Education Course A Exercises

Transcription

1 Education Course A Exercises 1

2 Institut Orthopédique et Pneumatique Bellevue Lyon 1835 References: "New method of treating deviations of the spine" "Gymnastics applied to treatment of some constitutional diseases." 2

3 Balance exercises Auto elongation Adjustment of asymmetric 09/05/2014paravertebral tension SOSORT - Wiesbaden 3

4 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. 4

5 Stopping evolutivity of scoliosis? No Group with physiotherapy Group without physiotherapy Decreasing evolutivity Evolutivity Insufficient to modify natural history 1,5 / year >10 /year 5

6 Pain But no pain due to scoliosis < 70 (Weinstein 2003) Pulmonary Function But no limitation due to scoliosis < 70 6

7 Psychological disturbance Well being Physiotherapy or psychotherapy? 7

8 Out Patient physiotherapy 1 2 / week + daily 30 min Scoliosis Intensive Rehabilitation (SIR) program 3 4 weeks 4 6 hours/day 8

9 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 chaotic way And the spine should be considered as a tensegrity system > 25 Vicious Circle 9

10 1 Method Lyon Method Principles 1. 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. 10

11 Stopping evolutivity of scoliosis? No Group with physiotherapy Group without physiotherapy Decreasing evolutivity Evolutivity Insufficient to modify natural history 1,5 / year >3 /year 11

12 1 Method 2 Phases Lyon Method Chaotic Scoliosis < 20 Linear Scoliosis > 20 12

13 Scoliosis occurs in approximately 2,5 % of the adolescent population (> 10 ), occurring equally among both genders But only 0,25 % are progressing SCOLIOSIS to a curve magnitude that requires treatment, females are eight times more likely to. Linear Chaotic 13

14 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 14

15 The system is : 0pen (standing position, exchange with the outside) Nonpredictive (butterfly effect) Complex (multifactorial) Discontinuous (steps) Deterministic (not by luck) Patternable (4 th fractal dimension) Strange attractor Change of physiological behaviour at puberty time 15

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20 Physiotherapy can t avoid the scoliotic earthquake but realize an antisismic building. 20

21 Kiwirail New Zealand

22 1 Method Lyon Method 2 Phases Chaotic Scoliosis < 20 Linear Scoliosis > 20 3 Stages Before bracing In plaster cast In Lyon Brace 22

23 1 Method Lyon Method 2 Phases Chaotic Scoliosis < 20 Linear Scoliosis > 20 3 Stages Before bracing In plaster cast In Lyon Brace 4 Major Positions Lying Rolling Sitting Standing 23

24 1 Method 2 Phases Lyon Method Chaotic Scoliosis < 20 Linear Scoliosis > 20 3 Stages Before bracing In plaster cast In Lyon Brace 4 Major Positions Lying Rolling Sitting Standing 5 Steps Lumbar lordotisation & thoracic kyphotisation Lateral corrective bending Derotation Maintaining correct posture during unbalanced situations Strengthening in correct posture 24

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26 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). 26

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28 Failure of postural control Vestibular dysfunction and imbalance Mel i MT1-2 GTP GDP ATP AC AMPc Growth hormone secretion Failure of proprioception Reduction of muscle spindles Abnormalities of muscle fibers Abnormal muscle tone osteopenia Malfunction of cellular signaling of melatonin Platelet abnormalities Increased levels of calmodulin Based on Jean Dubousset 28

29 awareness of postural defects with camcorder Developing perception of the spine with the video feed back 29

30 1 st position Supine Kyphotisation with cushion 30

31 Lateral bending Derotation Concavity stretching 31

32 2 nd position Foetal position with cushion 32

33 Analytic mobilisation pressure on the convex transverse apophysis 33

34 1 Adjustment of the lumbar lordosis in sitting position 34

35 2 Positioning of the upper limbs 35

36 Lumbar side shift 36

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38 Proprioceptive exercise on swiss ball In lumbar lordosis and Thoracic kyphosis 38

39 Derotation exercise on swiss ball In thoracic kyphosis 39

40 Corrective bending exercise on swiss ball 40

41 Lumbar mobilisation on swiss ball 41

42 Balance of the shoulder girdle 42

43 Balance exercises on the tilt tray 43

44 Thoracic mobilization Lumbar mobilization Shoulder balance Concave stretch, Posture 44

45 Axial Active Auto elongation, integration during the movement 45

46 Klapp quadrupedic position Stretching left upper limb, right lower limb Fast stretch is better than low stretch Preparation for the dissociation of scapular and pelvic girdle 46

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48 Pelvic mobilisation Slow reversal Hold Relax 48

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51 On a side horizontal position 51

52 In constrained inspiration 52

53 Vestibular stimulation With thoracic kyphotisation Development of balance reactions Coordination and Agility 53

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59 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

60 The practice of sport is encouraged 60

61 Before lateralization (< 7 years) Before Puberty growth (7 11 years girls) During Puberty growth (11 15 years) During Bone Mass acquisition (15 20 years) Higher activities of bipedalism and walking Balance exercises Adjustment of asymmetric paravertebral tension Step, Grand porter Axial impact 61

62 Best conservative orthopedic treatment results with children who practice regular sporting activity Initial Plâtre Corset Ablation pas de sport Sport Sport pas de sport 62

63 Asymmetric Sports Ski, skating 63

64 Sarah Michelle Gellar Buffy has a thoraco-lumbar scoliosis and John Galliano must adapt fashion to braces. The daughter of Prince Andrews and Sarah Ferguson was also operated for scoliosis John Galliano 64

65 Thank you for attention 09/05/ SOSORT - Wiesbaden