KINESITHERAPY

1.1. Definition
Gre. Kinesismovement, motion + Therapietherapy
Kinesitherapy is the therapeutic and corrective application of passive and active movements and of
exercise. It is part of medical science and one of the methods in physical medicine and rehabilitation.
1.2. History
China
o 2700 yr. B Kong Fu boo! in "hich are described elements of therapeutic #ymnastics
passive, active and combined exercises and massa#es.
o Hua Tuo hinese physician "ho invented medical Daoyin $%ao &in' exercise.
India
o Yogis "ho lived in ancient India !ne" and used (00 different breathin# exercises and used them
to prevent and treat diseases.
Ancient reece
o Merodik, Hipokrat, Asklepiad had used body exercises in healin# and treatin# diseases.
o Aristot!e )00 years B.., termed the "ord !inesiolo#y and is often referred to as the *Father of
Kinesiology+.
o Archi"edes "as the first to develop principles of fluid mechanics
o a!en "as a ,oman physician for #ladiators often !no"n as the first athletic team physician.
-sed the #ym for the treatment and prevention of diseases of bone and muscular systems.
.mon# other thin#s, from a therapeutic purpose, he ordered the sports exercise $ro"in#, "al!in#
outdoors, etc.'. In its edition of /%he .rt of return to health/ 0 "Thousands and thousands of
times I was returning health to their patients through exercise."
o .bu .li Ibn 1ina $.vicenna' in his boo! /anon of 2edicine/ and /Boo! of 3ealin#/ describes
in detail the treatment and prevention of various diseases "ith the help of "edica! #y"nastics$
o Ni%o!as Andry& 4rench physician, published his introduction to orthopedics in 5765. -nder the
title 7rthop8die. 3e teaches the different 2ethods of preventin# and correction of 9eformities of
hildren.
o Per Henri% 'in# $577: 5();' "as a 1"edish physical therapist, developer and teacher of
medical0#ymnastics. <in#=s system of medical #ymnastics also influenced later institutions and
systems. %he Gymnastic 7rthopedic Institute "as founded in 1toc!holm in 5(22. In 57(0. the
published "or! of %issot /2edical #ymnastics, or exercise of human or#ans under the la"s of
physiolo#y, hy#iene and therapeutics, it sets out descriptions of various physical exercises,
massa#e $rubbin#' as "ell as their use for treatin# all sorts of diseases.
o Tissot published in 57(0. his "or! *2edical #ymnastics, or exercise of human or#ans under the
la"s of physiolo#y, hy#iene and therapeutics+. It includes descriptions of various physical
exercises, massa#es as "ell as their use for treatin# all sorts of diseases.
1.(. P)rpose
1. to pre*ent
2. to correct
(. to c)re
2ain or pri"ary operator in !inesitherapy is movement exercise. .n exercise can be static or
dyna"ic. >ither static or dynamic, they are passi*e& s)pporti*e& acti*e and acti*e +ith +ei#hts.
Secondary operators in !inesitherapy are?
o physical resources
o massa#e
o manipulation
o electric and mechanic devices
1.,. Physica! therapy
PHYSICA' THERAPY or physiotherapy is the art and science of physical care and rehabilitation. Its
main #oal is to develop, maintain and restore maximum movement and functional ability. 4unctional
movement is central to "hat it means to be healthy. @hysical therapy is concerned "ith identifyin# and
maximiAin# Buality of life and movement potential "ithin the spheres of?
o promotion
o prevention
o treatmentCintervention
o habilitation
o rehabilitation
%here are different treatment modalities in physical therapy such as?
o Hydrotherapy 0 use of "ater for pain relief and treatin# illness. It includes also usin# Dets,
under"ater massa#e and mineral baths $balneotherapy, thalassotherapy'.
o Ther"otherapy 0 is the application of heat to the body such as hot cloth, hot "ater, heatin#
pad, paraffin etc.
o Phototherapy or <i#ht therapy $heliotherapy' consists of exposure to dayli#ht or to
specific "avelen#ths of li#ht usin# lasers, li#ht0emittin# diodes, fluorescent lamps,
diachronic lamps or very bri#ht, full0spectrum li#htE
o E!ectrotherapy is the use of electrical ener#y as a medical treatment.
o -!traso)nd
o .a#net therapy $ma#netic therapy' involves the use of ma#nets of varyin# siAes and
stren#ths that are placed on the body to relieve pain and treat disease.
