Sportomed Fizik Tedavi ve Rehabilitasyon Merkezleri

Sportomed Spine Care Unit

When we observe a healthy spine from the posterior ,we will see that all the vertebrae are aligned straight down the middle. On the lateral side ;we see an inward concave curving in sevical and lumbar regions and convex outward curving on the dorsal part of the spine. These are funtional curves of the (thorasic) spine.

The deviation of these curves from normal limits causes some problems in the spine.The thoracal spine has an anatomical angle, ranging from 20’-45’, when the roundness of the spine increases and passes 45’, it is called kyphosis( round back,hunchback) or ‘’hyperkhiphosis’’. It often accompanies a lomber lordosis (inward curving).

Another deformity in which the spine has a sideways and rotational deviations is the condition called Scoliosis.

WHAT IS SCOLIOSIS?

Scoliosis is a 3 dimensional, over 10’ curved deformity of the spine. That means ;curving of the vertebrae right or left and rotation on its axes.

The curving of the spine on the thoracic and lumbar regions may ocur solely or accompany kyphosis (increased roundness of the thoracic spine) ; called kyphoscoliosis.

WHAT CAUSES SCOLIOSIS?

Scoliosis is a 3 dimensional curved deformity of the spine over 10 degrees .That means,curving of the vertebrae right or left and rotation on its axes.

The curving of the spine on the thoracic and lumbar regions may ocur solely or accompany kyphosis (increased roundness of the thoracic spine) called kyphoscoliosis.

Congenital Scoliosis

It can be congenital,which is due to a defect in the spine (the vertebrae may be incomplete or fail to divide properly) or fused ribs.

Poliomyelitis,
Cerebral palsy,
Muscular dystrophy,
Infections,
Tumors may be some of the causes.

Idiopathic Scoliosis

Idiopathic (cause unknown) scoliosis; shows up from an unknown reason of the spine that had previously no deformity.It can be seen at any period of the growing age.Infantile (0-3 years), juvenile (3-10 years),Adolescant (11 years to skeleton maturity).The progression of the disorder depends on age and degree of the curve.

What are the Symptoms and Signs of Scoliosis and How Can Patients Be Aware of this Disorder?

In the early stage of the disorder,there are rarely signs or symptoms.
Back pain isn’t necessary;if in case there is pain,it must be examined by a physician.
Any sideways curve of the spine must be examined.
Ribcage and scapula protrusions must be examined on both sides of the body to evaluate if there is an elevation.
Symmetricity of shoulder and hips must be observed.
Asymmetry in curvatures,trunk imbalances,clothes hanging unevenly or body tilting to one side must be noticed
Dyspnea (>70-80 degrees) can be an important sign.

Tests 

During physical examination,as the patient leans forward,sideways curvature becomes more significant.
X-Ray screening in different positions and scoliometer (device used to measure the degree of the curvature) help confirm the diagnosis.

Treatment 

Treatment modalities depend on the degree of the curvature and stage of the skeletal maturity.
Alternative treatment modalities are;Inspection,Intensive Scoliosis rehabilitation (Katharina Schroth technique;specific exercise and inspirium techniques designed for scoliosis), Bracing or surgery.It is crucial to develop treatment plan before the scoliosis curve progresses and compilcatios develop.

SCHROTH-3 DIMENSIONAL SCOLIOSIS EXERCISE TREATMENT 

The basic principles of SCHROTH 3-DIMENSIONAL SCOLIOSIS EXERCİSES,which is currently the most validable treatment method comprises:
Rotational inspirium,
Correction exercises and correction of stabilisation,
Agreeable mobilisation ,massage,stretching,
Symmetric awareness,
Focused daily activities.
The similarity of Pilates exercises,increases the importance of modified pilates in scoliosis treatment.
The individually prescribed and monitored Schroth 3-Dimensional Scoliosis Treatment exercises that are performed within our Sportomed-Suadiye Clinic.

 

CORRECTION EXERCISES AND STABILISATION OF THE CORRECTION

It is aimed to position,stabilise and strenghten all the body 3-dimensionally by correcting the asymmetric posture,using convenient (ribs) levers. 

ROTATIONAL ASYMMETRIC INSPIRIUM

While healthy people can stabilize the spine and rib-cage with symmetric inspirium,in scoliosis patients this increases the rotational deformity of the spine.
In scoliosis patients,the spine is corrected by a special technique using rotational and asymmetric inspirium.
Using rotational inspiration,the restricted rib-cage is mobilised and the lesser parts of the lungs are activated.

MOBILISATION,MASSAGE,STRETCH

Mobilisations on a correct positioned spine helps improve rotational correction and symmetric posture.
Masage and stretching to the related muscle groups not only support the symmetric posture but also improves the success of the exercise program.

