresholds
S Negrini 10
EDUCATION MEETING SATURDAY8th of APRIL 2006
Disfunctions at a biological organic and psychological
lever
Oisfunclions at a biological organlc and psychologlcal lever
Cheng
Bane density in scoliotic teenagers is lower than in normal subjects
~~~~middotA~IIlUtIy ~7œl 1d l
Oisfunctions at a blologlcal organic and psychologicallevel
A significant reduction of vital capacity and V02max in teenagers with a medium severity scoliosis
S Negrini 11
li
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Disfunctions at a biological organic and psychologicallevel
Disorders in the development of body image that the teenager has of himherself
Disfunctions at a blologlca l organlc and psychologicallevel
Therapeutic aims
cJ Activate cardioshyrespiratory function
cJ Favour bone density increase
cJ Develop a positive image of the body
Disfunctions at il biological organi and psydlologicallevel
Stagnara
Sport
D The active side of
kinesitherapy
S Negrini 12
EDUCATION MEETING SATURDAY 8thof APRIL 2006
Disfunctions at a biological organic and psychological
level
Distunctions at a biologlcal organlc and psychologicallevel
Cheng
Bone density in scoliotic teenagers is lower than in normal subjects
~n~IIIvpWr~middotA~stWy s- XXJl M J
Disfunctions at a biological organic and psychologicallevel
A significant reduction of vital capacity and V02max in teenagers with a medium severity scoliosis
G
S Negrini 11
EDUCATIONMEETING SATURDAY 8th of APRIL 2006
Kinesitherapy on the scoliotic subject
q Postural control
q Axial stability
q Muscular trophism
q Balance
q Respiratory function
The limits of kinesitherapy
There is a threshold beyond which
rehabilitation alone is not enough
sssr
Kinesitherapy in scoliosis treatment with brace
Therapeutic aims
S Negrini 13
6
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Therapeutic aims Srace kinesitherapy
With brace
il Postural corrections and
vertebral stability are obtained by the brace
Therapeutic aims Srace kinesitherapy
In preparation to the brace
il Mobilize spine on ail plans
Therapeutic aims Srace kinesitherapy
With brace D
Maintain a normal spine elasticity
~ Maintain a good muscular toneshy
trophism
C Model the hump with kyphotizating
exercises
S Negrini 14
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Exercises and their methodologies can vary accord ing to learning and individual sensibility of the single rehabilitator that proposes the m provided that they stay within the
Iimits of fixed therapeutic objectives
li
Therapeutic modalities
(Exercises)
QAuto-correction
QRespiratory education
QErgonomie education
QMuscular strengthening
QDevelopment of balance reactions
WNeuromotor integration
ci Vertebral mobiJization
QSpecifie modalities in brace treatment
S Negrini 15
EDUCATION MEETING SATURDAY 8th of APRIL 2006
The protocol of kinesitherapic
treatment
G
QChoice and dosage of exercises
Variatiosn of the work program every 2 - 3 months
Q Execute e)(ercises on an individual base or in a small group
Q Frequency not less than 2 times 1 week
Involve and awaken the family
G
S Negrini 16
EDUCATION MEETINGSATURDAY 8thof APRIL 2006
Q Determine the action and the localization of auto-correction
QAuto-correction must be associated to ail exercises
QAt the end of treatment ergonomy lesson
Auto-correction didactics
G
SCOLIOSI DORSALE---- shy ----
r
S Negrini 17
EDUCATION MEETING SATURDAY8thof APRIL 2006
SCOLIOS OORSOLOMBARE
shy
SCOLIOSI OOIlSALE 011 bull LOMBARE S1I--shy
SCOLIOSI LOMBARE
il --~_-
S Negrini 18
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Scoliotic patients are not radiographs
middotSeoliotie Mtients are not ndiographs but hum beings with a vertebral deviation-
Slagnara
Metha For the physieian Cobb angle is of utmost
importance For the patient it is body deformity t hat eounts most rib hump a protruding seapula or hip We are in a situation in whieh today dodors eure the radiographie deformity but what the patient really desires is to get rid of clinieal deformity and of ensuing psyehologieal distress
CIIQItIo shDuIdtucirc lM WIld tJw~~ I~~M~~~~ J9f~
S Negrini 19
- Poznan_workshop_Physiotherapy
- physio2
- physio3pdf
- physio4
- physio5
- physio6
- physio7
- physio8
- physio9
- physio10
-
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Material
The control group consisted of 77 healthy
girls aged 6-17 years (mean age 12
years SD 31)
Material
The examined girls participated in school
only in scheduled physical education
lessons and have not been enrolled in
other sporting activity
METHOD
The exercise cycle
ergometer test was
performed
J Durmala K Dobosiewicz 3
EDUCATION MEETING SATURDAY 8th of APRIL 2006
METHOD
The Incrementai exercise test has been applied
We have found that tests ln whlch the Incrementai part of the protocol ln completed between 8 -12 minutes duration glve the
bullhighest maximum VOz in normal subjects
METHOD
The workload was Increased stepwlse
bull by 10 Watt every minute - ln chlldren
with high ~ 135 cm
bull by 15 Watt every minute ln chlldren
with high gt 135 cm
METHOD
The test had been contlnued untll refusai of the patient or exceeding the pulse Ilmit
Durlng the exerclse the gas exchange parameters were recorded by Jaeger device model Oxycon Alfa uslng direct breath-byshybreath rnethod (with face mask)
J Durmala K Dobosewlcz 4
EDUCATION MEETING SATURDAY 8th of APRIL 2006
METHOD ~ ~~ r 3 min 3 min 8 - 12 min 6 min -~
_ 0 rpiYJ 0 rpm 60 rpm ~1 30 rpm
_ t o~w=att~o~~na ~~ att__~ tl~~S~~ l ad l ~~~~~r o~w= Hlcremenlal t
pedaillog i i ~
~ ilt ~I~-----tl-~ I t ~ i ~ lOSt sffortivB
lW r resututlon r rm-u middot 1 - bullA~cremen tal ~~ ~ ~ ifr- ~ VtI 1 ~i ~ tllng _
METHOD
On the basis of recorded parameters VAT
has been individually computed for each
child using V-slope method by
Wasserman
METHOD
For assesment of physical capacity
the maximal minute oxygen o
consumption (V02max) ventilatory
anaerobic threshold (VAT) and
maximal workload was used
J Durmala K Dobosiewicz 5
EDUCATION MEETING SATURDAY 8thof APRIL 2006
RESULTS
Ali girls with 18 have been classified
within normal range of predicted
values of
bull maximal minute oxygen uptake
bull VAT and
bull maximal workload
RESULTS
The differences between group of girls
treated using Dobosiewicz s method and
group of girl s treated using symmetric
exercises were statistically significant
Lower exercise efficiency of girls treated
using sym metric exercises has been
observed
RESULTS Girls wilh IS Irealed using
N=87 p value
Dobosiewlczs method N64
symmetJic oxor-ci Nz23
Perœnlage of predicled vaJue of
maximal minute oxygen uptake
98 905 0033
Percenlage of predicled value of
VAT 97 933 0049
Percenlage 01 predided value ni
maximal workload 101 939 0038
J Durmala K Dobosiewicz 6
EDUCATION MEETING SATURDAY8th of APRIL 2006
RESULTS 26 girl s twice tested - at fi rst and last day of intensive hospital rehabilitation
The value of ventilatory anaerobic threshold increased during intensive hospital rehabilitation (asymmetric mobilization of the trunk by Oobosiewicz) statistically significantly (p=00019)
2047 ml O2 minkg (SO 268)
vs 2239 ml O2 minkg (SO 232)
Conclusions
1 The exerc ise eff iciency of girls with IS treated by asymmetric exerc ises of Oobosiewicz is norm al
2 Such high level of the exercise efficiency of thIcircs group resulted fram using of Oobosiewiczs method
r
J Durmala K Dobosiewicz 7
REVIEWS
Role of physical exercise in tbe treattnent of mild idiopathie adolescent scoliosis
Revicw of th- literature
A NECRlNl N VElWNL s PARZI 1 A NEGRINJ 5 NEClU NI
P1t~silillxlrd~ Ihcrapy (or klucgtlttlwrlpyl i pro shy-tJm of physka] cXlrd-cs ipcci I(a~ (IJcloJgtcd hy l li trIWlltl phrslollwrapbt wilh tb m~ln a1mor pl shyVCnI in lhe ilAAfIVltilH1 llf the ucirccfonuity III mild IgtC )
Lil1Si bclpin~ thebm ( aocl co uaufllclilIg ils ~jd- clf IS in nlOdlJmiddotnh-culiosis Th middotalillofthi paper ito r (W
Ille Ii lc ram r 1 a-ccrulin wh kh of Ih bull Lu[Jalmlcrus Ind (Lb hili til~ CLlLt-cd br scnli()si- clluld bl pl Y nlcd or r d uccd hl phylolld LXtmiddotrdsi n Il p--to-da le knowl Uuml~l nr tIll~C aspcc[~ i ne bulled in oruer 10 dndc whclh~r 11Rf blLl adcqlmtt Ib(uuml n middotlicaJ balis fo r ora)aini l Ihe US4~ of lUgravellgtitlerap) wltcllj(r or fln l th e prtl1iœ of kimiddot ~lre IUlll poNjn~ a t iil ies ~bould h allowtcI II uuml middot c enliaI toltlentlf)wh k lu alClor ie - lf pl lr~kiJl -c rmiddot d gtlt- (Ic rnnhi UzJ( inn ni (t hl HrJltlon [ rtn~hcll iJl ~ or 1i1J(IChIumlJlJt etc) Sh llU Ld be TolullllCcluse ulemiddot l onld b- clclIimcntalancl wukh sho ll ld he IJlI-n~ifl~d I~~a l lhc (o uld h 11lfu 1 Know k dg CJnc1in t (wIn SeiCIImiddot Hlk rCS([lflt h daw ccordinll to Ih bull llVit w o f tIlt iii 111 1( plop(lsltd in (h i papcr lmiddotonllmJ l lnl plLyi 11 cxcr(j$( pn (nti or (tmiddotduce dhlblli t ic 1 ~lt Il Jj ll(k pl ti Jlt fadl j w(~ the nlIIIrl li7alinn n f poMural dd shylitS tu p n xJ llc aSl COIlMqnen c(middot 1 all )llal) or r(tn~ shys i middot middotlIrve Tilt u~c (I f appn1priattmiddot kincsiuuml wrlpy 0 in rcns polttllcal swhiIHy Icirc IIHmiddotorc Illta ll y (0 r 1(lt1 lllho UAh mon ltlccurlltc 1Ut dl1alkd -rLk l(lWfils 111111 )11 h Jlccdt(
11) wurcJlt 0 lit)-IcircS (Iumpy - x rcLs P()lun
n rllt lT(ltnklf u f COll1tlK H (rtd) I 1i plfho l og l ~$I rUlglng tr m low tmiddot k Pl 1l1 to IdiOpath ie SCUIshy
Submitt(oJ [or PUhltCl l1 011 uly Tt 2001 Acc~pttJ ugu - ~2 1(t-1l
Addre rltj-xlfll telt~I(middotb If) - grinl Flt(1(bziurllt r )(m Ofl ()(Cl1I shy Lt middotqlltœlll ro () - 1u I4t agravehLIlKil ta IYIL-lTt ilSllltp lfllmiddot ~ 1l1uumldull
CelII ~ (niiOS I I~ middot ann (1) IfUh middot lIlfU di louhilll(tymi ( Nlmiddot ~iI rli -ilIIUmiddotltlfl
Nlti(ir 1( ) il r() (ltbullagt1
lt vLL_ l IiII no 1ftfI
jS ) we are a IUil ly tJc ing n1n) ltblll lS 1 k l1 b ~J)w in~ tl~ t S Jfll l approad llt - l1n til hy on ielshyertd ~tan lard ugraveJuld ln m any ~1~ he lI ~t les i if Ilot dange r )ll lt rhlS is lrut of reil l lnw 1gtlt1lt1 pa in l ~ or 5urgi c ll lrea lmltnl5 in dbc r lmiddot ll Sc - 2
ln tlle cj-e ut ~ t lll(tlWtl i( li p l ll1JC luuml- I ~ middottnl ~() shyliosis phys cal ((_lt1(( is emr1uved ltI t()fIl1 0 lh~rtrv
lo ly in cel1l in L)lllllde (nluumlnlr in tilt Lltlll middotorkl i e Iw l) r llt t Srain hUI IIgt() 111 Gert11lny 5- 1~1 in other reg lOl1 wbere thi I-incl qf tre l tm e rll 1 p~ 1 pmiddot t 1( cI il Jws Ixen cri ri cilld md rel -cltd Lw m~lI1 1 11 Jlu~ Fue Fnlny r ~lrs thio middot15 a lsgt(ru( f ~rth r -~ltc rrJtf))~ ll t vit11 br1Cltcgt b r II1 ([C Llt n ClW grmvlng 1lt1 0 L Sti g
gcsti n the lIsefulnes- u r Ih is form o t treatm n t 1
Hmiddotu]rs have nerged jn El or uf pll y~ iLd eegraverdse eacute 00[ 1 but tlw are nUl yel 11 11 t llu i vIC~11 and r hi ~
f rm of trt ~ltmenr IS stiJ l Ul1 ckf ckhate FfI t Jt 111 il i 11t (eltary td 1I iFy 11umbtr ot
b l sic COI ceP rlJ lf w ill he cIh tt d in t hi pap r
Scollosis
DCijIrI iriolls
ScnUoSlS is Irlircc c1 lme nsIcircltnal (I(gt i l cj on ot tht spinc thar cau C a CU 1 lh lt ca n h e $ t~en ln (1 me1Sshy
ured ultinF Coh) lll ltllCXI o n HI anreu middot p rtc rilt r
EUJlOI -1 lœDICOPHYSlc~ IR
NECRI Nl
110
f)i)
1 7J
amp aS g 5li - 0 v
V
31
10
(1 1) Il 15
-tc i ytjtr~)
FigJ----jllph ot DlI w l-lkaupegraverel) The agloimvltltinn Or idio r lrhlc 50gt1iflll~ IS rpiJ bel~ en th e- [l0 IH P (l)ltg tnntll lol (JI PUllcmiddotny) mtl 1 ( f( lS-er sigll paiilivltecirc lt Dlt(i I1 11illg r the iti l 1Kgt n n t rll icirclicH a ) 111lt m omal prebulled the mno rche md ociks with lll I)ttlx flal gr Ih pll fl
rlcljoprdphLi 1 hl merl prestIK ~ of this curvt c10es n t autom~l ritllJy indi ate the pn$CI1(t of a defurshyTnitv (SlllKtUrd (Unel
It i~ possible tu clil1e ren tute a struCnlt t CI1tve fruIn a pogt urll 011e by identifyi og the hum]) du ring AdIlns tesr I~OQ looklng tra m beh lnd at the p atient w ho b benchng fUfward il is p -- ible ta d d~ct 1l1 eh ucirc n of o ne liidlt 0 1 the trunk usually n n the (onvex ~ jde ul tbe radiographie CUfve Ugrave1lr C Ul be mlt~I Slred lISin~
BUlln els S o liomere( 1 ~ l This h Uf1lp is du(- lO (Ile pregravegtecircn ~ of vertel ra i rolltion 1c1 Ollt tn tic f~YJ tllre o f the def trrnit tli [ c m be seen and measurc(i v ith Perddolles lb lsLometer on an amero-Ix)iferior radioshygrapb ~2
Seven ry pel cent o f li Ises a re conid 1lt 1tO be idiopa thie 1 bull ia l-nosilt in this CI$C is b exdlls i ~ n as idinpa thlc me-us t11H wc do n()[ know rJw origio of lheacute curvc [n othe] ~Ie$ it b Ix )~i ble ro ide nrify a dieak (bat CHl jusrify the c1etgtnniry slIch a rna lfo rshymar i ns I1(gtufol Ig ic~ l or genlttic cl iscas s Glnclt~r trauma etc )
[dicirc)parhk S(oliosis has been divicled ~(corcling (0
the ~Ie of tlie patient egrave1l the tiJ1ll of d~[ccli n of the condil ion into ti) ur t ypei ln fanUlc jU nik ltldolesshyccnt lnd aduh Til l m n st cnnunon (VPC IS the acloshylescegravenr o licirceacute I1IJctenzec1 hy 1 sud le l1 tggrH3l ion uuml uring the grow tll Spllrt (Hg 1)2
lhile p tu 1l sco liosi i5 Ycry lomnw n thl pre shy~Iknct ra te f r adole ent icuumlop~lthic structural CU IY~S in sch )o chilclren are 18middot20
- 10 Co bb d~grels o r m on l -lil
- 2) ~ohh dtgreclt or mort O 2~j - bull () (obb d gre -s )1 mOfeacute ()ll 2
Clin iltI [ d e isio ns lfl IXlSed 111 an lccu r~He pregshynosi which obt inccl in eJch pa ti nt mainly o n the basi of the nsidu~ll p()tlnllltl l of TH1h and the result s of 1 rh clin 1 1 ~l1d tadiogmpl i exlminashyti(ln12ll c noieq uentlya d inica ] la sifiou io n o f the ing le pHient tn -ome estent co incic1 ing w irh the
D diographic one c l n lw SLlIl1H1arizeci 1 1 folIcJ - mikl lc~ (1)(n 20 C bh de~r es - moderJt l betwlen ln md 15 ohh de~ rtes - StV re 111( gt1lt rh n ~J) )bh (kgf s
On the 1) lsis of [hi - dinic d d a lfic t i n (Vith l1l il el lrb tiOI ~ o f the ir b() und~ri e ) in Itllt l cente rS Of SCOtiO LS ITe ltlllent in the Lltin odcl (i rJ Ital lnmct md PI iJ Ugrave tre tmtnt i s plmmcd a fo lltJw 8l
- mild kineslth e (~1fw ~1Il (1 luok-ou t - Hl demte IJragravecegrave 1111101 c(~r md k i rws ithe lJpy - ~cven surgery
Physical exe rcL~e for S(ol iosis
Defi t tiOl l S
PhyS i 11 nU b lIKrlttp middot (or kines ithcIa Pl) i a p rvgrlill or plt~i Gl l (xeriltecircS ~1ci fi ( llJ y ltk ~ loped
y a -11 [ru ine 1pll yslo ther3pisr wirh th e m 10 Hllll
- pre (~ n tit1g tlc aggraaLion of the cl I )flnily in rnild bullcoUm is
- helping tlk Il ld Ct ~lOd ounter~lCtjng its skie elfects in III de rltegrave sc li sis
Tn tl1i_ feSpec1 kinesitl1ert py f JI s oliosis is tonshysider l a o on of peciticcedil training and s genecirc tltllly proposelt in sessions 0 1 4~ ro 60 minute IW) t) tour limes 1 Cee PhysiGtl exerci es can aLo ll v o ther auumlns 1S it oill he dise Issed in this plper
Ir 15 Ilot possib le to cl escribe a single progrlIT1 o r exerc ise a5 pro nrams ale USLIJUy p fgt nll ized ( ( lt
EUH PA ~illDI (DP1I YS IC~ 182
ROlL UF P l 1YSICAL lXl 1lt 1~E IN l IlE 11 ~l) IEd If IlU) l[)VP 1HI AIJ() J)~Cl~ r COl ~I NlG1W il
f)( 15 egraved ( )Il the nee L- 01 indi iuua l pJl itnts) al l l10ugh Lheacute) C l n h t 11 plicd o n a WOU p hJ~js (-1 (0 () pnients PC[ ~l ()lI r)middot lugrave reQCf lhese 1 10 grl lll frequt ml~ V IIT
hnm on in middotituk w allClthltJmiddot -Ill Jnv L l~egrave at Wc w Ht ~huw in lhis lyl peJ it i~ 111 n u -eII1 tu id e ntilv kirK itheJapturlc aims w hitl l ucircrr~spnd LO ugravelt~lil1 DUtshy
g X ir ur ph -s ici l lxtTi~l I~llhe r thln ln dj( us- indishyiJ u1 1progr-lfll
Aduumll l lxUl kisure time ~lOd h )u] Sp u lllll8 ~Ilttishy
i lt egrave~ i middotomm )Ly s iven lel mJ ing ro w hlf ~ Iuumlnsidshyer~d usdul or il lrmfu l in t1 lt rruning (lI tJw ptliJicirct ln tl1bplper Ugrave1 gent ltl l t rl ll bull p lwsiCUgrave lttG iviUes is rl ktll 10 JllI1ltlCc hOlll gtpOlt mJ kIJ1lsIcircl hc lJ l f
i ve lUen tloneumld )bo C on lv ine n dul( re Ull~ 1t~1 t s far Ilten publislt d f I~ mJ I(i noltgtithltl rgt is 11 11 a su h jel lnI deacutehate CJitk haltlt t llltit m itn ltl of l ny lorm o t p l1 ySiClI lxrcL e as a Itwr1 [ J- fo r i liopa tb il jcoJL~b un iL ()ri gin~ initial1) it WIS Ille r rOmiddotUumlK lt brgdv u f p l~lt titu gtllergt w h ) intervenecl hutll tc llcrl ll (mon as cltl HtilJ nic in terventi n man Jgt
1 t lltrJp utl t one 1 md rC j fkll l~ on rhe h sh lf som uni cOen I1v pn t I1cgts wt ldl hll ltl enl1 JI~ haLl nu na l scicnt lfic baisYmiddot HOlh tlle$( trr t peu shy to rh ~rl py tt nJecI to l~~rJ tte C Ih tk CUf -~ pnnshyclr~tll y as a f tsul t of lilo h llIzatio ll of tn imdqultdy ~u pp rt(d S pln eacute 7~ 12 to re-t1 r rI ltrl 1$ l l1C k o f WH llt~~rdl 10 I ndt~-dll()urnah tnd 11( on1 p~l per u suaJly Cl tc([ IS n prelimmtrf lll d 3 ln tt li w ay man (l rrlKpt(Hc H lf O iS Inll ph ~i C U l ~ d vi ~ cI nllog scnliotl pa t le nL~ 3gainst holll ph lca l egravexershyclc and p()rt~1
It m u st t~ n tfd [hat pllyknl txerc j~ tJe~ltm(nls t1iHer 1 lJ rd il1g r rhe rherlpcu tlC litTl~ on lllc h tJ rgt ap p lolc il l the IXlltent lncl hi im r IIIllHnt i- 1 (1(1 rI - 5lt1J lC igt tIl l ( f phJllIlllolopJ al rrea tmln ls Ihith cllffc r 1lt œQlfd- rhe m C cculc u ~t(l luI thl p al 1t n
~mc l 11i (lbE~e Tt i ~ P ~il k tlwreI[middote thll wuumlk ltlll t kin 1or ph~ i Clt1 1 lX r(j~ 1I 111~ t bc loidvd by t h~ Lo iurie IxujCJ1l al1ulhcr a dl ~IS nJI h~ iOg (1 11shygerols llugJr in racr le (wi ller d I ~fJIII ~ I ml thlls re(nl1l rn ndc(1
fn n UI cel1ll r we In(~ hccf) using 1 ) 1 1111 11 ve ) 1 (J p lw l icd ex(r(i~e (0 J ( 1I l tt i~ tlh aITt ~ l~d Ilv m ikl tru cflumiddott1 adokscltnt (cl ioj arh lC icoli is11 2)
ina the f U~ t rc-gt uJrs IefC pu b lishe - the pJ( )grd m 11lt1lt l1te n PWltllk d in fa c t deel()pnlln l~ in th t l itshy OlL1Ii in tl1 r b t ~() ycal f ha ve iclemi fiecl niO l l
m d 111 ur impl rnHm s md d i s )h ilir i (gt~ lue t idlo p lthk amp()lio -i ~ t Jll CIII he 1UO(l if Icirc 1by phyict1 egrave xert iSlgt l fe t rrncllt
l illl
111e aim of t l1JS r~l per ii tmiddot (tv iew tl1( l iterat urt to a(errl ln v llic ll of th~ impa irm 1t~ and Liit hil it il i GllIltec hy ~ o l i()gtj s -o ull he ll nt x or re middotlu celt1 Ili pl1ysical xerclse An u p-to-da te knOvkdge o f tl lt Lgtpecl-gt i necckC1 in rJeumlr) d -oek
- whetll~r there h ltl n adLtIIl ) l tht()d ical bbh fur or JqIIcirclb l l l1 Il( ) f k irt llit herlpy
- h N I)(1 ( 1 Dm tlle p r l c tIcirc(( o f Jebur tiJne )pOfung lcli v l ti ~ IIOU lci he tllf) -d o
II J U V f h 1 I11~ c~~lb li hed Ihe usefuhlLss 01 k il1 shyc ~thtrpy il i aIle dy l nsi 1([(( -r-tI Llleu i n )I11 plJt~ ut the wJrld ir ilt ecircS~nl i 1 I( id n Iv w l1i li ( 1shy
gories 0 1 pl1Vtl( 1excrClgtegt te D)bilI7it ric 1n (Ir st shylliuumlZltio f) lttlt tlgtbltn ing ni trcrccedilh ing erc) hn Id be
vnlcled he tll rhe nuld be lerrillldll1 1 md whidl s tlQu1d be inreœ jf ic(1 IJeClU~l tlley cOli lel Je LI ~ful
Ncuro1llotor impainncnts
Imv aUl llOr~ 11 lt1lt ~tlKlteJ lhe cltlndatiotl bd Ween tl UC1UmiddotIt t l ol(~C t nt id iopml je -nll ~J~ and cli~l l shyler~ lr 1tH lest ihuLIr yt 1 _ 13 ~ 311 D uhoussct 1
1-- ITS tln l ldiopath k s(o lio-L L cll -c d l J l hmgt in th terl tltr f prop li l l pu n md 1I1ar th e detrshyn Hi n i~ na tural 1 ~ronse to ril e need tu ts tu re p()tun ltlluilib riu Ul HcrmJJ1 31~ 11 () d tllat icliupathic ( liCl5j h l it re5u lt Ot1 rw nltuf mot r l ~ltelV
[Id )fcl 3 nI] ~1ltJ U Sr1lle nr to dtorders in centJtI lO~Cl shyIOIDNur) md 1xi~tI moro (Ul1lfOl syt( llI (Fig _l
N htIll -of) H1c S uumll h( rll1 ( ~ l( w ing JI t11 (oshyI-ie on the l l lO]ugy o b doll (nt Rl iu]icirc tlili- middot()lioL m unt fil t-hltll rhl ugravedcmnilV L th e fl5 ult o f 1 (k btcl 11lIFll llI ion nf som t11(WUgravetltnl md pO~ lur( (tnic l~ l licirc1 tl1lt if l p OgtlbJt b C 1l rlw sta l i lin 0f 11 1 Sf llle j lt g )tx l Tt) ohtil n a ))Cli U 1ILzltl I o f p ~llIr~il d l~flo [ in l1litkd ~J)llnSIS me CI Igt(middotqucnr J ~ a ~tmicirc ()nlly or regle Ie Llive
Ali th- 11yp ) tlw~es rd ~lte tr d irtl Itn t pnl1tlt o f [11 v hole ~piltm It11[ controls postu re ~nd mrw shyment lrre pell ic of tlh po int a d lI~ llv inH llYegraved il i ~ ll 1 nnable tCl aSUilll ri 1l tr l ll1 lo g thi ~ys ttm ( Qu it le 1I middoteli tl
lt ch ugt nlt~(S f rullliIl thil i nlomwtion th at p tlmiddot shyiCil J(tl iIies nw gt Il lInport~n t rr le to pbv [11Icircgt role ca n 1)lt slI i11l1lariztd ln lWO the ptu li ain Llt
- d elopmll1 l of p uumlltl St1 b Hlt ) - c1e veuml IOpm 1)[ o f bhll1ltc _
(k llhUl)lOr S Cll orr
ontrot oic whan-lt
------+ 1 ~ il lnll ugrave r AINnl
Cllnlr1
T bflt~ r
fltL1 tlli
lMini
l
~sary ~J-frlllen i )f
~ 1 ocirctnl
~UcirclllIJJlW Ll
AXl ~l1 n uumll l) r sy 5t ~nl
middoticoltoq ~ Fig 2-AcFgtrdong lU He-mutl 21 il is Fi)5~ ib1e rD prolXgtSlt l -oo ie1 mnd 1 ((if ~ elio egrave middotAhltr~d l)Qdy-p ati~ I I i u d) uren ttllOn k td LO In ~ory reHTt I1 eDi tn l al ) JdrnlV~ pn)4~ e l u r~o(Ofe 0-c1 eptunl dvstil t1 ctlon sltŒ(ry icircltu nu11t ilwnt [ ~mC ~ted tl l1 ce Ill trpntlshyUumlfJJl nd IKnle~ r~dibl jtugrave)n of -I) m tlosen Ir ~ig nj tl (I1vying ln fornll1U n (lI an ereltl ~piJl e Mmor aJJ r--a t ~) n ltgtf ti lt aXljl mowr plem iHUC Wh ~fl Ille 6ubjeco m uumlntl Icircn (1oJifitd perccpfLlI l ~na l ysilt of p n)lnocepti Icircnfu rnlaquol ti desnibJOS ~n t tecr spin A IICW motor co nrro l Ira I gy t adopt resu ltin~ in the ~tr ltctltr 1 ckformh y lf IdiopathirL scollos i=i Ht lrftU1uc nltnt l ISll I1lJy h1e- ~ I pro()und elkn on bralO Sfem flJll ct i(lnn~lLhu modifyRll Ille nltulltgtshytl10 ) 1 1111 Uu l-lHoror control 5~Shnl$ shy
As Srtgn1lt1 l ~ ltlssert~ if wc l C -Cp t 111 1 un o f the G IiC s oliosls L l tisorckr oi th e ltquilibrilltn sys t ~ms it is lagical to oriegravenrate physlCl l exercis( lherap y ln th is d ir(gtCli()[1
11lclte goals Cul tl lfOUgil ditrercn t modes 01 action be Olchic(-c1 witJ1 phykal accivit ie
- po rt ive Cll ities p ro ct LJ e aIl UgravelClltrtsc in 6lte nshyel ll )o rd in~lti n pinai pr0prinup ti_)[J nLi mOVeshyment control 0 vio lls iy ln thh repect ome lCtivshylites aœ pre um~I I)y lXrter tllln ntil crs
- kinrl lira py using pedJil exerCisocirc specially developecl lith th est 1101 5 in mind illVuuml VC I lllore prccilt( ll1d InC1 li zed cri n on rhe spiJw focusing
a90
1 ~~
lg -lNheJo ~1l l1 t r~l g rld in 1 1) h i(~ IImiddot ct r rHienl w i ll idlllhic _It ~i ~ _ iri s plt ~I le II find Jit ltH vlllleuml ~l Cgtbl tn~ ks III d il fef lt p ~ lt ihnS nu v~tl middot B ~a~pt u Il C middotl)Icircd ~(t l l11 C dlfkrCnl middot- hdween slllndi1g Uline nu nllt1Xinul oorrec ri nI t chied Vith Ct (J ) und tfdincJ ne lot es o UIine 1 fo llnVs middotIJfl tfi ni( - ltlrshy
reltiK)n ~ Ikexibiliry st3nucircing - -pirte - f ur~1 1IbjISC ltupin - ltorrcaion - - r~luci()il ll ymiddot For flmpllt in J npK l1 pH k1J il
plt1SSlhlc ln obtai n 10 u1 511ndlt)l [YLo lion yr ln Slt p ille rlOlgt itlugraven om l J ~ in ( gttf(C rigtIl lIex lbuil 15 i (r-l l=22deg pol lltl ~~J IIlpraquo is IcircO~-V- I t1 l nd tucircu(Ugrave) ilil) I~ 3laquoJO- IH-12
r ln Ugravel e abilit jl of tluuml [m e llu to co ntro l irse lr in ~ pac
fuld l oftlles uumlllelve ntio ns can presum1b1r incn~~ Ih enl ac )1 the orller and lHitlll r of Ille rn - 11 )ltd h e lllldenl lu EJ3)4il
Posl1l1-t collapse lnd slabilizariotl
lIle concept u fplt st lUal c(l lJap~e l l~t Iwen detin 61 by DlI II-T3e~tupegrave rL t Ac oJdin)j tu tl1i- ~ll1thor il [ nec(sary ~- l Hn Cv-tlualing th tleihility o f a col shylo tIcircC CUJVL (0 clistingu ih bt tVeen the re du ihil [ty index (th - li iffer gt le bet ~middot Il ~I r~tcli()grJph ie ~xnmshyinltio n of the iI111 pHienr in supine po ition m(i
ROte OF Pl rnmL EŒIlCISE IN THE TREAT-ŒNT OP ~I IJD IDIOPAnnC OOU~GEm seou SIS EltJRINI
I (~)-----------------------~
__ _~ _____ _~ __ __ L ___~ ________1 ____ _ __ ____ ___ ___ _____L___ _____ l___ ----------L ______ _
1 ~
1
-- ------- --1---- ---- ]---r --- -----_----t- ---- --- ---shy__ ______~---- __ ____ 1________ __ _1_ __ ____ __shy
~ (1 J
1
8 =~~=r=middotmiddotmiddotmiddoti~=-middotl--- middotmiddotmiddotshy--------------t----------~- -------- - ------__shy
~---- --- -- -~ -------------r---- -- -- ~-- - -------- --shy----i-------r-- - ---- ~~-shy
il 1~ 0
Dtl-Lmiddot ~ lttj l r~ UIltltlHt
f g 1 -TI1 u ilictf 1ld ( ii 11- ugraveu-sh) ld IX~ O 1d wllich ltJdnrshymII Il nf the pilll 1 ~tln~1 of th e -o lioti( spinc n IG~nI(J II IIIshytt) lhe iJeuml grl-e o f ~ ()Ii ti c (u rvH Il 1 w dcpc-nlknrly o l l he 10 111shy
P01(nl (pntt l ~ 1 1 nr ffll wrJ I) ln w hilth Ihe n i 1gt( ~ duc nL~ grlphs fm I h~lt 111lt hi~hr Iht Col h ~Ilu t (l f Lite ~Ul Ihe m Ol CI il y th t s(uumlJotil middotpin~ ~111 he ~middotJg gr~lVH(~(1
m mJxiTIt corrttt ion wll iJl i~ lIllCd to Ih - xt 1shy
lti Oilil y Jf tl1lt t Ut JO rl1t cdnUc idt md p OS shy
tU ll cul lapse ( th t ltHill enct b-tten l lUdioL) 1lphic egraveltamJl1ltlti OI1 J t th e ~lme pa tient in Sl il tl cling lOJ lline fX-sitiutl ) Wll ic h correb lc- onl wil ll fhe abilt ty of lllt p tu rl l gt s tem to C( lunternct lIk luree o r grl viry )cco d ing rv D lfVd- f3egraveLIprc po st li r t1 lt01shyIlDse is d ue to the Jnus -u lar ton a nd 11ll ex rCrIshy i) i itv of rhe tissus n the ( O IW-) si it (If the (01shyjl ti (~JtVe (Fi~ 3 L Pu~t llr1 C lltpstl lu lcl l ~~ reduc l-lt by llwans o f pl1ysica l cxerCles specitkally s tuclled ruuml i rnprove tIlus--ubr fOHt md lU pr )cllI Ct 1 ~11 hi shy
lizing ffCd
PararcL n tll CIJ cl the cr iti ca l (3 c1 thlsho ld beQ ld Il ich defol1J lHU n of the i pinlt 1 e~ in~ ne dtlllontr~1t _cl (1l ll t grclrf r mg] o f rllt C II in a qa m bng pos ition corn pOil 15 t l lowcr detormashytion lhnsllold (Fig 1) ie to ~11l Ulne3Se t the risk of pr ogr t~ lu n There t rh eJef re l J ea r l)iuuml 1itshycJ l ~ll1 l l(tl a 1 tnr tg ro b ohwined by d -cr t l ~ illg ilmiddot pU~lUrll cull lpse ptJcelJtge w bich lccording t i)
h llTd tnd ~l(heJ1l ~on 1~ b inde cl 1X llt icularly luumlgh Ugravel mllcl c Iio~ i (bdow 2( 0 ) (F ig 5 J
Fin a Il III ch iS respect lllljl hl and b um l 01 m linmiddot
ii iI 1 l _ _~ _ ___I ___ ___ __L ___ _ ___ ___J______ ___ 1 ___
li 1 1 1 1 i 1
1 i ___--____---___----__-_---_~- _ _--_ ___-+----
i
1
i -- ~- -- ---~-----_-~-_-_--_1-~
l ~
i
+----r--------t-------t------f-- J
Fj~ ~-Ac(XjJlin(Q luuml T O rIcd ~lnd Na(h(ln~ n i () dl( pCG w rd (rTIshy
POO ll is hiherin cu rvegt in wh ilt l1lh ~1flILWrd cII1I Olk l1t IS le- pr(v~knt ln th e grtph Ih t PogttJlJ I ugtnq) Ot1 -J1l j elfltS-e J tlt 1l1t obb dirr remc rlLIv obu incu f roll l the Cohb atl( 0 1stlI1dtJ1g IId gtupinc rldo~raf115 Ih Ille lt) [1l1t1 (i lndnl I pine) 511pille the ~(nlClu tJ1 compo l1lnt U rlk CU Y _VeJily I~ ltx p rlt 1 L1v UpUlt (obh Illeturo Ih t si _b Cct rtJeSIm l fie -ltn J trd Ugraveltuuml shyuumlo n A~-i)rding LP 11(lt uuta o n l ( r1I~( in ~I 2JQ sup itlt curvt 1hi C(]l)b ddhccno l l f lO is -J-lultt( thc s ldnd inr tnla Ol1l t lS wi Q) whil 11) 1 1)401 ~llp lne ClHVC If ~ 1Omiddot ( tcl Lhe ttnd trl~ nlca~ I(t I ~ ~I)
tli n ll w l lllE cq lin ti spin h~ i ng mo r ~ Llnt~II) 1 tlun the nOftl111 one n Cll l gr(lk ( (cU ve tl1u n da r u p shy
po rt in o r k r 10 m linrl in tht 1xi11po tuf_ n th ha__i of th egt onideratl lr1S it f(lll() rhJt
ph rH (~Uuml e erd es ulukl h u - ul iiuml tbeacuteY ~U-L lm cl 1l (It-d o pmg p05111 td C Jl1twl lS fuumlrnll~ rly d ccrll1td ln an Ql St if i imr ol1111 t ru t(( - tht m(d in C JI shy
r t t r sture fO Ir -ngthen tlll m u ck-gt of the spint mainl) in (11erl antig r3ilrl tIcirclt l]lli fun ctin ll U hy meU15 dl i )ll1 t trk ~ lhJ cl( -ll tlt C)nlr~lUions ~llld no l IdOshy
1l)llic d YIltll1k lt l jAJ lktic t) I1 ) II 11)t 111 hd posibleacute t lcluuml ee postura l io nrro and stfh ili lllllt IJI
w i thout food T1lw(ull r d I( Lf(11 Ibk t m ucircnuin Ihe c()rf ~ct [ ()S tu re for cl gtu ifKi IH lLl1gth 0f ti l11 ~
This i-l ddl usl a typl 11 dnmnin (tf k inesllh rap) in 11 (lt-11 [[k - p~d fk lnr in lng f u l1a in llllliCk is poss ihle lI sing ctrtain Idncl fJ l (lt) 11111 liun S p Ul in tb is Cl c is ulttful ooly sa I~tr 1~ il Iw lps t1w lxltknt 1 becuJl)t 1gtlt ltlt-I a ClJu~l inred irl ilL ntllru l o~ i cll
and I1lll~lJhl r-keJc LIl [rll-llIn~ middot etlt(wrs JI the int e rmiddot vlnrion
[J ROPA MfJ) I()Wf-I YSJ IR
1
ICR 1 1-1
r
1 shy ~
- shy
11 o-llrfOlhe5l~ o t Ih 1O~(1dity i n h ~ r ~ ll nr pbl1 l of ~ Spl11 in 111011 _llti1Gt l lPt f ltlJUCWJtl ( ~l Ihe Ir t 1 1gt illbll W Ilh LtltrJ1dlion Vln lbe rigronl middotUII~ l(I Dko n12 lIll h lumshydlanie1 1 [ nul 1 M hl whtrc M - gt) lnIUI1g 111laquo111laquo1 1 1 c rtJCshytjC~ f fce d -d Lill l1~ o f enr niI pUll spnmcl1y 1~ 111 mldlll1lt (n the fl1ur t 1 = tor~ of f(ward Ileuuml l = ughtel1lng fmiddotr p 1shynOf stn lClU= Alaquo rdtllg 1raquo Ihl~ - lin hull th l1ltgtllugrave ot tller1l lUr~Jtllrc F the ~pin t -ilh rlu1i tf Ihl 1 1Ibulll n lrlt InltT1 1
rbc prJI 3IJi l1ty d qrlOIJ~ n bull JI t IlJIII Hm lA the v=ltd gtc e lu-ing J 5lnK1ura i ltfnnity
Dioal e ch anicll itllp~lir J11 c nt
Ihrcemiddotdimcllgtional mc-cbal1in of the s pioc
~f Ikmiddot i t i nly l(œ ntly tlHr llk pr-5tnœ or nc ushy1 lnlo tnr impairment in Idiopttlllc s-ol ii IXl tknt liuml J$ heen h i- ll licircghlcJ hy re$eJ rh tll e preit ilegravee h inm b nIcirc Ji d lJutg~ lt hl ~ 1 ng t o n dO Ulll urcel 1 i5 (l lreldv well umlersrood H(j-ev~r nev lbt un h iomcrhankal im l) ion nI h1c rectm ly onk l n tIlt tre and p r~dou in f n rmtinn hou t pl1ykd (~fcl5( in t 11 0 tl1I _ltgt pbne of spact 1115 Im trqlt-u 1rom J i-[) v ing unclcrsrmdlng ot th l lmc -dim nshy~ilnl l l11 ~ hmk f the cO]jO[lC pln( ~2middot ) ) Ve- w ill )iI xnl t l1 d at lcL-orcltng tUl cl sif iol t lOn blsed o n gtolllt lricd h uumlCJ ) p lane
- b() rJzU[1tl ln th i pla n ~ th t 1o rm ll sp ine present no CUlye- w ll ile Uumll(~ ltc U Hic spLnc clevelops one of ir haracterls(Icircc deFo rm tiCs v elt tbrd ln lashytio n vh icl1 pJ()VcA~ theacute hw 11
- lgitltl in th llulJe U l(~ nonmll spIcirclle pl SenL kypl lOSis ~nd l dooi~ in tb lXI1 lhese [(Hu rts Vere m)( til ught [ 0 he relattd tlle scolkJtlc ( lI r Vegrave
- front l in hi pleme tht ncrmal p ine preseuron t no curYegrave whil thl ~11li tic p in ugravetI I ()~ icircl~ charshyad t Ilt I CU1C
Il Jri fJIIt palic
~l+I~na ra 3 r inr lut th l[ ber ll1d a œl1~lU1 degr 1
l f r()la tJo u lllu (lILa r forcKl ltxert ltJn tl ldefnmuumlng 1 tkllJ [J i1u a re- lhlt tll cly 11 [1 1 UI b y Olm ner w bn ~lh uiJwd tl egrave ro t1tic) l1 Ilm it ti lt p ica] lf shy
rhrl r() be (P (the Uma bevond Wl1iltJl th lCOJlb of [11( ~pmaJ musd ~ dthc COnCIt and nm ex ~l le btconk (t O li~[)
r ~l 18 ~1Il N lu t( ren i9 lun lu ted rlseurlt h in tlt ) tilt lULodeumlformipg1 tlo n ot tIH_ sc laquoJrle rh ox ercallkren lk 1l1~H li d11r once thl Il i ~ r tld1t5 [he lhrth ld f 111 JlIcirc lIi of tlle dnrlclc hurnp tlk
lI bslt Il l nt rlet()rlll lIcircon 01 the it l ()I~ C ( (ylm der (- sustalnecl by an H1tmi cforming aCOOIl
J1Ji h V hl rhyiical f~ f Ise CI 01 h spr n llnd kin middot ith ccedilrapJ my lX damlg ing vll e n l pplild as flle
igt Jk Iller ln SCC1IJ ~IS lllc lJ fxceed l auto in middot crca~ i n g lhrllgthuld [1 sh (~u Id ahn be j ofed that Ilw relscd pre sun 1l1111i insiugrave l fe pil1r inn) 1 mlshylt
- j Il- ( w atff 1 (nh ~1l 1(e Il10 utoldrml ng li1eCh~lI1 1sm
in flc l Geyer ~w tcd th1 t rm m 1 hI l)1ecircch1O lla1 puilll 0 l I C~ sw m mim t Ieuroamp no purpo t for cu lshyim le pllilt t1 s (weumlO middott r it is l~Jl(gtWl1 rhn in iculio r[ paULnl -iJl11T1ill~ doe_gt nor Il ~lp to i ncrt~SL n eur(1shym tor co mfU
(1irai p an (
Jerdnn lle 11 showecl thal ill CSl~ o f t10rLC IC 1i lUgrave
tllo lacolulllhil it lio_1 tlle cte tI llmiry in (he lg itt1 p lln t rn lnlftot il~ lf tspe iuUy in tlw initi 11 r luleuml )f cV IU[Icircon nf Ile ~oli ls W iU l 1 p(t)gr~s~ivlt il10middot~ shy
ment roward hvpok pho b G ll f ill~l Im lins l har dUflng (IN eWllLlfiu1 of 11Imh] co luumlgt i the l in t ot t l H~ gClyty Cegraven te l - 0 1 v llebed lxxli 5 r ro ject 1 seH fl r t side-ys and tlwn backlrcl bull thu~ p(0(1 lj n g a kyphQtlmg aet Il ln (h~ lu mhnr --PIl1 COftj tng
l l i tc Iugrave l lltl l( l rs1 tif s L -etllgt il l the lgirl11
1 Hl)
Ilu LE nI rIIY~Ic~L lXIlKISI 1 HI E TREhTMEtn OP JIU IDIOP llII C AD O USCUH O Ll Œl15 NEGR II
lLill tegt lre lenl1 ~I d ~fo rll1J[ ~ rhl recrSes the phyltiologiGII cmns of lh vine)
Accordlng () Dicion ~2 1 rtcluctio fl in the itgitttl CUIYtS combin l vi th a lueral Iviari n llltl ds t 1
mecban ism () ugravel~ta il ity in l he r rat r IllI1e which bVOf1i the unsd a nd i ncrea~e 0 1 co hlt1is (Fig 6 hiIf md Pl11jlbiJ Jl1eanwlt ile lt(udiecl lh e srnl ru t
orzyglpophySLs show ing t11 al ttleir 1I1tl rnic tl orienshytation f~I (jLi l~ltes aXIal ve rtegravebJl l rotllio ll in cun litluns lt f dorsal hypokrrhn Icirc tnd lum)H de i L lo IS
Tll t dat SLlgge 1 th t impOrfill ut pOitu res and l1lweil1 ) t Mudied in ord t r (CI mlIuml ntrlin or to reuwer fll e p llyslo lo~lCll ClIlye in lIe SlgJtta p lU)l Wlth the llm o t ch ~ kin~ rutltor in l~ bili ry7 AbC th ~e ~k-
1l11nL ~Irt del lnt [0 J jUc lt ftber l]kuti inrervenl ion vhich 1c)LJ k l IV - i(l ~ l compktl n l ililll on Il t c1 l shy-jel1 J11UVllT1ent IJ j o f 1uto-dOneacute(3tlon ( i e a -impk ld ion ) Iengtheni ng o f the pilleacute 011 a litlltl l aXl~ tll lt ((IT liJlI~rcdu e~ t lle ~---lJ linti- l lte ml-fkxj(l n h UI 11 - i llCrl I~t the plllH ](JgicJI dlt cr ~l S ( (1 k-yvllCiSh lIld O(ltOSh l o r c lch r1Iif n t a Ilew til(~ecirc dUuml llt Ilshy
si lflltl J ll1 u(~nlent iam ecl - 1l1t0- lIrfe rionmiddot7 4 llmshyp oed f Je-rura l iUIl cl middot-t1e- iltm lI1d ll1a intltnUlLe )( 5lg it d C Uf (gtS slig lll thltJrc i ypI1 tiZ) tIcircOI1 a nd lunugrave)ar 1()fdos i7~llion) sholild he esw b lb]HU 00 lb co
hl b oi hi p~l11il uU r -1Ir vlt Abo 111( e IlltUtl Chl lie o f purti n - a U vitk slJ1ultI h e )tuumlll ecl 1)] (1 n ldershy](ion r tl1i lt type for e upIe IilJ llyl)T S of repd shyiti( ml vemen prt n t in agonistK h)lnllltlSlks nI iIle kind f dlJ1ce C( uld he ([([r imentd
FmiddotO lllaljlallC and mobili ty of the SpIcircIlC
1 rd llo U 22 d L lm nrrare d lhlt in Illt fro nt a l pll ne
tilt 1 nge Clt 1)1lt vtment of tht scplit[i middot CU IY grcmr lIJ l il ~ d irectio n n f Lhe C ITelt tlO n tha n in tl le di re shyLion of pmgressi n l Fig 7 ) he IL o IS5err lJd tbat th15 mohiliry increac plrtil u la rly n apic [ cgcoeilts 1$ lh ~ ~c() li osb evolves Sragrm rJ 12 J ~ thus rigilt (0
VlI f n rller~p is ts Ilo t t) m o b uumliz - a sCtJl iu til curve w ilhout t [ uling ttwt tlle R lu tiOI o i til t ~a mt b fnlinruumln( 1hy l1tans o f ~I passic 01 1 rivE -uppnrt On tilt (ltllE r hand UgraveK d e iJlioJ1 in ease durill tlw tune 111 whicll tll C spmt i ~ not submjtrcd to correeshy( IV anl()n
j- Virh mi lei ol i b tlllt Upp i1n ill) lC tiol is d eveloped only lllmugil llClIf()mu$Cllbr f r llce thi ~
InegravelIl ~ thclcfo re tl1l[ inu eascgtt sp1J1all1extl)iity mua
11
Imiddotiumltgt 7-rurd illt Ir) 1 bull rdrilt I1 1 in tl lt frOlllll pbnlt- th( illl ge )r mOC llIeJlI o t the S-o UIIJC CUNe 1 supcrior in Ihlt diflt(l im ugrave( the n nKlIl thd n ll1 tllc dlrtcLion o f p rJ1(l( (llIl
be considrCtJ vntrl iJ)(l icltion and 1 undrli neocirc ab L a ~ubiljz~ILion 01 tilt spint pllss il)1y ohtl ll1td thrltJugll the stlengtlkl11ng o f the 1rltJgm vlt nonil lme shyCIC 111 illli orrant u bjcLliH- ln rhis r~f1 n sp u lllni lc tivitIumlLs sil uld lX tPI 10 dlegraveltl it l G lU t n w l1ik luring kine i Icircth lrr phyltical eXegraverci c~ tllat in ele
spinal m ot ilIcirclY sil nid 1e lt1 oid cdrt ~
Organ ie and psychologieal impainncuts and li islbi IiI le
A cgtI im lc pmi nr is moriOthl11 just 1 sp in and 1
compkt gt Ipp rnach to the gu in ad 1 ont i al~ shylute l e~se i t i11
[)a la 0 11[ [n ell lrom re semh pw tbat ome organi Iilnctiond cl fki ts suc]) as tlw clecrtiUe ut vild l tnd d fun ll l)Kity_orld ldly incrtJ k whil~ 0 shy[io s i -till in (1 miel q g of g JltlV ity ~ l ilI e 55 rtI lit
tllL pres e n ce )fl defidt Or Vi l~il Clp~1 - i~ ln one pIIiem in Ihr l ftectecl by 20 ICl 40 scoi stgt l ls~a r(h cunclutecl in tbe UA by Di Ruce- prod uegraveed an aaalo) u ll1lXimum 102 re u t in a group of Jd shyk 1ien t [(h sco llosls rang inF frum ) [0 1
Al10ther rudv bv rallt r m C chr111 lilcl NashycWrl1s( u 57 stlO eltt hil $(C 1 1 ui~ Ica js l( lllt cl (1 shy1prUlllI o f t1tgl lie bJd l imI in ~ul sct t1 t ltu b middot iects jlLltr l5 they are golng through ~I cltlici[e sllge in the fnm 1lt i n 01 tlWH o w n id uHitv t factor hit h Illy jeopmlize the cl velopme lit d ~ mIll lt lI1d htIshym cecl IWI sonalitr in Klulrhood
n RUI ~IEDl(( Ptl Y1-
ROU ltHmiddot PI [ I C~ 1 EXIRCIS]~ IN TI Il nW~JUNT OF SlllO lDIOP1HIC AI)C~ESΠ11 C(gt1[Oi 1S
This i why b IiCieacute ii is ~n imporrlIl t for p rcshyvegraveml e 1tLsr l tn en ou flge 1ari e nrs ~lfrecr(d by lIillcl middotu iosis ft) tlke p~l rt in portin -re rcatioluJ acrivitits Iha t 1eIU 10 L10 th r~1chophyinLl bull nd b~l )i 1l1o tur adlieem t n li 51Jmiddot2Even tlK)ugli [Dr bic mech~lnshy
ical mcl nellIUll10t 11 11 reltl ~ons lt r111 1gtomcrimes be l lefu l to ugg( ~t ne p rt in~ aCt iv ity r l h (gtr rll n anotlJer e th ink Ibal an exces~ ive IlHd icalizltion - Icirce l ll1posilion br plry~ilt i HlS nnejlor parents uf rh ry pe of po rt to lx p m lice 1 b Ule p 1Ucirc(Il L th1[ preshydLl ck l1 is fret clOice in lh ma tt r - -h II ll1 he avolc1ed wb 11 possLhle mainly for tlle i mport~ltll psyshyLb ) jogka l fe a SI)nS W( ha( ill ~ t nltntionegraved
Conclu ion
lbh ISsertegrave d t1H physkal tgtXtlci o is ) n fi ial whlIl practinu in order 10 ilnj rove the I11 llde
rœ nwh and tono C iral caplCiry and postu re o f the StOUO(I ~lIbj n II I nowkdge om ~ middotmg trom ci el1shyrlfi rls(~ Jrc li dJlJ accordl ng r the review 01 thE litshytirlture prnpo )td in t lli plpl r conflrm~ Ihe vuiclit ot th e -t ls ~rti ()ns
In l do l (ent Id iopl1il iC scoliuse il l n phee u i cl vk)pm e n t ( li tll iumlKh eXCC cl l g i en rhk thr hokl th e re i5 an und ubred need fn r l pprnpri 1tegrave (JJ1tOkJJe ~Ild Inr surgict1 therapics ill ortler 1) S l i p
the ( - Iuli on anugrave )JT~t~t UW ~pilll l dtlormities bull evshyerthtless in the illiti ~ll pl l~sC t ttlC c1iseLltc whcn the riS( r1 r euro )luli m is rtduced ocirc ~md tfle uifleal JOld threshold il ~ld flle po stural collai i reJcenw~ 43
JI l1 igh pllysicaJ egravexe rc ise - p revenc or r d llCe d i ~lh ilir ies o f [Iw ~ l() li )tic
p (iems R 28 J -6 5- 6 1 63
- f~KiHtare lh ( n utr ali711iCUl of postu m l d elicits tn produCel1 a coneql l nce J [)ti 0 I111)( or regre si -u lmiddotc 5middot Il 1 17 ~ M
-re 51udles U ~ n Ledecl tu con[mn or re jecr these conClLL i( 1 w l1 ich clerin-d frum 1l1 lIldytica l rcltw n f th e liter~iture appear r- ~Lo nlble Hnwecr Intil ne re ull are 31Iable wc should n r prevent our sroliotic patientmiddot trom tl ki ll p lt in s(loI1ing jshy
ir its pW1iada rly ltl t ~d1()o t () n til t c ntrHY -vith the l xcclrinn 01 gt[1 )11lt tIlat in rea-e t)1obility (tnU evc n thell oilly wh n progr~lgtion b p OSSibl) -uc h ~I( ucircvshyiUe -11 )ulu hl tIKoll w g ed The 11 S J ( rprOpriue kin (~irhe r~l Piuml to incr _~asc p()~tura l $llbil i ty is tl1egraveoretshyic tlly CiJUClt alttloughl more ~Iccu rtte aod deLli led ri k benefi rs anJlr~ is is netot1ed
Ria 1111tO
NIokl Mu d lle ftitYljJfu Jœl il 4IWr10UOifll S (JIvs i (1~1)Jshylidl ttno( cclIll le 11(11(1lt1 RCI fu lle ((lia LltfIt l1 I1I1i(i
LJ ci n s j(r3 pigt egrave li n IHUgru lkl di t rdz t fi sici pe e ft shytUlKm iluppno di un lisimerap15Ll rl lllcflt() 1 110 scopo di pnevirlt () fr en~lI 1-lgpwlllltnlcgt dclld lclonnitugrave o e il 5LOshy
Il i mi llon lt fH nugrave j (1 11ni dei co~e 1 lteIl I1J J nd ne ~Ii eifclti (()Tc rri udk s co lio si d i m e dia g rt iuuml ln que~ltlt
s rud i 30 llizzb mo i d ti cleU ric lca pel n ri Icare qJJ l lm 1 dis(imucirc x u le I[~ l z j-m i pro vna le da lla C gtl k A i json ere pr middote-nute () rk kl ducirc un~l rdeguCltl d nil cra pi lt di uJoseguerrnt Cjua li 1iU110 cli nbie tti 1 rcr lJ)tIId d~ fle)-UITC
n (- -fd7Io n~lcl)
Ut11claquo)si 1 lI tori htpnuuml )ludi-ttn I ~ cnntI1zttu fr Cq(in i idiJ)tic1 dbfl lOZ10l1 d d ~ leOla nelllOll1otoriO Lb un1I1cnUl 1n1l1i3 dcgli 111 lt1i ch DIJgt gtU l H crmU1 Nlch~mslt ( SIshygnaJ~l lerimiddot wo i esuemi -bletti d~ plt~e8lugraver- ne l pClZ le1lftgt scoliodcu kl s iluppo ddl ~ ~ uhjlil~ vertcbral~ lt o svilllp prJ Jdle JIl7 i() nl di ltCjuiljbrio Dng li studi sul lto lb( l~nlrale (OllddU i in pa rticdu d 1 DlIal-BeHJ (gtegraverl ~ P~II IId lI1 n~ llw - idente il v- m gtiu p eT il puientc clioti elgt di u n rnigb o t c)[ ro Ua sw mle dei radlldc onsegull o tramite il 11 fforzrlshyfl len to d e i l1luotoucirc l nllgr3ilri d e luOwo con crcbi ~Clltdr
in pOMltHJ corrctl e in va rie ~i[Jzioni s t llicb c c d inamIcirc tllt Dalle on sena d elb blOffiCcclIlicd tr idimlt n s io mlle d ei
r ~ chi Je ~oU()f icn ~Icirc ~videnuumll (l() ~llt tC p IYZIcircOSI ln(IiClZlfHicircl ~ 1I1shy
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EUROP MIDI C Pli hIC
EDUCATIONMEETING SATURDAY 8thof APRIL 2006
(iSS
SEAS02 Scientific
Exercises Approach to Scoliosis
version 2002
G
S Negrini 1
EDUCATION MEETING SATURDAY8th of APRIL 2006
Neuromotor disfunctions
Neuromuscular disfunctions
11 Postural collapse
Postural collapse
Duval-Beaupegravere
Flexibility of scoliotic curve
f---I--- I Postural element
-------1 Structural element
S Negrini 2
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Postural collapse
Duval-Beaupegravere
It is a value related to muscular tone and to flexibil ity of convex side tissues
Post ural collapse
Bunch e Patwardhan
Critical load
Load threshold beyond wh ich a spine begins buckling
JI~~Wt1lW~flfthtlJlœJtAr ~ J~It- l~l - IMS
Postu ral collapse
Bunch e Patwardhan
If a curve reduces there is an increase of the deformation threshold
~~~NW~-damaoc~IIIMf ~~ J~Iv JaJ-I7I9sect
S Negrini 3
EDUCATION MEETING SATURDAY 8th of APRIL2006
Postural collapse
Torrel e Nachemson ~
Scolioses below 20deg ~ ~ lt~
have a high ~ ~ percentage of ~ ~
~postural collapse (on u~
average 75) ~~ 2i~
CU~VE O EG~EE S WHllE SUPlti e
~laquotd~c6b ____lPffI1wtt1t~
$ww J(t ~~7 JM5
Postural collapse
Minor scolioses 7
Antigravity musc es strengthening D
Reduces postural collapse -G
Increases the critical threshold of deformation
G
Neuromotor disfunetions
Stagnara
If we admit that one of the causes of idiopathie scoliosis is a disfunction in balance systems it is logical to orientate physical exercises toward this direction
s Negrini 4
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Neuromotor disfunctions
Dubousset
Idiopathie seoliosis results fram alterations in praprioeeption centres and deformation is a natural compensation to restore postural balance
etattJtitIK ypothfQj~S ___~ own_ oJ)HQr lar 1t-1( r
Neuromotor disfunctions
Nachemson Initial idiopathie scoliosis
+ Goood spine stability
Neutralization of postural deficits
D Static curve
Neuromotor disfunctions
Therapeutic aims
c) Development of spine stability
C) Development of balance reactions
G
S Negrini 5
EDUCATION MEETING SATURDAY 8thof APRIL 2006
Biomechanical disfunctions
j Horizontal r-Ian
i Sagi ttal plan
Frontal plan
Frontal plan
q Frontal plan disfunetions
Fronta l plan
Perdriolle Movement magnitude
gt in the direction of lt in the direction of correction progression
S Negrini 6
EDUCATION MEETING SATURDAY8th of APRIL 2006
Frontal plan
Stagnara
Never mobilize a scoliotic curve without ensuring reduction maintenance over time otherwise a greater mobility favours scoliosis progression
Frontal plan
Ducongeacute~ research
On a group of adolescent idiopathie scolioses treated with
Meacuteziegraveres gymnastics
D After 1 year the mean angle of
curves increased from 18deg to 29deg
Frontal plan
Scoliosis without brace
D Greater spine
flexibility D-
Risk of progression
S Negrini 7
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Frontal plan
Mobilization is useful
D In preparation to
brace
D With brace
Sagittal plan
QSagittal plan disfunctions
Sagittal plan r middot _J o
Perdriolle scouos B CJ aDeformation of D
thoracic and thoraco-Iumbar curves evolves in extension
S Negrini 8
EDUCATION MEETING SATURDAY8th of APRIL 2006
Sagittal plan
Graf
The line of gravity centres in the vertebral bodies o s c oUOSt
projects itself firstly laterally and then fi
o
posteriorly lJ ~~ ~~ ~ ~~-_J-D ~nI~
Sagittal plan
Therapeutic a ims
D Maintain or
retrieve physiological curves on the sagittal plan
Horizontal plan
QHorizontal plan disfunctions
S Negnni 9
EDUCATION MEETINGSATURDAY 8th of APRIL 2006
Horizontal plan
Stagnara The forces applied ta the spi ne act in a autoshydeforming sense
Horizontal plan
Dimnet Rotation gt 200
ampII~ (
D The actions of concave and convex side
muscles become
agonistic
~ItJrOnrIIiItdllfUClltlluumlll~~tI ~1JIf1laJ
Horizontal plan
Minor scolioses never exceed these autoshy
deformation thresholds
S Negrini 10
EDUCATION MEETING SATURDAY8th of APRIL 2006
Disfunctions at a biological organic and psychological
lever
Oisfunclions at a biological organlc and psychologlcal lever
Cheng
Bane density in scoliotic teenagers is lower than in normal subjects
~~~~middotA~IIlUtIy ~7œl 1d l
Oisfunctions at a blologlcal organic and psychologicallevel
A significant reduction of vital capacity and V02max in teenagers with a medium severity scoliosis
S Negrini 11
li
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Disfunctions at a biological organic and psychologicallevel
Disorders in the development of body image that the teenager has of himherself
Disfunctions at a blologlca l organlc and psychologicallevel
Therapeutic aims
cJ Activate cardioshyrespiratory function
cJ Favour bone density increase
cJ Develop a positive image of the body
Disfunctions at il biological organi and psydlologicallevel
Stagnara
Sport
D The active side of
kinesitherapy
S Negrini 12
EDUCATION MEETING SATURDAY 8thof APRIL 2006
Disfunctions at a biological organic and psychological
level
Distunctions at a biologlcal organlc and psychologicallevel
Cheng
Bone density in scoliotic teenagers is lower than in normal subjects
~n~IIIvpWr~middotA~stWy s- XXJl M J
Disfunctions at a biological organic and psychologicallevel
A significant reduction of vital capacity and V02max in teenagers with a medium severity scoliosis
G
S Negrini 11
EDUCATIONMEETING SATURDAY 8th of APRIL 2006
Kinesitherapy on the scoliotic subject
q Postural control
q Axial stability
q Muscular trophism
q Balance
q Respiratory function
The limits of kinesitherapy
There is a threshold beyond which
rehabilitation alone is not enough
sssr
Kinesitherapy in scoliosis treatment with brace
Therapeutic aims
S Negrini 13
6
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Therapeutic aims Srace kinesitherapy
With brace
il Postural corrections and
vertebral stability are obtained by the brace
Therapeutic aims Srace kinesitherapy
In preparation to the brace
il Mobilize spine on ail plans
Therapeutic aims Srace kinesitherapy
With brace D
Maintain a normal spine elasticity
~ Maintain a good muscular toneshy
trophism
C Model the hump with kyphotizating
exercises
S Negrini 14
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Exercises and their methodologies can vary accord ing to learning and individual sensibility of the single rehabilitator that proposes the m provided that they stay within the
Iimits of fixed therapeutic objectives
li
Therapeutic modalities
(Exercises)
QAuto-correction
QRespiratory education
QErgonomie education
QMuscular strengthening
QDevelopment of balance reactions
WNeuromotor integration
ci Vertebral mobiJization
QSpecifie modalities in brace treatment
S Negrini 15
EDUCATION MEETING SATURDAY 8th of APRIL 2006
The protocol of kinesitherapic
treatment
G
QChoice and dosage of exercises
Variatiosn of the work program every 2 - 3 months
Q Execute e)(ercises on an individual base or in a small group
Q Frequency not less than 2 times 1 week
Involve and awaken the family
G
S Negrini 16
EDUCATION MEETINGSATURDAY 8thof APRIL 2006
Q Determine the action and the localization of auto-correction
QAuto-correction must be associated to ail exercises
QAt the end of treatment ergonomy lesson
Auto-correction didactics
G
SCOLIOSI DORSALE---- shy ----
r
S Negrini 17
EDUCATION MEETING SATURDAY8thof APRIL 2006
SCOLIOS OORSOLOMBARE
shy
SCOLIOSI OOIlSALE 011 bull LOMBARE S1I--shy
SCOLIOSI LOMBARE
il --~_-
S Negrini 18
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Scoliotic patients are not radiographs
middotSeoliotie Mtients are not ndiographs but hum beings with a vertebral deviation-
Slagnara
Metha For the physieian Cobb angle is of utmost
importance For the patient it is body deformity t hat eounts most rib hump a protruding seapula or hip We are in a situation in whieh today dodors eure the radiographie deformity but what the patient really desires is to get rid of clinieal deformity and of ensuing psyehologieal distress
CIIQItIo shDuIdtucirc lM WIld tJw~~ I~~M~~~~ J9f~
S Negrini 19
- Poznan_workshop_Physiotherapy
- physio2
- physio3pdf
- physio4
- physio5
- physio6
- physio7
- physio8
- physio9
- physio10
-
EDUCATION MEETING SATURDAY 8th of APRIL 2006
METHOD
The Incrementai exercise test has been applied
We have found that tests ln whlch the Incrementai part of the protocol ln completed between 8 -12 minutes duration glve the
bullhighest maximum VOz in normal subjects
METHOD
The workload was Increased stepwlse
bull by 10 Watt every minute - ln chlldren
with high ~ 135 cm
bull by 15 Watt every minute ln chlldren
with high gt 135 cm
METHOD
The test had been contlnued untll refusai of the patient or exceeding the pulse Ilmit
Durlng the exerclse the gas exchange parameters were recorded by Jaeger device model Oxycon Alfa uslng direct breath-byshybreath rnethod (with face mask)
J Durmala K Dobosewlcz 4
EDUCATION MEETING SATURDAY 8th of APRIL 2006
METHOD ~ ~~ r 3 min 3 min 8 - 12 min 6 min -~
_ 0 rpiYJ 0 rpm 60 rpm ~1 30 rpm
_ t o~w=att~o~~na ~~ att__~ tl~~S~~ l ad l ~~~~~r o~w= Hlcremenlal t
pedaillog i i ~
~ ilt ~I~-----tl-~ I t ~ i ~ lOSt sffortivB
lW r resututlon r rm-u middot 1 - bullA~cremen tal ~~ ~ ~ ifr- ~ VtI 1 ~i ~ tllng _
METHOD
On the basis of recorded parameters VAT
has been individually computed for each
child using V-slope method by
Wasserman
METHOD
For assesment of physical capacity
the maximal minute oxygen o
consumption (V02max) ventilatory
anaerobic threshold (VAT) and
maximal workload was used
J Durmala K Dobosiewicz 5
EDUCATION MEETING SATURDAY 8thof APRIL 2006
RESULTS
Ali girls with 18 have been classified
within normal range of predicted
values of
bull maximal minute oxygen uptake
bull VAT and
bull maximal workload
RESULTS
The differences between group of girls
treated using Dobosiewicz s method and
group of girl s treated using symmetric
exercises were statistically significant
Lower exercise efficiency of girls treated
using sym metric exercises has been
observed
RESULTS Girls wilh IS Irealed using
N=87 p value
Dobosiewlczs method N64
symmetJic oxor-ci Nz23
Perœnlage of predicled vaJue of
maximal minute oxygen uptake
98 905 0033
Percenlage of predicled value of
VAT 97 933 0049
Percenlage 01 predided value ni
maximal workload 101 939 0038
J Durmala K Dobosiewicz 6
EDUCATION MEETING SATURDAY8th of APRIL 2006
RESULTS 26 girl s twice tested - at fi rst and last day of intensive hospital rehabilitation
The value of ventilatory anaerobic threshold increased during intensive hospital rehabilitation (asymmetric mobilization of the trunk by Oobosiewicz) statistically significantly (p=00019)
2047 ml O2 minkg (SO 268)
vs 2239 ml O2 minkg (SO 232)
Conclusions
1 The exerc ise eff iciency of girls with IS treated by asymmetric exerc ises of Oobosiewicz is norm al
2 Such high level of the exercise efficiency of thIcircs group resulted fram using of Oobosiewiczs method
r
J Durmala K Dobosiewicz 7
REVIEWS
Role of physical exercise in tbe treattnent of mild idiopathie adolescent scoliosis
Revicw of th- literature
A NECRlNl N VElWNL s PARZI 1 A NEGRINJ 5 NEClU NI
P1t~silillxlrd~ Ihcrapy (or klucgtlttlwrlpyl i pro shy-tJm of physka] cXlrd-cs ipcci I(a~ (IJcloJgtcd hy l li trIWlltl phrslollwrapbt wilh tb m~ln a1mor pl shyVCnI in lhe ilAAfIVltilH1 llf the ucirccfonuity III mild IgtC )
Lil1Si bclpin~ thebm ( aocl co uaufllclilIg ils ~jd- clf IS in nlOdlJmiddotnh-culiosis Th middotalillofthi paper ito r (W
Ille Ii lc ram r 1 a-ccrulin wh kh of Ih bull Lu[Jalmlcrus Ind (Lb hili til~ CLlLt-cd br scnli()si- clluld bl pl Y nlcd or r d uccd hl phylolld LXtmiddotrdsi n Il p--to-da le knowl Uuml~l nr tIll~C aspcc[~ i ne bulled in oruer 10 dndc whclh~r 11Rf blLl adcqlmtt Ib(uuml n middotlicaJ balis fo r ora)aini l Ihe US4~ of lUgravellgtitlerap) wltcllj(r or fln l th e prtl1iœ of kimiddot ~lre IUlll poNjn~ a t iil ies ~bould h allowtcI II uuml middot c enliaI toltlentlf)wh k lu alClor ie - lf pl lr~kiJl -c rmiddot d gtlt- (Ic rnnhi UzJ( inn ni (t hl HrJltlon [ rtn~hcll iJl ~ or 1i1J(IChIumlJlJt etc) Sh llU Ld be TolullllCcluse ulemiddot l onld b- clclIimcntalancl wukh sho ll ld he IJlI-n~ifl~d I~~a l lhc (o uld h 11lfu 1 Know k dg CJnc1in t (wIn SeiCIImiddot Hlk rCS([lflt h daw ccordinll to Ih bull llVit w o f tIlt iii 111 1( plop(lsltd in (h i papcr lmiddotonllmJ l lnl plLyi 11 cxcr(j$( pn (nti or (tmiddotduce dhlblli t ic 1 ~lt Il Jj ll(k pl ti Jlt fadl j w(~ the nlIIIrl li7alinn n f poMural dd shylitS tu p n xJ llc aSl COIlMqnen c(middot 1 all )llal) or r(tn~ shys i middot middotlIrve Tilt u~c (I f appn1priattmiddot kincsiuuml wrlpy 0 in rcns polttllcal swhiIHy Icirc IIHmiddotorc Illta ll y (0 r 1(lt1 lllho UAh mon ltlccurlltc 1Ut dl1alkd -rLk l(lWfils 111111 )11 h Jlccdt(
11) wurcJlt 0 lit)-IcircS (Iumpy - x rcLs P()lun
n rllt lT(ltnklf u f COll1tlK H (rtd) I 1i plfho l og l ~$I rUlglng tr m low tmiddot k Pl 1l1 to IdiOpath ie SCUIshy
Submitt(oJ [or PUhltCl l1 011 uly Tt 2001 Acc~pttJ ugu - ~2 1(t-1l
Addre rltj-xlfll telt~I(middotb If) - grinl Flt(1(bziurllt r )(m Ofl ()(Cl1I shy Lt middotqlltœlll ro () - 1u I4t agravehLIlKil ta IYIL-lTt ilSllltp lfllmiddot ~ 1l1uumldull
CelII ~ (niiOS I I~ middot ann (1) IfUh middot lIlfU di louhilll(tymi ( Nlmiddot ~iI rli -ilIIUmiddotltlfl
Nlti(ir 1( ) il r() (ltbullagt1
lt vLL_ l IiII no 1ftfI
jS ) we are a IUil ly tJc ing n1n) ltblll lS 1 k l1 b ~J)w in~ tl~ t S Jfll l approad llt - l1n til hy on ielshyertd ~tan lard ugraveJuld ln m any ~1~ he lI ~t les i if Ilot dange r )ll lt rhlS is lrut of reil l lnw 1gtlt1lt1 pa in l ~ or 5urgi c ll lrea lmltnl5 in dbc r lmiddot ll Sc - 2
ln tlle cj-e ut ~ t lll(tlWtl i( li p l ll1JC luuml- I ~ middottnl ~() shyliosis phys cal ((_lt1(( is emr1uved ltI t()fIl1 0 lh~rtrv
lo ly in cel1l in L)lllllde (nluumlnlr in tilt Lltlll middotorkl i e Iw l) r llt t Srain hUI IIgt() 111 Gert11lny 5- 1~1 in other reg lOl1 wbere thi I-incl qf tre l tm e rll 1 p~ 1 pmiddot t 1( cI il Jws Ixen cri ri cilld md rel -cltd Lw m~lI1 1 11 Jlu~ Fue Fnlny r ~lrs thio middot15 a lsgt(ru( f ~rth r -~ltc rrJtf))~ ll t vit11 br1Cltcgt b r II1 ([C Llt n ClW grmvlng 1lt1 0 L Sti g
gcsti n the lIsefulnes- u r Ih is form o t treatm n t 1
Hmiddotu]rs have nerged jn El or uf pll y~ iLd eegraverdse eacute 00[ 1 but tlw are nUl yel 11 11 t llu i vIC~11 and r hi ~
f rm of trt ~ltmenr IS stiJ l Ul1 ckf ckhate FfI t Jt 111 il i 11t (eltary td 1I iFy 11umbtr ot
b l sic COI ceP rlJ lf w ill he cIh tt d in t hi pap r
Scollosis
DCijIrI iriolls
ScnUoSlS is Irlircc c1 lme nsIcircltnal (I(gt i l cj on ot tht spinc thar cau C a CU 1 lh lt ca n h e $ t~en ln (1 me1Sshy
ured ultinF Coh) lll ltllCXI o n HI anreu middot p rtc rilt r
EUJlOI -1 lœDICOPHYSlc~ IR
NECRI Nl
110
f)i)
1 7J
amp aS g 5li - 0 v
V
31
10
(1 1) Il 15
-tc i ytjtr~)
FigJ----jllph ot DlI w l-lkaupegraverel) The agloimvltltinn Or idio r lrhlc 50gt1iflll~ IS rpiJ bel~ en th e- [l0 IH P (l)ltg tnntll lol (JI PUllcmiddotny) mtl 1 ( f( lS-er sigll paiilivltecirc lt Dlt(i I1 11illg r the iti l 1Kgt n n t rll icirclicH a ) 111lt m omal prebulled the mno rche md ociks with lll I)ttlx flal gr Ih pll fl
rlcljoprdphLi 1 hl merl prestIK ~ of this curvt c10es n t autom~l ritllJy indi ate the pn$CI1(t of a defurshyTnitv (SlllKtUrd (Unel
It i~ possible tu clil1e ren tute a struCnlt t CI1tve fruIn a pogt urll 011e by identifyi og the hum]) du ring AdIlns tesr I~OQ looklng tra m beh lnd at the p atient w ho b benchng fUfward il is p -- ible ta d d~ct 1l1 eh ucirc n of o ne liidlt 0 1 the trunk usually n n the (onvex ~ jde ul tbe radiographie CUfve Ugrave1lr C Ul be mlt~I Slred lISin~
BUlln els S o liomere( 1 ~ l This h Uf1lp is du(- lO (Ile pregravegtecircn ~ of vertel ra i rolltion 1c1 Ollt tn tic f~YJ tllre o f the def trrnit tli [ c m be seen and measurc(i v ith Perddolles lb lsLometer on an amero-Ix)iferior radioshygrapb ~2
Seven ry pel cent o f li Ises a re conid 1lt 1tO be idiopa thie 1 bull ia l-nosilt in this CI$C is b exdlls i ~ n as idinpa thlc me-us t11H wc do n()[ know rJw origio of lheacute curvc [n othe] ~Ie$ it b Ix )~i ble ro ide nrify a dieak (bat CHl jusrify the c1etgtnniry slIch a rna lfo rshymar i ns I1(gtufol Ig ic~ l or genlttic cl iscas s Glnclt~r trauma etc )
[dicirc)parhk S(oliosis has been divicled ~(corcling (0
the ~Ie of tlie patient egrave1l the tiJ1ll of d~[ccli n of the condil ion into ti) ur t ypei ln fanUlc jU nik ltldolesshyccnt lnd aduh Til l m n st cnnunon (VPC IS the acloshylescegravenr o licirceacute I1IJctenzec1 hy 1 sud le l1 tggrH3l ion uuml uring the grow tll Spllrt (Hg 1)2
lhile p tu 1l sco liosi i5 Ycry lomnw n thl pre shy~Iknct ra te f r adole ent icuumlop~lthic structural CU IY~S in sch )o chilclren are 18middot20
- 10 Co bb d~grels o r m on l -lil
- 2) ~ohh dtgreclt or mort O 2~j - bull () (obb d gre -s )1 mOfeacute ()ll 2
Clin iltI [ d e isio ns lfl IXlSed 111 an lccu r~He pregshynosi which obt inccl in eJch pa ti nt mainly o n the basi of the nsidu~ll p()tlnllltl l of TH1h and the result s of 1 rh clin 1 1 ~l1d tadiogmpl i exlminashyti(ln12ll c noieq uentlya d inica ] la sifiou io n o f the ing le pHient tn -ome estent co incic1 ing w irh the
D diographic one c l n lw SLlIl1H1arizeci 1 1 folIcJ - mikl lc~ (1)(n 20 C bh de~r es - moderJt l betwlen ln md 15 ohh de~ rtes - StV re 111( gt1lt rh n ~J) )bh (kgf s
On the 1) lsis of [hi - dinic d d a lfic t i n (Vith l1l il el lrb tiOI ~ o f the ir b() und~ri e ) in Itllt l cente rS Of SCOtiO LS ITe ltlllent in the Lltin odcl (i rJ Ital lnmct md PI iJ Ugrave tre tmtnt i s plmmcd a fo lltJw 8l
- mild kineslth e (~1fw ~1Il (1 luok-ou t - Hl demte IJragravecegrave 1111101 c(~r md k i rws ithe lJpy - ~cven surgery
Physical exe rcL~e for S(ol iosis
Defi t tiOl l S
PhyS i 11 nU b lIKrlttp middot (or kines ithcIa Pl) i a p rvgrlill or plt~i Gl l (xeriltecircS ~1ci fi ( llJ y ltk ~ loped
y a -11 [ru ine 1pll yslo ther3pisr wirh th e m 10 Hllll
- pre (~ n tit1g tlc aggraaLion of the cl I )flnily in rnild bullcoUm is
- helping tlk Il ld Ct ~lOd ounter~lCtjng its skie elfects in III de rltegrave sc li sis
Tn tl1i_ feSpec1 kinesitl1ert py f JI s oliosis is tonshysider l a o on of peciticcedil training and s genecirc tltllly proposelt in sessions 0 1 4~ ro 60 minute IW) t) tour limes 1 Cee PhysiGtl exerci es can aLo ll v o ther auumlns 1S it oill he dise Issed in this plper
Ir 15 Ilot possib le to cl escribe a single progrlIT1 o r exerc ise a5 pro nrams ale USLIJUy p fgt nll ized ( ( lt
EUH PA ~illDI (DP1I YS IC~ 182
ROlL UF P l 1YSICAL lXl 1lt 1~E IN l IlE 11 ~l) IEd If IlU) l[)VP 1HI AIJ() J)~Cl~ r COl ~I NlG1W il
f)( 15 egraved ( )Il the nee L- 01 indi iuua l pJl itnts) al l l10ugh Lheacute) C l n h t 11 plicd o n a WOU p hJ~js (-1 (0 () pnients PC[ ~l ()lI r)middot lugrave reQCf lhese 1 10 grl lll frequt ml~ V IIT
hnm on in middotituk w allClthltJmiddot -Ill Jnv L l~egrave at Wc w Ht ~huw in lhis lyl peJ it i~ 111 n u -eII1 tu id e ntilv kirK itheJapturlc aims w hitl l ucircrr~spnd LO ugravelt~lil1 DUtshy
g X ir ur ph -s ici l lxtTi~l I~llhe r thln ln dj( us- indishyiJ u1 1progr-lfll
Aduumll l lxUl kisure time ~lOd h )u] Sp u lllll8 ~Ilttishy
i lt egrave~ i middotomm )Ly s iven lel mJ ing ro w hlf ~ Iuumlnsidshyer~d usdul or il lrmfu l in t1 lt rruning (lI tJw ptliJicirct ln tl1bplper Ugrave1 gent ltl l t rl ll bull p lwsiCUgrave lttG iviUes is rl ktll 10 JllI1ltlCc hOlll gtpOlt mJ kIJ1lsIcircl hc lJ l f
i ve lUen tloneumld )bo C on lv ine n dul( re Ull~ 1t~1 t s far Ilten publislt d f I~ mJ I(i noltgtithltl rgt is 11 11 a su h jel lnI deacutehate CJitk haltlt t llltit m itn ltl of l ny lorm o t p l1 ySiClI lxrcL e as a Itwr1 [ J- fo r i liopa tb il jcoJL~b un iL ()ri gin~ initial1) it WIS Ille r rOmiddotUumlK lt brgdv u f p l~lt titu gtllergt w h ) intervenecl hutll tc llcrl ll (mon as cltl HtilJ nic in terventi n man Jgt
1 t lltrJp utl t one 1 md rC j fkll l~ on rhe h sh lf som uni cOen I1v pn t I1cgts wt ldl hll ltl enl1 JI~ haLl nu na l scicnt lfic baisYmiddot HOlh tlle$( trr t peu shy to rh ~rl py tt nJecI to l~~rJ tte C Ih tk CUf -~ pnnshyclr~tll y as a f tsul t of lilo h llIzatio ll of tn imdqultdy ~u pp rt(d S pln eacute 7~ 12 to re-t1 r rI ltrl 1$ l l1C k o f WH llt~~rdl 10 I ndt~-dll()urnah tnd 11( on1 p~l per u suaJly Cl tc([ IS n prelimmtrf lll d 3 ln tt li w ay man (l rrlKpt(Hc H lf O iS Inll ph ~i C U l ~ d vi ~ cI nllog scnliotl pa t le nL~ 3gainst holll ph lca l egravexershyclc and p()rt~1
It m u st t~ n tfd [hat pllyknl txerc j~ tJe~ltm(nls t1iHer 1 lJ rd il1g r rhe rherlpcu tlC litTl~ on lllc h tJ rgt ap p lolc il l the IXlltent lncl hi im r IIIllHnt i- 1 (1(1 rI - 5lt1J lC igt tIl l ( f phJllIlllolopJ al rrea tmln ls Ihith cllffc r 1lt œQlfd- rhe m C cculc u ~t(l luI thl p al 1t n
~mc l 11i (lbE~e Tt i ~ P ~il k tlwreI[middote thll wuumlk ltlll t kin 1or ph~ i Clt1 1 lX r(j~ 1I 111~ t bc loidvd by t h~ Lo iurie IxujCJ1l al1ulhcr a dl ~IS nJI h~ iOg (1 11shygerols llugJr in racr le (wi ller d I ~fJIII ~ I ml thlls re(nl1l rn ndc(1
fn n UI cel1ll r we In(~ hccf) using 1 ) 1 1111 11 ve ) 1 (J p lw l icd ex(r(i~e (0 J ( 1I l tt i~ tlh aITt ~ l~d Ilv m ikl tru cflumiddott1 adokscltnt (cl ioj arh lC icoli is11 2)
ina the f U~ t rc-gt uJrs IefC pu b lishe - the pJ( )grd m 11lt1lt l1te n PWltllk d in fa c t deel()pnlln l~ in th t l itshy OlL1Ii in tl1 r b t ~() ycal f ha ve iclemi fiecl niO l l
m d 111 ur impl rnHm s md d i s )h ilir i (gt~ lue t idlo p lthk amp()lio -i ~ t Jll CIII he 1UO(l if Icirc 1by phyict1 egrave xert iSlgt l fe t rrncllt
l illl
111e aim of t l1JS r~l per ii tmiddot (tv iew tl1( l iterat urt to a(errl ln v llic ll of th~ impa irm 1t~ and Liit hil it il i GllIltec hy ~ o l i()gtj s -o ull he ll nt x or re middotlu celt1 Ili pl1ysical xerclse An u p-to-da te knOvkdge o f tl lt Lgtpecl-gt i necckC1 in rJeumlr) d -oek
- whetll~r there h ltl n adLtIIl ) l tht()d ical bbh fur or JqIIcirclb l l l1 Il( ) f k irt llit herlpy
- h N I)(1 ( 1 Dm tlle p r l c tIcirc(( o f Jebur tiJne )pOfung lcli v l ti ~ IIOU lci he tllf) -d o
II J U V f h 1 I11~ c~~lb li hed Ihe usefuhlLss 01 k il1 shyc ~thtrpy il i aIle dy l nsi 1([(( -r-tI Llleu i n )I11 plJt~ ut the wJrld ir ilt ecircS~nl i 1 I( id n Iv w l1i li ( 1shy
gories 0 1 pl1Vtl( 1excrClgtegt te D)bilI7it ric 1n (Ir st shylliuumlZltio f) lttlt tlgtbltn ing ni trcrccedilh ing erc) hn Id be
vnlcled he tll rhe nuld be lerrillldll1 1 md whidl s tlQu1d be inreœ jf ic(1 IJeClU~l tlley cOli lel Je LI ~ful
Ncuro1llotor impainncnts
Imv aUl llOr~ 11 lt1lt ~tlKlteJ lhe cltlndatiotl bd Ween tl UC1UmiddotIt t l ol(~C t nt id iopml je -nll ~J~ and cli~l l shyler~ lr 1tH lest ihuLIr yt 1 _ 13 ~ 311 D uhoussct 1
1-- ITS tln l ldiopath k s(o lio-L L cll -c d l J l hmgt in th terl tltr f prop li l l pu n md 1I1ar th e detrshyn Hi n i~ na tural 1 ~ronse to ril e need tu ts tu re p()tun ltlluilib riu Ul HcrmJJ1 31~ 11 () d tllat icliupathic ( liCl5j h l it re5u lt Ot1 rw nltuf mot r l ~ltelV
[Id )fcl 3 nI] ~1ltJ U Sr1lle nr to dtorders in centJtI lO~Cl shyIOIDNur) md 1xi~tI moro (Ul1lfOl syt( llI (Fig _l
N htIll -of) H1c S uumll h( rll1 ( ~ l( w ing JI t11 (oshyI-ie on the l l lO]ugy o b doll (nt Rl iu]icirc tlili- middot()lioL m unt fil t-hltll rhl ugravedcmnilV L th e fl5 ult o f 1 (k btcl 11lIFll llI ion nf som t11(WUgravetltnl md pO~ lur( (tnic l~ l licirc1 tl1lt if l p OgtlbJt b C 1l rlw sta l i lin 0f 11 1 Sf llle j lt g )tx l Tt) ohtil n a ))Cli U 1ILzltl I o f p ~llIr~il d l~flo [ in l1litkd ~J)llnSIS me CI Igt(middotqucnr J ~ a ~tmicirc ()nlly or regle Ie Llive
Ali th- 11yp ) tlw~es rd ~lte tr d irtl Itn t pnl1tlt o f [11 v hole ~piltm It11[ controls postu re ~nd mrw shyment lrre pell ic of tlh po int a d lI~ llv inH llYegraved il i ~ ll 1 nnable tCl aSUilll ri 1l tr l ll1 lo g thi ~ys ttm ( Qu it le 1I middoteli tl
lt ch ugt nlt~(S f rullliIl thil i nlomwtion th at p tlmiddot shyiCil J(tl iIies nw gt Il lInport~n t rr le to pbv [11Icircgt role ca n 1)lt slI i11l1lariztd ln lWO the ptu li ain Llt
- d elopmll1 l of p uumlltl St1 b Hlt ) - c1e veuml IOpm 1)[ o f bhll1ltc _
(k llhUl)lOr S Cll orr
ontrot oic whan-lt
------+ 1 ~ il lnll ugrave r AINnl
Cllnlr1
T bflt~ r
fltL1 tlli
lMini
l
~sary ~J-frlllen i )f
~ 1 ocirctnl
~UcirclllIJJlW Ll
AXl ~l1 n uumll l) r sy 5t ~nl
middoticoltoq ~ Fig 2-AcFgtrdong lU He-mutl 21 il is Fi)5~ ib1e rD prolXgtSlt l -oo ie1 mnd 1 ((if ~ elio egrave middotAhltr~d l)Qdy-p ati~ I I i u d) uren ttllOn k td LO In ~ory reHTt I1 eDi tn l al ) JdrnlV~ pn)4~ e l u r~o(Ofe 0-c1 eptunl dvstil t1 ctlon sltŒ(ry icircltu nu11t ilwnt [ ~mC ~ted tl l1 ce Ill trpntlshyUumlfJJl nd IKnle~ r~dibl jtugrave)n of -I) m tlosen Ir ~ig nj tl (I1vying ln fornll1U n (lI an ereltl ~piJl e Mmor aJJ r--a t ~) n ltgtf ti lt aXljl mowr plem iHUC Wh ~fl Ille 6ubjeco m uumlntl Icircn (1oJifitd perccpfLlI l ~na l ysilt of p n)lnocepti Icircnfu rnlaquol ti desnibJOS ~n t tecr spin A IICW motor co nrro l Ira I gy t adopt resu ltin~ in the ~tr ltctltr 1 ckformh y lf IdiopathirL scollos i=i Ht lrftU1uc nltnt l ISll I1lJy h1e- ~ I pro()und elkn on bralO Sfem flJll ct i(lnn~lLhu modifyRll Ille nltulltgtshytl10 ) 1 1111 Uu l-lHoror control 5~Shnl$ shy
As Srtgn1lt1 l ~ ltlssert~ if wc l C -Cp t 111 1 un o f the G IiC s oliosls L l tisorckr oi th e ltquilibrilltn sys t ~ms it is lagical to oriegravenrate physlCl l exercis( lherap y ln th is d ir(gtCli()[1
11lclte goals Cul tl lfOUgil ditrercn t modes 01 action be Olchic(-c1 witJ1 phykal accivit ie
- po rt ive Cll ities p ro ct LJ e aIl UgravelClltrtsc in 6lte nshyel ll )o rd in~lti n pinai pr0prinup ti_)[J nLi mOVeshyment control 0 vio lls iy ln thh repect ome lCtivshylites aœ pre um~I I)y lXrter tllln ntil crs
- kinrl lira py using pedJil exerCisocirc specially developecl lith th est 1101 5 in mind illVuuml VC I lllore prccilt( ll1d InC1 li zed cri n on rhe spiJw focusing
a90
1 ~~
lg -lNheJo ~1l l1 t r~l g rld in 1 1) h i(~ IImiddot ct r rHienl w i ll idlllhic _It ~i ~ _ iri s plt ~I le II find Jit ltH vlllleuml ~l Cgtbl tn~ ks III d il fef lt p ~ lt ihnS nu v~tl middot B ~a~pt u Il C middotl)Icircd ~(t l l11 C dlfkrCnl middot- hdween slllndi1g Uline nu nllt1Xinul oorrec ri nI t chied Vith Ct (J ) und tfdincJ ne lot es o UIine 1 fo llnVs middotIJfl tfi ni( - ltlrshy
reltiK)n ~ Ikexibiliry st3nucircing - -pirte - f ur~1 1IbjISC ltupin - ltorrcaion - - r~luci()il ll ymiddot For flmpllt in J npK l1 pH k1J il
plt1SSlhlc ln obtai n 10 u1 511ndlt)l [YLo lion yr ln Slt p ille rlOlgt itlugraven om l J ~ in ( gttf(C rigtIl lIex lbuil 15 i (r-l l=22deg pol lltl ~~J IIlpraquo is IcircO~-V- I t1 l nd tucircu(Ugrave) ilil) I~ 3laquoJO- IH-12
r ln Ugravel e abilit jl of tluuml [m e llu to co ntro l irse lr in ~ pac
fuld l oftlles uumlllelve ntio ns can presum1b1r incn~~ Ih enl ac )1 the orller and lHitlll r of Ille rn - 11 )ltd h e lllldenl lu EJ3)4il
Posl1l1-t collapse lnd slabilizariotl
lIle concept u fplt st lUal c(l lJap~e l l~t Iwen detin 61 by DlI II-T3e~tupegrave rL t Ac oJdin)j tu tl1i- ~ll1thor il [ nec(sary ~- l Hn Cv-tlualing th tleihility o f a col shylo tIcircC CUJVL (0 clistingu ih bt tVeen the re du ihil [ty index (th - li iffer gt le bet ~middot Il ~I r~tcli()grJph ie ~xnmshyinltio n of the iI111 pHienr in supine po ition m(i
ROte OF Pl rnmL EŒIlCISE IN THE TREAT-ŒNT OP ~I IJD IDIOPAnnC OOU~GEm seou SIS EltJRINI
I (~)-----------------------~
__ _~ _____ _~ __ __ L ___~ ________1 ____ _ __ ____ ___ ___ _____L___ _____ l___ ----------L ______ _
1 ~
1
-- ------- --1---- ---- ]---r --- -----_----t- ---- --- ---shy__ ______~---- __ ____ 1________ __ _1_ __ ____ __shy
~ (1 J
1
8 =~~=r=middotmiddotmiddotmiddoti~=-middotl--- middotmiddotmiddotshy--------------t----------~- -------- - ------__shy
~---- --- -- -~ -------------r---- -- -- ~-- - -------- --shy----i-------r-- - ---- ~~-shy
il 1~ 0
Dtl-Lmiddot ~ lttj l r~ UIltltlHt
f g 1 -TI1 u ilictf 1ld ( ii 11- ugraveu-sh) ld IX~ O 1d wllich ltJdnrshymII Il nf the pilll 1 ~tln~1 of th e -o lioti( spinc n IG~nI(J II IIIshytt) lhe iJeuml grl-e o f ~ ()Ii ti c (u rvH Il 1 w dcpc-nlknrly o l l he 10 111shy
P01(nl (pntt l ~ 1 1 nr ffll wrJ I) ln w hilth Ihe n i 1gt( ~ duc nL~ grlphs fm I h~lt 111lt hi~hr Iht Col h ~Ilu t (l f Lite ~Ul Ihe m Ol CI il y th t s(uumlJotil middotpin~ ~111 he ~middotJg gr~lVH(~(1
m mJxiTIt corrttt ion wll iJl i~ lIllCd to Ih - xt 1shy
lti Oilil y Jf tl1lt t Ut JO rl1t cdnUc idt md p OS shy
tU ll cul lapse ( th t ltHill enct b-tten l lUdioL) 1lphic egraveltamJl1ltlti OI1 J t th e ~lme pa tient in Sl il tl cling lOJ lline fX-sitiutl ) Wll ic h correb lc- onl wil ll fhe abilt ty of lllt p tu rl l gt s tem to C( lunternct lIk luree o r grl viry )cco d ing rv D lfVd- f3egraveLIprc po st li r t1 lt01shyIlDse is d ue to the Jnus -u lar ton a nd 11ll ex rCrIshy i) i itv of rhe tissus n the ( O IW-) si it (If the (01shyjl ti (~JtVe (Fi~ 3 L Pu~t llr1 C lltpstl lu lcl l ~~ reduc l-lt by llwans o f pl1ysica l cxerCles specitkally s tuclled ruuml i rnprove tIlus--ubr fOHt md lU pr )cllI Ct 1 ~11 hi shy
lizing ffCd
PararcL n tll CIJ cl the cr iti ca l (3 c1 thlsho ld beQ ld Il ich defol1J lHU n of the i pinlt 1 e~ in~ ne dtlllontr~1t _cl (1l ll t grclrf r mg] o f rllt C II in a qa m bng pos ition corn pOil 15 t l lowcr detormashytion lhnsllold (Fig 1) ie to ~11l Ulne3Se t the risk of pr ogr t~ lu n There t rh eJef re l J ea r l)iuuml 1itshycJ l ~ll1 l l(tl a 1 tnr tg ro b ohwined by d -cr t l ~ illg ilmiddot pU~lUrll cull lpse ptJcelJtge w bich lccording t i)
h llTd tnd ~l(heJ1l ~on 1~ b inde cl 1X llt icularly luumlgh Ugravel mllcl c Iio~ i (bdow 2( 0 ) (F ig 5 J
Fin a Il III ch iS respect lllljl hl and b um l 01 m linmiddot
ii iI 1 l _ _~ _ ___I ___ ___ __L ___ _ ___ ___J______ ___ 1 ___
li 1 1 1 1 i 1
1 i ___--____---___----__-_---_~- _ _--_ ___-+----
i
1
i -- ~- -- ---~-----_-~-_-_--_1-~
l ~
i
+----r--------t-------t------f-- J
Fj~ ~-Ac(XjJlin(Q luuml T O rIcd ~lnd Na(h(ln~ n i () dl( pCG w rd (rTIshy
POO ll is hiherin cu rvegt in wh ilt l1lh ~1flILWrd cII1I Olk l1t IS le- pr(v~knt ln th e grtph Ih t PogttJlJ I ugtnq) Ot1 -J1l j elfltS-e J tlt 1l1t obb dirr remc rlLIv obu incu f roll l the Cohb atl( 0 1stlI1dtJ1g IId gtupinc rldo~raf115 Ih Ille lt) [1l1t1 (i lndnl I pine) 511pille the ~(nlClu tJ1 compo l1lnt U rlk CU Y _VeJily I~ ltx p rlt 1 L1v UpUlt (obh Illeturo Ih t si _b Cct rtJeSIm l fie -ltn J trd Ugraveltuuml shyuumlo n A~-i)rding LP 11(lt uuta o n l ( r1I~( in ~I 2JQ sup itlt curvt 1hi C(]l)b ddhccno l l f lO is -J-lultt( thc s ldnd inr tnla Ol1l t lS wi Q) whil 11) 1 1)401 ~llp lne ClHVC If ~ 1Omiddot ( tcl Lhe ttnd trl~ nlca~ I(t I ~ ~I)
tli n ll w l lllE cq lin ti spin h~ i ng mo r ~ Llnt~II) 1 tlun the nOftl111 one n Cll l gr(lk ( (cU ve tl1u n da r u p shy
po rt in o r k r 10 m linrl in tht 1xi11po tuf_ n th ha__i of th egt onideratl lr1S it f(lll() rhJt
ph rH (~Uuml e erd es ulukl h u - ul iiuml tbeacuteY ~U-L lm cl 1l (It-d o pmg p05111 td C Jl1twl lS fuumlrnll~ rly d ccrll1td ln an Ql St if i imr ol1111 t ru t(( - tht m(d in C JI shy
r t t r sture fO Ir -ngthen tlll m u ck-gt of the spint mainl) in (11erl antig r3ilrl tIcirclt l]lli fun ctin ll U hy meU15 dl i )ll1 t trk ~ lhJ cl( -ll tlt C)nlr~lUions ~llld no l IdOshy
1l)llic d YIltll1k lt l jAJ lktic t) I1 ) II 11)t 111 hd posibleacute t lcluuml ee postura l io nrro and stfh ili lllllt IJI
w i thout food T1lw(ull r d I( Lf(11 Ibk t m ucircnuin Ihe c()rf ~ct [ ()S tu re for cl gtu ifKi IH lLl1gth 0f ti l11 ~
This i-l ddl usl a typl 11 dnmnin (tf k inesllh rap) in 11 (lt-11 [[k - p~d fk lnr in lng f u l1a in llllliCk is poss ihle lI sing ctrtain Idncl fJ l (lt) 11111 liun S p Ul in tb is Cl c is ulttful ooly sa I~tr 1~ il Iw lps t1w lxltknt 1 becuJl)t 1gtlt ltlt-I a ClJu~l inred irl ilL ntllru l o~ i cll
and I1lll~lJhl r-keJc LIl [rll-llIn~ middot etlt(wrs JI the int e rmiddot vlnrion
[J ROPA MfJ) I()Wf-I YSJ IR
1
ICR 1 1-1
r
1 shy ~
- shy
11 o-llrfOlhe5l~ o t Ih 1O~(1dity i n h ~ r ~ ll nr pbl1 l of ~ Spl11 in 111011 _llti1Gt l lPt f ltlJUCWJtl ( ~l Ihe Ir t 1 1gt illbll W Ilh LtltrJ1dlion Vln lbe rigronl middotUII~ l(I Dko n12 lIll h lumshydlanie1 1 [ nul 1 M hl whtrc M - gt) lnIUI1g 111laquo111laquo1 1 1 c rtJCshytjC~ f fce d -d Lill l1~ o f enr niI pUll spnmcl1y 1~ 111 mldlll1lt (n the fl1ur t 1 = tor~ of f(ward Ileuuml l = ughtel1lng fmiddotr p 1shynOf stn lClU= Alaquo rdtllg 1raquo Ihl~ - lin hull th l1ltgtllugrave ot tller1l lUr~Jtllrc F the ~pin t -ilh rlu1i tf Ihl 1 1Ibulll n lrlt InltT1 1
rbc prJI 3IJi l1ty d qrlOIJ~ n bull JI t IlJIII Hm lA the v=ltd gtc e lu-ing J 5lnK1ura i ltfnnity
Dioal e ch anicll itllp~lir J11 c nt
Ihrcemiddotdimcllgtional mc-cbal1in of the s pioc
~f Ikmiddot i t i nly l(œ ntly tlHr llk pr-5tnœ or nc ushy1 lnlo tnr impairment in Idiopttlllc s-ol ii IXl tknt liuml J$ heen h i- ll licircghlcJ hy re$eJ rh tll e preit ilegravee h inm b nIcirc Ji d lJutg~ lt hl ~ 1 ng t o n dO Ulll urcel 1 i5 (l lreldv well umlersrood H(j-ev~r nev lbt un h iomcrhankal im l) ion nI h1c rectm ly onk l n tIlt tre and p r~dou in f n rmtinn hou t pl1ykd (~fcl5( in t 11 0 tl1I _ltgt pbne of spact 1115 Im trqlt-u 1rom J i-[) v ing unclcrsrmdlng ot th l lmc -dim nshy~ilnl l l11 ~ hmk f the cO]jO[lC pln( ~2middot ) ) Ve- w ill )iI xnl t l1 d at lcL-orcltng tUl cl sif iol t lOn blsed o n gtolllt lricd h uumlCJ ) p lane
- b() rJzU[1tl ln th i pla n ~ th t 1o rm ll sp ine present no CUlye- w ll ile Uumll(~ ltc U Hic spLnc clevelops one of ir haracterls(Icircc deFo rm tiCs v elt tbrd ln lashytio n vh icl1 pJ()VcA~ theacute hw 11
- lgitltl in th llulJe U l(~ nonmll spIcirclle pl SenL kypl lOSis ~nd l dooi~ in tb lXI1 lhese [(Hu rts Vere m)( til ught [ 0 he relattd tlle scolkJtlc ( lI r Vegrave
- front l in hi pleme tht ncrmal p ine preseuron t no curYegrave whil thl ~11li tic p in ugravetI I ()~ icircl~ charshyad t Ilt I CU1C
Il Jri fJIIt palic
~l+I~na ra 3 r inr lut th l[ ber ll1d a œl1~lU1 degr 1
