Sp Soc Int J Ph Ed Sp 2014 - Volume 14 ~ Issue 2 REHABILITATION OF LUMBAR HYPERLORDOSIS THROUGH SWIMMING-SPECIFIC EXERCISES Petrea R. G. (Petrea Renato Gabriel)', Rusu D. E. (Rusu Diana Elena)” “Alexandru loan Cuza” University lasi, Faculty of Physical Education and Sport, Interdisciplinary Research Centre in Human Movement Science, Sir. Toma Coma nr. 3, lasi, 700534, Romania, renato-petrea@ waic.ro, +40 745517475, 2 Alexandru loan Cuza” University lasi, Faculty of Physics, B-dul Carol I, Nr. 11, Iasi, 700506, Romania, ranaid@ yahoo.com, +40 754972560. ABSTRAC The purpose of this paper is to show the importance and utility of swimming within rehabifitation and therapeutic programs for posture deficiencies, in our context forthe rehabilitation of lumbar hyperlordosis, We consider ‘that, by using exercises specific to swimming and means specific to acquiring swimming procedures, we will reduce the range of lumbar hyperlordosis. More precisely, we believe tha, through exercises specific to swimming, we will reduce the range of lumbar hyperlordosis by at least 15 mum, Our study comprise three subjects (young girs), who suffer froma lumbar hyperlordasis, For establishing the diagnostic, the following examinations and tests took place: anamnesis somatoscopy; somatometry; muscular testing; specific tests (Schober, “finger-loos"). The therapeutic program applied included the following: exercises for learning and consolidating the swimming procedures of crawl, backstroke, breaststroke and butterfly, The rehabilitation program lasted five months and a half; we had two sessions per week, each session of 35-40 minutes; water temperature ranged between 29 and 31 degrees Celsius. Initial testing showed thatthe Jordosis amplitude was 70 mm for subject A.B., 60 mim for subject R.A. and SS mm for subject S.A. At the end of reseatch the results of the lordosis amplitude were 52 mm for subject A.B., 45 mm for subject R.A. and 40 mm for subject S.A, The conclusion of this study underlines that the early and correct intervention through indiviislized rehabilitation programs for lumbar hyperlordosis leads to a decrease in the Tumbar curvature, dawn to physiological values, In addition, the means used for acquiring and consolidating swimming procedures can constitute important means in the rehabilitation process for lumbar hyperlordosis. Keywords: rehabilitation, lordosis, swimming procedures, test. INTRODUCTION The position of normal spine in orthostatism is not rectilinear, but sinuous; in the anterior posterior plane, it features a series of curves that favour its balance on the pelvis and that attenuate shocks on the vertical. Therefore, in the cervical region, the spine presents a curve with anterior convexity - called lordosis, while in the thoracic region, a posterior curve called kyphosis, and in the lumbar region again a lordosis, deviations of the spine may acquire the form of lordosis, kyphosis and kypholordosis (when there is @ combination of the two types) [3] Lumbar hyperlordosis is a deviation of the spine in sagittal plane, with anterior convexity, caused by the accentuation of physiological lumbar lordosis, The pelvis features an accentuated anteversion, the abdomen sticks out, while the lower limbs are stretched from the knees or the knees are in hyperextension [4]. Lumbar hyperlordosis is a common condition; it can appear even in the growth period, and it is ‘important to discover favouring factors early, in order to stop the evolution of lordosis [1]. CASE REPORT Throughout the research, we used several methods that contributed to the attainment of proposed goals and to the confirmation of the hypothesis. The methods were the following: the method of bibliographic study, the method of participative observation and the comparative method [5] The research was conducted on three subjects - children with lumbar hyperlordosis ~ in the same stage and with a similar evolution, We elaborated the rehabilitation programs based on