1./. Introd)ction to %inesitherapy
PRINCIP'ES 01 KINESITHERAPY
1. Princip!e of "oti*ation
2. Princip!e of ear!y 2e#innin#
(. Princip!e of ana!y3e of e4ercise
,. Princip!e of )nderstandin# e4ercise
/. Princip!e of a*oidin# the pain
5. Princip!e of #rad)a!!y
6. Princip!e of pra#"atica!!y
7. Princip!e of contin)es of e4ercise
8. Princip!e of acti*e in*o!*e"ent of participant
19. Princip!e of persistence
11. Princip!e of a*oidin# "onotony
12. Princip!e of fo!!o+in# and recordin# of res)!ts
2ethods of "or! are "o*e"ent& e4ercise& sport #a"es and e!e"ents of sports. 7r#aniAation forms of
"or! are individual "or! and #roup "or!. .reas in "hich !inesitherapy is practiced are
cardiopulmonary, #eriatric, neurolo#ical, orthopedic, pediatricE
2. The foot
In thousands of years of human evolution the foot has chan#ed but it is still not adapted enou#h
for upri#ht body position. 1ome of the functional and anatomic adaptations havenFt yet occurred.
,e#ardin# that and addin# over"ei#ht and poor foot"ear it doesnFt surprise the appearance of the f!at
feet or pes p!an)s :pes planoval#us;.
Gery complex structure of feet allo"s hu#e ran#e of movements<
p!antar f!e4ion& dorsa! f!e4ion& a2d)ction& add)ction& in*ersion
and e*ersion.
But, t"o are main or basic functions of the foot? the static f)nction throu#h the talus it absorbs the
"hole body "ei#htH and dyna"ic f)nction elastic re#ulator durin# physical activity.
%hree are three +ei#ht 2earin# points $"hen heel is lifted 2cm, "ei#ht is uniformly distributed on all
of them' and , arches connectin# those points?
1R0NT .EDIA' C0NTACT P0INT
1R0NTA' TRANS=ERSA' ARCH
1R0NT 'ATERA' C0NTACT P0INT
.EDIA' '0NIT-DINA' ARCH
'ATERA' '0NIT-DINA' ARCH
>ACK C0NTACT P0INT
%hree often found deformities of foot are?
1. Pes *a!#)s
o 2edial lon#itudinal foot arch flatted
o 4oot eversion
o .chilles tendonFs medial convexity
2. Pes *ar)s
o <ateral lon#itudinal foot arch flatted
o 4oot inversion
o .chilles tendonFs lateral convexity
(. Pes p!an)s
o .ll arches flattened
2.1. Pes p!an)s
Pes p!an)s is a condition in "hich the arch or instep of the foot collapses and comes in contact "ith the
#round. It comes in three phases? the ")sc!e phase& the !i#a"ent phase and the 2one phase.
%he foot can be evaluated "ith inspection, palpation, I ray, #ypsum contour, planto#raphy, podometer,
force plates.
o P!anto#raphy, method of ta!in# planto#ram, is most often used method to evaluate foot and
determine the flat feet.
o 1orce p!ates measures the distribution of the "hole body "ei#ht. .s the result, it is made the center
of pressure distribution. It allo"s static and dynamic measurements. %here is better option in
evaluation because its enables easier detection of flattened transversal foot arch, better indications
for the individual construction of foot"ear and corrective insole and helps in prevention.
Kinesitherapy pro#ram is aimed in stren#thenin# and stretchin# foot and lo"er le# muscles. %he best
results are sho"n "hen combinin# KINESITHERAPY AND INS0'E?
