vestibular testing [Archive] - National Scoliosis Foundation Forums

structural75

12-23-2006, 09:31 PM

gerbo,

Sorry folks that this is so long, but it's concise and makes a point. It's certainly more in depth and comprehensive than anything else that's being offered. I know you're [Gerbo] a spincor user, ...Are you really against this vestibular rehab? It is in fact an integral part of the premise behind the spincor brace as noted by the Doctors themselves.

The Spinecor(TM) brace is fitted and worn home the same day. Adults can be fitted in New York, Chicago, Atlanta, Los Angeles and Phoenix as an ongoing clinical study to determine the long-term efficacy of Spinecor(TM) and vestibular rehabilitation in the adult population.

Dr. Collaird (creator of spincor) and her team of physicians are now convinced the success of the program is due to changes in postural control from the brain.

Through a collaborative effort, Scoliosis Systems(TM) and SpineCor(TM) are responsible for amazing advancements in spinal and neurological rehabilitation. Today's sophisticated medical equipment allows for monitoring of how the brain controls posture. An imbalance in specific parts of the brain including the vestibular cortex and the brainstem has been reported in scoliosis for nearly 25 years

Vestibular tests can help determine if more expensive tests, such as magnetic resonance imaging (MRI), are needed. Recent studies (Levy and Arts, 1996) have shown that vestibular testing is much more accurate than clinical symptoms in predicting whether neuroimaging tests will be abnormal.

Recent studies have documented that vestibular tests are more accurate than clinical examination in identifying inner ear disorders (Gordon et al, 1996).

Abstract from Scoliosis Research Society (SRS) 2003 Meeting

Matthew T. Provencher M.D., Derin Wester, Ph.D., Bruce Gillingham M.D.; Naval Medical Center- San Diego, CA. Orthopedic Research and Education Foundation- Resident Research Grant
Conclusion: A central vestibular deficit is present in scoliosis patients. Central vestibular function is worse with larger curves, and the dysfunction is opposite to the curve. Curves with location in the mid-thoracic region demonstrated less central deficit than low-thoracic and lumbar scoliosis curves. The data supports a central vestibular dysfunction in patients with scoliosis

In a study published in SPINE 1995, researchers tested linguistic processing, a higher cortical function, and concluded children with scoliosis had an entire brain dominance lateralized to one side, unlike unaffected children in the control group. This study demonstrates the need for advanced neuro-diagnostic testing and clinical correlations which leads to meaningful neurologically based rehabilitation.

Patients with scoliosis are known to have neurological dysfunction which contributes to the progressive nature of scoliosis, as well as interfering with the rehabilitation of posture in the adult and child. Studies have identified an increased incidence of brainstem and cerebellar abnormalities such as brainstem hypoplasia and Arnold Chiari Malformation in patients with Scoliosis. Certain findings such as cervical lordosis, thoracic kyphosis, abnormal Somatosensory evoked potentials (SSEP) and nystagmus on electronystagmographic testing have been linked to neurogenic causes of scoliosis. In the event neurological dysfunction is identified, MRI imaging may be necessary. Other interventions may include neuromuscular rehabilitation which can be offered on an individual basis. Vestibular and oculomotor dysfunction has been shown to respond to personalized treatment programs, which are designed to re-educate the brain perception of subjective postural vertical.

Physiotherapy techniques have been successfully utilized in scoliosis treatment for the past sixty years. Myofascial Release Technique (MRT) is designed to neurologically inhibit the connective tissues which become fibrotic when a muscle is in a shortened state for a prolonged period of time, thereby preparing the muscle to be lengthened.

There are numerous studies lending to the efficacy of vestibular rehab.

The evidence that it works as an integrative aspect of treatment is all over the place.

Although, I certainly agree that there is no evidence or probability that it will ever change a scoliosis by itself (there are so many factors at play in attempting to "stabilize" a curvature that no one thing is going to do it. And certainly nothing but a forceful approach, i.e. - rods/fusion or bracing possibly, is going to hold it if the underlaying cause is never found). Therefore I do believe it has varying degrees of importance in the management of scoliosis, either pre or post operatively. To say that its purely "academic" is a brash assumption Gerbo. Considering the medical fact/reality that neurology is an extremely infantile field of study, it would be hard to formulate any definitive stance on this subject. Any neurologist will tell you that we know very little about the brain and how/why it works. This topic dealves into an abyss of unknown realities... no studies does not equate to illigetimacy. Maybe if we started giving this field some credibility we might start getting some answers. But until we give attention to it, we'll continue to remain ignorant on the matter. The creators of the spincor brace certainly see its relevance.

structural

structural75

12-23-2006, 09:36 PM

From the Scoliosis Care Foundation

Beyond Only The Spine

Current research in the U.S. and Britain is showing that idiopathic scoliosis is a multifaceted disease that compromises all five of the body’s systems: neurological, digestive, hormonal, muscular and osseous (bone). These newer insights about the impact of the disease of scoliosis on a patient recognize that the body’s systems work together in an integrated fashion. When one of the body’s systems suffers a malady it can create problems with one or more of the body’s other systems.