swimming-specific exercises already familiar to the children, but we adapted them to their particularities and afterwards we analyzed the results. Therefore, we discovered new information on the efficiency of exercises specific to ‘swimming procedures training, due to the improvement of functional indices. In order to measure the range of lumbar hyperlordosis, we used the plumb bob and the meter band (to measure the distance form the plumb bab to the spine apex) [6] ‘The dependent variable of this paper is represented by the spinal disorder called lumbar hyperlordosis, while the independent variable is represented by the means specific to learning the crawl, backstroke, breaststroke and butterfly, as well as to diving and breathing underwater [2], 142Int J Ph Ed Sp 2014 - Volume 14 - Issue 2 The study was conducted on 60 children, whom we tested and measured. Hence, the measuring of the distance form the plumb bob to the spine apex showed lumbar hyperlordosis in 35 of the subjects; however, we selected only three of them, who presented long, common hyperlordosis (70 mim, 60 mm, and 55 mm). These subjects are: ‘© Subject A. B. aged 11, female student, complained of lumbar pain at the beginning of the program. Anamnesis showed that the family was aware of her vicious posture, but that they had not benefited from any rehabilitation plan, Somatoscopy underlined common, typical lumbar hyperlordosis, as well as a reduction of spine mobility; © Subject S. A., female student, aged 13, had lumbar pain, reason for which she began this rehabilitation program, advised by the general practitioner, who noticed the exaggerated lumbar curvature manifested by musculoligamentous insufficiency, which prevented a correct body posture. Somatoscopy showed the presence of lumbar hyperlordosis, but the absence of spine mobility deficiencies or muscle force deficiencies; © Subject R.A, female student, aged 10, was diagnosed with disharmonic physical development, accompanied by excess weight. Somatoscopy underlined long Iumbar hyperlordosis, while tests showed & reduction of spine mobility. Abdominal muscles were week, and the abdomen itself was prominent RESULTS AND DISCUSSION We analyzed the results from the perspective of the changes in the values of spinal range and mobility and of muscle force, by comparing the inital, intermediate and final figures. Through anamnesis and specific tests and measurements, we were able (0 follow the evolution of the condition after our treatment, Initial testing showed that the lordosis amplitude was 70 mm for subject A.B, 60 mm for subject R.A. and 55 mm for subject S.A. At the end of research the results of the lordosis amplitude were 52 mm for subject A.B., 45 mm for subject R.A. and 40 mm for subject S.A. (aspects presented in Table 1). ‘Table 1: Initial, intermediate and final clinical and functional examination Date Tor201 1503014 0102014 14062014 Name co Pain: (lack i jo Reetus abdominis of pain) - 0 Muscular B/S /8/s\/s 85's intense pain)| 2 | @ testing -5 ‘Abdominal B|/8|4@|/8/8\/5|/8\|8\|s| 8 a ‘Spine Height(m) ‘Weight (kg) Specific Shobber obliques tests Finger oor T Muscular a testing 3 oe soe - The rehabilitation treatment consisted of swimming-specific exercises familiar to the subjects, but adapted to their particularities. Thus, we used means specific to learning crawl, backstroke, breaststroke and butterfly, as well as to diving and to breathing underwater. 143,ip Soc Int J Ph Ed Sp 2014 - Volume 14 - Issue 2. Findings show the climination of pain, the correction of lordotic curvature, the increase in lumbar spine mobility (illustrated by specific tests), as well as weight loss and better awareness of pelvis straightening during daily activities (by toning the abdominal muscles) (Fig. 1 and 2). 