EXERCISE AND QUALITY OF LIFE - Eqol Journal

EXERCISE AND QUALITY OF LIFE

EQOLJOURNAL OF SCIENCE IN SPORT

EQOL


Faculty of Sport and Physical Education, University of Novi Sad, Serbia

Volume 6, Issue 1ISSN 1821-3480

UDC 796June 2014

EQOLA project implemented by Пројекат финансира ЕУ

This project is funded byThe European Union

STAND CORRECTLY – GROW UP HEALTHY!STOJ PRAVO – RASTI ZDRAVO!

СТОЈ ПРАВО – РАСТИ ЗДРАВО!

This publication was made with the help of the European Union. The content of this application isthe responsibility of the European Integration Office of the Government of the Republic of Serbia andDirectorate of European Integration for the Republic of Serbia and Directorate of European Integration

for Bosnia and Herzegovina and does not reflec the attitudes of the European Union.


Journal of Science in SportPublished by Faculty of Sport and Physical Education, University of Novi Sad, Serbia

For the Publisher:Dejan Madić, DeanFaculty of Sport and Physical Education, University of Novi Sad, Serbia

Editor-in-Chief: Višnja Đorđić,Faculty of Sport and Physical Education, University of Novi Sad, Serbia

Guest editor: Dejan Madić,Faculty of Sport and Physical Education,University of Novi Sad, Serbia

Editorial Board:Špela Golubović, Faculty of Medicine, University of Novi Sad, Serbia

Nikola Grujić, Faculty of Medicine, University of Novi Sad, Serbia

Dragan Koković, Faculty of Philosophy, University of Novi Sad, Serbia

Dejan Madić, Faculty of Sport and Physical Education, University of Novi Sad, Serbia

Nebojša Maksimović, Faculty of Sport and Physical Education, University of Novi Sad, Serbia

Aleksandar Nedeljković, Faculty of Sport and Physical Education, University of Belgrade, Serbia

Borislav Obradović, Faculty of Sport and Physical Education, University of Novi Sad, Serbia

Tatjana Tubić, Faculty of Sport and Physical Education, University of Novi Sad, Serbia

Advisory Board:Nikos Aggeloussis, Greece Gustav Bala, SerbiaIstván Berkes, Hungary Wieslav Blach, Poland Tudor Bompa, Canada Julio Calleja, Spain Igor Jukić, Croatia Christos Kotzamanidis, Greece Nebojša Majstorović, Serbia Miroslav Milankov, Serbia Rado Pišot, Slovenia Izet Rađo, Bosnia and Herzegovina Stanisław Sterkowicz, Poland Gorazd Stokin, USARomuald Stupnicki, PolandSergey Tabakov, Russia Language Editor:Mira Milić

Editorial Assistant: Sunčica Poček

Technical Editor/Layout: Penpro, Novi Sad

Indexed in:Scindex Journal “Exercise and Quality of Life” is classified as scientific journal (M53) by Ministry of Education and Science’s Scientific Committee for Social Sciences and Scientific Committee for Medicine Sciences

Editorial Office:The Editorial Board of “Exercise and Quality of Life”. Faculty of Sport and Physical Education, 21000 Novi Sad. Lovcenska 16. Serbia, Phone: +381 21 450 188, Fax +381 21 450 199, e-mail: [email protected], URL: http://www.fsfvns.rs. Exercise and Quality of Life is published biannually in June and December.Printed in 250 copies. Printed by Alfa-graf NS, Novi Sad.

Full-text available free of charge at http://www.fsfvns.rs/

UDC 796 ISSN 1821–3480

EXERCISE AND QUALITY OF LIFEJournal of Science in Sport

Volume 6, No. 1, 2014, 1–38

Contents

Branka Protić - Gava The importance of postural status for the health of children and youth ................................. 1

Snežana Tomašević-Todorović Physiotherapy aspect of diagnosis and treatment of postural disorders ................................. 7

Milan Kojić Differences in indicators of postural status between boys and girls from srem .................... 17

Nikola Jevtić Scoliosis and treating scoliosis with schroth method ............................................................... 23

Dušica Marić, Mirela Erić, Bojana Krstonošić and Dragana Smiljenić Fascia – the forgotten tissue ....................................................................................................... 31

Guest Editor’s Foreword

Special issue of the Exercise and Quality of Life journal is dedicated to the IPA project cross border programme Serbia and Bosnia and Herzegovina “Improving testing abilities on pos-tural and spinal column status - SpinLab”, founded by the European Union, Directorate for Euro-pean Integration.

Project leader is the Faculty of Sport and Physical Education of the University of Novi Sad, with project partners being the Faculty of Sport and Physical Education of the University of Sa-rajevo.

The project is the result of the need to improve the assessment of postural status among children and to adopt it more widely. According to previous studies, the level of physical activities is globally declining. Children and youth in transitional countries might be particularly vulnerable groups in terms of physical inactivity. Huge economical and political changes in these countries have led to significant changes in everyday living, affecting both parents and children. Research conducted in Vojvodina and Bosnia and Herzegovina suggest that there are some negative trends in children’s postural status as well as in their motor and functional abilities. At the same time, evaluation of the postural status has been conducted, so far, mainly by using subjective methods, which are time consuming and often lack accuracy.

The overall goal of the project is to improve the detection and prevention of postural disor-ders, health problems of sensorimotor apparatus in children and adolescents between the two re-gions, Srem (Serbia, Autonomous Province of Vojvodina) and Sarajevo (Bosnia and Herzegovi-na). The project activities should develop one efficient, self-sustaining system that will, by using advanced methods, provide early detection followed by programmed exercise for the correction of the problem related to postural status. The first specific goal is to improve the assessment of pos-tural status and the status of the spine as well as proper identification of the sensorimotor appara-tus problem. The second specific goal is to raise awareness about the importance of early detection and prevention of sensorimotor apparatus in children among target groups.

Authors of the contributions to the special issue are eminent scientist and professionals within their field of expertise, who cooperate within the project network.

The papers present the state of art in the scientific areas relevant to the project, which pro-vides stable framework for further project activities and interpreting the project findings.

Prof. Dejan Madić, PhD Project Manager

EXERCISE AND QUALITY OF LIFE Review articleVolume 6, No. 1, 2014, 1–6 UDC 616.711-007.5-053.5/.6:613.95

THE IMPORTANCE OF POSTURAL STATUS FOR THE HEALTH OF CHILDREN AND YOUTH

Branka Protić - Gava* Faculty of Sport and Physical Education – University of Novi Sad

Abstract

Postural disorders occur not just among school children but also among preschoolers, the fact which coincides with critical periods of growth and development that are characteristic for the occurrence of the mentioned disorders. They can be located on all the segments along the spi-nal column, torso and lower limbs. Good body posture is of great importance for healthy growing of the youngest while poor postural status harmfully influences locomotor system, circulation, as well as respiratory and digestive system. Inadequate position while sitting, standing and walking (as the result of muscular disbalance) causes pain in cervical, thoracic and lumbar part of the spi-nal column, which later influences the overall quality of life. Surveys and numerous researches of the locomotor system are all aimed at finding the most adequate system of preventive and correc-tive activities with an emphasis on timely diagnostic of changes.

Keywords: postural status, body posture, health, importance, children and youth

Introduction

The occurrence of postural disorders as well as finding relationships among them and pos-sible causes of their development raises interest of health workers and physical education teach-ers. Older researches indicated more frequent occurrences of postural disorders among school children. However, newer researches alarm us of more frequent occurrences of poor posture even among preschoolers (Sabo, 2006).

Postural disorders of locomotor system among school children and preschoolers, which have not been recognized and treated in a timely manner, can develop into body deformations that are later difficult to treat (Protić – Gava et al., 2010). That is why it is highly recommended for children to start practising well-designed and professionally-leaded physical activities at an ear-ly age.

* Corresponding author. Faculty of Sport and Physical Education, University of Novi Sad, Lovćenska 16, 21000 Novi Sad, Serbia, e-mail: [email protected]

© 2014 Faculty of Sport and Physical Education, University of Novi Sad, Serbia

Branka Protić - Gava

The importance of postural status for the health of children and youth

2


The results of researches regarding the occurrence of postural disorders indicate more fre-quent occurrence of multiple deviations in musculoskeletal system among young-school age chil-dren (Protić - Gava et al., 2009a). However, the positive thing is that most of them are on the level of functional stadium which has not yet reached the level of structural changes.

Postural status

The term posture refers to the position of body (Đorđić, 2007) which represents relative position of body segments during rest or during some activity (Demeši-Drljan and Mikov, 2012). Good postural status is conditioned by good muscular-skeleton balance that protects certain struc-tures from injuries and occurrences of progressive deformations (Pavlović, 2009) reagrdless of the position of body (Aleksić-Veljković and Stanković, 2010).

Muscles, which represent the active part of movement apparatus, have the most significant role in the creation and preservation of regular posture. Together with ligament apparatus and ar-ticulation system, they confront gravity both during movement and rest (Pavlović, 2009). If the balance is dislocated (in these cases muscles suffer mostly), good body posture suffers as well (Koturović and Jeričević, 1996).

Good and regular relations between all the segments in a body contribute to well-balanced and uninterrupted functioning, and as such result in good body posture. Consequently, good body posture causes muscles to function at their best (Aleksić-Veljković and Stanković, 2010), thus pro-viding optimal position for abdominal and thoracic organs (Pavlović, 2009).

Upright and relaxed posture is characterized by body weight well-balanced on both legs and adequate muscle tension to suppress gravity, while at the same time energy consumption is in-significant. If vertical that goes from common centre of all the segments that burden the articula-tion goes closer to the centre of that articulation, muscle strain is smaller (Đorđić, 2007).

Physiological curves of the spinal columns stabilize around the 18th month of age or even later, while the curves range between 20º and 35º in thoracic and 15º and 30º in lumbar part (Radisavljević, 2001). Spinal column is curveless in frontal plane (10º deviance is tolerable) and should be without any rotation (Đorđić, 2007). Bone, ligament and muscle structures in a foot play a significant role in the creation and preservation of foot arch (Đorđić, 2007; Radisavljević, 2001). The height of longitudinal arches is determined by the shape of bones and ligament strength (Jovičić, 2007). Deterioration of this unique functional composition of active and passive tensors causes changes in the shape, position and function of a foot (Radisavljević, 2001). Causes of de-formations can be of different etiology, but what all of them have in common is disbalance of foot muscles (Lee & Sucato, 2008).

Growth and development of any child follows the same rhythmic pattern which is marked by certain so-called “growth crises” (Kosinac, 2006). The first and second year of life represent the years when children experience intensive growth and as such these years are referred to as the first critical period when rapid motor growth happens (upright position). In their seventh year of age (second critical period) when they start school, children are exposed to more physical challeng-es (carrying heavy school bag, sitting for longer period of time). Third critical period is the age of puberty when children experience rapid growth. This period is followed by intensive secretion of reproductive glands and closure of certain cartilago epiphysialis of long skeleton bones (Demeši-Drljan and Mikov, 2012).

One of the primary preconditions for the occurrence of poor body posture, which is con-sequently followed by disorders along the spinal column, is lack of movement. School environ-


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ment represent a “fertile ground” for the occurence and development of certain postural disorders (Medojević and Jakšić, 2007). In order to prove their claim that children who start school have much less physical activity than younger children, these authors cite Vuković (1999) who claims that children who start school have 50 % less physical activity than preschoolers. Đorđić (2007) quotes Cardon (2004) who says that children spend 97 % of their school time sitting.

Weakness and inadequate development of musculoskeletal system are caused by lack or smaller number of physical activities which than results in the development of poor postural hab-its among the youngest (Demeši-Drljan and Mikov, 2012). Repeated and long-lasting activities ef-fecting the spinal column in certain positions create poor habits regarding body posture. The re-sult is the occurrence of many different forms of postural disorders. Tired muscular system finds the best position to rest in the shortest time possible. However, due to disbalance it experiences, it causes inadequate postural status (Medojević and Jakšić, 2007). What follows is the shortening or weakening of a certain muscular system which then causes muscle disbalance that represents the main cause of the occurrence and development of body deformations (Đokić and Stojanović, 2010). After primary changes on muscles, changes on ligament apparatus and then on skeleton also occur, which means that poor body posture actually represents the first phase of certain deforma-tions.

Obesity also represents a base for the development of certain deformations among chil-dren, especially for the occurrence and development of lower limbs deformations - “X” shape legs (Paušić, 2007) and flat feet (Protić-Gava, Krneta and Romanov, 2011).