l f r()la tJo u lllu (lILa r forcKl ltxert ltJn tl ldefnmuumlng 1 tkllJ [J i1u a re- lhlt tll cly 11 [1 1 UI b y Olm ner w bn ~lh uiJwd tl egrave ro t1tic) l1 Ilm it ti lt p ica] lf shy
rhrl r() be (P (the Uma bevond Wl1iltJl th lCOJlb of [11( ~pmaJ musd ~ dthc COnCIt and nm ex ~l le btconk (t O li~[)
r ~l 18 ~1Il N lu t( ren i9 lun lu ted rlseurlt h in tlt ) tilt lULodeumlformipg1 tlo n ot tIH_ sc laquoJrle rh ox ercallkren lk 1l1~H li d11r once thl Il i ~ r tld1t5 [he lhrth ld f 111 JlIcirc lIi of tlle dnrlclc hurnp tlk
lI bslt Il l nt rlet()rlll lIcircon 01 the it l ()I~ C ( (ylm der (- sustalnecl by an H1tmi cforming aCOOIl
J1Ji h V hl rhyiical f~ f Ise CI 01 h spr n llnd kin middot ith ccedilrapJ my lX damlg ing vll e n l pplild as flle
igt Jk Iller ln SCC1IJ ~IS lllc lJ fxceed l auto in middot crca~ i n g lhrllgthuld [1 sh (~u Id ahn be j ofed that Ilw relscd pre sun 1l1111i insiugrave l fe pil1r inn) 1 mlshylt
- j Il- ( w atff 1 (nh ~1l 1(e Il10 utoldrml ng li1eCh~lI1 1sm
in flc l Geyer ~w tcd th1 t rm m 1 hI l)1ecircch1O lla1 puilll 0 l I C~ sw m mim t Ieuroamp no purpo t for cu lshyim le pllilt t1 s (weumlO middott r it is l~Jl(gtWl1 rhn in iculio r[ paULnl -iJl11T1ill~ doe_gt nor Il ~lp to i ncrt~SL n eur(1shym tor co mfU
(1irai p an (
Jerdnn lle 11 showecl thal ill CSl~ o f t10rLC IC 1i lUgrave
tllo lacolulllhil it lio_1 tlle cte tI llmiry in (he lg itt1 p lln t rn lnlftot il~ lf tspe iuUy in tlw initi 11 r luleuml )f cV IU[Icircon nf Ile ~oli ls W iU l 1 p(t)gr~s~ivlt il10middot~ shy
ment roward hvpok pho b G ll f ill~l Im lins l har dUflng (IN eWllLlfiu1 of 11Imh] co luumlgt i the l in t ot t l H~ gClyty Cegraven te l - 0 1 v llebed lxxli 5 r ro ject 1 seH fl r t side-ys and tlwn backlrcl bull thu~ p(0(1 lj n g a kyphQtlmg aet Il ln (h~ lu mhnr --PIl1 COftj tng
l l i tc Iugrave l lltl l( l rs1 tif s L -etllgt il l the lgirl11
1 Hl)
Ilu LE nI rIIY~Ic~L lXIlKISI 1 HI E TREhTMEtn OP JIU IDIOP llII C AD O USCUH O Ll Œl15 NEGR II
lLill tegt lre lenl1 ~I d ~fo rll1J[ ~ rhl recrSes the phyltiologiGII cmns of lh vine)
Accordlng () Dicion ~2 1 rtcluctio fl in the itgitttl CUIYtS combin l vi th a lueral Iviari n llltl ds t 1
mecban ism () ugravel~ta il ity in l he r rat r IllI1e which bVOf1i the unsd a nd i ncrea~e 0 1 co hlt1is (Fig 6 hiIf md Pl11jlbiJ Jl1eanwlt ile lt(udiecl lh e srnl ru t
orzyglpophySLs show ing t11 al ttleir 1I1tl rnic tl orienshytation f~I (jLi l~ltes aXIal ve rtegravebJl l rotllio ll in cun litluns lt f dorsal hypokrrhn Icirc tnd lum)H de i L lo IS
Tll t dat SLlgge 1 th t impOrfill ut pOitu res and l1lweil1 ) t Mudied in ord t r (CI mlIuml ntrlin or to reuwer fll e p llyslo lo~lCll ClIlye in lIe SlgJtta p lU)l Wlth the llm o t ch ~ kin~ rutltor in l~ bili ry7 AbC th ~e ~k-
1l11nL ~Irt del lnt [0 J jUc lt ftber l]kuti inrervenl ion vhich 1c)LJ k l IV - i(l ~ l compktl n l ililll on Il t c1 l shy-jel1 J11UVllT1ent IJ j o f 1uto-dOneacute(3tlon ( i e a -impk ld ion ) Iengtheni ng o f the pilleacute 011 a litlltl l aXl~ tll lt ((IT liJlI~rcdu e~ t lle ~---lJ linti- l lte ml-fkxj(l n h UI 11 - i llCrl I~t the plllH ](JgicJI dlt cr ~l S ( (1 k-yvllCiSh lIld O(ltOSh l o r c lch r1Iif n t a Ilew til(~ecirc dUuml llt Ilshy
si lflltl J ll1 u(~nlent iam ecl - 1l1t0- lIrfe rionmiddot7 4 llmshyp oed f Je-rura l iUIl cl middot-t1e- iltm lI1d ll1a intltnUlLe )( 5lg it d C Uf (gtS slig lll thltJrc i ypI1 tiZ) tIcircOI1 a nd lunugrave)ar 1()fdos i7~llion) sholild he esw b lb]HU 00 lb co
hl b oi hi p~l11il uU r -1Ir vlt Abo 111( e IlltUtl Chl lie o f purti n - a U vitk slJ1ultI h e )tuumlll ecl 1)] (1 n ldershy](ion r tl1i lt type for e upIe IilJ llyl)T S of repd shyiti( ml vemen prt n t in agonistK h)lnllltlSlks nI iIle kind f dlJ1ce C( uld he ([([r imentd
FmiddotO lllaljlallC and mobili ty of the SpIcircIlC
1 rd llo U 22 d L lm nrrare d lhlt in Illt fro nt a l pll ne
tilt 1 nge Clt 1)1lt vtment of tht scplit[i middot CU IY grcmr lIJ l il ~ d irectio n n f Lhe C ITelt tlO n tha n in tl le di re shyLion of pmgressi n l Fig 7 ) he IL o IS5err lJd tbat th15 mohiliry increac plrtil u la rly n apic [ cgcoeilts 1$ lh ~ ~c() li osb evolves Sragrm rJ 12 J ~ thus rigilt (0
VlI f n rller~p is ts Ilo t t) m o b uumliz - a sCtJl iu til curve w ilhout t [ uling ttwt tlle R lu tiOI o i til t ~a mt b fnlinruumln( 1hy l1tans o f ~I passic 01 1 rivE -uppnrt On tilt (ltllE r hand UgraveK d e iJlioJ1 in ease durill tlw tune 111 whicll tll C spmt i ~ not submjtrcd to correeshy( IV anl()n
j- Virh mi lei ol i b tlllt Upp i1n ill) lC tiol is d eveloped only lllmugil llClIf()mu$Cllbr f r llce thi ~
InegravelIl ~ thclcfo re tl1l[ inu eascgtt sp1J1all1extl)iity mua
11
Imiddotiumltgt 7-rurd illt Ir) 1 bull rdrilt I1 1 in tl lt frOlllll pbnlt- th( illl ge )r mOC llIeJlI o t the S-o UIIJC CUNe 1 supcrior in Ihlt diflt(l im ugrave( the n nKlIl thd n ll1 tllc dlrtcLion o f p rJ1(l( (llIl
be considrCtJ vntrl iJ)(l icltion and 1 undrli neocirc ab L a ~ubiljz~ILion 01 tilt spint pllss il)1y ohtl ll1td thrltJugll the stlengtlkl11ng o f the 1rltJgm vlt nonil lme shyCIC 111 illli orrant u bjcLliH- ln rhis r~f1 n sp u lllni lc tivitIumlLs sil uld lX tPI 10 dlegraveltl it l G lU t n w l1ik luring kine i Icircth lrr phyltical eXegraverci c~ tllat in ele
spinal m ot ilIcirclY sil nid 1e lt1 oid cdrt ~
Organ ie and psychologieal impainncuts and li islbi IiI le
A cgtI im lc pmi nr is moriOthl11 just 1 sp in and 1
compkt gt Ipp rnach to the gu in ad 1 ont i al~ shylute l e~se i t i11
[)a la 0 11[ [n ell lrom re semh pw tbat ome organi Iilnctiond cl fki ts suc]) as tlw clecrtiUe ut vild l tnd d fun ll l)Kity_orld ldly incrtJ k whil~ 0 shy[io s i -till in (1 miel q g of g JltlV ity ~ l ilI e 55 rtI lit
tllL pres e n ce )fl defidt Or Vi l~il Clp~1 - i~ ln one pIIiem in Ihr l ftectecl by 20 ICl 40 scoi stgt l ls~a r(h cunclutecl in tbe UA by Di Ruce- prod uegraveed an aaalo) u ll1lXimum 102 re u t in a group of Jd shyk 1ien t [(h sco llosls rang inF frum ) [0 1
Al10ther rudv bv rallt r m C chr111 lilcl NashycWrl1s( u 57 stlO eltt hil $(C 1 1 ui~ Ica js l( lllt cl (1 shy1prUlllI o f t1tgl lie bJd l imI in ~ul sct t1 t ltu b middot iects jlLltr l5 they are golng through ~I cltlici[e sllge in the fnm 1lt i n 01 tlWH o w n id uHitv t factor hit h Illy jeopmlize the cl velopme lit d ~ mIll lt lI1d htIshym cecl IWI sonalitr in Klulrhood
n RUI ~IEDl(( Ptl Y1-
ROU ltHmiddot PI [ I C~ 1 EXIRCIS]~ IN TI Il nW~JUNT OF SlllO lDIOP1HIC AI)C~ESΠ11 C(gt1[Oi 1S
This i why b IiCieacute ii is ~n imporrlIl t for p rcshyvegraveml e 1tLsr l tn en ou flge 1ari e nrs ~lfrecr(d by lIillcl middotu iosis ft) tlke p~l rt in portin -re rcatioluJ acrivitits Iha t 1eIU 10 L10 th r~1chophyinLl bull nd b~l )i 1l1o tur adlieem t n li 51Jmiddot2Even tlK)ugli [Dr bic mech~lnshy
ical mcl nellIUll10t 11 11 reltl ~ons lt r111 1gtomcrimes be l lefu l to ugg( ~t ne p rt in~ aCt iv ity r l h (gtr rll n anotlJer e th ink Ibal an exces~ ive IlHd icalizltion - Icirce l ll1posilion br plry~ilt i HlS nnejlor parents uf rh ry pe of po rt to lx p m lice 1 b Ule p 1Ucirc(Il L th1[ preshydLl ck l1 is fret clOice in lh ma tt r - -h II ll1 he avolc1ed wb 11 possLhle mainly for tlle i mport~ltll psyshyLb ) jogka l fe a SI)nS W( ha( ill ~ t nltntionegraved
Conclu ion
lbh ISsertegrave d t1H physkal tgtXtlci o is ) n fi ial whlIl practinu in order 10 ilnj rove the I11 llde
rœ nwh and tono C iral caplCiry and postu re o f the StOUO(I ~lIbj n II I nowkdge om ~ middotmg trom ci el1shyrlfi rls(~ Jrc li dJlJ accordl ng r the review 01 thE litshytirlture prnpo )td in t lli plpl r conflrm~ Ihe vuiclit ot th e -t ls ~rti ()ns
In l do l (ent Id iopl1il iC scoliuse il l n phee u i cl vk)pm e n t ( li tll iumlKh eXCC cl l g i en rhk thr hokl th e re i5 an und ubred need fn r l pprnpri 1tegrave (JJ1tOkJJe ~Ild Inr surgict1 therapics ill ortler 1) S l i p
the ( - Iuli on anugrave )JT~t~t UW ~pilll l dtlormities bull evshyerthtless in the illiti ~ll pl l~sC t ttlC c1iseLltc whcn the riS( r1 r euro )luli m is rtduced ocirc ~md tfle uifleal JOld threshold il ~ld flle po stural collai i reJcenw~ 43
JI l1 igh pllysicaJ egravexe rc ise - p revenc or r d llCe d i ~lh ilir ies o f [Iw ~ l() li )tic
p (iems R 28 J -6 5- 6 1 63
- f~KiHtare lh ( n utr ali711iCUl of postu m l d elicits tn produCel1 a coneql l nce J [)ti 0 I111)( or regre si -u lmiddotc 5middot Il 1 17 ~ M
-re 51udles U ~ n Ledecl tu con[mn or re jecr these conClLL i( 1 w l1 ich clerin-d frum 1l1 lIldytica l rcltw n f th e liter~iture appear r- ~Lo nlble Hnwecr Intil ne re ull are 31Iable wc should n r prevent our sroliotic patientmiddot trom tl ki ll p lt in s(loI1ing jshy
ir its pW1iada rly ltl t ~d1()o t () n til t c ntrHY -vith the l xcclrinn 01 gt[1 )11lt tIlat in rea-e t)1obility (tnU evc n thell oilly wh n progr~lgtion b p OSSibl) -uc h ~I( ucircvshyiUe -11 )ulu hl tIKoll w g ed The 11 S J ( rprOpriue kin (~irhe r~l Piuml to incr _~asc p()~tura l $llbil i ty is tl1egraveoretshyic tlly CiJUClt alttloughl more ~Iccu rtte aod deLli led ri k benefi rs anJlr~ is is netot1ed
Ria 1111tO
NIokl Mu d lle ftitYljJfu Jœl il 4IWr10UOifll S (JIvs i (1~1)Jshylidl ttno( cclIll le 11(11(1lt1 RCI fu lle ((lia LltfIt l1 I1I1i(i
LJ ci n s j(r3 pigt egrave li n IHUgru lkl di t rdz t fi sici pe e ft shytUlKm iluppno di un lisimerap15Ll rl lllcflt() 1 110 scopo di pnevirlt () fr en~lI 1-lgpwlllltnlcgt dclld lclonnitugrave o e il 5LOshy
Il i mi llon lt fH nugrave j (1 11ni dei co~e 1 lteIl I1J J nd ne ~Ii eifclti (()Tc rri udk s co lio si d i m e dia g rt iuuml ln que~ltlt
s rud i 30 llizzb mo i d ti cleU ric lca pel n ri Icare qJJ l lm 1 dis(imucirc x u le I[~ l z j-m i pro vna le da lla C gtl k A i json ere pr middote-nute () rk kl ducirc un~l rdeguCltl d nil cra pi lt di uJoseguerrnt Cjua li 1iU110 cli nbie tti 1 rcr lJ)tIId d~ fle)-UITC
n (- -fd7Io n~lcl)
Ut11claquo)si 1 lI tori htpnuuml )ludi-ttn I ~ cnntI1zttu fr Cq(in i idiJ)tic1 dbfl lOZ10l1 d d ~ leOla nelllOll1otoriO Lb un1I1cnUl 1n1l1i3 dcgli 111 lt1i ch DIJgt gtU l H crmU1 Nlch~mslt ( SIshygnaJ~l lerimiddot wo i esuemi -bletti d~ plt~e8lugraver- ne l pClZ le1lftgt scoliodcu kl s iluppo ddl ~ ~ uhjlil~ vertcbral~ lt o svilllp prJ Jdle JIl7 i() nl di ltCjuiljbrio Dng li studi sul lto lb( l~nlrale (OllddU i in pa rticdu d 1 DlIal-BeHJ (gtegraverl ~ P~II IId lI1 n~ llw - idente il v- m gtiu p eT il puientc clioti elgt di u n rnigb o t c)[ ro Ua sw mle dei radlldc onsegull o tramite il 11 fforzrlshyfl len to d e i l1luotoucirc l nllgr3ilri d e luOwo con crcbi ~Clltdr
in pOMltHJ corrctl e in va rie ~i[Jzioni s t llicb c c d inamIcirc tllt Dalle on sena d elb blOffiCcclIlicd tr idimlt n s io mlle d ei
r ~ chi Je ~oU()f icn ~Icirc ~videnuumll (l() ~llt tC p IYZIcircOSI ln(IiClZlfHicircl ~ 1I1shy
liumln fluenzt Je ll middote~rUrio tl SC) lgt lIi I rc pibull m i tldln sJlI71 Stl shygn~I I1 afferma che slI l p Ia no [11 middotccedilr~lk tre un œ rtlJ grado di l L1Liuuml IlC dclh vEltlh r1 apj(de le tu rœ mu SCltJ llri njtbc J n in $tJ ) t rodcfQfll1t1l1te PltJtantu b i r~it-~ r -lp il puugrave t~~
Ixnt-ftla solo nt Ile so )[j)~i Jl1Icirc na rl in qunnt ) ilon SlrM ntne )(l(Ofa tu soglb in caq ) co lltrLJIcircn l)lrilto llt~( i lJudotlsi di lfr~ lI1 C llg grVlmenl J 111 11 io lr riltd ll(17jOill leld rinlle 113 dimO~iumlrlto d llt nell o lin~l cl()~ li t th~oIOl))1 dri la defltgtrshymiti sul p iluO slfl iuale ~vohl lf1 (en5 ion~ sO lnm utto nd 1e bsi iniliali deWggrwm1Cnln mcn trl C a( lfLmn che occlleshyvoluzi ne dene = 110 i [ mhari IJ lin c l ki cen tri ch -1vi1( de i cp i CIt IJ rI Ji SI p m ittIl pnm l Iem lmeme e p o j pOS( shyrio fllwnte dtldnli mdv ( i un ziuuml ne ciloliz7nnl dd rlLtide lu mbJ œ ( lIlelttlaquo on NC n d d (gt11 uIdu m 1I1 Ilgt) cli r-Iure (0 eserClzi che IllUllengano 0 ltlUperifo le Clgt 6gt1 lo)iche sul pirluuml gilwlt Su l p iCl no fron itk Perdnulk il dlll1lt-trlto d1 lampkz-l d i LU ovimento amp111 lI rv Kolio ti ~ nd lt1 0 ddlJ cnrrc-LIcircQo i Ji gC 1 n lungl SUpegraveliltlrccedil 1M llS0 tlell 3ampIGI shyvamcnlo C che l~Jltmiddot mobiliti GlI mcnta co n l c lu7j o fle d l i) snAio i A ulln amplgrtJc1 ltllllmunjx~ i terlpGli nn n m obi shyUZ73It ma eutva coli ti0 1 1ct HsicVlfe nd tcmplt 11 1111nshyttllIcirc1nc n tc (k ll ~1 llu u zinnt n l1 un me77uuml d i sost l11( gt ln 0
e 11111ri b cle - Ilziunc egrave deorinatcl d l rlyarsi Snzcl la pr gtshy
liltlnl l i un() rtl~ i ptmiddot Jtl n(o 1S(Hl () (( ntJ() i ndit~tr i ~ Ii ISt (izi e l m iviL Illdlode ebe Hlmen tno laJlc ibiJii dcl rlc lide SCshy
li io) [n p articobre rune q lldl r C-I1 ich~ xlSiddcHe CUf t shyli ve ch~ iJllpi tgino e~rciii 01( biIi2 ZanUgrave HhnmL-trid () in tmiddot~t~nshy
sione kl fuchide O tne pure k- ~ttivit1 tnotoJII~ non prHi(~ llCcedil
in forma r k rel1tiva d Ie ~1I 11 rF~1l1( n otcol mcnlC 1 lll ubib Ll vcrteblmiddote (ad ~ flp j(l 11 n l) to L ginn ~Iilt Utl clkl rilshyC
mka la cli OT- tcc)
r1il to l~ _ I[Dl COlI rY IC~
NE olUNI
fillncr ( ni ((uuml(( n hIIo( rilclIO ~middothe k lln dtfidl fUr1z i shy
nlu CQll1~ la llcl llZIO 1e delb c apKJl ilde e della capacltl di 0170 mizianu luJndn le (OJ il~ gtna a nc r3 di m~i3 gmshy
v it ln G mlxl r i ~ gko Fl llslrom C dlllJ O e Nachcms(J h iU1I) dim lr JtQ che b o liosl p IOO C1 neUaduksœnr 10 SYil l1p pn d i lIniumlmn~gin nlt8Jliva de corpo in (o nridcnz di Ln ddic3w p ri d di f( m l lz i nlt deUa SUl idenritl condishyZltonc ch pOlrebh ~[I cubrmiddot ln vilu pp di un pe bull n nn lir m llur cd e quiJibfarn in t[C adulro TaU CO1DSCe nZe tvlde nshyZ[II)() la n ( middotess iti di ltimobre la plfte ip a7j0 r1e atl an ivi ll1ltHClr n gl b a li ltl h ~ di tlpO s pu rti middotu dl ittlrc nd gloani iCo lID ti i lirtugraveta z io ni llb vila di relazionc
ln concllliu fu la d tfoflll lL saliu iG egrave il sin l mo di lin) idrotnc C Il1pk 1 d e eoinvo l d middotmiddot= fu n (n i dd rgashynIcirc5H10 n Hi lhdli e lesenizjo fi 1lt0 se 1 Il indirill~t() pllO pr~cnin 0 odLf rgt t lli di fu nzlonicirc adlc s()Jj(bi 111Icircn(i rrHtatc CO ll nl1 cinesi rap i Quand l~ coli i ( n LS~middot iJ11 zia k il rischio evnluLIcircvo egrave lid [() mente no tcole 11 (ltlll asso p o lll shylal ltOtSltgllen7~1 _ ta cincsiterapia pc rslIk bidtlvi shyptutibulli d ubllIcirctIcirc vltnc brn1e di conrro llo )(JSu k d i 5IcirclupPQ d Ile rLlt ziofll d i eC[u ihb ugraveo dJ ftffr otZJH1 r1w dei IIl llJgtCili 1 11Icircshyg rdtarl in posru ra rrenu posslhile JnnalL in Illo lt i clsi l(j luucircun lt di lin ~c() li oi mi n rc ( ume [11 duumlnQstrIO la tinc~ jn~l el1lric ((1l1 ~rtlppi d i contnmiddotllo cnndnlt1 p nso i l entrt d e Massue di Li n nc da [ o llo n ~ Rodo l (1 986) Julndo il1vlce lIfU~ ho ~vutlJ tiVll 11lt1 1IjXIl to un dekrshyuina r o~itl di g rl vir~l bull a~-n lllull~nte n ec ~~uiu rlCUuml rf( ff dla tcrJpll rle si c a eo chirurg ica
1Ho le clllC ooliosi idjopHI 3 ttl1p ~ - E~er l zjo hsco shy11ln ~ I((fapil
l Bg 5 CUle Lo [la k ll oblems in tlu ll~ (U ni Cl) FrKUce CU ( )lIILr no 1 AllCPR lu b1lG1t10 11 middotCI 9()(iJ2 RockilJe MI) i)~Cr ~()f I [( al th all 1 () I ~Y 1(~Re~C~Hd ~gtutnlt Ilallb Srshy1ltC Cgt D~p(rulllnr CJf I Ilalil 11 1 HumlIl sen Lel 199-1
2 SI) lrzcf ( LcB I ~IIl( FE DupUb L ampkIll~ 1c ~ppro l c h ll tht rnent und mmgemlt-rlt ot ~ ct vlyrl~ led splnul (hs r)fder~ A monQglJph rr r d lll kic Re p o l1 or Ih Ou bcc TlSk Fu rcl 0 11 ipmd DIo rele Sp ine L9H LU) 59
) Clntino F 111i1 i(ll Ci nerte1H C Nou gltHhl C Kln(~Jl llBICII [lIe1 hmlln (Il dry rra ll1ltfll of QIil pa ll m log iC by l11e 1 lIb li 1le-llh laquorilC~ of ~ 10(lna 111 Jrc)Jcxli r~~ (of flle h l lntrnIUonll SVIll Illgt~iu tn - II 5lt Ik lIc lk0flllllic lu llln-I I r l III Fhhlt ri g 1092 -ltlIJ-7
i - ri of niii MA N()LJV II ~ mel h)ltks de kin ~~klk rlr k di lll J r~cdllclli (n d~s ~()li oes jn f ~tel r~1ruuml(ILI -lo s bl fl c sur IcIj cquishyl)œ~ Ik SOll ll l)(eacute Eli ror eetlfllS d )111 1~ 1)1-
5 iloll n G Ruumld(~ le s () I ~middotmiddots tnlcl l l1 I n in 1Ifc el kiwil~~ 1)11lt KillegraveSlthe ripJe SCleacutentlnlue lYl6 2 47 ~ 6
r) Feacuterr[ffgt en 1tsiero 5 Venlllfln A ll~~n () M MJglio nu N EfkUuml o r eXltClse tI~tl Yoj o n nild id iO rXllhlc iC() 1i()~ lrt~ lirnIcircIluy r sull Eur feltl lb)ii 1 1j34 Z5 -~ 1 NOilrill1 A Sbill P egn ni i Ll Linesilegraverpi l 1lt1 Itallllll~nlO
ddlJ soI K~ i llO 1 Orkl1Llllwnrl m efodoloil1c1 RbbilltlZiOllc Ot1(1 1 )29(1) 1l-~
8 Nli(rinl Nl(lr1n l A blll P LI rieduGlzione dl p llicml atflt rro (11 coli ns i idi opr lir1 l n SC(Um i le or h( JI 1rcLlIQn1 ~0Cl le Imc lI1etW)n11e de Recltcrchc ci 0 Ftude sm 1lt Radw jlt)(j S-71
gt Nftriruuml S SeJhrf U LI r i l bllh ~l liOlie dd plziecirc11te ulet1n 11 - r
lin Kllopd (1 In l1l Jgl L N eduoL Tf1It II d ll11e ji cln1 rJtbl IiIUvJ Milan) 1ltfddH~n(x~hl 2(1~111gt-1-PU ob L cllln t iRll p l nelLi rl tgtO llcui n~ dilt ~lio i - l rn~f- li ~iIa n 3efllnl -Kurflr 19-11
11 lIIra S lJll M EVtJltHlvugrave egraveI lt t rnrumel1t() d db S(oli - U r) surie doCum nUle fintgt 31 tIUUli Mibn SI rlin) KlIpf -r 199 2
L2 1 ~W I1l(IJ P _leacuteVia tio n I~lhra k~ du IlchlS ~- ( i( IoltS ccedil l r lI C1 l1 fl leq
Ene 1 l C hi r ApparctlIClCOn l~ ltll1 l ltx6lt (i W Er 20 j )7 l
U StrI tr d P Lcs 1) rm IlO du Hltlctli Parb ME n 115 li ~u n un_ l c- l ol lJn e~IL1roy JC EagtOllŒrio n sc lluocs
L cl middot Exp CO_fiL [-In 190 15 Xd BR llet13n) J Th ltJl-xwenc a l o-(l1 tUcn~kuud txer
C le re-glflW 1 lhe tfelmc nl o f id iopllhiC Collaraquo n lroc~-din) t Lhl 1 r 111(1ltli0 I111 Symf SiUl1l un 3-D Scl IiDliJ DclOfshymillelt ~k)J1[rlt u Gugtu l1Shltr Verbg 1lti t)L j32-t)
16 N1lh~Ir~il Al Peumlf r~o n LE Erree htJkmiddotmiddot~ n f t~U lt hfIl middot Ith J
hran in ~rls V ll ~ ttiVl ~HkJ k-nt IHuIXtthilaquo ic I) Li ~I~ts H t 1l1i JflIn t ~ j l~jl)5iuml7A(~)8Jj- 21 bull
17 M(jo n Y ( ullck J p ~ R A PrdulllnlIr rpurt 11 Iht e rt l f rnltJsu red 5l ren jl lh rrll nrl1 III ililleInr Hi rrt tllk scoJliagt
J lin1I IJisn rd 21 1 1)12) 102- - Hl Hunng CU[- -If p~lIll)~thc - Uonktd in -c h JI IL
c reacutetnl n~ ptnl l C)Q~ Z ) t 1 t(li-v 19 Kou )UrJKh L Glr~ k G KRI iJI G KLmiddotmiddotrnl kh g UlUI
) KrJ UkQULlk i~ ~l ~~ fl c+l l1ng ~t (w)j (h ildrcn frit ltt lmiddot( ti ~l~ 0 1 (he
isbnd of Cfdt J middotpin 1 Dior el 1 9J7 lIX( )middot i2 ~ middotl I i) SG IC1Iugrave lS r olle lCOS rh Zadrc C Ber E Xend s T A
ohool scr(l nin~ f r Loli rraquo pro~ p ah pidemlaIO)( Io Jl lUcJ ~middot In ncIfllwt~t~rll dncl Ctt1fLll Grttc J none 1cUlf ~)Ufg Arnl
19lt) ) JOJ )8-1)3 tl llunnd P n ohlecTln CfjtefO I1 f r SCCi II Ots t-CTctt1 lngJ BOIlt
Joi nl lIrg AI11 1~gt81 (1 )1)1 -0 22 re rdrlo lk R 11 gtcolk)c on Ftudc TrldrI1lUl i0 nnli1t FHIS
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EUROP MIDI C Pli hIC
EDUCATIONMEETING SATURDAY 8thof APRIL 2006
(iSS
SEAS02 Scientific
Exercises Approach to Scoliosis
version 2002
G
S Negrini 1
EDUCATION MEETING SATURDAY8th of APRIL 2006
Neuromotor disfunctions
Neuromuscular disfunctions
11 Postural collapse
Postural collapse
Duval-Beaupegravere
Flexibility of scoliotic curve
f---I--- I Postural element
-------1 Structural element
S Negrini 2
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Postural collapse
Duval-Beaupegravere
It is a value related to muscular tone and to flexibil ity of convex side tissues
Post ural collapse
Bunch e Patwardhan
Critical load
Load threshold beyond wh ich a spine begins buckling
JI~~Wt1lW~flfthtlJlœJtAr ~ J~It- l~l - IMS
Postu ral collapse
Bunch e Patwardhan
If a curve reduces there is an increase of the deformation threshold
~~~NW~-damaoc~IIIMf ~~ J~Iv JaJ-I7I9sect
S Negrini 3
EDUCATION MEETING SATURDAY 8th of APRIL2006
Postural collapse
Torrel e Nachemson ~
Scolioses below 20deg ~ ~ lt~
have a high ~ ~ percentage of ~ ~
~postural collapse (on u~
average 75) ~~ 2i~
CU~VE O EG~EE S WHllE SUPlti e
~laquotd~c6b ____lPffI1wtt1t~
$ww J(t ~~7 JM5
Postural collapse
Minor scolioses 7
Antigravity musc es strengthening D
Reduces postural collapse -G
Increases the critical threshold of deformation
G
Neuromotor disfunetions
Stagnara
If we admit that one of the causes of idiopathie scoliosis is a disfunction in balance systems it is logical to orientate physical exercises toward this direction
s Negrini 4
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Neuromotor disfunctions
Dubousset
Idiopathie seoliosis results fram alterations in praprioeeption centres and deformation is a natural compensation to restore postural balance
etattJtitIK ypothfQj~S ___~ own_ oJ)HQr lar 1t-1( r
Neuromotor disfunctions
Nachemson Initial idiopathie scoliosis
+ Goood spine stability
Neutralization of postural deficits
D Static curve
Neuromotor disfunctions
Therapeutic aims
c) Development of spine stability
C) Development of balance reactions
G
S Negrini 5
EDUCATION MEETING SATURDAY 8thof APRIL 2006
Biomechanical disfunctions
j Horizontal r-Ian
i Sagi ttal plan
Frontal plan
Frontal plan
q Frontal plan disfunetions
Fronta l plan
Perdriolle Movement magnitude
gt in the direction of lt in the direction of correction progression
S Negrini 6
EDUCATION MEETING SATURDAY8th of APRIL 2006
Frontal plan
Stagnara
Never mobilize a scoliotic curve without ensuring reduction maintenance over time otherwise a greater mobility favours scoliosis progression
Frontal plan
Ducongeacute~ research
On a group of adolescent idiopathie scolioses treated with
Meacuteziegraveres gymnastics
D After 1 year the mean angle of
curves increased from 18deg to 29deg
Frontal plan
Scoliosis without brace
D Greater spine
flexibility D-
Risk of progression
S Negrini 7
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Frontal plan
Mobilization is useful
D In preparation to
brace
D With brace
Sagittal plan
QSagittal plan disfunctions
Sagittal plan r middot _J o
Perdriolle scouos B CJ aDeformation of D
thoracic and thoraco-Iumbar curves evolves in extension
S Negrini 8
EDUCATION MEETING SATURDAY8th of APRIL 2006
Sagittal plan
Graf
The line of gravity centres in the vertebral bodies o s c oUOSt
projects itself firstly laterally and then fi
o
posteriorly lJ ~~ ~~ ~ ~~-_J-D ~nI~
Sagittal plan
Therapeutic a ims
D Maintain or
retrieve physiological curves on the sagittal plan
Horizontal plan
QHorizontal plan disfunctions
S Negnni 9
EDUCATION MEETINGSATURDAY 8th of APRIL 2006
Horizontal plan
Stagnara The forces applied ta the spi ne act in a autoshydeforming sense
Horizontal plan
Dimnet Rotation gt 200
ampII~ (
D The actions of concave and convex side
muscles become
agonistic
~ItJrOnrIIiItdllfUClltlluumlll~~tI ~1JIf1laJ
Horizontal plan
Minor scolioses never exceed these autoshy
deformation thresholds
S Negrini 10
EDUCATION MEETING SATURDAY8th of APRIL 2006
Disfunctions at a biological organic and psychological
lever
Oisfunclions at a biological organlc and psychologlcal lever
Cheng
Bane density in scoliotic teenagers is lower than in normal subjects
~~~~middotA~IIlUtIy ~7œl 1d l
Oisfunctions at a blologlcal organic and psychologicallevel
A significant reduction of vital capacity and V02max in teenagers with a medium severity scoliosis
S Negrini 11
li
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Disfunctions at a biological organic and psychologicallevel
Disorders in the development of body image that the teenager has of himherself
Disfunctions at a blologlca l organlc and psychologicallevel
Therapeutic aims
cJ Activate cardioshyrespiratory function
cJ Favour bone density increase
cJ Develop a positive image of the body
Disfunctions at il biological organi and psydlologicallevel
Stagnara
Sport
D The active side of
kinesitherapy
S Negrini 12
EDUCATION MEETING SATURDAY 8thof APRIL 2006
Disfunctions at a biological organic and psychological
level
Distunctions at a biologlcal organlc and psychologicallevel
Cheng
Bone density in scoliotic teenagers is lower than in normal subjects
~n~IIIvpWr~middotA~stWy s- XXJl M J
Disfunctions at a biological organic and psychologicallevel
A significant reduction of vital capacity and V02max in teenagers with a medium severity scoliosis
G
S Negrini 11
EDUCATIONMEETING SATURDAY 8th of APRIL 2006
Kinesitherapy on the scoliotic subject
q Postural control
q Axial stability
q Muscular trophism
q Balance
q Respiratory function
The limits of kinesitherapy
There is a threshold beyond which
rehabilitation alone is not enough
sssr
Kinesitherapy in scoliosis treatment with brace
Therapeutic aims
S Negrini 13
6
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Therapeutic aims Srace kinesitherapy
With brace
il Postural corrections and
vertebral stability are obtained by the brace
Therapeutic aims Srace kinesitherapy
In preparation to the brace
il Mobilize spine on ail plans
Therapeutic aims Srace kinesitherapy
With brace D
Maintain a normal spine elasticity
~ Maintain a good muscular toneshy
trophism
C Model the hump with kyphotizating
exercises
S Negrini 14
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Exercises and their methodologies can vary accord ing to learning and individual sensibility of the single rehabilitator that proposes the m provided that they stay within the
Iimits of fixed therapeutic objectives
li
Therapeutic modalities
(Exercises)
QAuto-correction
QRespiratory education
QErgonomie education
QMuscular strengthening
QDevelopment of balance reactions
WNeuromotor integration
ci Vertebral mobiJization
QSpecifie modalities in brace treatment
S Negrini 15
EDUCATION MEETING SATURDAY 8th of APRIL 2006
The protocol of kinesitherapic
treatment
G
QChoice and dosage of exercises
Variatiosn of the work program every 2 - 3 months
Q Execute e)(ercises on an individual base or in a small group
Q Frequency not less than 2 times 1 week
Involve and awaken the family
G
S Negrini 16
EDUCATION MEETINGSATURDAY 8thof APRIL 2006
Q Determine the action and the localization of auto-correction
QAuto-correction must be associated to ail exercises
QAt the end of treatment ergonomy lesson
Auto-correction didactics
G
SCOLIOSI DORSALE---- shy ----
r
S Negrini 17
EDUCATION MEETING SATURDAY8thof APRIL 2006
SCOLIOS OORSOLOMBARE
shy
SCOLIOSI OOIlSALE 011 bull LOMBARE S1I--shy
SCOLIOSI LOMBARE
il --~_-
S Negrini 18
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Scoliotic patients are not radiographs
middotSeoliotie Mtients are not ndiographs but hum beings with a vertebral deviation-
Slagnara
Metha For the physieian Cobb angle is of utmost
importance For the patient it is body deformity t hat eounts most rib hump a protruding seapula or hip We are in a situation in whieh today dodors eure the radiographie deformity but what the patient really desires is to get rid of clinieal deformity and of ensuing psyehologieal distress
CIIQItIo shDuIdtucirc lM WIld tJw~~ I~~M~~~~ J9f~
S Negrini 19
- Poznan_workshop_Physiotherapy
- physio2
- physio3pdf
- physio4
- physio5
- physio6
- physio7
- physio8
- physio9
- physio10
-
EDUCATION MEETING SATURDAY 8th of APRIL 2006
METHOD ~ ~~ r 3 min 3 min 8 - 12 min 6 min -~
_ 0 rpiYJ 0 rpm 60 rpm ~1 30 rpm
_ t o~w=att~o~~na ~~ att__~ tl~~S~~ l ad l ~~~~~r o~w= Hlcremenlal t
pedaillog i i ~
~ ilt ~I~-----tl-~ I t ~ i ~ lOSt sffortivB
lW r resututlon r rm-u middot 1 - bullA~cremen tal ~~ ~ ~ ifr- ~ VtI 1 ~i ~ tllng _
METHOD
On the basis of recorded parameters VAT
has been individually computed for each
child using V-slope method by
Wasserman
METHOD
For assesment of physical capacity
the maximal minute oxygen o
consumption (V02max) ventilatory
anaerobic threshold (VAT) and
maximal workload was used
J Durmala K Dobosiewicz 5
EDUCATION MEETING SATURDAY 8thof APRIL 2006
RESULTS
Ali girls with 18 have been classified
within normal range of predicted
values of
bull maximal minute oxygen uptake
bull VAT and
bull maximal workload
RESULTS
The differences between group of girls
treated using Dobosiewicz s method and
group of girl s treated using symmetric
exercises were statistically significant
Lower exercise efficiency of girls treated
using sym metric exercises has been
observed
RESULTS Girls wilh IS Irealed using
N=87 p value
Dobosiewlczs method N64
symmetJic oxor-ci Nz23
Perœnlage of predicled vaJue of
maximal minute oxygen uptake
98 905 0033
Percenlage of predicled value of
VAT 97 933 0049
Percenlage 01 predided value ni
maximal workload 101 939 0038
J Durmala K Dobosiewicz 6
EDUCATION MEETING SATURDAY8th of APRIL 2006
RESULTS 26 girl s twice tested - at fi rst and last day of intensive hospital rehabilitation
The value of ventilatory anaerobic threshold increased during intensive hospital rehabilitation (asymmetric mobilization of the trunk by Oobosiewicz) statistically significantly (p=00019)
2047 ml O2 minkg (SO 268)
vs 2239 ml O2 minkg (SO 232)
Conclusions
1 The exerc ise eff iciency of girls with IS treated by asymmetric exerc ises of Oobosiewicz is norm al
2 Such high level of the exercise efficiency of thIcircs group resulted fram using of Oobosiewiczs method
r
J Durmala K Dobosiewicz 7
REVIEWS
Role of physical exercise in tbe treattnent of mild idiopathie adolescent scoliosis
Revicw of th- literature
A NECRlNl N VElWNL s PARZI 1 A NEGRINJ 5 NEClU NI
P1t~silillxlrd~ Ihcrapy (or klucgtlttlwrlpyl i pro shy-tJm of physka] cXlrd-cs ipcci I(a~ (IJcloJgtcd hy l li trIWlltl phrslollwrapbt wilh tb m~ln a1mor pl shyVCnI in lhe ilAAfIVltilH1 llf the ucirccfonuity III mild IgtC )
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n rllt lT(ltnklf u f COll1tlK H (rtd) I 1i plfho l og l ~$I rUlglng tr m low tmiddot k Pl 1l1 to IdiOpath ie SCUIshy
Submitt(oJ [or PUhltCl l1 011 uly Tt 2001 Acc~pttJ ugu - ~2 1(t-1l
Addre rltj-xlfll telt~I(middotb If) - grinl Flt(1(bziurllt r )(m Ofl ()(Cl1I shy Lt middotqlltœlll ro () - 1u I4t agravehLIlKil ta IYIL-lTt ilSllltp lfllmiddot ~ 1l1uumldull
CelII ~ (niiOS I I~ middot ann (1) IfUh middot lIlfU di louhilll(tymi ( Nlmiddot ~iI rli -ilIIUmiddotltlfl
Nlti(ir 1( ) il r() (ltbullagt1
lt vLL_ l IiII no 1ftfI
jS ) we are a IUil ly tJc ing n1n) ltblll lS 1 k l1 b ~J)w in~ tl~ t S Jfll l approad llt - l1n til hy on ielshyertd ~tan lard ugraveJuld ln m any ~1~ he lI ~t les i if Ilot dange r )ll lt rhlS is lrut of reil l lnw 1gtlt1lt1 pa in l ~ or 5urgi c ll lrea lmltnl5 in dbc r lmiddot ll Sc - 2
ln tlle cj-e ut ~ t lll(tlWtl i( li p l ll1JC luuml- I ~ middottnl ~() shyliosis phys cal ((_lt1(( is emr1uved ltI t()fIl1 0 lh~rtrv
lo ly in cel1l in L)lllllde (nluumlnlr in tilt Lltlll middotorkl i e Iw l) r llt t Srain hUI IIgt() 111 Gert11lny 5- 1~1 in other reg lOl1 wbere thi I-incl qf tre l tm e rll 1 p~ 1 pmiddot t 1( cI il Jws Ixen cri ri cilld md rel -cltd Lw m~lI1 1 11 Jlu~ Fue Fnlny r ~lrs thio middot15 a lsgt(ru( f ~rth r -~ltc rrJtf))~ ll t vit11 br1Cltcgt b r II1 ([C Llt n ClW grmvlng 1lt1 0 L Sti g
gcsti n the lIsefulnes- u r Ih is form o t treatm n t 1
Hmiddotu]rs have nerged jn El or uf pll y~ iLd eegraverdse eacute 00[ 1 but tlw are nUl yel 11 11 t llu i vIC~11 and r hi ~
f rm of trt ~ltmenr IS stiJ l Ul1 ckf ckhate FfI t Jt 111 il i 11t (eltary td 1I iFy 11umbtr ot
b l sic COI ceP rlJ lf w ill he cIh tt d in t hi pap r
Scollosis
DCijIrI iriolls
ScnUoSlS is Irlircc c1 lme nsIcircltnal (I(gt i l cj on ot tht spinc thar cau C a CU 1 lh lt ca n h e $ t~en ln (1 me1Sshy
ured ultinF Coh) lll ltllCXI o n HI anreu middot p rtc rilt r
EUJlOI -1 lœDICOPHYSlc~ IR
NECRI Nl
110
f)i)
1 7J
amp aS g 5li - 0 v
V
31
10
(1 1) Il 15
-tc i ytjtr~)
FigJ----jllph ot DlI w l-lkaupegraverel) The agloimvltltinn Or idio r lrhlc 50gt1iflll~ IS rpiJ bel~ en th e- [l0 IH P (l)ltg tnntll lol (JI PUllcmiddotny) mtl 1 ( f( lS-er sigll paiilivltecirc lt Dlt(i I1 11illg r the iti l 1Kgt n n t rll icirclicH a ) 111lt m omal prebulled the mno rche md ociks with lll I)ttlx flal gr Ih pll fl
rlcljoprdphLi 1 hl merl prestIK ~ of this curvt c10es n t autom~l ritllJy indi ate the pn$CI1(t of a defurshyTnitv (SlllKtUrd (Unel
It i~ possible tu clil1e ren tute a struCnlt t CI1tve fruIn a pogt urll 011e by identifyi og the hum]) du ring AdIlns tesr I~OQ looklng tra m beh lnd at the p atient w ho b benchng fUfward il is p -- ible ta d d~ct 1l1 eh ucirc n of o ne liidlt 0 1 the trunk usually n n the (onvex ~ jde ul tbe radiographie CUfve Ugrave1lr C Ul be mlt~I Slred lISin~
BUlln els S o liomere( 1 ~ l This h Uf1lp is du(- lO (Ile pregravegtecircn ~ of vertel ra i rolltion 1c1 Ollt tn tic f~YJ tllre o f the def trrnit tli [ c m be seen and measurc(i v ith Perddolles lb lsLometer on an amero-Ix)iferior radioshygrapb ~2
Seven ry pel cent o f li Ises a re conid 1lt 1tO be idiopa thie 1 bull ia l-nosilt in this CI$C is b exdlls i ~ n as idinpa thlc me-us t11H wc do n()[ know rJw origio of lheacute curvc [n othe] ~Ie$ it b Ix )~i ble ro ide nrify a dieak (bat CHl jusrify the c1etgtnniry slIch a rna lfo rshymar i ns I1(gtufol Ig ic~ l or genlttic cl iscas s Glnclt~r trauma etc )
[dicirc)parhk S(oliosis has been divicled ~(corcling (0
the ~Ie of tlie patient egrave1l the tiJ1ll of d~[ccli n of the condil ion into ti) ur t ypei ln fanUlc jU nik ltldolesshyccnt lnd aduh Til l m n st cnnunon (VPC IS the acloshylescegravenr o licirceacute I1IJctenzec1 hy 1 sud le l1 tggrH3l ion uuml uring the grow tll Spllrt (Hg 1)2
lhile p tu 1l sco liosi i5 Ycry lomnw n thl pre shy~Iknct ra te f r adole ent icuumlop~lthic structural CU IY~S in sch )o chilclren are 18middot20
- 10 Co bb d~grels o r m on l -lil
- 2) ~ohh dtgreclt or mort O 2~j - bull () (obb d gre -s )1 mOfeacute ()ll 2
Clin iltI [ d e isio ns lfl IXlSed 111 an lccu r~He pregshynosi which obt inccl in eJch pa ti nt mainly o n the basi of the nsidu~ll p()tlnllltl l of TH1h and the result s of 1 rh clin 1 1 ~l1d tadiogmpl i exlminashyti(ln12ll c noieq uentlya d inica ] la sifiou io n o f the ing le pHient tn -ome estent co incic1 ing w irh the
D diographic one c l n lw SLlIl1H1arizeci 1 1 folIcJ - mikl lc~ (1)(n 20 C bh de~r es - moderJt l betwlen ln md 15 ohh de~ rtes - StV re 111( gt1lt rh n ~J) )bh (kgf s
On the 1) lsis of [hi - dinic d d a lfic t i n (Vith l1l il el lrb tiOI ~ o f the ir b() und~ri e ) in Itllt l cente rS Of SCOtiO LS ITe ltlllent in the Lltin odcl (i rJ Ital lnmct md PI iJ Ugrave tre tmtnt i s plmmcd a fo lltJw 8l
- mild kineslth e (~1fw ~1Il (1 luok-ou t - Hl demte IJragravecegrave 1111101 c(~r md k i rws ithe lJpy - ~cven surgery
Physical exe rcL~e for S(ol iosis
Defi t tiOl l S
PhyS i 11 nU b lIKrlttp middot (or kines ithcIa Pl) i a p rvgrlill or plt~i Gl l (xeriltecircS ~1ci fi ( llJ y ltk ~ loped
y a -11 [ru ine 1pll yslo ther3pisr wirh th e m 10 Hllll
- pre (~ n tit1g tlc aggraaLion of the cl I )flnily in rnild bullcoUm is
- helping tlk Il ld Ct ~lOd ounter~lCtjng its skie elfects in III de rltegrave sc li sis
Tn tl1i_ feSpec1 kinesitl1ert py f JI s oliosis is tonshysider l a o on of peciticcedil training and s genecirc tltllly proposelt in sessions 0 1 4~ ro 60 minute IW) t) tour limes 1 Cee PhysiGtl exerci es can aLo ll v o ther auumlns 1S it oill he dise Issed in this plper
Ir 15 Ilot possib le to cl escribe a single progrlIT1 o r exerc ise a5 pro nrams ale USLIJUy p fgt nll ized ( ( lt
EUH PA ~illDI (DP1I YS IC~ 182
ROlL UF P l 1YSICAL lXl 1lt 1~E IN l IlE 11 ~l) IEd If IlU) l[)VP 1HI AIJ() J)~Cl~ r COl ~I NlG1W il
f)( 15 egraved ( )Il the nee L- 01 indi iuua l pJl itnts) al l l10ugh Lheacute) C l n h t 11 plicd o n a WOU p hJ~js (-1 (0 () pnients PC[ ~l ()lI r)middot lugrave reQCf lhese 1 10 grl lll frequt ml~ V IIT
hnm on in middotituk w allClthltJmiddot -Ill Jnv L l~egrave at Wc w Ht ~huw in lhis lyl peJ it i~ 111 n u -eII1 tu id e ntilv kirK itheJapturlc aims w hitl l ucircrr~spnd LO ugravelt~lil1 DUtshy
g X ir ur ph -s ici l lxtTi~l I~llhe r thln ln dj( us- indishyiJ u1 1progr-lfll
Aduumll l lxUl kisure time ~lOd h )u] Sp u lllll8 ~Ilttishy
i lt egrave~ i middotomm )Ly s iven lel mJ ing ro w hlf ~ Iuumlnsidshyer~d usdul or il lrmfu l in t1 lt rruning (lI tJw ptliJicirct ln tl1bplper Ugrave1 gent ltl l t rl ll bull p lwsiCUgrave lttG iviUes is rl ktll 10 JllI1ltlCc hOlll gtpOlt mJ kIJ1lsIcircl hc lJ l f
i ve lUen tloneumld )bo C on lv ine n dul( re Ull~ 1t~1 t s far Ilten publislt d f I~ mJ I(i noltgtithltl rgt is 11 11 a su h jel lnI deacutehate CJitk haltlt t llltit m itn ltl of l ny lorm o t p l1 ySiClI lxrcL e as a Itwr1 [ J- fo r i liopa tb il jcoJL~b un iL ()ri gin~ initial1) it WIS Ille r rOmiddotUumlK lt brgdv u f p l~lt titu gtllergt w h ) intervenecl hutll tc llcrl ll (mon as cltl HtilJ nic in terventi n man Jgt
1 t lltrJp utl t one 1 md rC j fkll l~ on rhe h sh lf som uni cOen I1v pn t I1cgts wt ldl hll ltl enl1 JI~ haLl nu na l scicnt lfic baisYmiddot HOlh tlle$( trr t peu shy to rh ~rl py tt nJecI to l~~rJ tte C Ih tk CUf -~ pnnshyclr~tll y as a f tsul t of lilo h llIzatio ll of tn imdqultdy ~u pp rt(d S pln eacute 7~ 12 to re-t1 r rI ltrl 1$ l l1C k o f WH llt~~rdl 10 I ndt~-dll()urnah tnd 11( on1 p~l per u suaJly Cl tc([ IS n prelimmtrf lll d 3 ln tt li w ay man (l rrlKpt(Hc H lf O iS Inll ph ~i C U l ~ d vi ~ cI nllog scnliotl pa t le nL~ 3gainst holll ph lca l egravexershyclc and p()rt~1
It m u st t~ n tfd [hat pllyknl txerc j~ tJe~ltm(nls t1iHer 1 lJ rd il1g r rhe rherlpcu tlC litTl~ on lllc h tJ rgt ap p lolc il l the IXlltent lncl hi im r IIIllHnt i- 1 (1(1 rI - 5lt1J lC igt tIl l ( f phJllIlllolopJ al rrea tmln ls Ihith cllffc r 1lt œQlfd- rhe m C cculc u ~t(l luI thl p al 1t n
~mc l 11i (lbE~e Tt i ~ P ~il k tlwreI[middote thll wuumlk ltlll t kin 1or ph~ i Clt1 1 lX r(j~ 1I 111~ t bc loidvd by t h~ Lo iurie IxujCJ1l al1ulhcr a dl ~IS nJI h~ iOg (1 11shygerols llugJr in racr le (wi ller d I ~fJIII ~ I ml thlls re(nl1l rn ndc(1
fn n UI cel1ll r we In(~ hccf) using 1 ) 1 1111 11 ve ) 1 (J p lw l icd ex(r(i~e (0 J ( 1I l tt i~ tlh aITt ~ l~d Ilv m ikl tru cflumiddott1 adokscltnt (cl ioj arh lC icoli is11 2)
ina the f U~ t rc-gt uJrs IefC pu b lishe - the pJ( )grd m 11lt1lt l1te n PWltllk d in fa c t deel()pnlln l~ in th t l itshy OlL1Ii in tl1 r b t ~() ycal f ha ve iclemi fiecl niO l l
m d 111 ur impl rnHm s md d i s )h ilir i (gt~ lue t idlo p lthk amp()lio -i ~ t Jll CIII he 1UO(l if Icirc 1by phyict1 egrave xert iSlgt l fe t rrncllt
l illl
111e aim of t l1JS r~l per ii tmiddot (tv iew tl1( l iterat urt to a(errl ln v llic ll of th~ impa irm 1t~ and Liit hil it il i GllIltec hy ~ o l i()gtj s -o ull he ll nt x or re middotlu celt1 Ili pl1ysical xerclse An u p-to-da te knOvkdge o f tl lt Lgtpecl-gt i necckC1 in rJeumlr) d -oek
- whetll~r there h ltl n adLtIIl ) l tht()d ical bbh fur or JqIIcirclb l l l1 Il( ) f k irt llit herlpy
- h N I)(1 ( 1 Dm tlle p r l c tIcirc(( o f Jebur tiJne )pOfung lcli v l ti ~ IIOU lci he tllf) -d o
II J U V f h 1 I11~ c~~lb li hed Ihe usefuhlLss 01 k il1 shyc ~thtrpy il i aIle dy l nsi 1([(( -r-tI Llleu i n )I11 plJt~ ut the wJrld ir ilt ecircS~nl i 1 I( id n Iv w l1i li ( 1shy
gories 0 1 pl1Vtl( 1excrClgtegt te D)bilI7it ric 1n (Ir st shylliuumlZltio f) lttlt tlgtbltn ing ni trcrccedilh ing erc) hn Id be
vnlcled he tll rhe nuld be lerrillldll1 1 md whidl s tlQu1d be inreœ jf ic(1 IJeClU~l tlley cOli lel Je LI ~ful
Ncuro1llotor impainncnts
Imv aUl llOr~ 11 lt1lt ~tlKlteJ lhe cltlndatiotl bd Ween tl UC1UmiddotIt t l ol(~C t nt id iopml je -nll ~J~ and cli~l l shyler~ lr 1tH lest ihuLIr yt 1 _ 13 ~ 311 D uhoussct 1
1-- ITS tln l ldiopath k s(o lio-L L cll -c d l J l hmgt in th terl tltr f prop li l l pu n md 1I1ar th e detrshyn Hi n i~ na tural 1 ~ronse to ril e need tu ts tu re p()tun ltlluilib riu Ul HcrmJJ1 31~ 11 () d tllat icliupathic ( liCl5j h l it re5u lt Ot1 rw nltuf mot r l ~ltelV
[Id )fcl 3 nI] ~1ltJ U Sr1lle nr to dtorders in centJtI lO~Cl shyIOIDNur) md 1xi~tI moro (Ul1lfOl syt( llI (Fig _l
N htIll -of) H1c S uumll h( rll1 ( ~ l( w ing JI t11 (oshyI-ie on the l l lO]ugy o b doll (nt Rl iu]icirc tlili- middot()lioL m unt fil t-hltll rhl ugravedcmnilV L th e fl5 ult o f 1 (k btcl 11lIFll llI ion nf som t11(WUgravetltnl md pO~ lur( (tnic l~ l licirc1 tl1lt if l p OgtlbJt b C 1l rlw sta l i lin 0f 11 1 Sf llle j lt g )tx l Tt) ohtil n a ))Cli U 1ILzltl I o f p ~llIr~il d l~flo [ in l1litkd ~J)llnSIS me CI Igt(middotqucnr J ~ a ~tmicirc ()nlly or regle Ie Llive
Ali th- 11yp ) tlw~es rd ~lte tr d irtl Itn t pnl1tlt o f [11 v hole ~piltm It11[ controls postu re ~nd mrw shyment lrre pell ic of tlh po int a d lI~ llv inH llYegraved il i ~ ll 1 nnable tCl aSUilll ri 1l tr l ll1 lo g thi ~ys ttm ( Qu it le 1I middoteli tl
lt ch ugt nlt~(S f rullliIl thil i nlomwtion th at p tlmiddot shyiCil J(tl iIies nw gt Il lInport~n t rr le to pbv [11Icircgt role ca n 1)lt slI i11l1lariztd ln lWO the ptu li ain Llt
- d elopmll1 l of p uumlltl St1 b Hlt ) - c1e veuml IOpm 1)[ o f bhll1ltc _
(k llhUl)lOr S Cll orr
ontrot oic whan-lt
------+ 1 ~ il lnll ugrave r AINnl
Cllnlr1
T bflt~ r
fltL1 tlli
lMini
l
~sary ~J-frlllen i )f
~ 1 ocirctnl
~UcirclllIJJlW Ll
AXl ~l1 n uumll l) r sy 5t ~nl
middoticoltoq ~ Fig 2-AcFgtrdong lU He-mutl 21 il is Fi)5~ ib1e rD prolXgtSlt l -oo ie1 mnd 1 ((if ~ elio egrave middotAhltr~d l)Qdy-p ati~ I I i u d) uren ttllOn k td LO In ~ory reHTt I1 eDi tn l al ) JdrnlV~ pn)4~ e l u r~o(Ofe 0-c1 eptunl dvstil t1 ctlon sltŒ(ry icircltu nu11t ilwnt [ ~mC ~ted tl l1 ce Ill trpntlshyUumlfJJl nd IKnle~ r~dibl jtugrave)n of -I) m tlosen Ir ~ig nj tl (I1vying ln fornll1U n (lI an ereltl ~piJl e Mmor aJJ r--a t ~) n ltgtf ti lt aXljl mowr plem iHUC Wh ~fl Ille 6ubjeco m uumlntl Icircn (1oJifitd perccpfLlI l ~na l ysilt of p n)lnocepti Icircnfu rnlaquol ti desnibJOS ~n t tecr spin A IICW motor co nrro l Ira I gy t adopt resu ltin~ in the ~tr ltctltr 1 ckformh y lf IdiopathirL scollos i=i Ht lrftU1uc nltnt l ISll I1lJy h1e- ~ I pro()und elkn on bralO Sfem flJll ct i(lnn~lLhu modifyRll Ille nltulltgtshytl10 ) 1 1111 Uu l-lHoror control 5~Shnl$ shy
As Srtgn1lt1 l ~ ltlssert~ if wc l C -Cp t 111 1 un o f the G IiC s oliosls L l tisorckr oi th e ltquilibrilltn sys t ~ms it is lagical to oriegravenrate physlCl l exercis( lherap y ln th is d ir(gtCli()[1
11lclte goals Cul tl lfOUgil ditrercn t modes 01 action be Olchic(-c1 witJ1 phykal accivit ie
- po rt ive Cll ities p ro ct LJ e aIl UgravelClltrtsc in 6lte nshyel ll )o rd in~lti n pinai pr0prinup ti_)[J nLi mOVeshyment control 0 vio lls iy ln thh repect ome lCtivshylites aœ pre um~I I)y lXrter tllln ntil crs
- kinrl lira py using pedJil exerCisocirc specially developecl lith th est 1101 5 in mind illVuuml VC I lllore prccilt( ll1d InC1 li zed cri n on rhe spiJw focusing
a90
1 ~~
lg -lNheJo ~1l l1 t r~l g rld in 1 1) h i(~ IImiddot ct r rHienl w i ll idlllhic _It ~i ~ _ iri s plt ~I le II find Jit ltH vlllleuml ~l Cgtbl tn~ ks III d il fef lt p ~ lt ihnS nu v~tl middot B ~a~pt u Il C middotl)Icircd ~(t l l11 C dlfkrCnl middot- hdween slllndi1g Uline nu nllt1Xinul oorrec ri nI t chied Vith Ct (J ) und tfdincJ ne lot es o UIine 1 fo llnVs middotIJfl tfi ni( - ltlrshy
reltiK)n ~ Ikexibiliry st3nucircing - -pirte - f ur~1 1IbjISC ltupin - ltorrcaion - - r~luci()il ll ymiddot For flmpllt in J npK l1 pH k1J il
plt1SSlhlc ln obtai n 10 u1 511ndlt)l [YLo lion yr ln Slt p ille rlOlgt itlugraven om l J ~ in ( gttf(C rigtIl lIex lbuil 15 i (r-l l=22deg pol lltl ~~J IIlpraquo is IcircO~-V- I t1 l nd tucircu(Ugrave) ilil) I~ 3laquoJO- IH-12
r ln Ugravel e abilit jl of tluuml [m e llu to co ntro l irse lr in ~ pac
fuld l oftlles uumlllelve ntio ns can presum1b1r incn~~ Ih enl ac )1 the orller and lHitlll r of Ille rn - 11 )ltd h e lllldenl lu EJ3)4il
Posl1l1-t collapse lnd slabilizariotl
lIle concept u fplt st lUal c(l lJap~e l l~t Iwen detin 61 by DlI II-T3e~tupegrave rL t Ac oJdin)j tu tl1i- ~ll1thor il [ nec(sary ~- l Hn Cv-tlualing th tleihility o f a col shylo tIcircC CUJVL (0 clistingu ih bt tVeen the re du ihil [ty index (th - li iffer gt le bet ~middot Il ~I r~tcli()grJph ie ~xnmshyinltio n of the iI111 pHienr in supine po ition m(i
ROte OF Pl rnmL EŒIlCISE IN THE TREAT-ŒNT OP ~I IJD IDIOPAnnC OOU~GEm seou SIS EltJRINI
I (~)-----------------------~
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8 =~~=r=middotmiddotmiddotmiddoti~=-middotl--- middotmiddotmiddotshy--------------t----------~- -------- - ------__shy
~---- --- -- -~ -------------r---- -- -- ~-- - -------- --shy----i-------r-- - ---- ~~-shy
il 1~ 0
Dtl-Lmiddot ~ lttj l r~ UIltltlHt
f g 1 -TI1 u ilictf 1ld ( ii 11- ugraveu-sh) ld IX~ O 1d wllich ltJdnrshymII Il nf the pilll 1 ~tln~1 of th e -o lioti( spinc n IG~nI(J II IIIshytt) lhe iJeuml grl-e o f ~ ()Ii ti c (u rvH Il 1 w dcpc-nlknrly o l l he 10 111shy
P01(nl (pntt l ~ 1 1 nr ffll wrJ I) ln w hilth Ihe n i 1gt( ~ duc nL~ grlphs fm I h~lt 111lt hi~hr Iht Col h ~Ilu t (l f Lite ~Ul Ihe m Ol CI il y th t s(uumlJotil middotpin~ ~111 he ~middotJg gr~lVH(~(1
m mJxiTIt corrttt ion wll iJl i~ lIllCd to Ih - xt 1shy
lti Oilil y Jf tl1lt t Ut JO rl1t cdnUc idt md p OS shy
tU ll cul lapse ( th t ltHill enct b-tten l lUdioL) 1lphic egraveltamJl1ltlti OI1 J t th e ~lme pa tient in Sl il tl cling lOJ lline fX-sitiutl ) Wll ic h correb lc- onl wil ll fhe abilt ty of lllt p tu rl l gt s tem to C( lunternct lIk luree o r grl viry )cco d ing rv D lfVd- f3egraveLIprc po st li r t1 lt01shyIlDse is d ue to the Jnus -u lar ton a nd 11ll ex rCrIshy i) i itv of rhe tissus n the ( O IW-) si it (If the (01shyjl ti (~JtVe (Fi~ 3 L Pu~t llr1 C lltpstl lu lcl l ~~ reduc l-lt by llwans o f pl1ysica l cxerCles specitkally s tuclled ruuml i rnprove tIlus--ubr fOHt md lU pr )cllI Ct 1 ~11 hi shy
lizing ffCd
PararcL n tll CIJ cl the cr iti ca l (3 c1 thlsho ld beQ ld Il ich defol1J lHU n of the i pinlt 1 e~ in~ ne dtlllontr~1t _cl (1l ll t grclrf r mg] o f rllt C II in a qa m bng pos ition corn pOil 15 t l lowcr detormashytion lhnsllold (Fig 1) ie to ~11l Ulne3Se t the risk of pr ogr t~ lu n There t rh eJef re l J ea r l)iuuml 1itshycJ l ~ll1 l l(tl a 1 tnr tg ro b ohwined by d -cr t l ~ illg ilmiddot pU~lUrll cull lpse ptJcelJtge w bich lccording t i)
h llTd tnd ~l(heJ1l ~on 1~ b inde cl 1X llt icularly luumlgh Ugravel mllcl c Iio~ i (bdow 2( 0 ) (F ig 5 J
Fin a Il III ch iS respect lllljl hl and b um l 01 m linmiddot
ii iI 1 l _ _~ _ ___I ___ ___ __L ___ _ ___ ___J______ ___ 1 ___
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i
+----r--------t-------t------f-- J
Fj~ ~-Ac(XjJlin(Q luuml T O rIcd ~lnd Na(h(ln~ n i () dl( pCG w rd (rTIshy
POO ll is hiherin cu rvegt in wh ilt l1lh ~1flILWrd cII1I Olk l1t IS le- pr(v~knt ln th e grtph Ih t PogttJlJ I ugtnq) Ot1 -J1l j elfltS-e J tlt 1l1t obb dirr remc rlLIv obu incu f roll l the Cohb atl( 0 1stlI1dtJ1g IId gtupinc rldo~raf115 Ih Ille lt) [1l1t1 (i lndnl I pine) 511pille the ~(nlClu tJ1 compo l1lnt U rlk CU Y _VeJily I~ ltx p rlt 1 L1v UpUlt (obh Illeturo Ih t si _b Cct rtJeSIm l fie -ltn J trd Ugraveltuuml shyuumlo n A~-i)rding LP 11(lt uuta o n l ( r1I~( in ~I 2JQ sup itlt curvt 1hi C(]l)b ddhccno l l f lO is -J-lultt( thc s ldnd inr tnla Ol1l t lS wi Q) whil 11) 1 1)401 ~llp lne ClHVC If ~ 1Omiddot ( tcl Lhe ttnd trl~ nlca~ I(t I ~ ~I)
tli n ll w l lllE cq lin ti spin h~ i ng mo r ~ Llnt~II) 1 tlun the nOftl111 one n Cll l gr(lk ( (cU ve tl1u n da r u p shy
po rt in o r k r 10 m linrl in tht 1xi11po tuf_ n th ha__i of th egt onideratl lr1S it f(lll() rhJt
ph rH (~Uuml e erd es ulukl h u - ul iiuml tbeacuteY ~U-L lm cl 1l (It-d o pmg p05111 td C Jl1twl lS fuumlrnll~ rly d ccrll1td ln an Ql St if i imr ol1111 t ru t(( - tht m(d in C JI shy
r t t r sture fO Ir -ngthen tlll m u ck-gt of the spint mainl) in (11erl antig r3ilrl tIcirclt l]lli fun ctin ll U hy meU15 dl i )ll1 t trk ~ lhJ cl( -ll tlt C)nlr~lUions ~llld no l IdOshy
1l)llic d YIltll1k lt l jAJ lktic t) I1 ) II 11)t 111 hd posibleacute t lcluuml ee postura l io nrro and stfh ili lllllt IJI
w i thout food T1lw(ull r d I( Lf(11 Ibk t m ucircnuin Ihe c()rf ~ct [ ()S tu re for cl gtu ifKi IH lLl1gth 0f ti l11 ~
This i-l ddl usl a typl 11 dnmnin (tf k inesllh rap) in 11 (lt-11 [[k - p~d fk lnr in lng f u l1a in llllliCk is poss ihle lI sing ctrtain Idncl fJ l (lt) 11111 liun S p Ul in tb is Cl c is ulttful ooly sa I~tr 1~ il Iw lps t1w lxltknt 1 becuJl)t 1gtlt ltlt-I a ClJu~l inred irl ilL ntllru l o~ i cll
and I1lll~lJhl r-keJc LIl [rll-llIn~ middot etlt(wrs JI the int e rmiddot vlnrion
[J ROPA MfJ) I()Wf-I YSJ IR
1
ICR 1 1-1
r
1 shy ~
- shy
11 o-llrfOlhe5l~ o t Ih 1O~(1dity i n h ~ r ~ ll nr pbl1 l of ~ Spl11 in 111011 _llti1Gt l lPt f ltlJUCWJtl ( ~l Ihe Ir t 1 1gt illbll W Ilh LtltrJ1dlion Vln lbe rigronl middotUII~ l(I Dko n12 lIll h lumshydlanie1 1 [ nul 1 M hl whtrc M - gt) lnIUI1g 111laquo111laquo1 1 1 c rtJCshytjC~ f fce d -d Lill l1~ o f enr niI pUll spnmcl1y 1~ 111 mldlll1lt (n the fl1ur t 1 = tor~ of f(ward Ileuuml l = ughtel1lng fmiddotr p 1shynOf stn lClU= Alaquo rdtllg 1raquo Ihl~ - lin hull th l1ltgtllugrave ot tller1l lUr~Jtllrc F the ~pin t -ilh rlu1i tf Ihl 1 1Ibulll n lrlt InltT1 1
rbc prJI 3IJi l1ty d qrlOIJ~ n bull JI t IlJIII Hm lA the v=ltd gtc e lu-ing J 5lnK1ura i ltfnnity
Dioal e ch anicll itllp~lir J11 c nt
Ihrcemiddotdimcllgtional mc-cbal1in of the s pioc
~f Ikmiddot i t i nly l(œ ntly tlHr llk pr-5tnœ or nc ushy1 lnlo tnr impairment in Idiopttlllc s-ol ii IXl tknt liuml J$ heen h i- ll licircghlcJ hy re$eJ rh tll e preit ilegravee h inm b nIcirc Ji d lJutg~ lt hl ~ 1 ng t o n dO Ulll urcel 1 i5 (l lreldv well umlersrood H(j-ev~r nev lbt un h iomcrhankal im l) ion nI h1c rectm ly onk l n tIlt tre and p r~dou in f n rmtinn hou t pl1ykd (~fcl5( in t 11 0 tl1I _ltgt pbne of spact 1115 Im trqlt-u 1rom J i-[) v ing unclcrsrmdlng ot th l lmc -dim nshy~ilnl l l11 ~ hmk f the cO]jO[lC pln( ~2middot ) ) Ve- w ill )iI xnl t l1 d at lcL-orcltng tUl cl sif iol t lOn blsed o n gtolllt lricd h uumlCJ ) p lane
- b() rJzU[1tl ln th i pla n ~ th t 1o rm ll sp ine present no CUlye- w ll ile Uumll(~ ltc U Hic spLnc clevelops one of ir haracterls(Icircc deFo rm tiCs v elt tbrd ln lashytio n vh icl1 pJ()VcA~ theacute hw 11
- lgitltl in th llulJe U l(~ nonmll spIcirclle pl SenL kypl lOSis ~nd l dooi~ in tb lXI1 lhese [(Hu rts Vere m)( til ught [ 0 he relattd tlle scolkJtlc ( lI r Vegrave
- front l in hi pleme tht ncrmal p ine preseuron t no curYegrave whil thl ~11li tic p in ugravetI I ()~ icircl~ charshyad t Ilt I CU1C
Il Jri fJIIt palic
~l+I~na ra 3 r inr lut th l[ ber ll1d a œl1~lU1 degr 1
l f r()la tJo u lllu (lILa r forcKl ltxert ltJn tl ldefnmuumlng 1 tkllJ [J i1u a re- lhlt tll cly 11 [1 1 UI b y Olm ner w bn ~lh uiJwd tl egrave ro t1tic) l1 Ilm it ti lt p ica] lf shy
rhrl r() be (P (the Uma bevond Wl1iltJl th lCOJlb of [11( ~pmaJ musd ~ dthc COnCIt and nm ex ~l le btconk (t O li~[)
r ~l 18 ~1Il N lu t( ren i9 lun lu ted rlseurlt h in tlt ) tilt lULodeumlformipg1 tlo n ot tIH_ sc laquoJrle rh ox ercallkren lk 1l1~H li d11r once thl Il i ~ r tld1t5 [he lhrth ld f 111 JlIcirc lIi of tlle dnrlclc hurnp tlk
lI bslt Il l nt rlet()rlll lIcircon 01 the it l ()I~ C ( (ylm der (- sustalnecl by an H1tmi cforming aCOOIl
J1Ji h V hl rhyiical f~ f Ise CI 01 h spr n llnd kin middot ith ccedilrapJ my lX damlg ing vll e n l pplild as flle
igt Jk Iller ln SCC1IJ ~IS lllc lJ fxceed l auto in middot crca~ i n g lhrllgthuld [1 sh (~u Id ahn be j ofed that Ilw relscd pre sun 1l1111i insiugrave l fe pil1r inn) 1 mlshylt
- j Il- ( w atff 1 (nh ~1l 1(e Il10 utoldrml ng li1eCh~lI1 1sm
in flc l Geyer ~w tcd th1 t rm m 1 hI l)1ecircch1O lla1 puilll 0 l I C~ sw m mim t Ieuroamp no purpo t for cu lshyim le pllilt t1 s (weumlO middott r it is l~Jl(gtWl1 rhn in iculio r[ paULnl -iJl11T1ill~ doe_gt nor Il ~lp to i ncrt~SL n eur(1shym tor co mfU
(1irai p an (
Jerdnn lle 11 showecl thal ill CSl~ o f t10rLC IC 1i lUgrave
tllo lacolulllhil it lio_1 tlle cte tI llmiry in (he lg itt1 p lln t rn lnlftot il~ lf tspe iuUy in tlw initi 11 r luleuml )f cV IU[Icircon nf Ile ~oli ls W iU l 1 p(t)gr~s~ivlt il10middot~ shy
ment roward hvpok pho b G ll f ill~l Im lins l har dUflng (IN eWllLlfiu1 of 11Imh] co luumlgt i the l in t ot t l H~ gClyty Cegraven te l - 0 1 v llebed lxxli 5 r ro ject 1 seH fl r t side-ys and tlwn backlrcl bull thu~ p(0(1 lj n g a kyphQtlmg aet Il ln (h~ lu mhnr --PIl1 COftj tng
l l i tc Iugrave l lltl l( l rs1 tif s L -etllgt il l the lgirl11
1 Hl)
Ilu LE nI rIIY~Ic~L lXIlKISI 1 HI E TREhTMEtn OP JIU IDIOP llII C AD O USCUH O Ll Œl15 NEGR II
lLill tegt lre lenl1 ~I d ~fo rll1J[ ~ rhl recrSes the phyltiologiGII cmns of lh vine)
Accordlng () Dicion ~2 1 rtcluctio fl in the itgitttl CUIYtS combin l vi th a lueral Iviari n llltl ds t 1
mecban ism () ugravel~ta il ity in l he r rat r IllI1e which bVOf1i the unsd a nd i ncrea~e 0 1 co hlt1is (Fig 6 hiIf md Pl11jlbiJ Jl1eanwlt ile lt(udiecl lh e srnl ru t
orzyglpophySLs show ing t11 al ttleir 1I1tl rnic tl orienshytation f~I (jLi l~ltes aXIal ve rtegravebJl l rotllio ll in cun litluns lt f dorsal hypokrrhn Icirc tnd lum)H de i L lo IS
Tll t dat SLlgge 1 th t impOrfill ut pOitu res and l1lweil1 ) t Mudied in ord t r (CI mlIuml ntrlin or to reuwer fll e p llyslo lo~lCll ClIlye in lIe SlgJtta p lU)l Wlth the llm o t ch ~ kin~ rutltor in l~ bili ry7 AbC th ~e ~k-
1l11nL ~Irt del lnt [0 J jUc lt ftber l]kuti inrervenl ion vhich 1c)LJ k l IV - i(l ~ l compktl n l ililll on Il t c1 l shy-jel1 J11UVllT1ent IJ j o f 1uto-dOneacute(3tlon ( i e a -impk ld ion ) Iengtheni ng o f the pilleacute 011 a litlltl l aXl~ tll lt ((IT liJlI~rcdu e~ t lle ~---lJ linti- l lte ml-fkxj(l n h UI 11 - i llCrl I~t the plllH ](JgicJI dlt cr ~l S ( (1 k-yvllCiSh lIld O(ltOSh l o r c lch r1Iif n t a Ilew til(~ecirc dUuml llt Ilshy
si lflltl J ll1 u(~nlent iam ecl - 1l1t0- lIrfe rionmiddot7 4 llmshyp oed f Je-rura l iUIl cl middot-t1e- iltm lI1d ll1a intltnUlLe )( 5lg it d C Uf (gtS slig lll thltJrc i ypI1 tiZ) tIcircOI1 a nd lunugrave)ar 1()fdos i7~llion) sholild he esw b lb]HU 00 lb co
hl b oi hi p~l11il uU r -1Ir vlt Abo 111( e IlltUtl Chl lie o f purti n - a U vitk slJ1ultI h e )tuumlll ecl 1)] (1 n ldershy](ion r tl1i lt type for e upIe IilJ llyl)T S of repd shyiti( ml vemen prt n t in agonistK h)lnllltlSlks nI iIle kind f dlJ1ce C( uld he ([([r imentd
FmiddotO lllaljlallC and mobili ty of the SpIcircIlC
1 rd llo U 22 d L lm nrrare d lhlt in Illt fro nt a l pll ne
tilt 1 nge Clt 1)1lt vtment of tht scplit[i middot CU IY grcmr lIJ l il ~ d irectio n n f Lhe C ITelt tlO n tha n in tl le di re shyLion of pmgressi n l Fig 7 ) he IL o IS5err lJd tbat th15 mohiliry increac plrtil u la rly n apic [ cgcoeilts 1$ lh ~ ~c() li osb evolves Sragrm rJ 12 J ~ thus rigilt (0
VlI f n rller~p is ts Ilo t t) m o b uumliz - a sCtJl iu til curve w ilhout t [ uling ttwt tlle R lu tiOI o i til t ~a mt b fnlinruumln( 1hy l1tans o f ~I passic 01 1 rivE -uppnrt On tilt (ltllE r hand UgraveK d e iJlioJ1 in ease durill tlw tune 111 whicll tll C spmt i ~ not submjtrcd to correeshy( IV anl()n
j- Virh mi lei ol i b tlllt Upp i1n ill) lC tiol is d eveloped only lllmugil llClIf()mu$Cllbr f r llce thi ~
InegravelIl ~ thclcfo re tl1l[ inu eascgtt sp1J1all1extl)iity mua
11
Imiddotiumltgt 7-rurd illt Ir) 1 bull rdrilt I1 1 in tl lt frOlllll pbnlt- th( illl ge )r mOC llIeJlI o t the S-o UIIJC CUNe 1 supcrior in Ihlt diflt(l im ugrave( the n nKlIl thd n ll1 tllc dlrtcLion o f p rJ1(l( (llIl
be considrCtJ vntrl iJ)(l icltion and 1 undrli neocirc ab L a ~ubiljz~ILion 01 tilt spint pllss il)1y ohtl ll1td thrltJugll the stlengtlkl11ng o f the 1rltJgm vlt nonil lme shyCIC 111 illli orrant u bjcLliH- ln rhis r~f1 n sp u lllni lc tivitIumlLs sil uld lX tPI 10 dlegraveltl it l G lU t n w l1ik luring kine i Icircth lrr phyltical eXegraverci c~ tllat in ele
spinal m ot ilIcirclY sil nid 1e lt1 oid cdrt ~
Organ ie and psychologieal impainncuts and li islbi IiI le
A cgtI im lc pmi nr is moriOthl11 just 1 sp in and 1
compkt gt Ipp rnach to the gu in ad 1 ont i al~ shylute l e~se i t i11
[)a la 0 11[ [n ell lrom re semh pw tbat ome organi Iilnctiond cl fki ts suc]) as tlw clecrtiUe ut vild l tnd d fun ll l)Kity_orld ldly incrtJ k whil~ 0 shy[io s i -till in (1 miel q g of g JltlV ity ~ l ilI e 55 rtI lit
tllL pres e n ce )fl defidt Or Vi l~il Clp~1 - i~ ln one pIIiem in Ihr l ftectecl by 20 ICl 40 scoi stgt l ls~a r(h cunclutecl in tbe UA by Di Ruce- prod uegraveed an aaalo) u ll1lXimum 102 re u t in a group of Jd shyk 1ien t [(h sco llosls rang inF frum ) [0 1
Al10ther rudv bv rallt r m C chr111 lilcl NashycWrl1s( u 57 stlO eltt hil $(C 1 1 ui~ Ica js l( lllt cl (1 shy1prUlllI o f t1tgl lie bJd l imI in ~ul sct t1 t ltu b middot iects jlLltr l5 they are golng through ~I cltlici[e sllge in the fnm 1lt i n 01 tlWH o w n id uHitv t factor hit h Illy jeopmlize the cl velopme lit d ~ mIll lt lI1d htIshym cecl IWI sonalitr in Klulrhood
n RUI ~IEDl(( Ptl Y1-
ROU ltHmiddot PI [ I C~ 1 EXIRCIS]~ IN TI Il nW~JUNT OF SlllO lDIOP1HIC AI)C~ESΠ11 C(gt1[Oi 1S
This i why b IiCieacute ii is ~n imporrlIl t for p rcshyvegraveml e 1tLsr l tn en ou flge 1ari e nrs ~lfrecr(d by lIillcl middotu iosis ft) tlke p~l rt in portin -re rcatioluJ acrivitits Iha t 1eIU 10 L10 th r~1chophyinLl bull nd b~l )i 1l1o tur adlieem t n li 51Jmiddot2Even tlK)ugli [Dr bic mech~lnshy
ical mcl nellIUll10t 11 11 reltl ~ons lt r111 1gtomcrimes be l lefu l to ugg( ~t ne p rt in~ aCt iv ity r l h (gtr rll n anotlJer e th ink Ibal an exces~ ive IlHd icalizltion - Icirce l ll1posilion br plry~ilt i HlS nnejlor parents uf rh ry pe of po rt to lx p m lice 1 b Ule p 1Ucirc(Il L th1[ preshydLl ck l1 is fret clOice in lh ma tt r - -h II ll1 he avolc1ed wb 11 possLhle mainly for tlle i mport~ltll psyshyLb ) jogka l fe a SI)nS W( ha( ill ~ t nltntionegraved
Conclu ion
lbh ISsertegrave d t1H physkal tgtXtlci o is ) n fi ial whlIl practinu in order 10 ilnj rove the I11 llde
rœ nwh and tono C iral caplCiry and postu re o f the StOUO(I ~lIbj n II I nowkdge om ~ middotmg trom ci el1shyrlfi rls(~ Jrc li dJlJ accordl ng r the review 01 thE litshytirlture prnpo )td in t lli plpl r conflrm~ Ihe vuiclit ot th e -t ls ~rti ()ns
In l do l (ent Id iopl1il iC scoliuse il l n phee u i cl vk)pm e n t ( li tll iumlKh eXCC cl l g i en rhk thr hokl th e re i5 an und ubred need fn r l pprnpri 1tegrave (JJ1tOkJJe ~Ild Inr surgict1 therapics ill ortler 1) S l i p
the ( - Iuli on anugrave )JT~t~t UW ~pilll l dtlormities bull evshyerthtless in the illiti ~ll pl l~sC t ttlC c1iseLltc whcn the riS( r1 r euro )luli m is rtduced ocirc ~md tfle uifleal JOld threshold il ~ld flle po stural collai i reJcenw~ 43
JI l1 igh pllysicaJ egravexe rc ise - p revenc or r d llCe d i ~lh ilir ies o f [Iw ~ l() li )tic
p (iems R 28 J -6 5- 6 1 63
- f~KiHtare lh ( n utr ali711iCUl of postu m l d elicits tn produCel1 a coneql l nce J [)ti 0 I111)( or regre si -u lmiddotc 5middot Il 1 17 ~ M
-re 51udles U ~ n Ledecl tu con[mn or re jecr these conClLL i( 1 w l1 ich clerin-d frum 1l1 lIldytica l rcltw n f th e liter~iture appear r- ~Lo nlble Hnwecr Intil ne re ull are 31Iable wc should n r prevent our sroliotic patientmiddot trom tl ki ll p lt in s(loI1ing jshy
ir its pW1iada rly ltl t ~d1()o t () n til t c ntrHY -vith the l xcclrinn 01 gt[1 )11lt tIlat in rea-e t)1obility (tnU evc n thell oilly wh n progr~lgtion b p OSSibl) -uc h ~I( ucircvshyiUe -11 )ulu hl tIKoll w g ed The 11 S J ( rprOpriue kin (~irhe r~l Piuml to incr _~asc p()~tura l $llbil i ty is tl1egraveoretshyic tlly CiJUClt alttloughl more ~Iccu rtte aod deLli led ri k benefi rs anJlr~ is is netot1ed
Ria 1111tO
NIokl Mu d lle ftitYljJfu Jœl il 4IWr10UOifll S (JIvs i (1~1)Jshylidl ttno( cclIll le 11(11(1lt1 RCI fu lle ((lia LltfIt l1 I1I1i(i
LJ ci n s j(r3 pigt egrave li n IHUgru lkl di t rdz t fi sici pe e ft shytUlKm iluppno di un lisimerap15Ll rl lllcflt() 1 110 scopo di pnevirlt () fr en~lI 1-lgpwlllltnlcgt dclld lclonnitugrave o e il 5LOshy
Il i mi llon lt fH nugrave j (1 11ni dei co~e 1 lteIl I1J J nd ne ~Ii eifclti (()Tc rri udk s co lio si d i m e dia g rt iuuml ln que~ltlt
s rud i 30 llizzb mo i d ti cleU ric lca pel n ri Icare qJJ l lm 1 dis(imucirc x u le I[~ l z j-m i pro vna le da lla C gtl k A i json ere pr middote-nute () rk kl ducirc un~l rdeguCltl d nil cra pi lt di uJoseguerrnt Cjua li 1iU110 cli nbie tti 1 rcr lJ)tIId d~ fle)-UITC
n (- -fd7Io n~lcl)
Ut11claquo)si 1 lI tori htpnuuml )ludi-ttn I ~ cnntI1zttu fr Cq(in i idiJ)tic1 dbfl lOZ10l1 d d ~ leOla nelllOll1otoriO Lb un1I1cnUl 1n1l1i3 dcgli 111 lt1i ch DIJgt gtU l H crmU1 Nlch~mslt ( SIshygnaJ~l lerimiddot wo i esuemi -bletti d~ plt~e8lugraver- ne l pClZ le1lftgt scoliodcu kl s iluppo ddl ~ ~ uhjlil~ vertcbral~ lt o svilllp prJ Jdle JIl7 i() nl di ltCjuiljbrio Dng li studi sul lto lb( l~nlrale (OllddU i in pa rticdu d 1 DlIal-BeHJ (gtegraverl ~ P~II IId lI1 n~ llw - idente il v- m gtiu p eT il puientc clioti elgt di u n rnigb o t c)[ ro Ua sw mle dei radlldc onsegull o tramite il 11 fforzrlshyfl len to d e i l1luotoucirc l nllgr3ilri d e luOwo con crcbi ~Clltdr
in pOMltHJ corrctl e in va rie ~i[Jzioni s t llicb c c d inamIcirc tllt Dalle on sena d elb blOffiCcclIlicd tr idimlt n s io mlle d ei
r ~ chi Je ~oU()f icn ~Icirc ~videnuumll (l() ~llt tC p IYZIcircOSI ln(IiClZlfHicircl ~ 1I1shy
liumln fluenzt Je ll middote~rUrio tl SC) lgt lIi I rc pibull m i tldln sJlI71 Stl shygn~I I1 afferma che slI l p Ia no [11 middotccedilr~lk tre un œ rtlJ grado di l L1Liuuml IlC dclh vEltlh r1 apj(de le tu rœ mu SCltJ llri njtbc J n in $tJ ) t rodcfQfll1t1l1te PltJtantu b i r~it-~ r -lp il puugrave t~~
Ixnt-ftla solo nt Ile so )[j)~i Jl1Icirc na rl in qunnt ) ilon SlrM ntne )(l(Ofa tu soglb in caq ) co lltrLJIcircn l)lrilto llt~( i lJudotlsi di lfr~ lI1 C llg grVlmenl J 111 11 io lr riltd ll(17jOill leld rinlle 113 dimO~iumlrlto d llt nell o lin~l cl()~ li t th~oIOl))1 dri la defltgtrshymiti sul p iluO slfl iuale ~vohl lf1 (en5 ion~ sO lnm utto nd 1e bsi iniliali deWggrwm1Cnln mcn trl C a( lfLmn che occlleshyvoluzi ne dene = 110 i [ mhari IJ lin c l ki cen tri ch -1vi1( de i cp i CIt IJ rI Ji SI p m ittIl pnm l Iem lmeme e p o j pOS( shyrio fllwnte dtldnli mdv ( i un ziuuml ne ciloliz7nnl dd rlLtide lu mbJ œ ( lIlelttlaquo on NC n d d (gt11 uIdu m 1I1 Ilgt) cli r-Iure (0 eserClzi che IllUllengano 0 ltlUperifo le Clgt 6gt1 lo)iche sul pirluuml gilwlt Su l p iCl no fron itk Perdnulk il dlll1lt-trlto d1 lampkz-l d i LU ovimento amp111 lI rv Kolio ti ~ nd lt1 0 ddlJ cnrrc-LIcircQo i Ji gC 1 n lungl SUpegraveliltlrccedil 1M llS0 tlell 3ampIGI shyvamcnlo C che l~Jltmiddot mobiliti GlI mcnta co n l c lu7j o fle d l i) snAio i A ulln amplgrtJc1 ltllllmunjx~ i terlpGli nn n m obi shyUZ73It ma eutva coli ti0 1 1ct HsicVlfe nd tcmplt 11 1111nshyttllIcirc1nc n tc (k ll ~1 llu u zinnt n l1 un me77uuml d i sost l11( gt ln 0
e 11111ri b cle - Ilziunc egrave deorinatcl d l rlyarsi Snzcl la pr gtshy
liltlnl l i un() rtl~ i ptmiddot Jtl n(o 1S(Hl () (( ntJ() i ndit~tr i ~ Ii ISt (izi e l m iviL Illdlode ebe Hlmen tno laJlc ibiJii dcl rlc lide SCshy
li io) [n p articobre rune q lldl r C-I1 ich~ xlSiddcHe CUf t shyli ve ch~ iJllpi tgino e~rciii 01( biIi2 ZanUgrave HhnmL-trid () in tmiddot~t~nshy
sione kl fuchide O tne pure k- ~ttivit1 tnotoJII~ non prHi(~ llCcedil
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EUROP MIDI C Pli hIC
EDUCATIONMEETING SATURDAY 8thof APRIL 2006
(iSS
SEAS02 Scientific
Exercises Approach to Scoliosis
version 2002
G
S Negrini 1
EDUCATION MEETING SATURDAY8th of APRIL 2006
Neuromotor disfunctions
Neuromuscular disfunctions
11 Postural collapse
Postural collapse
Duval-Beaupegravere
Flexibility of scoliotic curve
f---I--- I Postural element
-------1 Structural element
S Negrini 2
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Postural collapse
Duval-Beaupegravere
It is a value related to muscular tone and to flexibil ity of convex side tissues
Post ural collapse
Bunch e Patwardhan
Critical load
Load threshold beyond wh ich a spine begins buckling
JI~~Wt1lW~flfthtlJlœJtAr ~ J~It- l~l - IMS
Postu ral collapse
Bunch e Patwardhan
If a curve reduces there is an increase of the deformation threshold
~~~NW~-damaoc~IIIMf ~~ J~Iv JaJ-I7I9sect
S Negrini 3
EDUCATION MEETING SATURDAY 8th of APRIL2006
Postural collapse
Torrel e Nachemson ~
Scolioses below 20deg ~ ~ lt~
have a high ~ ~ percentage of ~ ~
~postural collapse (on u~
average 75) ~~ 2i~
CU~VE O EG~EE S WHllE SUPlti e
~laquotd~c6b ____lPffI1wtt1t~
$ww J(t ~~7 JM5
Postural collapse
Minor scolioses 7
Antigravity musc es strengthening D
Reduces postural collapse -G
Increases the critical threshold of deformation
G
Neuromotor disfunetions
Stagnara
If we admit that one of the causes of idiopathie scoliosis is a disfunction in balance systems it is logical to orientate physical exercises toward this direction
s Negrini 4
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Neuromotor disfunctions
Dubousset
Idiopathie seoliosis results fram alterations in praprioeeption centres and deformation is a natural compensation to restore postural balance
etattJtitIK ypothfQj~S ___~ own_ oJ)HQr lar 1t-1( r
Neuromotor disfunctions
Nachemson Initial idiopathie scoliosis
+ Goood spine stability
Neutralization of postural deficits
D Static curve
Neuromotor disfunctions
Therapeutic aims
c) Development of spine stability
C) Development of balance reactions
G
S Negrini 5
EDUCATION MEETING SATURDAY 8thof APRIL 2006
Biomechanical disfunctions
j Horizontal r-Ian
i Sagi ttal plan
Frontal plan
Frontal plan
q Frontal plan disfunetions
Fronta l plan
Perdriolle Movement magnitude
gt in the direction of lt in the direction of correction progression
S Negrini 6
EDUCATION MEETING SATURDAY8th of APRIL 2006
Frontal plan
Stagnara
Never mobilize a scoliotic curve without ensuring reduction maintenance over time otherwise a greater mobility favours scoliosis progression
Frontal plan
Ducongeacute~ research
On a group of adolescent idiopathie scolioses treated with
Meacuteziegraveres gymnastics
D After 1 year the mean angle of
curves increased from 18deg to 29deg
Frontal plan
Scoliosis without brace
D Greater spine
flexibility D-
Risk of progression
S Negrini 7
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Frontal plan
Mobilization is useful
D In preparation to
brace
D With brace
Sagittal plan
QSagittal plan disfunctions
Sagittal plan r middot _J o
Perdriolle scouos B CJ aDeformation of D
thoracic and thoraco-Iumbar curves evolves in extension
S Negrini 8
EDUCATION MEETING SATURDAY8th of APRIL 2006
Sagittal plan
Graf
The line of gravity centres in the vertebral bodies o s c oUOSt
projects itself firstly laterally and then fi
o
posteriorly lJ ~~ ~~ ~ ~~-_J-D ~nI~
Sagittal plan
Therapeutic a ims
D Maintain or
retrieve physiological curves on the sagittal plan
Horizontal plan
QHorizontal plan disfunctions
S Negnni 9
EDUCATION MEETINGSATURDAY 8th of APRIL 2006
Horizontal plan
Stagnara The forces applied ta the spi ne act in a autoshydeforming sense
Horizontal plan
Dimnet Rotation gt 200
ampII~ (
D The actions of concave and convex side
muscles become
agonistic
~ItJrOnrIIiItdllfUClltlluumlll~~tI ~1JIf1laJ
Horizontal plan
Minor scolioses never exceed these autoshy
deformation thresholds
S Negrini 10
EDUCATION MEETING SATURDAY8th of APRIL 2006
Disfunctions at a biological organic and psychological
lever
Oisfunclions at a biological organlc and psychologlcal lever
Cheng
Bane density in scoliotic teenagers is lower than in normal subjects
~~~~middotA~IIlUtIy ~7œl 1d l
Oisfunctions at a blologlcal organic and psychologicallevel
A significant reduction of vital capacity and V02max in teenagers with a medium severity scoliosis
S Negrini 11
li
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Disfunctions at a biological organic and psychologicallevel
Disorders in the development of body image that the teenager has of himherself
Disfunctions at a blologlca l organlc and psychologicallevel
Therapeutic aims
cJ Activate cardioshyrespiratory function
cJ Favour bone density increase
cJ Develop a positive image of the body
Disfunctions at il biological organi and psydlologicallevel
Stagnara
Sport
D The active side of
kinesitherapy
S Negrini 12
EDUCATION MEETING SATURDAY 8thof APRIL 2006
Disfunctions at a biological organic and psychological
level
Distunctions at a biologlcal organlc and psychologicallevel
Cheng
Bone density in scoliotic teenagers is lower than in normal subjects
~n~IIIvpWr~middotA~stWy s- XXJl M J
Disfunctions at a biological organic and psychologicallevel
A significant reduction of vital capacity and V02max in teenagers with a medium severity scoliosis
G
S Negrini 11
EDUCATIONMEETING SATURDAY 8th of APRIL 2006
Kinesitherapy on the scoliotic subject
q Postural control
q Axial stability
q Muscular trophism
q Balance
q Respiratory function
The limits of kinesitherapy
There is a threshold beyond which
rehabilitation alone is not enough
sssr
Kinesitherapy in scoliosis treatment with brace
Therapeutic aims
S Negrini 13
6
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Therapeutic aims Srace kinesitherapy
With brace
il Postural corrections and
vertebral stability are obtained by the brace
Therapeutic aims Srace kinesitherapy
In preparation to the brace
il Mobilize spine on ail plans
Therapeutic aims Srace kinesitherapy
With brace D
Maintain a normal spine elasticity
~ Maintain a good muscular toneshy
trophism
C Model the hump with kyphotizating
exercises
S Negrini 14
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Exercises and their methodologies can vary accord ing to learning and individual sensibility of the single rehabilitator that proposes the m provided that they stay within the
Iimits of fixed therapeutic objectives
li
Therapeutic modalities
(Exercises)
QAuto-correction
QRespiratory education
QErgonomie education
QMuscular strengthening
QDevelopment of balance reactions
WNeuromotor integration
ci Vertebral mobiJization
QSpecifie modalities in brace treatment
S Negrini 15
EDUCATION MEETING SATURDAY 8th of APRIL 2006
The protocol of kinesitherapic
treatment
G
QChoice and dosage of exercises
Variatiosn of the work program every 2 - 3 months
Q Execute e)(ercises on an individual base or in a small group
Q Frequency not less than 2 times 1 week
Involve and awaken the family
G
S Negrini 16
EDUCATION MEETINGSATURDAY 8thof APRIL 2006
Q Determine the action and the localization of auto-correction
QAuto-correction must be associated to ail exercises
QAt the end of treatment ergonomy lesson
Auto-correction didactics
G
SCOLIOSI DORSALE---- shy ----
r
S Negrini 17
EDUCATION MEETING SATURDAY8thof APRIL 2006
SCOLIOS OORSOLOMBARE
shy
SCOLIOSI OOIlSALE 011 bull LOMBARE S1I--shy
SCOLIOSI LOMBARE
il --~_-
S Negrini 18
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Scoliotic patients are not radiographs
middotSeoliotie Mtients are not ndiographs but hum beings with a vertebral deviation-
Slagnara
Metha For the physieian Cobb angle is of utmost
importance For the patient it is body deformity t hat eounts most rib hump a protruding seapula or hip We are in a situation in whieh today dodors eure the radiographie deformity but what the patient really desires is to get rid of clinieal deformity and of ensuing psyehologieal distress
CIIQItIo shDuIdtucirc lM WIld tJw~~ I~~M~~~~ J9f~
S Negrini 19
- Poznan_workshop_Physiotherapy
- physio2
- physio3pdf
- physio4
- physio5
- physio6
- physio7
- physio8
- physio9
- physio10
-
EDUCATION MEETING SATURDAY 8thof APRIL 2006
RESULTS
Ali girls with 18 have been classified
within normal range of predicted
values of
bull maximal minute oxygen uptake
bull VAT and
bull maximal workload
RESULTS
The differences between group of girls
treated using Dobosiewicz s method and
group of girl s treated using symmetric
exercises were statistically significant
Lower exercise efficiency of girls treated
using sym metric exercises has been
observed
RESULTS Girls wilh IS Irealed using
N=87 p value
Dobosiewlczs method N64
symmetJic oxor-ci Nz23
Perœnlage of predicled vaJue of
maximal minute oxygen uptake
98 905 0033
Percenlage of predicled value of
VAT 97 933 0049
Percenlage 01 predided value ni
maximal workload 101 939 0038
J Durmala K Dobosiewicz 6
EDUCATION MEETING SATURDAY8th of APRIL 2006
RESULTS 26 girl s twice tested - at fi rst and last day of intensive hospital rehabilitation
The value of ventilatory anaerobic threshold increased during intensive hospital rehabilitation (asymmetric mobilization of the trunk by Oobosiewicz) statistically significantly (p=00019)
2047 ml O2 minkg (SO 268)
vs 2239 ml O2 minkg (SO 232)
Conclusions
1 The exerc ise eff iciency of girls with IS treated by asymmetric exerc ises of Oobosiewicz is norm al
2 Such high level of the exercise efficiency of thIcircs group resulted fram using of Oobosiewiczs method
r
J Durmala K Dobosiewicz 7
REVIEWS
Role of physical exercise in tbe treattnent of mild idiopathie adolescent scoliosis
Revicw of th- literature
A NECRlNl N VElWNL s PARZI 1 A NEGRINJ 5 NEClU NI
P1t~silillxlrd~ Ihcrapy (or klucgtlttlwrlpyl i pro shy-tJm of physka] cXlrd-cs ipcci I(a~ (IJcloJgtcd hy l li trIWlltl phrslollwrapbt wilh tb m~ln a1mor pl shyVCnI in lhe ilAAfIVltilH1 llf the ucirccfonuity III mild IgtC )
Lil1Si bclpin~ thebm ( aocl co uaufllclilIg ils ~jd- clf IS in nlOdlJmiddotnh-culiosis Th middotalillofthi paper ito r (W
Ille Ii lc ram r 1 a-ccrulin wh kh of Ih bull Lu[Jalmlcrus Ind (Lb hili til~ CLlLt-cd br scnli()si- clluld bl pl Y nlcd or r d uccd hl phylolld LXtmiddotrdsi n Il p--to-da le knowl Uuml~l nr tIll~C aspcc[~ i ne bulled in oruer 10 dndc whclh~r 11Rf blLl adcqlmtt Ib(uuml n middotlicaJ balis fo r ora)aini l Ihe US4~ of lUgravellgtitlerap) wltcllj(r or fln l th e prtl1iœ of kimiddot ~lre IUlll poNjn~ a t iil ies ~bould h allowtcI II uuml middot c enliaI toltlentlf)wh k lu alClor ie - lf pl lr~kiJl -c rmiddot d gtlt- (Ic rnnhi UzJ( inn ni (t hl HrJltlon [ rtn~hcll iJl ~ or 1i1J(IChIumlJlJt etc) Sh llU Ld be TolullllCcluse ulemiddot l onld b- clclIimcntalancl wukh sho ll ld he IJlI-n~ifl~d I~~a l lhc (o uld h 11lfu 1 Know k dg CJnc1in t (wIn SeiCIImiddot Hlk rCS([lflt h daw ccordinll to Ih bull llVit w o f tIlt iii 111 1( plop(lsltd in (h i papcr lmiddotonllmJ l lnl plLyi 11 cxcr(j$( pn (nti or (tmiddotduce dhlblli t ic 1 ~lt Il Jj ll(k pl ti Jlt fadl j w(~ the nlIIIrl li7alinn n f poMural dd shylitS tu p n xJ llc aSl COIlMqnen c(middot 1 all )llal) or r(tn~ shys i middot middotlIrve Tilt u~c (I f appn1priattmiddot kincsiuuml wrlpy 0 in rcns polttllcal swhiIHy Icirc IIHmiddotorc Illta ll y (0 r 1(lt1 lllho UAh mon ltlccurlltc 1Ut dl1alkd -rLk l(lWfils 111111 )11 h Jlccdt(
11) wurcJlt 0 lit)-IcircS (Iumpy - x rcLs P()lun
n rllt lT(ltnklf u f COll1tlK H (rtd) I 1i plfho l og l ~$I rUlglng tr m low tmiddot k Pl 1l1 to IdiOpath ie SCUIshy
Submitt(oJ [or PUhltCl l1 011 uly Tt 2001 Acc~pttJ ugu - ~2 1(t-1l
Addre rltj-xlfll telt~I(middotb If) - grinl Flt(1(bziurllt r )(m Ofl ()(Cl1I shy Lt middotqlltœlll ro () - 1u I4t agravehLIlKil ta IYIL-lTt ilSllltp lfllmiddot ~ 1l1uumldull
CelII ~ (niiOS I I~ middot ann (1) IfUh middot lIlfU di louhilll(tymi ( Nlmiddot ~iI rli -ilIIUmiddotltlfl
Nlti(ir 1( ) il r() (ltbullagt1
lt vLL_ l IiII no 1ftfI
