PDA

View Full Version : More Info on Muscle Atrophy, please



BaltoMom
05-16-2011, 10:10 AM
I have noted some people commenting that they or their children have developed muscle atrophy associated with wearing a brace. Could someone give me a little more detail to better understand this possibility? I am wondering (1) Does atrophy mainly occur only in patients wearing a brace basically all day? (2) Are we talking about just the muscles along the spine, or abs and such as well? (3) How quickly can atrophy occur (weeks/months/years?)? (4) If you are physically active in something like dance, where you are stretching and using a variety of muscles, and do sit-ups or other torso-related exercises at least 5 days per week when unbraced, can you still develop muscle atrophy?

I'm obviously no anatomy expert. Just hoping to learn from others' experience. Thank you!

scolio1964
05-16-2011, 10:41 AM
I don't know a lot about this stuff either, but what I do know is that after wearing the boston brace for nearly 3 years, my daughter started to have pain when she would take the brace off. This started about 6 months before she stopped wearing the boston brace. When I asked her doctor about it, he said it was because she had become dependent on the brace. Even though she is extremely active in ballet and has very strong abdominal muscles, this still happened. But, I will also say that as soon as she changed to the LA brace, the pain she was having stopped. She doesn't have pain when she's not wearing the LA brace. It could happen again, but she's learned now to also do postural corrections while wearing the brace, so she doesn't become so dependent on it.

BaltoMom
05-16-2011, 10:52 AM
Even though she is extremely active in ballet and has very strong abdominal muscles, this still happened.
... It could happen again, but she's learned now to also do postural corrections while wearing the brace, so she doesn't become so dependent on it.

So it is assumed to be the muscles along the spine? And can you tell me what "postural corrections" means? Thank you!

scolio1964
05-16-2011, 11:30 AM
So it is assumed to be the muscles along the spine? And can you tell me what "postural corrections" means? Thank you!

I am not really sure which muscles - she would just complain that her back hurt. She does the exercises that her Schroth physical therapist taught her. They are specific for her curve. She is learning to hold herself up differently. And, so far it's working for her. I hope this helps!!!

BaltoMom
05-16-2011, 11:59 AM
I. I hope this helps!!!

Yes, thank you! We are fairly new to this journey, so I appreciate all the experiences and perspectives I can get! :)

mariaf
05-16-2011, 01:52 PM
Keep in mind that while muscle atrophy most certainly can occur, on the flip side, for a lot of kids, it is not the case.

My son wore a brace pretty much full time for three and a half years and fortunately never had any back pain. We also tried to keep him very active (swimming, etc.) during the hours he was not in the brace.

As with all things, I would discuss with your doctor.

Best of luck and please keep us posted.

skevimc
05-17-2011, 02:16 PM
I would like to respond a bit more in-depth to this thread but don't have the time right now.

The short answers: Yes, bracing causes atrophy of the muscles. Specifically the paraspinal muscles. Exercise can and does help this. Basic concept of muscle physiology is, for muscles - use it or lose it.

More later...

Pooka1
05-17-2011, 02:28 PM
The short answers: Yes, bracing causes atrophy of the muscles.

Including Spinecor, their claims otherwise notwithstanding.

mamandcrm
05-17-2011, 04:33 PM
I also was worried about muscle atrophy but my daughter did not experience any while she wore a full time brace. I think that is because she is a rider (3-4x a week) with a trainer who really works her and she definitely got a lot of core exercise (this was with the brace on). I also had her "play" on a balance board while she was watching tv or whatever as extra exercise. Maybe the type of brace helped as well as even though it's a hard brace it doesn't constrict the torso quite as a Boston I think.

titaniumed
05-17-2011, 06:39 PM
I was going to respond exactly like skevimc with “use it or lose it”.

I have a few experience’s with this matter. The first one being that I broke my shoulder up pretty good in a ski crash right before my scoli surgeries. They didn’t deviate from the schedule, and I had to do my recovery with my right arm wasted. Since I couldn’t use it much, the muscles withered and my arm was very weak from “minimal” use. It was 8 months later that I had my shoulder repaired and started PT immediately on the arm. It did come back with exercise and is as good as new.

