Kines I Therapy

Dubravka Ciliga Tatjana Trošt Bobić

KINESITHERAPY reviewed teaching materials

r

University of Zagreb Faculty of Kinesiology

Dubravka Ciliga Tatjana Trošt Bobić

KINESITHERAPY Reviewed teaching materials

University of Zagreb Faculty of Kinesiology Zagreb, 2013

Publisher : University of Zagreb, Faculty of Kinesiology For the Publisher: Prof. Damir Knjaz, PhD, Dean Authors: Prof. Dubravka Ciliga, PhD and Tatjana Trošt Bobić, PhD Reviewers: Prof. Branka Matković,Ph.D. University of Zagreb Faculty of Kinesiology Prim. Senka Rendulić-Slivar, Ph.D., Special hospital for medical rehabilitation Lipik Edition: 1st Internet edition URL: http://kif.hr/predmet/kin_a Date of publication on the internet: 17th January 2014 ISBN: 978-953-317-022-0 Available in the digital catalog of the National and University Library in Zagreb Copyright © 2013. University of Zagreb Faculty of Kinesiology. All rights reserved. Except for use in a review, the reproduction or utilization of this work in any form or by any electronic, mechanical, or other means, now known or hereafter invented, including xerography, photocopyng, and recording, and in any information storage and retrieval system, is forbidden without the written permission of the publisher.

FOREWORD As an area of applied kinesiology and a clinical discipline, kinesitherapy encompasses the implementation of different kinds of exercise modalities in order to rehabilitate a person. “The healing proprieties of movement“ were recognized many years ago, and has been used, in the form of kinesitherapeutic sessions in order to help people with different kinds of illness or diseases. Kinesitherapeutic programs are widely used in Physical medicine and rehabilitation (physiotherapy, physiatry, rehabilitation medicine), orthopaedics, pulmology, cardiology, neurology, geriatrics, paediatrics and many other areas of medicine. As a scientific discipline, as well as an academic field of study though within the master university program at the Faculty of Kinesiology it covers many interdisciplinary areas, primarily linked with different fields of medicine. It represents an interdisciplinary field where the basic kinesiological knowledge is linked with the knowledge of medicine in order to better understand the effects of different transformational processes on human health. This handbook is aimed at helping international students to better follow the classes and understand the part of kinesitherapy concerning the field of orthopaedics. It explains the characteristics and causes of the more common poor postures and deformities of the locomotor system. It also explains the possible approaches in correcting poor posture or slowing down the progression of deformities. Basic notes of the kinesitherapy approaches are given at the end of every chapter with the aim of introducing the students to the teaching materials that will successively be taught in the gym, during the practical lessons. Basic knowledge of functional rehabilitation of the most common sports injuries is also given. The aim of preparing this handbook/workbook is to help international students, who might not be native speakers of English, to follow the classes and better prepare for the written and oral exams. In order to make attending classes easier, space has been provided for students’ notes. In such a way, students may make a note of the professor’s explanations about the already given text. Also, at the end of each chapter there is a list of recommended reading material that might help students to enlarge their knowledge and prepare for the exam. Key questions or topics for discussion for every chapter are also given with the same aim. The intention behind the creation of this handbook/workbook was to help students to focus their attention on what is taught during the lessons, rather than only writing down the lecturer’s words. Here, systematized notes are given, and students are asked to follow the lecture actively and make additional notes of their own thoughts about the subject being taught. By doing so, the authors hope to help students to think about kinesitherapy as a specific field of applied kinesiology in which they may use new as well as already learned knowledge about transformational processes, in different rehabilitation protocols for the

loco-motor system. By using this handbook during the classes, making notes in the space provided and answering the given key questions throughout the lessons, students are encouraged to become active participants of the kinesitherapy classes. Additionally, by enlarging their knowledge using the recommended reading, students may discover knowledge beyond the given key questions and if interested, enrol in the selective module of kinesitherapy that lasts for two academic years.

CONTENTS 1. INTRODUCTION TO KINESITHERAPY 1.1. Definition of kinesitherapy 1.2. History of kinesitherapy 1.3. Objective of kinesitherapy 1.4. Basic and secondary operators in kinesitherapy 1.5. Physiotherapy 1.6. Principles of kinesitherapy 1.7. Working methods in kinesitherapy 1.8. Organizational forms of work 1.9. Indications and contraindications 2. THE HUMAN FOOT 2.1. The evolution of the foot 2.2. Functional anatomy of the foot 2.3. The arches of the foot 2.4. Flat feet 2.5. Methods for the evaluation of flat feet 2.6. Kinesitherapy for flat feet 3. FOOT 3.1. 3.2. 3.3. 3.4. 3.5. 3.6.

DEFORMATIONS Types of foot deformities Pes equinovarus Pes cavus Pes equinus Pes calcaneus Hallux valgus

4. LEG DEFORMATIONS 4.1. Genua vara 4.2. Genua valga 4.3. Genua recurvata 5. ANKLE AND KNEE INJURY REHABILITATION 5.1. Ankle injury rehabilitation 4.1.1 Functional anatomy of the ankle 4.1.2 Lateral ankle sprain 4.1.3 Degree of severity of an ankle sprain 4.1.4 Overuse injury 5.2. Knee injury rehabilitation 4.2.1 Functional anatomy of the knee

4.2.2 4.3 4.3.1 4.3.2

Knee injuries Rehabilitation protocol The acute stage of rehabilitation The functional stage of rehabilitation

6. THE HIP 6.1. Functional anatomy of the hip 6.2. Degenerative changes in the hip 6.3. Hip development 6.4. Hip luxation 6.5. Hip luxation therapy 7. LORDOTHIC AND KIPHOTIC POOR POSTURE 7.1. Upright posture 7.2. Causes of poor posture 7.3. Kyphotic poor posture and kyphosis 7.4. Lordotic poor posture and lordosis 8. SCOLIOSIS 8.1. Definition of scoliosis 8.2. Types of scoliosis 8.3. Symptoms of scoliosis 8.4. Scoliosis examination 8.5. Methods to determine the degree of the curvature 8.6. Treatment for scoliosis 9. THORACIC DEFORMITIES 9.1. Pectus carinatum 9.2. Causes of pectus carinatum 9.3. Treatment for pectus carinatum 9.4. Pectus excavatum 9.5. Causes of pectus excavatum 9.6. Treatment for pectus excavatum 10. LOW 10.1. 10.2. 10.3. 10.4.

BACK PAIN Definition of lower back pain Causes of lower back pain Possible symptoms Treatment of lower back pain

11. CERVICOBRACHIAL SYNDROME 11.1. Definition of the cervico-brachial syndrome 11.2. Causes of neck pain

11.3. Possible symptoms 11.4. Treatment of neck pain 12. TORTICOLLIS 12.1. Causes of torticollis 12.2. Symptoms of torticollis 12.3. Treatment of torticollis 13. SHOULDER INJURY REHABILITATION 13.1. Functional anatomy of the shoulder 13.2. Shoulder injuries 13.3. Traumatic shoulder injury mechanism 13.4. Overuse injury mechanism 13.5. Shoulder injury rehabilitation 14. LITERATURE

22.1.2014.

1st chapter

INTRODUCTION TO KINESITHERAPY - healing through movement -

1st chapter – Introduction to kinesitherapy

After attending the class and mastering this chapter students will be able to: • • • • •

Define kinesitherapy Describe the history and development of kinesitherapy Define the specific goals of kinesitherapy Describe the basic operators in kinesitherapy Explain the possible differences between kinesitherapy and physiotherapy • Define the principles of kinesitherapy • Discuss methods and organisational forms of work in kinesitherapy • Discuss indications and contraindications for kinesitherapy

1

22.1.2014.

1st chapter – Introduction to kinesitherapy: definition

1.1 DEFINITION OF KINESITHERAPY • Kinesitherapy - as an area of applied kinesiology and a clinical discipline, encompasses the implementation of different exercise modalities for therapeutic aims (Ciliga, 1998).

Greek words: Kinesis "κίνησις“ - movement, motion Therapeia “θεραπεία”– therapy, medical treatment

• Kinesitherapy is an interdisciplinary field that combines medical and kinesiological knowledge.

1st chapter – Introduction to kinesitherapy: definition

• Kinesitherapy is a well-estabilished discipline in kinesiology. • Physical medicine uses exercise in different rehabilitation processes (Jajić, 2000). Therefore kinesitherapy is also well-estabilished in the field of medicine.

http://www.topnews.in/health/exercise

http://www.concorde.edu/program

2

22.1.2014.

1st chapter – Introduction to kinesitherapy: definition

IS THERE ANY DIFFERENCE ? • • • • • • •

Corrective gymnastics Medical gymnastics Therapeutic gymnastics Orthopedic gymnastics Kinesitherapy Kinesiotherapy Physiotherapy

http://www.jasonwhitetherapy.com

http://www.mdsportscare.com/ aquatic-therapy

http://www.webmd.com

1st chapter – Introduction to kinesitherapy: history

1.2 HISTORY OF KINESITHERAPY • China - 2700 BC – the book Kong-Fu – elements of therapeutic gymnastics: descriptions of active, passive and combined exercises as well as massage. • The Chinese physician - Hua Tuo - medical Daoyin exercise.

• The Chinese believe that exercising is the most important factor in preventive medicine (Svetina, 2010).

3

22.1.2014.

1st chapter – Introduction to kinesitherapy: history

• In ancient India, yogis used at least 800 different breathing exercises with the aim of preventing and treating different diseases. • In ancient Greece, Hippocrates and Asklepios recommended exercise as a compulsory part of therapeutic and preventive prophylaxis. • In ancient Rome, therapeutic exercise was particularly well developed (Mathys,

http://images.trulia.com/blogimg/0/2/a /4/191364_1331336358785_o.jpg

http://www.benessere.com/remise/r emise_en_forme/bagno_turco.htm

1987).

1st chapter – Introduction to kinesitherapy: history

• Galen was a Roman physician for gladiators, often known as the first athletic team physician. • Galen organized exercise classes in specialized gyms as a part of the therapeutic treatment or prevention of different locomotor systems` problems. – among other things, in the therapeutic sessions he prescribed activities such as rowing and walking. • In the edition of "The Art of returning to health“ he wrote: "Thousands and thousands of times I returned health to patients through exercise." http://www.lookandlearn.com/historyimages/XM10058085/Galen-and-Gladiators

4

22.1.2014.

1st chapter – Introduction to kinesitherapy: history

• Abu Ali Ibn Sina (Avicenna) in his books “Canon of Medicine” and “Book of Healing”, he describes in detail the treatment and prevention of various diseases with the help of medical gymnastics.

• Nikolas Andry, a French physician who published the book “Orthopédie” in 1741, used to teach students methods of preventing and correcting deformities in children. • In 1780. the published work of Tissot of France “Medical and surgical gymnastics”, set out descriptions of various physical exercises, and their use for treating all sorts of diseases.

1st chapter – Introduction to kinesitherapy: history

• Per Henrik Ling (1776 – 1839) was a Swedish physical therapist (Physiotherapist), developer and teacher of medical-gymnastics.

http://wyattfleming.hubpages.co m/hub/Per-Henrik-Ling-10Z3H1

• Ling's system of medical gymnastics also influenced later institutions and systems. The Gymnastic Orthopedic Institute was founded in Stockholm in 1822 (Svetina, 2010).

5

22.1.2014.

1st chapter – Introduction to kinesitherapy: the objective

1.3 THE OBJECTIVE OF KINESITHERAPY • To improve health through different exercise modalities. To apply kinesiological knowledge in therapeutic sessions (Ciliga, 1998).

http://www.gazzetta.it/Fitness/Corpo_psiche

http://kiransawhney.wordpress.com/

http://www.nba.com/features

1st chapter – Introduction to kinesitherapy: the objective

• CORRECTION http://thepilateshundred.blogspot.com/20 11/04/posture-201-kyphosis.html

• REHABILITATION http://breakingmuscle.com/health-medicine/ankleinjuries-secret-preventing-and-healing-them

• PREVENTION http://www.thermalon.com/article-12arthritis-prevention.php

6

22.1.2014.

1st chapter – Introduction to kinesitherapy: operators

1.4 BASIC AND SECONDARY OPERATORS IN KINESITHERAPY 1.4.1 BASIC OPERATORS MOVEMENT - EXERCISE • STATIC • DYNAMIC

• PASSIVE • SUPPORTING • ACTIVE • ACTIVE WITH RESISTANCE

1st chapter – Introduction to kinesitherapy: operators

1.4.2 SECONDARY OPERATORS • Mechanotherapy (hidrotherapy, kinezitherapy, massage, manipulation, mobilization) • Thermotherapy • Electrotherapy • Phototherapy • Natural healthy remedies

http://www.fitandtherapy.it/massaggio% 20cervicale.php

http://www.fisiomedica.org/trattamenti

http://www.medrehab.info/medical _services/4/rehabilitation.html

7

22.1.2014.

1st chapter – Introduction to kinesitherapy: physiotherapy

1.5 PHYSIOTHERAPY •

PHYSIOTHERAPY (PT) is a field of physical medicine that uses different physical aids for therapeutic issues (Prentice, 1986; Myrer, Drapper & Durrant, 1994; Jzuluaga i sur., 1995; ajić, 2000; Monedero & Donne, 2000; Trošt, Šimek, Grubišić, 2005).

http://www.fisiomedica.org/trattamenti

http://www.fisiomedica.org/trattamenti

http://www.fisiomedica.org/trattamenti

1st chapter – Introduction to kinesitherapy: physiotherapy

• Hydrotherapy - use of water for treating illness. Using jets, hydrotherapy in the pools, underwater massage and thermal mineral baths (balneotherapy), cold baths, thalassotherapy, Hubbard tank…

• Thermotherapy - the application of heat to the body. Peripheral (paraffin, mud, thermal warm baths) and deep (therapeutic ultrasound, shortwave diathermy) thermotherapy. Kriotherapy (the application of ice to the body) may also be considered a part of thermotherapy.

http://www.operepubbliche.regione.umbri a.it/Mediacenter/FE

http://fisioterpia-salud.blogspot.com/ 2010/06/termoterapia.html

8

22.1.2014.

1st chapter – Introduction to kinesitherapy: physiotherapy

• Phototherapy – or Light therapy consists of exposure to daylight or to specific wavelengths of light. The most commonly applied are infrared rays (sunlight and solux lamp), infraviolet rays (sunlight and sun lamp) and laser. • Electrotherapy - use of various modalities of electric current (galvanism, electrostimulation, low, middle and highly frequenty current) as a medical treatment.

http://www.maquetdynamed.com/inside_sales

http://www.kingsvillehomerehab.com/modalities/el ectrotherapy.aspx

1st chapter – Introduction to kinesitherapy: physiotherapy

• Therapeutic ultrasound refers generally to any type of procedure that uses ultrasound for therapeutic benefit (HIFU). http://www.osteopathuk.co.uk/ultrasound.htm

• Magnet therapy, (magnetotherapy, or magnotherapy)- the use of static magnetic fields as a medical treatment.

http://www.fisiomedica.org/trattamenti

9

22.1.2014.

1st chapter – Introduction to kinesitherapy: principles

1.6 PRINCIPLES OF KINESITHERAPY • Principle of motivation • Principle of beginning early • Principle of exercise analysis

http://www.spala.cos.pl/91,rehabilitationand-health-care.html

• Principle of understanding the exercise • Principle of avoiding pain • Principle of progression http://besport.org/sportmedicina/hydro

1st chapter – Introduction to kinesitherapy: principles

• Principle of pragmatism • Principle of continuous exercising • Principle of active participants` involvement • Principle of persistence • Principle of avoiding monotony • Principle of following and recording the results

10

22.1.2014.

1st chapter – Introduction to kinesitherapy: working methods

1.7 WORKING METHODS IN KINESITHERAPY • • • •

Movement Exercise Sports games Elements of sports

http://health.howstuffworks.com/wellness/dietfitness/exercise/cardio-vs-weight-training.htm

http://coloradosportschiro.com/custom_cont ent/c_84976_sports_medicine.html

http://www.terviseparadiis.ee/treatment___r elaxationen/loogastused_raviden

1st chapter – Introduction to kinesitherapy: organizational forms

1.8 ORGANIZATIONAL FORMS OF WORK

Individual

http://www.webmd.com

Group exercise

http://www.gazzetta.it/Fitness/Corpo_psiche

11

22.1.2014.

1st chapter – Introduction to kinesitherapy: indications & contraindications

1.9 INDICATIONS AND CONTRAINDICATIONS 1.9.1 INDICATIONS • Areas – Cardiopulmonary – Geriatric – Neurological – Pediatric – Orthopedic – Physical medicine and rehabilitation (physiotherapy, physiatry, rehabilitation medicine)

1st chapter – Introduction to kinesitherapy: indications & contraindications

1.9.2 CONTRAINDICATIONS • • • •

infectious disease febrile status malignant disease inflammation process in the body

12

22.1.2014.

1st chapter – Introduction to kinesitherapy

QUESTIONS • What is kinesitherapy? • What is the main goal of kinesitherapy? • What are the primary and secondary operators in kinesitherapy? • Describe the principles of kinesitherapy. • How can a kinesitherapy session be organized according to the number of individuals involved? • What are the indications and contraindications for kinesitherapy? • What is the difference between a poor posture and a deformation of the locomotor system?

1st chapter – Introduction to kinesitherapy

The following additional literary titles are recommended: • Ćurković, B., Tepšić, N. (2004). Basics of kinesitherapy (in Croatian). Osnove kineziterapije. U: Ćurković i sur. (ur.) Fizikalna i rehabilitacijska medicina. Zagreb: Medicinska naklada, str. 72-73. • Mathys, F.K. (1987). The history of sports medicine (continuation and end). Olympic Review, 242, 650-653. • Mathys, F.K. (1987). The history of sports medicine (part I). Olympic Review, 241, 582-585. • Prentice, W.E. (1986). Therapeutic modalities in sports medicine. St. Louis: Times Mirror/Mosby College. • Zuluaga, M., Briggs, C., Carlisle, J., McDonald, V., McMeeken, J., Nickson, W., Oddy, P, Wilson, D. (1995). Sports Physiotherapy: Applied Science and Practice. Melbourne: Churchill Livingstone.

