RU2846346C1 - Method for differentiated conscious correction of idiopathic scoliosis (ccs) in children and adolescents - Google Patents

Abstract

FIELD: medical science.

SUBSTANCE: invention relates to medicine, paediatric orthopaedics, diagnosis and differentiated treatment of idiopathic scoliosis in children and adolescents from 6 to 18 years old, depending on the localization of the scoliotic curve and the direction of its apex and can be used in specialized hospitals, outpatient in medical centres and polyclinics, in sanatoriums and resorts. Method for differentiated conscious correction of idiopathic scoliosis (CCS) in children and adolescents is carried out with the help of physical exercises and a functional corrective Cheneau corset taking into account the results of the preliminary screening diagnosis, which is carried out using a scoliometer in its position in a vertical plane perpendicular to the horizontal passing through the anatomical landmarks – the spinous processes of the patient's vertebrae at certain levels of the spine during the patient's discrete inclination forward. For each examined level, a deviation of the scoliometer readings from the median value is recorded in degrees with indicating the direction: "minus" – in case of deviation to the left, "plus" – in case of deviation to the right. If the deviation is more than 5.0 degrees, idiopathic scoliotic spinal deformity is stated at the appropriate level – thoracic and/or lumbar. Deviation range in degrees shows a presumable degree of the spinal scoliosis and a spinal arc direction. CCS is carried out in the form of daily performance of a set of gymnastic exercises using conscious breathing during the performance of the given exercises. Conscious breathing is a cycle of exhalation with resistance – through half-compressed lips – with duration of 8 seconds and conscious directed inhalation (CDI), which is a breath with expansion of that part of the chest, which is opposite to the top of the scoliotic arc, with the doctor's focusing the patient's voluntary attention during CDI on the work of the intercostal muscles of this part of the chest by pressing on it with a hand. General-purpose complex involves 14 exercises described in the patent claim which include a number of the pre-set exercises with conscious breathing. Besides, a number of supplementary exercises for thoracic, lumbar and combined scoliosis are presented.

EFFECT: method provides the simplification and integration of various exercises for the conscious correction of various types of scoliosis into an integral system with modification of both the screening diagnosis of the IS (its simplification and acceleration) and the performed exercises so that they are most suitable (understood) for children of any age from 6 to 18 years with any localization and type of scoliosis (thoracic, lumbar, combined), without loss of efficiency, with the exclusion of a number of physically complex exercises and the addition of conscious breathing (CB) to the series of exercises, changing the number of sets in the exercises, as well as the addition of new, modified exercises with the transition to a less pronounced degree of scoliosis in children and adolescents.

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Description

The invention relates to medicine, pediatric orthopedics, diagnostics and differentiated treatment of idiopathic scoliosis in children and adolescents from 6 to 18 years old - depending on the localization of the scoliotic arc and the direction of its apex, and can be used in specialized hospitals, outpatient in medical centers and clinics, in health resort institutions.

Normally, the spine has several physiological curves: forward cervical curve - lordosis, backward curve of the thoracic spine - kyphosis (normally 20-35 degrees), lumbar lordosis, and sacral kyphosis.

All physiological curves are fully formed by the age of 4-5 years, which is associated with the completion of the formation of the walking stereotype under the influence of gravitational forces.

Physiological curves are of great importance for cushioning movements during walking, protecting the spinal cord from sharp axial loads, ensuring stabilization of the vertebrae and protecting them from rotation.

If, for various reasons, the physiological curves of the spine change towards strengthening or straightening (smoothing), this leads to disorders.

In this case, scoliosis is a three-dimensional deformation (curvature) of the spine. A number of its classifications are known, the main classification is by severity, taking into account which a diagnosis is made and treatment is prescribed. It is based on the results of measuring the deviation of the spinal column in the frontal (lateral) plane.

There are several methods for determining this deviation. In recent years, the Cobb measurement has been used primarily (J.R. Cobb, 1948): the 1st degree is scoliosis with an arc angle of curvature of up to 10 degrees, the 2nd - 11-25 degrees, the 3rd - 26-40 degrees, the 4th - more than 40 degrees.

In case of scoliosis with two or three arcs of curvature, it is necessary to count the degrees and determine the severity of the deformation for each curvature, each arc.

According to the localization of the curvature arc, there are 5 main types, sometimes with a more detailed description:

1. Thoracic scoliosis with maximally deviated Th7-Th9 vertebrae; in most cases, right-sided with one arc of curvature.

2. S-shaped combined scoliosis with 2 arcs, thoracic arc - with maximum deviation at the level of Th7-Th9, lumbar arc - with the peak of deviation at the level of L1-L3.

This type of scoliosis can be divided into 3 more types:

a) the arcs are approximately the same (within 5-7 degrees),

b) the thoracic arch is significantly larger than the lumbar arch,

c) the lumbar arch is significantly larger than the thoracic one.

However, in all the listed cases, the thoracic arch is more often right-sided, and the lumbar arch is left-sided.

3. Lumbar scoliosis - with the peak at the level of L2-L3. It can be divided into 2 more types:

a) lumbar scoliosis itself, in most cases left-sided;

b) in combination with thoracic hyperkyphosis.

4. Upper thoracic scoliosis with the apex in Th2-Th4 (rare). Its variants are:

a) upper thoracic scoliosis with one arc of curvature;

b) the third upper thoracic arch, usually on the left, if there are already two - thoracic on the right and lumbar on the left;

c) the second upper thoracic arch with an existing thoracic arch.

5. C-shaped thoracolumbar scoliosis, in which one extended arc of curvature is observed, including the vertebrae of the thoracic and lumbar spine.

Early detection of any type of scoliosis is the key to its successful treatment.

During the initial examination of patients, 2 tests are usually performed to differentiate between postural disorders and scoliosis and to decide on the need for X-ray diagnostics. Patients are examined in the standing and lying positions.

When examined in a lying position, the signs of posture disorders in the patient may be leveled. Scoliotic deformation, on the contrary, has a persistent character in any position. With persistent deformation, unlike posture disorders, the patient cannot independently assume the correct position.

A number of well-known tests are also used for diagnostics (Levkov V.Yu., Polyaev B.A. “Conscious correction of scoliosis and posture disorders” (based on the German method of Katharina Schroth), scientific and practical manual. M. 2020. 144 p.; see also: https://skoliose.ru/articles/diagnostika-skolioza/).

The Adams test helps to visualize the presence of scoliosis, and the scoliometer used by Bunnel (W.P. Bunnel) in the 80s of the 20th century provided objective criteria for screening studies of spinal deformities (Bunnel WP: An objective criterion for scoliosis screening. Jornal of Bone and Joint Surgery. 1984, 66A (9): 1381-1387). In our work, we also propose diagnosing spinal curvatures using our own scoliometer (https://skolios.ru/skoliometriya, patent RU 221086 U1, 17.10.2023, Levkov V.Yu.).

There is practical experience in organizing mass screening for scoliosis using the COMOT (computer optical topography) method (Sarnadskiy V.N., Fomichev N.G. Screening diagnostics of childhood and adolescent spinal pathology using the computer optical topography method. - Manual for doctors of the Ministry of Health of the Russian Federation. - Novosibirsk, NIITO. - 2002, 36 p.). This method is quite effective and allows for the imaging and processing of a large number of patients during the working day. However, correct interpretation of the topographic results required the involvement of qualified medical personnel, and in some cases it was impossible to make a conclusion based on only one image without additional clinical examination of the patient.

The use of a natural, relaxed posture of patients for examination in this method made it possible to identify postural disorders and determine the shape of the spine in three planes. However, pronounced postural disorders in patients often led to a false detection of scoliotic deformation (false-positive screening result) and, less often, to its omission (false-negative result).

The most informative topographic sign of structural scoliosis according to the KOMOT method is local rotational asymmetry in the paravertebral region (clinically manifested as a muscle ridge when using the Adams test). In the presence of structural scoliosis, this asymmetry is clearly recorded on the graphs of axial rotation and volumetric asymmetry of the dorsal surface of the trunk with a maximum at the level of the apex of the scoliotic arc. The most typical reasons for the distortion of the shape of these graphs and the resulting difficulties in interpreting the results of examining patients in their natural position are:

- pronounced rotational deformation of the trunk (“twisting” - rotation of the shoulder girdle relative to the pelvic girdle by more than 5°);

- significant lateral functional curvature of the trunk axis (deviation of the line of the spinous processes by more than 10 mm from the midline of the trunk);

- pronounced lumbar lordosis (with a pelvic tilt in the sagittal plane of 30° or more);

- shoulder blades shifted towards each other and asymmetrically located, etc.

The above reasons, when using only the natural posture of patients, lead to a relatively high percentage (from 10 to 20%) of false positive results of the topographic screening test (TST) for structural scoliosis.

To increase the efficiency of structural scoliosis screening, in addition to the natural posture (posture 1), researchers have developed special functional postures for examining patients in a standing position. These postures correspond to different degrees of flexion-extension of the spinal column in the sagittal plane, namely:

- “active pose” - in the “attention” position with a straight back and a drawn-in stomach (pose 2);

- a pose with a maximally flattened lumbar lordosis (pose 3);

- a pose with maximally increased lumbar lordosis (pose 4);

- a pose with the shoulder blades spread apart as much as possible, arms lowered down in front of the body with the elbow joints brought together (pose 5).

The study (Sarnadskiy V.N., Fomichev N.G. Screening diagnostics of childhood and adolescent spinal pathology using computer optical topography. - Manual for doctors of the Ministry of Health of the Russian Federation. - Novosibirsk, NIITO. - 2002, 36 p.) showed that the use of functional poses in diagnostics allows solving the problem of the high percentage of false-positive results of the topographic screening test for structural scoliosis. At the same time, due to the complete automation of the process of processing patient images on the TODP device, the labor intensity of screening using additional functional poses increases insignificantly.

Accurate identification of the nature of local pathological changes in the lesion and the extent of the pathological process traditionally belongs to X-ray examination of the spine.

Modern diagnostic systems CT, MRI, ultrasound provide valuable data on the local pathomorphology of the anatomical structures of the spine and are taken into account by clinicians. Even a classical X-ray examination of the spine, carried out methodically correctly, allows us to evaluate the spine as a single multi-structural system reflecting the individual characteristics of biomechanics, statics and human movement. All these data complement each other, helping the rehabilitation process (Fedotova Z.I., Pershin A.A. Review of methods for studying trunk deformation and deformation indices in scoliosis // Physical and rehabilitation medicine. - 2020. - Vol. 2. - No. 2. - P. 35-50. DOI: 10.26211/2658-4522-2020-2-2-35-50).

However, many well-known domestic and foreign methods for measuring spinal curvatures in general are either loaded with ionizing radiation or require rather bulky equipment and serious hardware and software (Scoliosis @ Knott at al. - licensee BioMed Central Ltd. 2014: SOSORT 2012 consensus paper: reducing x-ray exposure in pediatric patients with scoliosis. DOI: 10.1186/1748-7161-9-4).

