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09/05/2014 1
Education
Course A
Exercises
SOSORT - Wiesbaden
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References:"New method of treating deviations of the spine""Gymnastics applied to treatment of some constitutional diseases."
Institut Orthopédique et Pneumatique Bellevue Lyon ‐ 1835
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Balance exercises
Adjustment of asymmetric paravertebral tension
Auto elongation
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Gymnastics from the early 1900's involved stretching, exercises and the use of traction from machines that had names like "trunk bending apparatus" and "shoulder pushing apparatus". The apparatus equipment of the early 20th century was similar to modern traction equipment.
SOSORT - Wiesbaden
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• Stopping evolutivity of scoliosis ?– No
Group with physiotherapy
Decreasing evolutivity
1,5° / year
Group without physiotherapy
Evolutivity
>10°/yearInsufficient to modify natural history
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• Pain– But no pain due to scoliosis < 70°
• (Weinstein 2003)
• Pulmonary Function– But no limitation due to scoliosis < 70°
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• Psychological disturbance
• Well being
Physiotherapy or psychotherapy ?
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• Out Patient physiotherapy– 1‐2 / week + daily 30 min
• Scoliosis Intensive Rehabilitation (SIR) program– 3‐4 weeks 4‐6 hours/day
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• For this reason we can discuss physiotherapy for scoliosis at risk of brace under 25°…
This confusion exists because under 25°, scoliosis evolves in a chaoticway…And the spine should be considered as a tensegrity system
> 25° Vicious Circle
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1 Method
Lyon Method
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Principles1. No complex material. All the exercices have to be repeated at home. 2. No sportive counter indication. The sport practiced by the child must be continued :
By adapting if necessary the sportive gesture ( avoid the deep quick inspiration, and the flexion of the trunk forward)By completing if necessary the sportive activity thanks to physiotherapy.
3. The exercises are symmetric in the frontal plane.4. No chapel and miracle exercice. Choosing the best technical way for every child, at every age,
and every therapeutic sequence.5. No revolution, therefore but an evolution in the exercises which are repeated few minutes a
day at home.6. We treat a child and not a scoliosis or an X‐ray.
SOSORT - Wiesbaden
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• Stopping evolutivity of scoliosis ?– No
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Group with physiotherapy
Decreasing evolutivity
1,5° / year
Group without physiotherapy
Evolutivity
>3°/yearInsufficient to modify natural history
SOSORT - Wiesbaden
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1 Method
Lyon Method
2 Phases
ChaoticScoliosis < 20°
Linear Scoliosis> 20°
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• Scoliosis occurs in approximately 2,5 % of the adolescent population (> 10°), occurring equally among both genders
• But only 0,25 % are progressing to a curve magnitude that requires treatment, females are eight times more likely to.
SCOLIOSIS
LinearChaotic
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• A Chaotic Scoliosis is a real 3D structural scoliosis (dynamic deterministic system) with:– Highly sensitivity to initial conditions (butterfly effect)
– Topological mixing of the curves– Strange attractor…
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The system is : 0pen (standing position, exchange with the outside)
Nonpredictive (butterfly effect)
Complex (multifactorial)
Discontinuous (steps) Deterministic (not by luck)
Patternable (4th fractal dimension) Strange attractor
Change of physiological behaviour at puberty timeSOSORT - Wiesbaden
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Physiotherapy can’t avoid the scoliotic earthquake but realize an antisismic building.
SOSORT - Wiesbaden
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09/05/2014 212010 – Kiwirail – New ZealandSOSORT - Wiesbaden
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1 Method
Lyon Method
2 Phases
Chaotic Scoliosis< 20°
Linear Scoliosis > 20°
3 Stages Before bracing
In plaster cast
In Lyon Brace
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1 Method
Lyon Method
2 Phases ChaoticScoliosis < 20°
LinearScoliosis > 20°
3 Stages Before bracing
In plaster cast
In Lyon Brace
4 Major Positions Lying Rolling Sitting Standing
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1 Method
Lyon Method
2 PhasesChaotic
Scoliosis < 20°
LinearScoliosis >
20°
3 Stages Before bracing In plaster cast In Lyon Brace
4 Major Positions
Lying Rolling Sitting Standing
5 StepsLumbar
lordotisation & thoracic
kyphotisation
Lateral corrective bending Derotation
Maintaining correct posture
during unbalanced situations
Strengthening in correct posture
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Molécule de Mélatonine
Removal of the pineal gland in chickens produced scoliosis similar in many respects to human pathology, but the level of melatonin in the blood of scoliosis is normal.