(. Knee defor"ities
9eformities can include !nees, distal part of upper and proximal part of lo"er le#s. 2ost common
deformities are?
en)a *ara& cr)ra *ara :0 %nees;
en)a *a!#a :@ %nees;
en)a rec)r*ata :%nee hypere4tension;
(.1. en)a *ara
Jith this deformity are connected flattened of !atera! !on#it)dina! arch of the foot, stretched muscles
on the outside $con*e4 side' and contracted muscles on the inside $conca*e side' part of the le#.
9eformity can occur as con#enita! or it can be acA)ired. It may affect the distal part of the upper le#
and than it=s !no"n as #en)a *ara or can affect the proximal part of the lo"er le# and it=s !no"n as
cr)ra *ara.
2ost common sy"pto"s are that the functional capacity of the le#s is reduced, there appears the
muscle fati#ue $tiredness' an often pain in the lo"er le#, upper le#, hips and lumbar spine.
Therapy can be conservative $anti0rachitic treatment, ultraviolet ray, passive correction 0 corrective
trac!s, bracin# and !inesitherapy' or operative.
(.2. en)a *a!#a
Jith this deformity are connected flattened of "edia! !on#it)dina! arch of the foot, contracted
muscles on the outside $conca*e side' and extended muscles on the inside $con*e4 side' part of the le#.
It appears more often "ithin "omen.
Ca)ses<
Gitamin 9 deficiency
3eredity
9ifferent professions
1port
7ver"ei#ht
1tatic loads
Inflammatory processes
.fter a bad repositionin# of the fractured femur
Therapy is same as in #enu vara conservative or operative.
0ften )sed test in deter"inin# %nee defor"ities is test of "a4i"a! f!e4ion<
o %he examinee lie in a prone position "ith one !nee flexed.
If the proDection of the heel falls?
In the middle of m. gluteus no deformation
7utside m. gluteus of the flexed le# I !nees
7n the m. gluteus of the extended le# 7 !nees
(.(. en) rec)r*ata
In ;0K of the cases it includes only one le#. %he convexity is on the bac! part of the le#.
auses ?
5. <ac! of the !neecap
2. 3ypoplasia of the !neecap
). 9ysplasia of the !neecap
,. InB)ry reha2i!itation
,.1. An%!e inB)ries
.n!le consists of t"o Doints?
5. tr)e an%!e Boint 0 tibiaCfibulaCtalus
o plantar and dorsal flexion
2. s)2ta!ar Boint D talusCcalcaneus
o inversion and eversion
%he lateral malleolus is lon# and narro", "hile the medial is short and "ide. 1uch bone anatomy of
the true an!le Doint ma!es it instable durin# movements of plantar flexion and inversion.
%here are also t"o main li#aments holdin# an!le firm? the
talofibular li#aments on the lateral side and the deltoid li#ament
on the medial side.
%he most common ac)te inB)ry is the an%!e sprain. In 5LK the true an!le Doint is in Buestion, "hen
in (LK subtalar Doint is hurt and "ith it the anterior talofibular li#ament also.
InB)ry "echanis"<
@lantar flexion and inversion of the foot. .ost co""on?
4oot inversion lateral an!le sprain talofibular li#ament.
4oot eversion medial an!le sprain deltoid li#ament.
. possible cause is the "ea!ness of the dorsal foot flexors compared "ith the stren#th of the plantar
foot flexors. 1o in the rehabilitation process after an an!le sprain m. peroneus and m. tibialis
anterior should be stren#thened.
De#ree of se*erity of the an%!e sprain<
rade I 0 stretch andCor minor tear of the li#ament "ithout laxity $loosenin#'
rade II 0 partial tear of li#ament plus some laxity
rade III 0 complete tear of the affected li#aments $very loose'
9uration and content of rehabilitation depends on the #rade of the inDury.
%he most common chronic pro2!e"s are tendonitis& 2)rsitis& stress fract)res "ith most common
causes poor post)re or foot defor"ations& hard s)rfaces& 2ad foot+ear& hor"ona! factor...
,.2. Knee inB)ries
Mnee inDuries could be?
