{"id":33838,"date":"2024-09-17T08:45:53","date_gmt":"2024-09-17T15:45:53","guid":{"rendered":"https:\/\/medfitnetwork.org\/public\/?p=33838"},"modified":"2024-09-05T08:36:04","modified_gmt":"2024-09-05T15:36:04","slug":"parkinsons-bone-health-camptocormia","status":"publish","type":"post","link":"https:\/\/medfitnetwork.org\/public\/all-mfn\/parkinsons-bone-health-camptocormia\/","title":{"rendered":"Parkinson&#8217;s Bone Health: Camptocormia"},"content":{"rendered":"\n<p id=\"viewer-dqi48\">Welcome back fighters, care-partners and fitness professionals! At <a href=\"https:\/\/www.bridgesforparkinsons.com\/\" target=\"_blank\" rel=\"noreferrer noopener\">Bridges For Parkinson\u2019s<\/a>, posture\/vertical stability is a big concern and one we address in every class. Why? Because a strong, vertical spine means reduced falls, better gait, less back pain, increased lung capacity, ability to enjoy activities and live independently. However, fitness professionals observe some folks living with Parkinson\u2019s disease having a severe forward lean at a 45-90 degree angle.<\/p>\n\n\n\n<p id=\"viewer-4a9vh\">What is this? What causes it? And, is there a solution?<\/p>\n\n\n\n<p id=\"viewer-7h0od\">This forward lean is called \u201cCamptocormia\u201d, derived from two Greek words: <em>Kampto- (To bend) <\/em>and <em>Kormos (trunk). <\/em>Camptocormia was first documented in the 17th century by the Spanish painter Francisco de Zurbaran. In the 19th century, Brodie wrote about it. Later the term was coined by Rosanoff and Saloff who described the abnormality in World War 1 soldiers traumatized by shell shocks.<\/p>\n\n\n\n<p id=\"viewer-1v953\">Camptocormia is defined as <strong>bent spine syndrome<\/strong> (BSS), an abnormal flexion of the trunk, appearing in standing position, increasing during walking and abating in supine position.<\/p>\n\n\n\n<p id=\"viewer-dhqm1\">According to Srivanitchapoom and Hallett, approximately 3%-17% of the Parkinson\u2019s population suffers from Camptocormia. See below examples of Camptocormia syndrome.<\/p>\n\n\n<div class=\"wp-block-image\">\n<figure class=\"aligncenter size-full is-resized\"><img fetchpriority=\"high\" decoding=\"async\" width=\"603\" height=\"485\" src=\"https:\/\/medfitnetwork.org\/public\/wp-content\/uploads\/2024\/08\/camptocormia.jpg\" alt=\"\" class=\"wp-image-33839\" style=\"width:603px;height:auto\" srcset=\"https:\/\/medfitnetwork.org\/public\/wp-content\/uploads\/2024\/08\/camptocormia.jpg 603w, https:\/\/medfitnetwork.org\/public\/wp-content\/uploads\/2024\/08\/camptocormia-300x241.jpg 300w\" sizes=\"(max-width: 603px) 100vw, 603px\" \/><\/figure><\/div>\n\n\n<div style=\"height:15px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<h4 class=\"wp-block-heading\"><strong>What Causes \u201cCamptocormia\u201d?<\/strong><\/h4>\n\n\n\n<p id=\"viewer-9u0ku\">From a <em><u>muscular perspective,<\/u><\/em> the paraspinal, hip and glute muscles are in a weakened state making it difficult for the body to \u201cfight back\u201d against the neurological side of Camptocormia which we will discuss later in this article.<\/p>\n\n\n\n<p id=\"viewer-5uf89\">The paraspinal muscles are located on the left and right side of your spine and are made up of three groups.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Iliocostalis<\/li>\n\n\n\n<li>Longissimus<\/li>\n\n\n\n<li>Spinalis<\/li>\n<\/ul>\n\n\n<div class=\"wp-block-image\">\n<figure class=\"aligncenter size-full\"><img decoding=\"async\" width=\"489\" height=\"483\" src=\"https:\/\/medfitnetwork.org\/public\/wp-content\/uploads\/2024\/08\/ba82eb_88974675d552487a85a072afdebd2d0cmv2.webp\" alt=\"\" class=\"wp-image-33840\" srcset=\"https:\/\/medfitnetwork.org\/public\/wp-content\/uploads\/2024\/08\/ba82eb_88974675d552487a85a072afdebd2d0cmv2.webp 489w, https:\/\/medfitnetwork.org\/public\/wp-content\/uploads\/2024\/08\/ba82eb_88974675d552487a85a072afdebd2d0cmv2-300x296.webp 300w, https:\/\/medfitnetwork.org\/public\/wp-content\/uploads\/2024\/08\/ba82eb_88974675d552487a85a072afdebd2d0cmv2-80x80.webp 80w, https:\/\/medfitnetwork.org\/public\/wp-content\/uploads\/2024\/08\/ba82eb_88974675d552487a85a072afdebd2d0cmv2-75x75.webp 