Machine Translated by Google
scoliosis
A. Koelle, M. Bientzle
The Spiraldynamik® in the
Treatment of patients with
idiopathic scoliosis
A three-dimensional physiopedagogical concept
Spiraldynamik® in the Treatment of
Patients with Idiopathic Scoliosis
A Three-Dimensional Physio Training Concept
Idiopathic scoliosis can cause
limitations in the functional areas
“locomotor system”, “internal organs”,
“development and control of movement”
and “experience and behaviour”. In
addition to biomedical aspects,
conservative therapy should therefore
also take into account biopsychosocial
aspects in order to sustainably improve
the posture and movement of patients
with scoliosis.
Therapy according to Spiraldynamik®
fulfills this requirement. In this article,
the basic principles of Spiraldynamik®
and the physiopedagogical approach
are explained using the example of the
treatment of patients with scoliosis.
Keywords: Spiraldynamik®,
Scoliosis, physiotherapy, sustainability
hung of the individual vertebrae and
rotation of the spine in the curvature area
[1]. “Idiopathic scoliosis accounts for 90%
of all scoliosis in growing age, with
adolescent scoliosis occurring most
frequently within this group at around 90%.
9% are juvenile and 1% infantile idiopathic
scoliosis.” [2] Since the causes of idiopathic
scoliosis are unclear, there is no causal
treatment strategy. The effectiveness of
brace treatment in the conservative
treatment of idiopathic scoliosis has been
well documented, see, among others, [3].
The study situation on the effectiveness of
physiotherapy and active exercise therapy
is still unsatisfactory, since only short-term
and no permanent effects have been
proven [4, 5]. There is currently no
scientific evidence of the effectiveness of
therapy based on Spiraldynamik® (as of
November 2016). In addition to the
limitations in spinal mobility due to
structural deformation, patients are
exposed to other impairments that must
be taken into account in conservative
therapy. patients with
Idiopathic scoliosis can impose
limitations on various functional
systems such as the musculoskeletal
system, the internal organs, motor
development and control, and
experience and behaviour. Conservative treatment of
scoliosis should therefore involve bio
medical aspects as well as biopsycho
social aspects to sustainably improve
posture and movement of scoliosis
patients. Physiotherapy intervention
functional circle
using Spiraldynamik® meets these
requirements. This paper explains the
movement system
basic principles of Spiraldynamik® and
the physio training strategy for the
treatment of patients suffering from
Movement development
idiopathic scoliosis.
and control
Key words: Spiraldynamik®, scoliosis,
physiotherapy, sustainability
Introduction
Scoliosis is a structural growth deformity
of the spine with fixed lateral curvature,
Dre
26
idiopathic scoliosis can show a reduced
ability to balance [6], have abnormalities
in gait [7], are often less satisfied with their
lives [8] and have lower self-esteem [8].
This makes it clear that a purely
biomechanical point of view, ie the
reduction to the pathological deviations
of the spine, is not sufficient for the
description of the entirety of the patients'
complaints and the treatment of patients
with scoliosis. A biopsychosocial therapy
strategy should therefore be pursued in
scoliosis therapy.
Biopsychosocial Perspective
in Physiotherapy The “New
Thought Model of Physiotherapy” [9,
10] published in 1997 is no longer
exclusively based on the specialist
areas of clinical medicine, but on
the organ and functional systems
(1) movement system, (2)
Movement development and
control, (3) internal organs and
(4) human experience and
behavior. The effects of a disease such a
Possible impact on
e.g. B. joint mobility, muscle strength,
muscle tension, fascia
e.g. B. Depth sensitivity, body awareness,
coordination, balance, coordination of gait
sequence
Internal organs
e.g. B. Respiration, cardiovascular system
Behavior & Experience
e.g. B. Self-esteem, mood, life satisfaction
Table 1 Possible effects of idiopathic scoliosis.
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For example, scoliosis can be found in
all four functional groups (Tab. 1). Like
the International Classification of
Functioning, Disability and Health (ICF,
[11]), the perspective and approach
presented in the “New Thought Model
of Physiotherapy” is based on a
biopsychosocial understanding of health
and illness. In addition to the therapy
methods commonly used in the
conservative therapy of scoliosis, such
as the three-dimensional scoliosis
treatment according to Schroth [12],
Spiraldynamik® is also used in the
conservative scoliosis therapy of
idiopathic scoliosis [13]. Spiraldynamik®
sees itself as a holistic therapy and
movement concept that addresses all
four sites of action of the new thought
model and thus all functional circles in
which the effects of scoliosis manifest
themselves. A pedagogical approach is
intended to ensure that patients learn
more economical posture and movement
patterns and integrate them into their
everyday lives over the long term.
