PDA

View Full Version : Why is SpineCor not an accepted means of treatment among Orthopedists' in the USA?



ccgonzalesnm
03-04-2006, 10:00 PM
It is used worldwide with proven data of success, so why are Pediatric Ortho's in the States reluctant to prescribe it? Which physician/clinic do you see, and why? Cannot seem to find one in the Southwest (USA). Saw one mention of a specialist in Studio City (CA), but when I "googled" him, all I seemed to find was info about the coffe shop he and his wife own. I looked at the website of the specialist in Sugarland TX, his site has a picture of the SpineCor dancer, but no mention of the product or the type of individual he works with. My daughter is 7 with lumbar 20, thoracic 12.

Celia
03-05-2006, 08:52 AM
Hi ccgonzalesnm,

I see Dr. Rivard and Dr. Coillard in Montreal, Canada. I'm not sure why its not widely offered, but I have a hunch that it has to do with insurance issues more than anything else. Most parents would rather choose a brace that is guaranteed to be re-imbursed by insurance companies. For the record, our insurance company paid for the brace but it was pretty iffy in the beginning.

MATJESNIC
03-05-2006, 08:55 AM
I believe that part of the reason it has not been accepted among the orthos is that doctors generally are going to go with what they know. Most of them don't even believe that bracing works. So they figure that the curves are going to go up regardless, and then they will perform surgery. I think it would be difficult for them to start recommending a brace that is relatively new when so many people have not been trained to fit this brace. The brace is only as good as the person who is fitting you for it. It takes a lot of time and money to train a lot of people. This is just my humble opinion. The hard brace has been around for a very long time. It is just easier to say "Wear the Boston, and if your curves get too high, I will operate."
Chiros are always trying to avoid surgery so they are more open to prescribing exercises and alternative treatments.
One ortho I spoke with told me he doesn't know enough about Spinecor to prescribe it. Another told me he believes a soft brace will not hold a large curve like a hard brace does. This makes no sense. The Spinecor is not trying to hold the spine in one place the way the hard brace does. The philosophy is completely different. I am sorry for going on and on. Anyway, we as Parents have to look at our child and decide what we think is best.
I would strongly recommend looking into the Spinecor while your child is so young and her curve is still small.
God Bless.
Melissa

MATJESNIC
03-05-2006, 08:57 AM
Hi Celia,
Just curious, is your daughter one of the youngest children wearing Spinecor?

Melissa

Celia
03-05-2006, 09:03 AM
Hi Melissa,

Happy belated Birthday ! :D Dr. Rivard told me that the youngest patient he has fitted with the Spinecor brace is a four year old from Maine. Deirdre had just turned 5 when she got her brace.

pat
03-05-2006, 09:29 AM
I agree with Melissa, I've been told by docs that the SpineCor takes a lot of time training and monitoring and they're just not ready to do it yet. John Hopkins in Maryland, Shriners in Erie, PA is now offering it. It's starting to prove itself. I just hope people keep asking about it with their "traditional" ortho docs.

MATJESNIC
03-05-2006, 10:38 AM
Celia,
You are actually early in your birthday greetings. It was my husband's birthday on March 2nd. Thanks anyway. My birthday is May 28.
Your daughter is definitely one of the youngest. That is great!!! She is a real cutie. Thanks for sharing your pictures.

Melissa

The Slice
03-05-2006, 12:33 PM
There was something that I read reently that touched on this subject, and I think it also had to do with one of the studies as well. That was that there is a great deal of training involved for the pros, as well as the patients and their families. It's relatively new therapy and like everything else, it's slow to catch on. There was also some question as to the reliability of the study results as the numbers in the studies were relatively small. Alond with that, the main study results come from the manufacturer, rather than objective parties.

LindaRacine
03-05-2006, 01:39 PM
Hi...

I think most scoliosis specialists are reluctant to move to new technology until not only are there short-term studies published (and results recreated by a non-related center), but long-term studies that show the results are as good or better than current treatment options. I personally think this is the responsible way to practice medicine. If the Spinecor long-term results turn out to be worse than currently accepted braces, we'd end up with a lot of kids needing surgery who might have been saved from it.

When the Spinecor brace was first available to the U.S. market, there were quite a few U.S. specialists who agreed to try them on some of their patients. Most of those doctors did not continue using the brace after the trial period. Why that happened is anyone's guess, but I'm thinking that Melissa's idea of insurance issues and a long learning curve are probably correct.