jS ) we are a IUil ly tJc ing n1n) ltblll lS 1 k l1 b ~J)w in~ tl~ t S Jfll l approad llt - l1n til hy on ielshyertd ~tan lard ugraveJuld ln m any ~1~ he lI ~t les i if Ilot dange r )ll lt rhlS is lrut of reil l lnw 1gtlt1lt1 pa in l ~ or 5urgi c ll lrea lmltnl5 in dbc r lmiddot ll Sc - 2
ln tlle cj-e ut ~ t lll(tlWtl i( li p l ll1JC luuml- I ~ middottnl ~() shyliosis phys cal ((_lt1(( is emr1uved ltI t()fIl1 0 lh~rtrv
lo ly in cel1l in L)lllllde (nluumlnlr in tilt Lltlll middotorkl i e Iw l) r llt t Srain hUI IIgt() 111 Gert11lny 5- 1~1 in other reg lOl1 wbere thi I-incl qf tre l tm e rll 1 p~ 1 pmiddot t 1( cI il Jws Ixen cri ri cilld md rel -cltd Lw m~lI1 1 11 Jlu~ Fue Fnlny r ~lrs thio middot15 a lsgt(ru( f ~rth r -~ltc rrJtf))~ ll t vit11 br1Cltcgt b r II1 ([C Llt n ClW grmvlng 1lt1 0 L Sti g
gcsti n the lIsefulnes- u r Ih is form o t treatm n t 1
Hmiddotu]rs have nerged jn El or uf pll y~ iLd eegraverdse eacute 00[ 1 but tlw are nUl yel 11 11 t llu i vIC~11 and r hi ~
f rm of trt ~ltmenr IS stiJ l Ul1 ckf ckhate FfI t Jt 111 il i 11t (eltary td 1I iFy 11umbtr ot
b l sic COI ceP rlJ lf w ill he cIh tt d in t hi pap r
Scollosis
DCijIrI iriolls
ScnUoSlS is Irlircc c1 lme nsIcircltnal (I(gt i l cj on ot tht spinc thar cau C a CU 1 lh lt ca n h e $ t~en ln (1 me1Sshy
ured ultinF Coh) lll ltllCXI o n HI anreu middot p rtc rilt r
EUJlOI -1 lœDICOPHYSlc~ IR
NECRI Nl
110
f)i)
1 7J
amp aS g 5li - 0 v
V
31
10
(1 1) Il 15
-tc i ytjtr~)
FigJ----jllph ot DlI w l-lkaupegraverel) The agloimvltltinn Or idio r lrhlc 50gt1iflll~ IS rpiJ bel~ en th e- [l0 IH P (l)ltg tnntll lol (JI PUllcmiddotny) mtl 1 ( f( lS-er sigll paiilivltecirc lt Dlt(i I1 11illg r the iti l 1Kgt n n t rll icirclicH a ) 111lt m omal prebulled the mno rche md ociks with lll I)ttlx flal gr Ih pll fl
rlcljoprdphLi 1 hl merl prestIK ~ of this curvt c10es n t autom~l ritllJy indi ate the pn$CI1(t of a defurshyTnitv (SlllKtUrd (Unel
It i~ possible tu clil1e ren tute a struCnlt t CI1tve fruIn a pogt urll 011e by identifyi og the hum]) du ring AdIlns tesr I~OQ looklng tra m beh lnd at the p atient w ho b benchng fUfward il is p -- ible ta d d~ct 1l1 eh ucirc n of o ne liidlt 0 1 the trunk usually n n the (onvex ~ jde ul tbe radiographie CUfve Ugrave1lr C Ul be mlt~I Slred lISin~
BUlln els S o liomere( 1 ~ l This h Uf1lp is du(- lO (Ile pregravegtecircn ~ of vertel ra i rolltion 1c1 Ollt tn tic f~YJ tllre o f the def trrnit tli [ c m be seen and measurc(i v ith Perddolles lb lsLometer on an amero-Ix)iferior radioshygrapb ~2
Seven ry pel cent o f li Ises a re conid 1lt 1tO be idiopa thie 1 bull ia l-nosilt in this CI$C is b exdlls i ~ n as idinpa thlc me-us t11H wc do n()[ know rJw origio of lheacute curvc [n othe] ~Ie$ it b Ix )~i ble ro ide nrify a dieak (bat CHl jusrify the c1etgtnniry slIch a rna lfo rshymar i ns I1(gtufol Ig ic~ l or genlttic cl iscas s Glnclt~r trauma etc )
[dicirc)parhk S(oliosis has been divicled ~(corcling (0
the ~Ie of tlie patient egrave1l the tiJ1ll of d~[ccli n of the condil ion into ti) ur t ypei ln fanUlc jU nik ltldolesshyccnt lnd aduh Til l m n st cnnunon (VPC IS the acloshylescegravenr o licirceacute I1IJctenzec1 hy 1 sud le l1 tggrH3l ion uuml uring the grow tll Spllrt (Hg 1)2
lhile p tu 1l sco liosi i5 Ycry lomnw n thl pre shy~Iknct ra te f r adole ent icuumlop~lthic structural CU IY~S in sch )o chilclren are 18middot20
- 10 Co bb d~grels o r m on l -lil
- 2) ~ohh dtgreclt or mort O 2~j - bull () (obb d gre -s )1 mOfeacute ()ll 2
Clin iltI [ d e isio ns lfl IXlSed 111 an lccu r~He pregshynosi which obt inccl in eJch pa ti nt mainly o n the basi of the nsidu~ll p()tlnllltl l of TH1h and the result s of 1 rh clin 1 1 ~l1d tadiogmpl i exlminashyti(ln12ll c noieq uentlya d inica ] la sifiou io n o f the ing le pHient tn -ome estent co incic1 ing w irh the
D diographic one c l n lw SLlIl1H1arizeci 1 1 folIcJ - mikl lc~ (1)(n 20 C bh de~r es - moderJt l betwlen ln md 15 ohh de~ rtes - StV re 111( gt1lt rh n ~J) )bh (kgf s
On the 1) lsis of [hi - dinic d d a lfic t i n (Vith l1l il el lrb tiOI ~ o f the ir b() und~ri e ) in Itllt l cente rS Of SCOtiO LS ITe ltlllent in the Lltin odcl (i rJ Ital lnmct md PI iJ Ugrave tre tmtnt i s plmmcd a fo lltJw 8l
- mild kineslth e (~1fw ~1Il (1 luok-ou t - Hl demte IJragravecegrave 1111101 c(~r md k i rws ithe lJpy - ~cven surgery
Physical exe rcL~e for S(ol iosis
Defi t tiOl l S
PhyS i 11 nU b lIKrlttp middot (or kines ithcIa Pl) i a p rvgrlill or plt~i Gl l (xeriltecircS ~1ci fi ( llJ y ltk ~ loped
y a -11 [ru ine 1pll yslo ther3pisr wirh th e m 10 Hllll
- pre (~ n tit1g tlc aggraaLion of the cl I )flnily in rnild bullcoUm is
- helping tlk Il ld Ct ~lOd ounter~lCtjng its skie elfects in III de rltegrave sc li sis
Tn tl1i_ feSpec1 kinesitl1ert py f JI s oliosis is tonshysider l a o on of peciticcedil training and s genecirc tltllly proposelt in sessions 0 1 4~ ro 60 minute IW) t) tour limes 1 Cee PhysiGtl exerci es can aLo ll v o ther auumlns 1S it oill he dise Issed in this plper
Ir 15 Ilot possib le to cl escribe a single progrlIT1 o r exerc ise a5 pro nrams ale USLIJUy p fgt nll ized ( ( lt
EUH PA ~illDI (DP1I YS IC~ 182
ROlL UF P l 1YSICAL lXl 1lt 1~E IN l IlE 11 ~l) IEd If IlU) l[)VP 1HI AIJ() J)~Cl~ r COl ~I NlG1W il
f)( 15 egraved ( )Il the nee L- 01 indi iuua l pJl itnts) al l l10ugh Lheacute) C l n h t 11 plicd o n a WOU p hJ~js (-1 (0 () pnients PC[ ~l ()lI r)middot lugrave reQCf lhese 1 10 grl lll frequt ml~ V IIT
hnm on in middotituk w allClthltJmiddot -Ill Jnv L l~egrave at Wc w Ht ~huw in lhis lyl peJ it i~ 111 n u -eII1 tu id e ntilv kirK itheJapturlc aims w hitl l ucircrr~spnd LO ugravelt~lil1 DUtshy
g X ir ur ph -s ici l lxtTi~l I~llhe r thln ln dj( us- indishyiJ u1 1progr-lfll
Aduumll l lxUl kisure time ~lOd h )u] Sp u lllll8 ~Ilttishy
i lt egrave~ i middotomm )Ly s iven lel mJ ing ro w hlf ~ Iuumlnsidshyer~d usdul or il lrmfu l in t1 lt rruning (lI tJw ptliJicirct ln tl1bplper Ugrave1 gent ltl l t rl ll bull p lwsiCUgrave lttG iviUes is rl ktll 10 JllI1ltlCc hOlll gtpOlt mJ kIJ1lsIcircl hc lJ l f
i ve lUen tloneumld )bo C on lv ine n dul( re Ull~ 1t~1 t s far Ilten publislt d f I~ mJ I(i noltgtithltl rgt is 11 11 a su h jel lnI deacutehate CJitk haltlt t llltit m itn ltl of l ny lorm o t p l1 ySiClI lxrcL e as a Itwr1 [ J- fo r i liopa tb il jcoJL~b un iL ()ri gin~ initial1) it WIS Ille r rOmiddotUumlK lt brgdv u f p l~lt titu gtllergt w h ) intervenecl hutll tc llcrl ll (mon as cltl HtilJ nic in terventi n man Jgt
1 t lltrJp utl t one 1 md rC j fkll l~ on rhe h sh lf som uni cOen I1v pn t I1cgts wt ldl hll ltl enl1 JI~ haLl nu na l scicnt lfic baisYmiddot HOlh tlle$( trr t peu shy to rh ~rl py tt nJecI to l~~rJ tte C Ih tk CUf -~ pnnshyclr~tll y as a f tsul t of lilo h llIzatio ll of tn imdqultdy ~u pp rt(d S pln eacute 7~ 12 to re-t1 r rI ltrl 1$ l l1C k o f WH llt~~rdl 10 I ndt~-dll()urnah tnd 11( on1 p~l per u suaJly Cl tc([ IS n prelimmtrf lll d 3 ln tt li w ay man (l rrlKpt(Hc H lf O iS Inll ph ~i C U l ~ d vi ~ cI nllog scnliotl pa t le nL~ 3gainst holll ph lca l egravexershyclc and p()rt~1
It m u st t~ n tfd [hat pllyknl txerc j~ tJe~ltm(nls t1iHer 1 lJ rd il1g r rhe rherlpcu tlC litTl~ on lllc h tJ rgt ap p lolc il l the IXlltent lncl hi im r IIIllHnt i- 1 (1(1 rI - 5lt1J lC igt tIl l ( f phJllIlllolopJ al rrea tmln ls Ihith cllffc r 1lt œQlfd- rhe m C cculc u ~t(l luI thl p al 1t n
~mc l 11i (lbE~e Tt i ~ P ~il k tlwreI[middote thll wuumlk ltlll t kin 1or ph~ i Clt1 1 lX r(j~ 1I 111~ t bc loidvd by t h~ Lo iurie IxujCJ1l al1ulhcr a dl ~IS nJI h~ iOg (1 11shygerols llugJr in racr le (wi ller d I ~fJIII ~ I ml thlls re(nl1l rn ndc(1
fn n UI cel1ll r we In(~ hccf) using 1 ) 1 1111 11 ve ) 1 (J p lw l icd ex(r(i~e (0 J ( 1I l tt i~ tlh aITt ~ l~d Ilv m ikl tru cflumiddott1 adokscltnt (cl ioj arh lC icoli is11 2)
ina the f U~ t rc-gt uJrs IefC pu b lishe - the pJ( )grd m 11lt1lt l1te n PWltllk d in fa c t deel()pnlln l~ in th t l itshy OlL1Ii in tl1 r b t ~() ycal f ha ve iclemi fiecl niO l l
m d 111 ur impl rnHm s md d i s )h ilir i (gt~ lue t idlo p lthk amp()lio -i ~ t Jll CIII he 1UO(l if Icirc 1by phyict1 egrave xert iSlgt l fe t rrncllt
l illl
111e aim of t l1JS r~l per ii tmiddot (tv iew tl1( l iterat urt to a(errl ln v llic ll of th~ impa irm 1t~ and Liit hil it il i GllIltec hy ~ o l i()gtj s -o ull he ll nt x or re middotlu celt1 Ili pl1ysical xerclse An u p-to-da te knOvkdge o f tl lt Lgtpecl-gt i necckC1 in rJeumlr) d -oek
- whetll~r there h ltl n adLtIIl ) l tht()d ical bbh fur or JqIIcirclb l l l1 Il( ) f k irt llit herlpy
- h N I)(1 ( 1 Dm tlle p r l c tIcirc(( o f Jebur tiJne )pOfung lcli v l ti ~ IIOU lci he tllf) -d o
II J U V f h 1 I11~ c~~lb li hed Ihe usefuhlLss 01 k il1 shyc ~thtrpy il i aIle dy l nsi 1([(( -r-tI Llleu i n )I11 plJt~ ut the wJrld ir ilt ecircS~nl i 1 I( id n Iv w l1i li ( 1shy
gories 0 1 pl1Vtl( 1excrClgtegt te D)bilI7it ric 1n (Ir st shylliuumlZltio f) lttlt tlgtbltn ing ni trcrccedilh ing erc) hn Id be
vnlcled he tll rhe nuld be lerrillldll1 1 md whidl s tlQu1d be inreœ jf ic(1 IJeClU~l tlley cOli lel Je LI ~ful
Ncuro1llotor impainncnts
Imv aUl llOr~ 11 lt1lt ~tlKlteJ lhe cltlndatiotl bd Ween tl UC1UmiddotIt t l ol(~C t nt id iopml je -nll ~J~ and cli~l l shyler~ lr 1tH lest ihuLIr yt 1 _ 13 ~ 311 D uhoussct 1
1-- ITS tln l ldiopath k s(o lio-L L cll -c d l J l hmgt in th terl tltr f prop li l l pu n md 1I1ar th e detrshyn Hi n i~ na tural 1 ~ronse to ril e need tu ts tu re p()tun ltlluilib riu Ul HcrmJJ1 31~ 11 () d tllat icliupathic ( liCl5j h l it re5u lt Ot1 rw nltuf mot r l ~ltelV
[Id )fcl 3 nI] ~1ltJ U Sr1lle nr to dtorders in centJtI lO~Cl shyIOIDNur) md 1xi~tI moro (Ul1lfOl syt( llI (Fig _l
N htIll -of) H1c S uumll h( rll1 ( ~ l( w ing JI t11 (oshyI-ie on the l l lO]ugy o b doll (nt Rl iu]icirc tlili- middot()lioL m unt fil t-hltll rhl ugravedcmnilV L th e fl5 ult o f 1 (k btcl 11lIFll llI ion nf som t11(WUgravetltnl md pO~ lur( (tnic l~ l licirc1 tl1lt if l p OgtlbJt b C 1l rlw sta l i lin 0f 11 1 Sf llle j lt g )tx l Tt) ohtil n a ))Cli U 1ILzltl I o f p ~llIr~il d l~flo [ in l1litkd ~J)llnSIS me CI Igt(middotqucnr J ~ a ~tmicirc ()nlly or regle Ie Llive
Ali th- 11yp ) tlw~es rd ~lte tr d irtl Itn t pnl1tlt o f [11 v hole ~piltm It11[ controls postu re ~nd mrw shyment lrre pell ic of tlh po int a d lI~ llv inH llYegraved il i ~ ll 1 nnable tCl aSUilll ri 1l tr l ll1 lo g thi ~ys ttm ( Qu it le 1I middoteli tl
lt ch ugt nlt~(S f rullliIl thil i nlomwtion th at p tlmiddot shyiCil J(tl iIies nw gt Il lInport~n t rr le to pbv [11Icircgt role ca n 1)lt slI i11l1lariztd ln lWO the ptu li ain Llt
- d elopmll1 l of p uumlltl St1 b Hlt ) - c1e veuml IOpm 1)[ o f bhll1ltc _
(k llhUl)lOr S Cll orr
ontrot oic whan-lt
------+ 1 ~ il lnll ugrave r AINnl
Cllnlr1
T bflt~ r
fltL1 tlli
lMini
l
~sary ~J-frlllen i )f
~ 1 ocirctnl
~UcirclllIJJlW Ll
AXl ~l1 n uumll l) r sy 5t ~nl
middoticoltoq ~ Fig 2-AcFgtrdong lU He-mutl 21 il is Fi)5~ ib1e rD prolXgtSlt l -oo ie1 mnd 1 ((if ~ elio egrave middotAhltr~d l)Qdy-p ati~ I I i u d) uren ttllOn k td LO In ~ory reHTt I1 eDi tn l al ) JdrnlV~ pn)4~ e l u r~o(Ofe 0-c1 eptunl dvstil t1 ctlon sltŒ(ry icircltu nu11t ilwnt [ ~mC ~ted tl l1 ce Ill trpntlshyUumlfJJl nd IKnle~ r~dibl jtugrave)n of -I) m tlosen Ir ~ig nj tl (I1vying ln fornll1U n (lI an ereltl ~piJl e Mmor aJJ r--a t ~) n ltgtf ti lt aXljl mowr plem iHUC Wh ~fl Ille 6ubjeco m uumlntl Icircn (1oJifitd perccpfLlI l ~na l ysilt of p n)lnocepti Icircnfu rnlaquol ti desnibJOS ~n t tecr spin A IICW motor co nrro l Ira I gy t adopt resu ltin~ in the ~tr ltctltr 1 ckformh y lf IdiopathirL scollos i=i Ht lrftU1uc nltnt l ISll I1lJy h1e- ~ I pro()und elkn on bralO Sfem flJll ct i(lnn~lLhu modifyRll Ille nltulltgtshytl10 ) 1 1111 Uu l-lHoror control 5~Shnl$ shy
As Srtgn1lt1 l ~ ltlssert~ if wc l C -Cp t 111 1 un o f the G IiC s oliosls L l tisorckr oi th e ltquilibrilltn sys t ~ms it is lagical to oriegravenrate physlCl l exercis( lherap y ln th is d ir(gtCli()[1
11lclte goals Cul tl lfOUgil ditrercn t modes 01 action be Olchic(-c1 witJ1 phykal accivit ie
- po rt ive Cll ities p ro ct LJ e aIl UgravelClltrtsc in 6lte nshyel ll )o rd in~lti n pinai pr0prinup ti_)[J nLi mOVeshyment control 0 vio lls iy ln thh repect ome lCtivshylites aœ pre um~I I)y lXrter tllln ntil crs
- kinrl lira py using pedJil exerCisocirc specially developecl lith th est 1101 5 in mind illVuuml VC I lllore prccilt( ll1d InC1 li zed cri n on rhe spiJw focusing
a90
1 ~~
lg -lNheJo ~1l l1 t r~l g rld in 1 1) h i(~ IImiddot ct r rHienl w i ll idlllhic _It ~i ~ _ iri s plt ~I le II find Jit ltH vlllleuml ~l Cgtbl tn~ ks III d il fef lt p ~ lt ihnS nu v~tl middot B ~a~pt u Il C middotl)Icircd ~(t l l11 C dlfkrCnl middot- hdween slllndi1g Uline nu nllt1Xinul oorrec ri nI t chied Vith Ct (J ) und tfdincJ ne lot es o UIine 1 fo llnVs middotIJfl tfi ni( - ltlrshy
reltiK)n ~ Ikexibiliry st3nucircing - -pirte - f ur~1 1IbjISC ltupin - ltorrcaion - - r~luci()il ll ymiddot For flmpllt in J npK l1 pH k1J il
plt1SSlhlc ln obtai n 10 u1 511ndlt)l [YLo lion yr ln Slt p ille rlOlgt itlugraven om l J ~ in ( gttf(C rigtIl lIex lbuil 15 i (r-l l=22deg pol lltl ~~J IIlpraquo is IcircO~-V- I t1 l nd tucircu(Ugrave) ilil) I~ 3laquoJO- IH-12
r ln Ugravel e abilit jl of tluuml [m e llu to co ntro l irse lr in ~ pac
fuld l oftlles uumlllelve ntio ns can presum1b1r incn~~ Ih enl ac )1 the orller and lHitlll r of Ille rn - 11 )ltd h e lllldenl lu EJ3)4il
Posl1l1-t collapse lnd slabilizariotl
lIle concept u fplt st lUal c(l lJap~e l l~t Iwen detin 61 by DlI II-T3e~tupegrave rL t Ac oJdin)j tu tl1i- ~ll1thor il [ nec(sary ~- l Hn Cv-tlualing th tleihility o f a col shylo tIcircC CUJVL (0 clistingu ih bt tVeen the re du ihil [ty index (th - li iffer gt le bet ~middot Il ~I r~tcli()grJph ie ~xnmshyinltio n of the iI111 pHienr in supine po ition m(i
ROte OF Pl rnmL EŒIlCISE IN THE TREAT-ŒNT OP ~I IJD IDIOPAnnC OOU~GEm seou SIS EltJRINI
I (~)-----------------------~
__ _~ _____ _~ __ __ L ___~ ________1 ____ _ __ ____ ___ ___ _____L___ _____ l___ ----------L ______ _
1 ~
1
-- ------- --1---- ---- ]---r --- -----_----t- ---- --- ---shy__ ______~---- __ ____ 1________ __ _1_ __ ____ __shy
~ (1 J
1
8 =~~=r=middotmiddotmiddotmiddoti~=-middotl--- middotmiddotmiddotshy--------------t----------~- -------- - ------__shy
~---- --- -- -~ -------------r---- -- -- ~-- - -------- --shy----i-------r-- - ---- ~~-shy
il 1~ 0
Dtl-Lmiddot ~ lttj l r~ UIltltlHt
f g 1 -TI1 u ilictf 1ld ( ii 11- ugraveu-sh) ld IX~ O 1d wllich ltJdnrshymII Il nf the pilll 1 ~tln~1 of th e -o lioti( spinc n IG~nI(J II IIIshytt) lhe iJeuml grl-e o f ~ ()Ii ti c (u rvH Il 1 w dcpc-nlknrly o l l he 10 111shy
P01(nl (pntt l ~ 1 1 nr ffll wrJ I) ln w hilth Ihe n i 1gt( ~ duc nL~ grlphs fm I h~lt 111lt hi~hr Iht Col h ~Ilu t (l f Lite ~Ul Ihe m Ol CI il y th t s(uumlJotil middotpin~ ~111 he ~middotJg gr~lVH(~(1
m mJxiTIt corrttt ion wll iJl i~ lIllCd to Ih - xt 1shy
lti Oilil y Jf tl1lt t Ut JO rl1t cdnUc idt md p OS shy
tU ll cul lapse ( th t ltHill enct b-tten l lUdioL) 1lphic egraveltamJl1ltlti OI1 J t th e ~lme pa tient in Sl il tl cling lOJ lline fX-sitiutl ) Wll ic h correb lc- onl wil ll fhe abilt ty of lllt p tu rl l gt s tem to C( lunternct lIk luree o r grl viry )cco d ing rv D lfVd- f3egraveLIprc po st li r t1 lt01shyIlDse is d ue to the Jnus -u lar ton a nd 11ll ex rCrIshy i) i itv of rhe tissus n the ( O IW-) si it (If the (01shyjl ti (~JtVe (Fi~ 3 L Pu~t llr1 C lltpstl lu lcl l ~~ reduc l-lt by llwans o f pl1ysica l cxerCles specitkally s tuclled ruuml i rnprove tIlus--ubr fOHt md lU pr )cllI Ct 1 ~11 hi shy
lizing ffCd
PararcL n tll CIJ cl the cr iti ca l (3 c1 thlsho ld beQ ld Il ich defol1J lHU n of the i pinlt 1 e~ in~ ne dtlllontr~1t _cl (1l ll t grclrf r mg] o f rllt C II in a qa m bng pos ition corn pOil 15 t l lowcr detormashytion lhnsllold (Fig 1) ie to ~11l Ulne3Se t the risk of pr ogr t~ lu n There t rh eJef re l J ea r l)iuuml 1itshycJ l ~ll1 l l(tl a 1 tnr tg ro b ohwined by d -cr t l ~ illg ilmiddot pU~lUrll cull lpse ptJcelJtge w bich lccording t i)
h llTd tnd ~l(heJ1l ~on 1~ b inde cl 1X llt icularly luumlgh Ugravel mllcl c Iio~ i (bdow 2( 0 ) (F ig 5 J
Fin a Il III ch iS respect lllljl hl and b um l 01 m linmiddot
ii iI 1 l _ _~ _ ___I ___ ___ __L ___ _ ___ ___J______ ___ 1 ___
li 1 1 1 1 i 1
1 i ___--____---___----__-_---_~- _ _--_ ___-+----
i
1
i -- ~- -- ---~-----_-~-_-_--_1-~
l ~
i
+----r--------t-------t------f-- J
Fj~ ~-Ac(XjJlin(Q luuml T O rIcd ~lnd Na(h(ln~ n i () dl( pCG w rd (rTIshy
POO ll is hiherin cu rvegt in wh ilt l1lh ~1flILWrd cII1I Olk l1t IS le- pr(v~knt ln th e grtph Ih t PogttJlJ I ugtnq) Ot1 -J1l j elfltS-e J tlt 1l1t obb dirr remc rlLIv obu incu f roll l the Cohb atl( 0 1stlI1dtJ1g IId gtupinc rldo~raf115 Ih Ille lt) [1l1t1 (i lndnl I pine) 511pille the ~(nlClu tJ1 compo l1lnt U rlk CU Y _VeJily I~ ltx p rlt 1 L1v UpUlt (obh Illeturo Ih t si _b Cct rtJeSIm l fie -ltn J trd Ugraveltuuml shyuumlo n A~-i)rding LP 11(lt uuta o n l ( r1I~( in ~I 2JQ sup itlt curvt 1hi C(]l)b ddhccno l l f lO is -J-lultt( thc s ldnd inr tnla Ol1l t lS wi Q) whil 11) 1 1)401 ~llp lne ClHVC If ~ 1Omiddot ( tcl Lhe ttnd trl~ nlca~ I(t I ~ ~I)
tli n ll w l lllE cq lin ti spin h~ i ng mo r ~ Llnt~II) 1 tlun the nOftl111 one n Cll l gr(lk ( (cU ve tl1u n da r u p shy
po rt in o r k r 10 m linrl in tht 1xi11po tuf_ n th ha__i of th egt onideratl lr1S it f(lll() rhJt
ph rH (~Uuml e erd es ulukl h u - ul iiuml tbeacuteY ~U-L lm cl 1l (It-d o pmg p05111 td C Jl1twl lS fuumlrnll~ rly d ccrll1td ln an Ql St if i imr ol1111 t ru t(( - tht m(d in C JI shy
r t t r sture fO Ir -ngthen tlll m u ck-gt of the spint mainl) in (11erl antig r3ilrl tIcirclt l]lli fun ctin ll U hy meU15 dl i )ll1 t trk ~ lhJ cl( -ll tlt C)nlr~lUions ~llld no l IdOshy
1l)llic d YIltll1k lt l jAJ lktic t) I1 ) II 11)t 111 hd posibleacute t lcluuml ee postura l io nrro and stfh ili lllllt IJI
w i thout food T1lw(ull r d I( Lf(11 Ibk t m ucircnuin Ihe c()rf ~ct [ ()S tu re for cl gtu ifKi IH lLl1gth 0f ti l11 ~
This i-l ddl usl a typl 11 dnmnin (tf k inesllh rap) in 11 (lt-11 [[k - p~d fk lnr in lng f u l1a in llllliCk is poss ihle lI sing ctrtain Idncl fJ l (lt) 11111 liun S p Ul in tb is Cl c is ulttful ooly sa I~tr 1~ il Iw lps t1w lxltknt 1 becuJl)t 1gtlt ltlt-I a ClJu~l inred irl ilL ntllru l o~ i cll
and I1lll~lJhl r-keJc LIl [rll-llIn~ middot etlt(wrs JI the int e rmiddot vlnrion
[J ROPA MfJ) I()Wf-I YSJ IR
1
ICR 1 1-1
r
1 shy ~
- shy
11 o-llrfOlhe5l~ o t Ih 1O~(1dity i n h ~ r ~ ll nr pbl1 l of ~ Spl11 in 111011 _llti1Gt l lPt f ltlJUCWJtl ( ~l Ihe Ir t 1 1gt illbll W Ilh LtltrJ1dlion Vln lbe rigronl middotUII~ l(I Dko n12 lIll h lumshydlanie1 1 [ nul 1 M hl whtrc M - gt) lnIUI1g 111laquo111laquo1 1 1 c rtJCshytjC~ f fce d -d Lill l1~ o f enr niI pUll spnmcl1y 1~ 111 mldlll1lt (n the fl1ur t 1 = tor~ of f(ward Ileuuml l = ughtel1lng fmiddotr p 1shynOf stn lClU= Alaquo rdtllg 1raquo Ihl~ - lin hull th l1ltgtllugrave ot tller1l lUr~Jtllrc F the ~pin t -ilh rlu1i tf Ihl 1 1Ibulll n lrlt InltT1 1
rbc prJI 3IJi l1ty d qrlOIJ~ n bull JI t IlJIII Hm lA the v=ltd gtc e lu-ing J 5lnK1ura i ltfnnity
Dioal e ch anicll itllp~lir J11 c nt
Ihrcemiddotdimcllgtional mc-cbal1in of the s pioc
~f Ikmiddot i t i nly l(œ ntly tlHr llk pr-5tnœ or nc ushy1 lnlo tnr impairment in Idiopttlllc s-ol ii IXl tknt liuml J$ heen h i- ll licircghlcJ hy re$eJ rh tll e preit ilegravee h inm b nIcirc Ji d lJutg~ lt hl ~ 1 ng t o n dO Ulll urcel 1 i5 (l lreldv well umlersrood H(j-ev~r nev lbt un h iomcrhankal im l) ion nI h1c rectm ly onk l n tIlt tre and p r~dou in f n rmtinn hou t pl1ykd (~fcl5( in t 11 0 tl1I _ltgt pbne of spact 1115 Im trqlt-u 1rom J i-[) v ing unclcrsrmdlng ot th l lmc -dim nshy~ilnl l l11 ~ hmk f the cO]jO[lC pln( ~2middot ) ) Ve- w ill )iI xnl t l1 d at lcL-orcltng tUl cl sif iol t lOn blsed o n gtolllt lricd h uumlCJ ) p lane
- b() rJzU[1tl ln th i pla n ~ th t 1o rm ll sp ine present no CUlye- w ll ile Uumll(~ ltc U Hic spLnc clevelops one of ir haracterls(Icircc deFo rm tiCs v elt tbrd ln lashytio n vh icl1 pJ()VcA~ theacute hw 11
- lgitltl in th llulJe U l(~ nonmll spIcirclle pl SenL kypl lOSis ~nd l dooi~ in tb lXI1 lhese [(Hu rts Vere m)( til ught [ 0 he relattd tlle scolkJtlc ( lI r Vegrave
- front l in hi pleme tht ncrmal p ine preseuron t no curYegrave whil thl ~11li tic p in ugravetI I ()~ icircl~ charshyad t Ilt I CU1C
Il Jri fJIIt palic
~l+I~na ra 3 r inr lut th l[ ber ll1d a œl1~lU1 degr 1
l f r()la tJo u lllu (lILa r forcKl ltxert ltJn tl ldefnmuumlng 1 tkllJ [J i1u a re- lhlt tll cly 11 [1 1 UI b y Olm ner w bn ~lh uiJwd tl egrave ro t1tic) l1 Ilm it ti lt p ica] lf shy
rhrl r() be (P (the Uma bevond Wl1iltJl th lCOJlb of [11( ~pmaJ musd ~ dthc COnCIt and nm ex ~l le btconk (t O li~[)
r ~l 18 ~1Il N lu t( ren i9 lun lu ted rlseurlt h in tlt ) tilt lULodeumlformipg1 tlo n ot tIH_ sc laquoJrle rh ox ercallkren lk 1l1~H li d11r once thl Il i ~ r tld1t5 [he lhrth ld f 111 JlIcirc lIi of tlle dnrlclc hurnp tlk
lI bslt Il l nt rlet()rlll lIcircon 01 the it l ()I~ C ( (ylm der (- sustalnecl by an H1tmi cforming aCOOIl
J1Ji h V hl rhyiical f~ f Ise CI 01 h spr n llnd kin middot ith ccedilrapJ my lX damlg ing vll e n l pplild as flle
igt Jk Iller ln SCC1IJ ~IS lllc lJ fxceed l auto in middot crca~ i n g lhrllgthuld [1 sh (~u Id ahn be j ofed that Ilw relscd pre sun 1l1111i insiugrave l fe pil1r inn) 1 mlshylt
- j Il- ( w atff 1 (nh ~1l 1(e Il10 utoldrml ng li1eCh~lI1 1sm
in flc l Geyer ~w tcd th1 t rm m 1 hI l)1ecircch1O lla1 puilll 0 l I C~ sw m mim t Ieuroamp no purpo t for cu lshyim le pllilt t1 s (weumlO middott r it is l~Jl(gtWl1 rhn in iculio r[ paULnl -iJl11T1ill~ doe_gt nor Il ~lp to i ncrt~SL n eur(1shym tor co mfU
(1irai p an (
Jerdnn lle 11 showecl thal ill CSl~ o f t10rLC IC 1i lUgrave
tllo lacolulllhil it lio_1 tlle cte tI llmiry in (he lg itt1 p lln t rn lnlftot il~ lf tspe iuUy in tlw initi 11 r luleuml )f cV IU[Icircon nf Ile ~oli ls W iU l 1 p(t)gr~s~ivlt il10middot~ shy
ment roward hvpok pho b G ll f ill~l Im lins l har dUflng (IN eWllLlfiu1 of 11Imh] co luumlgt i the l in t ot t l H~ gClyty Cegraven te l - 0 1 v llebed lxxli 5 r ro ject 1 seH fl r t side-ys and tlwn backlrcl bull thu~ p(0(1 lj n g a kyphQtlmg aet Il ln (h~ lu mhnr --PIl1 COftj tng
l l i tc Iugrave l lltl l( l rs1 tif s L -etllgt il l the lgirl11
1 Hl)
Ilu LE nI rIIY~Ic~L lXIlKISI 1 HI E TREhTMEtn OP JIU IDIOP llII C AD O USCUH O Ll Œl15 NEGR II
lLill tegt lre lenl1 ~I d ~fo rll1J[ ~ rhl recrSes the phyltiologiGII cmns of lh vine)
Accordlng () Dicion ~2 1 rtcluctio fl in the itgitttl CUIYtS combin l vi th a lueral Iviari n llltl ds t 1
mecban ism () ugravel~ta il ity in l he r rat r IllI1e which bVOf1i the unsd a nd i ncrea~e 0 1 co hlt1is (Fig 6 hiIf md Pl11jlbiJ Jl1eanwlt ile lt(udiecl lh e srnl ru t
orzyglpophySLs show ing t11 al ttleir 1I1tl rnic tl orienshytation f~I (jLi l~ltes aXIal ve rtegravebJl l rotllio ll in cun litluns lt f dorsal hypokrrhn Icirc tnd lum)H de i L lo IS
Tll t dat SLlgge 1 th t impOrfill ut pOitu res and l1lweil1 ) t Mudied in ord t r (CI mlIuml ntrlin or to reuwer fll e p llyslo lo~lCll ClIlye in lIe SlgJtta p lU)l Wlth the llm o t ch ~ kin~ rutltor in l~ bili ry7 AbC th ~e ~k-
1l11nL ~Irt del lnt [0 J jUc lt ftber l]kuti inrervenl ion vhich 1c)LJ k l IV - i(l ~ l compktl n l ililll on Il t c1 l shy-jel1 J11UVllT1ent IJ j o f 1uto-dOneacute(3tlon ( i e a -impk ld ion ) Iengtheni ng o f the pilleacute 011 a litlltl l aXl~ tll lt ((IT liJlI~rcdu e~ t lle ~---lJ linti- l lte ml-fkxj(l n h UI 11 - i llCrl I~t the plllH ](JgicJI dlt cr ~l S ( (1 k-yvllCiSh lIld O(ltOSh l o r c lch r1Iif n t a Ilew til(~ecirc dUuml llt Ilshy
si lflltl J ll1 u(~nlent iam ecl - 1l1t0- lIrfe rionmiddot7 4 llmshyp oed f Je-rura l iUIl cl middot-t1e- iltm lI1d ll1a intltnUlLe )( 5lg it d C Uf (gtS slig lll thltJrc i ypI1 tiZ) tIcircOI1 a nd lunugrave)ar 1()fdos i7~llion) sholild he esw b lb]HU 00 lb co
hl b oi hi p~l11il uU r -1Ir vlt Abo 111( e IlltUtl Chl lie o f purti n - a U vitk slJ1ultI h e )tuumlll ecl 1)] (1 n ldershy](ion r tl1i lt type for e upIe IilJ llyl)T S of repd shyiti( ml vemen prt n t in agonistK h)lnllltlSlks nI iIle kind f dlJ1ce C( uld he ([([r imentd
FmiddotO lllaljlallC and mobili ty of the SpIcircIlC
1 rd llo U 22 d L lm nrrare d lhlt in Illt fro nt a l pll ne
tilt 1 nge Clt 1)1lt vtment of tht scplit[i middot CU IY grcmr lIJ l il ~ d irectio n n f Lhe C ITelt tlO n tha n in tl le di re shyLion of pmgressi n l Fig 7 ) he IL o IS5err lJd tbat th15 mohiliry increac plrtil u la rly n apic [ cgcoeilts 1$ lh ~ ~c() li osb evolves Sragrm rJ 12 J ~ thus rigilt (0
VlI f n rller~p is ts Ilo t t) m o b uumliz - a sCtJl iu til curve w ilhout t [ uling ttwt tlle R lu tiOI o i til t ~a mt b fnlinruumln( 1hy l1tans o f ~I passic 01 1 rivE -uppnrt On tilt (ltllE r hand UgraveK d e iJlioJ1 in ease durill tlw tune 111 whicll tll C spmt i ~ not submjtrcd to correeshy( IV anl()n
j- Virh mi lei ol i b tlllt Upp i1n ill) lC tiol is d eveloped only lllmugil llClIf()mu$Cllbr f r llce thi ~
InegravelIl ~ thclcfo re tl1l[ inu eascgtt sp1J1all1extl)iity mua
11
Imiddotiumltgt 7-rurd illt Ir) 1 bull rdrilt I1 1 in tl lt frOlllll pbnlt- th( illl ge )r mOC llIeJlI o t the S-o UIIJC CUNe 1 supcrior in Ihlt diflt(l im ugrave( the n nKlIl thd n ll1 tllc dlrtcLion o f p rJ1(l( (llIl
be considrCtJ vntrl iJ)(l icltion and 1 undrli neocirc ab L a ~ubiljz~ILion 01 tilt spint pllss il)1y ohtl ll1td thrltJugll the stlengtlkl11ng o f the 1rltJgm vlt nonil lme shyCIC 111 illli orrant u bjcLliH- ln rhis r~f1 n sp u lllni lc tivitIumlLs sil uld lX tPI 10 dlegraveltl it l G lU t n w l1ik luring kine i Icircth lrr phyltical eXegraverci c~ tllat in ele
spinal m ot ilIcirclY sil nid 1e lt1 oid cdrt ~
Organ ie and psychologieal impainncuts and li islbi IiI le
A cgtI im lc pmi nr is moriOthl11 just 1 sp in and 1
compkt gt Ipp rnach to the gu in ad 1 ont i al~ shylute l e~se i t i11
[)a la 0 11[ [n ell lrom re semh pw tbat ome organi Iilnctiond cl fki ts suc]) as tlw clecrtiUe ut vild l tnd d fun ll l)Kity_orld ldly incrtJ k whil~ 0 shy[io s i -till in (1 miel q g of g JltlV ity ~ l ilI e 55 rtI lit
tllL pres e n ce )fl defidt Or Vi l~il Clp~1 - i~ ln one pIIiem in Ihr l ftectecl by 20 ICl 40 scoi stgt l ls~a r(h cunclutecl in tbe UA by Di Ruce- prod uegraveed an aaalo) u ll1lXimum 102 re u t in a group of Jd shyk 1ien t [(h sco llosls rang inF frum ) [0 1
Al10ther rudv bv rallt r m C chr111 lilcl NashycWrl1s( u 57 stlO eltt hil $(C 1 1 ui~ Ica js l( lllt cl (1 shy1prUlllI o f t1tgl lie bJd l imI in ~ul sct t1 t ltu b middot iects jlLltr l5 they are golng through ~I cltlici[e sllge in the fnm 1lt i n 01 tlWH o w n id uHitv t factor hit h Illy jeopmlize the cl velopme lit d ~ mIll lt lI1d htIshym cecl IWI sonalitr in Klulrhood
n RUI ~IEDl(( Ptl Y1-
ROU ltHmiddot PI [ I C~ 1 EXIRCIS]~ IN TI Il nW~JUNT OF SlllO lDIOP1HIC AI)C~ESΠ11 C(gt1[Oi 1S
This i why b IiCieacute ii is ~n imporrlIl t for p rcshyvegraveml e 1tLsr l tn en ou flge 1ari e nrs ~lfrecr(d by lIillcl middotu iosis ft) tlke p~l rt in portin -re rcatioluJ acrivitits Iha t 1eIU 10 L10 th r~1chophyinLl bull nd b~l )i 1l1o tur adlieem t n li 51Jmiddot2Even tlK)ugli [Dr bic mech~lnshy
ical mcl nellIUll10t 11 11 reltl ~ons lt r111 1gtomcrimes be l lefu l to ugg( ~t ne p rt in~ aCt iv ity r l h (gtr rll n anotlJer e th ink Ibal an exces~ ive IlHd icalizltion - Icirce l ll1posilion br plry~ilt i HlS nnejlor parents uf rh ry pe of po rt to lx p m lice 1 b Ule p 1Ucirc(Il L th1[ preshydLl ck l1 is fret clOice in lh ma tt r - -h II ll1 he avolc1ed wb 11 possLhle mainly for tlle i mport~ltll psyshyLb ) jogka l fe a SI)nS W( ha( ill ~ t nltntionegraved
Conclu ion
lbh ISsertegrave d t1H physkal tgtXtlci o is ) n fi ial whlIl practinu in order 10 ilnj rove the I11 llde
rœ nwh and tono C iral caplCiry and postu re o f the StOUO(I ~lIbj n II I nowkdge om ~ middotmg trom ci el1shyrlfi rls(~ Jrc li dJlJ accordl ng r the review 01 thE litshytirlture prnpo )td in t lli plpl r conflrm~ Ihe vuiclit ot th e -t ls ~rti ()ns
In l do l (ent Id iopl1il iC scoliuse il l n phee u i cl vk)pm e n t ( li tll iumlKh eXCC cl l g i en rhk thr hokl th e re i5 an und ubred need fn r l pprnpri 1tegrave (JJ1tOkJJe ~Ild Inr surgict1 therapics ill ortler 1) S l i p
the ( - Iuli on anugrave )JT~t~t UW ~pilll l dtlormities bull evshyerthtless in the illiti ~ll pl l~sC t ttlC c1iseLltc whcn the riS( r1 r euro )luli m is rtduced ocirc ~md tfle uifleal JOld threshold il ~ld flle po stural collai i reJcenw~ 43
JI l1 igh pllysicaJ egravexe rc ise - p revenc or r d llCe d i ~lh ilir ies o f [Iw ~ l() li )tic
p (iems R 28 J -6 5- 6 1 63
- f~KiHtare lh ( n utr ali711iCUl of postu m l d elicits tn produCel1 a coneql l nce J [)ti 0 I111)( or regre si -u lmiddotc 5middot Il 1 17 ~ M
-re 51udles U ~ n Ledecl tu con[mn or re jecr these conClLL i( 1 w l1 ich clerin-d frum 1l1 lIldytica l rcltw n f th e liter~iture appear r- ~Lo nlble Hnwecr Intil ne re ull are 31Iable wc should n r prevent our sroliotic patientmiddot trom tl ki ll p lt in s(loI1ing jshy
ir its pW1iada rly ltl t ~d1()o t () n til t c ntrHY -vith the l xcclrinn 01 gt[1 )11lt tIlat in rea-e t)1obility (tnU evc n thell oilly wh n progr~lgtion b p OSSibl) -uc h ~I( ucircvshyiUe -11 )ulu hl tIKoll w g ed The 11 S J ( rprOpriue kin (~irhe r~l Piuml to incr _~asc p()~tura l $llbil i ty is tl1egraveoretshyic tlly CiJUClt alttloughl more ~Iccu rtte aod deLli led ri k benefi rs anJlr~ is is netot1ed
Ria 1111tO
NIokl Mu d lle ftitYljJfu Jœl il 4IWr10UOifll S (JIvs i (1~1)Jshylidl ttno( cclIll le 11(11(1lt1 RCI fu lle ((lia LltfIt l1 I1I1i(i
LJ ci n s j(r3 pigt egrave li n IHUgru lkl di t rdz t fi sici pe e ft shytUlKm iluppno di un lisimerap15Ll rl lllcflt() 1 110 scopo di pnevirlt () fr en~lI 1-lgpwlllltnlcgt dclld lclonnitugrave o e il 5LOshy
Il i mi llon lt fH nugrave j (1 11ni dei co~e 1 lteIl I1J J nd ne ~Ii eifclti (()Tc rri udk s co lio si d i m e dia g rt iuuml ln que~ltlt
s rud i 30 llizzb mo i d ti cleU ric lca pel n ri Icare qJJ l lm 1 dis(imucirc x u le I[~ l z j-m i pro vna le da lla C gtl k A i json ere pr middote-nute () rk kl ducirc un~l rdeguCltl d nil cra pi lt di uJoseguerrnt Cjua li 1iU110 cli nbie tti 1 rcr lJ)tIId d~ fle)-UITC
n (- -fd7Io n~lcl)
Ut11claquo)si 1 lI tori htpnuuml )ludi-ttn I ~ cnntI1zttu fr Cq(in i idiJ)tic1 dbfl lOZ10l1 d d ~ leOla nelllOll1otoriO Lb un1I1cnUl 1n1l1i3 dcgli 111 lt1i ch DIJgt gtU l H crmU1 Nlch~mslt ( SIshygnaJ~l lerimiddot wo i esuemi -bletti d~ plt~e8lugraver- ne l pClZ le1lftgt scoliodcu kl s iluppo ddl ~ ~ uhjlil~ vertcbral~ lt o svilllp prJ Jdle JIl7 i() nl di ltCjuiljbrio Dng li studi sul lto lb( l~nlrale (OllddU i in pa rticdu d 1 DlIal-BeHJ (gtegraverl ~ P~II IId lI1 n~ llw - idente il v- m gtiu p eT il puientc clioti elgt di u n rnigb o t c)[ ro Ua sw mle dei radlldc onsegull o tramite il 11 fforzrlshyfl len to d e i l1luotoucirc l nllgr3ilri d e luOwo con crcbi ~Clltdr
in pOMltHJ corrctl e in va rie ~i[Jzioni s t llicb c c d inamIcirc tllt Dalle on sena d elb blOffiCcclIlicd tr idimlt n s io mlle d ei
r ~ chi Je ~oU()f icn ~Icirc ~videnuumll (l() ~llt tC p IYZIcircOSI ln(IiClZlfHicircl ~ 1I1shy
liumln fluenzt Je ll middote~rUrio tl SC) lgt lIi I rc pibull m i tldln sJlI71 Stl shygn~I I1 afferma che slI l p Ia no [11 middotccedilr~lk tre un œ rtlJ grado di l L1Liuuml IlC dclh vEltlh r1 apj(de le tu rœ mu SCltJ llri njtbc J n in $tJ ) t rodcfQfll1t1l1te PltJtantu b i r~it-~ r -lp il puugrave t~~
Ixnt-ftla solo nt Ile so )[j)~i Jl1Icirc na rl in qunnt ) ilon SlrM ntne )(l(Ofa tu soglb in caq ) co lltrLJIcircn l)lrilto llt~( i lJudotlsi di lfr~ lI1 C llg grVlmenl J 111 11 io lr riltd ll(17jOill leld rinlle 113 dimO~iumlrlto d llt nell o lin~l cl()~ li t th~oIOl))1 dri la defltgtrshymiti sul p iluO slfl iuale ~vohl lf1 (en5 ion~ sO lnm utto nd 1e bsi iniliali deWggrwm1Cnln mcn trl C a( lfLmn che occlleshyvoluzi ne dene = 110 i [ mhari IJ lin c l ki cen tri ch -1vi1( de i cp i CIt IJ rI Ji SI p m ittIl pnm l Iem lmeme e p o j pOS( shyrio fllwnte dtldnli mdv ( i un ziuuml ne ciloliz7nnl dd rlLtide lu mbJ œ ( lIlelttlaquo on NC n d d (gt11 uIdu m 1I1 Ilgt) cli r-Iure (0 eserClzi che IllUllengano 0 ltlUperifo le Clgt 6gt1 lo)iche sul pirluuml gilwlt Su l p iCl no fron itk Perdnulk il dlll1lt-trlto d1 lampkz-l d i LU ovimento amp111 lI rv Kolio ti ~ nd lt1 0 ddlJ cnrrc-LIcircQo i Ji gC 1 n lungl SUpegraveliltlrccedil 1M llS0 tlell 3ampIGI shyvamcnlo C che l~Jltmiddot mobiliti GlI mcnta co n l c lu7j o fle d l i) snAio i A ulln amplgrtJc1 ltllllmunjx~ i terlpGli nn n m obi shyUZ73It ma eutva coli ti0 1 1ct HsicVlfe nd tcmplt 11 1111nshyttllIcirc1nc n tc (k ll ~1 llu u zinnt n l1 un me77uuml d i sost l11( gt ln 0
e 11111ri b cle - Ilziunc egrave deorinatcl d l rlyarsi Snzcl la pr gtshy
liltlnl l i un() rtl~ i ptmiddot Jtl n(o 1S(Hl () (( ntJ() i ndit~tr i ~ Ii ISt (izi e l m iviL Illdlode ebe Hlmen tno laJlc ibiJii dcl rlc lide SCshy
li io) [n p articobre rune q lldl r C-I1 ich~ xlSiddcHe CUf t shyli ve ch~ iJllpi tgino e~rciii 01( biIi2 ZanUgrave HhnmL-trid () in tmiddot~t~nshy
sione kl fuchide O tne pure k- ~ttivit1 tnotoJII~ non prHi(~ llCcedil
in forma r k rel1tiva d Ie ~1I 11 rF~1l1( n otcol mcnlC 1 lll ubib Ll vcrteblmiddote (ad ~ flp j(l 11 n l) to L ginn ~Iilt Utl clkl rilshyC
mka la cli OT- tcc)
r1il to l~ _ I[Dl COlI rY IC~
NE olUNI
fillncr ( ni ((uuml(( n hIIo( rilclIO ~middothe k lln dtfidl fUr1z i shy
nlu CQll1~ la llcl llZIO 1e delb c apKJl ilde e della capacltl di 0170 mizianu luJndn le (OJ il~ gtna a nc r3 di m~i3 gmshy
v it ln G mlxl r i ~ gko Fl llslrom C dlllJ O e Nachcms(J h iU1I) dim lr JtQ che b o liosl p IOO C1 neUaduksœnr 10 SYil l1p pn d i lIniumlmn~gin nlt8Jliva de corpo in (o nridcnz di Ln ddic3w p ri d di f( m l lz i nlt deUa SUl idenritl condishyZltonc ch pOlrebh ~[I cubrmiddot ln vilu pp di un pe bull n nn lir m llur cd e quiJibfarn in t[C adulro TaU CO1DSCe nZe tvlde nshyZ[II)() la n ( middotess iti di ltimobre la plfte ip a7j0 r1e atl an ivi ll1ltHClr n gl b a li ltl h ~ di tlpO s pu rti middotu dl ittlrc nd gloani iCo lID ti i lirtugraveta z io ni llb vila di relazionc
ln concllliu fu la d tfoflll lL saliu iG egrave il sin l mo di lin) idrotnc C Il1pk 1 d e eoinvo l d middotmiddot= fu n (n i dd rgashynIcirc5H10 n Hi lhdli e lesenizjo fi 1lt0 se 1 Il indirill~t() pllO pr~cnin 0 odLf rgt t lli di fu nzlonicirc adlc s()Jj(bi 111Icircn(i rrHtatc CO ll nl1 cinesi rap i Quand l~ coli i ( n LS~middot iJ11 zia k il rischio evnluLIcircvo egrave lid [() mente no tcole 11 (ltlll asso p o lll shylal ltOtSltgllen7~1 _ ta cincsiterapia pc rslIk bidtlvi shyptutibulli d ubllIcirctIcirc vltnc brn1e di conrro llo )(JSu k d i 5IcirclupPQ d Ile rLlt ziofll d i eC[u ihb ugraveo dJ ftffr otZJH1 r1w dei IIl llJgtCili 1 11Icircshyg rdtarl in posru ra rrenu posslhile JnnalL in Illo lt i clsi l(j luucircun lt di lin ~c() li oi mi n rc ( ume [11 duumlnQstrIO la tinc~ jn~l el1lric ((1l1 ~rtlppi d i contnmiddotllo cnndnlt1 p nso i l entrt d e Massue di Li n nc da [ o llo n ~ Rodo l (1 986) Julndo il1vlce lIfU~ ho ~vutlJ tiVll 11lt1 1IjXIl to un dekrshyuina r o~itl di g rl vir~l bull a~-n lllull~nte n ec ~~uiu rlCUuml rf( ff dla tcrJpll rle si c a eo chirurg ica
1Ho le clllC ooliosi idjopHI 3 ttl1p ~ - E~er l zjo hsco shy11ln ~ I((fapil
l Bg 5 CUle Lo [la k ll oblems in tlu ll~ (U ni Cl) FrKUce CU ( )lIILr no 1 AllCPR lu b1lG1t10 11 middotCI 9()(iJ2 RockilJe MI) i)~Cr ~()f I [( al th all 1 () I ~Y 1(~Re~C~Hd ~gtutnlt Ilallb Srshy1ltC Cgt D~p(rulllnr CJf I Ilalil 11 1 HumlIl sen Lel 199-1
2 SI) lrzcf ( LcB I ~IIl( FE DupUb L ampkIll~ 1c ~ppro l c h ll tht rnent und mmgemlt-rlt ot ~ ct vlyrl~ led splnul (hs r)fder~ A monQglJph rr r d lll kic Re p o l1 or Ih Ou bcc TlSk Fu rcl 0 11 ipmd DIo rele Sp ine L9H LU) 59
) Clntino F 111i1 i(ll Ci nerte1H C Nou gltHhl C Kln(~Jl llBICII [lIe1 hmlln (Il dry rra ll1ltfll of QIil pa ll m log iC by l11e 1 lIb li 1le-llh laquorilC~ of ~ 10(lna 111 Jrc)Jcxli r~~ (of flle h l lntrnIUonll SVIll Illgt~iu tn - II 5lt Ik lIc lk0flllllic lu llln-I I r l III Fhhlt ri g 1092 -ltlIJ-7
i - ri of niii MA N()LJV II ~ mel h)ltks de kin ~~klk rlr k di lll J r~cdllclli (n d~s ~()li oes jn f ~tel r~1ruuml(ILI -lo s bl fl c sur IcIj cquishyl)œ~ Ik SOll ll l)(eacute Eli ror eetlfllS d )111 1~ 1)1-
5 iloll n G Ruumld(~ le s () I ~middotmiddots tnlcl l l1 I n in 1Ifc el kiwil~~ 1)11lt KillegraveSlthe ripJe SCleacutentlnlue lYl6 2 47 ~ 6
r) Feacuterr[ffgt en 1tsiero 5 Venlllfln A ll~~n () M MJglio nu N EfkUuml o r eXltClse tI~tl Yoj o n nild id iO rXllhlc iC() 1i()~ lrt~ lirnIcircIluy r sull Eur feltl lb)ii 1 1j34 Z5 -~ 1 NOilrill1 A Sbill P egn ni i Ll Linesilegraverpi l 1lt1 Itallllll~nlO
ddlJ soI K~ i llO 1 Orkl1Llllwnrl m efodoloil1c1 RbbilltlZiOllc Ot1(1 1 )29(1) 1l-~
8 Nli(rinl Nl(lr1n l A blll P LI rieduGlzione dl p llicml atflt rro (11 coli ns i idi opr lir1 l n SC(Um i le or h( JI 1rcLlIQn1 ~0Cl le Imc lI1etW)n11e de Recltcrchc ci 0 Ftude sm 1lt Radw jlt)(j S-71
gt Nftriruuml S SeJhrf U LI r i l bllh ~l liOlie dd plziecirc11te ulet1n 11 - r
lin Kllopd (1 In l1l Jgl L N eduoL Tf1It II d ll11e ji cln1 rJtbl IiIUvJ Milan) 1ltfddH~n(x~hl 2(1~111gt-1-PU ob L cllln t iRll p l nelLi rl tgtO llcui n~ dilt ~lio i - l rn~f- li ~iIa n 3efllnl -Kurflr 19-11
11 lIIra S lJll M EVtJltHlvugrave egraveI lt t rnrumel1t() d db S(oli - U r) surie doCum nUle fintgt 31 tIUUli Mibn SI rlin) KlIpf -r 199 2
L2 1 ~W I1l(IJ P _leacuteVia tio n I~lhra k~ du IlchlS ~- ( i( IoltS ccedil l r lI C1 l1 fl leq
Ene 1 l C hi r ApparctlIClCOn l~ ltll1 l ltx6lt (i W Er 20 j )7 l
U StrI tr d P Lcs 1) rm IlO du Hltlctli Parb ME n 115 li ~u n un_ l c- l ol lJn e~IL1roy JC EagtOllŒrio n sc lluocs
L cl middot Exp CO_fiL [-In 190 15 Xd BR llet13n) J Th ltJl-xwenc a l o-(l1 tUcn~kuud txer
C le re-glflW 1 lhe tfelmc nl o f id iopllhiC Collaraquo n lroc~-din) t Lhl 1 r 111(1ltli0 I111 Symf SiUl1l un 3-D Scl IiDliJ DclOfshymillelt ~k)J1[rlt u Gugtu l1Shltr Verbg 1lti t)L j32-t)
16 N1lh~Ir~il Al Peumlf r~o n LE Erree htJkmiddotmiddot~ n f t~U lt hfIl middot Ith J
hran in ~rls V ll ~ ttiVl ~HkJ k-nt IHuIXtthilaquo ic I) Li ~I~ts H t 1l1i JflIn t ~ j l~jl)5iuml7A(~)8Jj- 21 bull
17 M(jo n Y ( ullck J p ~ R A PrdulllnlIr rpurt 11 Iht e rt l f rnltJsu red 5l ren jl lh rrll nrl1 III ililleInr Hi rrt tllk scoJliagt
J lin1I IJisn rd 21 1 1)12) 102- - Hl Hunng CU[- -If p~lIll)~thc - Uonktd in -c h JI IL
c reacutetnl n~ ptnl l C)Q~ Z ) t 1 t(li-v 19 Kou )UrJKh L Glr~ k G KRI iJI G KLmiddotmiddotrnl kh g UlUI
) KrJ UkQULlk i~ ~l ~~ fl c+l l1ng ~t (w)j (h ildrcn frit ltt lmiddot( ti ~l~ 0 1 (he
isbnd of Cfdt J middotpin 1 Dior el 1 9J7 lIX( )middot i2 ~ middotl I i) SG IC1Iugrave lS r olle lCOS rh Zadrc C Ber E Xend s T A
ohool scr(l nin~ f r Loli rraquo pro~ p ah pidemlaIO)( Io Jl lUcJ ~middot In ncIfllwt~t~rll dncl Ctt1fLll Grttc J none 1cUlf ~)Ufg Arnl
19lt) ) JOJ )8-1)3 tl llunnd P n ohlecTln CfjtefO I1 f r SCCi II Ots t-CTctt1 lngJ BOIlt
Joi nl lIrg AI11 1~gt81 (1 )1)1 -0 22 re rdrlo lk R 11 gtcolk)c on Ftudc TrldrI1lUl i0 nnli1t FHIS
~Lluin l) Du vd-BtlltJpmiddotre Icirc Dubcu ttJ Qllln~Hl P GrC6 l~)f d Po ur Url tb (~fniumll~ uniqU( d t l rlmiddot q lultllI degrave -oU clt rr S4~ ftftxl-a[tmiddot [9 nJ8 11Icirc l -0
2L COl 7 G Fla~ l rdi M Ubllhr I- Ili ~ U)( ciplt-rfmof1lal ~c()lir t Prtlaquo l1 ttJ Ir lh t 1~l Eu n pL Il eacuteollhr~- 1lt11 -~ 11ltb und Ky phojj DulJr wnik Y ugmla O IO(-f 1 9$5
2 u ttlllJil ~ 1 gtCli ll Ofli e 1lI tpLI lJ1lluak Hntd ~Nltmiddot ) lnLpmiddotmiddot Fi)) SdwrJ r ll r [(111lt1 1gtl( lEl ~ bri UI nc 1lt)79 Slone H neekman C H ill Cues V fuooks 1 IL 1bc d rrCl o f an c Xt rc lslt r rog tlm ~)n chanfe ln cur( in uJokS( r 1H wtt h lllinr l11bulll IdJo p thiC SC(J lioh A prcl rnunH) Iud Pill Th r 19-9597Yfgtl Rlt td J Ccedil d(dtltx middotnl IdOcircgtpUhinK()liosl fl(nsugiCIJ lrellmenl ln lt-C llSlt ln Sl edit The P edtlt r bull SpIn Prmclp ilt and 1 1 shyte t Nemiddot Yo rk RIVCJ) PrtS j~)f197- 10 1(gr Ul1 A il lulfo l7amenro rnu_ olu e in S bfClti p()n ~nuuml(f di d lsme rf lsill i middot Wb li La i inm~ti MtmiddotdiQ 19$nYl - l
)0 DuIYLls-oe J E~ 1 d hypot he~ d tk gj(lult~ d b = shyli(~ Id lOIllll1lqu ahleacute~ de Knlt~il hr p le l ~ ~llK l H I
31 1 hnrwll R MLm n J [j her A ~Wlu (middoti R bull nlfc k J IdlopalhK 0 1101- llId lll ntr1 nervrlU$ S)511111 p ine 1il-111 H
12 KheacutelTl~(l 11 i Srh lrClno T E1lrtcmiddot fil middotlm 1deJi lI Idio shy111111lt l(middot lk is plm 112 1i6-8middotf la i Fm rIC) PL ( IJIlfThJ 1 V I1W F 1--1 w hl P ) IlOI ) ) lIet ( fnorfis rnl IlI lnPrt d~IL I (lonrl Vie rkh r h -Df [ 11 lltd Rt JlJ Il 190jmiddot middot (3) 2)middot -8
H Slh lrJIHl T P(lrugt()Jl n A s rurl ( bbnintl1in lLllkrion in pllIents Vilh ad() l~eJ1t idiopcuhiccedil -collsl ioLI~ 0 11110 1 -C1lld 1)795)51
35 Siblll r l Si~tltm t ocircHboIJ f( t los pproajo (lIoneuroiq-k 0 Ib duta7Jltme PWlIlltrS(Kmiddotl C (ltl~I1OSlilt1 dei middotoUosl Pr~Smltl ar PchHria ~i(J S MarghrllL LigUflmiddot l( J
lH9
RfU o r Pll~ IGL bull
x ilgtlIh P lt-ejcanl N~1(fl l ll At_1 n~sIO Alp nl O J(0nuoo 1 lt a l ~l rpfn 1 1K1nuumll uIcircl n ln ~ccedilr)liO~i 1-~lIu~H I_1j hy the l n ~Ul [ rltllc~cJr()grnrhy 1o TI)lU li K LgIlt1111 M ~I rt ~d i r rs r il ull f md t u r11 fl on l l l itJLLlUl Eb--Icr SC legrave nu B V 19~middotH ~)-l2
)7 Y~lI J ib K Y IOUJJl(lro 1r T~ t lll1r~t l TtZIlLl 1 rmiddot ~b lplnt nr (f ltmltomiddotjmiddot unkr nu rf j 1 1 pa rtlCub rtv in (dHUH l ull bl~lllcm l b numiddotIUllltk- J fkm I n rg 1 lt gt 17
301 Yum1ntv Il YJl1ll d~ r lqu lll lll1 ll Lppr 111 ICi ~rljritJccedil p tUf( ~cOILgtgk J)-6 1711
W NeW1 N~grm l ~ Xn[(ui chlncltltcfIILl 1 (L ln CfmuO r Bk r 1lt1 511 tn tlt [C IUIl~1 AUtlI IJt1 TecnILln J I TCI 1J1l flD ~ Cont rQnltl Mock n1 tl l J~ middot ) rollplt KIIlCSlherlplllLl Elirope ~H gtle 1 ra~tiI iUf lil ioII O~ l -N ill l- il middotmiddot
1) Negrini ~wn UllnnQ c 0 1i ~ 1 lucirc lopau c-l prnlo l i1Ii Ilnki 1 L1 otiltJlliU lt fldl ll u ru middot j ltId bull itcll lJ pt)ol llrUgravec Lt flblrtl 1 I dilt l middoth ~ 1 +gt-I1
1 r u I -rkIlp ~h 6 leltp1Tgt - Il lt1 rd A r lltoucirc Ully f 0 shy
gtltI~ Tl m l J A 1 Illan ~ pilW 1 lt)~ II )ILo ~ 2 12 lltuwardhan Av Bu n ch Xl i bullbull1ltlLk f~ i hl 111 1Lnk1 fu i Ii
(Jf l I t ffllj(rIo~n 11 tl ort ilou -( lbljzLi 111 n rJfol Jll lt- Cr
1 1 HInKch 1 ~gt 1 ~ 1 f)~ 17 middot I ~ Trrd Gbull ldHno A Irlltkjpcck K 1ltulrz St bullbullndlng nltl
f lk craquohb n e l9J r III QJd~ wllh fdJopthK-C lllo~ls Spi n 1lt) U(I middotlZ=~7
+1 PlL1J101 M ~bllml K Srm11 bil ity and lUIC1ltltWlIIlI~ oll Ulc ~ biIJItltmiddotnl1 11 n1nlcl ~rt l1 It)bX) Imiddot1 t91- 211O
-1-) OU(Tn~lt r l rWe~lv ltl lx fbullbull1 Collm l j1C f(~~ 1I0n li1 il rt middot znttl plJ IW gtlns~qU ne l o n Cl Ullures ln ~ ttI Ubulllf pbJle ~ R~ n n JnccedilL- Cu rnpecnnes du JKh~ l ~lH ~~ (
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EUROP MIDI C Pli hIC
EDUCATIONMEETING SATURDAY 8thof APRIL 2006
(iSS
SEAS02 Scientific
Exercises Approach to Scoliosis
version 2002
G
S Negrini 1
EDUCATION MEETING SATURDAY8th of APRIL 2006
Neuromotor disfunctions
Neuromuscular disfunctions
11 Postural collapse
Postural collapse
Duval-Beaupegravere
Flexibility of scoliotic curve
f---I--- I Postural element
-------1 Structural element
S Negrini 2
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Postural collapse
Duval-Beaupegravere
It is a value related to muscular tone and to flexibil ity of convex side tissues
Post ural collapse
Bunch e Patwardhan
Critical load
Load threshold beyond wh ich a spine begins buckling
JI~~Wt1lW~flfthtlJlœJtAr ~ J~It- l~l - IMS
Postu ral collapse
Bunch e Patwardhan
If a curve reduces there is an increase of the deformation threshold
~~~NW~-damaoc~IIIMf ~~ J~Iv JaJ-I7I9sect
S Negrini 3
EDUCATION MEETING SATURDAY 8th of APRIL2006
Postural collapse
Torrel e Nachemson ~
Scolioses below 20deg ~ ~ lt~
have a high ~ ~ percentage of ~ ~
~postural collapse (on u~
average 75) ~~ 2i~
CU~VE O EG~EE S WHllE SUPlti e
~laquotd~c6b ____lPffI1wtt1t~
$ww J(t ~~7 JM5
Postural collapse
Minor scolioses 7
Antigravity musc es strengthening D
Reduces postural collapse -G
Increases the critical threshold of deformation
G
Neuromotor disfunetions
Stagnara
If we admit that one of the causes of idiopathie scoliosis is a disfunction in balance systems it is logical to orientate physical exercises toward this direction
s Negrini 4
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Neuromotor disfunctions
Dubousset
Idiopathie seoliosis results fram alterations in praprioeeption centres and deformation is a natural compensation to restore postural balance
etattJtitIK ypothfQj~S ___~ own_ oJ)HQr lar 1t-1( r
Neuromotor disfunctions
Nachemson Initial idiopathie scoliosis
+ Goood spine stability
Neutralization of postural deficits
D Static curve
Neuromotor disfunctions
Therapeutic aims
c) Development of spine stability
C) Development of balance reactions
G
S Negrini 5
EDUCATION MEETING SATURDAY 8thof APRIL 2006
Biomechanical disfunctions
j Horizontal r-Ian
i Sagi ttal plan
Frontal plan
Frontal plan
q Frontal plan disfunetions
Fronta l plan
Perdriolle Movement magnitude
gt in the direction of lt in the direction of correction progression
S Negrini 6
EDUCATION MEETING SATURDAY8th of APRIL 2006
Frontal plan
Stagnara
Never mobilize a scoliotic curve without ensuring reduction maintenance over time otherwise a greater mobility favours scoliosis progression
Frontal plan
Ducongeacute~ research
On a group of adolescent idiopathie scolioses treated with
Meacuteziegraveres gymnastics
D After 1 year the mean angle of
curves increased from 18deg to 29deg
Frontal plan
Scoliosis without brace
D Greater spine
flexibility D-
Risk of progression
S Negrini 7
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Frontal plan
Mobilization is useful
D In preparation to
brace
D With brace
Sagittal plan
QSagittal plan disfunctions
Sagittal plan r middot _J o
Perdriolle scouos B CJ aDeformation of D
thoracic and thoraco-Iumbar curves evolves in extension
S Negrini 8
EDUCATION MEETING SATURDAY8th of APRIL 2006
Sagittal plan
Graf
The line of gravity centres in the vertebral bodies o s c oUOSt
projects itself firstly laterally and then fi
o
posteriorly lJ ~~ ~~ ~ ~~-_J-D ~nI~
Sagittal plan
Therapeutic a ims
D Maintain or
retrieve physiological curves on the sagittal plan
Horizontal plan
QHorizontal plan disfunctions
S Negnni 9
EDUCATION MEETINGSATURDAY 8th of APRIL 2006
Horizontal plan
Stagnara The forces applied ta the spi ne act in a autoshydeforming sense
Horizontal plan
Dimnet Rotation gt 200
ampII~ (
D The actions of concave and convex side
muscles become
agonistic
~ItJrOnrIIiItdllfUClltlluumlll~~tI ~1JIf1laJ
Horizontal plan
Minor scolioses never exceed these autoshy
deformation thresholds
S Negrini 10
EDUCATION MEETING SATURDAY8th of APRIL 2006
Disfunctions at a biological organic and psychological
lever
Oisfunclions at a biological organlc and psychologlcal lever
Cheng
Bane density in scoliotic teenagers is lower than in normal subjects
~~~~middotA~IIlUtIy ~7œl 1d l
Oisfunctions at a blologlcal organic and psychologicallevel
A significant reduction of vital capacity and V02max in teenagers with a medium severity scoliosis
S Negrini 11
li
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Disfunctions at a biological organic and psychologicallevel
Disorders in the development of body image that the teenager has of himherself
Disfunctions at a blologlca l organlc and psychologicallevel
Therapeutic aims
cJ Activate cardioshyrespiratory function
cJ Favour bone density increase
cJ Develop a positive image of the body
Disfunctions at il biological organi and psydlologicallevel
Stagnara
Sport
D The active side of
kinesitherapy
S Negrini 12
EDUCATION MEETING SATURDAY 8thof APRIL 2006
Disfunctions at a biological organic and psychological
level
Distunctions at a biologlcal organlc and psychologicallevel
Cheng
Bone density in scoliotic teenagers is lower than in normal subjects
~n~IIIvpWr~middotA~stWy s- XXJl M J
Disfunctions at a biological organic and psychologicallevel
A significant reduction of vital capacity and V02max in teenagers with a medium severity scoliosis
G
S Negrini 11
EDUCATIONMEETING SATURDAY 8th of APRIL 2006
Kinesitherapy on the scoliotic subject
q Postural control
q Axial stability
q Muscular trophism
q Balance
q Respiratory function
The limits of kinesitherapy
There is a threshold beyond which
rehabilitation alone is not enough
sssr
Kinesitherapy in scoliosis treatment with brace
Therapeutic aims
S Negrini 13
6
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Therapeutic aims Srace kinesitherapy
With brace
il Postural corrections and
vertebral stability are obtained by the brace
Therapeutic aims Srace kinesitherapy
In preparation to the brace
il Mobilize spine on ail plans
Therapeutic aims Srace kinesitherapy
With brace D
Maintain a normal spine elasticity
~ Maintain a good muscular toneshy
trophism
C Model the hump with kyphotizating
exercises
S Negrini 14
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Exercises and their methodologies can vary accord ing to learning and individual sensibility of the single rehabilitator that proposes the m provided that they stay within the
Iimits of fixed therapeutic objectives
li
Therapeutic modalities
(Exercises)
QAuto-correction
QRespiratory education
QErgonomie education
QMuscular strengthening
QDevelopment of balance reactions
WNeuromotor integration
ci Vertebral mobiJization
QSpecifie modalities in brace treatment
S Negrini 15
EDUCATION MEETING SATURDAY 8th of APRIL 2006
The protocol of kinesitherapic
treatment
G
QChoice and dosage of exercises
Variatiosn of the work program every 2 - 3 months
Q Execute e)(ercises on an individual base or in a small group
Q Frequency not less than 2 times 1 week
Involve and awaken the family
G
S Negrini 16
EDUCATION MEETINGSATURDAY 8thof APRIL 2006
Q Determine the action and the localization of auto-correction
QAuto-correction must be associated to ail exercises
QAt the end of treatment ergonomy lesson
Auto-correction didactics
G
SCOLIOSI DORSALE---- shy ----
r
S Negrini 17
EDUCATION MEETING SATURDAY8thof APRIL 2006
SCOLIOS OORSOLOMBARE
shy
SCOLIOSI OOIlSALE 011 bull LOMBARE S1I--shy
SCOLIOSI LOMBARE
il --~_-
S Negrini 18
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Scoliotic patients are not radiographs
middotSeoliotie Mtients are not ndiographs but hum beings with a vertebral deviation-
Slagnara
Metha For the physieian Cobb angle is of utmost
importance For the patient it is body deformity t hat eounts most rib hump a protruding seapula or hip We are in a situation in whieh today dodors eure the radiographie deformity but what the patient really desires is to get rid of clinieal deformity and of ensuing psyehologieal distress
CIIQItIo shDuIdtucirc lM WIld tJw~~ I~~M~~~~ J9f~
S Negrini 19
- Poznan_workshop_Physiotherapy
- physio2
- physio3pdf
- physio4
- physio5
- physio6
- physio7
- physio8
- physio9
- physio10
-
EDUCATION MEETING SATURDAY8th of APRIL 2006
RESULTS 26 girl s twice tested - at fi rst and last day of intensive hospital rehabilitation
The value of ventilatory anaerobic threshold increased during intensive hospital rehabilitation (asymmetric mobilization of the trunk by Oobosiewicz) statistically significantly (p=00019)
2047 ml O2 minkg (SO 268)
vs 2239 ml O2 minkg (SO 232)
Conclusions
1 The exerc ise eff iciency of girls with IS treated by asymmetric exerc ises of Oobosiewicz is norm al
2 Such high level of the exercise efficiency of thIcircs group resulted fram using of Oobosiewiczs method
r
J Durmala K Dobosiewicz 7
REVIEWS
Role of physical exercise in tbe treattnent of mild idiopathie adolescent scoliosis
Revicw of th- literature
A NECRlNl N VElWNL s PARZI 1 A NEGRINJ 5 NEClU NI
P1t~silillxlrd~ Ihcrapy (or klucgtlttlwrlpyl i pro shy-tJm of physka] cXlrd-cs ipcci I(a~ (IJcloJgtcd hy l li trIWlltl phrslollwrapbt wilh tb m~ln a1mor pl shyVCnI in lhe ilAAfIVltilH1 llf the ucirccfonuity III mild IgtC )
Lil1Si bclpin~ thebm ( aocl co uaufllclilIg ils ~jd- clf IS in nlOdlJmiddotnh-culiosis Th middotalillofthi paper ito r (W
Ille Ii lc ram r 1 a-ccrulin wh kh of Ih bull Lu[Jalmlcrus Ind (Lb hili til~ CLlLt-cd br scnli()si- clluld bl pl Y nlcd or r d uccd hl phylolld LXtmiddotrdsi n Il p--to-da le knowl Uuml~l nr tIll~C aspcc[~ i ne bulled in oruer 10 dndc whclh~r 11Rf blLl adcqlmtt Ib(uuml n middotlicaJ balis fo r ora)aini l Ihe US4~ of lUgravellgtitlerap) wltcllj(r or fln l th e prtl1iœ of kimiddot ~lre IUlll poNjn~ a t iil ies ~bould h allowtcI II uuml middot c enliaI toltlentlf)wh k lu alClor ie - lf pl lr~kiJl -c rmiddot d gtlt- (Ic rnnhi UzJ( inn ni (t hl HrJltlon [ rtn~hcll iJl ~ or 1i1J(IChIumlJlJt etc) Sh llU Ld be TolullllCcluse ulemiddot l onld b- clclIimcntalancl wukh sho ll ld he IJlI-n~ifl~d I~~a l lhc (o uld h 11lfu 1 Know k dg CJnc1in t (wIn SeiCIImiddot Hlk rCS([lflt h daw ccordinll to Ih bull llVit w o f tIlt iii 111 1( plop(lsltd in (h i papcr lmiddotonllmJ l lnl plLyi 11 cxcr(j$( pn (nti or (tmiddotduce dhlblli t ic 1 ~lt Il Jj ll(k pl ti Jlt fadl j w(~ the nlIIIrl li7alinn n f poMural dd shylitS tu p n xJ llc aSl COIlMqnen c(middot 1 all )llal) or r(tn~ shys i middot middotlIrve Tilt u~c (I f appn1priattmiddot kincsiuuml wrlpy 0 in rcns polttllcal swhiIHy Icirc IIHmiddotorc Illta ll y (0 r 1(lt1 lllho UAh mon ltlccurlltc 1Ut dl1alkd -rLk l(lWfils 111111 )11 h Jlccdt(
11) wurcJlt 0 lit)-IcircS (Iumpy - x rcLs P()lun
n rllt lT(ltnklf u f COll1tlK H (rtd) I 1i plfho l og l ~$I rUlglng tr m low tmiddot k Pl 1l1 to IdiOpath ie SCUIshy
Submitt(oJ [or PUhltCl l1 011 uly Tt 2001 Acc~pttJ ugu - ~2 1(t-1l
Addre rltj-xlfll telt~I(middotb If) - grinl Flt(1(bziurllt r )(m Ofl ()(Cl1I shy Lt middotqlltœlll ro () - 1u I4t agravehLIlKil ta IYIL-lTt ilSllltp lfllmiddot ~ 1l1uumldull
CelII ~ (niiOS I I~ middot ann (1) IfUh middot lIlfU di louhilll(tymi ( Nlmiddot ~iI rli -ilIIUmiddotltlfl
Nlti(ir 1( ) il r() (ltbullagt1
lt vLL_ l IiII no 1ftfI
jS ) we are a IUil ly tJc ing n1n) ltblll lS 1 k l1 b ~J)w in~ tl~ t S Jfll l approad llt - l1n til hy on ielshyertd ~tan lard ugraveJuld ln m any ~1~ he lI ~t les i if Ilot dange r )ll lt rhlS is lrut of reil l lnw 1gtlt1lt1 pa in l ~ or 5urgi c ll lrea lmltnl5 in dbc r lmiddot ll Sc - 2
ln tlle cj-e ut ~ t lll(tlWtl i( li p l ll1JC luuml- I ~ middottnl ~() shyliosis phys cal ((_lt1(( is emr1uved ltI t()fIl1 0 lh~rtrv
lo ly in cel1l in L)lllllde (nluumlnlr in tilt Lltlll middotorkl i e Iw l) r llt t Srain hUI IIgt() 111 Gert11lny 5- 1~1 in other reg lOl1 wbere thi I-incl qf tre l tm e rll 1 p~ 1 pmiddot t 1( cI il Jws Ixen cri ri cilld md rel -cltd Lw m~lI1 1 11 Jlu~ Fue Fnlny r ~lrs thio middot15 a lsgt(ru( f ~rth r -~ltc rrJtf))~ ll t vit11 br1Cltcgt b r II1 ([C Llt n ClW grmvlng 1lt1 0 L Sti g
gcsti n the lIsefulnes- u r Ih is form o t treatm n t 1
Hmiddotu]rs have nerged jn El or uf pll y~ iLd eegraverdse eacute 00[ 1 but tlw are nUl yel 11 11 t llu i vIC~11 and r hi ~
f rm of trt ~ltmenr IS stiJ l Ul1 ckf ckhate FfI t Jt 111 il i 11t (eltary td 1I iFy 11umbtr ot
b l sic COI ceP rlJ lf w ill he cIh tt d in t hi pap r
Scollosis
DCijIrI iriolls
ScnUoSlS is Irlircc c1 lme nsIcircltnal (I(gt i l cj on ot tht spinc thar cau C a CU 1 lh lt ca n h e $ t~en ln (1 me1Sshy
ured ultinF Coh) lll ltllCXI o n HI anreu middot p rtc rilt r
EUJlOI -1 lœDICOPHYSlc~ IR
NECRI Nl
110
f)i)
1 7J
amp aS g 5li - 0 v
V
31
10
(1 1) Il 15
-tc i ytjtr~)
FigJ----jllph ot DlI w l-lkaupegraverel) The agloimvltltinn Or idio r lrhlc 50gt1iflll~ IS rpiJ bel~ en th e- [l0 IH P (l)ltg tnntll lol (JI PUllcmiddotny) mtl 1 ( f( lS-er sigll paiilivltecirc lt Dlt(i I1 11illg r the iti l 1Kgt n n t rll icirclicH a ) 111lt m omal prebulled the mno rche md ociks with lll I)ttlx flal gr Ih pll fl
rlcljoprdphLi 1 hl merl prestIK ~ of this curvt c10es n t autom~l ritllJy indi ate the pn$CI1(t of a defurshyTnitv (SlllKtUrd (Unel
It i~ possible tu clil1e ren tute a struCnlt t CI1tve fruIn a pogt urll 011e by identifyi og the hum]) du ring AdIlns tesr I~OQ looklng tra m beh lnd at the p atient w ho b benchng fUfward il is p -- ible ta d d~ct 1l1 eh ucirc n of o ne liidlt 0 1 the trunk usually n n the (onvex ~ jde ul tbe radiographie CUfve Ugrave1lr C Ul be mlt~I Slred lISin~
BUlln els S o liomere( 1 ~ l This h Uf1lp is du(- lO (Ile pregravegtecircn ~ of vertel ra i rolltion 1c1 Ollt tn tic f~YJ tllre o f the def trrnit tli [ c m be seen and measurc(i v ith Perddolles lb lsLometer on an amero-Ix)iferior radioshygrapb ~2
Seven ry pel cent o f li Ises a re conid 1lt 1tO be idiopa thie 1 bull ia l-nosilt in this CI$C is b exdlls i ~ n as idinpa thlc me-us t11H wc do n()[ know rJw origio of lheacute curvc [n othe] ~Ie$ it b Ix )~i ble ro ide nrify a dieak (bat CHl jusrify the c1etgtnniry slIch a rna lfo rshymar i ns I1(gtufol Ig ic~ l or genlttic cl iscas s Glnclt~r trauma etc )
[dicirc)parhk S(oliosis has been divicled ~(corcling (0
the ~Ie of tlie patient egrave1l the tiJ1ll of d~[ccli n of the condil ion into ti) ur t ypei ln fanUlc jU nik ltldolesshyccnt lnd aduh Til l m n st cnnunon (VPC IS the acloshylescegravenr o licirceacute I1IJctenzec1 hy 1 sud le l1 tggrH3l ion uuml uring the grow tll Spllrt (Hg 1)2
lhile p tu 1l sco liosi i5 Ycry lomnw n thl pre shy~Iknct ra te f r adole ent icuumlop~lthic structural CU IY~S in sch )o chilclren are 18middot20
- 10 Co bb d~grels o r m on l -lil
- 2) ~ohh dtgreclt or mort O 2~j - bull () (obb d gre -s )1 mOfeacute ()ll 2
Clin iltI [ d e isio ns lfl IXlSed 111 an lccu r~He pregshynosi which obt inccl in eJch pa ti nt mainly o n the basi of the nsidu~ll p()tlnllltl l of TH1h and the result s of 1 rh clin 1 1 ~l1d tadiogmpl i exlminashyti(ln12ll c noieq uentlya d inica ] la sifiou io n o f the ing le pHient tn -ome estent co incic1 ing w irh the
D diographic one c l n lw SLlIl1H1arizeci 1 1 folIcJ - mikl lc~ (1)(n 20 C bh de~r es - moderJt l betwlen ln md 15 ohh de~ rtes - StV re 111( gt1lt rh n ~J) )bh (kgf s
On the 1) lsis of [hi - dinic d d a lfic t i n (Vith l1l il el lrb tiOI ~ o f the ir b() und~ri e ) in Itllt l cente rS Of SCOtiO LS ITe ltlllent in the Lltin odcl (i rJ Ital lnmct md PI iJ Ugrave tre tmtnt i s plmmcd a fo lltJw 8l
- mild kineslth e (~1fw ~1Il (1 luok-ou t - Hl demte IJragravecegrave 1111101 c(~r md k i rws ithe lJpy - ~cven surgery
Physical exe rcL~e for S(ol iosis
Defi t tiOl l S
PhyS i 11 nU b lIKrlttp middot (or kines ithcIa Pl) i a p rvgrlill or plt~i Gl l (xeriltecircS ~1ci fi ( llJ y ltk ~ loped
y a -11 [ru ine 1pll yslo ther3pisr wirh th e m 10 Hllll
- pre (~ n tit1g tlc aggraaLion of the cl I )flnily in rnild bullcoUm is
- helping tlk Il ld Ct ~lOd ounter~lCtjng its skie elfects in III de rltegrave sc li sis
Tn tl1i_ feSpec1 kinesitl1ert py f JI s oliosis is tonshysider l a o on of peciticcedil training and s genecirc tltllly proposelt in sessions 0 1 4~ ro 60 minute IW) t) tour limes 1 Cee PhysiGtl exerci es can aLo ll v o ther auumlns 1S it oill he dise Issed in this plper
Ir 15 Ilot possib le to cl escribe a single progrlIT1 o r exerc ise a5 pro nrams ale USLIJUy p fgt nll ized ( ( lt
EUH PA ~illDI (DP1I YS IC~ 182
ROlL UF P l 1YSICAL lXl 1lt 1~E IN l IlE 11 ~l) IEd If IlU) l[)VP 1HI AIJ() J)~Cl~ r COl ~I NlG1W il
f)( 15 egraved ( )Il the nee L- 01 indi iuua l pJl itnts) al l l10ugh Lheacute) C l n h t 11 plicd o n a WOU p hJ~js (-1 (0 () pnients PC[ ~l ()lI r)middot lugrave reQCf lhese 1 10 grl lll frequt ml~ V IIT
hnm on in middotituk w allClthltJmiddot -Ill Jnv L l~egrave at Wc w Ht ~huw in lhis lyl peJ it i~ 111 n u -eII1 tu id e ntilv kirK itheJapturlc aims w hitl l ucircrr~spnd LO ugravelt~lil1 DUtshy
g X ir ur ph -s ici l lxtTi~l I~llhe r thln ln dj( us- indishyiJ u1 1progr-lfll
Aduumll l lxUl kisure time ~lOd h )u] Sp u lllll8 ~Ilttishy
i lt egrave~ i middotomm )Ly s iven lel mJ ing ro w hlf ~ Iuumlnsidshyer~d usdul or il lrmfu l in t1 lt rruning (lI tJw ptliJicirct ln tl1bplper Ugrave1 gent ltl l t rl ll bull p lwsiCUgrave lttG iviUes is rl ktll 10 JllI1ltlCc hOlll gtpOlt mJ kIJ1lsIcircl hc lJ l f
i ve lUen tloneumld )bo C on lv ine n dul( re Ull~ 1t~1 t s far Ilten publislt d f I~ mJ I(i noltgtithltl rgt is 11 11 a su h jel lnI deacutehate CJitk haltlt t llltit m itn ltl of l ny lorm o t p l1 ySiClI lxrcL e as a Itwr1 [ J- fo r i liopa tb il jcoJL~b un iL ()ri gin~ initial1) it WIS Ille r rOmiddotUumlK lt brgdv u f p l~lt titu gtllergt w h ) intervenecl hutll tc llcrl ll (mon as cltl HtilJ nic in terventi n man Jgt
1 t lltrJp utl t one 1 md rC j fkll l~ on rhe h sh lf som uni cOen I1v pn t I1cgts wt ldl hll ltl enl1 JI~ haLl nu na l scicnt lfic baisYmiddot HOlh tlle$( trr t peu shy to rh ~rl py tt nJecI to l~~rJ tte C Ih tk CUf -~ pnnshyclr~tll y as a f tsul t of lilo h llIzatio ll of tn imdqultdy ~u pp rt(d S pln eacute 7~ 12 to re-t1 r rI ltrl 1$ l l1C k o f WH llt~~rdl 10 I ndt~-dll()urnah tnd 11( on1 p~l per u suaJly Cl tc([ IS n prelimmtrf lll d 3 ln tt li w ay man (l rrlKpt(Hc H lf O iS Inll ph ~i C U l ~ d vi ~ cI nllog scnliotl pa t le nL~ 3gainst holll ph lca l egravexershyclc and p()rt~1
It m u st t~ n tfd [hat pllyknl txerc j~ tJe~ltm(nls t1iHer 1 lJ rd il1g r rhe rherlpcu tlC litTl~ on lllc h tJ rgt ap p lolc il l the IXlltent lncl hi im r IIIllHnt i- 1 (1(1 rI - 5lt1J lC igt tIl l ( f phJllIlllolopJ al rrea tmln ls Ihith cllffc r 1lt œQlfd- rhe m C cculc u ~t(l luI thl p al 1t n
~mc l 11i (lbE~e Tt i ~ P ~il k tlwreI[middote thll wuumlk ltlll t kin 1or ph~ i Clt1 1 lX r(j~ 1I 111~ t bc loidvd by t h~ Lo iurie IxujCJ1l al1ulhcr a dl ~IS nJI h~ iOg (1 11shygerols llugJr in racr le (wi ller d I ~fJIII ~ I ml thlls re(nl1l rn ndc(1
fn n UI cel1ll r we In(~ hccf) using 1 ) 1 1111 11 ve ) 1 (J p lw l icd ex(r(i~e (0 J ( 1I l tt i~ tlh aITt ~ l~d Ilv m ikl tru cflumiddott1 adokscltnt (cl ioj arh lC icoli is11 2)
ina the f U~ t rc-gt uJrs IefC pu b lishe - the pJ( )grd m 11lt1lt l1te n PWltllk d in fa c t deel()pnlln l~ in th t l itshy OlL1Ii in tl1 r b t ~() ycal f ha ve iclemi fiecl niO l l
m d 111 ur impl rnHm s md d i s )h ilir i (gt~ lue t idlo p lthk amp()lio -i ~ t Jll CIII he 1UO(l if Icirc 1by phyict1 egrave xert iSlgt l fe t rrncllt
l illl
111e aim of t l1JS r~l per ii tmiddot (tv iew tl1( l iterat urt to a(errl ln v llic ll of th~ impa irm 1t~ and Liit hil it il i GllIltec hy ~ o l i()gtj s -o ull he ll nt x or re middotlu celt1 Ili pl1ysical xerclse An u p-to-da te knOvkdge o f tl lt Lgtpecl-gt i necckC1 in rJeumlr) d -oek
- whetll~r there h ltl n adLtIIl ) l tht()d ical bbh fur or JqIIcirclb l l l1 Il( ) f k irt llit herlpy
- h N I)(1 ( 1 Dm tlle p r l c tIcirc(( o f Jebur tiJne )pOfung lcli v l ti ~ IIOU lci he tllf) -d o
II J U V f h 1 I11~ c~~lb li hed Ihe usefuhlLss 01 k il1 shyc ~thtrpy il i aIle dy l nsi 1([(( -r-tI Llleu i n )I11 plJt~ ut the wJrld ir ilt ecircS~nl i 1 I( id n Iv w l1i li ( 1shy
gories 0 1 pl1Vtl( 1excrClgtegt te D)bilI7it ric 1n (Ir st shylliuumlZltio f) lttlt tlgtbltn ing ni trcrccedilh ing erc) hn Id be
vnlcled he tll rhe nuld be lerrillldll1 1 md whidl s tlQu1d be inreœ jf ic(1 IJeClU~l tlley cOli lel Je LI ~ful
Ncuro1llotor impainncnts
Imv aUl llOr~ 11 lt1lt ~tlKlteJ lhe cltlndatiotl bd Ween tl UC1UmiddotIt t l ol(~C t nt id iopml je -nll ~J~ and cli~l l shyler~ lr 1tH lest ihuLIr yt 1 _ 13 ~ 311 D uhoussct 1
1-- ITS tln l ldiopath k s(o lio-L L cll -c d l J l hmgt in th terl tltr f prop li l l pu n md 1I1ar th e detrshyn Hi n i~ na tural 1 ~ronse to ril e need tu ts tu re p()tun ltlluilib riu Ul HcrmJJ1 31~ 11 () d tllat icliupathic ( liCl5j h l it re5u lt Ot1 rw nltuf mot r l ~ltelV
[Id )fcl 3 nI] ~1ltJ U Sr1lle nr to dtorders in centJtI lO~Cl shyIOIDNur) md 1xi~tI moro (Ul1lfOl syt( llI (Fig _l
N htIll -of) H1c S uumll h( rll1 ( ~ l( w ing JI t11 (oshyI-ie on the l l lO]ugy o b doll (nt Rl iu]icirc tlili- middot()lioL m unt fil t-hltll rhl ugravedcmnilV L th e fl5 ult o f 1 (k btcl 11lIFll llI ion nf som t11(WUgravetltnl md pO~ lur( (tnic l~ l licirc1 tl1lt if l p OgtlbJt b C 1l rlw sta l i lin 0f 11 1 Sf llle j lt g )tx l Tt) ohtil n a ))Cli U 1ILzltl I o f p ~llIr~il d l~flo [ in l1litkd ~J)llnSIS me CI Igt(middotqucnr J ~ a ~tmicirc ()nlly or regle Ie Llive
Ali th- 11yp ) tlw~es rd ~lte tr d irtl Itn t pnl1tlt o f [11 v hole ~piltm It11[ controls postu re ~nd mrw shyment lrre pell ic of tlh po int a d lI~ llv inH llYegraved il i ~ ll 1 nnable tCl aSUilll ri 1l tr l ll1 lo g thi ~ys ttm ( Qu it le 1I middoteli tl
lt ch ugt nlt~(S f rullliIl thil i nlomwtion th at p tlmiddot shyiCil J(tl iIies nw gt Il lInport~n t rr le to pbv [11Icircgt role ca n 1)lt slI i11l1lariztd ln lWO the ptu li ain Llt
- d elopmll1 l of p uumlltl St1 b Hlt ) - c1e veuml IOpm 1)[ o f bhll1ltc _
(k llhUl)lOr S Cll orr
ontrot oic whan-lt
------+ 1 ~ il lnll ugrave r AINnl
Cllnlr1
T bflt~ r
fltL1 tlli
lMini
l
~sary ~J-frlllen i )f
~ 1 ocirctnl
~UcirclllIJJlW Ll
AXl ~l1 n uumll l) r sy 5t ~nl
middoticoltoq ~ Fig 2-AcFgtrdong lU He-mutl 21 il is Fi)5~ ib1e rD prolXgtSlt l -oo ie1 mnd 1 ((if ~ elio egrave middotAhltr~d l)Qdy-p ati~ I I i u d) uren ttllOn k td LO In ~ory reHTt I1 eDi tn l al ) JdrnlV~ pn)4~ e l u r~o(Ofe 0-c1 eptunl dvstil t1 ctlon sltŒ(ry icircltu nu11t ilwnt [ ~mC ~ted tl l1 ce Ill trpntlshyUumlfJJl nd IKnle~ r~dibl jtugrave)n of -I) m tlosen Ir ~ig nj tl (I1vying ln fornll1U n (lI an ereltl ~piJl e Mmor aJJ r--a t ~) n ltgtf ti lt aXljl mowr plem iHUC Wh ~fl Ille 6ubjeco m uumlntl Icircn (1oJifitd perccpfLlI l ~na l ysilt of p n)lnocepti Icircnfu rnlaquol ti desnibJOS ~n t tecr spin A IICW motor co nrro l Ira I gy t adopt resu ltin~ in the ~tr ltctltr 1 ckformh y lf IdiopathirL scollos i=i Ht lrftU1uc nltnt l ISll I1lJy h1e- ~ I pro()und elkn on bralO Sfem flJll ct i(lnn~lLhu modifyRll Ille nltulltgtshytl10 ) 1 1111 Uu l-lHoror control 5~Shnl$ shy
As Srtgn1lt1 l ~ ltlssert~ if wc l C -Cp t 111 1 un o f the G IiC s oliosls L l tisorckr oi th e ltquilibrilltn sys t ~ms it is lagical to oriegravenrate physlCl l exercis( lherap y ln th is d ir(gtCli()[1
11lclte goals Cul tl lfOUgil ditrercn t modes 01 action be Olchic(-c1 witJ1 phykal accivit ie
- po rt ive Cll ities p ro ct LJ e aIl UgravelClltrtsc in 6lte nshyel ll )o rd in~lti n pinai pr0prinup ti_)[J nLi mOVeshyment control 0 vio lls iy ln thh repect ome lCtivshylites aœ pre um~I I)y lXrter tllln ntil crs
- kinrl lira py using pedJil exerCisocirc specially developecl lith th est 1101 5 in mind illVuuml VC I lllore prccilt( ll1d InC1 li zed cri n on rhe spiJw focusing
a90
1 ~~
lg -lNheJo ~1l l1 t r~l g rld in 1 1) h i(~ IImiddot ct r rHienl w i ll idlllhic _It ~i ~ _ iri s plt ~I le II find Jit ltH vlllleuml ~l Cgtbl tn~ ks III d il fef lt p ~ lt ihnS nu v~tl middot B ~a~pt u Il C middotl)Icircd ~(t l l11 C dlfkrCnl middot- hdween slllndi1g Uline nu nllt1Xinul oorrec ri nI t chied Vith Ct (J ) und tfdincJ ne lot es o UIine 1 fo llnVs middotIJfl tfi ni( - ltlrshy
reltiK)n ~ Ikexibiliry st3nucircing - -pirte - f ur~1 1IbjISC ltupin - ltorrcaion - - r~luci()il ll ymiddot For flmpllt in J npK l1 pH k1J il
plt1SSlhlc ln obtai n 10 u1 511ndlt)l [YLo lion yr ln Slt p ille rlOlgt itlugraven om l J ~ in ( gttf(C rigtIl lIex lbuil 15 i (r-l l=22deg pol lltl ~~J IIlpraquo is IcircO~-V- I t1 l nd tucircu(Ugrave) ilil) I~ 3laquoJO- IH-12
r ln Ugravel e abilit jl of tluuml [m e llu to co ntro l irse lr in ~ pac
fuld l oftlles uumlllelve ntio ns can presum1b1r incn~~ Ih enl ac )1 the orller and lHitlll r of Ille rn - 11 )ltd h e lllldenl lu EJ3)4il
Posl1l1-t collapse lnd slabilizariotl
lIle concept u fplt st lUal c(l lJap~e l l~t Iwen detin 61 by DlI II-T3e~tupegrave rL t Ac oJdin)j tu tl1i- ~ll1thor il [ nec(sary ~- l Hn Cv-tlualing th tleihility o f a col shylo tIcircC CUJVL (0 clistingu ih bt tVeen the re du ihil [ty index (th - li iffer gt le bet ~middot Il ~I r~tcli()grJph ie ~xnmshyinltio n of the iI111 pHienr in supine po ition m(i
ROte OF Pl rnmL EŒIlCISE IN THE TREAT-ŒNT OP ~I IJD IDIOPAnnC OOU~GEm seou SIS EltJRINI
I (~)-----------------------~
__ _~ _____ _~ __ __ L ___~ ________1 ____ _ __ ____ ___ ___ _____L___ _____ l___ ----------L ______ _
1 ~
1
-- ------- --1---- ---- ]---r --- -----_----t- ---- --- ---shy__ ______~---- __ ____ 1________ __ _1_ __ ____ __shy
~ (1 J
1
8 =~~=r=middotmiddotmiddotmiddoti~=-middotl--- middotmiddotmiddotshy--------------t----------~- -------- - ------__shy
~---- --- -- -~ -------------r---- -- -- ~-- - -------- --shy----i-------r-- - ---- ~~-shy
il 1~ 0
Dtl-Lmiddot ~ lttj l r~ UIltltlHt
f g 1 -TI1 u ilictf 1ld ( ii 11- ugraveu-sh) ld IX~ O 1d wllich ltJdnrshymII Il nf the pilll 1 ~tln~1 of th e -o lioti( spinc n IG~nI(J II IIIshytt) lhe iJeuml grl-e o f ~ ()Ii ti c (u rvH Il 1 w dcpc-nlknrly o l l he 10 111shy
P01(nl (pntt l ~ 1 1 nr ffll wrJ I) ln w hilth Ihe n i 1gt( ~ duc nL~ grlphs fm I h~lt 111lt hi~hr Iht Col h ~Ilu t (l f Lite ~Ul Ihe m Ol CI il y th t s(uumlJotil middotpin~ ~111 he ~middotJg gr~lVH(~(1
m mJxiTIt corrttt ion wll iJl i~ lIllCd to Ih - xt 1shy
lti Oilil y Jf tl1lt t Ut JO rl1t cdnUc idt md p OS shy
tU ll cul lapse ( th t ltHill enct b-tten l lUdioL) 1lphic egraveltamJl1ltlti OI1 J t th e ~lme pa tient in Sl il tl cling lOJ lline fX-sitiutl ) Wll ic h correb lc- onl wil ll fhe abilt ty of lllt p tu rl l gt s tem to C( lunternct lIk luree o r grl viry )cco d ing rv D lfVd- f3egraveLIprc po st li r t1 lt01shyIlDse is d ue to the Jnus -u lar ton a nd 11ll ex rCrIshy i) i itv of rhe tissus n the ( O IW-) si it (If the (01shyjl ti (~JtVe (Fi~ 3 L Pu~t llr1 C lltpstl lu lcl l ~~ reduc l-lt by llwans o f pl1ysica l cxerCles specitkally s tuclled ruuml i rnprove tIlus--ubr fOHt md lU pr )cllI Ct 1 ~11 hi shy
lizing ffCd
PararcL n tll CIJ cl the cr iti ca l (3 c1 thlsho ld beQ ld Il ich defol1J lHU n of the i pinlt 1 e~ in~ ne dtlllontr~1t _cl (1l ll t grclrf r mg] o f rllt C II in a qa m bng pos ition corn pOil 15 t l lowcr detormashytion lhnsllold (Fig 1) ie to ~11l Ulne3Se t the risk of pr ogr t~ lu n There t rh eJef re l J ea r l)iuuml 1itshycJ l ~ll1 l l(tl a 1 tnr tg ro b ohwined by d -cr t l ~ illg ilmiddot pU~lUrll cull lpse ptJcelJtge w bich lccording t i)
h llTd tnd ~l(heJ1l ~on 1~ b inde cl 1X llt icularly luumlgh Ugravel mllcl c Iio~ i (bdow 2( 0 ) (F ig 5 J
Fin a Il III ch iS respect lllljl hl and b um l 01 m linmiddot
ii iI 1 l _ _~ _ ___I ___ ___ __L ___ _ ___ ___J______ ___ 1 ___
li 1 1 1 1 i 1
1 i ___--____---___----__-_---_~- _ _--_ ___-+----
i
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+----r--------t-------t------f-- J
Fj~ ~-Ac(XjJlin(Q luuml T O rIcd ~lnd Na(h(ln~ n i () dl( pCG w rd (rTIshy
POO ll is hiherin cu rvegt in wh ilt l1lh ~1flILWrd cII1I Olk l1t IS le- pr(v~knt ln th e grtph Ih t PogttJlJ I ugtnq) Ot1 -J1l j elfltS-e J tlt 1l1t obb dirr remc rlLIv obu incu f roll l the Cohb atl( 0 1stlI1dtJ1g IId gtupinc rldo~raf115 Ih Ille lt) [1l1t1 (i lndnl I pine) 511pille the ~(nlClu tJ1 compo l1lnt U rlk CU Y _VeJily I~ ltx p rlt 1 L1v UpUlt (obh Illeturo Ih t si _b Cct rtJeSIm l fie -ltn J trd Ugraveltuuml shyuumlo n A~-i)rding LP 11(lt uuta o n l ( r1I~( in ~I 2JQ sup itlt curvt 1hi C(]l)b ddhccno l l f lO is -J-lultt( thc s ldnd inr tnla Ol1l t lS wi Q) whil 11) 1 1)401 ~llp lne ClHVC If ~ 1Omiddot ( tcl Lhe ttnd trl~ nlca~ I(t I ~ ~I)
tli n ll w l lllE cq lin ti spin h~ i ng mo r ~ Llnt~II) 1 tlun the nOftl111 one n Cll l gr(lk ( (cU ve tl1u n da r u p shy
po rt in o r k r 10 m linrl in tht 1xi11po tuf_ n th ha__i of th egt onideratl lr1S it f(lll() rhJt
ph rH (~Uuml e erd es ulukl h u - ul iiuml tbeacuteY ~U-L lm cl 1l (It-d o pmg p05111 td C Jl1twl lS fuumlrnll~ rly d ccrll1td ln an Ql St if i imr ol1111 t ru t(( - tht m(d in C JI shy
r t t r sture fO Ir -ngthen tlll m u ck-gt of the spint mainl) in (11erl antig r3ilrl tIcirclt l]lli fun ctin ll U hy meU15 dl i )ll1 t trk ~ lhJ cl( -ll tlt C)nlr~lUions ~llld no l IdOshy
1l)llic d YIltll1k lt l jAJ lktic t) I1 ) II 11)t 111 hd posibleacute t lcluuml ee postura l io nrro and stfh ili lllllt IJI
w i thout food T1lw(ull r d I( Lf(11 Ibk t m ucircnuin Ihe c()rf ~ct [ ()S tu re for cl gtu ifKi IH lLl1gth 0f ti l11 ~
This i-l ddl usl a typl 11 dnmnin (tf k inesllh rap) in 11 (lt-11 [[k - p~d fk lnr in lng f u l1a in llllliCk is poss ihle lI sing ctrtain Idncl fJ l (lt) 11111 liun S p Ul in tb is Cl c is ulttful ooly sa I~tr 1~ il Iw lps t1w lxltknt 1 becuJl)t 1gtlt ltlt-I a ClJu~l inred irl ilL ntllru l o~ i cll
and I1lll~lJhl r-keJc LIl [rll-llIn~ middot etlt(wrs JI the int e rmiddot vlnrion
[J ROPA MfJ) I()Wf-I YSJ IR
1
ICR 1 1-1
r
1 shy ~
- shy
11 o-llrfOlhe5l~ o t Ih 1O~(1dity i n h ~ r ~ ll nr pbl1 l of ~ Spl11 in 111011 _llti1Gt l lPt f ltlJUCWJtl ( ~l Ihe Ir t 1 1gt illbll W Ilh LtltrJ1dlion Vln lbe rigronl middotUII~ l(I Dko n12 lIll h lumshydlanie1 1 [ nul 1 M hl whtrc M - gt) lnIUI1g 111laquo111laquo1 1 1 c rtJCshytjC~ f fce d -d Lill l1~ o f enr niI pUll spnmcl1y 1~ 111 mldlll1lt (n the fl1ur t 1 = tor~ of f(ward Ileuuml l = ughtel1lng fmiddotr p 1shynOf stn lClU= Alaquo rdtllg 1raquo Ihl~ - lin hull th l1ltgtllugrave ot tller1l lUr~Jtllrc F the ~pin t -ilh rlu1i tf Ihl 1 1Ibulll n lrlt InltT1 1
rbc prJI 3IJi l1ty d qrlOIJ~ n bull JI t IlJIII Hm lA the v=ltd gtc e lu-ing J 5lnK1ura i ltfnnity
Dioal e ch anicll itllp~lir J11 c nt
Ihrcemiddotdimcllgtional mc-cbal1in of the s pioc
~f Ikmiddot i t i nly l(œ ntly tlHr llk pr-5tnœ or nc ushy1 lnlo tnr impairment in Idiopttlllc s-ol ii IXl tknt liuml J$ heen h i- ll licircghlcJ hy re$eJ rh tll e preit ilegravee h inm b nIcirc Ji d lJutg~ lt hl ~ 1 ng t o n dO Ulll urcel 1 i5 (l lreldv well umlersrood H(j-ev~r nev lbt un h iomcrhankal im l) ion nI h1c rectm ly onk l n tIlt tre and p r~dou in f n rmtinn hou t pl1ykd (~fcl5( in t 11 0 tl1I _ltgt pbne of spact 1115 Im trqlt-u 1rom J i-[) v ing unclcrsrmdlng ot th l lmc -dim nshy~ilnl l l11 ~ hmk f the cO]jO[lC pln( ~2middot ) ) Ve- w ill )iI xnl t l1 d at lcL-orcltng tUl cl sif iol t lOn blsed o n gtolllt lricd h uumlCJ ) p lane
- b() rJzU[1tl ln th i pla n ~ th t 1o rm ll sp ine present no CUlye- w ll ile Uumll(~ ltc U Hic spLnc clevelops one of ir haracterls(Icircc deFo rm tiCs v elt tbrd ln lashytio n vh icl1 pJ()VcA~ theacute hw 11
- lgitltl in th llulJe U l(~ nonmll spIcirclle pl SenL kypl lOSis ~nd l dooi~ in tb lXI1 lhese [(Hu rts Vere m)( til ught [ 0 he relattd tlle scolkJtlc ( lI r Vegrave
- front l in hi pleme tht ncrmal p ine preseuron t no curYegrave whil thl ~11li tic p in ugravetI I ()~ icircl~ charshyad t Ilt I CU1C
Il Jri fJIIt palic
~l+I~na ra 3 r inr lut th l[ ber ll1d a œl1~lU1 degr 1
l f r()la tJo u lllu (lILa r forcKl ltxert ltJn tl ldefnmuumlng 1 tkllJ [J i1u a re- lhlt tll cly 11 [1 1 UI b y Olm ner w bn ~lh uiJwd tl egrave ro t1tic) l1 Ilm it ti lt p ica] lf shy
rhrl r() be (P (the Uma bevond Wl1iltJl th lCOJlb of [11( ~pmaJ musd ~ dthc COnCIt and nm ex ~l le btconk (t O li~[)