13

2nd chapter THE FOOT

2nd chapter – The foot

After attending the class and mastering this chapter students will be able to: • Discuss the filogenetic evolution of the human foot • Discuss the static and dynamic function of the human foot • Locate the three main weight bearing points of the foot • Describe the arches of a healthy foot • Describe flattened medial or lateral foot arches and explain the consequent foot position and Achilles tendon convexity • Define the three phases of a flattened foot • Explain the methods used for the evaluation of a flattened foot • Describe plantography and draw the different methods for the evaluation of a flattened foot on the plantogram • Discuss a possible kinesitherapy program for the correction of a flattened foot

1

2nd chapter – The foot: evolution

2.1 THE EVOLUTION OF THE FOOT • During human phylogenetic evolution, the foot has changed due to numerous factors. • The upright position has contributed to drastic changes. • The evolution is still going on. http://www.abovetopsecret.com/for um/thread315579/pg1

2nd chapter – The foot: evolution

• The foot has experienced a lot of changes, but it is still not adapted for the upright position in conditions of hard straight surfaces. • Some anatomic and functional adaptations have not yet occurred. • Footwear, being overweight and artificial surfaces have contributed to the development of flat feet.

http://www.livescience.com/19331-unknown-homininspecies-bipedalism.html

2

2nd chapter – The foot: functional anatomy

2.2 FUNCTIONAL ANATOMY OF THE FOOT

PASSIVE AND ACTIVE SUPPORT •26 bones •ligaments •muscles

http://library.thinkquest.org/J0111100/ graphics/bones2.html

2nd chapter – The foot: functional anatomy

•Active support is assured by the foot muscles and by the muscles of the lower leg.

http://www.eorthopod.com/content/foot-anatomy

http://www.projectswole.com/weight-training/the-top-5-best-calf-exercises/

3

2nd chapter – The foot: functional anatomy

THE FOOT HAS TWO BASIC FUNCTIONS: • The static function - through the talus it absorbs the whole body weight http://heart-of-light.blogspot.com/ 2009_05_01_archive.html

• The dynamic function – elastic regulator of forces acting during physical activity http://www.annsrunningcommentary.com/

2nd chapter – The foot: functional anatomy

MOVEMENTS • Plantar flexion - recently also called plantar extension because of the adapted function of the foot in an upright (bipedal) position (Keros &Pećina, 2007). • Dorsal flexion • Abduction

• Adduction • Eversion • Inversion

4

2nd chapter – The foot: functional anatomy

While standing, the foot has three weight bearing points: 1. Back contact point 2. Frontal medial contact point 3. Frontal lateral contact point

2

Lifting the heel 2 cm should arrange the body weight uniformly on all three contact points.

3

1

2nd chapter – The foot: functional anatomy

ACTIVE TRIANGLE

PASSIVE TRIANGLE

http://www.chichester-march.org.uk/html/walking.html

5

2nd chapter – The foot: the arches

2.3 THE ARCHES OF THE FOOT When the three weight bearing points are linked together, they form four 3 foot arches. 1. 2. 3. 4.

Medial longitudinal arch (10-15 mm) Lateral longitudinal arch (2-3 mm) Frontal transversal arch Back transversal arch

1

2

4 http://www.answers.com/topic/arches

2nd chapter – The foot: flat feet

2.4 FLAT FEET If the foot and lower leg muscles are weak, the arches become less pronounced (Wearing i sur., 2012; Kosinac, 2005). Their primary function as dynamic weight regulators is compromised and the foot slowly flattens. THREE PHASES OF FLATTENED FOOT

1. The muscle phase 2. The ligament phase 3. The bone phase

6

2nd chapter – The foot: flat feet

http://www.drfoot.co.uk/flat.htm

2nd chapter – The foot: flat feet

PES VARUS •Lateral longitudinal foot arch flattened •Foot inversion •Achilles tendon`s lateral convexity PES VALGUS •Medial longitudinal foot arch flattened •Foot eversion •Achilles tendon`s medial convexity

PES VARUS

PES VALGUS

7

2nd chapter – The foot: flat feet

PES PLANUS • All arches flattened

http://www.copabones.com/ankle_foot.htm

2nd chapter – The foot: flat feet assesement and evaluation

2.5 METHODS FOR THE ASSESEMENT AND EVALUATION OF FLAT FEET 1. 2. 3. 4. 5. 6. 7. 8.

Inspection Palpation X ray Gypsum contour Plantography Pedobarography Podometer Force plates

http://texashealthathlete.wordpress.co m/2011/12/08/should-i-wear-orthotics/

http://www.medicalfootgroup.com/services/advance d-diagnostics/

8

2nd chapter – The foot: flat feet assesement and evaluation

•PLANTOGRAPHY is a method used to take a foot print called a PLANTOGRAM. •Several methods are used to determine the grade of flattened feet on a plantogram (Kosinac, 2005).

Mayer`s method

2nd chapter – The foot: flat feet assesement and evaluation

42

Clark`s method

9

2nd chapter – The foot: flat feet assesement and evaluation

A

B B

C

Müller`s method

2nd chapter – The foot: flat feet assesement and evaluation

The modified Russian author`s method

10

2nd chapter – The foot: flat feet assesement and evaluation

• A FORCE PLATE – measures the distribution of the whole body weight, the centre of pressure (CP) distribution. • Static and dynamic measurements (Pedobarography). • Force plates enable: - An easier detection of a flattened transversal foot arch - Better indications for the individual construction of footwear and an insole - Prevention

http://www.thehealthybackblog.com/category/c hiropractic/chiropractor/page/10/

2nd chapter – The foot: kinesitherapy

2.6 KINESITHERAPY FOR FLAT FEET • An individual kinesitherapy program according to: - the grade of flattened feet - the flattened arch - the age • STATIC exercises (lying down position, sitting position, standing position). • DYNAMIC exercises. • Use different tools

11

2nd chapter – The foot: kinesitherapy

• The targeted muscles are: - foot muscles - lower leg muscles http://www.eorthopod.com/ content/foot-anatomy

http://www.projectswole.com/weight -training/the-top-5-best-calfexercises/

• Combine kinesitherapy and a corrective insole (active and passive treatment) (Evans & Rome, 2011; Jimenez-Ormeño et al., 2011). • Massage is not effective. http://www.chirofirst.ca/index.php?page=service_sub4

2nd chapter – The foot

QUESTIONS • Describe the foot functional anatomy. • Name and describe the foot arches and their function. • How would you interpret the Achilles’ Tendon convexity in the evaluation of flat feet? • Which are the stages of flat feet? • Which are the methods used for the evaluation of flat feet. • Explain the terms plantography and plantogram. Describe the Clark method. • Describe a kinesitherapy program for flat feet. At what age should kinesitherapy be prescribed?

12

2nd chapter – The foot

The following additional literary titles are recommended: • Evans, A. M., & Rome, K. (2011). A cochrane review of the evidence for non-surgical interventions for flexible pediatric flat feet. European Journal of Physical and Rehabilitation Medicine, 47(1), 69-89. • Jimenez-Ormeño, E., Aguado, X., Delgado-Abellan, L., Mecerreyes, L., & Alegre, L. M. (2011). Changes in footprint with resistance exercise. International Journal of Sports Medicine, 32(8), 623-628. • Wearing, S. C., Grigg, N. L., Lau, H. C., & Smeathers, J. E. (2012). Footprint-based estimates of arch structure are confounded by body composition in adults. Journal of Orthopaedic Research, 30(8), 13511354.

13

22.1.2014.

3rd chapter FOOT DEFORMATIONS

3rd chapter – foot deformations

After attending the class and mastering this chapter students will be able to: • Define the most common foot deformations • Describe the aetiology of the most common foot deformations • Describe the role of footwear in the process of foot deformation • Discuss a possible treatment for the most common foot deformations

1

22.1.2014.

3rd chapter – foot deformations

• Foot deformities have a decisive influence on the functional state of the loco-motor system, especially the lower extremities. • Pain, limited mobility of the joints. • Problems only localized in the foot or in other areas of the body. http://www.myseveralworlds.com/2007/07/11/suffering-forbeauty-graphic-photos-of-chinese-footbinding/

3rd chapter – foot deformations

3.1 TYPES OF FOOT DEFORMITIES • Congenital • Acquired – Static – Traumatic – Inflammatory

2

22.1.2014.

3rd chapter – foot deformations: acquired foot deformities

3.2 ACQUIRED FOOT DEFORMITIES Static: • Inappropriate footwear (short, tight, narrow, pointed, or high heels) that puts pressure on the feet and keeps toes in an unnatural bent and/or squashed position. • Excessive body weight • Hypokinesis, hyperkinesis

http://www.mendmeshop.com/toe/deformity-causes.php

• Traumatske: traume, saobraćajne nesreće...

• Upalne: upalne reakcije, čirevi, Mb Bürger ...

http://escapebookclub.blogspot.com/2012/05/wednesday-2nd-may-2012-snowflower-and.html

http://leviuqse.blogspot.com/2008/09/one-withjapanese-geisha-shoes.html

3

22.1.2014.

3rd chapter – foot deformations: acquired foot deformities

Traumatic: • Previous toe injuries or poor foot mechanics and movement • Partial or complete dislocation of one of the toe joints

http://www.swiga.com/blog/catalog.asp?cate=19

3rd chapter – foot deformations: acquired foot deformities

Inflammatory: • Rheumatoid arthritis • Psoriatic arthritis • Arthritis urica

http://www.health.com/health/diseases-conditions/

4

22.1.2014.

3rd chapter – foot deformations: foot deformities, pes equinovarus

3.2 PES EQUINOVARUS (clubfoot) • It is a congenital foot deformity. • Clubfoot primarily affects three bones: the calcaneus (the heel bone), talus ( the ankle bone) and the navicular bone. • Other bones can be involved as the deformity can affect the growth of the entire foot to some degree. • The foot is turned under and towards the other foot.

http://www.eorthopod.com/content/clubfoot

http://www.eorthopod.com/content/clubfoot

3rd chapter – foot deformations: pes equinovarus

• The ligaments between the bones are shortened. • The joints between the tarsal bones do not move as they should. • The bones are deformed. • A very tight stiff foot that cannot be placed flat on the ground for walking. • A child must walk on the outside edge of the foot http://www.healthofchildren.com/C/Clubfoot.html

5

22.1.2014.

3rd chapter – foot deformations: pes equinovarus

TREATMENT OF PES EQUINOVARUS: • Non surgical, conservative treatment - foot manipulation and casting, therapeutical exercise or kinesitherapy (Horn & Davidson, 2010).

http://www.eorthopod.com/content/clubfoot

• Surgical treatment

3rd chapter – foot deformations: pes cavus

3.3 PES CAVUS • Characterized by a high foot arch, as there is a fixed plantar flexion of the foot (foot extension). There is a limited dorsal foot flexion. Characteristic “non elastic” walking. Three main types of pes cavus are: 1. Pes cavovarus - seen primarily in neuromuscular disorders and in cases of unknown aetiology (idiopathic) -The front of the foot is typically plantar flexed in relation to the rear of the foot (foot extension).

http://www.healingfeet.com/blog/footcare/hi-arch-cavus-foot

6

22.1.2014.

3rd chapter – foot deformations: pes cavus

2. Pes calcaneocavus - seen primarily following paralysis of m. triceps surae due to poliomyelitis. - the calcaneus is dorsi-flexed and the front of the foot is plantar-flexed (extended). 3. Pes cavus - the calcaneus is neither dorsi-flexed or in varus, and is highly-arched due to the plantar-flexed (extended) position of the front of the foot on the rear of the foot.

3rd chapter – foot deformations: pes cavus

TREATMENT OF PES CAVUS:

• Non surgical, conservative treatment - foot orthotics - specialized cushioned footwear - stretching and strengthening of the weak muscles - osseous mobilization - massage, chiropractic manipulation of the foot - specific exercises aimed to improve the ankle strategy in maintaining balance • Surgical treatment (soft-tissue procedures , osteotomy, bone-stabilising procedures)

7

22.1.2014.

3rd chapter – foot deformations: pes equinus

3.4 PES EQUINUS • • • • •

Lack of dorsi-flexion in the ankle joint Excessive plantar-flexion (extension) in the ankle joint This creates problems during the swing phase of gait causes instability during the stance phase Typically seen in neuromuscular disorders

http://www.uni-kiel.de/orthop/kinder.html

3rd chapter – foot deformations: pes equinus

TREATMENT OF PES EQUINUS: • Non surgical, conservative treatment - strengthen the dorsal foot flexors muscles - stretch the plantar flexors (extensor) muscles - foot orthotics to control instability - botox injections (to relax spastic overactive muscles) - manipulation • Surgical treatment (lengthening the Achilles tendon and shortening the m. tibialis anterior tendon).

8

22.1.2014.

3rd chapter – foot deformations: pes calcaneus

3.5 PES CALCANEUS • • • • •

The ankle is dorsi-flexed The toes are elevated Body weight primarily borne on the heel Poor foot functionality during walking Calcaneovalgus and calcaneovarus are also possible

http://www.fachgebaerdenlexikon.de/index.php?id=2140

3rd chapter – foot deformations: treatment of pes calcaneus

TREATMENT OF PES CALCANEUS: • Non surgical, conservative treatment - stretch the dorsal foot flexor muscles - strengthen the plantar flexor (extensor) muscles - foot orthotics to control instability - manipulation • Surgical treatment (lengthening the m. tibialis anterior tendon).

9

22.1.2014.

3rd chapter – foot deformations: hallux valgus

3.6 HALLUX VALGUS • Hallux= big toe; Valgus= veering outward from the body sagittal plane. • In more severe cases, the large/big toe either overlaps or underlaps the subsequent lesser (smaller) toes especially the second one (the adjacent toe). • Commonly hereditary but it may become worse by using improperly fitting shoes and may worsen slowly over time. http://www.hygenicblog.com/2010/04/28/thera-bandexercises-beneficial-after-surgery-to-correct-hallux-valgus/

3rd chapter – foot deformations: treatment of hallux valgus

TREATMENT OF HALLUX VALGUS: • Non surgical, conservative treatment (may be passive and active or kinesitherapy). - Abduction of the large/big toe in relation to the 2nd toe (dividing the bog toe from the 2nd toe) Passive non surgical treatment: Wear night and day orthoses, anatomical and comfortable shoes (avoid pressure on the large/big toe) (Matanović i sur., 2011). Active non surgical treatment: kinesitherapy, big toe abduction in relation to the other toes. • Surgical treatment.

http://www.halluxvalgustips.com/halluxvalgus-deformity/

10

22.1.2014.

3rd chapter – foot deformations

QUESTIONS

• Name the most common foot deformations (English and Latin names). • Describe pes equinovarus and its possible treatment options. • Describe pes cavus and its possible treatment options. • Describe pes equinus and its possible treatment options. • Describe pes calcaneus and its possible treatment options. • Describe hallux valgus and its possible treatment options.

3rd chapter – foot deformations

The following additional literary titles are recommended: • Horn, B. D., & Davidson, R. S. (2010). Current treatment of clubfoot in infancy and childhood. Foot and Ankle Clinics, 15(2), 235-243. • Matanović, D. D., Vukasinović, Z. S., Zivković, Z. M., Spasovski, D. V., Bascarević, Z. L., & Slavković, N. S. (2011). Physical treatment of foot deformities in childhood. Acta Chirurgica Iugoslavica, 58(3), 113116.

11

4th chapter LEG DEFORMATIONS - the knee -

4th chapter – Leg deformations

After attending the class and mastering this chapter students will be able to: • Name and describe the three most common leg deformations • Discuss possible changes of the foot arches as a consequence of different leg deformities • Describe the possible aetiology of lower leg deformities • Name the most common causes of leg deformities • Describe the test of maximal flexion • Explain possible therapy approaches for lower leg deformities • Discuss a possible kinesitherapy program for the correction of genua vara, genua valga and genua recurvata

1

4th chapter – Leg deformations

• The deformations may include the knee, the distal part of the upper and the proximal part of the lower leg (Fabry, 2010). - Genua vara, crura vara (O knees/bandy-legged) - Genua valga (X knees/knock-kneed) - Genua recurvata (knee hyperextension) • Knee injuries include traumas of the collateral ligaments, cruciate ligaments, kneecup, menisci… (Bartel, Davy, Keaveny, 2006).

4th chapter – Leg deformations: genua vara, crura vara

4.1 GENUA VARA, CRURA VARA • O KNEES (bandy-legged) • They are related to the flatness of the lateral longitudinal arch of the foot. • Lateral convexity.

2

4th chapter – Leg deformations: genua vara, crura vara

ETIOLOGY • Congenital deformation • Acquired deformation

• Usually both legs are affected • Rarely one leg (bad femur reposition)

Špišić, 1952

4th chapter – Leg deformations: genua vara, crura vara

It may affect the distal part of the upper leg or the proximal part of the lower leg. • Genua vara – the deformity is in the distal part of the upper leg. • Crura vara – the deformity is in the proximal part of the lower leg.

3

4th chapter – Leg deformations: genua vara, crura vara

SYMPTOMS: • The functional capacity of the legs is reduced. • Muscle fatigue.

• Pain may encompass the area of the lower leg, upper leg, hips and lumbar spine. • School children with severe deformities should be spared the activities of jumping and running for long periods of time.

4th chapter – Leg deformations: genua vara, crura vara

THERAPY:

• Conservative • Operative (surgery) CONSERVATIVE TREATMENT: • Anti-rachitic therapy • Ultraviolet rays • Passive correction (corrective tracks, braces) • Kinesitherapy Walking on the inner side of a corrective board designed in the shape of the letter «V».

4

4th chapter – Leg deformations: genua valga

4.2 GENUA VALGA (CRURA VALGA) • X KNEES (knock-kneed) • They are related to the flatness of the medial longitudinal arch of the foot. • Medial convexity. • More usual in women.