Regards,
Linda

Celia
03-05-2006, 07:00 PM
All really excellent points ! However, what really clinched it for me was the study conducted by Dr. Rivard who I have enormous faith and trust in. I don't think he skewed the results in his favour, he is a member of the SRS and a scientist. I don't have the time to wait another 20 years before a final conclusive study showing the merits of the spinecor brace comes out - by that time my daughter will be 25 years old ;) If her curve progresses, I know where to find a rigid brace. The thought of having her wear one of those things for the next 10 - 12 years (23/7) was just too much for me and I honestly think I would have lost my mind - that's if I haven't already lost it :D

Melisssa, wish Ed a very HAPPY belated birthday for me :) I saw the name Majesnic on the spinekids wish list the other day.

cherylplinder
03-05-2006, 07:45 PM
I asked Dr. Rivard why he thought doctors in the states were not prescribing this brace. He said he thought it was the time involved. This brace takes more of their time than traditional treatments. I'm sure insurance and the status quo influence decisions also.

I also have complete confidence in Dr. Rivard's integrity. His dedication and compassion are unquestionable, to me. This man cares about children. Like you, Celia, if Rachel's curve progresses in the Spinecor, we will change braces. I have a lot of confidence in this brace and Dr. Rivard, but these curves have a mind of their own.

I also think that your brace is only as good as the person fitting it. This is true whether you use the Spinecor, TLSO, Milwaukee, etc. The skill of the orthotists is very important.

Rachel's TLSO should have had a high underarm component(which it did not). Her apex is at T7. Out ortho did not specify the apex; she is missing a rib, and the orthotists counted her thoracic vertebrae wrong. He placed the apex at T8. A traditional TLSO can treat and apex of T8, but should not be used with an apex of T7. No one seemed to know or care(doctor or orthotists.) I did research on my own and stumbled across this information(too late). Obviously a lack of skill and caring led to the inefficacy of this brace for Rachel.

One point I would like to make is that the hard braces weaken back muscles,restrict lung capacity, and restrict renal blood flow. Therefore they are not prescribed until curves reach 25 degrees, at least this is the criteria our ortho used. The Spinecor does not weaken the muscles of the back. The biomechanics of this brace are totally unique. It can be prescribed for smaller curves and correct problems at an earlier stage. I wonder how many surgeries could be prevented if more aggressive measures were taken against smaller curves. The Spinecor allows this option not previously avialable without adverse side effects. I wish I had known about it before Rachel's curves reached 38 degrees (she went from 24 to 38 degrees in 6 months).

I have since read criteria that states that in premenstrual females with either rapidly advancing curves(5 degrees in 6 months) or curves 20 degrees or more, bracing is recommended. It is obviously up to the individual doctor which criteria he uses, but it pays to be informed of your options.

Our ortho did not even know the Spinecor existed.

Happy Birthday, Ed! :)

MATJESNIC
03-05-2006, 07:48 PM
Celia,
Thanks for Ed's birthday wishes. I totally understand that you didn't want your daughter spending all of those years in a hard brace. Did you say that you live in Canada? How far do you travel to see Dr. Rivard? I would love to meet him one day. If this brace works, I am going to definitely meet with him personally.
Change of subject -- I don't think Nicole's thigh bands have been completely dry when she has put her brace back on and now she has a bright red area on both thighs where the straps go. It is burning her. Is vaseline the best thing for that or does anyone know of something better. In additon, she was dancing and sweating a lot so it probably caused further irritation. If anyone has any immediate suggestions, please let me know. I know you have all mentioned moleskin, but I am talking specifically about what to put on the irritation.
Thanks so much,
Melissa

cloggerx3
03-05-2006, 08:31 PM
hello everyone =]

these are all really good points to hit on spine cor

MATJESNiC: im having the same problem as nikki. because the other day i was too lazy to dry my thigh bands and now my thighs are irritated and red. ive been using aquaphor. i also put it on my lower hip(quite odd) because my brace like irritates it and makes it bleed and get really dry and scratchy. so my mom put aquaphor on it too and it helped a lot. so i would try some aquaphor on it.

i wanna meet Dr. Rivard too

gerbo
03-06-2006, 02:02 AM
Is vaseline the best thing for that or does anyone know of something better

something with zinc in tends to be good for the skin, in the UK i would say "zinc and castor oil" as is used for irritated baby's bottoms. Don't know whether equavalent is available in USA

gerbo
03-06-2006, 02:21 AM
re brace studies

I know there is only one proper spinecorstudy, (spine 2003) published, but it is so much more comprehensive than any study i have seen for hardbraces and therefor so much more informative. What I specially like is that the same group is followed for many years with clear indication what measurements they go through over time, i.e curve at diagnosis, initial correction, correction at 3 - 6 months etc, and even post traetment results. Now, either these results are doctored (adjusted to suit the researcher) or they are extremely convincing. Like celia says, we cannot afford to wait 25 years for the definite study to appear.

