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cbiondillo
12-29-2010, 08:34 PM
Hello,
I am new here. I feel kind of like a bad mom. I don't know what kind of brace she wears. We've only ever gone to one doctor who has said that he would watch and see until her curve progressed to 25 degrees and at that time she would be put in a brace. He has never done the Risser test, that I know of. I had never heard of that until just recently. What exactly is the Risser test? I feel like I should have done a lot more, especially because I, too, have scoliosis.

My daughter is 14 years old. She has scoliosis, diagnosed when she was 7. At that time she had an S-curve 17 degrees on top and 12 degrees on the bottom. She was put in a brace when she was 11 when her top curve progressed to 25 degrees. I can't remember what the bottom curve was. She is currently in her 4th brace. She hasn't really grown very fast. She has not started her menstrual cycle either. She is about 5'2 and weighs about 90 lbs. She has been a ballet dancer since she was 4 and she absolutely loves it. I am terrified that her curves are going to progress further to the point where she will need surgery. She's very good about wearing her brace. The only problem we have is that it is hard for her to wear it as tight as she is supposed to. She complains that it hurts her hips. Her next appt. for x-rays is Jan. 20th. I've seen a few posts from parents who have girls in ballet. Is there anything else she can do to prevent her curves from getting bigger? She dances 5 days a week, about 20-25 hours a week. She really wants to be a professional ballet dancer someday. At her last appt. in August of 2010, her top curve was 27 degrees. I guess her bottom curve wasn't that bad because I don't have that information. In her brace, her top curve was 18 degrees.

I had scoliosis as a teenager and had surgery when I was 15. I had a C-curve that was 40 degrees. I knew right away when I had my kids to watch for it, so I was the one who saw it in my daughter when she was 7. My rod was removed in 2000 because it had broken when I was pregnant with my twins. Because I had surgery, I am trying desperately to keep her from having to go through it. I have no flexibility in my back and as a ballet dancer, she needs that flexibility.

I would really appreciate any advice from anyone!!

Thank you!
Cheryl

mamandcrm
12-30-2010, 08:42 AM
Hi there, I can't answer your questions about ballet, but the Risser sign is something that is observable from a routine x-ray. When the growth plates begin to close (become bone, I think), the Risser sign begins to increase from 0. When it is 4 (plates closed), growth is supposed to be complete. That takes a couple of years I think from when it begins to close. Your doctor is probably keeping an eye on it and just not mentioning it to you, but it is something he can show you at her next x-ray. Another test for maturity is the Tanner test I think, which involves a wrist x-ray, which some docs think is a more reliable indicator.

Ballet Mom
12-30-2010, 01:08 PM
Hi Cheryl,

Another ballet mom! Welcome.

First off, you are absolutely NOT a bad mom. You watched your child closely and got her in to see a doctor early. Fortunately, you landed in a doctor's office who uses bracing and not just waiting and watching until surgery is required. Kudos to your daughter for being diligent in wearing her brace! :-)

My daughter also started ballet at four years old, she is now 15 and will turn 16 in a few months. She is an advanced student in a Russian technique school and dearly loves the difficulty of it. She was diagnosed with scoliosis when she was 12 with a 35 degree curve. She now hovers around 30 degrees at her appointments with 30 hours out of the brace before x-rays. She wears night-time braces and I am thrilled that it has worked for her because the odds were certainly against her but she has been completely compliant with the bracing and during her frightening major growth spurt, actually tightened up her brace straps much tighter than the orthopedist marked. She is currently Risser 4 and two years post menarchal....and still growing!

Your daughter would actually be classified with juvenile scoliosis not adolescent idiopathic scoliosis (AIS), because she was diagnosed at 7. The statistics are different for juvenile versus AIS as the odds of progressing to surgery are increased in juvenile scoliosis with a smaller curve than AIS at the start of puberty.

The question of when puberty starts in serious ballet dancers can be hard to determine. These are questions you will need to talk to both your daughter's orthopedic surgeon and her pediatrician. My daughter's orthopedist is only interested in her first period, he is uninterested in whether she has continued to have them or not. The pediatrician will work with you if your daughter continues to not have her period. This is very common with ballet students. We have ballet students in our studio who had to gain weight in order to have their periods start, and some go on birth control pills to regulate. It needs to be watched by the pediatrician at some point because it can affect her bones, etc, especially important since she has scoliosis.

Ballet dancers are known to have a late puberty and the resulting delay in sexual maturation results in delayed epiphyseal closure of long-bones. You will have to be very careful to not stop bracing too early. It has been proven that growth and therefore growth of the scoliosis curve can continue after Risser 4 and your doctor will hopefully take that into account and delay the cessation of bracing, just as my daughter's doctor is doing (at least until Risser 5).

I'm attaching a study regarding these issues in athletes and ballet dancers in case you are interested in reading scientific papers. Hope this helps! Just feel free to ask questions to your daughter's doctor at her appointments regarding Risser scores and puberty, etc.

http://joe.endocrinology-journals.org/cgi/reprint/170/1/3.pdf

cbiondillo
12-30-2010, 03:54 PM
Thank you both for your help!

I wasn't able to open the PDF file - I don't know why.

