History

 The foundations of the Lyon method of physiotherapy of vertebral deviations were described 200 years ago by Charles Gabriel Pravaz. This is the oldest of the methods worldwide, and the first combining exercises and mechanical correction of scoliosis.

  Long before Pravaz, in the Middle Ages, Ambroise Paré used an iron brace, derived from the armor of the time, which remained in use for several centuries. Likewise gymnastic exercises are very old.

 In the seventeenth century, Francis Glisson notes the frequency of infantile scoliosis in children with rickets.

  Extract from Nicolas Andry's book

The lyon method is the oldest PSSE which consists of individually adapted and curve -specific exercises.

 This is undoubtedly the reason why the Lyon method is the first to combine specific exercises and orthopaedic devices such as the brace. This complementarity still persists today.

 Since the creation of the concept of orthopedics, progress in treatment will progress rapidly. The use of plaster marks a step, because it will greatly improve the creep or plastic deformation of the concavity.

 The XIX ° century is that of the first orthopedic reeducation centers in Europe and at the same time braces will develop.

 Charles Gabriel Pravaz, the creator of the Lyon method was not only a doctor, but also an engineer, a pupil of the prestigious polytechnic school of Paris. This explains why he was the inventor of the syringe and why he developed ingenious methods of correcting scoliosis.

 Lyon has always had a great tradition of physiotherapy and Gabriel Pravaz was not only the inventor of the syringe, but he also created a great Orthopaedic and at this time pneumatic.

 Lyon has always had a great tradition of Orthopaedic and Charles Gabriel Pravaz was not only the inventor of the syringe, but he also created in Lyon a great Orthopaedic Institute to treat scoliosis 200 years ago. The first Lyon brace in leather and steel was created by Stagnara 70 years ago. It undergoes a first change with the replacement of leather by polymethacrylate. In 2013, the use of very high rigidity polyamide and asymmetry allowed to avoid the plaster cast which was the characteristic of the Lyon Brace.

 The exercises used at the time were already based on self-elongation, with a helical scale system for 3D correction.

 Translation along the vertical axis is usually performed at night on a special bed with progressive extension. Subsequently a wheel system will allow the child to move during the day while maintaining traction to obtain a plastic deformation.

 Vertebral traction systems prefiguring the frames of Risser, Abbott and EDF to obtain plastic deformation were already used.

 Corrections in the frontal plane are also used. In this corrective bending position for a thoraco-lumbar curvature, the lumbar lordosis is preserved.

 Vertebral traction systems prefiguring the frames of Risser, Abbott and EDF to obtain plastic deformation were already used.

 The sporting activity supplements the specific exercises. Balneotherapy was also widely used. You notice the kyphotic exercises of climbing rope. The daily repetition of these exercises allows a progressive strengthening of the extra-pyramidal deep automatic musculature.

 The engravings of Pravaz's books are very explicit. The postures taken by Schroth were already practiced in Lyon, and throughout Europe, 200 years ago....

 But the most important element of this engraving is not the posture, but the support on an unstable plate that stimulates the extra-pyramidal system, as we see on the left in the cat.

 Please click on the image on the left for the anatomo-physiological bases of the extra-pyramidal postural system.

 Claude Bernard is surrounded by students, colleagues and research assistants. He is the creator of Experimental Medicine as opposed to empirical and observational medicine, Science is a permanent exchange between theory and experimental facts. “For a man of science, there is no separate science of medicine or physiology, there is only a science of life.” 1865

 He also published a book with good results of conservative treatment.

 The plaster cast dates from the beginning of the XX ° century and comes from the United States. Calot à Berck will use Sayre's correction principles. The plaster cast is made in a standing position, the elongation effect has priority.

 The braces are improved. Here the Shantz brace is very close to the Milwaukee of Blount and Schmidt.

 Schroth's method was also born at the start of the 20th century. The Lyon brace dates from the last world war, it is the only adjustable underarm brace. More recently Min Mehta uses translation along the transverse axis of the vertebrae as a basic exercise for lumbar and thoraco-lumbar curvatures.

 Schmidt and Blount, the creators of the Milwaukee brace, adapt the brace to the child. Note the pelvic retroversion characteristic of braces at this time.

 Here Pierre Stagnara the creator of the Lyon brace, measuring the rib hump using a plumb line. The brace is always adjustable before the end of growth.