Cooperation – parents, teachers, doctors – key to success in the prevention of postural disorders

Cooperation between health facilities, preschool and school institutions, sport clubs and family is of great importance in the school education system, where the main task is to teach youth about the importance of good body posture for their health and overall quality of life. Physical ed-ucation teachers in educational and sport institutions can contribute significantly when the recog-nition of postural disorders, the prevention of poor body posture and mild forms of body deforma-tions are in question. The role of family in raising consciousness regarding healthy life habits and the importance of organized forms of physical activities is of great significance for the prevention of any kind of disorder. Basic information and knowledge of the development of disorders and de-formations can contribute to their prevention.

Continuous, adequately chosen, and controlled physical activity represents an efficient

tool that can influence growth and development of children as well as the creation and pres-ervation of body status. In this sense, parents have great responsibility to motivate and encourage their children to take part in different forms of physical activities. Adequate and precisely planned physical activity positively influences the process of development, corrects postural disorders and deformations and develops positive motor skills (Grabara & Hadzik, 2009a, prema Krneta, Protić-Gava, Vuković and Šćepanović, 2012).

Since parents and physical education teachers are those who children spend most of their time with and who follow children’s growth and development, they are the ones who, if they rec-ognize any type of postural disorder, should react and initiate treatment.

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Instead of conclusion

The task of physical education teachers is to influence the adoption of good body posture as well as to recognize functional changes of the postural status and foot status while medical facili-ties should be in charge of diagnostics and treatment of structural changes (deformations).

The importance of timely recognition of postural disorders results in a smaller number of children with poor body posture. Starting to teach children different forms of physical activities at an early age has preventive and corrective effects on growth and development, especially in the critical periods of growth.

Having in mind the etiology of the occurrences of postural disorders and basic principles of preventive work, application of adequate techniques can prevent further progression of already existing disorders and enable complete recovery. Adequate choice of physical activities can make growth and development easier by improving the immunity, correcting postural disorders and developing positive motor skills. Integration of compensative activities in everyday teaching of physical education can greatly help and influence the creation of good body posture.

References

Aleksić-Veljković, A., & Stanković, M. (2010). Povrede kičmenog stuba u sportskoj gimnastici. U: R. Stanković (ur.), Zbornik radova sa XIV međunarodnog naučnog skupa “Fis komuni-kacije 2010” u sportu, fizičkom vaspitanju i rekreaciji (str. 363-369). Niš: Fakultet sporta i fizičkog vaspitanja.

Demeši-Drljan, Č., i Mikov, A. (2012). Posturalni status dece predškolskog i ranog školskog uzras-ta. U: M. Lazović (ur.), Zbornik radova sa 12. kongresa fizijatara Srbije sa međunarodnim učešćem (str. 65-69). Vrnjačka Banja: Udruženje fizijatara Srbije.

Đokić, Z., i Stojanović, M. (2010). Morfološke karakteristike i posturalni status dece od 9 do 12 godina na području Sremske Mitrovice. Opšta medicina, 16(1-2), 41-49.

Đorđić, V. (2007). Posturalni status predškolske dece. Anthropological Characteristics and Abili-ties of Preschool Children (ur. Gustav Bala), 155-202. Novi Sad: Fakultet sporta i fizičkog vaspitanja.

Jovičić, M. (2007). Fleksibilno ravno stopalo kod dece: problem ili ne? Sportska medicina, 7(1), 9-14.

Kosinac, Z. (2006). Utjecaj nekih antropometrijskih i somatskih pokazatelja na dismorfične prom-jene prsnog koša (pectus carinatum i pectus excavatum). Fizička kultura, 60(1), 39 – 49.

Koturović, Lj., Jeričević, D. (1996). Korektivna gimnastika. Beograd: IGP “MIS SPORT”.

Lee, M. C., & Sucato, D. J. (2008). Pediatric Issues with Cavovarus Foot Deformities. Foot Ankle Clinics, 13(2), 199-219.

Madić, D. (2006). Relacije motoričkog i posturalnog statusa dece predškolskog uzrasta u Vojvo-dini. Zbornik radova interdisciplinarne naučne konferencije sa međunarodnim učešćem „Antropološki status i fizička aktivnost dece i omladine“, Novi Sad, 2006, (pp.185-191). Novi Sad: Fakultet sporta i fizičkog vaspitanja.


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Medojević, S. & Jakšić, D. (2007). Razlike u posturalnim poremećajima između devojčica i dečaka od 7 - 15 godina na teritoriji Vojvodine. Zbornik radova interdisciplinarne naučne konfer-encije sa međunarodnim učešćem „Antropološki status i fizička aktivnost dece, omladine i odraslih“, Novi Sad, 2007, (pp.49-54). Novi Sad: Fakultet sporta i fizičkog vaspitanja.

Paušić, J. (2007). Konstrukcija i vrednovanje mjernih postupaka za procjenu tjelesnog držanja u dječaka dobi od 10 do 13 godina, doktorska disertacija. Kineziološki fakultet, Zagreb.

Pavlović, M. (2009). Odabrana poglavlja iz osnova kineziterapije, teorijske postavke sa uputst-vima za vežbe (drugo dopunjeno izdanje). Beograd: Visoka zdravstvena škola strukovnih studija.

Protić - Gava, B., Bošković, K., Krsmanović, T. & Romanov, R. (2009). The relationship between pelvis posture and lower extremities in young schoolchildren. Proceedings of 1st Interna-tional Scientific Conference ”Exercise and Quality of life”, Novi Sad, 2009, (pp. 447-452). Novi Sad: Faculty of Sport and Physical Education, University of Novi Sad.

Protić - Gava, B., Krneta, Ž., Bošković, K. & Romanov, R. (2010). Efekti programiranog vežbanja na status kičmenog stuba osmogodišnje dece Novog Sada. Glasnik antropološkog društva Srbije sv.45, 365-374.

Protić-Gava, B., Krneta, Ž., i Romanov, R. (2011). Razlike u posturalnim poremećajima donjih ekstremiteta kod adolescenata grupisanih prema morfološkim karakteristikama. Glasnik Antropološkog društva Srbije, 46, 401-406.

Radisavljević, M. (2001). Korektivna gimnastika sa osnovama kineziterapije (prerađeno i dopun-jeno izdanje). Beograd: Fakultet za sport i fizičko vaspitanje.

Sabo, E. (2006). Posturalni status dece predškolskog uzrasta na teritoriji AP Vojvodine. Zbornik ra-dova interdisciplinarne naučne konferencije sa međunarodnim učešćem „Antropološki sta-tus i fizička aktivnost dece i omladine“, Novi Sad, 2006, (pp. 97-100). Novi Sad: Fakultet sporta i fizičkog vaspitanja.

EXERCISE AND QUALITY OF LIFE Review articleVolume 6, No. 1, 2014, 7–15 UDC 616.711-007.5:615.8

PHYSIOTHERAPY ASPECT OF DIAGNOSIS AND TREATMENT OF POSTURAL DISORDERS

Snežana Tomašević-Todorović* Medical faculty, University of Novi Sad, Clinical Center of Vojvodina

Abstract

Postural disorders are common among preschool and school-age children. In regard to gen-der and age distribution, children are characterized by different indicators of body posture. Posture for different professionals has different importance, and from a standpoint of one physiatrist it rep-resents a measure of the efficiency of muscular balance and neuromuscular coordination. Bad pos-ture represents a functional deviation from normal posture status without structural changes to the spine or lower extremities. Evaluation and treatment of postural disorders requires knowledge of basic principles related to the conduct of individual body segments, joints and muscles. The com-bined physical training programmes that include strength and muscle stretching exercises, particu-larly with regard to the postural antigravity muscles, should help in the prevention of health prob-lems that could occur later in life. Future research on the impact of early school-based back pos-ture promotion in relation to the integration of back posture principles according to biomechanical favourable lifestyle and back pain prevalence later in life is essential.

Keywords: posture, assessment, exercise, scoliosis

Introduction

Holding body is biological characteristics of human beings created through evolution. Pos-ture includes static and dynamic behavior of the body in space relative to each other and the envi-ronment.

It is difficult to define the legality and models “proper posture” of the body, because it is very individual and specific. Proper posture depends on the structure of the skeleton, on correct ar-rangement of muscles, muscle strength as well as the symmetry of the paired parts. Holding body depends on the current emotional state of the personality as well as from a variety of influences. Posture for different professionals has different importance, and from a standpoint of one physiat-rist it represents a measure of the efficiency of muscular balance and neuromuscular coordination

* Corresponding author. Medical Faculty, University of Novi Sad, Hajduk Veljkova 3, 21000 Novi Sad, Serbia, e-mail: [email protected]


Snežana Tomasevic-Todorovic

Physiotherapy aspect of diagnosis and treatment of postural disorders

8


(Zec, 1984). Each individual will engage in many different postures every day. A good posture is a posture that is stable, and produces minimal stress and strain on the spinal structures, such as muscles, ligaments, intervertebral discs and nerves (Scannell & McGill, 2003; Callaghan & Mc-Gill, 2001).

To put it simply, the posture of the body involves proper alignment of the body segments and their balance, which is achieved by providing a minimal input of power with maximum me-chanical efficiency (Garrison & Read, 1999; Zec, 1994). The malalignment of one body segments will cause change to occur in adjacent segments, as well changes in other segments, as the body seeks to adjust or compensate for the malalignment (closed-chain response to keep the head over the sacrum) (Gelb et al., 1995).

Bad posture represents a functional deviation from normal posture status without structur-al changes to the spine or lower extremities.

A bad posture is likely to subject the spine to abnormal and high levels of stress and strain (Bullock-Saxton. 1993). Postures that represent an attempt to either improve function or normal appearance are called compensatory postures ( Riegger-Krugh & Keysor, 1996). Bad posture has also been linked to poor balance, as well as to decreases in gait and functional performance. In fact, research shows that poor posture is even associated with increased mortality rates in older adults (Page, 2005).

Current trends among domestic and foreign authors inidcate that poor posture among chil-dren occurs in two forms: a neurological and kinesiology. Neurological is characterized by mus-cular hypotonia, which is a consequence of immaturity of the central nervous system and usually disappears by the age of five. In Kinesiology bad posture is described as an evident shortening of the muscles, which needs to be timely noticed and treated. (Savic, 1994). “Typically, muscles over-used in a certain direction will become tighter and shorter—an effect known as adaptive shorten-ing. Opposing muscles to repetitive movements sustain stretches during prolonged postures. As a result, these muscles tend to become longer and weaker—an effect known as stretch weakness” (Kendall et. al., 2005).

The seated posture is a flexor-dominated posture that further shortens and tightens the mus-culature on the ventral side of the body and lengthens while weakening the musculature on the dorsal side of the body. “As a result of the muscle imbalances that develop in our musculoskele-tal system, postural distortions occur that tend to correspond with the muscular findings” (Ham-mer, 2007).

Monitoring of the growth and development of preschool and school-age children includes continuous checking of their posture, especially during critical periods of growth and develop-ment. There are periods during the growth of a child which are particularly important for the ap-pearance of bad posture (Milosevic & Obradovic, 2008; Sabo, 2006). Therefore, it is highly im-portant to detect the postural problems at an early stage and keep them under the strict kinesiolog-ical control (Auxter et al., 1989). The first critical period - 1-2 years of life which is a marked as a period of increasing in body weight and the development of locomotor function. Posture which is accomplished in the first year of life is a complex function which is preceded by a series of chang-es in the active and passive part of the locomotor apparatus, in particular musscle localized along the spinal column. Of great importance is the state of mineral metabolism which is intensified in this period often leads to various changes in the skeleton.

Second critical period - 6-7 years of life when the child moves from preschool to school age with a new physical load: more seating, as well as sitting in inadequate class-rooms, writing often in incorrect position, carrying heavy school bags and so on. In the age be-tween 5 and 10, when the growth becomes slower, the postural problems show somewhat low-er rate of incidence, whereas with the onset of puberty, an increased emergence of postur-


9

al abruptly deteriorating conditions and the detection of new cases can be widely anticipated. The third critical period – from the age of 11 to the age of 14 is the period when it comes to of work intensive sex glands, weight gain and increased physical activity, and thus to an increased load of the skeleton. Bad posture can occur in adolescence when mainly conditioned by external factors (bad seater, bad beds, inadequate clothing, professionally burden - particularly heavy pe-riod of study crafts during the maturation of the skeleton, which is unable to resist the permanent load, insufficient engagement sports activities). Some of these factors have an influence on the for-mation of bad posture in the previous stages of the developmental period of the child. Due to the long-term negative impact of gravity and retention of irregular posture while sitting, standing, aid-ed by wearing (too) heavy school bag in one hand or on one shoulder posture over time takes on the curve in the sagittal or frontal plane and thus incorrectly scoliotic posture (Kosinac 2006). A prolonged flexed posture may also cause deconditioning of the spinal muscles thus inducing high-er risk of injury (O ‘Sullivan et al., 2006).

