DIRECTED BY Ms. YAEL RUBIN
Written by Dr. Vardita Gur, who was director of the Center from 1995-2011. Today she is a diagnostician and professional consultant.
Many adults discover posture disorders that cannot be corrected because they were not treated in time. The Posture Center at the Zinman Academic College at Wingate opens a “window of opportunity” for the public at large to diagnose posture disorders and to treat them at a young age. Diagnosing posture disorders at ages 9-17 is the key to receiving treatment at the right time. Treatment in time makes it possible to create desirable changes in the developing skeleton and to foster correct habits that the adolescent will continue to practice in adulthood as well.
Background
The Zinman Academic College at Wingate has been operating a center for posture diagnosis, treatment and rehabilitation for more than 20 years. The Center is part of the Rehabilitation through Movement Division and functions as part of the Department for Posture Rehabilitation, which is one of the specializations at the College.
The department and the center were established by the late Dr. Dov Aldubi who was Director of the School of Physiotherapy, a lecturer in Anatomy at Tel Aviv University and a lecturer in Anatomy and Kinesiology at the Zinman Academic College at Wingate. With the retirement of Dr. Aldubi the center was headed by Dr. Vardita Gur until 2011.
What is posture – and what are posture disorders?
Posture reflects the static and dynamic organization and interrelationships of parts of the body. The cervical (neck) concavity, the thoracic (chest) convexity and the lumbar concavity, which can be seen when viewing the body from the side, are clear expressions of postural organization and are known as the spinal curves.
Deviations from normal structure, such as excessive kyphosis, which is a prominent convexity of the thoracic spine (back is bent forward and shoulders hunch forward), or scoliosis (a permanent curvature of the back to the right or left), are examples of common postural disorders during adolescence. Kyphosis disorders can appear with equal frequency among boys and girls while scoliosis is more frequent among girls.
Posture disorders appear with varying degrees of severity. Severity can be measured by extent of deviation (in degrees), rigidity of scoliosis (structural or behavioral), rate of development, external appearance and genetic (family) dispositions. Structural postural disorders are to a great extent hereditary and therefore parents in families with one or more members who have severe scoliosis or kyphosis should be extremely aware of symptoms. Whatever the severity of the disorder, it can be treated, where treatment varies from case to case. Posture disorders affect external appearance but as importantly, they affect the health of the skeleton and its components (muscles, tendons, nerves etc.). This effect may sometimes entail pain, fatigue and a loss of vitality and motor functioning but for the most part these symptoms appear in later stages of life when the ability for self-correction is highly limited.
The Center and its uniqueness
The therapeutic center at the Zinman Academic College at Wingate offers diagnosis, consultation, rehabilitation and monitoring. The initial diagnosis and follow-up tests are conducted by the head of the Center and treatments are given by different members of the Center staff, including the head. Treatment is individual, and each patient has his or her own permanent rehabilitator. Treatment sessions are held once a week or once every two weeks, depending on the patient’s condition.
All staff members of the Center are graduates of the Posture Department of the College, who have a broad education (most of them have Master’s degrees) and experience in posture rehabilitation, education and instructing children and adolescents. The Center head and the staff are familiar with the various schools of treatment for posture problems and they integrate orthopedic treatment with posture-designated movement treatment.
The Center head maintains regular contact with patients for ongoing updates, consultation and fine-tuning of treatment, and is available to the parents of patients whenever necessary. Team work and tailoring movement treatment to orthopedic guidelines are cornerstones of work at the Center.
Patients
Most of the attention at the Posture Center at the College is directed to children and adolescents aged 9-17. Various types of posture disorders can be diagnosed throughout the life cycle. But, as mentioned above, the critical and most important period for diagnosing and treating these disorders is late childhood – adolescence. At these ages changes in posture occur as parts of the skeleton develop at different rates. These changes are not defined as posture disorders. They are mostly behavioral, flexible, transient and therefore easier to correct. In contrast there are structural disorders with a tendency to greater severity that occur in parallel to the adolescent growth process.
Any posture disorder, be it kyphosis or scoliosis, may be structural and developmental in some cases and flexible and behavioral in others, with few chances of its becoming more severe. It is important to distinguish between the two types and according to the diagnosis determine the manner of treatment. The effectiveness of treatment and the rehabilitative process is greater when the skeleton has not hardened completely, which occurs among girls at age 14/15 and boys at age 16/17. Proper treatment given at the right time, that is, during the period of development, can in many cases stop worsening of the problem and improve posture habits that have not yet become ingrained as unchangeable patterns of movement.
Methods of diagnosis and monitoring
Posture evaluation and diagnosis of disorders are conducted in several ways:
- Questioning
- Observing patients in three movement planes as they stand, sit, bend over and walk
- Movement tests (flexibility, strength and functioning) – to identify the nature of the disorder (flexible or rigid, structural or acquired)
- X-rays – to identify the exact location of the disorder, determine the extent of deviation, identify structural changes and evaluate the probability of worsening
- Tests are conducted before treatment begins and several times during treatment in order to monitor results and to adjust treatment accordingly
Methods of treatment
By the nature of the work, treatments in the Center are based on physical-movement therapy. We do not adhere to any one method. Rather we treat systematically, based on principles derived from a knowledge and understanding of the movement system of the body and a fundamental knowledge of normal posture and of faulty posture. These principles are reflected in the many movement approaches and physical techniques we use, which can be classified into two main categories:
- One is based on the guidelines of biomechanics, clinical work and orthopedics including PNF and other methods
- The second is based on a holistic view, which sees body posture as a component of the entire movement system. This approach includes methods such as Feldenkraiz, Alexander, Pilates, yoga, etc.
- It is important to note that the starting point of treatment at the College is not alternative treatment such as those mentioned in category two above. Rather, they are included for variety and for enrichment of the treatment process.
Professional ethics
The Center staff is aware that some posture problems may stem from medical causes with which they are not familiar. Therefore, the Center has established clear boundaries between issues and problems that are within the domain of their expertise and skills, and those which require clarification and involvement of the medical system. The staff respects medical guidelines and assists patients through these treatments.
The philosophy of the Center places the child at the center of the entire therapeutic process. All decisions about treatment are taken after discussing them with the children involved and receiving their consent. Patients are active partners in the treatment but do not bear responsibility for the results of treatment. The staff bears the main responsibility for the results of treatment.
The staff stands by the child at all stages: giving encouragement, support and adjusting the treatment techniques to the child’s special needs. As part of treatment patients receive guidelines for exercise and behavior in daily life.
For further details:
Ilana Mazuz – Coordinator of Outreach Services, Tel., 972-9-8639335, Fax, 972-9-8639391, email: ilana-m@wincol.ac.il
Yael Rubin – Head, Posture Center, Tel. 972-52-2220663