Benefits of prevention/ rehabilitation physical training model for children and adolescents with scoliosis

Dr.Biol., Professor A.P. Shklyarenko1
Dr.Hab., Professor T.G. Kovalenko2
PhD D.A. Ulyanov2
1Kuban State University, Slavyansk-on-Kuban branch
2Volgograd State University, Volgograd

Keywords: physical education, scoliosis, physical exercises, posture, motor activity, spine functionality.

Background. Scoliosis is ranked among the most severe musculoskeletal system diseases. Exposure to  the musculoskeletal disorders and ailments is known to be largely due to the genetic developmental abnormalities plus many factors associated with the growing urbanization, physical inactivity and environmental issues [4, 6]. Despite scoliosis being prevalent among the musculoskeletal system diseases, it is still underexplored in many aspects. A special role in this situation may be played by the modern physical education service models to prevent/ reverse the potential health disorders in the sick children and adolescents [3, 5].
Objective of the study was to rate benefits of a prevention/ rehabilitation physical training model for children and adolescents diagnosed with stage I/II scoliosis.
Methods and structure of the study. Sampled for the 7-year study at the Children Orthopedic Sanatorium in Gelenjik were the 8-16 year-old girls (n=241) and boys (n=142) diagnosed with stage I/II scoliosis. The spine flexibility was tested by the Levit, Zahse and Yanda test method to obtain the bend/ extension/ rotation test rates; with the flexibility data classified as А – (subnormal) hypo-mobility; B – normal mobility; and C – (supernormal) hyper-mobility [2]. The movement asymmetry was rated by special video-recorded test exercises.
Results and discussion. Multidirectional spinal mobility in children and adolescents diagnosed with scoliosis is known to significantly vary in the hypo- and hypermobility ranges. Thus the 8-11, 12-14 and 15-16 years old girls are normally more flexible than boys albeit the proportions of the girls tested with high trunk extension and flexion indices tend to fall and grow with age, respectively. Within this general trend, percentages of the normally flexible boys tend to be higher than the share of their female peers with the same spinal disorders.
Highly flexible junior-age schoolgirls diagnosed with scoliosis are not recommended to go in for physical practices with multidirectional biomechanical stresses on the spinal column that are unavoidable, e.g. in the spinal mobility intensive sports (rhythmic and artistic gymnastics, acrobatics, diving, trampoline, rhythmic dance, etc.).
Most (55%) of the 12-16 year old girls with limited lumbar lordosis (flat back symptom) and stage II scoliosis are normally tested with the highest flexibility in the sagittal plane and significantly limited frontal-plane trunk rotation and amplitude on the bulged side with increased mobility towards the other side. These symptoms are less expressed (19%) in their peers with initial stage of the spinal deformation, although the average spinal mobility tends to change with age with the bones growth process, with some gender specifics. The age-specific mobility rates may be widely different in case of severe spinal deformities.
Progress of scoliosis may be spurred up by technically complex exercises, irrational physical activity and manipulations on the deformed spine. The general physiological/ biomechanical movement patterns of the deformed spine and their analyses give grounds to revise the common ideas on how symmetric/ asymmetric practices should be used in the school physical education service for these health groups. The disease-specific movement asymmetry further aggravated by the temporary growth disproportions in the fast skeletal growth period associated with a neuromuscular insufficiency is known to contribute to progression of scoliosis, with the 12-16 year old girls diagnosed with stage II scoliosis tested with particularly severe limitations of the movement coordination qualities.
The asymmetry ratio of the sample in the test exercises was found close to the absolute values (89%). Serious difficulties in the tests were experienced by the stage I scoliosis diagnosed subgroup since only one of three girls could perform the coordination-intensive exercises satisfactory. The tests found a direct correlation between the progress of scoliosis and coordination qualities. 
The tests found no direct connection between the postural disorders and scoliosis. A structural analysis of the spinal functionality, pathological postural stereotypes and basic motor skills (sitting, leaning, walking) provides the theoretical grounds for the physical development and performance rating studies on the ontogenesis-stage-specific basis (of the 8-11, 12-14 and 15-16 year olds). The disease-specific physical education service should include at least the following three interrelated components: (1) prevention and treatment of scoliosis in the 8-11 year-olds; (2) corrective actions in the sensitive period; and (3) rehabilitative programs by the end of the fast adolescent skeletal growth period. The physical education service models for the stage-I/II scoliosis diagnosed children and adolescents should be sensitive enough to prevent potential spinal injuries (due to falls, bumps, etc.) and excessive longitudinal-vertical physical stresses typical for the weight lifting practices, long endurance-intensive races, special acrobatic elements, etc.
Conclusion.The study data were used to analyze benefits of the genetic motor resource mobilizing and prevention/ rehabilitation physical training model for the scoliosis-diagnosed underage groups to effectively compensate the motor disorders and facilitate progress of the growing body. The model was tested to generally activate and correct the most critical everyday motor skills (walking, postural controls etc.) and mitigate the scoliosis-specific disorders in the static and dynamic motor functionality. Active corrective measures to improve the muscular system functionality were found to prevent regresses in the paravertebral spinal tissue. The model revises the traditional orthopedic prohibitions to extend the range of applicable physical training tools and effectively correct the visual bodily distortions, stabilize the postures, cater for the natural demand of this age group for physical activity and mitigate the body reshaping related mental stressors.

References

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Corresponding author: kovalenko1288@mail.ru

Abstract
Scoliosis is ranked among the most severe musculoskeletal system diseases. Objective of the study was to rate benefits of a prevention/ rehabilitation physical training model for children and adolescents with stage I/II scoliosis. Sampled for the 7-year study at the Children Orthopedic Sanatorium in Gelenjik were the 8-16 year-old girls (n=241) and boys (n=142) diagnosed with stage I/II scoliosis. The spine flexibility was tested by the Levit, Zahse and Yanda test method to obtain the bent/ extension/ rotation test rates; with the flexibility data classified as А – (subnormal) hypo-mobility; B – normal mobility; and C – (supernormal) hyper-mobility [2]. The movement asymmetry was rated by special video-recorded test exercises. The study data were used to analyze benefits of the genetic motor resource mobilizing and prevention/ rehabilitation physical training model for the health group to effectively compensate the motor disorders and facilitate progress of the growing body. The model was tested to generally activate and correct the most critical everyday motor skills (walking, postural controls etc.) and level down to a degree the scoliosis-specific disorders in the static and dynamic motor functionality. The model revises the traditional orthopedic prohibitions to extend the range of applicable physical training tools and effectively correct the visual bodily distortions, stabilize the postures, cater for the natural demand of this age group for physical activity and mitigate the body reshaping related mental stressors.