Diagnosis of postural disorders

Postural status of children in preschool and school conditions is estimated by observation or measurement. Visual methods are subjective, and measurement methods give somewhat more accurate picture of body posture. The observation was performed in the sagittal plane from the side, in the frontal plane with the front and rear. Analysis of each subject at a distance of 2 m with the measures and evaluate individual body segments in the following order (Protic-Gava & Scep-anovic, 2012).

1. Holding head and neck - holding your head includes raised brow parallel to the frontal plane, and the direction of view is parallel with the horizontal plane. The shape of the neck is cy-lindrical in posture lordosis formed with the distance from the vertical 3.5 cm. Head and neck pos-ture describes when the patients sitting and standing and any differences should be notied. Janda describes “upper crossed syndrome” to show the effect “poking chin” on the neck muscles, with the weak neck deep flexors, as are rhomboids and serratus anterior (Page, 2005) .

2. Shoulders position: shoulders are normally placed in the frontal plane. Deviations may be in the form of the curvature of the shoulders forward or asymmetry of the left and right shoul-der. Inequality at shoulder height is usually associated with the dominant hand, raised his shoulder tension of the upper trapezoid and levator scapula.

3. Appeatance of the chest - and the shape of the thorax, adjustedness front wall, the pres-ence of deformities, half symmetry, regularity rebarnih arches, respiratory mobility of the ribs dur-ing normal and deep inspiratory and muscle relief. Particular attention should be paid to the con-figuration of the ribs of the posterior wall of the thorax, especially in front of the slope, which we can indicate the presence of structural deformities of the spine.

4. Position the hull - look at whether the hull is set in the center line or dezaksiran.

5. Appearance of the abdomen - the anterior wall of the abdomen should be in the line of the anterior chest wall or something behind.

6. Appearance Lorentz triangles stature - the space between the hull and the inner side of limbs. We see their symmetry or asymmetry.

7. Pelvic position:- physiological pelvic tilt relative to the transverse plane is about 60 de-grees.

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8. The appearance and position of scapula - are normally placed in the region of 4 -7 ribs. Observe the asymmetry, distance and lift the inside edges relative to the spinal column. The asym-metry of the position of the scapula (or attracting too much lapse of one or both scapulas or curved fins) consequence is the weakening of serratus anterior muscle of the dominant hand (her shoul-der is lower), the rhomboid muscle tension and lattisimus dorsi muscle. Drawn scapulas: shortened rhomboid muscles, elongated pectoralis major and pectoralis minor muscle, spaced scapula: ser-ratus anterior muscle tension, prolonged rhomboid and middle trapezoid muscle; curved fins: the anterior serratus muscle weakness (Kosinac & Banovic, 2008).

9. Appearance of the spine - look at the position of the spine as a whole following the thorny extensions, variations in the sagittal and frontal planes, the size of the physiological curve. Exces-sive lumbar lordosis usually cause streching of anterior longitudinal ligament and shortening dor-sal back extensors, posterior ligaments and scapular muscles as a result of excessive dorsal kypho-sis (Adams & Hutton, 1985).

10. Appearance of the lower ekstremiteta- should pay attention to the direction of the lon-gitudinal axis of the lower extremities, the presence of deformities (“x” or “o” leg), the length of the limbs. Measuring with centimeter tape, starting from the anterior superior iliac spine to the in-ternal malleolus or from the navel to the internal malleolus.Some extent of genu varum is normal at birth and during infancy up to 3 or 4 years of age (Edgar, 2002).

11. The position and appearance of the feet - identification of the constitution of the foot, an overview on all sides including plantar and spotting deformities. When one malleolus appears more prominent or lower than the other and calcanear eversion is present, it is possible that the a common foot problem known as pes planus, or flat foot, may be present.Calcaneal eversion of 5 to 10 is normal in toddlers, but by 7 years of age, no calcaneal eversion should be presents (Val-massy, 1996).

Measurement methods

Assessment of posture is performed by measuring the physiological curvature of the spine using the surplus with thinner ribbon, ruler. These methods give results, but not completely reli-able. No matter what you have already overcome, this method is still applicable for pre-schools and schools that are not able to purchase modern diagnostic equipment.

The most frequently used method of measurement is a method for assessing from Napele-on Wolanski with measure 8 segments of body posture (pose, shoulders, keeping shoulder blades, chest, thorax in the frontal plane, keeping the anterior abdominal wall, the shape of the leg and in-step) (Protic-Gava , Scepanovic, 2012). By Wolanski there are three ratings: 0, 1 and 2 (Table 1). The rating is 0 when all parameters are normal relations - normal status. Grade 1 represents some deviation from the normal status posture. It is a functional deformity - give the active part of the locomotor apparatus. Grade 2 is characterized by significant deviations from normal state, and cor-responds to the structural changes of the locomotor apparatus. By calculating the score for each segment, we get the total score based on which the posture estimates from very poor to excellent (Table 1).


11

Table 1. Grades by Wolanski

POSTURE SCORE

EXCELLENT 0

VERY GOOD 1-4

GOOD 5-8

BAD 9-12

VERY POOR 13-16

Somathoscopic method according Radisavljević includes evaluation of the following seg-mentSomathoscopic method according Radisavljević includes evaluation of the following seg-ments body posture in the frontal plane, the back side: head, shoulders, shoulder blades, triangles stature (Lorentz triangles), pelvis, knee, Achilles tendon. Observation in the sagittal plane (with sides), includes posture: the neck (cervical), the chest (thoracic) and lumbar (lumbar) curve, the po-sition of the knees and feet. From the front, in the frontal plane, watching the thorax (Radisavljević, 2001).

The mobility of the spine determine active and passive range of motion measurements of flexion, extension, laterofleksije and rotation of the spine (Jandrić, 2009). Other tests that should be part of the postural examination are measuring the length of the leg and straight-leg raising test (Laseque test), as well as reviews of specific joints, length and muscle strength (Kendal et al., 1993). The location of the joints indicates that the muscles in elongated or not (Magee, 1992). Neurophysiological review covers motor skills, sensitivity and sensory function.There are many methods and a range of equipment available for spinal posture and motion measurement. These different measurement methods vary in size, cost, accuracy, dimensions of measurements, ease of use and invasiveness, and each has its advantages and disadvantages. From the range of equip-ment available, biplanar radiography, opto-electronic systems, electromagnetic tracking systems, and inertial measurement systems are all capable of both 3 dimensional spinal posture and motion measurements. Biplanar radiography, opto-electronic systems and electromagnetic tracking sys-tems are the more established and common methods employed. Radiography or X-ray is one of the popular methods used in posture and motion measurement, especially in spinal mobility mea-surement; intersegmental vertebra kinematic analysis and postural tracking (Harrison et al., 2005).

It is necessary for lateral radiography of the whole spine in an upright position with scoli-osis. The radiographic result is used for the determination of side (left or right, depending on the convexity) and the degree of curvature (Cobb angles), the rotation of vertebral bodies and to deter-mine the bone maturity to of the patient. To measure the angle of curvature by Cobb there is need to choose the vertebrae above and below the apex of the curve, which are most inclined. Cobb an-gle is the angle between the lines that intersect and are placed on top top and bottom of the low-est vertebra.

Treatment of postural disorders

Individual approach to patients with postural disorders in the context of the history and clinical evaluation is essential, and requires education of doctors and physiotherapists in specially designed methods, focused on specific spinal deformity. Evaluation and treatment of postural dis-orders requires knowledge of basic principles related to the conduct of individual body segments,

12


joints and muscles. Improper handling resulting in uneven loads and stresses the bone, articular, ligaments and muscles (Magee, 1992; Michele, & Moore, 2004). By understanding muscle imbal-ances associated with functional impingement, specialist for physical medicine and rehabilitation can prescribe appropriate exercises for both treatment and prevention.

Kinesiology treatment of scoliosis posture directed toward a specific type of problem caused by poor posture is carried out in several stages (Tribastone, 1994). Cooperation with the doctor and therapist is very important at the beginning of treatment, with the establishment of psychophysical harmony with relaxation and acceptance exercises to develop awareness of poor posture. The most important phase of Kinesiology treatment is correction of posture. Stretching with exercises in dif-ferent positions and in motion, support the correction of the spine. In most cases, it is necessary to complete the correction of posture breathing exercises, muscle relaxation, to eliminate certain mus-cular tension and strengthening muscles to the functional findings, especially abdominal, in order to give adequate support to the spine and to prepare for any sporting activities . They are extremely important posture correction exercises with the mirror. Are the most effective exercises in the com-pensation conditions, for example Klapp exercises creep. The ultimate goal of Kinesiology treat-ment is the integration of postural adjustments that can be achieved in posture in everyday move-ments, which allows a person with a scoliotic posture ability to resist negative impacts on standing or when carrying schoolbags, improper seating, sports with monotonous motion (Tribastone, 1994) . A very interesting approach to postural disorders represent Bowen therapy that includes a com-plete relaxation of the body which activates the internal capabilities of the body and mind, return-ing to balance and harmony.Bowen terapija dovodi do bolje usklađenosti tela, bez manipulacije na zglobovima. Bowen moves stimulate several types of intrafascial mechanoreceptors that affect muscle tonus and increase vagal tone. The type of move used in Bowen also assists the hydration of fascia, which in turn encourages better vascular and nerve supply (Wilks, 2013).

Therapeutic exercise, alone or in combination with other forms of treatment, are a logi-cal way to maintain and improve flexibility in patients with functional and structural changes in the spinal cord, the risk for pain, pulmonary dysfunction, and progression (Jandrić, 2012). Liter-ature data shows that exercises with the addition of (active release technique ) ART® will more effectively correct postural distortion (Tacker et al., 2011). The combined physical training pro-grammes that include strength and muscle stretching exercises, particularly with regard to the pos-tural antigravity muscles, should help in the prevention of health problems that could occur later in life, since incorrect or improper posture constitutes the basis for further deterioration of health. The combined program of corrective gymnastics with games and exercises in water had signifi-cant eff ects on improving the muscle tone in the respondents, which in turn had a direct impact on improving their body posture, both in terms of all of the individually surveyed body parts and in overall terms (Torlakovic et al., 2013). The more interventions studied are needed to allow the formulation of evidence based guidelines for the prevention of back pain in schoolchildren (Car-don et al., 2007). The intensive effective back posture education through elementary school curric-ulum is effective til adolescence.

Therapeutic exercise can improve the angle of the curve Cobb angles in patients with id-iopathic scoliosis, strength, mobility and balance, vital capacity (Fusco et al., 2011). International Association of Society on Scoliosis Orthopaedic and Rehabilitation Treatment (SOSORT) in 2006 provided guidelines for conservative treatment of scoliosis (Weiss et al., 2006). The first of the three methods of conservative treatment of spinal deformity are based on kinesiotherapeutic meth-ods including Schroth, Lyonaiseovu, Side-Shiftovu and Dobosiewiczevui method, and other meth-ods kinesiotherapeutical (Negrini et al., 2003). Scoliosis Intensive Rehabilitation (SIR), leads to a subjective improvement and reduction of progression of the curve (Weiss et al., 2003). Treatment of spinal orthosis has been shown effective in preventing the progression of curvature at the IS


13

(Maruyama et al., 2011). It has been shown that treatment of spinal orthoses can reduce the preva-lence of surgery, then restored sagittal profile and influence the rotation of the spine.

Future research on the impact of early school-based back posture promotion in relation to the integration of back posture principles according to biomechanical favorable lifestyle and back pain prevalence later in life is essential (Geldhof et al.,2007).

References

Adams, M.A., Hutton, W.C.(1985). The effect of posture on the lumbar spine. J Bone Joint Surg Br, 47,625.