Somehow, and i do not know why, despite all its failings and despite many, many stories of progression whilst wearing them, boston braces do not seem to attract similar scrutiny/ critisism.

In our case the ortho paedic surgeon was quite happy for my daughter to have an unproven type of hardbrace, had no figures from his own hospital to indicate succesrates, wasn't bothered about how much correction was achieved (was happy with 25% correction in brace, whilst all studies for hardbracing suggest you need to aim for at least 50%), wasn't alarmed when it did not fir her properly anymore (we had to wait 2 months before we werew offered a better fitting one)! And this was a specialist scoliosis centre!!!!! :mad: :mad: :mad: :mad: :mad: In all fairness, i felt they were just not bothered :eek: :eek: :eek:

life seems a bit better now, with clinicians which are interested, and take time and take care, now "just" some results to match!!!! :rolleyes:

MATJESNIC
03-06-2006, 06:00 AM
Thank you all for your good advice. I will definitely try some of those ointments. I really think they should make a bodysuit that covers the thigh area so that the thigh bands are not directly on the skin. Or they should make little shorts that have snaps in the crotch area.
I believe Dr. Deutchman said they were tossing around a few ideas to improve upon the bodysuit or short idea.
I can't wait until sat when the weather is warm so that I can hang up her brace to dry in the sun. That will be the best thing.
Gerbo, you made a lot of good points.
Melissa

Celia
03-06-2006, 09:15 AM
Did you say that you live in Canada? How far do you travel to see Dr. Rivard?
Change of subject -- I don't think Nicole's thigh bands have been completely dry when she has put her brace back on and now she has a bright red area on both thighs where the straps go. It is burning her. Is vaseline the best thing for that or does anyone know of something better. Melissa

Melissa,

Yes, I'm from Central Canada. We travel by train 10 hours to see Dr. Rivard. The local hospital doesn't carry the brace even though our local ortho believes in the Spinecor brace :confused: To top it off, he's the division head so one would think he would have the official capacity to bring it in :eek: This is sooooo bizarre to me.

What I do for red chafing is just put a bandaid on it, after a day the chafing is gone.

Gerbo,

REALLY excellent points, I couldn't agree with you more !

gerbo
03-06-2006, 10:02 AM
they were tossing around a few ideas to improve upon the bodysuit or short idea.

what is fashionable currently here in the uk are underpants with ever so slightly extended legs, they prevent rubbing against the skin till some extend

gerbo
03-06-2006, 10:08 AM
Dr. Alman believes in the Spinecor brace

does he believe in it now (rather than just going along with it?)

tmom
03-06-2006, 10:53 AM
My son's SpineCor doctor is the one you mentioned you were not able to find. His name is Ronald Marinaro, he is in Studio City, the phone number is (818) 505-0816. He is very nice and seems to know what he is doing. If you need more info about him, you can contact me.

MATJESNIC
03-06-2006, 01:02 PM
Nicole loves her Spinecor bodysuits. If they can just have them come down longer on the thighs, it would solve the problem of the chafing. I will also be very careful from now on to be sure the bands are completely dry.
Thanks everyone.
Melissa

LATigner
03-06-2006, 01:07 PM
I've been able to wash the bottom half of my daughter's brace by zipping it in a lingerie bag and washing with the load in cold water. The bolero and elastic straps also get washed with a regular load of clothes. I use the Quick Load cycle so its 22 minutes instead of 45 in the washer. I dry them both (bottom half still in the lingerie bag) in my dryer on extra low. So far there has been no problem., except for the paper number stickers coming off the pastic portion. But my daughter knows where it snaps and we just wrote on it with a marker.

If I just lay the bottom half flat to dry it takes forever and the timing when my daughter is not wearing it is difficult. I don't want her to have more excuses for less time in the brace.

gerbo
03-06-2006, 02:30 PM
we are putting both parts in their own knotted pillowcase, washing them at 30 degree on the "delicates setting".

(didn't think it was of much interest, but just fancied being "one of the girls", exchanging some domestic essentials) ;) ;) ;)

cloggerx3
03-06-2006, 03:07 PM
well i have found that wearing a pair of cheer shorts rolled maybe twice with a tank top under my brace works just as well as the bodysuits, maybe even better. because the snaps on the bodysuits would just frustrate me so much and now i dont have to deal with them.

and about the bottom part of the brace: Dr. Oulette, my chiro and person who does the brace, is now designing a new bottom piece so we wont have to deal with the thigh and crotch straps and you wouldnt have any extra snaps. he's supposed to have it ready to try in the next couple of weeks. he's having some older people try it because he said in case it doesnt work it wont effect their scoliosis

sportsdoc
03-06-2006, 03:15 PM
Urgh..I'm going to break my promise and post this one time...
I'd think it's safe enough since I'm not talking about chiropractic this time...
So those who are chiro haters..I'm just trying to contribute...so let's not start up arguments...

