Scoliosis is a persistent lateral deviation of the spine from its normal straightened position. Physical education teacher L.N. Deryabina
Scoliosis as a problem for schoolchildren Shevchenko I. 8b For proportionality, beauty and health, not only education in the field of science and art is required, but also a lifetime of physical exercise and gymnastics.
- Plato
- , but at school age (10 - 15 years), it manifests itself most pronouncedly. Their immediate cause may be improperly arranged desks, seating schoolchildren without taking into account their height and desk numbers, carrying briefcases from the first grades, holding a child by one hand while walking, etc. etc. This list, of course, does not cover all types of scoliosis, but only the main ones. It is generally accepted that the cause of lower back injuries is training overload. Meanwhile, pain in the lower spine is much more often caused by normal daily human activities.
- For children of primary school age, various types of physical exercises in the open air are useful. In the summer, this could be cycling, swimming in open water, walking in the forest or park, playing football, volleyball, badminton with peers. In winter, of course, skiing and skating. In inclement weather (during the so-called transition periods - autumn and spring), when it is slushy, chilly and windy, you can vigorously perform general developmental exercises. An approximate set of such exercises (which can be performed without any devices or sports equipment
- Ways to control correct posture: Posture is usually checked while standing against a wall. If the back of the head, shoulder blades, buttocks and heels touch the wall, then the posture can be considered generally correct. If you find that the head is tilted too far forward (the back of the head does not touch the wall), the entire back touches the wall (flat back), and the buttocks do not touch the wall, there are signs of poor posture. In this case, you need to contact your pediatrician and check your posture more carefully. The doctor will help you choose an individual set of exercises that are required for different types of postural disorders.
- To form the correct beautiful posture, it is necessary to additionally use breathing exercises and strengthen the abdominal muscles. Let's look at this in more detail. Breathing exercises. It is believed that with the help of proper breathing you can avoid sinusitis, asthma, neuroses, get rid of headaches, runny nose, colds, digestive and sleep disorders forever, and quickly restore performance after mental or physical fatigue. Most children breathe through their mouth. Usually they get sick often, have poor physical development, and get tired quickly. Special breathing exercises will cleanse the mucous membrane of the respiratory tract and strengthen the respiratory muscles, which will immediately affect the child’s well-being. Classes breathing exercises should be carried out in a well-ventilated area, in a calm environment. After eating, 30-40 minutes should pass. A survey was conducted of middle school (namely 6-9 grades).
- For modern schoolchildren, in addition to spending many hours in a sitting position at school, they also spend a long time sitting at the computer.
- Possible solutions...
- 1. The student is forced to sit at a desk, we can’t get away from this. But we can reduce the time spent in a static position: every 15-20 minutes, raise the “martyr of science” and take a break in the lesson for at least a few seconds (10 seconds - 1 minute).
- 2. The second trick is to constantly change the position of your feet while in a static sitting position. The feet can be moved forward, pulled back, placed together or apart. It would seem like a trifle? Yes, but if we multiply this little thing by hundreds of hours spent sitting, it appears before us in a completely different light.
- 3. Of course, the student must sit correctly: straight back, knees bent at an angle of 90 degrees, feet on the floor and not dangling in the air, the distance from the eyes to the surface of the desk is at least 30 centimeters. In order to bring all this to life, it is enough to purchase high-quality furniture for the nursery once. Well, it doesn’t hurt to ask what kind of desks and chairs school classrooms are equipped with. 4. During breaks between classes and during short pauses while performing homework
- the student must hang on the horizontal bar. Please note that the treatment of scoliosis in children excludes this type of physical activity, but the crossbar is ideal for the prevention of scoliosis. If there are children growing up in the family, make sure there is a wall bars or at least a simple crossbar in the apartment/house.
- 5. The following exercise will be a good unloading for the spine: the child kneels, rests his arms straight on the floor, and then bends his back as much as possible, up and down. Simple but effective.
- NB! Treatment of scoliosis in children is also based on performing special sets of corrective exercises and playing sports. However, parents should keep in mind that with already formed scoliosis, asymmetrical sports (for example, tennis), as well as sports and rhythmic gymnastics, which increase the flexibility of the spine, are contraindicated (with scoliosis, this is unacceptable).
- 7. A schoolchild should sleep on a good bed. You've probably read about orthopedic mattresses or wooden boards that can be placed under a regular mattress. The last recommendation these days has perhaps lost its relevance, but a truly high-quality mattress is the alpha and omega of scoliosis prevention!
- 8. Another important point is a backpack or bag for textbooks, notebooks and other attributes school life. We all carried backpacks as children, and this is no coincidence. It is a backpack with two straps that allows you to evenly distribute the load on the spinal column, but a bag or backpack that can be thrown over one shoulder is almost a 100% guarantee of the development of scoliosis. Make sure that the child uses both straps of the backpack for their intended purpose.
Causes, classification of curvatures. The spine, when viewed from behind, should be straight. In some, however, it takes on an S-shape (scoliosis). In mild cases this does not lead to any complications. With significant curvature of the spine, when it rotates around its axis, pain sometimes occurs and its ability to function normally decreases.
1. The primary pathological kyphotic deformity in the thoracic spine leads to an anterior displacement of the center of gravity of the body. In response, to compensate for this pathological condition, the entire torso is tilted posteriorly due to the rotation of the pelvis at the hip joints, since this compensation mechanism is the most effective.
2. The newly emerging biomechanical situation leads to a change in the loads in the lumbar spine, which, being less rigid than the thoracic spine, continues to bend under the influence of increased bending loads due to an increase in the force arm, which leads to a gradual increase in lumbar lordosis. Continued strengthening of lordosis inevitably leads to loss of the vertical position of the body. To prevent this situation, as the lumbar lordosis increases, the pelvis gradually returns to its normal position.
3. The created new pathological biomechanical situation of the system’s balance does not exclude further progression of both thoracic kyphosis and lumbar lordosis. The muscles of the trunk that are involved in the compensation process fix the position of the pelvis and thereby turn off the original compensation mechanism. Now the continuing increase in thoracic kyphosis can only be compensated by flexion of the knee and hip joints, because the physiological possibilities of hyperextension of the lumbar motor segments are also exhausted. Flexion in the knee and hip joints most clearly affects the change in the spatial position of the thoracic spine, which is manifested in a change in the position of the chord of its arch.
