Primarius Katarina S. Marković

Risultati della terapia medica e fisioterapia di trattamento nella Spa sulla forza muscolare e sulla mobilità del tronco in soggetti con bassa

densità ossea

Primarius Primarius Katarina S. MarkovićKatarina S. Marković

Istituto per la cura e riabilitazione delle malattie Istituto per la cura e riabilitazione delle malattie reumatiche e cardiovascolari reumatiche e cardiovascolari

"Niska Banja""Niska Banja"

Results of Physical Treatment in the Spa Results of Physical Treatment in the Spa and Medicamentous Therapy on Muscle and Medicamentous Therapy on Muscle Strength and Trunk Mobility in Subjects Strength and Trunk Mobility in Subjects

with Lower Bone Densitywith Lower Bone Density

Katarina S. Marković Katarina S. Marković M M..DD.. Institute for treatment and rehabilitation of Institute for treatment and rehabilitation of

rheumatic and cardiovascular diseases “Nirheumatic and cardiovascular diseases “Niška Banjaška Banja””

introductionintroduction

the assessment of the the assessment of the muscle strength and trunk muscle strength and trunk movability are especially movability are especially significant in the significant in the prevention of falls and prevention of falls and fractures, in patients with fractures, in patients with lower bone mineral lower bone mineral densitydensity and and may be of may be of great importance in great importance in making a diagnosis and making a diagnosis and assessment of therapy assessment of therapy effect, as welleffect, as well

Spinal musculature functional damage Spinal musculature functional damage measuring is obtained by: isokinetical, measuring is obtained by: isokinetical, isometrical and isoinertial testsisometrical and isoinertial tests

Isostation B200Isostation B200 – – is is iissoineroinertial tial dynamometer with three measurement dynamometer with three measurement axesaxes, , which monitors movements on fully which monitors movements on fully natural basenatural base and and used for examination of used for examination of quantity of dysfunctionquantity of dysfunction

- c- construction of Isostation B200 made spineonstruction of Isostation B200 made spine Th parts and pelvis movements unable Th parts and pelvis movements unable

- - results are shown graphical byresults are shown graphical by::

1. 1. standard graph standard graph

2.2. motion motion range range gragraphph

3. 3. combined parameters graph combined parameters graph

4. 4. repetition analyzes tablerepetition analyzes table – –

showing average valuesshowing average values

graph shows functional amplitude of movements

global speed decreasing of extension – suspect of global speed decreasing of extension – suspect of osteoporosisosteoporosis

ttesting protocolesting protocol

give snapshoot in general give snapshoot in general muscular potential examined muscular potential examined body part showing especially body part showing especially values of muscular potentional values of muscular potentional especially of : left and right especially of : left and right rotation, flections, extensions rotation, flections, extensions and left and right lateral flectionsand left and right lateral flections

1.1. Registration of maximal rotary movement moments Registration of maximal rotary movement moments of isometric contractionsof isometric contractions


2. measurement of 2. measurement of movement rangemovement range

- First examine without First examine without loadload

- This parameter is This parameter is evaluated during dynamic evaluated during dynamic reception examine with reception examine with different loaded heightdifferent loaded height

3. 3. dynamic redynamic reppetietitition test with load on test with load

- - muscle movement is composed of :muscle movement is composed of :

a) a) phasesphases of acceleration of acceleration

b) dynamic equilibrium – last very b) dynamic equilibrium – last very short only with constant short only with constant

movement movement

c) deacceleration c) deacceleration phasephase

-- IsostationIsostation B200 B200 measures rotary measures rotary moments in all moments in all phases of movementphases of movement


RebilitationRebilitation

increase bone density and increase bone density and osteoblastic osteoblastic bone formingbone forming is possible only with the is possible only with the exercise load exercise load and and Physical Treatment in the Spa Therapy

exercise alone is inadequate to exercise alone is inadequate to maintain the spina trabecular bone in maintain the spina trabecular bone in perimenopausal or postmenopausal perimenopausal or postmenopausal womenwomen

Institute ¨Niška Banja¨ made study of correlation Institute ¨Niška Banja¨ made study of correlation between lumbosacral bone mineral density and between lumbosacral bone mineral density and muscles kineziology parametersmuscles kineziology parameters

The objective of this The objective of this studiesstudies is is to investigate to investigate how much the application of how much the application of Physical Treatment in the Spa therapy (PTS)(PTS) and medicamentous and medicamentous therapytherapy,, make intergroups differences, in muscle make intergroups differences, in muscle strength and trunk movability - substrength and trunk movability - subpopulation, population, sheshe-patients with low bone mineral density-patients with low bone mineral density

representationrepresentation of the studyof the study

Methods:Methods: 125 postmenopausal women with low 125 postmenopausal women with low bone mineral density, were on defined regime: bone mineral density, were on defined regime: hydro, mud, kinezzy, magnet and hydro, mud, kinezzy, magnet and bisphosphonate therapy, during the period of six bisphosphonate therapy, during the period of six monthsmonths

Functional status of trunk musculature was Functional status of trunk musculature was determined by the apparatus Isostation B 200determined by the apparatus Isostation B 200

The groups were made according ot T-scor, The groups were made according ot T-scor, muscle strength and trunk movability, as well.muscle strength and trunk movability, as well.


measuring of bone mineral density was measuring of bone mineral density was performed on Lunar DPX densitometer, at performed on Lunar DPX densitometer, at the some time anteroposterior scan of the some time anteroposterior scan of lumbal verebrae L1-L4 by the method of lumbal verebrae L1-L4 by the method of two energetic absorbtiometery btwo energetic absorbtiometery byy X-rays X-rays (DXA) was performed, the results were (DXA) was performed, the results were interpreted according to the accepted interpreted according to the accepted definition of OP accordinig to the WHO definition of OP accordinig to the WHO and according to the T-scorand according to the T-scor


iin the period of six months n the period of six months Physical Treatment in the Spa Therapy (PTS)(PTS) was conducted twice was conducted twice

in the span of 3 months in duration from two in the span of 3 months in duration from two weeks weeks

involved the application ofinvolved the application of

- - mud therapy (LS part of the spine) mud therapy (LS part of the spine)

- - hydro therapy (bathing in the thermo-mineral hydro therapy (bathing in the thermo-mineral

water 20min.) water 20min.)

