F.I.T.S. Method. Functional Individual Therapy of Scoliosis. Marianna Białek PT, MSc., PhD. (POLAND) Andrzej M hango PT, MSc.,D.O.

Transcription

1 F.I.T.S. Method Functional Individual Therapy of Scoliosis Marianna Białek PT, MSc., PhD. (POLAND) Andrzej M hango PT, MSc.,D.O. (POLAND)

2 FITS method was created in 2004 for diagnosis and therapy of structural and not structural scoliosis and it is being developed.

3 FITS method may be used as: separate system of scoliosis correction, supportive therapy to bracing, preparation for surgery, shoulder and pelvic girdle correction after surgical interventions.

4 FITS is a complex asymmetrical and individual therapy that can be used at any age with any Cobb angle. The authors propose an individually adjusted programme of exercises depending on: a curvature angle, a result of clinical examination of a patient, a therapeutic goal. It requires the child to take an active part in the process of therapy guided by an experienced therapist.

5 Main stages of FITS method: FITS method consist of three stages: Stage I Patient examination: Examination of the child with scoliosis using classical assessment but also in terms of FITS method.

6 Main stages of FITS method: Stage II - Preparing for correction: Examination, detection and elimination of myofascial restrictions which limits three-plane corrective movement by using different techniques of myofascial relaxation such as: trigger points, passive and active relaxation, post-isometric relaxation, joint mobilization.

7 Main stages of FITS method: Stage III - 3-D correction Building and fixation of new corrective patterns in functional positions.

8 STAGE I Patient examination

9 Stage I We need to examine the following: X-ray analysis, Distance from plumb line to: anal cleft, the apex of the curve, the edge of the scapula, Position of both scapulas using Bunell scoliometer and ruler, Measuring the angle of trunk rotation (Bunell scoliometer),

10 Stage I Observing the type and location of compensation (structural or functional), Assessing the settings of the lower limbs in standing position and gait, Assessing the length of muscles in lower limbs, pelvic girdle, shoulder girdle and trunk.

11 Stage I Passive corrective movement Examining the flexibility of the scoliotic spine in functional positions is very important part of this stage. We can feel which myofascial structures limit correction movement and try to relax them.

12 Stage I We explain to the child what scoliois she/he has. Making the child a partner not a subject of therapy, increases significantly motivation to exercice and improves the effects of therapy at the same time.

13 STAGE II Preparing for correction

14 We release myofascial structures which limit a three-plane corrective movement. W terapii wykorzystujemy taśmy mięśniowo-powięziowe wg Myersa. SBL and DFL odpowiada za ustawienie kręgosłupa w płaszczyźnie strzałkowej. LL w płaszczyźnie czołowej SL w płaszczyźnie poprzecznej Anatomy Trains (D. Juhan, L. Chaitow)

15 Stage II SBL Active relaxation of plantar fascia, hamstring and sacrotuberale ligaments Anatomy Trains (D. Juhan, L. Chaitow)

16 Stage II Active relaxation of muscle erector spinalis in functional position. Decrease of SBL tension - active forward bending. before FITS session after one FITS session

17 Stage II We work locally in flattened sections of the thoracic spine in order to increase thoracic kyphosis.

18 Stage II Decrease of tension in deep front line (DFL).

19 Stage II Decrease of myofascial tension in lateral line (LL) between the thoraco-lumbar scoliosis apex and the iliac crest which limits the spine shift towards the correction movement.

20 Stage II Decrease of tension in anterior part of the spiral line (SL). The anterior superior iliac spine (ASIS) is the place where many competing vectors meet. 1. Internal oblique 2. IO+Transversus abdominis 3. IO+ inquinal ligament 4. Sartorius 5. Iliacus 6. Rectus femoris 7. Tensor fasciae latae

21 STAGE III 3-D correction

22 Stage III We teach correct foot loading in order to improve the pelvic position and produce symmetrical loading of the lower limbs while keeping scoliosis in correction. We think that feet loading is very important for stability of other parts of the body.

23 Stage III It is important to stabilize the lower trunk, first in horizontal position, then in vertical position. It is not specific for idiopathic scoliosis, but we put stress on it, because lower trunk stability is necessary for effective exercises for the upper segments of the trunk.