Iso!ated D only one element inDured
Co"2ined %nee inB)ry D t"o elements inDured $e.#. .< + 2<'
Co"p!e4 tra)"a of the %nee BointD three or more elements inDured
In !nee anatomy the most important and most often inDured parts are? "enisci $medial and lateral'
"hich provide sta2i!ity $as secondary stabiliAers, the intact menisci interact "ith the stabiliAin#
function of the li#aments', !)2rication and n)trition $the menisci act as spacers bet"een the femur
and the tibia and prevent friction bet"een these t"o bones and allo" for the diffusion of the normal
Doint fluid and its nutrients', shoc% a2sorption $lo"er the stress applied to the articular cartila#e, and
thereby have a role in preventin# the development of de#enerative arthritis', AC' $anterior cruciate
li#aments', PC' $posterior cruciate li#ament', .C' $medial collateral li#ament'.
.enisci co)!d 2e inB)red durin# the internal
rotation of the lo"er le# accompanied by the !nee
flexion $medial' and durin# the external rotation of the
lo"er le# accompanied by the !nee flexion
$lateral'.
Test of "enisci tear<
AC' tear comes "ith medial menisci inDury internal rotation and !nee flexion. 1ymptoms are
pain, loss of function, s"ellin#, bruisin#, muscle atrophy, difficulty bearin# "ei#ht.
,.(. Sho)!der reha2i!itation
3uman shoulder, and ran#e of motions in it, is a result of dynamic interplay of str)ct)ra! $bones',
static $tendon and li#ament restraints' and dyna"ic $muscles' forces.
1houlder #irdle consists of ) Doints?
5. acromioclavicular $.N'
2. sternoclavicular $1N'
). #lenohumaral $G3N'
In #lenohumeral Doint, the concave
surface scap)!a ca*ity, is )06 times
#reater than convex surface head of
h)"er)s. %hat !ind of Doint structure
ma!es it very easy to dislocate the
shoulder. ,esearches sho"s that in ;0K of cases, "hen shoulder is first time dislocated before a#e of
20, "ill be dislocated a#ain.
4orces that act on the shoulder #irdle durin# sport activity can cause t"o types of inDuries?
11 AC-TE INE-RY dislocation $fallin# on extended and abducted arm, direct fall on the
shoulder, bloc!ed extended arm in hittin# a ball'
11 CHR0NIC INE-RIES impin#ement syndrome, chronic instability
I"pin#e"ent syndro"e mostly involves the tendon of m.supraspinatus $tear' "hen liftin# the
arm above shoulder hei#ht and rotatin# it.
Sy"pto"s<
STAE PAIN 1-NCTI0N
5st no normal
2nd "hen extremelly loaded normal
)rd on the be#innin# and after sport acitivity normal or sli#htly reduced
6th durin# and after sport activity sli#htly reduced
Lth 9urin# sport had to end the activty 1everely reduced
:th 9urin# everyday life acitivities Impossible to practice sport
Treat"ent<
1ur#ery or conservative. 2ain #oals of !inesitherapy in functional sta#e of rehabilitation are?
5. %o re#ain ran#e of motion
2. @ro#ressively stren#then the muscles that stabiliAes the shoulder
). %o develop neuro0muscular coordination
6. %o prepare the athlete for the specific return to play situations
Minesitherapy pro#ram "ill start "ith stretchin# exercises if needed in close !inetic chain. .fter that, it
comes to passive, @O4 and dynamic exercises in closed and than in opened !inetic chain. In the end, "e
start "ith proprioceptive and plyometric exercises, first basic and then specific for sport branch.
,.,. InB)ry reha2i!itation
1. ac)te sta#e
2. f)nctiona! sta#e
AC-TE STAE
o in conservative treatment the main #oal in this phase is to prevent s"ellin# and bruisin# and
maintain the ran#e of Doint motion
o ,.I..>. method $rest ice compression elevation'
o Jrappin# in this phase help in resumption of metabolites
o O7 J.,2IOG 7, 2.11.G>1PP
o -sin# crutches, "al!in# as normally as possible, orthosis
1-NCTI0NA' STAE
o It could be#in ri#ht after the inDury and it lasts until the inDured athletes can perform "ithout pain.
onseBuences of an improper rehabilitation? diminished movement amplitude, chronic pain,
chronic s"ellin#, chronic instabilityE
o <on# lastin# immobiliAation is a freBuent mista!e
o 1o)r "ain ai"s<
1. omplete recovery of the full ran#e of motion "ithout pain
2. @ro#ressive muscle stren#thenin#
(. %o restore the neuromuscular coordination
,. Gradual return to the everyday activities
o %o accomplish those #oals one should do exercises as follo"s?