4. A typical patient’s posture is formed, which allows one to keep the torso in an upright position, but does not prevent the slow progression of thoracic kyphosis, which becomes rigid with age and as the restructuring of the vertebral bodies is completed.
Treatment. Treatment of scoliosis consists of three interconnected links: mobilization of the curved spine, correction of the deformity and stabilization of the spine in the position of the achieved correction. Manual therapy techniques are very effective for correcting spinal deformities.
The concept of scoliotic disease SCOLIOSIS (from the Greek scolios - “curved, crooked”) is a progressive disease characterized by lateral curvature of the spine and twisting of the vertebrae around its axis (torsion). At the same time, the functions of the chest organs are disrupted, cosmetic defects and psychological trauma appear. Therefore, it is reasonable to talk not just about scoliosis, but about scoliotic disease.
SCOLIOTIC VERTEBRAL DEFORMITY C COLIOTIC VERTEBRAL DEFORMITY develops according to certain laws and goes through the following stages: torsion, lateral curvature, elements of kyphosis, chest deformation, etc. Knowledge of these laws makes it possible to predict the course of the disease. Clinically, scoliotic deformity is manifested by rib protrusion.
Classification of scoliosis According to the localization of curvature (types of scoliosis): cervicothoracic scoliosis (apex of curvature at the level Th3 - Th4). This type of scoliosis is accompanied by early deformations in the chest area, changes in the facial skeleton. thoracic scoliosis (apex of curvature at the level of Th8 - Th9), Curvatures are right- and left-sided. The most common type of scoliosis is thoracolumbar scoliosis (apex of curvature at the level of Th11 - Th12). lumbar scoliosis (the apex of the curvature at the L1 - L2 level). Scoliosis of this type progresses slowly, but pain in the area of the deformity occurs early. lumbosacral scoliosis (apex of curvature at level L5 - S1). Combined, or S-shaped scoliosis. Combined scoliosis is characterized by two primary arcs of curvature - at the level of the eighth-ninth thoracic and first-second lumbar vertebrae.
Conservative treatment of scoliosis Comprehensive includes: 1. massage, 2. acupuncture 3. therapeutic exercises, 4. use of corsets. The leading method of conservative treatment of spinal scoliosis is physical therapy. Exercises aimed at strengthening muscles allow you to achieve the formation of a muscle corset. Therapeutic exercise is indicated at all stages of scoliosis development, but more successful results are achieved on the blood circulation of muscle tissue, as a result of which their nutrition improves and muscles develop more intensively.
TREATMENT METHODS AND EXERCISES FOR SCOLIOSIS The main goal of complex conservative treatment of scoliosis is to prevent its progression and, whenever possible, to achieve correction of the deformity. Conservative treatment methods include: 1) restorative treatment; 2) exercise therapy and massage; 3) traction methods; 4) orthopedic treatment. The basis of orthopedic treatment should be, firstly, a regime of unloading of the spine. It includes sleeping on a hard bed, daytime rest while lying down, and in difficult cases, training while lying down in specialized boarding schools or sanatoriums, plaster beds while sleeping, and walking corsets.
Indications for prescribing exercise therapy Exercise therapy exercises are aimed primarily at the formation of a rational muscle corset that holds the spinal column in the position of maximum correction and prevents the progression of scoliotic disease. Exercise therapy is indicated at all stages of scoliosis development; its most effective use is in the initial stages of the disease.
Contraindications Running, jumping, skipping, dismounting - any concussion of the torso Performing exercises in a sitting position Exercises twisting the torso (except for de-torsion exercises) Exercises with a large amplitude of movements of the torso (increasing flexibility) Hangings (over-stretching the spine - pure hangings)
Objectives of exercise therapy Improving the general condition and creating a “mental stimulus” for further treatment Hardening Improvement respiratory function lungs and increasing the excursion of the chest, thereby increasing gas exchange and metabolic processes in the body Establishing proper breathing Strengthening of cardio-vascular system Strengthening the muscular system, creating a muscular corset Establishing correct posture Improving coordination of movements Possible correction of deformity These tasks are solved through exercise therapy, swimming, adaptive physical education, i.e. comprehensively. The leading role belongs to exercise therapy.
Principles of exercise therapy for scoliosis Use exercise therapy only in combination with orthopedic treatment Dose the load when performing exercises under the control of tests for muscle strength and endurance, taking into account the state of the cardiovascular system. Perform exercises at a slow pace with good muscle tension. Avoid hanging and passive extensions. Only traction itself in the initial lying position is permissible. Avoid exercises that mobilize the spine and increase its flexibility. They are recommended only in preparation for surgical treatment. Do not use exercises that rotate the torso around the longitudinal axis of the spine. Correction of the deformity is performed through the use of special corrective exercises. The starting positions of the correction are selected depending on the type and degree of scoliosis: with 1 degree of scoliosis, the starting position of the correction is symmetrical; in grade 2 - hand from the side of the convexity of the spinal arch to the side. The purpose of the asymmetrical starting position is to bring the center of mass of the spine closer to the mid-axial line and train the muscles in this position.
METHODOLOGY OF LFK During exercise therapy classes, it is advisable to carry out the main part of them in the starting position lying down. The most appropriate is the continuous method of constructing classes, which increases their density. When performing PH, general and special training is carried out. Through general training, the child’s entire body is gradually included in a uniform load. General training is only an introduction to special training. In this case, the axes of motion are taken into account. A set of exercises prescribed by a physical therapy doctor is monitored by an orthopedist and periodically replaced with a new set. The emotional factor should be taken into account, especially for young children who quickly get bored with monotonous movements. Therefore, it is necessary to include play exercises in the set of exercises; all children and adolescents should periodically change exercises, maintaining their therapeutic orientation. Children and adolescents with non-progressive scoliosis should be prescribed weight-bearing exercises (dumbbells, spring devices), as well as sports loads without training for sports performance. LH is used for any degree of curvature. The LH technique varies depending on the stage of treatment and the objectives.
