Forced Straightening of the Back Does Not Improve Body Shape

BACKGROUND

Sitting for a long time causes various postural problems, such as slump sitting. It has been reported that employing a corrected sitting position while lifting the sternum is effective in improving this form of posture. We investigated how a corrected sitting posture with the lifting of the sternum is different from a forced position that is applied through the command and passive positions.

MATERIALS AND METHODS

The postural angle of 270 subjects aged 19-23 years was measured in the passive, forced, and corrected positions using a Saunders inclinometer and a Formetric 4D system.

RESULTS

As a result, the corrected position had a small range (min-max) at all angles, but the forced position and passive position had a large range (min-max). The lumbar lordosis angle in the corrected position showed positive values throughout its range (min-max), while the other groups showed negative values, which indicates the kyphotic position of the lumbar section. In addition, the percentage error in the corrected position was small, but it presented high values in the other groups. When comparing the average angles between the groups, there were substantial changes observed between the corrected position and the other groups. It was found that the corrected position with the sternum lifted, which is applied to improve slump sitting in the clinical environment, exhibited an angle that differed from that of the forced position and the passive position.

CONCLUSIONS

Our results suggest that a forced position on the command "scapular retraction" does not meet the clinical assumptions of posture correction, in contrast to the corrected position with the lifting of the sternum for the improvement of slump sitting. The accurate correction of the position of the sternum and sacrum improves the position of the spine in the sagittal plane, enabling physiological values for the kyphosis and lordosis angle parameters to be obtained. This approach combines the ease of execution and precision of the effect. The fact that this method does not require complex tools to accurately correct the body encourages the implementation of this solution in clinical practice.

Monitoring Expression of Balance during Therapy in Children with Postural Disorders

In the literature, we find information about the impact of changes in the shape of the spine on the efficiency of equivalent reactions, and we also find information about the methods and effects of physiotherapy in improving equivalent reactions. However, there is a lack of publications showing the process of changes taking place over time and defining their nature at individual stages of treatment. The aim of this study is to present the process of monitoring the expression of balance in patients aged 8-12 years with postural disorders, in the course of the therapeutic process. The shape of the spine and the efficiency of equilibrium reactions in standing posture and during gait were assessed in all the subjects. The subjects were put into two groups: with a shape-of-spine disorder and without one. The recommended set of therapeutic activities in home conditions lasted about 20 min and was performed by the child with a parent's supervision. The therapeutic program was based on elements of neurophysiological methods: Vojta and PNF. The following parameters were measured: the maximum movement of the center of pressure (CoP) in the frontal plane during gait, the maximum movement of the CoP in the sagittal plane, the movement of the CoP in the frontal plane in static conditions and the movement of the CoP in the sagittal plane in static conditions. Six statistically significant differences were recorded, and all of them were related to measurement I. The Friedman test result was statistically significant for all the indexes. Post hoc analyses were performed using the Dunn-Bonferroni test. The children with shape-of-spine disorders had a lower efficiency of equivalent reactions in relation to the children without disorders. The therapy with the application of neurophysiological methods in the treatment of shape-of-spine disorders improved equilibrium reactions in these patients. Long-lasting and thorough observations of the therapeutic process in children with shape-of-spine disorders should include the monitoring of the efficiency of equilibrium reactions.

Evaluation of the Functional Status of the Posture Control System in Children with Detected Disorders in Body Posture

Screening tests for body posture defects and abnormalities conducted over the past several decades have revealed a significant and constantly increasing problem of health risks in children. A sedentary lifestyle, which is considered to be the primary cause, can result in proprioceptive disorders leading to postural instability. The aim of the study was to find the correlation between the level of proprioceptive control and the number of postural disorders. The study involved a representative group of 1090 children aged 8-10 years, from randomly selected primary schools. Subjects who scored from 1 to 5 points in a prior postural screening test were qualified for the examination of the postural control system. The examination of the postural control system was carried out using an electronic station enabling assessment of postural stability and proprioception. A single leg stance test showed that the number of postural disorders does not significantly impact proprioceptive control. Proprioceptive control was found to significantly increase with the age of the children, and girls presented significantly better proprioceptive control in relation to the boys in each age group.

Effect of Thoracic Kyphosis and Lumbar Lordosis on the Distribution of Ground Reaction Forces on the Feet

Introduction

In clinical practice, foot load receptors are very important in shaping the correct vertical posture and optimal equilibrium reactions. They are so important that stimulating them gives measurable effects in improving both balance and posture. Plantar pressure distribution is an important parameter that provides information on changes in a person’s posture, also during gait.