So, 8 months seems like a long time, I wonder how long I could have gone?

My father had ALS (Lou Gehrigs) It’s a terminal disease where you lose the ability to control certain muscles. His right leg went first, and the muscles did reduce in size. His feet also extended straight at the ankles.(Like pointing with your toes)That was about 18 months with NO use at all. It’s a brutal disease.....

There is a big difference between NO use, and minimal use, which would be the case when wearing a brace is concerned. This is assuming that the brace is removed at some point every day. From my experience’s I don’t think that scoliosis bracing is something to really worry about, the muscles do come back with some effort.

Ed

BaltoMom
05-18-2011, 12:41 AM
Thank you all, I really do appreciate all the insights. I am feeling a little better about the bracing. I had thought along the "use it or lose it" theory as well, so I couldn't understand how people can still get muscle atrophy if they are working their muscles in physical activities outside of the brace...that's why I wondered if there were different muscle groups involved with the spine that atrophy because they're just not exercised effectively in a short time out of the brace, or what... I dunno.

mariaf
05-18-2011, 07:40 AM
There is a big difference between NO use, and minimal use, which would be the case when wearing a brace is concerned. This is assuming that the brace is removed at some point every day. From my experience’s I don’t think that scoliosis bracing is something to really worry about, the muscles do come back with some effort.

Great point about no use vs. minimal use.

I forgot to mention that when David was braced 22 hours/day, we were told by our doctor that any time swimming (not dangling his feet, but actually swimming in shoulder high water) was counted as in-brace time. So on a lot of summer days, he spent 3 or 4 hours swimming in the pool and still got to have another 2 hours running around brace free. We wanted to keep him as active as possible.

Resilience
05-18-2011, 08:58 AM
Our plan too is to be as active as possible during out of brace time.

Initially I was also very concerned about the possibility of muscle atrophy but my daughter remains very strong. After a recent 24 hour period out of brace for XRays she said that her back "felt tired" but not weak or painful.

Dr. Newton has encouraged as much out of brace time as she wants AS LONG AS she is physically active during that time. He said this has led some of his patients to being very competitive athletes. In addition to swim team and dance class we have a balance board at home and core exercises that we do.

Thinking back to my bracing experience, I went from a strong ballet dancer at age 13 to a full time brace wearer (and in the 70s there was no encouragement to exercise out of brace, I had to quit dance and sports) then a very slow wean out of brace period: just night time, every other night, free! I recall feeling unhappy with my "core" after my time in the brace but got back into shape with aerobics classes (a la Jane Fonda, early 80s :)

Seems the current thinking of out of brace exercise time being encouraged is the way to go!

Just thought I'd share, hope it's helpful.

skevimc
05-18-2011, 12:31 PM
Not a whole lot more to add. There are a handful of studies (although not many) that have looked at paraspinal atrophy during brace wear. I'm not sure specifically what type of brace or if it was varied, but it was definitely looking at the rigid braces. This is one primary reason why they 'ween' the kids off of their brace at the end of treatment. So paraspinal atrophy is known about and expected. The issue is that there were one or two studies looking at exercise concurrent with bracing and the results showed no enhanced outcome with the exercise, i.e. it didn't reduce the number of surgeries. The issue I have with that study is that the exercises they were doing could hardly be considered exercise AND that pain or treatment satisfaction was not measured, but that's another discussion. Regardless, this study is what has set the clinical dogma that exercise while bracing isn't necessary.

The bad news with this dogma, is that I think allowing muscles to atrophy does open the possibility for back pain or discomfort. Many studies show that back pain, especially low back pain, is correlated with muscle atrophy/weakness. And this pain can be reduced or fixed with strengthening. The good news is that the atrophy that occurs during bracing is easily reversible or prevented with all of the activities listed above and then some. Hopefully more clinicians are encouraging their patients to take part in some type of strengthening exercise or activity while out of the brace.

Muscles are what supports and moves the spine. Why a spine doctor would not encourage patients with a 'sick' spine to exercise those muscles is beyond me. But again, I think that's for another discussion.

BaltoMom
06-01-2011, 09:55 PM
Thank you for your insights, skevimc. It is encouraging to think there's no long-term damage to the muscles from bracing. I appreciate your input!