| Background and purpose Adolescent idiopathic scoliosis(AIS)is a structural three-dimensional deformity of the spine with vertebral rotation during or around puberty,usually accompanied by rib deformities.Its treatment methods mainly include physiotherapeutic scoliosis-specific exercises(PSSE),brace therapy and surgical treatment for scoliosis,but the orthopedic effect of PSSE is still unclear,which is probably related to the inaccurate orthopedic programs of various types of AIS.As the effector of trunk posture reflex,paraspinal muscle can stabilize spinal posture,while respiratory muscle can also affect spinal posture through ribs.Most of the existing studies show that the myoelectric activity of the paravertebral muscles on the convex side of the main curve tends to be higher during naturally sitting,standing or symmetrical movements.However,there are few studies on the effects of various orthopedic actions on the activation of the paravertebral muscles and the respiratory muscles.The purpose of this study is to explore the characteristics of muscle activation in patients with Rigo A type AIS during different orthopedic actions by observing the changes of paraspinal muscles and respiratory muscles with surface electromyography system in patients with mild to moderate Rigo A type AIS during naturally sitting and correcting postures,and so as to provide basis for AIS precise exercise therapy.Research subjects and methods The AIS patients were recruited from the Guangdong Provincial Sports Rehabilitation and Orthosis Engineering and Technology Development Center for Adolescent Scoliosis from September 2021 to December 2022.Eighteen patients with mild to moderate Rigo A type AIS were selected.All patients were right thoracic curvature with age of 14.2 ±1.4 years and Cobb angle of 23.9 ±1.6 °,and 18 healthy subjects without scoliosis were selected as control group according to age and sex match.All subjects used DELSYS wireless portable surface electromyography testing system to detect the surface electromyography changes of paravertebral muscles(upper vertebra of main thoracic curvature,top vertebra,lower vertebra and 5th lumbar vertebra)and respiratory muscles(rectus abdominis,external oblique abdominis,internal oblique abdominis,sternocleidomastoid muscle,scalene muscle and saw anterior muscle)when they were positioned in naturally standing,naturally sitting,and AIS patients also did during various correcting exercises including orthopedic standing,orthopedic sitting,Schroth intensive training and muscle cylinder.The activation status of all muscles was expressed by root mean square(RMS).Data were expressed in mean ±standard deviation.Paired T test was used to compare the convex and concave RMS ratio of the left and right sides of the body,the orthopedic action,and the convex and concave RMS ratio of the natural movement,and the independent sample T test was used to compare the groups.Results(1)In AIS patients,the RMS values of paravertebral muscles in the upper and apical vertebrae regions were significantly higher in the convex side than in the concave side(p<0.05).In the naturally sitting,the RMS values of the same convex and concave regions in the apical vertebral region were significantly different(p < 0.05).Compared with healthy people,there were significant differences between the left and right sides RMS values of abdominal external oblique muscle and scalenus muscle in AIS patients(P<0.05).The activation of abdominal external oblique muscle and scalenus muscle on the right side was higher than that on the left side(p<0.05).The ratio of convexity and concave of paraspinal muscles in patients with AIS was significantly higher than that in normal subjects(p < 0.05),but there was no difference in the ratio of convexity to concave in respiratory muscles.(2)Compared with the naturally standing,the corrected standing posture can reduce the RMS ratio of the paraspinal muscle on the convex and concave side at the vertex,and reduce RMS ratio for the scalenus muscle.Compared with naturally sitting,there was no difference in the ratio of convex and concave RMS of respiratory muscle and paraspinal muscle before and after correction.Compared with the naturally standing,the RMS ratio of convex and concave in the parietal vertebra after Schroth intensive training was lower than that before correction(p < 0.05),while in the lower vertebra and the fifth lumbar vertebra,the ratio after correction was higher than that before correction(p<0.05),and the left-right ratio of sternocleidomastoid muscle was also increased.Compared with the naturally standing,the convex and concave RMS ratio of the fifth lumbar vertebra and the RMS ratio of the left and right side of the abdominal external oblique muscle increased.Conclusions(1)In the natural state,there has asymmetric activation of paraspinal muscle and respiratory muscle in Rigo A type of AIS patients,the activation of the convex side of the paraspinal muscle is higher than that of the concave side,the activation of the right side of the abdominal external oblique muscle and scalenus muscle was higher than that of the left side,while the activation of the serratus anterior muscle is higher on the left side than on the right side.(2)Four kinds of correcting exercises,including orthopedic station,orthopedic sitting,Schroth intensive training and muscle cylinder,have different characteristics in activating convex and concave paravertebral muscles and respiratory muscles in patients with Rigo A type AIS.Correcting standing posture can change the RMS ratio of paraspinal muscle and respiratory muscle in Rigo A AIS patients;correcting sitting posture has little change in RMS ratio in patients with this kind of scoliosis;Schroth intensive training can improve the symmetrical activation of paraspinal muscles at the top,but aggravate the asymmetric activation of lower vertebrae and respiratory muscles.Muscle cylinder is more reverse activation of paraspinal muscles and respiratory muscles in Rigo A patients,which should be considered in balance.It is suggested that the balance of paraspinal muscles should be taken into account in the guidance of physiotherapy,and the imbalance of respiratory muscles in the proximal and distal spine should be treated cautiously. |
PDF Full Text Request