4th chapter – Leg deformations: genua valga

POSSIBLE CAUSES: • • • • • • • •

Špišić, 1952

Vitamin D deficiency Heredity Different professions Sport Overweight Static loads Inflammatory processes Bad re-setting of a fractured femur

5

4th chapter – Leg deformations: genua valga

THERAPY: • Conservative • Operative CONSERVATIVE TREATMENT: • Anti-rachitic therapy • Passive correction (corrective tracks, braces) • Kinesitherapy Walking on the outer side of a corrective board designed in the shape of the letter «A».

4th chapter – Leg deformations: test of maximal flexion

TEST OF THE MAXIMAL FLEXION

A person lies in a prone position with one knee flexed. If the projection of the heel falls: • In the middle of m. gluteus – no deformation • Outside m. gluteus of the flexed leg - X knees (knock-kneed) • On the m. gluteus of the extended leg – O knees (bandy-legged)

6

4th chapter – Leg deformations: genua recurvata

4.3 GENUA RECURVATA • KNEE HYPER-EXTENSION

Špišić, 1952

Špišić, 1952

• The convexity is located on the back part of the leg. • The deformity may be bilateral or only one leg may be affected. • It may be acquired or congenital.

4th chapter – Leg deformations: genua recurvata

• CAUSES OF CONGENITAL GENUA RECURVATA:

1. Lack of the kneecup, hypoplasia and/or dysplasia of the kneecup 2. Fetal myodystrophy of the quadriceps femoris muscle 3. Hereditary causes

Špišić, 1952

Špišić, 1952

Špišić, 1952

7

4th chapter – Leg deformations: genua recurvata

THERAPY: • Conservative • Operative CONSERVATIVE TREATMENT: • Anti-rachitic therapy • Passive correction (corrective tracks, braces) • Kinesitherapy Strenghtening the flexors of the lower leg.

4th chapter – Leg deformations

QUESTIONS • Describe the knee functional anatomy. • Name the most common knee deformations (English and Latin names with convexity and concavity sides). • What are the characteristics of genua vara and how does this deformation affect the foot arches? • What are the characteristics of genua valga and how does this deformation affect the foot arches? • What are the causes of genua recurvata? • What do the terms hypoplasia and dysphasia mean? How are they linked with a knee deformation? • Describe the test of maximal flexion. • Describe a kinesitherapy program for the studies’ knee deformations. At what age should they be prescribed?

8

4th chapter – Leg deformations

The following additional literary titles are recommended: • Bartel, D.L., Davy, D.T., Keaveny, T.M. (2006). Orthopaedic Biomechanics: Mechanics and Design in Musculoskeletal Systems / Edition 1. Prentice Hall publisher. • Fabry, G. (2010). Clinical practice: Static, axial, and rotational deformities of the lower extremities in children. European Journal of Pediatrics, 169(5), 529-534.

9

22.1.2014.

5th chapter ANKLE AND KNEE INJURY REHABILITATION

5th chapter – Ankle and knee injury rehabilitation

After attending the class and mastering this chapter students will be able to: • Discuss the specificity of passive and active ankle stabilizers with regard to the risk of ankle injury • Describe the mechanism of lateral and medial ankle injury • Explain the difference between an acute ankle injury and an overuse injury • Define the symptoms of an ankle sprain of 1st, 2nd and 3rd grade • Discuss the specificity of passive and active knee stabilizers with regard to their mechanisms of injury • Define a knee injury according to the number of injured tissues • Discuss the reasons for the more usual anterior cruciate ligament tear in women than in men • Define the difference between artography and arthroscopy • Explain the main goal of the acute stage of the rehabilitation protocol after an ankle or knee injury • Explain the phases of the RICE method used in the acute stage of rehabilitation • Define the four main goals of the functional stage of the rehabilitation protocol after an ankle or a knee injury • Discuss the possible progression in a functional rehabilitation after a lateral ankle sprain or a knee injury • Describe the specificities of kinesitherapy in the acute stage of the rehabilitation protocol as well as during the functional stage

1

22.1.2014.

5th chapter – Ankle and knee injury rehabilitation: functional anatomy of the ankle

5.1 ANKLE INJURY REHABILITATION 5.1.1 FUNCTIONAL ANATOMY OF THE ANKLE • The true ankle joint is composed of 3 bones: the tibia the fibula and the talus. • The sub-talar joint is under the true ankle joint and consists of the talus on top and calcaneus on the bottom.

http://www.scoi.com/anklanat.htm

5th chapter – Ankle and knee injury rehabilitation: functional anatomy of the ankle

• The true ankle joint is responsible for the plantar and dorsal flexion of the foot.

• The sub-talar joint is responsible for the inversion and eversion of the foot.

DORSAL FLEXION

EVERSION

PLANTAR FLEXION

INVERSION

2

22.1.2014.

5th chapter – Ankle and knee injury rehabilitation: functional anatomy of the ankle

• The lateral malleolus is long and narrow, while the medial is short and wide. • Such bone anatomy of the true ankle joint makes it unstable during movements of plantar flexion and inversion.

5th chapter – Ankle and knee injury rehabilitation: functional anatomy of the ankle

• On the lateral side: the talofibular ligaments.

• On the medial side: the deltoid ligament.

LATERAL VIEW

http://www.bartleby.com/107/95.html

MEDIAL VIEW

3

22.1.2014.

5th chapter – Ankle and knee injury rehabilitation: lateral ankle sprain

5.1.2 LATERAL ANKLE SPRAIN • A sprain is the most frequent joint injury (Frontera, 2003) • The real ankle joint (ankle sprain) • 15% medial sprain http://morphopedics.wikidot.com/la teral-ankle-sprain

• 85% lateral sprain • The anterior talofibular ligament (Janković & Trošt, 2004)

http://www.webbfitness.net/training-andsports-medicine

5th chapter – Ankle and knee injury rehabilitation: lateral ankle sprain

• The mechanism of a lateral ankle sprain describes a plantar flexion (extension) and inversion of the foot.

http://drseanmiller.wordpress.com/category/cold-laser/

http://www.dubinchiro.com/features/ankle1.html

4

22.1.2014.

5th chapter – Ankle and knee injury rehabilitation: lateral ankle sprain

• foot inversion – lateral ankle sprain – talofibular ligament.

http://docpods.com/lateral-ankle-ligament-sprain

• Foot eversion – medial ankle sprain – deltoid ligament.

http://docpods.com/lateral-ankle-ligament-sprain

5th chapter – Ankle and knee injury rehabilitation: lateral ankle sprain

• A possible cause for the more frequent lateral ankle sprain may be found in the weak dorsal foot flexors compared to the plantar foot flexors (extensors) muscles. • In the rehabilitation process after an ankle sprain the m. peroneus and m. tibialis anterior should be strengthened.

5

22.1.2014.

5th chapter – Ankle and knee injury rehabilitation: lateral ankle sprain

5.1.3 DEGREE OF SEVERITY OF AN ANKLE SPRAIN • Grade I - stretch and/or minor tear of the ligament without laxity (loosening).

5th chapter – Ankle and knee injury rehabilitation: lateral ankle sprain

• Grade II – partial tear of ligament and some laxity

6

22.1.2014.

5th chapter – Ankle and knee injury rehabilitation: lateral ankle sprain

• Grade III - complete tear of the affected ligaments (very loose)

5th chapter – Ankle and knee injury rehabilitation: lateral ankle sprain

http://www.aafp.org/afp/2001/0101/p93.html

7

22.1.2014.

5th chapter – Ankle and knee injury rehabilitation: lateral ankle sprain

• Symptoms (Wolfe i sur., 2001): Sign/symptom

Grade I

Grade II

Grade III

Tendon

No tear

Partial tear

Complete tear

Loss of function

Minimal

Some

Great

Pain

Minimal

Moderate

Severe

Swelling

Minimal

Moderate

Severe

Bruising

Usually not

Frequently

Yes

Difficulty bearing weight

No

Usually

Almost always

• The duration and the content of the rehabilitation process changes depending on the ankle sprain grade.

5th chapter – Ankle and knee injury rehabilitation: lateral ankle sprain

5.1.4 OVERUSE INJURY • tendinitis • bursitis • stress fractures

http://orthoinfo.aaos.org/topic.cfm?topic=a00379 http://www.coreconcepts.com.sg/mcr/when-isachilles-tendonitis-not-achilles-tendonitis-whenit-is-retrocalcaneal-bursitis/

• Causes: poor posture or foot deformations, hard surfaces, bad footwear, excessive-training, hormonal factors…

8

22.1.2014.

5th chapter – Ankle and knee injury rehabilitation: functional anatomy of the knee

5.2 KNEE INJURY REHABILITATION 5.2.1 FUNCTIONAL ANATOMY OF THE ANKLE The meniscii have several functions: l

Stability - As secondary stabilizers, the intact meniscii interact with the stabilizing function of the ligaments. s

Lubrication and nutrition - The meniscii act as spacers between the femur and the tibia. By doing so, they prevent friction between these two bones and allow for the diffusion of the normal joint fluid and its nutrients. i

Shock absorption - lower the stress applied to the articular cartilage, and thereby have a role in preventing the development of degenerative arthritis.

5th chapter – Ankle and knee injury rehabilitation: functional anatomy of the knee

• The hamstring muscles control the tibial anterior shift preventing the anterior cruciate ligament (ACL) from tearing (Fellenberg i sur., 2000).

http://www.daviddarling.info/encyclopedia/H/ham string_muscles.html

http://www.daviddarling.info/encyclopedia/H/hamstring_muscles.html

9

22.1.2014.

5th chapter – Ankle and knee injury rehabilitation: knee injuries

5.2.2 KNEE INJURIES • Isolated: only one element injured • Combined: two elements injured • Complex trauma of the knee joint: three or more elements injured

5th chapter – Ankle and knee injury rehabilitation: knee injuries

• Example of a complex trauma of the knee joint.

10

22.1.2014.

5th chapter – Ankle and knee injury rehabilitation: knee injuries

• The medial meniscus is more movable than the lateral. It could be injured during the internal rotation of the lower leg accompanied by knee flexion.

• The lateral meniscus could be injured during the external rotation of the lower leg accompanied by knee flexion

http://www.aclsolutions.com/theacl_3.php

5th chapter – Ankle and knee injury rehabilitation: knee injuries

• The rehabilitation protocol of an injured meniscus, and especially the kinesitherapy part differs depending on the surgical modalities.

http://www.aclsolutions.com/theacl_3.php

http://www.aclsolutions.com/theacl_3.php

11

22.1.2014.

5th chapter – Ankle and knee injury rehabilitation: knee injuries

• Mechanism of medial knee injuries

http://www.physioroom.com/injuries/knee/medial_collateral_ligament_sprain_full.php

5th chapter – Ankle and knee injury rehabilitation: knee injuries

• Mechanism of lateral knee injuries

http://www.physioroom.com/injuries/knee/lateral_collateral_ligament_sprain_full.php

12

22.1.2014.

5th chapter – Ankle and knee injury rehabilitation: knee injuries

ACL (anterior cruciate ligament) tear • happens more frequently in women (Wahl i sur., 2012).

http://louisvilleorthopedics.com/libr ary/patient-education/acl-tears/

http://www.nismat.or g/ptcor/female_knee/

5th chapter – Ankle and knee injury rehabilitation: knee injuries

Knee examination • X-RAY EXAMINATION – painless test that uses a small amount of radiation to make an image of the joint. • ULTRASOUND EXAMINATION - painless test that uses ultrasound technology to make an image of the joint. • MRI (magnetic resonance imaging) – a technique that uses a magnetic field and radio waves to create detailed images in slices of the examined joint. 3D images may also be produced.

• CT (computed tomography) - a radiologic imaging that uses computer processing to generate an image of tissue density in slices through the examined joint. • ARTHROSCOPY - a minimally invasive surgical procedure.

13

22.1.2014.

5th chapter – Ankle and knee injury rehabilitation: rehabilitation protocol

5.3 THE REHABILITATION PROTOCOL The rehabilitation protocol consists of two main stages (Frontera, 2003):

1. The acute stage 2. The functional stage • The main goal of the acute stage is to prevent bruising, swelling and to maintain the joint’s range of motion.

5th chapter – Ankle and knee injury rehabilitation: rehabilitation protocol, the acute stage

5.3.1 THE ACUTE STAGE OF REHABILITATION • The RICE method R - rest I - ice C - compression E - elevation

http://www.physiosupplies.com.au/fitness/AircastCyrocuff-Cooler.html

• In the acute stage, methods using warmth or massage should not be applied (Knight i sur., 1995; Wolfe, Tim & McCluskey, 2001).

14

22.1.2014.

5th chapter – Ankle and knee injury rehabilitation: rehabilitation protocol, the acute stage

• In the acute stage, weight bearing should be avoided or minimal (use of crutches). • Dynamic Knee/ankle orthosis should be used at the beginning of the rehabilitation.

http://www.braceshop.com/productcart/pc/Baue rfeind-CaligaLoc-Ankle-Brace-17p884.htm

• The injured athlete has to walk as normally as possible. http://www.shustuff.com/Catalogue.htm

5th chapter – Ankle and knee injury rehabilitation: rehabilitation protocol, the functional stage

5.3.2 THE FUNCTIONAL STAGE OF REHABILITATION • It can begin immediately after the injury and it lasts until the injured athlete can perform without pain (Renstrom, 1994; Frontera, 2003). • Consequences of an improper rehabilitation: diminished movement amplitude, chronic pain, chronic swelling, chronic instability… • Long-lasting immobilisation is a frequent mistake.

15

22.1.2014.

5th chapter – Ankle and knee injury rehabilitation: rehabilitation protocol, the functional stage

The four main goals of the functional stage 2003).

(Renstrom, 1994; Frontera,

1. Complete recovery of the full range of motion without pain, 2. Progressive muscle strengthening 3. Restoration of neuromuscular coordination 4. A gradual return to everyday activities • The RETURN TO PLAY CRITERIA are based on the satisfaction of these aims (Trošt Bobić & Rakovac, 2010).

5th chapter – Ankle and knee injury rehabilitation: rehabilitation protocol

Exercise modalities used in the functional stage

• Stretching exercises • Strength exercise • Proprioception, balance exercise • Agility, plyometric exercises • Running exercises

• Specific exercises

16

22.1.2014.

5th chapter – Ankle and knee injury rehabilitation

QUESTIONS • Why does a lateral ankle sprain happen more often than a medial one? • How long does the rehabilitation of an ankle sprain of the 1st, 2nd and 3rd grade last? • Name an acute injury and an overuse injury of the ankle and the knee. • Explain the difference in the aetiology of an acute injury and an overuse injury. • Describe the mechanisms of a lateral ankle sprain. Is the mechanism of a medial ankle sprain more often contact or non-contact? • Describe the mechanisms of an anterior cruciate ligament tear. • How can a knee injury be defined according to the number of injured elements? • Which muscles control the anterior tibial shift? And what ligament? • What are the two main phases of a rehabilitation protocol and what are their goals? • What does the RICE method encompass? • Describe the kinesitherapy exercise progression in the functional phase of rehabilitation of an ankle and knee injury.

5th chapter – Ankle and knee injury rehabilitation

The following additional literary titles are recommended: • Phisicians, 1;63(1), 93-105. Fellenberg, J., Mau, H., Nedel, S., Ewerbeck, V., & Debatin, K. (2000). Hamstrings and iliotibial band forces affect knee kinematics and contact pattern. Journal of Orthopaedic Research, 18(1), 101-108. • Frontera, W.R. (2003). Rehabilitation of sports injuries. Malden: Blackwell Scientific Publications. • Knight, K.L. (1995). Initial care of acute injuries: the RICE technique. In: Cryotherapy in sport injury management. Champaign, Il.: Human Kinetics. • Pećina,M., Bojanić, I. (2003).Overuse injuries of the musculoskeletal system. Boca Raton, London, New York, Washington D.C.: CRC Press. • Renstrom, P.A.F.H. (1994). Clinical practice of sports injury prevention and care. Oxford: Blackwell Scientific Publications. • Wahl, C. J., Westermann, R. W., Blaisdell, G. Y., & Cizik, A. M. (2012). An association of lateral knee sagittal anatomic factors with non-contact ACL injury: Sex or geometry? Journal of Bone and Joint Surgery - Series A, 94(3), 217-226. • Wolfe, M.W., Tim, L. i McCluskey, L.C. (2001). Management of ankle sprain. American Family Physician, 63, 93-104. • Wolfe, M.W., Uhl, T.L., Mattacola, C.G., McCluskey, L.C. (2001). Management of ankle sprains. American Family

17

22.1.2014.

6th chapter THE HIP

6th chapter – The hip

After attending the class and mastering this chapter students will be able to: • Describe the functional anatomy of the hip and discuss it with regard to a possible hip luxation • Explain the possible causes of an acquired hip luxation • Explain the possible causes of a congenital hip luxation • Describe the symptoms of a hip luxation • Discuss possible treatment options for a hip luxation • Describe the principles of passive corrective tools used in hip luxation • Discuss a possible kinesitherapeutic program for a hip luxation according to the existing symptoms

1

22.1.2014.

6th chapter – The hip: functional anatomy

6.1 FUNCTIONAL ANATOMY OF THE HIP • The hip is a multiaxial joint • The convex surface is the femoral head, while the concave surface is the acetabulum. • Flexion, extension, abduction, adduction, rotation, circumduction. http://www.adventistrehab.com/adam/Surgery %20and%20Procedures/13/100006.html

6th chapter – The hip: functional anathoy

http://www.netterimages.com/image/4654.htm

2

22.1.2014.

6th chapter – The hip: osteophytes

6.2 OSTEOPHYTES • When on the femoral head ostheophytes form, (bone growth) then arthrosis begins. • Osteophytes form because of excessive loadings, especially in sport. The cartilage reacts with the production of bone nodules.

Ostheophytes http://www.museumoflondon.org.uk/Collections-Research/LAARC/Centre-forHuman-Bioarchaeology/Resources/Photographs/bermondseyabbey.htm

http://www.flickr.com/photos/museumoflondon/3239465304/

6th chapter – The hip: development

6.3 HIP DEVELOPMENT The acetabulum of a newborn child is very shallow, and its shape is modified under the influence of standing and walking. 1st year 42% 2nd year 54% 5th year 100% http://www.fyp.emmettconroy.com/site/about-ddh?page=2

The constant contact of the two joint surfaces brings about the lowering of the acetabulum causing a better joint development and stabilization.