Auxter, D., Pyfer, J., Huettig C.(1989). Principles and Methods of Adapted Physical Education and recreation. Appendix a: Posture and Body Mechanics, WCB/Mc Graw-Hill, 517-558.

Bullock-Saxton, J., (1993). Postural Alignment in Standing: A Repeatability Study. Australian Physiotherapy, 39(1), 25-29.

Callaghan, J.P. and McGill, S.M. (2001). Low Back Joint Loading and Kinematics during Stand-ing and Unsupported Sitting. Ergonomics, 44(3), 280-294.

Cardon, G. M., de Clercq, D. L., Geldhof, E. J., Verstraete, S., & de Bourdeaudhuij, I. M. (2007). Back education in elementary schoolchildren: the effects of adding a physical activity pro-motion program to a back care program.European Spine Journal, 16(1), 125-133.

Edgar, M. (2002). A new clarification of adolescent idiopathic scoliosis.Lancet, 27, 270

Fusco, C., Zaina, F., Atanasio, S., Romano, M., Negrini, M., Negrini, S. (2011). Physical exercis-es in the treatment of adolescent idiopathic scoliosis: an updated systematic review. Phys-iother Theory Pract, 27(1),80-114.

Garrison L, Read A.K. (1999). Fitness for every body. Palo Alto: Calif. Mayfi eld Publishing. 1999.

Gelb, D.E., Lenke, L.G., Bridwell, K.H., et al. (1995). An analysis of sgittal spinal alignment in 100 asymptomatic middle and older aged volunteers. Spine, 20:1351.

Geldhof, E., Cardon, G., De Bourdeaudhuij, I., & De Clercq, D. (2007). Back posture education in elementary schoolchildren: a 2-year follow-up study.European spine journal, 16(6), 841-850.

Hammer, W.(2007). Fuctional Soft-Tissue Examination and Treatment by Manual Methods. 3rd,509.

Harrison, D.E., Colloca, C.J., Harrison, D.D., Janik, T.J. Haas J.W., Keller, T.S. (2005). Anteri-or Thoracic Posture Increases Thoracolumbar Disc Loading. European Spine Journal, 14, 234-242.

Jandrić, S.Đ.(2009). Osnovi fizikalne medicine i rehabilitacije. 2.izd. Laktaši: Grafomark; 2009.

Kendall, F., McCreary, E., et. al. Muscles. Testing and Function with Posture and Pain. Baltimore MD: Lippincott, Williams & Wilkins. 2005;5th ed.

Kosinac, Z. (2006.), Utjecaj nekih antropometrijskih i somatskih pokazatelja na dismorficne prom-jene prsnog koša (pectus carinatum i pectus excavatum). Fizicka kultura, Beograd, 60, 1:39.-49.

Magee, D.J.(1992). Orthopedic Physical Assessment (second edition). WB Saunders. Philadel-phia.

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Maruyama, T., Grivas, T.B, Kaspiris, A (2011). Effectiveness and outcomes of brace treatment: a systematic review. Physiother Theory Pract, 27(1), 6-42.

Michele, K., Moore, D.C. (2004). Upper Crossed Syndrome and Its Relationship to Cervicogenic Headache. Journal of Manipulative & Physiological Therapeutics, 27(6),414–420.

Milošević, Z., Obradović, B. (2008).Postularni satus dece novosadskih predškolskih ustanova uz-rasta 7 godina. Journal of the Anthropological Society of Serbia,43,301-309.

Negrini, S., Antoninni, G.I., Carabalona, R., Minozzi, S. (2003). Physical exercises as a treatment for adolescent idiopathic scoliosis: a systematic review. Pediatr Rehabil, 6,227-3516.

Page, P.(2005). Muscle imbalances in older adults: improving posture and decreasing pain. The Journal on Active Agi ng, 3:30.

Protic-Gava, B., Scepanovic, T. (2012). Osnove kineziterapije I primena korektivne gimnastike. Prirucnik. Fakultet sporta i fizickog vaspitanja, Novi Sad.

Riegger-Krugh, C., Keysor, J.J. (1996). Skeletal malalignments of the lower quarter: Correlated and compensatory motions and postures. Phys Ther, 23:164.

Sabo, E. (2006). Posturalni status dece predškolskog uzrasta na teritoriji opštine Sombor, Sremska Mitrovica i Bačka Palanka. U: Antropološki status i fizička aktivnost dece i omladine, ured-nik Gustav Bala (101-105).

Savić, K.(1994). Dečija habilitacija i rehabilitacija. Novi Sad, 1994.

Scannell, J.P., McGill, S.M. (2003). Lumbar Posture-Should It, and Can It, Be Modified? A Study of Passive Tissue Stiffness and Lumbar Position during Activities of Daily Living. Physi-cal Therapy, 83(10), 907-917.

Sullivan, P.B., Dankaerts, W. , Burnett, A.F. , Farrell, G.T., Jefford, E., Naylor, C.S., and O‟Sullivan, K.J. (2006). Effect of Different Upright Sitting Postures on Spinal-Pelvic Curvature and Trunk Muscle Activation in a Pain-Free Population. Spine, 31(19), E707-E712.

Thacker, D., Jameson, J., Baker, J., Divine, J., Unfried A. (2011). Management of upper cross syn-drome through the use of active release technique and prescribed exercises. Advisor Rob-ert Kuhn D.C., DACBR, ART®..Logan College of Chiropractic.

Torlakovic A., Muftic M., Avdic D., Kebata R.(2013). Effects of the combined swimming, correc-tive and aqua gymnastics programme on body posture of preschool age children. Journal of Health Sciences, 3(2),103-108.

Tribastone, F. (1994.), Compendio di Ginnastica Correttiva, Societa Stampa Sportiva, Roma, 121-124.

Valmassy, R.L.(1996). Clinical Biomechaincs of the Lower Extremities. St. Louis. CV Mosby, 1996.

Weiss, H.R., Negrini, S., Rigo, M., Kotwicki, T., Hawes, M.C., Grivas, T.B., et al. (2006). Indica-tions for conservative management of scoliosis: guidelines. Scoliosis, 1,5.

Weiss, H.R., Weiss, G., Petermann, F. (2003). Incidence of curvature progression in idiopath-ic scoliosis patients treated with scoliosis in-patient rehabilitation (SIR): an age- and sex-matched cotrolled study. Pediatr Rehabil, 6,23-30.

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Zdenko Kosinac, Z., Banovic, I. (2008). Povezanost između nekih pokazatelja nepravilnog teles-nog držanja I skolioze kod dece juvenilne dobi. Život i škola, 19, 9-21

Zec, Z. ( 1984 ): Osnovi kineziologije, Viša medicinska škola,Beograd.

EXERCISE AND QUALITY OF LIFE Research articleVolume 6, No. 1, 2014, 17–22 UDC 616.711-007.5-053.5(497.113 Srem)

DIFFERENCES IN INDICATORS OF POSTURAL STATUS BETWEEN BOYS AND GIRLS FROM SREM

Milan Kojić* Faculty of Sport and Physical Education – University of Novi Sad

Abstract

Improper seating, various forms of activities as well as certain endogenous and exogenous factors negatively affecting on postural status and does not lead to any body improvements. A healthy and good posture is the basic form for properly constructed mechanics and the assumption of good statics and dynamics of whole body. Postural status was evaluated on the sample of 833 children, aged 4-13, from the population of Preschool institution and Elementary School in Munic-ipality of Ruma, Stara Pazova, Sremska Mitrovica and Indjija. Two anthropometric measures and CONTEMPLAS 3D system for evaluation postural status were applied. Parameters of postural sta-tus and trend were analysed wit basic descriptive statistics ANOVA and MANOVA. Result show that almost 30% of all children have bad posture and there is a high number of those with weaker body segments. Boys have better posture status than girls especially in legs deformity.

Keywords: Posture, Contemplas, Children, Gender differences

Introduction

Improper seating, various forms of activities as well as certain endogenous and exogenous factors negatively affecting on postural status and does not lead to any body improvements. A healthy and good posture represents a base for properly constructed mechanics and the assumption of good statics and dynamics of the whole body. To adapt good posture in early childhood contrib-utes to proper development, and as a result it affects overall health and quality of life. Creating a proper posture status is of particular importance in pre-development period and the early years of school period (Sabo, 2003). Most authors consider that the posture of the good status depends on the health status of individuals. Disturbing the biomechanics and postural status leads to changes in muscle, skeletal system, as well as in psychological and social status. Along with certain health problems, aches and pains, causes of formation postural disorders among children are different: obesity (Milosevic et al., 2007a, Milosevic et al., 2007b), malnutrition (Protic-Gava, 2008), insuf-

* Corresponding author. Bul. Arsenija Carnojevica 84 lok.4 - Novi Beograd, Serbia, e-mail: [email protected]


Milan Kojić

Differences in indicators of postural status between boys and girls from Srem

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Milan Kojić

ficient physical activity (Sallis, 2000). Such a trend in the later development of the body and life can be a serious problem. An extremely important factor and element in the process of growth and development is certainly physical activity. Many previous studies have talked about it in the di-rection of development of the entire musculoskeletal system of the body. Lack of movement leads to a disorder and that is associated with the posture status. Modern way of life and living restric-tions reduce movements witch reflected to some problem in postural status. Hypokinesis and lack of exercise has consequences in terms of low activation of muscles, decreased activity of the whole body and the occurrence of deformities.

These factors certainly accelerate process and condition for develop many problems with postural status and body mechanics. One particular part of the deformity and disorder is definitely determined by genetic but the trend of increasing the number of postural disorders which are as-sociated with other factors. Thus, different endogenous and exogenous elements can act and cre-ate an unfavourable presumption of continuing develop of deformity of different body segments. However, active movement has the most important role in the formation and maintenance of prop-er body posture. The weakness of certain muscle groups, and their excessive workloads, can cause a variety of disorders of the spine, thorax, upper or lower extremities, especially the feet. Extreme-ly bad habits and conditions lead to inactivity of different muscle group and inadequate behavior segments in these conditions may in addition develop deformities and disorders. The prevalence of these disorders occurs particularly among school age children. Researches show that occurrenc-es of deformities and bad postural status have negative trends (Sabo, 2003; Slavnić et al., 2005).

Many studies showed that the flat-foot represents the most common disorder of the low-er extremities especially in early childhood (Mihajlovic, Tončev and Hmjelovjec, 2008; Trajkov-ic and Nikolic, 2008; Protic - Gava and Krneta, 2010). Such an occurrence is characterized by the loosening and weakening of the arch of the foot, leading to the loss of its physiological and func-tional properties. (Jovović, 1999, Jovovich and Čanjak, 2012). Zivkovic and Milenkovic (1994) examined the state of postural disorders and the results show the highest percentage in spine and feet deformity. Researches of postural status among preschool children in Novi Sad show that the largest deviations occur in holding back, shoulders, abdomen, also boys had better posture of the head and abdomen than girls (Sabo, 2003; Toth, 2001). From these studies it can be seen that the disturbances is in really high percentage and that their appearance becomes increasingly wide-spread, especially among children of pre-school age and also in early school period.

Method

The survey was conducted with a sample of 833 children, between the ages of 4 and 13. All children attend either Kindergarten or Elementary School and come from the Municipality of Ruma, Stara Pazova, Sremska Mitrovica and Indjija.

Measuring instruments used in this study were evaluating anthropometric and postural sta-tus. Anthropometric measures were assessed according to the method of the International Biologi-cal Program (IBP) (Lohman, Roche, & Martorell, 1988). The sample of anthropometric measures included (Bala, 1981):

1. Body height (mm) 2. Body weight (0.1 kg)


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Contemplas and 3D compact protocol analysis were used in assessing postural state.1. Cervica spine (C7) 2. Sacrum

3. Acromion left 4. Trochanter major left

5. Acromion right 6. Trochanter major right

7. Thoracic spine (kyphosis) 8. Condylus left

9. Lumbar spine (lordosis) 10. Condylus right

11. ISG left 12. Maleolus lateralis left

13. ISG right 14. Maleolus lateralis right

Based on the marked points we get the value in:

1. Position of the shoulders in the frontal plan;

2. Position of the pelvic in the frontal plan:

3. Posture in the sagittal plane

4. Position of the legs

The collected data was analysed through basic descriptive statistics means, Standard Devi-ation, Minimum, Maximum, Skewness and Kurtosis. The analysis was carried out separately ac-cording to different gender. Manova and Anova were used to determinate differences between gen-der in all system of variables and also separately by every variable. Statistical analysis was per-formed using the SPSS 20.0 statistical package.