Previously, we proposed a method for diagnosing scoliosis, which includes a number of stages (Levkov V.Yu., Polyaev B.A. "Conscious correction of scoliosis and posture disorders" (based on the German method of Katharina Schroth), scientific and practical guidance. M. 2020. 144 p.), including a number of positions. First, an examination is carried out in a standing position, lying down and in a forward bend position (Adams test), paying attention to the position of the head, shoulders, angles of the shoulder blades, waist triangles, symmetry of the ribs and pelvis, the position of the shins and ankles and the feet themselves.

Next, the Trendelenburg test allows us to determine the stability of the hip joint and the patient's ability to hold the pelvis in a standing position on one leg. In this position, the pelvis normally rises on the side of the raised leg. This test is considered positive if the pelvis drops on the side of the raised leg, which indicates weakness of the gluteus medius.

Since pelvic stabilization is one of the main tasks in the treatment of three-dimensional spinal deformities, and is of primary importance in lumbar scoliosis, this test is necessary for the optimal individual selection of exercises.

According to our observations, a positive Trendelenburg test occurs in more than half of patients with S-shaped or lumbar idiopathic scoliosis of 2-4 degrees on the side of the lumbar arc of curvature and in approximately 35% on both sides.

When examining standing, from the side, it is necessary to evaluate the sagittal profile of the patient, i.e. the severity of the physiological curves of the spine: cervical and lumbar lordosis and thoracic kyphosis. Pay attention to possible asymmetry of the shoulders. One shoulder may protrude forward.

When examining standing, from the front as well as from behind, the main criteria are assessed: the position of the head, shoulders, waist triangles, symmetry of the ribs and pelvis, the position of the shins, ankles and feet.

When examining in a tilted position (Adams test), the patient is asked to bend forward without bending the knees, arms hanging freely. The severity of asymmetry, the presence or absence of a costal hump in the thoracic and lumbar spine, and the presence of pelvic tilt are assessed visually and by palpation.

Additionally, during scoliometry, using a scoliometer, it is possible to measure the rotation of the vertebrae. The scoliometer is placed on the spine in the area of the 7th cervical vertebra (in the position of the patient's forward bend), then the scoliometer is moved down the spine. The maximum deviation is noted, its size in degrees and localization are recorded. For greater accuracy, this examination is repeated 2-3 times, allowing the patient to rest in an upright position.

For S-shaped scoliosis, rotation is measured for the thoracic and lumbar spine.

Scoliometry makes it possible to quickly and reliably determine the presence of rotation in the spine and take timely and necessary measures to prevent further progression of the disease.

When examined in a supine position, the human spine is not subject to axial gravity, so the signs of deformation that are determined in a vertical position may change. In the case of a significant reduction in rib deformation and equalization of muscle tone in a horizontal position, it can be considered that the disease is unstable. This is confirmed by an additional X-ray taken in a supine position.

With the patient lying on his stomach, the tone of the paravertebral muscles and the position of the ribs (presence of a rib hump) are assessed by palpation, comparing with the examination in a standing position. A test is performed to determine the strength of the back extensor muscles.

When examining the patient lying on the back, the position of the ribs and pelvis is assessed. A rib hump and pelvic tilt may be present. The length of the lower limbs is assessed and compared. In the presence of lumbar curvature, a relative shortening of the lower limb on the side of the curvature arc is possible.

A test is conducted to determine the strength of the abdominal muscles.

However, without an X-ray examination, it is impossible to establish an accurate diagnosis. The doctor should correctly indicate the type of examination and especially the boundaries of the examination. The optimal option is a survey digital image in a standing position in a direct projection with the boundaries of Th2-L5, including the iliac crests. If necessary (if a violation of the sagittal profile was detected during the examination), an X-ray is taken in a lateral projection. An X-ray in a lying position in a direct projection can only be taken as an additional study to determine the mobility/stability of scoliotic deformation. When prescribing corset treatment to a patient (Chenot corset), a control X-ray is taken 2-3 months after the start of wearing the corset. It is performed in a corset standing in a direct projection.

Previously, for the purposes of screening diagnostics of scoliosis in children and adolescents, as part of a poster report at the XII All-Russian Congress of Traumatologists and Orthopedists (December 1-3, 2022), we proposed an original technique (“Experience in using an original scoliometry technique for screening examinations of the spine of schoolchildren and students”, https:/www.rosturner.ru/wp-content/uploads/2022/11/prog.pdf, as well as patent RU 2809449 C1, 12/11/2023, Levkov V.Yu., Chogovadze G.A., Polyaev B.A., Eremushkin M.A., Panyukov M.V. et al.). The purpose of the method was to develop criteria and determine the functionality and limitations of the original method of screening examination of the spine in children and adolescents in conditions of limited time for an orthopedist appointment (in a clinic) or very limited time (during mass screening examination of children during medical examinations in schools and colleges, during medical examinations of young athletes, dancers, ballet dancers, circus performers, and variety artists).

The stages of implementation of this well-known technique are:

0 - starting position (SP) standing, legs straight (do not bend at the knees!), feet parallel, with the width of a foot between them;

1 - first tilt the head (chin to chest), find and set the scoliometer to level C7 (start of measurements);

2 - gradual tilt of the patient's body forward, rounding the back (without raising the head, shoulders relaxed, arms hanging freely towards the floor in front of the toes);

3 - touching the floor with the patient's fingertips in front of the toes (in case of dysplastic syndrome - also touching only with the fingertips).

In this process, the scoliometer readings are read perpendicular to the longitudinal axis of the spine when the corresponding section of the back reaches a horizontal position (in the frontal plane of the body), with the doctor standing behind and to the side of the patient. Scoliometer measurements are taken at a number of fixed reading levels (anatomical landmarks of 5 zones): C7 (spinous process of the vertebra), the middle (interspinous line) of the shoulder blades, the lower angle of the shoulder blades, the edge of the costal arches (level Th12-L1), L4 (iliac crests).

The difference between this method and others is that measurements are taken not in a fixed position of the back tilt during the Adams test, but in a functional state - directly during the tilt, but not during the patient's movement, but discretely, intermittently - at moments of a brief stop of this movement at certain levels of the spine. Such discreteness allows the patient's attention to be distracted from the movement itself and, accordingly, does not give him the opportunity to change muscle tone, as is possible with continuous movement, especially in active children of primary school age.

The diagnostic results include information about the type (“S”, “C”), direction (“-”, “+”), severity of scoliotic deformation (specific digital values in degrees), and the functional state of the spine (by placing a “?” sign).

The torsion values are taken into account: up to 3 degrees is normal, the range of readings from above 3 to 5 is a posture disorder, more than 5 degrees is a scoliotic deformity.

When using this well-known screening method, there are no factors harmful to the body (no exposure to ionizing radiation), the measuring device is compact and mobile, known and easily identifiable (visually and by palpation) anatomical landmarks are used, speed and variability of implementation are ensured with ease of assessing changes in dynamics (when monitoring treatment or during the child's growth). At the same time, the final research protocol is intuitively understandable for a quick visual assessment of the type, degree of severity of scoliotic deformation, and the functional state of the spine.

Limitations may include preschool age, impaired contact with the patient (due to the presence of psychosomatic disorders) and severe pain in the back.

In the proposed method of differentiated ACS, we have slightly modified this screening diagnostics, as will be shown below.

The proposed screening diagnostics method can be used from the age of 6 years in children, school-age adolescents, and later, at an older age (the boundary of childhood is now 17 years 11 months 28 days, i.e. up to 18 years).

In our work we use a scoliometer created with the support of RASMIRBI - the Russian Association for Sports Medicine and Rehabilitation of the Sick and Disabled (https://skolios.ru/skoliometriya).

This device allows objective and quantitative diagnostics of rotational changes in the spine, which is of great importance both in the early stages of diagnostics (detection and initial diagnosis) and in the process of treatment and dynamic observation. However, other suitable scoliometers can also be used.

As for idiopathic scoliosis (IS), it is a disease whose etiology has not yet been fully established, however, it is believed that the cause of IS may be a protective compensatory reaction of the body to excessive growth of the bones of the spinal column in relation to the growth of the spinal cord (M.G. Dudin, D.Yu. Pinchuk. Idiopathic scoliosis: diagnostics, pathogenesis. 2009). Deviations in the functional state of the body's control systems - nervous and endocrine - occur, excess bone growth of the spine is eliminated by turning and shifting the vertebrae to the side. Arguments are also made about the role of genetic factors in the development of IS.

One of the most difficult to correct types of IS and the most common is S-shaped combined scoliosis with 2 arcs of curvature, divided into 3 subtypes: with identical arcs of thoracic and lumbar curvature, with a more pronounced thoracic arc than lumbar, and with a more pronounced lumbar arc than thoracic. The thoracic arc is most often right-sided, and the lumbar arc is left-sided.

This type of IS is most often found in adolescents - from the age of 10 years until the end of active skeletal growth (up to 16-18 years). This type refers to the most common period of the debut and progression of the disease, which requires regular examinations 2-3 times a year in order not to miss the beginning of progression. In turn, in the group of adolescents, this type of IS is most often observed in girls.

There are various therapeutic exercise complexes, including proprietary ones, using specially developed devices for certain types of scoliosis (Complex treatment of scoliosis in children. Proceedings of the scientific and practical conference with the international scientific center. St. Petersburg, September 19, 2018. Electronic text publication. St. Petersburg: Science-intensive technologies. 2018. 133 p; RU 2329014 C2, 20.07.2008, Kholostov Yu.V. et al.; RU 2166922 C2, 20.05.2001, Nizhny Novgorod State Research Institute of Traumatology and Orthopedics), sometimes used in combination with other treatment methods - massage, physiotherapy, breathing techniques, manual therapy (SU 1806698 A1, 07.04.1993, Clinic of traditional medicine of Dr. A.I. Sukhanov).

Katharina Schroth gymnastics (Schroth therapy) is well known - the main method of conservative therapy for scoliosis in Germany and in Europe as a whole since the beginning of the 20th century (Timinko A.V. Katharina Schroth gymnastics for scoliosis: the basic principle of action and exercise performance. 10/15/2018. Electronic resource: https://spinatitana.com/pozvonochnik/grudnoj-otdel/skolioz/gimnastika-katariny-shot-pri-skolioze-osnovnoj-printsip-dejstviya-i-vypolneniya-uprashnenij.html).

Schroth therapy helps stop the progression of scoliosis, reduce the angle of curvature of the spine, even out muscle tone, and improve posture. This is a set of special isometric exercises based on controlled asymmetric breathing. These exercises are aimed at correcting pathological curvatures of the spine in 3 planes: frontal, horizontal, and sagittal. Schroth developed her own classification of scoliosis, several effective specific exercises, and called it all "Three-dimensional correction of scoliosis." This gymnastics is called respiratory orthopedics according to the K. Schroth method.