75w, https:\/\/medfitnetwork.org\/public\/wp-content\/uploads\/2024\/08\/ba82eb_88974675d552487a85a072afdebd2d0cmv2-24x24.webp 24w, https:\/\/medfitnetwork.org\/public\/wp-content\/uploads\/2024\/08\/ba82eb_88974675d552487a85a072afdebd2d0cmv2-48x48.webp 48w, https:\/\/medfitnetwork.org\/public\/wp-content\/uploads\/2024\/08\/ba82eb_88974675d552487a85a072afdebd2d0cmv2-96x96.webp 96w\" sizes=\"(max-width: 489px) 100vw, 489px\" \/><\/figure><\/div>\n\n\n<p id=\"viewer-essbu\">Paraspinal muscles<\/p>\n\n\n\n<p id=\"viewer-3r9le\">The job of the paraspinal muscles is to extend your spine and to bend it over to the same side on which the contracting paraspinal muscle is located. For example: bending to the side to pick something off the floor.<\/p>\n\n\n\n<p id=\"viewer-1lgl6\">The four main hip and glute muscles include:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>The gluteal group (butt muscles) &#8211; responsible for stabilizing the upper body and pelvis, aid in locomotion and extend the hip. Example: when your leg travels behind you before kicking a ball.<\/li>\n\n\n\n<li>The adductor group &#8211; responsible for pulling the thighs together and rotating the upper leg inward and stabilizing the hip. Example: When the leg moves to the center of the body after stepping out for a half-jumping jack..<\/li>\n\n\n\n<li>The lateral rotator group &#8211; responsible for rotating the hip joint laterally. Additionally this group will aid in extension and adduction of the hip. Example: Piriformis stretch also known as the \u201cfigure 4 stretch\u201d<\/li>\n\n\n\n<li>The iliopsoas &#8211; this is the primary hip flexor and assists with external rotation of the hip joint. It plays an important role in correct posture for standing\/sitting lumbar position and walking\/running.<\/li>\n<\/ul>\n\n\n\n<p id=\"viewer-ff97t\">These muscle groups play a vital part in your activities of daily living! Bridges For Parkinson\u2019s addresses these muscles groups with exercises such as:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Sit to stands <\/li>\n\n\n\n<li>Squats <\/li>\n\n\n\n<li>Bridges\/Bird dog\/Seated Back Extension (with tubes) <\/li>\n\n\n\n<li>Clamshells <\/li>\n\n\n\n<li>\u00bd Warrior step <\/li>\n\n\n\n<li>Deadlifts <\/li>\n\n\n\n<li>Lunges (forward, reverse, lateral and diagonally) <\/li>\n\n\n\n<li>Rows <\/li>\n\n\n\n<li>T\u2019s<\/li>\n<\/ul>\n\n\n\n<p id=\"viewer-actcn\">And we progress the exercise to a higher level of difficulty by: <\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Standing on one leg <\/li>\n\n\n\n<li>Adding repetitions or length of time <\/li>\n\n\n\n<li>Standing on the BOSU\/Pad<\/li>\n<\/ul>\n\n\n\n<p id=\"viewer-7f0q8\">Now, let\u2019s discuss the neurological aspect of Camptocormia. Much like \u201c<a href=\"https:\/\/medfitnetwork.org\/public\/all-mfn\/pisa-syndrome\/\" data-type=\"post\" data-id=\"33738\" target=\"_blank\" rel=\"noreferrer noopener\">Pisa Syndrome<\/a>\u201d, the root cause is multifactorial and largely unknown.<\/p>\n\n\n\n<p id=\"viewer-alvcn\">Camptocormia is largely considered a neurological disorder due to its comorbidity with other neurodegenerative and movement disorders such as ALS, dementia with Lewy Bodies, Alzheimer\u2019s, and Parkinson\u2019s (Srivanitchapoom &amp; Hallett, 2016). As mentioned, although the presentation of this disorder is largely based on the forward lean, with a tendency to worsen throughout the day due to muscle fatigue, the causes are up for debate in research. For now, the best guess we can take is that the association with PD and other dystonias translates to a faulty cascade of events in the major movement centers of the brain, and the brain-body connection as consequence (Margraf et al., 2016).<\/p>\n\n\n\n<p id=\"viewer-eqept\">Typically, you will find Camptocormia in the more advanced stages of PD, such as those living with Parkinson\u2019s for 7 or more years, those with previous spinal issues, and those who indicate lower motor function on neurological exams (Srivanitchapoom &amp; Hallett, 2016). <strong>However, even if you meet any\/all of these criteria you won\u2019t necessarily develop this disorder.