Autor: Mgr. Iva Bílková, FYZIOklinika fyzioterapie s.r.o., Praha
This paper is the result of almost one-year’s research on the influence of Dr. BRÜGGER's Concept of Diagnosis and Therapy of Functional Disorders of the Mobile System to therapy and the treatment of scoliosis.
This study was done with a group of 17 children aged from 7 to 18 years, with 8 girls and 9 boys.
The first examination was done in June and September 2000. Diagnostic elements from Dr. BRÜGGER's Concept were used to examine scoliosis. Examination by Moiré Tomography, assessments of posture using two weight scales, and description of posture by plumb line were done for objective comparison to the research. Intensive therapy with therapeutic elements from Dr. BRÜGGER's Concept was done over a monitored period. Checking and final examination was done in October 2000 and January 2001.
Key words: BRÜGGER's Concept, scoliosis therapy
The human body is not designed for a static load. Static load can be observed, for example, when a child sits for a long time at a school-desk. In this situation, the child cannot change body position or perform any dynamic movements (quantitative phase compensation). Static load brings about poor posture and can contribute to scoliotic posture, and can finally lead to scoliosis. Previous theory has led to the belief, that the therapy from BRÜGGER's Concept should be successful for scoliosis treatment of poor posture.
Patients and Methods
Group of children examined
The group of children examined comprised of 17 patients, 9 boys, and 8 girls, aged from 7 to 18 years. None of the children had ever worn a corset and their angle of scoliosis was not over 30 degrees.
Diagnosis of and therapy for the group was performed from theory in Dr. BRÜGGER's Concept. Elements of therapy were chosen individually according to each child’s mental state, physical condition, and effects of any previous therapy, scoliosis shape, change of shape during the treatment period, pathological form of backbone, pelvis position.
All therapeutic elements from Dr. BRÜGGER's Concept were used during the whole experimental period, as follows: Agistic-eccentric contraction and exercise with Thera-Band were preferred for scoliosis treatment. The aim was correction of poor posture and normalisation of all muscle tension responsible for poor posture. Muscles responsible for correct posture were activated by the chosen therapy at the same time. Application of a warm roll, position on the back, daily living activities, global movements and Brügger-Body-Walking were also used.
It is not possible to make progress with exercises for scoliosis treatment in groups. Therapy had to be applied individually according to the shape of scoliosis. LEWIT states that no two pathological scoliosis forms are identical (LEWIT, 2000). Each session took one hour. Each child exercised three times a week for the first month and once a week in the following four months. Exercising with each child took 28 hours.
All children filled in a questionnaire containing personal details, including their birthday, type of school attended, body height, body weight, previous diseases, information about their scoliosis, family disposition to scoliosis, history of other orthopaedic conditions in their family, sport activities, out-of-school activities, how long the child usually sits, stands, lies, and moves during the whole day, what kind of clothes and shoes the child wears. Temporary and persistent destructive factors were detected. After that the child’s habitual and corrected posture, movements, „Th5 springing“ (ROCK, 1999) and pelvis position, length of lower extremities and hypertonic muscles, were examined.
Subjective analysis of data was completed with standing on two weight scales, description of posture with a plumb line, and exploration by Moiré Tomography.
In contrast to x-ray radiation, Moiré Tomography is not an invasive method. Moiré Tomography allows easy analysis, storage, and computer processing of data. Spatial composition of the trunk was determined with this method. The following vertebrae C7, Th2, Th4, Th6, Th8, Th10, Th12, L2, L4, S1, as well as the spinae iliacae posteriores superiores (SIPS) bilateral, anguli superiores et inferiores scapulae and the lateral side of spinae scapulae, were marked with 5 mm large black dots. This method allows the shape of scoliosis, the contours of the medial part of shoulder blade in transversal intersection, shift of the trunk at the frontal level, the angle between both SIPS and horizontal line, to be observed from the acquired data.
Reasons for using BRÜGGER's Concept in scoliosis treatment
1. BRÜGGER applies therapy to poor posture based on the defect activity phase and postural system (muscle imbalance).
2. It is suggested that, for example, in the case of poor posture, scoliosis starts because of base uncoordinated muscle activation (ROCK, 1999). Poor posture increases during the child’s locomotive development without quantitative phase compensation. Quantitative phase compensation is not possible for school-aged-child during kinetic progress. The selected elements from BRÜGGER's Concept should be effective for treating scoliosis formed from poor posture according to this hypothesis.
3. Dr. BRÜGGER elaborated his theory for adult patients suffering from functional disorders of the mobile system. But children with scoliosis also suffer from functional disorders of mobile system.
4. There is not any known publication about an experiment to develop Dr. BRÜGGER's Concept in application to scoliosis treatment.
5. Scoliosis treatment practiced around the late 19th and early 20th century (SCHROTT, KLAPP, etc.) may seem outdated. These methods are difficult to apply with 100% discipline, as active exercises take more than 3 hours a day. Most of these old methods don’t factor the daily living activities of a child.
Assessment of Functional Examination
Comparison between the initial and final functional examination, saw positive changes in nearly all data for all children.
Habitual holding of the pelvis and of the cervical spine improved in 5 cases, habitual holding of the chest and of the cervical spine improved in 2 cases, of the chest and of the pelvis in 3 cases, of the chest, pelvis and the cervical spine in 3 cases, cervical spine only in 2 cases and habitual holding of the chest improved in 2 cases. Thorax-lumbal lordsis progressed over 2 degrees in 3 cases.