I am flying out to chicago next week to get some training done for spinecor and I think I could share some perspective on why it's not catching up like wild fire in the states...

#1: Historically, US has always been reluctant and slow in adopting to technologies developed from foreign soil...I myself tend to have less trust for foreign studies for some reason even though I am aware that they have peer review system just like we do...maybe i'm used to the idea that corruption is more likely else where lol...

#2: Yes. The accreditation process isn't quite easy...not to mention the initial cost involved for the providers. And to put up that kind of resource for a technology that hasn't been accepted by the med community at large is quite a daunting task.

#3: It's a totally new concept..a lot of docs will need paradigm shift and it's often challenging for many if not impossible

another reason is the existing competing technology. There are always forces that will resist the changes for whatever reasons of their own...below quote from Max Planck has put it quite nicely..

An important scientific innovation rarely makes its way by gradually
winning over and converting its opponents: it rarely happens that Saul
becomes Paul. What does happen is that its opponents gradually die
out, and that the growing generation is familiarised with the ideas
from the beginning.

Max Planck (the founder of Quantum Physics)

that's just human nature at work.

BTW, those in southwest, Dr. Ron's contact info is listed on spinecor web site. I didn't have problem contacting him. I think there are couple more sites opening in CA. In next year or two there should be big increase in numbers in my opinion.

OK..i'm going back to lurking mode..please put down your chiro-guard...

MATJESNIC
03-06-2006, 05:26 PM
Sportsdoc,
I appreciate your input. I obviously am not a hater of chiros since my daughter goes to one and her Spinecor Doc is one. I have always had an open mind towards chiros because I have some family members who have had good experiences with them. My family is very conservative and would certainly try to avoid surgery whenever possible. It must be very difficult to be in a field such as yours, when so many people have such anger toward it. I, myself, am fortunate because I work with young children with autism and other developmental delays. Who could find fault with that?
Anyway, good luck to you as you become more involved with Spinecor. Just wanted you to know that you have some "friends" on this site, as well.
Take care,
Melissa

MATJESNIC
03-07-2006, 05:35 AM
Lauren,
That sounds great that your doctor is trying to improve upon the brace. I'm sure Dr. Deutchman will fill us in when we go in April. Thanks for your input.
Melissa

Celia
03-07-2006, 12:26 PM
does he believe in it now (rather than just going along with it?)

Prior to my getting the brace, he said that the Spinecor was "not much better than other braces". I took this to mean he thinks it IS better than other braces but not by much :D He didn't say "it's NO better than other braces". He also seemed a little more animated when I mentioned the spinecor brace.... I'm very good at reading facial expressions so I don't think I'm imagining this ;) I knew by his reaction, that I could trust my instincts on the Spinecor.

Celia
03-07-2006, 12:30 PM
Dr. Oulette, my chiro and person who does the brace, is now designing a new bottom piece so we wont have to deal with the thigh and crotch straps and you wouldnt have any extra snaps. he's supposed to have it ready to try in the next couple of weeks. he's having some older people try it because he said in case it doesnt work it wont effect their scoliosis

I wonder if this is the "new" design :confused: I'd rather stick with the "old" design, knowing that it's effective and works. I don't feel comfortable being the test case.

Mom37
03-07-2006, 11:00 PM
Hi. We are going to go with Spinecor next week. We are going to New York for our initial fitting, and month check, but are doing our 3 month follow ups in Sugarland, TX. In case you aren't familiar with where it is, it is outside of Houston. (a suburb) It's closest to Houston Hobby airport. I have called and talked with the office and both Dr. Gary Smouse and Dr. Stephanie Smouse. They are happy to talk to you and answer any questions you may have. They endorse Spinecor. We are closer to Houston so Dr. Deutchman in NY so he told us of the TX location. Since I had already had so much contact with NY and had the appointment and ball rolling for insurance, we just stayed with our initial in NY. Both offices are very helpful. I'd call theTX office anytime. They were very helpful in answering all my questions and calling me back to answer any questions quickly if both the doctors were busy, and the office knew it was a question the doctors needed to attend to. Dr. Gary Smouse has a personal interest in Scoliosis as his daughter has it. That is what got him so involved in treatment. Best wishes.