r ~l 18 ~1Il N lu t( ren i9 lun lu ted rlseurlt h in tlt ) tilt lULodeumlformipg1 tlo n ot tIH_ sc laquoJrle rh ox ercallkren lk 1l1~H li d11r once thl Il i ~ r tld1t5 [he lhrth ld f 111 JlIcirc lIi of tlle dnrlclc hurnp tlk
lI bslt Il l nt rlet()rlll lIcircon 01 the it l ()I~ C ( (ylm der (- sustalnecl by an H1tmi cforming aCOOIl
J1Ji h V hl rhyiical f~ f Ise CI 01 h spr n llnd kin middot ith ccedilrapJ my lX damlg ing vll e n l pplild as flle
igt Jk Iller ln SCC1IJ ~IS lllc lJ fxceed l auto in middot crca~ i n g lhrllgthuld [1 sh (~u Id ahn be j ofed that Ilw relscd pre sun 1l1111i insiugrave l fe pil1r inn) 1 mlshylt
- j Il- ( w atff 1 (nh ~1l 1(e Il10 utoldrml ng li1eCh~lI1 1sm
in flc l Geyer ~w tcd th1 t rm m 1 hI l)1ecircch1O lla1 puilll 0 l I C~ sw m mim t Ieuroamp no purpo t for cu lshyim le pllilt t1 s (weumlO middott r it is l~Jl(gtWl1 rhn in iculio r[ paULnl -iJl11T1ill~ doe_gt nor Il ~lp to i ncrt~SL n eur(1shym tor co mfU
(1irai p an (
Jerdnn lle 11 showecl thal ill CSl~ o f t10rLC IC 1i lUgrave
tllo lacolulllhil it lio_1 tlle cte tI llmiry in (he lg itt1 p lln t rn lnlftot il~ lf tspe iuUy in tlw initi 11 r luleuml )f cV IU[Icircon nf Ile ~oli ls W iU l 1 p(t)gr~s~ivlt il10middot~ shy
ment roward hvpok pho b G ll f ill~l Im lins l har dUflng (IN eWllLlfiu1 of 11Imh] co luumlgt i the l in t ot t l H~ gClyty Cegraven te l - 0 1 v llebed lxxli 5 r ro ject 1 seH fl r t side-ys and tlwn backlrcl bull thu~ p(0(1 lj n g a kyphQtlmg aet Il ln (h~ lu mhnr --PIl1 COftj tng
l l i tc Iugrave l lltl l( l rs1 tif s L -etllgt il l the lgirl11
1 Hl)
Ilu LE nI rIIY~Ic~L lXIlKISI 1 HI E TREhTMEtn OP JIU IDIOP llII C AD O USCUH O Ll Œl15 NEGR II
lLill tegt lre lenl1 ~I d ~fo rll1J[ ~ rhl recrSes the phyltiologiGII cmns of lh vine)
Accordlng () Dicion ~2 1 rtcluctio fl in the itgitttl CUIYtS combin l vi th a lueral Iviari n llltl ds t 1
mecban ism () ugravel~ta il ity in l he r rat r IllI1e which bVOf1i the unsd a nd i ncrea~e 0 1 co hlt1is (Fig 6 hiIf md Pl11jlbiJ Jl1eanwlt ile lt(udiecl lh e srnl ru t
orzyglpophySLs show ing t11 al ttleir 1I1tl rnic tl orienshytation f~I (jLi l~ltes aXIal ve rtegravebJl l rotllio ll in cun litluns lt f dorsal hypokrrhn Icirc tnd lum)H de i L lo IS
Tll t dat SLlgge 1 th t impOrfill ut pOitu res and l1lweil1 ) t Mudied in ord t r (CI mlIuml ntrlin or to reuwer fll e p llyslo lo~lCll ClIlye in lIe SlgJtta p lU)l Wlth the llm o t ch ~ kin~ rutltor in l~ bili ry7 AbC th ~e ~k-
1l11nL ~Irt del lnt [0 J jUc lt ftber l]kuti inrervenl ion vhich 1c)LJ k l IV - i(l ~ l compktl n l ililll on Il t c1 l shy-jel1 J11UVllT1ent IJ j o f 1uto-dOneacute(3tlon ( i e a -impk ld ion ) Iengtheni ng o f the pilleacute 011 a litlltl l aXl~ tll lt ((IT liJlI~rcdu e~ t lle ~---lJ linti- l lte ml-fkxj(l n h UI 11 - i llCrl I~t the plllH ](JgicJI dlt cr ~l S ( (1 k-yvllCiSh lIld O(ltOSh l o r c lch r1Iif n t a Ilew til(~ecirc dUuml llt Ilshy
si lflltl J ll1 u(~nlent iam ecl - 1l1t0- lIrfe rionmiddot7 4 llmshyp oed f Je-rura l iUIl cl middot-t1e- iltm lI1d ll1a intltnUlLe )( 5lg it d C Uf (gtS slig lll thltJrc i ypI1 tiZ) tIcircOI1 a nd lunugrave)ar 1()fdos i7~llion) sholild he esw b lb]HU 00 lb co
hl b oi hi p~l11il uU r -1Ir vlt Abo 111( e IlltUtl Chl lie o f purti n - a U vitk slJ1ultI h e )tuumlll ecl 1)] (1 n ldershy](ion r tl1i lt type for e upIe IilJ llyl)T S of repd shyiti( ml vemen prt n t in agonistK h)lnllltlSlks nI iIle kind f dlJ1ce C( uld he ([([r imentd
FmiddotO lllaljlallC and mobili ty of the SpIcircIlC
1 rd llo U 22 d L lm nrrare d lhlt in Illt fro nt a l pll ne
tilt 1 nge Clt 1)1lt vtment of tht scplit[i middot CU IY grcmr lIJ l il ~ d irectio n n f Lhe C ITelt tlO n tha n in tl le di re shyLion of pmgressi n l Fig 7 ) he IL o IS5err lJd tbat th15 mohiliry increac plrtil u la rly n apic [ cgcoeilts 1$ lh ~ ~c() li osb evolves Sragrm rJ 12 J ~ thus rigilt (0
VlI f n rller~p is ts Ilo t t) m o b uumliz - a sCtJl iu til curve w ilhout t [ uling ttwt tlle R lu tiOI o i til t ~a mt b fnlinruumln( 1hy l1tans o f ~I passic 01 1 rivE -uppnrt On tilt (ltllE r hand UgraveK d e iJlioJ1 in ease durill tlw tune 111 whicll tll C spmt i ~ not submjtrcd to correeshy( IV anl()n
j- Virh mi lei ol i b tlllt Upp i1n ill) lC tiol is d eveloped only lllmugil llClIf()mu$Cllbr f r llce thi ~
InegravelIl ~ thclcfo re tl1l[ inu eascgtt sp1J1all1extl)iity mua
11
Imiddotiumltgt 7-rurd illt Ir) 1 bull rdrilt I1 1 in tl lt frOlllll pbnlt- th( illl ge )r mOC llIeJlI o t the S-o UIIJC CUNe 1 supcrior in Ihlt diflt(l im ugrave( the n nKlIl thd n ll1 tllc dlrtcLion o f p rJ1(l( (llIl
be considrCtJ vntrl iJ)(l icltion and 1 undrli neocirc ab L a ~ubiljz~ILion 01 tilt spint pllss il)1y ohtl ll1td thrltJugll the stlengtlkl11ng o f the 1rltJgm vlt nonil lme shyCIC 111 illli orrant u bjcLliH- ln rhis r~f1 n sp u lllni lc tivitIumlLs sil uld lX tPI 10 dlegraveltl it l G lU t n w l1ik luring kine i Icircth lrr phyltical eXegraverci c~ tllat in ele
spinal m ot ilIcirclY sil nid 1e lt1 oid cdrt ~
Organ ie and psychologieal impainncuts and li islbi IiI le
A cgtI im lc pmi nr is moriOthl11 just 1 sp in and 1
compkt gt Ipp rnach to the gu in ad 1 ont i al~ shylute l e~se i t i11
[)a la 0 11[ [n ell lrom re semh pw tbat ome organi Iilnctiond cl fki ts suc]) as tlw clecrtiUe ut vild l tnd d fun ll l)Kity_orld ldly incrtJ k whil~ 0 shy[io s i -till in (1 miel q g of g JltlV ity ~ l ilI e 55 rtI lit
tllL pres e n ce )fl defidt Or Vi l~il Clp~1 - i~ ln one pIIiem in Ihr l ftectecl by 20 ICl 40 scoi stgt l ls~a r(h cunclutecl in tbe UA by Di Ruce- prod uegraveed an aaalo) u ll1lXimum 102 re u t in a group of Jd shyk 1ien t [(h sco llosls rang inF frum ) [0 1
Al10ther rudv bv rallt r m C chr111 lilcl NashycWrl1s( u 57 stlO eltt hil $(C 1 1 ui~ Ica js l( lllt cl (1 shy1prUlllI o f t1tgl lie bJd l imI in ~ul sct t1 t ltu b middot iects jlLltr l5 they are golng through ~I cltlici[e sllge in the fnm 1lt i n 01 tlWH o w n id uHitv t factor hit h Illy jeopmlize the cl velopme lit d ~ mIll lt lI1d htIshym cecl IWI sonalitr in Klulrhood
n RUI ~IEDl(( Ptl Y1-
ROU ltHmiddot PI [ I C~ 1 EXIRCIS]~ IN TI Il nW~JUNT OF SlllO lDIOP1HIC AI)C~ESΠ11 C(gt1[Oi 1S
This i why b IiCieacute ii is ~n imporrlIl t for p rcshyvegraveml e 1tLsr l tn en ou flge 1ari e nrs ~lfrecr(d by lIillcl middotu iosis ft) tlke p~l rt in portin -re rcatioluJ acrivitits Iha t 1eIU 10 L10 th r~1chophyinLl bull nd b~l )i 1l1o tur adlieem t n li 51Jmiddot2Even tlK)ugli [Dr bic mech~lnshy
ical mcl nellIUll10t 11 11 reltl ~ons lt r111 1gtomcrimes be l lefu l to ugg( ~t ne p rt in~ aCt iv ity r l h (gtr rll n anotlJer e th ink Ibal an exces~ ive IlHd icalizltion - Icirce l ll1posilion br plry~ilt i HlS nnejlor parents uf rh ry pe of po rt to lx p m lice 1 b Ule p 1Ucirc(Il L th1[ preshydLl ck l1 is fret clOice in lh ma tt r - -h II ll1 he avolc1ed wb 11 possLhle mainly for tlle i mport~ltll psyshyLb ) jogka l fe a SI)nS W( ha( ill ~ t nltntionegraved
Conclu ion
lbh ISsertegrave d t1H physkal tgtXtlci o is ) n fi ial whlIl practinu in order 10 ilnj rove the I11 llde
rœ nwh and tono C iral caplCiry and postu re o f the StOUO(I ~lIbj n II I nowkdge om ~ middotmg trom ci el1shyrlfi rls(~ Jrc li dJlJ accordl ng r the review 01 thE litshytirlture prnpo )td in t lli plpl r conflrm~ Ihe vuiclit ot th e -t ls ~rti ()ns
In l do l (ent Id iopl1il iC scoliuse il l n phee u i cl vk)pm e n t ( li tll iumlKh eXCC cl l g i en rhk thr hokl th e re i5 an und ubred need fn r l pprnpri 1tegrave (JJ1tOkJJe ~Ild Inr surgict1 therapics ill ortler 1) S l i p
the ( - Iuli on anugrave )JT~t~t UW ~pilll l dtlormities bull evshyerthtless in the illiti ~ll pl l~sC t ttlC c1iseLltc whcn the riS( r1 r euro )luli m is rtduced ocirc ~md tfle uifleal JOld threshold il ~ld flle po stural collai i reJcenw~ 43
JI l1 igh pllysicaJ egravexe rc ise - p revenc or r d llCe d i ~lh ilir ies o f [Iw ~ l() li )tic
p (iems R 28 J -6 5- 6 1 63
- f~KiHtare lh ( n utr ali711iCUl of postu m l d elicits tn produCel1 a coneql l nce J [)ti 0 I111)( or regre si -u lmiddotc 5middot Il 1 17 ~ M
-re 51udles U ~ n Ledecl tu con[mn or re jecr these conClLL i( 1 w l1 ich clerin-d frum 1l1 lIldytica l rcltw n f th e liter~iture appear r- ~Lo nlble Hnwecr Intil ne re ull are 31Iable wc should n r prevent our sroliotic patientmiddot trom tl ki ll p lt in s(loI1ing jshy
ir its pW1iada rly ltl t ~d1()o t () n til t c ntrHY -vith the l xcclrinn 01 gt[1 )11lt tIlat in rea-e t)1obility (tnU evc n thell oilly wh n progr~lgtion b p OSSibl) -uc h ~I( ucircvshyiUe -11 )ulu hl tIKoll w g ed The 11 S J ( rprOpriue kin (~irhe r~l Piuml to incr _~asc p()~tura l $llbil i ty is tl1egraveoretshyic tlly CiJUClt alttloughl more ~Iccu rtte aod deLli led ri k benefi rs anJlr~ is is netot1ed
Ria 1111tO
NIokl Mu d lle ftitYljJfu Jœl il 4IWr10UOifll S (JIvs i (1~1)Jshylidl ttno( cclIll le 11(11(1lt1 RCI fu lle ((lia LltfIt l1 I1I1i(i
LJ ci n s j(r3 pigt egrave li n IHUgru lkl di t rdz t fi sici pe e ft shytUlKm iluppno di un lisimerap15Ll rl lllcflt() 1 110 scopo di pnevirlt () fr en~lI 1-lgpwlllltnlcgt dclld lclonnitugrave o e il 5LOshy
Il i mi llon lt fH nugrave j (1 11ni dei co~e 1 lteIl I1J J nd ne ~Ii eifclti (()Tc rri udk s co lio si d i m e dia g rt iuuml ln que~ltlt
s rud i 30 llizzb mo i d ti cleU ric lca pel n ri Icare qJJ l lm 1 dis(imucirc x u le I[~ l z j-m i pro vna le da lla C gtl k A i json ere pr middote-nute () rk kl ducirc un~l rdeguCltl d nil cra pi lt di uJoseguerrnt Cjua li 1iU110 cli nbie tti 1 rcr lJ)tIId d~ fle)-UITC
n (- -fd7Io n~lcl)
Ut11claquo)si 1 lI tori htpnuuml )ludi-ttn I ~ cnntI1zttu fr Cq(in i idiJ)tic1 dbfl lOZ10l1 d d ~ leOla nelllOll1otoriO Lb un1I1cnUl 1n1l1i3 dcgli 111 lt1i ch DIJgt gtU l H crmU1 Nlch~mslt ( SIshygnaJ~l lerimiddot wo i esuemi -bletti d~ plt~e8lugraver- ne l pClZ le1lftgt scoliodcu kl s iluppo ddl ~ ~ uhjlil~ vertcbral~ lt o svilllp prJ Jdle JIl7 i() nl di ltCjuiljbrio Dng li studi sul lto lb( l~nlrale (OllddU i in pa rticdu d 1 DlIal-BeHJ (gtegraverl ~ P~II IId lI1 n~ llw - idente il v- m gtiu p eT il puientc clioti elgt di u n rnigb o t c)[ ro Ua sw mle dei radlldc onsegull o tramite il 11 fforzrlshyfl len to d e i l1luotoucirc l nllgr3ilri d e luOwo con crcbi ~Clltdr
in pOMltHJ corrctl e in va rie ~i[Jzioni s t llicb c c d inamIcirc tllt Dalle on sena d elb blOffiCcclIlicd tr idimlt n s io mlle d ei
r ~ chi Je ~oU()f icn ~Icirc ~videnuumll (l() ~llt tC p IYZIcircOSI ln(IiClZlfHicircl ~ 1I1shy
liumln fluenzt Je ll middote~rUrio tl SC) lgt lIi I rc pibull m i tldln sJlI71 Stl shygn~I I1 afferma che slI l p Ia no [11 middotccedilr~lk tre un œ rtlJ grado di l L1Liuuml IlC dclh vEltlh r1 apj(de le tu rœ mu SCltJ llri njtbc J n in $tJ ) t rodcfQfll1t1l1te PltJtantu b i r~it-~ r -lp il puugrave t~~
Ixnt-ftla solo nt Ile so )[j)~i Jl1Icirc na rl in qunnt ) ilon SlrM ntne )(l(Ofa tu soglb in caq ) co lltrLJIcircn l)lrilto llt~( i lJudotlsi di lfr~ lI1 C llg grVlmenl J 111 11 io lr riltd ll(17jOill leld rinlle 113 dimO~iumlrlto d llt nell o lin~l cl()~ li t th~oIOl))1 dri la defltgtrshymiti sul p iluO slfl iuale ~vohl lf1 (en5 ion~ sO lnm utto nd 1e bsi iniliali deWggrwm1Cnln mcn trl C a( lfLmn che occlleshyvoluzi ne dene = 110 i [ mhari IJ lin c l ki cen tri ch -1vi1( de i cp i CIt IJ rI Ji SI p m ittIl pnm l Iem lmeme e p o j pOS( shyrio fllwnte dtldnli mdv ( i un ziuuml ne ciloliz7nnl dd rlLtide lu mbJ œ ( lIlelttlaquo on NC n d d (gt11 uIdu m 1I1 Ilgt) cli r-Iure (0 eserClzi che IllUllengano 0 ltlUperifo le Clgt 6gt1 lo)iche sul pirluuml gilwlt Su l p iCl no fron itk Perdnulk il dlll1lt-trlto d1 lampkz-l d i LU ovimento amp111 lI rv Kolio ti ~ nd lt1 0 ddlJ cnrrc-LIcircQo i Ji gC 1 n lungl SUpegraveliltlrccedil 1M llS0 tlell 3ampIGI shyvamcnlo C che l~Jltmiddot mobiliti GlI mcnta co n l c lu7j o fle d l i) snAio i A ulln amplgrtJc1 ltllllmunjx~ i terlpGli nn n m obi shyUZ73It ma eutva coli ti0 1 1ct HsicVlfe nd tcmplt 11 1111nshyttllIcirc1nc n tc (k ll ~1 llu u zinnt n l1 un me77uuml d i sost l11( gt ln 0
e 11111ri b cle - Ilziunc egrave deorinatcl d l rlyarsi Snzcl la pr gtshy
liltlnl l i un() rtl~ i ptmiddot Jtl n(o 1S(Hl () (( ntJ() i ndit~tr i ~ Ii ISt (izi e l m iviL Illdlode ebe Hlmen tno laJlc ibiJii dcl rlc lide SCshy
li io) [n p articobre rune q lldl r C-I1 ich~ xlSiddcHe CUf t shyli ve ch~ iJllpi tgino e~rciii 01( biIi2 ZanUgrave HhnmL-trid () in tmiddot~t~nshy
sione kl fuchide O tne pure k- ~ttivit1 tnotoJII~ non prHi(~ llCcedil
in forma r k rel1tiva d Ie ~1I 11 rF~1l1( n otcol mcnlC 1 lll ubib Ll vcrteblmiddote (ad ~ flp j(l 11 n l) to L ginn ~Iilt Utl clkl rilshyC
mka la cli OT- tcc)
r1il to l~ _ I[Dl COlI rY IC~
NE olUNI
fillncr ( ni ((uuml(( n hIIo( rilclIO ~middothe k lln dtfidl fUr1z i shy
nlu CQll1~ la llcl llZIO 1e delb c apKJl ilde e della capacltl di 0170 mizianu luJndn le (OJ il~ gtna a nc r3 di m~i3 gmshy
v it ln G mlxl r i ~ gko Fl llslrom C dlllJ O e Nachcms(J h iU1I) dim lr JtQ che b o liosl p IOO C1 neUaduksœnr 10 SYil l1p pn d i lIniumlmn~gin nlt8Jliva de corpo in (o nridcnz di Ln ddic3w p ri d di f( m l lz i nlt deUa SUl idenritl condishyZltonc ch pOlrebh ~[I cubrmiddot ln vilu pp di un pe bull n nn lir m llur cd e quiJibfarn in t[C adulro TaU CO1DSCe nZe tvlde nshyZ[II)() la n ( middotess iti di ltimobre la plfte ip a7j0 r1e atl an ivi ll1ltHClr n gl b a li ltl h ~ di tlpO s pu rti middotu dl ittlrc nd gloani iCo lID ti i lirtugraveta z io ni llb vila di relazionc
ln concllliu fu la d tfoflll lL saliu iG egrave il sin l mo di lin) idrotnc C Il1pk 1 d e eoinvo l d middotmiddot= fu n (n i dd rgashynIcirc5H10 n Hi lhdli e lesenizjo fi 1lt0 se 1 Il indirill~t() pllO pr~cnin 0 odLf rgt t lli di fu nzlonicirc adlc s()Jj(bi 111Icircn(i rrHtatc CO ll nl1 cinesi rap i Quand l~ coli i ( n LS~middot iJ11 zia k il rischio evnluLIcircvo egrave lid [() mente no tcole 11 (ltlll asso p o lll shylal ltOtSltgllen7~1 _ ta cincsiterapia pc rslIk bidtlvi shyptutibulli d ubllIcirctIcirc vltnc brn1e di conrro llo )(JSu k d i 5IcirclupPQ d Ile rLlt ziofll d i eC[u ihb ugraveo dJ ftffr otZJH1 r1w dei IIl llJgtCili 1 11Icircshyg rdtarl in posru ra rrenu posslhile JnnalL in Illo lt i clsi l(j luucircun lt di lin ~c() li oi mi n rc ( ume [11 duumlnQstrIO la tinc~ jn~l el1lric ((1l1 ~rtlppi d i contnmiddotllo cnndnlt1 p nso i l entrt d e Massue di Li n nc da [ o llo n ~ Rodo l (1 986) Julndo il1vlce lIfU~ ho ~vutlJ tiVll 11lt1 1IjXIl to un dekrshyuina r o~itl di g rl vir~l bull a~-n lllull~nte n ec ~~uiu rlCUuml rf( ff dla tcrJpll rle si c a eo chirurg ica
1Ho le clllC ooliosi idjopHI 3 ttl1p ~ - E~er l zjo hsco shy11ln ~ I((fapil
l Bg 5 CUle Lo [la k ll oblems in tlu ll~ (U ni Cl) FrKUce CU ( )lIILr no 1 AllCPR lu b1lG1t10 11 middotCI 9()(iJ2 RockilJe MI) i)~Cr ~()f I [( al th all 1 () I ~Y 1(~Re~C~Hd ~gtutnlt Ilallb Srshy1ltC Cgt D~p(rulllnr CJf I Ilalil 11 1 HumlIl sen Lel 199-1
2 SI) lrzcf ( LcB I ~IIl( FE DupUb L ampkIll~ 1c ~ppro l c h ll tht rnent und mmgemlt-rlt ot ~ ct vlyrl~ led splnul (hs r)fder~ A monQglJph rr r d lll kic Re p o l1 or Ih Ou bcc TlSk Fu rcl 0 11 ipmd DIo rele Sp ine L9H LU) 59
) Clntino F 111i1 i(ll Ci nerte1H C Nou gltHhl C Kln(~Jl llBICII [lIe1 hmlln (Il dry rra ll1ltfll of QIil pa ll m log iC by l11e 1 lIb li 1le-llh laquorilC~ of ~ 10(lna 111 Jrc)Jcxli r~~ (of flle h l lntrnIUonll SVIll Illgt~iu tn - II 5lt Ik lIc lk0flllllic lu llln-I I r l III Fhhlt ri g 1092 -ltlIJ-7
i - ri of niii MA N()LJV II ~ mel h)ltks de kin ~~klk rlr k di lll J r~cdllclli (n d~s ~()li oes jn f ~tel r~1ruuml(ILI -lo s bl fl c sur IcIj cquishyl)œ~ Ik SOll ll l)(eacute Eli ror eetlfllS d )111 1~ 1)1-
5 iloll n G Ruumld(~ le s () I ~middotmiddots tnlcl l l1 I n in 1Ifc el kiwil~~ 1)11lt KillegraveSlthe ripJe SCleacutentlnlue lYl6 2 47 ~ 6
r) Feacuterr[ffgt en 1tsiero 5 Venlllfln A ll~~n () M MJglio nu N EfkUuml o r eXltClse tI~tl Yoj o n nild id iO rXllhlc iC() 1i()~ lrt~ lirnIcircIluy r sull Eur feltl lb)ii 1 1j34 Z5 -~ 1 NOilrill1 A Sbill P egn ni i Ll Linesilegraverpi l 1lt1 Itallllll~nlO
ddlJ soI K~ i llO 1 Orkl1Llllwnrl m efodoloil1c1 RbbilltlZiOllc Ot1(1 1 )29(1) 1l-~
8 Nli(rinl Nl(lr1n l A blll P LI rieduGlzione dl p llicml atflt rro (11 coli ns i idi opr lir1 l n SC(Um i le or h( JI 1rcLlIQn1 ~0Cl le Imc lI1etW)n11e de Recltcrchc ci 0 Ftude sm 1lt Radw jlt)(j S-71
gt Nftriruuml S SeJhrf U LI r i l bllh ~l liOlie dd plziecirc11te ulet1n 11 - r
lin Kllopd (1 In l1l Jgl L N eduoL Tf1It II d ll11e ji cln1 rJtbl IiIUvJ Milan) 1ltfddH~n(x~hl 2(1~111gt-1-PU ob L cllln t iRll p l nelLi rl tgtO llcui n~ dilt ~lio i - l rn~f- li ~iIa n 3efllnl -Kurflr 19-11
11 lIIra S lJll M EVtJltHlvugrave egraveI lt t rnrumel1t() d db S(oli - U r) surie doCum nUle fintgt 31 tIUUli Mibn SI rlin) KlIpf -r 199 2
L2 1 ~W I1l(IJ P _leacuteVia tio n I~lhra k~ du IlchlS ~- ( i( IoltS ccedil l r lI C1 l1 fl leq
Ene 1 l C hi r ApparctlIClCOn l~ ltll1 l ltx6lt (i W Er 20 j )7 l
U StrI tr d P Lcs 1) rm IlO du Hltlctli Parb ME n 115 li ~u n un_ l c- l ol lJn e~IL1roy JC EagtOllŒrio n sc lluocs
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EUROP MIDI C Pli hIC
EDUCATIONMEETING SATURDAY 8thof APRIL 2006
(iSS
SEAS02 Scientific
Exercises Approach to Scoliosis
version 2002
G
S Negrini 1
EDUCATION MEETING SATURDAY8th of APRIL 2006
Neuromotor disfunctions
Neuromuscular disfunctions
11 Postural collapse
Postural collapse
Duval-Beaupegravere
Flexibility of scoliotic curve
f---I--- I Postural element
-------1 Structural element
S Negrini 2
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Postural collapse
Duval-Beaupegravere
It is a value related to muscular tone and to flexibil ity of convex side tissues
Post ural collapse
Bunch e Patwardhan
Critical load
Load threshold beyond wh ich a spine begins buckling
JI~~Wt1lW~flfthtlJlœJtAr ~ J~It- l~l - IMS
Postu ral collapse
Bunch e Patwardhan
If a curve reduces there is an increase of the deformation threshold
~~~NW~-damaoc~IIIMf ~~ J~Iv JaJ-I7I9sect
S Negrini 3
EDUCATION MEETING SATURDAY 8th of APRIL2006
Postural collapse
Torrel e Nachemson ~
Scolioses below 20deg ~ ~ lt~
have a high ~ ~ percentage of ~ ~
~postural collapse (on u~
average 75) ~~ 2i~
CU~VE O EG~EE S WHllE SUPlti e
~laquotd~c6b ____lPffI1wtt1t~
$ww J(t ~~7 JM5
Postural collapse
Minor scolioses 7
Antigravity musc es strengthening D
Reduces postural collapse -G
Increases the critical threshold of deformation
G
Neuromotor disfunetions
Stagnara
If we admit that one of the causes of idiopathie scoliosis is a disfunction in balance systems it is logical to orientate physical exercises toward this direction
s Negrini 4
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Neuromotor disfunctions
Dubousset
Idiopathie seoliosis results fram alterations in praprioeeption centres and deformation is a natural compensation to restore postural balance
etattJtitIK ypothfQj~S ___~ own_ oJ)HQr lar 1t-1( r
Neuromotor disfunctions
Nachemson Initial idiopathie scoliosis
+ Goood spine stability
Neutralization of postural deficits
D Static curve
Neuromotor disfunctions
Therapeutic aims
c) Development of spine stability
C) Development of balance reactions
G
S Negrini 5
EDUCATION MEETING SATURDAY 8thof APRIL 2006
Biomechanical disfunctions
j Horizontal r-Ian
i Sagi ttal plan
Frontal plan
Frontal plan
q Frontal plan disfunetions
Fronta l plan
Perdriolle Movement magnitude
gt in the direction of lt in the direction of correction progression
S Negrini 6
EDUCATION MEETING SATURDAY8th of APRIL 2006
Frontal plan
Stagnara
Never mobilize a scoliotic curve without ensuring reduction maintenance over time otherwise a greater mobility favours scoliosis progression
Frontal plan
Ducongeacute~ research
On a group of adolescent idiopathie scolioses treated with
Meacuteziegraveres gymnastics
D After 1 year the mean angle of
curves increased from 18deg to 29deg
Frontal plan
Scoliosis without brace
D Greater spine
flexibility D-
Risk of progression
S Negrini 7
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Frontal plan
Mobilization is useful
D In preparation to
brace
D With brace
Sagittal plan
QSagittal plan disfunctions
Sagittal plan r middot _J o
Perdriolle scouos B CJ aDeformation of D
thoracic and thoraco-Iumbar curves evolves in extension
S Negrini 8
EDUCATION MEETING SATURDAY8th of APRIL 2006
Sagittal plan
Graf
The line of gravity centres in the vertebral bodies o s c oUOSt
projects itself firstly laterally and then fi
o
posteriorly lJ ~~ ~~ ~ ~~-_J-D ~nI~
Sagittal plan
Therapeutic a ims
D Maintain or
retrieve physiological curves on the sagittal plan
Horizontal plan
QHorizontal plan disfunctions
S Negnni 9
EDUCATION MEETINGSATURDAY 8th of APRIL 2006
Horizontal plan
Stagnara The forces applied ta the spi ne act in a autoshydeforming sense
Horizontal plan
Dimnet Rotation gt 200
ampII~ (
D The actions of concave and convex side
muscles become
agonistic
~ItJrOnrIIiItdllfUClltlluumlll~~tI ~1JIf1laJ
Horizontal plan
Minor scolioses never exceed these autoshy
deformation thresholds
S Negrini 10
EDUCATION MEETING SATURDAY8th of APRIL 2006
Disfunctions at a biological organic and psychological
lever
Oisfunclions at a biological organlc and psychologlcal lever
Cheng
Bane density in scoliotic teenagers is lower than in normal subjects
~~~~middotA~IIlUtIy ~7œl 1d l
Oisfunctions at a blologlcal organic and psychologicallevel
A significant reduction of vital capacity and V02max in teenagers with a medium severity scoliosis
S Negrini 11
li
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Disfunctions at a biological organic and psychologicallevel
Disorders in the development of body image that the teenager has of himherself
Disfunctions at a blologlca l organlc and psychologicallevel
Therapeutic aims
cJ Activate cardioshyrespiratory function
cJ Favour bone density increase
cJ Develop a positive image of the body
Disfunctions at il biological organi and psydlologicallevel
Stagnara
Sport
D The active side of
kinesitherapy
S Negrini 12
EDUCATION MEETING SATURDAY 8thof APRIL 2006
Disfunctions at a biological organic and psychological
level
Distunctions at a biologlcal organlc and psychologicallevel
Cheng
Bone density in scoliotic teenagers is lower than in normal subjects
~n~IIIvpWr~middotA~stWy s- XXJl M J
Disfunctions at a biological organic and psychologicallevel
A significant reduction of vital capacity and V02max in teenagers with a medium severity scoliosis
G
S Negrini 11
EDUCATIONMEETING SATURDAY 8th of APRIL 2006
Kinesitherapy on the scoliotic subject
q Postural control
q Axial stability
q Muscular trophism
q Balance
q Respiratory function
The limits of kinesitherapy
There is a threshold beyond which
rehabilitation alone is not enough
sssr
Kinesitherapy in scoliosis treatment with brace
Therapeutic aims
S Negrini 13
6
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Therapeutic aims Srace kinesitherapy
With brace
il Postural corrections and
vertebral stability are obtained by the brace
Therapeutic aims Srace kinesitherapy
In preparation to the brace
il Mobilize spine on ail plans
Therapeutic aims Srace kinesitherapy
With brace D
Maintain a normal spine elasticity
~ Maintain a good muscular toneshy
trophism
C Model the hump with kyphotizating
exercises
S Negrini 14
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Exercises and their methodologies can vary accord ing to learning and individual sensibility of the single rehabilitator that proposes the m provided that they stay within the
Iimits of fixed therapeutic objectives
li
Therapeutic modalities
(Exercises)
QAuto-correction
QRespiratory education
QErgonomie education
QMuscular strengthening
QDevelopment of balance reactions
WNeuromotor integration
ci Vertebral mobiJization
QSpecifie modalities in brace treatment
S Negrini 15
EDUCATION MEETING SATURDAY 8th of APRIL 2006
The protocol of kinesitherapic
treatment
G
QChoice and dosage of exercises
Variatiosn of the work program every 2 - 3 months
Q Execute e)(ercises on an individual base or in a small group
Q Frequency not less than 2 times 1 week
Involve and awaken the family
G
S Negrini 16
EDUCATION MEETINGSATURDAY 8thof APRIL 2006
Q Determine the action and the localization of auto-correction
QAuto-correction must be associated to ail exercises
QAt the end of treatment ergonomy lesson
Auto-correction didactics
G
SCOLIOSI DORSALE---- shy ----
r
S Negrini 17
EDUCATION MEETING SATURDAY8thof APRIL 2006
SCOLIOS OORSOLOMBARE
shy
SCOLIOSI OOIlSALE 011 bull LOMBARE S1I--shy
SCOLIOSI LOMBARE
il --~_-
S Negrini 18
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Scoliotic patients are not radiographs
middotSeoliotie Mtients are not ndiographs but hum beings with a vertebral deviation-
Slagnara
Metha For the physieian Cobb angle is of utmost
importance For the patient it is body deformity t hat eounts most rib hump a protruding seapula or hip We are in a situation in whieh today dodors eure the radiographie deformity but what the patient really desires is to get rid of clinieal deformity and of ensuing psyehologieal distress
CIIQItIo shDuIdtucirc lM WIld tJw~~ I~~M~~~~ J9f~
S Negrini 19
- Poznan_workshop_Physiotherapy
- physio2
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REVIEWS
Role of physical exercise in tbe treattnent of mild idiopathie adolescent scoliosis
Revicw of th- literature
A NECRlNl N VElWNL s PARZI 1 A NEGRINJ 5 NEClU NI
P1t~silillxlrd~ Ihcrapy (or klucgtlttlwrlpyl i pro shy-tJm of physka] cXlrd-cs ipcci I(a~ (IJcloJgtcd hy l li trIWlltl phrslollwrapbt wilh tb m~ln a1mor pl shyVCnI in lhe ilAAfIVltilH1 llf the ucirccfonuity III mild IgtC )
Lil1Si bclpin~ thebm ( aocl co uaufllclilIg ils ~jd- clf IS in nlOdlJmiddotnh-culiosis Th middotalillofthi paper ito r (W
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11) wurcJlt 0 lit)-IcircS (Iumpy - x rcLs P()lun
n rllt lT(ltnklf u f COll1tlK H (rtd) I 1i plfho l og l ~$I rUlglng tr m low tmiddot k Pl 1l1 to IdiOpath ie SCUIshy
Submitt(oJ [or PUhltCl l1 011 uly Tt 2001 Acc~pttJ ugu - ~2 1(t-1l
Addre rltj-xlfll telt~I(middotb If) - grinl Flt(1(bziurllt r )(m Ofl ()(Cl1I shy Lt middotqlltœlll ro () - 1u I4t agravehLIlKil ta IYIL-lTt ilSllltp lfllmiddot ~ 1l1uumldull
CelII ~ (niiOS I I~ middot ann (1) IfUh middot lIlfU di louhilll(tymi ( Nlmiddot ~iI rli -ilIIUmiddotltlfl
Nlti(ir 1( ) il r() (ltbullagt1
lt vLL_ l IiII no 1ftfI
jS ) we are a IUil ly tJc ing n1n) ltblll lS 1 k l1 b ~J)w in~ tl~ t S Jfll l approad llt - l1n til hy on ielshyertd ~tan lard ugraveJuld ln m any ~1~ he lI ~t les i if Ilot dange r )ll lt rhlS is lrut of reil l lnw 1gtlt1lt1 pa in l ~ or 5urgi c ll lrea lmltnl5 in dbc r lmiddot ll Sc - 2
ln tlle cj-e ut ~ t lll(tlWtl i( li p l ll1JC luuml- I ~ middottnl ~() shyliosis phys cal ((_lt1(( is emr1uved ltI t()fIl1 0 lh~rtrv
lo ly in cel1l in L)lllllde (nluumlnlr in tilt Lltlll middotorkl i e Iw l) r llt t Srain hUI IIgt() 111 Gert11lny 5- 1~1 in other reg lOl1 wbere thi I-incl qf tre l tm e rll 1 p~ 1 pmiddot t 1( cI il Jws Ixen cri ri cilld md rel -cltd Lw m~lI1 1 11 Jlu~ Fue Fnlny r ~lrs thio middot15 a lsgt(ru( f ~rth r -~ltc rrJtf))~ ll t vit11 br1Cltcgt b r II1 ([C Llt n ClW grmvlng 1lt1 0 L Sti g
gcsti n the lIsefulnes- u r Ih is form o t treatm n t 1
Hmiddotu]rs have nerged jn El or uf pll y~ iLd eegraverdse eacute 00[ 1 but tlw are nUl yel 11 11 t llu i vIC~11 and r hi ~
f rm of trt ~ltmenr IS stiJ l Ul1 ckf ckhate FfI t Jt 111 il i 11t (eltary td 1I iFy 11umbtr ot
b l sic COI ceP rlJ lf w ill he cIh tt d in t hi pap r
Scollosis
DCijIrI iriolls
ScnUoSlS is Irlircc c1 lme nsIcircltnal (I(gt i l cj on ot tht spinc thar cau C a CU 1 lh lt ca n h e $ t~en ln (1 me1Sshy
ured ultinF Coh) lll ltllCXI o n HI anreu middot p rtc rilt r
EUJlOI -1 lœDICOPHYSlc~ IR
NECRI Nl
110
f)i)
1 7J
amp aS g 5li - 0 v
V
31
10
(1 1) Il 15
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FigJ----jllph ot DlI w l-lkaupegraverel) The agloimvltltinn Or idio r lrhlc 50gt1iflll~ IS rpiJ bel~ en th e- [l0 IH P (l)ltg tnntll lol (JI PUllcmiddotny) mtl 1 ( f( lS-er sigll paiilivltecirc lt Dlt(i I1 11illg r the iti l 1Kgt n n t rll icirclicH a ) 111lt m omal prebulled the mno rche md ociks with lll I)ttlx flal gr Ih pll fl
rlcljoprdphLi 1 hl merl prestIK ~ of this curvt c10es n t autom~l ritllJy indi ate the pn$CI1(t of a defurshyTnitv (SlllKtUrd (Unel
It i~ possible tu clil1e ren tute a struCnlt t CI1tve fruIn a pogt urll 011e by identifyi og the hum]) du ring AdIlns tesr I~OQ looklng tra m beh lnd at the p atient w ho b benchng fUfward il is p -- ible ta d d~ct 1l1 eh ucirc n of o ne liidlt 0 1 the trunk usually n n the (onvex ~ jde ul tbe radiographie CUfve Ugrave1lr C Ul be mlt~I Slred lISin~
BUlln els S o liomere( 1 ~ l This h Uf1lp is du(- lO (Ile pregravegtecircn ~ of vertel ra i rolltion 1c1 Ollt tn tic f~YJ tllre o f the def trrnit tli [ c m be seen and measurc(i v ith Perddolles lb lsLometer on an amero-Ix)iferior radioshygrapb ~2
Seven ry pel cent o f li Ises a re conid 1lt 1tO be idiopa thie 1 bull ia l-nosilt in this CI$C is b exdlls i ~ n as idinpa thlc me-us t11H wc do n()[ know rJw origio of lheacute curvc [n othe] ~Ie$ it b Ix )~i ble ro ide nrify a dieak (bat CHl jusrify the c1etgtnniry slIch a rna lfo rshymar i ns I1(gtufol Ig ic~ l or genlttic cl iscas s Glnclt~r trauma etc )
[dicirc)parhk S(oliosis has been divicled ~(corcling (0
the ~Ie of tlie patient egrave1l the tiJ1ll of d~[ccli n of the condil ion into ti) ur t ypei ln fanUlc jU nik ltldolesshyccnt lnd aduh Til l m n st cnnunon (VPC IS the acloshylescegravenr o licirceacute I1IJctenzec1 hy 1 sud le l1 tggrH3l ion uuml uring the grow tll Spllrt (Hg 1)2
lhile p tu 1l sco liosi i5 Ycry lomnw n thl pre shy~Iknct ra te f r adole ent icuumlop~lthic structural CU IY~S in sch )o chilclren are 18middot20
- 10 Co bb d~grels o r m on l -lil
- 2) ~ohh dtgreclt or mort O 2~j - bull () (obb d gre -s )1 mOfeacute ()ll 2
Clin iltI [ d e isio ns lfl IXlSed 111 an lccu r~He pregshynosi which obt inccl in eJch pa ti nt mainly o n the basi of the nsidu~ll p()tlnllltl l of TH1h and the result s of 1 rh clin 1 1 ~l1d tadiogmpl i exlminashyti(ln12ll c noieq uentlya d inica ] la sifiou io n o f the ing le pHient tn -ome estent co incic1 ing w irh the
D diographic one c l n lw SLlIl1H1arizeci 1 1 folIcJ - mikl lc~ (1)(n 20 C bh de~r es - moderJt l betwlen ln md 15 ohh de~ rtes - StV re 111( gt1lt rh n ~J) )bh (kgf s
On the 1) lsis of [hi - dinic d d a lfic t i n (Vith l1l il el lrb tiOI ~ o f the ir b() und~ri e ) in Itllt l cente rS Of SCOtiO LS ITe ltlllent in the Lltin odcl (i rJ Ital lnmct md PI iJ Ugrave tre tmtnt i s plmmcd a fo lltJw 8l
- mild kineslth e (~1fw ~1Il (1 luok-ou t - Hl demte IJragravecegrave 1111101 c(~r md k i rws ithe lJpy - ~cven surgery
Physical exe rcL~e for S(ol iosis
Defi t tiOl l S
PhyS i 11 nU b lIKrlttp middot (or kines ithcIa Pl) i a p rvgrlill or plt~i Gl l (xeriltecircS ~1ci fi ( llJ y ltk ~ loped
y a -11 [ru ine 1pll yslo ther3pisr wirh th e m 10 Hllll
- pre (~ n tit1g tlc aggraaLion of the cl I )flnily in rnild bullcoUm is
- helping tlk Il ld Ct ~lOd ounter~lCtjng its skie elfects in III de rltegrave sc li sis
Tn tl1i_ feSpec1 kinesitl1ert py f JI s oliosis is tonshysider l a o on of peciticcedil training and s genecirc tltllly proposelt in sessions 0 1 4~ ro 60 minute IW) t) tour limes 1 Cee PhysiGtl exerci es can aLo ll v o ther auumlns 1S it oill he dise Issed in this plper
Ir 15 Ilot possib le to cl escribe a single progrlIT1 o r exerc ise a5 pro nrams ale USLIJUy p fgt nll ized ( ( lt
EUH PA ~illDI (DP1I YS IC~ 182
ROlL UF P l 1YSICAL lXl 1lt 1~E IN l IlE 11 ~l) IEd If IlU) l[)VP 1HI AIJ() J)~Cl~ r COl ~I NlG1W il
f)( 15 egraved ( )Il the nee L- 01 indi iuua l pJl itnts) al l l10ugh Lheacute) C l n h t 11 plicd o n a WOU p hJ~js (-1 (0 () pnients PC[ ~l ()lI r)middot lugrave reQCf lhese 1 10 grl lll frequt ml~ V IIT
hnm on in middotituk w allClthltJmiddot -Ill Jnv L l~egrave at Wc w Ht ~huw in lhis lyl peJ it i~ 111 n u -eII1 tu id e ntilv kirK itheJapturlc aims w hitl l ucircrr~spnd LO ugravelt~lil1 DUtshy
g X ir ur ph -s ici l lxtTi~l I~llhe r thln ln dj( us- indishyiJ u1 1progr-lfll
Aduumll l lxUl kisure time ~lOd h )u] Sp u lllll8 ~Ilttishy
i lt egrave~ i middotomm )Ly s iven lel mJ ing ro w hlf ~ Iuumlnsidshyer~d usdul or il lrmfu l in t1 lt rruning (lI tJw ptliJicirct ln tl1bplper Ugrave1 gent ltl l t rl ll bull p lwsiCUgrave lttG iviUes is rl ktll 10 JllI1ltlCc hOlll gtpOlt mJ kIJ1lsIcircl hc lJ l f
i ve lUen tloneumld )bo C on lv ine n dul( re Ull~ 1t~1 t s far Ilten publislt d f I~ mJ I(i noltgtithltl rgt is 11 11 a su h jel lnI deacutehate CJitk haltlt t llltit m itn ltl of l ny lorm o t p l1 ySiClI lxrcL e as a Itwr1 [ J- fo r i liopa tb il jcoJL~b un iL ()ri gin~ initial1) it WIS Ille r rOmiddotUumlK lt brgdv u f p l~lt titu gtllergt w h ) intervenecl hutll tc llcrl ll (mon as cltl HtilJ nic in terventi n man Jgt
1 t lltrJp utl t one 1 md rC j fkll l~ on rhe h sh lf som uni cOen I1v pn t I1cgts wt ldl hll ltl enl1 JI~ haLl nu na l scicnt lfic baisYmiddot HOlh tlle$( trr t peu shy to rh ~rl py tt nJecI to l~~rJ tte C Ih tk CUf -~ pnnshyclr~tll y as a f tsul t of lilo h llIzatio ll of tn imdqultdy ~u pp rt(d S pln eacute 7~ 12 to re-t1 r rI ltrl 1$ l l1C k o f WH llt~~rdl 10 I ndt~-dll()urnah tnd 11( on1 p~l per u suaJly Cl tc([ IS n prelimmtrf lll d 3 ln tt li w ay man (l rrlKpt(Hc H lf O iS Inll ph ~i C U l ~ d vi ~ cI nllog scnliotl pa t le nL~ 3gainst holll ph lca l egravexershyclc and p()rt~1
It m u st t~ n tfd [hat pllyknl txerc j~ tJe~ltm(nls t1iHer 1 lJ rd il1g r rhe rherlpcu tlC litTl~ on lllc h tJ rgt ap p lolc il l the IXlltent lncl hi im r IIIllHnt i- 1 (1(1 rI - 5lt1J lC igt tIl l ( f phJllIlllolopJ al rrea tmln ls Ihith cllffc r 1lt œQlfd- rhe m C cculc u ~t(l luI thl p al 1t n
~mc l 11i (lbE~e Tt i ~ P ~il k tlwreI[middote thll wuumlk ltlll t kin 1or ph~ i Clt1 1 lX r(j~ 1I 111~ t bc loidvd by t h~ Lo iurie IxujCJ1l al1ulhcr a dl ~IS nJI h~ iOg (1 11shygerols llugJr in racr le (wi ller d I ~fJIII ~ I ml thlls re(nl1l rn ndc(1
fn n UI cel1ll r we In(~ hccf) using 1 ) 1 1111 11 ve ) 1 (J p lw l icd ex(r(i~e (0 J ( 1I l tt i~ tlh aITt ~ l~d Ilv m ikl tru cflumiddott1 adokscltnt (cl ioj arh lC icoli is11 2)
ina the f U~ t rc-gt uJrs IefC pu b lishe - the pJ( )grd m 11lt1lt l1te n PWltllk d in fa c t deel()pnlln l~ in th t l itshy OlL1Ii in tl1 r b t ~() ycal f ha ve iclemi fiecl niO l l
m d 111 ur impl rnHm s md d i s )h ilir i (gt~ lue t idlo p lthk amp()lio -i ~ t Jll CIII he 1UO(l if Icirc 1by phyict1 egrave xert iSlgt l fe t rrncllt
l illl
111e aim of t l1JS r~l per ii tmiddot (tv iew tl1( l iterat urt to a(errl ln v llic ll of th~ impa irm 1t~ and Liit hil it il i GllIltec hy ~ o l i()gtj s -o ull he ll nt x or re middotlu celt1 Ili pl1ysical xerclse An u p-to-da te knOvkdge o f tl lt Lgtpecl-gt i necckC1 in rJeumlr) d -oek
- whetll~r there h ltl n adLtIIl ) l tht()d ical bbh fur or JqIIcirclb l l l1 Il( ) f k irt llit herlpy
- h N I)(1 ( 1 Dm tlle p r l c tIcirc(( o f Jebur tiJne )pOfung lcli v l ti ~ IIOU lci he tllf) -d o
II J U V f h 1 I11~ c~~lb li hed Ihe usefuhlLss 01 k il1 shyc ~thtrpy il i aIle dy l nsi 1([(( -r-tI Llleu i n )I11 plJt~ ut the wJrld ir ilt ecircS~nl i 1 I( id n Iv w l1i li ( 1shy
gories 0 1 pl1Vtl( 1excrClgtegt te D)bilI7it ric 1n (Ir st shylliuumlZltio f) lttlt tlgtbltn ing ni trcrccedilh ing erc) hn Id be
vnlcled he tll rhe nuld be lerrillldll1 1 md whidl s tlQu1d be inreœ jf ic(1 IJeClU~l tlley cOli lel Je LI ~ful
Ncuro1llotor impainncnts
Imv aUl llOr~ 11 lt1lt ~tlKlteJ lhe cltlndatiotl bd Ween tl UC1UmiddotIt t l ol(~C t nt id iopml je -nll ~J~ and cli~l l shyler~ lr 1tH lest ihuLIr yt 1 _ 13 ~ 311 D uhoussct 1
1-- ITS tln l ldiopath k s(o lio-L L cll -c d l J l hmgt in th terl tltr f prop li l l pu n md 1I1ar th e detrshyn Hi n i~ na tural 1 ~ronse to ril e need tu ts tu re p()tun ltlluilib riu Ul HcrmJJ1 31~ 11 () d tllat icliupathic ( liCl5j h l it re5u lt Ot1 rw nltuf mot r l ~ltelV
[Id )fcl 3 nI] ~1ltJ U Sr1lle nr to dtorders in centJtI lO~Cl shyIOIDNur) md 1xi~tI moro (Ul1lfOl syt( llI (Fig _l
N htIll -of) H1c S uumll h( rll1 ( ~ l( w ing JI t11 (oshyI-ie on the l l lO]ugy o b doll (nt Rl iu]icirc tlili- middot()lioL m unt fil t-hltll rhl ugravedcmnilV L th e fl5 ult o f 1 (k btcl 11lIFll llI ion nf som t11(WUgravetltnl md pO~ lur( (tnic l~ l licirc1 tl1lt if l p OgtlbJt b C 1l rlw sta l i lin 0f 11 1 Sf llle j lt g )tx l Tt) ohtil n a ))Cli U 1ILzltl I o f p ~llIr~il d l~flo [ in l1litkd ~J)llnSIS me CI Igt(middotqucnr J ~ a ~tmicirc ()nlly or regle Ie Llive
Ali th- 11yp ) tlw~es rd ~lte tr d irtl Itn t pnl1tlt o f [11 v hole ~piltm It11[ controls postu re ~nd mrw shyment lrre pell ic of tlh po int a d lI~ llv inH llYegraved il i ~ ll 1 nnable tCl aSUilll ri 1l tr l ll1 lo g thi ~ys ttm ( Qu it le 1I middoteli tl
lt ch ugt nlt~(S f rullliIl thil i nlomwtion th at p tlmiddot shyiCil J(tl iIies nw gt Il lInport~n t rr le to pbv [11Icircgt role ca n 1)lt slI i11l1lariztd ln lWO the ptu li ain Llt
- d elopmll1 l of p uumlltl St1 b Hlt ) - c1e veuml IOpm 1)[ o f bhll1ltc _
(k llhUl)lOr S Cll orr
ontrot oic whan-lt
------+ 1 ~ il lnll ugrave r AINnl
Cllnlr1
T bflt~ r
fltL1 tlli
lMini
l
~sary ~J-frlllen i )f
~ 1 ocirctnl
~UcirclllIJJlW Ll
AXl ~l1 n uumll l) r sy 5t ~nl
middoticoltoq ~ Fig 2-AcFgtrdong lU He-mutl 21 il is Fi)5~ ib1e rD prolXgtSlt l -oo ie1 mnd 1 ((if ~ elio egrave middotAhltr~d l)Qdy-p ati~ I I i u d) uren ttllOn k td LO In ~ory reHTt I1 eDi tn l al ) JdrnlV~ pn)4~ e l u r~o(Ofe 0-c1 eptunl dvstil t1 ctlon sltŒ(ry icircltu nu11t ilwnt [ ~mC ~ted tl l1 ce Ill trpntlshyUumlfJJl nd IKnle~ r~dibl jtugrave)n of -I) m tlosen Ir ~ig nj tl (I1vying ln fornll1U n (lI an ereltl ~piJl e Mmor aJJ r--a t ~) n ltgtf ti lt aXljl mowr plem iHUC Wh ~fl Ille 6ubjeco m uumlntl Icircn (1oJifitd perccpfLlI l ~na l ysilt of p n)lnocepti Icircnfu rnlaquol ti desnibJOS ~n t tecr spin A IICW motor co nrro l Ira I gy t adopt resu ltin~ in the ~tr ltctltr 1 ckformh y lf IdiopathirL scollos i=i Ht lrftU1uc nltnt l ISll I1lJy h1e- ~ I pro()und elkn on bralO Sfem flJll ct i(lnn~lLhu modifyRll Ille nltulltgtshytl10 ) 1 1111 Uu l-lHoror control 5~Shnl$ shy
As Srtgn1lt1 l ~ ltlssert~ if wc l C -Cp t 111 1 un o f the G IiC s oliosls L l tisorckr oi th e ltquilibrilltn sys t ~ms it is lagical to oriegravenrate physlCl l exercis( lherap y ln th is d ir(gtCli()[1
11lclte goals Cul tl lfOUgil ditrercn t modes 01 action be Olchic(-c1 witJ1 phykal accivit ie
- po rt ive Cll ities p ro ct LJ e aIl UgravelClltrtsc in 6lte nshyel ll )o rd in~lti n pinai pr0prinup ti_)[J nLi mOVeshyment control 0 vio lls iy ln thh repect ome lCtivshylites aœ pre um~I I)y lXrter tllln ntil crs
- kinrl lira py using pedJil exerCisocirc specially developecl lith th est 1101 5 in mind illVuuml VC I lllore prccilt( ll1d InC1 li zed cri n on rhe spiJw focusing
a90
1 ~~
lg -lNheJo ~1l l1 t r~l g rld in 1 1) h i(~ IImiddot ct r rHienl w i ll idlllhic _It ~i ~ _ iri s plt ~I le II find Jit ltH vlllleuml ~l Cgtbl tn~ ks III d il fef lt p ~ lt ihnS nu v~tl middot B ~a~pt u Il C middotl)Icircd ~(t l l11 C dlfkrCnl middot- hdween slllndi1g Uline nu nllt1Xinul oorrec ri nI t chied Vith Ct (J ) und tfdincJ ne lot es o UIine 1 fo llnVs middotIJfl tfi ni( - ltlrshy
reltiK)n ~ Ikexibiliry st3nucircing - -pirte - f ur~1 1IbjISC ltupin - ltorrcaion - - r~luci()il ll ymiddot For flmpllt in J npK l1 pH k1J il
plt1SSlhlc ln obtai n 10 u1 511ndlt)l [YLo lion yr ln Slt p ille rlOlgt itlugraven om l J ~ in ( gttf(C rigtIl lIex lbuil 15 i (r-l l=22deg pol lltl ~~J IIlpraquo is IcircO~-V- I t1 l nd tucircu(Ugrave) ilil) I~ 3laquoJO- IH-12
r ln Ugravel e abilit jl of tluuml [m e llu to co ntro l irse lr in ~ pac
fuld l oftlles uumlllelve ntio ns can presum1b1r incn~~ Ih enl ac )1 the orller and lHitlll r of Ille rn - 11 )ltd h e lllldenl lu EJ3)4il
Posl1l1-t collapse lnd slabilizariotl
lIle concept u fplt st lUal c(l lJap~e l l~t Iwen detin 61 by DlI II-T3e~tupegrave rL t Ac oJdin)j tu tl1i- ~ll1thor il [ nec(sary ~- l Hn Cv-tlualing th tleihility o f a col shylo tIcircC CUJVL (0 clistingu ih bt tVeen the re du ihil [ty index (th - li iffer gt le bet ~middot Il ~I r~tcli()grJph ie ~xnmshyinltio n of the iI111 pHienr in supine po ition m(i
ROte OF Pl rnmL EŒIlCISE IN THE TREAT-ŒNT OP ~I IJD IDIOPAnnC OOU~GEm seou SIS EltJRINI
I (~)-----------------------~
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8 =~~=r=middotmiddotmiddotmiddoti~=-middotl--- middotmiddotmiddotshy--------------t----------~- -------- - ------__shy
~---- --- -- -~ -------------r---- -- -- ~-- - -------- --shy----i-------r-- - ---- ~~-shy
il 1~ 0
Dtl-Lmiddot ~ lttj l r~ UIltltlHt
f g 1 -TI1 u ilictf 1ld ( ii 11- ugraveu-sh) ld IX~ O 1d wllich ltJdnrshymII Il nf the pilll 1 ~tln~1 of th e -o lioti( spinc n IG~nI(J II IIIshytt) lhe iJeuml grl-e o f ~ ()Ii ti c (u rvH Il 1 w dcpc-nlknrly o l l he 10 111shy
P01(nl (pntt l ~ 1 1 nr ffll wrJ I) ln w hilth Ihe n i 1gt( ~ duc nL~ grlphs fm I h~lt 111lt hi~hr Iht Col h ~Ilu t (l f Lite ~Ul Ihe m Ol CI il y th t s(uumlJotil middotpin~ ~111 he ~middotJg gr~lVH(~(1
m mJxiTIt corrttt ion wll iJl i~ lIllCd to Ih - xt 1shy
lti Oilil y Jf tl1lt t Ut JO rl1t cdnUc idt md p OS shy
tU ll cul lapse ( th t ltHill enct b-tten l lUdioL) 1lphic egraveltamJl1ltlti OI1 J t th e ~lme pa tient in Sl il tl cling lOJ lline fX-sitiutl ) Wll ic h correb lc- onl wil ll fhe abilt ty of lllt p tu rl l gt s tem to C( lunternct lIk luree o r grl viry )cco d ing rv D lfVd- f3egraveLIprc po st li r t1 lt01shyIlDse is d ue to the Jnus -u lar ton a nd 11ll ex rCrIshy i) i itv of rhe tissus n the ( O IW-) si it (If the (01shyjl ti (~JtVe (Fi~ 3 L Pu~t llr1 C lltpstl lu lcl l ~~ reduc l-lt by llwans o f pl1ysica l cxerCles specitkally s tuclled ruuml i rnprove tIlus--ubr fOHt md lU pr )cllI Ct 1 ~11 hi shy
lizing ffCd
PararcL n tll CIJ cl the cr iti ca l (3 c1 thlsho ld beQ ld Il ich defol1J lHU n of the i pinlt 1 e~ in~ ne dtlllontr~1t _cl (1l ll t grclrf r mg] o f rllt C II in a qa m bng pos ition corn pOil 15 t l lowcr detormashytion lhnsllold (Fig 1) ie to ~11l Ulne3Se t the risk of pr ogr t~ lu n There t rh eJef re l J ea r l)iuuml 1itshycJ l ~ll1 l l(tl a 1 tnr tg ro b ohwined by d -cr t l ~ illg ilmiddot pU~lUrll cull lpse ptJcelJtge w bich lccording t i)
h llTd tnd ~l(heJ1l ~on 1~ b inde cl 1X llt icularly luumlgh Ugravel mllcl c Iio~ i (bdow 2( 0 ) (F ig 5 J
Fin a Il III ch iS respect lllljl hl and b um l 01 m linmiddot
ii iI 1 l _ _~ _ ___I ___ ___ __L ___ _ ___ ___J______ ___ 1 ___
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i
+----r--------t-------t------f-- J
Fj~ ~-Ac(XjJlin(Q luuml T O rIcd ~lnd Na(h(ln~ n i () dl( pCG w rd (rTIshy
POO ll is hiherin cu rvegt in wh ilt l1lh ~1flILWrd cII1I Olk l1t IS le- pr(v~knt ln th e grtph Ih t PogttJlJ I ugtnq) Ot1 -J1l j elfltS-e J tlt 1l1t obb dirr remc rlLIv obu incu f roll l the Cohb atl( 0 1stlI1dtJ1g IId gtupinc rldo~raf115 Ih Ille lt) [1l1t1 (i lndnl I pine) 511pille the ~(nlClu tJ1 compo l1lnt U rlk CU Y _VeJily I~ ltx p rlt 1 L1v UpUlt (obh Illeturo Ih t si _b Cct rtJeSIm l fie -ltn J trd Ugraveltuuml shyuumlo n A~-i)rding LP 11(lt uuta o n l ( r1I~( in ~I 2JQ sup itlt curvt 1hi C(]l)b ddhccno l l f lO is -J-lultt( thc s ldnd inr tnla Ol1l t lS wi Q) whil 11) 1 1)401 ~llp lne ClHVC If ~ 1Omiddot ( tcl Lhe ttnd trl~ nlca~ I(t I ~ ~I)
tli n ll w l lllE cq lin ti spin h~ i ng mo r ~ Llnt~II) 1 tlun the nOftl111 one n Cll l gr(lk ( (cU ve tl1u n da r u p shy
po rt in o r k r 10 m linrl in tht 1xi11po tuf_ n th ha__i of th egt onideratl lr1S it f(lll() rhJt
ph rH (~Uuml e erd es ulukl h u - ul iiuml tbeacuteY ~U-L lm cl 1l (It-d o pmg p05111 td C Jl1twl lS fuumlrnll~ rly d ccrll1td ln an Ql St if i imr ol1111 t ru t(( - tht m(d in C JI shy
r t t r sture fO Ir -ngthen tlll m u ck-gt of the spint mainl) in (11erl antig r3ilrl tIcirclt l]lli fun ctin ll U hy meU15 dl i )ll1 t trk ~ lhJ cl( -ll tlt C)nlr~lUions ~llld no l IdOshy
1l)llic d YIltll1k lt l jAJ lktic t) I1 ) II 11)t 111 hd posibleacute t lcluuml ee postura l io nrro and stfh ili lllllt IJI
w i thout food T1lw(ull r d I( Lf(11 Ibk t m ucircnuin Ihe c()rf ~ct [ ()S tu re for cl gtu ifKi IH lLl1gth 0f ti l11 ~
This i-l ddl usl a typl 11 dnmnin (tf k inesllh rap) in 11 (lt-11 [[k - p~d fk lnr in lng f u l1a in llllliCk is poss ihle lI sing ctrtain Idncl fJ l (lt) 11111 liun S p Ul in tb is Cl c is ulttful ooly sa I~tr 1~ il Iw lps t1w lxltknt 1 becuJl)t 1gtlt ltlt-I a ClJu~l inred irl ilL ntllru l o~ i cll
and I1lll~lJhl r-keJc LIl [rll-llIn~ middot etlt(wrs JI the int e rmiddot vlnrion
[J ROPA MfJ) I()Wf-I YSJ IR
1
ICR 1 1-1
r
1 shy ~
- shy
11 o-llrfOlhe5l~ o t Ih 1O~(1dity i n h ~ r ~ ll nr pbl1 l of ~ Spl11 in 111011 _llti1Gt l lPt f ltlJUCWJtl ( ~l Ihe Ir t 1 1gt illbll W Ilh LtltrJ1dlion Vln lbe rigronl middotUII~ l(I Dko n12 lIll h lumshydlanie1 1 [ nul 1 M hl whtrc M - gt) lnIUI1g 111laquo111laquo1 1 1 c rtJCshytjC~ f fce d -d Lill l1~ o f enr niI pUll spnmcl1y 1~ 111 mldlll1lt (n the fl1ur t 1 = tor~ of f(ward Ileuuml l = ughtel1lng fmiddotr p 1shynOf stn lClU= Alaquo rdtllg 1raquo Ihl~ - lin hull th l1ltgtllugrave ot tller1l lUr~Jtllrc F the ~pin t -ilh rlu1i tf Ihl 1 1Ibulll n lrlt InltT1 1
rbc prJI 3IJi l1ty d qrlOIJ~ n bull JI t IlJIII Hm lA the v=ltd gtc e lu-ing J 5lnK1ura i ltfnnity
Dioal e ch anicll itllp~lir J11 c nt
Ihrcemiddotdimcllgtional mc-cbal1in of the s pioc
~f Ikmiddot i t i nly l(œ ntly tlHr llk pr-5tnœ or nc ushy1 lnlo tnr impairment in Idiopttlllc s-ol ii IXl tknt liuml J$ heen h i- ll licircghlcJ hy re$eJ rh tll e preit ilegravee h inm b nIcirc Ji d lJutg~ lt hl ~ 1 ng t o n dO Ulll urcel 1 i5 (l lreldv well umlersrood H(j-ev~r nev lbt un h iomcrhankal im l) ion nI h1c rectm ly onk l n tIlt tre and p r~dou in f n rmtinn hou t pl1ykd (~fcl5( in t 11 0 tl1I _ltgt pbne of spact 1115 Im trqlt-u 1rom J i-[) v ing unclcrsrmdlng ot th l lmc -dim nshy~ilnl l l11 ~ hmk f the cO]jO[lC pln( ~2middot ) ) Ve- w ill )iI xnl t l1 d at lcL-orcltng tUl cl sif iol t lOn blsed o n gtolllt lricd h uumlCJ ) p lane
- b() rJzU[1tl ln th i pla n ~ th t 1o rm ll sp ine present no CUlye- w ll ile Uumll(~ ltc U Hic spLnc clevelops one of ir haracterls(Icircc deFo rm tiCs v elt tbrd ln lashytio n vh icl1 pJ()VcA~ theacute hw 11
- lgitltl in th llulJe U l(~ nonmll spIcirclle pl SenL kypl lOSis ~nd l dooi~ in tb lXI1 lhese [(Hu rts Vere m)( til ught [ 0 he relattd tlle scolkJtlc ( lI r Vegrave
- front l in hi pleme tht ncrmal p ine preseuron t no curYegrave whil thl ~11li tic p in ugravetI I ()~ icircl~ charshyad t Ilt I CU1C
Il Jri fJIIt palic
~l+I~na ra 3 r inr lut th l[ ber ll1d a œl1~lU1 degr 1
l f r()la tJo u lllu (lILa r forcKl ltxert ltJn tl ldefnmuumlng 1 tkllJ [J i1u a re- lhlt tll cly 11 [1 1 UI b y Olm ner w bn ~lh uiJwd tl egrave ro t1tic) l1 Ilm it ti lt p ica] lf shy
rhrl r() be (P (the Uma bevond Wl1iltJl th lCOJlb of [11( ~pmaJ musd ~ dthc COnCIt and nm ex ~l le btconk (t O li~[)
r ~l 18 ~1Il N lu t( ren i9 lun lu ted rlseurlt h in tlt ) tilt lULodeumlformipg1 tlo n ot tIH_ sc laquoJrle rh ox ercallkren lk 1l1~H li d11r once thl Il i ~ r tld1t5 [he lhrth ld f 111 JlIcirc lIi of tlle dnrlclc hurnp tlk
lI bslt Il l nt rlet()rlll lIcircon 01 the it l ()I~ C ( (ylm der (- sustalnecl by an H1tmi cforming aCOOIl
J1Ji h V hl rhyiical f~ f Ise CI 01 h spr n llnd kin middot ith ccedilrapJ my lX damlg ing vll e n l pplild as flle
igt Jk Iller ln SCC1IJ ~IS lllc lJ fxceed l auto in middot crca~ i n g lhrllgthuld [1 sh (~u Id ahn be j ofed that Ilw relscd pre sun 1l1111i insiugrave l fe pil1r inn) 1 mlshylt
- j Il- ( w atff 1 (nh ~1l 1(e Il10 utoldrml ng li1eCh~lI1 1sm
in flc l Geyer ~w tcd th1 t rm m 1 hI l)1ecircch1O lla1 puilll 0 l I C~ sw m mim t Ieuroamp no purpo t for cu lshyim le pllilt t1 s (weumlO middott r it is l~Jl(gtWl1 rhn in iculio r[ paULnl -iJl11T1ill~ doe_gt nor Il ~lp to i ncrt~SL n eur(1shym tor co mfU
(1irai p an (
Jerdnn lle 11 showecl thal ill CSl~ o f t10rLC IC 1i lUgrave
tllo lacolulllhil it lio_1 tlle cte tI llmiry in (he lg itt1 p lln t rn lnlftot il~ lf tspe iuUy in tlw initi 11 r luleuml )f cV IU[Icircon nf Ile ~oli ls W iU l 1 p(t)gr~s~ivlt il10middot~ shy
ment roward hvpok pho b G ll f ill~l Im lins l har dUflng (IN eWllLlfiu1 of 11Imh] co luumlgt i the l in t ot t l H~ gClyty Cegraven te l - 0 1 v llebed lxxli 5 r ro ject 1 seH fl r t side-ys and tlwn backlrcl bull thu~ p(0(1 lj n g a kyphQtlmg aet Il ln (h~ lu mhnr --PIl1 COftj tng
l l i tc Iugrave l lltl l( l rs1 tif s L -etllgt il l the lgirl11
1 Hl)
Ilu LE nI rIIY~Ic~L lXIlKISI 1 HI E TREhTMEtn OP JIU IDIOP llII C AD O USCUH O Ll Œl15 NEGR II
lLill tegt lre lenl1 ~I d ~fo rll1J[ ~ rhl recrSes the phyltiologiGII cmns of lh vine)
Accordlng () Dicion ~2 1 rtcluctio fl in the itgitttl CUIYtS combin l vi th a lueral Iviari n llltl ds t 1
mecban ism () ugravel~ta il ity in l he r rat r IllI1e which bVOf1i the unsd a nd i ncrea~e 0 1 co hlt1is (Fig 6 hiIf md Pl11jlbiJ Jl1eanwlt ile lt(udiecl lh e srnl ru t
orzyglpophySLs show ing t11 al ttleir 1I1tl rnic tl orienshytation f~I (jLi l~ltes aXIal ve rtegravebJl l rotllio ll in cun litluns lt f dorsal hypokrrhn Icirc tnd lum)H de i L lo IS
Tll t dat SLlgge 1 th t impOrfill ut pOitu res and l1lweil1 ) t Mudied in ord t r (CI mlIuml ntrlin or to reuwer fll e p llyslo lo~lCll ClIlye in lIe SlgJtta p lU)l Wlth the llm o t ch ~ kin~ rutltor in l~ bili ry7 AbC th ~e ~k-
1l11nL ~Irt del lnt [0 J jUc lt ftber l]kuti inrervenl ion vhich 1c)LJ k l IV - i(l ~ l compktl n l ililll on Il t c1 l shy-jel1 J11UVllT1ent IJ j o f 1uto-dOneacute(3tlon ( i e a -impk ld ion ) Iengtheni ng o f the pilleacute 011 a litlltl l aXl~ tll lt ((IT liJlI~rcdu e~ t lle ~---lJ linti- l lte ml-fkxj(l n h UI 11 - i llCrl I~t the plllH ](JgicJI dlt cr ~l S ( (1 k-yvllCiSh lIld O(ltOSh l o r c lch r1Iif n t a Ilew til(~ecirc dUuml llt Ilshy
si lflltl J ll1 u(~nlent iam ecl - 1l1t0- lIrfe rionmiddot7 4 llmshyp oed f Je-rura l iUIl cl middot-t1e- iltm lI1d ll1a intltnUlLe )( 5lg it d C Uf (gtS slig lll thltJrc i ypI1 tiZ) tIcircOI1 a nd lunugrave)ar 1()fdos i7~llion) sholild he esw b lb]HU 00 lb co
hl b oi hi p~l11il uU r -1Ir vlt Abo 111( e IlltUtl Chl lie o f purti n - a U vitk slJ1ultI h e )tuumlll ecl 1)] (1 n ldershy](ion r tl1i lt type for e upIe IilJ llyl)T S of repd shyiti( ml vemen prt n t in agonistK h)lnllltlSlks nI iIle kind f dlJ1ce C( uld he ([([r imentd
FmiddotO lllaljlallC and mobili ty of the SpIcircIlC
1 rd llo U 22 d L lm nrrare d lhlt in Illt fro nt a l pll ne
tilt 1 nge Clt 1)1lt vtment of tht scplit[i middot CU IY grcmr lIJ l il ~ d irectio n n f Lhe C ITelt tlO n tha n in tl le di re shyLion of pmgressi n l Fig 7 ) he IL o IS5err lJd tbat th15 mohiliry increac plrtil u la rly n apic [ cgcoeilts 1$ lh ~ ~c() li osb evolves Sragrm rJ 12 J ~ thus rigilt (0
VlI f n rller~p is ts Ilo t t) m o b uumliz - a sCtJl iu til curve w ilhout t [ uling ttwt tlle R lu tiOI o i til t ~a mt b fnlinruumln( 1hy l1tans o f ~I passic 01 1 rivE -uppnrt On tilt (ltllE r hand UgraveK d e iJlioJ1 in ease durill tlw tune 111 whicll tll C spmt i ~ not submjtrcd to correeshy( IV anl()n
j- Virh mi lei ol i b tlllt Upp i1n ill) lC tiol is d eveloped only lllmugil llClIf()mu$Cllbr f r llce thi ~
InegravelIl ~ thclcfo re tl1l[ inu eascgtt sp1J1all1extl)iity mua
11
Imiddotiumltgt 7-rurd illt Ir) 1 bull rdrilt I1 1 in tl lt frOlllll pbnlt- th( illl ge )r mOC llIeJlI o t the S-o UIIJC CUNe 1 supcrior in Ihlt diflt(l im ugrave( the n nKlIl thd n ll1 tllc dlrtcLion o f p rJ1(l( (llIl
be considrCtJ vntrl iJ)(l icltion and 1 undrli neocirc ab L a ~ubiljz~ILion 01 tilt spint pllss il)1y ohtl ll1td thrltJugll the stlengtlkl11ng o f the 1rltJgm vlt nonil lme shyCIC 111 illli orrant u bjcLliH- ln rhis r~f1 n sp u lllni lc tivitIumlLs sil uld lX tPI 10 dlegraveltl it l G lU t n w l1ik luring kine i Icircth lrr phyltical eXegraverci c~ tllat in ele
spinal m ot ilIcirclY sil nid 1e lt1 oid cdrt ~
Organ ie and psychologieal impainncuts and li islbi IiI le
A cgtI im lc pmi nr is moriOthl11 just 1 sp in and 1
compkt gt Ipp rnach to the gu in ad 1 ont i al~ shylute l e~se i t i11
[)a la 0 11[ [n ell lrom re semh pw tbat ome organi Iilnctiond cl fki ts suc]) as tlw clecrtiUe ut vild l tnd d fun ll l)Kity_orld ldly incrtJ k whil~ 0 shy[io s i -till in (1 miel q g of g JltlV ity ~ l ilI e 55 rtI lit
tllL pres e n ce )fl defidt Or Vi l~il Clp~1 - i~ ln one pIIiem in Ihr l ftectecl by 20 ICl 40 scoi stgt l ls~a r(h cunclutecl in tbe UA by Di Ruce- prod uegraveed an aaalo) u ll1lXimum 102 re u t in a group of Jd shyk 1ien t [(h sco llosls rang inF frum ) [0 1
Al10ther rudv bv rallt r m C chr111 lilcl NashycWrl1s( u 57 stlO eltt hil $(C 1 1 ui~ Ica js l( lllt cl (1 shy1prUlllI o f t1tgl lie bJd l imI in ~ul sct t1 t ltu b middot iects jlLltr l5 they are golng through ~I cltlici[e sllge in the fnm 1lt i n 01 tlWH o w n id uHitv t factor hit h Illy jeopmlize the cl velopme lit d ~ mIll lt lI1d htIshym cecl IWI sonalitr in Klulrhood
n RUI ~IEDl(( Ptl Y1-
ROU ltHmiddot PI [ I C~ 1 EXIRCIS]~ IN TI Il nW~JUNT OF SlllO lDIOP1HIC AI)C~ESΠ11 C(gt1[Oi 1S
This i why b IiCieacute ii is ~n imporrlIl t for p rcshyvegraveml e 1tLsr l tn en ou flge 1ari e nrs ~lfrecr(d by lIillcl middotu iosis ft) tlke p~l rt in portin -re rcatioluJ acrivitits Iha t 1eIU 10 L10 th r~1chophyinLl bull nd b~l )i 1l1o tur adlieem t n li 51Jmiddot2Even tlK)ugli [Dr bic mech~lnshy
ical mcl nellIUll10t 11 11 reltl ~ons lt r111 1gtomcrimes be l lefu l to ugg( ~t ne p rt in~ aCt iv ity r l h (gtr rll n anotlJer e th ink Ibal an exces~ ive IlHd icalizltion - Icirce l ll1posilion br plry~ilt i HlS nnejlor parents uf rh ry pe of po rt to lx p m lice 1 b Ule p 1Ucirc(Il L th1[ preshydLl ck l1 is fret clOice in lh ma tt r - -h II ll1 he avolc1ed wb 11 possLhle mainly for tlle i mport~ltll psyshyLb ) jogka l fe a SI)nS W( ha( ill ~ t nltntionegraved
Conclu ion
lbh ISsertegrave d t1H physkal tgtXtlci o is ) n fi ial whlIl practinu in order 10 ilnj rove the I11 llde
rœ nwh and tono C iral caplCiry and postu re o f the StOUO(I ~lIbj n II I nowkdge om ~ middotmg trom ci el1shyrlfi rls(~ Jrc li dJlJ accordl ng r the review 01 thE litshytirlture prnpo )td in t lli plpl r conflrm~ Ihe vuiclit ot th e -t ls ~rti ()ns
In l do l (ent Id iopl1il iC scoliuse il l n phee u i cl vk)pm e n t ( li tll iumlKh eXCC cl l g i en rhk thr hokl th e re i5 an und ubred need fn r l pprnpri 1tegrave (JJ1tOkJJe ~Ild Inr surgict1 therapics ill ortler 1) S l i p
the ( - Iuli on anugrave )JT~t~t UW ~pilll l dtlormities bull evshyerthtless in the illiti ~ll pl l~sC t ttlC c1iseLltc whcn the riS( r1 r euro )luli m is rtduced ocirc ~md tfle uifleal JOld threshold il ~ld flle po stural collai i reJcenw~ 43
JI l1 igh pllysicaJ egravexe rc ise - p revenc or r d llCe d i ~lh ilir ies o f [Iw ~ l() li )tic
p (iems R 28 J -6 5- 6 1 63
- f~KiHtare lh ( n utr ali711iCUl of postu m l d elicits tn produCel1 a coneql l nce J [)ti 0 I111)( or regre si -u lmiddotc 5middot Il 1 17 ~ M
-re 51udles U ~ n Ledecl tu con[mn or re jecr these conClLL i( 1 w l1 ich clerin-d frum 1l1 lIldytica l rcltw n f th e liter~iture appear r- ~Lo nlble Hnwecr Intil ne re ull are 31Iable wc should n r prevent our sroliotic patientmiddot trom tl ki ll p lt in s(loI1ing jshy
ir its pW1iada rly ltl t ~d1()o t () n til t c ntrHY -vith the l xcclrinn 01 gt[1 )11lt tIlat in rea-e t)1obility (tnU evc n thell oilly wh n progr~lgtion b p OSSibl) -uc h ~I( ucircvshyiUe -11 )ulu hl tIKoll w g ed The 11 S J ( rprOpriue kin (~irhe r~l Piuml to incr _~asc p()~tura l $llbil i ty is tl1egraveoretshyic tlly CiJUClt alttloughl more ~Iccu rtte aod deLli led ri k benefi rs anJlr~ is is netot1ed
Ria 1111tO
NIokl Mu d lle ftitYljJfu Jœl il 4IWr10UOifll S (JIvs i (1~1)Jshylidl ttno( cclIll le 11(11(1lt1 RCI fu lle ((lia LltfIt l1 I1I1i(i
LJ ci n s j(r3 pigt egrave li n IHUgru lkl di t rdz t fi sici pe e ft shytUlKm iluppno di un lisimerap15Ll rl lllcflt() 1 110 scopo di pnevirlt () fr en~lI 1-lgpwlllltnlcgt dclld lclonnitugrave o e il 5LOshy
Il i mi llon lt fH nugrave j (1 11ni dei co~e 1 lteIl I1J J nd ne ~Ii eifclti (()Tc rri udk s co lio si d i m e dia g rt iuuml ln que~ltlt
s rud i 30 llizzb mo i d ti cleU ric lca pel n ri Icare qJJ l lm 1 dis(imucirc x u le I[~ l z j-m i pro vna le da lla C gtl k A i json ere pr middote-nute () rk kl ducirc un~l rdeguCltl d nil cra pi lt di uJoseguerrnt Cjua li 1iU110 cli nbie tti 1 rcr lJ)tIId d~ fle)-UITC
n (- -fd7Io n~lcl)
Ut11claquo)si 1 lI tori htpnuuml )ludi-ttn I ~ cnntI1zttu fr Cq(in i idiJ)tic1 dbfl lOZ10l1 d d ~ leOla nelllOll1otoriO Lb un1I1cnUl 1n1l1i3 dcgli 111 lt1i ch DIJgt gtU l H crmU1 Nlch~mslt ( SIshygnaJ~l lerimiddot wo i esuemi -bletti d~ plt~e8lugraver- ne l pClZ le1lftgt scoliodcu kl s iluppo ddl ~ ~ uhjlil~ vertcbral~ lt o svilllp prJ Jdle JIl7 i() nl di ltCjuiljbrio Dng li studi sul lto lb( l~nlrale (OllddU i in pa rticdu d 1 DlIal-BeHJ (gtegraverl ~ P~II IId lI1 n~ llw - idente il v- m gtiu p eT il puientc clioti elgt di u n rnigb o t c)[ ro Ua sw mle dei radlldc onsegull o tramite il 11 fforzrlshyfl len to d e i l1luotoucirc l nllgr3ilri d e luOwo con crcbi ~Clltdr
in pOMltHJ corrctl e in va rie ~i[Jzioni s t llicb c c d inamIcirc tllt Dalle on sena d elb blOffiCcclIlicd tr idimlt n s io mlle d ei
r ~ chi Je ~oU()f icn ~Icirc ~videnuumll (l() ~llt tC p IYZIcircOSI ln(IiClZlfHicircl ~ 1I1shy
liumln fluenzt Je ll middote~rUrio tl SC) lgt lIi I rc pibull m i tldln sJlI71 Stl shygn~I I1 afferma che slI l p Ia no [11 middotccedilr~lk tre un œ rtlJ grado di l L1Liuuml IlC dclh vEltlh r1 apj(de le tu rœ mu SCltJ llri njtbc J n in $tJ ) t rodcfQfll1t1l1te PltJtantu b i r~it-~ r -lp il puugrave t~~
Ixnt-ftla solo nt Ile so )[j)~i Jl1Icirc na rl in qunnt ) ilon SlrM ntne )(l(Ofa tu soglb in caq ) co lltrLJIcircn l)lrilto llt~( i lJudotlsi di lfr~ lI1 C llg grVlmenl J 111 11 io lr riltd ll(17jOill leld rinlle 113 dimO~iumlrlto d llt nell o lin~l cl()~ li t th~oIOl))1 dri la defltgtrshymiti sul p iluO slfl iuale ~vohl lf1 (en5 ion~ sO lnm utto nd 1e bsi iniliali deWggrwm1Cnln mcn trl C a( lfLmn che occlleshyvoluzi ne dene = 110 i [ mhari IJ lin c l ki cen tri ch -1vi1( de i cp i CIt IJ rI Ji SI p m ittIl pnm l Iem lmeme e p o j pOS( shyrio fllwnte dtldnli mdv ( i un ziuuml ne ciloliz7nnl dd rlLtide lu mbJ œ ( lIlelttlaquo on NC n d d (gt11 uIdu m 1I1 Ilgt) cli r-Iure (0 eserClzi che IllUllengano 0 ltlUperifo le Clgt 6gt1 lo)iche sul pirluuml gilwlt Su l p iCl no fron itk Perdnulk il dlll1lt-trlto d1 lampkz-l d i LU ovimento amp111 lI rv Kolio ti ~ nd lt1 0 ddlJ cnrrc-LIcircQo i Ji gC 1 n lungl SUpegraveliltlrccedil 1M llS0 tlell 3ampIGI shyvamcnlo C che l~Jltmiddot mobiliti GlI mcnta co n l c lu7j o fle d l i) snAio i A ulln amplgrtJc1 ltllllmunjx~ i terlpGli nn n m obi shyUZ73It ma eutva coli ti0 1 1ct HsicVlfe nd tcmplt 11 1111nshyttllIcirc1nc n tc (k ll ~1 llu u zinnt n l1 un me77uuml d i sost l11( gt ln 0
e 11111ri b cle - Ilziunc egrave deorinatcl d l rlyarsi Snzcl la pr gtshy
liltlnl l i un() rtl~ i ptmiddot Jtl n(o 1S(Hl () (( ntJ() i ndit~tr i ~ Ii ISt (izi e l m iviL Illdlode ebe Hlmen tno laJlc ibiJii dcl rlc lide SCshy
li io) [n p articobre rune q lldl r C-I1 ich~ xlSiddcHe CUf t shyli ve ch~ iJllpi tgino e~rciii 01( biIi2 ZanUgrave HhnmL-trid () in tmiddot~t~nshy
sione kl fuchide O tne pure k- ~ttivit1 tnotoJII~ non prHi(~ llCcedil
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EUROP MIDI C Pli hIC
EDUCATIONMEETING SATURDAY 8thof APRIL 2006
(iSS
SEAS02 Scientific
Exercises Approach to Scoliosis
version 2002
G
S Negrini 1
EDUCATION MEETING SATURDAY8th of APRIL 2006
Neuromotor disfunctions
Neuromuscular disfunctions
11 Postural collapse
Postural collapse
Duval-Beaupegravere
Flexibility of scoliotic curve
f---I--- I Postural element
-------1 Structural element
S Negrini 2
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Postural collapse
Duval-Beaupegravere
It is a value related to muscular tone and to flexibil ity of convex side tissues
Post ural collapse
Bunch e Patwardhan
Critical load
Load threshold beyond wh ich a spine begins buckling
JI~~Wt1lW~flfthtlJlœJtAr ~ J~It- l~l - IMS
Postu ral collapse
Bunch e Patwardhan
If a curve reduces there is an increase of the deformation threshold
~~~NW~-damaoc~IIIMf ~~ J~Iv JaJ-I7I9sect
S Negrini 3
EDUCATION MEETING SATURDAY 8th of APRIL2006
Postural collapse
Torrel e Nachemson ~
Scolioses below 20deg ~ ~ lt~
have a high ~ ~ percentage of ~ ~
~postural collapse (on u~
average 75) ~~ 2i~
CU~VE O EG~EE S WHllE SUPlti e
~laquotd~c6b ____lPffI1wtt1t~
$ww J(t ~~7 JM5
Postural collapse
Minor scolioses 7
Antigravity musc es strengthening D
Reduces postural collapse -G
Increases the critical threshold of deformation
G
Neuromotor disfunetions
Stagnara
If we admit that one of the causes of idiopathie scoliosis is a disfunction in balance systems it is logical to orientate physical exercises toward this direction
s Negrini 4
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Neuromotor disfunctions
Dubousset
Idiopathie seoliosis results fram alterations in praprioeeption centres and deformation is a natural compensation to restore postural balance
etattJtitIK ypothfQj~S ___~ own_ oJ)HQr lar 1t-1( r
Neuromotor disfunctions
Nachemson Initial idiopathie scoliosis
+ Goood spine stability
Neutralization of postural deficits
D Static curve
Neuromotor disfunctions
Therapeutic aims
c) Development of spine stability
C) Development of balance reactions
G
S Negrini 5
EDUCATION MEETING SATURDAY 8thof APRIL 2006
Biomechanical disfunctions
j Horizontal r-Ian
i Sagi ttal plan
Frontal plan
Frontal plan
q Frontal plan disfunetions
Fronta l plan
Perdriolle Movement magnitude
gt in the direction of lt in the direction of correction progression
S Negrini 6
EDUCATION MEETING SATURDAY8th of APRIL 2006
Frontal plan
Stagnara
Never mobilize a scoliotic curve without ensuring reduction maintenance over time otherwise a greater mobility favours scoliosis progression
Frontal plan
Ducongeacute~ research
On a group of adolescent idiopathie scolioses treated with
Meacuteziegraveres gymnastics
D After 1 year the mean angle of
curves increased from 18deg to 29deg
Frontal plan
Scoliosis without brace
D Greater spine
flexibility D-
Risk of progression
S Negrini 7
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Frontal plan
Mobilization is useful
D In preparation to
brace
D With brace
Sagittal plan
QSagittal plan disfunctions
Sagittal plan r middot _J o
Perdriolle scouos B CJ aDeformation of D
thoracic and thoraco-Iumbar curves evolves in extension
S Negrini 8
EDUCATION MEETING SATURDAY8th of APRIL 2006
Sagittal plan
Graf
The line of gravity centres in the vertebral bodies o s c oUOSt
projects itself firstly laterally and then fi
o
posteriorly lJ ~~ ~~ ~ ~~-_J-D ~nI~
Sagittal plan
Therapeutic a ims
D Maintain or
retrieve physiological curves on the sagittal plan
Horizontal plan
QHorizontal plan disfunctions
S Negnni 9
EDUCATION MEETINGSATURDAY 8th of APRIL 2006
Horizontal plan
Stagnara The forces applied ta the spi ne act in a autoshydeforming sense
Horizontal plan
Dimnet Rotation gt 200
ampII~ (
D The actions of concave and convex side
muscles become
agonistic
~ItJrOnrIIiItdllfUClltlluumlll~~tI ~1JIf1laJ
Horizontal plan
Minor scolioses never exceed these autoshy
deformation thresholds
S Negrini 10
EDUCATION MEETING SATURDAY8th of APRIL 2006
Disfunctions at a biological organic and psychological
lever
Oisfunclions at a biological organlc and psychologlcal lever
Cheng
Bane density in scoliotic teenagers is lower than in normal subjects
~~~~middotA~IIlUtIy ~7œl 1d l
Oisfunctions at a blologlcal organic and psychologicallevel
A significant reduction of vital capacity and V02max in teenagers with a medium severity scoliosis
S Negrini 11
li
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Disfunctions at a biological organic and psychologicallevel
Disorders in the development of body image that the teenager has of himherself
Disfunctions at a blologlca l organlc and psychologicallevel
Therapeutic aims
cJ Activate cardioshyrespiratory function
cJ Favour bone density increase
cJ Develop a positive image of the body
Disfunctions at il biological organi and psydlologicallevel
Stagnara
Sport
D The active side of
kinesitherapy
S Negrini 12
EDUCATION MEETING SATURDAY 8thof APRIL 2006
Disfunctions at a biological organic and psychological
level
Distunctions at a biologlcal organlc and psychologicallevel
Cheng
Bone density in scoliotic teenagers is lower than in normal subjects
~n~IIIvpWr~middotA~stWy s- XXJl M J
Disfunctions at a biological organic and psychologicallevel
A significant reduction of vital capacity and V02max in teenagers with a medium severity scoliosis
G
S Negrini 11
EDUCATIONMEETING SATURDAY 8th of APRIL 2006
Kinesitherapy on the scoliotic subject
q Postural control
q Axial stability
q Muscular trophism
q Balance
q Respiratory function
The limits of kinesitherapy
There is a threshold beyond which
rehabilitation alone is not enough
sssr
Kinesitherapy in scoliosis treatment with brace
Therapeutic aims
S Negrini 13
6
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Therapeutic aims Srace kinesitherapy
With brace
il Postural corrections and
vertebral stability are obtained by the brace
Therapeutic aims Srace kinesitherapy
In preparation to the brace
il Mobilize spine on ail plans
Therapeutic aims Srace kinesitherapy
With brace D
Maintain a normal spine elasticity
~ Maintain a good muscular toneshy
trophism
C Model the hump with kyphotizating
exercises
S Negrini 14
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Exercises and their methodologies can vary accord ing to learning and individual sensibility of the single rehabilitator that proposes the m provided that they stay within the
Iimits of fixed therapeutic objectives
li
Therapeutic modalities
(Exercises)
QAuto-correction
QRespiratory education
QErgonomie education
QMuscular strengthening
QDevelopment of balance reactions
WNeuromotor integration
ci Vertebral mobiJization
QSpecifie modalities in brace treatment
S Negrini 15
EDUCATION MEETING SATURDAY 8th of APRIL 2006
The protocol of kinesitherapic
treatment
G
QChoice and dosage of exercises
Variatiosn of the work program every 2 - 3 months
Q Execute e)(ercises on an individual base or in a small group
Q Frequency not less than 2 times 1 week
Involve and awaken the family
G
S Negrini 16
EDUCATION MEETINGSATURDAY 8thof APRIL 2006
Q Determine the action and the localization of auto-correction
QAuto-correction must be associated to ail exercises
QAt the end of treatment ergonomy lesson
Auto-correction didactics
G
SCOLIOSI DORSALE---- shy ----
r
S Negrini 17
EDUCATION MEETING SATURDAY8thof APRIL 2006
SCOLIOS OORSOLOMBARE
shy
SCOLIOSI OOIlSALE 011 bull LOMBARE S1I--shy
SCOLIOSI LOMBARE
il --~_-
S Negrini 18
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Scoliotic patients are not radiographs
middotSeoliotie Mtients are not ndiographs but hum beings with a vertebral deviation-
Slagnara
Metha For the physieian Cobb angle is of utmost
importance For the patient it is body deformity t hat eounts most rib hump a protruding seapula or hip We are in a situation in whieh today dodors eure the radiographie deformity but what the patient really desires is to get rid of clinieal deformity and of ensuing psyehologieal distress
CIIQItIo shDuIdtucirc lM WIld tJw~~ I~~M~~~~ J9f~
S Negrini 19
- Poznan_workshop_Physiotherapy
- physio2
- physio3pdf
- physio4
- physio5
- physio6
- physio7
- physio8
- physio9
- physio10
-
NECRI Nl
110
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1 7J
amp aS g 5li - 0 v
V
31
10
(1 1) Il 15
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FigJ----jllph ot DlI w l-lkaupegraverel) The agloimvltltinn Or idio r lrhlc 50gt1iflll~ IS rpiJ bel~ en th e- [l0 IH P (l)ltg tnntll lol (JI PUllcmiddotny) mtl 1 ( f( lS-er sigll paiilivltecirc lt Dlt(i I1 11illg r the iti l 1Kgt n n t rll icirclicH a ) 111lt m omal prebulled the mno rche md ociks with lll I)ttlx flal gr Ih pll fl
rlcljoprdphLi 1 hl merl prestIK ~ of this curvt c10es n t autom~l ritllJy indi ate the pn$CI1(t of a defurshyTnitv (SlllKtUrd (Unel
It i~ possible tu clil1e ren tute a struCnlt t CI1tve fruIn a pogt urll 011e by identifyi og the hum]) du ring AdIlns tesr I~OQ looklng tra m beh lnd at the p atient w ho b benchng fUfward il is p -- ible ta d d~ct 1l1 eh ucirc n of o ne liidlt 0 1 the trunk usually n n the (onvex ~ jde ul tbe radiographie CUfve Ugrave1lr C Ul be mlt~I Slred lISin~
BUlln els S o liomere( 1 ~ l This h Uf1lp is du(- lO (Ile pregravegtecircn ~ of vertel ra i rolltion 1c1 Ollt tn tic f~YJ tllre o f the def trrnit tli [ c m be seen and measurc(i v ith Perddolles lb lsLometer on an amero-Ix)iferior radioshygrapb ~2
Seven ry pel cent o f li Ises a re conid 1lt 1tO be idiopa thie 1 bull ia l-nosilt in this CI$C is b exdlls i ~ n as idinpa thlc me-us t11H wc do n()[ know rJw origio of lheacute curvc [n othe] ~Ie$ it b Ix )~i ble ro ide nrify a dieak (bat CHl jusrify the c1etgtnniry slIch a rna lfo rshymar i ns I1(gtufol Ig ic~ l or genlttic cl iscas s Glnclt~r trauma etc )
[dicirc)parhk S(oliosis has been divicled ~(corcling (0
the ~Ie of tlie patient egrave1l the tiJ1ll of d~[ccli n of the condil ion into ti) ur t ypei ln fanUlc jU nik ltldolesshyccnt lnd aduh Til l m n st cnnunon (VPC IS the acloshylescegravenr o licirceacute I1IJctenzec1 hy 1 sud le l1 tggrH3l ion uuml uring the grow tll Spllrt (Hg 1)2
lhile p tu 1l sco liosi i5 Ycry lomnw n thl pre shy~Iknct ra te f r adole ent icuumlop~lthic structural CU IY~S in sch )o chilclren are 18middot20
- 10 Co bb d~grels o r m on l -lil
- 2) ~ohh dtgreclt or mort O 2~j - bull () (obb d gre -s )1 mOfeacute ()ll 2
Clin iltI [ d e isio ns lfl IXlSed 111 an lccu r~He pregshynosi which obt inccl in eJch pa ti nt mainly o n the basi of the nsidu~ll p()tlnllltl l of TH1h and the result s of 1 rh clin 1 1 ~l1d tadiogmpl i exlminashyti(ln12ll c noieq uentlya d inica ] la sifiou io n o f the ing le pHient tn -ome estent co incic1 ing w irh the
D diographic one c l n lw SLlIl1H1arizeci 1 1 folIcJ - mikl lc~ (1)(n 20 C bh de~r es - moderJt l betwlen ln md 15 ohh de~ rtes - StV re 111( gt1lt rh n ~J) )bh (kgf s
On the 1) lsis of [hi - dinic d d a lfic t i n (Vith l1l il el lrb tiOI ~ o f the ir b() und~ri e ) in Itllt l cente rS Of SCOtiO LS ITe ltlllent in the Lltin odcl (i rJ Ital lnmct md PI iJ Ugrave tre tmtnt i s plmmcd a fo lltJw 8l
- mild kineslth e (~1fw ~1Il (1 luok-ou t - Hl demte IJragravecegrave 1111101 c(~r md k i rws ithe lJpy - ~cven surgery
Physical exe rcL~e for S(ol iosis
Defi t tiOl l S
PhyS i 11 nU b lIKrlttp middot (or kines ithcIa Pl) i a p rvgrlill or plt~i Gl l (xeriltecircS ~1ci fi ( llJ y ltk ~ loped
y a -11 [ru ine 1pll yslo ther3pisr wirh th e m 10 Hllll
- pre (~ n tit1g tlc aggraaLion of the cl I )flnily in rnild bullcoUm is
- helping tlk Il ld Ct ~lOd ounter~lCtjng its skie elfects in III de rltegrave sc li sis
Tn tl1i_ feSpec1 kinesitl1ert py f JI s oliosis is tonshysider l a o on of peciticcedil training and s genecirc tltllly proposelt in sessions 0 1 4~ ro 60 minute IW) t) tour limes 1 Cee PhysiGtl exerci es can aLo ll v o ther auumlns 1S it oill he dise Issed in this plper
Ir 15 Ilot possib le to cl escribe a single progrlIT1 o r exerc ise a5 pro nrams ale USLIJUy p fgt nll ized ( ( lt
EUH PA ~illDI (DP1I YS IC~ 182
ROlL UF P l 1YSICAL lXl 1lt 1~E IN l IlE 11 ~l) IEd If IlU) l[)VP 1HI AIJ() J)~Cl~ r COl ~I NlG1W il
f)( 15 egraved ( )Il the nee L- 01 indi iuua l pJl itnts) al l l10ugh Lheacute) C l n h t 11 plicd o n a WOU p hJ~js (-1 (0 () pnients PC[ ~l ()lI r)middot lugrave reQCf lhese 1 10 grl lll frequt ml~ V IIT
hnm on in middotituk w allClthltJmiddot -Ill Jnv L l~egrave at Wc w Ht ~huw in lhis lyl peJ it i~ 111 n u -eII1 tu id e ntilv kirK itheJapturlc aims w hitl l ucircrr~spnd LO ugravelt~lil1 DUtshy
g X ir ur ph -s ici l lxtTi~l I~llhe r thln ln dj( us- indishyiJ u1 1progr-lfll
Aduumll l lxUl kisure time ~lOd h )u] Sp u lllll8 ~Ilttishy
i lt egrave~ i middotomm )Ly s iven lel mJ ing ro w hlf ~ Iuumlnsidshyer~d usdul or il lrmfu l in t1 lt rruning (lI tJw ptliJicirct ln tl1bplper Ugrave1 gent ltl l t rl ll bull p lwsiCUgrave lttG iviUes is rl ktll 10 JllI1ltlCc hOlll gtpOlt mJ kIJ1lsIcircl hc lJ l f
i ve lUen tloneumld )bo C on lv ine n dul( re Ull~ 1t~1 t s far Ilten publislt d f I~ mJ I(i noltgtithltl rgt is 11 11 a su h jel lnI deacutehate CJitk haltlt t llltit m itn ltl of l ny lorm o t p l1 ySiClI lxrcL e as a Itwr1 [ J- fo r i liopa tb il jcoJL~b un iL ()ri gin~ initial1) it WIS Ille r rOmiddotUumlK lt brgdv u f p l~lt titu gtllergt w h ) intervenecl hutll tc llcrl ll (mon as cltl HtilJ nic in terventi n man Jgt
1 t lltrJp utl t one 1 md rC j fkll l~ on rhe h sh lf som uni cOen I1v pn t I1cgts wt ldl hll ltl enl1 JI~ haLl nu na l scicnt lfic baisYmiddot HOlh tlle$( trr t peu shy to rh ~rl py tt nJecI to l~~rJ tte C Ih tk CUf -~ pnnshyclr~tll y as a f tsul t of lilo h llIzatio ll of tn imdqultdy ~u pp rt(d S pln eacute 7~ 12 to re-t1 r rI ltrl 1$ l l1C k o f WH llt~~rdl 10 I ndt~-dll()urnah tnd 11( on1 p~l per u suaJly Cl tc([ IS n prelimmtrf lll d 3 ln tt li w ay man (l rrlKpt(Hc H lf O iS Inll ph ~i C U l ~ d vi ~ cI nllog scnliotl pa t le nL~ 3gainst holll ph lca l egravexershyclc and p()rt~1
It m u st t~ n tfd [hat pllyknl txerc j~ tJe~ltm(nls t1iHer 1 lJ rd il1g r rhe rherlpcu tlC litTl~ on lllc h tJ rgt ap p lolc il l the IXlltent lncl hi im r IIIllHnt i- 1 (1(1 rI - 5lt1J lC igt tIl l ( f phJllIlllolopJ al rrea tmln ls Ihith cllffc r 1lt œQlfd- rhe m C cculc u ~t(l luI thl p al 1t n
~mc l 11i (lbE~e Tt i ~ P ~il k tlwreI[middote thll wuumlk ltlll t kin 1or ph~ i Clt1 1 lX r(j~ 1I 111~ t bc loidvd by t h~ Lo iurie IxujCJ1l al1ulhcr a dl ~IS nJI h~ iOg (1 11shygerols llugJr in racr le (wi ller d I ~fJIII ~ I ml thlls re(nl1l rn ndc(1
fn n UI cel1ll r we In(~ hccf) using 1 ) 1 1111 11 ve ) 1 (J p lw l icd ex(r(i~e (0 J ( 1I l tt i~ tlh aITt ~ l~d Ilv m ikl tru cflumiddott1 adokscltnt (cl ioj arh lC icoli is11 2)
ina the f U~ t rc-gt uJrs IefC pu b lishe - the pJ( )grd m 11lt1lt l1te n PWltllk d in fa c t deel()pnlln l~ in th t l itshy OlL1Ii in tl1 r b t ~() ycal f ha ve iclemi fiecl niO l l
m d 111 ur impl rnHm s md d i s )h ilir i (gt~ lue t idlo p lthk amp()lio -i ~ t Jll CIII he 1UO(l if Icirc 1by phyict1 egrave xert iSlgt l fe t rrncllt
l illl
111e aim of t l1JS r~l per ii tmiddot (tv iew tl1( l iterat urt to a(errl ln v llic ll of th~ impa irm 1t~ and Liit hil it il i GllIltec hy ~ o l i()gtj s -o ull he ll nt x or re middotlu celt1 Ili pl1ysical xerclse An u p-to-da te knOvkdge o f tl lt Lgtpecl-gt i necckC1 in rJeumlr) d -oek
- whetll~r there h ltl n adLtIIl ) l tht()d ical bbh fur or JqIIcirclb l l l1 Il( ) f k irt llit herlpy
- h N I)(1 ( 1 Dm tlle p r l c tIcirc(( o f Jebur tiJne )pOfung lcli v l ti ~ IIOU lci he tllf) -d o
