Fig. 167 is a diagram of the technique of K5. The lines representing the position of the pressure cushions indicate the height of pressure - on the right side 47, and on the left 33. As the patient is in sitting position it is here, as opposed to Kl, K2, and K3, not the left side of the measurement diagram, but the scale of height on the right which has to be considered. To render more marked the passive correction by special apparatus some general apparatus may also be used.

Thus, for example, Trunk-balancing apparatus, Dl, D2, and D3 (p. 3(H), may produce, by means of powerful passive flexions of the spine in various directions, a general mobility of the spine, particularly in the lumbar region. The fact that these movements can be so taken that their effect is asymmetrical is another factor in their usefulness.

Chest-expansion, E6 (p. 305), has a powerfully corrective effect. If there is any prominence of the ribs the patient is placed more to one side of the scat, so that the back cushion, when moved forward, is specially pressed against the prominence of the chest, and the effect is similar to that of K3, with this difference, that the corrective pressure is not constant, but rhythmical, and works only on the back.

Fig. 167.

Apparatus for Active Correction.

These exercises are given with the aid of the general apparatus from groups A, B, C, and also with the specially constructed apparatus of group L.

Amongst the groups A, B, C the most commonly used arc the following : -

A2. Arm- and Shoulder-lifting. - This apparatus is as simple as possible in construction, consisting only of weights with handles, "clubs," to be grasped while various arm exercises are performed. The weights vary from 1/2 to 5 kg. and are numbered from 1 to 10.

The club exercises mostly used in scoliosis treatment are three in number. They may either be taken in free standing position or with apparatus K5.

(1) Double Arm-Lifting With A Club In Each Hand Forward, Upward, Outward, Downward

The movement is symmetrical, and aims at strengthening the muscles of the shoulders and spine.

(2) Single ( Right Or Left) Arm-Lifting-Ouiward And -Upward

The effect of this depends on the secondary static contraction of the muscles of the spine which is caused by one-sided weighted arm exercises, but this is dealt with in more detail in the description of A3.

(3) Single Shoulder-lifting as high as possible, and sinking to starting position, while the weighted arm hangs downward throughout the exercise. The other arm may be in wing position. The movement aims at strengthening the muscles of the shoulder-girdle. It is used in the treatment of uneven shoulder-blades and is given for the shoulder which is lower. It has also a secondary effect on the back muscles of the opposite side, like that of Single Arm-lifting, but weaker.

A3. Double Arm-flexion (Fig. 168). - The apparatus consists of a stand on which are two pulleys with ropes above the patient's head, one end of each rope ending in a handle, the other end fastened to a lever with movable weights in the angle on each side of the lower part of the apparatus. The levers are raised when the patient pulls the handles down, and thus give the intended resistance. The starting position is with the arms stretched straight upward; the arms are then lowered till the hands are at the level of the shoulders, and then allow themselves to be drawn upward again during the negative phase of the movement.

The exercise can be given either for two arms or one. In the first case it is used to strengthen the muscles of the arm and spine, and also for expansion of the chest; in the second instance the movement is asymmetrical, and its effect upon the spine depends upon secondary contraction.

In weighted Single Arm movements the static contractions are according to the following rule : - In lifting (A2) the muscles of the trunk on the opposite side contract; in downdrawing (A3) the muscles on the same side contract. The reason of this is obvious. The upright position is maintained, among other things, by equal contraction of the spinal muscles on either side. If one side of the body, as in A2, is burdened more than the other, the body tends to bend over to that side, and this is prevented by the increased contraction of the muscles of the spine and trunk on the opposite side. This increased contraction is the result of the necessity of fixing the vertebrae where those muscles originate which in turn give the scapula the support required for the performance of the arm movement. The opposite takes place when the arm is drawn downward against resistance, as in A3, and the muscles of the spine and abdomen on the same side contract or increase their contraction. On these facts is based the use of the above-mentioned arm exercises in scoliosis treatment. In right-sided curvature Left Arm-stretching-upward (A2) or Right Arm-downdrawing (A3) are used, and vice versa. They may also be combined. In this case the movement is performed as follows : - The left arm with an A2 club is held bent upward so that the club is close to the shoulder; the right arm grasps one handle of A3 and is held stretched upward. From this position the left arm is stretched upward, the right at the same time being drawn downward till the hand is at the level of the shoulder, after which both arms return to position.

A5 and A6. Double Arm-carrying-forwardand-backward is used for the general strengthening of the muscles of the chest and back, the latter particularly in kyphosis.

Fig. 168.

B3. Hip-updrawing. - The working part of the apparatus is a stirrup resting on the instep, which the patient lifts by drawing his leg upward. In the treatment of scoliosis this apparatus is sometimes used for Single Hip-raising, when the leg working against resistance is kept straight the whole time, and the hip of the same side is raised as far as possible (compare Shoulder-lifting). The effect is analogous to that of A3, i.e., it strengthens the muscles of the same side in the lumbar region, and can be used for lumbar curvature.