ASPECTS OF HYDROSTATIC PRESSURE EFFECTS WITH SPECIFIC THERAPEUTICAL IMPLICATION FOR HYDROKINETOTHERAPY

ASPECTS OF HYDROSTATIC PRESSURE EFFECTS WITH SPECIFIC THERAPEUTICAL IMPLICATION FOR HYDROKINETOTHERAPY Tiberiu Tătaru 1, Lect. univ.dr. Camelia Plăstoi 2, Prof. univ. dr. Monica Bîcă 3, Lect. univ. dr. Georgian Badea-Miss 4 1 PNF. T Vladimirescu Hospital, Runcu, Gorj 2,3,4 Constantin Brâncuşi University of Târgu-Jiu, Faculty of Physical Education, Letters and Kinetotherapy Str. Calea Bucuresti, nr.75b, Targu-Jiu,Gorj Romania tatarutiberiu@gmail.com, cami_plastoi@yahoo.com, monicab@utgjiu.ro, geobadeammx@yahoo.com Abstract Medical science, due to the effects of the discoveries occurred much faster by combining medicinal treatment with recovery in aquatic environment, relates patient s treatment with the benefits received by the aquatic recovery program due to the hydrostatic pressure exerted by the water on the entire body. Hydrostatic pressure has positive effects on various disabilities, whether temporary or permanent, both in recovery after several injuries and also in maintenance (permanent impairments). The present paper will refer to changes of the spine, specifically the Scheuermann disease. Due to the different symptoms of this disease, spine changes are different to those of the typical form of the disease, so we considered necessary to design different exercise programs, both in the gym and pool. Atypical form of the Scheuermann disease is manifested mostly at the lumbar level, being characterized by the absence of Kyphosis, the appearance of Scmorl nodules with effects over mobility, shape and dynamics of thoracic-lumbar junctions and lumbar spine. Keywords: Scheuermann Disease, atypical form, hydrostatic pressure. 1 Introduction We begin with questions related to the patient s swimming history, questions that allow the determination of his preparing level (novice, beginner, advanced, etc) and training; Whereas most subjects manifest a tendency to overrate their swimming qualities, all the answers will be checked in the pool, aiming: 1. how the subject enters the pool first, in the pool with a depth of 6 cm and then that one with a depth of 2 m; 2. the buoyancy of the subject based on body composition and constitutional type; 3. the subject's ability to advance through the water of various depths; 4. the position of comfort and total relaxation; 5. the answer to various motive tasks; 6. confidence in his own capacities; 7. the subject's ability to go out alone of the pool; 8. knowledge of basic safety concepts in the pool. In this stage is also developed the cardiovascular conditioning in order to implement programs with more complex activities, with the athletic component. Increasing specific effort parameters (volume, intensity, duration and complexity of the effort) has been achieved, (as in gymnastics on dry land), progressively during the trainings (recovery meetings). In addition, the work carried out in the water has been taken into account more than cardiovascular component, which in this case is required, too. I applied and modeled in our hydrokinetotherapy programs all these three levels of cardiovascular workout, using as a monitoring tool the thresholds offered by the Karvonen formula. There were applied two types of exercises: - a program of exercises for the atypical form of the disease, practicable in the gym; - a program of exercises for the atypical form of the disease, practicable in the pool; ISBN: 978-1-6184-19-6 1

2 Methods: medical history, clinical examination, Anova test, SPSS for statistical indicators. The evaluated indicators: Schober lumbar index, Tomayer index, pain index and the Klapp index. The observed indexes were selected to capture the functionality and mobility of the tested spine part, the presence and intensity of the pain. 3 Subjects: The research on atypical shape was achieved on two groups of subjects, smaller this time, justified by a lower incidence of this form of the disease, and the patients partial availability to practice exercises in the aquatic environment (most have given arguments of financial problems, time, location, etc.. ). Thus was achieved: - a group of 13 subjects with an atypical form of the disease that had just performed the exercises in the gym, - a group of 7 subjects, which have performed in parallel with the gym program a new exercises in the pool, exercises designed by us. Were evaluated: Schober lumbar index, Tomayer index, the pain index and Klapp index. SCHOBER LUMBAR INDEX indicators G.w.HK G.w/out.HK Arithmetic average T T 3.57 4.31 Reliability level - = Median 4. 4. Null hypothesis H m 1 - m 2 = Standard deviation.53.75 Alternative hypothesis H1 m 1 - m 2 # Maximum value 4. 5. Critical F (table values) 4.41 Minimum value 3. 3. Freedom degrees between groups - df 1 1 Amplitude 1. 2. Freedom degrees between groups - df 2 18 Coefficient of variation 15.