Its principles are as follows. With scoliosis, asymmetrical pathological breathing is observed - most of the air enters the convex half of the chest, due to which the curvature of the spine increases, a costal hump is formed. According to K. Schroth, the body of a patient with scoliosis resembles a ball with a dent. If you fill the ball with air, the dent will straighten out. In the same way, the concave part of the human body can straighten out under air pressure.

Thus, if you consciously breathe through the concave side of the chest, you can prevent further curvature of the spine and achieve a significant reduction in the angle of displacement in scoliosis.

The intercostal muscles obey the commands of consciousness in the same way as the muscles of the limbs. In other words, conscious regulation of breathing is possible in both adults and children.

Correction should be gradual: from the third stage of scoliosis to the second, from the second stage to the first, from the first stage to complete recovery. Scoliosis of the 4th degree is not always amenable to correction and even more so - to recovery. However, to achieve a stable positive result, it is necessary to repeat the courses: for children - once a year, for adults - once every 2-3 years.

Before the gymnastics, the doctor assigns the patient a corrective initial position (CIP): on the floor, lying on the side or back, standing or sitting with the use of auxiliary means (gymnastic wall, poles, ball, roller). The patient performs the exercise, trying to make the maximum stretching effort on inhalation - this helps to increase the distance between the ribs and bring them to the correct position.

The patient exhales through half-pressed lips and performs an exercise, the purpose of which is to reduce the distance between the ribs on the convex side. On exhalation, an exercise is performed that reduces the distance between the ribs on the convex side.

Since the exercises are repeated many times, after some time of training the patient takes the position corrected by the doctor consciously, and without the presence of the doctor and mirrors.

Gymnastics classes are conducted individually. The patient lies on his stomach, and the doctor-instructor lightly massages the depressed area so that the patient focuses his attention on it and remembers its location.

Then the doctor asks the patient to inhale with the retracted part of the body. To do this, the doctor first places his hand on the patient's body, then holds it in the air; in the first case, the patient should lift the doctor's palm, then touch it with his back.

The patient exhales through semi-compressed lips. The exhalation should be long, which helps to increase the resistance to exhalation, training the intercostal muscles. When exhaling, the doctor can press on the convex areas, stimulating the muscles of these areas, contracting the muscles, reducing the intercostal distance on the convex side. With this type of breathing, the patient understands which areas of the body need to be used when exhaling, and which - when inhaling. The effectiveness of the training is significantly increased if:

- the patient maintains the body position prescribed by the doctor, as this helps to better work the muscles and correct the scoliosis arc;

- each exercise is performed at least 24-30 times a day, while the patient must monitor the progress of the training using mirrors;

- during gymnastics the patient drinks at least one liter of water.

Regular performance of Schroth gymnastics (at least 3 times a week for 2 hours a day) during periods of wearing a corset and after its discontinuation helps to achieve optimal correction of the deformation in the corset, develop a stereotype of consciously taking the correct position, even in the absence of orthopedic devices, and consolidate the effect of therapy.

Earlier in the publication of the authors: Levkov V.Yu., Polyaev B.A. Conscious correction of scoliosis and posture disorders (based on the German method of Katharina Schroth), scientific and practical manual, M, 2020, 144 p., (prototype method, closest analogue), the author's program of conscious correction of scoliosis (OCS) was also described, which combines a number of IS rehabilitation methods:

- local controlled breathing and individualized selection of derotational exercises, based on the K. Schroth method, which the patient, after training, can perform independently throughout his life to maintain the therapeutic effect;

- elements of corrective Vojta therapy to activate the deep muscles of the back and teach the patient new, adaptive movement patterns;

- the author's set of exercises "Balance-Coordination";

- analysis and correction of the patient’s daily motor skills;

- in the OKS complex, each exercise and movement is selected for the scoliotic deformation of a specific patient so that he can understand what and why he is doing, which increases motivation for exercise and improves the results of rehabilitation.

The prototype method is intended for correction of scoliosis of various types and localizations in children of different sexes and ages. It reveals techniques for teaching local breathing - conscious, controlled, directed breathing into specific areas of the chest. It is necessary to first teach the patient to visualize a deep breath, i.e. the process of air entering sequentially into all sections of the respiratory system from the nose to the final sections of the alveoli of the lungs (p. 45 of the prototype).

To do this, the process is first visualized symmetrically, then - depending on the specific deformation of the spine - with an emphasis on a specific respiratory area (zone), helping by pressing with the hand of the assistant/doctor on the interested area of the chest for the voluntary activation by the patient of the intercostal muscles of this area.

In S-shaped scoliosis, 3 respiratory zones are distinguished, directed breathing into which helps to correct a certain type of IS. If the thoracic and lumbar curves of curvature are approximately equal (p. 48 of the prototype), or the thoracic curve is greater than the lumbar one, then the main respiratory zone is the back of the chest, opposite the thoracic curvature (usually on the left). Directed breathing usually begins in one main zone, then adding breathing into the other zones (p. 45-48 of the prototype).

If the lumbar curve is noticeably larger than the thoracic curve, then the back of the chest, opposite the lumbar curvature (usually on the right), is taken as the main breathing zone. Then training begins with this zone.

The third respiratory zone is considered to be the right anterior upper region of the chest.

The main breathing zone (zone 1) in thoracic IS with a right-sided arc is the back of the chest, opposite the thoracic curvature (i.e., on the left). According to the prototype (pp. 48, 91), directed breathing exercises begin with it. The second breathing zone (pp. 4 5-48, p. 76 of the prototype) is the area of the lower chest on the right - i.e., opposite the curvature arc in the lumbar region, which is used in the proposed modified method of correcting lumbar scoliosis.

When mastering directed breathing within the framework of the prototype method, they move on to performing preparatory stretching exercises.

The technical task of the proposed complex method of differentiated conscious correction of idiopathic scoliosis (DCI) was the correction of idiopathic scoliosis with a transition to a less pronounced degree in children and adolescents through the use of screening diagnostics of its form and localization and the performance of a number of specified exercises with conscious breathing, which, depending on the localization and direction of the apex of the curvature arc identified during diagnostics, as well as on the degree of curvature, allows systematically, with the help of consciously directed inhalation (EDI), performed in the corrective initial position (CIP) before performing the specified exercises, alternating with exercises performed on free breathing, to straighten the corresponding area of the chest, respectively, reducing the arc of scoliosis.

The technical result of the proposed method is the simplification and integration of various exercises intended for the conscious correction of various types of scoliosis into a complete system, with the modification of both the screening diagnostics of the IS (to simplify and speed it up) and the exercises performed, so that they are most suitable (understandable) for children of any age from 6 to 18 years old with any localization and type of scoliosis (thoracic, lumbar, combined), without loss of effectiveness, with the exclusion of a number of physically complex exercises and the addition of conscious breathing (OB) to a number of exercises, a change in the number of approaches in the exercises, as well as the addition of new, modified exercises, with the ultimate transition to a less pronounced degree of scoliosis in children and adolescents.

In order to achieve the specified technical result, we have proposed a method of differentiated conscious correction of idiopathic scoliosis (ICS) in children and adolescents using physical exercises taking into account the results of diagnostics, characterized in that screening diagnostics of the condition of the spine is carried out at the initial consultation using a scoliometric study in the position of the patient bending forward and downward from the initial position (IP) standing straight, legs straight, feet parallel and at the width of a foot from each other, the doctor stands behind and to the side of the patient,

to do this, the doctor takes measurements and records in the examination protocol the readings of the scoliometer in its position in the vertical plane, perpendicular to the horizontal, passing through the anatomical landmarks - the spinous processes of the patient's vertebrae,

and the doctor stands behind the patient at the side - in a vertical plane located at an angle of 45 degrees to the sagittal plane of the patient's body,

and the patient's forward tilt is discrete - intermittent,

and the measurement and recording of the scoliometer readings is performed at each stop of the patient's intermittent movement during forward bending - upon reaching the position of the scoliometer in the vertical plane perpendicular to the horizontal plane passing through the corresponding anatomical landmark, with one finger of the doctor's hand first placed on the next anatomical landmark, and then the scoliometer is moved to this level,

in this case, the patient's discrete forward tilt is carried out first from the IP standing straight, with the patient's head tilted with the chin to the chest,

then, in the same position of the patient, the middle of the scoliometer is moved to the spinous process of the Th3 vertebra, and the patient continues to bend forward with the body,

upon reaching the horizontal plane at the level of the Th3 spine, the patient, on command from the doctor, stops the movement to take and record the readings of the scoliometer located in the vertical plane;

then the patient continues to bend the body forward, rounding the back, without raising the head, the shoulders are relaxed, the arms hang freely towards the floor in front of the toes, and when the Th7 spine level reaches the horizontal plane, the patient again stops the movement at the doctor's command to take and record the readings of the scoliometer, located in the vertical plane at the Th7 spine level;

using similar techniques, the patient continues to tilt forward and the patient’s movement is consistently stopped upon reaching horizontal planes that pass, respectively, through the subsequent anatomical landmarks Th12 and L4 to take readings at these levels from a scoliometer located in a vertical plane;

for each examined level of the spine, the deviation of the scoliometer readings from the median value is recorded in degrees, rounding off the tenths to a larger whole number, indicating the direction: “minus” - for a deviation to the left, “plus” - for a deviation to the right,

and if deviations are more than 5.0 degrees, idiopathic scoliotic deformation of the spine is diagnosed at the corresponding level - thoracic and/or lumbar, and the presumed degree of scoliotic deformation of the spine and the direction of the arc of deformation of the spine are established based on the magnitude of the deviation range in degrees;

then they begin conscious correction of scoliosis (CCS), which is the daily performance of a set of gymnastic exercises and exercises with conscious breathing,

where conscious breathing is a cycle of exhalation with resistance - through semi-compressed lips, lasting 8 seconds, and conscious directed inhalation (CDI), which is an inhalation with expansion of the area of the chest that is opposite the apex of the scoliotic arc, with the doctor focusing the patient's voluntary attention during CDI on the work of the intercostal muscles of this area of the chest by pressing with the hand on its projection on the back surface of the chest;

In this case, the set of gymnastic exercises consists of the following, performed daily; the first exercise is the initial one, the 14th is the final one, and the remaining exercises are performed between them in a free sequence:

1) “Half-hanging on a wall bars” - an exercise from the corrective IP (KIP): standing close to the wall bars, toes placed under the lower crossbar, arms extended upward, palms resting on the bar, which is one bar lower than the one the patient can reach,

the patient's arms are positioned wider than the shoulders, and the feet and knees are at the width of the patient's pelvis,

holding onto the bar with his hands, the patient hangs, pressing his knees to the lower bars and relaxing as much as possible,

then - return to the KIP and repeat the exercise while hanging one bar lower than the previous one, with knees bent, then - return to the KIP again and do another repetition one bar lower than the previous repetition,

the duration of the hang is 10-20 seconds while the patient maintains physiological lumbar lordosis,

perform 3 sets of 3 planks from top to bottom in each set, rest pause between sets is 30 seconds, the patient's breathing is free when performing this exercise;