<\/strong><\/p>\n\n\n\n<p id=\"viewer-bg91k\">The onset of Camptocormia can be mitigated with proper preventative care such as exercise and physical\/occupational therapy. Additionally, for individuals with this syndrome, botox and surgery (DBS) can alleviate the severe forward lean.<\/p>\n\n\n\n<p id=\"viewer-8hk4k\">Botox may be used as a treatment that \u201cfreezes&#8221; the muscles affected in this disorder, allowing the muscles to lengthen, in turn helping to improve posture. However, this is neither a permanent nor strong solution, although it is seemingly effective in smaller studies assessing the benefits of this treatment (Bertram et al., 2015; Todo et al., 2018; Anandan et al., 2021) . There are also long term drawbacks, the biggest one being muscle weakness that can cause overall worsening of the disorder. There are other, more permanent ways of managing this as well, but are much more invasive. Spinal surgery and Deep Brain Stimulation are two of the more \u201ccommon\u201d options, although to be considered for these the symptoms must be severe (Margraf et al., 2016). The best ways to manage this disorder are to continue taking your prescribed medication, and exercise to strengthen the muscles involved with keeping your posture upright.<\/p>\n\n\n\n<h4 class=\"wp-block-heading\"><strong>How Does Camptocormia Affect Activities of Daily Living?<\/strong><\/h4>\n\n\n\n<p id=\"viewer-3st16\">Similar to Pisa syndrome, Camptocormia is a non-fixed flexion of the trunk, which can lead to significant deficits in posture, balance, safety, and ability to perform daily activities. Posture is one of the pivotal components for ALL ADLs. So, from an occupational therapy scope, restoration of posture and maintenance of current occupational performance is key.<\/p>\n\n\n\n<p id=\"viewer-foe9u\"><strong>ADL training<\/strong>: due to posture changes when standing, patients may experience difficulty maintaining routine activities with dressing, bathing. ADL retraining helps to maintain independence and current level of occupational performance.<\/p>\n\n\n\n<p id=\"viewer-dfqso\"><strong>Seating and positioning<\/strong>: in order to promote improved posture, position hips in an anterior angle, which can allow for increased participation in ADL\u2019s such as feeding or grooming. This can also help with visual ability and increase social participation. Positioning during sleep is another potential area to examine as we do not want to encourage further postural deformity.<\/p>\n\n\n\n<p id=\"viewer-eka4d\"><strong>Visual strategies:<\/strong> due to the posture changes while standing, camptocormia can lead to difficulty interacting with our environment as we typically would, especially visually. Implementing visual cues or compensatory strategies can help promote improved posture and allow for safe interaction within their home or social environment.<\/p>\n\n\n\n<h4 class=\"wp-block-heading\"><strong>Examples of Cues<\/strong><\/h4>\n\n\n\n<p id=\"viewer-5ncsk\">1. Sit\/stand with shoulders down and shoulder blades pinched together as if you are royalty. Automatically, people position their head over the shoulders and sit\/stand taller.<\/p>\n\n\n\n<p id=\"viewer-1p2ip\">2. Walk with eyes lifted and looking in the distance. When people look down they tend to bend over and slump their shoulders. Looking in the distance prepares them for what is ahead and trains them to use peripheral vision for what is right in front of them.<\/p>\n\n\n\n<p id=\"viewer-ac48\"><strong>Home Modifications<\/strong>: modifying home and using assistive devices such as installing grab bars, removing trip hazards (rugs), training with reacher will ensure safety and promote ADL participation.<\/p>\n\n\n\n<p id=\"viewer-61lsg\"><strong>Energy conservation:<\/strong> as the day continues and the patient feels more fatigued, posture will be more difficult to maintain. Learning and implementing energy conservation techniques could help to promote improved posture throughout the day.