The concept of
Spiraldynamik®
The Spiraldynamik® was developed in
the 80s of the 20th century by the doctor
Dr. Christian Larsen and the
physiotherapist Yolande Deswarte. It is
a movement and therapy concept that
derives the sensible use of the body
from the three-dimensional spiral
structure of the body and thus makes
the movement coordination of the
human being understandable. Function
and structure are interrelated, that is,
the shape of the body structures
determines the type of function, and the
function influences the formation and
orientation of the anatomical structures.
The aim of Spiraldynamik® is to
make the physiological posture and
movement of people explainable,
tangible and learnable. It is based on
spatial and temporal movement
principles and integrates a pedagogical
approach.
Spatial movement
principles of Spiraldynamik®
The spatial movement principles of
Spiraldynamik® are based on the threedimensional blueprint of the anatomical
body structures. From this,
Spiraldynamik® derives the threedimensional spiral screw connection as
the decisive functional principle for
healthy and economical posture and
movement – which is often referred to
as “three-dimensional instructions for
use for the human body”. The basis of
the three-dimensional screw connection
is the polarity principle. This means that
the movement of two parts of the body
– called “poles” – causes the body
structures in between to also be moved.
For example, if the two poles, head and
pelvis, rotate mirror-symmetrically to
each other around the transverse axis,
the torso first straightens and then
curves evenly. In Spiraldynamik® we
speak of the straightening and arching
principle. If two poles rotate around all
three spatial axes, a spiral screw
connection is created in the body
structures between them - this is
referred to as the "spiral principle" (Fig.
1). The extent and direction of the
rotations are determined by the
functional anatomy of the respective
body section.
Temporal principle
of Spiraldynamik®
Another basic principle of spiral
dynamics includes the temporal
component of the movement. Natural
movements such as walking are
characterized by a rhythmic alternation
between standing and free leg phases,
by alternating counter-rotation of the
thorax to the pelvis, by building up and
reducing the arch of the foot and by the
rhythmic reactive arm swing. The body
structures are rhythmically alternately
loaded and unloaded with pressure and
tension. The temporal organization of
physiological movements follows from
According to Spiraldynamik® the
character of a wave movement: If the
neurophysiologically determined
temporal sequence of the muscle
contractions and a physiological
frequency and amplitude are observed
within the rhythmic change of a
movement, a stable posture background
for a movement can be organised. The
joints involved in the movement unite
stability and mobility through their
centering. The rhythmically alternating
spiral screwing and unscrewing between
two poles is referred to as the "wave
principle" in Spiraldynamik®.
Physiopedagogical
approach to Spiraldynamik®
The therapy structure within the
framework of Spiraldynamik® takes
place in pedagogically justifiable therapy
steps and enables the patient to learn
and integrate a new posture or
movement. Since it is primarily about
physical changes, one also speaks of a
physio-educational approach. In the
following physiopedagogical structure
of the treatment of patients with scoliosis
according to Spiraldynamik®, the
therapy steps (1) motivation, (2)
understanding, (3) perception, (4)
prerequisites, (5) basic exercises, (6)
variations and ( 7) Integration
differentiated. At every point in the
therapy process, it is checked whether
the necessary prerequisites for the next
therapy step are in place or whether
they still need to be worked out. For a
better understanding, the therapy steps
are shown as building on one another.
In the therapy situation, however, the
steps usually overlap or flow into one
another. In the course of therapy, the
cycle of therapy steps is repeated at an
ever higher learning level, which
ultimately leads to more and more
precise and varied movement execution
(Fig. 2).
after scoliosis treatment
Spiral Dynamics®
Fig. 1
In the following, individual therapy
steps are presented in a meaningful
pedagogical structure and their mode
of action is assigned to the respective
functional groups. A concrete treatment
structure is deliberately not presented
in order to prevent the reader from
understanding Spiral dynamik® as an
ordered collection of exercises for a
specific diagnosis.
Spiral principle.
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Fig. 3 Acquisition anatomi
shear and spiral dynamic
Knowledge of the model:
a) Clarification of the spiral
principle through the rotation
of two poles by three space axes
sen on the foam model; the
spatial axes are through
a.
the staffs shown.
Fig. 2 Physiopedagogical approach.
A functional diagnosis of the patient is
essential for a targeted and sustainable
therapy. The spatial and temporal movement
principles described above are used for the
posture and movement analysis. In the
physiological gait, the pelvis and thorax
rotate in opposite directions, so that the
spine spirals alternately to the right and left.