2) "Stretching the inner thigh" - an exercise with ONV, which is performed from the KIP: sitting on the buttocks on the mat, legs bent at the knees, knees spread apart, feet with plantar surfaces touching each other in front of the patient, palms of straightened arms lying on the floor behind the buttocks,

while performing the exercise, the patient pulls the feet together as much as possible, trying to lower the knees down, while simultaneously straightening the back as much as possible, pushing off the floor with the hands, lowering the shoulders and stretching the crown of the head upwards,

while doing this, they perform conscious breathing:

in KIP they perform exhalation with resistance, and when performing the exercise they perform ONV,

do 4 sets of five inhale-exhale cycles in each set, rest pause between sets - 30 seconds;

3) “Stretching the back of the thigh and hamstring” - an exercise that is performed from the KIP: lying on the back on a gymnastic mat, the patient’s straight legs are freely extended,

using a sports band, thrown over the middle of the arch of the foot, the patient pulls the straight leg towards himself by the ends of the band, raising it to the vertical, until pain occurs,

the exercise is performed alternately, 3 approaches for each leg - 6 approaches in total, breathing is free, the rest pause between approaches is 30 seconds;

4) "Balance", which is a stabilization exercise performed using a balancing board, the length and width of which are 2 cm larger than the corresponding dimensions of the patient's foot, and which has a semi-cylinder with a diameter of 2 cm rigidly fixed along the longitudinal axis of the board on its lower surface, which, when the patient stands on the board with one foot, creates a balancing effect, while the other leg is moved back by bending at the knee joint by 90 degrees;

while doing this, pull the crown of the head upward as much as possible, lower the shoulders, bring the shoulder blades together medially, draw in the stomach, try to lower the right buttock, pulling up the opposite buttock, hold the balancing position for as long as possible for the patient, then change legs;

During the exercise, 3 approaches are performed for each leg, the patient's breathing is free, the rest pause between approaches is 10 seconds;

5) “Astride a chair” - an exercise with ONV, in which a chair with a straight back is used,

KIP - sitting "astride" a chair, facing its back, the patient rests his forearms on the back of the chair, legs spread apart,

In CIP, the patient performs ONV, and during exhalation with resistance, simultaneously performs the following actions:

- lowers his shoulders,

- presses his forearms on the back of the chair,

- pulls the crown of the head upward as much as possible,

- tenses the abdominal muscles, pulls in the stomach and ribs,

perform 4 sets of 8 inhalation-exhalation cycles in each set, rest pause between sets - 30 seconds;

6) “Corrective gait” - an exercise with ONV, which is performed from the KIP: standing, feet together, the patient pulls the crown of the head up, the chin line is along the horizon line, the shoulders are lowered and turned back, the thumb of the lowered right hand is turned outward as much as possible, the palm is turned forward as much as possible, the stomach is pulled in, consciously trying to maintain a straight posture,

the movement begins with any leg, take a step forward and place the foot forward on the heel at a distance of 10 cm from the toes of the other foot - on the count of one,

then move the stepped leg back, placing it on the toes at a distance of 10 cm from the heel of the second leg - on the count of two,

then repeat the forward movement with the first leg on the heel - on the count of three,

again repeat the movement with the same leg back onto the toes - on the count of four,

then they put the first leg forward again and transfer the body weight onto it, taking a full step - on the count of five, then they repeat the listed movements with the second leg in the same way,

in KIP they perform ONV, and when performing a step - exhalation with resistance,

perform 30 times, 5 counts for each leg;

7) "Corrective gait with breathing" - an exercise with ONV, which is performed from the KIP: standing in front of a mirror at a distance of 5 meters from it, hands on the waist, the crown of the head is pulled up, shoulders are lowered and turned back, the stomach and pelvis are pulled inward; while the first leg in the KIP is one step ahead of the second;

the movement begins with any leg, taking a step forward with the second leg onto the heel and immediately moving it onto the toes, lowering its foot, leaving the first leg behind on the toes,

then take a step forward with the first foot onto the heel and immediately move into support on the toes for both feet;

while rising on the toes of both feet, perform ONV for 3 seconds, stretching the crown of the head upward as much as possible, and exhale with resistance for 5 seconds during the subsequent lowering of both feet onto the entire surface of the feet,

when taking steps, the distance from the toes of the leg standing behind to the heel of the leg standing in front should not exceed half the length of the foot;

perform the exercise for 3-4 minutes at a pace comfortable for the patient;

8) "Rubber band pull from above" - an exercise that is performed from the KIP: sitting on a bench in front of the Swedish wall facing it, legs crossed at ankle level, knees fixed between the bars of the Swedish wall, in the hands - a rubber expander, fixed by the middle to the upper bar of the Swedish wall,

holding onto the free ends of the expander, as you exhale, pull down towards your chest in front of you, as you inhale, release the expander upward, perform 3 sets of 12 repetitions;

9) “90-degree core press” - an exercise that is performed from the KIP: lying on your back, legs raised and bent at the hip and knee joints at 90 degrees, straight arms raised vertically above your head,

the patient raises his head, shoulders and shoulder blades, stretches his arms upwards as he exhales; lowers his arms, returning to the CIP, breathing is free,

in this case, first perform 3 sets of 15 repetitions of the inhalation-exhalation cycle in each set, rest pauses between sets are 30 seconds, every day add 1 inhalation-exhalation cycle in each set, bring it up to 30 inhalation-exhalation cycles in one set and then continue in this mode;

10) "Oblique abdominal press" - an exercise that is performed from the KIP: lying on your back, legs, half bent at the knees, are raised so that the feet are 20 cm above the floor, arms are bent at the elbows in front of you, hands are towards the ears, the head and shoulders are raised 20 cm from the floor,

the patient, holding himself in this position, then touches his left knee with his right elbow, while straightening his right leg at the knee, maintaining a 45-degree flexion angle in the right hip joint,

then touches the right knee with the left elbow, changing the position to mirror the previous one,

breathing is free, first perform 3 sets of 20 inhalation-exhalation cycles in each set, rest pauses between sets are 30 seconds,

every day add 1 inhalation-exhalation cycle in each approach, bring the total number of inhalation-exhalation cycles to 30 in one approach and then continue in this mode;

11) “Correct squats” - an exercise that is performed from the KIP: standing in front of a mirror, feet wider than shoulder-width apart, using a gymnastic stick to fix the thoracic spine as symmetrically as possible - placing the stick horizontally on the shoulders, holding it with a rear grip of both hands, located wider than shoulder-width apart,

from the KIP, they squat until the pelvis drops to the level of the knees, so that the thigh is parallel to the floor, support is on the entire foot, without lifting the heels off the floor, while maintaining the physiological curves of the spine,

when squatting, inhale normally, when rising, exhale normally,

start with 3 sets of 15 inhalation-exhalation cycles in each set, increasing the inhalation-exhalation cycle in each set daily by 1, bringing the total number of inhalation-exhalation cycles to 30 in each set and then continue in this mode, with a rest pause between sets of 30 seconds;

12) “Classic plank” - an exercise that is performed from the KIP with support on the toes and elbows, which are placed under the patient’s shoulder joints, and the forearms, which are extended forward along the horizontal surface of the support, the patient holds the torso in this position straight:

- maintains natural lumbar lordosis,

- tries to keep the pelvis symmetrical relative to the sagittal plane

bodies,

- the crown of the head is pulled as much as possible along the longitudinal axis of the body, maintaining the central position of the head,

start with one approach with the maximum possible duration of the patient holding the plank position, then add 1 approach daily, bringing it up to 4 approaches and then continue in this mode, the rest pause between approaches is 30 seconds, breathing is free;

13) “Knee balance on a ball” - an exercise with ONV, during which the patient maintains balance on a gymnastic ball-fitball, the exercise consists of three stages:

- first, the patient holds onto the wall bars with his hands and kneels on the ball, on which he tries to stay,

- then tries to stay on the ball, releasing his hands from the wall bars,

- the patient climbs onto the ball with his knees and stays on it,

perform 3 approaches with sequential execution of three stages of the exercise against the background of conscious breathing - ONV and exhalation with resistance, at a pace comfortable for the patient, rest pause between approaches - 30 seconds;

14) “Final hang on the wall bars” - the exercise is performed as a repetition of the first exercise of the complex;

moreover, if the degree of scoliotic deformation of any localization with a scoliotic arc value of more than 5 degrees is established during screening diagnostics, X-ray diagnostics are performed,

and if the magnitude of the scoliotic arc is confirmed by radiography to be 20 degrees or more, a functional-corrective Cheneau corset is worn daily after completing a set of exercises for at least 20 hours a day; the corset is worn until the patient's skeletal ossification is achieved according to the radiographic criterion - level 5 according to Risser.

Additionally, in case of isolated thoracic scoliosis with a right-sided apex of the scoliosis arc, ONV is performed in the left posterior zone of the chest and the following exercises are performed before exercise 14:

- "Chest stand with supports", which is an exercise that is performed from the KIP: standing facing the mirror, each hand grasps vertically placed sticks with a length equal to the length of the patient's body with arms extended upwards;

the patient's feet are on the floor on the inside of the sticks, parallel to each other, the heels are at the width of the hip joints,

the right hand grasps the stick so that the right elbow and shoulder are at the same horizontal level, the elbow is pressed against the stick,

with the left hand grasp the stick so that the left elbow is at ear level, and the body and head are in the middle between the sticks;

shoulders are not raised up, they stand straight and steady, the position of the head is straight, the chin line is level with the horizon line,

In the KIP, ONV is performed in the left posterior zone of the chest, and during exhalation with resistance, the following actions are performed simultaneously:

- they press down with sticks,

- press on the sticks with your right elbow,

- stretch your elbows to the sides,

- shoulders don't rise,

- pull the crown of the head upwards as much as possible,

- maintain a stable position,

- tighten the stomach and ribs;

perform 4 sets of 8 inhalation-exhalation cycles in each set, rest pause between sets - 30 seconds;

- “Lying on the left side with a chair”, which is an exercise with ONV, performed from the KIP: lying on the left side on a mat, the patient’s head is under the chair, the neck is between the legs of the chair,

the right arm, bent at the shoulder and elbow joints, lies with the palm on top of the chair seat, resting against it, the left arm is extended along the longitudinal axis of the body under the chair between its legs,

the patient's left leg is bent, the right leg is straight, extended along the body axis, the foot and ankle are placed on a hard object placed under it at a height that ensures the longitudinal axis of the right leg is parallel to the vertical axis of the patient's torso,

the patient's head rests on the left outstretched arm,

perform conscious breathing, for which in the KIP they perform ONV in the left rear zone of the chest, and during exhalation with resistance simultaneously:

