Bracing?

[suzyjay]

My daughter just started wearing a Boston brace. I remember reading somewhere that the brace can make the concave side of the back weak. Is this true, if so, are there any exercises she can do to prevent this from happening?

Sue

[LindaRacine]

Sue...

Is your daughter an adult?

--Linda

[suzyjay]

Bracing

She is 12 1/2 yrs. old. The doctor said she doesn't normally brace children her age, but 4 months after her first visit she went from 18 degrees to 26 degrees.

[LindaRacine]

Hi Sue...

This section is for adult scoliosis patients, so you might get more replies by posting here:

http://www.scoliosis.org/forum/forumdisplay.php?f=105

Regards,
Linda

[gerbo]

Our daughter (then 10 years old) was diagnosed with an initial 25 worsening towards 29 degree t11 scoliosis about 1.5 years ago, and is treated initially with a hard plastic and now a spinecor brace ( changed last month only)

I did notice earlier on that the muscles on the convex side of the curve appeared thicker than those on the concave side and did wonder whether that could have any influence on the progression of the scoliosis.

I did some background research and did find research articles which did confirm that there is indeed a difference in paraspinal muscles on either side of the curve (most likely secondary to the scoliosis) ( http://www.springerlink.com/(vbdnqtr...lts,1:101557,1 )

assuming that this difference in muscle fibre make up could have an effect on muscle strength on either side, i looked further and came across the Vert Mooney article which is mentioned further on.

Although the equipment used in this article isn't available in the UK, I did manage to find something reasonable similar and decided to try to do the same exercises with my daughter because
- it just made sense to us
- also, there is enough evidence around suggesting a general weakening of backmuscles in brace wearers, so on top of the regular swimming, we thought this wouldn't do any harm, even if it wouldn't have a specific effect on the scoliosis

Below is a quote from an earlier posting (so i do not have to repeat things)

we are trying to replicate an approach as taken by a Dr Vert Mooney, i.e torsorotation against resistance (if you want to know more, go to www.medxonline.com, > medical rehab equipment >pdf downloads > "role of measured resistance exercises in idiopathic scoliosis". Whether you think his approach makes sense or not,(I do) at least it is an interesting article to read




we have been doing this for the last 4 months, and it surely hasn't done us any harm. I am aware of an orthopaedic consultant who is taking this serious enough to try to repeat the study to see whether he can replicate the results.

The beauty of this particular kind of exercise is that you can isolate the left and right paraspinal muscles, ensuring that they get equal exposure to exercise. Essentially, in torsorotation if you turn left, you use the left paraspinal muscles mainly and if you turn right you use the right. (I worry that in "general" exercise the stronger side might be more dominant, and thereby getting relatively stronger, causing further imbalance)

We found initially that left turning (towards the concave side) was weaker, that has now equalised. Whether this eventually will have a stabilising effect on the spine is impossible to say as there are so many other potential factors, still, it makes sense and that is why we do it.

[suzyjay]

Thanks for the info.

[scoliosismom]

musculoskeletal asymmetries

Suzy,

I believe so much in the impact of bracing and exercse to address the asymmetric mucle development of scoliosis, that my daughter's therapist and I started a clinic devoted to making Americans aware of this modality of treatment. The Schroth method is not for everyone. It requires a daily commitment by the patient and family. And, for some curves, surgery will always be the right answer. But, for other kids, exercise and acceptance of their "curvy back" produces a successful way to control their scoliosis rather than it controlling them. And, even in those kids who should have the surgery, I believe they should first try to exercises to strengthen the asymmetric back muscles and learn how to live productively with their spinal problem. Following is our story about the Schroth method. For more information and reference publications, please visit our site at www.scoliosisrehab.com.

I am the mother of a 12yo daughter who was diagnosed last summer with 50RT (50 degree right thoracic) and 40LL (40 degree left lumbar) curves and a Risser of zero. She is 5 feet tall and has not had her adolescent growth spurts at all. Our orthopedic surgeon (a wonderful AIS specialist at Childrens' Hospital of Pittsburgh) thought she would be a surgical candidate with those curves, but conservatively wanted to brace her until she was more skeletally mature. She was put into a Boston (TLSO).

As the daughter of a physician and wife of a pediatrician, I was very fearful about the idea of an open spinal procedure, many hours of general anesthesia (which carries a risk as well as the surgery), the rehab, and the possibility of future surgeries. I was also skeptical about the unproven techniques and wild claims made by some unorthodox practitioners. So, I became obsessed with reading the medical literature and looking for some middle ground.

I found Martha Hawes book (available from the NSF) and devoured it. The chapter on the Vicious Cycle Theory made so much sense to me. Then, I went to the European literature and started to read about physical therapy programs being offered there to combat the vicious cycle.

The Europeans (and Israelis) are more open to the idea that physical therapy can help to correct these asymmetrical muscles which lengthen or shorten depending on the side of the curve (and continue to cause the curves to progress in some cases). Over time, I believe this asymmetry is what causes the pain of much adult scoliosis.

My husband and I discussed this with the orthopedic surgeon, who was skeptical, but said physical therapy wouldn't hurt and that we should give it a try given our daughter's Risser and age. We settled on the Schroth method of physical therapy to help stabilize the uneven muscle development and to improve her Vital Capacity (another casualty of both the scoliosis and, later, the brace).

My daughter, son (10yo with 15 degree curves already and a mild kyphosis), and I went to Stevens Point, Wisconsin in September to be a part of a course that was certifying US physical therapists in the German Schroth method. The kids learned the exercises, I learned a bit more of the theory, and we returned home to practice the exercises every day for a half hour. In addition, our daughter got a Rigo-Cheneau brace of the type used in Europe. Her Vital Capacity in this brace (via simple spirometer testings) is better than it was in the Boston brace (remember, this is a sample of one and I have not seen any studies which compare the Bostona and the Cheneau or Rigo-Cheneau head-to-head).

In February, my daughter went to the orthopedic surgeon for her follow-up.
In brace, she corrects to 27RT (46% change) and 28LL (30% change). Her doctor said, "Keep doing what you're doing and you won't need surgery."

Clearly, this is just one kid and the US needs to do referreed, double blind studies on the impact of bracing alone, brace modalities compared to each other, bracing and exercise, and longitudinal studies of bracing/exercise compared with surgery. But, if anyone asks if I think there is a positive life impact from diong the exercises, I would say try it.

One aside, does your daughter participate in any activity which is asymmetric? Our daughter was a very serious viola player (school orchestra, youth symphony, etc) and I continue to wonder whether that repititious, asymmmetirc bowing movement exacerbated her curves? We know that scoliosis is fairly common among serious golfers. Jus something to think about. . . there are no studies I've seen which address this issue. If anyone knows of any, I'd love the citation!

Best wishes to you and your daughter.