 Subsequently, many braces will be used. They often take the name of their authors or city of origin. They have in common the fact of being made on molding without correction.

 The Lyon brace continues to be made after a corrective plaster cast and is always adjustable during the growth period.

 The Lyon brace of Stagnara has anterior and posterior masts on which are articulated support valves at the level of the convexities and expansions at the level of the convexities. Both shoulder and pelvic girdles are stable.

 1. Awareness of postural defects. 2. Kyphotization of the thoracic region. 3. Passive Mobilization by concavities stretching. 4. Passive Mobilization  of the rib-vertebral joints (manual modeling of the rib hump & breathing execises). 5. Opening Ilio-lumbar angle. 6. Active Mobilization by convexity activation. 7. Lumbar Lordotization in sitting position. 8. Lumbar Side-shift (Min-Mehta). 9. Self Axial Active Elongation in standing position (grand porter). 10. Proprioceptive exercise In lumbar lordosis and Thoracic kyphosis. 11. Balance exercises. 12. Core stabilization in everyday life. More recently a 13th exercise on beam has come to complete the Lyon method

 The seven main schools of Physiotherapy Scoliosis Specific exercises have been studied by Hagit Berdishevsky with the particularities of each.

 The evaluation period of the Lyon method was transpubertal from 10 to 15 years. The group with physiotherapy included 160 patients. The average initial angulation was 17°, the final angulation was 18.5°. The group without physiotherapy included 50 patients. The initial angulation was 13°, the final angulation was 23.2°. The spontaneous evolution is 7 times less for patients treated by the Lyon method.

 In this picture of the Center des Massues in 1978, Pierre Stagnara is surrounded by all his assistants.

 Dating from the same period, we see children in braces practicing sports, as in the time of Pravaz.

 In 1975, Jean Claude de Mauroy defended his thesis on more than 100 infantile scoliosis. At that time, some curvatures were extremely progressive and surgical techniques did not yet allow effective stabilization.

 A first basic training "The days of scoliosis" was carried out in Lyon in 1979. 300 participants were expected, but more than 1000 registrants from all over Europe were present, showing the interest in the treatment of this affection.

 In addition to functional electrical stimulation tests, conventional treatments are becoming more relevant. In London, Min Mehta performs the serial casting for infantile scoliosis.

 The following decade will see the appearance of CAD / CAM technology which has been used in Lyon since 1986. More recently, the Schroth method specializes in 3 schools. The first moldings in the corrected position appear with the ARTbrace.

 The first CAD / CAM used a laser beam and went around the child in 30 seconds. The precision was equivalent to that of plaster molding. However, the immobility time was too important for carrying out a molding in the corrected position.

 Our experience with instantaneous CAD / CAM started 30 years ago and for more than 20 years we have been using the first generation ORTEN system with raster stereography. This acquisition followed that of the plastered cast, but allowed much more precise molding with breathing control..

 The measurement time is a few seconds. It is thanks to the precision of the measurement and the instantaneous nature of the volume measurement that the moldings can be carried out in very precise corrective postures region by region.

 The new Lyon brace derives from previous braces. It combines high stiffness (HR) and asymmetry like Chêneau brace.

 From 2004, the international members of SOSORT will meet once a year and draw up consensus and guidelines intended to promote the non-surgical treatment of scoliosis.

 The methods specific to scoliosis are essentially European.

 We will mainly study the Lyon method. Central to all other methods used in Europe.

 Many principles are common to all methods: Awareness of posture, 3D Postural correction, Balanced spine, Maintaining balanced posture, Sensory reintegration.

 The methods can be grouped. 3 methods use high rigidity: Lyon, SEAS and Shift. The Schroth is associated with polyethylene braces. The two Polish methods combine other methods.

 The lyon method is distinguished by many original concepts: chaotic and linear scoliosis, opening of the ilio-lumbar angle, Tensegrity and plastic deformation of soft tissues, Work on the extra-pyramidal automatic system, 3D correction by regional coupled movements, Isostatic balance in the sagittal plane, integration of sports activities, integration of the hypercorrective brace with physiotherapy.