SPECIAL EXERCISES FOR SCOLIOSIS Special exercises are exercises aimed at correcting pathological deformation of the spine - corrective exercises. They can be symmetrical, asymmetrical and detorsional. When drawing up a complex for scoliosis, one should take into account the nature of scoliotic deformation, which creates gross asymmetry of all parts and departments of the human body. Therefore, corrective exercises for scoliosis are aimed at correcting this asymmetry
SYMMETRICAL EXERCISES Uneven training of the back muscles when performing symmetrical exercises helps to strengthen weakened muscles on the convex side of the curvature and reduce muscle contractures on the concavity side, which leads to the normalization of muscle traction spinal column Symmetrical exercises do not disrupt the existing compensatory adaptations and do not lead to the development of counter-curvatures. An important advantage of these exercises is the simplicity of their selection and the methodology of implementation, which does not require taking into account the complex biomechanical conditions of the work of the deformed spinal motion segment and individual parts of the musculoskeletal system
ASYMMETRIC EXERCISES Asymmetrical corrective exercises are used to reduce scoliotic curvature. They are selected individually, affect the pathological deformation locally and are more likely to provide a more uniform load. They train weakened and stretched muscles, helping to equalize their tone.
DETORTION EXERCISES Scoliosis is a complex deformity that includes two main components: lateral curvature and torsion. Torsion also consists of two parts. Vertebral twisting occurs as a result of abnormal growth. This deformity cannot be corrected with conservative treatment methods. The second part of torsion is the rotation of one segment of the spine relative to another. This component is largely functional and can be targeted through detorsion exercises.
DETORSION EXERCISES Perform the following tasks: rotation of the vertebrae in the direction opposite to torsion, correction of scoliosis by leveling the pelvis, stretching of contracted and strengthening of stretched muscles in the lumbar and thoracic spine. Development of detorsion exercises is carried out taking into account the fact that with right-sided scoliosis, torsion occurs clockwise, and with left-hand - counterclockwise.
Formation of correct posture The student should sit on a hard chair with a straight back. The chair moves under the table to a quarter of the seat. Adjust the position of your feet on the floor using the stand. The seat on the chair should be deep with a straight back and head, symmetrical position of the shoulders and elbows located on the table. Every minute while doing lessons, it is recommended to take a physical education break with a change of position (standing or lying down). At school, children with poor posture and scoliosis should sit only in the middle row, and healthy children should periodically move from one side row to another.
Education of correct posture Consolidating the skills of correct posture through gymnastic exercises is a prerequisite during classes various forms physical culture and sports. Education of correct posture using pedagogical methods is carried out through a mental and visual representation of it. The mental representation is formed from the words of a specialist in physical therapy(or parent) as an ideal layout of the body in space (position of the head, shoulders, chest, abdomen, pelvis, legs) and as a visual image (drawings, photographs). You can teach children to adopt correct posture and correct any defects they notice using a mirror. Controlling posture requires significant volitional efforts, which children of primary school age are not ready to implement. A big role in this process belongs to parents in terms of patience and pedagogical tact.
Cultivating correct posture Having a smooth wall (without baseboard), preferably on the side opposite the mirror. This allows the child, standing against the wall, to take the correct posture, having 5 points of contact: the back of the head, shoulder blades, buttocks, calf muscles, heels; feel the correct position of your own body in space, developing a proprioceptive muscle feeling, which, with constant repetition, is transmitted and consolidated in the central nervous system - due to impulses coming from muscle receptors. Subsequently, the skill of correct posture is reinforced not only in the static (initial) position, but also when walking and doing exercises.
Physical exercises are selected according to the types of postural disorders. General development exercises (GDE) are used. for all types of postural disorders. Corrective, or special, exercises. Provide correction of existing postural disorders. Special exercises for poor posture include: exercises to strengthen the muscles of the back and front surface of the thigh, exercises to stretch the muscles of the front surface of the thigh and the front surface of the body (with an increase in physiological bends). Therapeutic gymnastics classes necessarily combine general developmental, breathing and special exercises, relaxation exercises and traction itself. Exercises to strengthen the muscle corset.
Guidelines LH is combined with muscle massage and wearing a corset that fixes the spine. PH classes include general developmental, breathing and special exercises aimed at correcting pathological deformation of the spine. Stretched and weakened muscles located on the side of the convexity must be strengthened, toned, helping to shorten them; shortened muscles and ligaments in the concavity area must be relaxed and stretched. This type of gymnastics is called corrective gymnastics. In order to strengthen weakened muscles (especially the extensors of the trunk, gluteal muscles and abdominal muscles), symmetrical exercises of various types are used to promote correct posture, normalize breathing, and create a rational muscle corset.
Features of the use of LH For scoliosis of the 1st degree, along with general developmental and breathing exercises, symmetrical corrective exercises are used; asymmetrical ones are used individually, extremely rarely. In case of scoliosis of the second degree, general developmental, breathing and symmetrical exercises predominate in corrective gymnastics classes. According to indications, asymmetrical and detorsion exercises are used; the latter - for corrective and preventive purposes, providing the maximum therapeutic effect specifically for grade II scoliosis. For scoliosis of III - IV degrees, the entire arsenal of physical exercises is used.
PROGRAM OF TREATMENT MEASURES FOR CHILDREN WITH SCOLIOSIS For 1st degree of scoliosis: Wearing a corset is not indicated, exercise therapy, restorative treatment (massage, physiotherapy, acupuncture, hardening procedures, etc.) For 2nd degree of scoliosis: Wearing a corset without a head holder strictly according to the indications of exercise therapy, general developmental sports, restorative treatment Special motor regimen For 3-4 degrees of scoliosis: Mandatory surgical treatment Mandatory wearing of a corset At all stages of treatment at any age of the patient and with any severity of scoliosis, the task remains of cultivating a conscious attitude towards consolidating the correct body position
* Goal: Study and prevent the problem of scoliosis. Studying methods of its treatment. * Objectives: * Collect information about scoliosis, the causes of its occurrence, classification and symptoms. * Selection of a set of exercises for the prevention of scoliosis. * Collection of information about methods of treating scoliosis.
* The development of scoliosis is proven by the symptoms of one shoulder being higher than the other in a standing position, and the bulging angle of one shoulder blade. * With severe scoliosis, symptoms such as gait disturbance and pelvic distortion occur. As a result, the internal organs of the lungs and heart suffer. * Complications of untreated scoliosis: chest deformation, limitation of lung function and, as a result, polycythemia and pulmonary hypertension, heart failure (due to increased pressure from the chest).
* By time of manifestation: * Infantile idiopathic scoliosis is called scoliosis that appears between the first and second year of life. * Juvenile idiopathic scoliosis refers to scoliosis that appears between four and six years of age. * Adolescent (adolescent) idiopathic scoliosis are scoliosis that occurs mainly between ten and fourteen years. * Scoliosis can also be congenital.