If you look at the middle stance phase, in
which the right leg is in the standing leg
function and the left leg is in the free leg
function, the right half of the pelvis rotates
around the transverse axis until it is
b) The model for observing
the direction of pull on the
elastic band shows the need
for elasticity in structures
surrounding the joint, such as
muscles and fascia.
b.
c) The simulation of the
function of the M. iliacus by
Attachment of the elastic band
clarifies the three-dimensional
function of the muscle on the
hip joint and the movement of
the pelvis.
c.
functionally upright, around the vertical axis
dorsally and around the sagittal axis caudal.
The right half of the chest rotates forwards,
upwards and inwards at the same time,
orienting itself towards the left leg that is
becoming the mainstay. The auto-elongation
of the spine results from the mirrorsymmetrical rotation of the head and pelvis
around the transverse axis and ensures that
the spiral screwing is evenly distributed over
the entire spine.
In patients with a three-curve rightconvex thoracic scoliosis, the spine is
partially fixed in a spiral screw connection,
which corresponds to the position for the
stance phase on the left. The classification
of the body sections for the standing leg
phase on the right is more difficult, since
the spine is difficult to get out of its position
partially fixed position can move out. When
walking, therefore, finds no
uniform rhythmic alternation of the right-left
screw connection.
The Spiraldynamik® therapy pursues the
strategy of combining the partially fixed
spiral of the scoliosis with the elements of
to deal with the “natural counter-spiral”.
Accordingly, one of the treatment goals is
both the global movement pattern of the
stance phase on the right (spatial principle)
and the alternating change between
Stance phase right and left (time
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common principle) to learn. The antirotational activities enable the best possible
mobility with the necessary stability of the
spine.
motivation
The therapy process begins with a
conversation in which the clinical anamnesis
and the psychosocial handling of the illness
are inquired about.
Complaints, specific needs and change
requests of the patients are recorded and
realistic goals for the therapeutic treatment
and the everyday life of the patients are
agreed in a partnership. In this first
discussion, the patient's ability and
willingness to actively cooperate outside of
the therapy units is also clarified. Possible
obstacles to active participation are
discussed and possible solutions are worked
out together in the context of the therapy
sessions. This strategy is intended to
motivate patients to change their physical
activity habits and ensure sustained,
independent exercise [14]. The patientcentred discussion takes on a central
function within the therapy according to
Spiraldynamik® and has a focus on the
functional group “experience and behavior”.
Understanding
In the subsequent therapy step, the therapist
analyzes the patient's posture and movement
habits. The connections between the
severity of their scoliosis and their posture
and movement quality as well as the
connections between the condition of their
body structures and the changed everyday
activities are explained to the patients in a
comprehensible way (therapy step 2:
understanding).
Better understanding can lead to more
active participation in therapy [15]. Following
this, the patients are taught the basic
principles of healthy movement according
to the Spiraldynamik® concept using simple
models, skeletal parts or therapy straps,
and the patients are instructed to simulate
muscle trains and power transmission (Fig.
3). They transfer what they have learned on
the model directly to their own bodies, so
that they can perceive and understand the
effects of their individual posture and
movement on the body structures and the
interaction of function and structure.
This therapy step has an effect in the
functional circle “Experience and
behavior” as well as in the function circle
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Machine Translated by Google
“Movement development and control”
and “Movement system”.
Perception
Accompanying and building on the
understanding is body perception. This
therapy step also influences the
functional circuits “movement system”,
“movement development and control”
as well as “experience and behavior”.
Patients learn to sense which
posture they prefer and which
movements they like to use or tend to
avoid. For this purpose, aids such as
photos of posture or videos of their
movements in everyday life are used
and perception exercises are used to
work on one’s own body image (therapy
step 3: perception). A central goal of
this therapy step is for the patients to
learn to arrange their body sections
around their individual plumb in such a
way that they find their “scoliotic center”.
This is understood as the maximum
possible correction of the scoliotic
malposition, in which stability and
mobility are balanced. The patient
should feel as upright and stable as
possible, but not stiff and immobile. In
addition, this therapy step can be used
to strengthen the patients’ conviction
that they can have a positive influence
on their body and the development of
the disease through their own abilities
[16].
This property has proven to be essential
for sustained activity in therapy and
training, especially in the case of chronic
diseases [14]. One way to strengthen
the belief in self-efficacy is to let the
patient consciously perceive that without
the hands of the therapist he can solve
a problem, e.g. B. Na ckenspannen, can
cope.
Creating the conditions In
many cases, the patient is not able to
carry out a movement spontaneously,
despite a precise idea and instructions.
If, for example, an upright position is
only possible to a limited extent due to
a lack of activity or elasticity of the body
structures, the structural requirements
in the connective tissue as well as in
muscles, ligaments and joints are
worked out. Measures from physical
therapy or techniques from therapy
methods such as manual therapy are
used for this purpose. If the reason lies
in insufficient coordination of the
muscles, neurophysiological methods
such as proprioceptive neuromuscular
facilitation with targeted gangty are used
Orthopedic technology 01/17
pical irradiation (therapy step 4: create
the conditions).