<\/p>\n\n\n\n<p id=\"viewer-5a3mk\"><strong>Supine exercises<\/strong>: Supine exercises (on your back) will help to maintain muscle strength and endurance while maintaining proper posture throughout range of motion. These exercises eliminate gravitational pull and forward flexion due to Camptocormia.<\/p>\n\n\n\n<p id=\"viewer-223rc\">In closing, Camptocormia is unique in that it develops over time in conjunction with a movement disorder. The strength of your physical structure depends on having the knowledge to identify possible bone issues such as Camptocormia, properly addressing the issue with corrective exercises and a team that provides support and encouragement.<\/p>\n\n\n\n<p id=\"viewer-2nrkk\">Bridges For Parkinson\u2019s focuses on helping our fighters and care-partners develop a sense of awareness, provide corrective exercise therapy for those dealing with Camptocormia or preventative exercises to support a strong, vertical spine!<\/p>\n\n\n\n<h4 class=\"wp-block-heading\"><strong>Fit Pros: You Can Improve the Lives of Those Living with Parkinson\u2019s<\/strong><\/h4>\n\n\n\n<p>Enroll in Colleen\u2019s 12-hour online course,&nbsp;<a href=\"https:\/\/www.medfitclassroom.org\/product\/parkinsons-fitness-specialist\/\" target=\"_blank\" rel=\"noreferrer noopener\">Parkinson\u2019s Disease Fitness Specialist<\/a>. The course brings the research, medical and fitness fields together so that fitness professionals gain a comprehensive understanding of Parkinson\u2019s disease, and learn how to work with those who have it.<a href=\"https:\/\/www.medfitclassroom.org\/pfs-offer\/#pfsoffer\"><\/a><\/p>\n\n\n\n<figure class=\"wp-block-image\"><a href=\"https:\/\/www.medfitclassroom.org\/product\/parkinsons-fitness-specialist\/\" target=\"_blank\" rel=\"noreferrer noopener\"><img decoding=\"async\" width=\"1024\" height=\"389\" src=\"https:\/\/medfitnetwork.org\/public\/wp-content\/uploads\/2021\/08\/PDFS_updated-1024x389.jpg\" alt=\"\" class=\"wp-image-30688\" srcset=\"https:\/\/medfitnetwork.org\/public\/wp-content\/uploads\/2021\/08\/PDFS_updated-1024x389.jpg 1024w, https:\/\/medfitnetwork.org\/public\/wp-content\/uploads\/2021\/08\/PDFS_updated-300x114.jpg 300w, https:\/\/medfitnetwork.org\/public\/wp-content\/uploads\/2021\/08\/PDFS_updated-768x292.jpg 768w, https:\/\/medfitnetwork.org\/public\/wp-content\/uploads\/2021\/08\/PDFS_updated.jpg 1185w\" sizes=\"(max-width: 1024px) 100vw, 1024px\" \/><\/a><\/figure>\n\n\n\n<hr class=\"wp-block-separator has-alpha-channel-opacity\"\/>\n\n\n\n<p><em>Originally printed on <a href=\"https:\/\/www.bridgesforparkinsons.com\/\" target=\"_blank\" rel=\"noreferrer noopener\">bridgesforparkinsons.com<\/a>. Reprinted with permission.<\/em><\/p>\n\n\n\n<p>Written by:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Colleen Bridges, M.Ed., NSCA-CPT, Parkinson\u2019s Disease Fitness Specialist<\/li>\n\n\n\n<li>Renee Rouleau, PhD candidate, Jacobs School of Biomedical Sciences, University at Buffalo<\/li>\n\n\n\n<li>Betsy Lerner, ISSA-CPT, MA English and African American Lit, Parkinson\u2019s Disease Specialist and Rock Steady Boxing Certified<\/li>\n\n\n\n<li>Cindy Nyquist, LPTA, ATC, Rock Steady Boxing Certified<\/li>\n<\/ul>\n\n\n\n<p id=\"viewer-4alr4\"><strong>References<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Anandan, C., &amp; Jankovic, J. (2021). Botulinum Toxin in Movement Disorders: An Update. Toxins, 13(1), 42. MDPI AG. Retrieved from <a href=\"http:\/\/dx.doi.org\/10.3390\/toxins13010042\" target=\"_blank\" rel=\"noreferrer noopener\">http:\/\/dx.doi.org\/10.3390\/toxins13010042<\/a><\/li>\n\n\n\n<li>Djaldetti R, Mosberg-Galili R, Sroka H, et al. Camptocormia (bent spine) in patients with Parkinson\u2019s disease-characterization and possible pathogenesis of an unusual phenomenon. Mov Disord. 1999;14:443\u20137.<\/li>\n\n\n\n<li>Margraf NG, Wrede A, Deuschl G, Schulz-Schaeffer WJ. Pathophysiological Concepts and Treatment of Camptocormia. J Parkinsons Dis. 2016 Jun 16;6(3):485-501. doi: 10.3233\/JPD-160836. PMID: 27314757; PMCID: PMC5008234.<\/li>\n\n\n\n<li>Sch\u00e4bitz WR, Glatz K, Schuhan C, et al. Severe forward flexion of the trunk in Parkinson\u2019s disease: focal myopathy of the paraspinal muscles mimickingcamptocormia. Mov Disord. 