MATJESNIC
03-08-2006, 12:06 PM
That sounds great. Good luck to you. Your daughter will really like Dr. Deutchman. He is very patient and kind to kids and adults. Does Dr. Smouse's daughter wear Spinecor?
Melissa

Mom37
03-08-2006, 06:05 PM
I will ask next time I talk to them. Shirley

gerbo
03-10-2006, 08:58 AM
i'm going back to lurking mode..please put down your chiro-guard...
totally off topic, but knowing that you are likely to lurk around here, and might feel safe to "come out and play"

I have build up my own little pet theory aboutscoliosis being, regardless of initiating factors, a selfperpetuating or selfmaintaining problem, with main factors being 1) posture and movement patterns (in our case corrected through spinecor and ballet) 2) muscle strength assymetry (which I am addressing through targeted measured resistance work.) Nothing too exciting about that as many orthopaedics think on similar lines.

However I am having this bee in my bonnet about the role of ligaments, specially the ones between the vertebrae, holding it all together. Inevitably, in established scoliosis, the ones on the concave side must have shortened, as much as the ones on the convex side must have lengthened. What I wonder is whether it is the shortened ligaments which physically keep the scoliosis in its curved position and resists attempts to straighten, a bit like a contracture in any joint which is kept in an immobilised position.

If that is true, then significant stretching of ligaments need to take place to have some chance of succesfull correction of a curve. I would imagine that a very highly corrective brace would do that, or the bending braces which some people use (providence etc)

I do some stretching with my daughter by using an yogaball, and let her curve over it (sideways, convex down) for 10 minutes every evening.

How would a chiropracter go about trying to lengthen ligaments, any exercises you would suggest?

Interested in your views (honestly)

Anybody else any views???

sportsdoc
03-10-2006, 07:56 PM
lol..since that seemed like an invitation..
what you described is much like the theory behind CBP..
However, with one cavit...
what holds bones in place aren't ligaments as many believe..
ligaments's function is to keep joints from going further than its' normal ROM..
It's the muscles and joint structures that keeps bones in certain position in neutral setting..

there was a study with pigs' spine where researchers stapled one side of spinal musculatures and succeeded in creating scoliosis...there were some histological changes with increased fibroblast activities on the concave side....
In CBP, they do what's called global adjusting(contrary to segmental in most other chiropractic spinal manipulation where movements are more segmental) to break down adhesions(fibrosis), fast stretch the ligaments and muscles on the contracted side..then they do mirror image exercise in order to activate and strenthen the convexity side..
high velocity low amplitude manipulation are done on sites known for abundance of mechanoreceptors in hopes(actually, this has been already proven..researchers were able to observe increased reading of the MR with HVLA on anaesthetised patient) to stimulate them(in posturer scoliosis, the cause is inhibition of MR) in mirror image to retrain your brain of what normal position is...that's just the basic premise of the technique..

There are more to it than that...but anyway, this is not a technique class lol..

There has been many successes with posturer scoliosis wit CBP, the data on idiopathic is just not there...there's an effort being made by profession to collect and sort datas and do some controlled studies...but in alternative health care, funding's always an issue..we don't have phalma $$$$ for more research...

I just wish there were more collaborative efforts between main stream health care practitioners and chiros...each hold certain piece of the puzzle and we may just get better view of the picture once all the pieces are fit together..

The main reason why chiros are attracted to spinecor is because it coincides with chiropractic philosophy...it keeps structures healthy and promotes strength...It's like 20hours of constant chiroractic rehab eveyday..

The bottom line is...this is just my theory also...I believe like you, Gerbo, that posturer component is there secondarily...there are therapies geared towards breaking down those fibrotic adhesions, there are techniques to lengthening the soft tissues...combine that with current exercise rehab along with braces like spinecor..I think we could expect much better outcome..
I mean we already do that with other joints...with extremities, we could improve ROM with just 1 or 2 visits...spine musculatures are deeper and less accessible..so it's harder to achieve..but it isn't impossible..just takes a whole lot more effort on practitioner's part...I mean it's going to be gruelling manual labor...only luck is that we are dealing with small children..not full grown linebacker sized adults lol...

Anyway, I'm going to see if sports rehab gurus could contribute to this dilemma...there are previous works done by European Neuro guys which are ahead of it's time and is being studies by PT's and DC's...one of my long term dream is to bring specialists from all discipline and create a super scoliosis treatment center lol..one can dream right? We'll have Spine Ortho, Neuro, chiros, PT's all working under one roof for same goal...gives me goosebumps just thinking about it...