01.01.2014 m15,03,2014 1 01,05,2014 14.05.2014 = 14,06,2015 Fig. 1 Graphic representation of curvature range and lumbar spine mobility 6 5 4 3 moLo1.2014 i 15.03.2014 0 01.05.2014 Prrye ee 14062014 e Fig. 2 Graphic representation of muscular testing CONCLUSIONS Following the rehabilitation program for lumbar hyperlordosis, which began in January 2014 and ‘ended in June 2014, we were able to confirm the following hypothesis: the use of exercises specific to swimming influenced the improvement of spinal posture deficiency in the lumbar area (hyperlordosis). Literally, the amplitude of lordosis (lumbar hyperlordosis) was corrected for each subject separately with at least 15 mm, which allows us fo say that the purpose was reached and the hypotesis confirmed. ‘The means we used — specific to swimming - brought improvements in the rehabilitation of lumbar hyperlordosis, in the case of our research subjects. Therefore, we posit that swimming can be recommended as.a rehabilitation method. We believe that the elaboration of @ therapeutic program comprising both swimming and kinesiotherapy will shorten the rehabilitation process, However, a good interdisciplinary collaboration between the general practitioner and the kinesiotherapist is required, as well as a good relationship with the patient ‘The conclusion of this paper is that early intervention through a therapeutic program, which includes ‘methods specific to swimming, will lead to an effective rehabilitation of lumbar hyperlordosis, 144Sp Soc Int J Ph Ed Sp 2014 - Volume 14 ~ Issue 2 BIBLIOGRAPHY LI} Antonescu D, Obragcu C. Corectarea coloanei vertebrale, Bucuresti: Editura Medicalé; 1993. 273p Romanian [2] Biltac G. fnvajarea metodicé a procedeetor de inot sport. Craiova: Editura Universitaria: 2006. 257p. Romanian [3] Diaconescu N, Coloana vertebral, Bucuresti: Editura Medical; 1977. 330p. Romanian [4] Duma E, Deficientele de dezvoltare fizid. Cluj-Napoca: Faitura Argonaut; 1997. 267. Romanian [5] Epuran M. Metodologia cercetrii activitiilor corporal, Bucuresti: Editura FEST; 2005, 420p. Romanian {6} Pop S. Durerea lombaré joss. Oradea: Editura Universitaria; 2003. 313p. Romanian RECUPERAREA HIPERLORDOZEI LOMBARE PRIN EXERCITII SPECIFICE INOTULUI SPORTIV Petrea R. G. (Petrea Renato Gabriel)', Rusu D. E, (Rusu Diana Elena)? ‘Universitatea , Alexandru loan Cuza” din lasi, Facultatea de Educatie Fizicd si Sport, Central de Cercetiri Interdisciplinare in Stiinja Motricitiyii Umane, Str. Toma Cozma nr. 3, lasi, 700554, Roménia, renato,petrea@uaic.ro, +40 TASSITA7S. "Universitatea Alexandra loan Cuca” din Iasi, Facultatea de Fizied, B-dul Carol I, Nr. 11, asi, 700506, Roménia, ranaid@ yahoo.com, +40 754972560. REZUMAT: Scopol acest luc estes arate importana si ulitatea iotulu sporti in cadral programelorterapeuice de recuperare a unor defcienje de posta, in contextul nose: recuperateahiperlordozei lombaee. Considerim 8 prin folosrea exerifilor speciice intului sportv, espestiv a mijloaceloe specifice invdjirt procedeelor de fnot, vom dimminua amplitndinea hiperloedozei lombare. Mai exact, cfedem c& prin exercitile specifice Motului sportiv’ vom diovinua amplitudines biperlordore: lombare cu cel putin 15 mm. Insti au fost cuprinsi tet subject (cop de gon feminin) care prezentauhiperiordozA lombard. in vederea preciziitdisgnosicuui s-au feu urmaitoarele examin gi testi: anamneza: examen somatoscope:examienul somstometic; testing muscular; teste specific: Schober, ,degete ~ sol, Programul terapeaticterapetic apicat a inchs: exerci pentru invataea si consoidareeprocedeelor de inot raul, spate bras si ature. Durata progeamuli ecuperatr a fost de cin luni si jumstae, realizat cu o freeven de doua singe pe saptinsini sdina avea o duraté de timp de 35-40 de minute, Ia o tempraiuri a apei de 29-81 grade Celsius. La textarea inigaldamplitudinea lordozei era de 70 mm peneu subieotl AB. 60 mm pentu subiectl RA. si 55 mm pentru subicetl S.A. La final cercetrirezulatele eu privie Ia amplitudes iodozei au fost de 52 mm pent Subiectul A.B. 45 mm pent subiectal R.A.,respectiv 40 mm pentru subictul S.A. Conclusia acestui studi subliniaza faplal cd insttwirea precoce $i corecté a unor programe