Title: Risultati della terapia medica e fisioterapia di trattamento nella Spa sulla forza muscolare e sulla mobilit
1 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. Markovic
- Istituto per la cura e riabilitazione delle
malattie reumatiche e cardiovascolari - "Niska Banja"
2Results of Physical Treatment in the Spa and
Medicamentous Therapy on Muscle Strength and
Trunk Mobility in Subjects with Lower Bone Density
- Katarina S. Markovic M.D.
- Institute for treatment and rehabilitation of
rheumatic and cardiovascular diseases Niška
Banja
3 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
4- 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
5 - - 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
6graph shows functional amplitude of movements
7- global speed decreasing of extension
suspect of osteoporosis
8 testing protocol
- 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 -
9 testing protocol
- 2. measurement of movement range
- First examine without load
- This parameter is evaluated during dynamic
reception examine with different loaded height -
10 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
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13Rebilitation
- 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
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16-
- 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
17 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.
18 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
19 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)
20 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
21 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)
22 distribution of patients in relation to age
and bone density
Age of life osteoporosa osteoporosa osteoporosa osteopenia osteopenia
Age of life
Age of life br. 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
23 results
- a group of 25 she-patients with average
- T-scor -2,470,04 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.
24 Maximum isometrically test increase
muscle strength and LS movability
25 results
- the similar results were achieved in the group of
50 she-patients with average - T-scor-2,570,09 who at the same period of
time, beside the same Physical Treatment in the
Spa Therapy, had calcium and vitamin D3 intake
26 Maximum isometrically test increase
muscle strength and LS movability
27 results
- the third group consisted of 25
- she-patients, they had the average
- T-scor-2,680,08 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
28 Maximum isometrically test increase
muscle strength and LS movability
29 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-2,390,03 decrease of muscle strength and
LS movability of 15,47, were noticed
30 Maximum isometrically test decrease
muscle strength and LS movability
31 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
32Acknowledgement
- Prim. Mirka Karadžic, M.D.
- Department of Rheumatology
- Institute for treatment and rehabilitation of
rheumatic diseases Niška Banja -
Prof. Aleksandar Dimic, M.D. Medical Faculty
The University of Niš, Serbia