Planning and Programming of Kinesitherapy Treatment in Scoliosis : Undergraduate Thesis

Nepravilno držanje ili loša postura je nepravilan odnos mišićno-koštanih struktura bez anatomskih promjena na kralježnici. Prilikom nepravilnog držanja opterećenja se neravnomjerno prenose na tijelo što dovodi do povećanog opterećenja kostiju, zglobova i mišićnog disbalansa. Kada tijelo gledamo sprijeda ili straga, centralni ravni stup kralježnice mora biti ravan. Skoliozu prepoznajemo tako što centralni stup kralježnice nije ravan nego se zavija u jednu stranu (lijevu ili desnu) u obliku slova „S“ ili „C“. Sjedilački način života pomaže u nastanku ovog deformiteta. Klijentica je studentica treće godine pomorskog fakulteta, koja se prije aktivno bavila košarkom. Danas se klijentica ne bavi nikakvim sportom, dane provodi uglavnom sjedeći na fakultetu i na poslu. Nastanak deformiteta klijentici je nepoznat, iako poveznicu mnogi stručnjaci vide u sportovima i zanimanjima gdje dominira jedan obrazac kretanja ili u većoj mjeri korištenje jednog ekstremiteta, no ništa nije sa sigurnošću potvrđeno. U ovom slučaju prisutna je desna torakolumbalna skolioza tipa „C“, što izaziva disbalans u obrascu kretanja. Klijentica se ne žali na nikakve bolove, te nikad nije prisustvovala procesu tretmana za ispravljanje skolioze. Plan i program koji provodimo podijelili smo u četiri faze, koje definiraju ciljeve po principu progresije. U prvoj fazi nastojimo se bazirati na pokretljivosti i kinesteziji, pravilnom početnom položaju vježbe, to jest položaju koji ne uzrokuje bol te pravilnom obrascu disanja. Druga faza fokusirana je na stabilizacijske vježbe u simetrčnim položajima DNS-a i stabilnost, dok u trećoj fazi nastojimo djelovati na oblikovanje kralježnice, također stabilizaciju trupa i derotaciju kralježaka. Završna faza je usmjerena na istezanje i jačanje mišića leđa. Cilj tretmana je smanjiti kut skolioze, njeno napredovanje, te klijentici pomoći uspostaviti pravilan i bezbolan obrazac kretanja.Incorrect posture or a bad posture is an irregular relationship between muscular and bone structures without anatomical changes on the spine. In incorrect posture, the load is being unevenly spread across rhe body which leads to the overload of bones and joints and muscular misbalance. When the body is being looked from the front or back, central straight pillar of the spine has to be straight. Scoliosis is recognized because the pillar is not straight and is bent to one side (right or left) in the shape of letters “S” or “C.” Sedentary lifestyle helps in forming this deformity. The client is a third year student of nautical college who used to actively play basketball. Today, she doesn’t participate in any sports and she spends her days sitting down either at the college or at work. The origin of the deformity is unknown to the client, but a lot of people see the connection in the sports and interests that are dominated by a certain movement pattern or the usage of a certain extremity, but nothing has been officially confirmed. In this case, bottom right thoracolumbar scoliosis type “C” is evident and it causes misbalance in the movement pattern. The client does not have any pain complaints and has not attended any treatments for curing scoliosis. Plan and program that is being implemented has been broken down into four phases that define goals with principal of progression. In the first phase, we are trying to focus on mobility and kinesthesia, correct starting position of an exercise (position that does not cause pain) and regular breathing pattern. Second phase is focused on stability exercises in symmetrical DNS positions, while in the third phase we are trying to affect the shaping of the spine, as well as core stability and de-rotation of vertebrae. Final phase is focused on stretching and strengthening of the back muscles. The goal of the treatment is to decrease the angle of scoliosis, its progression, and to help the client establish a regular and painless motion pattern