**3. Judo: an alternative form of physiotherapy in the treatment of multiple sclerosis**

An experiment was conducted, in which a program of physiotherapy for patients with relapsing–remitting (RR) multiple sclerosis was developed on the basis of judo elements. The study involved 4 women aged from 32 to 49 years who had been suffering from MS for several years (from 3 to 7 years). Before being qualified into the study, their physical activity was varied. Prior to the beginning of the study, the patients did not undergo any supervised physiotherapy. In the functional assessment, they presented different levels. However, all of them were able to move independently. They reported the following problems related to the disease: urinary incontinence, chronic fatigue, balance disorders and sensory disturbances. In addition, 3 respondents reported a sense of social isolation despite being active professionally. None of the women had practiced a sport like judo before. Unconventional therapy involving judo elements lasted for 8 weeks. All patients fully executed the plan they were provided with. The women participated in judo training supervised by a physiotherapist twice a week, in 45-minutes sessions and performed exercises at home twice a week, in 20-minutes sessions. The number of classes and their duration were determined based on the guidelines of physical activity for patients with MS developed by the Canadian Society for Exercise Physiology, which received a recommendation from the Multiple Sclerosis Society of Canada [14]. The participants exercised barefoot in sportswear in a room with a relatively low temperature (around 15°C). The program of classes included the following: learning about history and philosophy of the discipline, demonstration of throws and combat by professional sportsmen, coordination exercises (alternating arm circles, etc.), learning falling techniques from various positions (*ukemi*), ways of moving on the mat, body turns and body rotations, special judo exercises aimed at strengthening the stabilizing muscles of the torso, the so-called central stabilizers (moving: sitting straight forward and backward, lying back and forward, lying backwards with alternate right and left bends of the body, in a standing position with bent lower limbs, taut torso and bent upper limbs, etc.), learning 3 basic holds (*osaekomi - waza*) and getting out of them, performing individual throwing techniques without a partner (*tandoku - renshu*), responding to sound and visual signals, exercises and games aimed at throwing the partner (*uke*) off balance (including: pulling/pushing an *obi* with one's hands, pulling with the left upper limb and thrusting with the right, and vice versa, pushing the partner while approaching him), taking defensive positions on the ground (*ne - waza*) and trying to maintain them, training fights on the ground (*randori ne - waza*), adjusting one's own movements to the partner's movements, moving around the mat with your partner, entering different techniques with the partner (*uchi - komi*) in a spot or in movement, *tandoku - renshu* with closed eyes and overcoming the partner's resistance. Each class began with warmup exercises and ended with breathing and relaxation techniques on the basis of post-isometric muscle self-relaxation. The tasks to be performed at home correlated

### *Role of Physiotherapy and Practice of Judo as an Alternative Method of Treatment in Multiple… DOI: http://dx.doi.org/10.5772/intechopen.95501*

with the current stage of the rehabilitation program. Therefore, the plan included: coordination exercises (alternating forward and backward arms rotations), stabilization exercises, the so-called CORE (starting positions: point kneeling and lying on the back), falling on the mattress/bed, *tandoku - renshu* (also outdoor), simulation of exits from holds without a partner and breathing and relaxation exercises.

Prior to the start of the rehabilitation program and at the end of the program, patients completed the Multiple Sclerosis Impact Scale (MSIS - 29) questionnaire. The results showed that in the assessment of patients, the physiotherapy contributed to the decrease in the degree of their disability, both physically and mentally. Each of the women, after eight weeks of judo practice, in response to the questions contained in MSIS-29, emphasized that the intensity of the dominant and most bothersome symptoms significantly decreased compared to the baseline assessment. This proves that judo classes had a positive effect on the functional status of the patients (**Table 1**).

Before and after the study, the following tests were also performed: Lovett (for muscles: rectus femoris, biceps femoris, rectus abdominius, deltoideus), Time Walking (10mTW), Functional Reach Test and body posture assessment. The comparison of the results showed an improvement in all the areas after the completion of the program. One of the patients initially showed significant lack of balance that negatively affected her stability and movement. Prior to the physiotherapy, her gait was abnormal: small steps, slightly spastic and shaky, with wider base. She also reported fear of falls, which occurred regularly. Each time, she feared possible injury and a sore body. After therapy, however, she showed a more stable body posture when moving. Her gait improved and was closer to physiological one. In addition, the feeling of fear of uncontrolled falls decreased significantly, as during therapy she learned how to fall in a way that cushioned her fall to the ground.

All the patients who participated in the study stressed that they gained selfconfidence, felt less muscle tension, acquired control and inner peace, while their wellbeing improved. They reported much higher levels of concentration and observed that they were able to perform daily activities faster than before. In addition, they estimated that the level of depression they felt decreased within these two months.

On the basis of the pilot studies, the following conclusions can be drawn:

1.Practicing judo by people with multiple sclerosis improves all motor skills (speed, strength, endurance, coordination). Judo exercises allow to reduce the fatigue. Based on the results obtained in this study, it cannot be clearly stated whether the therapy had a direct effect on the chronic fatigue or only increased the level of tolerance for physical efforts, thus indirectly reducing this symptom.


*(maximum number of points = 145).*

#### **Table 1.**

*Analysis of the MSIS -29 questionnaire before and after the 8-week judo program.*