Older 20th century based philosophy about scoliosis treatment considered only the osseous part of the equation, with the focus of treatment being just on stopping skeletal curvature from progressing. The attention was on supporting the spine, while ignoring the body’s four other systems.

Take, for example, bracing, an important component in the non-surgical treatment of idiopathic scoliosis. Its purpose was to keep the curve from progressing while the patient is growing. Studies have shown bracing to be an effective treatment halting the progression of many a scoliosis curve; and that’s great. However, after skeletal growth has concluded and the brace removed, the curvature is expected to return. While bracing has traditionally been used to prevent things from getting any worse, there had not been simultaneous courses of action taken in non-surgical scoliosis treatment to attempt to make things any better.

The new thinking in idiopathic scoliosis research holds that helping patients achieve their own level of optimal health in each of their five body systems can result in more effective non-surgical treatment.

The Scoliosis Care Foundation supports research and non-surgical treatment for idiopathec scoliosis that takes into account all of the body’s systems.

structural75

12-23-2006, 09:43 PM

Celia wrote: ...take methods which are completely unproven and make them sound mainstream and effective when in fact there is no scientific basis for their validity.

Vestibular testing and rehabilitation is very scientifically based and valid as proven in studies.

Timothy C. Hain, MD
Professor of Neurology, Otolaryngology, and Physical Therapy/Human Movement Science, Northwestern University Medical School, Chicago IL, USA.
OFFICE PHONE NUMBER: 312-274-0197
OFFICE LOCATION: Chicago Dizziness and Hearing , 645 N. Michigan, Chicago 60611
WEB SITE: http://www.tchain.com/
EMAIL ADDRESS: cdb@dizziness-and-balance.com
FAX NUMBER: 312-274-0198
EDUCATION: MD and Neurology Residency: University of Illinois, Chicago IL. Fellowship: Johns Hopkins University (Neurophysiology and Neuro-ophthalmology). Board certified in Neurology (1981)

Dr. Hain states:

Why get vestibular tests ?

1.Vestibular tests are tests of function. Their purpose is to determine if there is something wrong with the vestibular portion of the inner ear. If dizziness is not caused by the inner ear, it might be caused by disorders of the brain, by medical disorders such as low blood pressure, or by psychological problems such as anxiety. Recent studies have suggested that vestibular tests are more accurate than clinical examination in identifying inner ear disorders (Gordon et al, 1996). Hearing pathway tests (audiometry, ABR, ECOG) can also be used for the same purpose, and are frequently combined with vestibular tests. In a cost-effectiveness analysis for evaluation for vertigo it was concluded that hearing testing followed by either posturography or ENG (electronystagmography) was the most effective method (Stewart et al, 1999).
2.To detect central disorders. Recent studies have suggested that internuclear ophthalmoplegia, a central eye movement disorder, is missed by 71% of physicians unaided by quantitative oculomotor testing (Frohman et al, 2003).
3.To decide if more expensive tests like MRI (Magnetic Resonance Imaging) are needed. Vestibular testing is more accurate than clinical symptoms in predicting whether neuroimaging tests will be abnormal.(Levy and Arts, 1996)
4.To document objectively vestibular conditions such as BPPV and Perilymph fistula, which commonly occur after head injury, vestibular neuritis, and Gentamicin ototoxicity, which commonly is a side effect of medication.

http://www.dizziness-and-balance.com/index.html
http://www.lifelinerehab.com/vestibular.html
http://www.vestibular.org/index.php
ETC.....

Celia Vogel

12-24-2006, 05:19 AM

Structural,

You have completely butchered the discussion we had under the Spinecor thread and I'm not even going to waste my time!

Happy Holidays to you!

gerbo

12-24-2006, 07:23 AM

celia, please blame me, i asked for this, just to keep spinecor thread clean and as an opportunity to stake stock of the various arguments.

i suggested stick to essentials only and get rid of the rest (specially non-factual and personal comments)

apologies

gerbo

Celia Vogel

12-24-2006, 08:40 AM

Gerbo,

It's funny that structural conveniently omitted the one paragraph in response to your question above that sparked this debate. If I remember correctly, you responded by saying that patients shouldn't be required to fund studies of any sort.