3

22.1.2014.

6th chapter – The hip: luxation

6.4 HIP LUXATION If the hip development does not follow this dynamic a hip luxation may happen. 1. Congenital luxation (developmental hip damage)- more often bilateral (40%). Unilateral luxation happens more often on the left side and in women (Noordin et al., 2010). 2. Acquired luxation – after different diseases or accidents …

©Roche lexikon Medizin, 4. Aufl. Urban & Fischer, 1999

6th chapter – The hip: luxation

Two main reasons of hip luxation: 1. Dysplasia – deformity of the developing hip (Developmental Dysplasia of the Hip – DDH) - Irregular growth of the femoral head - Irregular growth of the acetabulum

2. Hypoplasia – insufficient development of the joint surfaces - Insufficient growth of the femoral head - Insufficient growth of the acetabulum

4

22.1.2014.

6th chapter – The hip: luxation

Possible symptoms of a luxated hip: 1. Hip and knee flexed, emphasized adduction of the upper leg, external rotation of the foot 2. Spinae iliacae anterior superior are not at the same level (at the same line) 3. Limited abduction 4. Limited internal rotation of the foot 5. Limited leg extension 6. Joint crepitation 7. Assimetrical gluteal crease 8. Walking ploddingly 9. Increased lumbar lordosis

6th chapter – The hip: therapy

6.5 HIP LUXATION THERAPY Possible options: 1. Conservative 2. Surgical

• Hip dysplasia is treated surgically. • Hip hypoplasia is firstly treated with conservative therapy (Ihme i sur., 2003). In hypoplasia, if the acetabulum develops properly by the third year, the conservative treatment is considered successful.

5

22.1.2014.

6th chapter – The hip: therapy

Different equipment is used in conservative treatment: Abduction pants Pavlic harness Abduction pillow Different hip splints

http://www.marwell.cz/en/vyhody.htm

http://www.shopmedvet.com/product/hippillow-abduction-large-each/closeoutproducts-closeout-orthopedic-products

http://www.hellotrade.com/trulifeireland/orthotics-hip-dynamic-hip-splint.html

http://fyp.emmettconroy.com/sites/default/files/ima gecache/add-image-500px/Pavlik%20Farness.jpg

6th chapter – The hip: therapy

• An early diagnosis is crucial (Homer i sur., 2000). • The optimal relation between the femoral head (convex joint surface) and the acetabulum (concave joint surface) is 90° angle.

• This position helps to ensure the closure of the acetabulum.

http://www.emedicinehealth.com/script/main/art.asp ?articlekey=135633&ref=128554

6

22.1.2014.

6th chapter – The hip: therapy

• Referring to luxation, there are some muscles contractures: - Flexors of the leg - Adductors of the leg - External rotators of the foot KINESITHERAPY - Leg extension - Leg abduction - Foot internal rotation

6th chapter – The hip

QUESTIONS • Describe the hip functional anatomy. • Describe the difference between an acute hip luxation and arthritic changes of the hip. • How do we divide a hip luxation, according to its aetiology? • What are the causes of an acquired hip luxation? • How may hypoplasia or dysphasia cause a hip luxation? • Describe the position of the leg on the side of the luxated hip. • Which movements are limited in the luxated hip? • Describe a kinesitherapy program for the rehabilitation of a hip luxation.

7

22.1.2014.

6th chapter – The hip

The following recommended:

additional

literary

titles

are

• Homer, C. J., Baltz, R. D., Hickson, G. B., Miles, P. V., Newman, T. B., Shook, J. E., Sunshine, P. (2000). Clinical practice guideline: Early detection of developmental dysplasia of the hip. Pediatrics, 105(4 I), 896-905. • Ihme, N., Schmidt-Rohlfing, B., Lorani, A., & Niethard, F. U. (2003). Nonsurgical treatment of congenital dysplasia and dislocation of the hip. [Die konservative therapie der angeborenen hüftdysplasie und-luxation] Orthopade, 32(2), 133-138. • Noordin, S., Umer, M., Hafeez, K., Nawaz, H. (2010). Developmental dysplasia of the hip. Orthopedic Reviews, 23;2(2):e19.

8

22.1.2014.

7th chapter Lordotic and kyphotic poor posture

7th chapter – Lordotic and kyphotic poor posture

After attending the class and mastering this chapter students will be able to: • Define the function of active and passive spine stabilizers in maintaining an upright posture • Distinguish a good from a bad posture • Name the possible causes for a poor posture • Discuss critical life periods for the development of a poor posture • Describe the symptoms of a kyphotic and lordotic poor posture • Discuss the difference between a lordotic poor posture and lordosis as a spine deformation • Discuss the difference between a kyphotic poor posture and kyphosis as a spine deformation • Discuss possible treatment for kyphotic and lordotic poor posture • Define the role of kinesitherapy in the treatment of kyphotic and lordotic poor posture • Give basic guidelines for a kinesitherapy program for the correction of kyphotic and lordotic poor posture

1

22.1.2014.

7th chapter – Lordotic and kyphotic poor posture: upright posture

7.1 UPRIGHT POSTURE • Active and passive stabilizing elements  ACTIVE – muscles  PASSIVE– bones, joints, tendons

Changes occur under the influence of exercising and aging • The quality of these elements depends on their flexibility, stength etc.

7th chapter – Lordotic and kyphotic poor posture: upright posture

• The human spine has a “double S” shape in the sagittal plane. • This is very important for the human spine’s biomechanics. • It is necessary to differ physiological from pathological posture. The limit of differentiation: – Toracal kyphosis – Lumbar lordosis

2

22.1.2014.

7th chapter – Lordotic and kyphotic poor posture: upright posture

• The stability and existence of sagital human spine curvatures are determined by the interaction of : – The bones – The ligaments – The muscles

http://soshable.com/tag/human-evolution-and-social-media/

7th chapter – Lordotic and kyphotic poor posture: upright posture

PHYSIOLOGICAL SPINE CURVATURES • ...? lordosis

• ...? kyphosis • ...? lordosis When these curves become smaller or bigger, a poor posture, or a deformation may occur. http://nicktumminello.com/2010/05/an-inside-look-at-spinalosteoporosis-scoliosis-and-osteophytosis/

3

22.1.2014.

7th chapter – Lordotic and kyphotic poor posture: upright posture

• The correct relation between the different parts of the body leads to a GOOD POSTURE This means a correct relation between :

 639 muscles  206 bones  Dozens of organs  Hundreds of nerves  5 litres of blood http://www.medpedia.com/news_analysis/388-Sanodox/entries/79104Improving-Posture-and-Ergonomics

7th chapter – Lordotic and kyphotic poor posture: causes for poor posture

7.2 CAUSES OF POOR POSTURE Different factors may play a role in the creation of a poor posture (Ku et al, 2012). • The weakness or tension of certain muscle groups • A non-rehabilitated injury • The illness of organs or different body parts and the nutritional state • Osteoporosis • Different psychological conditions e.g. fatigue • Heredity • Improper shoes

4

22.1.2014.

7th chapter – Lordotic and kyphotic poor posture: causes for poor posture

• The line that differs a good from a bad posture

http://artshineqc.blogspot.com/2011/07/week-six-posture-stretching.html

7th chapter – Lordotic and kyphotic poor posture: causes for poor posture

• Muscles play a major rule in the maintenance of a human’s upright body posture. • Leg, hip, abdominal and back muscles, as well as the ligamentar and bones’ structures work against gravity. • In conditions of fatigue (long lasting standing or sitting) the body relaxes and a poor posture habit may originate.

http://symmetrygymdubai.com/blog/

5

22.1.2014.

7th chapter – Lordotic and kyphotic poor posture: causes for poor posture

There are several critical life periods for the development of poor posture (Gonçalves & Arezes, 2012). • First – 1st and 2nd year (start to walk) • Second –5 - 7 years of age (a child starts school)

• Third – puberty (sudden growth) • Fourth – at a later age (sarcopenia, different diseases etc.)

7th chapter – Lordotic and kyphotic poor posture: causes for poor posture

• There are three different poor postures i.e. deformations:

http://www.ivline.info/2010/10/clinical-examination-of-spine.html

http://www.richmondchiro.net/health-conditions/scoliosis/

6

22.1.2014.

7th chapter – Lordotic and kyphotic poor posture: kyphotic poor posture and kyphosis

7.3 KYPHOTIC POOR POSTURE AND KYPHOSIS • The curvature of the physiological thoracal kyphosis grows in the anteroposterior plane. • The muscles of the back are elongated, while the muscles of the frontal part of the trunk are shortened. • The convexity is in the back.

http://www.activeforever.com/a-2620-kyphosis.aspx

7th chapter – Lordotic and kyphotic poor posture: kyphotic poor posture and kyphosis

• Kyphotic poor posture often affects skinny people, often boys. • It mostly begins at the level of the 5th thoracic vertebra. • It can be cured/improved with kinesitherapy and wearing different corsets.

http://thepilateshundred.blogspot.com/2011/04/posture-201-kyphosis.html

7

22.1.2014.

7th chapter – Lordotic and kyphotic poor posture: kyphotic poor posture and kyphosis

KYPHOTIC POOR POSTURE • No structural deformation of the spine • Flexible (changes with muscular contraction)

http://accessdanceforlife.com/blog/

7th chapter – Lordotic and kyphotic poor posture: kyphotic poor posture and kyphosis

SYMPTOMS of kyphotic poor posture: • Trunk anteflexion (arcus posterior) • Head lowered towards the chest • Rounded shoulders • Chest retracted • Outlined abdomen

• Reduced neck lordosis • Emphasized lumbar lordosis • Knees slightly flexed • Pelvis reclination

http://www.aurorabaycare.com/healthinfo/display.aspx?URL=432311.html

8

22.1.2014.

7th chapter – Lordotic and kyphotic poor posture: kyphotic poor posture and kyphosis

Treatment of kyphotic poor posture (Kado, 2009; Lou i sur., 2002).

KINESITHERAPY • Mirror correction of poor posture • Strengthen the back muscles • Strengthen the abdominal muscles if necessary • Stretch the pectoral muscles PASSIVE CORRECTION … ?

7th chapter – Lordotic and kyphotic poor posture: kyphotic poor posture and kyphosis

Špišić, 1952

http://www.farosmedikal.com/page3.php

9

22.1.2014.

7th chapter – Lordotic and kyphotic poor posture: kyphotic poor posture and kyphosis

KYPHOSIS (as a structural deformation) may be congenital and acquired CAUSES: • Weak back muscles • Different rheumatoidal illnesses • A progressive muscular illness • Tumours • Long lasting immobilization • Rachitis • Senile kyphosis • Abnormal vertebra shape

http://www.orthoneuro.com/medical-conditions/kyphosis

7th chapter – Lordotic and kyphotic poor posture: kyphotic poor posture and kyphosis

THE WEDGED VERTEBRA A vertebra with an abnormal shape Situated in the middle of the curvature The wedged side is turned towards the concavity

http://www.sdspineinstitute.com/index.php/site/conditions/category/kyphosis/

http://chospine.com/2011/02/09/compressionfracture/

10

22.1.2014.

7th chapter – Lordotic and kyphotic poor posture: kyphotic poor posture and kyphosis

According to the shape and location we distinguish: • Low kyphosis • High kyphosis

http://www.working-well.org/articles/bounce_ball.html

• Partial kyphosis • Total kyphosis

7th chapter – Lordotic and kyphotic poor posture: lordotic poor posture and lordosis

7.3 LORDOTIC POOR POSTURE AND LORDOSIS • Increased lumbar lordosis. • Elongated abdominal muscles and shortened back muscles. • The convexity is forward. http://www.healthopedia.com/pictures/lordosis.html

11

22.1.2014.

7th chapter – Lordotic and kyphotic poor posture: lordotic poor posture and lordosis

• A shortened iliopsoas (m. psoas maior and m. iliacus) may cause lordotic poor posture

http://doubleyourgains.com/amazing-abs-101-core-training-system

7th chapter – Lordotic and kyphotic poor posture: lordotic poor posture and lordosis

SYMPTOMS of lordotic poor posture: • • • • • • •

Trunk retroflexion (arcus anterior) Enhanced lumbar and neck lordosis Head retroflexed Shoulders rounded backward Outlined abdomen Pelvis anterior rotation Knees slightly flexed http://www.spineuniverse.com/conditions/ osteoporosis/spinal-fracturesspondylolisthesis-scoliosis

12

22.1.2014.

7th chapter – Lordotic and kyphotic poor posture: lordotic poor posture and lordosis

Treatment of lordotic poor posture

KINESITHERAPY • Mirror correction of poor posture • Strengthen the abdominal muscles • Strengthen the paravertebral musculature • Stretch back muscles • Stretch m. iliopsoas

7th chapter – Lordotic and kyphotic poor posture

• Kyphotic and lordotic poor posture may form per se, or may develop as a compensation to other poor posture (Imagama i sur., 2011; Pećina, 2004; Špišić, 1952).

• Poor posture and deformation should be distinguished • KYPHOTIC POOR POSTURE ≠ KYPHOSIS

• LORDOTIC POOR POSTURE ≠ LORDOSIS • functional stage ≠ structural stage

13

22.1.2014.

7th chapter – Lordotic and kyphotic poor posture

QUESTIONS • Functional anatomy pf the human spine. What are the active and passive stabilizing elements of a human spine? • What may cause a spine poor posture? • What are the critical life periods for the development of a poor posture? • Define a lordotic poor posture. Where is the convexity located and which muscles are stretched? • Define a kiphotic poor posture. Where is the convexity located and which muscles are stretched? • What are the symptoms of a kiphotic poor posture? • What are the symptoms of a lordotic poor posture? • Is there any difference between a lordotic poor posture and a lordosys as a deformation? • Is there any difference between a kiphotic poor posture and a kiphosys as a deformation? • What are the causes of kiphosys? • Describe the shape, location and orientation of the wedged vertebra in kiphosys and lordosis. • How do we distinguish kiphosys according to its shape and location? • What are the causes of lordosys? • How may m. Iliopsoas affect the lumbar lordosys? • Describe a kinesitherapy program for the correction of kiphotic and lordotic poor posture.

7th chapter – Lordotic and kyphotic poor posture

The following literary titles are recommended: • Gonçalves, M. A., & Arezes, P. M. (2012). Postural assessment of school children: An input for the design of furniture. Work, 41(SUPPL.1), 876-880. • Imagama, S., Matsuyama, Y., Hasegawa, Y., Sakai, Y., Ito, Z., Ishiguro, N., & Hamajima, N. (2011). Back muscle strength and spinal mobility are predictors of quality of life in middle-aged and elderly males. European Spine Journal, 20(6), 954-961. • Kado, D. M. (2009). The rehabilitation of hyperkyphotic posture in the elderly. European Journal of Physical and Rehabilitation Medicine, 45(4), 583-593. • Ku, P. X., Abu Osman, N. A., Yusof, A., & Wan Abas, W. A. B. (2012). Biomechanical evaluation of the relationship between postural control and body mass index. Journal of Biomechanics, 45(9), 16381642. • Lou, E., Raso, J., Hill, D., Durdle, N., & Moreau, M. (2002). Spinestraight device for the treatment of kyphosis. Studies in Health Technology and Informatics, 91, 401-404.

14

22.1.2014.

8th chapter SCOLIOSIS

8th chapter – Scoliosis

After attending the class and mastering this chapter students will be able to: • Define structural and non structural scoliosis • Describe different types of scoliosis according to the number of curvatures • Describe different types of scoliosis according to the their aetiology • Discuss the difference between primary and compensatory curvatures • Discuss possible kinds of idiopathic scoliosis • Describe the symptoms of scoliosis • Describe the examination protocol • Determine the side of the scoliosis • Explain the methods frequently used to determine the degree of the curvature • Discuss possible treatments of scoliosis • Explain the EDF principle • Explain the role of kinesitherapy in the treatment of scoliosis

1

22.1.2014.

8th chapter – Scoliosis: definition

8.1 DEFINITION OF SCOLIOSIS • Scoliosis – lateral (side-to-side) curve of the spine.

http://morphopedics.wikidot.com/spinal-scoliosis

8th chapter – Scoliosis: definition

• Structural - usually combined with a rotation of the vertebrae.

• Non structural – scoliotic poor posture

≠ http://www.wecreatewellness.com/services/c hiropractic/education/scoliosis/

http://movementsafootblog.com/2008/12/07/u neven-shoulder-blades/

2

22.1.2014.

8th chapter – Scoliosis: definition

Scoliosis may develop: • In the whole spine (total scoliosis) • Only in one part of the spine (partial scoliosis)

http://physioclinic.sg/conditions-treated/postural-pain/scoliosis/

8th chapter – Scoliosis: definition

Scoliosis may be: • Simplex • Duplex • Triplex – with primary and compensatory curves

http://www.orthopediatrics.com/docs/guides/scoloisis.html

3

22.1.2014.

8th chapter – Scoliosis: types of scoliosis

8.2 TYPES OF SCOLIOSIS 1. IDIOPATHIC – the cause is unknown. 2. NEUROMUSCULAR – is due to loss of control of the nerves or muscles that support the spine. The most common causes of this type of scoliosis are cerebral palsy and muscular dystrophy. 3. DEGENERATIVE – may be caused by the breaking down of the intervertebral discs that separate the vertebrae or by arthritis in the joints that link them. 4. CONGENITAL – due to an abnormal formation of the bones of the spine and is often associated with other organ defects.

8th chapter – Scoliosis: types of scoliosis

IDIOPATHIC SCOLIOSIS (Weinstein et al., 2008; Asher & Burton, 2006). 1. INFANTILE – Curvature appears before the age of three. 2. JUVENILE – Curvature appears between the ages of three to ten. 3. ADOLESCENT– Curvature usually appears between the ages of ten to 13, near the beginning of puberty 4. ADULT - Curvature begins after physical maturation is completed.

http://orthoinfo.aaos.org/topic.cfm?topic=a00353

4

22.1.2014.