1. STRETCHIN E@ERCISES
2. STRENTH E@ERCISES
(. PR0PRI0CEPTI0N
,. AI'ITY
/. R-NNIN E@ERCISES
5. SPECI1IC E@ERCISES
/. Hips
3ip is a multiaxial Doint and movements are possible in every plane. %he convex surface is the
femoral head, "hile the concave surface is the accetabulum. %he constant contact of the t"o Doint
surfaces brin#s to the lo"erin# of the accetabulum and the t"ine of the femoral head "hich means
that the hip is formed durin# childhood and shaped "ith standin# and "al!in# by the childFs L
th
year.
Bone #ro"th means formation of ostheophytes as a result of #reat loadin#s, especially in sports, to
"hich hips are exposed to. %he cartila#e reacts "ith the production of bone nodules.
')4ation, the most common hip deformity could be con#enital but it can be acBuired also.
Sy"pto"s are<
5. 3ip and !nee flexed, emphasiAed adduction of the upper le#, external rotation of the foot
2. pina iliaca anterior superior are not at the same level $in the same line'
). <imited abduction
6. <imited internal rotation of the foot
L. <imited le# extension
:. Noint crepitatin#
7. .symmetrical #luteal crease
(. @loddin# "al!in#
;. Increased lumbar lordosis
0n the side of the !)4ation there are so"e ")sc!es contracted<
4lexors of the le#
.dductors of the le#
>xternal rotators of the foot
T+o "ain reasons for its for"in# are<
1. Dysp!asia D deformity of the developin# hip $9evelopmental 9yaplasia of the 3ip 993'
o Irre#ular #ro"th of the femoral head
o Irre#ular #ro"th of the acetabulum
It can on!y 2e treated s)r#ica!!y?
2. Hypop!asia D insufficient development of the Doint surfaces
o Insufficient #ro"th of the femoral head
o Insufficient #ro"th of the acetabulum
1irst!y& itFs treated +ith conser*ati*e
"ethods?
o .bduction pans
o @alvicFs harness
o .bduction pillo"
o 9ifferent hip splints
And then D KINESITHERAPY
<e# extension
<e# abduction
4oot internal rotation
5. 'ordotic and %yphotic poor post)re
@osture is position or bearin# of the body in the upri#ht position a#ainst #ravity. It comprises of
acti*e and passi*e stabiliAin# elements "hich chan#es under influence of e4ercisin# and a#in#. %he
Buality of these elements depends on their stren#th and flexibility.
Jatchin# human spine in sa#ittal plane, it can be seen that
it has shape of do)2!e GSH "hich is important for the spine
biomechanics. Jhen curves become bi##er or smaller $in #rades'
"e can tal! about patholo#ic posture poor post)re or
defor"ity.
<imits of normal curves are?
o 4or thoracic lordosis 2006LQ
o 4or lumbar lordosis 600:0Q

.-SC'ES >0NES& E0INTS& TEND0NS
%7,..< M&@371I1
<-2B., <7,971I1
%o maintain #ood post)re, the ri#ht shape of the spine in sa#ittal plane, it is necessary to maintain in
the correct relation of?
5(8 ")sc!es
295 2ones
A do3en of or#ans
A h)ndred of ner*es
/ !. of 2!ood
2ain causes of poor posture are the illness of or#ans or different body parts, different psycholo#ical
conditions and "ea!ness of certain muscle #roups. <e#, hip, abdominal and bac! muscles, as "ell as
the li#ament and bones structures "or!s a#ainst #ravity so in condition of #reat fati#ue after lon# last
standin# or sittin#, "hen muscles relaxes, the poor posture habit may ori#inate.
%hree are critica! !ife periods for development of poor postures?