- - pulsed magnetic field (50Hz,10mT,30 min)pulsed magnetic field (50Hz,10mT,30 min)


kinekinezzyzzy exercise were performed in the exercise were performed in the hall and the implied stretching exercises, hall and the implied stretching exercises, balance and strength into a lying, sitting balance and strength into a lying, sitting and standing position and standing position

kinekinezzyzzy exercise were exercise were also outside and also outside and are implied are implied are are training training of of breathing breathing exercises and general fitness, with a exercises and general fitness, with a change change inin speed of motionspeed of motion and and configuration terrain configuration terrain


mmedicament therapy consisted of taking: edicament therapy consisted of taking:

- - 1000 mg of calcium a day1000 mg of calcium a day

- - coated tablet of vitamin D3 (1000 i.j.)coated tablet of vitamin D3 (1000 i.j.)

- - bisphosphonates (Alendronat 10 mg)bisphosphonates (Alendronat 10 mg)

distribution of patients in relation to age and bone density

Age of life

osteoporosa osteopenia

br.br. %% br.br. %%

51 - 60 28 22,4 35 28

61 - 70 42 33,6 16 12,8

≥ 71 4 3,2 0 0

n* = 125

74 59,2 51 40,8 n*- the total number of patients

rresultsesults

a group of 25 she-patients with average a group of 25 she-patients with average

T-scor=T-scor= -2,47-2,47±±0,040,04 has been on has been on PTSPTS for for six monthssix months

PTS was included: PTS was included: hydrohydro therapy (15 min. therapy (15 min. in in thermo-mineral waterthermo-mineral water)), mud, pulsed , mud, pulsed magnetic field magnetic field and and kinezzykinezzy therapy therapy, ,

tthhis group is group had muscle strength increase had muscle strength increase and LS movability of 17,92%.and LS movability of 17,92%.

0

20

40

60

80

MIT rot. MIT flex. MIT ext. MITlat/flex

before th

after PTS

Maximum isometrically test

iincreasencrease muscle strength and LS movabilitymuscle strength and LS movability

rresultsesults

the sthe similar results were achieved in the imilar results were achieved in the group of 50 she-patients with average group of 50 she-patients with average

T-scor=-2,57T-scor=-2,57±±0,090,09 who at the same period who at the same period of time, beside of time, beside the same the same Physical Treatment in the Spa Therapy, had had calcium and vitamin D3 intake calcium and vitamin D3 intake

0

20

40

60

80


before th

after PTS,Ca and D3


iincreasencrease muscle strength and LS movabilitymuscle strength and LS movability

rresultsesults

tthe third group consisted of 25 he third group consisted of 25

she-patients, they had the average she-patients, they had the average

T-scor=-2,68T-scor=-2,68±±0,080,08 and during the period and during the period of six months, beside of six months, beside PTSPTS, calcium and , calcium and vitamin D3, they also got vitamin D3, they also got bisphosphonates, as wellbisphosphonates, as well

iicrease if muscle strength and LS crease if muscle strength and LS movability of over 35% were noticed movability of over 35% were noticed

0

20

40

60

80


before th

after PTS,Ca,D3and BF


increase increase muscle strength and LS movabilitymuscle strength and LS movability

rresultsesults

tthe control group, during the period of six he control group, during the period of six months, did not have any therapymonths, did not have any therapy

In tIn thishis group group of of 25 she-patients with 25 she-patients with average T-scor=-2,39average T-scor=-2,39±±0,030,03 decrease of decrease of muscle strength and LS movability of muscle strength and LS movability of 15,47%, were noticed15,47%, were noticed

0

20

40

60

80

100


before th

without th after 6months


decrdecreaseease muscle strength and LS movabilitymuscle strength and LS movability

CONCCONCLLUSIONUSION

tthere is a high possitive correlation between here is a high possitive correlation between muscle strength and trunk movability, at one muscle strength and trunk movability, at one handhand and application of both balneophysical and and application of both balneophysical and medicamentous therapy, at medicamentous therapy, at tthe other hand, in he other hand, in she-patients with low bone mineral density, no she-patients with low bone mineral density, no matter the age nor the level of bone densitymatter the age nor the level of bone density

values values of of muscle strength and trunk movability muscle strength and trunk movability werweree averageaverage:: for trunk extensors 20%, for for trunk extensors 20%, for rotators 30% and for flexors even 36%rotators 30% and for flexors even 36%

AcknowledgementAcknowledgement

Prim. Mirka Prim. Mirka

Karadžić, M.D.Karadžić, M.D. Department of Department of

RheumatologyRheumatologyInstitute for treatmentInstitute for treatment and rehabilitation of and rehabilitation of rheumatic diseases rheumatic diseases “Ni“Niška Banjaška Banja””

Prof. Aleksandar Dimić, M.D.Prof. Aleksandar Dimić, M.D. Medical FacultyMedical Faculty The University of Niš,The University of Niš, SerbiaSerbia

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Primarius Katarina S. Marković