8th chapter – Scoliosis: symptoms

8.3 SYMPTOMS OF SCOLIOSIS 1. Lateral deviation of the spine

http://www.healthgrouponline.com/scoliosis.html

8th chapter – Scoliosis: symptoms

2. Longitudinal rotation of the vertebrae • Procesus spinosus rotates towards the concavity, while the body of the vertebrae rotates towards the convexity. • The body of the vertebrae is wedged on the side of the concavity. • The spine changes its shape and way of functioning.

http://medicaldictionary.thefreedictio nary.com/Dextroscoliosis

http://www.drerrico.com/html/scoliosis.html

5

22.1.2014.

8th chapter – Scoliosis: symptoms

3. When the vertebrae rotates, the ribs also rotate, therefore a rib hump occurs.

http://www.umm.edu/patiented/articles/how_scoliosis_diagn osed_000068_6.htm

http://www.iscoliosis.com/treatment-surgical-thoracoplasty.html

8th chapter – Scoliosis: symptoms

4. The intercostal space is reduced on the concave side (the ribs become closer). 5. The intervertebral space is narrower on the concave side, and wider on the convex side.

http://www.youngwomenshealth.org/scoliosisarticle.html

6

22.1.2014.

8th chapter – Scoliosis: symptoms

6. The vertebral canal is narrower on the convex side.

http://www.rad.washington.edu/academics/academic-sections/msk/teaching-materials/onlinemusculoskeletal-radiology-book/scoliosis

8th chapter – Scoliosis: symptoms

7. Constriction of the vertebrae: the wedge of the vertebrae is situated on the concave side; the bigger wedge is located at the apex of the deformation.

http://www.jaaos.org/content/12/4/266/F1.expansion

7

22.1.2014.

8th chapter – Scoliosis: symptoms

• The apical vertebra –is in a curve, and is the vertebra most deviated laterally from the vertical axis that passes through the patient's sacrum, i.e. from the central sacral line

http://www.srs.org/professionals/glossary/SRS_revised _glossary_of_terms.htm

8th chapter – Scoliosis: symptoms

http://stronglifts.com/lamar-gant-long-limbsdeadlift/

http://espn.go.com/high-school/girl/story/_/id/7624664/logan-mcgill

http://chaimaaseesit.wordpress.com/2012/02/20/livin g-with-scoliosis/ http://www.saspine.org/conditions/scoliosis.htm

8

22.1.2014.

8th chapter – Scoliosis: examination

8.4 EXAMINATION OF SCOLIOSIS • Bend forward test • Uneven Lorens` triangle

http://www.umm.edu/patiented/articles /what_symptoms_of_scoliosis_000068_5 .htm

http://www.kmle.co.kr/search.php?Search=Nonstructural%20scoliosis

8th chapter – Scoliosis: examination

• Scoliosis is determined according to the convex side. • The Lorens` triangle is bigger on the concave side.

RIGHT SCOLIOSIS

LEFT SCOLIOSIS

http://www.chop.edu/healthinfo/scoliosis.html

9

22.1.2014.

8th chapter – Scoliosis: examination

• Scoliosis thoracalis dextroconvexa • Scoliosis thoracalis dextra • • • • • •

Cervical Cervicotoracal Toracal Toracolumbar Lumbar Lumbosacral http://rebuildhealth.com/kyphosis-lordosis

8th chapter – Scoliosis: curvature degree

8.5 METHODS TO DETERMINE THE DEGREE OF CURVATURE • Based on an X ray of the spine 1. Cobb method 2. Risser-Ferguson method

http://www.dynamicchiropractic.com/mpacms/dc/article.php?id=45531

10

22.1.2014.

8th chapter – Scoliosis: curvature degree

1. THE COBB METHOD

http://www.aafp.org/afp/2002/0501/p1817.html

8th chapter – Scoliosis: curvature degree

• With these methods the degree of curvature is determined according to which the curvature is classified into seven groups of scoliosis: GROUP

DEGREE OF FLEXION

1.

0 - 20

2.

21 - 30

3.

31 - 50

4.

51 - 75

5.

76 - 100

6.

101 - 125

7.

126 and more

11

22.1.2014.

8th chapter – Scoliosis: curvature degree

THE PROGNOSIS DEPENDS ON: • Type • Location • Etiology • Age http://www.healingbackpain.co.uk/scoliosis/scoliosis-prognosis/

8th chapter – Scoliosis: treatment

8.6 TREATMENT OF SCOLIOSIS • Surgical or conservative treatment In conservative treatment different approaches are used (D'Astous i Sanders, 2007; Everett i Patel, 2007; Radaš & Trošt Bobić, 2011; Mordecai & Dabke, 2012)

• KINESITHERAPY • PASSIVE CORRECTION

http://health.nytimes.com/health/guides/disease/scoliosis/print.html

12

22.1.2014.

8th chapter – Scoliosis: treatment

• KINESITHERAPY

http://www.spineharmony.com/exercises

http://www.fitness-programs-forlife.com/scoliosis_exercises.html

http://www.yelp.com/biz_photos/xOOu5krC PsBPTu79MvF9eA?select=2xgNiTCtCzf7c12N HFAg8g#2xgNiTCtCzf7c12NHFAg8g

8th chapter – Scoliosis: treatment

• BRACES (Milwaukee, Boston, Spinecor etc.) passive correction

http://www.bracingscoliosis.com/milwaukee-brace.html

http://www.orthoticsprostheticsne.com/home/index.php/O rthotics-Prosthetics/pediatric-orthotics.html

http://www.spinecorscoliosisbrace.com/

13

22.1.2014.

8th chapter – Scoliosis: treatment

EDF principle • Elongation – The brace elongates the trunk by lowering the pelvis and elevating the head. • Derotation – Derotation of the rotated vertebrae towards the normal position by creating a pressure on the rib hump. • Flexion (lateral) – flexion of the spine towards the convex side.

8th chapter – Scoliosis

QUESTIONS • Describe the scoliosis as a deformation and scoliotic poor posture. • How do we define scoliosis according to the number of curvatures? • What are the primary and compensatory curvatures? • Name the main types of scoliosis and describe their aetiology. • How do we divide the idiopathic scoliosis according to the patient’s age? • What are the symptoms of scoliosis? • What are apical and the wedged vertebra? • How do we determine the side of the scoliosis? • What are the most commonly used methods to determine the degree of the curvature? Learn how to draw them. • What are the possible treatments for scoliosis? • Describe the EDF principle and the Milwaukie brace.

14

22.1.2014.

8th chapter – Scoliosis

The following literary titles are recommended: • Asher, M.A., Burton, D.C. (2006). Adolescent idiopathic scoliosis: natural history and long term treatment effects. Scoliosis, 31;1(1):2. • d'Hemecourt, P. A., & Hresko, M. T. (2012). Spinal deformity in young athletes. Clinics in Sports Medicine, 31(3), 441-451. • Everett CR, Patel RK. A systematic literature review of nonsurgical treatment in adult scoliosis. Spine. 2007;32(19 Suppl):S130-134. • Mordecai, S. C., & Dabke, H. V. (2012). Efficacy of exercise therapy for the treatment of adolescent idiopathic scoliosis: A review of the literature. European Spine Journal, 21(3), 382-389.

15

22.1.2014.

9th chapter THORACIC DEFORMITIES

9th chapter – Thoracic deformities

After attending the class and mastering this chapter students will be able to: • Define the most common chest deformations • Describe the characteristics of pectus excavatum and pectus carrinatum • Explain the possible causes of an aquired pectus carrinatum • Explain the possible causes of a congenital pectus excavatum • Discuss possible treatments for pectus excavatum and pectus carrinatum • Explain the characteristics of the respiratory exercises for the treatment of pectus excavatum and pectus carrinatum • Discuss the kinesitherapy program for the conservative treatment of pectus excavatum and pectus carrinatum

1

22.1.2014.

9th chapter – Thoracic deformities

There are several kinds of thoracic deformities in children, with the two most common being pectus carinatum and excavatum (Saxena, 2005) • PECTUS EXCAVATUM • PECTUS CARINATUM

http://www.gamekyo.com/media24160.html

CHEST WALL ABNORMALITY

http://medicina.forum.st/t159-pectus-excavatum

9th chapter – Thoracic deformities: pectus carinatum

9.1 PECTUS CARINATUM 1. Congenital deformation 2. Acquired deformation

http://med.brown.edu/pedisurg/Brown/IBImages/Thorax/PectusCarin.html

2

22.1.2014.

9th chapter – Thoracic deformities: pectus carinatum

CHARACTERISTICS • protrusion of the sternum and ribs. Sternum protrusion

http://doctorshosp.adam.com/content.aspx?productId=39&pid=1&gid=003321

9th chapter – Thoracic deformities: pectus carinatum

• The sternum is protruded and it pulls the ribs forward. Therefore the chest is flattened laterally (Obermeyer & Goretsky, 2012).

http://risen-wind.blogspot.com/2008/02/pectus-excavatum-e-pectus-carinatum.html

3

22.1.2014.

9th chapter – Thoracic deformities: pectus carinatum

• The heart and lungs usually develop normally, but there could be some problems with their functioning.

http://www.pectuscarinatum.com.tr/eng/

9th chapter – Thoracic deformities: causes of pectus carinatum

9.2 CAUSES OF PECTUS CARINATUM • Rachitis • Mucopolysacharidosis • Tuberculosis of the thoracic vertebra • After a bad repositioning of a fractured sternum. http://www.scielo.br/scielo.php?pid=s180637132007000400017&script=sci_arttext&tlng=en

4

22.1.2014.

9th chapter – Thoracic deformities: treatment for pectus carinatum

9.3 TREATMENT FOR PECTUS CARINATUM • Firstly solve the cause (antirachitic therapy) • CONSERVATIVE TREATMENT - Braces (passive) (Frey i sur., 2006; Lee i sur., 2008) - Kinesitherapy (active) (Cahill, Lees & Robertson, 1984). - breathing exercises - corrective gimnastic - swimming … • SURGICAL TREATMENT (rarely)

9th chapter – Thoracic deformities: treatment for pectus carinatum

http://www.wcbl.com/product-spotlight/pectus-carinatum-2/

5

22.1.2014.

9th chapter – Thoracic deformities: treatment for pectus carinatum

http://www.cincinnatichildrens.org/health/p/pectus-carinatum/

http://www.cincinnatichildrens.org/health/p/pectus-carinatum/

9th chapter – Thoracic deformities: treatment for pectus carinatum

• Kinesitherapy: Respiration exercises – prolonged inhalation Strengthening of the abdominal muscles

http://www.umm.edu/imagepages/19072.htm

http://chickscope.beckman.uiuc.edu/explore/e mbryology/day15/focuson_humans.html#blank

6

22.1.2014.

9th chapter – Thoracic deformities: pectus excavatum

9.4 PECTUS EXCAVATUM 1. Congenital deformation 2. Acquired deformation

http://www.uwhealth.org/healthfacts/

9th chapter – Thoracic deformities: pectus excavatum

• It may develop on the xifoidal procesus or on the sternum body.

http://deepresentaza.blogspot.com/2010/12/pectus-excavatum.html

7

22.1.2014.

9th chapter – Thoracic deformities: pectus excavatum

• Internal organs may change position

9th chapter – Thoracic deformities: pectus excavatum

http://www.uwhealth.org/healthfacts/

http://bjr.birjournals.org/content/75/895/627.full

8

22.1.2014.

9th chapter – Thoracic deformities: causes of pectus excavatum

9.5 CAUSES OF PECTUS EXCAVATUM • Fetal position • Lack of space in the uterus in the case of twins • The retrosternal and suprasternal ligaments drag the procesus xifoideus inwards • Genetic factor (35%)

9th chapter – Thoracic deformities: treatment of pectus excavatum

9.6 TREATMENT FOR PECTUS EXCAVATUM • CONSERVATIVE TREATMENT - Braces (passive) - Kinesitherapy (active) (Cahill, Lees & Robertson, 1984). • SURGICAL TREATMENT (very often)

http://www.gundluth.org/?id=2691&sid=1

9

22.1.2014.

9th chapter – Thoracic deformities: treatment for pectus excavatum

• Kinesitherapy: Respiration exercises – prolonged exhalation (singing, laughing) Strengthening of the back muscles Strengthening of the abdominal muscles

http://www.umm.edu/imagepages/19072.htm

http://chickscope.beckman.uiuc.edu/expl ore/embryology/day15/focuson_humans. html#blank

9th chapter – Thoracic deformities

QUESTIONS • Which are the most common thoracic deformities? • What causes pectus carrinatum? • What causes pectus excavatum? • Which respiration phase should be stressed in a kinesitherapy program for pectus carrinatum? Why? • Which respiration phase should be stressed in a kinesitherapy program for pectus excavatum? Why?

10

22.1.2014.

9th chapter – Thoracic deformities

The following literary titles are recommended: • Cahill, J. L., Lees, G. M., & Robertson, H. T. (1984). A summary of preoperative and postoperative cardiorespiratory performance in patients undergoing pectus excavatum and carinatum repair. Journal of Pediatric Surgery, 19(4), 430-433. • Frey, A. S., Garcia, V. F., Brown, R. L., Inge, T. H., Ryckman, F. C., Cohen, A. P., Azizkhan, R. G. (2006). Nonoperative management of pectus carinatum. Journal of Pediatric Surgery, 41(1), 40-45. • Lee, S. Y., Lee, S. J., Jeon, C. W., Lee, C. S., & Lee, K. R. (2008). Effect of the compressive brace in pectus carinatum. European Journal of Cardio-Thoracic Surgery, 34(1), 146-149. • Obermeyer, R. J., & Goretsky, M. J. (2012). Chest wall deformities in pediatric surgery. Surgical Clinics of North America, 92(3), 669-684. • Saxena, A. K. (2005). Pectus excavatum, pectus carinatum and other forms of thoracic deformities. Journal of Indian Association of Pediatric Surgeons, 10(3), 147-157.

11

22.1.2014.

10th chapter LOW BACK PAIN

10th chapter – Low back pain

After attending the class and mastering this chapter students will be able to: • Describe the possible causes for a low back pain • Describe the symptoms of a low back pain syndrome • Explain the characteristics of a dynamical vertebral segment • Discuss the aetiology of the most common degenerative changes in a dynamical vertebral segment • Explain what the Lasègue`s sign is • Discuss the intervertebral discus anatomy and its relationship with lumbar back pain. Explain what is a protrusion and what is a prolaps • Explain the possible location of pain • Discuss possible treatment for a lumbar back pain with special emphasis on the role of kinesitherapy before and after an eventual surgery

1

22.1.2014.

10th chapter – Low back pain: definition

10.1 DEFINITION OF LOW BACK PAIN • Low back pain – a common musculoskeletal symptom that may be acute or chronic. Affects the lumbar spine. • Sacroiliac pain – when pain radiates in the sacrum region. • Sciatica (sciatic nerve pain) – pain involves the sciatic nerve and is felt in the lower back, the gluteal region, the back of the thigh and may radiate to the foot.

10th chapter – Low back pain: definition

• Sciatica

http://www.umm.edu/patiented/articles/what_causes_pain_low_back_pain_or_sci atica_000054_2.htm

2

22.1.2014.

10th chapter – Low back pain: causes

10.2 CAUSES OF LOW BACK PAIN • It may be caused by a variety of diseases and disorders that affect the lumbar spine.

http://www.zimmer.com/z/ctl/op/global/action/1/id/7753/template/IN

10th chapter – Low back pain: causes

• • • • • • • • •

Degenerative changes Hypomobility Hypermobility Internal organs’ diseases Muscular dystrophy Postural problems Trauma Compressive fractures Spine tumors http://www.yinovacenter.com/blog/archives/4582/

3

22.1.2014.

10th chapter – Low back pain: causes

• Degenerative changes may occur at three different locations: 1. At the vertebral body 2. At the intervertebral disc 3. At the procesus vertebralis (transversus, spinosus)

http://www.d-connect.cz/en/descriptions-of-surgeries.php

10th chapter – Low back pain: causes

• Possible degenerative problems of the spine: NORMAL DISC

DISC WITH DEGENERATIVE CHANGES

DISC PROTRUSION

DISC PROLAPS

THIN DISCUS

http://thebackdr.com.au/custom_content/c_95227_slipped_disc.html

DISCUS DEGENERATIVE CHANGES AND OSTEOPHYTES

http://www.bhpain.com/low_back_pain

4

22.1.2014.

10th chapter – Low back pain: causes

• Two main causes of pain that implies the pressure of the spinal cord or the pressure of the root of the nerve. 1. Protrusion

2. Prolapse or discus herniation

http://www.holladayphysicalmedicine.com/patient_information/patient_conditions/lumbar_disc_syndrome.htm

10th chapter – Low back pain: symptoms

10.3 SYMPTOMS OF LOW BACK PAIN • Pain in the lumbo-sacral area is the primary symptom of lower back pain, althought other symptoms may be present. Nerve root

Pain

Numbness

Motor weakness

Extension of quadriceps

Dorsiflexion of great toe and foot

Plantar flexion (extension) of great toe and foot

http://www.chirobase.org/07Strategy/AHCPR/ahcprclinician.html

5

22.1.2014.

10th chapter – Low back pain: symptoms

Degenerative changes on 4th and 5th lumbar vertebrae

Compression of the 5th lumbar nerve

A person is unable to raise the big toe upwards

Degenerative changes on 5th lumbar and 1st sacral vertebrae

Compression of the 1st sacral nerve

This can cause an inability to plantar flex (extend) the foot. A person has difficulties in standing on his/her toes or moving the foot downwards.

10th chapter – Low back pain: symptoms

LASÈGUE 'S SIGN

http://www.pic2fly.com/Lasegue.html

6

22.1.2014.

10th chapter – Low back pain: treatment

10.3 TREATMENT OF LOW BACK PAIN • Conservative • Operative

• Acute stage • Subacute stage • Chronic stage

http://www.doctorvlad.com/lowerbackpainexercises/index.php/2010/ 05/lower-back-pain/

http://www.webmd.com/back-pain/sleeping-positions-for-peoplewith-low-back-pain

10th chapter – Low back pain: treatment

• KINESITHERAPY 1. Strengthen the paravertebral muscles (Timm, 1999; Keller, 2006; Wininger, 2010; Vela, Haladay, & Denegar, 2011).