II J U V f h 1 I11~ c~~lb li hed Ihe usefuhlLss 01 k il1 shyc ~thtrpy il i aIle dy l nsi 1([(( -r-tI Llleu i n )I11 plJt~ ut the wJrld ir ilt ecircS~nl i 1 I( id n Iv w l1i li ( 1shy
gories 0 1 pl1Vtl( 1excrClgtegt te D)bilI7it ric 1n (Ir st shylliuumlZltio f) lttlt tlgtbltn ing ni trcrccedilh ing erc) hn Id be
vnlcled he tll rhe nuld be lerrillldll1 1 md whidl s tlQu1d be inreœ jf ic(1 IJeClU~l tlley cOli lel Je LI ~ful
Ncuro1llotor impainncnts
Imv aUl llOr~ 11 lt1lt ~tlKlteJ lhe cltlndatiotl bd Ween tl UC1UmiddotIt t l ol(~C t nt id iopml je -nll ~J~ and cli~l l shyler~ lr 1tH lest ihuLIr yt 1 _ 13 ~ 311 D uhoussct 1
1-- ITS tln l ldiopath k s(o lio-L L cll -c d l J l hmgt in th terl tltr f prop li l l pu n md 1I1ar th e detrshyn Hi n i~ na tural 1 ~ronse to ril e need tu ts tu re p()tun ltlluilib riu Ul HcrmJJ1 31~ 11 () d tllat icliupathic ( liCl5j h l it re5u lt Ot1 rw nltuf mot r l ~ltelV
[Id )fcl 3 nI] ~1ltJ U Sr1lle nr to dtorders in centJtI lO~Cl shyIOIDNur) md 1xi~tI moro (Ul1lfOl syt( llI (Fig _l
N htIll -of) H1c S uumll h( rll1 ( ~ l( w ing JI t11 (oshyI-ie on the l l lO]ugy o b doll (nt Rl iu]icirc tlili- middot()lioL m unt fil t-hltll rhl ugravedcmnilV L th e fl5 ult o f 1 (k btcl 11lIFll llI ion nf som t11(WUgravetltnl md pO~ lur( (tnic l~ l licirc1 tl1lt if l p OgtlbJt b C 1l rlw sta l i lin 0f 11 1 Sf llle j lt g )tx l Tt) ohtil n a ))Cli U 1ILzltl I o f p ~llIr~il d l~flo [ in l1litkd ~J)llnSIS me CI Igt(middotqucnr J ~ a ~tmicirc ()nlly or regle Ie Llive
Ali th- 11yp ) tlw~es rd ~lte tr d irtl Itn t pnl1tlt o f [11 v hole ~piltm It11[ controls postu re ~nd mrw shyment lrre pell ic of tlh po int a d lI~ llv inH llYegraved il i ~ ll 1 nnable tCl aSUilll ri 1l tr l ll1 lo g thi ~ys ttm ( Qu it le 1I middoteli tl
lt ch ugt nlt~(S f rullliIl thil i nlomwtion th at p tlmiddot shyiCil J(tl iIies nw gt Il lInport~n t rr le to pbv [11Icircgt role ca n 1)lt slI i11l1lariztd ln lWO the ptu li ain Llt
- d elopmll1 l of p uumlltl St1 b Hlt ) - c1e veuml IOpm 1)[ o f bhll1ltc _
(k llhUl)lOr S Cll orr
ontrot oic whan-lt
------+ 1 ~ il lnll ugrave r AINnl
Cllnlr1
T bflt~ r
fltL1 tlli
lMini
l
~sary ~J-frlllen i )f
~ 1 ocirctnl
~UcirclllIJJlW Ll
AXl ~l1 n uumll l) r sy 5t ~nl
middoticoltoq ~ Fig 2-AcFgtrdong lU He-mutl 21 il is Fi)5~ ib1e rD prolXgtSlt l -oo ie1 mnd 1 ((if ~ elio egrave middotAhltr~d l)Qdy-p ati~ I I i u d) uren ttllOn k td LO In ~ory reHTt I1 eDi tn l al ) JdrnlV~ pn)4~ e l u r~o(Ofe 0-c1 eptunl dvstil t1 ctlon sltŒ(ry icircltu nu11t ilwnt [ ~mC ~ted tl l1 ce Ill trpntlshyUumlfJJl nd IKnle~ r~dibl jtugrave)n of -I) m tlosen Ir ~ig nj tl (I1vying ln fornll1U n (lI an ereltl ~piJl e Mmor aJJ r--a t ~) n ltgtf ti lt aXljl mowr plem iHUC Wh ~fl Ille 6ubjeco m uumlntl Icircn (1oJifitd perccpfLlI l ~na l ysilt of p n)lnocepti Icircnfu rnlaquol ti desnibJOS ~n t tecr spin A IICW motor co nrro l Ira I gy t adopt resu ltin~ in the ~tr ltctltr 1 ckformh y lf IdiopathirL scollos i=i Ht lrftU1uc nltnt l ISll I1lJy h1e- ~ I pro()und elkn on bralO Sfem flJll ct i(lnn~lLhu modifyRll Ille nltulltgtshytl10 ) 1 1111 Uu l-lHoror control 5~Shnl$ shy
As Srtgn1lt1 l ~ ltlssert~ if wc l C -Cp t 111 1 un o f the G IiC s oliosls L l tisorckr oi th e ltquilibrilltn sys t ~ms it is lagical to oriegravenrate physlCl l exercis( lherap y ln th is d ir(gtCli()[1
11lclte goals Cul tl lfOUgil ditrercn t modes 01 action be Olchic(-c1 witJ1 phykal accivit ie
- po rt ive Cll ities p ro ct LJ e aIl UgravelClltrtsc in 6lte nshyel ll )o rd in~lti n pinai pr0prinup ti_)[J nLi mOVeshyment control 0 vio lls iy ln thh repect ome lCtivshylites aœ pre um~I I)y lXrter tllln ntil crs
- kinrl lira py using pedJil exerCisocirc specially developecl lith th est 1101 5 in mind illVuuml VC I lllore prccilt( ll1d InC1 li zed cri n on rhe spiJw focusing
a90
1 ~~
lg -lNheJo ~1l l1 t r~l g rld in 1 1) h i(~ IImiddot ct r rHienl w i ll idlllhic _It ~i ~ _ iri s plt ~I le II find Jit ltH vlllleuml ~l Cgtbl tn~ ks III d il fef lt p ~ lt ihnS nu v~tl middot B ~a~pt u Il C middotl)Icircd ~(t l l11 C dlfkrCnl middot- hdween slllndi1g Uline nu nllt1Xinul oorrec ri nI t chied Vith Ct (J ) und tfdincJ ne lot es o UIine 1 fo llnVs middotIJfl tfi ni( - ltlrshy
reltiK)n ~ Ikexibiliry st3nucircing - -pirte - f ur~1 1IbjISC ltupin - ltorrcaion - - r~luci()il ll ymiddot For flmpllt in J npK l1 pH k1J il
plt1SSlhlc ln obtai n 10 u1 511ndlt)l [YLo lion yr ln Slt p ille rlOlgt itlugraven om l J ~ in ( gttf(C rigtIl lIex lbuil 15 i (r-l l=22deg pol lltl ~~J IIlpraquo is IcircO~-V- I t1 l nd tucircu(Ugrave) ilil) I~ 3laquoJO- IH-12
r ln Ugravel e abilit jl of tluuml [m e llu to co ntro l irse lr in ~ pac
fuld l oftlles uumlllelve ntio ns can presum1b1r incn~~ Ih enl ac )1 the orller and lHitlll r of Ille rn - 11 )ltd h e lllldenl lu EJ3)4il
Posl1l1-t collapse lnd slabilizariotl
lIle concept u fplt st lUal c(l lJap~e l l~t Iwen detin 61 by DlI II-T3e~tupegrave rL t Ac oJdin)j tu tl1i- ~ll1thor il [ nec(sary ~- l Hn Cv-tlualing th tleihility o f a col shylo tIcircC CUJVL (0 clistingu ih bt tVeen the re du ihil [ty index (th - li iffer gt le bet ~middot Il ~I r~tcli()grJph ie ~xnmshyinltio n of the iI111 pHienr in supine po ition m(i
ROte OF Pl rnmL EŒIlCISE IN THE TREAT-ŒNT OP ~I IJD IDIOPAnnC OOU~GEm seou SIS EltJRINI
I (~)-----------------------~
__ _~ _____ _~ __ __ L ___~ ________1 ____ _ __ ____ ___ ___ _____L___ _____ l___ ----------L ______ _
1 ~
1
-- ------- --1---- ---- ]---r --- -----_----t- ---- --- ---shy__ ______~---- __ ____ 1________ __ _1_ __ ____ __shy
~ (1 J
1
8 =~~=r=middotmiddotmiddotmiddoti~=-middotl--- middotmiddotmiddotshy--------------t----------~- -------- - ------__shy
~---- --- -- -~ -------------r---- -- -- ~-- - -------- --shy----i-------r-- - ---- ~~-shy
il 1~ 0
Dtl-Lmiddot ~ lttj l r~ UIltltlHt
f g 1 -TI1 u ilictf 1ld ( ii 11- ugraveu-sh) ld IX~ O 1d wllich ltJdnrshymII Il nf the pilll 1 ~tln~1 of th e -o lioti( spinc n IG~nI(J II IIIshytt) lhe iJeuml grl-e o f ~ ()Ii ti c (u rvH Il 1 w dcpc-nlknrly o l l he 10 111shy
P01(nl (pntt l ~ 1 1 nr ffll wrJ I) ln w hilth Ihe n i 1gt( ~ duc nL~ grlphs fm I h~lt 111lt hi~hr Iht Col h ~Ilu t (l f Lite ~Ul Ihe m Ol CI il y th t s(uumlJotil middotpin~ ~111 he ~middotJg gr~lVH(~(1
m mJxiTIt corrttt ion wll iJl i~ lIllCd to Ih - xt 1shy
lti Oilil y Jf tl1lt t Ut JO rl1t cdnUc idt md p OS shy
tU ll cul lapse ( th t ltHill enct b-tten l lUdioL) 1lphic egraveltamJl1ltlti OI1 J t th e ~lme pa tient in Sl il tl cling lOJ lline fX-sitiutl ) Wll ic h correb lc- onl wil ll fhe abilt ty of lllt p tu rl l gt s tem to C( lunternct lIk luree o r grl viry )cco d ing rv D lfVd- f3egraveLIprc po st li r t1 lt01shyIlDse is d ue to the Jnus -u lar ton a nd 11ll ex rCrIshy i) i itv of rhe tissus n the ( O IW-) si it (If the (01shyjl ti (~JtVe (Fi~ 3 L Pu~t llr1 C lltpstl lu lcl l ~~ reduc l-lt by llwans o f pl1ysica l cxerCles specitkally s tuclled ruuml i rnprove tIlus--ubr fOHt md lU pr )cllI Ct 1 ~11 hi shy
lizing ffCd
PararcL n tll CIJ cl the cr iti ca l (3 c1 thlsho ld beQ ld Il ich defol1J lHU n of the i pinlt 1 e~ in~ ne dtlllontr~1t _cl (1l ll t grclrf r mg] o f rllt C II in a qa m bng pos ition corn pOil 15 t l lowcr detormashytion lhnsllold (Fig 1) ie to ~11l Ulne3Se t the risk of pr ogr t~ lu n There t rh eJef re l J ea r l)iuuml 1itshycJ l ~ll1 l l(tl a 1 tnr tg ro b ohwined by d -cr t l ~ illg ilmiddot pU~lUrll cull lpse ptJcelJtge w bich lccording t i)
h llTd tnd ~l(heJ1l ~on 1~ b inde cl 1X llt icularly luumlgh Ugravel mllcl c Iio~ i (bdow 2( 0 ) (F ig 5 J
Fin a Il III ch iS respect lllljl hl and b um l 01 m linmiddot
ii iI 1 l _ _~ _ ___I ___ ___ __L ___ _ ___ ___J______ ___ 1 ___
li 1 1 1 1 i 1
1 i ___--____---___----__-_---_~- _ _--_ ___-+----
i
1
i -- ~- -- ---~-----_-~-_-_--_1-~
l ~
i
+----r--------t-------t------f-- J
Fj~ ~-Ac(XjJlin(Q luuml T O rIcd ~lnd Na(h(ln~ n i () dl( pCG w rd (rTIshy
POO ll is hiherin cu rvegt in wh ilt l1lh ~1flILWrd cII1I Olk l1t IS le- pr(v~knt ln th e grtph Ih t PogttJlJ I ugtnq) Ot1 -J1l j elfltS-e J tlt 1l1t obb dirr remc rlLIv obu incu f roll l the Cohb atl( 0 1stlI1dtJ1g IId gtupinc rldo~raf115 Ih Ille lt) [1l1t1 (i lndnl I pine) 511pille the ~(nlClu tJ1 compo l1lnt U rlk CU Y _VeJily I~ ltx p rlt 1 L1v UpUlt (obh Illeturo Ih t si _b Cct rtJeSIm l fie -ltn J trd Ugraveltuuml shyuumlo n A~-i)rding LP 11(lt uuta o n l ( r1I~( in ~I 2JQ sup itlt curvt 1hi C(]l)b ddhccno l l f lO is -J-lultt( thc s ldnd inr tnla Ol1l t lS wi Q) whil 11) 1 1)401 ~llp lne ClHVC If ~ 1Omiddot ( tcl Lhe ttnd trl~ nlca~ I(t I ~ ~I)
tli n ll w l lllE cq lin ti spin h~ i ng mo r ~ Llnt~II) 1 tlun the nOftl111 one n Cll l gr(lk ( (cU ve tl1u n da r u p shy
po rt in o r k r 10 m linrl in tht 1xi11po tuf_ n th ha__i of th egt onideratl lr1S it f(lll() rhJt
ph rH (~Uuml e erd es ulukl h u - ul iiuml tbeacuteY ~U-L lm cl 1l (It-d o pmg p05111 td C Jl1twl lS fuumlrnll~ rly d ccrll1td ln an Ql St if i imr ol1111 t ru t(( - tht m(d in C JI shy
r t t r sture fO Ir -ngthen tlll m u ck-gt of the spint mainl) in (11erl antig r3ilrl tIcirclt l]lli fun ctin ll U hy meU15 dl i )ll1 t trk ~ lhJ cl( -ll tlt C)nlr~lUions ~llld no l IdOshy
1l)llic d YIltll1k lt l jAJ lktic t) I1 ) II 11)t 111 hd posibleacute t lcluuml ee postura l io nrro and stfh ili lllllt IJI
w i thout food T1lw(ull r d I( Lf(11 Ibk t m ucircnuin Ihe c()rf ~ct [ ()S tu re for cl gtu ifKi IH lLl1gth 0f ti l11 ~
This i-l ddl usl a typl 11 dnmnin (tf k inesllh rap) in 11 (lt-11 [[k - p~d fk lnr in lng f u l1a in llllliCk is poss ihle lI sing ctrtain Idncl fJ l (lt) 11111 liun S p Ul in tb is Cl c is ulttful ooly sa I~tr 1~ il Iw lps t1w lxltknt 1 becuJl)t 1gtlt ltlt-I a ClJu~l inred irl ilL ntllru l o~ i cll
and I1lll~lJhl r-keJc LIl [rll-llIn~ middot etlt(wrs JI the int e rmiddot vlnrion
[J ROPA MfJ) I()Wf-I YSJ IR
1
ICR 1 1-1
r
1 shy ~
- shy
11 o-llrfOlhe5l~ o t Ih 1O~(1dity i n h ~ r ~ ll nr pbl1 l of ~ Spl11 in 111011 _llti1Gt l lPt f ltlJUCWJtl ( ~l Ihe Ir t 1 1gt illbll W Ilh LtltrJ1dlion Vln lbe rigronl middotUII~ l(I Dko n12 lIll h lumshydlanie1 1 [ nul 1 M hl whtrc M - gt) lnIUI1g 111laquo111laquo1 1 1 c rtJCshytjC~ f fce d -d Lill l1~ o f enr niI pUll spnmcl1y 1~ 111 mldlll1lt (n the fl1ur t 1 = tor~ of f(ward Ileuuml l = ughtel1lng fmiddotr p 1shynOf stn lClU= Alaquo rdtllg 1raquo Ihl~ - lin hull th l1ltgtllugrave ot tller1l lUr~Jtllrc F the ~pin t -ilh rlu1i tf Ihl 1 1Ibulll n lrlt InltT1 1
rbc prJI 3IJi l1ty d qrlOIJ~ n bull JI t IlJIII Hm lA the v=ltd gtc e lu-ing J 5lnK1ura i ltfnnity
Dioal e ch anicll itllp~lir J11 c nt
Ihrcemiddotdimcllgtional mc-cbal1in of the s pioc
~f Ikmiddot i t i nly l(œ ntly tlHr llk pr-5tnœ or nc ushy1 lnlo tnr impairment in Idiopttlllc s-ol ii IXl tknt liuml J$ heen h i- ll licircghlcJ hy re$eJ rh tll e preit ilegravee h inm b nIcirc Ji d lJutg~ lt hl ~ 1 ng t o n dO Ulll urcel 1 i5 (l lreldv well umlersrood H(j-ev~r nev lbt un h iomcrhankal im l) ion nI h1c rectm ly onk l n tIlt tre and p r~dou in f n rmtinn hou t pl1ykd (~fcl5( in t 11 0 tl1I _ltgt pbne of spact 1115 Im trqlt-u 1rom J i-[) v ing unclcrsrmdlng ot th l lmc -dim nshy~ilnl l l11 ~ hmk f the cO]jO[lC pln( ~2middot ) ) Ve- w ill )iI xnl t l1 d at lcL-orcltng tUl cl sif iol t lOn blsed o n gtolllt lricd h uumlCJ ) p lane
- b() rJzU[1tl ln th i pla n ~ th t 1o rm ll sp ine present no CUlye- w ll ile Uumll(~ ltc U Hic spLnc clevelops one of ir haracterls(Icircc deFo rm tiCs v elt tbrd ln lashytio n vh icl1 pJ()VcA~ theacute hw 11
- lgitltl in th llulJe U l(~ nonmll spIcirclle pl SenL kypl lOSis ~nd l dooi~ in tb lXI1 lhese [(Hu rts Vere m)( til ught [ 0 he relattd tlle scolkJtlc ( lI r Vegrave
- front l in hi pleme tht ncrmal p ine preseuron t no curYegrave whil thl ~11li tic p in ugravetI I ()~ icircl~ charshyad t Ilt I CU1C
Il Jri fJIIt palic
~l+I~na ra 3 r inr lut th l[ ber ll1d a œl1~lU1 degr 1
l f r()la tJo u lllu (lILa r forcKl ltxert ltJn tl ldefnmuumlng 1 tkllJ [J i1u a re- lhlt tll cly 11 [1 1 UI b y Olm ner w bn ~lh uiJwd tl egrave ro t1tic) l1 Ilm it ti lt p ica] lf shy
rhrl r() be (P (the Uma bevond Wl1iltJl th lCOJlb of [11( ~pmaJ musd ~ dthc COnCIt and nm ex ~l le btconk (t O li~[)
r ~l 18 ~1Il N lu t( ren i9 lun lu ted rlseurlt h in tlt ) tilt lULodeumlformipg1 tlo n ot tIH_ sc laquoJrle rh ox ercallkren lk 1l1~H li d11r once thl Il i ~ r tld1t5 [he lhrth ld f 111 JlIcirc lIi of tlle dnrlclc hurnp tlk
lI bslt Il l nt rlet()rlll lIcircon 01 the it l ()I~ C ( (ylm der (- sustalnecl by an H1tmi cforming aCOOIl
J1Ji h V hl rhyiical f~ f Ise CI 01 h spr n llnd kin middot ith ccedilrapJ my lX damlg ing vll e n l pplild as flle
igt Jk Iller ln SCC1IJ ~IS lllc lJ fxceed l auto in middot crca~ i n g lhrllgthuld [1 sh (~u Id ahn be j ofed that Ilw relscd pre sun 1l1111i insiugrave l fe pil1r inn) 1 mlshylt
- j Il- ( w atff 1 (nh ~1l 1(e Il10 utoldrml ng li1eCh~lI1 1sm
in flc l Geyer ~w tcd th1 t rm m 1 hI l)1ecircch1O lla1 puilll 0 l I C~ sw m mim t Ieuroamp no purpo t for cu lshyim le pllilt t1 s (weumlO middott r it is l~Jl(gtWl1 rhn in iculio r[ paULnl -iJl11T1ill~ doe_gt nor Il ~lp to i ncrt~SL n eur(1shym tor co mfU
(1irai p an (
Jerdnn lle 11 showecl thal ill CSl~ o f t10rLC IC 1i lUgrave
tllo lacolulllhil it lio_1 tlle cte tI llmiry in (he lg itt1 p lln t rn lnlftot il~ lf tspe iuUy in tlw initi 11 r luleuml )f cV IU[Icircon nf Ile ~oli ls W iU l 1 p(t)gr~s~ivlt il10middot~ shy
ment roward hvpok pho b G ll f ill~l Im lins l har dUflng (IN eWllLlfiu1 of 11Imh] co luumlgt i the l in t ot t l H~ gClyty Cegraven te l - 0 1 v llebed lxxli 5 r ro ject 1 seH fl r t side-ys and tlwn backlrcl bull thu~ p(0(1 lj n g a kyphQtlmg aet Il ln (h~ lu mhnr --PIl1 COftj tng
l l i tc Iugrave l lltl l( l rs1 tif s L -etllgt il l the lgirl11
1 Hl)
Ilu LE nI rIIY~Ic~L lXIlKISI 1 HI E TREhTMEtn OP JIU IDIOP llII C AD O USCUH O Ll Œl15 NEGR II
lLill tegt lre lenl1 ~I d ~fo rll1J[ ~ rhl recrSes the phyltiologiGII cmns of lh vine)
Accordlng () Dicion ~2 1 rtcluctio fl in the itgitttl CUIYtS combin l vi th a lueral Iviari n llltl ds t 1
mecban ism () ugravel~ta il ity in l he r rat r IllI1e which bVOf1i the unsd a nd i ncrea~e 0 1 co hlt1is (Fig 6 hiIf md Pl11jlbiJ Jl1eanwlt ile lt(udiecl lh e srnl ru t
orzyglpophySLs show ing t11 al ttleir 1I1tl rnic tl orienshytation f~I (jLi l~ltes aXIal ve rtegravebJl l rotllio ll in cun litluns lt f dorsal hypokrrhn Icirc tnd lum)H de i L lo IS
Tll t dat SLlgge 1 th t impOrfill ut pOitu res and l1lweil1 ) t Mudied in ord t r (CI mlIuml ntrlin or to reuwer fll e p llyslo lo~lCll ClIlye in lIe SlgJtta p lU)l Wlth the llm o t ch ~ kin~ rutltor in l~ bili ry7 AbC th ~e ~k-
1l11nL ~Irt del lnt [0 J jUc lt ftber l]kuti inrervenl ion vhich 1c)LJ k l IV - i(l ~ l compktl n l ililll on Il t c1 l shy-jel1 J11UVllT1ent IJ j o f 1uto-dOneacute(3tlon ( i e a -impk ld ion ) Iengtheni ng o f the pilleacute 011 a litlltl l aXl~ tll lt ((IT liJlI~rcdu e~ t lle ~---lJ linti- l lte ml-fkxj(l n h UI 11 - i llCrl I~t the plllH ](JgicJI dlt cr ~l S ( (1 k-yvllCiSh lIld O(ltOSh l o r c lch r1Iif n t a Ilew til(~ecirc dUuml llt Ilshy
si lflltl J ll1 u(~nlent iam ecl - 1l1t0- lIrfe rionmiddot7 4 llmshyp oed f Je-rura l iUIl cl middot-t1e- iltm lI1d ll1a intltnUlLe )( 5lg it d C Uf (gtS slig lll thltJrc i ypI1 tiZ) tIcircOI1 a nd lunugrave)ar 1()fdos i7~llion) sholild he esw b lb]HU 00 lb co
hl b oi hi p~l11il uU r -1Ir vlt Abo 111( e IlltUtl Chl lie o f purti n - a U vitk slJ1ultI h e )tuumlll ecl 1)] (1 n ldershy](ion r tl1i lt type for e upIe IilJ llyl)T S of repd shyiti( ml vemen prt n t in agonistK h)lnllltlSlks nI iIle kind f dlJ1ce C( uld he ([([r imentd
FmiddotO lllaljlallC and mobili ty of the SpIcircIlC
1 rd llo U 22 d L lm nrrare d lhlt in Illt fro nt a l pll ne
tilt 1 nge Clt 1)1lt vtment of tht scplit[i middot CU IY grcmr lIJ l il ~ d irectio n n f Lhe C ITelt tlO n tha n in tl le di re shyLion of pmgressi n l Fig 7 ) he IL o IS5err lJd tbat th15 mohiliry increac plrtil u la rly n apic [ cgcoeilts 1$ lh ~ ~c() li osb evolves Sragrm rJ 12 J ~ thus rigilt (0
VlI f n rller~p is ts Ilo t t) m o b uumliz - a sCtJl iu til curve w ilhout t [ uling ttwt tlle R lu tiOI o i til t ~a mt b fnlinruumln( 1hy l1tans o f ~I passic 01 1 rivE -uppnrt On tilt (ltllE r hand UgraveK d e iJlioJ1 in ease durill tlw tune 111 whicll tll C spmt i ~ not submjtrcd to correeshy( IV anl()n
j- Virh mi lei ol i b tlllt Upp i1n ill) lC tiol is d eveloped only lllmugil llClIf()mu$Cllbr f r llce thi ~
InegravelIl ~ thclcfo re tl1l[ inu eascgtt sp1J1all1extl)iity mua
11
Imiddotiumltgt 7-rurd illt Ir) 1 bull rdrilt I1 1 in tl lt frOlllll pbnlt- th( illl ge )r mOC llIeJlI o t the S-o UIIJC CUNe 1 supcrior in Ihlt diflt(l im ugrave( the n nKlIl thd n ll1 tllc dlrtcLion o f p rJ1(l( (llIl
be considrCtJ vntrl iJ)(l icltion and 1 undrli neocirc ab L a ~ubiljz~ILion 01 tilt spint pllss il)1y ohtl ll1td thrltJugll the stlengtlkl11ng o f the 1rltJgm vlt nonil lme shyCIC 111 illli orrant u bjcLliH- ln rhis r~f1 n sp u lllni lc tivitIumlLs sil uld lX tPI 10 dlegraveltl it l G lU t n w l1ik luring kine i Icircth lrr phyltical eXegraverci c~ tllat in ele
spinal m ot ilIcirclY sil nid 1e lt1 oid cdrt ~
Organ ie and psychologieal impainncuts and li islbi IiI le
A cgtI im lc pmi nr is moriOthl11 just 1 sp in and 1
compkt gt Ipp rnach to the gu in ad 1 ont i al~ shylute l e~se i t i11
[)a la 0 11[ [n ell lrom re semh pw tbat ome organi Iilnctiond cl fki ts suc]) as tlw clecrtiUe ut vild l tnd d fun ll l)Kity_orld ldly incrtJ k whil~ 0 shy[io s i -till in (1 miel q g of g JltlV ity ~ l ilI e 55 rtI lit
tllL pres e n ce )fl defidt Or Vi l~il Clp~1 - i~ ln one pIIiem in Ihr l ftectecl by 20 ICl 40 scoi stgt l ls~a r(h cunclutecl in tbe UA by Di Ruce- prod uegraveed an aaalo) u ll1lXimum 102 re u t in a group of Jd shyk 1ien t [(h sco llosls rang inF frum ) [0 1
Al10ther rudv bv rallt r m C chr111 lilcl NashycWrl1s( u 57 stlO eltt hil $(C 1 1 ui~ Ica js l( lllt cl (1 shy1prUlllI o f t1tgl lie bJd l imI in ~ul sct t1 t ltu b middot iects jlLltr l5 they are golng through ~I cltlici[e sllge in the fnm 1lt i n 01 tlWH o w n id uHitv t factor hit h Illy jeopmlize the cl velopme lit d ~ mIll lt lI1d htIshym cecl IWI sonalitr in Klulrhood
n RUI ~IEDl(( Ptl Y1-
ROU ltHmiddot PI [ I C~ 1 EXIRCIS]~ IN TI Il nW~JUNT OF SlllO lDIOP1HIC AI)C~ESΠ11 C(gt1[Oi 1S
This i why b IiCieacute ii is ~n imporrlIl t for p rcshyvegraveml e 1tLsr l tn en ou flge 1ari e nrs ~lfrecr(d by lIillcl middotu iosis ft) tlke p~l rt in portin -re rcatioluJ acrivitits Iha t 1eIU 10 L10 th r~1chophyinLl bull nd b~l )i 1l1o tur adlieem t n li 51Jmiddot2Even tlK)ugli [Dr bic mech~lnshy
ical mcl nellIUll10t 11 11 reltl ~ons lt r111 1gtomcrimes be l lefu l to ugg( ~t ne p rt in~ aCt iv ity r l h (gtr rll n anotlJer e th ink Ibal an exces~ ive IlHd icalizltion - Icirce l ll1posilion br plry~ilt i HlS nnejlor parents uf rh ry pe of po rt to lx p m lice 1 b Ule p 1Ucirc(Il L th1[ preshydLl ck l1 is fret clOice in lh ma tt r - -h II ll1 he avolc1ed wb 11 possLhle mainly for tlle i mport~ltll psyshyLb ) jogka l fe a SI)nS W( ha( ill ~ t nltntionegraved
Conclu ion
lbh ISsertegrave d t1H physkal tgtXtlci o is ) n fi ial whlIl practinu in order 10 ilnj rove the I11 llde
rœ nwh and tono C iral caplCiry and postu re o f the StOUO(I ~lIbj n II I nowkdge om ~ middotmg trom ci el1shyrlfi rls(~ Jrc li dJlJ accordl ng r the review 01 thE litshytirlture prnpo )td in t lli plpl r conflrm~ Ihe vuiclit ot th e -t ls ~rti ()ns
In l do l (ent Id iopl1il iC scoliuse il l n phee u i cl vk)pm e n t ( li tll iumlKh eXCC cl l g i en rhk thr hokl th e re i5 an und ubred need fn r l pprnpri 1tegrave (JJ1tOkJJe ~Ild Inr surgict1 therapics ill ortler 1) S l i p
the ( - Iuli on anugrave )JT~t~t UW ~pilll l dtlormities bull evshyerthtless in the illiti ~ll pl l~sC t ttlC c1iseLltc whcn the riS( r1 r euro )luli m is rtduced ocirc ~md tfle uifleal JOld threshold il ~ld flle po stural collai i reJcenw~ 43
JI l1 igh pllysicaJ egravexe rc ise - p revenc or r d llCe d i ~lh ilir ies o f [Iw ~ l() li )tic
p (iems R 28 J -6 5- 6 1 63
- f~KiHtare lh ( n utr ali711iCUl of postu m l d elicits tn produCel1 a coneql l nce J [)ti 0 I111)( or regre si -u lmiddotc 5middot Il 1 17 ~ M
-re 51udles U ~ n Ledecl tu con[mn or re jecr these conClLL i( 1 w l1 ich clerin-d frum 1l1 lIldytica l rcltw n f th e liter~iture appear r- ~Lo nlble Hnwecr Intil ne re ull are 31Iable wc should n r prevent our sroliotic patientmiddot trom tl ki ll p lt in s(loI1ing jshy
ir its pW1iada rly ltl t ~d1()o t () n til t c ntrHY -vith the l xcclrinn 01 gt[1 )11lt tIlat in rea-e t)1obility (tnU evc n thell oilly wh n progr~lgtion b p OSSibl) -uc h ~I( ucircvshyiUe -11 )ulu hl tIKoll w g ed The 11 S J ( rprOpriue kin (~irhe r~l Piuml to incr _~asc p()~tura l $llbil i ty is tl1egraveoretshyic tlly CiJUClt alttloughl more ~Iccu rtte aod deLli led ri k benefi rs anJlr~ is is netot1ed
Ria 1111tO
NIokl Mu d lle ftitYljJfu Jœl il 4IWr10UOifll S (JIvs i (1~1)Jshylidl ttno( cclIll le 11(11(1lt1 RCI fu lle ((lia LltfIt l1 I1I1i(i
LJ ci n s j(r3 pigt egrave li n IHUgru lkl di t rdz t fi sici pe e ft shytUlKm iluppno di un lisimerap15Ll rl lllcflt() 1 110 scopo di pnevirlt () fr en~lI 1-lgpwlllltnlcgt dclld lclonnitugrave o e il 5LOshy
Il i mi llon lt fH nugrave j (1 11ni dei co~e 1 lteIl I1J J nd ne ~Ii eifclti (()Tc rri udk s co lio si d i m e dia g rt iuuml ln que~ltlt
s rud i 30 llizzb mo i d ti cleU ric lca pel n ri Icare qJJ l lm 1 dis(imucirc x u le I[~ l z j-m i pro vna le da lla C gtl k A i json ere pr middote-nute () rk kl ducirc un~l rdeguCltl d nil cra pi lt di uJoseguerrnt Cjua li 1iU110 cli nbie tti 1 rcr lJ)tIId d~ fle)-UITC
n (- -fd7Io n~lcl)
Ut11claquo)si 1 lI tori htpnuuml )ludi-ttn I ~ cnntI1zttu fr Cq(in i idiJ)tic1 dbfl lOZ10l1 d d ~ leOla nelllOll1otoriO Lb un1I1cnUl 1n1l1i3 dcgli 111 lt1i ch DIJgt gtU l H crmU1 Nlch~mslt ( SIshygnaJ~l lerimiddot wo i esuemi -bletti d~ plt~e8lugraver- ne l pClZ le1lftgt scoliodcu kl s iluppo ddl ~ ~ uhjlil~ vertcbral~ lt o svilllp prJ Jdle JIl7 i() nl di ltCjuiljbrio Dng li studi sul lto lb( l~nlrale (OllddU i in pa rticdu d 1 DlIal-BeHJ (gtegraverl ~ P~II IId lI1 n~ llw - idente il v- m gtiu p eT il puientc clioti elgt di u n rnigb o t c)[ ro Ua sw mle dei radlldc onsegull o tramite il 11 fforzrlshyfl len to d e i l1luotoucirc l nllgr3ilri d e luOwo con crcbi ~Clltdr
in pOMltHJ corrctl e in va rie ~i[Jzioni s t llicb c c d inamIcirc tllt Dalle on sena d elb blOffiCcclIlicd tr idimlt n s io mlle d ei
r ~ chi Je ~oU()f icn ~Icirc ~videnuumll (l() ~llt tC p IYZIcircOSI ln(IiClZlfHicircl ~ 1I1shy
liumln fluenzt Je ll middote~rUrio tl SC) lgt lIi I rc pibull m i tldln sJlI71 Stl shygn~I I1 afferma che slI l p Ia no [11 middotccedilr~lk tre un œ rtlJ grado di l L1Liuuml IlC dclh vEltlh r1 apj(de le tu rœ mu SCltJ llri njtbc J n in $tJ ) t rodcfQfll1t1l1te PltJtantu b i r~it-~ r -lp il puugrave t~~
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EUROP MIDI C Pli hIC
EDUCATIONMEETING SATURDAY 8thof APRIL 2006
(iSS
SEAS02 Scientific
Exercises Approach to Scoliosis
version 2002
G
S Negrini 1
EDUCATION MEETING SATURDAY8th of APRIL 2006
Neuromotor disfunctions
Neuromuscular disfunctions
11 Postural collapse
Postural collapse
Duval-Beaupegravere
Flexibility of scoliotic curve
f---I--- I Postural element
-------1 Structural element
S Negrini 2
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Postural collapse
Duval-Beaupegravere
It is a value related to muscular tone and to flexibil ity of convex side tissues
Post ural collapse
Bunch e Patwardhan
Critical load
Load threshold beyond wh ich a spine begins buckling
JI~~Wt1lW~flfthtlJlœJtAr ~ J~It- l~l - IMS
Postu ral collapse
Bunch e Patwardhan
If a curve reduces there is an increase of the deformation threshold
~~~NW~-damaoc~IIIMf ~~ J~Iv JaJ-I7I9sect
S Negrini 3
EDUCATION MEETING SATURDAY 8th of APRIL2006
Postural collapse
Torrel e Nachemson ~
Scolioses below 20deg ~ ~ lt~
have a high ~ ~ percentage of ~ ~
~postural collapse (on u~
average 75) ~~ 2i~
CU~VE O EG~EE S WHllE SUPlti e
~laquotd~c6b ____lPffI1wtt1t~
$ww J(t ~~7 JM5
Postural collapse
Minor scolioses 7
Antigravity musc es strengthening D
Reduces postural collapse -G
Increases the critical threshold of deformation
G
Neuromotor disfunetions
Stagnara
If we admit that one of the causes of idiopathie scoliosis is a disfunction in balance systems it is logical to orientate physical exercises toward this direction
s Negrini 4
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Neuromotor disfunctions
Dubousset
Idiopathie seoliosis results fram alterations in praprioeeption centres and deformation is a natural compensation to restore postural balance
etattJtitIK ypothfQj~S ___~ own_ oJ)HQr lar 1t-1( r
Neuromotor disfunctions
Nachemson Initial idiopathie scoliosis
+ Goood spine stability
Neutralization of postural deficits
D Static curve
Neuromotor disfunctions
Therapeutic aims
c) Development of spine stability
C) Development of balance reactions
G
S Negrini 5
EDUCATION MEETING SATURDAY 8thof APRIL 2006
Biomechanical disfunctions
j Horizontal r-Ian
i Sagi ttal plan
Frontal plan
Frontal plan
q Frontal plan disfunetions
Fronta l plan
Perdriolle Movement magnitude
gt in the direction of lt in the direction of correction progression
S Negrini 6
EDUCATION MEETING SATURDAY8th of APRIL 2006
Frontal plan
Stagnara
Never mobilize a scoliotic curve without ensuring reduction maintenance over time otherwise a greater mobility favours scoliosis progression
Frontal plan
Ducongeacute~ research
On a group of adolescent idiopathie scolioses treated with
Meacuteziegraveres gymnastics
D After 1 year the mean angle of
curves increased from 18deg to 29deg
Frontal plan
Scoliosis without brace
D Greater spine
flexibility D-
Risk of progression
S Negrini 7
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Frontal plan
Mobilization is useful
D In preparation to
brace
D With brace
Sagittal plan
QSagittal plan disfunctions
Sagittal plan r middot _J o
Perdriolle scouos B CJ aDeformation of D
thoracic and thoraco-Iumbar curves evolves in extension
S Negrini 8
EDUCATION MEETING SATURDAY8th of APRIL 2006
Sagittal plan
Graf
The line of gravity centres in the vertebral bodies o s c oUOSt
projects itself firstly laterally and then fi
o
posteriorly lJ ~~ ~~ ~ ~~-_J-D ~nI~
Sagittal plan
Therapeutic a ims
D Maintain or
retrieve physiological curves on the sagittal plan
Horizontal plan
QHorizontal plan disfunctions
S Negnni 9
EDUCATION MEETINGSATURDAY 8th of APRIL 2006
Horizontal plan
Stagnara The forces applied ta the spi ne act in a autoshydeforming sense
Horizontal plan
Dimnet Rotation gt 200
ampII~ (
D The actions of concave and convex side
muscles become
agonistic
~ItJrOnrIIiItdllfUClltlluumlll~~tI ~1JIf1laJ
Horizontal plan
Minor scolioses never exceed these autoshy
deformation thresholds
S Negrini 10
EDUCATION MEETING SATURDAY8th of APRIL 2006
Disfunctions at a biological organic and psychological
lever
Oisfunclions at a biological organlc and psychologlcal lever
Cheng
Bane density in scoliotic teenagers is lower than in normal subjects
~~~~middotA~IIlUtIy ~7œl 1d l
Oisfunctions at a blologlcal organic and psychologicallevel
A significant reduction of vital capacity and V02max in teenagers with a medium severity scoliosis
S Negrini 11
li
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Disfunctions at a biological organic and psychologicallevel
Disorders in the development of body image that the teenager has of himherself
Disfunctions at a blologlca l organlc and psychologicallevel
Therapeutic aims
cJ Activate cardioshyrespiratory function
cJ Favour bone density increase
cJ Develop a positive image of the body
Disfunctions at il biological organi and psydlologicallevel
Stagnara
Sport
D The active side of
kinesitherapy
S Negrini 12
EDUCATION MEETING SATURDAY 8thof APRIL 2006
Disfunctions at a biological organic and psychological
level
Distunctions at a biologlcal organlc and psychologicallevel
Cheng
Bone density in scoliotic teenagers is lower than in normal subjects
~n~IIIvpWr~middotA~stWy s- XXJl M J
Disfunctions at a biological organic and psychologicallevel
A significant reduction of vital capacity and V02max in teenagers with a medium severity scoliosis
G
S Negrini 11
EDUCATIONMEETING SATURDAY 8th of APRIL 2006
Kinesitherapy on the scoliotic subject
q Postural control
q Axial stability
q Muscular trophism
q Balance
q Respiratory function
The limits of kinesitherapy
There is a threshold beyond which
rehabilitation alone is not enough
sssr
Kinesitherapy in scoliosis treatment with brace
Therapeutic aims
S Negrini 13
6
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Therapeutic aims Srace kinesitherapy
With brace
il Postural corrections and
vertebral stability are obtained by the brace
Therapeutic aims Srace kinesitherapy
In preparation to the brace
il Mobilize spine on ail plans
Therapeutic aims Srace kinesitherapy
With brace D
Maintain a normal spine elasticity
~ Maintain a good muscular toneshy
trophism
C Model the hump with kyphotizating
exercises
S Negrini 14
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Exercises and their methodologies can vary accord ing to learning and individual sensibility of the single rehabilitator that proposes the m provided that they stay within the
Iimits of fixed therapeutic objectives
li
Therapeutic modalities
(Exercises)
QAuto-correction
QRespiratory education
QErgonomie education
QMuscular strengthening
QDevelopment of balance reactions
WNeuromotor integration
ci Vertebral mobiJization
QSpecifie modalities in brace treatment
S Negrini 15
EDUCATION MEETING SATURDAY 8th of APRIL 2006
The protocol of kinesitherapic
treatment
G
QChoice and dosage of exercises
Variatiosn of the work program every 2 - 3 months
Q Execute e)(ercises on an individual base or in a small group
Q Frequency not less than 2 times 1 week
Involve and awaken the family
G
S Negrini 16
EDUCATION MEETINGSATURDAY 8thof APRIL 2006
Q Determine the action and the localization of auto-correction
QAuto-correction must be associated to ail exercises
QAt the end of treatment ergonomy lesson
Auto-correction didactics
G
SCOLIOSI DORSALE---- shy ----
r
S Negrini 17
EDUCATION MEETING SATURDAY8thof APRIL 2006
SCOLIOS OORSOLOMBARE
shy
SCOLIOSI OOIlSALE 011 bull LOMBARE S1I--shy
SCOLIOSI LOMBARE
il --~_-
S Negrini 18
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Scoliotic patients are not radiographs
middotSeoliotie Mtients are not ndiographs but hum beings with a vertebral deviation-
Slagnara
Metha For the physieian Cobb angle is of utmost
importance For the patient it is body deformity t hat eounts most rib hump a protruding seapula or hip We are in a situation in whieh today dodors eure the radiographie deformity but what the patient really desires is to get rid of clinieal deformity and of ensuing psyehologieal distress
CIIQItIo shDuIdtucirc lM WIld tJw~~ I~~M~~~~ J9f~
S Negrini 19
- Poznan_workshop_Physiotherapy
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ROlL UF P l 1YSICAL lXl 1lt 1~E IN l IlE 11 ~l) IEd If IlU) l[)VP 1HI AIJ() J)~Cl~ r COl ~I NlG1W il
f)( 15 egraved ( )Il the nee L- 01 indi iuua l pJl itnts) al l l10ugh Lheacute) C l n h t 11 plicd o n a WOU p hJ~js (-1 (0 () pnients PC[ ~l ()lI r)middot lugrave reQCf lhese 1 10 grl lll frequt ml~ V IIT
hnm on in middotituk w allClthltJmiddot -Ill Jnv L l~egrave at Wc w Ht ~huw in lhis lyl peJ it i~ 111 n u -eII1 tu id e ntilv kirK itheJapturlc aims w hitl l ucircrr~spnd LO ugravelt~lil1 DUtshy
g X ir ur ph -s ici l lxtTi~l I~llhe r thln ln dj( us- indishyiJ u1 1progr-lfll
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i lt egrave~ i middotomm )Ly s iven lel mJ ing ro w hlf ~ Iuumlnsidshyer~d usdul or il lrmfu l in t1 lt rruning (lI tJw ptliJicirct ln tl1bplper Ugrave1 gent ltl l t rl ll bull p lwsiCUgrave lttG iviUes is rl ktll 10 JllI1ltlCc hOlll gtpOlt mJ kIJ1lsIcircl hc lJ l f
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1 t lltrJp utl t one 1 md rC j fkll l~ on rhe h sh lf som uni cOen I1v pn t I1cgts wt ldl hll ltl enl1 JI~ haLl nu na l scicnt lfic baisYmiddot HOlh tlle$( trr t peu shy to rh ~rl py tt nJecI to l~~rJ tte C Ih tk CUf -~ pnnshyclr~tll y as a f tsul t of lilo h llIzatio ll of tn imdqultdy ~u pp rt(d S pln eacute 7~ 12 to re-t1 r rI ltrl 1$ l l1C k o f WH llt~~rdl 10 I ndt~-dll()urnah tnd 11( on1 p~l per u suaJly Cl tc([ IS n prelimmtrf lll d 3 ln tt li w ay man (l rrlKpt(Hc H lf O iS Inll ph ~i C U l ~ d vi ~ cI nllog scnliotl pa t le nL~ 3gainst holll ph lca l egravexershyclc and p()rt~1
It m u st t~ n tfd [hat pllyknl txerc j~ tJe~ltm(nls t1iHer 1 lJ rd il1g r rhe rherlpcu tlC litTl~ on lllc h tJ rgt ap p lolc il l the IXlltent lncl hi im r IIIllHnt i- 1 (1(1 rI - 5lt1J lC igt tIl l ( f phJllIlllolopJ al rrea tmln ls Ihith cllffc r 1lt œQlfd- rhe m C cculc u ~t(l luI thl p al 1t n
~mc l 11i (lbE~e Tt i ~ P ~il k tlwreI[middote thll wuumlk ltlll t kin 1or ph~ i Clt1 1 lX r(j~ 1I 111~ t bc loidvd by t h~ Lo iurie IxujCJ1l al1ulhcr a dl ~IS nJI h~ iOg (1 11shygerols llugJr in racr le (wi ller d I ~fJIII ~ I ml thlls re(nl1l rn ndc(1
fn n UI cel1ll r we In(~ hccf) using 1 ) 1 1111 11 ve ) 1 (J p lw l icd ex(r(i~e (0 J ( 1I l tt i~ tlh aITt ~ l~d Ilv m ikl tru cflumiddott1 adokscltnt (cl ioj arh lC icoli is11 2)
ina the f U~ t rc-gt uJrs IefC pu b lishe - the pJ( )grd m 11lt1lt l1te n PWltllk d in fa c t deel()pnlln l~ in th t l itshy OlL1Ii in tl1 r b t ~() ycal f ha ve iclemi fiecl niO l l
m d 111 ur impl rnHm s md d i s )h ilir i (gt~ lue t idlo p lthk amp()lio -i ~ t Jll CIII he 1UO(l if Icirc 1by phyict1 egrave xert iSlgt l fe t rrncllt
l illl
111e aim of t l1JS r~l per ii tmiddot (tv iew tl1( l iterat urt to a(errl ln v llic ll of th~ impa irm 1t~ and Liit hil it il i GllIltec hy ~ o l i()gtj s -o ull he ll nt x or re middotlu celt1 Ili pl1ysical xerclse An u p-to-da te knOvkdge o f tl lt Lgtpecl-gt i necckC1 in rJeumlr) d -oek
- whetll~r there h ltl n adLtIIl ) l tht()d ical bbh fur or JqIIcirclb l l l1 Il( ) f k irt llit herlpy
- h N I)(1 ( 1 Dm tlle p r l c tIcirc(( o f Jebur tiJne )pOfung lcli v l ti ~ IIOU lci he tllf) -d o
II J U V f h 1 I11~ c~~lb li hed Ihe usefuhlLss 01 k il1 shyc ~thtrpy il i aIle dy l nsi 1([(( -r-tI Llleu i n )I11 plJt~ ut the wJrld ir ilt ecircS~nl i 1 I( id n Iv w l1i li ( 1shy
gories 0 1 pl1Vtl( 1excrClgtegt te D)bilI7it ric 1n (Ir st shylliuumlZltio f) lttlt tlgtbltn ing ni trcrccedilh ing erc) hn Id be
vnlcled he tll rhe nuld be lerrillldll1 1 md whidl s tlQu1d be inreœ jf ic(1 IJeClU~l tlley cOli lel Je LI ~ful
Ncuro1llotor impainncnts
Imv aUl llOr~ 11 lt1lt ~tlKlteJ lhe cltlndatiotl bd Ween tl UC1UmiddotIt t l ol(~C t nt id iopml je -nll ~J~ and cli~l l shyler~ lr 1tH lest ihuLIr yt 1 _ 13 ~ 311 D uhoussct 1
1-- ITS tln l ldiopath k s(o lio-L L cll -c d l J l hmgt in th terl tltr f prop li l l pu n md 1I1ar th e detrshyn Hi n i~ na tural 1 ~ronse to ril e need tu ts tu re p()tun ltlluilib riu Ul HcrmJJ1 31~ 11 () d tllat icliupathic ( liCl5j h l it re5u lt Ot1 rw nltuf mot r l ~ltelV
[Id )fcl 3 nI] ~1ltJ U Sr1lle nr to dtorders in centJtI lO~Cl shyIOIDNur) md 1xi~tI moro (Ul1lfOl syt( llI (Fig _l
N htIll -of) H1c S uumll h( rll1 ( ~ l( w ing JI t11 (oshyI-ie on the l l lO]ugy o b doll (nt Rl iu]icirc tlili- middot()lioL m unt fil t-hltll rhl ugravedcmnilV L th e fl5 ult o f 1 (k btcl 11lIFll llI ion nf som t11(WUgravetltnl md pO~ lur( (tnic l~ l licirc1 tl1lt if l p OgtlbJt b C 1l rlw sta l i lin 0f 11 1 Sf llle j lt g )tx l Tt) ohtil n a ))Cli U 1ILzltl I o f p ~llIr~il d l~flo [ in l1litkd ~J)llnSIS me CI Igt(middotqucnr J ~ a ~tmicirc ()nlly or regle Ie Llive
Ali th- 11yp ) tlw~es rd ~lte tr d irtl Itn t pnl1tlt o f [11 v hole ~piltm It11[ controls postu re ~nd mrw shyment lrre pell ic of tlh po int a d lI~ llv inH llYegraved il i ~ ll 1 nnable tCl aSUilll ri 1l tr l ll1 lo g thi ~ys ttm ( Qu it le 1I middoteli tl
lt ch ugt nlt~(S f rullliIl thil i nlomwtion th at p tlmiddot shyiCil J(tl iIies nw gt Il lInport~n t rr le to pbv [11Icircgt role ca n 1)lt slI i11l1lariztd ln lWO the ptu li ain Llt
- d elopmll1 l of p uumlltl St1 b Hlt ) - c1e veuml IOpm 1)[ o f bhll1ltc _
(k llhUl)lOr S Cll orr
ontrot oic whan-lt
------+ 1 ~ il lnll ugrave r AINnl
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middoticoltoq ~ Fig 2-AcFgtrdong lU He-mutl 21 il is Fi)5~ ib1e rD prolXgtSlt l -oo ie1 mnd 1 ((if ~ elio egrave middotAhltr~d l)Qdy-p ati~ I I i u d) uren ttllOn k td LO In ~ory reHTt I1 eDi tn l al ) JdrnlV~ pn)4~ e l u r~o(Ofe 0-c1 eptunl dvstil t1 ctlon sltŒ(ry icircltu nu11t ilwnt [ ~mC ~ted tl l1 ce Ill trpntlshyUumlfJJl nd IKnle~ r~dibl jtugrave)n of -I) m tlosen Ir ~ig nj tl (I1vying ln fornll1U n (lI an ereltl ~piJl e Mmor aJJ r--a t ~) n ltgtf ti lt aXljl mowr plem iHUC Wh ~fl Ille 6ubjeco m uumlntl Icircn (1oJifitd perccpfLlI l ~na l ysilt of p n)lnocepti Icircnfu rnlaquol ti desnibJOS ~n t tecr spin A IICW motor co nrro l Ira I gy t adopt resu ltin~ in the ~tr ltctltr 1 ckformh y lf IdiopathirL scollos i=i Ht lrftU1uc nltnt l ISll I1lJy h1e- ~ I pro()und elkn on bralO Sfem flJll ct i(lnn~lLhu modifyRll Ille nltulltgtshytl10 ) 1 1111 Uu l-lHoror control 5~Shnl$ shy
As Srtgn1lt1 l ~ ltlssert~ if wc l C -Cp t 111 1 un o f the G IiC s oliosls L l tisorckr oi th e ltquilibrilltn sys t ~ms it is lagical to oriegravenrate physlCl l exercis( lherap y ln th is d ir(gtCli()[1
11lclte goals Cul tl lfOUgil ditrercn t modes 01 action be Olchic(-c1 witJ1 phykal accivit ie
- po rt ive Cll ities p ro ct LJ e aIl UgravelClltrtsc in 6lte nshyel ll )o rd in~lti n pinai pr0prinup ti_)[J nLi mOVeshyment control 0 vio lls iy ln thh repect ome lCtivshylites aœ pre um~I I)y lXrter tllln ntil crs
- kinrl lira py using pedJil exerCisocirc specially developecl lith th est 1101 5 in mind illVuuml VC I lllore prccilt( ll1d InC1 li zed cri n on rhe spiJw focusing
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lg -lNheJo ~1l l1 t r~l g rld in 1 1) h i(~ IImiddot ct r rHienl w i ll idlllhic _It ~i ~ _ iri s plt ~I le II find Jit ltH vlllleuml ~l Cgtbl tn~ ks III d il fef lt p ~ lt ihnS nu v~tl middot B ~a~pt u Il C middotl)Icircd ~(t l l11 C dlfkrCnl middot- hdween slllndi1g Uline nu nllt1Xinul oorrec ri nI t chied Vith Ct (J ) und tfdincJ ne lot es o UIine 1 fo llnVs middotIJfl tfi ni( - ltlrshy
reltiK)n ~ Ikexibiliry st3nucircing - -pirte - f ur~1 1IbjISC ltupin - ltorrcaion - - r~luci()il ll ymiddot For flmpllt in J npK l1 pH k1J il
plt1SSlhlc ln obtai n 10 u1 511ndlt)l [YLo lion yr ln Slt p ille rlOlgt itlugraven om l J ~ in ( gttf(C rigtIl lIex lbuil 15 i (r-l l=22deg pol lltl ~~J IIlpraquo is IcircO~-V- I t1 l nd tucircu(Ugrave) ilil) I~ 3laquoJO- IH-12
r ln Ugravel e abilit jl of tluuml [m e llu to co ntro l irse lr in ~ pac
fuld l oftlles uumlllelve ntio ns can presum1b1r incn~~ Ih enl ac )1 the orller and lHitlll r of Ille rn - 11 )ltd h e lllldenl lu EJ3)4il
Posl1l1-t collapse lnd slabilizariotl
lIle concept u fplt st lUal c(l lJap~e l l~t Iwen detin 61 by DlI II-T3e~tupegrave rL t Ac oJdin)j tu tl1i- ~ll1thor il [ nec(sary ~- l Hn Cv-tlualing th tleihility o f a col shylo tIcircC CUJVL (0 clistingu ih bt tVeen the re du ihil [ty index (th - li iffer gt le bet ~middot Il ~I r~tcli()grJph ie ~xnmshyinltio n of the iI111 pHienr in supine po ition m(i
ROte OF Pl rnmL EŒIlCISE IN THE TREAT-ŒNT OP ~I IJD IDIOPAnnC OOU~GEm seou SIS EltJRINI
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P01(nl (pntt l ~ 1 1 nr ffll wrJ I) ln w hilth Ihe n i 1gt( ~ duc nL~ grlphs fm I h~lt 111lt hi~hr Iht Col h ~Ilu t (l f Lite ~Ul Ihe m Ol CI il y th t s(uumlJotil middotpin~ ~111 he ~middotJg gr~lVH(~(1
m mJxiTIt corrttt ion wll iJl i~ lIllCd to Ih - xt 1shy
lti Oilil y Jf tl1lt t Ut JO rl1t cdnUc idt md p OS shy
tU ll cul lapse ( th t ltHill enct b-tten l lUdioL) 1lphic egraveltamJl1ltlti OI1 J t th e ~lme pa tient in Sl il tl cling lOJ lline fX-sitiutl ) Wll ic h correb lc- onl wil ll fhe abilt ty of lllt p tu rl l gt s tem to C( lunternct lIk luree o r grl viry )cco d ing rv D lfVd- f3egraveLIprc po st li r t1 lt01shyIlDse is d ue to the Jnus -u lar ton a nd 11ll ex rCrIshy i) i itv of rhe tissus n the ( O IW-) si it (If the (01shyjl ti (~JtVe (Fi~ 3 L Pu~t llr1 C lltpstl lu lcl l ~~ reduc l-lt by llwans o f pl1ysica l cxerCles specitkally s tuclled ruuml i rnprove tIlus--ubr fOHt md lU pr )cllI Ct 1 ~11 hi shy
lizing ffCd
PararcL n tll CIJ cl the cr iti ca l (3 c1 thlsho ld beQ ld Il ich defol1J lHU n of the i pinlt 1 e~ in~ ne dtlllontr~1t _cl (1l ll t grclrf r mg] o f rllt C II in a qa m bng pos ition corn pOil 15 t l lowcr detormashytion lhnsllold (Fig 1) ie to ~11l Ulne3Se t the risk of pr ogr t~ lu n There t rh eJef re l J ea r l)iuuml 1itshycJ l ~ll1 l l(tl a 1 tnr tg ro b ohwined by d -cr t l ~ illg ilmiddot pU~lUrll cull lpse ptJcelJtge w bich lccording t i)
h llTd tnd ~l(heJ1l ~on 1~ b inde cl 1X llt icularly luumlgh Ugravel mllcl c Iio~ i (bdow 2( 0 ) (F ig 5 J
Fin a Il III ch iS respect lllljl hl and b um l 01 m linmiddot
ii iI 1 l _ _~ _ ___I ___ ___ __L ___ _ ___ ___J______ ___ 1 ___
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+----r--------t-------t------f-- J
Fj~ ~-Ac(XjJlin(Q luuml T O rIcd ~lnd Na(h(ln~ n i () dl( pCG w rd (rTIshy
POO ll is hiherin cu rvegt in wh ilt l1lh ~1flILWrd cII1I Olk l1t IS le- pr(v~knt ln th e grtph Ih t PogttJlJ I ugtnq) Ot1 -J1l j elfltS-e J tlt 1l1t obb dirr remc rlLIv obu incu f roll l the Cohb atl( 0 1stlI1dtJ1g IId gtupinc rldo~raf115 Ih Ille lt) [1l1t1 (i lndnl I pine) 511pille the ~(nlClu tJ1 compo l1lnt U rlk CU Y _VeJily I~ ltx p rlt 1 L1v UpUlt (obh Illeturo Ih t si _b Cct rtJeSIm l fie -ltn J trd Ugraveltuuml shyuumlo n A~-i)rding LP 11(lt uuta o n l ( r1I~( in ~I 2JQ sup itlt curvt 1hi C(]l)b ddhccno l l f lO is -J-lultt( thc s ldnd inr tnla Ol1l t lS wi Q) whil 11) 1 1)401 ~llp lne ClHVC If ~ 1Omiddot ( tcl Lhe ttnd trl~ nlca~ I(t I ~ ~I)
tli n ll w l lllE cq lin ti spin h~ i ng mo r ~ Llnt~II) 1 tlun the nOftl111 one n Cll l gr(lk ( (cU ve tl1u n da r u p shy
po rt in o r k r 10 m linrl in tht 1xi11po tuf_ n th ha__i of th egt onideratl lr1S it f(lll() rhJt
ph rH (~Uuml e erd es ulukl h u - ul iiuml tbeacuteY ~U-L lm cl 1l (It-d o pmg p05111 td C Jl1twl lS fuumlrnll~ rly d ccrll1td ln an Ql St if i imr ol1111 t ru t(( - tht m(d in C JI shy
r t t r sture fO Ir -ngthen tlll m u ck-gt of the spint mainl) in (11erl antig r3ilrl tIcirclt l]lli fun ctin ll U hy meU15 dl i )ll1 t trk ~ lhJ cl( -ll tlt C)nlr~lUions ~llld no l IdOshy
1l)llic d YIltll1k lt l jAJ lktic t) I1 ) II 11)t 111 hd posibleacute t lcluuml ee postura l io nrro and stfh ili lllllt IJI
w i thout food T1lw(ull r d I( Lf(11 Ibk t m ucircnuin Ihe c()rf ~ct [ ()S tu re for cl gtu ifKi IH lLl1gth 0f ti l11 ~
This i-l ddl usl a typl 11 dnmnin (tf k inesllh rap) in 11 (lt-11 [[k - p~d fk lnr in lng f u l1a in llllliCk is poss ihle lI sing ctrtain Idncl fJ l (lt) 11111 liun S p Ul in tb is Cl c is ulttful ooly sa I~tr 1~ il Iw lps t1w lxltknt 1 becuJl)t 1gtlt ltlt-I a ClJu~l inred irl ilL ntllru l o~ i cll
and I1lll~lJhl r-keJc LIl [rll-llIn~ middot etlt(wrs JI the int e rmiddot vlnrion
[J ROPA MfJ) I()Wf-I YSJ IR
1
ICR 1 1-1
r
1 shy ~
- shy
11 o-llrfOlhe5l~ o t Ih 1O~(1dity i n h ~ r ~ ll nr pbl1 l of ~ Spl11 in 111011 _llti1Gt l lPt f ltlJUCWJtl ( ~l Ihe Ir t 1 1gt illbll W Ilh LtltrJ1dlion Vln lbe rigronl middotUII~ l(I Dko n12 lIll h lumshydlanie1 1 [ nul 1 M hl whtrc M - gt) lnIUI1g 111laquo111laquo1 1 1 c rtJCshytjC~ f fce d -d Lill l1~ o f enr niI pUll spnmcl1y 1~ 111 mldlll1lt (n the fl1ur t 1 = tor~ of f(ward Ileuuml l = ughtel1lng fmiddotr p 1shynOf stn lClU= Alaquo rdtllg 1raquo Ihl~ - lin hull th l1ltgtllugrave ot tller1l lUr~Jtllrc F the ~pin t -ilh rlu1i tf Ihl 1 1Ibulll n lrlt InltT1 1
rbc prJI 3IJi l1ty d qrlOIJ~ n bull JI t IlJIII Hm lA the v=ltd gtc e lu-ing J 5lnK1ura i ltfnnity
Dioal e ch anicll itllp~lir J11 c nt
Ihrcemiddotdimcllgtional mc-cbal1in of the s pioc
~f Ikmiddot i t i nly l(œ ntly tlHr llk pr-5tnœ or nc ushy1 lnlo tnr impairment in Idiopttlllc s-ol ii IXl tknt liuml J$ heen h i- ll licircghlcJ hy re$eJ rh tll e preit ilegravee h inm b nIcirc Ji d lJutg~ lt hl ~ 1 ng t o n dO Ulll urcel 1 i5 (l lreldv well umlersrood H(j-ev~r nev lbt un h iomcrhankal im l) ion nI h1c rectm ly onk l n tIlt tre and p r~dou in f n rmtinn hou t pl1ykd (~fcl5( in t 11 0 tl1I _ltgt pbne of spact 1115 Im trqlt-u 1rom J i-[) v ing unclcrsrmdlng ot th l lmc -dim nshy~ilnl l l11 ~ hmk f the cO]jO[lC pln( ~2middot ) ) Ve- w ill )iI xnl t l1 d at lcL-orcltng tUl cl sif iol t lOn blsed o n gtolllt lricd h uumlCJ ) p lane
- b() rJzU[1tl ln th i pla n ~ th t 1o rm ll sp ine present no CUlye- w ll ile Uumll(~ ltc U Hic spLnc clevelops one of ir haracterls(Icircc deFo rm tiCs v elt tbrd ln lashytio n vh icl1 pJ()VcA~ theacute hw 11
- lgitltl in th llulJe U l(~ nonmll spIcirclle pl SenL kypl lOSis ~nd l dooi~ in tb lXI1 lhese [(Hu rts Vere m)( til ught [ 0 he relattd tlle scolkJtlc ( lI r Vegrave
- front l in hi pleme tht ncrmal p ine preseuron t no curYegrave whil thl ~11li tic p in ugravetI I ()~ icircl~ charshyad t Ilt I CU1C
Il Jri fJIIt palic
~l+I~na ra 3 r inr lut th l[ ber ll1d a œl1~lU1 degr 1
l f r()la tJo u lllu (lILa r forcKl ltxert ltJn tl ldefnmuumlng 1 tkllJ [J i1u a re- lhlt tll cly 11 [1 1 UI b y Olm ner w bn ~lh uiJwd tl egrave ro t1tic) l1 Ilm it ti lt p ica] lf shy
rhrl r() be (P (the Uma bevond Wl1iltJl th lCOJlb of [11( ~pmaJ musd ~ dthc COnCIt and nm ex ~l le btconk (t O li~[)
r ~l 18 ~1Il N lu t( ren i9 lun lu ted rlseurlt h in tlt ) tilt lULodeumlformipg1 tlo n ot tIH_ sc laquoJrle rh ox ercallkren lk 1l1~H li d11r once thl Il i ~ r tld1t5 [he lhrth ld f 111 JlIcirc lIi of tlle dnrlclc hurnp tlk
lI bslt Il l nt rlet()rlll lIcircon 01 the it l ()I~ C ( (ylm der (- sustalnecl by an H1tmi cforming aCOOIl
J1Ji h V hl rhyiical f~ f Ise CI 01 h spr n llnd kin middot ith ccedilrapJ my lX damlg ing vll e n l pplild as flle
igt Jk Iller ln SCC1IJ ~IS lllc lJ fxceed l auto in middot crca~ i n g lhrllgthuld [1 sh (~u Id ahn be j ofed that Ilw relscd pre sun 1l1111i insiugrave l fe pil1r inn) 1 mlshylt
- j Il- ( w atff 1 (nh ~1l 1(e Il10 utoldrml ng li1eCh~lI1 1sm
in flc l Geyer ~w tcd th1 t rm m 1 hI l)1ecircch1O lla1 puilll 0 l I C~ sw m mim t Ieuroamp no purpo t for cu lshyim le pllilt t1 s (weumlO middott r it is l~Jl(gtWl1 rhn in iculio r[ paULnl -iJl11T1ill~ doe_gt nor Il ~lp to i ncrt~SL n eur(1shym tor co mfU
(1irai p an (
Jerdnn lle 11 showecl thal ill CSl~ o f t10rLC IC 1i lUgrave
tllo lacolulllhil it lio_1 tlle cte tI llmiry in (he lg itt1 p lln t rn lnlftot il~ lf tspe iuUy in tlw initi 11 r luleuml )f cV IU[Icircon nf Ile ~oli ls W iU l 1 p(t)gr~s~ivlt il10middot~ shy
ment roward hvpok pho b G ll f ill~l Im lins l har dUflng (IN eWllLlfiu1 of 11Imh] co luumlgt i the l in t ot t l H~ gClyty Cegraven te l - 0 1 v llebed lxxli 5 r ro ject 1 seH fl r t side-ys and tlwn backlrcl bull thu~ p(0(1 lj n g a kyphQtlmg aet Il ln (h~ lu mhnr --PIl1 COftj tng
l l i tc Iugrave l lltl l( l rs1 tif s L -etllgt il l the lgirl11
1 Hl)
Ilu LE nI rIIY~Ic~L lXIlKISI 1 HI E TREhTMEtn OP JIU IDIOP llII C AD O USCUH O Ll Œl15 NEGR II
lLill tegt lre lenl1 ~I d ~fo rll1J[ ~ rhl recrSes the phyltiologiGII cmns of lh vine)
Accordlng () Dicion ~2 1 rtcluctio fl in the itgitttl CUIYtS combin l vi th a lueral Iviari n llltl ds t 1
mecban ism () ugravel~ta il ity in l he r rat r IllI1e which bVOf1i the unsd a nd i ncrea~e 0 1 co hlt1is (Fig 6 hiIf md Pl11jlbiJ Jl1eanwlt ile lt(udiecl lh e srnl ru t
orzyglpophySLs show ing t11 al ttleir 1I1tl rnic tl orienshytation f~I (jLi l~ltes aXIal ve rtegravebJl l rotllio ll in cun litluns lt f dorsal hypokrrhn Icirc tnd lum)H de i L lo IS
Tll t dat SLlgge 1 th t impOrfill ut pOitu res and l1lweil1 ) t Mudied in ord t r (CI mlIuml ntrlin or to reuwer fll e p llyslo lo~lCll ClIlye in lIe SlgJtta p lU)l Wlth the llm o t ch ~ kin~ rutltor in l~ bili ry7 AbC th ~e ~k-
1l11nL ~Irt del lnt [0 J jUc lt ftber l]kuti inrervenl ion vhich 1c)LJ k l IV - i(l ~ l compktl n l ililll on Il t c1 l shy-jel1 J11UVllT1ent IJ j o f 1uto-dOneacute(3tlon ( i e a -impk ld ion ) Iengtheni ng o f the pilleacute 011 a litlltl l aXl~ tll lt ((IT liJlI~rcdu e~ t lle ~---lJ linti- l lte ml-fkxj(l n h UI 11 - i llCrl I~t the plllH ](JgicJI dlt cr ~l S ( (1 k-yvllCiSh lIld O(ltOSh l o r c lch r1Iif n t a Ilew til(~ecirc dUuml llt Ilshy
si lflltl J ll1 u(~nlent iam ecl - 1l1t0- lIrfe rionmiddot7 4 llmshyp oed f Je-rura l iUIl cl middot-t1e- iltm lI1d ll1a intltnUlLe )( 5lg it d C Uf (gtS slig lll thltJrc i ypI1 tiZ) tIcircOI1 a nd lunugrave)ar 1()fdos i7~llion) sholild he esw b lb]HU 00 lb co
hl b oi hi p~l11il uU r -1Ir vlt Abo 111( e IlltUtl Chl lie o f purti n - a U vitk slJ1ultI h e )tuumlll ecl 1)] (1 n ldershy](ion r tl1i lt type for e upIe IilJ llyl)T S of repd shyiti( ml vemen prt n t in agonistK h)lnllltlSlks nI iIle kind f dlJ1ce C( uld he ([([r imentd
FmiddotO lllaljlallC and mobili ty of the SpIcircIlC
1 rd llo U 22 d L lm nrrare d lhlt in Illt fro nt a l pll ne
tilt 1 nge Clt 1)1lt vtment of tht scplit[i middot CU IY grcmr lIJ l il ~ d irectio n n f Lhe C ITelt tlO n tha n in tl le di re shyLion of pmgressi n l Fig 7 ) he IL o IS5err lJd tbat th15 mohiliry increac plrtil u la rly n apic [ cgcoeilts 1$ lh ~ ~c() li osb evolves Sragrm rJ 12 J ~ thus rigilt (0
VlI f n rller~p is ts Ilo t t) m o b uumliz - a sCtJl iu til curve w ilhout t [ uling ttwt tlle R lu tiOI o i til t ~a mt b fnlinruumln( 1hy l1tans o f ~I passic 01 1 rivE -uppnrt On tilt (ltllE r hand UgraveK d e iJlioJ1 in ease durill tlw tune 111 whicll tll C spmt i ~ not submjtrcd to correeshy( IV anl()n
j- Virh mi lei ol i b tlllt Upp i1n ill) lC tiol is d eveloped only lllmugil llClIf()mu$Cllbr f r llce thi ~
InegravelIl ~ thclcfo re tl1l[ inu eascgtt sp1J1all1extl)iity mua
11
Imiddotiumltgt 7-rurd illt Ir) 1 bull rdrilt I1 1 in tl lt frOlllll pbnlt- th( illl ge )r mOC llIeJlI o t the S-o UIIJC CUNe 1 supcrior in Ihlt diflt(l im ugrave( the n nKlIl thd n ll1 tllc dlrtcLion o f p rJ1(l( (llIl
be considrCtJ vntrl iJ)(l icltion and 1 undrli neocirc ab L a ~ubiljz~ILion 01 tilt spint pllss il)1y ohtl ll1td thrltJugll the stlengtlkl11ng o f the 1rltJgm vlt nonil lme shyCIC 111 illli orrant u bjcLliH- ln rhis r~f1 n sp u lllni lc tivitIumlLs sil uld lX tPI 10 dlegraveltl it l G lU t n w l1ik luring kine i Icircth lrr phyltical eXegraverci c~ tllat in ele
spinal m ot ilIcirclY sil nid 1e lt1 oid cdrt ~
Organ ie and psychologieal impainncuts and li islbi IiI le
A cgtI im lc pmi nr is moriOthl11 just 1 sp in and 1
compkt gt Ipp rnach to the gu in ad 1 ont i al~ shylute l e~se i t i11
[)a la 0 11[ [n ell lrom re semh pw tbat ome organi Iilnctiond cl fki ts suc]) as tlw clecrtiUe ut vild l tnd d fun ll l)Kity_orld ldly incrtJ k whil~ 0 shy[io s i -till in (1 miel q g of g JltlV ity ~ l ilI e 55 rtI lit
tllL pres e n ce )fl defidt Or Vi l~il Clp~1 - i~ ln one pIIiem in Ihr l ftectecl by 20 ICl 40 scoi stgt l ls~a r(h cunclutecl in tbe UA by Di Ruce- prod uegraveed an aaalo) u ll1lXimum 102 re u t in a group of Jd shyk 1ien t [(h sco llosls rang inF frum ) [0 1
Al10ther rudv bv rallt r m C chr111 lilcl NashycWrl1s( u 57 stlO eltt hil $(C 1 1 ui~ Ica js l( lllt cl (1 shy1prUlllI o f t1tgl lie bJd l imI in ~ul sct t1 t ltu b middot iects jlLltr l5 they are golng through ~I cltlici[e sllge in the fnm 1lt i n 01 tlWH o w n id uHitv t factor hit h Illy jeopmlize the cl velopme lit d ~ mIll lt lI1d htIshym cecl IWI sonalitr in Klulrhood
n RUI ~IEDl(( Ptl Y1-
ROU ltHmiddot PI [ I C~ 1 EXIRCIS]~ IN TI Il nW~JUNT OF SlllO lDIOP1HIC AI)C~ESΠ11 C(gt1[Oi 1S
This i why b IiCieacute ii is ~n imporrlIl t for p rcshyvegraveml e 1tLsr l tn en ou flge 1ari e nrs ~lfrecr(d by lIillcl middotu iosis ft) tlke p~l rt in portin -re rcatioluJ acrivitits Iha t 1eIU 10 L10 th r~1chophyinLl bull nd b~l )i 1l1o tur adlieem t n li 51Jmiddot2Even tlK)ugli [Dr bic mech~lnshy
ical mcl nellIUll10t 11 11 reltl ~ons lt r111 1gtomcrimes be l lefu l to ugg( ~t ne p rt in~ aCt iv ity r l h (gtr rll n anotlJer e th ink Ibal an exces~ ive IlHd icalizltion - Icirce l ll1posilion br plry~ilt i HlS nnejlor parents uf rh ry pe of po rt to lx p m lice 1 b Ule p 1Ucirc(Il L th1[ preshydLl ck l1 is fret clOice in lh ma tt r - -h II ll1 he avolc1ed wb 11 possLhle mainly for tlle i mport~ltll psyshyLb ) jogka l fe a SI)nS W( ha( ill ~ t nltntionegraved
Conclu ion
lbh ISsertegrave d t1H physkal tgtXtlci o is ) n fi ial whlIl practinu in order 10 ilnj rove the I11 llde
rœ nwh and tono C iral caplCiry and postu re o f the StOUO(I ~lIbj n II I nowkdge om ~ middotmg trom ci el1shyrlfi rls(~ Jrc li dJlJ accordl ng r the review 01 thE litshytirlture prnpo )td in t lli plpl r conflrm~ Ihe vuiclit ot th e -t ls ~rti ()ns
In l do l (ent Id iopl1il iC scoliuse il l n phee u i cl vk)pm e n t ( li tll iumlKh eXCC cl l g i en rhk thr hokl th e re i5 an und ubred need fn r l pprnpri 1tegrave (JJ1tOkJJe ~Ild Inr surgict1 therapics ill ortler 1) S l i p
the ( - Iuli on anugrave )JT~t~t UW ~pilll l dtlormities bull evshyerthtless in the illiti ~ll pl l~sC t ttlC c1iseLltc whcn the riS( r1 r euro )luli m is rtduced ocirc ~md tfle uifleal JOld threshold il ~ld flle po stural collai i reJcenw~ 43
JI l1 igh pllysicaJ egravexe rc ise - p revenc or r d llCe d i ~lh ilir ies o f [Iw ~ l() li )tic
p (iems R 28 J -6 5- 6 1 63
- f~KiHtare lh ( n utr ali711iCUl of postu m l d elicits tn produCel1 a coneql l nce J [)ti 0 I111)( or regre si -u lmiddotc 5middot Il 1 17 ~ M
-re 51udles U ~ n Ledecl tu con[mn or re jecr these conClLL i( 1 w l1 ich clerin-d frum 1l1 lIldytica l rcltw n f th e liter~iture appear r- ~Lo nlble Hnwecr Intil ne re ull are 31Iable wc should n r prevent our sroliotic patientmiddot trom tl ki ll p lt in s(loI1ing jshy
ir its pW1iada rly ltl t ~d1()o t () n til t c ntrHY -vith the l xcclrinn 01 gt[1 )11lt tIlat in rea-e t)1obility (tnU evc n thell oilly wh n progr~lgtion b p OSSibl) -uc h ~I( ucircvshyiUe -11 )ulu hl tIKoll w g ed The 11 S J ( rprOpriue kin (~irhe r~l Piuml to incr _~asc p()~tura l $llbil i ty is tl1egraveoretshyic tlly CiJUClt alttloughl more ~Iccu rtte aod deLli led ri k benefi rs anJlr~ is is netot1ed
Ria 1111tO
NIokl Mu d lle ftitYljJfu Jœl il 4IWr10UOifll S (JIvs i (1~1)Jshylidl ttno( cclIll le 11(11(1lt1 RCI fu lle ((lia LltfIt l1 I1I1i(i
LJ ci n s j(r3 pigt egrave li n IHUgru lkl di t rdz t fi sici pe e ft shytUlKm iluppno di un lisimerap15Ll rl lllcflt() 1 110 scopo di pnevirlt () fr en~lI 1-lgpwlllltnlcgt dclld lclonnitugrave o e il 5LOshy
Il i mi llon lt fH nugrave j (1 11ni dei co~e 1 lteIl I1J J nd ne ~Ii eifclti (()Tc rri udk s co lio si d i m e dia g rt iuuml ln que~ltlt
s rud i 30 llizzb mo i d ti cleU ric lca pel n ri Icare qJJ l lm 1 dis(imucirc x u le I[~ l z j-m i pro vna le da lla C gtl k A i json ere pr middote-nute () rk kl ducirc un~l rdeguCltl d nil cra pi lt di uJoseguerrnt Cjua li 1iU110 cli nbie tti 1 rcr lJ)tIId d~ fle)-UITC
n (- -fd7Io n~lcl)
Ut11claquo)si 1 lI tori htpnuuml )ludi-ttn I ~ cnntI1zttu fr Cq(in i idiJ)tic1 dbfl lOZ10l1 d d ~ leOla nelllOll1otoriO Lb un1I1cnUl 1n1l1i3 dcgli 111 lt1i ch DIJgt gtU l H crmU1 Nlch~mslt ( SIshygnaJ~l lerimiddot wo i esuemi -bletti d~ plt~e8lugraver- ne l pClZ le1lftgt scoliodcu kl s iluppo ddl ~ ~ uhjlil~ vertcbral~ lt o svilllp prJ Jdle JIl7 i() nl di ltCjuiljbrio Dng li studi sul lto lb( l~nlrale (OllddU i in pa rticdu d 1 DlIal-BeHJ (gtegraverl ~ P~II IId lI1 n~ llw - idente il v- m gtiu p eT il puientc clioti elgt di u n rnigb o t c)[ ro Ua sw mle dei radlldc onsegull o tramite il 11 fforzrlshyfl len to d e i l1luotoucirc l nllgr3ilri d e luOwo con crcbi ~Clltdr
in pOMltHJ corrctl e in va rie ~i[Jzioni s t llicb c c d inamIcirc tllt Dalle on sena d elb blOffiCcclIlicd tr idimlt n s io mlle d ei
r ~ chi Je ~oU()f icn ~Icirc ~videnuumll (l() ~llt tC p IYZIcircOSI ln(IiClZlfHicircl ~ 1I1shy
liumln fluenzt Je ll middote~rUrio tl SC) lgt lIi I rc pibull m i tldln sJlI71 Stl shygn~I I1 afferma che slI l p Ia no [11 middotccedilr~lk tre un œ rtlJ grado di l L1Liuuml IlC dclh vEltlh r1 apj(de le tu rœ mu SCltJ llri njtbc J n in $tJ ) t rodcfQfll1t1l1te PltJtantu b i r~it-~ r -lp il puugrave t~~
Ixnt-ftla solo nt Ile so )[j)~i Jl1Icirc na rl in qunnt ) ilon SlrM ntne )(l(Ofa tu soglb in caq ) co lltrLJIcircn l)lrilto llt~( i lJudotlsi di lfr~ lI1 C llg grVlmenl J 111 11 io lr riltd ll(17jOill leld rinlle 113 dimO~iumlrlto d llt nell o lin~l cl()~ li t th~oIOl))1 dri la defltgtrshymiti sul p iluO slfl iuale ~vohl lf1 (en5 ion~ sO lnm utto nd 1e bsi iniliali deWggrwm1Cnln mcn trl C a( lfLmn che occlleshyvoluzi ne dene = 110 i [ mhari IJ lin c l ki cen tri ch -1vi1( de i cp i CIt IJ rI Ji SI p m ittIl pnm l Iem lmeme e p o j pOS( shyrio fllwnte dtldnli mdv ( i un ziuuml ne ciloliz7nnl dd rlLtide lu mbJ œ ( lIlelttlaquo on NC n d d (gt11 uIdu m 1I1 Ilgt) cli r-Iure (0 eserClzi che IllUllengano 0 ltlUperifo le Clgt 6gt1 lo)iche sul pirluuml gilwlt Su l p iCl no fron itk Perdnulk il dlll1lt-trlto d1 lampkz-l d i LU ovimento amp111 lI rv Kolio ti ~ nd lt1 0 ddlJ cnrrc-LIcircQo i Ji gC 1 n lungl SUpegraveliltlrccedil 1M llS0 tlell 3ampIGI shyvamcnlo C che l~Jltmiddot mobiliti GlI mcnta co n l c lu7j o fle d l i) snAio i A ulln amplgrtJc1 ltllllmunjx~ i terlpGli nn n m obi shyUZ73It ma eutva coli ti0 1 1ct HsicVlfe nd tcmplt 11 1111nshyttllIcirc1nc n tc (k ll ~1 llu u zinnt n l1 un me77uuml d i sost l11( gt ln 0
e 11111ri b cle - Ilziunc egrave deorinatcl d l rlyarsi Snzcl la pr gtshy
liltlnl l i un() rtl~ i ptmiddot Jtl n(o 1S(Hl () (( ntJ() i ndit~tr i ~ Ii ISt (izi e l m iviL Illdlode ebe Hlmen tno laJlc ibiJii dcl rlc lide SCshy
li io) [n p articobre rune q lldl r C-I1 ich~ xlSiddcHe CUf t shyli ve ch~ iJllpi tgino e~rciii 01( biIi2 ZanUgrave HhnmL-trid () in tmiddot~t~nshy
sione kl fuchide O tne pure k- ~ttivit1 tnotoJII~ non prHi(~ llCcedil
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EUROP MIDI C Pli hIC
EDUCATIONMEETING SATURDAY 8thof APRIL 2006
(iSS
SEAS02 Scientific
Exercises Approach to Scoliosis
version 2002
G
S Negrini 1
EDUCATION MEETING SATURDAY8th of APRIL 2006
Neuromotor disfunctions
Neuromuscular disfunctions
11 Postural collapse
Postural collapse
Duval-Beaupegravere
Flexibility of scoliotic curve
f---I--- I Postural element
-------1 Structural element
S Negrini 2
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Postural collapse
Duval-Beaupegravere
It is a value related to muscular tone and to flexibil ity of convex side tissues
Post ural collapse
Bunch e Patwardhan
Critical load
Load threshold beyond wh ich a spine begins buckling
JI~~Wt1lW~flfthtlJlœJtAr ~ J~It- l~l - IMS
Postu ral collapse
Bunch e Patwardhan
If a curve reduces there is an increase of the deformation threshold
~~~NW~-damaoc~IIIMf ~~ J~Iv JaJ-I7I9sect
S Negrini 3
EDUCATION MEETING SATURDAY 8th of APRIL2006
Postural collapse
Torrel e Nachemson ~
Scolioses below 20deg ~ ~ lt~
have a high ~ ~ percentage of ~ ~
~postural collapse (on u~
average 75) ~~ 2i~
CU~VE O EG~EE S WHllE SUPlti e
~laquotd~c6b ____lPffI1wtt1t~
$ww J(t ~~7 JM5
Postural collapse
Minor scolioses 7
Antigravity musc es strengthening D
Reduces postural collapse -G
Increases the critical threshold of deformation
G
Neuromotor disfunetions
Stagnara
If we admit that one of the causes of idiopathie scoliosis is a disfunction in balance systems it is logical to orientate physical exercises toward this direction
s Negrini 4
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Neuromotor disfunctions
Dubousset
Idiopathie seoliosis results fram alterations in praprioeeption centres and deformation is a natural compensation to restore postural balance
etattJtitIK ypothfQj~S ___~ own_ oJ)HQr lar 1t-1( r
Neuromotor disfunctions
Nachemson Initial idiopathie scoliosis
+ Goood spine stability
Neutralization of postural deficits
D Static curve
Neuromotor disfunctions
Therapeutic aims
c) Development of spine stability
C) Development of balance reactions
G
S Negrini 5
EDUCATION MEETING SATURDAY 8thof APRIL 2006
Biomechanical disfunctions
j Horizontal r-Ian
i Sagi ttal plan
Frontal plan
Frontal plan
q Frontal plan disfunetions
Fronta l plan
Perdriolle Movement magnitude
gt in the direction of lt in the direction of correction progression
S Negrini 6
EDUCATION MEETING SATURDAY8th of APRIL 2006
Frontal plan
Stagnara
Never mobilize a scoliotic curve without ensuring reduction maintenance over time otherwise a greater mobility favours scoliosis progression
Frontal plan
Ducongeacute~ research
On a group of adolescent idiopathie scolioses treated with
Meacuteziegraveres gymnastics
D After 1 year the mean angle of
curves increased from 18deg to 29deg
Frontal plan
Scoliosis without brace
D Greater spine
flexibility D-
Risk of progression
S Negrini 7
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Frontal plan
Mobilization is useful
D In preparation to
brace
D With brace
Sagittal plan
QSagittal plan disfunctions
Sagittal plan r middot _J o
Perdriolle scouos B CJ aDeformation of D
thoracic and thoraco-Iumbar curves evolves in extension
S Negrini 8
EDUCATION MEETING SATURDAY8th of APRIL 2006
Sagittal plan
Graf
The line of gravity centres in the vertebral bodies o s c oUOSt
projects itself firstly laterally and then fi
o
posteriorly lJ ~~ ~~ ~ ~~-_J-D ~nI~
Sagittal plan
Therapeutic a ims
D Maintain or
retrieve physiological curves on the sagittal plan
Horizontal plan
QHorizontal plan disfunctions
S Negnni 9
EDUCATION MEETINGSATURDAY 8th of APRIL 2006
Horizontal plan
Stagnara The forces applied ta the spi ne act in a autoshydeforming sense
Horizontal plan
Dimnet Rotation gt 200
ampII~ (
D The actions of concave and convex side
muscles become
agonistic
~ItJrOnrIIiItdllfUClltlluumlll~~tI ~1JIf1laJ
Horizontal plan
Minor scolioses never exceed these autoshy
deformation thresholds
S Negrini 10
EDUCATION MEETING SATURDAY8th of APRIL 2006
Disfunctions at a biological organic and psychological
lever
Oisfunclions at a biological organlc and psychologlcal lever
Cheng
Bane density in scoliotic teenagers is lower than in normal subjects
~~~~middotA~IIlUtIy ~7œl 1d l
Oisfunctions at a blologlcal organic and psychologicallevel
A significant reduction of vital capacity and V02max in teenagers with a medium severity scoliosis
S Negrini 11
li
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Disfunctions at a biological organic and psychologicallevel
Disorders in the development of body image that the teenager has of himherself
Disfunctions at a blologlca l organlc and psychologicallevel
Therapeutic aims
cJ Activate cardioshyrespiratory function
cJ Favour bone density increase
cJ Develop a positive image of the body
Disfunctions at il biological organi and psydlologicallevel
Stagnara
Sport
D The active side of
kinesitherapy
S Negrini 12
EDUCATION MEETING SATURDAY 8thof APRIL 2006
Disfunctions at a biological organic and psychological
level
Distunctions at a biologlcal organlc and psychologicallevel
Cheng
Bone density in scoliotic teenagers is lower than in normal subjects
~n~IIIvpWr~middotA~stWy s- XXJl M J
Disfunctions at a biological organic and psychologicallevel
A significant reduction of vital capacity and V02max in teenagers with a medium severity scoliosis
G
S Negrini 11
EDUCATIONMEETING SATURDAY 8th of APRIL 2006
Kinesitherapy on the scoliotic subject
q Postural control
q Axial stability
q Muscular trophism
q Balance
q Respiratory function
The limits of kinesitherapy
There is a threshold beyond which
rehabilitation alone is not enough
sssr
Kinesitherapy in scoliosis treatment with brace
Therapeutic aims
S Negrini 13
6
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Therapeutic aims Srace kinesitherapy
With brace
il Postural corrections and
vertebral stability are obtained by the brace
Therapeutic aims Srace kinesitherapy
In preparation to the brace
il Mobilize spine on ail plans
Therapeutic aims Srace kinesitherapy
With brace D
Maintain a normal spine elasticity
~ Maintain a good muscular toneshy
trophism
C Model the hump with kyphotizating
exercises
S Negrini 14
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Exercises and their methodologies can vary accord ing to learning and individual sensibility of the single rehabilitator that proposes the m provided that they stay within the
Iimits of fixed therapeutic objectives
li
Therapeutic modalities
(Exercises)
QAuto-correction
QRespiratory education
QErgonomie education
QMuscular strengthening
QDevelopment of balance reactions
WNeuromotor integration
ci Vertebral mobiJization
QSpecifie modalities in brace treatment
S Negrini 15
EDUCATION MEETING SATURDAY 8th of APRIL 2006
The protocol of kinesitherapic
treatment
G
QChoice and dosage of exercises
Variatiosn of the work program every 2 - 3 months
Q Execute e)(ercises on an individual base or in a small group
Q Frequency not less than 2 times 1 week
Involve and awaken the family
G
S Negrini 16
EDUCATION MEETINGSATURDAY 8thof APRIL 2006
Q Determine the action and the localization of auto-correction
QAuto-correction must be associated to ail exercises
QAt the end of treatment ergonomy lesson
Auto-correction didactics
G
SCOLIOSI DORSALE---- shy ----
r
S Negrini 17
EDUCATION MEETING SATURDAY8thof APRIL 2006
SCOLIOS OORSOLOMBARE
shy
SCOLIOSI OOIlSALE 011 bull LOMBARE S1I--shy
SCOLIOSI LOMBARE
il --~_-
S Negrini 18
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Scoliotic patients are not radiographs
middotSeoliotie Mtients are not ndiographs but hum beings with a vertebral deviation-
Slagnara
Metha For the physieian Cobb angle is of utmost
importance For the patient it is body deformity t hat eounts most rib hump a protruding seapula or hip We are in a situation in whieh today dodors eure the radiographie deformity but what the patient really desires is to get rid of clinieal deformity and of ensuing psyehologieal distress
CIIQItIo shDuIdtucirc lM WIld tJw~~ I~~M~~~~ J9f~
S Negrini 19
- Poznan_workshop_Physiotherapy
- physio2
- physio3pdf
- physio4
- physio5
- physio6
- physio7
- physio8
- physio9
- physio10
-
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As Srtgn1lt1 l ~ ltlssert~ if wc l C -Cp t 111 1 un o f the G IiC s oliosls L l tisorckr oi th e ltquilibrilltn sys t ~ms it is lagical to oriegravenrate physlCl l exercis( lherap y ln th is d ir(gtCli()[1
11lclte goals Cul tl lfOUgil ditrercn t modes 01 action be Olchic(-c1 witJ1 phykal accivit ie
- po rt ive Cll ities p ro ct LJ e aIl UgravelClltrtsc in 6lte nshyel ll )o rd in~lti n pinai pr0prinup ti_)[J nLi mOVeshyment control 0 vio lls iy ln thh repect ome lCtivshylites aœ pre um~I I)y lXrter tllln ntil crs
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reltiK)n ~ Ikexibiliry st3nucircing - -pirte - f ur~1 1IbjISC ltupin - ltorrcaion - - r~luci()il ll ymiddot For flmpllt in J npK l1 pH k1J il
plt1SSlhlc ln obtai n 10 u1 511ndlt)l [YLo lion yr ln Slt p ille rlOlgt itlugraven om l J ~ in ( gttf(C rigtIl lIex lbuil 15 i (r-l l=22deg pol lltl ~~J IIlpraquo is IcircO~-V- I t1 l nd tucircu(Ugrave) ilil) I~ 3laquoJO- IH-12
r ln Ugravel e abilit jl of tluuml [m e llu to co ntro l irse lr in ~ pac
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Posl1l1-t collapse lnd slabilizariotl
lIle concept u fplt st lUal c(l lJap~e l l~t Iwen detin 61 by DlI II-T3e~tupegrave rL t Ac oJdin)j tu tl1i- ~ll1thor il [ nec(sary ~- l Hn Cv-tlualing th tleihility o f a col shylo tIcircC CUJVL (0 clistingu ih bt tVeen the re du ihil [ty index (th - li iffer gt le bet ~middot Il ~I r~tcli()grJph ie ~xnmshyinltio n of the iI111 pHienr in supine po ition m(i
ROte OF Pl rnmL EŒIlCISE IN THE TREAT-ŒNT OP ~I IJD IDIOPAnnC OOU~GEm seou SIS EltJRINI
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f g 1 -TI1 u ilictf 1ld ( ii 11- ugraveu-sh) ld IX~ O 1d wllich ltJdnrshymII Il nf the pilll 1 ~tln~1 of th e -o lioti( spinc n IG~nI(J II IIIshytt) lhe iJeuml grl-e o f ~ ()Ii ti c (u rvH Il 1 w dcpc-nlknrly o l l he 10 111shy
P01(nl (pntt l ~ 1 1 nr ffll wrJ I) ln w hilth Ihe n i 1gt( ~ duc nL~ grlphs fm I h~lt 111lt hi~hr Iht Col h ~Ilu t (l f Lite ~Ul Ihe m Ol CI il y th t s(uumlJotil middotpin~ ~111 he ~middotJg gr~lVH(~(1
m mJxiTIt corrttt ion wll iJl i~ lIllCd to Ih - xt 1shy
lti Oilil y Jf tl1lt t Ut JO rl1t cdnUc idt md p OS shy
tU ll cul lapse ( th t ltHill enct b-tten l lUdioL) 1lphic egraveltamJl1ltlti OI1 J t th e ~lme pa tient in Sl il tl cling lOJ lline fX-sitiutl ) Wll ic h correb lc- onl wil ll fhe abilt ty of lllt p tu rl l gt s tem to C( lunternct lIk luree o r grl viry )cco d ing rv D lfVd- f3egraveLIprc po st li r t1 lt01shyIlDse is d ue to the Jnus -u lar ton a nd 11ll ex rCrIshy i) i itv of rhe tissus n the ( O IW-) si it (If the (01shyjl ti (~JtVe (Fi~ 3 L Pu~t llr1 C lltpstl lu lcl l ~~ reduc l-lt by llwans o f pl1ysica l cxerCles specitkally s tuclled ruuml i rnprove tIlus--ubr fOHt md lU pr )cllI Ct 1 ~11 hi shy
lizing ffCd
PararcL n tll CIJ cl the cr iti ca l (3 c1 thlsho ld beQ ld Il ich defol1J lHU n of the i pinlt 1 e~ in~ ne dtlllontr~1t _cl (1l ll t grclrf r mg] o f rllt C II in a qa m bng pos ition corn pOil 15 t l lowcr detormashytion lhnsllold (Fig 1) ie to ~11l Ulne3Se t the risk of pr ogr t~ lu n There t rh eJef re l J ea r l)iuuml 1itshycJ l ~ll1 l l(tl a 1 tnr tg ro b ohwined by d -cr t l ~ illg ilmiddot pU~lUrll cull lpse ptJcelJtge w bich lccording t i)
h llTd tnd ~l(heJ1l ~on 1~ b inde cl 1X llt icularly luumlgh Ugravel mllcl c Iio~ i (bdow 2( 0 ) (F ig 5 J
Fin a Il III ch iS respect lllljl hl and b um l 01 m linmiddot
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POO ll is hiherin cu rvegt in wh ilt l1lh ~1flILWrd cII1I Olk l1t IS le- pr(v~knt ln th e grtph Ih t PogttJlJ I ugtnq) Ot1 -J1l j elfltS-e J tlt 1l1t obb dirr remc rlLIv obu incu f roll l the Cohb atl( 0 1stlI1dtJ1g IId gtupinc rldo~raf115 Ih Ille lt) [1l1t1 (i lndnl I pine) 511pille the ~(nlClu tJ1 compo l1lnt U rlk CU Y _VeJily I~ ltx p rlt 1 L1v UpUlt (obh Illeturo Ih t si _b Cct rtJeSIm l fie -ltn J trd Ugraveltuuml shyuumlo n A~-i)rding LP 11(lt uuta o n l ( r1I~( in ~I 2JQ sup itlt curvt 1hi C(]l)b ddhccno l l f lO is -J-lultt( thc s ldnd inr tnla Ol1l t lS wi Q) whil 11) 1 1)401 ~llp lne ClHVC If ~ 1Omiddot ( tcl Lhe ttnd trl~ nlca~ I(t I ~ ~I)
tli n ll w l lllE cq lin ti spin h~ i ng mo r ~ Llnt~II) 1 tlun the nOftl111 one n Cll l gr(lk ( (cU ve tl1u n da r u p shy
po rt in o r k r 10 m linrl in tht 1xi11po tuf_ n th ha__i of th egt onideratl lr1S it f(lll() rhJt
ph rH (~Uuml e erd es ulukl h u - ul iiuml tbeacuteY ~U-L lm cl 1l (It-d o pmg p05111 td C Jl1twl lS fuumlrnll~ rly d ccrll1td ln an Ql St if i imr ol1111 t ru t(( - tht m(d in C JI shy
r t t r sture fO Ir -ngthen tlll m u ck-gt of the spint mainl) in (11erl antig r3ilrl tIcirclt l]lli fun ctin ll U hy meU15 dl i )ll1 t trk ~ lhJ cl( -ll tlt C)nlr~lUions ~llld no l IdOshy
1l)llic d YIltll1k lt l jAJ lktic t) I1 ) II 11)t 111 hd posibleacute t lcluuml ee postura l io nrro and stfh ili lllllt IJI
w i thout food T1lw(ull r d I( Lf(11 Ibk t m ucircnuin Ihe c()rf ~ct [ ()S tu re for cl gtu ifKi IH lLl1gth 0f ti l11 ~
This i-l ddl usl a typl 11 dnmnin (tf k inesllh rap) in 11 (lt-11 [[k - p~d fk lnr in lng f u l1a in llllliCk is poss ihle lI sing ctrtain Idncl fJ l (lt) 11111 liun S p Ul in tb is Cl c is ulttful ooly sa I~tr 1~ il Iw lps t1w lxltknt 1 becuJl)t 1gtlt ltlt-I a ClJu~l inred irl ilL ntllru l o~ i cll
and I1lll~lJhl r-keJc LIl [rll-llIn~ middot etlt(wrs JI the int e rmiddot vlnrion
[J ROPA MfJ) I()Wf-I YSJ IR
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11 o-llrfOlhe5l~ o t Ih 1O~(1dity i n h ~ r ~ ll nr pbl1 l of ~ Spl11 in 111011 _llti1Gt l lPt f ltlJUCWJtl ( ~l Ihe Ir t 1 1gt illbll W Ilh LtltrJ1dlion Vln lbe rigronl middotUII~ l(I Dko n12 lIll h lumshydlanie1 1 [ nul 1 M hl whtrc M - gt) lnIUI1g 111laquo111laquo1 1 1 c rtJCshytjC~ f fce d -d Lill l1~ o f enr niI pUll spnmcl1y 1~ 111 mldlll1lt (n the fl1ur t 1 = tor~ of f(ward Ileuuml l = ughtel1lng fmiddotr p 1shynOf stn lClU= Alaquo rdtllg 1raquo Ihl~ - lin hull th l1ltgtllugrave ot tller1l lUr~Jtllrc F the ~pin t -ilh rlu1i tf Ihl 1 1Ibulll n lrlt InltT1 1
rbc prJI 3IJi l1ty d qrlOIJ~ n bull JI t IlJIII Hm lA the v=ltd gtc e lu-ing J 5lnK1ura i ltfnnity
Dioal e ch anicll itllp~lir J11 c nt
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~f Ikmiddot i t i nly l(œ ntly tlHr llk pr-5tnœ or nc ushy1 lnlo tnr impairment in Idiopttlllc s-ol ii IXl tknt liuml J$ heen h i- ll licircghlcJ hy re$eJ rh tll e preit ilegravee h inm b nIcirc Ji d lJutg~ lt hl ~ 1 ng t o n dO Ulll urcel 1 i5 (l lreldv well umlersrood H(j-ev~r nev lbt un h iomcrhankal im l) ion nI h1c rectm ly onk l n tIlt tre and p r~dou in f n rmtinn hou t pl1ykd (~fcl5( in t 11 0 tl1I _ltgt pbne of spact 1115 Im trqlt-u 1rom J i-[) v ing unclcrsrmdlng ot th l lmc -dim nshy~ilnl l l11 ~ hmk f the cO]jO[lC pln( ~2middot ) ) Ve- w ill )iI xnl t l1 d at lcL-orcltng tUl cl sif iol t lOn blsed o n gtolllt lricd h uumlCJ ) p lane
- b() rJzU[1tl ln th i pla n ~ th t 1o rm ll sp ine present no CUlye- w ll ile Uumll(~ ltc U Hic spLnc clevelops one of ir haracterls(Icircc deFo rm tiCs v elt tbrd ln lashytio n vh icl1 pJ()VcA~ theacute hw 11
- lgitltl in th llulJe U l(~ nonmll spIcirclle pl SenL kypl lOSis ~nd l dooi~ in tb lXI1 lhese [(Hu rts Vere m)( til ught [ 0 he relattd tlle scolkJtlc ( lI r Vegrave
- front l in hi pleme tht ncrmal p ine preseuron t no curYegrave whil thl ~11li tic p in ugravetI I ()~ icircl~ charshyad t Ilt I CU1C
Il Jri fJIIt palic
~l+I~na ra 3 r inr lut th l[ ber ll1d a œl1~lU1 degr 1
l f r()la tJo u lllu (lILa r forcKl ltxert ltJn tl ldefnmuumlng 1 tkllJ [J i1u a re- lhlt tll cly 11 [1 1 UI b y Olm ner w bn ~lh uiJwd tl egrave ro t1tic) l1 Ilm it ti lt p ica] lf shy
rhrl r() be (P (the Uma bevond Wl1iltJl th lCOJlb of [11( ~pmaJ musd ~ dthc COnCIt and nm ex ~l le btconk (t O li~[)
r ~l 18 ~1Il N lu t( ren i9 lun lu ted rlseurlt h in tlt ) tilt lULodeumlformipg1 tlo n ot tIH_ sc laquoJrle rh ox ercallkren lk 1l1~H li d11r once thl Il i ~ r tld1t5 [he lhrth ld f 111 JlIcirc lIi of tlle dnrlclc hurnp tlk
lI bslt Il l nt rlet()rlll lIcircon 01 the it l ()I~ C ( (ylm der (- sustalnecl by an H1tmi cforming aCOOIl
J1Ji h V hl rhyiical f~ f Ise CI 01 h spr n llnd kin middot ith ccedilrapJ my lX damlg ing vll e n l pplild as flle
igt Jk Iller ln SCC1IJ ~IS lllc lJ fxceed l auto in middot crca~ i n g lhrllgthuld [1 sh (~u Id ahn be j ofed that Ilw relscd pre sun 1l1111i insiugrave l fe pil1r inn) 1 mlshylt
- j Il- ( w atff 1 (nh ~1l 1(e Il10 utoldrml ng li1eCh~lI1 1sm
in flc l Geyer ~w tcd th1 t rm m 1 hI l)1ecircch1O lla1 puilll 0 l I C~ sw m mim t Ieuroamp no purpo t for cu lshyim le pllilt t1 s (weumlO middott r it is l~Jl(gtWl1 rhn in iculio r[ paULnl -iJl11T1ill~ doe_gt nor Il ~lp to i ncrt~SL n eur(1shym tor co mfU