Results

In the table we can see values of most of the observed parameters of postural status. Ap-proximately one third of respondents have a bad posture, and there id a high number of those with weaker body segments.

Table 1. Descriptive statistics

N Min Max AS SD

Boys

Age 431 4,53 13,72 7,452 2,023

Body high 430 103,50 160,60 127,526 13,169

Body weight 430 14,70 59,70 28,220 9,273

GirlsAge 405 3,95 11,88 7,658 2,069

Body high 406 103,10 166,40 128,628 13,802

Body weight 406 14,80 58,80 28,664 9,063

Legend: N - Number of respondents; Min - Minimum; Max - Maximum; AS - Mean; SD -Stand-ard Deviation.

The results presented in Table 1 show the parameters of anthropometric characteristics and distribution in each group of respondents

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Milan Kojić

Table 2. Manova and Anova according to a genderVariable Gender N AS SD f Sig.

Shoulder displacementBoys 437 ,1385 ,913

,001 ,971Girls 407 ,1407 ,850

Pelvic obliquityBoys 437 ,0264 ,340

,093 ,761Girls 407 ,0196 ,306

Shoulder obliquityBoys 437 -,2279 4,798

,563 ,453Girls 407 -,4715 4,620

Distance cervical spine -

sacrum

Boys 437 1,8387 2,121,134 ,715

Girls 407 1,7862 2,041Distance thoracic spine -

sacrum

Boys 437 -1,3736 1,6146,971 ,008

Girls 407 -1,0767 1,651Distance lumbar spine -

sacrum

Boys 437 1,5118 1,01960,034 ,000

Girls 407 2,0716 1,079

Varus/Valgus leftBoys 437 ,4926 2,731

39,957 ,000Girls 407 1,6551 2,601

Varus/Valgus rightBoys 437 ,8554 2,759

23,740 ,000Girls 407 1,7667 2,666

Cervical spineBoys 437 -,1947 ,942

,000 ,991Girls 407 -,1939 ,861

Thoracic spineBoys 437 -,3957 ,717

,188 ,665Girls 407 -,4171 ,712

Lumbar spineBoys 437 -,1606 ,318

,017 ,898Girls 407 -,1636 ,349

F Sig.9,701 ,000

Legend: N- Number of respondents; AS- Mean; SD- Standard Deviation; F- value of f test; Sig- Statistical signification on level of p≤0, 05

By determining the difference between boys and girls on the whole sample variable, trying to contribute to establishing the space in the relationship between gender and the characteristics of postural status between them. Table 2 shows the results of multivariate analysis of variance, which showed that there is a statistically significant difference between the two groups. When evaluat-ing individual we can see that the differences do not occur in all variables. Specifically, the vari-ables Distance thoracic spine - sacrum, lumbar spine Distance - sacrum, Varus / Valgus and Var-us left / right Valgus show significant differences among each other. There is no significant differ-ence between boys and girls when other variables are referred to. Univariate analysis of variance and F-test value may indicate that the greatest difference noticed in the variables Distance lumbar spine - sacrum and Varus / Valgus left. Moreover, it is evident that the distribution of the standard deviation does not show large deviations from the normal distribution of values in both male and


21

female samples. Accordingly, it may be said that the sample belongs to the normal distribution in the population.

Discussion

photometric method was applied in this research in order to assess postural status of sub-jects of both genders aged 4 to 13 using the system for postural analysis of 3D body with the TEM-PLO software. The great importance of this work lies in the fact that we are able to observe the de-velopment of posture during this very important and tumultuous development period of children. It gives us the ability to better identify their needs. We get the opportunity to make adequately and efficiently programmed preventive system of physical exercise.

Research results that the boys and girls significantly distinguish in postural status. It is ev-ident also that boys have a better segmental parameter and thus better postural status at a general level. Individually, the difference is greatest in the area of leg deformities as well as in distance of vertebrae in the frontal plane. Stronger muscles and better posture boys in this period may be the reason for these results. The girls have a higher degree of deformity of the legs as varus and valgus shape of legs. The bad status of spinal column in frontal plane show that scoliosis as a phenomenon more common in girls, and that such deformities result of weak muscles, especially in lower back.

Modern diagnostic postural status with Contemplas equipment provides precise and effi-cient detection of posture status. From result in the large number of respondents overall findings suggest that proper growth and development of children and youth depend on many factors, but primarily on the active involvement of parents. Therefore, it is necessary to let the kids run free, jump, to climb, crawl, which can be achieved by involving children in active life, sport, gymnas-tics but also in other forms of exercise. Children timely brought into the daily programming, and strictly controlled physical activity aimed at improving posture status. With fining of this research parents should pay more attention to the segments of the spine and legs as.

The lifestyle of parents and children causes a lack of movement so the children must spend less time at the computer and more time in a variety of physical activities: cycling, swimming training, training skating, roller skating, long walks. Along with that, with diagnostics of postur-al status it is possible to prevent it, and encourage the proper growth and development. That form should be created to help parents, physical education teachers, coaches, physicians and children.

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Trajković, S. i Nikolić, M. (2008). Komparativna analiza antropometrijskih mera i posturalnih poremećaja školske dece generacija 1987. i 2002. godine. Glasnik Antropološkog društva Srbije, 43(1), 386-391.

Živković, D. (2001). Teorija i metodika korektivne gimnastike. Niš: Fakultet sporta i fizičkog vaspitanja.

Živković, D., Milenković, S. (1994). Stanje posturalnog poremećaja kod dece predškolskih ustano-va. Fizička kultura, 40:2, str. 11. Beograd: Fakultet fizičke kulture.

EXERCISE AND QUALITY OF LIFE Review articleVolume 6, No. 1, 2014, 23–30 UDC 616.711-007.5-085

SCOLIOSIS AND TREATING SCOLIOSIS WITH SCHROTH METHOD

Nikola Jevtić* Faculty of Sports and Physical Education – University of Novi Sad

Abstract

Idiopathic scoliosis is a deformity of the spinal column and is found among healthy chil-dren. Etiology of idiopathic scoliosis is unknown. Spinal shift occurs in all three planes followed by muscle disfunction and reduced vital capacity of the lungs. Asymmetric loading on the spine can be listed as one of the factors of rapid progression of scoliosis, whereby large pressure is put on the concave side of the scoliotic curvature due to the shift of standing balance of the body. Reha-bilitation is based upon improvement of functionality, ability and capacity of the patient with sco-liosis. The initial stage of rehabilitation rests on correct diagnosis and estimation of patient’s con-dition in order to commence the treatment in the best possible manner. The Schroth method has a long-standing tradition and is primarily applied in correction of scoliosis. It is based on three-di-mensional breathing, proper pelvic correction and specific exercises and education of patients in order to continue the treatment at home.

Keywords: the Schroth method, scoliosis, asymmetric loading, muscle disbalance

Introduction

Idiopathic scoliosis may be defined as a complex three-dimensional deformity of the spine and trunk. It occurs in healthy persons and its etiology is unknown (Rigo, M., & Grivas, T. 2010). With the aim to detect scoliosis easier, its specific name can be obtained according to the localiza-tion of the principal curvatures (thoracic, lumbar, thoracolumbar, double major, double thoracic); however, there are numerous classifications by means of which it is easier to recognize the type of idiopathic scoliosis (Weiss, H.R. et al, 2013). In addition to idiopathic scoliosis, scoliosis can be classified into two more groups according to the etiology: congenital and neuromuscular. Congen-ital scoliosis is gained by nurture and the process of deformation can occur even in the embryonic conception, while the other type of scoliosis comprises of neuromuscular scoliosis, whereby neu-romuscular diseases occur as a result of deformity. Many authors dealt with etiology of idiopath-ic scoliosis and did not wind up with a concrete answer. They suggest various causes as the rea-

* Corresponding author. Avgusta Cesarca 11/9, 21 000 Novi Sad, Serbia, e-mail: [email protected]© 2014 Faculty of Sport and Physical Education, University of Novi Sad, Serbia

Nikola Jevtić

Scoliosis and treating scoliosis with Schroth method

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sons of occurrence of this type of scoliosis; nevertheless, it is assumed that genetics and asymmet-ric loading represent the greatest cause. The difference in rehabilitation from congenital and neuro-muscular scoliosis in comparison to idiopathic scoliosis lies in the fact that the first two deal with the causes of the deformity, while in idiopathic scoliosis consequences are ones that are addressed.

Biomechanical factors may have a significant role during the rapid progression of scolio-sis in adolescence (Stokes, I. 2007). Asymmetric loading of the body, as well as the shift of stand-ing balance of the body, may have serious consequences on the deformity of the lumbar spine. Mechanical factor becomes predominant, as compared to the initial factor, in the period of rapid growth during adolescence (Stokes, I. et al, 2006). Muscle disbalance occurs as a result of spinal column shift, thus the muscles on one side of the spinal column are less active, whereby rotation of the spinal column can be listed as the cause (Fidler, M.W. & Jowett, R.L. 1976). Patients who suffer from this condition often have problems with reduced function of respiratory muscles, and even reduced vital capacity of the lungs (Martinez-Liorens J. et al, 2010).

The Schroth method is a longstanding, traditional method applied in rehabilitation from scoliosis and it is used around the globe. It originates from Germany and it rapidly spread to oth-er countries in Europe and worldwide due to its results. The method was launched by Katharina Schroth; later, her daughter Christa Lehnert Schroth joined her and gave a large contribution to the development of this method (Weiss, H.R. 2010). The Schroth method corrects scoliosis in all three planes, which is actually its advantage as compared to certain methods.

The history of Schroth method

The Schroth method is a non-operative treatment applied in the correction of scoliosis and has a very long tradition. One may suggest that it is a conservative type of treatment that reminds of Hippocrates’ original method. Although it has been more than 2,000 years since Hippocrates’ era, the conservative type of scoliotic correction retained the same approach to the problem. The fact that three therapists used to work with one patient in order to prevent mistakes during the cor-rection shows how seriously this problem used to be approached two centuries ago. Corrective treatment based on the principles of the Schroth method is nowadays applied worldwide, precise-ly because of its approach to the problem, primarily based on three-dimensional breathing, which has the most significant role in treatment of scoliosis.

Development of the Schroth method rests upon professional work of three generations. The first steps were recorded back in 1921, by Katharina Schroth, who suffered from scoliosis herself. Dissatisfaction, caused by the treatment she had received in particular institutions, made her to look for the solution to her problem by herself. She started to explore her body and apply a new type of treatment. She was a teacher, so she did not know anything about anatomy, physiolo-gy and biomechanics; however, her inspiring spirit contributed to the development of something completely new, something that gave amazing results in the following years. She came to the con-clusion that it is possible to achieve postural control exclusively by changing of postural percep-tion. She was trying to make the correction of the rib cage by performing deep inhalations on the concave side. She used to do that in front of a mirror in order to be able to control the movements of the rib cage. Her primary inspiration was a balloon. While observing the balloon being inflat-ed, she concluded that there is a possibility to make a correction of the deformity by following the same principle. She started to develop the method in Meissen, Eastern Germany, where she had her first small institute. During the 1930s and 1940s, Katharina received support in work and de-velopment of the method from her daughter Christa, who was born in 1924. Katharina moved with her daughter Christa to Bad Sobernhein in 1961. This is the town where they founded their insti-


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tute which gradually developed into a well-established clinic, officially opened in 1983 under the name “Katharina Schroth Klinik”. After Katharina’s death in 1985, her daughter Christa Lehnert-Schroth, therapist, continued with the development of the method. Later on, her son, Hans Ru-dolf Weiss, orthopedic surgeon, joined her. Dr. Weiss was the director of the clinic during the peri-od from 1995 to 2008. German health care provider, Asklepios, bought the clinic in 1995 with all rights and liabilities to use the name “the Schroth Method”, thus today, the clinic bears the name “Asklepios Katharina-Schroth-Klinik”.

In order to assess the influence of the Schroth method, the first research with patients was conducted in the period 1989-1991, and it was published in German in 1995 and in English in 1997. The next research also included the division of patients according to their age and gender, which brought about more valid results. Studies included the improvement of cardio-pulmonary capacity, vital capacity, muscle function monitoring, electromyography and changes in pain dur-ing the treatment. It was determined by EKG tests that there is a statistically significant reduction of cardiac exertion during the intensive treatment of 6 weeks in 794 patients. The improvement of vital capacity of the lungs and mobility of the ribs were recorded in more than 800 patients. Activ-ity of the muscles was reduced in more than 300 patients after intensive treatment. The correction of thoracolumbar curvature, including derotation by means of muscle psoas was improved during the 1920s. The program of correction according to the principles of the Schroth method was de-signed so that patients continue to practice at home after being provided with proper education su-pervised by a Schroth therapist.