2003;18:408\u201314.<\/li>\n\n\n\n<li>Srivanitchapoom P, Hallett M. Camptocormia in Parkinson&#8217;s disease: definition, epidemiology, pathogenesis and treatment modalities. J Neurol Neurosurg Psychiatry. 2016 Jan;87(1):75-85. doi: 10.1136\/jnnp-2014-310049. Epub 2015 Apr 20. PMID: 25896683; PMCID: PMC5582594.<\/li>\n\n\n\n<li>Todo, H., Yamasaki, H., Ogawa, G. et al. Injection of Onabotulinum Toxin A into the Bilateral External Oblique Muscle Attenuated Camptocormia: A Prospective Open-Label Study in Six Patients with Parkinson\u2019s Disease. Neurol Ther 7, 365\u2013371 (2018). <a href=\"https:\/\/doi.org\/10.1007\/s40120-018-0108-x\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/doi.org\/10.1007\/s40120-018-0108-x<\/a><\/li>\n\n\n\n<li>Wartenberg R. Camptocormia. Arch Neurol Psychiatry. 1946;56:327.<\/li>\n<\/ul>\n","protected":false},"excerpt":{"rendered":"<p>Welcome back fighters, care-partners and fitness professionals! At Bridges For Parkinson\u2019s, posture\/vertical stability is a big concern and one we address in every class. Why? Because a strong, vertical spine means reduced falls, better gait, less back pain, increased lung capacity, ability to enjoy activities and live independently. However, fitness professionals observe some folks living with Parkinson\u2019s disease having a severe forward lean at a 45-90 degree angle. What is this? What causes it? And, is there a solution? This forward lean is called \u201cCamptocormia\u201d, derived from two Greek words: Kampto- (To bend) and Kormos (trunk). Camptocormia was first documented in the 17th century by the Spanish painter Francisco de Zurbaran. In the 19th century, Brodie wrote about it. Later the term was coined by Rosanoff and Saloff who described the abnormality in World War 1 soldiers traumatized by shell shocks. Camptocormia is defined as bent spine syndrome (BSS), an abnormal flexion of the trunk, appearing in standing position, increasing during walking and abating in supine position. According to Srivanitchapoom and Hallett, approximately 3%-17% of the Parkinson\u2019s population suffers from Camptocormia. See below examples of Camptocormia syndrome. What Causes \u201cCamptocormia\u201d? From a muscular perspective, the paraspinal, hip and glute muscles [&hellip;]<\/p>\n","protected":false},"author":361,"featured_media":33409,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":"","jetpack_publicize_message":"","jetpack_publicize_feature_enabled":true,"jetpack_social_post_already_shared":false,"jetpack_social_options":{"image_generator_settings":{"template":"highway","default_image_id":0,"font":"","enabled":false},"version":2}},"categories":[1],"tags":[198,92],"class_list":["post-33838","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-all-mfn","tag-fitness-professionals","tag-parkinsons"],"jetpack_publicize_connections":[],"_links":{"self":[{"href":"https:\/\/medfitnetwork.org\/public\/wp-json\/wp\/v2\/posts\/33838","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/medfitnetwork.org\/public\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/medfitnetwork.org\/public\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/medfitnetwork.org\/public\/wp-json\/wp\/v2\/users\/361"}],"replies":[{"embeddable":true,"href":"https:\/\/medfitnetwork.org\/public\/wp-json\/wp\/v2\/comments?post=33838"}],"version-history":[{"count":3,"href":"https:\/\/medfitnetwork.org\/public\/wp-json\/wp\/v2\/posts\/33838\/revisions"}],"predecessor-version":[{"id":33843,"href":"https:\/\/medfitnetwork.org\/public\/wp-json\/wp\/v2\/posts\/33838\/revisions\/33843"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/medfitnetwork.org\/public\/wp-json\/wp\/v2\/media\/33409"}],"wp:attachment":[{"href":"https:\/\/medfitnetwork.org\/public\/wp-json\/wp\/v2\/media?parent=33838"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/medfitnetwork.org\/public\/wp-json\/wp\/v2\/categories?post=33838"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/medfitnetwork.org\/public\/wp-json\/wp\/v2\/tags?post=33838"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}