2. Strengthen the abdominal muscles (Timm, 1999; Keller, 2006) 3. Strengthen the back muscles (Wininger, 2010) 4. Assure optimal range of motion with enough muscle control (Vela, Haladay, & Denegar, 2011).

http://doubleyourgains.com/core-muscle-strength-my-new-favorite-core-exercise

7

22.1.2014.

10th chapter – Low back pain

QUESTIONS • Describe the functional anatomy of the lumbar spine. • What are the causes of low back pain and which nerve is primarily involved? • How do we differentiate low back pain according to pain location? • What is the dynamic vertebral segment? • On which structure may degenerative changes occur in the lumbar spine? • What are the symptoms of lumbar back pain? • What is the Lasegue sign? • What is a protrusion? • What is a prolaps? • What are the possible treatments for low back pain? • Describe a kinesitherapy program for the rehabilitation of low back pain.

10th chapter – Low back pain

The following literary titles are recommended: • Keller, K. (2006). Exercise therapy for low back pain: A narrative review of the literature. Journal of Chiropractic Medicine, 5(1), 3842. • Timm, K. E. (1999). Therapeutic exercise guidelines for rehabilitating lumbar spine injuries in athletes. Athletic Therapy Today, 4(2), 17-21. • Vela, L. I., Haladay, D. E., & Denegar, C. (2011). Clinical assessment of low-back-pain treatment outcomes in athletes. Journal of Sport Rehabilitation, 20(1), 74-88. • Wininger, K. L. (2010). The lumbosacral spine: Kinesiology, physical rehabilitation, and interventional pain medicine. Clinical Kinesiology, 64(3), 22-50.

8

22.1.2014.

11th chapter CERVICO-BRACHIAL SYNDROME

11th chapter – Neck pain

After attending the class and mastering this chapter students will be able to: • Define the cervicobrachial syndrome • Describe the symptoms of the cervicobrachal syndrome • Discuss possible degenerative changes in the cervical spine that may led to neck pain • Discuss possible treatment for neck pain with special emphasis on the role of kinesitherapy

1

22.1.2014.

11th chapter – Neck pain: definition

11.1 DEFINITION • Cervical-brachial syndrome is a nonspecific term describing some combination of pain, numbness, weakness, and swelling in the region of the neck and shoulder.

• The word “syndrome” means a collection of symptoms commonly seen together but for which there is no known explanation. • The term neck pain is often used.

11th chapter – Neck pain: definition

• According to the localization of different symptoms several syndromes may be defined: • Cervico-cephalic syndrome (neck and head) • Cervical syndrome (neck) • Cervicobrachial syndrome (neck and arm)

http://www.e-algos.com/cervical-radicular-pain/

2

22.1.2014.

11th chapter – Neck pain: causes

11.2 CAUSES OF NECK PAIN • It may be caused by a variety of diseases and disorders that affect the cervical spine. • Degenerative problems of the spine, such as osteophytes (spondylophytes) or discus herniations may led to the pressure of: – the spinal nerve roots – the spinal cord – the vertebral artery

11th chapter – Neck pain: symptoms

11.3 SYMPTOMS OF NECK PAIN According to the location of the degenerative changes, and therefore of the pressure, different symptoms may be present.

http://www.backpain-guide.com/Chapter_Fig_folders/Ch06_Path_Folder/2ForaminalStenosis.html

3

22.1.2014.

11th chapter – Neck pain: symptoms

• Symptoms may be linked with sensation and functionality (Carette & Fehlings, 2005). INTERVERTEBRAL NERVE LEVEL ROOT C4-C5

C5

C5-C6

C6

C6-C7

C7

C7-T1

C8

PAIN DISTRIBUTION MEDIAL SCAPULA LATERAL UPPER ARM DOWN TO ELBOW

MUSCLE WEAKNESS DELTOID SUPRASPINATUS INFRASPINATUS BICEPS BRANCHIALIS

LATERAL FOREARM THUMB AND FOREFINGER BRACHIORADIALIS WRIST EXTENSORS MEDIAL SCAPULA TRICEPS POSTERIOR UPPER ARM WRIST FLEXORS DORSAL FOREARM AND EXTENSOR DIGITORUM THIRD FINGER SHOULDER ULNAR PART OF FOREARM THUMB FLEXOR FIFTH FINGER

SENSORY LOSS

REFLEX LOSS

LATERAL UPPER ARM

SUPINATOR REFLEX

THUMB AND FOREFINGER

BICEPS REFLEX

POSTERIOR FOREARM THIRD FINGER

TRICEPS REFLEX

FIFTH FINGER

11th chapter – Neck pain: symptoms

Pain in the neck area

Cervical syndrome

http://phr.emrystick.com/patient-education.aspx?medicalterm=displacement-cervical-intervertebral-disc-without-myelopathy

4

22.1.2014.

11th chapter – Neck pain: symptoms

• • • • • • •

Unilateral pain of the head Strong pain in the occipital region Buzzing in one ear Cervico-cephalic Eyes watering, vision problems (fogging) syndrome Skin sensitivity Nausea and vomiting Compression of arteria vertebralis

http://www.necksolutions.com/neck-pain.html

11th chapter – Neck pain: symptoms

• Blood flow and sensory-motor changes in the upper extremities. • Sensitive disturbances such as hypesthesia, anesthesia, paresthesia, hyperesthesia, also in the upper extremities.

Cervical-brachial syndrome http://www.wellsphere.com/back-neck-pain-article/cervical-brachialsyndrome-causes-neck-and-arm-pain/901762

5

22.1.2014.

11th chapter – Neck pain: treatment

11.3 TREATMENT OF NECK PAIN • Operative or Conservative • Acute stage (rest, wear a brace, educate the patient)

http://www.ortopediebaldinelli.it

• Subacute and chronic stage (educate the patient, physical therapy, kinesitherapy)

11th chapter – Neck pain: treatment

• KINESITHERAPY 1. Strengthen upper back and shoulder muscles (Hagberg i sur., 2000; Andersen et al., 2012).

2. Assure optimal range of motion (Hagberg i sur., 2000; Gross et al, 2012). 3. Improve muscular endurance in the neck and shoulder regions (Hagberg i sur., 2000; Gross et al, 2012).

http://www.necksolutions.com/nec k-exercises.html

http://www.holistic-back-relief.com/neck-pain-relief.html

http://www.prevention.com/fitness/strengthtraining/end-neck-pain-3-moves

6

22.1.2014.

11th chapter – Neck pain

QUESTIONS • • • • •

What is a syndrome? Describe the functional anatomy of the cervical spine. What are the causes of a cervicobrachial syndrome? What are the symptoms of a cervicobrachial syndrome? How do we differentiate the cervicobrachial syndrome according to symptoms location? • What are the long lasting symptoms of a cervicobrachial sindrom? • What are the possible treatments for cervicobrachial sindrom? • Describe a kinesitherapy program for the rehabilitation of a cervicobrachial syndrome.

11th chapter – Neck pain

The following literature titles are recommended: • Andersen, C. H., Andersen, L. L., Gram, B., Pedersen, M. T., Mortensen, O. S., Zebis, M. K., & Sjøgaard, G. (2012). Influence of frequency and duration of strength training for effective management of neck and shoulder pain: A randomised controlled trial. British Journal of Sports Medicine. • Carette, S., Fehlings, M.G. (2005). Clinical practice. Cervical radiculopathy. The New England Journal of Medicine;353:392–399. • Gross, A., Forget, M., St George, K., Fraser, M. M., Graham, N., Perry, L., Brunarski, D. (2012). Patient education for neck pain. Cochrane Database of Systematic Reviews (Online). • Hagberg, M., Harms-Ringdahl, K., Nisell, R., & Wigaeus Hjelm, E. (2000). Rehabilitation of neck-shoulder pain in women industrial workers: A randomized trial comparing isometric shoulder endurance training with isometric shoulder strength training. Archives of Physical Medicine and Rehabilitation, 81(8), 1051-1058.

7

22.1.2014.

12th chapter TORTICOLLIS

12th chapter – Torticollis

After attending the class and mastering this chapter students will be able to: • Describe possible causes of a congenital and acquired torticollis • Describe the symptoms of torticollis • Discuss different kinds of acquired torticollis referring to their aetiology • Discuss possible conservative treatments (passive and active) of torticollis with special refer to a possible kinesitherapeutic program

1

22.1.2014.

12th chapter – Torticollis

TORTICOLLIS – neck deformation causing lateral flexion of the head and contracture of the cervical spine musculature

http://drdanrae.wordpress.com/2012/04/23/chandler-chiropractor-talks-torticollis/

12th chapter – Torticollis: causes

12.1 CAUSES OF TORTICOLLIS ETHIOLOGY: CONGENITAL Birth trauma Intra-uterine malposition

Shortening or excessive contraction of the sternocleidomastoid muscle

ACQUIRED Different diseases to the neck region that happen during the life span

Shortening or excessive contraction of the sternocleidomastoid muscle

2

22.1.2014.

12th chapter – Torticollis: causes

CONGENITAL deformation

• During pregnancy – lack of space in the uterus • Twins

http://contemporarypediatrics.modernmedicine.com

http://contemporarypediatrics.modernmedicine.com

12th chapter – Torticollis: causes

CONGENITAL deformation

http://gardenrain.wordpress.com/2009/10/15/torticollis/

3

22.1.2014.

12th chapter – Torticollis: causes

ACQUIRED deformation Non-congenital muscular torticollis can result from scarring or disease of the cervical vertebrae, adenitis, tonsillitis, rheumatism, enlarged cervical glands, a retro-pharyngeal abscess, or cerebellar tumors.

http://www.health-reply.com/withcongenital-muscular-torticollis/

12th chapter – Torticollis: causes

• Types of acquired torticollis 1. Dermatogenic torticollis 2. Desmogenic torticollis 3. Miogenic torticollis 4. Habitual torticollis 5. Neurogenic torticollis

http://explow.com/Torticollis

4

22.1.2014.

12th chapter – Torticollis: symptoms

12.2 SYMPTOMS OF TORTICOLLIS • Latero-flexion of the head and the neck on the side of the shortened m. sternocleidomastoideus

• Chin rotation on the side of the elongated m. sternocleidomastoideus • Head slightly bent forward

http://www.injurylawsourcepa.com/2012/06/torticollispediatric-medical.html

12th chapter – Torticollis: treatment

12.3 TREATMENT OF TORTICOLLIS 1. CONSERVATIVE a) Passive correction  Schantz brace, collar

http://torticollistreatment.org/torticollistreatment-how-to-treat-wryneck/

http://www.24-7pressrelease.com/pressrelease/disabled-inventor-revolutionizes-neck-bracedesign-206022.php

5

22.1.2014.

12th chapter – Torticollis: treatment

1. CONSERVATIVE

b) kinesitherapy  Chin de-rotation toward the elongated muscle,  Head latero-flexion towards the stretched muscle,  Head backwards (Ohman et al., 2011).

http://donna.tuttogratis.it/mamma/torcicollo-miogenocongenito-cause-e-sintomi/P237171/

http://byebyedoctor.com/torticollis/

12th chapter – Torticollis: treatment

2. OPERATIVE SURGERY – kinesitherapy after surgery with special emphasis on the strengthening of the lateral neck muscles (Shim & Jang, 2008).

http://www.fpnotebook.com/nicu/ortho/trtcls.htm

6

22.1.2014.

12th chapter – Torticollis

QUESTIONS • What are the causes of torticollis? • What are the characteristics of torticollis according to m. sternocleidomastoideus? • Describe possible acquired neck deformations. • How does a Shantz brace for the correction of the torticollis work? • Describe a kinesitherapy program for the correction of torticollis.

12th chapter – Torticollis

The following literary titles are recommended: • Ohman, A., Mårdbrink, E. L., Stensby, J., & Beckung, E. (2011). Evaluation of treatment strategies for muscle function in infants with congenital muscular torticollis. Physiotherapy Theory and Practice, 27(7), 463-470. • Shim, J. S., & Jang, H. P. (2008). Operative treatment of congenital torticollis. Journal of Bone and Joint Surgery - Series B, 90(7), 934939.

7

22.1.2014.

13th chapter

SHOULDER INJURY REHABILITATION

13th chapter Shoulder injury rehabilitation

After attending the class and mastering this chapter students will be able to: • Describe the functional anatomy of the shoulder girdle in relations to its possible acute and overuse injury • Describe possible mechanisms of an anterior and posterior shoulder luxation • Discuss why the tendon of m. supraspinatus is frequently injured • Describe the symptoms of a rotator cuff overuse injury • Discuss possible options for the treatment of an acute and overuse shoulder injury • Discuss the conservative treatment of an acute and overuse shoulder injury with special reference to the targeted muscles in a kinesitherapy session • Discuss the main goals of the functional stage of the rehabilitation protocol after an anterior shoulder luxation • Explain the biomechanical progression of exercise in the functional rehabilitation stage

1

22.1.2014.

13th chapter Shoulder injury rehabilitation: functional anatomy of the shoulder

13.1 FUNCTIONAL ANATOMY OF THE SHOULDER Movements of the human shoulder represent the result of a complex dynamic interplay of structural bony anatomy and biomechanics, static ligamentous and tendinous restraints, and dynamic muscle forces.

http://www.zimmer.co.uk/z/ctl/op/global/action/1/id/391/template/PC/navid/10892

13th chapter Shoulder injury rehabilitation: functional anatomy of the shoulder

http://www.stetoskop.info/Povrede-ramena-4346-s13-content.htm

2

22.1.2014.

13th chapter Shoulder injury rehabilitation: functional anatomy of the shoulder

There are three main joints in the shoulder girdle: 1. 2. 3. 4.

Glenohumeral Joint (GHJ) Acromioclavicular Joint (ACJ) Sternoclavicular Joint (SCJ) Scapulothoracic “joint” (musculotendinous articulation in nature)

http://morphopedics.wikidot.com/shoulder-impingement-syndrome

13th chapter Shoulder injury rehabilitation: functional anathomy of the shoulder

• The shoulder joint (articulatio humeri) is a joint between the head of the humerus and the cavity of the scapula. • The convex joint surface is at least twice greater than the surface of the concave side.

http://www.shoulderandelbowcenter.com/sec_education_links.htm?education/arth.htm

3

22.1.2014.

13th chapter Shoulder injury rehabilitation: functional anatomy of the shoulder

• A wide number of deeper and peripheral muscles play an important rule in the stabilization of the shoulder. http://www.eorthopod.com/content/shoulderanatomy

• They should all be exercised in a functional rehabilitation program.

http://www.britannica.com/EBchecked/media/119225/Muscles-of-the-shoulder

13th chapter Shoulder injury rehabilitation: shoulder injuries

13.2 SHOULDER INJURIES Forces that act on the shoulder girdle during a sports activity may cause: • Chronic injuries (Littlewood et al., 2012) • Acute injuries (Murray et al., 2012) • Chronic joint instability

http://dimemag.com/2010/04/top-10-worst-basketball-injuries/

http://advancedbodydynamics.com/tag/muscle-activation-technique/

4

22.1.2014.

13th chapter Shoulder injury rehabilitation: traumatic shoulder injury mechanism

13.3 TRAUMATIC SHOULDER INJURY MECHANISM There are three most frequent injury situations (Trošt & Stepanić, 2007) : • A fall on the extended and abducted arm (wrestling). • A blocked extended arm while kicking the ball (team handball). • A direct fall on to the adducted shoulder (skiing, downhill cycling).

13th chapter Shoulder injury rehabilitation: traumatic shoulder injury mechanism

5

22.1.2014.

13th chapter Shoulder injury rehabilitation: traumatic shoulder injury mechanism

Repeated injuries lead to chronic shoulder instability (Trošt & Stepanić, 2007)

13th chapter Shoulder injury rehabilitation: traumatic shoulder injury mechanism

http://www.sports-injury-info.com/bankart-lesion.html

A dislocation before being 20 years of age will, in 90% of cases, result in a second dislocation later in life (Garth et al., 1987).

6

22.1.2014.

13th chapter Shoulder injury rehabilitation: overuseof injury mechanism

13.4 OVERUSE of INJURY MECHANISM Shoulder impingement - lifting the arm above shoulder height when rotating the shoulder (Littlewood et al., 2012).

13th chapter Shoulder injury rehabilitation: overuse of injury mechanism

7

22.1.2014.

13th chapter Shoulder injury rehabilitation: overuse of injury mechanism

http://rockislandworkerscompensationattorney.wordpress.com/2010/11/16/howmuch-is-a-shoulder-injury-worth-in-illinois-workers-compensation/

• Impingement syndromes most commonly involve the m. supra-spinatus tendon. • The tendon of the m. biceps brachii (long head) is also often involved.

13th chapter Shoulder injury rehabilitation: overuse of injury mechanisn

• There are several stages of overuse of injury mechanism symptoms. Athletes usually report the problems when the pain begins to be present during activity, which prolongs the rehabilitation protocol. STAGE

PAIN

FUNCTION

1st

no

normal

2nd

when extremely loaded

normal

3rd

at the beginning and after a sport activity

normal or slightly reduced

4th

during and after a sport activity

slightly reduced

5th

while doing the sport – had to end the activity

severely reduced

6th

while doing everyday activities

impossible to do the sport

8

22.1.2014.

13th chapter Shoulder injury rehabilitation: shoulder injury rehabilitation

13.5 SHOULDER INJURY REHABILITATION TREATMENT • Operative • Conservative Conservative treatment usually includes: • REST • PHYSICAL AIDS • MEDICAMENTS • KINESITHERAPY

http://www.umm.edu/imagepages/19689.htm

13th chapter Shoulder injury rehabilitation: shoulder injury rehabilitation

FUNCTIONAL REHABILITATION The main goals of functional rehabilitaion are (Renstrom, 1994; Frontera, 2003). : 1. To regain a range of motion 2. Progressively to strengthen the muscles that stabilize the shoulder 3. To develop neuro-muscular coordination 4. To prepare the athlete for a specific return to being in the situation to play again • The functional rehabilitation protocols for a traumatic injury and an overuse syndrome of the shoulder differ drastically (Hayes et al., 2002). This is due to their different etiology.