- the crown of the head is pulled forward as far as possible along the axis,

- pull in your stomach and ribs;

- leaning your right palm on the chair, pull your right elbow up and forward,

- while doing this, the torso, pelvis, right thigh and foot are kept in one line,

and by the beginning of the next ONV, relax the right arm and shoulder, return to KIP;

perform 4 sets of 8 inhalation-exhalation cycles in each set, rest pause between sets - 30 seconds;

- "Chest correction on a ball at the wall bars", which is an exercise with ONV, correcting the thoracic spine through asymmetrical muscle work,

This exercise is performed from the following KIP: sitting on a gymnastic fitball facing the wall bars,

the size of the ball is such that when sitting on it, the patient's pelvis is located above the level of his knees, the patient's feet with the entire plantar surface are under the lower crossbar of the wall bars, the knees touch the crossbar of the wall bars located above the knees;

the right hand is placed on the crossbar at shoulder level, the left hand is placed on the crossbar, which is at the level of the crown of the head, the elbows are straightened to the sides, the shoulders are lowered, the patient rotates the pelvis backwards, maintaining the physiological lordosis and kyphosis of the spine;

carry out conscious breathing, for which in the KIP they perform ONV in the left rear zone of the chest, and on exhalation with resistance they perform the following simultaneous actions:

- with his right hand the patient pulls the bar towards himself,

- with the left hand the patient pulls the crossbar towards himself and down,

- tries to bring his chest closer to the wall bars,

- pulls the crown of the head upward as much as possible, while the chin line corresponds to the horizon line,

- the patient springs on the ball with the maximum amplitude possible for him, elbows straightened to the sides,

- the patient pulls in his stomach and ribs,

perform 4 approaches with 8 inhalation-exhalation cycles in each approach, rest pause between approaches - 30 seconds, during pauses maintain KIP;

- "Lying on the side of the thoracic arch", which is an exercise with ONV, which is performed from the KIP: the patient lies on his right side - on the side of the thoracic arch of curvature, a massage roller with a diameter that provides passive correction of the patient's thoracic arch in the frontal plane is placed under the apex of the arch,

the patient's arms are extended upward, the head is between the arms, resting on the shoulder of the right arm, the right leg is bent at the knee and hip joint at 90 degrees, the right heel is in front of the knee of the left leg, the left leg is straight;

in this case, in the CIP, ONV is performed in the left posterior zone of the chest, and during exhalation with resistance, the patient, grasping the wrist of the left hand with the right hand, by pulling it upward, along the longitudinal axis of the body, stretches the left side of the chest, drawing in the ribs and abdomen as much as possible; by the beginning of inhalation - return to the CIP;

perform 4 sets of 8 inhalation-exhalation cycles in each set, with a 30-second rest break between sets.

Additionally, in case of combined thoracolumbar scoliosis with a right-sided apex of the arc in the thoracic and a left-sided apex of the arc in the lumbar spine, ONV is performed simultaneously in both zones of the chest - in accordance with the existing direction of each of the two apexes of the scoliotic arc,

in this case, before exercise 14, the following exercises with ONV are additionally performed:

- “Combined stand with supports”, which is an exercise with ONV, which is performed from the KIP: standing facing the wall bars, each hand grasps the vertical supports of the wall bars with its hand, which are located wider than the patient’s shoulders;

the patient's feet are on the floor on the inside of the wall bars parallel to each other, the heels are under the hip joints, the left leg is straight, the right leg is bent at the knee joint, the pelvis is turned backwards while maintaining the physiological lordosis of the lumbar spine,

with the brush of the right raised hand, grasp the vertical support of the Swedish wall at the top so that the right elbow and shoulder are at the same horizontal level, the right elbow is pressed against the vertical support of the Swedish wall;

with the brush of the left hand hold the vertical support of the Swedish wall higher so that the left elbow is at ear level,

the patient tries to maintain a symmetrical position of the body and head between the vertical supports of the wall bars,

In the KIP, ONV is performed simultaneously in both zones of the chest located behind the arcs of scoliotic deformation, and during exhalation with resistance, the following actions are performed simultaneously:

- press down on the vertical supports of the wall bars with your hands and elbows,

- shoulders are not raised,

- the crown of the head is pulled upward as much as possible,

- stand firmly, - pull in your stomach and ribs,

- try to lower the right buttock below the left;

perform 4 sets of 8 inhalation-exhalation cycles in each set, rest pause between sets - 30 seconds;

- “Combined correction on a ball at the Swedish wall”, which is an exercise with ONV, performed from the KIP: sitting on a fitball facing the Swedish wall, the size of the ball is such that when sitting on it the patient’s pelvis is located above the level of his knees,

the patient's feet are placed with their entire plantar surface under the lower bar of the wall bars, the knees touch the bar of the wall bars located above the knees;

the right hand is placed on the crossbar at shoulder level, the left hand is on the crossbar, which is at the level of the crown of the head, the elbows are straightened to the sides, the shoulders are lowered, the right buttock is lower than the left,

the patient rotates the pelvis backwards, maintaining physiological lordosis and kyphosis of the spine;

In the KIP, ONV is performed in both zones of the chest located behind the arcs of scoliotic deformation, and during exhalation with resistance, the following simultaneous actions are performed:

- with his right hand the patient pulls the crossbar towards himself,

- with the left hand the patient pulls the crossbar towards himself and down,

- tries to bring his chest closer to the wall bars,

- pulls the crown of the head upward as much as possible, while the chin line corresponds to the horizon line,

the patient bounces on the ball with the maximum amplitude possible for him,

- elbows straightened to the sides,

- the patient pulls in his stomach and ribs,

- the patient uses the toes of his right foot to support the bottom bar of the wall bars, at a level of 7-8 cm from the floor, and pushes it upwards,

perform 4 sets of 8 inhalation-exhalation cycles in each set, rest pause between sets - 30 seconds, during pauses maintain KIP.

Additionally, for lumbar scoliosis with a left-sided apex of the arc, ONV is performed in the right posterior zone of the chest and before exercise 14, the following exercises are performed:

- "Lumbar stand with supports", which is an exercise that is performed from the KIP: standing facing the mirror, each hand grasps vertically placed sticks with a length equal to the length of the patient's body with arms extended upwards;

the patient's feet are on the floor on the inside of the sticks, parallel to each other, the heels are at the width of the hip joints,

the right hand grasps the stick so that the elbow and shoulder are at the same horizontal level, the elbow is pressed against the stick,

with the left hand they grasp the stick in a similar manner so that the right and left elbows are connected by a straight horizontal line parallel to the floor, the body and head are in the middle between the sticks;

shoulders are not raised up, they stand straight and steady, the position of the head is straight, the chin line is level with the horizon line,

in the KIP, ONV is performed in the right posterior zone of the chest while maintaining pelvic correction - simultaneously bending the right knee joint and trying to lower the right buttock,

and during exhalation with resistance, the following actions are performed simultaneously:

- they press down with sticks,

- press on the sticks with both elbows,

- stretch your elbows to the sides,

- shoulders don't rise,

- pull the crown of the head upwards as much as possible,

- maintain a stable position,

- tighten the stomach and ribs;

perform 4 sets of 8 inhalation-exhalation cycles in each set, rest pause between sets - 30 seconds;

- “Lying on the side of the lumbar arch”, which is an exercise with ONV, performed from the KIP:

lying on the side of the lumbar arch - on the left side on the mat, the right arm is straight, lies on top along the body, the left arm is extended forward perpendicular to the body,

the patient's left leg is bent, the right leg is straight, extended along the body axis, the foot and ankle are placed on a hard object placed under it at a height that ensures the longitudinal axis of the right leg is parallel to the longitudinal axis of the patient's torso,

a cushion of a thickness sufficient to provide passive correction of the lumbar curvature of the spine is placed under the patient's left side,

the patient's head lies on a cushion with a thickness that ensures the maintenance of the longitudinal axis of the patient's body;

In the KIP, ONV is performed in the right posterior zone of the chest, and during exhalation with resistance, the following actions are simultaneously performed:

- the crown of the head is pulled as high as possible along the longitudinal axis of the body,

- pull in your stomach and ribs,

- raise the straightened right leg to a height equal to the length of the patient's foot, above a hard object placed under the foot and ankle and, holding this position, pull the toes of the right foot forward as much as possible - towards you, and the heel - away from you,

- try to move the right buttock towards the feet,

- the right thigh is moved back as far as possible, while keeping the torso, pelvis, right thigh and foot in one line,

then, at the beginning of the next ONV, lower the right leg, returning to the KIP,

perform 4 sets of 8 inhalation-exhalation cycles in each set, rest pause between sets - 30 seconds;

- "Lumbar correction on a ball at the wall bars", which is an exercise with ONV, performed from the KIP: sitting on a fitball facing the wall bars, the size of the ball is such that when sitting on it the patient's pelvis is located above the level of his knees,

the patient's feet are placed with their entire plantar surface under the lower bar of the wall bars, the knees touch the bar of the wall bars located above the knees;

the right hand is placed on the crossbar at shoulder level, the left hand is on the crossbar, which is at the level of the crown of the head, the elbows are straightened to the sides, the shoulders are lowered, the right buttock is lower than the left,

the patient rotates the pelvis backwards, maintaining physiological lordosis and kyphosis of the spine;

In the KIP, ONV is performed in the right posterior zone of the chest, and during exhalation with resistance, the following simultaneous actions are performed:

- the patient pulls the bar towards himself with his hands,

- tries to bring his chest closer to the wall bars,

- pulls the crown of the head upward as much as possible, while the chin line corresponds to the horizon line,

the patient bounces on the ball with the maximum amplitude possible for him,

- elbows are straightened to the sides, - the patient pulls in the stomach and ribs,

- the patient uses the toes of his right foot to support the bottom bar of the wall bars, at a level of 7-8 cm from the floor, and pushes it upwards,

perform 4 approaches with 8 inhalation-exhalation cycles in each approach, rest pause between approaches - 30 seconds, during pauses maintain KIP;

- "Lying on the ball", which is an exercise with ONV, which is performed with the help of a gymnastic fitball located at a distance of 30 cm from the wall bars, while the patient takes the CIP:

lies with the front surface of the chest on the ball, holds the crossbar of the wall bars with his hands so that the body is parallel to the floor, and the angle at the elbow joints is 90 degrees;

in the CIP, the patient performs ONV in the right posterior zone of the chest, and during exhalation with resistance, holds the thoracic spine parallel to the floor, moves the shoulders back, maintaining an angle of 90 degrees in the elbow joints, pulls the crown of the head forward, with the right leg, bent at the knee joint at 90 degrees, applies pressure to the center of the ball,

perform 4 sets of 8 inhalation-exhalation cycles in each set, rest pause between sets - 30 seconds;

- "Muscle cylinder" is an exercise with ONV, performed from the KIP in front of a mirror: place the straight right leg with the inside of the foot on the seat of a chair so that the angle between the patient's legs is 45 degrees, and tilt the torso to the left so that the right leg and torso form a straight line,

hands are placed on the waist, shoulders are lowered and turned back, shoulder blades are brought together medially, the left knee is half bent,

perform ONV into the right rear area of the chest, then, while exhaling with resistance, simultaneously perform the following actions:

- maintain instrumentation and control systems,

- pull the crown of the head diagonally up and to the left,

- pull the toes of the right foot towards you,

- consciously create tension in the muscles of the right lumbar region,

perform 4 sets of 6 inhale-exhale cycles in each set, rest pause between sets is 30 seconds.

