Download FUNKCIONALNO ISPITIVANJE MUSKULATURE TRUPA …

Risultati della terapia medica e fisioterapia di
trattamento nella Spa sulla forza muscolare e
sulla mobilità del tronco in soggetti con bassa
densità ossea
Primarius Katarina S. Marković
Istituto per la cura e riabilitazione delle malattie
reumatiche e cardiovascolari
"Niska Banja"
Results of Physical Treatment in the Spa
and Medicamentous Therapy on Muscle
Strength and Trunk Mobility in Subjects
with Lower Bone Density
Katarina S. Marković M.D.
Institute for treatment and rehabilitation of
rheumatic and cardiovascular diseases “Niška Banja”
introduction
 the assessment of the
muscle strength and trunk
movability are especially
significant in the
prevention of falls and
fractures, in patients with
lower bone mineral
density and may be of
great importance in
making a diagnosis and
assessment of therapy
effect, as well
 Spinal musculature functional damage
measuring is obtained by: isokinetical,
isometrical and isoinertial tests
 Isostation B200 – is isoinertial
dynamometer with three measurement
axes, which monitors movements on fully
natural base and used for examination of
quantity of dysfunction
- construction of Isostation B200 made spine
Th parts and pelvis movements unable
- results are shown graphical by:
1. standard graph
2. motion range graph
3. combined parameters graph
4. repetition analyzes table –
showing average values
graph shows functional amplitude of movements
global speed decreasing of extension – suspect of
osteoporosis
testing protocol
1. Registration of maximal rotary movement moments
of isometric contractions
give snapshoot in general
muscular potential examined
body part showing especially
values of muscular potentional
especially of : left and right
rotation, flections, extensions
and left and right lateral flections
testing protocol
2. measurement of
movement range
- First examine without
load
- This parameter is
evaluated during dynamic
reception examine with
different loaded height
testing protocol
3. dynamic repetition test with load
- muscle movement is composed of :
a) phases of acceleration
b) dynamic equilibrium – last very
short only with constant movement
c) deacceleration phase
- Isostation B200 measures rotary
moments in all phases of movement
Rebilitation
 increase bone density and osteoblastic
bone forming is possible only with the
exercise load and Physical Treatment
in the Spa Therapy
 exercise alone is inadequate to
maintain the spina trabecular bone in
perimenopausal or postmenopausal
women
 Institute ¨Niška Banja¨ made study of correlation
between lumbosacral bone mineral density and
muscles kineziology parameters
 The objective of this studies is to investigate
how much the application of Physical Treatment
in the Spa therapy (PTS) and medicamentous
therapy, make intergroups differences, in muscle
strength and trunk movability - subpopulation,
she-patients with low bone mineral density
representation of the study
 Methods: 125 postmenopausal women with low
bone mineral density, were on defined regime:
hydro, mud, kinezzy, magnet and
bisphosphonate therapy, during the period of six
months
 Functional status of trunk musculature was
determined by the apparatus Isostation B 200
 The groups were made according ot T-scor,
muscle strength and trunk movability, as well.
representation of the study
 measuring of bone mineral density was
performed on Lunar DPX densitometer, at
the some time anteroposterior scan of
lumbal verebrae L1-L4 by the method of
two energetic absorbtiometery by X-rays
(DXA) was performed, the results were
interpreted according to the accepted
definition of OP accordinig to the WHO
and according to the T-scor
representation of the study
 in the period of six months Physical Treatment in
the Spa Therapy (PTS) was conducted twice
 in the span of 3 months in duration from two
weeks
 involved the application of
- mud therapy (LS part of the spine)
- hydro therapy (bathing in the thermo-mineral
water 20min.)
- pulsed magnetic field (50Hz,10mT,30 min)
representation of the study
 kinezzy exercise were performed in the
hall and the implied stretching exercises,
balance and strength into a lying, sitting
and standing position
 kinezzy exercise were also outside and
are implied are training of breathing
exercises and general fitness, with a
change in speed of motion and
configuration terrain
representation of the study
 medicament therapy consisted of taking:
- 1000 mg of calcium a day
- coated tablet of vitamin D3 (1000 i.j.)
- bisphosphonates (Alendronat 10 mg)
distribution of patients in
relation to age and bone density
osteoporosa
Age of
life
br.
%
osteopenia
br.
%
51 - 60
28
22,4
35
28
61 - 70
42
33,6
16
12,8
≥ 71
4
3,2
0
0
n* = 125
74
59,2
51
40,8
n*- the total number of patients
results
 a group of 25 she-patients with average
T-scor= -2,47±0,04 has been on PTS for
six months
 PTS was included: hydro therapy (15 min.
in thermo-mineral water), mud, pulsed
magnetic field and kinezzy therapy,
 this group had muscle strength increase
and LS movability of 17,92%.
Maximum isometrically test
increase muscle strength and LS movability
80
60
40
before th
20
after PTS
0
MIT rot. MIT flex. MIT ext.
MIT
lat/flex
results
 the similar results were achieved in the
group of 50 she-patients with average
T-scor=-2,57±0,09 who at the same period
of time, beside the same Physical
Treatment in the Spa Therapy, had
calcium and vitamin D3 intake
Maximum isometrically test
increase muscle strength and LS movability
80
60
40
before th
20
after PTS,Ca and D3
0
MIT rot. MIT flex. MIT ext.
MIT
lat/flex
results
 the third group consisted of 25
she-patients, they had the average
T-scor=-2,68±0,08 and during the period
of six months, beside PTS, calcium and
vitamin D3, they also got
bisphosphonates, as well
 icrease if muscle strength and LS
movability of over 35% were noticed
Maximum isometrically test
increase muscle strength and LS movability
80
60
40
before th
20
after PTS,Ca,D3
and BF
0
MIT rot. MIT flex. MIT ext.
MIT
lat/flex
results
 the control group, during the period of six
months, did not have any therapy
 In this group of 25 she-patients with
average T-scor=-2,39±0,03 decrease of
muscle strength and LS movability of
15,47%, were noticed
Maximum isometrically test
decrease muscle strength and LS movability
100
80
60
before th
40
w ithout th after 6
m onths
20
0
MIT rot. MIT flex. MIT ext.
MIT
lat/flex
CONCLUSION
 there is a high possitive correlation between
muscle strength and trunk movability, at one
hand and application of both balneophysical and
medicamentous therapy, at the other hand, in
she-patients with low bone mineral density, no
matter the age nor the level of bone density
 values of muscle strength and trunk movability
were average: for trunk extensors 20%, for
rotators 30% and for flexors even 36%
Acknowledgement
Prof. Aleksandar Dimić, M.D.
Medical Faculty
The University of Niš,
Serbia
Prim. Mirka
Karadžić, M.D.
Department of
Rheumatology
Institute for treatment
and rehabilitation of
rheumatic diseases
“Niška Banja”