9

22.1.2014.

13th chapter Shoulder injury rehabilitation: shoulder injury rehabilitation

KINESITHERAPY STRETCHING – if there is a need • Static • PNF • Dynamic

13th chapter Shoulder injury rehabilitation: shoulder injury rehabilitation

STRENGTH EXERCISES • • • • • •

Isometric contraction Eccentric contraction Concentric contraction Exercise with elastic bands Exercise with apparatus Exercise with cow-bells…

• Closed

open kinetic chain exercise

10

22.1.2014.

13th chapter Shoulder injury rehabilitation: shoulder injury rehabilitation

• Kinaesthetic and biomechanical progression

13th chapter Shoulder injury rehabilitation: shoulder injury rehabilitation

PROPRIOCEPTION • Proprioceptive boards • Fitball • Dynadisc • Proprioceptive matresses • Open kinetic chain

PLYOMETRICS • Ball • Medicine ball SPECIFICS

11

22.1.2014.

13th chapter Shoulder injury rehabilitation

QUESTIONS • Why does the anterior shoulder luxation happen more often than the posterior one? • Describe the mechanisms of anterior shoulder luxation. • Name an acute injury and an overuse injury of the shoulder and explain the difference between them. • What is a rotator cuff overuse injury? What tendon is frequently injured and why? • Explain the difference in the kinesitherapy program for the rehabilitation of an acute and an overuse shoulder injury. • What are the main goals of functional rehabilitation? • Describe the biomechanical progression of exercise in the functional stage of the rehabilitation protocol.

13th chapter Shoulder injury rehabilitation

The following literary titles are recommended: • Hayes, K., Callanan, M., Walton, J., Paxinos, A., & Murrell, G. A. C. (2002). Shoulder instability: Management and rehabilitation. Journal of Orthopaedic and Sports Physical Therapy, 32(10), 497-509. • Littlewood, C., Ashton, J., Chance-Larsen, K., May, S., & Sturrock, B. (2012). Exercise for rotator cuff tendinopathy: A systematic review. Physiotherapy, 98(2), 101-109. • Murray, I. R., Ahmed, I., White, N. J., & Robinson, C. M. (2012). Traumatic anterior shoulder instability in the athlete. Scandinavian Journal of Medicine and Science in Sports. Jun 28 (Epub ahead of print).

12

Literature 1. Andersen, C. H., Andersen, L. L., Gram, B., Pedersen, M. T., Mortensen, O. S., Zebis, M. K., & Sjøgaard, G. (2012). Influence of frequency and duration of strength training for effective management of neck and shoulder pain: A randomised controlled trial. British Journal of Sports Medicine. 2. Asher, M.A., Burton, D.C. (2006). Adolescent idiopathic scoliosis: natural history and long term treatment effects. Scoliosis. 31;1(1):2. 3. Bartel, D.L., Davy, D.T., Keaveny, T.M. (2006). Orthopaedic Biomechanics: Mechanics and Design in Musculoskeletal Systems / Edition 1. Prentice Hall publisher. 4. Cahill, J. L., Lees, G. M., & Robertson, H. T. (1984). A summary of preoperative and postoperative cardiorespiratory performance in patients undergoing pectus excavatum and carinatum repair. Journal of Pediatric Surgery, 19(4), 430-433. 5. Carette, S., Fehlings, M.G. (2005). Clinical practice. Cervical radiculopathy. The New England Journal of Medicine;353:392–399. 6. Ciliga, D. (1998). Strategija razvoja kineziterapije. Zbornik radova 7. ljetne škole pedagoga fizičke kulture Republike Hrvatske, Rovinj, 23-27.06.1998. 7. Ćurković, B., Tepšić, N. (2004). Basics of kinesitherapy (in Croatian). Osnove kineziterapije. U: Ćurković i sur. (ur.) Fizikalna i rehabilitacijska medicina. Zagreb: Medicinska naklada, str. 72-73. 8. D'Astous JL, Sanders JO. Casting and traction treatment methods for scoliosis. Orthop Clin North Am. 2007;38(4):477-484. 9. d'Hemecourt, P. A., & Hresko, M. T. (2012). Spinal deformity in young athletes. Clinics in Sports Medicine, 31(3), 441-451. 10. Evans, A. M., & Rome, K. (2011). A cochrane review of the evidence for non-surgical interventions for flexible pediatric flat feet. European Journal of Physical and Rehabilitation Medicine, 47(1), 69-89. 11. Everett, C.R., Patel, R.K. (2007). A systematic literature review of nonsurgical treatment in adult scoliosis. Spine. 32(19 Suppl):S130-134. 12. Fabry, G. (2010). Clinical practice: Static, axial, and rotational deformities of the lower extremities in children. European Journal of Pediatrics, 169(5), 529-534. 13. Fellenberg, J., Mau, H., Nedel, S., Ewerbeck, V., & Debatin, K. (2000). Hamstrings and iliotibial band forces affect knee kinematics and contact pattern. Journal of Orthopaedic Research, 18(1), 101-108. 14. Frey, A. S., Garcia, V. F., Brown, R. L., Inge, T. H., Ryckman, F. C., Cohen, A. P., Azizkhan, R. G. (2006). Nonoperative management of pectus carinatum. Journal of Pediatric Surgery, 41(1), 40-45. 15. Frontera, W.R. (2003). Rehabilitation of sports injuries. Malden: Blackwell Scientific Publications. 1

16. Gonçalves, M. A., & Arezes, P. M. (2012). Postural assessment of school children: An input for the design of furniture. Work, 41(SUPPL.1), 876-880. 17. Gross, A., Forget, M., St George, K., Fraser, M. M., Graham, N., Perry, L., Brunarski, D. (2012). Patient education for neck pain. Cochrane Database of Systematic Reviews (Online). 18. Hagberg, M., Harms-Ringdahl, K., Nisell, R., & Wigaeus Hjelm, E. (2000). Rehabilitation of neck-shoulder pain in women industrial workers: A randomized trial comparing isometric shoulder endurance training with isometric shoulder strength training. Archives of Physical Medicine and Rehabilitation, 81(8), 1051-1058. 19. Hayes, K., Callanan, M., Walton, J., Paxinos, A., & Murrell, G. A. C. (2002). Shoulder instability: Management and rehabilitation. Journal of Orthopaedic and Sports Physical Therapy, 32(10), 497-509. 20. Homer, C. J., Baltz, R. D., Hickson, G. B., Miles, P. V., Newman, T. B., Shook, J. E., . . . Sunshine, P. (2000). Clinical practice guideline: Early detection of developmental dysplasia of the hip. Pediatrics, 105(4 I), 896-905. 21. Horn, B. D., & Davidson, R. S. (2010). Current treatment of clubfoot in infancy and childhood. Foot and Ankle Clinics, 15(2), 235-243. 22. Ihme, N., Schmidt-Rohlfing, B., Lorani, A., & Niethard, F. U. (2003). Nonsurgical treatment of congenital dysplasia and dislocation of the hip. [Die konservative therapie der angeborenen hüftdysplasie und-luxation] Orthopade, 32(2), 133-138. 23. Imagama, S., Matsuyama, Y., Hasegawa, Y., Sakai, Y., Ito, Z., Ishiguro, N., & Hamajima, N. (2011). Back muscle strength and spinal mobility are predictors of quality of life in middle-aged and elderly males. European Spine Journal, 20(6), 954-961. 24. Jajić, I. i sur. (2000). Fizikalna medicina i opća rehabilitacija. Zagreb: Medicinska naklada. 25. Janković, S., Trošt, T. (2004). Rehabilitacija ozljeda skočnog zgloba. Kondicijski trening, 1(2), 53-61. 26. Jimenez-Ormeño, E., Aguado, X., Delgado-Abellan, L., Mecerreyes, L., & Alegre, L. M. (2011). Changes in footprint with resistance exercise. International Journal of Sports Medicine, 32(8), 623-628. 27. Kado, D. M. (2009). The rehabilitation of hyperkyphotic posture in the elderly. European Journal of Physical and Rehabilitation Medicine, 45(4), 583-593. 28. Keller, K. (2006). Exercise therapy for low back pain: A narrative review of the literature. Journal of Chiropractic Medicine, 5(1), 38-42. 29. Keros, P. i Pećina, M. (2007). Funkcijska anatomija lokomotornog sustava. Zagreb: Naklada Ljevak d.o.o. 30. Keros Predrag, Pećina Marko, Ivančić-Košuta M. (1998). Temelji anatomije čovjeka. Zagreb: Školska knjiga. 31. Knight, K.L. (1995). Initial care of acute injuries: the RICE technique. In: Cryotherapy in sport injury management. Champaign, Il.: Human Kinetics.

2

32. Kosinac, Z. (2005) Kineziterapija sustava za kretanje. Split: Sveučilište u Splitu - Udruga za šport i rekreaciju djece i mladeži grada Splita 33. Ku, P. X., Abu Osman, N. A., Yusof, A., & Wan Abas, W. A. B. (2012). Biomechanical evaluation of the relationship between postural control and body mass index. Journal of Biomechanics, 45(9), 1638-1642. 34. Lee, S. Y., Lee, S. J., Jeon, C. W., Lee, C. S., & Lee, K. R. (2008). Effect of the compressive brace in pectus carinatum. European Journal of Cardio-Thoracic Surgery, 34(1), 146-149. 35. Littlewood, C., Ashton, J., Chance-Larsen, K., May, S., & Sturrock, B. (2012). Exercise for rotator cuff tendinopathy: A systematic review. Physiotherapy, 98(2), 101-109. 36. Lou, E., Raso, J., Hill, D., Durdle, N., & Moreau, M. (2002). Spine-straight device for the treatment of kyphosis. Studies in Health Technology and Informatics, 91, 401-404. 37. Matanović, D. D., Vukasinović, Z. S., Zivković, Z. M., Spasovski, D. V., Bascarević, Z. L., & Slavković, N. S. (2011). Physical treatment of foot deformities in childhood. Acta Chirurgica Iugoslavica, 58(3), 113-116. 38. Mathys, F.K. (1987). The history of sports medicine (part I). Olympic Review, 241, 582585. 39. Mathys, F.K. (1987). The history of sports medicine (continuation and end). Olympic Review, 242, 650-653. 40. Monedero, J., B. Donne (2000). Effect of recovery interventions on lactate removal and subsequent performance. International Journal of Sports Medicine, 21 (8), 593-597. 41. Mordecai, S. C., & Dabke, H. V. (2012). Efficacy of exercise therapy for the treatment of adolescent idiopathic scoliosis: A review of the literature. European Spine Journal, 21(3), 382-389. 42. Murray, I. R., Ahmed, I., White, N. J., & Robinson, C. M. (2012). Traumatic anterior shoulder instability in the athlete. Scandinavian Journal of Medicine and Science in Sports.Jun 28 (Epub ahead of print). 43. Myrer, J.W., Drapper, D.O., Durrant, E. (1994). Contrast therapy and intramuscular temperature in the human leg. Journal of Athletic Training, 29 (4), 318-322. 44. Noordin, S., Umer, M., Hafeez, K., Nawaz, H. (2010). Developmental dysplasia of the hip. Orthopedic Reviews, 23;2(2):e19. 45. Obermeyer, R. J., & Goretsky, M. J. (2012). Chest wall deformities in pediatric surgery. Surgical Clinics of North America, 92(3), 669-684. 46. Ohman, A., Mårdbrink, E. L., Stensby, J., & Beckung, E. (2011). Evaluation of treatment strategies for muscle function in infants with congenital muscular torticollis. Physiotherapy Theory and Practice, 27(7), 463-470. 47. Pećina, M. et al. (2004). Ortopedija. Zagreb: Ljevak. 48. Pećina,M., Bojanić, I. (2003).Overuse injuries of the musculoskeletal system. Boca Raton, London, New York, Washington D.C.: CRC Press. 49. Prentice, W.E. (1986). Therapeutic modalities in sports medicine. St. Louis: Times Mirror/Mosby College. 3

50. Radaš, J., Trošt Bobić, T. (2011). Posture in top-level Croatian rhythmic gymnasts and non-trainees. Kinesiology, 1(43), 64-73. 51. Renström, P.A.F.H. (1994). Clinical practice of sports injury prevention and care. Oxford: Blackwell Scientific Publications. 52. Saxena, A. K. (2005). Pectus excavatum, pectus carinatum and other forms of thoracic deformities. Journal of Indian Association of Pediatric Surgeons, 10(3), 147-157. 53. Shim, J. S., & Jang, H. P. (2008). Operative treatment of congenital torticollis. Journal of Bone and Joint Surgery - Series B, 90(7), 934-939. 54. Špišić, B. (1952). Ortopedija. Zagreb: Školska knjiga. 55. Svetina, B. (2010). Povjesni razvoj kineziterapije. Diplomski rad. Kineziološki fakultet Sveučilišta u Zagrebu. 56. Timm, K. E. (1999). Therapeutic exercise guidelines for rehabilitating lumbar spine injuries in athletes. Athletic Therapy Today, 4(2), 17-21. 57. Trošt Bobić, T., Rakovac, M. (2010). Povratak u redoviti trening i natjecanja nakon rehabilitacije ozljeda u sportskim igrama. Pozvano predavanje. U: I. Jukić, C. Gregov, S. Šalaj, L. Milanović i T. Trošt Bobić (ur.), Zbornik radova 8. Godišnje međunarodne konferencije Kondicijska priprema sportaša s glavnom temom „Trening brzine, agilnosti i eksplozivnosti“. Zagreb, 26.-27. veljače 2010. (str. 113-118). Zagreb: Kineziološki fakultet Sveučilišta u Zagrebu. 58. Trošt, T. i Stepanić, V. (2007). Funkcionalna rehabilitacija ozljede ramenog zgloba. Kondicijski trening, 5(1), 53-68. 59. Trošt, T., Šimek, S., Grubišić, F. (2005). Fizikalna sredstva u funkciji oporavka sportaša. U: I. Jukić, D. Milanović i S. Šimek (ur.). Kondicijska priprema sportaša: zbornik radova 3. međunarodne godišnje konferencije «Oporavak u sportu», Zagreb, 25. i 26. veljače 2005., str. 71-82. Zagreb: Kineziološki fakultet Sveučilišta u Zagrebu, Zagrebački sportski savez i Udruga kondicijskih trenera Hrvatske. 60. Vela, L. I., Haladay, D. E., & Denegar, C. (2011). Clinical assessment of low-back-pain treatment outcomes in athletes. Journal of Sport Rehabilitation, 20(1), 74-88. 61. Wahl, C. J., Westermann, R. W., Blaisdell, G. Y., & Cizik, A. M. (2012). An association of lateral knee sagittal anatomic factors with non-contact ACL injury: Sex or geometry? Journal of Bone and Joint Surgery - Series A, 94(3), 217-226. 62. Wearing, S. C., Grigg, N. L., Lau, H. C., & Smeathers, J. E. (2012). Footprint-based estimates of arch structure are confounded by body composition in adults. Journal of Orthopaedic Research, 30(8), 1351-1354. 63. Weinstein, S.L., Dolan, L.A,, Cheng, J.C, et al. (2008). Adolescent idiopathic scoliosis. Lancet. 3;371(9623):1527-37. 64. Wilmore, J.H. i Costil, D.L. (1997). Physiology of Sport and Exercise (2nd edition). Champaign, Il: Human Kinetics. 65. Wininger, K. L. (2010). The lumbosacral spine: Kinesiology, physical rehabilitation, and interventional pain medicine. Clinical Kinesiology, 64(3), 22-50. 4

66. Wolfe, M.W., Tim, L. i McCluskey, L.C. (2001). Management of ankle sprain. American Family Physician, 63, 93-104. 67. Zuluaga, M., Briggs, C., Carlisle, J., McDonald, V., McMeeken, J., Nickson, W., Oddy, P, Wilson, D. (1995). Sports Physiotherapy: Applied Science and Practice. Melbourne: Churchill Livingstone.