% 17.4% Subjects number 2 Difference of averages.74 F P Effect size (Cohen).54 calculated 5.23 <.5 RESULTS Table no.1 - Statistic index and the ANOVA test of the Schober lumbar index at the two groups (with or without hydrokinetotherapy) Results interpretation: The measurements for the Schoeber lumbar index were done on the subjects of the two groups to the final tests. The arithmetic results obtained were from 3.57 cm to 4,31 respectively. We note that the average of the group without hidrokinetotherapy is higher with.74 cm. The group with hydrokinetotherapy is relatively homogeneous, and the group without it is also relatively homogeneous. Cohen's index of effect size shows that the differences between the two averages are bigger, actually. verification performed with ANOVA test shows a statistically significant difference between the averages, P <.5, the graphical representation confirming these statements. c m 5. 4.5 4. 3.5 3. 3.57 G wit HYDROKINETOTHERA. h PY SCHOBER LOMBAR INDE X.67 G. Graph no. 1 - The comparative graphical representation of the arithmetic values of the lumbar Schoeber index between the two groups (with and without hydrokinetotherapy). The comparative graphical representation of the arithmetic values of the Schoeber lumbar index indicates a superiority value of.67 in favor of the group which practiced hydrokinetotherapy. This is justified, as I said, through the influence of water on: soft tissues, muscles, abdominal pressure with intervertebral articular decompression effect, antispasmodic effects, antiinflammatory myorelaxants, less action of antigravity force with a deforming and algesic effect at lumbar level (and not only). The results of these two tests highlight an improvement of results on final testing against the initial testing. TOMAYER INDEX 4.31 withou HYDROKINETOTHERA t PY indicators G.w.HK G.w/out.HK Arithmetic average T 3.14 T 7.85 Reliability level - = Median 3. 6. Null hypothesis H m 1 - m 2 = Standard deviation 2.73 5.23 Alternative hypothesis H 1 m 1 - m 2 # Maximum value 8. 16. Critical F (table values) 4.41 Minimum value.. Freedom degrees between groups -df 1 1 Amplitude 8. 16. Freedom degrees between groups -df 2 18 Coefficient of variation 87.% 66.6% Subjects number 2 Difference of averages 4.7 F P Effect size (Cohen).52 calculated 4.86 <.5 RESULTS ISBN: 978-1-6184-19-6 11

Table no. 2 - Statistic index and the ANOVA test of the Tomayer index at the two groups (with or without hydrokinetotherapy) Results interpretation The measurements for the TOMAYER INDEX were done on the subjects of the two groups at the final tests. The arithmetical values obtained were 3,14 respectively 7,85 cm. We note that the average of the group without hydrokinetotherapy is 4,7 cm greater. The group with hydrokinetotherapy is non-homogenous and also the group without HKT is nonhomogenous. Cohen s index of the effect size indicates that the differences between the two averages are. check performed with ANOVA test shows a statistically significant difference between the averages, P <.5, statement supported by the next graph. 18 16 14 12 1 u n 8 i t 6 s 4 2 G. with HYDROKINETOTHERAPY TOMAYER INDEX 3.14 Graph no. 2 - The comparative graphic representation of the arithmetic values of the Tomayer index between the two groups (with and without hydrokinetotherapy). The Tomayer index presents significant improvements in relation to the development of arithmetic values of the final tests of the two groups, expressed numerically by 4,7. It is represented by mobility at level of lumbar spine obviously improved at the group that practiced hydrokinetotherapy, argumented as I pointed out earlier the beneficial properties of water, which recommends completing the recovery program in the gym with the new exercises proposed by us in the water. Values recorded at the final tests for Tomayer index confirm and demonstrate the two hypotheses of the research. 4.7 7.85 G. without HYDROKINETOTHERAPY PAIN INDEX indicators G.w.HK G.w/out.HK Arithmetic average T 14. T 11.23 Reliability level - = Median 14. 11. Null hypothesis H m1 - m2 = Standard deviation 1.15 1.54 Alternative hypothesis H 1 m1 - m2 # Maximum value 15. 14. Critical F (table values) 4.41 Minimum value 12. 9. Freedom degrees between groups -df 1 1 Amplitude 3. 5. Freedom degrees between groups - df 2 18 Coefficient of variation 8.2% 13.7% Subjects number 2 Difference of averages -2.77 F calculated P Effect size (Cohen).98 17.3 <.5 RESULTS Table no. 3 - Statistics indicators and the ANOVA test of pain index at the two groups (with and without hydrokinetotherapy) Interpreting results: The measurements for PAIN INDEX were done on the subjects of the two groups at the final tests. Arithmetic average obtained were of 14. respectively 11.23 per cm. We notice that the average of the group without hydrokinetotherapy is lower with 2.77 cm. The hydrokinetotherapy group is homogeneous and the group without hiydrokinetotherapy is relatively homogeneous. Cohen's index of effect size shows that the differences between the two averages are large to very large. The checking with the statistical hypothesis with the ANOVA test shows a statistically significant difference between the averages, P <.5. The null hypothesis is rejected and are accepted the hypothesis of the research (alternative). Visually, these statements are supported by the next graph. u n i t s 15 14 13 12 11 1 9 14. G. with HYDROKINETOTHERAPY PAIN INDEX - 2.77 G. without HYDROKINETOTHERAPY Graph no. 3 - The comparative graphic of the arithmetic average values for the pain index between the two groups (with and without hydrokinetotherapy). 11.23 ISBN: 978-1-6184-19-6 12

