Biomechanical Aetiology of the So-Called Idiopathic Scoliosis. New

13 Pages·2014·1.57 MB·English

by  Karski Tomasz

Global Journal of Medical Research: H
Orthopedic and Musculoskeletal System
Volume 14 Issue 3 Version 1.0 Year 2014
Type: Double Blind Peer Reviewed International Research Journal
Publisher: Global Journals Inc. (USA)
Online ISSN: 2249-4618 & Print ISSN: 0975-5888

Biomechanical Aetiology of the So-Called Idiopathic Scoliosis. New
Classification (1995 – 2007) in Connection with “Model of Hips
Movements”

By Karski Tomasz
V incent Pol University in Lublin, Poland
Introduction- The article describes the biomechanical aetiology of the so-called idiopathic
scoliosis (1995 – 2007), known as an adolescent idiopathic scoliosis (AIS). The first lecture
dealing with the issue was delivered in Hungary in 1995. The first publication was made in
Germany in 1996 (Orthopädische Praxis).
Biomechanical development of scoliosis. The scoliosis appears as the secondary
deformity originating in the asymmetry of hips’ position and movement described by Prof. Hans
Mau in articles about Syndrome of Contractures (Fig. 1, 2a, 2b, 3, 4a, 4b, 4c). Next - while
walking and while standing ‘at ease’ on the right leg (T. Karski). The research proves that the
right leg is the preferred one over the years for standing. This phenomenon is because of better
stability of right leg in region of right hip during standing and this is because of smaller adduction
in straight position of joint.
Keywords: so-called idiopathic scoliosis, aetiology, biomechanics.
GJMR-H Classification: NLMC Code: WE 168

BiomechanicalAetiologyoftheSo-CalledIdiopathicScoliosisNewClassification19952007inConnectionwithModelofHipsMovements

Strictly as per the compliance and regulations of:

© 2014. Karski Tomasz. This is a research/review paper, distributed under the terms of the Creative Commons Attribution-
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distribution, and reproduction in any medium, provided the original work is properly cited.
Biomechanical Aetiology of the So-Called
Idiopathic Scoliosis. New Classification
(1995 – 2007) in Connection with “Model of Hips
Movements”
Karski Tomasz
4
1
0
2
Keywords: so-called idiopathic scoliosis, aetiology, The asymmetry of movement of the hips is as
r
a
biomechanics. mentioned above, is connected with “Seven e
Y
Contractures Syndrome” described by Professor Hans
I. Introduction Mau from Tübingen in Germany in 1960s (in German 25
T he article describes the biomechanical aetiology of Siebenersyndrom) and then further explained (T. Karski) I

the so-called idiopathic scoliosis (1995 – 2007), as a “Syndrome of Contractures and Deformities” on
known as an adolescent idiopathic scoliosis (AIS). (literature 1 – 15). rsi
The first lecture dealing with the issue was delivered in The consequential development of the spinal Ve
Hungary in 1995. The first publication was made in deformity is as follows:
I
Germany in 1996 (Orthopädische Praxis). 1. Every type of scoliosis depends on the Model of II
e
Biomechanical development of scoliosis. The Hips’ Movement [MHM] (T. Karski 2006). u
s
scoliosis appears as the secondary deformity originating 2. When the movement of hips is symmetrical – the is Is
in the asymmetry of hips’ position and movement no pathological influence on spine during V
described by Prof. Hans Mau in articles about Syndrome walking/gait and the is also symmetry of time XI

