Muscle relaxation technique to correct thoracocervical scoliotic disorders in athletes

Фотографии: 

PhD N.Yu.Tarabrina
V.I. Vernadsky Crimean Federal University, Taurida Academy

Keywords: muscle relaxation, rehabilitation, functional scoliosis, swimming, athletes

Introduction

Scoliosis (and postural disorders of different aetiology) is now rated among the most common and serious diseases of musculoskeletal apparatus typical for children and adolescents and, consequently, for many adults. It is quite typical for the stage II scoliosis that it causes dyskinetic and dystrophic performance disorders in the internal organs [1, 5] that contribute to chronic disease development processes in the cardio-respiratory system that lead with time to early disabilities in population [1, 3, 5, 6].

Athletes on the whole and wrestlers in particular are often diagnosed with scoliosis of different forms and stages, particularly the functional ones, due to the asymmetric workloads associated with stato-dynamic disorders that normally evolve to non-progressive or slowly progressive forms of scoliosis [4]. The long-term habitual asymmetric workloads suppress the growth of the relevant bone segments where the epiphyseal cartilage is exposed to strong and prolonged compressive actions, whilst the less loaded segments of the epiphyseal cartilage grow faster (according to the Hueter-Volkmann law as cited by I.A. Movshovich, 1969). The resultant asymmetries in growth of the bones and vertebrae in particular result in spine deformations.

It is a matter of common knowledge that hypertrophy of cervical muscles in wrestlers is also asymmetric [3, 10, 13]. This asymmetry is a prime reason for the cervical and dorsal muscle traction being uneven with an asymmetric muscular strength field being formed as a result [9, 10, 12, 13]. Very young athletes (5-9 years old) are exposed to spinal torsion or scoliosis due to such transformation of their muscular strength field. The muscular asymmetry in more senior athletes (10-14 years old) mostly results in movement coordination disorders (that may be very serious is some cases) that are always detrimental for the motor skill performance and competitive performance of the athletes [14].

This is the reason why so much attention is being given to the initiatives to develop and implement the relevant rehabilitative combination exercises to minimize the negative effects of the scoliotic disorders. The exercises are normally dominated by symmetric (in case of postural disorders and stage I scoliosis) and asymmetric (in case of stage II and more severe scoliosis) routines [2, 5] and swimming, with special appliances being used for corrective loading of different muscle groups [8, 9]. However, most of these routines are quite complicated, require quite expensive equipment and need to be performed under a close supervision of instructor.

Therefore, it is the corrective traction techniques in the present situation that are commonly recognized and used as the most efficient methods to correct the musculoskeletal disorders. As demonstrated by a few study reports, traction of mesodermal growths in the С3-Th8 zones with a variety of therapeutic methods being applied leads to expressed reduction of the sympathetic influences on the heart rate [10, 11, 13], with a notable increase of the oxygen concentration in the tissues of extremities and improvement of the respiratory system performance rates [3, 5]. The authors come to conclusion that the positive cardiovascular and respiratory responses at different stages of the oxygen cascade are basically due to the harmonization of the myotic tonus in the С3-Th8 segment projection areas and normalization of afference from the muscles in chains of the myo-cardial, myo-vascular and myo-respiratory reflexes [2, 3, 5, 8, 13].

It should be noted virtually no studies have been reported to explore how corrective APA routines may be applied to the С3-Th8 segments to positively affect the paravertebral muscle tonus in the thoracocervical spine segment to correct scoliotic disorders in athletes; and this issue was taken as an objective of the study.

Methods and structure of the study. Subject to the study were 15 combat wrestlers specialized in freestyle wrestling and Greco-Roman wrestling, aged 19.4±3.7 years on average, having at least 8-10 years-long track records in the sports, qualified Candidates for Master of Sport and Masters of Sport (in the weight category below 76 kg) and diagnosed with stage I-II scoliotic disorders. The subject athletes were exempted from training sessions one day prior to and on the day of examinations under the study.

Every selected athlete was subject to the paravertebral muscle tonus correction APA routines in a swimming pool using special appliances including aquatic noodle (that is a special foam-rubber cylinder widely applied in aquatic fitness practices to support different biomechanical body segments in water) and foam-plastic kickboards. Having analyzed the available research literature on the issue and practical reports of the relevant leading specialists from the Medical and Biological Basics of Physical Culture Research Department of V.I. Vernadsky Crimean Federal University under the Taurida Academy, we have developed a therapeutic APA course of 18 sessions taking six weeks on the whole, with three 45-minute sessions per week. The development was subject to Claim of Copyright #2015134116 priority of 13.08.2015 “Human paravertebral zone muscular tonus asymmetry correction method”.

The therapeutic Aquatic Postural Auto-traction (APA) routine will be performed as follows: the athlete will fulfil combined aquatic exercises using the aqua noodles and a standard foam plastic kickboard. Having fixed the buoyant appliances on the relevant body segments, the athlete will perform rhythmic symmetric movements by the free or fixed parts of the body at the rate of 30 movements per minute to apply balanced stretching loads to the muscular corset of the cervical zone and evenly increase strength of these muscles, with the existing asymmetry being levelled down and different tonus imbalances in the paravertebral muscles being removed with time.