Aim

The aim of the work is to assess the effect of thoracic kyphosis and lumbar lordosis on the distribution of ground reaction forces on the feet.

Materials and Methods

A total of 211 subjects aged 8–12 were examined. Body posture and distribution of ground reaction forces on the feet were assessed using the following parameters: thoracic kyphosis angle, lumbar lordosis angle, maximum pressure (static), average pressure (static), foot surface, distribution of foot pressure, maximum pressure (dynamic), time load (dynamic). DIERS formetric and DIERS pedoscan methods were used to measure the parameters.

Results

The level of the kyphosis angle correlated positively with the percentage distribution of forefoot load in static conditions. The level of lordosis angle correlated positively with the foot surface and forefoot load. Positive correlation of the lordosis angle is also related to its connection with the difference in leg load during gait. A broader cause and effect view of body posture defects and the distribution of ground reaction forces on the feet can affect a more complete assessment of the correlation between these variables, contributing to more effective treatment of any disorders of the described phenomena.

Conclusion

The size of thoracic kyphosis and lumbar lordosis affects the distribution of ground reaction forces on the feet. The effect of lumbar lordosis has a linear value in relation to percentage distribution of forefoot and heel loads.

The Relationship Between the Shape of the Spine and the Width of Linea Alba in Children Aged 6-9 Years. Case-Control Study

INTRODUCTION

Civilization development coupled with contemporary lifestyle leads to a systematic increase in postural disorders. An analysis of factors that may provoke postural disorders indicates that such a stimulus may be the diastasis of the rectus abdominis muscles. Moreover, abnormal activity of the rectus abdominis muscles may affect balance disorders through reduced spinal stabilization and disturbed body statics. There is an increase in body posture abnormalities between the ages of 6 and 9 related to new school duties.

PURPOSE OF THE STUDY

The purpose of the study was to evaluate the relationship between the shape of the spine and the width of the linea alba in children aged 6-9 years.

MATERIAL AND METHOD

The study was designed to evaluate parameters determining the shape of the spine, and the width of the linea alba in healthy children aged 6-9 years. The study participants were divided into two groups based on the width of the linea alba. The study group with the width of the linea alba >10 mm and the control group with the width of the linea alba ≤ 10 mm. The study group were included 37 children and the control group 24 children. The examination of the linea alba width was performed by a radiology specialist using a linear transducer and SAOTE- My Lab Classc-type ultrasound at rest and during contraction of the rectus abdominis muscles. Parameters describing the shape of the spine were measured using the Diers Formetric 4D system: trunk inclination, trunk imbalance, pelvis tilt, pelvic torsion, kyphotic apex, lordotic apex, kyphotic angle, lordotic angle, rotation angle, trunk torsion, lateral deviation. The obtained results were statistically analyzed using a Paired t test for comparison of differences between the results in the study and control groups and Pearson's test to assess the correlation between the width of the linea alba and parameters describing spinal alignment.

RESULTS

In both groups, the parameters describing the shape of the spine did not differ from the norms accepted as typical for the age norm. The only statistically significant difference between the study and control group concerned the trunk inclination, which was negative in the study group, signifying a shift of the entire spine axis backwards beyond the vertical.

CONCLUSIONS

There is a correlation between the shape of spine and the width of the linea alba in terms of selected parameters determining the body posture in the sagittal plane, which concern: the position of the lumbar lordotic apex, trunk inclination and the depth of the lumbar lordotic angle. The width of the linea alba is not explicitly related to abnormalities of pelvic and spinal alignment in the frontal and transverse planes.

Cortisol Levels in Infants with Central Coordination Disorders during Vojta Therapy

Background: Due to the decrease in the percentage of perinatal mortality, which is one of the Millennium Development Goals, the number of children with a central coordination disorder (CCD) has increased, present in up to 40% of premature babies. Neurodevelopmental disorders detected in the diagnostic process require early interventions that will eliminate or overcome existing dysfunctions. These treatments often cause discomfort in the infant, which induces insecurity and activation of basic defense mechanisms. The aim of the work is to assess changes in cortisol concentration in infants treated with the Vojta method. Methods and findings: The study included 35 children with CCD aged between three and nine months. The participants had no comorbidities that could have affected the obtained results. The activities were planned to occur in three stages: 1. Collection of a saliva sample directly before the physiotherapy appointment. 2. Collection of saliva immediately after rehabilitation. 3. Collection of saliva 20 min after the end of rehabilitation. The physiotherapeutic intervention included the assessment of seven reactions of the body position in space according to Vojta and the conduct of a therapeutic session consisting of the first phase of rotation and creeping reflex according to Vojta. The concentration of free cortisol in saliva was assessed with LC-MS/MS. In the first measurement, none of the children presented an excess of the normative concentration of cortisol. The cortisol measurement performed directly after rehabilitation showed above-normative values in three children. In the third measurement, all of the children presented a decreased concentration of free cortisol. The analysis (paired two-tailed t-test, p < 0.05) showed statistically significant differences between particular stages of the measurements. The analysis of the scores obtained in the second measurement showed the concentration of scores in the area of “normal” at a level of 0.83 (normal concentration) and the area “above normal” at the level of 0.005 (very weak concentration). Based on the analysis of significance of the obtained scores, it was found that the result was not accidental, and the Vojta method used in the treatment of children with CCD was suitable. Conclusions: Here, for the first time, we presented how Vojta therapy was correlated with cortisol levels among children with a central coordination disorder.