* Congenital causes of scoliosis: Congenital causes of scoliosis include disturbances of normal intrauterine development, which leads to underdevelopment of the vertebrae, the formation of wedge-shaped and additional vertebrae and other pathologies. The cause of disruption of normal intrauterine development may be improper nutrition of the mother, the presence bad habits, neglect of physical activity, etc. The incorrect shape of the mother’s pelvis can also have a detrimental effect on the child at birth.
* Acquired causes of scoliosis: * The causes of scoliosis development are: * Trauma (spinal fractures). * Subluxations of the cervical vertebrae, which the child receives from obstetrics. The injury is always accompanied by a shift of one vertebra relative to another; as experts say, it is subluxated, that is, shifted away from the vertical axis, which leads to a violation of the symmetry of the body. * Incorrect body position due to the physiological characteristics of a person (flat feet, different leg lengths, strabismus or myopia due to which a person is forced to take an incorrect posture when working).
Acquired causes of scoliosis: * Incorrect body position due to professional activity a person in which he constantly arrives in one position (working at a table with his head constantly bowed, simply an incorrect posture on a chair, habitual incorrect posture, etc.). * Different muscle development, and this may be due to some disease (unilateral paralysis, rheumatic diseases, etc.). In this case, the uniform traction of the muscles may be disrupted, which leads to greater curvature. * Poor nutrition, poor physical development. * Rickets, polio, tuberculosis, pleurisy, radiculitis and other diseases.
* Conservative therapy * Bloodless (conservative) effective treatment scoliosis in European practice currently represents specialized anti-scoliosis gymnastics. Scoliotic growth of posture should be treated with specialized gymnastics. For more serious curvatures, gymnastics and corsets are used (at least at night). * Progressive scoliosis should be treated with a derotation corset. In addition to this, inpatient treatment is recommended, if possible. intensive rehabilitation in one of the highly specialized clinics. * To correct spinal deformities, the use of manual therapy methods is very effective. According to most doctors, conservative treatment of scoliosis is effective only for initial degrees of scoliosis; for severe progressive forms of scoliosis, the main method is surgical.
* Surgical treatment * Initial indications for surgery vary depending on age and the effectiveness of available brace treatment, if all available conservative treatment options have been exhausted and have not brought sufficient success. * For late-onset (in adolescence) idiopathic scoliosis, surgery is usually not necessary from a medical point of view. * During surgical treatment, the spine is straightened to a certain angle using metal rods, which leads to immobilization of these parts of the spine. Scoliosis surgery is especially suitable for severe curvatures that can no longer be treated with other methods. Surgical fixation can prevent further progression and worsening of the condition.
* A set of basic exercise therapy exercises for scoliosis: * 3) stretch your arms forward, slowly move them back to your hips, passing them over medicine balls placed at the level of the shoulder blades (Fig. 5) * 4) in a supine position, resting your elbows on your bent arms, raise your shoulder blades above the floor and perform slow nodding movements (Fig. 6)
* The massage procedure is carried out in the following order: * 1. Place the patient on his stomach, arms along the body, head turned to the side opposite to rotation cervical region spine caused by scoliotic deformity. A cushion is placed under the ankle joints. They begin with longitudinal stroking of both halves of the back at the same time; smooth, rhythmic, long movements along the entire spine are performed due to the coordinated movement of the arms, body and legs. Gradually move from superficial to deeper stroking. * 2. Then perform deep friction with the edge of the palm with weights in long movements along the spine.
* 3. Then the massage therapist, with the base of the right and the edge of the left palm, grabs the skin-subcutaneous fold of the greatest possible thickness and, with counter circular movements, the right one towards you, the left one away from you, rub the fold between the palms; the right palm simultaneously kneads the underlying muscles with sliding pressure. Movements should be smooth, rhythmic, the contact of massaging palms with the tissues should be constant.
* 4. Then the massage therapist places the patient on his right side, facing him. Under chest places a thick pillow 68 cm thick. Right forearm under the head, left hand stretched forward. The left leg is slightly bent and lies in front of the right. A bracelet is attached to the right leg at the ankle joint. A cord with a hook is attached to the bracelet, and bags of sand are hung on the hook. The weight of the bags is 1020% of the patient's weight. Kneading is performed with the base of the palm of the left extensor of the back at the lumbar level with sharp, abrupt, rhythmic pushes. In the same position, massage and stretching of the pectoralis major muscle is performed.
* 5. Then the patient lies on his left side, a cushion is placed under the lower back, the left arm is extended forward, the right forearm rests on the surface of the table, fixing the ventral tilt; a load constituting 1015% of the patient’s weight is secured to the left arm in the same way as on the leg. A stretching kneading of the left back extensor is performed at the level of the thoracic region; kneading the right back extensor at the thoracic level is performed with sharp, jerky rhythmic movements (23 minutes). * The intensity of the techniques is selected according to the general condition and degree of physical development patient. Pain and bruising are unacceptable. * The massage therapist should not try to correct spinal deformity; this is the exclusive competence of the doctor.
Modern children sit a lot and parents should form the following habits in them: 1. Sit still for no more than 20 minutes. 2. Try to get up as often as possible and walk around the room for at least 10 seconds. 3. While sitting, change the position of your legs: feet forward, back, put them together, and then separately, and so on. 4. The child must be provided with a comfortable place to work and study. 5.Perform warm-up exercises for the spine and back muscles several times a day.
What a comfortable work chair looks like for adults and children: A good chair can be adjusted in height from the floor and the height of the lumbar support of the backrest. The chair must have armrests. Feet should be completely flat on the floor. The surface of the seat should be flat and tilted forward by about 15. The back of the chair should follow the anatomical curves of the spine, support the back in the area of the lower back and shoulder blades, thus relieving unnecessary tension from the muscles in this area. While sitting, watch your posture - don’t slouch, but don’t try to sit straight “like a stick.” The chest is slightly raised, the shoulders should not be raised excessively; they should lie relaxed on the chest. It is very useful to change your position more often - twist, twist, bend a little. If you often and without jerking change your position during sedentary work, then the intervertebral discs and back muscles do not experience excessive stress and remain functional and healthy longer.