of Contractures (Fig. 1, 2a, 2b, 3, 4a, 4b, 4c). Next - standing on left / right leg. In such situation develop me
while walking and while standing ‘at ease’ on the right never so-called idiopathic scoliosis (Fig. 6, 7). u
leg (T. Karski). The research proves that the right leg is 3. The asymmetry of the movement of hips in all cases Vol
of the so-called idiopathic scoliosis bases on the
the preferred one over the years for standing. This )
phenomenon is because of better stability of right leg in limited adduction, limited internal rotation and H DDDD
region of right hip during standing and this is because of limited extension in the right hip. This phenomenon (
h
smaller adduction in straight position of joint. Every type explain “the lest sided Syndrome of Contractures”. rc
of scoliosis starts to develop at the time when the child 4. In gait, there is a limited movement of the right hip ea
s
starts to stand and walk. Depending of types of scoliosis which is transmitted to pelvis and spine as a Re
is a special characterise of patho-morphology of compensatory process and “enlarges” the al
deformity of spine and their various properties. To movement in the spinal region. Consequently, there dic
occurs a permanent distortion of the inter-vertebral e
explain in details the biomechanical aetiology we must M
joints, a rotation deformity and later stiffness of the
remember about the three asymmetries causing the
f
spine. The asymmetry of the movement of hips in o
development of scoliosis:
gait also causes a load asymmetry “with passing al
1. The asymmetry of the movement in the hips – n
adductions test (Fig. 5) – is the primary cause for time” on both sides – left and right - and further, a ur
o
development of scoliosis. gradual development of scoliosis. J
2. The asymmetry of the movement and in loading in 5. The permanent standing ‘at ease’ on the right leg bal
(the right hip is more stable [!]) starts and widens o
pelvis and spine - left versus right side in gait. Gait – Gl
the curves – first, lumbar left convex and in II/B epg
influences factor in I epg scoliosis and in III epg
(see farther/next text) thoracic right convex curves.
scoliosis.
3. The asymmetry of the time while standing ‘at ease’ 6. The scoliosis “S” in I epg is connected with standing
‘at ease’ on the right leg and with gait.
on the left versus the right leg – more time on the
right leg. Standing on the right leg - influences factor 7. The scoliosis “I” in III epg is connected only with
gait. This type of scoliosis manifests itself as
in II/A epg scoliosis and in II/B epg scoliosis.
stiffness of spine. This deformity produces no

Author: Former head of Paediatric Orthopaedic and Rehabilitation curves or gibbous or a very slight one.
Department of Medical University in Lublin, Poland (1995 – 2009), 8. The following influences connected with gait and
Vincent Pol University in Lublin, Poland. with standing on the right leg gives - three groups
e-mails: [email protected], [email protected]
©2014 Global Journals Inc. (US)
Biomechanical Aetiology of the So-Called Idiopathic Scoliosis. New Classification (1995 –2007) in
Connection with “Model of Hips Movements”
and four types of scoliosis (see above): “S” double also the laxity of joints (typical for minimal brain
scoliosis - I etiopathological group (epg); causal dysfunction [MBD]) and harmful exercises in former
gait and standing on right leg, lumbar left convex therapy - before the stay in our Department.
curve in “C” - II/A scoliosis sometimes with Asymmetry in the movements of hips (Tab. I).
secondary thoracic right convex curve in “S” – II/B There are differences in the movement concerning the
epg scoliosis; causal standing on right leg. In this range of adduction, internal rotation and extension.
subgroup (“S” – II/B epg scoliosis) not only standing Types of scoliosis in connection to “the model of hip
‘at ease’ on the right leg is the cause of scoliosis but movements” are presented the table below: Tab. I
Model of Causative Type of “S” Type of “C” Type of “S” Type of “I”

hips influence scoliosis – I scoliosis – scoliosis – scoliosis – III

movements epg II/A epg II/B epg epg

4 Range of add. Gait and Scoliosis “S”
1
0
2 right hip -10 / standing on I epg
ar
e -5 / 0 degree the right leg Two curves.
Y

Range of add. ‘at ease’ Rigid spine.
26
left hip 30 / (free) Gibbous in

I 40 / 50 degree thorax right
n
o side. 3D.
ersi Progression.
V
Range of add. Standing on Scoliosis “C” Scoliosis “S”

III right hip 20 / the right leg II / A epg. II / B epg.

e
u 30 degree ‘at ease’ Lumbar or Lumbar left
s
s
I Range of add. (free) Sacro – convex.