 The stimulation of the extra-pyramidal deep paravertebral musculature is based on physiology with activation of the 4 tracts: reticulo-spinal, vestibulo-spinal, rubro-spinal and tecto-spinal. The static and dynamic sensors will be stimulated.

 3D correction by coupled movements is performed in the sagittal plane and in the frontal plane. In the sagittal plane, the isostatic balance is defined by the sagittalometer according to the lumbopelvic incidence for the pelvic version, lordosis and kyphosis. In the frontal plane, the correction takes into account the orientation of the posterior facets: bending by rotation around the sagittal axis for the thoracic region and shift by translation along the transverse axis for the lumbar region,

 The Lyon Method is the opposite of fitness, the problem is not muscle weakness (sarcopenia only affects adults), but an asymmetry of tension in the fascia. This is why stretching techniques and plastic deformation during "total time" are preferred. In a context of tensegrity, it is also important to maintain the mobility of all the vertebral segments..

 With regard to the new Lyon ARTbrace, there are many innovations: "pull" by corkscrew effect, solid geometry, overall detortion, Correction of the sagittal plane in isostatic balance, association of controlled asymmetry and very high rigidity, regional molding in corrected posture, 3D by coupled movements (frontal correction in sagittal isostatic balance), corrective brace in adults...

 The advantages of this new technology are multiple: brace and exercises are integrated and follow the same concepts, the classification is simple (one or two curvatures), the sagittal plane is in isostatic balance personalized according to the lumbopelvic incidence, the protocols have been identical for 50 years even if new tehnologies have made it possible to replace the plaster cast with "total time", the treatment is completely ambulatory, hypercorrection allows the treatment of soft tissues for scoliosis after Risser 3 and some curvatures of more than 40 °, the treatment is completely ambulatory whatever the angulation ...

 The results of treatment with Lyon ARTbrace are exceptional:

- average in-brace correction in the frontal plane greater than 70%,

- average improvement of the flat back by 9 °

- significant detorsion of up to 50%

- definitive average correction at the end of treatment of 30%

- slowing down the natural history of scoliosis in adulthood. 

 One of the major criticisms of scoliosis physiotherapy is the impossibility of objectively evaluating the results. It is not the same for the Lyon method. Advances in technology have made it possible to motorize the platform and especially to assess the improvement of the extra-pyramidal system.

 Abstract

AIM:

The aim of the present study was to analyse the effects of training performed on a rotating, motorised platform (the Huber/SpineForce device from LPG Systems, Valence, France) intended to improve, postural control and muscle function.

SUBJECTS:

Twelve healthy adults (divided into a sedentary group and an active group) took part in a two-month training programme (involving three sessions a week) on the SpineForce whole body rehabilitation device.

METHOD:

Instrumental assessment of postural control (on a Satel platform) and muscle function (on a Cybex Norm) was performed before and after training. Postural control in various conditions was measured using a position parameter (the mean anteroposterior position of the centre of foot pressure [CoP]) and two stability parameters (maximum CoP displacement and CoP sway area). Assessment of the muscle function was performed during knee and spine extension and featured maximum voluntary isometric contraction (MVIC), root mean square (RMS) and neuromuscular efficiency (MVIC/RMS) measurements.

RESULTS:

For static postural control, we observed a more forward CoP position in the maximum backward inclination condition (p<0.01) and a decrease in maximum CoP displacement in the "eyes closed on foam" and "maximum anterior inclination" conditions. In this latter condition, a lower CoP sway area was also noted (p<0.01). In terms of muscle function, a greater MVIC for knee extension was observed in the sedentary group only (p<0.05). These changes were not correlated with each another (p<0.05). However, the value of the pretraining maximum CoP displacement predicted its final value (p<0.05).

CONCLUSION:

Our results suggest that static postural control responds to training on a Huber((R))/SpineForce rehabilitation device. It seems probable that a population with a low initial level of physical activity would benefit most from training on this type of device. This training could notably be applied to elderly or disabled people and especially those with sensorimotor disabilities.

 An integrated functional assessment adapted to all types of patient for a precise assessment of their state of health and better monitoring of their rehabilitation.

Composed of 7 reference tests: stability test, unipodal, gait, stability limits, mobility restriction, strength, coordination.

 unipodal stance: fall indicator

 Gait like Fukuda test

 Stability limits

 Mobility restriction with pain

 Strength balance

 Coordination test