individualizte de recuperare hiperlordozsi lombare vor conduce la reduces amplitudinicurburitJombare, pnd la vali fziologice. De asemenea, mijloacele de foviare consolidare a procedeelor de inot pot fi mijloace importante im procesul de recuperare a hiperiordoze lobar. Cuvinte cheie: recuperate, lordord, procedee de inot, teste INTRODUCERE, Poritia coloanei vertebrale normale in ortostatism nu este rectlinie, ci sinuoasd, prezentind in planul antero-posterior o serie de curburi care favorizeazi menfinerea echilibrului acesteia pe bazin si atenueaz socurile pe verticali, Astfel in regiunea cervicali coloana vertebrali prezinti o curburd cu convexitatea anterioard, numitd lordo7i, in regiunea toracald o incurbare posterioard numité cifo7a gi in regiunea lombard din nou 0 lordoza, iar deviatiile coloanei vertebrale vor fi de tip londotic, cifotic si cifo-lordotic cdnd existd o combinafie intre primele doua tipuei (3) Hiperlordoza lombara este deviafie a coloanei vertebrale, in plan sagital, cu convexitatea anterioari, dati de accentuarca lordozei fiziologice lombare. Bazinul prezinti o anteversie accentuati, abdomenul proemini, iar membrele inferioare sunt intinse din genunchi sau cu genunchii in hiperextensie [4]. Hipertordoza lombard este o afectiune des intilnita, putind s& apard ined din perioada de crestere, fiind importantd depistarea precoce a factorilor favorizangi, pentru a stagna evolutia lordozei [1]. 145ip Soc Int J Ph Ed Sp 2014 - Volume 14 ~ Issue 2, STUDIU DE CAZ Pe parcursul cercetarii am folosit mai multe metode care au contribuit la realizarea sarcinilor propuse si la verificarea ipotezei, Acestea au fost: metoda studiului bibliografic, metoda observatiei participative, studiul de caz si metoda comparativa [5]. Corcetarea s-a realizat pe trei subiecli, copiii cu hiperlordoza lombari, in acelasi stadiu si cu evoluie aseminitoare. Am realizat programele de recuperare pe baza exerciiilor specifice inotului deja cunoscute de acestia, insd adaptate la particulartajile lor gi am efectuat analiza rezultatelor, fapt ce ne-a oferit informatii despre eficienja exercitilor specifice invajarii procedeelor de inot sportv, datorité imbunatajrilor indicilor functional Pentru misurarea amplitudinii hiperlordozei lombare am folosit firul cu plumb si banda metric cu care am misurat distanja de la fr la apexul coloanei lombare [6], Variabila dependenta a acestei criti este reprezentatd de tulburarea de static’ vertebralé numit hiperlordoza lombari, iar variabila independentd este reprezentati de mijloacele specifice invafirii procedeelor craul, spate, bras si fluture, cit cele specifice scufundatilor si respirafici acvatice [2] Studiul a fost aplicat unui lot de 60 de copiii, cdrora li s-au facut testéri si misuritori. Astle, rmiisurarea distanfei dintre fil cu plumb gi apexul coloanei lombare evidentia 0 hiperlordo74 lombara pentru 35 dintre acestia, insd au fost selectati doar 3 dintre acestia care prezentau o hiperlordoza habituala lunga de 70 mm, 60 mm, respectiv 55 mm. Acesti subiecti sunt: © Subiect A. B. in varsté de 11 ani, cleva, prezenta dureri Jombare la inceputul programului. Din anamnezi rezultd ci familia era constienta de postura vicioasi pe care a adoplat-o, insi nu s-a intervenit pang acum cu un plan de recuperare. Examinarea somatoscopic’ evidenfiazd 0 hiperlordoza lombara tipici habituala, precum si o diminuare a mobilitati coloanei lombare; © Subiect S. A., eleva, 13 ani. Prezenta dureri lombare si a inceput programul de recuperare in urma recomandiriimedicului de familie care a constatat exagerarea curburii lombare prin. insuficienfa musculoligamentara ce perturba postura corecti a corpului. La examinarea somatoscopicd s-a constatal prezenta hiperlordozei lombare, insi fard vreun deficit de mobilitatea a coloanei lombare sau de fort rmusculards © Subiect R.A, eleva, 10 ani, prezenta diagnosticul de dezvoltare fizicd: disarmonic cu plus de greutate. Examinarea somatoscopici evidenjiaz’ © hiperlordoza lombari