Disclaimer: Those of you who are allergic to chiro...above is unsubstantiated opinion of mine..so please do not start arguments..If you don't agree, let's just agree to disagree and move on.

sportsdoc
03-11-2006, 01:55 AM
oh..i reread and looks like I didn't really go over what we do to lengthen the shortened muscles...
one of the technique I use is Graston. It's derived from ancient chinese technique and basically, I use stainless steel tools to physically break down adhesive fibrous scar tissues(usually used in chronic strain type of injury).
There's also a technique called Active Release Technique which is used with pro-athletes and olympians...basically, you start from proximal tendon and as you glide your thumb distally, take muscles from contraction to elongation...it's a bit harder than described..but use is similar with Graston and utilizing both I get pretty good results..
Then there's muscle energy work. When you stretch a muscle, natural reflex is to contract...instead of just stretching it, what you do is take the joint to end range, hold it there, have the patient contract against your resistance...when they relax, you should be able to take them a bit further, a few degrees...then you keep doing the same until you achieve optimum ROM...on shoulders sometimes, we can gain as much as 20-30 degrees on one session..
In all of the above techniques, accurate knowledge of actions and locations of each muslces is crucial...so the practitioner needs to be very good at palpatory skills...it may seem easy from my description above..but..after I do a few patients, I'm poofed...
then there's the cox technique which is mainly used to treat disc herniation..while treating disc, one of the things we do is to try to work on all aspects of ROM utilizing the technique..each level of vertebrae are isolated manually and using specially designed table, you take the lower extremity through combination of flexion and lateral flextion in order to stretch each segments on all directions..(i'll probably have to purchase a table that does rotation also)...that can effect perhaps T9 down...

All of the above are patented techniques...there are perhaps hundreds who do each technique all across the country...then perhaps handful who does 2 of the above...I don't know of any who does all three..and none of the techniques are utilized by scoliosis docs as far as I know..

they aren't going to cure scoliosis since the correction probably won't hold..but with spinecor to hold and rehab exercise to strengthen the weak elongated side....I feel very good outcome could be expected..

The problem is finding a doc who does all the technique and let alone is willing to do it..it's extremely labor intensive and I doubt that one doc can see more than a handful of patients in a day even if he/she's fit...

there are other techniques that I haven't mentioned...but I don't quite know how to describe them here...perhaps some of you are familiar with Janda...
well..i gotta go..my mother in law is calling me on MSN lol..g'nite people..

gerbo
03-11-2006, 09:50 AM
what holds bones in place aren't ligaments as many believe..
ligaments's function is to keep joints from going further than its' normal ROM..
It's the muscles and joint structures that keeps bones in certain position in neutral setting..

however, we do not talk here about "normal rom" and "neutral settings" Put it this way, if a surgeon, who has paralysed his patients for surgery, in which case musclespasm is out of the way, tries to straighten out the spine as much as possible before attaching all kind of metal, what structure prevents him (or her) achieving 100% correction? Bonechanges, if they have occured, surely. Shortened muscles, maybe, but wouldn't all the fibrous tissue between vertebrae not have adapted to the years of abnormal position and resist correction as much, or even more? (as by nature it is much less elastic)


..then they do mirror image exercise in order to activate and strenthen the convexity side..

This seems to be the perceived wisdom, that the convex side is the weaker side, it just doesn't make sense to me. The strong bulky muscles, which must have most influence on the stability of the spine, run lateral to the spine. If they are stronger than the other side, then they should pull that part of the spine towards them, making the convexity face the stronger side. To me this seems confirmed by studies which shows that emg output is bigger on the convex side. There is also the reported change in muscle fibre type, resulting in muscle producing a lower tone on the concave side.
Furthermore, we found in our own daughter that the paraspinal muscles on the convex side felt "thicker" and "harder", and also, when doing targeted exercises using either left or right paraspinal muscles (torsorotation) the rotaion using the concave side muscles was initially much weaker.


high velocity low amplitude manipulation are done on sites known for abundance of mechanoreceptors in hopes(actually, this has been already proven..researchers were able to observe increased reading of the MR with HVLA on anaesthetised patient) to stimulate them(in posturer scoliosis, the cause is inhibition of MR) in mirror image to retrain your brain of what normal position is...that's just the basic premise of the technique..

lost me there


Note to anybody reading all this, can I please apologise profoundly for selfishly riding my own hobbyhorses here and boring everybody sick :o :o :o just ignore me

Celia
03-11-2006, 03:22 PM
Note to anybody reading all this, can I please apologise profoundly for selfishly riding my own hobbyhorses here and boring everybody sick :o :o :o just ignore me



:D :D :D You are a funny man !

