Primary prevention of discopathy and osteoporosis
Budapest, Hungary. March 24, 2000.
A health promotion and education program
of the National Center for Spinal Disorders
Peter Paul Varga, M.D., Center Director
Annamária Somhegyi, M.D., PhD., Program Director
As the socio-economic changes (i.e., motorization, information overload, mass use of computers) were introduced into Hungary over the past ten years, a more passive life style evolved to accommodate these changes. As this new life style took an ever more significant hold among the population, the cases of Discopathy markedly increased.
Not only is the present adult population affected, but also the children are increasingly becoming part of this less active life style and experiencing its reverberations. An alarming number of kindergarten and school age children in Hungary today, have bad posture or suffer from some form of spinal disease.
A few interesting facts: Musculosceletal Disease is the number one cause of sick leave and the third of disability; spinal disease has doubled over the past 10 years and increased five fold over the past 20 years among the young; and, the majority, that is 60% of kindergarten and school age children, have either bad posture or spinal disease.
We do not have data showing what socio-economic burden spinal disease and osteoporosis means to society.
I. Goals and methods of the prevention program
1. Spine exercises be part of Kindergarten and Public School Physical Education
Goal: that teaching the biomechanically correct use of the spine be an integral part of the regular physical education program through special exercises (hereinafter “spine exercises”). Spine exercises are designed to develop good posture by strengthening and stretching those muscles responsible for maintaining good posture, those holding the correct pelvic position and those keeping the proper muscle balance with the goal that good posture become automatic.
a) teaching the kindergarten and physical education teachers the necessary spine exercises;
b) influencing education: that the spine exercise be part of the regular physical education programs.
2. Daily Physical Education Classes in the Schools
Goal: that every school provide daily physical education classes for every student as part of the regular school schedule
a) educating principals and parents of the damage caused by civilization’s passive life style and convince them to join together in solving the problem by demanding daily physical education classes for the children;
b) influencing education: lobby for the new quality control program now being introduced nationwide to also encompass children’s welfare in the education system.
II. Achievements: March 1995 – 2000
1. Spine exercises as part of Kindergarten and Public School Physical Education Classes
a) Education program for physical education teachers
Between 1995 and 1998, we offered 172 courses wherein physical education teachers were first shown the importance of and the necessity for using the spine in a biomechanically correct way. We then proceeded to teach the teachers the spine exercises followed by instruction in the proper method of teaching these to the children. The course entailed 1½ hours of lectures followed by 1½ hours of actual practice. The teachers were very enthusiastic about the program and agreed with our request to use the exercises themselves
The exercise material was put together by University Educators of Physiotherapy (S. Gardi, I. Darabos, A. Feszthammer, V. Steinhausz) based on works by Saunders, Kendall, Magee, Kapandji, Tilscher, Janda and Hungarian professional literature. The program comprises 12 muscle tests that measure the strength and the stretching ability of the various muscles supporting the spine (Saunders C.O., Chaska, Minnesota, USA, 1993, pp.378-379).
In 1999, we won accreditation (and government support) for a 66-hour post-graduate physical education program with the exercise material for developing and maintaining biomechanically correct posture. We allowed graduate institutions of physical education (totaling 18 countrywide) to use the materials in our name and to continue the education program themselves. These institutions use our materials in teaching not only the already practicing physical education teachers but also the undergraduates who then, from the beginning of their education, will have this necessary knowledge at hand.
As of March 24, 2000, 3,881 physical education teachers from 2,240 institutions (678 kindergartens, 1,172 elementary schools, 369 High Schools, 21 Colleges) joined our Prevention Program. Each received, free of charge, a booklet and 3 videocassettes showing the spine exercises. Out of these, 799 teachers returned 37,882 completed muscle test forms on 28,320 children. These tests showed that only 13% of the children have healthy back muscles sustaining correct posture and that these muscles are either weakened or shortened in the remaining 87% resulting in improper muscle balance. (More detailed statistical analysis is to be completed.)