To demonstrate the achievement of the technical result indicated by us, we present clinical data on the results of correction of various types of IS in children of different ages after screening diagnostics using the proposed method (Table 1).

Note: * - statistically significant (p<0.05) when comparing related samples (before and after), Wilcoxon test.

According to the data in Table 1, it can be stated that the proposed method of differentiated conscious correction of IS in children and adolescents using the proposed modified screening diagnostics, which allows starting corrective exercises immediately, without waiting for the results of confirmatory radiography, is more effective in terms of correcting IS of various localizations and directions of the scoliotic arc.

Clinical examples.

1. Patient V., 10 years old, initial appointment.

Based on the results of the proposed screening diagnostics, a diagnosis of idiopathic scoliosis of the thoracic spine with a right-sided arc of curvature of grade 1, apex of the arc Th7 was established.

The diagnosis was confirmed radiologically. A course of "Conscious correction of scoliosis" was prescribed, according to paragraph 1 of the invention formula. Since there is only stage 1 scoliosis (the angle of the arc of curvature is 8 degrees, confirmed radiologically), the functional-corrective corset of Cheneau was not used.

A set of 14 exercises according to item 1 of the formula was performed daily for 2 years. Leveling of the scoliotic arc angle is observed, diagnosis - posture disorder. It is recommended to continue performing the exercises of the set.

2. Patient T., 14 years old, initial appointment.

Based on the results of the proposed screening diagnostics, a diagnosis of idiopathic S-shaped thoracolumbar (combined) scoliosis was established with a right-sided thoracic arc of stage 2 (angle 15 degrees, apex Th8) and a left-sided lumbar arc of stage 3 (27 degrees, apex L2).

The diagnosis was confirmed radiologically. A course of "Conscious correction of scoliosis" was prescribed, according to paragraph 1 of the formula of the invention, including the use of a Cheneau corset (since the angle of the lumbar arc of curvature is more than 20 degrees) for at least 20 hours a day after performing the exercises of the complex.

The complex according to item 1 of the formula was performed daily for 2 years. A decrease in the angles of both scoliotic arcs is observed; according to the control examination, the angle of the thoracic arc decreased to 10 degrees (transition to stage 1 scoliosis), the lumbar arc - 18 degrees (transition to stage 2 scoliosis). It is recommended to continue performing the exercises of the complex with additional performance of exercises according to item 3 of the formula of the invention and wearing a Cheneau corset until reaching level 5 according to Risser.

3. Patient M., 12 years old, initial appointment.

Based on the results of the proposed screening diagnostics, a diagnosis of idiopathic S-shaped thoracolumbar (combined) scoliosis was established with a right-sided thoracic curve of grade 1 (angle 10 degrees, apex Th6) and a left-sided lumbar curve of grade 2 (13 degrees, apex L3).

The diagnosis was confirmed radiologically. A course of "Conscious Correction of Scoliosis" was prescribed, according to paragraph 1 of the invention formula, without using the Cheneau corset (since the angle of each of the curvature arcs is less than 20 degrees). In addition to the exercises performed according to paragraph 1 of the formula, exercises of paragraph 3 of the formula for combined thoracolumbar scoliosis were additionally performed.

The set of exercises was performed daily for 2 years. A decrease in the angles of both scoliotic arcs was observed, according to the control examination data.

- the angle of the thoracic arc of curvature decreased to 8 degrees (scoliosis stage 1 remains), lumbar - to 10 degrees (transition to scoliosis stage 1, improvement). It is recommended to continue performing the exercises of the complex.

4. Patient P., 10 years old, initial appointment.

Based on the results of the proposed screening diagnostics, a diagnosis of lumbar spine ischemia with a left-sided arc of curvature of the 2nd degree (arc angle 22 degrees), the apex of the arc is L7. Flat-valgus deformity of the feet.

The diagnosis was confirmed radiologically. A course of "Conscious correction of scoliosis" was prescribed, according to paragraph 1 of the invention formula with additional exercise performance of paragraph 4 of the formula for lumbar scoliosis. Since the angle of the curvature arc is more than 20 degrees, a functionally corrective corset of Cheneau was used.

The set of exercises was performed daily for 1.5 years. A decrease in the angle of the scoliotic arc to 14 degrees was observed, the degree of scoliosis remains, with improvement in the indicators. It is recommended to continue performing the exercises of the set using the Cheneau corset until reaching level 5 according to Risser.

5. Patient B., 15 years old, initial appointment.

The diagnosis of isolated thoracic scoliosis (stage 1) was established 5 years ago, there were attempts at treatment using the K. Schroth method, however, due to personal circumstances, the classes were stopped.

Based on the results of the proposed screening diagnostics, a diagnosis of ischemic stroke of the thoracic spine with a right-sided arc of curvature of the 2nd degree (arc angle 23 degrees), the apex of the arc is Th7.

The diagnosis was confirmed radiologically. A course of "Conscious correction of scoliosis" was prescribed, according to paragraph 1 of the invention formula with additional exercise performance of paragraph 2 of the formula for thoracic scoliosis. Since the angle of the curvature arc is more than 20 degrees, a functionally corrective corset of Cheneau was used.

The set of exercises was performed daily for 1.5 years. A decrease in the angle of the scoliotic arc to 10 degrees was observed - transition to stage 1 scoliosis. It is recommended to continue performing the exercises of the set using the Cheneau corset until reaching level 5 according to Risser.

The proposed exercise complexes, despite their effectiveness after 1.5 years of implementation, are recommended to be performed by patients for life, daily, using the Cheneau corset with an initial magnitude of the scoliotic arc from 20 degrees and above and until the degree of ossification reaches level 5 according to Risser.

The expediency of lifelong exercise is related to the fact that, as a rule, the causes of IS are not eliminated in the process of the proposed complexes (the causes of the development of IS, as shown above, are most often completely unknown). Therefore, in the absence of supporting exercises, relapses and deterioration of the spine are possible. To avoid this, supporting lifelong correction is required.

Claims (205)