Originally Posted by gerbo:

I think that in the context of treatment of scoliosis, there is nothing wrong with vestibular testing as long as it is made clear that it is only of academic interest, patients are advised that there is no evidence at all that "treatment" based on this testing does anything to improve scoliosis or helps to maintain a curve, and of course no large additional payments are demanded (Did I pick up that dr d charges more than 1000 dollar for this; correct me if i am wrong)

Originally Posted by Structural:

Gerbo - I know we all want more definitive answers to help loved ones... but to get those answers costs $$$ (for studies that you often demand). Donating to causes such as this just might get us some of those answers with the "studies" to back them up.???

Who exactly is doing this study ? According to parents who have been to the chiropractors, claims are being made by the chiropractors that there is a study. Drs. Rivard and Coillard are not conducting such tests on their patients. How do these expensive tests affect how the brace works ? In fact, patients who are going to Montreal are getting better results than the chiropractors who are conducting these tests and recommending patients use wobble boards to enhance proprioceptive capacities! Furthermore...in one of your quotes you state that it can be used as a predictive test for chiari and the like however no red flags went up to the chiropractors who were treating Mom37's daughter - I'm not implying that you wouldn't have sent the young lady to see a neurosurgeon but that didn't happen in Mom37's case! So what exactly are these *tests* useful for ? Are the results being used in any meaningful way ?! As far as I know the chiropractors are charging patients $6,000.00 for the brace inculsive of tests/wobble boards versus $3,000.00 in Montreal.

Children who present at chiropractic/osteopathic offices for these "tests" have scoliosis hence the "test" is worthless as a predictive measure. As for the exercises/wobble board... we all agree it doesn't work. I've noticed when I ask you a direct question you distance yourself and argue the case from an empirical stance. You have an uncanny ability to skirt around questions and take methods which are completely unproven and make them sound mainstream and effective when in fact there is no scientific basis for their validity.

Here is a study: "Etiology of Idiopathic Scoliosis by T.G. Lowe, C.H. Rivard," Refer to page 1161 - 1162 under the heading: Neurological Mechanisms http://www.scoliosis-support.org/uploads/central_vestibular_dysfunction.pdf

1: Clin Orthop Relat Res. 1980 Oct;(152):232-6.

Equilibrium factors as predictors of the prognosis in adolescent idiopathic scoliosis.
Sahlstrand T, Lidstrom J.

Postural equilibrium factors were evaluated as indicators of the prognosis in 52 patients with adolescent idiopathic scoliosis. The hypothesis was that dysfunction in these equilibrium factors might imply a higher risk for the curve to progress. The postural equilibrium was studied by stabilometry, and the function of the central nervous system was assessed by electoencephalography (EEG) and the vestibular function by electronystomography (ENG). During a follow-up period averaging 2.9 years, ten patients showed progression of the scoliosis. No differences were found in the distribution and frequency of abnormalities between the patients with progressive and nonprogressive scoliosis. Stabilometry, electroencephalography, and electronystomography as used in this study did not seem to be of predictive value for the outcome in the individual case.
PMID: 7438607 [PubMed - indexed for MEDLINE]

1: Spine. 1980 Nov-Dec;5(6):512-8. Links

An analysis of lateral predominance in adolescent idiopathic scoliosis with special reference to convexity of the curve.

Sahlstrand T.

An analysis of lateral predominance of 51 patients with adolescent idiopathic scoliosis is presented. Determination of handedness, the dominant foot, and the dominant eye was performed. Postural equilibrium was studied by stabilometry, and the vestibular function was evaluated with electronystagmography. Central and peripheral nervous function were evaluated as reflected by electroencephalography and nerve-conduction velocity measurements. Results were compared with those obtained for a control group and were evaluated with special reference to convexity and location of the curve. Significant differences were found between patients with right convex curves and those with left convex curves in the distribution of eye predominance and in labyrinthine sensitivity. The direction of convexity was correlated with the predominant labyrinth for both groups. An analysis of these findings indicates that they can be of pathogenetic importance.
PMID: 7466460 [PubMed - indexed for MEDLINE]

ARE ASYMMETRIC OTOLITH VESTIBULO-OCULAR REPONSES A PREDICTIVE FACTOR FOR IDIOPATHIC SCOLIOSIS IN CHILDREN?