sportsdoc
03-11-2006, 03:36 PM
however, we do not talk here about "normal rom" and "neutral settings" Put it this way, if a surgeon, who has paralysed his patients for surgery, in which case musclespasm is out of the way, tries to straighten out the spine as much as possible before attaching all kind of metal, what structure prevents him (or her) achieving 100% correction? Bonechanges, if they have occured, surely. Shortened muscles, maybe, but wouldn't all the fibrous tissue between vertebrae not have adapted to the years of abnormal position and resist correction as much, or even more? (as by nature it is much less elastic)

Well..I didn't mention the bone changes because in chiropractic there's no way of addressing that. As far as muscle spasms out of the way comment goes...the muscles themselves shorten..there's really not much of activity with chrocnially spasmodic muscles..as you've mentioned, it does give lower reading with emg..but it isn't because it's weak..it's because there's hardly any activity compared to the opposite side. Perhaps strong or weak is probably not the right way to address it...contracted and elongated would be more accurate...I don't think strength is all that of big an issue...as long as all the muscles are toned up...

the rotation using the concave side muscles was initially much weaker.

That would make sense..remember...concave side muscles are already at shortened state and you are trying to shorten it further...

paraspinal muscles on the convex side felt "thicker" and "harder"

What you've probably felt are erector spinae, quadratus lumborum or other big musculatures...those would be responsible for global movements...small muscles such as multifidus responsible for segmental movements are not easily palpable..that is if you could palpate at all...anyway, it wouldn't be easy to explain with just words..at least, it isn't easy for me lol....what you need to do is look at anatomical charts...it'll make sense to you why those large muscles would seem to be larger or stronger than the concavity side...also..on convexity side would be easier to palpate also..it would "stick out" more...especially if there are rotations involved...

lost me there

You wouldn't be the first one..
do some research on proprioception and mechanoreceptors...will make much more sense to you...

Karen Ocker
03-12-2006, 01:31 PM
Put it this way, if a surgeon, who has paralysed his patients for surgery, in which case musclespasm is out of the way, tries to straighten out the spine as much as possible before attaching all kind of metal, what structure prevents him (or her) achieving 100% correction ?

Actually, the hardware(screws) are placed in first then the rods are attached and turned to straighten out the spine.
Here's an animation showing the technique:

http://www.understandspinesurgery.com/template2/v_site.asp

cherylplinder
03-14-2006, 12:55 PM
Note to anybody reading all this, can I please apologise profoundly for selfishly riding my own hobbyhorses here and boring everybody sick :o :o :o just ignore me[/QUOTE]

You are never boring and usually entertaining! :D

Did I misunderstand the article on torsorotation you posted?
I also thought that the convex side was the stronger side. I thought I read that swimmers often develop a slight convex curve on their dominant side. I had it all worked out, and it made sense to me. :confused:

I had also noted your results doing torsorotation that I thought confirmed my thoughts.
I am confused.

I feel I spend a lot of my life that way - seeking to understand the mysteries of life. AAAhhhhhhhhhhhhhhh! :D :D :D

gerbo
03-14-2006, 02:57 PM
I also thought that the convex side was the stronger side.

sorry if i confused, maybe i did not understand you

yes indeed, from all i have read and seen; the paraspinal muscles on the convex side are the stronger ones.

what i am still trying to work out is whether this has a detremental effect on the scoliosis (this is what i think) or whether it actually supports the scoilosis and is beneficial (which others have suggested)

gerbo

cherylplinder
03-14-2006, 06:23 PM
sorry if i confused, maybe i did not understand you

yes indeed, from all i have read and seen; the paraspinal muscles on the convex side are the stronger ones.

what i am still trying to work out is whether this has a detremental effect on the scoliosis (this is what i think) or whether it actually supports the scoilosis and is beneficial (which others have suggested)

gerbo

I felt the same because of the data on swimmers and atheletes. Their dominant sides have a convex curve. Also, you witnessed Lisianna's(sp) weakness on her concave side. That one study indicated benefit from strenghtening the weaker side, although it has been a while since I read it. I have been looking for a machine for Rachel to use. I think it makes sense.
Thanks so much for the info! :)
Cheryl

gerbo
03-15-2006, 04:24 AM
I have been looking for a machine for Rachel to use. I think it makes sense.

phone the medx company and ask whether they have any record of one of their machines being used in your vicinity

Alternatively, we found a torsorotation or torsotwist machine in our local gym, which is doing a similar/ same job. Main problems we had to overcome were

1) even initial resistance without any weight added was considerable, so we had to be very careful
2) ensuring equal or initial even more exposure to the weaker side, we clearly did not want to train convex side too much
3) correct positioning, body as straight as possible and pelvis fairly fixed (basically using my hands to stabilise pelvis when she twists)

hope you succeed

gerbo

gerbo
03-15-2006, 04:32 AM
Geometric and Electromyographic Assessments in the Evaluation of Curve Progression in Idiopathic Scoliosis.
Spine. 31(3):322-329, February 1, 2006.
Cheung, John MD, PhD *; Veldhuizen, Albert G. MD, PhD *; Halberts, Jan P. K. MA, PhD +; Sluiter, Wim J. PhD *; Van Horn, Jim R. MD, PhD *
Abstract:
Study Design. The natural history of patients with idiopathic scoliosis was analyzed radiographically and electromyographically in a prospective longitudinal study.

