The Side Shift Exercise School Presentation 2014 T.Betts

Transcription

1 The Side Shift Exercise School Presentation 2014 T.Betts

2 Royal National Orthopaedic Hospital

3 Background The Side Shift approach to correction of scoliosis curves has been used by therapist at the RNOHT for over 35 years. The side shift approach has been used by the treating spinal therapist and Ms Min Mehta, whom also used the approach to help treat infantile scoliosis. (Case reports) The approach of using excessive side trunk movements to correct the lateral shift of the trunk in the coronal plane is based on the theory that a flexible curve can be stabilised with lateral movements. These lateral movements which promote a reduction in the postural forces which affect a structural curve. While correcting the curve position through truncal shifts, the body is using muscular forces and connective tissue stretches/ mobility to re-align the soft tissue components of a scoliosis. It is felt that frequent repetition of corrective movements helps to also promote somosensory integration of the spinal position to a more upright and physiological posture; Growth Modulation Shift direction directed by Curve direction (not just postural presentation)

4 Clinical Examination

5 Side Shift Overcorrection Alignment Ideal Postural Faulty Postural Alignment

6 Side Shift correction, assisted.

7 what is the most important curve? (Cobb angle) is elongation necessary/possible? (arrows plumbline sagittal slumped posture) Is shift/translation necessary/possible? (overhanging trunk frontal plumbline) is derotation necessary/possible? (rib humps, breathing/twisting) is lordosing/kyphosing necessary/possible? (sagittal plane alignment what is the easiest movt to perform/remember? (only do corrective movts at home that are accurately/easily reproduced in clinic exercises at home

8 Presentation Referred by Consultant Orthopaedic surgeon (Mr Molloy) Left sided AIS 12 year old female Right sided Back Pain Abnormal take off at Lumbo-sacral Junction Risser 0 ( but period in last year) Growth spurt (3 inches in one year) Normal leg lengths Convex to left 26 degrees MRI no pars, no neuraxial abnormality

9 Presentation ATR 7 degrees Side Shift Type 3 -Flexible (mirror image correction) Postural mild Lordo-scoliosis VAS 5/10 (Right LBP) Hypermobility 6/9

10 Radiological examination

11 Presentation

12 Presentation- side view

13 Presentation: Over-correction Side Shift

14 Treatment Plan Active form of auto-correction Taught to shift the trunk sideways in the direction opposite to the convexity of the primary curve Patient has to be old enough to understand instructions and perform exercise independently

15 Treatment One hour initial session ½-one- hour follow ups 2 weekly- monthly Assisted Side-Shift exercises ( over correction- Midline) Standing-sitting-kneeling think Shift during transitional movements-sit to stand, walking, stair climbing. Balance and Core Drills in think Shift position advice on sitting pads, wedges (left side) School positions and carrying bags

16 Exercises

17 Scoliosis exercises for children with left lumbar curve Up and tall Shift,(trans late upwards) to the right Hold prominent Right pelvis towards/ in the centre Further instructions and advice (core stability/breathing/balance)

18 Exercises in Sitting Scoliosis exercises for children with left lumbar curve Up and tall Shift,(trans late upwards) to the right Hold prominent Right pelvis towards/ in the centre Further instructions and advice (core stability/breathing/balance)

19 Core and Balance drills- Think Shift - isometric Holding

20 Orthotic

21 Orthotic Symmetrical Brace Single pad Left convex below Apex of Lumbar curve 3 point (pelvic Pad) Pad EVA complex X3 Braces in one year

22 Outcome to date Stable to date ( to ) LBP 1/10 (NRS) Mild Coronal imbalance Additional treatment recommendations Review the rotational tendency (torsional profile ) of the Kinetic chain feet to spine. Use Postural Apps Biofeedback (EMG) Pelvic tilt control Apps