The tonus-reduction effect of the therapeutic APA routine on the paravertebral muscles of the  thoracocervical segment was verified by the muscular (myotic) tonus metering tests prior to and after the therapeutic APA course, with the following symmetrical paravertebral points being tested using METRIMPEX ElectroMyotonometer Unit (made in Hungary): “ya-men” VG15 point; “tian-liao” TR15 point; and “ga-guang” V46 point.

The tonus-reduction effect of the therapeutic APA routine on the paravertebral muscles of the thoracocervical segment was valued in percentage terms versus the baseline level. The test data were subject to a standard statistical processing toolkit available in the STATISTIСА 8.0 software package. Mean arithmetic (X) and standard deviation (σ) values were used to rate the central trend and dispersion; and the non-parametric data benchmarking methods (W-criterion of randomness by Wilcoxon) were used, with p<005 being assumed as indicative of the statistically significant differences.

Study results and discussion. The study of the therapeutic APA routine effects on the myotonic responses in the subject athletes showed that the most statistically significant (p<0.001, W-criterion of Wilcoxon) reduction of the muscular tonus (up to 16.52%) was found to occur in the “tian-liao” TR15 point (see Table 1 and Figure 1 hereunder).

Table 1. Muscular tonus reduction rates for the С3-Тh8 bodily segments (in myotones) of the subject athletes as a result of the therapeutic Aquatic Postural Auto-traction (APA) course, X± σ

Points

Baseline value

APA

Δ, %

VG15

22,36±2,73

19,48±1,78

-12,88*

TR15 dexter

40,67±6,41

33,95±4,90

-16,52**

TR15 sinister

37,02±7,17

32,09±5,88

-13,30**

V46 dexter

39,94±6,37

33,42±5,33

-16,32**

V46 sinister

36,83±6,89

33,01±5,44

-10,37**

 

Note: * and ** mean (herein and on Figure hereunder) the difference significance versus the baseline level of р<0.05 and р<0.01, respectively

It may be pertinent to note that every subject athlete was diagnosed with an intact asymmetry of cervical muscle group, with the muscle tonus being higher on the right side. However, the combined exercise routines of the therapeutic APA course resulted in the following: the muscular tonus in the VG15-point was found to reduce by 12.88% (p<0.05); the muscular tonus in the symmetric paravertebral points sugnificantly changed within the range of 16.52-16.32%; in TR15 point it was found to fall by 13.3%; and in V46 point – by 10.37% (p<0.001); with the tonus reduction effects being higher on the left side. This fact may be explained in terms of the law of initial values” by Wilder and Leites in view of the fact that most of the subjects (90%) were right-handers. It is reasonable to suppose that it is the tonus of the muscle groups most engaged in the competitions that was most affected by the corrective APA course.

Figure 1. Paravertebral muscle tonus rates (in myotones) of the subject athletes prior to and after the therapeutic Aquatic Postural Auto-traction (APA) course

Summary

Noodles and kickboard will be applied to fix the muscle-traction posture during the corrective aquatic routine and to load the relevant muscle groups by additional elastic resistance being applied to the С3-Тh8 segment muscles. The rated loads in the aquatic routine will be applied so as to minimize the pathologic motor stereotypes, harmonize the muscular tonuses and strengthen the flexion ability of the thoracic muscle group to help improve the musculoskeletal system performance and rehabilitate the dyskinetic conditions. The routine will improve the blood supply to the pathologically cramped muscles, and their motor units will renovate being engaged in the reciprocal movements of the aquatic routine. Myofibrils and sarcomeres will restore their lengths and perform in the new close-to-norm dynamic and biomechanical conditions [3, 5]. Therefore, the corrective method may be applied as an auxiliary therapeutic course even when the spinal disorders are severe enough, with an emphasis being made on the preliminary corrective action in a conservative therapeutic course as it gives the means to employ the renewed muscular corset into the “right work” to the maximum possible degree so as to correct the disorders.

Conclusion

  • Athletes engaged in anaerobic sport disciplines that apply heavy workloads on the thoracocervical spine segment are normally diagnosed with skoliotic conditions caused by the sport-specific performance factors.
  • Every subject athlete was diagnosed with intact-state asymmetry of the cervical muscle group, with the muscle tonus being found higher on the right side.
  • The corrective Aquatic Postural Auto-traction (APA) routine was found to help selectively stretch the local muscular hyper-tonus of skoliotic pathogenesis in the С3-Тh8 zone, with the highest positive changes of up to 16.52% (p<0.001) being detected in the TR15 point.