1. A method of differentiated conscious correction of idiopathic scoliosis (ICS) in children and adolescents using physical exercises taking into account the results of diagnostics, characterized in that screening diagnostics of the condition of the spine is carried out at the initial consultation using a scoliometric study in the position of the patient bending forward and downward from the initial position (IP) standing straight, legs straight, feet parallel and at the width of a foot from each other, the doctor stands behind and to the side of the patient, To do this, the doctor takes measurements and records in the examination protocol the readings of the scoliometer in its position in the vertical plane, perpendicular to the horizontal, passing through the anatomical landmarks - the spinous processes of the patient's vertebrae, and the doctor stands behind the patient at the side - in a vertical plane located at an angle of 45 degrees to the sagittal plane of the patient's body, and the patient's forward tilt is discrete - intermittent, and the measurement and recording of the scoliometer readings is performed at each stop of the patient's intermittent movement during forward bending - upon reaching the position of the scoliometer in the vertical plane perpendicular to the horizontal plane passing through the corresponding anatomical landmark, with one finger of the doctor's hand first placed on the next anatomical landmark and then the scoliometer is moved to this level, in this case, the patient's discrete forward tilt is carried out first from the IP standing straight, with the patient's head tilted with the chin to the chest, then, in the same position of the patient, the middle of the scoliometer is moved to the spinous process of the Th3 vertebra and the patient continues to bend forward with the body, upon reaching the horizontal plane at the level of the Th3 spine, the patient, on command from the doctor, stops the movement to take and record the readings of the scoliometer located in the vertical plane; then the patient continues to bend the body forward, rounding the back, without raising the head, the shoulders are relaxed, the arms hang freely towards the floor in front of the toes and when the Th7 spine level reaches the horizontal plane, the patient again stops the movement at the doctor's command to take and record the readings of the scoliometer, located in the vertical plane at the Th7 spine level; using similar techniques, the patient continues to tilt forward and the patient’s movement is consistently stopped upon reaching horizontal planes that pass, respectively, through the subsequent anatomical landmarks Th12 and L4 to take readings at these levels from a scoliometer located in a vertical plane; for each examined level of the spine, the deviation of the scoliometer readings from the median value is recorded in degrees, rounding off the tenths to a larger whole number, indicating the direction: “minus” - for a deviation to the left, “plus” - for a deviation to the right, and if deviations are more than 5.0 degrees, idiopathic scoliotic deformation of the spine is diagnosed at the corresponding level - thoracic and/or lumbar, and the presumed degree of scoliotic deformation of the spine and the direction of the arc of deformation of the spine are established based on the magnitude of the deviation range in degrees; then they begin conscious correction of scoliosis (CCS), which is the daily performance of a set of gymnastic exercises and exercises with conscious breathing, where conscious breathing is a cycle of exhalation with resistance - through semi-compressed lips, lasting 8 seconds, and conscious directed inhalation (CDI), which is an inhalation with expansion of the area of the chest that is opposite the apex of the scoliotic arc, with the doctor focusing the patient's voluntary attention during CDI on the work of the intercostal muscles of this area of the chest by pressing with the hand on its projection on the back surface of the chest; In this case, the set of gymnastic exercises consists of the following, performed daily, the first exercise is the initial one, the 14th is the final one, and the remaining exercises are performed between them in a free sequence: 1) “Half-hanging on a wall bars” - an exercise from the corrective IP (KIP): standing close to the wall bars, toes placed under the lower crossbar, arms extended upward, palms resting on the bar, which is one bar lower than the one the patient can reach, the patient's arms are positioned wider than the shoulders, and the feet and knees are at the width of the patient's pelvis, holding onto the bar with his hands, the patient hangs, pressing his knees to the lower bars and relaxing as much as possible, then - return to the KIP and repeat the exercise while hanging one bar lower than the previous one, with knees bent, then - return to the KIP again and do another repetition one bar lower than the previous repetition, the duration of the hang is 10-20 seconds while the patient maintains physiological lumbar lordosis, perform 3 sets of 3 planks from top to bottom in each set, rest pause between sets is 30 seconds, the patient's breathing is free when performing this exercise; 2) "Stretching the inner thigh" - an exercise with ONV, which is performed from the KIP: sitting on the buttocks on the mat, legs bent at the knees, knees spread apart, feet with plantar surfaces touching each other in front of the patient, palms of straightened arms lying on the floor behind the buttocks, while performing the exercise, the patient pulls the feet together as much as possible, trying to lower the knees down, while simultaneously straightening the back as much as possible, pushing off the floor with the hands, lowering the shoulders and stretching the crown of the head upwards, while doing this, they perform conscious breathing: in KIP they perform exhalation with resistance, and when performing the exercise they perform ONV, do 4 sets of five inhale-exhale cycles in each set, rest pause between sets - 30 seconds; 3) "Stretching the back of the thigh and hamstring" - an exercise that is performed from the KIP: lying on the back on a gymnastic mat, the patient's straight legs are freely extended, using a sports band, thrown over the middle of the arch of the foot, the patient pulls the straight leg towards himself by the ends of the band, raising it to the vertical, until pain occurs, the exercise is performed alternately, 3 approaches for each leg - 6 approaches in total, breathing is free, the rest pause between approaches is 30 seconds; 4) "Balance", which is a stabilization exercise performed using a balancing board, the length and width of which are 2 cm larger than the corresponding dimensions of the patient's foot and which has a semi-cylinder with a diameter of 2 cm rigidly fixed along the longitudinal axis of the board on its lower surface, which, when the patient stands on the board with one foot, creates a balancing effect, while the other leg is moved back by bending at the knee joint by 90 degrees; while doing this, pull the crown of the head upward as much as possible, lower the shoulders, bring the shoulder blades together medially, draw in the stomach, try to lower the right buttock, pulling up the opposite buttock, hold the balancing position for as long as possible for the patient, then change legs; During the exercise, 3 approaches are performed for each leg, the patient's breathing is free, the rest pause between approaches is 10 seconds; 5) “Astride a chair” - an exercise with ONV, in which a chair with a straight back is used, KIP - sitting "astride" a chair, facing its back, the patient rests his forearms on the back of the chair, legs spread apart, In CIP, the patient performs ONV, and during exhalation with resistance, simultaneously performs the following actions: - lowers his shoulders, - presses his forearms on the back of the chair, - pulls the crown of the head upward as much as possible, - tenses the abdominal muscles, pulls in the stomach and ribs, perform 4 sets of 8 inhalation-exhalation cycles in each set, rest pause between sets - 30 seconds; 6) “Corrective gait” - an exercise with ONV, which is performed from the KIP: standing, feet together, the patient pulls the crown of the head up, the chin line is along the horizon line, the shoulders are lowered and turned back, the thumb of the lowered right hand is turned outward as much as possible, the palm is turned forward as much as possible, the stomach is pulled in, consciously trying to maintain a straight posture, the movement begins with any leg, take a step forward and place the foot forward on the heel at a distance of 10 cm from the toes of the other foot - on the count of one, then move the stepped leg back, placing it on the toes at a distance of 10 cm from the heel of the second leg - on the count of two, then repeat the forward movement with the first leg on the heel - on the count of three, again repeat the movement with the same leg back onto the toes - on the count of four, then they put the first leg forward again and transfer the body weight onto it, taking a full step - on the count of five, then they repeat the listed movements with the second leg in the same way, in KIP they perform ONV, and when performing a step - exhalation with resistance, perform 30 times, 5 counts for each leg; 7) "Corrective gait with breathing" - an exercise with ONV, which is performed from the KIP: standing in front of a mirror at a distance of 5 meters from it, hands on the waist, the crown of the head is pulled up, shoulders are lowered and turned back, the stomach and pelvis are pulled inward; while the first leg in the KIP is one step ahead of the second; the movement begins with any leg, taking a step forward with the second leg onto the heel and immediately moving it onto the toes, lowering its foot, leaving the first leg behind on the toes, then take a step forward with the first foot onto the heel and immediately move into support on the toes for both feet; while rising on the toes of both feet, perform ONV for 3 seconds, stretching the crown of the head upward as much as possible, and exhale with resistance for 5 seconds during the subsequent lowering of both legs onto the entire surface of the feet, when taking steps, the distance from the toes of the leg standing behind to the heel of the leg standing in front should not exceed half the length of the foot; perform the exercise for 3-4 minutes at a pace comfortable for the patient; 8) "Rubber band pull from above" - an exercise that is performed from the KIP: sitting on a bench in front of the Swedish wall facing it, legs crossed at ankle level, knees fixed between the bars of the Swedish wall, in the hands - a rubber expander, fixed by the middle to the upper bar of the Swedish wall, holding onto the free ends of the expander, as you exhale, pull down towards your chest in front of you, as you inhale, release the expander upward, perform 3 sets of 12 repetitions; 9) “90-degree core press” - an exercise that is performed from the KIP: lying on your back, legs raised and bent at the hip and knee joints at 90 degrees, straight arms raised vertically above your head, the patient raises his head, shoulders and shoulder blades, stretches his arms upwards as he exhales; lowers his arms, returning to the CIP, breathing is free, in this case, first perform 3 sets of 15 repetitions of the inhalation-exhalation cycle in each set, rest pauses between sets are 30 seconds, every day add 1 inhalation-exhalation cycle in each set, bring it up to 30 inhalation-exhalation cycles in one set and then continue in this mode; 10) "Oblique abdominal press" - an exercise that is performed from the KIP: lying on your back, legs, half bent at the knees, are raised so that the feet are 20 cm above the floor, arms are bent at the elbows in front of you, hands are towards the ears, the head and shoulders are raised 20 cm from the floor, the patient, holding himself in this position, then touches his left knee with his right elbow, while straightening his right leg at the knee, maintaining a 45-degree flexion angle in the right hip joint, then touches the right knee with the left elbow, changing the position to mirror the previous one, breathing is free, first perform 3 sets of 20 inhalation-exhalation cycles in each set, rest pauses between sets are 30 seconds, every day add 1 inhalation-exhalation cycle in each approach, bring the total number of inhalation-exhalation cycles to 30 in one approach and then continue in this mode; 11) “Correct squats” - an exercise that is performed from the KIP: standing in front of a mirror, feet wider than shoulder-width apart, fix the thoracic spine with a gymnastic stick as symmetrically as possible, placing the stick horizontally on the shoulders, holding it with a rear grip of both hands, located wider than shoulder-width apart, from the KIP, they squat until the pelvis drops to the level of the knees, so that the thigh is parallel to the floor, support is on the entire foot, without lifting the heels off the floor, while maintaining the physiological curves of the spine, when squatting, inhale normally, when rising, exhale normally, start with three approaches of 15 inhalation-exhalation cycles in each approach, increasing the inhalation-exhalation cycle in each approach daily by 1, bringing the total number of inhalation-exhalation cycles to 30 in each approach, and then continue in this mode, with a rest pause between approaches of 30 seconds; 12) “Classic plank” - an exercise that is performed from the KIP with support on the toes and elbows, which are placed under the patient’s shoulder joints, and the forearms, which are extended forward along the horizontal surface of the support, the patient holds the torso in this position straight: - maintains natural lumbar lordosis, - tries to keep the pelvis symmetrical relative to the sagittal plane of the body, - the crown of the head is pulled as much as possible along the longitudinal axis of the body, maintaining the central position of the head, start with one approach with the maximum possible duration of the patient holding the plank position, then add 1 approach daily, bringing it up to 4 approaches and then continue in this mode, the rest pause between approaches is 30 seconds, breathing is free; 13) “Knee balance on a ball” - an exercise with ONV, during which the patient maintains balance on a gymnastic ball-fitball, the exercise consists of three stages: - first, the patient holds onto the wall bars with his hands and kneels on the ball, on which he tries to stay, - then tries to stay on the ball, releasing his hands from the wall bars, - the patient climbs onto the ball with his knees and stays on it, perform 3 approaches with sequential execution of three stages of the exercise against the background of conscious breathing - ONV and exhalation with resistance, at a pace comfortable for the patient, rest pause between approaches - 30 seconds; 14) “Final hang on the wall bars” - the exercise is performed as a repetition of the first exercise of the complex; moreover, if the degree of scoliotic deformation of any localization with a scoliotic arc value of more than 5 degrees is established during screening diagnostics, X-ray diagnostics are performed and if the magnitude of the scoliotic arc is confirmed by radiography to be 20 degrees or more, a functional corrective Cheneau corset is worn daily after completing a set of exercises for at least 20 hours a day; the corset is worn until the patient's skeletal ossification is achieved according to the radiographic criterion - level 5 according to Risser. 