(1irai p an (
Jerdnn lle 11 showecl thal ill CSl~ o f t10rLC IC 1i lUgrave
tllo lacolulllhil it lio_1 tlle cte tI llmiry in (he lg itt1 p lln t rn lnlftot il~ lf tspe iuUy in tlw initi 11 r luleuml )f cV IU[Icircon nf Ile ~oli ls W iU l 1 p(t)gr~s~ivlt il10middot~ shy
ment roward hvpok pho b G ll f ill~l Im lins l har dUflng (IN eWllLlfiu1 of 11Imh] co luumlgt i the l in t ot t l H~ gClyty Cegraven te l - 0 1 v llebed lxxli 5 r ro ject 1 seH fl r t side-ys and tlwn backlrcl bull thu~ p(0(1 lj n g a kyphQtlmg aet Il ln (h~ lu mhnr --PIl1 COftj tng
l l i tc Iugrave l lltl l( l rs1 tif s L -etllgt il l the lgirl11
1 Hl)
Ilu LE nI rIIY~Ic~L lXIlKISI 1 HI E TREhTMEtn OP JIU IDIOP llII C AD O USCUH O Ll Œl15 NEGR II
lLill tegt lre lenl1 ~I d ~fo rll1J[ ~ rhl recrSes the phyltiologiGII cmns of lh vine)
Accordlng () Dicion ~2 1 rtcluctio fl in the itgitttl CUIYtS combin l vi th a lueral Iviari n llltl ds t 1
mecban ism () ugravel~ta il ity in l he r rat r IllI1e which bVOf1i the unsd a nd i ncrea~e 0 1 co hlt1is (Fig 6 hiIf md Pl11jlbiJ Jl1eanwlt ile lt(udiecl lh e srnl ru t
orzyglpophySLs show ing t11 al ttleir 1I1tl rnic tl orienshytation f~I (jLi l~ltes aXIal ve rtegravebJl l rotllio ll in cun litluns lt f dorsal hypokrrhn Icirc tnd lum)H de i L lo IS
Tll t dat SLlgge 1 th t impOrfill ut pOitu res and l1lweil1 ) t Mudied in ord t r (CI mlIuml ntrlin or to reuwer fll e p llyslo lo~lCll ClIlye in lIe SlgJtta p lU)l Wlth the llm o t ch ~ kin~ rutltor in l~ bili ry7 AbC th ~e ~k-
1l11nL ~Irt del lnt [0 J jUc lt ftber l]kuti inrervenl ion vhich 1c)LJ k l IV - i(l ~ l compktl n l ililll on Il t c1 l shy-jel1 J11UVllT1ent IJ j o f 1uto-dOneacute(3tlon ( i e a -impk ld ion ) Iengtheni ng o f the pilleacute 011 a litlltl l aXl~ tll lt ((IT liJlI~rcdu e~ t lle ~---lJ linti- l lte ml-fkxj(l n h UI 11 - i llCrl I~t the plllH ](JgicJI dlt cr ~l S ( (1 k-yvllCiSh lIld O(ltOSh l o r c lch r1Iif n t a Ilew til(~ecirc dUuml llt Ilshy
si lflltl J ll1 u(~nlent iam ecl - 1l1t0- lIrfe rionmiddot7 4 llmshyp oed f Je-rura l iUIl cl middot-t1e- iltm lI1d ll1a intltnUlLe )( 5lg it d C Uf (gtS slig lll thltJrc i ypI1 tiZ) tIcircOI1 a nd lunugrave)ar 1()fdos i7~llion) sholild he esw b lb]HU 00 lb co
hl b oi hi p~l11il uU r -1Ir vlt Abo 111( e IlltUtl Chl lie o f purti n - a U vitk slJ1ultI h e )tuumlll ecl 1)] (1 n ldershy](ion r tl1i lt type for e upIe IilJ llyl)T S of repd shyiti( ml vemen prt n t in agonistK h)lnllltlSlks nI iIle kind f dlJ1ce C( uld he ([([r imentd
FmiddotO lllaljlallC and mobili ty of the SpIcircIlC
1 rd llo U 22 d L lm nrrare d lhlt in Illt fro nt a l pll ne
tilt 1 nge Clt 1)1lt vtment of tht scplit[i middot CU IY grcmr lIJ l il ~ d irectio n n f Lhe C ITelt tlO n tha n in tl le di re shyLion of pmgressi n l Fig 7 ) he IL o IS5err lJd tbat th15 mohiliry increac plrtil u la rly n apic [ cgcoeilts 1$ lh ~ ~c() li osb evolves Sragrm rJ 12 J ~ thus rigilt (0
VlI f n rller~p is ts Ilo t t) m o b uumliz - a sCtJl iu til curve w ilhout t [ uling ttwt tlle R lu tiOI o i til t ~a mt b fnlinruumln( 1hy l1tans o f ~I passic 01 1 rivE -uppnrt On tilt (ltllE r hand UgraveK d e iJlioJ1 in ease durill tlw tune 111 whicll tll C spmt i ~ not submjtrcd to correeshy( IV anl()n
j- Virh mi lei ol i b tlllt Upp i1n ill) lC tiol is d eveloped only lllmugil llClIf()mu$Cllbr f r llce thi ~
InegravelIl ~ thclcfo re tl1l[ inu eascgtt sp1J1all1extl)iity mua
11
Imiddotiumltgt 7-rurd illt Ir) 1 bull rdrilt I1 1 in tl lt frOlllll pbnlt- th( illl ge )r mOC llIeJlI o t the S-o UIIJC CUNe 1 supcrior in Ihlt diflt(l im ugrave( the n nKlIl thd n ll1 tllc dlrtcLion o f p rJ1(l( (llIl
be considrCtJ vntrl iJ)(l icltion and 1 undrli neocirc ab L a ~ubiljz~ILion 01 tilt spint pllss il)1y ohtl ll1td thrltJugll the stlengtlkl11ng o f the 1rltJgm vlt nonil lme shyCIC 111 illli orrant u bjcLliH- ln rhis r~f1 n sp u lllni lc tivitIumlLs sil uld lX tPI 10 dlegraveltl it l G lU t n w l1ik luring kine i Icircth lrr phyltical eXegraverci c~ tllat in ele
spinal m ot ilIcirclY sil nid 1e lt1 oid cdrt ~
Organ ie and psychologieal impainncuts and li islbi IiI le
A cgtI im lc pmi nr is moriOthl11 just 1 sp in and 1
compkt gt Ipp rnach to the gu in ad 1 ont i al~ shylute l e~se i t i11
[)a la 0 11[ [n ell lrom re semh pw tbat ome organi Iilnctiond cl fki ts suc]) as tlw clecrtiUe ut vild l tnd d fun ll l)Kity_orld ldly incrtJ k whil~ 0 shy[io s i -till in (1 miel q g of g JltlV ity ~ l ilI e 55 rtI lit
tllL pres e n ce )fl defidt Or Vi l~il Clp~1 - i~ ln one pIIiem in Ihr l ftectecl by 20 ICl 40 scoi stgt l ls~a r(h cunclutecl in tbe UA by Di Ruce- prod uegraveed an aaalo) u ll1lXimum 102 re u t in a group of Jd shyk 1ien t [(h sco llosls rang inF frum ) [0 1
Al10ther rudv bv rallt r m C chr111 lilcl NashycWrl1s( u 57 stlO eltt hil $(C 1 1 ui~ Ica js l( lllt cl (1 shy1prUlllI o f t1tgl lie bJd l imI in ~ul sct t1 t ltu b middot iects jlLltr l5 they are golng through ~I cltlici[e sllge in the fnm 1lt i n 01 tlWH o w n id uHitv t factor hit h Illy jeopmlize the cl velopme lit d ~ mIll lt lI1d htIshym cecl IWI sonalitr in Klulrhood
n RUI ~IEDl(( Ptl Y1-
ROU ltHmiddot PI [ I C~ 1 EXIRCIS]~ IN TI Il nW~JUNT OF SlllO lDIOP1HIC AI)C~ESΠ11 C(gt1[Oi 1S
This i why b IiCieacute ii is ~n imporrlIl t for p rcshyvegraveml e 1tLsr l tn en ou flge 1ari e nrs ~lfrecr(d by lIillcl middotu iosis ft) tlke p~l rt in portin -re rcatioluJ acrivitits Iha t 1eIU 10 L10 th r~1chophyinLl bull nd b~l )i 1l1o tur adlieem t n li 51Jmiddot2Even tlK)ugli [Dr bic mech~lnshy
ical mcl nellIUll10t 11 11 reltl ~ons lt r111 1gtomcrimes be l lefu l to ugg( ~t ne p rt in~ aCt iv ity r l h (gtr rll n anotlJer e th ink Ibal an exces~ ive IlHd icalizltion - Icirce l ll1posilion br plry~ilt i HlS nnejlor parents uf rh ry pe of po rt to lx p m lice 1 b Ule p 1Ucirc(Il L th1[ preshydLl ck l1 is fret clOice in lh ma tt r - -h II ll1 he avolc1ed wb 11 possLhle mainly for tlle i mport~ltll psyshyLb ) jogka l fe a SI)nS W( ha( ill ~ t nltntionegraved
Conclu ion
lbh ISsertegrave d t1H physkal tgtXtlci o is ) n fi ial whlIl practinu in order 10 ilnj rove the I11 llde
rœ nwh and tono C iral caplCiry and postu re o f the StOUO(I ~lIbj n II I nowkdge om ~ middotmg trom ci el1shyrlfi rls(~ Jrc li dJlJ accordl ng r the review 01 thE litshytirlture prnpo )td in t lli plpl r conflrm~ Ihe vuiclit ot th e -t ls ~rti ()ns
In l do l (ent Id iopl1il iC scoliuse il l n phee u i cl vk)pm e n t ( li tll iumlKh eXCC cl l g i en rhk thr hokl th e re i5 an und ubred need fn r l pprnpri 1tegrave (JJ1tOkJJe ~Ild Inr surgict1 therapics ill ortler 1) S l i p
the ( - Iuli on anugrave )JT~t~t UW ~pilll l dtlormities bull evshyerthtless in the illiti ~ll pl l~sC t ttlC c1iseLltc whcn the riS( r1 r euro )luli m is rtduced ocirc ~md tfle uifleal JOld threshold il ~ld flle po stural collai i reJcenw~ 43
JI l1 igh pllysicaJ egravexe rc ise - p revenc or r d llCe d i ~lh ilir ies o f [Iw ~ l() li )tic
p (iems R 28 J -6 5- 6 1 63
- f~KiHtare lh ( n utr ali711iCUl of postu m l d elicits tn produCel1 a coneql l nce J [)ti 0 I111)( or regre si -u lmiddotc 5middot Il 1 17 ~ M
-re 51udles U ~ n Ledecl tu con[mn or re jecr these conClLL i( 1 w l1 ich clerin-d frum 1l1 lIldytica l rcltw n f th e liter~iture appear r- ~Lo nlble Hnwecr Intil ne re ull are 31Iable wc should n r prevent our sroliotic patientmiddot trom tl ki ll p lt in s(loI1ing jshy
ir its pW1iada rly ltl t ~d1()o t () n til t c ntrHY -vith the l xcclrinn 01 gt[1 )11lt tIlat in rea-e t)1obility (tnU evc n thell oilly wh n progr~lgtion b p OSSibl) -uc h ~I( ucircvshyiUe -11 )ulu hl tIKoll w g ed The 11 S J ( rprOpriue kin (~irhe r~l Piuml to incr _~asc p()~tura l $llbil i ty is tl1egraveoretshyic tlly CiJUClt alttloughl more ~Iccu rtte aod deLli led ri k benefi rs anJlr~ is is netot1ed
Ria 1111tO
NIokl Mu d lle ftitYljJfu Jœl il 4IWr10UOifll S (JIvs i (1~1)Jshylidl ttno( cclIll le 11(11(1lt1 RCI fu lle ((lia LltfIt l1 I1I1i(i
LJ ci n s j(r3 pigt egrave li n IHUgru lkl di t rdz t fi sici pe e ft shytUlKm iluppno di un lisimerap15Ll rl lllcflt() 1 110 scopo di pnevirlt () fr en~lI 1-lgpwlllltnlcgt dclld lclonnitugrave o e il 5LOshy
Il i mi llon lt fH nugrave j (1 11ni dei co~e 1 lteIl I1J J nd ne ~Ii eifclti (()Tc rri udk s co lio si d i m e dia g rt iuuml ln que~ltlt
s rud i 30 llizzb mo i d ti cleU ric lca pel n ri Icare qJJ l lm 1 dis(imucirc x u le I[~ l z j-m i pro vna le da lla C gtl k A i json ere pr middote-nute () rk kl ducirc un~l rdeguCltl d nil cra pi lt di uJoseguerrnt Cjua li 1iU110 cli nbie tti 1 rcr lJ)tIId d~ fle)-UITC
n (- -fd7Io n~lcl)
Ut11claquo)si 1 lI tori htpnuuml )ludi-ttn I ~ cnntI1zttu fr Cq(in i idiJ)tic1 dbfl lOZ10l1 d d ~ leOla nelllOll1otoriO Lb un1I1cnUl 1n1l1i3 dcgli 111 lt1i ch DIJgt gtU l H crmU1 Nlch~mslt ( SIshygnaJ~l lerimiddot wo i esuemi -bletti d~ plt~e8lugraver- ne l pClZ le1lftgt scoliodcu kl s iluppo ddl ~ ~ uhjlil~ vertcbral~ lt o svilllp prJ Jdle JIl7 i() nl di ltCjuiljbrio Dng li studi sul lto lb( l~nlrale (OllddU i in pa rticdu d 1 DlIal-BeHJ (gtegraverl ~ P~II IId lI1 n~ llw - idente il v- m gtiu p eT il puientc clioti elgt di u n rnigb o t c)[ ro Ua sw mle dei radlldc onsegull o tramite il 11 fforzrlshyfl len to d e i l1luotoucirc l nllgr3ilri d e luOwo con crcbi ~Clltdr
in pOMltHJ corrctl e in va rie ~i[Jzioni s t llicb c c d inamIcirc tllt Dalle on sena d elb blOffiCcclIlicd tr idimlt n s io mlle d ei
r ~ chi Je ~oU()f icn ~Icirc ~videnuumll (l() ~llt tC p IYZIcircOSI ln(IiClZlfHicircl ~ 1I1shy
liumln fluenzt Je ll middote~rUrio tl SC) lgt lIi I rc pibull m i tldln sJlI71 Stl shygn~I I1 afferma che slI l p Ia no [11 middotccedilr~lk tre un œ rtlJ grado di l L1Liuuml IlC dclh vEltlh r1 apj(de le tu rœ mu SCltJ llri njtbc J n in $tJ ) t rodcfQfll1t1l1te PltJtantu b i r~it-~ r -lp il puugrave t~~
Ixnt-ftla solo nt Ile so )[j)~i Jl1Icirc na rl in qunnt ) ilon SlrM ntne )(l(Ofa tu soglb in caq ) co lltrLJIcircn l)lrilto llt~( i lJudotlsi di lfr~ lI1 C llg grVlmenl J 111 11 io lr riltd ll(17jOill leld rinlle 113 dimO~iumlrlto d llt nell o lin~l cl()~ li t th~oIOl))1 dri la defltgtrshymiti sul p iluO slfl iuale ~vohl lf1 (en5 ion~ sO lnm utto nd 1e bsi iniliali deWggrwm1Cnln mcn trl C a( lfLmn che occlleshyvoluzi ne dene = 110 i [ mhari IJ lin c l ki cen tri ch -1vi1( de i cp i CIt IJ rI Ji SI p m ittIl pnm l Iem lmeme e p o j pOS( shyrio fllwnte dtldnli mdv ( i un ziuuml ne ciloliz7nnl dd rlLtide lu mbJ œ ( lIlelttlaquo on NC n d d (gt11 uIdu m 1I1 Ilgt) cli r-Iure (0 eserClzi che IllUllengano 0 ltlUperifo le Clgt 6gt1 lo)iche sul pirluuml gilwlt Su l p iCl no fron itk Perdnulk il dlll1lt-trlto d1 lampkz-l d i LU ovimento amp111 lI rv Kolio ti ~ nd lt1 0 ddlJ cnrrc-LIcircQo i Ji gC 1 n lungl SUpegraveliltlrccedil 1M llS0 tlell 3ampIGI shyvamcnlo C che l~Jltmiddot mobiliti GlI mcnta co n l c lu7j o fle d l i) snAio i A ulln amplgrtJc1 ltllllmunjx~ i terlpGli nn n m obi shyUZ73It ma eutva coli ti0 1 1ct HsicVlfe nd tcmplt 11 1111nshyttllIcirc1nc n tc (k ll ~1 llu u zinnt n l1 un me77uuml d i sost l11( gt ln 0
e 11111ri b cle - Ilziunc egrave deorinatcl d l rlyarsi Snzcl la pr gtshy
liltlnl l i un() rtl~ i ptmiddot Jtl n(o 1S(Hl () (( ntJ() i ndit~tr i ~ Ii ISt (izi e l m iviL Illdlode ebe Hlmen tno laJlc ibiJii dcl rlc lide SCshy
li io) [n p articobre rune q lldl r C-I1 ich~ xlSiddcHe CUf t shyli ve ch~ iJllpi tgino e~rciii 01( biIi2 ZanUgrave HhnmL-trid () in tmiddot~t~nshy
sione kl fuchide O tne pure k- ~ttivit1 tnotoJII~ non prHi(~ llCcedil
in forma r k rel1tiva d Ie ~1I 11 rF~1l1( n otcol mcnlC 1 lll ubib Ll vcrteblmiddote (ad ~ flp j(l 11 n l) to L ginn ~Iilt Utl clkl rilshyC
mka la cli OT- tcc)
r1il to l~ _ I[Dl COlI rY IC~
NE olUNI
fillncr ( ni ((uuml(( n hIIo( rilclIO ~middothe k lln dtfidl fUr1z i shy
nlu CQll1~ la llcl llZIO 1e delb c apKJl ilde e della capacltl di 0170 mizianu luJndn le (OJ il~ gtna a nc r3 di m~i3 gmshy
v it ln G mlxl r i ~ gko Fl llslrom C dlllJ O e Nachcms(J h iU1I) dim lr JtQ che b o liosl p IOO C1 neUaduksœnr 10 SYil l1p pn d i lIniumlmn~gin nlt8Jliva de corpo in (o nridcnz di Ln ddic3w p ri d di f( m l lz i nlt deUa SUl idenritl condishyZltonc ch pOlrebh ~[I cubrmiddot ln vilu pp di un pe bull n nn lir m llur cd e quiJibfarn in t[C adulro TaU CO1DSCe nZe tvlde nshyZ[II)() la n ( middotess iti di ltimobre la plfte ip a7j0 r1e atl an ivi ll1ltHClr n gl b a li ltl h ~ di tlpO s pu rti middotu dl ittlrc nd gloani iCo lID ti i lirtugraveta z io ni llb vila di relazionc
ln concllliu fu la d tfoflll lL saliu iG egrave il sin l mo di lin) idrotnc C Il1pk 1 d e eoinvo l d middotmiddot= fu n (n i dd rgashynIcirc5H10 n Hi lhdli e lesenizjo fi 1lt0 se 1 Il indirill~t() pllO pr~cnin 0 odLf rgt t lli di fu nzlonicirc adlc s()Jj(bi 111Icircn(i rrHtatc CO ll nl1 cinesi rap i Quand l~ coli i ( n LS~middot iJ11 zia k il rischio evnluLIcircvo egrave lid [() mente no tcole 11 (ltlll asso p o lll shylal ltOtSltgllen7~1 _ ta cincsiterapia pc rslIk bidtlvi shyptutibulli d ubllIcirctIcirc vltnc brn1e di conrro llo )(JSu k d i 5IcirclupPQ d Ile rLlt ziofll d i eC[u ihb ugraveo dJ ftffr otZJH1 r1w dei IIl llJgtCili 1 11Icircshyg rdtarl in posru ra rrenu posslhile JnnalL in Illo lt i clsi l(j luucircun lt di lin ~c() li oi mi n rc ( ume [11 duumlnQstrIO la tinc~ jn~l el1lric ((1l1 ~rtlppi d i contnmiddotllo cnndnlt1 p nso i l entrt d e Massue di Li n nc da [ o llo n ~ Rodo l (1 986) Julndo il1vlce lIfU~ ho ~vutlJ tiVll 11lt1 1IjXIl to un dekrshyuina r o~itl di g rl vir~l bull a~-n lllull~nte n ec ~~uiu rlCUuml rf( ff dla tcrJpll rle si c a eo chirurg ica
1Ho le clllC ooliosi idjopHI 3 ttl1p ~ - E~er l zjo hsco shy11ln ~ I((fapil
l Bg 5 CUle Lo [la k ll oblems in tlu ll~ (U ni Cl) FrKUce CU ( )lIILr no 1 AllCPR lu b1lG1t10 11 middotCI 9()(iJ2 RockilJe MI) i)~Cr ~()f I [( al th all 1 () I ~Y 1(~Re~C~Hd ~gtutnlt Ilallb Srshy1ltC Cgt D~p(rulllnr CJf I Ilalil 11 1 HumlIl sen Lel 199-1
2 SI) lrzcf ( LcB I ~IIl( FE DupUb L ampkIll~ 1c ~ppro l c h ll tht rnent und mmgemlt-rlt ot ~ ct vlyrl~ led splnul (hs r)fder~ A monQglJph rr r d lll kic Re p o l1 or Ih Ou bcc TlSk Fu rcl 0 11 ipmd DIo rele Sp ine L9H LU) 59
) Clntino F 111i1 i(ll Ci nerte1H C Nou gltHhl C Kln(~Jl llBICII [lIe1 hmlln (Il dry rra ll1ltfll of QIil pa ll m log iC by l11e 1 lIb li 1le-llh laquorilC~ of ~ 10(lna 111 Jrc)Jcxli r~~ (of flle h l lntrnIUonll SVIll Illgt~iu tn - II 5lt Ik lIc lk0flllllic lu llln-I I r l III Fhhlt ri g 1092 -ltlIJ-7
i - ri of niii MA N()LJV II ~ mel h)ltks de kin ~~klk rlr k di lll J r~cdllclli (n d~s ~()li oes jn f ~tel r~1ruuml(ILI -lo s bl fl c sur IcIj cquishyl)œ~ Ik SOll ll l)(eacute Eli ror eetlfllS d )111 1~ 1)1-
5 iloll n G Ruumld(~ le s () I ~middotmiddots tnlcl l l1 I n in 1Ifc el kiwil~~ 1)11lt KillegraveSlthe ripJe SCleacutentlnlue lYl6 2 47 ~ 6
r) Feacuterr[ffgt en 1tsiero 5 Venlllfln A ll~~n () M MJglio nu N EfkUuml o r eXltClse tI~tl Yoj o n nild id iO rXllhlc iC() 1i()~ lrt~ lirnIcircIluy r sull Eur feltl lb)ii 1 1j34 Z5 -~ 1 NOilrill1 A Sbill P egn ni i Ll Linesilegraverpi l 1lt1 Itallllll~nlO
ddlJ soI K~ i llO 1 Orkl1Llllwnrl m efodoloil1c1 RbbilltlZiOllc Ot1(1 1 )29(1) 1l-~
8 Nli(rinl Nl(lr1n l A blll P LI rieduGlzione dl p llicml atflt rro (11 coli ns i idi opr lir1 l n SC(Um i le or h( JI 1rcLlIQn1 ~0Cl le Imc lI1etW)n11e de Recltcrchc ci 0 Ftude sm 1lt Radw jlt)(j S-71
gt Nftriruuml S SeJhrf U LI r i l bllh ~l liOlie dd plziecirc11te ulet1n 11 - r
lin Kllopd (1 In l1l Jgl L N eduoL Tf1It II d ll11e ji cln1 rJtbl IiIUvJ Milan) 1ltfddH~n(x~hl 2(1~111gt-1-PU ob L cllln t iRll p l nelLi rl tgtO llcui n~ dilt ~lio i - l rn~f- li ~iIa n 3efllnl -Kurflr 19-11
11 lIIra S lJll M EVtJltHlvugrave egraveI lt t rnrumel1t() d db S(oli - U r) surie doCum nUle fintgt 31 tIUUli Mibn SI rlin) KlIpf -r 199 2
L2 1 ~W I1l(IJ P _leacuteVia tio n I~lhra k~ du IlchlS ~- ( i( IoltS ccedil l r lI C1 l1 fl leq
Ene 1 l C hi r ApparctlIClCOn l~ ltll1 l ltx6lt (i W Er 20 j )7 l
U StrI tr d P Lcs 1) rm IlO du Hltlctli Parb ME n 115 li ~u n un_ l c- l ol lJn e~IL1roy JC EagtOllŒrio n sc lluocs
L cl middot Exp CO_fiL [-In 190 15 Xd BR llet13n) J Th ltJl-xwenc a l o-(l1 tUcn~kuud txer
C le re-glflW 1 lhe tfelmc nl o f id iopllhiC Collaraquo n lroc~-din) t Lhl 1 r 111(1ltli0 I111 Symf SiUl1l un 3-D Scl IiDliJ DclOfshymillelt ~k)J1[rlt u Gugtu l1Shltr Verbg 1lti t)L j32-t)
16 N1lh~Ir~il Al Peumlf r~o n LE Erree htJkmiddotmiddot~ n f t~U lt hfIl middot Ith J
hran in ~rls V ll ~ ttiVl ~HkJ k-nt IHuIXtthilaquo ic I) Li ~I~ts H t 1l1i JflIn t ~ j l~jl)5iuml7A(~)8Jj- 21 bull
17 M(jo n Y ( ullck J p ~ R A PrdulllnlIr rpurt 11 Iht e rt l f rnltJsu red 5l ren jl lh rrll nrl1 III ililleInr Hi rrt tllk scoJliagt
J lin1I IJisn rd 21 1 1)12) 102- - Hl Hunng CU[- -If p~lIll)~thc - Uonktd in -c h JI IL
c reacutetnl n~ ptnl l C)Q~ Z ) t 1 t(li-v 19 Kou )UrJKh L Glr~ k G KRI iJI G KLmiddotmiddotrnl kh g UlUI
) KrJ UkQULlk i~ ~l ~~ fl c+l l1ng ~t (w)j (h ildrcn frit ltt lmiddot( ti ~l~ 0 1 (he
isbnd of Cfdt J middotpin 1 Dior el 1 9J7 lIX( )middot i2 ~ middotl I i) SG IC1Iugrave lS r olle lCOS rh Zadrc C Ber E Xend s T A
ohool scr(l nin~ f r Loli rraquo pro~ p ah pidemlaIO)( Io Jl lUcJ ~middot In ncIfllwt~t~rll dncl Ctt1fLll Grttc J none 1cUlf ~)Ufg Arnl
19lt) ) JOJ )8-1)3 tl llunnd P n ohlecTln CfjtefO I1 f r SCCi II Ots t-CTctt1 lngJ BOIlt
Joi nl lIrg AI11 1~gt81 (1 )1)1 -0 22 re rdrlo lk R 11 gtcolk)c on Ftudc TrldrI1lUl i0 nnli1t FHIS
~Lluin l) Du vd-BtlltJpmiddotre Icirc Dubcu ttJ Qllln~Hl P GrC6 l~)f d Po ur Url tb (~fniumll~ uniqU( d t l rlmiddot q lultllI degrave -oU clt rr S4~ ftftxl-a[tmiddot [9 nJ8 11Icirc l -0
2L COl 7 G Fla~ l rdi M Ubllhr I- Ili ~ U)( ciplt-rfmof1lal ~c()lir t Prtlaquo l1 ttJ Ir lh t 1~l Eu n pL Il eacuteollhr~- 1lt11 -~ 11ltb und Ky phojj DulJr wnik Y ugmla O IO(-f 1 9$5
2 u ttlllJil ~ 1 gtCli ll Ofli e 1lI tpLI lJ1lluak Hntd ~Nltmiddot ) lnLpmiddotmiddot Fi)) SdwrJ r ll r [(111lt1 1gtl( lEl ~ bri UI nc 1lt)79 Slone H neekman C H ill Cues V fuooks 1 IL 1bc d rrCl o f an c Xt rc lslt r rog tlm ~)n chanfe ln cur( in uJokS( r 1H wtt h lllinr l11bulll IdJo p thiC SC(J lioh A prcl rnunH) Iud Pill Th r 19-9597Yfgtl Rlt td J Ccedil d(dtltx middotnl IdOcircgtpUhinK()liosl fl(nsugiCIJ lrellmenl ln lt-C llSlt ln Sl edit The P edtlt r bull SpIn Prmclp ilt and 1 1 shyte t Nemiddot Yo rk RIVCJ) PrtS j~)f197- 10 1(gr Ul1 A il lulfo l7amenro rnu_ olu e in S bfClti p()n ~nuuml(f di d lsme rf lsill i middot Wb li La i inm~ti MtmiddotdiQ 19$nYl - l
)0 DuIYLls-oe J E~ 1 d hypot he~ d tk gj(lult~ d b = shyli(~ Id lOIllll1lqu ahleacute~ de Knlt~il hr p le l ~ ~llK l H I
31 1 hnrwll R MLm n J [j her A ~Wlu (middoti R bull nlfc k J IdlopalhK 0 1101- llId lll ntr1 nervrlU$ S)511111 p ine 1il-111 H
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EUROP MIDI C Pli hIC
EDUCATIONMEETING SATURDAY 8thof APRIL 2006
(iSS
SEAS02 Scientific
Exercises Approach to Scoliosis
version 2002
G
S Negrini 1
EDUCATION MEETING SATURDAY8th of APRIL 2006
Neuromotor disfunctions
Neuromuscular disfunctions
11 Postural collapse
Postural collapse
Duval-Beaupegravere
Flexibility of scoliotic curve
f---I--- I Postural element
-------1 Structural element
S Negrini 2
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Postural collapse
Duval-Beaupegravere
It is a value related to muscular tone and to flexibil ity of convex side tissues
Post ural collapse
Bunch e Patwardhan
Critical load
Load threshold beyond wh ich a spine begins buckling
JI~~Wt1lW~flfthtlJlœJtAr ~ J~It- l~l - IMS
Postu ral collapse
Bunch e Patwardhan
If a curve reduces there is an increase of the deformation threshold
~~~NW~-damaoc~IIIMf ~~ J~Iv JaJ-I7I9sect
S Negrini 3
EDUCATION MEETING SATURDAY 8th of APRIL2006
Postural collapse
Torrel e Nachemson ~
Scolioses below 20deg ~ ~ lt~
have a high ~ ~ percentage of ~ ~
~postural collapse (on u~
average 75) ~~ 2i~
CU~VE O EG~EE S WHllE SUPlti e
~laquotd~c6b ____lPffI1wtt1t~
$ww J(t ~~7 JM5
Postural collapse
Minor scolioses 7
Antigravity musc es strengthening D
Reduces postural collapse -G
Increases the critical threshold of deformation
G
Neuromotor disfunetions
Stagnara
If we admit that one of the causes of idiopathie scoliosis is a disfunction in balance systems it is logical to orientate physical exercises toward this direction
s Negrini 4
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Neuromotor disfunctions
Dubousset
Idiopathie seoliosis results fram alterations in praprioeeption centres and deformation is a natural compensation to restore postural balance
etattJtitIK ypothfQj~S ___~ own_ oJ)HQr lar 1t-1( r
Neuromotor disfunctions
Nachemson Initial idiopathie scoliosis
+ Goood spine stability
Neutralization of postural deficits
D Static curve
Neuromotor disfunctions
Therapeutic aims
c) Development of spine stability
C) Development of balance reactions
G
S Negrini 5
EDUCATION MEETING SATURDAY 8thof APRIL 2006
Biomechanical disfunctions
j Horizontal r-Ian
i Sagi ttal plan
Frontal plan
Frontal plan
q Frontal plan disfunetions
Fronta l plan
Perdriolle Movement magnitude
gt in the direction of lt in the direction of correction progression
S Negrini 6
EDUCATION MEETING SATURDAY8th of APRIL 2006
Frontal plan
Stagnara
Never mobilize a scoliotic curve without ensuring reduction maintenance over time otherwise a greater mobility favours scoliosis progression
Frontal plan
Ducongeacute~ research
On a group of adolescent idiopathie scolioses treated with
Meacuteziegraveres gymnastics
D After 1 year the mean angle of
curves increased from 18deg to 29deg
Frontal plan
Scoliosis without brace
D Greater spine
flexibility D-
Risk of progression
S Negrini 7
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Frontal plan
Mobilization is useful
D In preparation to
brace
D With brace
Sagittal plan
QSagittal plan disfunctions
Sagittal plan r middot _J o
Perdriolle scouos B CJ aDeformation of D
thoracic and thoraco-Iumbar curves evolves in extension
S Negrini 8
EDUCATION MEETING SATURDAY8th of APRIL 2006
Sagittal plan
Graf
The line of gravity centres in the vertebral bodies o s c oUOSt
projects itself firstly laterally and then fi
o
posteriorly lJ ~~ ~~ ~ ~~-_J-D ~nI~
Sagittal plan
Therapeutic a ims
D Maintain or
retrieve physiological curves on the sagittal plan
Horizontal plan
QHorizontal plan disfunctions
S Negnni 9
EDUCATION MEETINGSATURDAY 8th of APRIL 2006
Horizontal plan
Stagnara The forces applied ta the spi ne act in a autoshydeforming sense
Horizontal plan
Dimnet Rotation gt 200
ampII~ (
D The actions of concave and convex side
muscles become
agonistic
~ItJrOnrIIiItdllfUClltlluumlll~~tI ~1JIf1laJ
Horizontal plan
Minor scolioses never exceed these autoshy
deformation thresholds
S Negrini 10
EDUCATION MEETING SATURDAY8th of APRIL 2006
Disfunctions at a biological organic and psychological
lever
Oisfunclions at a biological organlc and psychologlcal lever
Cheng
Bane density in scoliotic teenagers is lower than in normal subjects
~~~~middotA~IIlUtIy ~7œl 1d l
Oisfunctions at a blologlcal organic and psychologicallevel
A significant reduction of vital capacity and V02max in teenagers with a medium severity scoliosis
S Negrini 11
li
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Disfunctions at a biological organic and psychologicallevel
Disorders in the development of body image that the teenager has of himherself
Disfunctions at a blologlca l organlc and psychologicallevel
Therapeutic aims
cJ Activate cardioshyrespiratory function
cJ Favour bone density increase
cJ Develop a positive image of the body
Disfunctions at il biological organi and psydlologicallevel
Stagnara
Sport
D The active side of
kinesitherapy
S Negrini 12
EDUCATION MEETING SATURDAY 8thof APRIL 2006
Disfunctions at a biological organic and psychological
level
Distunctions at a biologlcal organlc and psychologicallevel
Cheng
Bone density in scoliotic teenagers is lower than in normal subjects
~n~IIIvpWr~middotA~stWy s- XXJl M J
Disfunctions at a biological organic and psychologicallevel
A significant reduction of vital capacity and V02max in teenagers with a medium severity scoliosis
G
S Negrini 11
EDUCATIONMEETING SATURDAY 8th of APRIL 2006
Kinesitherapy on the scoliotic subject
q Postural control
q Axial stability
q Muscular trophism
q Balance
q Respiratory function
The limits of kinesitherapy
There is a threshold beyond which
rehabilitation alone is not enough
sssr
Kinesitherapy in scoliosis treatment with brace
Therapeutic aims
S Negrini 13
6
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Therapeutic aims Srace kinesitherapy
With brace
il Postural corrections and
vertebral stability are obtained by the brace
Therapeutic aims Srace kinesitherapy
In preparation to the brace
il Mobilize spine on ail plans
Therapeutic aims Srace kinesitherapy
With brace D
Maintain a normal spine elasticity
~ Maintain a good muscular toneshy
trophism
C Model the hump with kyphotizating
exercises
S Negrini 14
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Exercises and their methodologies can vary accord ing to learning and individual sensibility of the single rehabilitator that proposes the m provided that they stay within the
Iimits of fixed therapeutic objectives
li
Therapeutic modalities
(Exercises)
QAuto-correction
QRespiratory education
QErgonomie education
QMuscular strengthening
QDevelopment of balance reactions
WNeuromotor integration
ci Vertebral mobiJization
QSpecifie modalities in brace treatment
S Negrini 15
EDUCATION MEETING SATURDAY 8th of APRIL 2006
The protocol of kinesitherapic
treatment
G
QChoice and dosage of exercises
Variatiosn of the work program every 2 - 3 months
Q Execute e)(ercises on an individual base or in a small group
Q Frequency not less than 2 times 1 week
Involve and awaken the family
G
S Negrini 16
EDUCATION MEETINGSATURDAY 8thof APRIL 2006
Q Determine the action and the localization of auto-correction
QAuto-correction must be associated to ail exercises
QAt the end of treatment ergonomy lesson
Auto-correction didactics
G
SCOLIOSI DORSALE---- shy ----
r
S Negrini 17
EDUCATION MEETING SATURDAY8thof APRIL 2006
SCOLIOS OORSOLOMBARE
shy
SCOLIOSI OOIlSALE 011 bull LOMBARE S1I--shy
SCOLIOSI LOMBARE
il --~_-
S Negrini 18
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Scoliotic patients are not radiographs
middotSeoliotie Mtients are not ndiographs but hum beings with a vertebral deviation-
Slagnara
Metha For the physieian Cobb angle is of utmost
importance For the patient it is body deformity t hat eounts most rib hump a protruding seapula or hip We are in a situation in whieh today dodors eure the radiographie deformity but what the patient really desires is to get rid of clinieal deformity and of ensuing psyehologieal distress
CIIQItIo shDuIdtucirc lM WIld tJw~~ I~~M~~~~ J9f~
S Negrini 19
- Poznan_workshop_Physiotherapy
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-
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1 shy ~
- shy
11 o-llrfOlhe5l~ o t Ih 1O~(1dity i n h ~ r ~ ll nr pbl1 l of ~ Spl11 in 111011 _llti1Gt l lPt f ltlJUCWJtl ( ~l Ihe Ir t 1 1gt illbll W Ilh LtltrJ1dlion Vln lbe rigronl middotUII~ l(I Dko n12 lIll h lumshydlanie1 1 [ nul 1 M hl whtrc M - gt) lnIUI1g 111laquo111laquo1 1 1 c rtJCshytjC~ f fce d -d Lill l1~ o f enr niI pUll spnmcl1y 1~ 111 mldlll1lt (n the fl1ur t 1 = tor~ of f(ward Ileuuml l = ughtel1lng fmiddotr p 1shynOf stn lClU= Alaquo rdtllg 1raquo Ihl~ - lin hull th l1ltgtllugrave ot tller1l lUr~Jtllrc F the ~pin t -ilh rlu1i tf Ihl 1 1Ibulll n lrlt InltT1 1
rbc prJI 3IJi l1ty d qrlOIJ~ n bull JI t IlJIII Hm lA the v=ltd gtc e lu-ing J 5lnK1ura i ltfnnity
Dioal e ch anicll itllp~lir J11 c nt
Ihrcemiddotdimcllgtional mc-cbal1in of the s pioc
~f Ikmiddot i t i nly l(œ ntly tlHr llk pr-5tnœ or nc ushy1 lnlo tnr impairment in Idiopttlllc s-ol ii IXl tknt liuml J$ heen h i- ll licircghlcJ hy re$eJ rh tll e preit ilegravee h inm b nIcirc Ji d lJutg~ lt hl ~ 1 ng t o n dO Ulll urcel 1 i5 (l lreldv well umlersrood H(j-ev~r nev lbt un h iomcrhankal im l) ion nI h1c rectm ly onk l n tIlt tre and p r~dou in f n rmtinn hou t pl1ykd (~fcl5( in t 11 0 tl1I _ltgt pbne of spact 1115 Im trqlt-u 1rom J i-[) v ing unclcrsrmdlng ot th l lmc -dim nshy~ilnl l l11 ~ hmk f the cO]jO[lC pln( ~2middot ) ) Ve- w ill )iI xnl t l1 d at lcL-orcltng tUl cl sif iol t lOn blsed o n gtolllt lricd h uumlCJ ) p lane
- b() rJzU[1tl ln th i pla n ~ th t 1o rm ll sp ine present no CUlye- w ll ile Uumll(~ ltc U Hic spLnc clevelops one of ir haracterls(Icircc deFo rm tiCs v elt tbrd ln lashytio n vh icl1 pJ()VcA~ theacute hw 11
- lgitltl in th llulJe U l(~ nonmll spIcirclle pl SenL kypl lOSis ~nd l dooi~ in tb lXI1 lhese [(Hu rts Vere m)( til ught [ 0 he relattd tlle scolkJtlc ( lI r Vegrave
- front l in hi pleme tht ncrmal p ine preseuron t no curYegrave whil thl ~11li tic p in ugravetI I ()~ icircl~ charshyad t Ilt I CU1C
Il Jri fJIIt palic
~l+I~na ra 3 r inr lut th l[ ber ll1d a œl1~lU1 degr 1
l f r()la tJo u lllu (lILa r forcKl ltxert ltJn tl ldefnmuumlng 1 tkllJ [J i1u a re- lhlt tll cly 11 [1 1 UI b y Olm ner w bn ~lh uiJwd tl egrave ro t1tic) l1 Ilm it ti lt p ica] lf shy
rhrl r() be (P (the Uma bevond Wl1iltJl th lCOJlb of [11( ~pmaJ musd ~ dthc COnCIt and nm ex ~l le btconk (t O li~[)
r ~l 18 ~1Il N lu t( ren i9 lun lu ted rlseurlt h in tlt ) tilt lULodeumlformipg1 tlo n ot tIH_ sc laquoJrle rh ox ercallkren lk 1l1~H li d11r once thl Il i ~ r tld1t5 [he lhrth ld f 111 JlIcirc lIi of tlle dnrlclc hurnp tlk
lI bslt Il l nt rlet()rlll lIcircon 01 the it l ()I~ C ( (ylm der (- sustalnecl by an H1tmi cforming aCOOIl
J1Ji h V hl rhyiical f~ f Ise CI 01 h spr n llnd kin middot ith ccedilrapJ my lX damlg ing vll e n l pplild as flle
igt Jk Iller ln SCC1IJ ~IS lllc lJ fxceed l auto in middot crca~ i n g lhrllgthuld [1 sh (~u Id ahn be j ofed that Ilw relscd pre sun 1l1111i insiugrave l fe pil1r inn) 1 mlshylt
- j Il- ( w atff 1 (nh ~1l 1(e Il10 utoldrml ng li1eCh~lI1 1sm
in flc l Geyer ~w tcd th1 t rm m 1 hI l)1ecircch1O lla1 puilll 0 l I C~ sw m mim t Ieuroamp no purpo t for cu lshyim le pllilt t1 s (weumlO middott r it is l~Jl(gtWl1 rhn in iculio r[ paULnl -iJl11T1ill~ doe_gt nor Il ~lp to i ncrt~SL n eur(1shym tor co mfU
(1irai p an (
Jerdnn lle 11 showecl thal ill CSl~ o f t10rLC IC 1i lUgrave
tllo lacolulllhil it lio_1 tlle cte tI llmiry in (he lg itt1 p lln t rn lnlftot il~ lf tspe iuUy in tlw initi 11 r luleuml )f cV IU[Icircon nf Ile ~oli ls W iU l 1 p(t)gr~s~ivlt il10middot~ shy
ment roward hvpok pho b G ll f ill~l Im lins l har dUflng (IN eWllLlfiu1 of 11Imh] co luumlgt i the l in t ot t l H~ gClyty Cegraven te l - 0 1 v llebed lxxli 5 r ro ject 1 seH fl r t side-ys and tlwn backlrcl bull thu~ p(0(1 lj n g a kyphQtlmg aet Il ln (h~ lu mhnr --PIl1 COftj tng
l l i tc Iugrave l lltl l( l rs1 tif s L -etllgt il l the lgirl11
1 Hl)
Ilu LE nI rIIY~Ic~L lXIlKISI 1 HI E TREhTMEtn OP JIU IDIOP llII C AD O USCUH O Ll Œl15 NEGR II
lLill tegt lre lenl1 ~I d ~fo rll1J[ ~ rhl recrSes the phyltiologiGII cmns of lh vine)
Accordlng () Dicion ~2 1 rtcluctio fl in the itgitttl CUIYtS combin l vi th a lueral Iviari n llltl ds t 1
mecban ism () ugravel~ta il ity in l he r rat r IllI1e which bVOf1i the unsd a nd i ncrea~e 0 1 co hlt1is (Fig 6 hiIf md Pl11jlbiJ Jl1eanwlt ile lt(udiecl lh e srnl ru t
orzyglpophySLs show ing t11 al ttleir 1I1tl rnic tl orienshytation f~I (jLi l~ltes aXIal ve rtegravebJl l rotllio ll in cun litluns lt f dorsal hypokrrhn Icirc tnd lum)H de i L lo IS
Tll t dat SLlgge 1 th t impOrfill ut pOitu res and l1lweil1 ) t Mudied in ord t r (CI mlIuml ntrlin or to reuwer fll e p llyslo lo~lCll ClIlye in lIe SlgJtta p lU)l Wlth the llm o t ch ~ kin~ rutltor in l~ bili ry7 AbC th ~e ~k-
1l11nL ~Irt del lnt [0 J jUc lt ftber l]kuti inrervenl ion vhich 1c)LJ k l IV - i(l ~ l compktl n l ililll on Il t c1 l shy-jel1 J11UVllT1ent IJ j o f 1uto-dOneacute(3tlon ( i e a -impk ld ion ) Iengtheni ng o f the pilleacute 011 a litlltl l aXl~ tll lt ((IT liJlI~rcdu e~ t lle ~---lJ linti- l lte ml-fkxj(l n h UI 11 - i llCrl I~t the plllH ](JgicJI dlt cr ~l S ( (1 k-yvllCiSh lIld O(ltOSh l o r c lch r1Iif n t a Ilew til(~ecirc dUuml llt Ilshy
si lflltl J ll1 u(~nlent iam ecl - 1l1t0- lIrfe rionmiddot7 4 llmshyp oed f Je-rura l iUIl cl middot-t1e- iltm lI1d ll1a intltnUlLe )( 5lg it d C Uf (gtS slig lll thltJrc i ypI1 tiZ) tIcircOI1 a nd lunugrave)ar 1()fdos i7~llion) sholild he esw b lb]HU 00 lb co
hl b oi hi p~l11il uU r -1Ir vlt Abo 111( e IlltUtl Chl lie o f purti n - a U vitk slJ1ultI h e )tuumlll ecl 1)] (1 n ldershy](ion r tl1i lt type for e upIe IilJ llyl)T S of repd shyiti( ml vemen prt n t in agonistK h)lnllltlSlks nI iIle kind f dlJ1ce C( uld he ([([r imentd
FmiddotO lllaljlallC and mobili ty of the SpIcircIlC
1 rd llo U 22 d L lm nrrare d lhlt in Illt fro nt a l pll ne
tilt 1 nge Clt 1)1lt vtment of tht scplit[i middot CU IY grcmr lIJ l il ~ d irectio n n f Lhe C ITelt tlO n tha n in tl le di re shyLion of pmgressi n l Fig 7 ) he IL o IS5err lJd tbat th15 mohiliry increac plrtil u la rly n apic [ cgcoeilts 1$ lh ~ ~c() li osb evolves Sragrm rJ 12 J ~ thus rigilt (0
VlI f n rller~p is ts Ilo t t) m o b uumliz - a sCtJl iu til curve w ilhout t [ uling ttwt tlle R lu tiOI o i til t ~a mt b fnlinruumln( 1hy l1tans o f ~I passic 01 1 rivE -uppnrt On tilt (ltllE r hand UgraveK d e iJlioJ1 in ease durill tlw tune 111 whicll tll C spmt i ~ not submjtrcd to correeshy( IV anl()n
j- Virh mi lei ol i b tlllt Upp i1n ill) lC tiol is d eveloped only lllmugil llClIf()mu$Cllbr f r llce thi ~
InegravelIl ~ thclcfo re tl1l[ inu eascgtt sp1J1all1extl)iity mua
11
Imiddotiumltgt 7-rurd illt Ir) 1 bull rdrilt I1 1 in tl lt frOlllll pbnlt- th( illl ge )r mOC llIeJlI o t the S-o UIIJC CUNe 1 supcrior in Ihlt diflt(l im ugrave( the n nKlIl thd n ll1 tllc dlrtcLion o f p rJ1(l( (llIl
be considrCtJ vntrl iJ)(l icltion and 1 undrli neocirc ab L a ~ubiljz~ILion 01 tilt spint pllss il)1y ohtl ll1td thrltJugll the stlengtlkl11ng o f the 1rltJgm vlt nonil lme shyCIC 111 illli orrant u bjcLliH- ln rhis r~f1 n sp u lllni lc tivitIumlLs sil uld lX tPI 10 dlegraveltl it l G lU t n w l1ik luring kine i Icircth lrr phyltical eXegraverci c~ tllat in ele
spinal m ot ilIcirclY sil nid 1e lt1 oid cdrt ~
Organ ie and psychologieal impainncuts and li islbi IiI le
A cgtI im lc pmi nr is moriOthl11 just 1 sp in and 1
compkt gt Ipp rnach to the gu in ad 1 ont i al~ shylute l e~se i t i11
[)a la 0 11[ [n ell lrom re semh pw tbat ome organi Iilnctiond cl fki ts suc]) as tlw clecrtiUe ut vild l tnd d fun ll l)Kity_orld ldly incrtJ k whil~ 0 shy[io s i -till in (1 miel q g of g JltlV ity ~ l ilI e 55 rtI lit
tllL pres e n ce )fl defidt Or Vi l~il Clp~1 - i~ ln one pIIiem in Ihr l ftectecl by 20 ICl 40 scoi stgt l ls~a r(h cunclutecl in tbe UA by Di Ruce- prod uegraveed an aaalo) u ll1lXimum 102 re u t in a group of Jd shyk 1ien t [(h sco llosls rang inF frum ) [0 1
Al10ther rudv bv rallt r m C chr111 lilcl NashycWrl1s( u 57 stlO eltt hil $(C 1 1 ui~ Ica js l( lllt cl (1 shy1prUlllI o f t1tgl lie bJd l imI in ~ul sct t1 t ltu b middot iects jlLltr l5 they are golng through ~I cltlici[e sllge in the fnm 1lt i n 01 tlWH o w n id uHitv t factor hit h Illy jeopmlize the cl velopme lit d ~ mIll lt lI1d htIshym cecl IWI sonalitr in Klulrhood
n RUI ~IEDl(( Ptl Y1-
ROU ltHmiddot PI [ I C~ 1 EXIRCIS]~ IN TI Il nW~JUNT OF SlllO lDIOP1HIC AI)C~ESΠ11 C(gt1[Oi 1S
This i why b IiCieacute ii is ~n imporrlIl t for p rcshyvegraveml e 1tLsr l tn en ou flge 1ari e nrs ~lfrecr(d by lIillcl middotu iosis ft) tlke p~l rt in portin -re rcatioluJ acrivitits Iha t 1eIU 10 L10 th r~1chophyinLl bull nd b~l )i 1l1o tur adlieem t n li 51Jmiddot2Even tlK)ugli [Dr bic mech~lnshy
ical mcl nellIUll10t 11 11 reltl ~ons lt r111 1gtomcrimes be l lefu l to ugg( ~t ne p rt in~ aCt iv ity r l h (gtr rll n anotlJer e th ink Ibal an exces~ ive IlHd icalizltion - Icirce l ll1posilion br plry~ilt i HlS nnejlor parents uf rh ry pe of po rt to lx p m lice 1 b Ule p 1Ucirc(Il L th1[ preshydLl ck l1 is fret clOice in lh ma tt r - -h II ll1 he avolc1ed wb 11 possLhle mainly for tlle i mport~ltll psyshyLb ) jogka l fe a SI)nS W( ha( ill ~ t nltntionegraved
Conclu ion
lbh ISsertegrave d t1H physkal tgtXtlci o is ) n fi ial whlIl practinu in order 10 ilnj rove the I11 llde
rœ nwh and tono C iral caplCiry and postu re o f the StOUO(I ~lIbj n II I nowkdge om ~ middotmg trom ci el1shyrlfi rls(~ Jrc li dJlJ accordl ng r the review 01 thE litshytirlture prnpo )td in t lli plpl r conflrm~ Ihe vuiclit ot th e -t ls ~rti ()ns
In l do l (ent Id iopl1il iC scoliuse il l n phee u i cl vk)pm e n t ( li tll iumlKh eXCC cl l g i en rhk thr hokl th e re i5 an und ubred need fn r l pprnpri 1tegrave (JJ1tOkJJe ~Ild Inr surgict1 therapics ill ortler 1) S l i p
the ( - Iuli on anugrave )JT~t~t UW ~pilll l dtlormities bull evshyerthtless in the illiti ~ll pl l~sC t ttlC c1iseLltc whcn the riS( r1 r euro )luli m is rtduced ocirc ~md tfle uifleal JOld threshold il ~ld flle po stural collai i reJcenw~ 43
JI l1 igh pllysicaJ egravexe rc ise - p revenc or r d llCe d i ~lh ilir ies o f [Iw ~ l() li )tic
p (iems R 28 J -6 5- 6 1 63
- f~KiHtare lh ( n utr ali711iCUl of postu m l d elicits tn produCel1 a coneql l nce J [)ti 0 I111)( or regre si -u lmiddotc 5middot Il 1 17 ~ M
-re 51udles U ~ n Ledecl tu con[mn or re jecr these conClLL i( 1 w l1 ich clerin-d frum 1l1 lIldytica l rcltw n f th e liter~iture appear r- ~Lo nlble Hnwecr Intil ne re ull are 31Iable wc should n r prevent our sroliotic patientmiddot trom tl ki ll p lt in s(loI1ing jshy
ir its pW1iada rly ltl t ~d1()o t () n til t c ntrHY -vith the l xcclrinn 01 gt[1 )11lt tIlat in rea-e t)1obility (tnU evc n thell oilly wh n progr~lgtion b p OSSibl) -uc h ~I( ucircvshyiUe -11 )ulu hl tIKoll w g ed The 11 S J ( rprOpriue kin (~irhe r~l Piuml to incr _~asc p()~tura l $llbil i ty is tl1egraveoretshyic tlly CiJUClt alttloughl more ~Iccu rtte aod deLli led ri k benefi rs anJlr~ is is netot1ed
Ria 1111tO
NIokl Mu d lle ftitYljJfu Jœl il 4IWr10UOifll S (JIvs i (1~1)Jshylidl ttno( cclIll le 11(11(1lt1 RCI fu lle ((lia LltfIt l1 I1I1i(i
LJ ci n s j(r3 pigt egrave li n IHUgru lkl di t rdz t fi sici pe e ft shytUlKm iluppno di un lisimerap15Ll rl lllcflt() 1 110 scopo di pnevirlt () fr en~lI 1-lgpwlllltnlcgt dclld lclonnitugrave o e il 5LOshy
Il i mi llon lt fH nugrave j (1 11ni dei co~e 1 lteIl I1J J nd ne ~Ii eifclti (()Tc rri udk s co lio si d i m e dia g rt iuuml ln que~ltlt
s rud i 30 llizzb mo i d ti cleU ric lca pel n ri Icare qJJ l lm 1 dis(imucirc x u le I[~ l z j-m i pro vna le da lla C gtl k A i json ere pr middote-nute () rk kl ducirc un~l rdeguCltl d nil cra pi lt di uJoseguerrnt Cjua li 1iU110 cli nbie tti 1 rcr lJ)tIId d~ fle)-UITC
n (- -fd7Io n~lcl)
Ut11claquo)si 1 lI tori htpnuuml )ludi-ttn I ~ cnntI1zttu fr Cq(in i idiJ)tic1 dbfl lOZ10l1 d d ~ leOla nelllOll1otoriO Lb un1I1cnUl 1n1l1i3 dcgli 111 lt1i ch DIJgt gtU l H crmU1 Nlch~mslt ( SIshygnaJ~l lerimiddot wo i esuemi -bletti d~ plt~e8lugraver- ne l pClZ le1lftgt scoliodcu kl s iluppo ddl ~ ~ uhjlil~ vertcbral~ lt o svilllp prJ Jdle JIl7 i() nl di ltCjuiljbrio Dng li studi sul lto lb( l~nlrale (OllddU i in pa rticdu d 1 DlIal-BeHJ (gtegraverl ~ P~II IId lI1 n~ llw - idente il v- m gtiu p eT il puientc clioti elgt di u n rnigb o t c)[ ro Ua sw mle dei radlldc onsegull o tramite il 11 fforzrlshyfl len to d e i l1luotoucirc l nllgr3ilri d e luOwo con crcbi ~Clltdr
in pOMltHJ corrctl e in va rie ~i[Jzioni s t llicb c c d inamIcirc tllt Dalle on sena d elb blOffiCcclIlicd tr idimlt n s io mlle d ei
r ~ chi Je ~oU()f icn ~Icirc ~videnuumll (l() ~llt tC p IYZIcircOSI ln(IiClZlfHicircl ~ 1I1shy
liumln fluenzt Je ll middote~rUrio tl SC) lgt lIi I rc pibull m i tldln sJlI71 Stl shygn~I I1 afferma che slI l p Ia no [11 middotccedilr~lk tre un œ rtlJ grado di l L1Liuuml IlC dclh vEltlh r1 apj(de le tu rœ mu SCltJ llri njtbc J n in $tJ ) t rodcfQfll1t1l1te PltJtantu b i r~it-~ r -lp il puugrave t~~
Ixnt-ftla solo nt Ile so )[j)~i Jl1Icirc na rl in qunnt ) ilon SlrM ntne )(l(Ofa tu soglb in caq ) co lltrLJIcircn l)lrilto llt~( i lJudotlsi di lfr~ lI1 C llg grVlmenl J 111 11 io lr riltd ll(17jOill leld rinlle 113 dimO~iumlrlto d llt nell o lin~l cl()~ li t th~oIOl))1 dri la defltgtrshymiti sul p iluO slfl iuale ~vohl lf1 (en5 ion~ sO lnm utto nd 1e bsi iniliali deWggrwm1Cnln mcn trl C a( lfLmn che occlleshyvoluzi ne dene = 110 i [ mhari IJ lin c l ki cen tri ch -1vi1( de i cp i CIt IJ rI Ji SI p m ittIl pnm l Iem lmeme e p o j pOS( shyrio fllwnte dtldnli mdv ( i un ziuuml ne ciloliz7nnl dd rlLtide lu mbJ œ ( lIlelttlaquo on NC n d d (gt11 uIdu m 1I1 Ilgt) cli r-Iure (0 eserClzi che IllUllengano 0 ltlUperifo le Clgt 6gt1 lo)iche sul pirluuml gilwlt Su l p iCl no fron itk Perdnulk il dlll1lt-trlto d1 lampkz-l d i LU ovimento amp111 lI rv Kolio ti ~ nd lt1 0 ddlJ cnrrc-LIcircQo i Ji gC 1 n lungl SUpegraveliltlrccedil 1M llS0 tlell 3ampIGI shyvamcnlo C che l~Jltmiddot mobiliti GlI mcnta co n l c lu7j o fle d l i) snAio i A ulln amplgrtJc1 ltllllmunjx~ i terlpGli nn n m obi shyUZ73It ma eutva coli ti0 1 1ct HsicVlfe nd tcmplt 11 1111nshyttllIcirc1nc n tc (k ll ~1 llu u zinnt n l1 un me77uuml d i sost l11( gt ln 0
e 11111ri b cle - Ilziunc egrave deorinatcl d l rlyarsi Snzcl la pr gtshy
liltlnl l i un() rtl~ i ptmiddot Jtl n(o 1S(Hl () (( ntJ() i ndit~tr i ~ Ii ISt (izi e l m iviL Illdlode ebe Hlmen tno laJlc ibiJii dcl rlc lide SCshy
li io) [n p articobre rune q lldl r C-I1 ich~ xlSiddcHe CUf t shyli ve ch~ iJllpi tgino e~rciii 01( biIi2 ZanUgrave HhnmL-trid () in tmiddot~t~nshy
sione kl fuchide O tne pure k- ~ttivit1 tnotoJII~ non prHi(~ llCcedil
in forma r k rel1tiva d Ie ~1I 11 rF~1l1( n otcol mcnlC 1 lll ubib Ll vcrteblmiddote (ad ~ flp j(l 11 n l) to L ginn ~Iilt Utl clkl rilshyC
mka la cli OT- tcc)
r1il to l~ _ I[Dl COlI rY IC~
NE olUNI
fillncr ( ni ((uuml(( n hIIo( rilclIO ~middothe k lln dtfidl fUr1z i shy
nlu CQll1~ la llcl llZIO 1e delb c apKJl ilde e della capacltl di 0170 mizianu luJndn le (OJ il~ gtna a nc r3 di m~i3 gmshy
v it ln G mlxl r i ~ gko Fl llslrom C dlllJ O e Nachcms(J h iU1I) dim lr JtQ che b o liosl p IOO C1 neUaduksœnr 10 SYil l1p pn d i lIniumlmn~gin nlt8Jliva de corpo in (o nridcnz di Ln ddic3w p ri d di f( m l lz i nlt deUa SUl idenritl condishyZltonc ch pOlrebh ~[I cubrmiddot ln vilu pp di un pe bull n nn lir m llur cd e quiJibfarn in t[C adulro TaU CO1DSCe nZe tvlde nshyZ[II)() la n ( middotess iti di ltimobre la plfte ip a7j0 r1e atl an ivi ll1ltHClr n gl b a li ltl h ~ di tlpO s pu rti middotu dl ittlrc nd gloani iCo lID ti i lirtugraveta z io ni llb vila di relazionc
ln concllliu fu la d tfoflll lL saliu iG egrave il sin l mo di lin) idrotnc C Il1pk 1 d e eoinvo l d middotmiddot= fu n (n i dd rgashynIcirc5H10 n Hi lhdli e lesenizjo fi 1lt0 se 1 Il indirill~t() pllO pr~cnin 0 odLf rgt t lli di fu nzlonicirc adlc s()Jj(bi 111Icircn(i rrHtatc CO ll nl1 cinesi rap i Quand l~ coli i ( n LS~middot iJ11 zia k il rischio evnluLIcircvo egrave lid [() mente no tcole 11 (ltlll asso p o lll shylal ltOtSltgllen7~1 _ ta cincsiterapia pc rslIk bidtlvi shyptutibulli d ubllIcirctIcirc vltnc brn1e di conrro llo )(JSu k d i 5IcirclupPQ d Ile rLlt ziofll d i eC[u ihb ugraveo dJ ftffr otZJH1 r1w dei IIl llJgtCili 1 11Icircshyg rdtarl in posru ra rrenu posslhile JnnalL in Illo lt i clsi l(j luucircun lt di lin ~c() li oi mi n rc ( ume [11 duumlnQstrIO la tinc~ jn~l el1lric ((1l1 ~rtlppi d i contnmiddotllo cnndnlt1 p nso i l entrt d e Massue di Li n nc da [ o llo n ~ Rodo l (1 986) Julndo il1vlce lIfU~ ho ~vutlJ tiVll 11lt1 1IjXIl to un dekrshyuina r o~itl di g rl vir~l bull a~-n lllull~nte n ec ~~uiu rlCUuml rf( ff dla tcrJpll rle si c a eo chirurg ica
1Ho le clllC ooliosi idjopHI 3 ttl1p ~ - E~er l zjo hsco shy11ln ~ I((fapil
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EUROP MIDI C Pli hIC
EDUCATIONMEETING SATURDAY 8thof APRIL 2006
(iSS
SEAS02 Scientific
Exercises Approach to Scoliosis
version 2002
G
S Negrini 1
EDUCATION MEETING SATURDAY8th of APRIL 2006
Neuromotor disfunctions
Neuromuscular disfunctions
11 Postural collapse
Postural collapse
Duval-Beaupegravere
Flexibility of scoliotic curve
f---I--- I Postural element
-------1 Structural element
S Negrini 2
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Postural collapse
Duval-Beaupegravere
It is a value related to muscular tone and to flexibil ity of convex side tissues
Post ural collapse
Bunch e Patwardhan
Critical load
Load threshold beyond wh ich a spine begins buckling
JI~~Wt1lW~flfthtlJlœJtAr ~ J~It- l~l - IMS
Postu ral collapse
Bunch e Patwardhan
If a curve reduces there is an increase of the deformation threshold
~~~NW~-damaoc~IIIMf ~~ J~Iv JaJ-I7I9sect
S Negrini 3
EDUCATION MEETING SATURDAY 8th of APRIL2006
Postural collapse
Torrel e Nachemson ~
Scolioses below 20deg ~ ~ lt~
have a high ~ ~ percentage of ~ ~
~postural collapse (on u~
average 75) ~~ 2i~
CU~VE O EG~EE S WHllE SUPlti e
~laquotd~c6b ____lPffI1wtt1t~
$ww J(t ~~7 JM5
Postural collapse
Minor scolioses 7
Antigravity musc es strengthening D
Reduces postural collapse -G
Increases the critical threshold of deformation
G
Neuromotor disfunetions
Stagnara
If we admit that one of the causes of idiopathie scoliosis is a disfunction in balance systems it is logical to orientate physical exercises toward this direction
s Negrini 4
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Neuromotor disfunctions
Dubousset
Idiopathie seoliosis results fram alterations in praprioeeption centres and deformation is a natural compensation to restore postural balance
etattJtitIK ypothfQj~S ___~ own_ oJ)HQr lar 1t-1( r
Neuromotor disfunctions
Nachemson Initial idiopathie scoliosis
+ Goood spine stability
Neutralization of postural deficits
D Static curve
Neuromotor disfunctions
Therapeutic aims
c) Development of spine stability
C) Development of balance reactions
G
S Negrini 5
EDUCATION MEETING SATURDAY 8thof APRIL 2006
Biomechanical disfunctions
j Horizontal r-Ian
i Sagi ttal plan
Frontal plan
Frontal plan
q Frontal plan disfunetions
Fronta l plan
Perdriolle Movement magnitude
gt in the direction of lt in the direction of correction progression
S Negrini 6
EDUCATION MEETING SATURDAY8th of APRIL 2006
Frontal plan
Stagnara
Never mobilize a scoliotic curve without ensuring reduction maintenance over time otherwise a greater mobility favours scoliosis progression
Frontal plan
Ducongeacute~ research
On a group of adolescent idiopathie scolioses treated with
Meacuteziegraveres gymnastics
D After 1 year the mean angle of
curves increased from 18deg to 29deg
Frontal plan
Scoliosis without brace
D Greater spine
flexibility D-
Risk of progression
S Negrini 7
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Frontal plan
Mobilization is useful
D In preparation to
brace
D With brace
Sagittal plan
QSagittal plan disfunctions
Sagittal plan r middot _J o
Perdriolle scouos B CJ aDeformation of D
thoracic and thoraco-Iumbar curves evolves in extension
S Negrini 8
EDUCATION MEETING SATURDAY8th of APRIL 2006
Sagittal plan
Graf
The line of gravity centres in the vertebral bodies o s c oUOSt
projects itself firstly laterally and then fi
o
posteriorly lJ ~~ ~~ ~ ~~-_J-D ~nI~
Sagittal plan
Therapeutic a ims
D Maintain or
retrieve physiological curves on the sagittal plan
Horizontal plan
QHorizontal plan disfunctions
S Negnni 9
EDUCATION MEETINGSATURDAY 8th of APRIL 2006
Horizontal plan
Stagnara The forces applied ta the spi ne act in a autoshydeforming sense
Horizontal plan
Dimnet Rotation gt 200
ampII~ (
D The actions of concave and convex side
muscles become
agonistic
~ItJrOnrIIiItdllfUClltlluumlll~~tI ~1JIf1laJ
Horizontal plan
Minor scolioses never exceed these autoshy
deformation thresholds
S Negrini 10
EDUCATION MEETING SATURDAY8th of APRIL 2006
Disfunctions at a biological organic and psychological
lever
Oisfunclions at a biological organlc and psychologlcal lever
Cheng
Bane density in scoliotic teenagers is lower than in normal subjects
~~~~middotA~IIlUtIy ~7œl 1d l
Oisfunctions at a blologlcal organic and psychologicallevel
A significant reduction of vital capacity and V02max in teenagers with a medium severity scoliosis
S Negrini 11
li
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Disfunctions at a biological organic and psychologicallevel
Disorders in the development of body image that the teenager has of himherself
Disfunctions at a blologlca l organlc and psychologicallevel
Therapeutic aims
cJ Activate cardioshyrespiratory function
cJ Favour bone density increase
cJ Develop a positive image of the body
Disfunctions at il biological organi and psydlologicallevel
Stagnara
Sport
D The active side of
kinesitherapy
S Negrini 12
EDUCATION MEETING SATURDAY 8thof APRIL 2006
Disfunctions at a biological organic and psychological
level
Distunctions at a biologlcal organlc and psychologicallevel
Cheng
Bone density in scoliotic teenagers is lower than in normal subjects
~n~IIIvpWr~middotA~stWy s- XXJl M J
Disfunctions at a biological organic and psychologicallevel
A significant reduction of vital capacity and V02max in teenagers with a medium severity scoliosis
G
S Negrini 11
EDUCATIONMEETING SATURDAY 8th of APRIL 2006
Kinesitherapy on the scoliotic subject
q Postural control
q Axial stability
q Muscular trophism
q Balance
q Respiratory function
The limits of kinesitherapy
There is a threshold beyond which
rehabilitation alone is not enough
sssr
Kinesitherapy in scoliosis treatment with brace
Therapeutic aims
S Negrini 13
6
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Therapeutic aims Srace kinesitherapy
With brace
il Postural corrections and
vertebral stability are obtained by the brace
Therapeutic aims Srace kinesitherapy
In preparation to the brace
il Mobilize spine on ail plans
Therapeutic aims Srace kinesitherapy
With brace D
Maintain a normal spine elasticity
~ Maintain a good muscular toneshy
trophism
C Model the hump with kyphotizating
exercises
S Negrini 14
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Exercises and their methodologies can vary accord ing to learning and individual sensibility of the single rehabilitator that proposes the m provided that they stay within the
Iimits of fixed therapeutic objectives
li
Therapeutic modalities
(Exercises)
QAuto-correction
QRespiratory education
QErgonomie education
QMuscular strengthening
QDevelopment of balance reactions
WNeuromotor integration
ci Vertebral mobiJization
QSpecifie modalities in brace treatment
S Negrini 15
EDUCATION MEETING SATURDAY 8th of APRIL 2006
The protocol of kinesitherapic
treatment
G
QChoice and dosage of exercises
Variatiosn of the work program every 2 - 3 months
Q Execute e)(ercises on an individual base or in a small group
Q Frequency not less than 2 times 1 week
Involve and awaken the family
G
S Negrini 16
EDUCATION MEETINGSATURDAY 8thof APRIL 2006
Q Determine the action and the localization of auto-correction
QAuto-correction must be associated to ail exercises
QAt the end of treatment ergonomy lesson
Auto-correction didactics
G
SCOLIOSI DORSALE---- shy ----
r
S Negrini 17
EDUCATION MEETING SATURDAY8thof APRIL 2006
SCOLIOS OORSOLOMBARE
shy
SCOLIOSI OOIlSALE 011 bull LOMBARE S1I--shy
SCOLIOSI LOMBARE
il --~_-
S Negrini 18
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Scoliotic patients are not radiographs
middotSeoliotie Mtients are not ndiographs but hum beings with a vertebral deviation-
Slagnara
Metha For the physieian Cobb angle is of utmost
importance For the patient it is body deformity t hat eounts most rib hump a protruding seapula or hip We are in a situation in whieh today dodors eure the radiographie deformity but what the patient really desires is to get rid of clinieal deformity and of ensuing psyehologieal distress
CIIQItIo shDuIdtucirc lM WIld tJw~~ I~~M~~~~ J9f~
S Negrini 19
- Poznan_workshop_Physiotherapy
- physio2
- physio3pdf
- physio4
- physio5
- physio6
- physio7
- physio8
- physio9
- physio10
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1
ICR 1 1-1
r
1 shy ~
- shy
11 o-llrfOlhe5l~ o t Ih 1O~(1dity i n h ~ r ~ ll nr pbl1 l of ~ Spl11 in 111011 _llti1Gt l lPt f ltlJUCWJtl ( ~l Ihe Ir t 1 1gt illbll W Ilh LtltrJ1dlion Vln lbe rigronl middotUII~ l(I Dko n12 lIll h lumshydlanie1 1 [ nul 1 M hl whtrc M - gt) lnIUI1g 111laquo111laquo1 1 1 c rtJCshytjC~ f fce d -d Lill l1~ o f enr niI pUll spnmcl1y 1~ 111 mldlll1lt (n the fl1ur t 1 = tor~ of f(ward Ileuuml l = ughtel1lng fmiddotr p 1shynOf stn lClU= Alaquo rdtllg 1raquo Ihl~ - lin hull th l1ltgtllugrave ot tller1l lUr~Jtllrc F the ~pin t -ilh rlu1i tf Ihl 1 1Ibulll n lrlt InltT1 1
rbc prJI 3IJi l1ty d qrlOIJ~ n bull JI t IlJIII Hm lA the v=ltd gtc e lu-ing J 5lnK1ura i ltfnnity
Dioal e ch anicll itllp~lir J11 c nt
Ihrcemiddotdimcllgtional mc-cbal1in of the s pioc
~f Ikmiddot i t i nly l(œ ntly tlHr llk pr-5tnœ or nc ushy1 lnlo tnr impairment in Idiopttlllc s-ol ii IXl tknt liuml J$ heen h i- ll licircghlcJ hy re$eJ rh tll e preit ilegravee h inm b nIcirc Ji d lJutg~ lt hl ~ 1 ng t o n dO Ulll urcel 1 i5 (l lreldv well umlersrood H(j-ev~r nev lbt un h iomcrhankal im l) ion nI h1c rectm ly onk l n tIlt tre and p r~dou in f n rmtinn hou t pl1ykd (~fcl5( in t 11 0 tl1I _ltgt pbne of spact 1115 Im trqlt-u 1rom J i-[) v ing unclcrsrmdlng ot th l lmc -dim nshy~ilnl l l11 ~ hmk f the cO]jO[lC pln( ~2middot ) ) Ve- w ill )iI xnl t l1 d at lcL-orcltng tUl cl sif iol t lOn blsed o n gtolllt lricd h uumlCJ ) p lane
- b() rJzU[1tl ln th i pla n ~ th t 1o rm ll sp ine present no CUlye- w ll ile Uumll(~ ltc U Hic spLnc clevelops one of ir haracterls(Icircc deFo rm tiCs v elt tbrd ln lashytio n vh icl1 pJ()VcA~ theacute hw 11
- lgitltl in th llulJe U l(~ nonmll spIcirclle pl SenL kypl lOSis ~nd l dooi~ in tb lXI1 lhese [(Hu rts Vere m)( til ught [ 0 he relattd tlle scolkJtlc ( lI r Vegrave
- front l in hi pleme tht ncrmal p ine preseuron t no curYegrave whil thl ~11li tic p in ugravetI I ()~ icircl~ charshyad t Ilt I CU1C
Il Jri fJIIt palic
~l+I~na ra 3 r inr lut th l[ ber ll1d a œl1~lU1 degr 1
l f r()la tJo u lllu (lILa r forcKl ltxert ltJn tl ldefnmuumlng 1 tkllJ [J i1u a re- lhlt tll cly 11 [1 1 UI b y Olm ner w bn ~lh uiJwd tl egrave ro t1tic) l1 Ilm it ti lt p ica] lf shy
rhrl r() be (P (the Uma bevond Wl1iltJl th lCOJlb of [11( ~pmaJ musd ~ dthc COnCIt and nm ex ~l le btconk (t O li~[)
r ~l 18 ~1Il N lu t( ren i9 lun lu ted rlseurlt h in tlt ) tilt lULodeumlformipg1 tlo n ot tIH_ sc laquoJrle rh ox ercallkren lk 1l1~H li d11r once thl Il i ~ r tld1t5 [he lhrth ld f 111 JlIcirc lIi of tlle dnrlclc hurnp tlk
lI bslt Il l nt rlet()rlll lIcircon 01 the it l ()I~ C ( (ylm der (- sustalnecl by an H1tmi cforming aCOOIl
J1Ji h V hl rhyiical f~ f Ise CI 01 h spr n llnd kin middot ith ccedilrapJ my lX damlg ing vll e n l pplild as flle
igt Jk Iller ln SCC1IJ ~IS lllc lJ fxceed l auto in middot crca~ i n g lhrllgthuld [1 sh (~u Id ahn be j ofed that Ilw relscd pre sun 1l1111i insiugrave l fe pil1r inn) 1 mlshylt
- j Il- ( w atff 1 (nh ~1l 1(e Il10 utoldrml ng li1eCh~lI1 1sm
in flc l Geyer ~w tcd th1 t rm m 1 hI l)1ecircch1O lla1 puilll 0 l I C~ sw m mim t Ieuroamp no purpo t for cu lshyim le pllilt t1 s (weumlO middott r it is l~Jl(gtWl1 rhn in iculio r[ paULnl -iJl11T1ill~ doe_gt nor Il ~lp to i ncrt~SL n eur(1shym tor co mfU
(1irai p an (
Jerdnn lle 11 showecl thal ill CSl~ o f t10rLC IC 1i lUgrave
tllo lacolulllhil it lio_1 tlle cte tI llmiry in (he lg itt1 p lln t rn lnlftot il~ lf tspe iuUy in tlw initi 11 r luleuml )f cV IU[Icircon nf Ile ~oli ls W iU l 1 p(t)gr~s~ivlt il10middot~ shy
ment roward hvpok pho b G ll f ill~l Im lins l har dUflng (IN eWllLlfiu1 of 11Imh] co luumlgt i the l in t ot t l H~ gClyty Cegraven te l - 0 1 v llebed lxxli 5 r ro ject 1 seH fl r t side-ys and tlwn backlrcl bull thu~ p(0(1 lj n g a kyphQtlmg aet Il ln (h~ lu mhnr --PIl1 COftj tng
l l i tc Iugrave l lltl l( l rs1 tif s L -etllgt il l the lgirl11
1 Hl)
Ilu LE nI rIIY~Ic~L lXIlKISI 1 HI E TREhTMEtn OP JIU IDIOP llII C AD O USCUH O Ll Œl15 NEGR II
lLill tegt lre lenl1 ~I d ~fo rll1J[ ~ rhl recrSes the phyltiologiGII cmns of lh vine)
Accordlng () Dicion ~2 1 rtcluctio fl in the itgitttl CUIYtS combin l vi th a lueral Iviari n llltl ds t 1
mecban ism () ugravel~ta il ity in l he r rat r IllI1e which bVOf1i the unsd a nd i ncrea~e 0 1 co hlt1is (Fig 6 hiIf md Pl11jlbiJ Jl1eanwlt ile lt(udiecl lh e srnl ru t
orzyglpophySLs show ing t11 al ttleir 1I1tl rnic tl orienshytation f~I (jLi l~ltes aXIal ve rtegravebJl l rotllio ll in cun litluns lt f dorsal hypokrrhn Icirc tnd lum)H de i L lo IS
Tll t dat SLlgge 1 th t impOrfill ut pOitu res and l1lweil1 ) t Mudied in ord t r (CI mlIuml ntrlin or to reuwer fll e p llyslo lo~lCll ClIlye in lIe SlgJtta p lU)l Wlth the llm o t ch ~ kin~ rutltor in l~ bili ry7 AbC th ~e ~k-
1l11nL ~Irt del lnt [0 J jUc lt ftber l]kuti inrervenl ion vhich 1c)LJ k l IV - i(l ~ l compktl n l ililll on Il t c1 l shy-jel1 J11UVllT1ent IJ j o f 1uto-dOneacute(3tlon ( i e a -impk ld ion ) Iengtheni ng o f the pilleacute 011 a litlltl l aXl~ tll lt ((IT liJlI~rcdu e~ t lle ~---lJ linti- l lte ml-fkxj(l n h UI 11 - i llCrl I~t the plllH ](JgicJI dlt cr ~l S ( (1 k-yvllCiSh lIld O(ltOSh l o r c lch r1Iif n t a Ilew til(~ecirc dUuml llt Ilshy
si lflltl J ll1 u(~nlent iam ecl - 1l1t0- lIrfe rionmiddot7 4 llmshyp oed f Je-rura l iUIl cl middot-t1e- iltm lI1d ll1a intltnUlLe )( 5lg it d C Uf (gtS slig lll thltJrc i ypI1 tiZ) tIcircOI1 a nd lunugrave)ar 1()fdos i7~llion) sholild he esw b lb]HU 00 lb co
hl b oi hi p~l11il uU r -1Ir vlt Abo 111( e IlltUtl Chl lie o f purti n - a U vitk slJ1ultI h e )tuumlll ecl 1)] (1 n ldershy](ion r tl1i lt type for e upIe IilJ llyl)T S of repd shyiti( ml vemen prt n t in agonistK h)lnllltlSlks nI iIle kind f dlJ1ce C( uld he ([([r imentd
FmiddotO lllaljlallC and mobili ty of the SpIcircIlC
1 rd llo U 22 d L lm nrrare d lhlt in Illt fro nt a l pll ne
tilt 1 nge Clt 1)1lt vtment of tht scplit[i middot CU IY grcmr lIJ l il ~ d irectio n n f Lhe C ITelt tlO n tha n in tl le di re shyLion of pmgressi n l Fig 7 ) he IL o IS5err lJd tbat th15 mohiliry increac plrtil u la rly n apic [ cgcoeilts 1$ lh ~ ~c() li osb evolves Sragrm rJ 12 J ~ thus rigilt (0
VlI f n rller~p is ts Ilo t t) m o b uumliz - a sCtJl iu til curve w ilhout t [ uling ttwt tlle R lu tiOI o i til t ~a mt b fnlinruumln( 1hy l1tans o f ~I passic 01 1 rivE -uppnrt On tilt (ltllE r hand UgraveK d e iJlioJ1 in ease durill tlw tune 111 whicll tll C spmt i ~ not submjtrcd to correeshy( IV anl()n
j- Virh mi lei ol i b tlllt Upp i1n ill) lC tiol is d eveloped only lllmugil llClIf()mu$Cllbr f r llce thi ~
InegravelIl ~ thclcfo re tl1l[ inu eascgtt sp1J1all1extl)iity mua
11
Imiddotiumltgt 7-rurd illt Ir) 1 bull rdrilt I1 1 in tl lt frOlllll pbnlt- th( illl ge )r mOC llIeJlI o t the S-o UIIJC CUNe 1 supcrior in Ihlt diflt(l im ugrave( the n nKlIl thd n ll1 tllc dlrtcLion o f p rJ1(l( (llIl
be considrCtJ vntrl iJ)(l icltion and 1 undrli neocirc ab L a ~ubiljz~ILion 01 tilt spint pllss il)1y ohtl ll1td thrltJugll the stlengtlkl11ng o f the 1rltJgm vlt nonil lme shyCIC 111 illli orrant u bjcLliH- ln rhis r~f1 n sp u lllni lc tivitIumlLs sil uld lX tPI 10 dlegraveltl it l G lU t n w l1ik luring kine i Icircth lrr phyltical eXegraverci c~ tllat in ele
spinal m ot ilIcirclY sil nid 1e lt1 oid cdrt ~
Organ ie and psychologieal impainncuts and li islbi IiI le
A cgtI im lc pmi nr is moriOthl11 just 1 sp in and 1
compkt gt Ipp rnach to the gu in ad 1 ont i al~ shylute l e~se i t i11
[)a la 0 11[ [n ell lrom re semh pw tbat ome organi Iilnctiond cl fki ts suc]) as tlw clecrtiUe ut vild l tnd d fun ll l)Kity_orld ldly incrtJ k whil~ 0 shy[io s i -till in (1 miel q g of g JltlV ity ~ l ilI e 55 rtI lit
tllL pres e n ce )fl defidt Or Vi l~il Clp~1 - i~ ln one pIIiem in Ihr l ftectecl by 20 ICl 40 scoi stgt l ls~a r(h cunclutecl in tbe UA by Di Ruce- prod uegraveed an aaalo) u ll1lXimum 102 re u t in a group of Jd shyk 1ien t [(h sco llosls rang inF frum ) [0 1
Al10ther rudv bv rallt r m C chr111 lilcl NashycWrl1s( u 57 stlO eltt hil $(C 1 1 ui~ Ica js l( lllt cl (1 shy1prUlllI o f t1tgl lie bJd l imI in ~ul sct t1 t ltu b middot iects jlLltr l5 they are golng through ~I cltlici[e sllge in the fnm 1lt i n 01 tlWH o w n id uHitv t factor hit h Illy jeopmlize the cl velopme lit d ~ mIll lt lI1d htIshym cecl IWI sonalitr in Klulrhood
n RUI ~IEDl(( Ptl Y1-
ROU ltHmiddot PI [ I C~ 1 EXIRCIS]~ IN TI Il nW~JUNT OF SlllO lDIOP1HIC AI)C~ESΠ11 C(gt1[Oi 1S
This i why b IiCieacute ii is ~n imporrlIl t for p rcshyvegraveml e 1tLsr l tn en ou flge 1ari e nrs ~lfrecr(d by lIillcl middotu iosis ft) tlke p~l rt in portin -re rcatioluJ acrivitits Iha t 1eIU 10 L10 th r~1chophyinLl bull nd b~l )i 1l1o tur adlieem t n li 51Jmiddot2Even tlK)ugli [Dr bic mech~lnshy
ical mcl nellIUll10t 11 11 reltl ~ons lt r111 1gtomcrimes be l lefu l to ugg( ~t ne p rt in~ aCt iv ity r l h (gtr rll n anotlJer e th ink Ibal an exces~ ive IlHd icalizltion - Icirce l ll1posilion br plry~ilt i HlS nnejlor parents uf rh ry pe of po rt to lx p m lice 1 b Ule p 1Ucirc(Il L th1[ preshydLl ck l1 is fret clOice in lh ma tt r - -h II ll1 he avolc1ed wb 11 possLhle mainly for tlle i mport~ltll psyshyLb ) jogka l fe a SI)nS W( ha( ill ~ t nltntionegraved
Conclu ion
lbh ISsertegrave d t1H physkal tgtXtlci o is ) n fi ial whlIl practinu in order 10 ilnj rove the I11 llde
rœ nwh and tono C iral caplCiry and postu re o f the StOUO(I ~lIbj n II I nowkdge om ~ middotmg trom ci el1shyrlfi rls(~ Jrc li dJlJ accordl ng r the review 01 thE litshytirlture prnpo )td in t lli plpl r conflrm~ Ihe vuiclit ot th e -t ls ~rti ()ns
In l do l (ent Id iopl1il iC scoliuse il l n phee u i cl vk)pm e n t ( li tll iumlKh eXCC cl l g i en rhk thr hokl th e re i5 an und ubred need fn r l pprnpri 1tegrave (JJ1tOkJJe ~Ild Inr surgict1 therapics ill ortler 1) S l i p
the ( - Iuli on anugrave )JT~t~t UW ~pilll l dtlormities bull evshyerthtless in the illiti ~ll pl l~sC t ttlC c1iseLltc whcn the riS( r1 r euro )luli m is rtduced ocirc ~md tfle uifleal JOld threshold il ~ld flle po stural collai i reJcenw~ 43
JI l1 igh pllysicaJ egravexe rc ise - p revenc or r d llCe d i ~lh ilir ies o f [Iw ~ l() li )tic
p (iems R 28 J -6 5- 6 1 63
- f~KiHtare lh ( n utr ali711iCUl of postu m l d elicits tn produCel1 a coneql l nce J [)ti 0 I111)( or regre si -u lmiddotc 5middot Il 1 17 ~ M
-re 51udles U ~ n Ledecl tu con[mn or re jecr these conClLL i( 1 w l1 ich clerin-d frum 1l1 lIldytica l rcltw n f th e liter~iture appear r- ~Lo nlble Hnwecr Intil ne re ull are 31Iable wc should n r prevent our sroliotic patientmiddot trom tl ki ll p lt in s(loI1ing jshy
ir its pW1iada rly ltl t ~d1()o t () n til t c ntrHY -vith the l xcclrinn 01 gt[1 )11lt tIlat in rea-e t)1obility (tnU evc n thell oilly wh n progr~lgtion b p OSSibl) -uc h ~I( ucircvshyiUe -11 )ulu hl tIKoll w g ed The 11 S J ( rprOpriue kin (~irhe r~l Piuml to incr _~asc p()~tura l $llbil i ty is tl1egraveoretshyic tlly CiJUClt alttloughl more ~Iccu rtte aod deLli led ri k benefi rs anJlr~ is is netot1ed
Ria 1111tO
NIokl Mu d lle ftitYljJfu Jœl il 4IWr10UOifll S (JIvs i (1~1)Jshylidl ttno( cclIll le 11(11(1lt1 RCI fu lle ((lia LltfIt l1 I1I1i(i
LJ ci n s j(r3 pigt egrave li n IHUgru lkl di t rdz t fi sici pe e ft shytUlKm iluppno di un lisimerap15Ll rl lllcflt() 1 110 scopo di pnevirlt () fr en~lI 1-lgpwlllltnlcgt dclld lclonnitugrave o e il 5LOshy
Il i mi llon lt fH nugrave j (1 11ni dei co~e 1 lteIl I1J J nd ne ~Ii eifclti (()Tc rri udk s co lio si d i m e dia g rt iuuml ln que~ltlt
s rud i 30 llizzb mo i d ti cleU ric lca pel n ri Icare qJJ l lm 1 dis(imucirc x u le I[~ l z j-m i pro vna le da lla C gtl k A i json ere pr middote-nute () rk kl ducirc un~l rdeguCltl d nil cra pi lt di uJoseguerrnt Cjua li 1iU110 cli nbie tti 1 rcr lJ)tIId d~ fle)-UITC
n (- -fd7Io n~lcl)
Ut11claquo)si 1 lI tori htpnuuml )ludi-ttn I ~ cnntI1zttu fr Cq(in i idiJ)tic1 dbfl lOZ10l1 d d ~ leOla nelllOll1otoriO Lb un1I1cnUl 1n1l1i3 dcgli 111 lt1i ch DIJgt gtU l H crmU1 Nlch~mslt ( SIshygnaJ~l lerimiddot wo i esuemi -bletti d~ plt~e8lugraver- ne l pClZ le1lftgt scoliodcu kl s iluppo ddl ~ ~ uhjlil~ vertcbral~ lt o svilllp prJ Jdle JIl7 i() nl di ltCjuiljbrio Dng li studi sul lto lb( l~nlrale (OllddU i in pa rticdu d 1 DlIal-BeHJ (gtegraverl ~ P~II IId lI1 n~ llw - idente il v- m gtiu p eT il puientc clioti elgt di u n rnigb o t c)[ ro Ua sw mle dei radlldc onsegull o tramite il 11 fforzrlshyfl len to d e i l1luotoucirc l nllgr3ilri d e luOwo con crcbi ~Clltdr
in pOMltHJ corrctl e in va rie ~i[Jzioni s t llicb c c d inamIcirc tllt Dalle on sena d elb blOffiCcclIlicd tr idimlt n s io mlle d ei
r ~ chi Je ~oU()f icn ~Icirc ~videnuumll (l() ~llt tC p IYZIcircOSI ln(IiClZlfHicircl ~ 1I1shy
liumln fluenzt Je ll middote~rUrio tl SC) lgt lIi I rc pibull m i tldln sJlI71 Stl shygn~I I1 afferma che slI l p Ia no [11 middotccedilr~lk tre un œ rtlJ grado di l L1Liuuml IlC dclh vEltlh r1 apj(de le tu rœ mu SCltJ llri njtbc J n in $tJ ) t rodcfQfll1t1l1te PltJtantu b i r~it-~ r -lp il puugrave t~~
Ixnt-ftla solo nt Ile so )[j)~i Jl1Icirc na rl in qunnt ) ilon SlrM ntne )(l(Ofa tu soglb in caq ) co lltrLJIcircn l)lrilto llt~( i lJudotlsi di lfr~ lI1 C llg grVlmenl J 111 11 io lr riltd ll(17jOill leld rinlle 113 dimO~iumlrlto d llt nell o lin~l cl()~ li t th~oIOl))1 dri la defltgtrshymiti sul p iluO slfl iuale ~vohl lf1 (en5 ion~ sO lnm utto nd 1e bsi iniliali deWggrwm1Cnln mcn trl C a( lfLmn che occlleshyvoluzi ne dene = 110 i [ mhari IJ lin c l ki cen tri ch -1vi1( de i cp i CIt IJ rI Ji SI p m ittIl pnm l Iem lmeme e p o j pOS( shyrio fllwnte dtldnli mdv ( i un ziuuml ne ciloliz7nnl dd rlLtide lu mbJ œ ( lIlelttlaquo on NC n d d (gt11 uIdu m 1I1 Ilgt) cli r-Iure (0 eserClzi che IllUllengano 0 ltlUperifo le Clgt 6gt1 lo)iche sul pirluuml gilwlt Su l p iCl no fron itk Perdnulk il dlll1lt-trlto d1 lampkz-l d i LU ovimento amp111 lI rv Kolio ti ~ nd lt1 0 ddlJ cnrrc-LIcircQo i Ji gC 1 n lungl SUpegraveliltlrccedil 1M llS0 tlell 3ampIGI shyvamcnlo C che l~Jltmiddot mobiliti GlI mcnta co n l c lu7j o fle d l i) snAio i A ulln amplgrtJc1 ltllllmunjx~ i terlpGli nn n m obi shyUZ73It ma eutva coli ti0 1 1ct HsicVlfe nd tcmplt 11 1111nshyttllIcirc1nc n tc (k ll ~1 llu u zinnt n l1 un me77uuml d i sost l11( gt ln 0
e 11111ri b cle - Ilziunc egrave deorinatcl d l rlyarsi Snzcl la pr gtshy
liltlnl l i un() rtl~ i ptmiddot Jtl n(o 1S(Hl () (( ntJ() i ndit~tr i ~ Ii ISt (izi e l m iviL Illdlode ebe Hlmen tno laJlc ibiJii dcl rlc lide SCshy
li io) [n p articobre rune q lldl r C-I1 ich~ xlSiddcHe CUf t shyli ve ch~ iJllpi tgino e~rciii 01( biIi2 ZanUgrave HhnmL-trid () in tmiddot~t~nshy
sione kl fuchide O tne pure k- ~ttivit1 tnotoJII~ non prHi(~ llCcedil
in forma r k rel1tiva d Ie ~1I 11 rF~1l1( n otcol mcnlC 1 lll ubib Ll vcrteblmiddote (ad ~ flp j(l 11 n l) to L ginn ~Iilt Utl clkl rilshyC
mka la cli OT- tcc)
r1il to l~ _ I[Dl COlI rY IC~
NE olUNI
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EUROP MIDI C Pli hIC
EDUCATIONMEETING SATURDAY 8thof APRIL 2006
(iSS
SEAS02 Scientific
Exercises Approach to Scoliosis
version 2002
G
S Negrini 1
EDUCATION MEETING SATURDAY8th of APRIL 2006
Neuromotor disfunctions
Neuromuscular disfunctions
11 Postural collapse
Postural collapse
Duval-Beaupegravere
Flexibility of scoliotic curve
f---I--- I Postural element
-------1 Structural element
S Negrini 2
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Postural collapse
Duval-Beaupegravere
It is a value related to muscular tone and to flexibil ity of convex side tissues
Post ural collapse
Bunch e Patwardhan
Critical load
Load threshold beyond wh ich a spine begins buckling
JI~~Wt1lW~flfthtlJlœJtAr ~ J~It- l~l - IMS
Postu ral collapse
Bunch e Patwardhan
If a curve reduces there is an increase of the deformation threshold
~~~NW~-damaoc~IIIMf ~~ J~Iv JaJ-I7I9sect
S Negrini 3
EDUCATION MEETING SATURDAY 8th of APRIL2006
Postural collapse
Torrel e Nachemson ~
Scolioses below 20deg ~ ~ lt~
have a high ~ ~ percentage of ~ ~
~postural collapse (on u~
average 75) ~~ 2i~
CU~VE O EG~EE S WHllE SUPlti e
~laquotd~c6b ____lPffI1wtt1t~
$ww J(t ~~7 JM5
Postural collapse
Minor scolioses 7
Antigravity musc es strengthening D
Reduces postural collapse -G
Increases the critical threshold of deformation
G
Neuromotor disfunetions
Stagnara
If we admit that one of the causes of idiopathie scoliosis is a disfunction in balance systems it is logical to orientate physical exercises toward this direction
s Negrini 4
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Neuromotor disfunctions
Dubousset
Idiopathie seoliosis results fram alterations in praprioeeption centres and deformation is a natural compensation to restore postural balance
etattJtitIK ypothfQj~S ___~ own_ oJ)HQr lar 1t-1( r
Neuromotor disfunctions
Nachemson Initial idiopathie scoliosis
+ Goood spine stability
Neutralization of postural deficits
D Static curve
Neuromotor disfunctions
Therapeutic aims
c) Development of spine stability
C) Development of balance reactions
G
S Negrini 5
EDUCATION MEETING SATURDAY 8thof APRIL 2006
Biomechanical disfunctions
j Horizontal r-Ian
i Sagi ttal plan
Frontal plan
Frontal plan
q Frontal plan disfunetions
Fronta l plan
Perdriolle Movement magnitude
gt in the direction of lt in the direction of correction progression
S Negrini 6
EDUCATION MEETING SATURDAY8th of APRIL 2006
Frontal plan
Stagnara
Never mobilize a scoliotic curve without ensuring reduction maintenance over time otherwise a greater mobility favours scoliosis progression
Frontal plan
Ducongeacute~ research
On a group of adolescent idiopathie scolioses treated with
Meacuteziegraveres gymnastics
D After 1 year the mean angle of
curves increased from 18deg to 29deg
Frontal plan
Scoliosis without brace
D Greater spine
flexibility D-
Risk of progression
S Negrini 7
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Frontal plan
Mobilization is useful
D In preparation to
brace
D With brace
Sagittal plan
QSagittal plan disfunctions
Sagittal plan r middot _J o
Perdriolle scouos B CJ aDeformation of D
thoracic and thoraco-Iumbar curves evolves in extension
S Negrini 8
EDUCATION MEETING SATURDAY8th of APRIL 2006
Sagittal plan
Graf
The line of gravity centres in the vertebral bodies o s c oUOSt
projects itself firstly laterally and then fi
o
posteriorly lJ ~~ ~~ ~ ~~-_J-D ~nI~
Sagittal plan
Therapeutic a ims
D Maintain or
retrieve physiological curves on the sagittal plan
Horizontal plan
QHorizontal plan disfunctions
S Negnni 9
EDUCATION MEETINGSATURDAY 8th of APRIL 2006
Horizontal plan
Stagnara The forces applied ta the spi ne act in a autoshydeforming sense
Horizontal plan
Dimnet Rotation gt 200
ampII~ (
D The actions of concave and convex side
muscles become
agonistic
~ItJrOnrIIiItdllfUClltlluumlll~~tI ~1JIf1laJ
Horizontal plan
Minor scolioses never exceed these autoshy
deformation thresholds
S Negrini 10
EDUCATION MEETING SATURDAY8th of APRIL 2006
Disfunctions at a biological organic and psychological
lever
Oisfunclions at a biological organlc and psychologlcal lever
Cheng
Bane density in scoliotic teenagers is lower than in normal subjects
~~~~middotA~IIlUtIy ~7œl 1d l
Oisfunctions at a blologlcal organic and psychologicallevel
A significant reduction of vital capacity and V02max in teenagers with a medium severity scoliosis
S Negrini 11
li
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Disfunctions at a biological organic and psychologicallevel
Disorders in the development of body image that the teenager has of himherself
Disfunctions at a blologlca l organlc and psychologicallevel
Therapeutic aims
cJ Activate cardioshyrespiratory function
cJ Favour bone density increase
cJ Develop a positive image of the body
Disfunctions at il biological organi and psydlologicallevel
Stagnara
Sport
D The active side of
kinesitherapy
S Negrini 12
EDUCATION MEETING SATURDAY 8thof APRIL 2006
Disfunctions at a biological organic and psychological
level
Distunctions at a biologlcal organlc and psychologicallevel
Cheng
Bone density in scoliotic teenagers is lower than in normal subjects
~n~IIIvpWr~middotA~stWy s- XXJl M J
Disfunctions at a biological organic and psychologicallevel
A significant reduction of vital capacity and V02max in teenagers with a medium severity scoliosis
G
S Negrini 11
EDUCATIONMEETING SATURDAY 8th of APRIL 2006
Kinesitherapy on the scoliotic subject
q Postural control
q Axial stability
q Muscular trophism
q Balance
q Respiratory function
The limits of kinesitherapy
There is a threshold beyond which
rehabilitation alone is not enough
sssr
Kinesitherapy in scoliosis treatment with brace
Therapeutic aims
S Negrini 13
6
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Therapeutic aims Srace kinesitherapy
With brace
il Postural corrections and
vertebral stability are obtained by the brace
Therapeutic aims Srace kinesitherapy
In preparation to the brace
il Mobilize spine on ail plans
Therapeutic aims Srace kinesitherapy
With brace D
Maintain a normal spine elasticity
~ Maintain a good muscular toneshy
trophism
C Model the hump with kyphotizating
exercises
S Negrini 14
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Exercises and their methodologies can vary accord ing to learning and individual sensibility of the single rehabilitator that proposes the m provided that they stay within the
Iimits of fixed therapeutic objectives
li
Therapeutic modalities
(Exercises)
QAuto-correction
QRespiratory education
QErgonomie education
QMuscular strengthening
QDevelopment of balance reactions
WNeuromotor integration
ci Vertebral mobiJization
QSpecifie modalities in brace treatment
S Negrini 15
EDUCATION MEETING SATURDAY 8th of APRIL 2006
The protocol of kinesitherapic
treatment
G
QChoice and dosage of exercises
Variatiosn of the work program every 2 - 3 months
Q Execute e)(ercises on an individual base or in a small group
Q Frequency not less than 2 times 1 week
Involve and awaken the family
G
S Negrini 16
EDUCATION MEETINGSATURDAY 8thof APRIL 2006
Q Determine the action and the localization of auto-correction
QAuto-correction must be associated to ail exercises
QAt the end of treatment ergonomy lesson
Auto-correction didactics
G
SCOLIOSI DORSALE---- shy ----
r
S Negrini 17
EDUCATION MEETING SATURDAY8thof APRIL 2006
SCOLIOS OORSOLOMBARE
shy
SCOLIOSI OOIlSALE 011 bull LOMBARE S1I--shy
SCOLIOSI LOMBARE
il --~_-
S Negrini 18
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Scoliotic patients are not radiographs
middotSeoliotie Mtients are not ndiographs but hum beings with a vertebral deviation-
Slagnara
Metha For the physieian Cobb angle is of utmost
importance For the patient it is body deformity t hat eounts most rib hump a protruding seapula or hip We are in a situation in whieh today dodors eure the radiographie deformity but what the patient really desires is to get rid of clinieal deformity and of ensuing psyehologieal distress