Sylvette R. Wiener-Vacher, and Dominique Antolini., Nn. 1

In idiopathic scoliosis spinal deformities start to develop at the time of the initial rapid growth at the onset of puberty. A suggested cause of IS is a disequilibrium in the otolith vestibular control of the trunk muscles. Supporting this hypothesis our previous results (2) showed that 67% of children with IS, but no other inner ear or neurological abnormalities, had an asymmetry of their otolith vestibulo-ocular reponses to the Off Vertical Axis Rotation test. These were significatively greater than in a control age-matched
group of normal children. We suggested that this asymmetry was a central otolith vestibular system disorder and could lead to a vestibulospinal system imbalance, which would then provoke IS.

The goal of this study was to determine if this asymmetry exists prior to the appearance of the spinal deformities. Our preliminary results show that the vestibulo-ocular asymmetry appears before the spine starts to show any significant clinical and radiological deformity. In patients at risk for IS(e.g. a family with IS history) screening for otolith functional asymmetry could be used as predictive factor of scoliosis and help for earlier prescription of IS preventative treatment.

1 Thanks to the Cotrel Foundation (Fondation de France) for supporting this research.

2 S.R. Wiener-Vacher, K. Mazda. Asymmetric otolith vestibulo-ocular responses in children with
idiopathic scoliosis. J. Pediatr 1998 ;132:1028-1032.

Celia Vogel

12-24-2006, 08:49 AM

This is something Structural stated in the Spinecor thread:

...Despite the lack of studies on scoliosis/vest., the field of neurophysiology has a lot to offer many conditions. I am pleased to see it being used in combination with other things. There are methods being used everyday to help people learn to walk again following serious trauma/injury to the spine and/or head.... There are documented cases of formerly parapalegic/quadrapalegic individuals who learned to WALK again (despite the prognosis from their doctors) due, in part, to methods and excersices designed to correct vestibular dysfunctions, usually under the guidance of Physical Therapists and neurologists. (In fact, learning to walk again REQUIRES vestibular re-programming, otherwise it is literally impossible) From my working knowledge of these methods there is nothing mystical or airy fairy about it..... The evidence that it works as an integrative aspect of treatment is all over the place. Although, I certainly agree that there is no evidence or probability that it will ever change a scoliosis in and of itself

Show me *one* documented case of vestibular rehab correcting a scoliotic spine! This is a scoliosis forum and you insist on bringing up matters which have absolutely nothing to do with scoliosis!

structural75

12-24-2006, 08:54 AM

Celia,

That is probably a good idea for us all... I think all of our points have been made.

However, I don't believe there was even a "discussion" in the first place, and that was my point. After I deleted all of posts from the spinecor thread as Gerbo intelligently suggested, I went on to read the previous "discussion" he referenced on the matter. I was uphauld to see that you did the same thing to another member, denigrating the topic and again making the same false statements about it. Making condescending remarks about "eye exercises" and claiming the field is "bogus" is not a "discussion". You could have inquired with questions for clarification and understanding instead of dismissing what you didn't know. That's partly why we are gere, to learn something.

We know now that it is: not a chiro thing, but an MD, not about the eyes/eye exercises per se, but the inner ears, and that the field is not "bogus, but very much scientifically validated for its importance/relevance in a variety of conditions including scoliosis. There may not be the studies you'd like to see at this time, but it is applicable and relevant nonetheless.

I mean seriously now, Are there any studies proving the efficacy of the spinecor brace 20 -30 -40 years from now? Do we really know that it is going to stabilize the curve indefinitely/permanently, any moreso than other braces have? No, but I still support its use due to its integration of postural re-education via the nervous system(vestibular re-programming). And those folks using the brace are undergoing a generalized vest. re-programming by lessening the curvature and moving/activating the spinal soft tissue at the same time... that is largely the reason for its success... and that is vestibular rehabilitation.

And by the way, I have nothing, absolutely nothing to gain from people utilizing this approach(financially or otherwise... I use my hands in treatment, no interst in fancy machines... I'll leave that up to the Docs). I do not do this "expensive" testing/rehab that the chiros/MDs do, but rather take a functional approach in working with the dysfunctions.(by the way, haven't I read that bracing costs/replacement parts/straps can be quite expensive. With x-rays, visits, etc.... why keep spending money on frequent x-rays when you know the curve "already exists" and you're using a "proven and effective" method?

My only stake in this is to prevent the less educated from disseminating false information.

Gerbo,

...just holding people accountable for their comments. What I have posted to end my contribution on this is quite factual.

structual

Celia Vogel

12-24-2006, 08:57 AM

.. After I deleted all of posts from the spinecor thread as Gerbo intelligently suggested, I went on to read the previous "discussion" he referenced on the matter.

Sure you did ;) You knew it all along and I really don't see how it was your discussion to reference in the first place and take my words out of context! But since you chose to reference it, I'll post it here to save people the aggravation of going back 50 pages in the Spinecor thread!