References

  1. Lewit K. Manual'naya meditsina (Manual medicine) / K. Lewit, J. Sachse, V. Yanda. – Moscow: Meditsina, 1993. – 510 p.
  2. Mavlieva G.M. Neformakologicheskaya korrektsiya gipertonusa myshts plechevogo poyasa (Non-pharmacological correction of hypersthenia of shoulder girdle muscles) / G.M. Mavlieva, R.A. Bodrova // LFK i massazh. – 2005. – № 5. – P. 37–38.
  3. Mel'nichenko E.V. Miovistseral'naya reflektornaya korrektsiya vestibulyarnykh reaktsiy serdechno-sosudistoy sistemy u sportsmenov (Miovisceral reflex correction of vestibular responses of cardiovascular system in athletes) / E.V. Mel'nichenko, N.Yu. Tarabrina, A.I. Parkhomenko // Tavricheskiy mediko-biologicheskiy vestnik (Taurida Biomedical Herald). – 2010. – Vol.13, № 3 (51). – P. 133–136.
  4. Movshovich I.A. Rentgenodiagnostika i printsipy lecheniya skolioza (X-ray diagnostic and principles of scoliosis treatment) / I.A. Movshovich, I.A. Rits. – Moscow: Meditsina, 1969. – 391 p.
  5. Pat. 37217 Ukraina, Sposob korrektsii respiratornoy sistemyi pri skolioznoy bolezni (Pat. 37217 Ukraine, respiratory system correction method for scoliosis disease) / Mel'nichenko E.V., Parkhomenko A.I., Mametova O.B.; appl. and patentee – V.I. Vernadsky Taurida National Universit ; Bul. # 22, 2008, pub. 25.11.2008.
  6. Platonov V.N. Teoriya adaptatsii i rezervy sovershenstvovaniya sistemy podgotovki sportsmenov (Theory of adaptation and capacities for improvement of athletic training system) / V.N. Platonov, G.V. Danko // Nauka v olimp.sporte. – 2007. – № 1. – P. 3–16.
  7. Plekhanov G.F. Zavisimost' reaktsii biosistemy na razdrazhitel' ot ee iskhodnogo znacheniya (Dependence of biosystem reaction to stimulus and its initial value) / G.F. Plekhanov, N.V. Vasiliev, T.I. Kozlova // Bul. Sib. dep. AMS USSR. – 1989. – № 2. – P. 83–86.
  8. Polyakova A.G. Diskussionnyie aspekty nemedikamentoznykh metodov aktivatsionnoy terapii v protsesse reabilitatsii. (Controversial aspects of non-drug methods of activation therapy in rehabilitation) / A.G. Polyakova, A.G. Suslov, T.V. Drubich // Vestnik RUDN, seriya Meditsina (Herald of Peoples' Friendship University, Medicine series). – 2010. – №3. – P. 216–219.
  9. Samorukov A.E. Manual'naya terapiya i fizicheskie faktory v vosstanovitel'nom lechenii sindroma vertebral'noy arterii pri disfunktsii sheynogo otdela pozvonochnika (Manual therapy and physical factors in medical rehabiliation of vertebral artery syndrome with cervical spine dysfunction) / A.E. Samorukov, I.P. Bobrovnitskiy, L.Yu. Tarasova // Manual'naya terapiya. – 2010. – № 1. – P. 22–31.
  10. Sitel' A.B. Vliyanie degenerativno-distroficheskikh protsessov v sheynom otdele pozvonochnika na narushenie gemodinamiki v vertebral'no-bazilyarnoy sisteme (Effect of degenerative and dystrophic processes in cervical spine on hemodynamic disorders in vertebrobasilar system) / A.B. Sitel', K.O. Kuzminov, M.A. Bakhtatze // Manual'naya terapiya. – 2010. – № 1(37). – P. 10–22.
  11. Spinal'naya angionevrologiya. Rukovodstvo dlya vrachey (Spinal Angioneurology. Physician's Guide) / A.A. Skoromets, T.A. Skoromets, A.P. Skoromets, T.P. Tissen. – Moscow: Medpressinform. – 2003. – 607 p.
  12. Stefanidou A.V. Myshechno-fastsial'nye bolevye sindromy (klinicheskie varianty, mehanizmy razvitiya, lechenie): dis. ... dokt. med.nauk (Myofascial pain syndromes (clinical variants, mechanisms of development, treatment): doctoral thesis (Med.) / A.V. Stefanidou. – St. Petersburg, 2009. – 360 p.
  13. Tarabrina N.Yu. Aktivnaya miorelaksatsiya kak metod povysheniya rabotosposobnosti sportsmenov pri vestibulyarnykh nagruzkakh (Active muscle relaxation to athletes' increase work capacity at vestibular loads) // Lechebnaya fizicheskaya kul'tura: dostizheniya i perspektivy razvitiya: IV Vseros. nauch.-prakt. konf. s mezhdunar. uchastiem (Physical therapy: advance and development prospects: IV Russian res.-practical conf. with int. part.).– Moscow, 2015. – P. 169–172.
  14. Chelnokov V.A. Metodika otsenki asimmetrii grudnoy kletki u yunykh sportsmenov (Breast asymmetry evaluation technique for young athletes) / V.A. Chelnokov // Fizicheskaya kultura: vospitanie, obrazovanie, trenirovka. – 2006. – № 4. – P. 57–60.