5. 5
st
and 2
nd
year
2. 7
th
year $school'
). puberty $#ro"th'
5.1. Kyphotic poor post)re
Jhen physiolo#ical $normal' thoracic lordoisis #ro"s in anteroposterior plane, muscles in bac!
elon#ates "hile muscles in frontal part of trun! shortens $con*e4ity is on the 2ac% side' "e tal! about
%yphotic poor post)re. %he most common !yphotic poor posture happens on Lth thoracic vertebrae,
there are no structural chan#es in bones and the spine remains flexible. ItFs possible to recover usin#
!inesitherapy and "earin# different corsets.
Sy"pto"s<
o %run! anteflexion $arcus posterior'
o 3ead lo"ered to"ard the chest
o ,ounded shoulders
o hest retracted
o 7utlined abdomen
o ,educed nec! lordosis
o >mphasiAed lumbar lordosis
o Mnee sli#htly flexed
o @elvis reinclination
Treat"ent<
o .irror correction of poor post)re
o Stren#then the 2ac% ")sc!es
o To pre*ent the pro#ression
o To re"o*e pain
o Passi*e correction
o -sin# the .i!+a)%ee corset
5.2. Kyphosis
Myphosis, as a deformation, can be con#enital or acBuired, and can develop as a result of?
o Iea% 2ac% ")sc!es
o Different re)"atoida! i!!ness
o Pro#ressi*e ")sc)!ar i!!ness ti
o T)"ors
o 'on# !astin# i""o2i!i3ation
o Rahitis
o Seni!e %yphosis
o A2nor"a! *erte2ra shape J IEDE =ERTE>RA
o . vertebra "ith abnormal shape
o 1ituated in the middle of the curvature
o %he "ed#ed side is turned to"ard the concavity
Je can distin#uish different types of !yphosis, dependin# on the place "here it develops? !o+
%yphosis& hi#h %yphosis& partia! %yphosis& tota! %yphosis.
5.(. 'ordotic poor post)re
Jhen physiolo#ical lumbar lordosis increases in anteroposterior plane, muscles in the front of
the trun! elon#ates, "here con*e4ity occurs, and those in bac! shortens. %"o most common reasons
"hy poor posture develops are as compensation and because of shortened m. Iliopsoas.
Sy"pto"s<
o %run! retroflexion $arcus anterior'
o >nhanced lumbar and nec! lordosis
o 3ead retroflexed
o 1houlders rounded bac!"ard
o 7utlined abdomen
o @elvis anterior rotation
o Mnee sli#htly flexed
@oor posture must be distin#uished out of deformity. 2ain difference is that in poor postures comes to
functional chan#es only, "hile in deformities structural chan#es occurs.
6. Sco!iosis
1coliosis is a deformity or a poor posture "hen a side0to0side curve occurs. @oor posture is non0
structural, "hile deformity is structural and usually comes "ith rotation of the vertebrae. %ypes of
scoliosis depend on?
5. the part of the spine "here it develops? Cer*ica!& cer*icotoraca!& toraca!& toraco!)"2ar&
!)"2ar& !)"2osacra!
2. siAe of scoliosis? partia! or tota!
). number of curves? si"p!e4& d)p!e4 and trip!e4
6. ho" it occurs? idiopathic the cause is un!no"n, ne)ro")sc)!ar 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', de#enerati*e may be caused by
brea!in# do"n of the discs that separate the vertebrae or by arthritis in the Doints that lin!
them, con#enita! due to abnormal formation of the bones of the spine and is often
associated "ith other or#an defects.
Idiopathic sco!iosis can occur in different sta#es of life, so "e distin#uish? infanti!e, B)*eni!e&
ado!escent and ad)!t sco!iosis.
Sy"pto"s<
o lateral deviation
o lon#itudinal rotation of vertebrae 0 torsion? procesus spinosus rotates to"ard the concavity, "hile
the body of the vertebrae rotates to"ard the convexityH the body of the vertebrae is "ed#ed on the
side of the concavity.
o ,ib hump $ribs rotates because of torsion of vertebras'
o %he intercostal space is reduced on the concav side $ribs
are #ettin# closer'.