The final tests record a significant increase for both groups of subjects, 2.77 units greater in favor of those who practiced hydrokinetotherapy. I've previously argued this aspect (by the beneficial effects of the water due to its properties) and have an important correspondent over the clinical aspect of the subjects, mobility and functionality of the spine segment studied (i.e. lumbar), ability of those subjects to engage in daily activities, specific to the age and social status. KLAPP INDEX indicators G.w.HK G.w/out.HK Arithmetic average T T 2.71 2.15 Reliability level - = Median 3. 2. Null hypothesis H m 1 - m 2 = Standard deviation.49.69 Alternative hypothesis H 1 m 1 - m 2 # Maximum value 3. 3. Critical F (table values) 4.41 Minimum value 2. 1. Freedom degrees between groups - df 1 1 Amplitude 1. 2. Freedom degrees between groups - df 2 18 Coefficient of variation 18.% 32.% Subjects number 2 Difference of averages -.56 F calculated P RESULTS Effect size (Cohen).45 3.61 >.5 Table no. 4 - Statistic indicators and the ANOVA test of Klapp index at the two groups (with or without kinetotherapy). Interpreting results: The measurements for the Klapp index were done on the subjects of the both groups at final testing. The arithmetic values obtained were 2.71 respectively, 2.15. We notice that the average of the group without hydrokinetotherapy is lower with,56cm. The group with HKT is relatively homogenous and the group without HKT is nonhomogenous. COHEN index of effect size proves that the differences between the two averages are. The Anova test shows a little and statistically insignifiant difference between the averages, P >.5. c m 3. 2. 5 2. 1. 5 1. KLAPP INDEX 2.7 1 G. with HYDROKINETOTHERAPY -.56 2.1 5 G. without HYDROKINETOTHERAPY Graphic no. 4 - The comparative graphical representation of arithmetic values of the Klapp index between the two groups (with and without hydrokinetotherapy). Graphical representation of arithmetic values of the Klapp index has prompted a change in the purpose of improving it, only.56, which, from the point of view of social security is considered to have little significance. From a practical and clinical point of view, however, the significance is important, having arguments both on the small area (which characterizes this indicator) and on the major importance of any benefit, however small, recorded in the mobility and functionality of these subjects. The interpretation of the results for the atypical form THE GROUP WITH HYDROKINETOTHERAPY Measured indexes SCHOBER thoracic index TOMAYER index Pain index KLAPP index Test Average Dif. F-I Ab. Std. Table no. 5 - The statistical and mathematical indicators calculated for the evaluated index (GROUP with hydrokynetotherapy) Indicators statistics produced by the statistical processing of the measurements of 7 subjects of the group on which hydrokinetotherapy has been applied and the statistical hypothesis testing using t-test dependent, gives us the opportunity to state that the results obtained from the subjects before and after the recovery program, differs significantly to all samples (p <. 5.). The positive evolution of the subjects is also confirmed by the value and the significance of the differences between the average values obtained from the two tests. The size of the effect, showing how big are the differences between the results of two tests, is bigger at all 4 indices. In general, we note that the final testing results have a relatively uniform distribution, with the exception of the index Tomayer of whose distribution is nonhomogenous. This means that the recovery program had as effect an improvement of the measured parameters. Cv I 1.71.76 44.1% 1.86 F 3.57.53 14.97% I 25.86 4.98 19.26% -22.71 F 3.14 2.73 87.% I 5.43 2.3 42.35% 8.57 F 14. 1.15 8.25% I.29.49 17.78% 2.43 F 2.71.49 17.98% Size effect t p Null (H) hypothesis 13. <.5 rejected 19.77 <.5 rejected 11.92 <.5 rejected 12.2 <.5 rejected ISBN: 978-1-6184-19-6 13

