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(jj II < fill i Jfl "TH -1 ©HT 1 - t_W JT |T1 I r^g) APPLICATION OF AUTHOR'S METHODS TO IMPROVE THE MUSCULOSKELETAL DISORDERS IN PRESCHOOL CHILDREN Filkova Silviya Ivanova, Usheva Natalya Vasilevna, Medical Univerity - Varna Prof. Dr. Paraskev Stoyanov, Varna E-mail: s.filkova@abv.bg
Annotation. The musculoskeletal disorders are common conditions among the children and are usually caused by the long-term effects of the poor posture. These effects can be considered in physical, mental, social and economic aspect.
Objective:
To examine the effect of application of author's methods - exercises with sports hammock - in order to improve the most common disorders of the posture in preschool children.
Materials and methods: experimental study among 200 children (control group of 100 children and experimental group of 100 children performing exercises with sports hammock) from the city of Varna aged 5-7 who attend a municipal kindergarten.
After application of the methods, the reduction in the frequency of asymmetries in the experimental group proved to be statistically significant when compared to the results obtained in the control group at all points with the exception of lordosis (p <0.05).
Conclusion: The regular classes with sports hammock for at least six months are recommended in the preschool children for correction and prevention of musculoskeletal asymmetries.
Keywords: musculoskeletal disorders, poor posture in children
The proper children posture is one of the signs of good physical development and health. It provides the conditions needed for the normal functioning of the internal organs, maintains the muscle balance and creates favourable prerequisites for mechanical development of the musculoskeletal system (MS).
The creation of habit of proper body posture from early childhood has a
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sustainable and positive impact throughout life.
The poor posture is a functional disorder of the posture motor habit [1]. It is a deviation from the normal location of the musculoskeletal system individual parts caused by poor body control. In the cases of asymmetry, regardless of its location, the posture always causes changes in the spinal segments, thus shifting the common centre of gravity. This leads to overload of the muscle-tendon and ligament structures, zygapophyseal joints and intervertebral discs. The disorder of the curves causes also changes in the volume of body cavities. For example, the changes in thoracic kyphosis change the volume of thoracic cavity and limit the excursion of the chest and lungs during breathing. [3] The poor posture is not associated with structural changes but causes increased stress on the joints [22]. The repeated abnormal stress leads to compensatory degenerative changes in the musculoskeletal system. The soft tissue structures (muscles and ligaments) may weaken, or can be overstretched or traumatized. The loaded structures subjected to chronic trauma are a prerequisite for more serious lesion [9, 23].
The modern lifestyle and reduced physical activity are factors that contribute to the development of musculoskeletal disorders in children [6, 14, 15, 16, 17, 20]. They are mainly associated with reduced muscle strength, poor endurance of the postural muscles and limited joint mobility or muscle stiffness and are a logical consequence of the poor body posture [2].
The data on prevalence of posture abnormalities are various due to the lack of consensus on the diagnostic criteria, different age of the respondents, and experience of the examiners [7, 8, 10, 11, 16, 25]. The majority of the studies identify the asymmetries in the shoulder region [12, 14, 18, 21, 25] as the most common disorders in the preschool children: they reach 89.7% among the examined children, as stated in a study of Akbari A. et al. (2010) [5].
The poor posture can be improved and can reach the normal one through active contractions of the relevant muscles after the child has been paid attention to do this by his parents, thus improving the motor activity and through appropriate sports [4, 13, 14, 19, 24]. Many studies show that the early detection of postural deviations can prevent the progression and occurrence of intensive deformations [13, 14, 19, 25]. However, if the reason still have effect for a long time, the poor posture can be fixed and can turn into a spinal curvature (third degree of spinal curvature - fixed degree). If no attention has been paid to this condition, then poor body posture and spinal curvature are formed. The increased number of children with postural disorders of first and second grade confirms the suggestion that the prolonged sitting posture during classes represents a static load of the postural muscles which leads to poor body posture.
The large number of studies in the area of musculoskeletal disorders which are considered as the most common problem of the children musculoskeletal system
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affects both the great interest of the scientists from all over the world and their wide dissemination among the children. This trend should be counteracted by strengthening the muscles which stabilise the preschool children posture before the school period and by appropriate movement regimen which includes strengthening exercises. The improvement of the motor habit which leads to proper body posture in children aged 5 -7 is important for the overall condition of the body and creates favourable conditions for its growth. Prevention, early detection and timely correction of the asymmetries are considered as appropriate.
Objective:
To examine the effect of application of author's methods - exercises with sports hammock - in order to improve the most common disorders of the posture in preschool children.
Materials and Methods
The study was conducted in the period February 2014 - December 2015. The experiment involved two hundred children from 3 rd and 4th group of two municipal kindergartens in the city of Varna: Alen Mak 9 Healing Kindergarten. The children were divided into two groups:
- experimental group - remedial gymnastics which includes exercises with sports hammock (n = 100) created by applying author's methods;
- control group - assessment of the children posture before and after the remedial gymnastics (n = 100).
The sports hammock classes were held within four months, three times a week, in the gymnasium of Alen Mak 9 Healing Kindergarten, city of Varna. They were aimed at strengthening the muscles of the shoulder region, back and abdomen.