How to sleep properly Night rest is very important for the health of the whole body and in particular for restoring the spine and relaxing the back muscles. Whether the body will rest at night or, on the contrary, accumulate fatigue depends on the position in which a person sleeps. Basic tips to help you organize a night's rest that is useful for the prevention of scoliosis. 1. The bed should be neither soft nor hard, it should have a little spring under the person’s body. 2. The most useful sleeping position is on your left or right side with your legs slightly bent. Sleeping on your back or stomach creates tension in your back muscles.
How to sleep properly 3. Sleeping without a pillow at all is harmful to health; a large and soft pillow also creates a lot of inconvenience in the body. The cushion cushion is considered the most suitable. The height of the pillow is selected individually, so that the depression between the back of the head and the shoulder blades is filled, and the spine remains straight.
*Exercises can be performed in any order. * Exercise 1. Lie down so that your forehead touches the floor, stretch your arms along your body. Relax. Slowly tilt your head back and, using your back muscles, lift your body as far as possible from the floor without using your hands. Extend your arms forward and place them at shoulder level, fingers facing each other. Push off the floor very slowly with your hands. In the extreme position, slowly count to 15. Slowly lower your body, making all movements in reverse order. Lowering your body about halfway, press your arms to your sides and force your back muscles to work. Do the exercise very slowly 2 more times. * Exercise 2. Sit on the floor with your legs stretched forward. The feet should be together. Keep your body straight, without tension. Place your hands on your knees. Slowly raise your arms above your head and move your body back an inch. Slowly raise your arms forward and tilt your body. Wrap your hands tightly around your knees or calves. Gently tilt your body down. Slowly count to 20 in this position. Move your hands towards your feet and firmly grasp your ankles. Gently tilt your body down. Slowly count to 20. Repeat the exercise 2 more times.
* Exercise 3. Lie down so that your chin rests on the floor and your arms are pressed to your sides. Bend your knees, keeping your heels together. Stretch your arms back and try to grab your feet. Holding your legs firmly, slowly and effortlessly lift your body up. Without lowering your body, raise your legs. The head is tilted back. In the extreme position, count to 15. When leaving the position, it is important to adhere to the indicated sequence - first lower your knees to the floor, but do not release your feet. Without releasing your legs, lower your body until your chin touches your body. Now lower your legs. Relax. Perform the exercise 2 times. * Exercise 4. In a standing position, extend your arms in front of you. Lean forward very slowly as much as possible without overexerting yourself. Do not bend your knees. Place your hands behind your knees or calves. Tilt your body towards your knees. Count to 10. Move your clasped hands as close to your ankles as possible. Press your forehead to your knees. Count to 10. Slowly straighten your body. Perform the exercise four times in each position.
* In our project we studied such a serious disease as scoliosis, methods of its treatment and prevention. We looked at examples of exercises and massage against scoliosis. We also provided you with the necessary recommendations for preventing scoliosis. We hope our advice will help us cope with this problem or prevent it.
Description of the presentation by individual slides:
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Why does scoliosis occur in children? Prevention of scoliosis Completed by: physical education teacher Shulga S.V.
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Functional anatomy and physiology of the spinal column The spine (from the Latin columna vertebralis, synonym - spinal column) is the load-bearing element of the skeleton in vertebrates. The spine is an axial organ that performs the function of ensuring a vertical posture under static and dynamic loads in a wide range; it consists of 32 - 33 vertebrae (7 cervical, 12 thoracic, 5 lumbar, 5 sacral, connected to form the sacrum, and 3 - 4 coccygeal), between which there are 23 intervertebral discs. The spine forms 4 curvatures: cervical lordosis, thoracic kyphosis, lumbar lordosis and sacrococcygeal kyphosis. Normally, when viewed from the side, the spinal column is S-shaped. This shape provides the spine with a shock-absorbing function. In addition, the spine performs supporting, protective and motor functions.
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Scoliosis (from the Greek σκολιός - “crooked”) is a persistent lateral deviation of the spine from the normal straightened position. Scoliosis is one of the most common orthopedic diseases, the frequency of which, according to various authors, varies widely - from 0.5 to 20%. Scoliosis is not just a sideways curvature of the spine, it is serious illness musculoskeletal system, which can lead to disruption of internal organs.
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Causes of scoliosis I Congenital and acquired forms of scoliosis Congenital discogenic scoliosis: develops due to dysplastic syndrome (about 90%). Metabolic disorders in connective tissue this leads to a change in the structure of the vertebrae, as a result of which the connection between the intervertebral disc and the vertebral bodies weakens. This is where spinal curvature and disc displacement occur. At the same time, the nucleus pulposus shifts, being located not in the center, as usual, but closer to the convex side of the curvature. This causes a primary tilt of the vertebrae, which causes tension in the trunk muscles and ligaments and leads to the development of secondary curvatures - scoliosis. Static (gravitational) scoliosis: develops with an asymmetric load on the spine due to different lengths of the lower limbs, pathology hip joint, congenital torticollis, extensive and rough scars on the body. Paralytic scoliosis: develops due to asymmetric damage to the muscles involved in the formation of posture, or their functional insufficiency, for example, with poliomyelitis, myopathy, cerebral palsy.
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Morphological classification Structural scoliosis is characterized by changes in the structure of the vertebrae. The structural component of the deformity is represented by wedge-shaped deformity and vertebral torsion. Functional scoliosis (non-structural) – reversible shortening and stretching of ligaments, muscles, asymmetry of muscle tone, initial stages of the formation of muscle contractures, functional blocks of intervertebral joints, formation of a vicious motor stereotype.
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Diagnosis of scoliosis Visual examination (position, rib protrusion) X-ray examination (standing and lying down). Based on radiographs, the degree of the disease is determined, most often using the Kob method. To determine the angle of curvature of the spine, draw two lines parallel to the surface of the neutral vertebrae (above and below the arcs of curvature); the perpendiculars restored to these lines form an angle corresponding to the curvature of the spine. The most recognized clinical and radiological classification according to V.D. Chaklin (1957). It is based on scoliosis arches that differ in shape, in the angle of deviation of the primary arch from the vertical line, in the degree of severity of torsion changes and in the persistence of existing deformations.
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1st degree (C-shaped) This degree of scoliosis is usually characterized by the following features: oblique pelvis; somewhat flattened shoulders; slight stoop. During this period of development of scoliosis, the angle of curvature (Koba) is approximately 1-10 degrees, which is practically invisible visually.