2. The method according to paragraph 1, characterized in that in case of isolated thoracic scoliosis with a right-sided apex of the scoliosis arc, the ONV is performed in the left posterior zone of the chest and, in addition, before exercise 14), the following exercises are performed: - "Chest stand with supports", which is an exercise that is performed from the KIP: standing facing the mirror, each hand grasps vertically placed sticks with a length equal to the length of the patient's body with arms extended upwards; the patient's feet are on the floor on the inside of the sticks, parallel to each other, the heels are at the width of the hip joints, the right hand grasps the stick so that the right elbow and shoulder are at the same horizontal level, the elbow is pressed against the stick, with the left hand grasp the stick so that the left elbow is at ear level, and the body and head are in the middle between the sticks; shoulders are not raised up, they stand straight and steady, the position of the head is straight, the chin line is level with the horizon line, In the KIP, ONV is performed in the left posterior zone of the chest, and during exhalation with resistance, the following actions are performed simultaneously: - they press down with sticks, - press on the sticks with your right elbow, - stretch your elbows to the sides, - shoulders don't rise, - pull the crown of the head upwards as much as possible, - maintain a stable position, - tighten the stomach and ribs; perform 4 sets of 8 inhalation-exhalation cycles in each set, rest pause between sets - 30 seconds; - “Lying on the left side with a chair”, which is an exercise with ONV, performed from the KIP: lying on the left side on a mat, the patient’s head is under the chair, the neck is between the legs of the chair, the right arm, bent at the shoulder and elbow joints, lies with the palm on top of the chair seat, resting against it, the left arm is extended along the longitudinal axis of the body under the chair between its legs, the patient's left leg is bent, the right leg is straight, extended along the body axis, the foot and ankle are placed on a hard object placed under it at a height that ensures the longitudinal axis of the right leg is parallel to the vertical axis of the patient's torso, the patient's head rests on the left outstretched arm, perform conscious breathing, for which in the KIP they perform ONV in the left rear zone of the chest, and during exhalation with resistance simultaneously: - the crown of the head is pulled forward as far as possible along the axis, - pull in your stomach and ribs; - leaning your right palm on the chair, pull your right elbow up and forward, - while doing this, the torso, pelvis, right thigh and foot are kept in one line, and by the beginning of the next ONV, relax the right arm and shoulder, return to KIP; perform 4 sets of 8 inhalation-exhalation cycles in each set, rest pause between sets - 30 seconds; - "Chest correction on a ball at the wall bars", which is an exercise with ONV, correcting the thoracic spine through asymmetrical muscle work, This exercise is performed from the following KIP: sitting on a gymnastic fitball facing the wall bars, the size of the ball is such that when sitting on it, the patient's pelvis is located above the level of his knees, the patient's feet with the entire plantar surface are under the lower crossbar of the wall bars, the knees touch the crossbar of the wall bars located above the knees; the right hand is placed on the crossbar at shoulder level, the left hand is placed on the crossbar, which is at the level of the crown of the head, the elbows are straightened to the sides, the shoulders are lowered, the patient rotates the pelvis backwards, maintaining the physiological lordosis and kyphosis of the spine; carry out conscious breathing, for which in the KIP they perform ONV in the left rear zone of the chest, and on exhalation with resistance they perform the following simultaneous actions: - with his right hand the patient pulls the bar towards himself, - with the left hand the patient pulls the crossbar towards himself and down, - tries to bring his chest closer to the wall bars, - pulls the crown of the head upward as much as possible, while the chin line corresponds to the horizon line, - the patient springs on the ball with the maximum amplitude possible for him, elbows straightened to the sides, - the patient pulls in his stomach and ribs, perform 4 approaches with 8 inhalation-exhalation cycles in each approach, rest pause between approaches - 30 seconds, during pauses maintain KIP; - "Lying on the side of the thoracic arch", which is an exercise with ONV, which is performed from the KIP: the patient lies on his right side - on the side of the thoracic arch of curvature, a massage roller with a diameter that provides passive correction of the patient's thoracic arch in the frontal plane is placed under the apex of the arch, the patient's arms are extended upward, the head is between the arms, resting on the shoulder of the right arm, the right leg is bent at the knee and hip joint at 90 degrees, the right heel is in front of the knee of the left leg, the left leg is straight; in this case, in the CIP, ONV is performed in the left posterior zone of the chest, and during exhalation with resistance, the patient, grasping the wrist of the left hand with the right hand, by pulling it upward, along the longitudinal axis of the body, stretches the left side of the chest, drawing in the ribs and abdomen as much as possible; by the beginning of inhalation - return to the CIP; perform 4 sets of 8 inhalation-exhalation cycles in each set, rest pause between sets is 30 seconds. 3. The method according to item 1, characterized in that in case of combined thoracolumbar scoliosis with a right-sided apex of the arc in the thoracic and a left-sided apex of the arc in the lumbar spine, ONV is performed simultaneously in both zones of the chest - in accordance with the existing direction of each of the two apexes of the scoliotic arc, in this case, before exercise 14) the following exercises with ONV are additionally performed: - “Combined stand with supports”, which is an exercise with ONV, which is performed from the KIP: standing facing the wall bars, each hand grasps the vertical supports of the wall bars with its hand, which are located wider than the patient’s shoulders; the patient's feet are on the floor on the inside of the wall bars parallel to each other, the heels are under the hip joints, the left leg is straight, the right leg is bent at the knee joint, the pelvis is turned backwards while maintaining the physiological lordosis of the lumbar spine, with the brush of the right raised hand, grasp the vertical support of the Swedish wall at the top so that the right elbow and shoulder are at the same horizontal level, the right elbow is pressed against the vertical support of the Swedish wall; with the brush of the left hand hold the vertical support of the Swedish wall higher so that the left elbow is at ear level, the patient tries to maintain a symmetrical position of the body and head between the vertical supports of the wall bars, In the KIP, ONV is performed simultaneously in both zones of the chest located behind the arcs of scoliotic deformation, and during exhalation with resistance, the following actions are performed simultaneously: - press down on the vertical supports of the wall bars with your hands and elbows, - shoulders don't rise, - the crown of the head is pulled upward as much as possible, - stand stable - pull in your stomach and ribs, - try to lower the right buttock below the left; perform 4 sets of 8 inhalation-exhalation cycles in each set, rest pause between sets - 30 seconds; - “Combined correction on a ball at the Swedish wall”, which is an exercise with ONV, performed from the KIP: sitting on a fitball facing the Swedish wall, the size of the ball is such that when sitting on it the patient’s pelvis is located above the level of his knees, the patient's feet are placed with their entire plantar surface under the lower bar of the wall bars, the knees touch the bar of the wall bars located above the knees; the right hand is placed on the crossbar at shoulder level, the left hand is on the crossbar, which is at the level of the crown of the head, the elbows are straightened to the sides, the shoulders are lowered, the right buttock is lower than the left, the patient rotates the pelvis backwards, maintaining physiological lordosis and kyphosis of the spine; In the KIP, ONV is performed in both zones of the chest located behind the arcs of scoliotic deformation, and during exhalation with resistance, the following simultaneous actions are performed: - with his right hand the patient pulls the bar towards himself, - with the left hand the patient pulls the crossbar towards himself and down, - tries to bring his chest closer to the wall bars, - pulls the crown of the head upward as much as possible, while the chin line corresponds to the horizon line, - the patient springs on the ball with the maximum amplitude possible for him, elbows straightened to the sides, - the patient pulls in his stomach and ribs, - the patient uses the toes of his right foot to support the bottom bar of the wall bars, at a level of 7-8 cm from the floor, and pushes it upwards, perform 4 sets of 8 inhalation-exhalation cycles in each set, rest pause between sets is 30 seconds, during pauses maintain KIP. 4. The method according to item 1, characterized in that in case of lumbar scoliosis with a left-sided apex of the arc, the ONV is performed in the right posterior zone of the chest and, in addition, before exercise 14), the following exercises are performed: - "Lumbar stand with supports", which is an exercise that is performed from the KIP: standing facing the mirror, each hand grasps vertically placed sticks with a length equal to the length of the patient's body with arms extended upwards; the patient's feet are on the floor on the inside of the sticks, parallel to each other, the heels are at the width of the hip joints, the right hand grasps the stick so that the elbow and shoulder are at the same horizontal level, the elbow is pressed against the stick, with the left hand, grasp the stick in a similar manner so that the right and left elbows are connected by a straight horizontal line parallel to the floor, the body and head are in the middle between the sticks; shoulders are not raised up, they stand straight and steady, the position of the head is straight, the chin line is level with the horizon line, in the KIP, ONV is performed in the right posterior zone of the chest while maintaining the correction of the pelvis, simultaneously bending the right knee joint and trying to lower the right buttock, and during exhalation with resistance, the following actions are performed simultaneously: - they press down with sticks, - press on the sticks with both elbows, - stretch your elbows to the sides, - shoulders don't rise, - pull the crown of the head upwards as much as possible, - maintain a stable position, - tighten the stomach and ribs; perform 4 sets of 8 inhalation-exhalation cycles in each set, rest pause between sets - 30 seconds; - “Lying on the side of the lumbar arch”, which is an exercise with ONV, performed from the KIP: lying on the side of the lumbar arch - on the left side on the mat, the right arm is straight, lies on top along the body, the left arm is extended forward perpendicular to the body, the patient's left leg is bent, the right leg is straight, extended along the body axis, the foot and ankle are placed on a hard object placed under it at a height that ensures the longitudinal axis of the right leg is parallel to the longitudinal axis of the patient's torso, a cushion of a thickness sufficient to provide passive correction of the lumbar curvature of the spine is placed under the patient's left side, the patient's head lies on a cushion with a thickness that ensures the maintenance of the longitudinal axis of the patient's body; In the KIP, ONV is performed in the right posterior zone of the chest, and during exhalation with resistance, the following actions are simultaneously performed: - the crown of the head is pulled as high as possible along the longitudinal axis of the body, - pull in your stomach and ribs, - raise the straightened right leg to a height equal to the length of the patient's foot, above a hard object placed under the foot and ankle and, holding this position, pull the toes of the right foot forward as much as possible - towards you, and the heel - away from you, - try to move the right buttock towards the feet, - the right thigh is moved back as far as possible, while keeping the torso, pelvis, right thigh and foot in one line, then, at the beginning of the next ONV, lower the right leg, returning to the KIP, perform 4 sets of 8 inhalation-exhalation cycles in each set, rest pause between sets - 30 seconds; - "Lumbar correction on a ball at the wall bars", which is an exercise with ONV, performed from the KIP: sitting on a fitball facing the wall bars, the size of the ball is such that when sitting on it the patient's pelvis is located above the level of his knees, the patient's feet are placed with their entire plantar surface under the lower bar of the wall bars, the knees touch the bar of the wall bars located above the knees; the right hand is placed on the crossbar at shoulder level, the left hand is on the crossbar, which is at the level of the crown of the head, the elbows are straightened to the sides, the shoulders are lowered, the right buttock is lower than the left, the patient rotates the pelvis backwards, maintaining physiological lordosis and kyphosis of the spine; In the KIP, ONV is performed in the right posterior zone of the chest, and during exhalation with resistance, the following simultaneous actions are performed: - the patient pulls the bar towards himself with his hands, - tries to bring his chest closer to the wall bars, - pulls the crown of the head upward as much as possible, while the chin line corresponds to the horizon line, - the patient springs on the ball with the maximum amplitude possible for him, - elbows straightened to the sides, - the patient pulls in his stomach and ribs, - the patient uses the toes of his right foot to support the bottom bar of the wall bars, at a level of 7-8 cm from the floor, and pushes it upwards, perform 4 approaches with 8 inhalation-exhalation cycles in each approach, rest pause between approaches - 30 seconds, during pauses maintain KIP; - "Lying on the ball", which is an exercise with ONV, which is performed with the help of a gymnastic fitball located at a distance of 30 cm from the wall bars, while the patient takes the CIP: lies with the front surface of the chest on the ball, holds the crossbar of the wall bars with his hands so that the body is parallel to the floor, and the angle at the elbow joints is 90 degrees; in the CIP, the patient performs ONV in the right posterior zone of the chest, and during exhalation with resistance, holds the thoracic spine parallel to the floor, moves the shoulders back, maintaining an angle of 90 degrees in the elbow joints, pulls the crown of the head forward, with the right leg, bent at the knee joint at 90 degrees, applies pressure to the center of the ball, perform 4 sets of 8 inhalation-exhalation cycles in each set, rest pause between sets - 30 seconds; - "Muscle cylinder" is an exercise with ONV, performed from the KIP in front of a mirror: place the straight right leg with the inside of the foot on the seat of a chair so that the angle between the patient's legs is 45 degrees, and tilt the torso to the left so that the right leg and torso form a straight line, hands are placed on the waist, shoulders are lowered and turned back, shoulder blades are brought together medially, the left knee is half bent, perform ONV into the right rear area of the chest, then, while exhaling with resistance, simultaneously perform the following actions: - maintain instrumentation and control systems, - pull the crown of the head diagonally up and to the left, - pull the toes of the right foot towards you, - consciously create tension in the muscles of the right lumbar region, perform 4 sets of 6 inhale-exhale cycles in each set, rest pause between sets is 30 seconds.