The resulting data were entered and processed with statistical package IBM SPSS for Windows, v. 19.0. Student's t -test to compare the averages and relative shares of the asymmetries between the studied groups was attached.
To assess the body posture, we performed somatoscopy - a view and analysis of the normal (relaxed) child posture, while monitoring pathological asymmetries and muscular hypotrophy.
- during the front view we monitored the position of the head, shoulder contour, clavicles, acromioclavicular joints, waist triangles and iliac crests;
- to detect an asymmetry in a front-rear direction, the child stood in profile to the examiner;
- during the side view attention was paid to the position of the head, thoracic kyphosis, lumbar lordosis, shoulders and shoulder blades;
- during the specific back view attention was paid to the position of the head, shoulder contour, shoulder blades, waist triangles and popliteal fossa.
The requirements that we met to obtain an accurate assessment of the posture and to reduce the possibility of errors during the view were as follows: to make the view in
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the morning; to use the same person to make the view, even to make it in the same room; to make the view at natural (daily) light; to view the child undressed and barefoot stepped on a special step stand; to view the child standing with his back to the light that falls right behind him, rather than aside, so as to avoid any shadows that lead to errors in the diagnosis of the scoliosis; to view the child standing in front of the examiner, with his back to him or in profile depending on the body parts being viewed - curved sideways or front - rear curvature; to view the child with his legs crossed and with his knees strained, without straining the dorsal muscles.
The resulting data were recorded in a special working record, as each visit of the children was subject to preparation of a new one.
Results and Discussion
The distribution of children depended on their gender - 105 (52.5%) of them were girls, while 95 (47.5%) were boys.
Upon completion of the somatoscopy we found that the most common asymmetries were observed in the shoulder region (SR) and in the three tested positions - front, side and rear.
The comparative analysis of the change in the frequency of the posture asymmetries reported in the initial and final assessment of the posture in a front view while performing exercises with sports hammock in the experimental group showed statistically significant full improvement of the anatomical landmarks observed (p <0.001). Full symmetry was achieved. The biggest positive change was observed in the shoulder region where 26% improvement was achieved (Table 1).
Table 1
Initial and final assessment in the front view
Group Asymmetry (%) Head SR Clavicles Waist Flanks
Experimental group Initial 19 26 24 10 24
Final 0 0 0 0 0
Difference -19 -26 -24 -10 -24
Control group Initial 16 38 12 33 30
Final 16 35 12 31 28
Difference 0 -3 0 -2 -2
P Experimental group - control group <0,001 <0,001 <0,001 <0,02 <0,001
The results of the posture assessment of the children involved in the experimental group in the side view after applying the methods showed statistically significant improvement of the observed anatomical landmarks. The largest improvement is observed again in the shoulder region - 43 %. The winged scapula was fully improved (by 40%). Full improvement (Table 2) was not achieved under the influence of the
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increased lumbar lordosis.
Table 2
Initial and final assessment in the side view
Group Asymmetry (%) Head Kyphosis Lordosis SR Shoulder blades
Experimental group Initial 9 18 9 43 40
Final 0 0 9 2 0
Difference -9 -18 0 -41 -40
Control group Initial 2 7 24 49 42
Final 2 7 24 48 41
Difference 0 0 0 -1 -1
P Experimental group - control group <0,001 <0,001 n.a. <0,001 <0,001
Full correction of the asymmetries in the observed anatomical landmarks was found in the monitoring of the results of the posture assessment of the children involved in the experimental group in the back view after applying the methods which proved to be statistically significant (P<0,001). The biggest positive change was observed in the shoulder region (23%) and shoulder blades (23%) (Table 3).
Table 3
Initial and final assessment in the back view
Group Asymmetry (%) Head SR Shoulder blades Waist Knees Ankles
Experimental group Initial 14 23 23 20 14 18
Final 0 0 0 0 0 0
Difference -14 -23 -23 -20 -14 -18
Control group Initial 4 22 47 27 5 4
Final 4 21 44 27 0 0
Difference 0 -1 -3 0 -5 -4
P Experimental group - control group <0,001 <0,001 <0,001 <0,001 <0,05 <0,002
The children showed great interest in the exercises with sports hammock and did their utmost with pleasure. According to the results obtained the analytical exercises specifically selected to influence the muscles of the shoulder region presented in the form of a game effectively contributed to correct the posture asymmetries, especially the most common ones - those of the shoulder region. The final posture assessment in the experimental group shows reduction in the frequency of asymmetries in all observed points with the exception of lordosis.
It remained unchanged in the control group as well (0% difference). Biggest increase of the share of asymmetries in the final assessment was found in the
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experimental group (with sports hammock) - reduction of the asymmetries in the shoulder region by 41% in the side posture assessment. The differences were smallest in the control group where improvements were not found or were in the range of 1% -5%. The reduction in the frequency of asymmetries in the experimental group proved to be statistically significant when compared to the results obtained in the control group at all points with the exception of lordosis (p <0.05). Conclusion
The regular classes with sports hammock for at least six months are recommended in the preschool children for correction and prevention of musculoskeletal asymmetries.
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