SYMMETRIC AWARENESS AND ADAPTATION TO DAILY LIFE ACTIVITIES

The spine that is forced to correction with exercises,is akin to performing asymmetric and the most comfortable posture in daily life.That’s why the scoliosis patients must always correct their postures in every instance and adapt this during routine daily life.The patients must be instructed on correcting postures while sitting,walking,sleeping and emphasize on conscious correction must be motivated. 

 

WHAT IS KYPHOSIS?

A normal spine from the posterior looks straight down the middle.On the other lateral side,we see some functional curves.In the cervical region there is inward,in the thoracic region out-ward and in the lumbar region inward curving.The deviation of these curves from their physiologic angle is called kyphosis or lordosis.

The thoracal spine from the lateral side has an anatomical angle of 20-40 degrees outwards.When this angle passes 45 degrees, it is named as ‘hyperkyphosis’ (round back,hunchback).As the degree of the curvature increases,other health problems may ocur.The rounding of shoulders forward,the pitching of the head forward,depression of the ribcage may cause cervical,dorsal pain,inspiration problems and disc problems in time.

Diagnostic Methods

The patient is evaluated initially with physical examination.
3 dimensional posture analysis is done (antero-posterior and lateral sides)
Starting from feet,knees,hips,low back,back,shoulders and head positioning are evaluated.
A forward bending test reveals the thoracal spine from lateral.
X-Ray imaging determines the degree of the angle and whether it is structural or postural.
When necessary,MR,Neurological tests and Inspirium Function tests can be applied.

Kyphosis Types

Kyphosis can be structural or postural

Structural Kyphosis:

Enhancement of the kyphotic angle in the thoracic spine over 55 degrees,which normally must be 40 degrees while standing.It is usually attributed to bone or soft tissue pathologies.Congenital spine anomalies,bone disorders (osteoporosis),spine tumors or fractures may be some of the causes.

Congenital Kyphosis;

Scheuermann’s Disease (Kyphosis)

Is one of structural causes of kyphosis.It is a juvenile (adolescant) disorder of the growing vertebra with the cause unknown.It affects boys more than girls.The disease can cause decreased intervertabral disc space and vertebral wedging,resulting in an excessive curve,involving three consecutive vertebrae.The neck and may present in an abnormal forward position.Sometimes Scoliosis accompanies the disease.Pain is common complaint at the beginning.

What are the Treatment Modalities?

The goals are;
Relieving pain
Correcting or preventing the progression of kyphosis
Increasing inspirium capacity.

 

EXERCİSE

No matter what the degree of kyphosis is,exercise programs must be started as soon as possible.Schroth exercises is the most agreeable method in spine disorders.Besides this,posture,inspirium exercises and Clinic Pilates must be a part of their treatment.

BRACING

In mild to moderate kyphosis (50-75 degrees),bracing is recommended.A suitable brace must be prescribed in a young person to stop or reverse the curvature angle and support the posture during the growing years.The goal for bracing is also to prevent the disorder from the need of surgery.The effectiveness of baracing is enhanced by the growing of the child,using regularly (20-22 hours a day) and additive exercises like swimming,Pilates,Schroth.

 

SURGERY

Although there are different opinions on surgery,it may be considered for patients with severe deformities,such as a curvature of more than 70 degrees for thoracic kyphosis.

After surgery,the patients can start activities like swimming and walking.After a year the patient resumes his/her daily activities.

 

POSTURAL KYPHOSIS

It is acquired from distorted posture,mostly seen in adults.It progresses slowly.In today’s conditions multi factors like long-term Office work or sedentary life,pes planus (flattened foot sole),weakness of the thoracal,lumbar,abdominal muscles,obesity,osteoporosis may be the cause.It’s frequency in children is also raising currently.Abstaining from games that arouse body awareness,lack of sports,school conditions,long duration of spending time with computer or television,: are important factors in manifestation of postural kyphosis.

CAN POSTURAL KYPHOSIS BE PREVENTED?
The best methods to manage postural kyphosis in children are; correcting the sitting position,fixing the table and chair,positioning the monitor and keyboard in an ergonomic height and angle.Orienting the children to proper sports (swimming,gymnastics,balet,yoga etc.), will not only aid them increase their physical condition,but possess a healthy spine.Parents are under great responsibilty in this situation.
In adults,ergonomy in offices and age-appropriate sports are also important in prevention of kyphosis.

TREATMENT MODALİTIES
For pain relief,physical therapy is beneficial and posture analysis must be done.Besides this:
Muscle testing,
Shortness testing,
Balance,
Inspirium evaluation etc. must be done.
Therapeutic Exercises;
In the early period,posture exercises must be initiated.
The goals of these exercises are;
Strenghtening abdominal and thoracal muscles,
Stretching exercises,
Inspirium exercises,
Giving functional exercises are and orienting the patient to age-appropriate sports.

 

SCHROTH-3 DIMENSIONAL SCOLIOSIS EXERCISE TREATMENT
Bracing in Scoliosis Care