exercise suggestion for kyphoscoliotic elderly

Dear all,

I really have problem in prescribing the exercises for elderly with kyphoscoliotic eldelry, I have tried core strenghening but it seems to be aggravating his/her low back pain.

and I now have a case just like this:

client complaint of low back "broken" for more than 10 years, unable to walk for long, about 5 mins than required to rest.
?? collapse of several vertebra.
client stayed in OAH for 2 months due to pain, back home on 8/10, then started to have numbness, cramp.

with observation showing kyphoscoliosis to L side , palpation, upper Tx reduced kyphosis from T3 to T8, Lx 1-5 kyphosis rotate towards L side. tenderness found near sacroiliac joint.

special test :
open book test : +ve
closed book test : -ve
anterior tilt : -ve
post tilt : + ve comparable pain provoked


mm length test :
90-90 test : (L) -20 (R) -20

functional mobility : outdoor walker with stick.

Sometimes it helps just to use rolls and get them to open up the joints, especially in the rib region and lay there for 5 minutes. Begin with gentle joint mobilizing and then commence with gentle stabilization exercises to establish a base. What have you prescribed so far?

Exercising when there is tightness can definately cause further stiffness and thus more pain. Kyphoscoliosis is an indication of fascial shortening in some areas, not uncommonly the psoas, and as this is connected to the low back, it commonly causes LBP. I try and test the strength of the hip muscles first to assess muscle balance, usually finding weakness in one or both hip flexion or abduction. This can be corrected by soft tissue work over these muscles (abdomen and anterior thigh in the case of psoas), and a return of flexibility in the sheath of the muscles often restores stremgth as well. The spine posture is altered by changes in fascial networks in the affected area, so I tend to go for this first, and release what I can. Then as a maintanance, give them some gentle stretching axercises they can do at home. Not too many as they either forget or get bored. Simple things like hip flexion, lunge stretch for psoas.

Patients with a scoliosis often have more pain when they become older. If they also have a kyphosis it can become really problematic.
They have serious problems staying aligned and have to fight against gravity and their decreasing strength.
Pain is the biggest problem, stiffness and breathing problems can also become a problem.

In these cases I teach patients to fight gravity, explaining why they need to do so.
I will also give very soft passive mobilisations and this can be done in many ways depending on your own practical skills and education.
The trunk patterns of the PNF can be very helpful as the fascial techniques, but many manual techniques can be used including massage.
In the Schroth and SEAS clinics you can be offered a brace if need be.

Pain can become an increasing problem and should be taken seriously. The elderly loose muscle strength and need a strengthening programme as well.
Lots of possibilities to do so. The SEAS, Bugnet and Schroth techniques teach patients to know their bodies well, increasing awareness of posture, muscle position and physical fitness.

Esther

hi there
how old is the pt??? u need to know what the orginal posture was?? any red falgs?? x-rays??? if this is new posture, it could be due to maladaptive posture of back due to pain. i would start with lying quadratus lumborum stretch, you dont want to give any heavy load bearing ex's . what is pain medications pt taking, you need to arrange with the medics to allow rehab. check for redflags too. sorry i am just typing points as i think...

Have to agree with Naveenedin, a little more information if possible... age and social history would be useful to establish the patients working pattern and their medication for pain. furthermore has the patient been prescrbed any exercises in a hydro-pool? may help the patient with propreoception and balance and build the patients confidence up a little,if these facilities are available.... again whats the patients overal strength regards oxford scale ? thanks,just thinking as i write