Effectiveness of physiotherapy interventions for injury in ballet dancers: A systematic review

Background

The unique repetitive nature of ballet dancing, which often involves transgressing endurance limits of anatomical structures, makes dancers prone to injury. The following systematic review aims to assess the effectiveness of physiotherapy interventions in the treatment of injuries in ballet dancers.

Methods

The review was performed in line with the PRISMA statement on preferred reporting items for systematic reviews and meta-analyses. Six electronic databases (PubMed, Ovid Embase, Cochrane, Medline, PEDro, Google Scholar) were queried. The study populations comprised active ballet dancers and/or ballet school attendees with acute and chronic injuries and those with persistent pain. There were no restrictions regarding age, sex, ethnicity or nationality. The Modified McMaster Critical Review Form for quantitative studies was used to assess the methodological quality of the studies reviewed in accordance with the relevant guidelines.

Results

Out of the total of 687 articles subjected to the review, 10 met the inclusion criteria. Diverse physiotherapeutic interventions were described and effectiveness was assessed using different parameters and measurements. Overall, the results indicate that physiotherapy interventions in ballet dancers exert a positive effect on a number of indices, including pain, ROM and functional status.

Conclusions

Due to the small amount of evidence confirming the effectiveness of physiotherapeutic interventions in ballet dancers after injuries and methodological uncertainties, it is recommended to improve the quality of prospective studies.

Efficacy of the use of the McKenzie and Vojta methods to treat discopathy-associated syndromes in the pediatric population

OBJECTIVES

This paper evaluates the efficacy of using the McKenzie and Vojta methods for patients with low back pain and the use of the DIERS Formetric 4D system as an objective diagnostic tool.

MATERIAL AND METHODS

The study enrolled 28 patients aged 15-17 years old. The patients were hospitalized at the Department of Orthopedics and Traumatology of the Świętokrzyskie Center for Pediatrics in Kielce with a diagnosis of back pain associated with a discopathy. The patients were rehabilitated according to the McKenzie and Vojta methods. Assessment by means of the DIERS Formetric system had taken place before the first therapy session and on the day that pain was eliminated to evaluate trunk inclination, angle of thoracic kyphosis, angle of lumbar lordosis, lateral deviation, trunk torsion, surface rotation and pelvic obliquity. Pain intensity and change in pain intensity over time were assessed by means of a numerical rating scale.

RESULTS

Pain intensity was reduced to 0 over 3-12 days. The study participants demonstrated reduction in anterior trunk inclination of the mean value at 1.83°. The angle of thoracic kyphosis was also reduced by 7.95°. The angle of lordosis increased by 7.6°. The lateral spinal curvature was reduced by 8.92 mm. There was a reduction of 4.64° in trunk torsion. Surface rotation was reduced by 1.61° and pelvic obliquity was reduced by 3.78°.

CONCLUSIONS

In discopathic patients, postural parameters comprising trunk inclination, angle of thoracic kyphosis, angle of lumbar lordosis, lateral deviation, trunk torsion, vertebral rotation and pelvic obliquity fail to reach Hartzmann's physiological reference ranges. A therapeutic intervention based on the Vojta and McKenzie methods may normalize the posture to physiological reference ranges and is effective in the treatment of patients with back pain. The DIERS system is an objective tool for tracing the effects of therapy in patients with back pain. Int J Occup Med Environ Health. 2019;32(1):33-41.

Effect of physiotherapy on spinal alignment in children with postural defects

OBJECTIVES

This paper assesses the effect of neurophysiological rehabilitation in children with postural defects on the depth of thoracic kyphosis, lateral spinal deviation and rotation of spinal motor segments.

