FITS CONCEPT

Scoliosis is defined as 3-dimentional spine deformation. In the sagital plane there is a noticeable disorder in magnitude the proper courve of the spine - like for example hiperlordosis and hyperkyphosis. In the lateral plane the spain is bent and rotationed in the transverse plane.

Trunk deformations connected with the courve of the scoliosis:

• Asymmetry of head position
  
• Asymmetry of the line of shoulders
• Asymmetry of the waist triangles
• Asymmetry of the pelvic

Scoliosis are divided into two categories:

• Structural - is aslways 3-D deformation in sagital, lateral and transverse planes. Begins only during period of growth.
• Nonstructural/functional/ - changes in the spine column are only in the lateral plane. The lateral spine curvature can be reduced/eliminated when the source of the deformation has been identified.

Structural scoliosis affects children and teenagers during periods of rapid growth - the most often in the ages between 1 to 3, 7 to 9, 12 to 15.

The progresion of curvature in scoliosis is influence by the child's age and the time when the scoliosis began.

Examination.

Therapy should be started from very careful examination of the patient.

We should check:

• feet loading and theirs shape
• knee shape and position
• pelvic position
• the spain position in all 3 planes
• the shoulders line
• the head position

Functional Individual Therapy of Scolioses - FITS concept

May be used as a separate system of scoliosis correction, a supportive therapy to bracing, children preparation to surgery and also shoulder and pelvic girdle correction after surgical interventions.
Taking into account the dysfunctions accompanying scoliosis, the authors of the concept propose an individually adjusted programme of exercises depending on a curvature angle and a result of clinical examination of a patient. On this basis both general and specific goals are set.

FITS concept consists of two stages:

1. Elimination of myofascial restrictions which limit a three-plane corrective movement, by using different techniques of muscle energization.
2. Building new corrective posture patterns in functional positions;

According to the authors, the most important factor in conservative management of idiopathic scoliosis is an individualization of the therapy. After careful examination of the patient, the exercise program can be established for each child. The therapy aims not only to apply a passive correction of the deformity but attempts to accomplish the correction in an automatic fashion. Mechanical obstacles to curve correction need to be removed, for example muscle contractures and articular dysfunctions. The child should learn to manage to maintain a corrected posture.

The postural reeducation is an active process of attaining and maintaining proper posture. It requires a child to establish and consolidate the postural habit. Proper education is necessary to establish such a habit therefore maintaining good posture automatically is not possible even taking under consideration great power and endurance of postural muscles. Scoliotic children frequently have impaired body awareness. They perceive scoliotic posture as a natural one. They feel any attempt to attain the correct posture as something unnatural and artificial. This phenomenon is due to a long time of the presence of scoliosis. During that time the improper pattern of posture has been established because the entire system of postural control has been functioning under abnormal conditions [1]. Muscular balance continuously adapts the posture to forces of gravity. Improper posture results in the displacement of the center of gravity which initiates kinetic reactions requiring muscular response. Change in mechanical response of a joint results in the change of neuro-reflexive activity of related muscles, secondary to aberration of afferent impulsation from joint mechanoreceptors. Long term improper stimulation from joint mechanoreceptors may cause change in plasticity of the nervous system, which controls normal movement and lead to foundation of improper movement patterns that may perpetuate scoliosis [2].

Dysfunctions associated to scoliosis:

1. Insufficient awareness of his/her own posture which makes children less involved in the treatment process.
2. Myofascial limitations which make three-plane corrective movements of scoliosis corrections difficult.
3. Incorrect feet loading.
4. Disturbed stabilization of lower trunk.
5. Increased myofascial tension between the thoracolumbar scoliosis apex and the iliac crest which limits the spine shift of the scoliosis correction.
6. Limited mobility of 3-4 ribs on the side of the scoliosis concavity, disturbed mechanism of thorax movements during breathing (breathing with convexities).
7. Incorrect posture patterns caused by the long-lasting scoliogenic stimulation.

Main goals of FITS concept:

1. To make a child aware of existing deformation of the spine and the trunk and to provide a direction for scoliosis correction.
2. To release myofascial structures which limit a three-plane corrective movement.
3. To teach correct foot loading in order to improve the pelvic position and produce symmetrical loading of the lower limbs.
4. To strengthen the force of pelvic floor muscles and short rotator muscles of the spine in order to improve the lower trunk stabilization.
5. To teach the correct shift of the spine in the frontal plane in order to correct the main curve, while stabilizing (or maintaining in correction) the secondary curve.
6. To facilitate the ability to perform the correct three-plane corrective breathing in physiological positions.
7. To make the child aware of the correct patterns and any trunk deformations connected with the curve of the scoliosis (asymmetry of head position, asymmetry of the lines of shoulders, shoulder-blades, waist triangles and pelvis and hip joints).

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  1. Uświadamianie pacjenta
  
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  2. Badanie możliwości korekcji i szukanie struktur ograniczających korekcję
  
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  3. Relaksacja SBL (mięśniowej taśmy powierzchownej tylnej)
  
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  4. Trening kontroli sensomotorycznej
  
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  5. Relaksacja SL (mięśniowej taśmy spiralnej prawej)
  
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  6. Stabilizacja dolnego tułowia w pozycji korekcyjnej
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  7. Nauka shiftu Th/L w prawo
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  8. Stymulacja oddechu 3-D w poz. funkcjonalnej
  
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  9. Wzorce korygujące skoliozę Th dex z kompensacją C/Th sin
  
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  10. Stymulacja oddechu 3-D we wzorcach korygujących