V
left hip 40 / Lumbar or Thoracic
I
X
50 degree Lumbar – secondary
e
m
Thoracic left right convex
u
ol convex curve. curve.
V
) Flexible Flexible
H DDDD
spine. 2D. No spine. 2D or
(
h progression or 3D. No
c
ar small. progression or
ese amall.
R

Range of add. Gait Scoliosis “I”
cal
di right hip -10 / III epg
e
M -5 / 0 degree No curves or

f Range of add. slight.
o
al left hip 0 / 10 Rigid spine.
n
r / 20 degree 2D or 3D.
u
o
J Stable

al deformity.
b
o
Gl Not included
till now to

“scoliosis”.

Material. In the years between 1985 and 2012, Classification [literature 1 - 15]
1950 children with scoliosis were examined and 360 (Tab. I) When movement of hips (see model of
children constituted the control group. The material for movements), especial adduction in strait position of joint
the years 2012- 2014 is in research processing. The (this position is important in function - in standing and in
children from the control group were presented by gait) – is equal its mean symmetric of both sides - there

parents as ones with the problem of sc oliosis but there is no scoliosis.
were without any visible spine deformity.
© 2014 Global Journals Inc. (US)
Biomechanical Aetiology of the So-Called Idiopathic Scoliosis. New Classification (1995 –2007) in
Connection with “Model of Hips Movements”
In new classification there are three groups and the possibility to introduce causative prophylaxis which
four types of scoliosis (Fig. 8, 9, 10, 11, 12, 13, 14). is the theme of the next two lectures.
I / “S” double scoliosis with stiff spine (3D - I
epg), connected with gait and standing ‘at ease’ on the III. Conclusions
right leg;
1. Last 39 years of Lublin observations confirmed the
IIA / IIB “C” and “S” scoliosis with flexible spine
biomechanical aetiology of scoliosis.
(II/A - 1D & II/B - 2D epg), connected only with standing 2. There are three types and four groups of scoliosis
‘at ease’ on the right leg in “C” II/A epg and in “S” II/B connected with causative influence “standing on the
epg additionally connected with laxity of joints and / or right leg at ease” (treated as “standing”) and with
harmful previous exercises “walking” (gait).
III / “I” scoliosis (III epg – 2D) – stiff spine
3. There are following types of scoliosis: “S” scoliosis I
without curves and gibbous or with very slight ones.
epg, 3D. Causative influence: standing and gait, “C”
Connection with gait only. scoliosis II/A epg, 1D. Causative influence: 14
0
Every type of scoliosis starts to develop at the age of 2 2
standing, “S” scoliosis II/B epg, 2D or mix.
r
or 3. a
Causative influence: standing, plus laxity of joints e
Y
and/or incorrect exercises in previous therapy, “I”
II. Comment to the New Classification
scoliosis III epg, 2D or mix. Causative influence: 27
I-st etiopathological group of scoliosis is “S” gait.
I

deformity in I epg. (Tab. I). This scoliosis can be 4. Each type of scoliosis starts to develop in age of 2-3 n
o
diagnosed very early, at the age of 3 to 5. The authors years. si
r
observed that children aged 1 year who can walk and 5. Both - the old tests (Adams & Meyer test) but also Ve
stand independently, stand mostly ‘at ease’ on the right the new tests should be used for early screening.