lungi, precum si reduccrea mobilita coloanei lombare prin testele efectuate, For{a musculaturii abdominale era slab, abdomenul proemina mult spre inant. REZU siDIscUTIL ‘Am analizat rezultatcle objinute prin intermediul modificitilor valorilor amplitudinii si mobilititi coloanei lombare cat si a forfei musculare, comparsnd cifrele inifiale, intermediate si pe ce cele finale, pentru ca prin anamne7d, teste si misuritori specifice si putem observa evolutia afectiunii in urma tratamentului aplicat La testarea inifiald amplitudinea lordovei era de 70 mm pentru subiectul A.B., 60 mm pent subiectul R.A. si 55 mm pentru subiectul S.A. La finalul cercetirii rezultatele cu privire la amplitudinea Tordozei au fost de 52 mm pentru subiectul A.B, 45 mm pentru subiectul R.A., respectiv 40 mm pentru subiectul S.A. (aspecte prezentate gi in tabelul nr.1) ‘Tabel nr. 1: Examinarea clinico-funetionali efectuatt termediar $i final Data Ti,201¢ 15.03.20 01.05.2014 14062014 Bune Ne SA |e TS |e | Sa (ipsa dueri)- 0] 2] B | # | © | @] @} oo] 6] o Oo} (durere Siow am | | Mon |e | MR] S| YY | | | es ES vertebrale Tnaiime (=) | 18sData 1012014 ‘Nume Greutate (kg) Teste specifice Shobber Degete-Sol Texting muscular: Musculatura dreptilor abdominal Testing See muscular: Obici 5 abdominali a Ba BB aH a a BB a a a BB a4 Tratamentul de recuperare a constat in exercitii specifice inotului, cunoscute de subiecti, insi adaptate particularitafilor fiecdruia, Astfel s-au utilizat mijloacele specifice invatarii procedeclor claul, bras $i spate, cit gi cele specifice scufundatilor gi respiratiei acvatice. Rezultatele indicd disparitia durerii, corectarea curburii lordotice, cresterea mobilitatii coloanei lombare exprimate prin testele specifice, sciderea greutitii si o mai bund constientizare a redresirii bazinului in cadrul activitailor zilnice, prin tonifierea musculaturii abdominale (fig. 1 si 2) moLoLza4 15.03.2014 m= OL05.2014 m1406.204 m1a06.205 147ip Soc Int J Ph Ed Sp 2014 - Volume 14 - Issue 2. 6 5 4 ; 01.01.2014 i 25.03.2034 o 02.05.2014 prey rege re sama eo Fig. nr. 2 Reprezentarea grafied privind testingu! muscular CONCLUZII {n urma tratamentului aplicat fn recuperarea hiperlordozei lombare, care a nceput in luna ianuatie 2014 si s-afinalizat in junie 2014, sa confirmat urmitoarea ipote7a: folosirea exercifidor specific inotului sporti a influengat imbundtatirea deficientei de posturi a coloanei vertebrale in zona lombard mums hiperlordoza. Coneret, amplitudinea lordozei (hiperlordozei) lombare a fost corcctati pentru fiecare subiect in parte cu cel pujin 15 mm, ceea ce ne permite si afirmim cX scopul luerri a fost atins iar ipoteza confirmata Mijloacele folosite, respectiv mijloacele inotului sportiv au adus imbundtajii in recuperarea hiperlordozei lombare, in contextul subiectlor cercetari, Astfel considerim c& inotul sportiv poate fi recomandat ca metoda de recuperare. Considerim ca stabilirea unui program terapeutic care s8 cuprinda att inotul sporti cat si programul kinetoterapeutic va grabi procesul de recuperare,fiind impedios necesari © bund colaborare intediseiplinara (medic de familie, Kinetoterapeut) si 0 bund relafionare cu pacientul. Coneluzia acestei ucrdei evidentia78 faptul cd instituirea precoce a unui program terapeutic, care si ‘cuprindd mijloacele specifice inotului sportiv, va conduce eficient la recuperarea hiperlordozei lomibar. BIBLIOGRAFIE, [1] Antonescu D, Obrascu C. Corectarea coloanei vertebrale. Bucuresti: Editura Medicala; 1993. 273p. Romanian (2] Bia G. favatarea metodici a procedeetor de int spor, Craiova: Eitura Universitaria; 2006, 257p. Romanian [3] Diaconescu N. Coloana vertebral. Bucuresti: Editura Medical; 1977. 330p. Romanian (4 Duma E, Deficienfle de dezvollarefiicd. Cluj-Napoca: Editura Argonaut; 1997. 267. Romanian {5] Epuran M. Metodologia cercetirt activitjilor comporale. Bucuresti; Editura FEST; 2005. 420p. Romanian (6 Pop S, Durerealombarsjoas8, Oradea: Editura Universitaria; 2003. 313p. Romanian 148