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2nd degree (S-shaped) This degree of development of the disease is characterized by: 1. visually visible rotation of the vertebrae directly around the axis (vertical) - torsion; 2. slightly sloping pelvis; 3. curvature, which is already noticeable in any position. The angle of curvature (Koba) during this period is approximately 11-25 degrees.
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3rd degree This degree is characterized by: a large hump (costal); obvious retraction of the ribs; significant weakening abdominal muscles(i.e. belly); pronounced pelvic obliquity. At the same time, the angle of deflection (Koba) is already approximately 26-50 degrees.
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Grade 4 Usually characterized by severe deformation of the entire spine. Signs of the 3rd degree intensify, severe stretching of the muscles in the curvature zone is observed. During this period, the angle of curvature (Koba) is already more than 50 degrees.
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Form, type and development of scoliosis 1. According to the shape of the curvature and the sign, scoliosis is divided into simple and complex. Simple - characterized by one arc of curvature, with a deviation of the spine to one side (C-shaped scoliosis). Complex scoliosis is characterized by two or more deviations of the spine in several directions (S-shaped, ?-shaped, triple scoliosis). 2. By type, scoliosis is divided into simple cervical, cervicothoracic, thoracic, thoracolumbar, lumbar, lumbosacral and complex or combined. 3. According to the development of the process, non-progressive, slowly progressive and rapidly progressive scoliosis are distinguished. More than 50% do not progress, 40% progress slowly and 10% progress rapidly. The most dangerous period of child development is during the period of rapid skeletal growth.
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It is not for nothing that experts say that advanced scoliosis is indeed very dangerous. This disease can actually lead to dangerous and irreversible changes: 1. spinal deformation; 2. lead to the appearance of a terrible rib hump; 3. cause excessive asymmetry of the pelvis; 4. disruption of the development of important internal organs. In addition, the patient constantly feels tired quickly and is tormented by regular muscle pain/headaches - this is also a consequence of scoliosis - a disease that the parents did not pay any attention to in time. In addition, the consequences of scoliosis include: 1. cosmetic defect (posture looks ugly); 2. disruption of the relationships of many important internal organs; 3. chest deformation; 4. dysfunctions of the respiratory/cardiovascular systems; 5. impaired functionality of the spinal cord (this is in especially severe cases).
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Signs of scoliosis in children and adolescents Carry out the most careful examination of your child. Pay attention to the following features: is the overall height of his shoulder blades, shoulder girdles, iliac bones, popliteal/subgluteal folds symmetrical; whether the space between the body and the arms, lowered along the sides, is the same; Is your child holding his or her neck straight in a relaxed state? To do this, ask him to bend over so that his arms hang freely (down), and then evaluate everything indicated above.
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The following signs will tell you about the probable presence of scoliosis: 1. one shoulder is located slightly higher than the other; 2. one of the shoulder blades has started to “take off” (that is, the corner of the shoulder blade is sticking out, as it were); 3. different distances from the hand pressed to the side to the waist; 4. When bending forward, the curvature of the spine is visually noticeable.
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Treatment of scoliosis Most often, orthopedic doctors prescribe to sick children: 1. wearing a special fixing corset; 2. physical exercise of a therapeutic nature, which strengthens the back muscles; 3. massage; 4. various tonic procedures. If conservative methods do not help, then after some time the child will need a serious operation, which involves the installation of mechanical devices to correct the curvature of the spine.
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Treatment of scoliotic disease consists of three interconnected links: mobilization of the curved spine, correction of deformity, stabilization of the spine in the position of the achieved correction. The main and most difficult task, the solution of which determines the success of treatment as a whole, is not mobilization and correction of the curvature, but stabilization of the spine in the corrected position. Correction of deformity that is not supported by measures to ensure spinal stabilization is ineffective. The essence of conservative treatment is to correct the curvature of the spine by reducing the functional component of the curvature and stabilizing the achieved correction by improving the functional state of the muscular-ligamentous apparatus or using corsetry. Exercise therapy promotes the formation of a rational muscle corset that holds the vertebral column in the position of maximum correction.
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Types of exercises General developmental, breathing and special exercises are used. Special exercises are corrective and are divided into symmetrical and asymmetrical. Uneven muscle training when performing symmetrical exercises helps to strengthen weakened muscles on the convex side of the curvature and reduce muscle contractures on the concave side of the curvature, which directly leads to normalization of traction of the spinal column. T.A. Fonareva, M.I. Fonarev (1988) indicate that symmetrical exercises do not disrupt the existing compensatory adaptations and do not lead to the development of counter-curvatures. An important advantage of these exercises is the simplicity of their selection and the method of implementation, which does not require taking into account the complex biomechanical conditions of the deformed spinal motion segment and individual parts of the musculoskeletal system. Asymmetric exercises are used to reduce scoliotic curvature. They are selected individually and affect the pathological deformation locally. Asymmetrical exercises train weakened and stretched muscles.
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Examples of symmetrical and asymmetrical exercises Example of asymmetrical exercises: from a starting position standing, arms along the body, legs shoulder-width apart, perform the following exercise: a) on the side of thoracic scoliosis, the shoulder girdle is lowered, the shoulder is rotated outward, while the scapula is brought to the midline. At the moment of adduction of the scapula, the rib protrusion is corrected; b) on the opposite side of the thoracic scoliosis, the shoulder girdle rises and the shoulder rotates forward and inward, while the scapula is pulled outward. This movement involves the shoulder girdle, shoulder and shoulder blade. Torso rotation is not allowed. When performing this asymmetrical exercise, the upper portion of the trapezius muscle is stretched and the scapular muscles on the side of scoliosis are strengthened; strengthening the upper trapezius muscle and stretching the scapular muscles on the opposite side. Exercises help to equalize muscle tone, the position of the shoulder girdle, and reduce the asymmetry of the position of the shoulder blades. It should be remembered that incorrect use of asymmetrical exercises can provoke further progression of scoliosis. Rice. A. - symmetrical corrective exercise; b - asymmetrically corrective exercise
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Detorsion exercises perform the following tasks: rotation of the vertebrae in the direction opposite to torsion; correction of scoliosis by leveling the pelvis; stretching contracted and strengthening stretched muscles in the lumbar and thoracic spine. For example, on the side of the lumbar concavity - moving the leg back in the opposite direction; on the side of thoracic scoliosis - abduction of the arm with a slight rotation of the body in the upper part forward and inward. When the leg is abducted, the pelvis is moderately abducted in the same direction. The exercise promotes detorsion in the lumbar and thoracic spine. The group of general developmental exercises includes general strengthening exercises for all muscle groups of a strength and speed-strength nature, balance exercises, movement correction, stretching and relaxation. Exercises are performed with and without an object (mace, jump rope, medicine balls, dumbbells, etc.). For children involved in corrective gymnastics, great importance have breathing exercises, since their chest is usually poorly developed and often deformed. The chest is developed with the help of special breathing exercises. At the same time, it increases in volume, and consequently, the vital capacity of the lungs also increases. Chest and abdominal breathing are used. Often children, carried away by movement, forget about breathing and hold it. Therefore, the methodologist’s “one-two” command is in many cases replaced by the “inhale-exhale” command. For example, lying exercises with dumbbells, swimming movements, rowing, etc. The methodologist focuses the children’s attention on the combination of exercise with breathing and the categorically unacceptable holding of breath during exercise.