Objectives. To identify changes in geometric variables and the sequence in which these changes occur during curve progression in the natural history of patients with idiopathic scoliosis. In addition, to study the relationship between several geometric variables and electromyographic (EMG) measurements to determine their predictive value as risk factors to curve progression of the scoliotic deformity.

Summary of Background Data. The main area of concern in treating children with adolescent idiopathic scoliosis is the unpredictability of curve progression during the early development of the deformity.

Methods. The changes in radiographic geometric and EMG variables between the first presentation and consecutive 4-6-month follow-up periods were analyzed in 105 patients with idiopathic scoliosis. Statistical analyses were performed to elucidate in more detail how spinal geometry evolves during curve progression.

Results. Curve severity was associated with remaining growth potential expressed as an increasing spinal growth velocity (SGV). With increasing SGV, an enhanced EMG activity at the lower part on the convex side of the curve expressed as EMG ratio was found. High EMG ratio was associated with increased axial rotation and diminished kyphosis before the rapid increase in Cobb angle. Lateral deviation, wedge angle, and axial rotation all increased during periods of progression. Changes in tilt angle and lordosis were not associated with curve progression.

Conclusions. In the natural history of idiopathic scoliosis, SGV and EMG ratio at the lower end vertebra are prominent risk factors of curve progression. The asymmetric muscle activity is associated with increased axial rotation, which in its turn is associated with increasing Cobb angle and diminishing kyphosis. The combination of these variables provides insight in the physiologic and 3-dimensional biomechanical evolution of the natural history of curve progression in idiopathic scoliosis.

(C) 2006 Lippincott Williams & Wilkins, Inc.

this article, recently published is interesting as it confirms the link between increased emg activity on convex side and worsening scoliosis

I have read the full article, the author thinks this is due to increased strength on the convex side "in an attempt to correct the curve", as i said before, I think it is counterproductive and actually worsens the curve.

Not totally sure yet what the answer is, but will keep on looking for one

gerbo

cherylplinder
03-15-2006, 01:38 PM
Gerbo,
You are a gem! It seems that this may be very important in the progression of scoliosis.
More than fascinating!
Cheryl

Celia
03-15-2006, 02:01 PM
[COLOR=DarkRed] High EMG ratio was associated with increased axial rotation and diminished kyphosis before the rapid increase in Cobb angle. Lateral deviation, wedge angle, and axial rotation all increased during periods of progression. Changes in tilt angle and lordosis were not associated with curve progression.

Conclusions. In the natural history of idiopathic scoliosis, SGV and EMG ratio at the lower end vertebra are prominent risk factors of curve progression. The asymmetric muscle activity is associated with increased axial rotation, which in its turn is associated with increasing Cobb angle and diminishing kyphosis. The combination of these variables provides insight in the physiologic and 3-dimensional biomechanical evolution of the natural history of curve progression in idiopathic scoliosis.




I read somewhere that an increase in RVAD can precede an increase in cobb angle by a few months. Is this what they mean by "an increase in axial rotation" ? As for muscle imbalances, I'm not really sure if its a causative factor or just a consequence.

cherylplinder
03-15-2006, 02:44 PM
That makes sense. Let me show my ignorance and ask exactly what the initials RVAD stand for?

Celia
03-15-2006, 03:44 PM
what the initials RVAD stand for?


Cheryl,

RVAD stands for Rib Vertebral Angle difference. I'm pretty sure they measure this number with a protractor. There is a real excellent article by Min Mehta on the subject here:


http://www.scoliosis-support.org/modules/wfdownloads/viewcat.php?cid=4&start=10

Mom37
05-08-2006, 10:19 PM
That sounds great. Good luck to you. Your daughter will really like Dr. Deutchman. He is very patient and kind to kids and adults. Does Dr. Smouse's daughter wear Spinecor?
Melissa

I understand that the Houston office supporting Spinecor is the father daughter team of Drs. Smouse-one being Stephanie, whom I believe has scoliosis.
We haven't gone there yet as I had our one month in CA with Andrew Mills.