CIIQItIo shDuIdtucirc lM WIld tJw~~ I~~M~~~~ J9f~
S Negrini 19
- Poznan_workshop_Physiotherapy
- physio2
- physio3pdf
- physio4
- physio5
- physio6
- physio7
- physio8
- physio9
- physio10
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Ilu LE nI rIIY~Ic~L lXIlKISI 1 HI E TREhTMEtn OP JIU IDIOP llII C AD O USCUH O Ll Œl15 NEGR II
lLill tegt lre lenl1 ~I d ~fo rll1J[ ~ rhl recrSes the phyltiologiGII cmns of lh vine)
Accordlng () Dicion ~2 1 rtcluctio fl in the itgitttl CUIYtS combin l vi th a lueral Iviari n llltl ds t 1
mecban ism () ugravel~ta il ity in l he r rat r IllI1e which bVOf1i the unsd a nd i ncrea~e 0 1 co hlt1is (Fig 6 hiIf md Pl11jlbiJ Jl1eanwlt ile lt(udiecl lh e srnl ru t
orzyglpophySLs show ing t11 al ttleir 1I1tl rnic tl orienshytation f~I (jLi l~ltes aXIal ve rtegravebJl l rotllio ll in cun litluns lt f dorsal hypokrrhn Icirc tnd lum)H de i L lo IS
Tll t dat SLlgge 1 th t impOrfill ut pOitu res and l1lweil1 ) t Mudied in ord t r (CI mlIuml ntrlin or to reuwer fll e p llyslo lo~lCll ClIlye in lIe SlgJtta p lU)l Wlth the llm o t ch ~ kin~ rutltor in l~ bili ry7 AbC th ~e ~k-
1l11nL ~Irt del lnt [0 J jUc lt ftber l]kuti inrervenl ion vhich 1c)LJ k l IV - i(l ~ l compktl n l ililll on Il t c1 l shy-jel1 J11UVllT1ent IJ j o f 1uto-dOneacute(3tlon ( i e a -impk ld ion ) Iengtheni ng o f the pilleacute 011 a litlltl l aXl~ tll lt ((IT liJlI~rcdu e~ t lle ~---lJ linti- l lte ml-fkxj(l n h UI 11 - i llCrl I~t the plllH ](JgicJI dlt cr ~l S ( (1 k-yvllCiSh lIld O(ltOSh l o r c lch r1Iif n t a Ilew til(~ecirc dUuml llt Ilshy
si lflltl J ll1 u(~nlent iam ecl - 1l1t0- lIrfe rionmiddot7 4 llmshyp oed f Je-rura l iUIl cl middot-t1e- iltm lI1d ll1a intltnUlLe )( 5lg it d C Uf (gtS slig lll thltJrc i ypI1 tiZ) tIcircOI1 a nd lunugrave)ar 1()fdos i7~llion) sholild he esw b lb]HU 00 lb co
hl b oi hi p~l11il uU r -1Ir vlt Abo 111( e IlltUtl Chl lie o f purti n - a U vitk slJ1ultI h e )tuumlll ecl 1)] (1 n ldershy](ion r tl1i lt type for e upIe IilJ llyl)T S of repd shyiti( ml vemen prt n t in agonistK h)lnllltlSlks nI iIle kind f dlJ1ce C( uld he ([([r imentd
FmiddotO lllaljlallC and mobili ty of the SpIcircIlC
1 rd llo U 22 d L lm nrrare d lhlt in Illt fro nt a l pll ne
tilt 1 nge Clt 1)1lt vtment of tht scplit[i middot CU IY grcmr lIJ l il ~ d irectio n n f Lhe C ITelt tlO n tha n in tl le di re shyLion of pmgressi n l Fig 7 ) he IL o IS5err lJd tbat th15 mohiliry increac plrtil u la rly n apic [ cgcoeilts 1$ lh ~ ~c() li osb evolves Sragrm rJ 12 J ~ thus rigilt (0
VlI f n rller~p is ts Ilo t t) m o b uumliz - a sCtJl iu til curve w ilhout t [ uling ttwt tlle R lu tiOI o i til t ~a mt b fnlinruumln( 1hy l1tans o f ~I passic 01 1 rivE -uppnrt On tilt (ltllE r hand UgraveK d e iJlioJ1 in ease durill tlw tune 111 whicll tll C spmt i ~ not submjtrcd to correeshy( IV anl()n
j- Virh mi lei ol i b tlllt Upp i1n ill) lC tiol is d eveloped only lllmugil llClIf()mu$Cllbr f r llce thi ~
InegravelIl ~ thclcfo re tl1l[ inu eascgtt sp1J1all1extl)iity mua
11
Imiddotiumltgt 7-rurd illt Ir) 1 bull rdrilt I1 1 in tl lt frOlllll pbnlt- th( illl ge )r mOC llIeJlI o t the S-o UIIJC CUNe 1 supcrior in Ihlt diflt(l im ugrave( the n nKlIl thd n ll1 tllc dlrtcLion o f p rJ1(l( (llIl
be considrCtJ vntrl iJ)(l icltion and 1 undrli neocirc ab L a ~ubiljz~ILion 01 tilt spint pllss il)1y ohtl ll1td thrltJugll the stlengtlkl11ng o f the 1rltJgm vlt nonil lme shyCIC 111 illli orrant u bjcLliH- ln rhis r~f1 n sp u lllni lc tivitIumlLs sil uld lX tPI 10 dlegraveltl it l G lU t n w l1ik luring kine i Icircth lrr phyltical eXegraverci c~ tllat in ele
spinal m ot ilIcirclY sil nid 1e lt1 oid cdrt ~
Organ ie and psychologieal impainncuts and li islbi IiI le
A cgtI im lc pmi nr is moriOthl11 just 1 sp in and 1
compkt gt Ipp rnach to the gu in ad 1 ont i al~ shylute l e~se i t i11
[)a la 0 11[ [n ell lrom re semh pw tbat ome organi Iilnctiond cl fki ts suc]) as tlw clecrtiUe ut vild l tnd d fun ll l)Kity_orld ldly incrtJ k whil~ 0 shy[io s i -till in (1 miel q g of g JltlV ity ~ l ilI e 55 rtI lit
tllL pres e n ce )fl defidt Or Vi l~il Clp~1 - i~ ln one pIIiem in Ihr l ftectecl by 20 ICl 40 scoi stgt l ls~a r(h cunclutecl in tbe UA by Di Ruce- prod uegraveed an aaalo) u ll1lXimum 102 re u t in a group of Jd shyk 1ien t [(h sco llosls rang inF frum ) [0 1
Al10ther rudv bv rallt r m C chr111 lilcl NashycWrl1s( u 57 stlO eltt hil $(C 1 1 ui~ Ica js l( lllt cl (1 shy1prUlllI o f t1tgl lie bJd l imI in ~ul sct t1 t ltu b middot iects jlLltr l5 they are golng through ~I cltlici[e sllge in the fnm 1lt i n 01 tlWH o w n id uHitv t factor hit h Illy jeopmlize the cl velopme lit d ~ mIll lt lI1d htIshym cecl IWI sonalitr in Klulrhood
n RUI ~IEDl(( Ptl Y1-
ROU ltHmiddot PI [ I C~ 1 EXIRCIS]~ IN TI Il nW~JUNT OF SlllO lDIOP1HIC AI)C~ESΠ11 C(gt1[Oi 1S
This i why b IiCieacute ii is ~n imporrlIl t for p rcshyvegraveml e 1tLsr l tn en ou flge 1ari e nrs ~lfrecr(d by lIillcl middotu iosis ft) tlke p~l rt in portin -re rcatioluJ acrivitits Iha t 1eIU 10 L10 th r~1chophyinLl bull nd b~l )i 1l1o tur adlieem t n li 51Jmiddot2Even tlK)ugli [Dr bic mech~lnshy
ical mcl nellIUll10t 11 11 reltl ~ons lt r111 1gtomcrimes be l lefu l to ugg( ~t ne p rt in~ aCt iv ity r l h (gtr rll n anotlJer e th ink Ibal an exces~ ive IlHd icalizltion - Icirce l ll1posilion br plry~ilt i HlS nnejlor parents uf rh ry pe of po rt to lx p m lice 1 b Ule p 1Ucirc(Il L th1[ preshydLl ck l1 is fret clOice in lh ma tt r - -h II ll1 he avolc1ed wb 11 possLhle mainly for tlle i mport~ltll psyshyLb ) jogka l fe a SI)nS W( ha( ill ~ t nltntionegraved
Conclu ion
lbh ISsertegrave d t1H physkal tgtXtlci o is ) n fi ial whlIl practinu in order 10 ilnj rove the I11 llde
rœ nwh and tono C iral caplCiry and postu re o f the StOUO(I ~lIbj n II I nowkdge om ~ middotmg trom ci el1shyrlfi rls(~ Jrc li dJlJ accordl ng r the review 01 thE litshytirlture prnpo )td in t lli plpl r conflrm~ Ihe vuiclit ot th e -t ls ~rti ()ns
In l do l (ent Id iopl1il iC scoliuse il l n phee u i cl vk)pm e n t ( li tll iumlKh eXCC cl l g i en rhk thr hokl th e re i5 an und ubred need fn r l pprnpri 1tegrave (JJ1tOkJJe ~Ild Inr surgict1 therapics ill ortler 1) S l i p
the ( - Iuli on anugrave )JT~t~t UW ~pilll l dtlormities bull evshyerthtless in the illiti ~ll pl l~sC t ttlC c1iseLltc whcn the riS( r1 r euro )luli m is rtduced ocirc ~md tfle uifleal JOld threshold il ~ld flle po stural collai i reJcenw~ 43
JI l1 igh pllysicaJ egravexe rc ise - p revenc or r d llCe d i ~lh ilir ies o f [Iw ~ l() li )tic
p (iems R 28 J -6 5- 6 1 63
- f~KiHtare lh ( n utr ali711iCUl of postu m l d elicits tn produCel1 a coneql l nce J [)ti 0 I111)( or regre si -u lmiddotc 5middot Il 1 17 ~ M
-re 51udles U ~ n Ledecl tu con[mn or re jecr these conClLL i( 1 w l1 ich clerin-d frum 1l1 lIldytica l rcltw n f th e liter~iture appear r- ~Lo nlble Hnwecr Intil ne re ull are 31Iable wc should n r prevent our sroliotic patientmiddot trom tl ki ll p lt in s(loI1ing jshy
ir its pW1iada rly ltl t ~d1()o t () n til t c ntrHY -vith the l xcclrinn 01 gt[1 )11lt tIlat in rea-e t)1obility (tnU evc n thell oilly wh n progr~lgtion b p OSSibl) -uc h ~I( ucircvshyiUe -11 )ulu hl tIKoll w g ed The 11 S J ( rprOpriue kin (~irhe r~l Piuml to incr _~asc p()~tura l $llbil i ty is tl1egraveoretshyic tlly CiJUClt alttloughl more ~Iccu rtte aod deLli led ri k benefi rs anJlr~ is is netot1ed
Ria 1111tO
NIokl Mu d lle ftitYljJfu Jœl il 4IWr10UOifll S (JIvs i (1~1)Jshylidl ttno( cclIll le 11(11(1lt1 RCI fu lle ((lia LltfIt l1 I1I1i(i
LJ ci n s j(r3 pigt egrave li n IHUgru lkl di t rdz t fi sici pe e ft shytUlKm iluppno di un lisimerap15Ll rl lllcflt() 1 110 scopo di pnevirlt () fr en~lI 1-lgpwlllltnlcgt dclld lclonnitugrave o e il 5LOshy
Il i mi llon lt fH nugrave j (1 11ni dei co~e 1 lteIl I1J J nd ne ~Ii eifclti (()Tc rri udk s co lio si d i m e dia g rt iuuml ln que~ltlt
s rud i 30 llizzb mo i d ti cleU ric lca pel n ri Icare qJJ l lm 1 dis(imucirc x u le I[~ l z j-m i pro vna le da lla C gtl k A i json ere pr middote-nute () rk kl ducirc un~l rdeguCltl d nil cra pi lt di uJoseguerrnt Cjua li 1iU110 cli nbie tti 1 rcr lJ)tIId d~ fle)-UITC
n (- -fd7Io n~lcl)
Ut11claquo)si 1 lI tori htpnuuml )ludi-ttn I ~ cnntI1zttu fr Cq(in i idiJ)tic1 dbfl lOZ10l1 d d ~ leOla nelllOll1otoriO Lb un1I1cnUl 1n1l1i3 dcgli 111 lt1i ch DIJgt gtU l H crmU1 Nlch~mslt ( SIshygnaJ~l lerimiddot wo i esuemi -bletti d~ plt~e8lugraver- ne l pClZ le1lftgt scoliodcu kl s iluppo ddl ~ ~ uhjlil~ vertcbral~ lt o svilllp prJ Jdle JIl7 i() nl di ltCjuiljbrio Dng li studi sul lto lb( l~nlrale (OllddU i in pa rticdu d 1 DlIal-BeHJ (gtegraverl ~ P~II IId lI1 n~ llw - idente il v- m gtiu p eT il puientc clioti elgt di u n rnigb o t c)[ ro Ua sw mle dei radlldc onsegull o tramite il 11 fforzrlshyfl len to d e i l1luotoucirc l nllgr3ilri d e luOwo con crcbi ~Clltdr
in pOMltHJ corrctl e in va rie ~i[Jzioni s t llicb c c d inamIcirc tllt Dalle on sena d elb blOffiCcclIlicd tr idimlt n s io mlle d ei
r ~ chi Je ~oU()f icn ~Icirc ~videnuumll (l() ~llt tC p IYZIcircOSI ln(IiClZlfHicircl ~ 1I1shy
liumln fluenzt Je ll middote~rUrio tl SC) lgt lIi I rc pibull m i tldln sJlI71 Stl shygn~I I1 afferma che slI l p Ia no [11 middotccedilr~lk tre un œ rtlJ grado di l L1Liuuml IlC dclh vEltlh r1 apj(de le tu rœ mu SCltJ llri njtbc J n in $tJ ) t rodcfQfll1t1l1te PltJtantu b i r~it-~ r -lp il puugrave t~~
Ixnt-ftla solo nt Ile so )[j)~i Jl1Icirc na rl in qunnt ) ilon SlrM ntne )(l(Ofa tu soglb in caq ) co lltrLJIcircn l)lrilto llt~( i lJudotlsi di lfr~ lI1 C llg grVlmenl J 111 11 io lr riltd ll(17jOill leld rinlle 113 dimO~iumlrlto d llt nell o lin~l cl()~ li t th~oIOl))1 dri la defltgtrshymiti sul p iluO slfl iuale ~vohl lf1 (en5 ion~ sO lnm utto nd 1e bsi iniliali deWggrwm1Cnln mcn trl C a( lfLmn che occlleshyvoluzi ne dene = 110 i [ mhari IJ lin c l ki cen tri ch -1vi1( de i cp i CIt IJ rI Ji SI p m ittIl pnm l Iem lmeme e p o j pOS( shyrio fllwnte dtldnli mdv ( i un ziuuml ne ciloliz7nnl dd rlLtide lu mbJ œ ( lIlelttlaquo on NC n d d (gt11 uIdu m 1I1 Ilgt) cli r-Iure (0 eserClzi che IllUllengano 0 ltlUperifo le Clgt 6gt1 lo)iche sul pirluuml gilwlt Su l p iCl no fron itk Perdnulk il dlll1lt-trlto d1 lampkz-l d i LU ovimento amp111 lI rv Kolio ti ~ nd lt1 0 ddlJ cnrrc-LIcircQo i Ji gC 1 n lungl SUpegraveliltlrccedil 1M llS0 tlell 3ampIGI shyvamcnlo C che l~Jltmiddot mobiliti GlI mcnta co n l c lu7j o fle d l i) snAio i A ulln amplgrtJc1 ltllllmunjx~ i terlpGli nn n m obi shyUZ73It ma eutva coli ti0 1 1ct HsicVlfe nd tcmplt 11 1111nshyttllIcirc1nc n tc (k ll ~1 llu u zinnt n l1 un me77uuml d i sost l11( gt ln 0
e 11111ri b cle - Ilziunc egrave deorinatcl d l rlyarsi Snzcl la pr gtshy
liltlnl l i un() rtl~ i ptmiddot Jtl n(o 1S(Hl () (( ntJ() i ndit~tr i ~ Ii ISt (izi e l m iviL Illdlode ebe Hlmen tno laJlc ibiJii dcl rlc lide SCshy
li io) [n p articobre rune q lldl r C-I1 ich~ xlSiddcHe CUf t shyli ve ch~ iJllpi tgino e~rciii 01( biIi2 ZanUgrave HhnmL-trid () in tmiddot~t~nshy
sione kl fuchide O tne pure k- ~ttivit1 tnotoJII~ non prHi(~ llCcedil
in forma r k rel1tiva d Ie ~1I 11 rF~1l1( n otcol mcnlC 1 lll ubib Ll vcrteblmiddote (ad ~ flp j(l 11 n l) to L ginn ~Iilt Utl clkl rilshyC
mka la cli OT- tcc)
r1il to l~ _ I[Dl COlI rY IC~
NE olUNI
fillncr ( ni ((uuml(( n hIIo( rilclIO ~middothe k lln dtfidl fUr1z i shy
nlu CQll1~ la llcl llZIO 1e delb c apKJl ilde e della capacltl di 0170 mizianu luJndn le (OJ il~ gtna a nc r3 di m~i3 gmshy
v it ln G mlxl r i ~ gko Fl llslrom C dlllJ O e Nachcms(J h iU1I) dim lr JtQ che b o liosl p IOO C1 neUaduksœnr 10 SYil l1p pn d i lIniumlmn~gin nlt8Jliva de corpo in (o nridcnz di Ln ddic3w p ri d di f( m l lz i nlt deUa SUl idenritl condishyZltonc ch pOlrebh ~[I cubrmiddot ln vilu pp di un pe bull n nn lir m llur cd e quiJibfarn in t[C adulro TaU CO1DSCe nZe tvlde nshyZ[II)() la n ( middotess iti di ltimobre la plfte ip a7j0 r1e atl an ivi ll1ltHClr n gl b a li ltl h ~ di tlpO s pu rti middotu dl ittlrc nd gloani iCo lID ti i lirtugraveta z io ni llb vila di relazionc
ln concllliu fu la d tfoflll lL saliu iG egrave il sin l mo di lin) idrotnc C Il1pk 1 d e eoinvo l d middotmiddot= fu n (n i dd rgashynIcirc5H10 n Hi lhdli e lesenizjo fi 1lt0 se 1 Il indirill~t() pllO pr~cnin 0 odLf rgt t lli di fu nzlonicirc adlc s()Jj(bi 111Icircn(i rrHtatc CO ll nl1 cinesi rap i Quand l~ coli i ( n LS~middot iJ11 zia k il rischio evnluLIcircvo egrave lid [() mente no tcole 11 (ltlll asso p o lll shylal ltOtSltgllen7~1 _ ta cincsiterapia pc rslIk bidtlvi shyptutibulli d ubllIcirctIcirc vltnc brn1e di conrro llo )(JSu k d i 5IcirclupPQ d Ile rLlt ziofll d i eC[u ihb ugraveo dJ ftffr otZJH1 r1w dei IIl llJgtCili 1 11Icircshyg rdtarl in posru ra rrenu posslhile JnnalL in Illo lt i clsi l(j luucircun lt di lin ~c() li oi mi n rc ( ume [11 duumlnQstrIO la tinc~ jn~l el1lric ((1l1 ~rtlppi d i contnmiddotllo cnndnlt1 p nso i l entrt d e Massue di Li n nc da [ o llo n ~ Rodo l (1 986) Julndo il1vlce lIfU~ ho ~vutlJ tiVll 11lt1 1IjXIl to un dekrshyuina r o~itl di g rl vir~l bull a~-n lllull~nte n ec ~~uiu rlCUuml rf( ff dla tcrJpll rle si c a eo chirurg ica
1Ho le clllC ooliosi idjopHI 3 ttl1p ~ - E~er l zjo hsco shy11ln ~ I((fapil
l Bg 5 CUle Lo [la k ll oblems in tlu ll~ (U ni Cl) FrKUce CU ( )lIILr no 1 AllCPR lu b1lG1t10 11 middotCI 9()(iJ2 RockilJe MI) i)~Cr ~()f I [( al th all 1 () I ~Y 1(~Re~C~Hd ~gtutnlt Ilallb Srshy1ltC Cgt D~p(rulllnr CJf I Ilalil 11 1 HumlIl sen Lel 199-1
2 SI) lrzcf ( LcB I ~IIl( FE DupUb L ampkIll~ 1c ~ppro l c h ll tht rnent und mmgemlt-rlt ot ~ ct vlyrl~ led splnul (hs r)fder~ A monQglJph rr r d lll kic Re p o l1 or Ih Ou bcc TlSk Fu rcl 0 11 ipmd DIo rele Sp ine L9H LU) 59
) Clntino F 111i1 i(ll Ci nerte1H C Nou gltHhl C Kln(~Jl llBICII [lIe1 hmlln (Il dry rra ll1ltfll of QIil pa ll m log iC by l11e 1 lIb li 1le-llh laquorilC~ of ~ 10(lna 111 Jrc)Jcxli r~~ (of flle h l lntrnIUonll SVIll Illgt~iu tn - II 5lt Ik lIc lk0flllllic lu llln-I I r l III Fhhlt ri g 1092 -ltlIJ-7
i - ri of niii MA N()LJV II ~ mel h)ltks de kin ~~klk rlr k di lll J r~cdllclli (n d~s ~()li oes jn f ~tel r~1ruuml(ILI -lo s bl fl c sur IcIj cquishyl)œ~ Ik SOll ll l)(eacute Eli ror eetlfllS d )111 1~ 1)1-
5 iloll n G Ruumld(~ le s () I ~middotmiddots tnlcl l l1 I n in 1Ifc el kiwil~~ 1)11lt KillegraveSlthe ripJe SCleacutentlnlue lYl6 2 47 ~ 6
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EUROP MIDI C Pli hIC
EDUCATIONMEETING SATURDAY 8thof APRIL 2006
(iSS
SEAS02 Scientific
Exercises Approach to Scoliosis
version 2002
G
S Negrini 1
EDUCATION MEETING SATURDAY8th of APRIL 2006
Neuromotor disfunctions
Neuromuscular disfunctions
11 Postural collapse
Postural collapse
Duval-Beaupegravere
Flexibility of scoliotic curve
f---I--- I Postural element
-------1 Structural element
S Negrini 2
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Postural collapse
Duval-Beaupegravere
It is a value related to muscular tone and to flexibil ity of convex side tissues
Post ural collapse
Bunch e Patwardhan
Critical load
Load threshold beyond wh ich a spine begins buckling
JI~~Wt1lW~flfthtlJlœJtAr ~ J~It- l~l - IMS
Postu ral collapse
Bunch e Patwardhan
If a curve reduces there is an increase of the deformation threshold
~~~NW~-damaoc~IIIMf ~~ J~Iv JaJ-I7I9sect
S Negrini 3
EDUCATION MEETING SATURDAY 8th of APRIL2006
Postural collapse
Torrel e Nachemson ~
Scolioses below 20deg ~ ~ lt~
have a high ~ ~ percentage of ~ ~
~postural collapse (on u~
average 75) ~~ 2i~
CU~VE O EG~EE S WHllE SUPlti e
~laquotd~c6b ____lPffI1wtt1t~
$ww J(t ~~7 JM5
Postural collapse
Minor scolioses 7
Antigravity musc es strengthening D
Reduces postural collapse -G
Increases the critical threshold of deformation
G
Neuromotor disfunetions
Stagnara
If we admit that one of the causes of idiopathie scoliosis is a disfunction in balance systems it is logical to orientate physical exercises toward this direction
s Negrini 4
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Neuromotor disfunctions
Dubousset
Idiopathie seoliosis results fram alterations in praprioeeption centres and deformation is a natural compensation to restore postural balance
etattJtitIK ypothfQj~S ___~ own_ oJ)HQr lar 1t-1( r
Neuromotor disfunctions
Nachemson Initial idiopathie scoliosis
+ Goood spine stability
Neutralization of postural deficits
D Static curve
Neuromotor disfunctions
Therapeutic aims
c) Development of spine stability
C) Development of balance reactions
G
S Negrini 5
EDUCATION MEETING SATURDAY 8thof APRIL 2006
Biomechanical disfunctions
j Horizontal r-Ian
i Sagi ttal plan
Frontal plan
Frontal plan
q Frontal plan disfunetions
Fronta l plan
Perdriolle Movement magnitude
gt in the direction of lt in the direction of correction progression
S Negrini 6
EDUCATION MEETING SATURDAY8th of APRIL 2006
Frontal plan
Stagnara
Never mobilize a scoliotic curve without ensuring reduction maintenance over time otherwise a greater mobility favours scoliosis progression
Frontal plan
Ducongeacute~ research
On a group of adolescent idiopathie scolioses treated with
Meacuteziegraveres gymnastics
D After 1 year the mean angle of
curves increased from 18deg to 29deg
Frontal plan
Scoliosis without brace
D Greater spine
flexibility D-
Risk of progression
S Negrini 7
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Frontal plan
Mobilization is useful
D In preparation to
brace
D With brace
Sagittal plan
QSagittal plan disfunctions
Sagittal plan r middot _J o
Perdriolle scouos B CJ aDeformation of D
thoracic and thoraco-Iumbar curves evolves in extension
S Negrini 8
EDUCATION MEETING SATURDAY8th of APRIL 2006
Sagittal plan
Graf
The line of gravity centres in the vertebral bodies o s c oUOSt
projects itself firstly laterally and then fi
o
posteriorly lJ ~~ ~~ ~ ~~-_J-D ~nI~
Sagittal plan
Therapeutic a ims
D Maintain or
retrieve physiological curves on the sagittal plan
Horizontal plan
QHorizontal plan disfunctions
S Negnni 9
EDUCATION MEETINGSATURDAY 8th of APRIL 2006
Horizontal plan
Stagnara The forces applied ta the spi ne act in a autoshydeforming sense
Horizontal plan
Dimnet Rotation gt 200
ampII~ (
D The actions of concave and convex side
muscles become
agonistic
~ItJrOnrIIiItdllfUClltlluumlll~~tI ~1JIf1laJ
Horizontal plan
Minor scolioses never exceed these autoshy
deformation thresholds
S Negrini 10
EDUCATION MEETING SATURDAY8th of APRIL 2006
Disfunctions at a biological organic and psychological
lever
Oisfunclions at a biological organlc and psychologlcal lever
Cheng
Bane density in scoliotic teenagers is lower than in normal subjects
~~~~middotA~IIlUtIy ~7œl 1d l
Oisfunctions at a blologlcal organic and psychologicallevel
A significant reduction of vital capacity and V02max in teenagers with a medium severity scoliosis
S Negrini 11
li
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Disfunctions at a biological organic and psychologicallevel
Disorders in the development of body image that the teenager has of himherself
Disfunctions at a blologlca l organlc and psychologicallevel
Therapeutic aims
cJ Activate cardioshyrespiratory function
cJ Favour bone density increase
cJ Develop a positive image of the body
Disfunctions at il biological organi and psydlologicallevel
Stagnara
Sport
D The active side of
kinesitherapy
S Negrini 12
EDUCATION MEETING SATURDAY 8thof APRIL 2006
Disfunctions at a biological organic and psychological
level
Distunctions at a biologlcal organlc and psychologicallevel
Cheng
Bone density in scoliotic teenagers is lower than in normal subjects
~n~IIIvpWr~middotA~stWy s- XXJl M J
Disfunctions at a biological organic and psychologicallevel
A significant reduction of vital capacity and V02max in teenagers with a medium severity scoliosis
G
S Negrini 11
EDUCATIONMEETING SATURDAY 8th of APRIL 2006
Kinesitherapy on the scoliotic subject
q Postural control
q Axial stability
q Muscular trophism
q Balance
q Respiratory function
The limits of kinesitherapy
There is a threshold beyond which
rehabilitation alone is not enough
sssr
Kinesitherapy in scoliosis treatment with brace
Therapeutic aims
S Negrini 13
6
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Therapeutic aims Srace kinesitherapy
With brace
il Postural corrections and
vertebral stability are obtained by the brace
Therapeutic aims Srace kinesitherapy
In preparation to the brace
il Mobilize spine on ail plans
Therapeutic aims Srace kinesitherapy
With brace D
Maintain a normal spine elasticity
~ Maintain a good muscular toneshy
trophism
C Model the hump with kyphotizating
exercises
S Negrini 14
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Exercises and their methodologies can vary accord ing to learning and individual sensibility of the single rehabilitator that proposes the m provided that they stay within the
Iimits of fixed therapeutic objectives
li
Therapeutic modalities
(Exercises)
QAuto-correction
QRespiratory education
QErgonomie education
QMuscular strengthening
QDevelopment of balance reactions
WNeuromotor integration
ci Vertebral mobiJization
QSpecifie modalities in brace treatment
S Negrini 15
EDUCATION MEETING SATURDAY 8th of APRIL 2006
The protocol of kinesitherapic
treatment
G
QChoice and dosage of exercises
Variatiosn of the work program every 2 - 3 months
Q Execute e)(ercises on an individual base or in a small group
Q Frequency not less than 2 times 1 week
Involve and awaken the family
G
S Negrini 16
EDUCATION MEETINGSATURDAY 8thof APRIL 2006
Q Determine the action and the localization of auto-correction
QAuto-correction must be associated to ail exercises
QAt the end of treatment ergonomy lesson
Auto-correction didactics
G
SCOLIOSI DORSALE---- shy ----
r
S Negrini 17
EDUCATION MEETING SATURDAY8thof APRIL 2006
SCOLIOS OORSOLOMBARE
shy
SCOLIOSI OOIlSALE 011 bull LOMBARE S1I--shy
SCOLIOSI LOMBARE
il --~_-
S Negrini 18
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Scoliotic patients are not radiographs
middotSeoliotie Mtients are not ndiographs but hum beings with a vertebral deviation-
Slagnara
Metha For the physieian Cobb angle is of utmost
importance For the patient it is body deformity t hat eounts most rib hump a protruding seapula or hip We are in a situation in whieh today dodors eure the radiographie deformity but what the patient really desires is to get rid of clinieal deformity and of ensuing psyehologieal distress
CIIQItIo shDuIdtucirc lM WIld tJw~~ I~~M~~~~ J9f~
S Negrini 19
- Poznan_workshop_Physiotherapy
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ROU ltHmiddot PI [ I C~ 1 EXIRCIS]~ IN TI Il nW~JUNT OF SlllO lDIOP1HIC AI)C~ESΠ11 C(gt1[Oi 1S
This i why b IiCieacute ii is ~n imporrlIl t for p rcshyvegraveml e 1tLsr l tn en ou flge 1ari e nrs ~lfrecr(d by lIillcl middotu iosis ft) tlke p~l rt in portin -re rcatioluJ acrivitits Iha t 1eIU 10 L10 th r~1chophyinLl bull nd b~l )i 1l1o tur adlieem t n li 51Jmiddot2Even tlK)ugli [Dr bic mech~lnshy
ical mcl nellIUll10t 11 11 reltl ~ons lt r111 1gtomcrimes be l lefu l to ugg( ~t ne p rt in~ aCt iv ity r l h (gtr rll n anotlJer e th ink Ibal an exces~ ive IlHd icalizltion - Icirce l ll1posilion br plry~ilt i HlS nnejlor parents uf rh ry pe of po rt to lx p m lice 1 b Ule p 1Ucirc(Il L th1[ preshydLl ck l1 is fret clOice in lh ma tt r - -h II ll1 he avolc1ed wb 11 possLhle mainly for tlle i mport~ltll psyshyLb ) jogka l fe a SI)nS W( ha( ill ~ t nltntionegraved
Conclu ion
lbh ISsertegrave d t1H physkal tgtXtlci o is ) n fi ial whlIl practinu in order 10 ilnj rove the I11 llde
rœ nwh and tono C iral caplCiry and postu re o f the StOUO(I ~lIbj n II I nowkdge om ~ middotmg trom ci el1shyrlfi rls(~ Jrc li dJlJ accordl ng r the review 01 thE litshytirlture prnpo )td in t lli plpl r conflrm~ Ihe vuiclit ot th e -t ls ~rti ()ns
In l do l (ent Id iopl1il iC scoliuse il l n phee u i cl vk)pm e n t ( li tll iumlKh eXCC cl l g i en rhk thr hokl th e re i5 an und ubred need fn r l pprnpri 1tegrave (JJ1tOkJJe ~Ild Inr surgict1 therapics ill ortler 1) S l i p
the ( - Iuli on anugrave )JT~t~t UW ~pilll l dtlormities bull evshyerthtless in the illiti ~ll pl l~sC t ttlC c1iseLltc whcn the riS( r1 r euro )luli m is rtduced ocirc ~md tfle uifleal JOld threshold il ~ld flle po stural collai i reJcenw~ 43
JI l1 igh pllysicaJ egravexe rc ise - p revenc or r d llCe d i ~lh ilir ies o f [Iw ~ l() li )tic
p (iems R 28 J -6 5- 6 1 63
- f~KiHtare lh ( n utr ali711iCUl of postu m l d elicits tn produCel1 a coneql l nce J [)ti 0 I111)( or regre si -u lmiddotc 5middot Il 1 17 ~ M
-re 51udles U ~ n Ledecl tu con[mn or re jecr these conClLL i( 1 w l1 ich clerin-d frum 1l1 lIldytica l rcltw n f th e liter~iture appear r- ~Lo nlble Hnwecr Intil ne re ull are 31Iable wc should n r prevent our sroliotic patientmiddot trom tl ki ll p lt in s(loI1ing jshy
ir its pW1iada rly ltl t ~d1()o t () n til t c ntrHY -vith the l xcclrinn 01 gt[1 )11lt tIlat in rea-e t)1obility (tnU evc n thell oilly wh n progr~lgtion b p OSSibl) -uc h ~I( ucircvshyiUe -11 )ulu hl tIKoll w g ed The 11 S J ( rprOpriue kin (~irhe r~l Piuml to incr _~asc p()~tura l $llbil i ty is tl1egraveoretshyic tlly CiJUClt alttloughl more ~Iccu rtte aod deLli led ri k benefi rs anJlr~ is is netot1ed
Ria 1111tO
NIokl Mu d lle ftitYljJfu Jœl il 4IWr10UOifll S (JIvs i (1~1)Jshylidl ttno( cclIll le 11(11(1lt1 RCI fu lle ((lia LltfIt l1 I1I1i(i
LJ ci n s j(r3 pigt egrave li n IHUgru lkl di t rdz t fi sici pe e ft shytUlKm iluppno di un lisimerap15Ll rl lllcflt() 1 110 scopo di pnevirlt () fr en~lI 1-lgpwlllltnlcgt dclld lclonnitugrave o e il 5LOshy
Il i mi llon lt fH nugrave j (1 11ni dei co~e 1 lteIl I1J J nd ne ~Ii eifclti (()Tc rri udk s co lio si d i m e dia g rt iuuml ln que~ltlt
s rud i 30 llizzb mo i d ti cleU ric lca pel n ri Icare qJJ l lm 1 dis(imucirc x u le I[~ l z j-m i pro vna le da lla C gtl k A i json ere pr middote-nute () rk kl ducirc un~l rdeguCltl d nil cra pi lt di uJoseguerrnt Cjua li 1iU110 cli nbie tti 1 rcr lJ)tIId d~ fle)-UITC
n (- -fd7Io n~lcl)
Ut11claquo)si 1 lI tori htpnuuml )ludi-ttn I ~ cnntI1zttu fr Cq(in i idiJ)tic1 dbfl lOZ10l1 d d ~ leOla nelllOll1otoriO Lb un1I1cnUl 1n1l1i3 dcgli 111 lt1i ch DIJgt gtU l H crmU1 Nlch~mslt ( SIshygnaJ~l lerimiddot wo i esuemi -bletti d~ plt~e8lugraver- ne l pClZ le1lftgt scoliodcu kl s iluppo ddl ~ ~ uhjlil~ vertcbral~ lt o svilllp prJ Jdle JIl7 i() nl di ltCjuiljbrio Dng li studi sul lto lb( l~nlrale (OllddU i in pa rticdu d 1 DlIal-BeHJ (gtegraverl ~ P~II IId lI1 n~ llw - idente il v- m gtiu p eT il puientc clioti elgt di u n rnigb o t c)[ ro Ua sw mle dei radlldc onsegull o tramite il 11 fforzrlshyfl len to d e i l1luotoucirc l nllgr3ilri d e luOwo con crcbi ~Clltdr
in pOMltHJ corrctl e in va rie ~i[Jzioni s t llicb c c d inamIcirc tllt Dalle on sena d elb blOffiCcclIlicd tr idimlt n s io mlle d ei
r ~ chi Je ~oU()f icn ~Icirc ~videnuumll (l() ~llt tC p IYZIcircOSI ln(IiClZlfHicircl ~ 1I1shy
liumln fluenzt Je ll middote~rUrio tl SC) lgt lIi I rc pibull m i tldln sJlI71 Stl shygn~I I1 afferma che slI l p Ia no [11 middotccedilr~lk tre un œ rtlJ grado di l L1Liuuml IlC dclh vEltlh r1 apj(de le tu rœ mu SCltJ llri njtbc J n in $tJ ) t rodcfQfll1t1l1te PltJtantu b i r~it-~ r -lp il puugrave t~~
Ixnt-ftla solo nt Ile so )[j)~i Jl1Icirc na rl in qunnt ) ilon SlrM ntne )(l(Ofa tu soglb in caq ) co lltrLJIcircn l)lrilto llt~( i lJudotlsi di lfr~ lI1 C llg grVlmenl J 111 11 io lr riltd ll(17jOill leld rinlle 113 dimO~iumlrlto d llt nell o lin~l cl()~ li t th~oIOl))1 dri la defltgtrshymiti sul p iluO slfl iuale ~vohl lf1 (en5 ion~ sO lnm utto nd 1e bsi iniliali deWggrwm1Cnln mcn trl C a( lfLmn che occlleshyvoluzi ne dene = 110 i [ mhari IJ lin c l ki cen tri ch -1vi1( de i cp i CIt IJ rI Ji SI p m ittIl pnm l Iem lmeme e p o j pOS( shyrio fllwnte dtldnli mdv ( i un ziuuml ne ciloliz7nnl dd rlLtide lu mbJ œ ( lIlelttlaquo on NC n d d (gt11 uIdu m 1I1 Ilgt) cli r-Iure (0 eserClzi che IllUllengano 0 ltlUperifo le Clgt 6gt1 lo)iche sul pirluuml gilwlt Su l p iCl no fron itk Perdnulk il dlll1lt-trlto d1 lampkz-l d i LU ovimento amp111 lI rv Kolio ti ~ nd lt1 0 ddlJ cnrrc-LIcircQo i Ji gC 1 n lungl SUpegraveliltlrccedil 1M llS0 tlell 3ampIGI shyvamcnlo C che l~Jltmiddot mobiliti GlI mcnta co n l c lu7j o fle d l i) snAio i A ulln amplgrtJc1 ltllllmunjx~ i terlpGli nn n m obi shyUZ73It ma eutva coli ti0 1 1ct HsicVlfe nd tcmplt 11 1111nshyttllIcirc1nc n tc (k ll ~1 llu u zinnt n l1 un me77uuml d i sost l11( gt ln 0
e 11111ri b cle - Ilziunc egrave deorinatcl d l rlyarsi Snzcl la pr gtshy
liltlnl l i un() rtl~ i ptmiddot Jtl n(o 1S(Hl () (( ntJ() i ndit~tr i ~ Ii ISt (izi e l m iviL Illdlode ebe Hlmen tno laJlc ibiJii dcl rlc lide SCshy
li io) [n p articobre rune q lldl r C-I1 ich~ xlSiddcHe CUf t shyli ve ch~ iJllpi tgino e~rciii 01( biIi2 ZanUgrave HhnmL-trid () in tmiddot~t~nshy
sione kl fuchide O tne pure k- ~ttivit1 tnotoJII~ non prHi(~ llCcedil
in forma r k rel1tiva d Ie ~1I 11 rF~1l1( n otcol mcnlC 1 lll ubib Ll vcrteblmiddote (ad ~ flp j(l 11 n l) to L ginn ~Iilt Utl clkl rilshyC
mka la cli OT- tcc)
r1il to l~ _ I[Dl COlI rY IC~
NE olUNI
fillncr ( ni ((uuml(( n hIIo( rilclIO ~middothe k lln dtfidl fUr1z i shy
nlu CQll1~ la llcl llZIO 1e delb c apKJl ilde e della capacltl di 0170 mizianu luJndn le (OJ il~ gtna a nc r3 di m~i3 gmshy
v it ln G mlxl r i ~ gko Fl llslrom C dlllJ O e Nachcms(J h iU1I) dim lr JtQ che b o liosl p IOO C1 neUaduksœnr 10 SYil l1p pn d i lIniumlmn~gin nlt8Jliva de corpo in (o nridcnz di Ln ddic3w p ri d di f( m l lz i nlt deUa SUl idenritl condishyZltonc ch pOlrebh ~[I cubrmiddot ln vilu pp di un pe bull n nn lir m llur cd e quiJibfarn in t[C adulro TaU CO1DSCe nZe tvlde nshyZ[II)() la n ( middotess iti di ltimobre la plfte ip a7j0 r1e atl an ivi ll1ltHClr n gl b a li ltl h ~ di tlpO s pu rti middotu dl ittlrc nd gloani iCo lID ti i lirtugraveta z io ni llb vila di relazionc
ln concllliu fu la d tfoflll lL saliu iG egrave il sin l mo di lin) idrotnc C Il1pk 1 d e eoinvo l d middotmiddot= fu n (n i dd rgashynIcirc5H10 n Hi lhdli e lesenizjo fi 1lt0 se 1 Il indirill~t() pllO pr~cnin 0 odLf rgt t lli di fu nzlonicirc adlc s()Jj(bi 111Icircn(i rrHtatc CO ll nl1 cinesi rap i Quand l~ coli i ( n LS~middot iJ11 zia k il rischio evnluLIcircvo egrave lid [() mente no tcole 11 (ltlll asso p o lll shylal ltOtSltgllen7~1 _ ta cincsiterapia pc rslIk bidtlvi shyptutibulli d ubllIcirctIcirc vltnc brn1e di conrro llo )(JSu k d i 5IcirclupPQ d Ile rLlt ziofll d i eC[u ihb ugraveo dJ ftffr otZJH1 r1w dei IIl llJgtCili 1 11Icircshyg rdtarl in posru ra rrenu posslhile JnnalL in Illo lt i clsi l(j luucircun lt di lin ~c() li oi mi n rc ( ume [11 duumlnQstrIO la tinc~ jn~l el1lric ((1l1 ~rtlppi d i contnmiddotllo cnndnlt1 p nso i l entrt d e Massue di Li n nc da [ o llo n ~ Rodo l (1 986) Julndo il1vlce lIfU~ ho ~vutlJ tiVll 11lt1 1IjXIl to un dekrshyuina r o~itl di g rl vir~l bull a~-n lllull~nte n ec ~~uiu rlCUuml rf( ff dla tcrJpll rle si c a eo chirurg ica
1Ho le clllC ooliosi idjopHI 3 ttl1p ~ - E~er l zjo hsco shy11ln ~ I((fapil
l Bg 5 CUle Lo [la k ll oblems in tlu ll~ (U ni Cl) FrKUce CU ( )lIILr no 1 AllCPR lu b1lG1t10 11 middotCI 9()(iJ2 RockilJe MI) i)~Cr ~()f I [( al th all 1 () I ~Y 1(~Re~C~Hd ~gtutnlt Ilallb Srshy1ltC Cgt D~p(rulllnr CJf I Ilalil 11 1 HumlIl sen Lel 199-1
2 SI) lrzcf ( LcB I ~IIl( FE DupUb L ampkIll~ 1c ~ppro l c h ll tht rnent und mmgemlt-rlt ot ~ ct vlyrl~ led splnul (hs r)fder~ A monQglJph rr r d lll kic Re p o l1 or Ih Ou bcc TlSk Fu rcl 0 11 ipmd DIo rele Sp ine L9H LU) 59
) Clntino F 111i1 i(ll Ci nerte1H C Nou gltHhl C Kln(~Jl llBICII [lIe1 hmlln (Il dry rra ll1ltfll of QIil pa ll m log iC by l11e 1 lIb li 1le-llh laquorilC~ of ~ 10(lna 111 Jrc)Jcxli r~~ (of flle h l lntrnIUonll SVIll Illgt~iu tn - II 5lt Ik lIc lk0flllllic lu llln-I I r l III Fhhlt ri g 1092 -ltlIJ-7
i - ri of niii MA N()LJV II ~ mel h)ltks de kin ~~klk rlr k di lll J r~cdllclli (n d~s ~()li oes jn f ~tel r~1ruuml(ILI -lo s bl fl c sur IcIj cquishyl)œ~ Ik SOll ll l)(eacute Eli ror eetlfllS d )111 1~ 1)1-
5 iloll n G Ruumld(~ le s () I ~middotmiddots tnlcl l l1 I n in 1Ifc el kiwil~~ 1)11lt KillegraveSlthe ripJe SCleacutentlnlue lYl6 2 47 ~ 6
r) Feacuterr[ffgt en 1tsiero 5 Venlllfln A ll~~n () M MJglio nu N EfkUuml o r eXltClse tI~tl Yoj o n nild id iO rXllhlc iC() 1i()~ lrt~ lirnIcircIluy r sull Eur feltl lb)ii 1 1j34 Z5 -~ 1 NOilrill1 A Sbill P egn ni i Ll Linesilegraverpi l 1lt1 Itallllll~nlO
ddlJ soI K~ i llO 1 Orkl1Llllwnrl m efodoloil1c1 RbbilltlZiOllc Ot1(1 1 )29(1) 1l-~
8 Nli(rinl Nl(lr1n l A blll P LI rieduGlzione dl p llicml atflt rro (11 coli ns i idi opr lir1 l n SC(Um i le or h( JI 1rcLlIQn1 ~0Cl le Imc lI1etW)n11e de Recltcrchc ci 0 Ftude sm 1lt Radw jlt)(j S-71
gt Nftriruuml S SeJhrf U LI r i l bllh ~l liOlie dd plziecirc11te ulet1n 11 - r
lin Kllopd (1 In l1l Jgl L N eduoL Tf1It II d ll11e ji cln1 rJtbl IiIUvJ Milan) 1ltfddH~n(x~hl 2(1~111gt-1-PU ob L cllln t iRll p l nelLi rl tgtO llcui n~ dilt ~lio i - l rn~f- li ~iIa n 3efllnl -Kurflr 19-11
11 lIIra S lJll M EVtJltHlvugrave egraveI lt t rnrumel1t() d db S(oli - U r) surie doCum nUle fintgt 31 tIUUli Mibn SI rlin) KlIpf -r 199 2
L2 1 ~W I1l(IJ P _leacuteVia tio n I~lhra k~ du IlchlS ~- ( i( IoltS ccedil l r lI C1 l1 fl leq
Ene 1 l C hi r ApparctlIClCOn l~ ltll1 l ltx6lt (i W Er 20 j )7 l
U StrI tr d P Lcs 1) rm IlO du Hltlctli Parb ME n 115 li ~u n un_ l c- l ol lJn e~IL1roy JC EagtOllŒrio n sc lluocs
L cl middot Exp CO_fiL [-In 190 15 Xd BR llet13n) J Th ltJl-xwenc a l o-(l1 tUcn~kuud txer
C le re-glflW 1 lhe tfelmc nl o f id iopllhiC Collaraquo n lroc~-din) t Lhl 1 r 111(1ltli0 I111 Symf SiUl1l un 3-D Scl IiDliJ DclOfshymillelt ~k)J1[rlt u Gugtu l1Shltr Verbg 1lti t)L j32-t)
16 N1lh~Ir~il Al Peumlf r~o n LE Erree htJkmiddotmiddot~ n f t~U lt hfIl middot Ith J
hran in ~rls V ll ~ ttiVl ~HkJ k-nt IHuIXtthilaquo ic I) Li ~I~ts H t 1l1i JflIn t ~ j l~jl)5iuml7A(~)8Jj- 21 bull
17 M(jo n Y ( ullck J p ~ R A PrdulllnlIr rpurt 11 Iht e rt l f rnltJsu red 5l ren jl lh rrll nrl1 III ililleInr Hi rrt tllk scoJliagt
J lin1I IJisn rd 21 1 1)12) 102- - Hl Hunng CU[- -If p~lIll)~thc - Uonktd in -c h JI IL
c reacutetnl n~ ptnl l C)Q~ Z ) t 1 t(li-v 19 Kou )UrJKh L Glr~ k G KRI iJI G KLmiddotmiddotrnl kh g UlUI
) KrJ UkQULlk i~ ~l ~~ fl c+l l1ng ~t (w)j (h ildrcn frit ltt lmiddot( ti ~l~ 0 1 (he
isbnd of Cfdt J middotpin 1 Dior el 1 9J7 lIX( )middot i2 ~ middotl I i) SG IC1Iugrave lS r olle lCOS rh Zadrc C Ber E Xend s T A
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Joi nl lIrg AI11 1~gt81 (1 )1)1 -0 22 re rdrlo lk R 11 gtcolk)c on Ftudc TrldrI1lUl i0 nnli1t FHIS
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2L COl 7 G Fla~ l rdi M Ubllhr I- Ili ~ U)( ciplt-rfmof1lal ~c()lir t Prtlaquo l1 ttJ Ir lh t 1~l Eu n pL Il eacuteollhr~- 1lt11 -~ 11ltb und Ky phojj DulJr wnik Y ugmla O IO(-f 1 9$5
2 u ttlllJil ~ 1 gtCli ll Ofli e 1lI tpLI lJ1lluak Hntd ~Nltmiddot ) lnLpmiddotmiddot Fi)) SdwrJ r ll r [(111lt1 1gtl( lEl ~ bri UI nc 1lt)79 Slone H neekman C H ill Cues V fuooks 1 IL 1bc d rrCl o f an c Xt rc lslt r rog tlm ~)n chanfe ln cur( in uJokS( r 1H wtt h lllinr l11bulll IdJo p thiC SC(J lioh A prcl rnunH) Iud Pill Th r 19-9597Yfgtl Rlt td J Ccedil d(dtltx middotnl IdOcircgtpUhinK()liosl fl(nsugiCIJ lrellmenl ln lt-C llSlt ln Sl edit The P edtlt r bull SpIn Prmclp ilt and 1 1 shyte t Nemiddot Yo rk RIVCJ) PrtS j~)f197- 10 1(gr Ul1 A il lulfo l7amenro rnu_ olu e in S bfClti p()n ~nuuml(f di d lsme rf lsill i middot Wb li La i inm~ti MtmiddotdiQ 19$nYl - l
)0 DuIYLls-oe J E~ 1 d hypot he~ d tk gj(lult~ d b = shyli(~ Id lOIllll1lqu ahleacute~ de Knlt~il hr p le l ~ ~llK l H I
31 1 hnrwll R MLm n J [j her A ~Wlu (middoti R bull nlfc k J IdlopalhK 0 1101- llId lll ntr1 nervrlU$ S)511111 p ine 1il-111 H
12 KheacutelTl~(l 11 i Srh lrClno T E1lrtcmiddot fil middotlm 1deJi lI Idio shy111111lt l(middot lk is plm 112 1i6-8middotf la i Fm rIC) PL ( IJIlfThJ 1 V I1W F 1--1 w hl P ) IlOI ) ) lIet ( fnorfis rnl IlI lnPrt d~IL I (lonrl Vie rkh r h -Df [ 11 lltd Rt JlJ Il 190jmiddot middot (3) 2)middot -8
H Slh lrJIHl T P(lrugt()Jl n A s rurl ( bbnintl1in lLllkrion in pllIents Vilh ad() l~eJ1t idiopcuhiccedil -collsl ioLI~ 0 11110 1 -C1lld 1)795)51
35 Siblll r l Si~tltm t ocircHboIJ f( t los pproajo (lIoneuroiq-k 0 Ib duta7Jltme PWlIlltrS(Kmiddotl C (ltl~I1OSlilt1 dei middotoUosl Pr~Smltl ar PchHria ~i(J S MarghrllL LigUflmiddot l( J
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x ilgtlIh P lt-ejcanl N~1(fl l ll At_1 n~sIO Alp nl O J(0nuoo 1 lt a l ~l rpfn 1 1K1nuumll uIcircl n ln ~ccedilr)liO~i 1-~lIu~H I_1j hy the l n ~Ul [ rltllc~cJr()grnrhy 1o TI)lU li K LgIlt1111 M ~I rt ~d i r rs r il ull f md t u r11 fl on l l l itJLLlUl Eb--Icr SC legrave nu B V 19~middotH ~)-l2
)7 Y~lI J ib K Y IOUJJl(lro 1r T~ t lll1r~t l TtZIlLl 1 rmiddot ~b lplnt nr (f ltmltomiddotjmiddot unkr nu rf j 1 1 pa rtlCub rtv in (dHUH l ull bl~lllcm l b numiddotIUllltk- J fkm I n rg 1 lt gt 17
301 Yum1ntv Il YJl1ll d~ r lqu lll lll1 ll Lppr 111 ICi ~rljritJccedil p tUf( ~cOILgtgk J)-6 1711
W NeW1 N~grm l ~ Xn[(ui chlncltltcfIILl 1 (L ln CfmuO r Bk r 1lt1 511 tn tlt [C IUIl~1 AUtlI IJt1 TecnILln J I TCI 1J1l flD ~ Cont rQnltl Mock n1 tl l J~ middot ) rollplt KIIlCSlherlplllLl Elirope ~H gtle 1 ra~tiI iUf lil ioII O~ l -N ill l- il middotmiddot
1) Negrini ~wn UllnnQ c 0 1i ~ 1 lucirc lopau c-l prnlo l i1Ii Ilnki 1 L1 otiltJlliU lt fldl ll u ru middot j ltId bull itcll lJ pt)ol llrUgravec Lt flblrtl 1 I dilt l middoth ~ 1 +gt-I1
1 r u I -rkIlp ~h 6 leltp1Tgt - Il lt1 rd A r lltoucirc Ully f 0 shy
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(Jf l I t ffllj(rIo~n 11 tl ort ilou -( lbljzLi 111 n rJfol Jll lt- Cr
1 1 HInKch 1 ~gt 1 ~ 1 f)~ 17 middot I ~ Trrd Gbull ldHno A Irlltkjpcck K 1ltulrz St bullbullndlng nltl
f lk craquohb n e l9J r III QJd~ wllh fdJopthK-C lllo~ls Spi n 1lt) U(I middotlZ=~7
+1 PlL1J101 M ~bllml K Srm11 bil ity and lUIC1ltltWlIIlI~ oll Ulc ~ biIJItltmiddotnl1 11 n1nlcl ~rt l1 It)bX) Imiddot1 t91- 211O
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EUROP MIDI C Pli hIC
EDUCATIONMEETING SATURDAY 8thof APRIL 2006
(iSS
SEAS02 Scientific
Exercises Approach to Scoliosis
version 2002
G
S Negrini 1
EDUCATION MEETING SATURDAY8th of APRIL 2006
Neuromotor disfunctions
Neuromuscular disfunctions
11 Postural collapse
Postural collapse
Duval-Beaupegravere
Flexibility of scoliotic curve
f---I--- I Postural element
-------1 Structural element
S Negrini 2
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Postural collapse
Duval-Beaupegravere
It is a value related to muscular tone and to flexibil ity of convex side tissues
Post ural collapse
Bunch e Patwardhan
Critical load
Load threshold beyond wh ich a spine begins buckling
JI~~Wt1lW~flfthtlJlœJtAr ~ J~It- l~l - IMS
Postu ral collapse
Bunch e Patwardhan
If a curve reduces there is an increase of the deformation threshold
~~~NW~-damaoc~IIIMf ~~ J~Iv JaJ-I7I9sect
S Negrini 3
EDUCATION MEETING SATURDAY 8th of APRIL2006
Postural collapse
Torrel e Nachemson ~
Scolioses below 20deg ~ ~ lt~
have a high ~ ~ percentage of ~ ~
~postural collapse (on u~
average 75) ~~ 2i~
CU~VE O EG~EE S WHllE SUPlti e
~laquotd~c6b ____lPffI1wtt1t~
$ww J(t ~~7 JM5
Postural collapse
Minor scolioses 7
Antigravity musc es strengthening D
Reduces postural collapse -G
Increases the critical threshold of deformation
G
Neuromotor disfunetions
Stagnara
If we admit that one of the causes of idiopathie scoliosis is a disfunction in balance systems it is logical to orientate physical exercises toward this direction
s Negrini 4
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Neuromotor disfunctions
Dubousset
Idiopathie seoliosis results fram alterations in praprioeeption centres and deformation is a natural compensation to restore postural balance
etattJtitIK ypothfQj~S ___~ own_ oJ)HQr lar 1t-1( r
Neuromotor disfunctions
Nachemson Initial idiopathie scoliosis
+ Goood spine stability
Neutralization of postural deficits
D Static curve
Neuromotor disfunctions
Therapeutic aims
c) Development of spine stability
C) Development of balance reactions
G
S Negrini 5
EDUCATION MEETING SATURDAY 8thof APRIL 2006
Biomechanical disfunctions
j Horizontal r-Ian
i Sagi ttal plan
Frontal plan
Frontal plan
q Frontal plan disfunetions
Fronta l plan
Perdriolle Movement magnitude
gt in the direction of lt in the direction of correction progression
S Negrini 6
EDUCATION MEETING SATURDAY8th of APRIL 2006
Frontal plan
Stagnara
Never mobilize a scoliotic curve without ensuring reduction maintenance over time otherwise a greater mobility favours scoliosis progression
Frontal plan
Ducongeacute~ research
On a group of adolescent idiopathie scolioses treated with
Meacuteziegraveres gymnastics
D After 1 year the mean angle of
curves increased from 18deg to 29deg
Frontal plan
Scoliosis without brace
D Greater spine
flexibility D-
Risk of progression
S Negrini 7
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Frontal plan
Mobilization is useful
D In preparation to
brace
D With brace
Sagittal plan
QSagittal plan disfunctions
Sagittal plan r middot _J o
Perdriolle scouos B CJ aDeformation of D
thoracic and thoraco-Iumbar curves evolves in extension
S Negrini 8
EDUCATION MEETING SATURDAY8th of APRIL 2006
Sagittal plan
Graf
The line of gravity centres in the vertebral bodies o s c oUOSt
projects itself firstly laterally and then fi
o
posteriorly lJ ~~ ~~ ~ ~~-_J-D ~nI~
Sagittal plan
Therapeutic a ims
D Maintain or
retrieve physiological curves on the sagittal plan
Horizontal plan
QHorizontal plan disfunctions
S Negnni 9
EDUCATION MEETINGSATURDAY 8th of APRIL 2006
Horizontal plan
Stagnara The forces applied ta the spi ne act in a autoshydeforming sense
Horizontal plan
Dimnet Rotation gt 200
ampII~ (
D The actions of concave and convex side
muscles become
agonistic
~ItJrOnrIIiItdllfUClltlluumlll~~tI ~1JIf1laJ
Horizontal plan
Minor scolioses never exceed these autoshy
deformation thresholds
S Negrini 10
EDUCATION MEETING SATURDAY8th of APRIL 2006
Disfunctions at a biological organic and psychological
lever
Oisfunclions at a biological organlc and psychologlcal lever
Cheng
Bane density in scoliotic teenagers is lower than in normal subjects
~~~~middotA~IIlUtIy ~7œl 1d l
Oisfunctions at a blologlcal organic and psychologicallevel
A significant reduction of vital capacity and V02max in teenagers with a medium severity scoliosis
S Negrini 11
li
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Disfunctions at a biological organic and psychologicallevel
Disorders in the development of body image that the teenager has of himherself
Disfunctions at a blologlca l organlc and psychologicallevel
Therapeutic aims
cJ Activate cardioshyrespiratory function
cJ Favour bone density increase
cJ Develop a positive image of the body
Disfunctions at il biological organi and psydlologicallevel
Stagnara
Sport
D The active side of
kinesitherapy
S Negrini 12
EDUCATION MEETING SATURDAY 8thof APRIL 2006
Disfunctions at a biological organic and psychological
level
Distunctions at a biologlcal organlc and psychologicallevel
Cheng
Bone density in scoliotic teenagers is lower than in normal subjects
~n~IIIvpWr~middotA~stWy s- XXJl M J
Disfunctions at a biological organic and psychologicallevel
A significant reduction of vital capacity and V02max in teenagers with a medium severity scoliosis
G
S Negrini 11
EDUCATIONMEETING SATURDAY 8th of APRIL 2006
Kinesitherapy on the scoliotic subject
q Postural control
q Axial stability
q Muscular trophism
q Balance
q Respiratory function
The limits of kinesitherapy
There is a threshold beyond which
rehabilitation alone is not enough
sssr
Kinesitherapy in scoliosis treatment with brace
Therapeutic aims
S Negrini 13
6
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Therapeutic aims Srace kinesitherapy
With brace
il Postural corrections and
vertebral stability are obtained by the brace
Therapeutic aims Srace kinesitherapy
In preparation to the brace
il Mobilize spine on ail plans
Therapeutic aims Srace kinesitherapy
With brace D
Maintain a normal spine elasticity
~ Maintain a good muscular toneshy
trophism
C Model the hump with kyphotizating
exercises
S Negrini 14
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Exercises and their methodologies can vary accord ing to learning and individual sensibility of the single rehabilitator that proposes the m provided that they stay within the
Iimits of fixed therapeutic objectives
li
Therapeutic modalities
(Exercises)
QAuto-correction
QRespiratory education
QErgonomie education
QMuscular strengthening
QDevelopment of balance reactions
WNeuromotor integration
ci Vertebral mobiJization
QSpecifie modalities in brace treatment
S Negrini 15
EDUCATION MEETING SATURDAY 8th of APRIL 2006
The protocol of kinesitherapic
treatment
G
QChoice and dosage of exercises
Variatiosn of the work program every 2 - 3 months
Q Execute e)(ercises on an individual base or in a small group
Q Frequency not less than 2 times 1 week
Involve and awaken the family
G
S Negrini 16
EDUCATION MEETINGSATURDAY 8thof APRIL 2006
Q Determine the action and the localization of auto-correction
QAuto-correction must be associated to ail exercises
QAt the end of treatment ergonomy lesson
Auto-correction didactics
G
SCOLIOSI DORSALE---- shy ----
r
S Negrini 17
EDUCATION MEETING SATURDAY8thof APRIL 2006
SCOLIOS OORSOLOMBARE
shy
SCOLIOSI OOIlSALE 011 bull LOMBARE S1I--shy
SCOLIOSI LOMBARE
il --~_-
S Negrini 18
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Scoliotic patients are not radiographs
middotSeoliotie Mtients are not ndiographs but hum beings with a vertebral deviation-
Slagnara
Metha For the physieian Cobb angle is of utmost
importance For the patient it is body deformity t hat eounts most rib hump a protruding seapula or hip We are in a situation in whieh today dodors eure the radiographie deformity but what the patient really desires is to get rid of clinieal deformity and of ensuing psyehologieal distress
CIIQItIo shDuIdtucirc lM WIld tJw~~ I~~M~~~~ J9f~
S Negrini 19
- Poznan_workshop_Physiotherapy
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EUROP MIDI C Pli hIC
EDUCATIONMEETING SATURDAY 8thof APRIL 2006
(iSS
SEAS02 Scientific
Exercises Approach to Scoliosis
version 2002
G
S Negrini 1
EDUCATION MEETING SATURDAY8th of APRIL 2006
Neuromotor disfunctions
Neuromuscular disfunctions
11 Postural collapse
Postural collapse
Duval-Beaupegravere
Flexibility of scoliotic curve
f---I--- I Postural element
-------1 Structural element
S Negrini 2
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Postural collapse
Duval-Beaupegravere
It is a value related to muscular tone and to flexibil ity of convex side tissues
Post ural collapse
Bunch e Patwardhan
Critical load
Load threshold beyond wh ich a spine begins buckling
JI~~Wt1lW~flfthtlJlœJtAr ~ J~It- l~l - IMS
Postu ral collapse
Bunch e Patwardhan
If a curve reduces there is an increase of the deformation threshold
~~~NW~-damaoc~IIIMf ~~ J~Iv JaJ-I7I9sect
S Negrini 3
EDUCATION MEETING SATURDAY 8th of APRIL2006
Postural collapse
Torrel e Nachemson ~
Scolioses below 20deg ~ ~ lt~
have a high ~ ~ percentage of ~ ~
~postural collapse (on u~
average 75) ~~ 2i~
CU~VE O EG~EE S WHllE SUPlti e
~laquotd~c6b ____lPffI1wtt1t~
$ww J(t ~~7 JM5
Postural collapse
Minor scolioses 7
Antigravity musc es strengthening D
Reduces postural collapse -G
Increases the critical threshold of deformation
G
Neuromotor disfunetions
Stagnara
If we admit that one of the causes of idiopathie scoliosis is a disfunction in balance systems it is logical to orientate physical exercises toward this direction
s Negrini 4
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Neuromotor disfunctions
Dubousset
Idiopathie seoliosis results fram alterations in praprioeeption centres and deformation is a natural compensation to restore postural balance
etattJtitIK ypothfQj~S ___~ own_ oJ)HQr lar 1t-1( r
Neuromotor disfunctions
Nachemson Initial idiopathie scoliosis
+ Goood spine stability
Neutralization of postural deficits
D Static curve
Neuromotor disfunctions
Therapeutic aims
c) Development of spine stability
C) Development of balance reactions
G
S Negrini 5
EDUCATION MEETING SATURDAY 8thof APRIL 2006
Biomechanical disfunctions
j Horizontal r-Ian
i Sagi ttal plan
Frontal plan
Frontal plan
q Frontal plan disfunetions
Fronta l plan
Perdriolle Movement magnitude
gt in the direction of lt in the direction of correction progression
S Negrini 6
EDUCATION MEETING SATURDAY8th of APRIL 2006
Frontal plan
Stagnara
Never mobilize a scoliotic curve without ensuring reduction maintenance over time otherwise a greater mobility favours scoliosis progression
Frontal plan
Ducongeacute~ research
On a group of adolescent idiopathie scolioses treated with
Meacuteziegraveres gymnastics
D After 1 year the mean angle of
curves increased from 18deg to 29deg
Frontal plan
Scoliosis without brace
D Greater spine
flexibility D-
Risk of progression
S Negrini 7
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Frontal plan
Mobilization is useful
D In preparation to
brace
D With brace
Sagittal plan
QSagittal plan disfunctions
Sagittal plan r middot _J o
Perdriolle scouos B CJ aDeformation of D
thoracic and thoraco-Iumbar curves evolves in extension
S Negrini 8
EDUCATION MEETING SATURDAY8th of APRIL 2006
Sagittal plan
Graf
The line of gravity centres in the vertebral bodies o s c oUOSt
projects itself firstly laterally and then fi
o
posteriorly lJ ~~ ~~ ~ ~~-_J-D ~nI~
Sagittal plan
Therapeutic a ims
D Maintain or
retrieve physiological curves on the sagittal plan
Horizontal plan
QHorizontal plan disfunctions
S Negnni 9
EDUCATION MEETINGSATURDAY 8th of APRIL 2006
Horizontal plan
Stagnara The forces applied ta the spi ne act in a autoshydeforming sense
Horizontal plan
Dimnet Rotation gt 200
ampII~ (
D The actions of concave and convex side
muscles become
agonistic
~ItJrOnrIIiItdllfUClltlluumlll~~tI ~1JIf1laJ
Horizontal plan
Minor scolioses never exceed these autoshy
deformation thresholds
S Negrini 10
EDUCATION MEETING SATURDAY8th of APRIL 2006
Disfunctions at a biological organic and psychological
lever
Oisfunclions at a biological organlc and psychologlcal lever
Cheng
Bane density in scoliotic teenagers is lower than in normal subjects
~~~~middotA~IIlUtIy ~7œl 1d l
Oisfunctions at a blologlcal organic and psychologicallevel
A significant reduction of vital capacity and V02max in teenagers with a medium severity scoliosis
S Negrini 11
li
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Disfunctions at a biological organic and psychologicallevel
Disorders in the development of body image that the teenager has of himherself
Disfunctions at a blologlca l organlc and psychologicallevel
Therapeutic aims
cJ Activate cardioshyrespiratory function
cJ Favour bone density increase
cJ Develop a positive image of the body
Disfunctions at il biological organi and psydlologicallevel
Stagnara
Sport
D The active side of
kinesitherapy
S Negrini 12
EDUCATION MEETING SATURDAY 8thof APRIL 2006
Disfunctions at a biological organic and psychological
level
Distunctions at a biologlcal organlc and psychologicallevel
Cheng
Bone density in scoliotic teenagers is lower than in normal subjects
~n~IIIvpWr~middotA~stWy s- XXJl M J
Disfunctions at a biological organic and psychologicallevel
A significant reduction of vital capacity and V02max in teenagers with a medium severity scoliosis
G
S Negrini 11
EDUCATIONMEETING SATURDAY 8th of APRIL 2006
Kinesitherapy on the scoliotic subject
q Postural control
q Axial stability
q Muscular trophism
q Balance
q Respiratory function
The limits of kinesitherapy
There is a threshold beyond which
rehabilitation alone is not enough
sssr
Kinesitherapy in scoliosis treatment with brace
Therapeutic aims
S Negrini 13
6
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Therapeutic aims Srace kinesitherapy
With brace
il Postural corrections and
vertebral stability are obtained by the brace
Therapeutic aims Srace kinesitherapy
In preparation to the brace
il Mobilize spine on ail plans
Therapeutic aims Srace kinesitherapy
With brace D
Maintain a normal spine elasticity
~ Maintain a good muscular toneshy
trophism
C Model the hump with kyphotizating
exercises
S Negrini 14
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Exercises and their methodologies can vary accord ing to learning and individual sensibility of the single rehabilitator that proposes the m provided that they stay within the
Iimits of fixed therapeutic objectives
li
Therapeutic modalities
(Exercises)
QAuto-correction
QRespiratory education
QErgonomie education
QMuscular strengthening
QDevelopment of balance reactions
WNeuromotor integration
ci Vertebral mobiJization
QSpecifie modalities in brace treatment
S Negrini 15
EDUCATION MEETING SATURDAY 8th of APRIL 2006
The protocol of kinesitherapic
treatment
G
QChoice and dosage of exercises
Variatiosn of the work program every 2 - 3 months
Q Execute e)(ercises on an individual base or in a small group
Q Frequency not less than 2 times 1 week
Involve and awaken the family
G
S Negrini 16
EDUCATION MEETINGSATURDAY 8thof APRIL 2006
Q Determine the action and the localization of auto-correction
QAuto-correction must be associated to ail exercises
QAt the end of treatment ergonomy lesson
Auto-correction didactics
G
SCOLIOSI DORSALE---- shy ----
r
S Negrini 17
EDUCATION MEETING SATURDAY8thof APRIL 2006
SCOLIOS OORSOLOMBARE
shy
SCOLIOSI OOIlSALE 011 bull LOMBARE S1I--shy
SCOLIOSI LOMBARE
il --~_-
S Negrini 18
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Scoliotic patients are not radiographs
middotSeoliotie Mtients are not ndiographs but hum beings with a vertebral deviation-
Slagnara
Metha For the physieian Cobb angle is of utmost
importance For the patient it is body deformity t hat eounts most rib hump a protruding seapula or hip We are in a situation in whieh today dodors eure the radiographie deformity but what the patient really desires is to get rid of clinieal deformity and of ensuing psyehologieal distress
CIIQItIo shDuIdtucirc lM WIld tJw~~ I~~M~~~~ J9f~
S Negrini 19
- Poznan_workshop_Physiotherapy
- physio2
- physio3pdf
- physio4
- physio5
- physio6
- physio7
- physio8
- physio9
- physio10
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EUROP MIDI C Pli hIC
EDUCATIONMEETING SATURDAY 8thof APRIL 2006
(iSS
SEAS02 Scientific
Exercises Approach to Scoliosis
version 2002
G
S Negrini 1
EDUCATION MEETING SATURDAY8th of APRIL 2006
Neuromotor disfunctions
Neuromuscular disfunctions
11 Postural collapse
Postural collapse
Duval-Beaupegravere
Flexibility of scoliotic curve
f---I--- I Postural element
-------1 Structural element
S Negrini 2
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Postural collapse
Duval-Beaupegravere
It is a value related to muscular tone and to flexibil ity of convex side tissues
Post ural collapse
Bunch e Patwardhan
Critical load
Load threshold beyond wh ich a spine begins buckling
JI~~Wt1lW~flfthtlJlœJtAr ~ J~It- l~l - IMS
Postu ral collapse
Bunch e Patwardhan
If a curve reduces there is an increase of the deformation threshold
~~~NW~-damaoc~IIIMf ~~ J~Iv JaJ-I7I9sect
S Negrini 3
EDUCATION MEETING SATURDAY 8th of APRIL2006
Postural collapse
Torrel e Nachemson ~
Scolioses below 20deg ~ ~ lt~
have a high ~ ~ percentage of ~ ~
~postural collapse (on u~
average 75) ~~ 2i~
CU~VE O EG~EE S WHllE SUPlti e
~laquotd~c6b ____lPffI1wtt1t~
$ww J(t ~~7 JM5
Postural collapse
Minor scolioses 7
Antigravity musc es strengthening D
Reduces postural collapse -G
Increases the critical threshold of deformation
G
Neuromotor disfunetions
Stagnara
If we admit that one of the causes of idiopathie scoliosis is a disfunction in balance systems it is logical to orientate physical exercises toward this direction
s Negrini 4
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Neuromotor disfunctions
Dubousset
Idiopathie seoliosis results fram alterations in praprioeeption centres and deformation is a natural compensation to restore postural balance
etattJtitIK ypothfQj~S ___~ own_ oJ)HQr lar 1t-1( r
Neuromotor disfunctions
Nachemson Initial idiopathie scoliosis
+ Goood spine stability
Neutralization of postural deficits
D Static curve
Neuromotor disfunctions
Therapeutic aims
c) Development of spine stability
C) Development of balance reactions
G
S Negrini 5
EDUCATION MEETING SATURDAY 8thof APRIL 2006
Biomechanical disfunctions
j Horizontal r-Ian
i Sagi ttal plan
Frontal plan
Frontal plan
q Frontal plan disfunetions
Fronta l plan
Perdriolle Movement magnitude
gt in the direction of lt in the direction of correction progression
S Negrini 6
EDUCATION MEETING SATURDAY8th of APRIL 2006
Frontal plan
Stagnara
Never mobilize a scoliotic curve without ensuring reduction maintenance over time otherwise a greater mobility favours scoliosis progression
Frontal plan
Ducongeacute~ research
On a group of adolescent idiopathie scolioses treated with
Meacuteziegraveres gymnastics
D After 1 year the mean angle of
curves increased from 18deg to 29deg
Frontal plan
Scoliosis without brace
D Greater spine
flexibility D-
Risk of progression
S Negrini 7
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Frontal plan
Mobilization is useful
D In preparation to
brace
D With brace
Sagittal plan
QSagittal plan disfunctions
Sagittal plan r middot _J o
Perdriolle scouos B CJ aDeformation of D
thoracic and thoraco-Iumbar curves evolves in extension
S Negrini 8
EDUCATION MEETING SATURDAY8th of APRIL 2006
Sagittal plan
Graf
The line of gravity centres in the vertebral bodies o s c oUOSt
projects itself firstly laterally and then fi
o
posteriorly lJ ~~ ~~ ~ ~~-_J-D ~nI~
Sagittal plan
Therapeutic a ims
D Maintain or
retrieve physiological curves on the sagittal plan
Horizontal plan
QHorizontal plan disfunctions
S Negnni 9
EDUCATION MEETINGSATURDAY 8th of APRIL 2006
Horizontal plan
Stagnara The forces applied ta the spi ne act in a autoshydeforming sense
Horizontal plan
Dimnet Rotation gt 200
ampII~ (
D The actions of concave and convex side
muscles become
agonistic
~ItJrOnrIIiItdllfUClltlluumlll~~tI ~1JIf1laJ
Horizontal plan
Minor scolioses never exceed these autoshy
deformation thresholds
S Negrini 10
EDUCATION MEETING SATURDAY8th of APRIL 2006
Disfunctions at a biological organic and psychological
lever
Oisfunclions at a biological organlc and psychologlcal lever
Cheng
Bane density in scoliotic teenagers is lower than in normal subjects
~~~~middotA~IIlUtIy ~7œl 1d l
Oisfunctions at a blologlcal organic and psychologicallevel
A significant reduction of vital capacity and V02max in teenagers with a medium severity scoliosis
S Negrini 11
li
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Disfunctions at a biological organic and psychologicallevel
Disorders in the development of body image that the teenager has of himherself
Disfunctions at a blologlca l organlc and psychologicallevel
Therapeutic aims
cJ Activate cardioshyrespiratory function
cJ Favour bone density increase
cJ Develop a positive image of the body
Disfunctions at il biological organi and psydlologicallevel
Stagnara
Sport
D The active side of
kinesitherapy
S Negrini 12
EDUCATION MEETING SATURDAY 8thof APRIL 2006
Disfunctions at a biological organic and psychological
level
Distunctions at a biologlcal organlc and psychologicallevel
Cheng
Bone density in scoliotic teenagers is lower than in normal subjects
~n~IIIvpWr~middotA~stWy s- XXJl M J
Disfunctions at a biological organic and psychologicallevel
A significant reduction of vital capacity and V02max in teenagers with a medium severity scoliosis
G
S Negrini 11
EDUCATIONMEETING SATURDAY 8th of APRIL 2006
Kinesitherapy on the scoliotic subject
q Postural control
q Axial stability
q Muscular trophism
q Balance
q Respiratory function
The limits of kinesitherapy
There is a threshold beyond which
rehabilitation alone is not enough
sssr
Kinesitherapy in scoliosis treatment with brace
Therapeutic aims
S Negrini 13
6
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Therapeutic aims Srace kinesitherapy
With brace
il Postural corrections and
vertebral stability are obtained by the brace
Therapeutic aims Srace kinesitherapy
In preparation to the brace
il Mobilize spine on ail plans
Therapeutic aims Srace kinesitherapy
With brace D
Maintain a normal spine elasticity
~ Maintain a good muscular toneshy
trophism
C Model the hump with kyphotizating
exercises
S Negrini 14
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Exercises and their methodologies can vary accord ing to learning and individual sensibility of the single rehabilitator that proposes the m provided that they stay within the
Iimits of fixed therapeutic objectives
li
Therapeutic modalities
(Exercises)
QAuto-correction
QRespiratory education
QErgonomie education
QMuscular strengthening
QDevelopment of balance reactions
WNeuromotor integration
ci Vertebral mobiJization
QSpecifie modalities in brace treatment
S Negrini 15
EDUCATION MEETING SATURDAY 8th of APRIL 2006
The protocol of kinesitherapic
treatment
G
QChoice and dosage of exercises
Variatiosn of the work program every 2 - 3 months
Q Execute e)(ercises on an individual base or in a small group
Q Frequency not less than 2 times 1 week
Involve and awaken the family
G
S Negrini 16
EDUCATION MEETINGSATURDAY 8thof APRIL 2006
Q Determine the action and the localization of auto-correction
QAuto-correction must be associated to ail exercises
QAt the end of treatment ergonomy lesson
Auto-correction didactics
G
SCOLIOSI DORSALE---- shy ----
r
S Negrini 17
EDUCATION MEETING SATURDAY8thof APRIL 2006
SCOLIOS OORSOLOMBARE
shy
SCOLIOSI OOIlSALE 011 bull LOMBARE S1I--shy
SCOLIOSI LOMBARE
il --~_-
S Negrini 18
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Scoliotic patients are not radiographs
middotSeoliotie Mtients are not ndiographs but hum beings with a vertebral deviation-
Slagnara
Metha For the physieian Cobb angle is of utmost
importance For the patient it is body deformity t hat eounts most rib hump a protruding seapula or hip We are in a situation in whieh today dodors eure the radiographie deformity but what the patient really desires is to get rid of clinieal deformity and of ensuing psyehologieal distress
CIIQItIo shDuIdtucirc lM WIld tJw~~ I~~M~~~~ J9f~
S Negrini 19
- Poznan_workshop_Physiotherapy
- physio2
- physio3pdf
- physio4
- physio5
- physio6
- physio7
- physio8
- physio9
- physio10
-
EDUCATIONMEETING SATURDAY 8thof APRIL 2006
(iSS
SEAS02 Scientific
Exercises Approach to Scoliosis
version 2002
G
S Negrini 1
EDUCATION MEETING SATURDAY8th of APRIL 2006
Neuromotor disfunctions
Neuromuscular disfunctions
11 Postural collapse
Postural collapse
Duval-Beaupegravere
Flexibility of scoliotic curve
f---I--- I Postural element
-------1 Structural element
S Negrini 2
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Postural collapse
Duval-Beaupegravere
It is a value related to muscular tone and to flexibil ity of convex side tissues
Post ural collapse
Bunch e Patwardhan
Critical load
Load threshold beyond wh ich a spine begins buckling
JI~~Wt1lW~flfthtlJlœJtAr ~ J~It- l~l - IMS
Postu ral collapse
Bunch e Patwardhan
If a curve reduces there is an increase of the deformation threshold
~~~NW~-damaoc~IIIMf ~~ J~Iv JaJ-I7I9sect
S Negrini 3
EDUCATION MEETING SATURDAY 8th of APRIL2006
Postural collapse
Torrel e Nachemson ~
Scolioses below 20deg ~ ~ lt~
have a high ~ ~ percentage of ~ ~
~postural collapse (on u~
average 75) ~~ 2i~
CU~VE O EG~EE S WHllE SUPlti e
~laquotd~c6b ____lPffI1wtt1t~
$ww J(t ~~7 JM5
Postural collapse
Minor scolioses 7
Antigravity musc es strengthening D
Reduces postural collapse -G
Increases the critical threshold of deformation
G
Neuromotor disfunetions
Stagnara
If we admit that one of the causes of idiopathie scoliosis is a disfunction in balance systems it is logical to orientate physical exercises toward this direction
s Negrini 4
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Neuromotor disfunctions
Dubousset
Idiopathie seoliosis results fram alterations in praprioeeption centres and deformation is a natural compensation to restore postural balance
etattJtitIK ypothfQj~S ___~ own_ oJ)HQr lar 1t-1( r
Neuromotor disfunctions
Nachemson Initial idiopathie scoliosis
+ Goood spine stability
Neutralization of postural deficits
D Static curve
Neuromotor disfunctions
Therapeutic aims
c) Development of spine stability
C) Development of balance reactions
G
S Negrini 5
EDUCATION MEETING SATURDAY 8thof APRIL 2006
Biomechanical disfunctions
j Horizontal r-Ian
i Sagi ttal plan
Frontal plan
Frontal plan
q Frontal plan disfunetions
Fronta l plan
Perdriolle Movement magnitude
gt in the direction of lt in the direction of correction progression
S Negrini 6
EDUCATION MEETING SATURDAY8th of APRIL 2006
Frontal plan
Stagnara
Never mobilize a scoliotic curve without ensuring reduction maintenance over time otherwise a greater mobility favours scoliosis progression
Frontal plan
Ducongeacute~ research
On a group of adolescent idiopathie scolioses treated with
Meacuteziegraveres gymnastics
D After 1 year the mean angle of
curves increased from 18deg to 29deg
Frontal plan
Scoliosis without brace
D Greater spine
flexibility D-
Risk of progression
S Negrini 7
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Frontal plan
Mobilization is useful
D In preparation to
brace
D With brace
Sagittal plan
QSagittal plan disfunctions
Sagittal plan r middot _J o
Perdriolle scouos B CJ aDeformation of D
thoracic and thoraco-Iumbar curves evolves in extension
S Negrini 8
EDUCATION MEETING SATURDAY8th of APRIL 2006
Sagittal plan
Graf
The line of gravity centres in the vertebral bodies o s c oUOSt
projects itself firstly laterally and then fi
o
posteriorly lJ ~~ ~~ ~ ~~-_J-D ~nI~
Sagittal plan
Therapeutic a ims
D Maintain or
retrieve physiological curves on the sagittal plan
Horizontal plan
QHorizontal plan disfunctions
S Negnni 9
EDUCATION MEETINGSATURDAY 8th of APRIL 2006
Horizontal plan
Stagnara The forces applied ta the spi ne act in a autoshydeforming sense
Horizontal plan
Dimnet Rotation gt 200
ampII~ (
D The actions of concave and convex side
muscles become
agonistic
~ItJrOnrIIiItdllfUClltlluumlll~~tI ~1JIf1laJ
Horizontal plan
Minor scolioses never exceed these autoshy
deformation thresholds
S Negrini 10
EDUCATION MEETING SATURDAY8th of APRIL 2006
Disfunctions at a biological organic and psychological
lever
Oisfunclions at a biological organlc and psychologlcal lever
Cheng
Bane density in scoliotic teenagers is lower than in normal subjects
~~~~middotA~IIlUtIy ~7œl 1d l
Oisfunctions at a blologlcal organic and psychologicallevel
A significant reduction of vital capacity and V02max in teenagers with a medium severity scoliosis
S Negrini 11
li
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Disfunctions at a biological organic and psychologicallevel
Disorders in the development of body image that the teenager has of himherself
Disfunctions at a blologlca l organlc and psychologicallevel
Therapeutic aims
cJ Activate cardioshyrespiratory function
cJ Favour bone density increase
cJ Develop a positive image of the body
Disfunctions at il biological organi and psydlologicallevel
Stagnara
Sport
D The active side of
kinesitherapy
S Negrini 12
EDUCATION MEETING SATURDAY 8thof APRIL 2006
Disfunctions at a biological organic and psychological
level
Distunctions at a biologlcal organlc and psychologicallevel
Cheng
Bone density in scoliotic teenagers is lower than in normal subjects
~n~IIIvpWr~middotA~stWy s- XXJl M J
Disfunctions at a biological organic and psychologicallevel
A significant reduction of vital capacity and V02max in teenagers with a medium severity scoliosis
G
S Negrini 11
EDUCATIONMEETING SATURDAY 8th of APRIL 2006
Kinesitherapy on the scoliotic subject
q Postural control
q Axial stability
q Muscular trophism
q Balance
q Respiratory function
The limits of kinesitherapy
There is a threshold beyond which
rehabilitation alone is not enough
sssr
Kinesitherapy in scoliosis treatment with brace
Therapeutic aims
S Negrini 13
6
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Therapeutic aims Srace kinesitherapy
With brace
il Postural corrections and
vertebral stability are obtained by the brace
Therapeutic aims Srace kinesitherapy
In preparation to the brace
il Mobilize spine on ail plans
Therapeutic aims Srace kinesitherapy
With brace D
Maintain a normal spine elasticity
~ Maintain a good muscular toneshy
trophism
C Model the hump with kyphotizating
exercises
S Negrini 14
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Exercises and their methodologies can vary accord ing to learning and individual sensibility of the single rehabilitator that proposes the m provided that they stay within the
Iimits of fixed therapeutic objectives
li
Therapeutic modalities
(Exercises)
QAuto-correction
QRespiratory education
QErgonomie education
QMuscular strengthening
QDevelopment of balance reactions
WNeuromotor integration
ci Vertebral mobiJization
QSpecifie modalities in brace treatment
S Negrini 15
EDUCATION MEETING SATURDAY 8th of APRIL 2006
The protocol of kinesitherapic
treatment
G
QChoice and dosage of exercises
Variatiosn of the work program every 2 - 3 months
Q Execute e)(ercises on an individual base or in a small group
Q Frequency not less than 2 times 1 week
Involve and awaken the family
G
S Negrini 16
EDUCATION MEETINGSATURDAY 8thof APRIL 2006
Q Determine the action and the localization of auto-correction
QAuto-correction must be associated to ail exercises
QAt the end of treatment ergonomy lesson
Auto-correction didactics
G
SCOLIOSI DORSALE---- shy ----
r
S Negrini 17
EDUCATION MEETING SATURDAY8thof APRIL 2006
SCOLIOS OORSOLOMBARE
shy
SCOLIOSI OOIlSALE 011 bull LOMBARE S1I--shy
SCOLIOSI LOMBARE
il --~_-
S Negrini 18
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Scoliotic patients are not radiographs
middotSeoliotie Mtients are not ndiographs but hum beings with a vertebral deviation-
Slagnara
Metha For the physieian Cobb angle is of utmost
importance For the patient it is body deformity t hat eounts most rib hump a protruding seapula or hip We are in a situation in whieh today dodors eure the radiographie deformity but what the patient really desires is to get rid of clinieal deformity and of ensuing psyehologieal distress
CIIQItIo shDuIdtucirc lM WIld tJw~~ I~~M~~~~ J9f~
S Negrini 19
- Poznan_workshop_Physiotherapy
- physio2
- physio3pdf
- physio4
- physio5
- physio6
- physio7
- physio8
- physio9
- physio10
-
EDUCATION MEETING SATURDAY8th of APRIL 2006
Neuromotor disfunctions
Neuromuscular disfunctions
11 Postural collapse
Postural collapse
Duval-Beaupegravere
Flexibility of scoliotic curve
f---I--- I Postural element
-------1 Structural element
S Negrini 2
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Postural collapse
Duval-Beaupegravere
It is a value related to muscular tone and to flexibil ity of convex side tissues
Post ural collapse
Bunch e Patwardhan
Critical load
Load threshold beyond wh ich a spine begins buckling
JI~~Wt1lW~flfthtlJlœJtAr ~ J~It- l~l - IMS
Postu ral collapse
Bunch e Patwardhan
If a curve reduces there is an increase of the deformation threshold
~~~NW~-damaoc~IIIMf ~~ J~Iv JaJ-I7I9sect
S Negrini 3
EDUCATION MEETING SATURDAY 8th of APRIL2006
Postural collapse
Torrel e Nachemson ~
Scolioses below 20deg ~ ~ lt~
have a high ~ ~ percentage of ~ ~
~postural collapse (on u~
average 75) ~~ 2i~
CU~VE O EG~EE S WHllE SUPlti e
~laquotd~c6b ____lPffI1wtt1t~
$ww J(t ~~7 JM5
Postural collapse
Minor scolioses 7
Antigravity musc es strengthening D
Reduces postural collapse -G
Increases the critical threshold of deformation
G
Neuromotor disfunetions
Stagnara
If we admit that one of the causes of idiopathie scoliosis is a disfunction in balance systems it is logical to orientate physical exercises toward this direction
s Negrini 4
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Neuromotor disfunctions
Dubousset
Idiopathie seoliosis results fram alterations in praprioeeption centres and deformation is a natural compensation to restore postural balance
etattJtitIK ypothfQj~S ___~ own_ oJ)HQr lar 1t-1( r
Neuromotor disfunctions
Nachemson Initial idiopathie scoliosis
+ Goood spine stability
Neutralization of postural deficits
D Static curve
Neuromotor disfunctions
Therapeutic aims
c) Development of spine stability
C) Development of balance reactions
G
S Negrini 5
EDUCATION MEETING SATURDAY 8thof APRIL 2006
Biomechanical disfunctions
j Horizontal r-Ian
i Sagi ttal plan
Frontal plan
Frontal plan
q Frontal plan disfunetions
Fronta l plan
Perdriolle Movement magnitude
gt in the direction of lt in the direction of correction progression
S Negrini 6
EDUCATION MEETING SATURDAY8th of APRIL 2006
Frontal plan
Stagnara
Never mobilize a scoliotic curve without ensuring reduction maintenance over time otherwise a greater mobility favours scoliosis progression
Frontal plan
Ducongeacute~ research
On a group of adolescent idiopathie scolioses treated with
Meacuteziegraveres gymnastics
D After 1 year the mean angle of
curves increased from 18deg to 29deg
Frontal plan
Scoliosis without brace
D Greater spine
flexibility D-
Risk of progression
S Negrini 7
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Frontal plan
Mobilization is useful
D In preparation to
brace
D With brace
Sagittal plan
QSagittal plan disfunctions
Sagittal plan r middot _J o
Perdriolle scouos B CJ aDeformation of D
thoracic and thoraco-Iumbar curves evolves in extension
S Negrini 8
EDUCATION MEETING SATURDAY8th of APRIL 2006
Sagittal plan
Graf
The line of gravity centres in the vertebral bodies o s c oUOSt
projects itself firstly laterally and then fi
o
posteriorly lJ ~~ ~~ ~ ~~-_J-D ~nI~
Sagittal plan
Therapeutic a ims
D Maintain or
retrieve physiological curves on the sagittal plan
Horizontal plan
QHorizontal plan disfunctions
S Negnni 9
EDUCATION MEETINGSATURDAY 8th of APRIL 2006
Horizontal plan
Stagnara The forces applied ta the spi ne act in a autoshydeforming sense
Horizontal plan
Dimnet Rotation gt 200
ampII~ (
D The actions of concave and convex side
muscles become
agonistic
~ItJrOnrIIiItdllfUClltlluumlll~~tI ~1JIf1laJ
Horizontal plan
Minor scolioses never exceed these autoshy
deformation thresholds
S Negrini 10
EDUCATION MEETING SATURDAY8th of APRIL 2006
Disfunctions at a biological organic and psychological
lever
Oisfunclions at a biological organlc and psychologlcal lever
Cheng
Bane density in scoliotic teenagers is lower than in normal subjects
~~~~middotA~IIlUtIy ~7œl 1d l
Oisfunctions at a blologlcal organic and psychologicallevel
A significant reduction of vital capacity and V02max in teenagers with a medium severity scoliosis