MATERIAL AND METHODS

A total of 201 patients aged 8-15 years old with a postural defect diagnosed by medical examination were enrolled. The analyzed parameters were determined using the DIERS system before the first therapeutic session and after 4 weeks of therapy. The angle of thoracic kyphosis, lateral deviation of the spine and spinal rotation were assessed. The therapy employed techniques associated with the proprioceptive neuromuscular facilitation (PNF) and Vojta's approaches. The results were analyzed separately for both sexes and for patients rehabilitated solely with Vojta's techniques vs. patients rehabilitated according to combined Vojta's and PNF techniques. The χ2 test was used for statistical analyses, at p < 0.05.

RESULTS

There was improvement in the angle of thoracic kyphosis, ranging from 0.14 (among boys with kyphosis < 42°) to 5.47 (among girls with kyphosis ≥ 42°), spinal rotation, from 0.37 (among boys with kyphosis ≥ 42°) to 4.33 (among patients with kyphosis ≥ 42° rehabilitated solely according to Vojta's method), and lateral deviations, ranging from 1.32 mm (among boys with kyphosis < 42°) to 2.99 mm (among patients with kyphosis ≥ 42° rehabilitated solely according to Vojta's method).

CONCLUSIONS

Neurophysiological rehabilitation of patients with postural defects produced positive effects by improving the angle of thoracic kyphosis, spinal rotation and lateral deviation of the spine. Children with reduced thoracic kyphosis achieved less improvement in the kyphosis angle, lateral spinal deviation and spinal rotation than children with kyphosis ≥ 42°. The DIERS Formetric System enables precise monitoring of therapeutic outcomes. Int J Occup Med Environ Health. 2019;32(1):25-32.

Managing Toe Walking, a Treatment Side Effect, in a Child With T-Cell Non-Hodgkin's Lymphoma: A Case Report

Background and Purpose: Children who have survived cancer are at risk of experiencing adverse effects of the cancer or its treatments. One of the adverse effects may be the limitation of ankle dorsiflexion (DF), which may result in "toe walking." Although there is an increasing number of studies in pediatric oncology presenting evidences of different therapeutic interventions to improve DF function, none of these therapeutic interventions has been sufficiently documented. This case report shows the results of non-invasive neurodevelopmental treatment program combined with application of inhibiting casts in a pediatric cancer patient who presented with severe and persistent toe walking. The treatment was aimed to improve DF function and postural and gait pattern and to normalize weight distribution between forefoot and heel. Case Presentation: A 7-year-old girl with T-cell lymphoma, who presented with severe and persistent toe walking, was assessed 10 times over a course of 6 months by both clinical examination (ankle range of motion measurement) and neurophysiological measures (weight distribution between forefoot and hindfoot, postural sway, body posture, and gait). Outcomes: Neurodevelopmental treatment program combined with application of inhibiting casts for 3 months increased passive ankle DF by 10° in both lower limbs, normalized weight distribution between the forefoot and heel in both lower limbs, as well as established a heel-toe walking gait pattern. Improved ankle DF function and normalized postural and gait patterns were maintained in repeated examinations even 3 months after the removal inhibiting casts. Discussion: Early identification of toe walking in the female pediatric patient with T-cell non-Hodgkin's lymphoma and early physiotherapy intervention were beneficial in terms of her body posture and gait pattern development. Non-invasive neurodevelopmental treatment program combined with application of inhibiting casts as described in this study can be useful for managing treatment side effects in pediatric cancer patients.

Vojta method in the treatment of developmental hip dysplasia - a case report

Background

Developmental dysplasia of the hip joint is one of the most common congenital defects and often results in functional and structural disorders. Such cases particularly demand optimizing therapeutic effects and maximally reducing the duration of therapy.

Purpose

The aim of this case report is to present the therapeutic process in a child with developmental hip dysplasia.

Case report

This is a case report of a female child with a birth weight of 2,800 g and an Apgar score of 9 points born to a gravida 3 para 3 mother at 37 weeks. The child was delivered by cesarean section, and the pregnancy was complicated by oligohydramnios. Subluxation of the left hip joint was diagnosed by an orthopedist in the third month of life. The treatment followed was the Vojta method (the first phase of reflex turning and reflex crawling).

Results

During the 6 weeks of the Vojta treatment, the left half of the femoral head was centralized, and the process of formation of the hip joint acetabulum was influenced effectively enough to change the acetabulum’s Graff type from the baseline D to IIb after 41 days of treatment.

Conclusion

The diagnostic work-up of congenital hip joint dysplasia should involve a physiotherapist who will investigate the child’s neuromuscular coordination, in addition to a neonatologist and a pediatrician. The therapy for a disorder of hip joint development of neuromotor origin should involve the application of global patterns according to Vojta. Children with congenital dysplasia of the hip joint should commence rehabilitation as early as possible.