N0R.A' PHYSICA'
ED-CATI0N C'ASSES
>RACES
S
-
R

E
R
Y
o the intervertebralis space is narro"er on the concav side, and "ider on the convex side.
o %he vertebral canal is narro"er on the convex side.
o onstriction of the vertebrae $the "ed#e of the vertebrae is situated on the concav sideH the bi##er
"ed#e is located in the apex of the deformation
Apica! *erte2ra is the vertebra most deviated laterally from the vertical axis that passes throu#h the
patient=s sacrum, i.e. from the central sacral line.
Jhen examinatin# patient, "e=re loo!in# for?
1coliosis is determined by the side of con*e4ity left or ri#ht.
%o determine the de#ree of curvature "e use t"o methods based on the I rays of the spine?
1. Co22 "ethod D <ines are dra"n parallel to the end plates of the vertebral bodies at the
be#innin# and the end of the curve. . second line is dra"n perpendicular to each of the first
lines, and the an#le bet"een these t"o lines is eBual to the obb measurement.
2. Raiser 1er#)son "ethod
Jith these methods "e #et the de#ree of curvature and "e classify scoliosis in seven #roups?
G,7-@ 9>G,>> 74 4<>II7O
5. 0 0 20
2. 25 0 )0
). )5 0 L0
6. L5 0 7L
L. 7: 0 500
:. 505 0 52L
7. 52: and more
Lowered shoulder
Lowered shoulder blade
Lowered pelvis
Inequality of the Lorent`s triangle Curvature of the spine
%reatment can be conser*ati*e D %inesitherapy or passi*e correction $"ith braces' or operati*e.
7ne of the principles is ED1 D e!on#ation& derotation& f!e4ion.
7. Chest defor"ities
%here are t"o chest deformities $chest "all abnormalities'?
5. pect)s carinat)"
2. pect)s e4ca*at)"
7.1. Pect)s carinat)" :pi#eon chest;
Pect)s carinat)" can be con#enital or, "hich is more often, acBuired. ItFs characteriAed by protrusion
of sternum and ribs. 1ternum is protruded and it pulls ribs for"ards, so therefore the chest is flatted
laterally. 3eart and lun# usually develops normally, but in some cases it can occur functional problem
"ith one of the or#ans.
Ca)ses<
o RACHITIS
o PERT-SSIS
o T->ERC-'0SIS 01 THE TH0RACIC =ERTE>RA
o A1TER A >AD REP0SITI0N 01 THE 1RACT-RED STERN-.
Therapy<
4irstly, it=s necessary to solve the cause and after that it comes to a conser*ati*e therapy $braces and
!inesitherapy' or, rarely, to a s)r#ery.
7.2. Pect)c e4ca*at)"
Jhen sternum is moved in"ards, "e can tal! about pect)s e4ca*at)". .s opposed of pectus
carinatum, this deformity is more often con#enital than acBuired. It may develop on the xiphoidal
procesus or on the body of the sternum. It can happen that some of internal or#ans chan#e its position.
Ca)ses<
1ETA' P0SITI0N
'ACK 01 SPACE IN THE -TER-S IN THE CASE 01 TIINS
THE RETR0STERNA' AND S-PRASTERNA' 'IA.ENTS DR- THE PR0CES-S @I10IDE-S
INSIDE.
Therapy<
1ometimes it can be conser*ati*e $!inesitherapy', but more often it is s)r#ica!.
8. >ac% pain
Bac! pain usually appears as a !o+ 2ac% pain& !o+ 2ac% and sacra! pain and !o+ 2ac% and !e# pain.
o ,>1@I,.%7O @,7<7OG>9 IO3.<.%I7O
o 1%,>OG3%>OIOG .B972IO.< 2-1<>1
DISC WITH
DEE!E"#TI$E
CH#!ES
Ca)ses<
9e#enerative processes on the vertebral body, on the intervertebralis disc or on the procesus
vertebrae $spinosus or transverses'
3ypomobility
3ypermobility
Internal or#ans deseases
2uscular distrophy
@ostural problems
1pine tumors
Ihen pain is !ocated in !)"2ar spine probably, de#eneration is on the vertebral body or
intervetebral discus.