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For scoliosis of the first degree, along with general developmental and breathing exercises, symmetrical corrective exercises are used. Asymmetrical exercises are used individually and extremely rarely. In case of second degree scoliosis, therapeutic exercises also predominate in therapeutic exercises, breathing exercises, and symmetrical exercises. According to indications, asymmetrical and detorsion exercises are used. For scoliosis of III-IV degrees, the entire arsenal of physical exercises is used. For scoliosis, physical exercises that increase the flexibility of the spine (bending, twisting, turning) and leading to its overstretching (hangs) are contraindicated.
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Exercise therapy is carried out in the form of therapeutic exercises (corrective exercises). In order to reach as many children as possible suffering from scoliotic disease, corrective gymnastics classes are carried out in a group method. Individualization of therapeutic effects in the group method of training is achieved by recruiting small groups of up to 10-12 people, homogeneous in deformation, age, as well as by prescribing individual exercises and dosage. By age, children are divided into 4 groups: 5-6 year olds; 7-10 year olds; 11-13 year olds; 14-16 year olds. Children with progressive scoliosis are recommended to conduct classes individually. Corrective gymnastics classes are held 3 times a week for 30-45 minutes. The classes are divided into 3 parts.
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The preparatory part includes organizing a group for classes, formation, walking, during which various arm movements are performed, developing the muscles of the shoulder girdle and mobility in the shoulder joints, for example, swings, circular movements. Walking with straight legs raised, legs bent at the knees, squatting, “frog jump”, “elephant walk”, “bear steps”, walking on heels, on toes, on the outer edge of the foot, heel-to-toe rolls, walking at different paces and different directions (snake, backwards). Short run. Breathing exercises. Next, the exercises are performed standing in front of a mirror: general developmental exercises for the neck, lower extremities and shoulder girdle; to form and consolidate the skill of correct posture; for the prevention and correction of flat feet. The main part of the lesson. Special corrective exercises are used; respiratory; individual corrective exercises; balance exercises; exercises for general and strength endurance of the abdominal muscles, back, chest, promoting the formation of a rational muscle corset; exercises to correct leg deformities; exercises at the gymnastic wall, on the gymnastic wall; outdoor games. Corrective gymnastics is based on the principle of maximum static unloading of the spine. The most effective starting positions are lying, kneeling, kneeling. In the final part, relaxation exercises, slow walking while maintaining correct posture, and breathing exercises are used. According to indications, positional treatment is used individually.
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The duration of the various parts of the lesson depends on the physical fitness of the children, the assigned tasks, and the period of rehabilitation. The pace of exercise is usually medium and slow in exercises aimed at the strength development of individual muscle groups, as well as in exercises of a corrective nature. Therapeutic gymnastics classes should be carried out taking into account the functional state of the cardiovascular and respiratory systems, for which it is necessary to evaluate the impact of loads by shifts in heart rate and its recovery (determining the physiological curve), as well as general fitness by simple functional tests (20 squats, 30 jumps) - pulse and blood pressure. It is very important to evaluate the strength and endurance of various muscle groups during exercise using motor tests. The strength and endurance of the torso extensor muscles is judged by the time the upper body is held in weight, as well as the condition of the muscles that provide bending to the right and left. The endurance strength of the abdominal muscles is judged by the number of transitions from a supine position to a sitting position with fixed legs. Can serve as a guide standard indicators, installed for children A.M. Reizman and F.I. Bagrov: for the extensor muscles of the trunk at 7-11 years old - 1-2 minutes, at 12-16 years old - 1.5-2.5 minutes; for abdominal muscles at 7-11 years old - 15-20 movements, at 12-16 years old - 25-30 movements at a pace not exceeding 16 movements per minute. Functional test indicators provide differentiated approach to the appointment of an individual complex during therapeutic gymnastics classes.
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Therapeutic swimming occupies a significant place in the physical rehabilitation of scoliosis; its health-improving, therapeutic and hygienic significance in a child’s life cannot be overestimated. During swimming, natural unloading of the spine is ensured, and self-extension during sliding complements the unloading of the growth zones. When performing rowing movements, almost all muscle groups are consistently involved in the work, the asymmetrical work of the intervertebral muscles disappears, and the conditions for normal growth of the vertebral bodies are restored. At the same time, the muscles of the abdomen, back and limbs are strengthened, and coordination of movements is improved. Modern technique therapeutic swimming was developed by employees of the Moscow orthopedic boarding school No. 76 L.A. Borodich, R.D. Nazarova. Researchers have proven that the main swimming style for the treatment of scoliosis in children is breaststroke with an extended gliding pause, during which the spine is maximally extended and the torso muscles are statically tense. In this case, the shoulder girdle is located parallel to the surface of the water and perpendicular to the movement, the movements of the arms and legs are symmetrical, made in the same plane. With this style of swimming, the possibilities of increasing the mobility of the spine and rotational movements of the body and pelvis are minimal, which are extremely undesirable for scoliosis. Swimming crawl, butterfly and dolphin style in their pure form cannot be used in therapeutic swimming for children with scoliosis. However, elements of these styles may apply. The selection of swimming exercises takes into account the degree of scoliosis. For grade I scoliosis, only symmetrical swimming exercises are used: breaststroke, extended gliding pause, front crawl for the legs. In case of grade II-III scoliosis, the task of deformity correction dictates the use of asymmetric starting positions. Swimming in a correction position after mastering the chest breaststroke technique should occupy 40-50% of the time in the lesson. This significantly relieves the load on the concave side of the spinal curvature.