S Negrini 11
li
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Disfunctions at a biological organic and psychologicallevel
Disorders in the development of body image that the teenager has of himherself
Disfunctions at a blologlca l organlc and psychologicallevel
Therapeutic aims
cJ Activate cardioshyrespiratory function
cJ Favour bone density increase
cJ Develop a positive image of the body
Disfunctions at il biological organi and psydlologicallevel
Stagnara
Sport
D The active side of
kinesitherapy
S Negrini 12
EDUCATION MEETING SATURDAY 8thof APRIL 2006
Disfunctions at a biological organic and psychological
level
Distunctions at a biologlcal organlc and psychologicallevel
Cheng
Bone density in scoliotic teenagers is lower than in normal subjects
~n~IIIvpWr~middotA~stWy s- XXJl M J
Disfunctions at a biological organic and psychologicallevel
A significant reduction of vital capacity and V02max in teenagers with a medium severity scoliosis
G
S Negrini 11
EDUCATIONMEETING SATURDAY 8th of APRIL 2006
Kinesitherapy on the scoliotic subject
q Postural control
q Axial stability
q Muscular trophism
q Balance
q Respiratory function
The limits of kinesitherapy
There is a threshold beyond which
rehabilitation alone is not enough
sssr
Kinesitherapy in scoliosis treatment with brace
Therapeutic aims
S Negrini 13
6
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Therapeutic aims Srace kinesitherapy
With brace
il Postural corrections and
vertebral stability are obtained by the brace
Therapeutic aims Srace kinesitherapy
In preparation to the brace
il Mobilize spine on ail plans
Therapeutic aims Srace kinesitherapy
With brace D
Maintain a normal spine elasticity
~ Maintain a good muscular toneshy
trophism
C Model the hump with kyphotizating
exercises
S Negrini 14
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Exercises and their methodologies can vary accord ing to learning and individual sensibility of the single rehabilitator that proposes the m provided that they stay within the
Iimits of fixed therapeutic objectives
li
Therapeutic modalities
(Exercises)
QAuto-correction
QRespiratory education
QErgonomie education
QMuscular strengthening
QDevelopment of balance reactions
WNeuromotor integration
ci Vertebral mobiJization
QSpecifie modalities in brace treatment
S Negrini 15
EDUCATION MEETING SATURDAY 8th of APRIL 2006
The protocol of kinesitherapic
treatment
G
QChoice and dosage of exercises
Variatiosn of the work program every 2 - 3 months
Q Execute e)(ercises on an individual base or in a small group
Q Frequency not less than 2 times 1 week
Involve and awaken the family
G
S Negrini 16
EDUCATION MEETINGSATURDAY 8thof APRIL 2006
Q Determine the action and the localization of auto-correction
QAuto-correction must be associated to ail exercises
QAt the end of treatment ergonomy lesson
Auto-correction didactics
G
SCOLIOSI DORSALE---- shy ----
r
S Negrini 17
EDUCATION MEETING SATURDAY8thof APRIL 2006
SCOLIOS OORSOLOMBARE
shy
SCOLIOSI OOIlSALE 011 bull LOMBARE S1I--shy
SCOLIOSI LOMBARE
il --~_-
S Negrini 18
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Scoliotic patients are not radiographs
middotSeoliotie Mtients are not ndiographs but hum beings with a vertebral deviation-
Slagnara
Metha For the physieian Cobb angle is of utmost
importance For the patient it is body deformity t hat eounts most rib hump a protruding seapula or hip We are in a situation in whieh today dodors eure the radiographie deformity but what the patient really desires is to get rid of clinieal deformity and of ensuing psyehologieal distress
CIIQItIo shDuIdtucirc lM WIld tJw~~ I~~M~~~~ J9f~
S Negrini 19
- Poznan_workshop_Physiotherapy
- physio2
- physio3pdf
- physio4
- physio5
- physio6
- physio7
- physio8
- physio9
- physio10
-
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Postural collapse
Duval-Beaupegravere
It is a value related to muscular tone and to flexibil ity of convex side tissues
Post ural collapse
Bunch e Patwardhan
Critical load
Load threshold beyond wh ich a spine begins buckling
JI~~Wt1lW~flfthtlJlœJtAr ~ J~It- l~l - IMS
Postu ral collapse
Bunch e Patwardhan
If a curve reduces there is an increase of the deformation threshold
~~~NW~-damaoc~IIIMf ~~ J~Iv JaJ-I7I9sect
S Negrini 3
EDUCATION MEETING SATURDAY 8th of APRIL2006
Postural collapse
Torrel e Nachemson ~
Scolioses below 20deg ~ ~ lt~
have a high ~ ~ percentage of ~ ~
~postural collapse (on u~
average 75) ~~ 2i~
CU~VE O EG~EE S WHllE SUPlti e
~laquotd~c6b ____lPffI1wtt1t~
$ww J(t ~~7 JM5
Postural collapse
Minor scolioses 7
Antigravity musc es strengthening D
Reduces postural collapse -G
Increases the critical threshold of deformation
G
Neuromotor disfunetions
Stagnara
If we admit that one of the causes of idiopathie scoliosis is a disfunction in balance systems it is logical to orientate physical exercises toward this direction
s Negrini 4
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Neuromotor disfunctions
Dubousset
Idiopathie seoliosis results fram alterations in praprioeeption centres and deformation is a natural compensation to restore postural balance
etattJtitIK ypothfQj~S ___~ own_ oJ)HQr lar 1t-1( r
Neuromotor disfunctions
Nachemson Initial idiopathie scoliosis
+ Goood spine stability
Neutralization of postural deficits
D Static curve
Neuromotor disfunctions
Therapeutic aims
c) Development of spine stability
C) Development of balance reactions
G
S Negrini 5
EDUCATION MEETING SATURDAY 8thof APRIL 2006
Biomechanical disfunctions
j Horizontal r-Ian
i Sagi ttal plan
Frontal plan
Frontal plan
q Frontal plan disfunetions
Fronta l plan
Perdriolle Movement magnitude
gt in the direction of lt in the direction of correction progression
S Negrini 6
EDUCATION MEETING SATURDAY8th of APRIL 2006
Frontal plan
Stagnara
Never mobilize a scoliotic curve without ensuring reduction maintenance over time otherwise a greater mobility favours scoliosis progression
Frontal plan
Ducongeacute~ research
On a group of adolescent idiopathie scolioses treated with
Meacuteziegraveres gymnastics
D After 1 year the mean angle of
curves increased from 18deg to 29deg
Frontal plan
Scoliosis without brace
D Greater spine
flexibility D-
Risk of progression
S Negrini 7
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Frontal plan
Mobilization is useful
D In preparation to
brace
D With brace
Sagittal plan
QSagittal plan disfunctions
Sagittal plan r middot _J o
Perdriolle scouos B CJ aDeformation of D
thoracic and thoraco-Iumbar curves evolves in extension
S Negrini 8
EDUCATION MEETING SATURDAY8th of APRIL 2006
Sagittal plan
Graf
The line of gravity centres in the vertebral bodies o s c oUOSt
projects itself firstly laterally and then fi
o
posteriorly lJ ~~ ~~ ~ ~~-_J-D ~nI~
Sagittal plan
Therapeutic a ims
D Maintain or
retrieve physiological curves on the sagittal plan
Horizontal plan
QHorizontal plan disfunctions
S Negnni 9
EDUCATION MEETINGSATURDAY 8th of APRIL 2006
Horizontal plan
Stagnara The forces applied ta the spi ne act in a autoshydeforming sense
Horizontal plan
Dimnet Rotation gt 200
ampII~ (
D The actions of concave and convex side
muscles become
agonistic
~ItJrOnrIIiItdllfUClltlluumlll~~tI ~1JIf1laJ
Horizontal plan
Minor scolioses never exceed these autoshy
deformation thresholds
S Negrini 10
EDUCATION MEETING SATURDAY8th of APRIL 2006
Disfunctions at a biological organic and psychological
lever
Oisfunclions at a biological organlc and psychologlcal lever
Cheng
Bane density in scoliotic teenagers is lower than in normal subjects
~~~~middotA~IIlUtIy ~7œl 1d l
Oisfunctions at a blologlcal organic and psychologicallevel
A significant reduction of vital capacity and V02max in teenagers with a medium severity scoliosis
S Negrini 11
li
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Disfunctions at a biological organic and psychologicallevel
Disorders in the development of body image that the teenager has of himherself
Disfunctions at a blologlca l organlc and psychologicallevel
Therapeutic aims
cJ Activate cardioshyrespiratory function
cJ Favour bone density increase
cJ Develop a positive image of the body
Disfunctions at il biological organi and psydlologicallevel
Stagnara
Sport
D The active side of
kinesitherapy
S Negrini 12
EDUCATION MEETING SATURDAY 8thof APRIL 2006
Disfunctions at a biological organic and psychological
level
Distunctions at a biologlcal organlc and psychologicallevel
Cheng
Bone density in scoliotic teenagers is lower than in normal subjects
~n~IIIvpWr~middotA~stWy s- XXJl M J
Disfunctions at a biological organic and psychologicallevel
A significant reduction of vital capacity and V02max in teenagers with a medium severity scoliosis
G
S Negrini 11
EDUCATIONMEETING SATURDAY 8th of APRIL 2006
Kinesitherapy on the scoliotic subject
q Postural control
q Axial stability
q Muscular trophism
q Balance
q Respiratory function
The limits of kinesitherapy
There is a threshold beyond which
rehabilitation alone is not enough
sssr
Kinesitherapy in scoliosis treatment with brace
Therapeutic aims
S Negrini 13
6
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Therapeutic aims Srace kinesitherapy
With brace
il Postural corrections and
vertebral stability are obtained by the brace
Therapeutic aims Srace kinesitherapy
In preparation to the brace
il Mobilize spine on ail plans
Therapeutic aims Srace kinesitherapy
With brace D
Maintain a normal spine elasticity
~ Maintain a good muscular toneshy
trophism
C Model the hump with kyphotizating
exercises
S Negrini 14
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Exercises and their methodologies can vary accord ing to learning and individual sensibility of the single rehabilitator that proposes the m provided that they stay within the
Iimits of fixed therapeutic objectives
li
Therapeutic modalities
(Exercises)
QAuto-correction
QRespiratory education
QErgonomie education
QMuscular strengthening
QDevelopment of balance reactions
WNeuromotor integration
ci Vertebral mobiJization
QSpecifie modalities in brace treatment
S Negrini 15
EDUCATION MEETING SATURDAY 8th of APRIL 2006
The protocol of kinesitherapic
treatment
G
QChoice and dosage of exercises
Variatiosn of the work program every 2 - 3 months
Q Execute e)(ercises on an individual base or in a small group
Q Frequency not less than 2 times 1 week
Involve and awaken the family
G
S Negrini 16
EDUCATION MEETINGSATURDAY 8thof APRIL 2006
Q Determine the action and the localization of auto-correction
QAuto-correction must be associated to ail exercises
QAt the end of treatment ergonomy lesson
Auto-correction didactics
G
SCOLIOSI DORSALE---- shy ----
r
S Negrini 17
EDUCATION MEETING SATURDAY8thof APRIL 2006
SCOLIOS OORSOLOMBARE
shy
SCOLIOSI OOIlSALE 011 bull LOMBARE S1I--shy
SCOLIOSI LOMBARE
il --~_-
S Negrini 18
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Scoliotic patients are not radiographs
middotSeoliotie Mtients are not ndiographs but hum beings with a vertebral deviation-
Slagnara
Metha For the physieian Cobb angle is of utmost
importance For the patient it is body deformity t hat eounts most rib hump a protruding seapula or hip We are in a situation in whieh today dodors eure the radiographie deformity but what the patient really desires is to get rid of clinieal deformity and of ensuing psyehologieal distress
CIIQItIo shDuIdtucirc lM WIld tJw~~ I~~M~~~~ J9f~
S Negrini 19
- Poznan_workshop_Physiotherapy
- physio2
- physio3pdf
- physio4
- physio5
- physio6
- physio7
- physio8
- physio9
- physio10
-
EDUCATION MEETING SATURDAY 8th of APRIL2006
Postural collapse
Torrel e Nachemson ~
Scolioses below 20deg ~ ~ lt~
have a high ~ ~ percentage of ~ ~
~postural collapse (on u~
average 75) ~~ 2i~
CU~VE O EG~EE S WHllE SUPlti e
~laquotd~c6b ____lPffI1wtt1t~
$ww J(t ~~7 JM5
Postural collapse
Minor scolioses 7
Antigravity musc es strengthening D
Reduces postural collapse -G
Increases the critical threshold of deformation
G
Neuromotor disfunetions
Stagnara
If we admit that one of the causes of idiopathie scoliosis is a disfunction in balance systems it is logical to orientate physical exercises toward this direction
s Negrini 4
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Neuromotor disfunctions
Dubousset
Idiopathie seoliosis results fram alterations in praprioeeption centres and deformation is a natural compensation to restore postural balance
etattJtitIK ypothfQj~S ___~ own_ oJ)HQr lar 1t-1( r
Neuromotor disfunctions
Nachemson Initial idiopathie scoliosis
+ Goood spine stability
Neutralization of postural deficits
D Static curve
Neuromotor disfunctions
Therapeutic aims
c) Development of spine stability
C) Development of balance reactions
G
S Negrini 5
EDUCATION MEETING SATURDAY 8thof APRIL 2006
Biomechanical disfunctions
j Horizontal r-Ian
i Sagi ttal plan
Frontal plan
Frontal plan
q Frontal plan disfunetions
Fronta l plan
Perdriolle Movement magnitude
gt in the direction of lt in the direction of correction progression
S Negrini 6
EDUCATION MEETING SATURDAY8th of APRIL 2006
Frontal plan
Stagnara
Never mobilize a scoliotic curve without ensuring reduction maintenance over time otherwise a greater mobility favours scoliosis progression
Frontal plan
Ducongeacute~ research
On a group of adolescent idiopathie scolioses treated with
Meacuteziegraveres gymnastics
D After 1 year the mean angle of
curves increased from 18deg to 29deg
Frontal plan
Scoliosis without brace
D Greater spine
flexibility D-
Risk of progression
S Negrini 7
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Frontal plan
Mobilization is useful
D In preparation to
brace
D With brace
Sagittal plan
QSagittal plan disfunctions
Sagittal plan r middot _J o
Perdriolle scouos B CJ aDeformation of D
thoracic and thoraco-Iumbar curves evolves in extension
S Negrini 8
EDUCATION MEETING SATURDAY8th of APRIL 2006
Sagittal plan
Graf
The line of gravity centres in the vertebral bodies o s c oUOSt
projects itself firstly laterally and then fi
o
posteriorly lJ ~~ ~~ ~ ~~-_J-D ~nI~
Sagittal plan
Therapeutic a ims
D Maintain or
retrieve physiological curves on the sagittal plan
Horizontal plan
QHorizontal plan disfunctions
S Negnni 9
EDUCATION MEETINGSATURDAY 8th of APRIL 2006
Horizontal plan
Stagnara The forces applied ta the spi ne act in a autoshydeforming sense
Horizontal plan
Dimnet Rotation gt 200
ampII~ (
D The actions of concave and convex side
muscles become
agonistic
~ItJrOnrIIiItdllfUClltlluumlll~~tI ~1JIf1laJ
Horizontal plan
Minor scolioses never exceed these autoshy
deformation thresholds
S Negrini 10
EDUCATION MEETING SATURDAY8th of APRIL 2006
Disfunctions at a biological organic and psychological
lever
Oisfunclions at a biological organlc and psychologlcal lever
Cheng
Bane density in scoliotic teenagers is lower than in normal subjects
~~~~middotA~IIlUtIy ~7œl 1d l
Oisfunctions at a blologlcal organic and psychologicallevel
A significant reduction of vital capacity and V02max in teenagers with a medium severity scoliosis
S Negrini 11
li
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Disfunctions at a biological organic and psychologicallevel
Disorders in the development of body image that the teenager has of himherself
Disfunctions at a blologlca l organlc and psychologicallevel
Therapeutic aims
cJ Activate cardioshyrespiratory function
cJ Favour bone density increase
cJ Develop a positive image of the body
Disfunctions at il biological organi and psydlologicallevel
Stagnara
Sport
D The active side of
kinesitherapy
S Negrini 12
EDUCATION MEETING SATURDAY 8thof APRIL 2006
Disfunctions at a biological organic and psychological
level
Distunctions at a biologlcal organlc and psychologicallevel
Cheng
Bone density in scoliotic teenagers is lower than in normal subjects
~n~IIIvpWr~middotA~stWy s- XXJl M J
Disfunctions at a biological organic and psychologicallevel
A significant reduction of vital capacity and V02max in teenagers with a medium severity scoliosis
G
S Negrini 11
EDUCATIONMEETING SATURDAY 8th of APRIL 2006
Kinesitherapy on the scoliotic subject
q Postural control
q Axial stability
q Muscular trophism
q Balance
q Respiratory function
The limits of kinesitherapy
There is a threshold beyond which
rehabilitation alone is not enough
sssr
Kinesitherapy in scoliosis treatment with brace
Therapeutic aims
S Negrini 13
6
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Therapeutic aims Srace kinesitherapy
With brace
il Postural corrections and
vertebral stability are obtained by the brace
Therapeutic aims Srace kinesitherapy
In preparation to the brace
il Mobilize spine on ail plans
Therapeutic aims Srace kinesitherapy
With brace D
Maintain a normal spine elasticity
~ Maintain a good muscular toneshy
trophism
C Model the hump with kyphotizating
exercises
S Negrini 14
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Exercises and their methodologies can vary accord ing to learning and individual sensibility of the single rehabilitator that proposes the m provided that they stay within the
Iimits of fixed therapeutic objectives
li
Therapeutic modalities
(Exercises)
QAuto-correction
QRespiratory education
QErgonomie education
QMuscular strengthening
QDevelopment of balance reactions
WNeuromotor integration
ci Vertebral mobiJization
QSpecifie modalities in brace treatment
S Negrini 15
EDUCATION MEETING SATURDAY 8th of APRIL 2006
The protocol of kinesitherapic
treatment
G
QChoice and dosage of exercises
Variatiosn of the work program every 2 - 3 months
Q Execute e)(ercises on an individual base or in a small group
Q Frequency not less than 2 times 1 week
Involve and awaken the family
G
S Negrini 16
EDUCATION MEETINGSATURDAY 8thof APRIL 2006
Q Determine the action and the localization of auto-correction
QAuto-correction must be associated to ail exercises
QAt the end of treatment ergonomy lesson
Auto-correction didactics
G
SCOLIOSI DORSALE---- shy ----
r
S Negrini 17
EDUCATION MEETING SATURDAY8thof APRIL 2006
SCOLIOS OORSOLOMBARE
shy
SCOLIOSI OOIlSALE 011 bull LOMBARE S1I--shy
SCOLIOSI LOMBARE
il --~_-
S Negrini 18
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Scoliotic patients are not radiographs
middotSeoliotie Mtients are not ndiographs but hum beings with a vertebral deviation-
Slagnara
Metha For the physieian Cobb angle is of utmost
importance For the patient it is body deformity t hat eounts most rib hump a protruding seapula or hip We are in a situation in whieh today dodors eure the radiographie deformity but what the patient really desires is to get rid of clinieal deformity and of ensuing psyehologieal distress
CIIQItIo shDuIdtucirc lM WIld tJw~~ I~~M~~~~ J9f~
S Negrini 19
- Poznan_workshop_Physiotherapy
- physio2
- physio3pdf
- physio4
- physio5
- physio6
- physio7
- physio8
- physio9
- physio10
-
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Neuromotor disfunctions
Dubousset
Idiopathie seoliosis results fram alterations in praprioeeption centres and deformation is a natural compensation to restore postural balance
etattJtitIK ypothfQj~S ___~ own_ oJ)HQr lar 1t-1( r
Neuromotor disfunctions
Nachemson Initial idiopathie scoliosis
+ Goood spine stability
Neutralization of postural deficits
D Static curve
Neuromotor disfunctions
Therapeutic aims
c) Development of spine stability
C) Development of balance reactions
G
S Negrini 5
EDUCATION MEETING SATURDAY 8thof APRIL 2006
Biomechanical disfunctions
j Horizontal r-Ian
i Sagi ttal plan
Frontal plan
Frontal plan
q Frontal plan disfunetions
Fronta l plan
Perdriolle Movement magnitude
gt in the direction of lt in the direction of correction progression
S Negrini 6
EDUCATION MEETING SATURDAY8th of APRIL 2006
Frontal plan
Stagnara
Never mobilize a scoliotic curve without ensuring reduction maintenance over time otherwise a greater mobility favours scoliosis progression
Frontal plan
Ducongeacute~ research
On a group of adolescent idiopathie scolioses treated with
Meacuteziegraveres gymnastics
D After 1 year the mean angle of
curves increased from 18deg to 29deg
Frontal plan
Scoliosis without brace
D Greater spine
flexibility D-
Risk of progression
S Negrini 7
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Frontal plan
Mobilization is useful
D In preparation to
brace
D With brace
Sagittal plan
QSagittal plan disfunctions
Sagittal plan r middot _J o
Perdriolle scouos B CJ aDeformation of D
thoracic and thoraco-Iumbar curves evolves in extension
S Negrini 8
EDUCATION MEETING SATURDAY8th of APRIL 2006
Sagittal plan
Graf
The line of gravity centres in the vertebral bodies o s c oUOSt
projects itself firstly laterally and then fi
o
posteriorly lJ ~~ ~~ ~ ~~-_J-D ~nI~
Sagittal plan
Therapeutic a ims
D Maintain or
retrieve physiological curves on the sagittal plan
Horizontal plan
QHorizontal plan disfunctions
S Negnni 9
EDUCATION MEETINGSATURDAY 8th of APRIL 2006
Horizontal plan
Stagnara The forces applied ta the spi ne act in a autoshydeforming sense
Horizontal plan
Dimnet Rotation gt 200
ampII~ (
D The actions of concave and convex side
muscles become
agonistic
~ItJrOnrIIiItdllfUClltlluumlll~~tI ~1JIf1laJ
Horizontal plan
Minor scolioses never exceed these autoshy
deformation thresholds
S Negrini 10
EDUCATION MEETING SATURDAY8th of APRIL 2006
Disfunctions at a biological organic and psychological
lever
Oisfunclions at a biological organlc and psychologlcal lever
Cheng
Bane density in scoliotic teenagers is lower than in normal subjects
~~~~middotA~IIlUtIy ~7œl 1d l
Oisfunctions at a blologlcal organic and psychologicallevel
A significant reduction of vital capacity and V02max in teenagers with a medium severity scoliosis
S Negrini 11
li
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Disfunctions at a biological organic and psychologicallevel
Disorders in the development of body image that the teenager has of himherself
Disfunctions at a blologlca l organlc and psychologicallevel
Therapeutic aims
cJ Activate cardioshyrespiratory function
cJ Favour bone density increase
cJ Develop a positive image of the body
Disfunctions at il biological organi and psydlologicallevel
Stagnara
Sport
D The active side of
kinesitherapy
S Negrini 12
EDUCATION MEETING SATURDAY 8thof APRIL 2006
Disfunctions at a biological organic and psychological
level
Distunctions at a biologlcal organlc and psychologicallevel
Cheng
Bone density in scoliotic teenagers is lower than in normal subjects
~n~IIIvpWr~middotA~stWy s- XXJl M J
Disfunctions at a biological organic and psychologicallevel
A significant reduction of vital capacity and V02max in teenagers with a medium severity scoliosis
G
S Negrini 11
EDUCATIONMEETING SATURDAY 8th of APRIL 2006
Kinesitherapy on the scoliotic subject
q Postural control
q Axial stability
q Muscular trophism
q Balance
q Respiratory function
The limits of kinesitherapy
There is a threshold beyond which
rehabilitation alone is not enough
sssr
Kinesitherapy in scoliosis treatment with brace
Therapeutic aims
S Negrini 13
6
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Therapeutic aims Srace kinesitherapy
With brace
il Postural corrections and
vertebral stability are obtained by the brace
Therapeutic aims Srace kinesitherapy
In preparation to the brace
il Mobilize spine on ail plans
Therapeutic aims Srace kinesitherapy
With brace D
Maintain a normal spine elasticity
~ Maintain a good muscular toneshy
trophism
C Model the hump with kyphotizating
exercises
S Negrini 14
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Exercises and their methodologies can vary accord ing to learning and individual sensibility of the single rehabilitator that proposes the m provided that they stay within the
Iimits of fixed therapeutic objectives
li
Therapeutic modalities
(Exercises)
QAuto-correction
QRespiratory education
QErgonomie education
QMuscular strengthening
QDevelopment of balance reactions
WNeuromotor integration
ci Vertebral mobiJization
QSpecifie modalities in brace treatment
S Negrini 15
EDUCATION MEETING SATURDAY 8th of APRIL 2006
The protocol of kinesitherapic
treatment
G
QChoice and dosage of exercises
Variatiosn of the work program every 2 - 3 months
Q Execute e)(ercises on an individual base or in a small group
Q Frequency not less than 2 times 1 week
Involve and awaken the family
G
S Negrini 16
EDUCATION MEETINGSATURDAY 8thof APRIL 2006
Q Determine the action and the localization of auto-correction
QAuto-correction must be associated to ail exercises
QAt the end of treatment ergonomy lesson
Auto-correction didactics
G
SCOLIOSI DORSALE---- shy ----
r
S Negrini 17
EDUCATION MEETING SATURDAY8thof APRIL 2006
SCOLIOS OORSOLOMBARE
shy
SCOLIOSI OOIlSALE 011 bull LOMBARE S1I--shy
SCOLIOSI LOMBARE
il --~_-
S Negrini 18
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Scoliotic patients are not radiographs
middotSeoliotie Mtients are not ndiographs but hum beings with a vertebral deviation-
Slagnara
Metha For the physieian Cobb angle is of utmost
importance For the patient it is body deformity t hat eounts most rib hump a protruding seapula or hip We are in a situation in whieh today dodors eure the radiographie deformity but what the patient really desires is to get rid of clinieal deformity and of ensuing psyehologieal distress
CIIQItIo shDuIdtucirc lM WIld tJw~~ I~~M~~~~ J9f~
S Negrini 19
- Poznan_workshop_Physiotherapy
- physio2
- physio3pdf
- physio4
- physio5
- physio6
- physio7
- physio8
- physio9
- physio10
-
EDUCATION MEETING SATURDAY 8thof APRIL 2006
Biomechanical disfunctions
j Horizontal r-Ian
i Sagi ttal plan
Frontal plan
Frontal plan
q Frontal plan disfunetions
Fronta l plan
Perdriolle Movement magnitude
gt in the direction of lt in the direction of correction progression
S Negrini 6
EDUCATION MEETING SATURDAY8th of APRIL 2006
Frontal plan
Stagnara
Never mobilize a scoliotic curve without ensuring reduction maintenance over time otherwise a greater mobility favours scoliosis progression
Frontal plan
Ducongeacute~ research
On a group of adolescent idiopathie scolioses treated with
Meacuteziegraveres gymnastics
D After 1 year the mean angle of
curves increased from 18deg to 29deg
Frontal plan
Scoliosis without brace
D Greater spine
flexibility D-
Risk of progression
S Negrini 7
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Frontal plan
Mobilization is useful
D In preparation to
brace
D With brace
Sagittal plan
QSagittal plan disfunctions
Sagittal plan r middot _J o
Perdriolle scouos B CJ aDeformation of D
thoracic and thoraco-Iumbar curves evolves in extension
S Negrini 8
EDUCATION MEETING SATURDAY8th of APRIL 2006
Sagittal plan
Graf
The line of gravity centres in the vertebral bodies o s c oUOSt
projects itself firstly laterally and then fi
o
posteriorly lJ ~~ ~~ ~ ~~-_J-D ~nI~
Sagittal plan
Therapeutic a ims
D Maintain or
retrieve physiological curves on the sagittal plan
Horizontal plan
QHorizontal plan disfunctions
S Negnni 9
EDUCATION MEETINGSATURDAY 8th of APRIL 2006
Horizontal plan
Stagnara The forces applied ta the spi ne act in a autoshydeforming sense
Horizontal plan
Dimnet Rotation gt 200
ampII~ (
D The actions of concave and convex side
muscles become
agonistic
~ItJrOnrIIiItdllfUClltlluumlll~~tI ~1JIf1laJ
Horizontal plan
Minor scolioses never exceed these autoshy
deformation thresholds
S Negrini 10
EDUCATION MEETING SATURDAY8th of APRIL 2006
Disfunctions at a biological organic and psychological
lever
Oisfunclions at a biological organlc and psychologlcal lever
Cheng
Bane density in scoliotic teenagers is lower than in normal subjects
~~~~middotA~IIlUtIy ~7œl 1d l
Oisfunctions at a blologlcal organic and psychologicallevel
A significant reduction of vital capacity and V02max in teenagers with a medium severity scoliosis
S Negrini 11
li
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Disfunctions at a biological organic and psychologicallevel
Disorders in the development of body image that the teenager has of himherself
Disfunctions at a blologlca l organlc and psychologicallevel
Therapeutic aims
cJ Activate cardioshyrespiratory function
cJ Favour bone density increase
cJ Develop a positive image of the body
Disfunctions at il biological organi and psydlologicallevel
Stagnara
Sport
D The active side of
kinesitherapy
S Negrini 12
EDUCATION MEETING SATURDAY 8thof APRIL 2006
Disfunctions at a biological organic and psychological
level
Distunctions at a biologlcal organlc and psychologicallevel
Cheng
Bone density in scoliotic teenagers is lower than in normal subjects
~n~IIIvpWr~middotA~stWy s- XXJl M J
Disfunctions at a biological organic and psychologicallevel
A significant reduction of vital capacity and V02max in teenagers with a medium severity scoliosis
G
S Negrini 11
EDUCATIONMEETING SATURDAY 8th of APRIL 2006
Kinesitherapy on the scoliotic subject
q Postural control
q Axial stability
q Muscular trophism
q Balance
q Respiratory function
The limits of kinesitherapy
There is a threshold beyond which
rehabilitation alone is not enough
sssr
Kinesitherapy in scoliosis treatment with brace
Therapeutic aims
S Negrini 13
6
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Therapeutic aims Srace kinesitherapy
With brace
il Postural corrections and
vertebral stability are obtained by the brace
Therapeutic aims Srace kinesitherapy
In preparation to the brace
il Mobilize spine on ail plans
Therapeutic aims Srace kinesitherapy
With brace D
Maintain a normal spine elasticity
~ Maintain a good muscular toneshy
trophism
C Model the hump with kyphotizating
exercises
S Negrini 14
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Exercises and their methodologies can vary accord ing to learning and individual sensibility of the single rehabilitator that proposes the m provided that they stay within the
Iimits of fixed therapeutic objectives
li
Therapeutic modalities
(Exercises)
QAuto-correction
QRespiratory education
QErgonomie education
QMuscular strengthening
QDevelopment of balance reactions
WNeuromotor integration
ci Vertebral mobiJization
QSpecifie modalities in brace treatment
S Negrini 15
EDUCATION MEETING SATURDAY 8th of APRIL 2006
The protocol of kinesitherapic
treatment
G
QChoice and dosage of exercises
Variatiosn of the work program every 2 - 3 months
Q Execute e)(ercises on an individual base or in a small group
Q Frequency not less than 2 times 1 week
Involve and awaken the family
G
S Negrini 16
EDUCATION MEETINGSATURDAY 8thof APRIL 2006
Q Determine the action and the localization of auto-correction
QAuto-correction must be associated to ail exercises
QAt the end of treatment ergonomy lesson
Auto-correction didactics
G
SCOLIOSI DORSALE---- shy ----
r
S Negrini 17
EDUCATION MEETING SATURDAY8thof APRIL 2006
SCOLIOS OORSOLOMBARE
shy
SCOLIOSI OOIlSALE 011 bull LOMBARE S1I--shy
SCOLIOSI LOMBARE
il --~_-
S Negrini 18
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Scoliotic patients are not radiographs
middotSeoliotie Mtients are not ndiographs but hum beings with a vertebral deviation-
Slagnara
Metha For the physieian Cobb angle is of utmost
importance For the patient it is body deformity t hat eounts most rib hump a protruding seapula or hip We are in a situation in whieh today dodors eure the radiographie deformity but what the patient really desires is to get rid of clinieal deformity and of ensuing psyehologieal distress
CIIQItIo shDuIdtucirc lM WIld tJw~~ I~~M~~~~ J9f~
S Negrini 19
- Poznan_workshop_Physiotherapy
- physio2
- physio3pdf
- physio4
- physio5
- physio6
- physio7
- physio8
- physio9
- physio10
-
EDUCATION MEETING SATURDAY8th of APRIL 2006
Frontal plan
Stagnara
Never mobilize a scoliotic curve without ensuring reduction maintenance over time otherwise a greater mobility favours scoliosis progression
Frontal plan
Ducongeacute~ research
On a group of adolescent idiopathie scolioses treated with
Meacuteziegraveres gymnastics
D After 1 year the mean angle of
curves increased from 18deg to 29deg
Frontal plan
Scoliosis without brace
D Greater spine
flexibility D-
Risk of progression
S Negrini 7
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Frontal plan
Mobilization is useful
D In preparation to
brace
D With brace
Sagittal plan
QSagittal plan disfunctions
Sagittal plan r middot _J o
Perdriolle scouos B CJ aDeformation of D
thoracic and thoraco-Iumbar curves evolves in extension
S Negrini 8
EDUCATION MEETING SATURDAY8th of APRIL 2006
Sagittal plan
Graf
The line of gravity centres in the vertebral bodies o s c oUOSt
projects itself firstly laterally and then fi
o
posteriorly lJ ~~ ~~ ~ ~~-_J-D ~nI~
Sagittal plan
Therapeutic a ims
D Maintain or
retrieve physiological curves on the sagittal plan
Horizontal plan
QHorizontal plan disfunctions
S Negnni 9
EDUCATION MEETINGSATURDAY 8th of APRIL 2006
Horizontal plan
Stagnara The forces applied ta the spi ne act in a autoshydeforming sense
Horizontal plan
Dimnet Rotation gt 200
ampII~ (
D The actions of concave and convex side
muscles become
agonistic
~ItJrOnrIIiItdllfUClltlluumlll~~tI ~1JIf1laJ
Horizontal plan
Minor scolioses never exceed these autoshy
deformation thresholds
S Negrini 10
EDUCATION MEETING SATURDAY8th of APRIL 2006
Disfunctions at a biological organic and psychological
lever
Oisfunclions at a biological organlc and psychologlcal lever
Cheng
Bane density in scoliotic teenagers is lower than in normal subjects
~~~~middotA~IIlUtIy ~7œl 1d l
Oisfunctions at a blologlcal organic and psychologicallevel
A significant reduction of vital capacity and V02max in teenagers with a medium severity scoliosis
S Negrini 11
li
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Disfunctions at a biological organic and psychologicallevel
Disorders in the development of body image that the teenager has of himherself
Disfunctions at a blologlca l organlc and psychologicallevel
Therapeutic aims
cJ Activate cardioshyrespiratory function
cJ Favour bone density increase
cJ Develop a positive image of the body
Disfunctions at il biological organi and psydlologicallevel
Stagnara
Sport
D The active side of
kinesitherapy
S Negrini 12
EDUCATION MEETING SATURDAY 8thof APRIL 2006
Disfunctions at a biological organic and psychological
level
Distunctions at a biologlcal organlc and psychologicallevel
Cheng
Bone density in scoliotic teenagers is lower than in normal subjects
~n~IIIvpWr~middotA~stWy s- XXJl M J
Disfunctions at a biological organic and psychologicallevel
A significant reduction of vital capacity and V02max in teenagers with a medium severity scoliosis
G
S Negrini 11
EDUCATIONMEETING SATURDAY 8th of APRIL 2006
Kinesitherapy on the scoliotic subject
q Postural control
q Axial stability
q Muscular trophism
q Balance
q Respiratory function
The limits of kinesitherapy
There is a threshold beyond which
rehabilitation alone is not enough
sssr
Kinesitherapy in scoliosis treatment with brace
Therapeutic aims
S Negrini 13
6
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Therapeutic aims Srace kinesitherapy
With brace
il Postural corrections and
vertebral stability are obtained by the brace
Therapeutic aims Srace kinesitherapy
In preparation to the brace
il Mobilize spine on ail plans
Therapeutic aims Srace kinesitherapy
With brace D
Maintain a normal spine elasticity
~ Maintain a good muscular toneshy
trophism
C Model the hump with kyphotizating
exercises
S Negrini 14
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Exercises and their methodologies can vary accord ing to learning and individual sensibility of the single rehabilitator that proposes the m provided that they stay within the
Iimits of fixed therapeutic objectives
li
Therapeutic modalities
(Exercises)
QAuto-correction
QRespiratory education
QErgonomie education
QMuscular strengthening
QDevelopment of balance reactions
WNeuromotor integration
ci Vertebral mobiJization
QSpecifie modalities in brace treatment
S Negrini 15
EDUCATION MEETING SATURDAY 8th of APRIL 2006
The protocol of kinesitherapic
treatment
G
QChoice and dosage of exercises
Variatiosn of the work program every 2 - 3 months
Q Execute e)(ercises on an individual base or in a small group
Q Frequency not less than 2 times 1 week
Involve and awaken the family
G
S Negrini 16
EDUCATION MEETINGSATURDAY 8thof APRIL 2006
Q Determine the action and the localization of auto-correction
QAuto-correction must be associated to ail exercises
QAt the end of treatment ergonomy lesson
Auto-correction didactics
G
SCOLIOSI DORSALE---- shy ----
r
S Negrini 17
EDUCATION MEETING SATURDAY8thof APRIL 2006
SCOLIOS OORSOLOMBARE
shy
SCOLIOSI OOIlSALE 011 bull LOMBARE S1I--shy
SCOLIOSI LOMBARE
il --~_-
S Negrini 18
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Scoliotic patients are not radiographs
middotSeoliotie Mtients are not ndiographs but hum beings with a vertebral deviation-
Slagnara
Metha For the physieian Cobb angle is of utmost
importance For the patient it is body deformity t hat eounts most rib hump a protruding seapula or hip We are in a situation in whieh today dodors eure the radiographie deformity but what the patient really desires is to get rid of clinieal deformity and of ensuing psyehologieal distress
CIIQItIo shDuIdtucirc lM WIld tJw~~ I~~M~~~~ J9f~
S Negrini 19
- Poznan_workshop_Physiotherapy
- physio2
- physio3pdf
- physio4
- physio5
- physio6
- physio7
- physio8
- physio9
- physio10
-
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Frontal plan
Mobilization is useful
D In preparation to
brace
D With brace
Sagittal plan
QSagittal plan disfunctions
Sagittal plan r middot _J o
Perdriolle scouos B CJ aDeformation of D
thoracic and thoraco-Iumbar curves evolves in extension
S Negrini 8
EDUCATION MEETING SATURDAY8th of APRIL 2006
Sagittal plan
Graf
The line of gravity centres in the vertebral bodies o s c oUOSt
projects itself firstly laterally and then fi
o
posteriorly lJ ~~ ~~ ~ ~~-_J-D ~nI~
Sagittal plan
Therapeutic a ims
D Maintain or
retrieve physiological curves on the sagittal plan
Horizontal plan
QHorizontal plan disfunctions
S Negnni 9
EDUCATION MEETINGSATURDAY 8th of APRIL 2006
Horizontal plan
Stagnara The forces applied ta the spi ne act in a autoshydeforming sense
Horizontal plan
Dimnet Rotation gt 200
ampII~ (
D The actions of concave and convex side
muscles become
agonistic
~ItJrOnrIIiItdllfUClltlluumlll~~tI ~1JIf1laJ
Horizontal plan
Minor scolioses never exceed these autoshy
deformation thresholds
S Negrini 10
EDUCATION MEETING SATURDAY8th of APRIL 2006
Disfunctions at a biological organic and psychological
lever
Oisfunclions at a biological organlc and psychologlcal lever
Cheng
Bane density in scoliotic teenagers is lower than in normal subjects
~~~~middotA~IIlUtIy ~7œl 1d l
Oisfunctions at a blologlcal organic and psychologicallevel
A significant reduction of vital capacity and V02max in teenagers with a medium severity scoliosis
S Negrini 11
li
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Disfunctions at a biological organic and psychologicallevel
Disorders in the development of body image that the teenager has of himherself
Disfunctions at a blologlca l organlc and psychologicallevel
Therapeutic aims
cJ Activate cardioshyrespiratory function
cJ Favour bone density increase
cJ Develop a positive image of the body
Disfunctions at il biological organi and psydlologicallevel
Stagnara
Sport
D The active side of
kinesitherapy
S Negrini 12
EDUCATION MEETING SATURDAY 8thof APRIL 2006
Disfunctions at a biological organic and psychological
level
Distunctions at a biologlcal organlc and psychologicallevel
Cheng
Bone density in scoliotic teenagers is lower than in normal subjects
~n~IIIvpWr~middotA~stWy s- XXJl M J
Disfunctions at a biological organic and psychologicallevel
A significant reduction of vital capacity and V02max in teenagers with a medium severity scoliosis
G
S Negrini 11
EDUCATIONMEETING SATURDAY 8th of APRIL 2006
Kinesitherapy on the scoliotic subject
q Postural control
q Axial stability
q Muscular trophism
q Balance
q Respiratory function
The limits of kinesitherapy
There is a threshold beyond which
rehabilitation alone is not enough
sssr
Kinesitherapy in scoliosis treatment with brace
Therapeutic aims
S Negrini 13
6
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Therapeutic aims Srace kinesitherapy
With brace
il Postural corrections and
vertebral stability are obtained by the brace
Therapeutic aims Srace kinesitherapy
In preparation to the brace
il Mobilize spine on ail plans
Therapeutic aims Srace kinesitherapy
With brace D
Maintain a normal spine elasticity
~ Maintain a good muscular toneshy
trophism
C Model the hump with kyphotizating
exercises
S Negrini 14
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Exercises and their methodologies can vary accord ing to learning and individual sensibility of the single rehabilitator that proposes the m provided that they stay within the
Iimits of fixed therapeutic objectives
li
Therapeutic modalities
(Exercises)
QAuto-correction
QRespiratory education
QErgonomie education
QMuscular strengthening
QDevelopment of balance reactions
WNeuromotor integration
ci Vertebral mobiJization
QSpecifie modalities in brace treatment
S Negrini 15
EDUCATION MEETING SATURDAY 8th of APRIL 2006
The protocol of kinesitherapic
treatment
G
QChoice and dosage of exercises
Variatiosn of the work program every 2 - 3 months
Q Execute e)(ercises on an individual base or in a small group
Q Frequency not less than 2 times 1 week
Involve and awaken the family
G
S Negrini 16
EDUCATION MEETINGSATURDAY 8thof APRIL 2006
Q Determine the action and the localization of auto-correction
QAuto-correction must be associated to ail exercises
QAt the end of treatment ergonomy lesson
Auto-correction didactics
G
SCOLIOSI DORSALE---- shy ----
r
S Negrini 17
EDUCATION MEETING SATURDAY8thof APRIL 2006
SCOLIOS OORSOLOMBARE
shy
SCOLIOSI OOIlSALE 011 bull LOMBARE S1I--shy
SCOLIOSI LOMBARE
il --~_-
S Negrini 18
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Scoliotic patients are not radiographs
middotSeoliotie Mtients are not ndiographs but hum beings with a vertebral deviation-
Slagnara
Metha For the physieian Cobb angle is of utmost
importance For the patient it is body deformity t hat eounts most rib hump a protruding seapula or hip We are in a situation in whieh today dodors eure the radiographie deformity but what the patient really desires is to get rid of clinieal deformity and of ensuing psyehologieal distress
CIIQItIo shDuIdtucirc lM WIld tJw~~ I~~M~~~~ J9f~
S Negrini 19
- Poznan_workshop_Physiotherapy
- physio2
- physio3pdf
- physio4
- physio5
- physio6
- physio7
- physio8
- physio9
- physio10
-
EDUCATION MEETING SATURDAY8th of APRIL 2006
Sagittal plan
Graf
The line of gravity centres in the vertebral bodies o s c oUOSt
projects itself firstly laterally and then fi
o
posteriorly lJ ~~ ~~ ~ ~~-_J-D ~nI~
Sagittal plan
Therapeutic a ims
D Maintain or
retrieve physiological curves on the sagittal plan
Horizontal plan
QHorizontal plan disfunctions
S Negnni 9
EDUCATION MEETINGSATURDAY 8th of APRIL 2006
Horizontal plan
Stagnara The forces applied ta the spi ne act in a autoshydeforming sense
Horizontal plan
Dimnet Rotation gt 200
ampII~ (
D The actions of concave and convex side
muscles become
agonistic
~ItJrOnrIIiItdllfUClltlluumlll~~tI ~1JIf1laJ
Horizontal plan
Minor scolioses never exceed these autoshy
deformation thresholds
S Negrini 10
EDUCATION MEETING SATURDAY8th of APRIL 2006
Disfunctions at a biological organic and psychological
lever
Oisfunclions at a biological organlc and psychologlcal lever
Cheng
Bane density in scoliotic teenagers is lower than in normal subjects
~~~~middotA~IIlUtIy ~7œl 1d l
Oisfunctions at a blologlcal organic and psychologicallevel
A significant reduction of vital capacity and V02max in teenagers with a medium severity scoliosis
S Negrini 11
li
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Disfunctions at a biological organic and psychologicallevel
Disorders in the development of body image that the teenager has of himherself
Disfunctions at a blologlca l organlc and psychologicallevel
Therapeutic aims
cJ Activate cardioshyrespiratory function
cJ Favour bone density increase
cJ Develop a positive image of the body
Disfunctions at il biological organi and psydlologicallevel
Stagnara
Sport
D The active side of
kinesitherapy
S Negrini 12
EDUCATION MEETING SATURDAY 8thof APRIL 2006
Disfunctions at a biological organic and psychological
level
Distunctions at a biologlcal organlc and psychologicallevel
Cheng
Bone density in scoliotic teenagers is lower than in normal subjects
~n~IIIvpWr~middotA~stWy s- XXJl M J
Disfunctions at a biological organic and psychologicallevel
A significant reduction of vital capacity and V02max in teenagers with a medium severity scoliosis
G
S Negrini 11
EDUCATIONMEETING SATURDAY 8th of APRIL 2006
Kinesitherapy on the scoliotic subject
q Postural control
q Axial stability
q Muscular trophism
q Balance
q Respiratory function
The limits of kinesitherapy
There is a threshold beyond which
rehabilitation alone is not enough
sssr
Kinesitherapy in scoliosis treatment with brace
Therapeutic aims
S Negrini 13
6
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Therapeutic aims Srace kinesitherapy
With brace
il Postural corrections and
vertebral stability are obtained by the brace
Therapeutic aims Srace kinesitherapy
In preparation to the brace
il Mobilize spine on ail plans
Therapeutic aims Srace kinesitherapy
With brace D
Maintain a normal spine elasticity
~ Maintain a good muscular toneshy
trophism
C Model the hump with kyphotizating
exercises
S Negrini 14
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Exercises and their methodologies can vary accord ing to learning and individual sensibility of the single rehabilitator that proposes the m provided that they stay within the
Iimits of fixed therapeutic objectives
li
Therapeutic modalities
(Exercises)
QAuto-correction
QRespiratory education
QErgonomie education
QMuscular strengthening
QDevelopment of balance reactions
WNeuromotor integration
ci Vertebral mobiJization
QSpecifie modalities in brace treatment
S Negrini 15
EDUCATION MEETING SATURDAY 8th of APRIL 2006
The protocol of kinesitherapic
treatment
G
QChoice and dosage of exercises
Variatiosn of the work program every 2 - 3 months
Q Execute e)(ercises on an individual base or in a small group
Q Frequency not less than 2 times 1 week
Involve and awaken the family
G
S Negrini 16
EDUCATION MEETINGSATURDAY 8thof APRIL 2006
Q Determine the action and the localization of auto-correction
QAuto-correction must be associated to ail exercises
QAt the end of treatment ergonomy lesson
Auto-correction didactics
G
SCOLIOSI DORSALE---- shy ----
r
S Negrini 17
EDUCATION MEETING SATURDAY8thof APRIL 2006
SCOLIOS OORSOLOMBARE
shy
SCOLIOSI OOIlSALE 011 bull LOMBARE S1I--shy
SCOLIOSI LOMBARE
il --~_-
S Negrini 18
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Scoliotic patients are not radiographs
middotSeoliotie Mtients are not ndiographs but hum beings with a vertebral deviation-
Slagnara
Metha For the physieian Cobb angle is of utmost
importance For the patient it is body deformity t hat eounts most rib hump a protruding seapula or hip We are in a situation in whieh today dodors eure the radiographie deformity but what the patient really desires is to get rid of clinieal deformity and of ensuing psyehologieal distress
CIIQItIo shDuIdtucirc lM WIld tJw~~ I~~M~~~~ J9f~
S Negrini 19
- Poznan_workshop_Physiotherapy
- physio2
- physio3pdf
- physio4
- physio5
- physio6
- physio7
- physio8
- physio9
- physio10
-
EDUCATION MEETINGSATURDAY 8th of APRIL 2006
Horizontal plan
Stagnara The forces applied ta the spi ne act in a autoshydeforming sense
Horizontal plan
Dimnet Rotation gt 200
ampII~ (
D The actions of concave and convex side
muscles become
agonistic
~ItJrOnrIIiItdllfUClltlluumlll~~tI ~1JIf1laJ
Horizontal plan
Minor scolioses never exceed these autoshy
deformation thresholds
S Negrini 10
EDUCATION MEETING SATURDAY8th of APRIL 2006
Disfunctions at a biological organic and psychological
lever
Oisfunclions at a biological organlc and psychologlcal lever
Cheng
Bane density in scoliotic teenagers is lower than in normal subjects
~~~~middotA~IIlUtIy ~7œl 1d l
Oisfunctions at a blologlcal organic and psychologicallevel
A significant reduction of vital capacity and V02max in teenagers with a medium severity scoliosis
S Negrini 11
li
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Disfunctions at a biological organic and psychologicallevel
Disorders in the development of body image that the teenager has of himherself
Disfunctions at a blologlca l organlc and psychologicallevel
Therapeutic aims
cJ Activate cardioshyrespiratory function
cJ Favour bone density increase
cJ Develop a positive image of the body
Disfunctions at il biological organi and psydlologicallevel
Stagnara
Sport
D The active side of
kinesitherapy
S Negrini 12
EDUCATION MEETING SATURDAY 8thof APRIL 2006
Disfunctions at a biological organic and psychological
level
Distunctions at a biologlcal organlc and psychologicallevel
Cheng
Bone density in scoliotic teenagers is lower than in normal subjects
~n~IIIvpWr~middotA~stWy s- XXJl M J
Disfunctions at a biological organic and psychologicallevel
A significant reduction of vital capacity and V02max in teenagers with a medium severity scoliosis
G
S Negrini 11
EDUCATIONMEETING SATURDAY 8th of APRIL 2006
Kinesitherapy on the scoliotic subject
q Postural control
q Axial stability
q Muscular trophism
q Balance
q Respiratory function
The limits of kinesitherapy
There is a threshold beyond which
rehabilitation alone is not enough
sssr
Kinesitherapy in scoliosis treatment with brace
Therapeutic aims
S Negrini 13
6
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Therapeutic aims Srace kinesitherapy
With brace
il Postural corrections and
vertebral stability are obtained by the brace
Therapeutic aims Srace kinesitherapy
In preparation to the brace
il Mobilize spine on ail plans
Therapeutic aims Srace kinesitherapy
With brace D
Maintain a normal spine elasticity
~ Maintain a good muscular toneshy
trophism
C Model the hump with kyphotizating
exercises
S Negrini 14
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Exercises and their methodologies can vary accord ing to learning and individual sensibility of the single rehabilitator that proposes the m provided that they stay within the
Iimits of fixed therapeutic objectives
li
Therapeutic modalities
(Exercises)
QAuto-correction
QRespiratory education
QErgonomie education
QMuscular strengthening
QDevelopment of balance reactions
WNeuromotor integration
ci Vertebral mobiJization
QSpecifie modalities in brace treatment
S Negrini 15
EDUCATION MEETING SATURDAY 8th of APRIL 2006
The protocol of kinesitherapic
treatment
G
QChoice and dosage of exercises
Variatiosn of the work program every 2 - 3 months
Q Execute e)(ercises on an individual base or in a small group
Q Frequency not less than 2 times 1 week
Involve and awaken the family
G
S Negrini 16
EDUCATION MEETINGSATURDAY 8thof APRIL 2006
Q Determine the action and the localization of auto-correction
QAuto-correction must be associated to ail exercises
QAt the end of treatment ergonomy lesson
Auto-correction didactics
G
SCOLIOSI DORSALE---- shy ----
r
S Negrini 17
EDUCATION MEETING SATURDAY8thof APRIL 2006
SCOLIOS OORSOLOMBARE
shy
SCOLIOSI OOIlSALE 011 bull LOMBARE S1I--shy
SCOLIOSI LOMBARE
il --~_-
S Negrini 18
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Scoliotic patients are not radiographs
middotSeoliotie Mtients are not ndiographs but hum beings with a vertebral deviation-
Slagnara
Metha For the physieian Cobb angle is of utmost
importance For the patient it is body deformity t hat eounts most rib hump a protruding seapula or hip We are in a situation in whieh today dodors eure the radiographie deformity but what the patient really desires is to get rid of clinieal deformity and of ensuing psyehologieal distress
CIIQItIo shDuIdtucirc lM WIld tJw~~ I~~M~~~~ J9f~
S Negrini 19
- Poznan_workshop_Physiotherapy
- physio2
- physio3pdf
- physio4
- physio5
- physio6
- physio7
- physio8
- physio9
- physio10
-
EDUCATION MEETING SATURDAY8th of APRIL 2006
Disfunctions at a biological organic and psychological
lever
Oisfunclions at a biological organlc and psychologlcal lever
Cheng
Bane density in scoliotic teenagers is lower than in normal subjects
~~~~middotA~IIlUtIy ~7œl 1d l
Oisfunctions at a blologlcal organic and psychologicallevel
A significant reduction of vital capacity and V02max in teenagers with a medium severity scoliosis
S Negrini 11
li
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Disfunctions at a biological organic and psychologicallevel
Disorders in the development of body image that the teenager has of himherself
Disfunctions at a blologlca l organlc and psychologicallevel
Therapeutic aims
cJ Activate cardioshyrespiratory function
cJ Favour bone density increase
cJ Develop a positive image of the body
Disfunctions at il biological organi and psydlologicallevel
Stagnara
Sport
D The active side of
kinesitherapy
S Negrini 12
EDUCATION MEETING SATURDAY 8thof APRIL 2006
Disfunctions at a biological organic and psychological
level
Distunctions at a biologlcal organlc and psychologicallevel
Cheng
Bone density in scoliotic teenagers is lower than in normal subjects
~n~IIIvpWr~middotA~stWy s- XXJl M J
Disfunctions at a biological organic and psychologicallevel
A significant reduction of vital capacity and V02max in teenagers with a medium severity scoliosis
G
S Negrini 11
EDUCATIONMEETING SATURDAY 8th of APRIL 2006
Kinesitherapy on the scoliotic subject
q Postural control
q Axial stability
q Muscular trophism
q Balance
q Respiratory function
The limits of kinesitherapy
There is a threshold beyond which
rehabilitation alone is not enough
sssr
Kinesitherapy in scoliosis treatment with brace
Therapeutic aims
S Negrini 13
6
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Therapeutic aims Srace kinesitherapy
With brace
il Postural corrections and
vertebral stability are obtained by the brace
Therapeutic aims Srace kinesitherapy
In preparation to the brace
il Mobilize spine on ail plans
Therapeutic aims Srace kinesitherapy
With brace D
Maintain a normal spine elasticity
~ Maintain a good muscular toneshy
trophism
C Model the hump with kyphotizating
exercises
S Negrini 14
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Exercises and their methodologies can vary accord ing to learning and individual sensibility of the single rehabilitator that proposes the m provided that they stay within the
Iimits of fixed therapeutic objectives
li
Therapeutic modalities
(Exercises)
QAuto-correction
QRespiratory education
QErgonomie education
QMuscular strengthening
QDevelopment of balance reactions
WNeuromotor integration
ci Vertebral mobiJization
QSpecifie modalities in brace treatment
S Negrini 15
EDUCATION MEETING SATURDAY 8th of APRIL 2006
The protocol of kinesitherapic
treatment
G
QChoice and dosage of exercises
Variatiosn of the work program every 2 - 3 months
Q Execute e)(ercises on an individual base or in a small group
Q Frequency not less than 2 times 1 week
Involve and awaken the family
G
S Negrini 16
EDUCATION MEETINGSATURDAY 8thof APRIL 2006
Q Determine the action and the localization of auto-correction
QAuto-correction must be associated to ail exercises
QAt the end of treatment ergonomy lesson
Auto-correction didactics
G
SCOLIOSI DORSALE---- shy ----
r
S Negrini 17
EDUCATION MEETING SATURDAY8thof APRIL 2006
SCOLIOS OORSOLOMBARE
shy
SCOLIOSI OOIlSALE 011 bull LOMBARE S1I--shy
SCOLIOSI LOMBARE
il --~_-
S Negrini 18
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Scoliotic patients are not radiographs
middotSeoliotie Mtients are not ndiographs but hum beings with a vertebral deviation-
Slagnara
Metha For the physieian Cobb angle is of utmost
importance For the patient it is body deformity t hat eounts most rib hump a protruding seapula or hip We are in a situation in whieh today dodors eure the radiographie deformity but what the patient really desires is to get rid of clinieal deformity and of ensuing psyehologieal distress
CIIQItIo shDuIdtucirc lM WIld tJw~~ I~~M~~~~ J9f~
S Negrini 19
- Poznan_workshop_Physiotherapy
- physio2
- physio3pdf
- physio4
- physio5
- physio6
- physio7
- physio8
- physio9
- physio10
-
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Disfunctions at a biological organic and psychologicallevel
Disorders in the development of body image that the teenager has of himherself
Disfunctions at a blologlca l organlc and psychologicallevel
Therapeutic aims
cJ Activate cardioshyrespiratory function
cJ Favour bone density increase
cJ Develop a positive image of the body
Disfunctions at il biological organi and psydlologicallevel
Stagnara
Sport
D The active side of
kinesitherapy
S Negrini 12
EDUCATION MEETING SATURDAY 8thof APRIL 2006
Disfunctions at a biological organic and psychological
level
Distunctions at a biologlcal organlc and psychologicallevel
Cheng
Bone density in scoliotic teenagers is lower than in normal subjects
~n~IIIvpWr~middotA~stWy s- XXJl M J
Disfunctions at a biological organic and psychologicallevel
A significant reduction of vital capacity and V02max in teenagers with a medium severity scoliosis
G
S Negrini 11
EDUCATIONMEETING SATURDAY 8th of APRIL 2006
Kinesitherapy on the scoliotic subject
q Postural control
q Axial stability
q Muscular trophism
q Balance
q Respiratory function
The limits of kinesitherapy
There is a threshold beyond which
rehabilitation alone is not enough
sssr
Kinesitherapy in scoliosis treatment with brace
Therapeutic aims
S Negrini 13
6
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Therapeutic aims Srace kinesitherapy
With brace
il Postural corrections and
vertebral stability are obtained by the brace
Therapeutic aims Srace kinesitherapy
In preparation to the brace
il Mobilize spine on ail plans
Therapeutic aims Srace kinesitherapy
With brace D
Maintain a normal spine elasticity
~ Maintain a good muscular toneshy
trophism
C Model the hump with kyphotizating
exercises
S Negrini 14
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Exercises and their methodologies can vary accord ing to learning and individual sensibility of the single rehabilitator that proposes the m provided that they stay within the
Iimits of fixed therapeutic objectives
li
Therapeutic modalities
(Exercises)
QAuto-correction
QRespiratory education
QErgonomie education
QMuscular strengthening
QDevelopment of balance reactions
WNeuromotor integration
ci Vertebral mobiJization
QSpecifie modalities in brace treatment
S Negrini 15
EDUCATION MEETING SATURDAY 8th of APRIL 2006
The protocol of kinesitherapic
treatment
G
QChoice and dosage of exercises
Variatiosn of the work program every 2 - 3 months
Q Execute e)(ercises on an individual base or in a small group
Q Frequency not less than 2 times 1 week
Involve and awaken the family
G
S Negrini 16
EDUCATION MEETINGSATURDAY 8thof APRIL 2006
Q Determine the action and the localization of auto-correction
QAuto-correction must be associated to ail exercises
QAt the end of treatment ergonomy lesson
Auto-correction didactics
G
SCOLIOSI DORSALE---- shy ----
r
S Negrini 17
EDUCATION MEETING SATURDAY8thof APRIL 2006
SCOLIOS OORSOLOMBARE
shy
SCOLIOSI OOIlSALE 011 bull LOMBARE S1I--shy
SCOLIOSI LOMBARE
il --~_-
S Negrini 18
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Scoliotic patients are not radiographs
middotSeoliotie Mtients are not ndiographs but hum beings with a vertebral deviation-
Slagnara
Metha For the physieian Cobb angle is of utmost
importance For the patient it is body deformity t hat eounts most rib hump a protruding seapula or hip We are in a situation in whieh today dodors eure the radiographie deformity but what the patient really desires is to get rid of clinieal deformity and of ensuing psyehologieal distress
CIIQItIo shDuIdtucirc lM WIld tJw~~ I~~M~~~~ J9f~
S Negrini 19
- Poznan_workshop_Physiotherapy
- physio2
- physio3pdf
- physio4
- physio5
- physio6
- physio7
- physio8
- physio9
- physio10
-
EDUCATION MEETING SATURDAY 8thof APRIL 2006
Disfunctions at a biological organic and psychological
level
Distunctions at a biologlcal organlc and psychologicallevel
Cheng
Bone density in scoliotic teenagers is lower than in normal subjects
~n~IIIvpWr~middotA~stWy s- XXJl M J
Disfunctions at a biological organic and psychologicallevel
A significant reduction of vital capacity and V02max in teenagers with a medium severity scoliosis
G
S Negrini 11
EDUCATIONMEETING SATURDAY 8th of APRIL 2006
Kinesitherapy on the scoliotic subject
q Postural control
q Axial stability
q Muscular trophism
q Balance
q Respiratory function
The limits of kinesitherapy
There is a threshold beyond which
rehabilitation alone is not enough
sssr
Kinesitherapy in scoliosis treatment with brace
Therapeutic aims
S Negrini 13
6
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Therapeutic aims Srace kinesitherapy
With brace
il Postural corrections and
vertebral stability are obtained by the brace
Therapeutic aims Srace kinesitherapy
In preparation to the brace
il Mobilize spine on ail plans
Therapeutic aims Srace kinesitherapy
With brace D
Maintain a normal spine elasticity
~ Maintain a good muscular toneshy
trophism
C Model the hump with kyphotizating
exercises
S Negrini 14
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Exercises and their methodologies can vary accord ing to learning and individual sensibility of the single rehabilitator that proposes the m provided that they stay within the
Iimits of fixed therapeutic objectives
li
Therapeutic modalities
(Exercises)
QAuto-correction
QRespiratory education
QErgonomie education
QMuscular strengthening
QDevelopment of balance reactions
WNeuromotor integration
ci Vertebral mobiJization
QSpecifie modalities in brace treatment
S Negrini 15
EDUCATION MEETING SATURDAY 8th of APRIL 2006
The protocol of kinesitherapic
treatment
G
QChoice and dosage of exercises
Variatiosn of the work program every 2 - 3 months
Q Execute e)(ercises on an individual base or in a small group
Q Frequency not less than 2 times 1 week
Involve and awaken the family
G
S Negrini 16
EDUCATION MEETINGSATURDAY 8thof APRIL 2006
Q Determine the action and the localization of auto-correction
QAuto-correction must be associated to ail exercises
QAt the end of treatment ergonomy lesson
Auto-correction didactics
G
SCOLIOSI DORSALE---- shy ----
r
S Negrini 17
EDUCATION MEETING SATURDAY8thof APRIL 2006
SCOLIOS OORSOLOMBARE
shy
SCOLIOSI OOIlSALE 011 bull LOMBARE S1I--shy
SCOLIOSI LOMBARE
il --~_-
S Negrini 18
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Scoliotic patients are not radiographs
middotSeoliotie Mtients are not ndiographs but hum beings with a vertebral deviation-
Slagnara
Metha For the physieian Cobb angle is of utmost
importance For the patient it is body deformity t hat eounts most rib hump a protruding seapula or hip We are in a situation in whieh today dodors eure the radiographie deformity but what the patient really desires is to get rid of clinieal deformity and of ensuing psyehologieal distress
CIIQItIo shDuIdtucirc lM WIld tJw~~ I~~M~~~~ J9f~
S Negrini 19
- Poznan_workshop_Physiotherapy
- physio2
- physio3pdf
- physio4
- physio5
- physio6
- physio7
- physio8
- physio9
- physio10
-
EDUCATIONMEETING SATURDAY 8th of APRIL 2006
Kinesitherapy on the scoliotic subject
q Postural control
q Axial stability
q Muscular trophism
q Balance
q Respiratory function
The limits of kinesitherapy
There is a threshold beyond which
rehabilitation alone is not enough
sssr
Kinesitherapy in scoliosis treatment with brace
Therapeutic aims
S Negrini 13
6
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Therapeutic aims Srace kinesitherapy
With brace
il Postural corrections and
vertebral stability are obtained by the brace
Therapeutic aims Srace kinesitherapy
In preparation to the brace
il Mobilize spine on ail plans
Therapeutic aims Srace kinesitherapy
With brace D
Maintain a normal spine elasticity
~ Maintain a good muscular toneshy
trophism
C Model the hump with kyphotizating
exercises
S Negrini 14
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Exercises and their methodologies can vary accord ing to learning and individual sensibility of the single rehabilitator that proposes the m provided that they stay within the
Iimits of fixed therapeutic objectives
li
Therapeutic modalities
(Exercises)
QAuto-correction
QRespiratory education
QErgonomie education
QMuscular strengthening
QDevelopment of balance reactions
WNeuromotor integration
ci Vertebral mobiJization
QSpecifie modalities in brace treatment
S Negrini 15
EDUCATION MEETING SATURDAY 8th of APRIL 2006
The protocol of kinesitherapic
treatment
G
QChoice and dosage of exercises
Variatiosn of the work program every 2 - 3 months
Q Execute e)(ercises on an individual base or in a small group
Q Frequency not less than 2 times 1 week
Involve and awaken the family
G
S Negrini 16
EDUCATION MEETINGSATURDAY 8thof APRIL 2006
Q Determine the action and the localization of auto-correction
QAuto-correction must be associated to ail exercises
QAt the end of treatment ergonomy lesson
Auto-correction didactics
G
SCOLIOSI DORSALE---- shy ----
r
S Negrini 17
EDUCATION MEETING SATURDAY8thof APRIL 2006
SCOLIOS OORSOLOMBARE
shy
SCOLIOSI OOIlSALE 011 bull LOMBARE S1I--shy
SCOLIOSI LOMBARE
il --~_-
S Negrini 18
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Scoliotic patients are not radiographs
middotSeoliotie Mtients are not ndiographs but hum beings with a vertebral deviation-
Slagnara
Metha For the physieian Cobb angle is of utmost
importance For the patient it is body deformity t hat eounts most rib hump a protruding seapula or hip We are in a situation in whieh today dodors eure the radiographie deformity but what the patient really desires is to get rid of clinieal deformity and of ensuing psyehologieal distress
CIIQItIo shDuIdtucirc lM WIld tJw~~ I~~M~~~~ J9f~
S Negrini 19
- Poznan_workshop_Physiotherapy
- physio2
- physio3pdf
- physio4
- physio5
- physio6
- physio7
- physio8
- physio9
- physio10
-
6
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Therapeutic aims Srace kinesitherapy
With brace
il Postural corrections and
vertebral stability are obtained by the brace
Therapeutic aims Srace kinesitherapy
In preparation to the brace
il Mobilize spine on ail plans
Therapeutic aims Srace kinesitherapy
With brace D
Maintain a normal spine elasticity
~ Maintain a good muscular toneshy
trophism
C Model the hump with kyphotizating
exercises
S Negrini 14
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Exercises and their methodologies can vary accord ing to learning and individual sensibility of the single rehabilitator that proposes the m provided that they stay within the
Iimits of fixed therapeutic objectives
li
Therapeutic modalities
(Exercises)
QAuto-correction
QRespiratory education
QErgonomie education
QMuscular strengthening
QDevelopment of balance reactions
WNeuromotor integration
ci Vertebral mobiJization
QSpecifie modalities in brace treatment
S Negrini 15
EDUCATION MEETING SATURDAY 8th of APRIL 2006
The protocol of kinesitherapic
treatment
G
QChoice and dosage of exercises
Variatiosn of the work program every 2 - 3 months
Q Execute e)(ercises on an individual base or in a small group
Q Frequency not less than 2 times 1 week
Involve and awaken the family
G
S Negrini 16
EDUCATION MEETINGSATURDAY 8thof APRIL 2006
Q Determine the action and the localization of auto-correction
QAuto-correction must be associated to ail exercises
QAt the end of treatment ergonomy lesson
Auto-correction didactics
G
SCOLIOSI DORSALE---- shy ----
r
S Negrini 17
EDUCATION MEETING SATURDAY8thof APRIL 2006
SCOLIOS OORSOLOMBARE
shy
SCOLIOSI OOIlSALE 011 bull LOMBARE S1I--shy
SCOLIOSI LOMBARE
il --~_-
S Negrini 18
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Scoliotic patients are not radiographs
middotSeoliotie Mtients are not ndiographs but hum beings with a vertebral deviation-
Slagnara
Metha For the physieian Cobb angle is of utmost
importance For the patient it is body deformity t hat eounts most rib hump a protruding seapula or hip We are in a situation in whieh today dodors eure the radiographie deformity but what the patient really desires is to get rid of clinieal deformity and of ensuing psyehologieal distress
CIIQItIo shDuIdtucirc lM WIld tJw~~ I~~M~~~~ J9f~
S Negrini 19
- Poznan_workshop_Physiotherapy
- physio2
- physio3pdf
- physio4
- physio5
- physio6
- physio7
- physio8
- physio9
- physio10
-
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Exercises and their methodologies can vary accord ing to learning and individual sensibility of the single rehabilitator that proposes the m provided that they stay within the
Iimits of fixed therapeutic objectives
li
Therapeutic modalities
(Exercises)
QAuto-correction
QRespiratory education
QErgonomie education
QMuscular strengthening
QDevelopment of balance reactions
WNeuromotor integration
ci Vertebral mobiJization
QSpecifie modalities in brace treatment
S Negrini 15
EDUCATION MEETING SATURDAY 8th of APRIL 2006
The protocol of kinesitherapic
treatment
G
QChoice and dosage of exercises
Variatiosn of the work program every 2 - 3 months
Q Execute e)(ercises on an individual base or in a small group
Q Frequency not less than 2 times 1 week
Involve and awaken the family
G
S Negrini 16
EDUCATION MEETINGSATURDAY 8thof APRIL 2006
Q Determine the action and the localization of auto-correction
QAuto-correction must be associated to ail exercises
QAt the end of treatment ergonomy lesson
Auto-correction didactics
G
SCOLIOSI DORSALE---- shy ----
r
S Negrini 17
EDUCATION MEETING SATURDAY8thof APRIL 2006
SCOLIOS OORSOLOMBARE
shy
SCOLIOSI OOIlSALE 011 bull LOMBARE S1I--shy
SCOLIOSI LOMBARE
il --~_-
S Negrini 18
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Scoliotic patients are not radiographs
middotSeoliotie Mtients are not ndiographs but hum beings with a vertebral deviation-
Slagnara
Metha For the physieian Cobb angle is of utmost
importance For the patient it is body deformity t hat eounts most rib hump a protruding seapula or hip We are in a situation in whieh today dodors eure the radiographie deformity but what the patient really desires is to get rid of clinieal deformity and of ensuing psyehologieal distress
CIIQItIo shDuIdtucirc lM WIld tJw~~ I~~M~~~~ J9f~
S Negrini 19
- Poznan_workshop_Physiotherapy
- physio2
- physio3pdf
- physio4
- physio5
- physio6
- physio7
- physio8
- physio9
- physio10
-
EDUCATION MEETING SATURDAY 8th of APRIL 2006
The protocol of kinesitherapic
treatment
G
QChoice and dosage of exercises
Variatiosn of the work program every 2 - 3 months
Q Execute e)(ercises on an individual base or in a small group
Q Frequency not less than 2 times 1 week
Involve and awaken the family
G
S Negrini 16
EDUCATION MEETINGSATURDAY 8thof APRIL 2006
Q Determine the action and the localization of auto-correction
QAuto-correction must be associated to ail exercises
QAt the end of treatment ergonomy lesson
Auto-correction didactics
G
SCOLIOSI DORSALE---- shy ----
r
S Negrini 17
EDUCATION MEETING SATURDAY8thof APRIL 2006
SCOLIOS OORSOLOMBARE
shy
SCOLIOSI OOIlSALE 011 bull LOMBARE S1I--shy
SCOLIOSI LOMBARE
il --~_-
S Negrini 18
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Scoliotic patients are not radiographs
middotSeoliotie Mtients are not ndiographs but hum beings with a vertebral deviation-
Slagnara
Metha For the physieian Cobb angle is of utmost
importance For the patient it is body deformity t hat eounts most rib hump a protruding seapula or hip We are in a situation in whieh today dodors eure the radiographie deformity but what the patient really desires is to get rid of clinieal deformity and of ensuing psyehologieal distress
CIIQItIo shDuIdtucirc lM WIld tJw~~ I~~M~~~~ J9f~
S Negrini 19
- Poznan_workshop_Physiotherapy
- physio2
- physio3pdf
- physio4
- physio5
- physio6
- physio7
- physio8
- physio9
- physio10
-
EDUCATION MEETINGSATURDAY 8thof APRIL 2006
Q Determine the action and the localization of auto-correction
QAuto-correction must be associated to ail exercises
QAt the end of treatment ergonomy lesson
Auto-correction didactics
G
SCOLIOSI DORSALE---- shy ----
r
S Negrini 17
EDUCATION MEETING SATURDAY8thof APRIL 2006
SCOLIOS OORSOLOMBARE
shy
SCOLIOSI OOIlSALE 011 bull LOMBARE S1I--shy
SCOLIOSI LOMBARE
il --~_-
S Negrini 18
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Scoliotic patients are not radiographs
middotSeoliotie Mtients are not ndiographs but hum beings with a vertebral deviation-
Slagnara
Metha For the physieian Cobb angle is of utmost
importance For the patient it is body deformity t hat eounts most rib hump a protruding seapula or hip We are in a situation in whieh today dodors eure the radiographie deformity but what the patient really desires is to get rid of clinieal deformity and of ensuing psyehologieal distress
CIIQItIo shDuIdtucirc lM WIld tJw~~ I~~M~~~~ J9f~
S Negrini 19
- Poznan_workshop_Physiotherapy
- physio2
- physio3pdf
- physio4
- physio5
- physio6
- physio7
- physio8
- physio9
- physio10
-
EDUCATION MEETING SATURDAY8thof APRIL 2006
SCOLIOS OORSOLOMBARE
shy
SCOLIOSI OOIlSALE 011 bull LOMBARE S1I--shy
SCOLIOSI LOMBARE
il --~_-
S Negrini 18
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Scoliotic patients are not radiographs
middotSeoliotie Mtients are not ndiographs but hum beings with a vertebral deviation-
Slagnara
Metha For the physieian Cobb angle is of utmost
importance For the patient it is body deformity t hat eounts most rib hump a protruding seapula or hip We are in a situation in whieh today dodors eure the radiographie deformity but what the patient really desires is to get rid of clinieal deformity and of ensuing psyehologieal distress
CIIQItIo shDuIdtucirc lM WIld tJw~~ I~~M~~~~ J9f~
S Negrini 19
- Poznan_workshop_Physiotherapy
- physio2
- physio3pdf
- physio4
- physio5
- physio6
- physio7
- physio8
- physio9
- physio10
-
EDUCATION MEETING SATURDAY 8th of APRIL 2006
Scoliotic patients are not radiographs
middotSeoliotie Mtients are not ndiographs but hum beings with a vertebral deviation-
Slagnara
Metha For the physieian Cobb angle is of utmost
importance For the patient it is body deformity t hat eounts most rib hump a protruding seapula or hip We are in a situation in whieh today dodors eure the radiographie deformity but what the patient really desires is to get rid of clinieal deformity and of ensuing psyehologieal distress
CIIQItIo shDuIdtucirc lM WIld tJw~~ I~~M~~~~ J9f~
S Negrini 19
- Poznan_workshop_Physiotherapy
- physio2
- physio3pdf
- physio4
- physio5
- physio6
- physio7
- physio8
- physio9
- physio10
-