Since the approach to this therapy step
depends heavily on the individual
limitations of the patient and these are
very diverse, this step can affect all four
functional groups.
Basic exercises
The patients implement their newly
developed range of motion in the form
of basic exercises, which are initially
carried out very slowly, with concentration
and as regularly as possible several
times a week in the self-exercise
program. For these exercises, the
patients first learn to move individual
body sections three-dimensionally and
then put the building blocks together to
form a global whole-body movement
pattern. Parallel to the practical execution
of the spiral dynamic movements, the
patients experience the specific mode
of action of the movement and thus
acquire the competence over time to
deal with individual problems, e.g. B.
muscle tension/pain to help yourself
(therapy step 5: basic exercises). A
typical basic exercise for patients with a
three-curve right-convex thoracic
scoliosis is whole-body coordination of
all body sections for the standing leg
phase on the right side (Fig. 4). The
basic exercises are designed in such a
way that they affect all four functional
circles.
Individual exercise variations As soon
as the patient can perform a basic
exercise correctly, this is progressively
expanded and varied with regard to the
therapeutic starting positions, the use of
equipment, the rhythm of movement or
the speed in order to improve the motor
learning effect. The basic principles of
differential movement learning can be
used here [17] (therapy step 6:
variations). This therapy step also shows
its effect in all four functi
onskreisen. If the patient still finds it
difficult to perform the three-dimensional
movement pattern after consistent
practice, it must be checked again
whether he has all the necessary
prerequisites to perform the basic
exercises in variations. At this point,
targeted strengthening in threedimensional movement patterns may
have to be integrated into the therapy.
Integration in everyday
life and leisure time
Diverse variations should enable the
patient to integrate the newly learned
movements into their everyday and
leisure activities (therapy step 7:
integration). The global movement
pattern of a specific stance phase can,
for example, be emphasized when
climbing stairs (Fig. 5); This is how an
everyday movement becomes a
therapeutic exercise. Patients who wear
a corset learn to transfer the idea of
spiral dynamic movement into their
everyday life with a corset. Patients who
are active in sports are instructed to
incorporate what they have learned into
individual training sequences, for
example when riding, inline skating or
playing soccer. The regular
implementation of the newly learned
movement sequences in individual
everyday, professional and leisure
activities is fundamental for a lasting
change in the movement sequences
and thus also for lasting structural changes.
Due to the numerous repetitions of the
three-dimensional movement pattern in
everyday life, the body structures are
challenged in a three-dimensional
direction. It is hoped that this will result
in a corresponding reorganization of the
anatomical structures. By improving the
posture and movement habits of patients
with scoliosis, which is anchored in
everyday life, a sustainable therapeutic
success should be achieved. The
integration into the individual everyday
life of the patient has an effect on all
four functional groups.
Fig. 4 Stance phase right in SL. In this exercise, the
upper side of the pelvis (supporting leg) is moved threedimensionally backwards, downwards, and outwards
against the elastic resistance of the band (spiral dynamics
terminology: “outer spiral”).
The thoracic spine should be moved
forwards and upwards towards the
free leg. This counter-screwing has
a corrective effect on the threecurved, right-convex thoracic scoliosis.
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Machine Translated by Google
Fig. 5 Transfer of the exercise
"standing leg phase right in SL" to
going upstairs. The left image
shows the uncorrected position.
In the middle and right image, the
scoliotic malposition is corrected
three-dimensionally by counterscrewing the thorax and pelvis,
with autoelongation becoming
clearer in the right image due to
the intensification of activity.
biomechanics?
No problem!
Conclusion
For
self-study
and
seminars
Idiopathic scoliosis is a clinical picture
that can result in limitations in the
functional areas of the “locomotor
system”, “development and control of
movement”, “internal organs” and
“experience and behavior”.
To ensure that all limitations are
addressed, conservative therapy should
work in all four functional groups. Due to
the spatial and temporal basic principles
of healthy posture and movement, which
are easy to convey on the model, and
the physio-pedagogical structure of the
therapy, the therapy according to
Spiraldynamik® fulfills this requirement.
The patient attains from
Sufficient knowledge and the skills to
master the variety of movement
challenges in everyday life. However,
there are currently no scientific studies
on the effectiveness of Spiraldynamik®
therapy in patients with scoliosis.
For the authors:
Andrea Kölle, B. Sc. Physiotherapy
Deputy Head Teacher, PT
Academy, BG Clinic Tübingen
Schnarrenbergstraße 95 72076
Tübingen akoelle@bgutuebingen.de
Peer reviewed paper
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