In conclusion, there are accepted the hypothesis of the research (alternative) and is rejected the null hypothesis in all analyzed samples. Table no. 6 - and mathematical indicators calculated for the evaluated index (the GROUP with no hydroynetotherapy). The statistic indicators obtained Indicators statistic by the statistical processing of the measurements done on 13 subjects in the group on which has not been applied hydrokinetotherapy and the testing of statistical hypothesis using the dependent t-test, gives us the opportunity to state that the results obtained from the subjects before and after the recovery program, differs significantly at all samples (p <.5). The positive evolution of the subjects is also confirmed by the value and significance of the differences between the average values obtained at the two tests carried out. The size of the effect is greater at all clues/index. Generally, we can see that at the final testing a lower coefficient of variation, with the exception of the Tomayer index. This shows us that the recovery program implemented with the help of hydrokinetotherapy resulted in an improvement of parameters value to be measured. Group with hydrokinetotherapy versus group without hydrokinetotherapy Table no. 7 - The comparative presentation of statistical and mathematical indicators at final testing between the two groups (with and without hydrokinetotherapy). The statistic indicators obtained from the statistical processing of the data recorded at the final tests for measured parameters at the two groups and testing the statistical hypothesis using the test ANOVA, gives us the opportunity to note that the results obtained from the subjects, after recovery programs applied to each GROUP, differs significantly at all indices (p <.5), with the exception of the index Klapp where p >.5. The difference of the average of the two groups at the level of each point shows us a better evolution of subjects with a program based on hydrokinetotherapy, with the exception of the Klapp index, where better results were obtained by the group without hydrokinetotherapy. The size effect, between the results of two GROUPS, ranges from small to medium, from, predominant being the medium to big size (5%). Small to medium effect is present on Klapp index. We note that the results are generally relatively uniform/homogenous, except for the Tomayer index whose results have a non-homogeneous distribution. In conclusion, the best results were obtained for subjects who followed the program of recovery with hydrokinetotherapy at all parameters, except the Klapp index. Conclusions Disease acts synergistically to physiological tendency of Kyphosis of the spine once with the age (manifested at women more poignantly than at men for reasons like: weight, hormonal issues, pregnancy, typically constitutions bone fragility - specific to female gender, etc. The atypical form of the disease unrecognized condemns the patients to wrong therapeutic approaches without any result later. It is common the situation in which to the young people are recommended prolonged sleep and analgesic and anti-inflammatory treatment, though the disease does not present inflammatory phenomena and the pause provides relief of pain only temporarily, without acting on the case (on the contrary, determining mobility deficits, tonus and articular alignment). We consider useful to adapt the means of DEPOSTURARI correction of the spine, to be easily accepted by these subjects, easy to practice and to allow the perseverance and constancy in time. ISBN: 978-1-6184-19-6 14

The completion of growth ends the active manifestation of the disease, but from our point of view does not coincide with the end of the recovery activity; even in the best circumstances of recovering the curvature of the kyphosis, the spine remains with a characteristic weakness and predispositions at relapse, therefore, we recommend continuing the program of rehabilitation exercises for the conservation, maintenance and improvements of the results obtained. Refernces: Albu, C., Vlad, T., L., Albu, A. (24) - Kinetoterapia activă, Polirom Publishing House, Albu, C., Vlad, T., L., Albu, A. (24) - Kinetoterapia pasivă, Polirom Publishing House, Bălan, V., (27) Ghid metodologic pentru corectarea deficienţelor fizice prin înot, Publishing House Didactică şi Pedagogică, R.A., Bota, Aura (27) Kinesiologie, Publishing House Didactică şi Pedagogică, Collins, J., D., Saxton, E., H., Miller, T., Q., Ahn, S., S., Gelabert, H., Carnes, A., (23) - Scheuermann's disease as a model displaying the mechanism of venous obstruction in thoracic outlet syndrome and migraine patients: MRI and MRA, Journal National Medicine Association; 95(4):298-36; Docu, D., Any, D., (29) Kinetoterapia în cifoză, Andrei Şaguna Publishing House, Epuran, M. (25) - Metodologia cercetării activităţilor corporale, ediţia a 2-a, FEST Publishing House, Fotiadis, E., Kenanidis, E., Samoladas, E., Christodoulou, A., Akritopoulos, P., Akritopoulou, K., (28) - Scheuermann's disease: focus on weight and height role, Eur Spine J 17 (5): 673 8; Huck, S., W. (24) Reading statistics and research. Reading, MA: Addison-Westley; Nica, S., Adriana (24) - Recuperare medicală, Carol Davila Publishing House University, Tătaru, T., Marinescu, Gh., Ene, D., Dumangiu, M., (21) Ankylosing spondylitis to sportsmen and to unsportsmen functional assessment and recovery using physical training mean - 15-th Annual Congress of the ECSS (European College of Sport Science), Antalya, Turkey, June 21 Book of Abstracts ISBN 978-65-61427--3, pag. 111, Edited by Middle East Technical University; Weiss, H.,R., Werkmann, M., (29) - Treatment of chronic low back pain in patients with spinal deformities using a sagittal realignment brace;4:7. doi: 1.1186/1748-7161-4-7. [PMC free article] [PubMed] [Cross Ref] ISBN: 978-1-6184-19-6 15