There is a malfunction in the melatonin signaling at the level of musculoskeletal tissues in a series of patients with AIS (Moreau et al. 2004). This defect was confirmed in a larger number of patients and by using new technology (cellular dielectric spectroscopy).
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Failure of postural controlVestibular dysfunction and imbalance
Failure of proprioception
Platelet abnormalitiesIncreased levels of calmodulin
osteopenia
Reduction of muscle spindles
Abnormalities of muscle fibersAbnormal muscle tone
Growth hormone secretion
Mel
i
GTP
AC
MT1-2 ATP AMPcGDP
Malfunction of cellular signaling of melatonin Based on Jean Dubousset
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awareness of postural defectswith camcorderDeveloping perception of the spine with the video feed back
SOSORT - Wiesbaden
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1st positionSupineKyphotisationwith cushion
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Lateral bendingDerotationConcavity stretching
SOSORT - Wiesbaden
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2nd positionFoetal positionwith cushion
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Analytic mobilisation ‐pressure on the convex transverse apophysis
SOSORT - Wiesbaden
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1 ‐ Adjustment of the lumbar lordosis in sitting position
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2 ‐ Positioning of the upper limbs
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Lumbar side shift
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Proprioceptive exercise on swiss ballIn lumbar lordosis andThoracic kyphosis
SOSORT - Wiesbaden
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Derotation exercise on swiss ballIn thoracic kyphosis
SOSORT - Wiesbaden
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Corrective bending exercise on swiss ball
SOSORT - Wiesbaden
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Lumbar mobilisationon swiss ball
SOSORT - Wiesbaden
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Balance of the shoulder girdle
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Balance exercises on the tilt tray
SOSORT - Wiesbaden
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Thoracic mobilization Lumbar mobilization Shoulder balance
Concave stretch, Posture SOSORT - Wiesbaden
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Axial Active Auto‐elongation, integration during the movementSOSORT - Wiesbaden
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Klapp quadrupedic positionStretching left upper limb, right lower limbFast stretch is better than low stretchPreparation for the dissociation of scapular and pelvic girdle
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Pelvic mobilisationSlow reversal Hold Relax
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On a side horizontal position
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In constrained inspiration
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Vestibular stimulationWith thoracic kyphotisation
Development of balance reactionsCoordination and Agility
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The Romans many centuries ago discovered that their slaves who were employed in rowing, if always kept on the same side of the ship, developed lateral curvature of the spine. To prevent this they frequently changed from one side of the boat to the other.
From The Home Physician and Guide to Health, Mountain View. Pacific Press. Pub. Assoc. 1931
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The practice of sport is encouragedSOSORT - Wiesbaden
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Before lateralization(< 7 years)
Before Puberty growth(7‐11 years –girls)
During Puberty growth(11‐15 years)
During Bone Mass acquisition(15‐20 years)
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Higher activities of bipedalism and
walkingBalance exercises
Adjustment of asymmetric
paravertebral tension
Step,Grand porterAxial impact
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Best conservative orthopedic treatment results with children who practice regular sporting activity.
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Sportpas de sport
0
10
20
30
40
Initial Plâtre Corset Ablation
Sport pas de sport
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Asymmetric SportsSki, skating
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Sarah Michelle Gellar John Galliano
Buffy has a thoraco-lumbar scoliosis and John Galliano must adapt fashionto braces.
The daughter of Prince Andrews and Sarah Ferguson was also operated for scoliosis…
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Thank you for attention
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