24 Stage III We teach the active correction shift of the spine in the Frontal plane in order to correct the main curve, while Stabilizing (or maintaining in correction) the secondary curve. q before therapy after therapy Trunk shift in functional positions.

25 Stage III We teach the 3-D corrective breathing in functional positions starting from lower to higher position.

26 Stage III Individually adjusted corrective exercises relevant to the aims which we want to achieve, connected with the corrective breathing, shifting and elongation. They are done in open and closed kinematic chains.

27 Corrective tension At the end of our therapy we teach corrective tension it s the tension that comes from the inside of human body Self control in everyday life is also important, for example at work, at school or at the computer.

28 Physical Therapy Course Since 2004 we organize a Physical Therapy Course for physiotherapists and physicians. In 2005 it received Polish Society of Physiotherapy accreditation. So far almost 596 trainees have completed our course.

29 Group XXV r.

30 The way of FITS treatment 1. Outpatient rehabilitation. 2. Inpatient rehabilitation (2 week camps). To April 2014 about 1036 children participated in our camps.

31 Inpatient rehabilitation (2 week camps) During the camps we conduct research of various nature, for example: spirometric in brace, EMG in functional positions. Orthopedic physician adjusts the brace at the end of the camp.

32 Scoliosis 2011 Nov 28;6(1):25. Białek M. Conservative treatment of idiopathic scoliosis according to FITS concept: presentation of the method and preliminary, short term radiological and clinical results based on SOSORT and SRS criteria.

33 Group analyzed I analyzed 115 children out of 374 who received treatment according to FITS method between Patient characteristics 10 years old or older, Cobb angle from 10 to 40, Risser sign from 0 to 2, Average observation period 2,08 years.

34 The children were analyzed in two groups separately GROUP A 68 girls and 10 boys, Cobb angle between 10-25, FITS therapy without bracing, Risser between 0 2. They had been divided into two subgroups: A1 single scoliosis 52 children: A2 double scoliosis 26 children:

35 GROUP B 34 girls and 3 boys, Cobb angle between 26-40, FITS therapy combined with bracing, Risser between 0 2. They were classified into two subgroups: B1 single scoliosis 5 children: B2 double scoliosis 32 children:

36 Results in group A (FITS without the brace) Cobb angle between Subgroup A1 (single scoliosis) Subgroup A2 (double scoliosis)

37 Results in group B (FITS combined with bracing) Cobb angle between Subgroup B1 Subgroup B2 (single scoliosis) (double scoliosis)

38 The results of FITS therapy for EOIS I will show you in my Friday morning presentation.

39 Aleksandra 12 years old FITS + Cheneau brace 20h/24h Rtg date Th 1 -Th 8 sin 25 o 18 o 15 Th 8 L 3 dex 15 o 11 o 11 Risser Th kyphosis 58 o 43 o 36 L lordosis 95 o 79 o

40 Aleksandra 12 years old FITS + Cheneau brace 20h/24h

41

42 Agata 6 years old and follow-up 6 years (FITS+brace)

43 Exceptional case - Anna 12 years old Her parents didn t agree to surgery FITS + Cheneau brace 20h/24h Rtg date Th6-Th12 dex Th12 L4 sin 60 o 70 o 64 o 55 o 57 o 46 o 51 o 51 o 51 o 48 o Risser

44 Anna 15 years old An example of exercises in correction patterns.

45 Anna 15 years old (back view) Before therapy (2008) After therapy (2012)

46 Anna 15 years old Clinical frontal and side view of the patient with scoliosis 55.

47 Comparison between the X-ray and clinical body after therapy (examples) Natalia aged 15 Th/L sin 32

48 Kamila aged 16 Th dex 39, Th/L sin 22

49 Barbara aged 14 Th dex 46, Th/L sin 30

50 Joanna aged 16, Th dex 41, Th/L sin 39

51 Agata aged 16, Th dex 33, Th/L sin 35.

52 Aleksandra aged 16, Th dex 42, Th/L sin 42

53 Karolina aged 14 C/Th sin 50, Th dex 40, Th/L sin 14

54 Thank you for your attention