Ihen pain radiates in !e#s de#eneration is probably located in procesus transverses.
Jhen de#enerative chan#e happens bet"een ', and '/& or '/ and S1 D it comes to inf!a""ation of
n. ischiadicus.
Inter*erte2ra!is disc)s can cause pain "hen comes to a?
Protr)sion
Pro!aps or disc)s hernation $dorso medial presses spinal
cord, or dorso lateral presses the root of the nerve, prolaps'
Treat"ent in acute sta#e is Jilliams position, and in chronic sta#e
!inesitherapy.
19. Cer*ico2rachia! syndro"e
ervicobrachila syndrome is a combination of different symptoms amon# "hich are nec! and hand
pain and decreased ran#e of motion in cervical spine. 9e#enerative chan#es, such as osteophytes and
discus prolaps, can happen on spinal roots, spinal cord or on the vertebro0basilar artery. %here are
several similar syndromes?
Cer*icoJcepha!ic syndro"e
o -nilateral pain of the head
o 1tron# pain in the occipital re#ion
o BuAAin# in one ear
!%"&#L DISC
DISC '"%T"(SI%!
DISC '"%L#'S
THI! DISC(S
DISC(S
DEE!E"#TI$E
CH#!ES #!D
%STE%'H)TES
o %earin#, vision problem $fo##in#'
o 1!in sensitivity
o Oausea and vomitin#
o ompression of arteria vertebralis
Cer*ica! syndro"e
o @ain in the bac! part of the nec!
Cer*ico2rachia! syndro"e
o Jhen compresses spinal roots bet"een L0:, :07, 70%5
o Blood flo" and sensory motor chan#es $hipestesia, anestesia, parestesia,
hiperestesia' happens in upper extremities
o @ain #ets "orst in sudden movements, in the ni#ht, coldness
o In lon# lastin# syndrome the stren#th loss and muscle atrophy can occur
o Treat"ent< in acute sta#e rest, in chronic sta#e physical therapy
11. Tortico!!is
%orticollis is a nec! deformation that can be con#enital $lac! of space in uterus or "hen carryin#
t"ins' or acBuired?
9ermato#enic torticollis
9esmo#enic torticollis
2io#enic torticollis
3abitual torticollis
Oeuro#enic torticollis
Sy"pto"s<
<ateroflexion of the head $shortened m. sternocleidomasteoideus'
hin rotation
3ead bend for"ards
Treat"ent<
onservative, "hich can be acti*e !inesitherapy, or passi*e 1hantAFs braceH and sometimes
operative treatment after "hich follo"s !inesitherapy.
Inc!)sion
GINTERATI0N IS C0NDITI0N :STATE; AND INC'-SI0N IS A PR0CESH
Inte#ration D children "ith special needs in re#ular pro#ram but "ithout extra help $special
education'.
Inc!)sion process $one step more then inte#ration' inclusion is about the childFs ri#ht to
participate and the schoolFs duty to accept the child $individualiAation and interaction'.
Ter"ino!o#y<
9isability
3andicap
@erson "ith disability
hildren "ith special needs
%here are about 50K people "ith disabilities amon# population. hildren "ith special needs are
clinically dia#nosed individuals "ho reBuire assistance for disabilities that may be medical, mental, or
psycholo#ical. auses of disability could be heredity or it mi#ht be acA)ired and it can be hearin#
i"pair"ent& *is)a! i"pair"ent& "enta! retardation and 2ody i"pair"ent.
@eople "ith disabilities in
SEREATI0N INTERATI0N INC'-SI0N
$emphasiAe' $emphasiAe' $emphasiAe'
1ervices for helpin# people "ith
disability
Oeeds persons "ith disability ,i#hts persons "ith disability
ItFs important to include children "ith disabilities into pro#ram of physical education by adDustin#
thin#s "e can?
.o*e"ent $instead of runnin# they can use "heelchair, hand bi!eEH instead of hittin# the ball
they can roll it, carry itE'
En*iron"ent
EA)ip"ent
R)!es and instr)ctions