Etiology of scoliosis

Idiopathic scoliosis is a complex deformity of unknown etiology which includes morpho-logical changes and transformation of the spinal column in all three planes. Scoliosis is a term that describes lateral deviation of the vertebrae, axillar rotation of which stimulates three-dimension-al deformity of the trunk. Therapists and doctors, who deal with this problem, understand what the term “idiopathic scoliosis” is, but are speechless when etiology is concerned. Various studies who deal with etiology of the idiopathic scoliosis have not come to a direct response, but they have made certain conclusions. Thomas et al. (2008) listed several factors which cause the development of scoliosis, the first of which is genetics.

Genetic or hereditary factors are widely accepted in the development of idiopathic scolio-sis (Thomas et al., 2000). Harrington’s research with women who had scoliotic curvatures of more than 15 degrees, ended with a result that showed that 27 percent of these women’s daughters have scoliosis. It was determined that 11 percent of patients (first-degree relatives are affected), 2,4 per-cent second-degree and 1,4 percent third-degree relatives suffer from scoliosis (Harrington, P.R. 1977). The research conducted with identical and fraternal twins who had scoliosis showed that genetics has a large infuence on the developement of scoliosis. The group of autors obtained the results which indicated that 73 percent of scoliosis developed in both identical twins when one of them initially had scoliosis, while the percentage was slightly less in fraternal twins, so that scoli-osis developed in both of them in 36 percent of cases (Kesling, K. L., i Reinker, K.A. 2009).

Other studies show that a hormon called melatonin also has a large influence on the de-velopement of idiopathic scoliosis. In consequence, certain authors conducted numerous studies in order to prove that fact. Dubousset et al. (1998) controlled the level of melatonin in thirty ad-olescents in his study who had severe curvature, between 57 and 75 degrees. Patients who expe-rienced the deterioration of the curvature of more than 10 degree had 35 percent- reduced secre-tion of melatonin during the night, while in the group of patients with stable scoliosis, during the

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same year, melatonin secreted without any problems. Lafortune et al. (2007) conducted an exper-iment in which he did a research of the influence of melatonin on scoliosis in chickens. He divid-ed the chickens into three groups. He removed the pineal gland, which secrets melatonin, from the first group, made an incision on the second group in order to simulate the removal of the gland, and the third group was the control group. All three groups had the same treatment during the ex-periment, 12 hours of light, 12 hours of dark, 26 degree Celsius and 78% humidity. Scoliotic cur-vature occurred in 55% of the chickens in the first group after two weeks and developed into a se-vere condition during the third and fourth week. Cases of scoliosis were not recorded in the sec-ond and third group.

Besides genetics and melatonin, some other factors, mentioned by various authors, can be listed as the cause of idiopathic scoliosis. One of these factors can be effects of connective tissue. Collagen and elastic fibers are crucial elements of the supporting structure of the spinal column and have a significant role, according to many authors who deal with the pathophysiology of idio-pathic scoliosis (Thomas, L. et al. 2000). Skeletal muscle abnormalities are also one of the factors that can be claimed to have a significant role in the development of idiopathic scoliosis, as well as the Role of Growth and Development.

Nevertheless, Manuel Rigo (2010) stated that there are two types of pathogenetic factors for idiopathic scoliosis. The first group comprises the initial stage of scoliosis, where the main fac-tors are biological, morphological, neuromuscular and biomechanical, while the main cause of rapid progression of scoliosis lies in the biomechanical factors, i.e. asymmetric loading on the spi-nal column.

Biomechanics of scoliosis

Understanding the etiology of scoliosis is a great challenge, but it is well known that me-chanical factors have a significant role in the development of deformity. Geometry and anatomy are fundamental for understanding mechanical part of deformity. It is mentioned that scoliosis is a three-dimensional deformity; however, the entire process may include the fourth dimension as well (Bagnall et al. 2009). Deformity shifts over time and, consequently, this is the time when the fourth dimension is very important for patients because they can follow and control their own con-dition.

The shifting process of deformity occurs due to the shifted standing balance of the body which causes altered pressure on the spinal column (Rigo, M., Grivas, T. 2010). The concave side of the spinal column suffers a lot more pressure than the convex side, which leads to certain conse-quences. One of them is that vertebral body loses its natural geometry and becomes wedging ver-tebrae over time (Stokes, I. 2007). Scoliosis progresses rapidly during the adolescent growth. That period is considered the most critical for the development of scoliosis. Spinal column tissue and trunk tissue also suffer from the loading during everyday activities, precisely because of the asym-metric loading. In 2006, Professor Stokes introduced biomechanical modulation of spinal growth and development of scoliosis in adolescents. In the illustrated scenario of loading, he explains to what extent altered pressure actually affects the progress of scoliosis. He calculated that vertebral body suffers the pressure of 1.3 MPa on the concave side on the verge of the curvature, whereas the convex side suffers the loading of 0.7 MPa, with annual spinal growth of 3 percent (30 mm). Growth of the vertebral body at the center of the curvature on the concave side amounts 0.5 mm and 1.3 mm on the convex side, which would lead to the increase of the curvature of 6.7 degrees and forming the wedging vertebrae. The influence of gravity can be listed as one of the crucial factors in producing axial force that leads to asymmetry and torsion, because standing balance of


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the body is shifted to the side of convexity of the primary curvature. In that manner, the increase of loading on the concave side, and consequently the increase of deformity, occurs (Stokes, I., et al. 2006). Scoliosis research society explains that torsion of the spinal column may be defined in two manners. The first is a mechanical torsion that influences the intervertebral disc in the verte-bral body. The second type of torsion is explained as geometric and represents the movement of the spinal column in space, i.e. the change in its physiological shape in all three planes (Rigo, M., Grivas, T., 2010).

Scoliosis also has significant influence on movement. Mahaudens et al. (2008) conducted a research in which, besides muscle activation, he wanted to examine the difference in mobility of certain parts of the body during movement. Between participants with formed scoliotic curvature (exclusively lumbar and thoracolumbar) and healthy participants, those with scoliosis were divid-ed into three groups in respect to the degree of the curvature. They concluded that statistically sig-nificant reduced mobility of certain parts of the body, as well as length of a step, in comparison to the control group, alterations mainly occurred during the movement of body segments in the fron-tal plane. Participants with scoliosis had shorter steps as compared to the control group. Reduction of pelvic and hip movement in the frontal plane, as well as hip movement reduction in the trans-versal plane occurred. Differences between the experimental groups were not recorded, regardless of the difference in the degree of the deformity.

Muscle disfunction

Besides the changes in bone structure, changes also occur in the muscles. In 1976, Fiddler and Jowett conducted a research on corpses with large scoliotic curvatures in order to determine the disbalance of the deep back muscles. They came to a conclusion that the muscle multifidus on the verge of scoliotic curvature is shorter on the convex side. That was the consequence of the ro-tation of the spinal column, while the erector spinae was longer on the convex side than on the con-cave side, which is the cause of movement in the spinal column in the frontal plane.

Long-term use of braces may have a significant role in the change of muscle structure since, due to muscular inactivity, transformation of muscle fibers may occur. In a research, during biop-sy, Meier et al. (1997) discovered the transformation of muscle fibers in the muscle multifidus in patients with scoliosis who had worn braces. Considering the fact that multifidus mainly compris-es of slow muscle fibers, the other author came to the conclusion that, after long use of braces, the muscles change their structure due to inactivity and slow muscle fibers become fast. The role of braces is very significant in prevention of the progression of scoliosis; however, patients have to be engaged in corrective activities in order to prevent transformation of the muscle fibers.

It can be noticed that numerous consequences occur on muscles in patients with scolio-sis. Therefore, Dr. Weiss (1933) wanted to determine the effect of the Schroth treatment on mus-cle activation. The study included 316 scoliotic persons who were tested before and after treat-ment. Muscle activation was tested by electromyography having a patient extend the trunk from the prone position. Overall results indicated significant improvement in postural capacity. Results also showed significant reduction of muscle activation on the convex side of thoracic and lumbar curvatures after the treatment. Major reduction in muscle activation was recorded on lumbar sco-liotic curvature in comparison to thoracic scoliotic curvature.

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Conclusion

Idiopathic scoliosis is a deformity that most often occurs among adolescents and its etiolo-gy is unknown. However, rapid progression of scoliosis is assigned to biomechanical factors such as asymmetric loading where the crucial role belongs to gravity. Due to this three-dimensional de-formity, numerous side effects, such as disfunction of the respiratory system, muscle disbalance, pelvic shift and shoulder girdle shift, come into play. All of them have an influence on the move-ment disorder. The Schroth method is applied in correction of scoliosis and it influences the defor-mity in all three planes. It impacts the improvement of vital capacity of the lungs and derotation of the rib cage. This method appeared to be very effective in correction of scoliotic curvature by us-ing gravity as an aid in rehabilitation. Therefore, it can be assumed that more rapid rehabilitation from scoliosis would be achieved exactly with the increase of gravity.

References

Ake, I., Yazici, M. (2009). Growth modulation in the management of growing spine deformities. Journal of child ortop, 3:1-9.

Bagnall, K., Grivas, T, Alos, N., Asher M., Aubin, C.E., Burwell, G., Dangerfield, P., Edouard, T., Hill, D., Lou, E., Moreau, A., O’Brein, J., Stokes, I., Weiss, H.R., Raso, J. (2009). The in-ternational research society of spinal deformities (IRSSD) and its contribution to science. Scoliosis J., 4:28.

Fidler, M.W., Jowett, R.L., (1976). Muscle imbalance in the aetiology of scoliosis. The journal of bone and joint surgery, vol. 58-B, No. 2.

Lehnert-Schroth, C. (2007). Three-dimensional tretmant for scoliosis. Palo Alto, California, The Martindale Press.

Lowe, T., Edgar, M., Chir, M, Margulies, J., Miller, N., Raso, J., Reinker, K. and Rivard, C-H. (2000). Etiology of idiopathic scoliosis: Current trents in Research. The Journal of Bone and Joint Surgery, 82-A, No 8.

Martinez-Liorens, J., Ramirez, M., Colomina, M.J., Bago, J., Molina, A., Caceres, E., Gea, J. (2010). Muscle dysfunction and exercise limitation in adolescent idiopathic scoliosis. Eur Respire J., 36, 393-400.

Rigo, M., and Grivas, T. (2010). “Rehabilitation schools for scoliosis” thematic series: describing the methods and results. Scoliosis J., 5:27.

Stokes, I., Geoffrey, B., Dangerfield, P. (2006). Biomechanical spinal growth modulation and pro-gressive adolescent scoliosis – a test of the “vicious cycle” pathogenetic hypothesis: Sum-mary of an electronic focus group debate of the IBSE. Scoliosis J. 1:16.

Stokes, I. (2007). Analysis and simulation of progressive adolescent scoliosis by biomechanical growth modulation. Eur Spine J. 10.1007/s00586-007-0442-7.

Stokes, I. (1993). Three-Dimensional terminology of spinal deformity. Spine 19(2):236-248.

Weiss, H.R. (1993). Imbalance of electromyographic activity and physical rehabilitation of pa-tients with idiopathic scoliosis. Europen Spine Journal 1:240-243.


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Weiss, H.R. (2011). The method of Katharina Schroth – history, principles and current develop-ment. Scoliosis J. 6:17.

Weiss, H.R. (2010). Spinal deformities rehabilitation – state of the art review. Scoliosis 5:28.