For the teachers in the program, a Home Page is available for information on the schools and the physical education teachers involved in the program and for muscle test results. The data is constantly being updated. (Only the testing teacher may gain access to an individual’s data with a personal access code.)
b) Influencing education: that the spine exercise be part of the regular physical education programs
The Ministry of Education is in the process of establishing teaching material requirements. We were able to get the teaching of the biomechanically correct use of the spine to appear among these requirements. This fact should give educators the incentive to learn the spine exercises and to make them a regular part of their physical education classes.
2. Daily Physical Education Classes in the Schools
a) Convincing School Officials and Parents
Schools are autonomous entities even in Hungary today and, as such, want to please the population. For this reason, it is important to show school officials the magnitude of the burden inflicted upon society by modern civilization’s passive life style and parents what this burden means to them individually. This burden can be reduced if, during childhood, we ensure that each child receives the proper physical education during the growing years. Since after school sports are as yet not very well organized in Hungary, the best and most economical way to ensure daily physical exercise for the children is in the schools. To this end, we ask the school officials to make this a reality and the parents that they demand this of the schools.
The LIONS Clubs International, the Hungarian National Parents’ Organization, the National Association of Large Families, Family Practitioners, Pediatricians, and various organizations of school doctors have helped us in our quest to convince parents. Newspapers, TV and radio stations have also helped us in our efforts.
b) Influencing Education
The process of quality management and quality control is slowly beginning in the education sector in Hungary, as well. The population’s demands for good health need to be taken into account even on the ministerial level especially where the young, the future workforce is concerned. According to medical evidence, children must have regular, daily physical exercise over a long period of time to become healthy, viable and productive adults. This would also eliminate much of modern civilization’s diseases such as cardiovascular disease, osteoporosis, discopathy, psychosomatic diseases, etc. The government ministries have understood this fact and have included this topic in many of their conferences where school principals were present. This has greatly helped our cause.
The Ministry of Health has recognized the importance of daily physical exercise and presently, the Minister of Youth and Sport announced that the Government supports daily physical education classes in the schools. Also, the support of the Ministry of the Interior was of great value to us in convincing school officials as well as local governments. The armed forces have included the spine exercises in their physical education program. The Ministry of Health has steadily supported our work over the past five years.
III. Future goals
1. Gather data regarding exercise program results - blind muscle tests on children of varying ages. (Planning and execution of controlled trials; completion of Home Page test evaluation.) 2. Support schools that introduce daily physical education by offering higher hourly wages, exercise equipment and maintenance, building new gyms.
3. To support those schools that teach the spine exercises by supplying them with equipment (i.e., exercise mats, exercise balls, posture correct furniture, etc.).
Since schools in Hungary are suffering from lack of funds, financial assistance to schools willing to participate in an innovative health program is very important.
When they see the physical education classes become a reality for their children through their own efforts, the parents, themselves, might become motivated to participate in physical activities for their own health and welfare.
IV. Our program fits bone and joint decade goals by
1. decreasing the socio-economic burden of musculoskeletal disorders;
2. having children do spine exercises regularly and in the long term plays an important part in the primary prevention of discopathy by reducing spinal damage caused by the sedentary life style;
3. encouraging increased physical activity which helps in primary prevention through better bone calcification and development of musculature and joints - also aids in preventing cardiovascular and psychosomatic disease;
4. measuring the value of the spine exercises;
5. bringing parents into the programs gives them power and responsibility over their own and their children’s health and welfare;
6. including various segments of society – multi-disciplinary program;
7. protecting future generations;
8. including the whole society in the education program;
9. reducing financial impact since the program works within already functioning structures (kindergartens and schools);
10. increasing ergonomic knowledge and raising body awareness;
11. providing functional training;
12. furthering the understanding of the spine’s function;
13. encouraging regular implementation of the exercises for long term results.