Web sites: 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23. 24. 25. 26. 27. 28. 29. 30. 31. 32. 33.

http://accessdanceforlife.com/blog http://advancedbodydynamics.com/tag/muscle-activation-technique http://artshineqc.blogspot.com/2011/07/week-six-posture-stretching.html http://besport.org/sportmedicina/hydro http://bjr.birjournals.org/content/75/895/627.full http://breakingmuscle.com/health-medicine/ankle-injuries-secret-preventing-and-healing-them http://byebyedoctor.com/torticollis http://chaimaaseesit.wordpress.com/2012/02/20/living-with-scoliosis http://chickscope.beckman.uiuc.edu/explore/embryology/day15/focuson_humans.html#blank http://chickscope.beckman.uiuc.edu/explore/embryology/day15/focuson_humans.html#blank http://chospine.com/2011/02/09/compression-fracture http://coloradosportschiro.com/custom_content/c_84976_sports_medicine.html http://contemporarypediatrics.modernmedicine.com http://deepresentaza.blogspot.com/2010/12/pectus-excavatum.html http://dimemag.com/2010/04/top-10-worst-basketball-injuries http://docpods.com/lateral-ankle-ligament-sprain http://doctorshosp.adam.com/content.aspx?productId=39&pid=1&gid=003321 http://donna.tuttogratis.it/mamma/torcicollo-miogeno-congenito-cause-e-sintomi/P237171 http://doubleyourgains.com/amazing-abs-101-core-training-system http://doubleyourgains.com/core-muscle-strength-my-new-favorite-core-exercise http://drdanrae.wordpress.com/2012/04/23/chandler-chiropractor-talks-torticollis http://drseanmiller.wordpress.com/category/cold-laser http://escapebookclub.blogspot.com/2012/05/wednesday-2nd-may-2012-snow-flowerand.html http://espn.go.com/high-school/girl/story/_/id/7624664/logan-mcgill http://explow.com/Torticollis http://fisioterpia-salud.blogspot.com/ 2010/06/termoterapia.html http://fyp.emmettconroy.com/sites/default/files/imagecache/add-image500px/Pavlik%20Farness.jpg http://gardenrain.wordpress.com/2009/10/15/torticollis http://health.howstuffworks.com/wellness/diet-fitness/exercise/cardio-vs-weight-training.htm http://health.nytimes.com/health/guides/disease/scoliosis/print.html http://heart-of-light.blogspot.com/ 2009_05_01_archive.html http://images.trulia.com/blogimg/0/2/a/4/191364_1331336358785_o.jpg http://kiransawhney.wordpress.com 5

34. 35. 36. 37. 38. 39. 40. 41. 42. 43. 44. 45. 46. 47. 48. 49. 50. 51. 52. 53. 54. 55. 56. 57. 58. 59. 60. 61. 62. 63. 64. 65. 66. 67. 68. 69. 70. 71. 72. 73.

http://leviuqse.blogspot.com/2008/09/one-with-japanese-geisha-shoes.html http://library.thinkquest.org/J0111100/graphics/bones2.html http://louisvilleorthopedics.com/library/patient-education/acl-tears http://med.brown.edu/pedisurg/Brown/IBImages/Thorax/PectusCarin.html http://medicaldictionary.thefreedictionary.com/Dextroscoliosis http://medicina.forum.st/t159-pectus-excavatum http://morphopedics.wikidot.com/lateral-ankle-sprain http://morphopedics.wikidot.com/shoulder-impingement-syndrome http://morphopedics.wikidot.com/spinal-scoliosis http://movementsafootblog.com/2008/12/07/uneven-shoulder-blades http://nicktumminello.com/2010/05/an-inside-look-at-spinal-osteoporosis-scoliosis-andosteophytosis http://orthoinfo.aaos.org http://phr.emrystick.com/patient-education.aspx?medical-term=displacement-cervicalintervertebral-disc-without-myelopathy http://physioclinic.sg/conditions-treated/postural-pain/scoliosis http://rebuildhealth.com/kyphosis-lordosis http://risen-wind.blogspot.com/2008/02/pectus-excavatum-e-pectus-carinatum.html http://rockislandworkerscompensationattorney.wordpress.com/2010/11/16/how-much-is-ashoulder-injury-worth-in-illinois-workers-compensation http://soshable.com/tag/human-evolution-and-social-media http://stronglifts.com/lamar-gant-long-limbs-deadlift http://symmetrygymdubai.com/blog http://texashealthathlete.wordpress.com/2011/12/08/should-i-wear-orthotics http://thebackdr.com.au/custom_content/c_95227_slipped_disc.html http://thepilateshundred.blogspot.com/2011/04/posture-201-kyphosis.html http://torticollistreatment.org/torticollis-treatment-how-to-treat-wryneck http://www.24-7pressrelease.com/press-release/disabled-inventor-revolutionizes-neck-bracedesign-206022.php http://www.aafp.org/afp/2001/0101/p93.html http://www.aafp.org/afp/2002/0501/p1817.html http://www.abovetopsecret.com/forum/thread315579/pg1 http://www.aclsolutions.com/theacl_3.php http://www.activeforever.com/a-2620-kyphosis.aspx http://www.adventistrehab.com/adam/Surgery%20and%20Procedures/13/100006.html http://www.annsrunningcommentary.com http://www.answers.com/topic/arches http://www.aurorabaycare.com/health-info/display.aspx?URL=432311.html http://www.backpain-guide.com/Chapter_Fig_folders/Ch06_Path_Folder/2ForaminalStenosis.html http://www.bartleby.com/107/95.html http://www.benessere.com/remise/remise_en_forme/bagno_turco.htm http://www.bhpain.com/low_back_pain http://www.braceshop.com/productcart/pc/Bauerfeind-CaligaLoc-Ankle-Brace-17p884.htm http://www.bracingscoliosis.com/milwaukee-brace.html 6

74. 75. 76. 77. 78. 79. 80. 81. 82.

http://www.britannica.com/EBchecked/media/119225/Muscles-of-the-shoulder http://www.chichester-march.org.uk/html/walking.html http://www.chirobase.org/07Strategy/AHCPR/ahcprclinician.html http://www.chirofirst.ca/index.php?page=service_sub4 http://www.chop.edu/healthinfo/scoliosis.html http://www.cincinnatichildrens.org/health/p/pectus-carinatum http://www.concorde.edu/program http://www.copabones.com/ankle_foot.htm http://www.coreconcepts.com.sg/mcr/when-is-achilles-tendonitis-not-achilles-tendonitis-whenit-is-retrocalcaneal-bursitis 83. http://www.daviddarling.info/encyclopedia/H/hamstring_muscles.html 84. http://www.d-connect.cz/en/descriptions-of-surgeries.php 85. http://www.doctorvlad.com/lowerbackpainexercises/index.php/2010/05/lower-back-pain 86. http://www.drerrico.com/html/scoliosis.html 87. http://www.drfoot.co.uk/flat.htm 88. http://www.dubinchiro.com/features/ankle1.html 89. http://www.dynamicchiropractic.com/mpacms/dc/article.php?id=45531 90. http://www.e-algos.com/cervical-radicular-pain 91. http://www.emedicinehealth.com/script/main/art.asp?articlekey=135633&ref=128554 92. http://www.eorthopod.com/content/clubfoot 93. http://www.eorthopod.com/content/foot-anatomy 94. http://www.fachgebaerdenlexikon.de/index.php?id=2140 95. http://www.farosmedikal.com/page3.php 96. http://www.fisiomedica.org/trattamenti 97. http://www.fitandtherapy.it/massaggio%20cervicale.php 98. http://www.fitness-programs-for-life.com/scoliosis_exercises.html 99. http://www.flickr.com/photos/museumoflondon/3239465304 100. http://www.fpnotebook.com/nicu/ortho/trtcls.htm 101. http://www.fyp.emmettconroy.com/site/about-ddh?page=2 102. http://www.gamekyo.com/media24160.html 103. http://www.gazzetta.it/Fitness/Corpo_psiche 104. http://www.gundluth.org/?id=2691&sid=1 105. http://www.halluxvalgustips.com/hallux-valgus-deformity 106. http://www.healingbackpain.co.uk/scoliosis/scoliosis-prognosis 107. http://www.healingfeet.com/blog/foot-care/hi-arch-cavus-foot 108. http://www.health.com/health/diseases-conditions 109. http://www.healthgrouponline.com/scoliosis.html 110. http://www.healthofchildren.com/C/Clubfoot.html 111. http://www.healthopedia.com/pictures/lordosis.html 112. http://www.health-reply.com/with-congenital-muscular-torticollis 113. http://www.hellotrade.com/trulife-ireland/orthotics-hip-dynamic-hip-splint.html 114. http://www.holistic-back-relief.com/neck-pain-relief.html 115. http://www.holladayphysicalmedicine.com/patient_information/patient_conditions/lumbar _disc_syndrome.htm 7

116. http://www.hygenicblog.com/2010/04/28/thera-band-exercises-beneficial-after-surgery-tocorrect-hallux-valgus 117. http://www.injurylawsourcepa.com/2012/06/torticollis-pediatric-medical.html 118. http://www.iscoliosis.com/treatment-surgical-thoracoplasty.html 119. http://www.ivline.info/2010/10/clinical-examination-of-spine.html 120. http://www.jaaos.org/content/12/4/266/F1.expansion 121. http://www.jasonwhitetherapy.com 122. http://www.kingsvillehomerehab.com/modalities/electrotherapy.aspx 123. http://www.kmle.co.kr/search.php?Search=Nonstructural%20scoliosis 124. http://www.livescience.com/19331-unknown-hominin-species-bipedalism.html 125. http://www.lookandlearn.com/history-images/XM10058085/Galen-and-Gladiators 126. http://www.maquet-dynamed.com/inside_sales 127. http://www.marwell.cz/en/vyhody.htm 128. http://www.mdsportscare.com/aquatic-therapy 129. http://www.medicalfootgroup.com/services/advanced-diagnostics 130. http://www.medpedia.com/news_analysis/388-Sanodox/entries/79104-Improving-Postureand-Ergonomics 131. http://www.medrehab.info/medical_services/4/rehabilitation.html 132. http://www.mendmeshop.com/toe/deformity-causes.php 133. http://www.museumoflondon.org.uk/Collections-Research/LAARC/Centre-for-HumanBioarchaeology/Resources/Photographs/bermondseyabbey.htm 134. http://www.myseveralworlds.com/2007/07/11/suffering-for-beauty-graphic-photos-ofchinese-footbinding 135. http://www.nba.com/features 136. http://www.necksolutions.com/neck-exercises.html 137. http://www.necksolutions.com/neck-pain.html 138. http://www.netterimages.com/image/4654.htm 139. http://www.nismat.org/ptcor/female_knee 140. http://www.operepubbliche.regione.umbria.it/Mediacenter/FE 141. http://www.orthoneuro.com/medical-conditions/kyphosis 142. http://www.orthopediatrics.com/docs/guides/scoloisis.html 143. http://www.orthoticsprostheticsne.com/home/index.php/Orthotics-Prosthetics/pediatricorthotics.html 144. http://www.ortopediebaldinelli.it 145. http://www.osteopathuk.co.uk/ultrasound.htm 146. http://www.pectuscarinatum.com.tr/eng 147. http://www.physioroom.com/injuries/knee/medial_collateral_ligament_sprain_full.php 148. http://www.physiosupplies.com.au/fitness/Aircast-Cyrocuff-Cooler.html 149. http://www.pic2fly.com/Lasegue.html 150. http://www.prevention.com/fitness/strength-training/end-neck-pain-3-moves 151. http://www.projectswole.com/weight-training/the-top-5-best-calf-exercises 152. http://www.rad.washington.edu/academics/academic-sections/msk/teachingmaterials/online-musculoskeletal-radiology-book/scoliosis 153. http://www.richmondchiro.net/health-conditions/scoliosis 8

154. http://www.saspine.org/conditions/scoliosis.htm 155. http://www.scielo.br/scielo.php?pid=s1806-37132007000400017&script=sci_arttext&tlng=en 156. http://www.scoi.com/anklanat.htm 157. http://www.sdspineinstitute.com/index.php/site/conditions/category/kyphosis 158. http://www.shopmedvet.com/product/hip-pillow-abduction-large-each/closeout-productscloseout-orthopedic-products 159. http://www.shoulderandelbowcenter.com/sec_education_links.htm?education/arth.htm 160. http://www.shustuff.com/Catalogue.htm 161. http://www.spala.cos.pl/91,rehabilitation-and-health-care.html 162. http://www.spinecorscoliosisbrace.com 163. http://www.spineharmony.com/exercises 164. http://www.spineuniverse.com/conditions/osteoporosis/spinal-fractures-spondylolisthesisscoliosis 165. http://www.sports-injury-info.com/bankart-lesion.html 166. http://www.srs.org/professionals/glossary/SRS_revised_glossary_of_terms.htm 167. http://www.stetoskop.info/Povrede-ramena-4346-s13-content.htm 168. http://www.swiga.com/blog/catalog.asp?cate=19 169. http://www.terviseparadiis.ee/treatment___relaxationen/loogastused_raviden 170. http://www.thehealthybackblog.com/category/chiropractic/chiropractor/page/10 171. http://www.thermalon.com/article-12-arthritis-prevention.php 172. http://www.topnews.in/health/exercise 173. http://www.umm.edu/imagepages/19072.htm 174. http://www.umm.edu/imagepages/19689.htm 175. http://www.umm.edu/patiented/articles/how_scoliosis_diagnosed_000068_6.htm 176. http://www.umm.edu/patiented/articles/what_causes_pain_low_back_pain_or_sciatica_00 0054_2.htm 177. http://www.umm.edu/patiented/articles/what_symptoms_of_scoliosis_000068_5.htm 178. http://www.uni-kiel.de/orthop/kinder.html 179. http://www.uwhealth.org/healthfacts 180. http://www.wcbl.com/product-spotlight/pectus-carinatum-2 181. http://www.webbfitness.net/training-and-sports-medicine 182. http://www.webmd.com 183. http://www.webmd.com/back-pain/sleeping-positions-for-people-with-low-back-pain 184. http://www.wecreatewellness.com/services/chiropractic/education/scoliosis 185. http://www.wellsphere.com/back-neck-pain-article/cervical-brachial-syndrome-causesneck-and-arm-pain/901762 186. http://www.working-well.org/articles/bounce_ball.html 187. http://www.yelp.com/biz_photos/xOOu5krCPsBPTu79MvF9eA?select=2xgNiTCtCzf7c12NHF Ag8g#2xgNiTCtCzf7c12NHFAg8g 188. http://www.yinovacenter.com/blog/archives/4582 189. http://www.youngwomenshealth.org/scoliosis-article.html 190. http://www.zimmer.co.uk/z/ctl/op/global/action/1/id/391/template/PC/navid/10892 191. http://www.zimmer.com/z/ctl/op/global/action/1/id/7753/template/IN 192. http://wyattfleming.hubpages.com/hub/Per-Henrik-Ling-10Z3H1 9

Key words for the electronic search of the whole handbook: kinesitherapy, physiotherapy, flat feet, foot deformations, leg deformations, ankle, knee, shoulder, rehabilitation, injury, the hip, lordotic poor posture, kyphotic poor posture, scoliosis, thoracic deformities, low back pain, cervicobrachial syndrome, torticollis.

Glossary: Acquired deformity – a physical abnormality gained during life. Active joint stabilizers – contractile joint elements (muscles). Antalgic position – a position assumed in order to avoid or lessen pain. Bilateral – involving both parts of the body (eg. the right and the left arm). Cervicobrachial syndrome - a nonspecific term describing some combination of pain, numbness, weakness, and swelling in the region of the neck and shoulder. In the cervicocephalic syndrome symptoms are located in the neck and head. In the cervical syndrome symptoms are present in the neck. In the cervicobrachial syndrome symptoms are located in the neck and arm. Compensatory movement – a reflex movement that maintains a particular body position. Concave - hollowed inward, curving in. Congenital deformity – a physical abnormality existing from birth. Conservative therapy – rehabilitation treatment that does not involve surgery. Convex – bulging outward, curving out. Deformation – structural deformation. A structural (bone) deformation of the locomotor system (eg. scoliosis, kiphosis...). Disc prolapse – a discus herniation. Describes the rupture of annulus fibrosus and leakage of nucleus pusposus. Disc protrusion - a common form of spinal disc deterioration in which part of the spinal disc bulges out, causing pain. Dysplasia – abnormality of development (eg. deformation of joint surfaces). 10

EDF principle – a principle used in the therapy of scoliosis, meaning elongation, derotation and flexion. Etiology - the cause of a disease or abnormal condition. Foot arches – tarsal and metatarsal bones held together by tendons and ligaments, and supported by foot and lower leg muscles. Functional rehabilitation – a rehabilitation protocol that focus on the restoration of the injured patient to an optimal functional level in all areas of activity, from everyday basic to sport-specific motor tasks. Genua valga – a knee deformation involving medial convexity. Genua vara – a knee deformation involving lateral convexity. Hypoplasia – incomplete development of an organ or tissue (eg. insufficient development of the joint surfaces). Injury mechanism – describes the circumstance in which an injury occurs (eg. a sudden deceleration, an unexpected landing, valgus knee position…). Kinesitherapy - as an area of applied kinesiology and a clinical discipline, encompasses the implementation of different exercise modalities for therapeutic aims. It is an interdisciplinary field that combines medical and kinesiological knowledge. Kyphosis – a structural deformation of the spine involving a posterior convexity, with the trunk bend forward, and vertebrae deformation. Kyphotic poor posture – a postural change of the spine involving a posterior convexity, with the trunk bend forward. Usually describes an increase of the physiological thoracal kyphosis. Leg deformation – a physical abnormality that include the knee, the distal part of the upper and/or the proximal part of the lower leg. Lordosis – a structural deformation of the spine involving an anterior convexity, and vertebrae deformation. Lordotic poor posture – a postural change of the spine involving an anterior convexity. Usually describes an increase of the physiological lumbar lordosis. Low back pain – a common disorder representing the symptom of pain or discomfort felt in the back or buttocks. 11

Luxation - a joint injury where the bones of a joint move out of position. Osteophytes – small lumps of extra bone present in a joints damaged by arthritis. Overuse injury – a cumulative trauma that results from repetitive minor damages over the course of time. Usually the exact time of the first micro trauma is not known (eg. stress fracture, tendinitis…). Passive joint stabilizers – non contractile joint elements (bones, ligaments, cartilage...). Pectus carrinatum – a chest wall abnormality involving protrusion of the sternum and ribs. Pectus excavatum – a chest wall abnormality involving a frontal concavity. Physiotherapy - a field of physical medicine that uses different physical aids for therapeutic issues. Poor posture – a non structural change in an individual posture. It involves changes on soft (muscle tissue). Posture - describes an individual way of standing (upright posture) or sitting (sitting posture). It also implies mechanisms involved in the compensation of postural perturbations. Sacroiliac pain – describing the pain int he sacrum region, eg. when an initial lumbar pain radiates in the sacrum region. Sciatica (sciatic nerve pain) – pain that involves the sciatic nerve and is felt in the lower back, the gluteal region, the back of the thigh and may radiate to the foot. Scoliosis – a structural deformation of the spine involving lateral flexion of the spine, vertebrae deformation and rotation. Scoliotic poor posture – a postural change involving trunk lateral flexion, without bone deformation. Sport rehabilitation – a treatment of an injury that happened through sport participation, performed on professional athletes or amateur. Usually encompasses a wide range of multidisciplinary treatment techniques aimed to return to pre-injury activities. Syndrome - a collection of symptoms commonly seen together but for which there is no known explanation.

12

Torticollis – a neck deformation involving head lateral flexion, chin rotation with head slightly bent forward. Traumatic injury - an acute damage of a body part produced by a sudden shock, like a collision, a fall ecc. Usually the time of injury is well known (eg. joint dislocation, rupture of a ligament...). Unilateral – involving only one part of the body (eg. the right arm). Wedged vertebra – a vertebra that is wedged on one side. Usually the wedged side is turn toward the concavity.

13