Rotation and shift of the trunk at the frontal level, lateral flexion of the chest and rotation of the pelvis was positively affected in all cases. No changes of the shift in transversal and frontal level were detected. Optimal backbone position at the frontal and transversal level and correct position at the sagital level were also detected in 1 case and optimal backbone position at the frontal and transversal level in 1 case.
Functional test of „Th5 flexibility“ shows many destructive factors affecting flexibility of the backbone. It can be shown, that the more destructive factors affecting the child, the worse the test assessment result for that child. The worse the destructive factors, the poorer the flexibility of the backbone. The results of the Functional test „Th5 flexibility changed in all cases (100%).
Assessment of Moiré Tomography
Improvement of the pelvic position was seen in 11 cases (64,70%). In 6/11 cases (35,29%), optimal position of the pelvis at the frontal level was seen. In 5/11 cases (29,41%) a smaller degree of angle between both SIPS and the horizontal was detected. In 2 cases (11,76%) a major degree of angle between both SIPS and horizontal was detected. In 8 cases (47,05%) pathological curve of the backbone was completely improved at the frontal level, and in 5 cases (29,41%) less distance between vertebra S1 and vertebra C7 at the vertical level was detected.
Adduction and caudal position at the frontal level of the shoulder blades was detected in 12 cases (70,58%), and closer position of the shoulder blade to the thorax in 10 cases (58,82%). Worse symmetry of shoulder blades at the transversal level was detected in 2 cases (11,76%), and in 1 case there was equal asymmetry at the transversal level at the end of the treatment.
General improvement of pathological backbone curve and straightening of thorax-lumbal lordsis was seen in 16 cases out of 17.
General straightening of pathological backbone curve with optimal pelvic position at the frontal level was seen in 2 cases (11,76%).
In the assessment of functional examination, positive changes in all initially measured negative values were detected. Positive changes were detected in all cases (100%).
The measured values from Moiré Tomography could be interpreted in this way:
In cases of greater shoulder-blade position at the frontal level, it is supposed that internal rotation and protraction of shoulders also exists. Selected exercises led to harmonic activities among musculus pectoralis major, m. serratus anterior, m. latissimus dorsi, mm. supra- and infraspinatus and m. teres minor. Caudal position of the shoulder blades was reduced by activity of m. trapesius pars cranialis and m. levator scapulae and contemporaneous activity of mm. rhomboidei, m. trapezius pars medialis et caudalis and m. serratus anterior. Harmonic pelvis position at the frontal level is given by activities mm. abdominales, m. latissimus dorsi, m. quadratus lumborum, and muscles of the pelvic girdle, mm. diaphragma pelvis and m. diaphragma abdominis. Less distance between the shoulder blades to thorax at the transversal level is given by activity of m. serratus anterior, mm. rhomboidei and m. trapezius pars medialis and caudalis.
Of course, measured values can’t be evaluated only by the activities of written descriptions of muscles, but by complex muscles of the whole movement system including soft tissues closed into complex system muscle’s chains (ROCK, 1999).
There could be several reasons how scoliosis is formed based on poor posture. For example, too tight clothes and high shoe heels limit the child’s movement and constrain a child in a certain posture under gravity (LEWIT, 1990, 2000; ROCK, 1999). It leads to anteversion of the pelvis, it changes the physiological curve of the backbone at the sagital level. Anteversion of the pelvis allows the reduction of lumbal lordsis and rotation lumbal vertebras (OTAHAL, 2000). Shift in the frontal level of the lumbal part of the backbone causes the changes of position of the lumbal vertebras at the sagital and transversal level. Lateral flexion of the backbone is connected with rotation of backbone and vice versa (LEWIT, 2000).
The next theory about how scoliosis is formed discusses a child’s ontogenesis evolution. VOJTA states, that every baby is endangered with central coordination disorder, if its ontogenesis evolution wasn’t following the correct evolution strictly described by VOJTA (VOJTA, 1993, 1995). This central coordination disorder has 4 stages of development. Central coordination disorder can change poor posture in the first stage of development, after which it can develop into scoliosis. Only a small percentage of babies can be seen in practice that follow VOJTA's described evolution (NOVAKOVA, 2000). It follows, that most children are endangered with central coordination disorder.
As there hasn’t been awareness of VOJTA´s description of ontogenesis evolution in the Czech Republic, diagnosis and therapy among paediatricians and child neurologists have not detected central coordination disorder in many children with scoliosis. The effect of central coordination disorder’s pathogenesis to the formation of scoliosis is beyond the scope of this paper, although this research was initially planned as a study of scoliosis based on poor posture.
Errors in measurement cannot be ruled out by any experimental work. Errors generally produced the following problems: the immediate mental state of the child influences the postural system, subjective methods can be misjudged by the examiner, or instruments used in measurement can be incorrectly calibrated. In this research, all effects were eliminated that could have confused measured and acquired data. The same weight scales and plumb line for assessment of posture were used and calibrated before each set of measurements. All subjective methods were done by the same examiner. In this way, all subjective errors in the examination results were eliminated.
It can be said that Dr. BRÜGGER's Concept of Diagnosis and Therapy of Functional Disorders of the Mobile System has a positive effect to therapy and influences the treatment of scoliosis. It is possible to note, that this conclusion may be used as an additional extension to Dr. BRÜGGER's Concept and for extending a physiotherapist’s work. This paper may also offer a modern look at scoliosis therapy.
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