Our doctor has told me that my daughter will grow up to 2 years after she starts her period. But if she hasn't started yet because of her weight, couldn't that mean that she might stop growing before 2 years after she starts? I know of a few other girls at her studio who have not started either.

Does your daughter only wear her brace at night? What kind of brace does she wear? Does your daughter do any exercises other than ballet?

I know you brought up my daughter as having juvenile scoliosis. I actually had to show her pediatrician the curve in my daughter's back when she was 7. I wanted to see if her pediatrician would notice it, but she didn't. I think I could have waited until she was a little older, but I guess because I had the surgery for scoliosis, I didn't want her to go through it, so I was always watching for it. So, I'm just wondering if more kids actually have juvenile, not idiopathic - only because they just don't go to the doctor until they are older and it's more noticeable.

Thank you!!
Cheryl

mamandcrm
12-30-2010, 04:20 PM
Juvenile onset is still predominantly idiopathic but I get your point, and have wondered that myself. I think anything over 10 degrees is technically scoliosis, which is a very small curve. The categorization of IIS, JIS, and AIS stems from the time of detection which is inherently a very false premise on which to base things if it's actually supposed to represent onset. My daughter's scoliosis was detected immediately after we switched pediatricians. I think the original one was just missing it and may have continued to miss it. For all I know, she actually is an IIS case that was missed. In the end I don't think it matters much except that researchers draw conclusions based on the categories, e.g., JIS or AIS patient have this or that % of success or likelihood for X,Y,Z, when in reality it's patients DIAGNOSED at that age have that characterization. Maybe kids who actually were juvenile onset but went undetected negatively skew the results for the adolescent category.

Ballet Mom
12-30-2010, 06:46 PM
I don't know why you can't open the pdf link, it works for me. Perhaps you can go to this link, which is the abstract and then click on the pdf link off on the right hand side to get the full paper.

http://joe.endocrinology-journals.org/cgi/content/abstract/170/1/3

If that doesn't work, perhaps you can just google the title and click on the link that comes up:

The effects of intense exercise on the female reproductive system
M P Warren and N E Perlroth

Ballet Mom
12-30-2010, 07:17 PM
Oh, and my daughter initially wore a Charleston Bending Brace when she was first diagnosed, and her second brace was a custom designed brace made by a local orthotist that is very similar to a Providence brace. Night braces are designed differently than regular braces so they can be worn only at night, so don't have your daughter just start wearing hers at night unless her doctor tells her to!!

My daughter is not doing any other exercises than ballet at this point, I am planning on having her start with side-shift exercises as shown by Min Mehta MD (of infantile casting fame). I don't know how your daughter might do them in her brace, but maybe she could do them when she's out of her brace like when she's standing around in ballet class and waiting, etc.

http://www.springerlink.com/content/u8c5d80y3dl9b8j4/

There's a link floating on the internet out there somewhere with the actual publication by Min Mehta. It may take some looking for.

cbiondillo
12-30-2010, 11:48 PM
Thanks - I was able to open the PDF file. I'm going to ask my daughter's doctor about her not starting her period yet. I was thinking it was a good thing, but now I think maybe it isn't!

What are your thoughts about the Schroth method?

Thank you!

cbiondillo
12-30-2010, 11:52 PM
Juvenile onset is still predominantly idiopathic but I get your point, and have wondered that myself. I think anything over 10 degrees is technically scoliosis, which is a very small curve. The categorization of IIS, JIS, and AIS stems from the time of detection which is inherently a very false premise on which to base things if it's actually supposed to represent onset. My daughter's scoliosis was detected immediately after we switched pediatricians. I think the original one was just missing it and may have continued to miss it. For all I know, she actually is an IIS case that was missed. In the end I don't think it matters much except that researchers draw conclusions based on the categories, e.g., JIS or AIS patient have this or that % of success or likelihood for X,Y,Z, when in reality it's patients DIAGNOSED at that age have that characterization. Maybe kids who actually were juvenile onset but went undetected negatively skew the results for the adolescent category.

This is exactly what I was thinking. My scoliosis wasn't found until I was 15, but my doctor was sure that I had it for a very long time. Your daughter's correction in the brace is wonderful. Does she do any exercises?

Thanks!!

mamandcrm
12-31-2010, 03:36 PM
She doesn't do anything specific for her scoliosis but she is an avid horseback rider and I think that is good for her overall. She rides English (hunter), so she is trained to keep her back straight/flat and her shoulders in line when she is riding, and it's really good core exercise.

Ballet Mom
12-31-2010, 04:46 PM
Thanks - I was able to open the PDF file. I'm going to ask my daughter's doctor about her not starting her period yet. I was thinking it was a good thing, but now I think maybe it isn't!

What are your thoughts about the Schroth method?

Thank you!

I think it sounds like Schroth probably has some benefit to it if you have a child who would do those types of exercises. I think it might be especially beneficial in people with a larger curve.

I know my daughter wouldn't do the types of exercises pictured in Schroth on a regular basis, which is why side-shift exercises appeal to me, she doesn't need any devices, it's useful in smaller curves, and she can do it whenever she thinks about it.

That is just my opinion, however, I really don't know enough about it to make any kind of judgement other than it is not what we intend to pursue.