I
leg (observation in Out – Patient Clinic) and it should be The new tests include: Lublin – “side bending test”, II

an alarming sign for doctors and parents indicating / checking for the habit of standing ‘at ease’ (right ue
s
showing the beginning of the developing of scoliosis. In versus left leg), Ely Duncan test (or Thom or Staheli s
I

the I epg group, the first clinical sign is the rotation test), adduction of hips test (Ober test), and other
V
deformity which should warm against future spinal (described in other article). XI
deformity. In some cases of I epg group there is “lordo- 6. In the course of treatment and prophylaxis of spine e
m
scoliosis”. The property of such scoliosis is: the following should be introduced: stretching
u
progression, especially after harmful exercises. exercises, typical for karate, kung fu, taekwon-do, ol
V
II-nd etiopathological group of scoliosis - “C” aiki-do, yoga. All these exercises prove be very
)
II/A epg deformity and “S” II/B epg deformity (2001). The beneficial for “mal position of body” and for H DDDD

scoliosis in II/A epg or II/B epg can be diagnosed at the scoliosis (described in other article). (

h
age of 8 - 10 - 12 (Tab. I). The cause is the habit of c
r
permanent standing ‘at ease’ on the right leg for many ea
s
years. Initially, it is the lateral physiological deviation, e
R
then fixed “C” left convex curve. In the development of
al
the “S” II/B epg scoliosis there occurs additionally laxity c
di
of joints and / or harmful exercises (mentioned above). e
M
In some cases of II/B epg group we observe kypho (kifo)

f
-scoliosis. o

III-rd etiopathological group of scoliosis (2004) – al
n
scoliosis with little or no curvature (Tab. I). The cause is ur
o
connected only with gait. In gait due to a restricted J

movement in the right hip, and a small movement in the al
b
left hip, a compensatory rotation movement in the spine o
Gl
is created. This compensatory movement makes, as
mentioned above, a permanent distortion in the inter-
vertebral joints which result in stiffness and rigidity of the
whole spine. The stiffness of the spine can be observed
in youth. However, nobody considered this to be
scoliosis. These patients when adult often suffer from
back pain.
The necessity of causal prophylaxis. The new
classification clarifies the need for therapeutic approach
to each etiopathological group of scoliosis and provides
©2014 Global Journals Inc. (US)
Biomechanical Aetiology of the So-Called Idiopathic Scoliosis. New Classification (1995 –2007) in
Connection with “Model of Hips Movements”
Figures

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Figure 2a, 2b : Syndrome of contractures and deformities
© 2014 Global Journals Inc. (US)
Biomechanical Aetiology of the So-Called Idiopathic Scoliosis. New Classification (1995 –2007) in
Connection with “Model of Hips Movements”

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Figure3 :Syndrome of co ntractures and deformities XI

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Figure4a, 4b, 4c : Syndrome of contractures and deformi ties. Difference in abduction of hips. Smaller movement in
left hip.
©2014 Global Journals Inc. (US)
Biomechanical Aetiology of the So-Called Idiopathic Scoliosis. New Classification (1995 –2007) in
Connection with “Model of Hips Movements”

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Figure 5 : Test to check the rage of add uction of hips in their extension position
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Figure6 : Proper model of hips movement – healthy child, without spine deformity
© 2014 Global Journals Inc. (US)
Biomechanical Aetiology of the So-Called Idiopathic Scoliosis. New Classification (1995 –2007) in
Connection with “Model of Hips Movements”

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Figure 7 :Example of a hea lthy child, without deformity ol
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Figure8:„S” scoliosis in I epg (etiopathological group)
©2014 Global Journals Inc. (US)
Biomechanical Aetiology of the So-Called Idiopathic Scoliosis. New Classification (1995 –2007) in
Connection with “Model of Hips Movements”

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X Figure9 : Example of „S” scoliosis in I epg (etiopathological group) – before and after improper therapy (exercises)

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Figure 10 : “C” and “S” scoliosis in II/A epg and II/B epg
© 2014 Global Journals Inc. (US)
Biomechanical Aetiology of the So-Called Idiopathic Scoliosis. New Classification (1995 –2007) in
Connection with “Model of Hips Movements”

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Figu re11 :Example of “C” scoliosis in II/A epg – standing ‘at e ase’ on the right leg as causal influence for I
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development of scolios is
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Figure12 :“I” scoliosis in III epg
©2014 Global Journals Inc. (US)