Weiss, H.R., Moramarco, M. (2013). Adolescent idiopathic scoliosis: Etiological concepts and im-plication for treatment. OA Musculosceletal Medicine, 1(3):2

EXERCISE AND QUALITY OF LIFE Review articleVolume 6, No. 1, 2014, 31–42 UDC 611.74/612.75/616.75

FASCIA – THE FORGOTTEN TISSUE

Dušica Marić*, Mirela Erić, Bojana Krstonošić and Dragana Smiljenić Department of Anatomy, School of Medicine, University of Novi Sad, Serbia

Corresponding author: Department of Anatomy, Medical Faculty, University of Novi Sad

Abstract

Fascia is an important component of connective tissue that surrounds bones, muscles, blood vessels, nerve and organs of the body. The fibrous fascia creates a web that wraps around struc-tures of the body, providing a continuum that unites the entire human body from head to toe with-out interruption. The term myofascial refers to the unit comprised of muscle and connective tis-sue. A myofascial meridian can be defined as a linear series of muscles units interconnected with-in the fascial webbing of the body. A myofascial meridian transfers tension sequentially from one myofascial unit of the meridian to the next. Understanding the role of fascia in postural distortion is of vital importance to movement therapists. Poor posture deforms the fascia and stress the mus-cles, resulting in pain and weakness. Correction is possible, but both muscles and fascia need to be taken into account.

Key words: Fascia; Myofascia; Connective tissue

Myofascial antomy

Fascia is a amazing event of bioengineering whose importance is now being realized. In re-cent years fascia has accelerated to the leading position of rehabilitation science. Recommended terminology generated after Ist International Fascia Research Congress in 2007 states that fascia is a soft tissue component of connective tissue system, and it’s an uninterrupted, three-dimensional web of tissue that extends from head to toe, from front to back, from interior to exterior, and sur-rounds muscles, bones, organs, nerves, blood vessels and other structures.

The complexity of fascial tissue can be simplified into three parts: superficial, middle and deep layers. The musculo-skeletal system is double bagged structure (Myers, 2009). The bones, cartilage, periosteum and ligaments forming the inner bag, and the muscles are in the outer bag. The outer bag makes the structures called fascia, intermuscular septa, and myofascia. Looking at the body from this fascial perspective, we can see that fascia provides the context for all other tis-

* Corresponding author. Medical Faculty, University of Novi Sad, Hajduk Veljkova 3, 21000 Novi Sad, Serbia, e-mail: [email protected]

© 2014 Faculty of Sport and Physical Education, University of Novi Sad, Serbia Dušica Marić, Mirela Erić, Bojana Krstonošić and Dragana Smiljenić

Fascia – the forgotten tissue

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Dušica Marić, Mirela Erić, Bojana Krstonošić and Dragana Smiljenić

sues to form. If bone cells lay down bone matrix within a fascial sleeve, a bone is formed within fascial periosteum. If nerve cells are formed within fascial sleeving, the brain and spinal cord are formed within meninges, and peripheral nerves are formed within sleeves of endoneurium, peri-neurium, and epineurium (Myers, 2009).

The classic anatomical studies start with human dissection in the 17th century and explain-ing the body as a series of isolated parts. The classic representation of muscles is that they have discrete attachment on bones. By this model, each of the muscles is independent of one another (a single muscle theory). We have convenient mechanical picture that a muscle ‘begins’ here and ‘ends’ there. According to new myofascial theory we have in body only one muscle; it just hangs around in 600 or more fascial pockets (Myers, 2009). We need to remind ourselves that muscle never attaches to bone. Muscle cells float within the fascial net like fish within fishing net (Myers, 2009). Their movement pulls on the fascia, the fascia is attached to the periosteum, and the peri-osteum pulls on the bone. Far more often, even though some of the fascial tendinous fibers of the muscle do attach into and end at the attachment bone, other fascial tendinous fibers go beyond the bony attachment site and are continuous with the fascial tendinous fibers of the adjacent muscle. These myofascial units are linked to each other. Examining the fascial connections between mus-cles allows us to discern specific lines of linkage that travel throughout the body. These lines are called myofascial meridians. Each myofascial meridian is a somewhat discrete aspect of the fas-cial web that travels and connects far reaches of the body (Myers, 2009). In the single muscle the-ory, the biceps gets defined as a radio-ulnar supinator, an elbow flexor, and a weak flexor of the shoulder. In the Anatomy Trains view the biceps brachii is an element in a continous fascial plane or myofascial meridian which runs from the outside of the thumb to the 4th rib and beyond. The second fact does not negate the first, but adds a contex for understanding the biceps role in stabi-lizing the thumb and keeping the chest open and breath full (Myers, 2009).

Myofascial meridians

The Anatomy Trains model identifies a set of myofascial meridians as the major continu-al tension bands along which this tensile strain runs through the outer myofasciae from bone to bone (Myers, 2009). Muscle attachments (stations in Anatomy Trains) are where the continuous tensile net attaches to the relatively isolated, outwardly-pushing compressive struts. Thomas My-ers describes myofascial meridians as a map of global lines of tension that traverse the entire mus-cular surface of the human body acting to keep the skeleton in shape. Myofascial meridians in the human body include: the superficial front line, the superficial back line, the lateral lines (2 sides), the spiral line, the arm lines (2 front and 2 back), the functional lines (2 front and 2 back), and the deep front line (Myers, 2009).

The superficial back line runs from the underside of the foot up the back of the leg to the sa-crum, and up the back to the skull, and over the skull to the forehead. The superficial front line runs from the toes up the front of the leg and up the torso to the top of the sternum, and passes along the side of neck to the back of the skull. The lateral line runs from the underside of the foot up the side of the leg and trunk, under the shoulder complex to the side of the neck and skull. Arms line: deep front arm line runs from the ribs down the front of the arm to the thumb. The superficial front arm line runs from the sternum and ribs down the inside of the arm to the palm of the hand. The deep back arm line runs from the spinous processes through the scapula to the back of the arm and little finger. The superficial back arm line runs from the spinous processes over the shoulder and outside the arm to the back of the hand. The spiral line runs from the side of the skull across the neck to the opposite shoulder and ribs, and back across the belly to the front of the hip, the outside


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of the knee, the inside of the ankle, and under the arch of the foot and back up the leg and back to the skull. The functional line: the back functional line runs from one shoulder across the back to the opposite leg. The front functional line runs from one shoulder across the front of the belly to the opposite leg. The deep front line is a core line that begins deep on the sole of the foot and runs up of the leg to the front of the hip joint and across the pelvis to the front of the spine and on up through the thoracic cavity to the jaw and the skull (Myers, 2009)..

Fascia takes responsibility for maintaining structural integrity, for providing support and protection, and acts as shock absorber. Fascia has an essential role in hemodynamic and biochem-ical process and provides the matrix that allows for intercellular communication (LeMoon, 2008). Chaitow (Chaitow et al., 2006) adds that fascia extends to all dense fibrous connective tissues, in-cluding aponeuroses, ligaments, tendons, retinaculae, joint capsules, organ and vessel tunics, the epineurium, the meninges, the periostea, and all the endomysial and intermuscular fibers of the myofasciae.

Fascia are controls the posture and regulate movements (Myers, 2009). The spinal mobili-ty is limited by the lumbar fascia and the stability of foot is reachable thanks to the stiffness of the plantar fascia (Grant & Riggs, 2008, Schleip, 2005), knee is supported by iliotibial tract along the lateral thigh (Grant & Riggs, 2008). Retinacula are not static structures for joint stabilisation as the ligaments, but specialized fasciae for local spatial proprioception of the foot and ankle move-ments, and play integrative role of the fascial system in peripheral control of articular motility (Stecco, 2010).

Fascial inerevation and response to tension

Fascia is densely innervated with mechanoreceptors and nociceptors (Langevin, 2006, Schleip, 2003a, Schleip, 2003b). The mechanoreceptors, such as Pacini corpucles, Ruffini organs and free-nerve endings, maintain muscular coordination via the constant feedback from ligaments. Diversity in location of them suggest different functions, hence, retinaculum plays more percep-tive function, while tendinous expansions are responsible for mechanical transmission of tension. Various types of receptors capable of monitoring tension, elongation, pressure, velocity, pain are located in fascial tissues and create a neurological feedback mechanism by which reflexive interac-tion with muscles is provided to maintain joint stability and safety as well as coordination of move-ment. Disruption of the fascia due to injury or overuse also results in corrupted feedback signals and neurological disorders that are exposing the tissue to additional potential for injury or move-ment disorders.

Bones, cartilage, ligaments, and tendons are built of varying degrees of the same substance – collagen – so this unity is more than a structural connection. It is well known that all these things are malleable, that is, they will transform and change shape and structure when stressed. Over time the body becomes deformed, the legs bowed, the back bowed, the shoulders hunched, etc. Fascia pulled continually out of alignment will eventually stay there. Poor posture and bad habits grad-ually deform the fascia and stress the muscles, resulting in pain and weakness. Correction is pos-sible, but both muscles and fascia need to be taken into account. The entire supporting structure needs to be rebuilt.

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Dušica Marić, Mirela Erić, Bojana Krstonošić and Dragana Smiljenić

Myofascial pain syndrome

Fascia is being recognized in etiology of pain and proprioception (Stecco et al., 2008). Tightening of myofascia may occur as a response to trauma, overuse syndrome, repetitive stress injuries, strain, stress, infection, poor posture, and chronic non-physiological tension in the fascia or surgical scaring. Restricted fascia may compress and put extra stress on the linked soft tissue structures, resulting in dysfunction and pain (LeBauer et al., 2008). According to Schleip, when fascia increases its stiffness for a fairly short whereas constantly raised tension may consequently have metabolic and physiological disadvantages leading to pathological contractures such as Du-putryen disease, plantar fibromatosis, club foot or frozen shoulder. On the contrary, loss of fas-cial tone may result in hypermobility of a joint, as in the example of sacroiliac pain (Schleip et al., 2005). There is an accepted concept that unresolved trauma and/or frozen emotions can be ‘stored’ within the connective tissue in the form of pathology (Minasny, 2009).

The fascia of active people has more strength and springiness to it than that of inactive peo-ple (Schleip, et al, 2005). Even strenuous activity has shown to strengthen and improve facial re-sponse. In other words training can cause fascia to improve its function. This discovery can prove why many players see increased velocity and arm strength after starting a long toss program. The arms of those who long toss may have more ‘elastic’ storage capacity which can help with rapid acceleration (Schleip, et al, 2005). By throwing longer and more often you can condition the fas-cia in the arm. Training the myofascial system is one way that may be accomplished. Those who adhere to a shorter throwing program or throw infrequently may never reach the level required to train the myofascial system (Schleip, et al, 2005).

Myofascial pain syndrome is a chronic musculoskeletal pain disorder associated with lo-cal or referred pain, decreased range of motion, autonomic phenomena, local twitch response in the affected muscle and muscle weakness without an atrophy (LeMoon, 2008). The term “myofas-cial pain syndrome” is used synonymously with “regional myofascial pain” and “myofascial trig-ger point pain syndrome” (Cummings & Baldry, 2007). Myofascial trigger points can be located in fascia, ligaments, muscles and tendons (Fernandez-de-las-Penas et al., 2005). Trauma, stress, muscle wasting or ischaemia, visceral pain referral may aggravate the development of this criti-cal point (Fernandez de las Penas et al., 2005, Fryer & Hodgson, 2005, Grieve, 2006). Myofas-cial trigger points are considered to be one of the most common cause of musculoskeletal pain and dysfunction (Cummings & Baldry 2007, Fernandez-de-las-Penas et al., 2005, Fryer & Hodgson, 2005, Simons, 2002). Trigger points are recognized as main cause of headache and neck pain (Fer-nandez-de-las-Penas et al., 2005). They can be a reason to conditions like frozen shoulder, epicon-dylitis, carpal tunnel syndrome, atypical angina pectoris or lower back pain (Simons, 2002).

References

Ist International Fascia Research Congress. 2007. (htpp://www.fasciacongress.org/2007/).

Myers, T. (2009). Anatomy trains, Myofascial meridians for manual and movement therapies. 2nd edition, China: Churchill Livingstone.

LeMoon, K. (2008). Terminology used in Fascia Research. Journal of Bodywork and Movement Therapies 12, 204-212


35

Chaitow L., Bradley D., & Gilbert C. (2002). Multidisciplinary Approaches to Breathing Pattern Disorders. Churchill Livingstone, Edinburgh.

Grant, K. E., & Riggs, A. (2008). Chapter 9: Myofascial Release. 149-166 (Stillerman, E. 2008. Modalities for Massage and Bodywork. USA: Elsevier Health Sciences).

Schleip, R., Klingier, W. & Lehmann-Horn, F. (2005). Active fascial contractility: Fascia may be able to contract in a smooth muscle-like manner and thereby influence musculoskeletal dy-namics. Medical Hypothesis 65, 273-277.

Stecco C, Macchi V, Porzionato A, Morra A, Parenti A, Stecco A, Delmas V & De Caro R. (2010). The ankle retinacula: morphological evidence of the proprioceptive role of the fascial sys-tem. Cell Tissue Organs 192(3), 200-210.