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For children with grade II-III scoliosis, the initial correction position is selected strictly individually depending on the type of scoliosis. For example, in the thoracic type of scoliosis with the apex on the 8-9th thoracic vertebra, to reduce compression on the concave side of the arch, asymmetric starting positions for the shoulder girdle are used: the arm on the concave side of the scoliosis is extended forward when swimming. In case of lumbar hyposcoliosis (apex of the curve on the 2nd-3rd lumbar vertebrae), sternolumbar type of scoliosis (top of the curve on the 12th thoracic or 1st lumbar vertebrae), asymmetric starting positions for the pelvic girdle can be used to correct the curve: when swimming, the leg on the convex side of the lumbar arch is abducted with the pelvis fixed on the board. In the case of a combined type of scoliosis with two primary curves (thoracic and lumbar), special attention is paid to correcting the thoracic curve. D.M. Tsverava (1985), in addition to traditional forms of rehabilitation, proposed using horseback riding for the treatment of postural disorders in the frontal plane and dysplastic sternolumbar scoliosis of the first degree. The effectiveness of treatment by horseback riding, according to the author, is as follows: stabilization of spinal mobility, i.e. eliminating a functional component; creating a powerful, reliable muscular corset of the torso; in teaching active correction of the torso by self-extension; eliminating stiffness in movements; developing correct posture; increasing the stability of higher nervous activity; removing the “inferiority complex”; increasing the function of the musculoskeletal, cardiovascular and respiratory systems; development of dexterity, courage, organization, internal discipline and love for animals. Equestrian sport is contraindicated for lumbar scoliosis, as it increases the torsion of the vertebrae and increases the degree of the lumbosacral arch; with sternolumbar scoliosis of the first degree, when the apex of the curvature is located below C and L2, since training of the iliopsoas muscles, intensively carried out during horse riding, has a negative effect on its course.
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Organizational treatment of scoliotic patients is divided into 3 types: outpatient treatment; treatment in specialized boarding schools; inpatient treatment. The following are subject to outpatient treatment: children with a scoliosis curve of up to 10° and torsion of 5-10° (without the described signs of progression); children with newly diagnosed scoliosis of I-III degree with complete growth, but in need of muscle training and correct posture. After training in physical exercises, increasing muscle strength endurance and establishing correct posture, children of the first group and the second group with I-II degrees of scoliosis are recommended to rationally increase physical activity in the sections of swimming, volleyball, skiing.
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Sample exercises Exercise therapy for scoliosis in children Lie on your back. Then place your hands on the back of your head. Extend your elbows to the side and then return them to their starting position. Lying on your back, bend your knees. Then alternately bring your knees to your stomach. Lie on your back and bend your knees. After this, raise the pelvis and bend in the thoracic spine. Lying on your back, lift your torso, thereby making deflections in the thoracic spine. Lying on your stomach, extend your arms along your body, palms down. Leaning on your palms, alternately lift your legs along with your torso. Lying on your back, do rotational movements legs like a bicycle. During rotations, try to bring your legs as close as possible to the floor surface without touching it. Lying on your back, perform cross movements with your legs in a horizontal and vertical plane, like scissors. Lying on your back, raise your legs together. Then spread them apart and hold in this position for several seconds. Lying on your stomach, raise your head and shoulders, holding them in this position for several seconds. In the same way, while lying on your stomach, simultaneously raise your lower limbs and upper torso, leaning on your chest. Passive traction. To do this, lying on your back, try to stretch your body as much as possible along the longitudinal axis. To do this, stretch your head up and your feet down. Lying on your stomach, imitate swimming movements with your arms and legs.
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Exercises to strengthen the muscle corset (according to T.A. Fonareva, 1980) For the back muscles: Lying on your stomach, chin on the back of your hands, placed on top of each other. 1. Raise your head and shoulders, put your hands on your waist, and connect your shoulder blades. Maintain this position at the instructor's command. 2. The same exercise, but move your hands to your shoulders or behind your head. 3. Raising your head and shoulders, slowly move your arms up, to the sides and towards your shoulders (as when swimming breaststroke). 4. Arms to the sides, back, to the sides, up. 5. Raise your head and shoulders. Hands to the side. Squeeze and unclench your hands. 6. Same as ex. 5, but perform circular movements with straight arms. Ex. Perform 1-6 with complication - delaying each movement for up to 3-4 counts. In the future, you can use weights and resistance. 7. Alternately raise straight legs without lifting your pelvis from the floor. The pace is slow. 8. Raise both straight legs and hold them for 3-5 counts. 9. 1 - raise the right leg, 2 - attach the left leg, 3-6 - hold, 7 - lower the right leg, 8 - lower the left leg. 10. Raise your straight legs, spread them, connect them and lower them into an i.p. 11. Ex. 11-13 perform in pairs, lying on your stomach opposite each other, the ball in bent arms in front of you. Rolling the ball to a partner, catching the ball while maintaining an elevated position of the head and shoulders. 12. Throw the ball to a partner. Hands up, head and chest raised, catch the ball. 13.In your hands is a gymnastic stick. Throw the stick to your partner, catch it with an overhand or underhand grip. Lying on your stomach on a gymnastic bench: 14. Raise your head, chest and straight legs. Hold this position for 3-5 counts. 15. Performing movements with arms and legs, as in breaststroke swimming. 16. Rolling a medicine ball to a partner.
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Prevention of functional scoliosis in children Choose the right mattress for your child so that it is not too hard, but not too soft either. If possible, give preference to orthopedic mattresses. Place a pillow on your child only after one year. And know that it must certainly be flat, that is, low. It is necessary to hold the baby correctly when picking him up - support his back. Try not to place your baby on one side all the time - you need to regularly alternate between the left and right sides. Do not sit your baby passively (for example, resting him on a pillow every time). He must still learn to sit on his own, that is, to firmly hold his back in an upright position. Teach your child to do any activities, such as drawing, modeling, construction sets, appliqué, only at the table. Create a correct and healthy diet for your child. This will ease the load on the spine. Provide your baby with a diet rich in minerals/vitamins (especially the spine needs: calcium, copper and zinc). Teach your child to do morning exercises. Teach your child to sit correctly at the table. Tell your child that the back of the head must be slightly raised and pulled back a little, but the chin, on the contrary, must be slightly lowered. It is important to note that in this position the blood supply to the brain improves.
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