Langevin, H.M. (2006). Connective tissue: a body-wide signaling network? Medical Hypotheses 66,1074–1077.

Schleip, R. (2003a). Fascial plasticity – a new neurobiological explanation: part 1. Journal of Bodywork and Movement Therapies 7(1), 11-19.

Schleip, R. (2003b). Fascial plasticity – a new neurobiological explanation: part 2. Journal of Bodywork and Movement Therapies 7(2), 104-116.

Stecco, C., Porzionato, A., Lancerotto, L., Stecco, A, Macchi, V., Ann Day, J. & De Caro, R. 2008. Histological study of the deep fasciae of the limbs. Journal of Bodywork and Movement Therapies 12, 225-230.

LeBauer, A., Brtalik, R. & Stowe, K. (2008). The effect of myofascial release (MFR) on an adult with idiopathic scoliosis. Journal of Bodywork and Movement Therapies 12, 356-363.

Minasny, B. (2009). Understanding the Process of Fascial Unwinding. International Journal of Therapeutic Massage and Bodywork 2 (3), 10-16.

LeMoon, K. (2008). Terminology used in Fascia Research. Journal of Bodywork and Movement Therapies 12, 204-212.

Cummings, M. & Baldry, P. (2007). Regional myofascial pain: diagnosis and menagment. Best Practice & Research Clinical Rheumatology 21(2), 367-387.

Fernandez de las Penas, C., Sohrbeck Campo, M., Carnero, J. & Page, J. (2005). Manual therapies in the myofascial trigger point treatment: A systematic review Journal of Bodywork and Movement Therapies 9, 27-34.

Fryer, G. & Hodgson, L. (2005). The effect of manual pressure release on myofascial trigger points in the upper trapezius muscle. Journal of Bodywork and Movement Therapies 9, 248-255.

Grieve, R. (2006). Proximal hamstrings rupture, restoration of function without surgical interven-tion: A case study of myofascial trigger point pressure release. Journal of Bodywork and Movement Therapies 10, 99-104.

Simons, D. (2002). Understanding effective treatment of myofascial trigger points. Journal of Bodywork and Movement Therapies 6(2), 81-88.

Instructions for Authors

Aim and scope. The Exercise and Quality of Life (EQOL) is multidisciplinary journal that pub-lishes articles of high standard on the relationship between exercise and the quality of life. The Journal aims to promote and enhance communication across sub-disciplines of the sport scienc-es, which contribute to understanding of the impact of physical activity on quality of life. Manu-scripts concerning current issues in the field such as physical education, recreation, sport, health, sport psychology, pedagogy and sociology are within the scope of the Journal. In addition to orig-inal research articles, review articles, short communications, case studies and book reviews are published.

Peer Review Policy. All research and review articles undergo initial assessment by editor/editorial board. If accepted, they are sent to two experts for an anonymous (double-blind) review process. In the case of conflicting reviews the editor will look for an independent opinion. Editor makes final decision based on reviewers’ comments. Review process is expected to take from 9 to 12 weeks.

Disclaimer. The publisher makes every effort to ensure the accuracy of all the information con-tained in the Journal. However, the opinions and statements expressed in this publication are the views of the authors and do not necessearily represent the views of the publisher or the editor.

Authorship. Each author should have made sufficient scientific contribution to the article in or-der to take public responsibility for the content. Authorship credit should be assigned only on sub-stantial input to:

• conception and design of the study;

• analysis and interpretation of data;

• writing a major portion of the paper;

• critically revising the paper and

• final approval of the version to be published.

Authors are listed in the byline. Individuals who do not meet the criteria for authorship may be list-ed in the acknowledgements section of the manuscript. Such contributions may include funds col-lection, recruiting participants, collecting or entering the data, etc.

Duplicate publication policy. Manuscript should not have already been published in whole or in substantial part in any journal or other citable form. Manuscript, or substantial parts of it, must not be submitted to any other journal at the same time. Authors uncertain of what constitutes prior pub-lication should consult with the editor.

Submission.

When submitting their work to EQOL authors should enclose:

• Cover Letter

• Manuscript.

Cover Letter. Includes (1) the title of the manuscript; (2) the date of submission; and (3) the full names of all the authors, their institutional or corporate affiliations, and their e-mail addresses. In addition to this essential information, the cover letter should list specific details about the manu-script (length, number of tables and figures) and provide information about any prior presentation of the data (e.g., at a scientific meeting) and/or potential fragmented publication. Include the state-ment “This manuscript represents results of original work that have not been published elsewhere

(except as an abstract in conference proceedings). This manuscript has not and will not be submit-ted for publication elsewhere until a decision is made regarding its acceptability for publication in ’Exercise and Quality of Life’. If accepted for publication, it will not be published elsewhere. Fur-thermore, if there are any perceived competing interest related to the research reported in the man-uscript, I/we (the author/s) have disclosed it in the Author’s Notes.” If some copyrighted materi-al is used in the manuscript, a copy of permission granted for reproduction or adaptation should be enclosed. Also, a clear statement concerning authorship and ethical standards adherence should be provided. The sample available on pp. 411–412 of the APA Publication Manual (5th ed., 2001) could be useful in preparing the Cover Letter.

Manuscript. The manuscript should be prepared in accordance with the Publication Manual of the American Psychology Association (5th ed., 2001). It must be submitted as a Microsoft Word doc-ument. Use the 12-pt Times Roman font and double-spacing throughout the manuscript. Adjust margins to 1 inch on all sides of every page. Number all pages, except artwork for figures, in ar-abic numerals in the upper right-hand corner. Indent the first line of every paragraph by using the tab key, which should be set at ½ inch. Type the remaining lines of the manuscript aligned left. For-mats of numbers, metrication, tables, figures, quotations and all other style matters, including cap-italization and punctuation, must follow the APA Publication Manual, 5th edition. Articles should not exceed a total of 28 pages including references, tables, and figures.

Order of the manuscript elements: 1. title page (separate page, numbered page 1) 2. abstract and keywords (separate page, numbered page 2) 3. text (start on a separate page, numbered page 3) 4. references (start on a separate page) 5. appendixes (if any, start each on a separate page) 6. author’s note (if any, start on a separate page) 7. footnotes (if any, list together starting on the separate page) 8. tables (if any, start each on a separate page) 9. Figure captions (if any, list together, starting on a separate page)10. Figures (if any, place each on a separate page).

Title page. The title page includes: running head for publication, title, author’s name and institu-tional affiliation, and the address of the corresponding author. The title page is removed before sending the manuscript to external review. Running head. Short version of title should be typed in all uppercase letters and consists of no more than 50 characters, punctuation and spaces. Title. Rec-ommended length for a title is 10 to 12 words. Use the uppercase and lowercase letters and cen-tered the title in the upper half of the page. Author’s name and affiliation. Type the author’s first name, initial(s) of middle name and surname. List the names of all authors in the order of their con-tribution to the article. Affiliation should be typed centered on the line below the author’s name. Adress of the corresponding author. Clearly indicate who will handle correspondence at all stag-es of reviewing, publication and post-publication. Provide the complete postal address, as well as telephone and fax number, and the e-mail address of corresponding author.

Abstract and keywords. The length of abstract should not exceed 150 words. Type the label Ab-stract in uppercase and lowercase letters, centered, at the top of the page. Format the abstract as a single paragraph without paragraph indentation. An abstract of a original research article should delineate the main problem, the participants, the procedures, the findings (including statistical sig-nificance levels), the conclusions and the implications. An abstract for a review article should de-lineate the topic, the purpose, the structure of the article, the sources used and the conclusions.

Designate 3 to 5 qeywords, preferably not already used in the manuscript title. Type the qeywords on the line bellow the abstract using lowercase letters.

Text. Text of the manuscript should contain no indications of author identity, such as referring to previous work, acknowledgments, institutional information, and mention of a specific city. The ti-tle of the manuscript should reappear on the first page of the text. The sections of the text for re-search articles are as follows: Introduction, Method, Results and Discussion. Illustrations and ta-bles must accompany the manuscript but not be included in the text. А preference for the location of tables and figures might be expressed by including comments such as “Table 1 near here” or “Figure 2 near here” separated by at least one line space from the main text. The author names and dates of citations in the text must match those in the reference list.

References. List of references cited in text should be prepared in accordance with the Publica-tion Manual of the American Psychology Association (5th ed., 2001). First line of each reference should be aligned left, with subsequent lines indented by ½ inches. Arrange references alphabeti-cally, then sort them chronologically if needed. If there is more than one reference from the same author(s) published in the same year, each reference should be identified by the letters “a”, “b”, “c”, etc., put in the brackets after the publication year.

Examples:

Reference to a journal article: Biddle, S. J. H., Gorely, T., Marshall, S. J., Murdey, I., & Cameron, N. (2004). Physical activ-ity and sedentary behaviours in youth: issues and controversies. Perspectives in Public Health, 124(1), 29–33.

Reference to a book: Harter, S. (1999). The construction of the self: a developmental perspective. New York: The Guil-ford Press.

Reference to a chapter in an edited book:Malina, R. M. (1986). Physical activity and maturation. In V. Seefeldt (Ed.), Physical activity and well-being (pp. 3–38). Reston, Va: American Alliance for Health, Physical Education, Recreation, and Dance.

Appendixes. Type the word Appendix centered at the top of the page. If there is more than one ap-pendix, use an identifying capital letters (A, B, etc.) in the order they are mentioned in the text. Type the title of the appendix on the line below.

Author’s note. Identifies the sources of financial support, acknowledges contributors, mentions the bases of the study (e.g. a dissertation or larger project), denotes some special circumstances, etc.

Footnotes. Footnotes should be used sparingly. Number them consecutively throughout the article, using superscript arabic numbers. Footnotes should not be included in the reference list.

Tables. Type the word Table and its arabic numeral aligned left. On the line below type the table title using italic style. Number the tables in order they are first mentioned in the text. Use the dou-ble space in each table.

Figures captions. Type all figure captions together on the separate page. Each figure should have a caption that includes the figure number. Example: Figure 1. Level of physical activity as a function of socio-economic status. Number the figures consecutively in order in which they are first men-tioned in the text. Do not put the captions for the figures on the figures themselves.

Figures. Figures should be of professional quality and no larger than the print area on a journal page. The following formats are acceptable: TIFF, JPEG and EPS. Color illustrations should be omitted.

Proofs

The corresponding author will receive page proofs (as PDF files) by e-mail. Corrections refer-ring to typesetting, editing, completeness and correctness of the manuscript should be made with-in five days. Significant changes at this stage are not acceptable. The authors bear main responsi-bility for proofreading: any subsequent corrections cannot be guaranteed. If no response from the authors is received, the Editor reserves the right to delay publication or to proceed to press with-out author proofs.

Offprints

The corresponding author, at no cost, will be provided with a PDF file of the article via e-mail.

Correspondence

Please direct all correspondence concerning manuscript submissions to:

Višnja Đorđić, Editor-in-Chief, Exercise and Quality of Life, Faculty of Sport and Physical Education, University of Novi Sad, 21000 Novi Sad, Lovćenska 16.+381 21 450 188e-mail: [email protected]

CIP – Каталогизација у публикацији Библиотека Матице српске, Нови Сад

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EXERCISE and quality of life : journal of science in sport / editor-in-chief Višnja Đorđić. - Vol. 6, no. 1 (2014)-. Novi Sad : Faculty of Sport and Physical Education University of Novi Sad, 2009-. - 29 cm.

Dva puta godišnje ISSN 1821-3480

COBISS.SR-ID 245004551



EQOL


Faculty of Sport and Physical Education, University of Novi Sad, Serbia

Volume 6, Issue 1ISSN 1821-3480

UDC 796June 2014

EQOLA project implemented by Пројекат финансира ЕУ

This project is funded byThe European Union

STAND CORRECTLY – GROW UP HEALTHY!STOJ PRAVO – RASTI ZDRAVO!

СТОЈ ПРАВО – РАСТИ ЗДРАВО!

This publication was made with the help of the European Union. The content of this application isthe responsibility of the European Integration Office of the Government of the Republic of Serbia andDirectorate of European Integration for the Republic of Serbia and Directorate of European Integration

for Bosnia and Herzegovina and does not reflec the attitudes of the European Union.

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EXERCISE AND QUALITY OF LIFE - Eqol Journal