Posted by DizzyMom:
New to site, interesting read. Have 14 yr daughter- been Boston bracing- 4 yrs- curve worsening. Referral to surgeon. now 30 in brace-thoracic.

Looking at Spinecor..... Atlanta is closest for me- 7 hours- I'm in eastern NC. Do those of you who have used this awhile feel it is helping? I take it from the site, most kids prefer it over the hard brace.

Anyone have trouble with getting approval thru insurance?

Also saw where Shriners does it free. Any other info on this and are they as good there as Dr D and Dr L- except for the Canadian Docs.

Actually got an appt in just 1 month when I called- but having difficulty with the $6000 up front. Any suggestions or helpful info would be great!

Posted by Gerbo:
blasted, $6000 upfront, that's a lot, is that the going rate??

For what it is worth, and you might have seen this already, this is link to the spinecorwebsite http://www.spinecorporation.com/English/index.htm , with a list of treatment centres

Posted by Sherie:
I think we paid $4500, 6k sounds high to me.

Posted by Celia:
I think the chiropractors charge more *coughs* because they do some phoney baloney eye exercise testing to "correct" the scoliosis.

Posted by Christine:
We just went to Montreal 3 weeks ago. We paid a total of $3534.00 which include 2 x tra body suits. We are also expecting reinbursement of $2434. in out of network insurance. From all of the research we have done the placement of the brace is extremely important to get the best results!!!!

Perhaps if you could get a referal from a orthopedic in network you may be able to fight for in network benefits.

Posted by JGD1991:
Celia, I would be careful to discredit someones work without giving good back up research to support your opinion. There seems to be a number of research articles connecting scoliosis to a vestibular problem. I think that the additional cost to evaluate the vestibular system is worth doing, based on my readings.

For example i found this paper

ARE ASYMMETRIC OTOLITH VESTIBULO-OCULAR REPONSES A
PREDICTIVE FACTOR FOR IDIOPATHIC SCOLIOSIS IN CHILDREN?

Sylvette R. Wiener-Vacher, and Dominique Antolini., Nn. 1

The goal of this study was to determine if this asymmetry exists prior to the appearance of the spinal deformities. Our preliminary results show that the vestibulo-ocular asymmetry appears before the spine starts to show any significant clinical and radiological deformity.

In patients at risk for IS (e.g. a family with IS history) screening for otolith functional asymmetry could be used as predictive factor of scoliosis and help for earlier prescription of IS preventative treatment.

Posted by Celia:
I don't see the point of expensive *tests* by chiropractors if the children that go there *already* have scoliosis and as the above study points out "vestibulo-ocular asymmetry appears before the spine starts to show any significant or radiological deformity". What exactly are the chiropractors planning to do with their results ????? Brain surgery ?????

Posted by JGD1991:
The vestibular Systems controls the muscle tone of the back muscles surounding the spine . If that system is not working symetrically, the scoliosis is being supported in negative way. Vestibular exercises have been well established and in the research. I rather have this system working with me then against me.

Posted by Celia:
You mean eye exercises ? Where is it well established ?

Posted by Cheryl:
This may be a factor in scoliosis, but it is one theory of possible causes. It may deserve further study, and probably does. But should the patient pay huge sums to be the recipient of such research? I highly question, not the study, but the profit from the study. That, I think, is where Celia is coming from...

A true researcher is not going to charge astronomical sums. A true researcher rather is looking for a participant willing to take the risk to be a part of his study.

The vestibular component of scoliosis and treatment of that component of scoliosis are still under research.

I think this practice is a racket motivated by profit. It cannot cost 3000 dollars a patient to run these tests and teach the exercises. There is no documentation that these exercises do anything to help the scoliosis. Therefore, they are still experimental. I think it is highly suspect to charge such astronomical sums and prey upon the fears of the parents and patients.

When and if this is ever a well documented treatment for scoliosis, it would be ethical to charge a reasonable fee.

Posted by Christine:
Well said Cherylplinder !!! Dr. Rivard's Office visit was only $100. and he spent approx. 3 hours on my daughters case.

Posted by Celia:
The man is a Saint! I have to agree with Christine that Cheryl made some EXCELLENT points!

JGD: Nowhere in the studies that you have referred to, does it elaborate on how to *correct* this asymmetry. You are trying to legitimize these bogus eye exercises which are totally unproven by referencing studies conducted by *true* researchers such as the Cotrel Foundation.

Posted by Cheryl:
Yes, Dr. Rivard is a Saint. He asks so little for his time, I am tempted to make a donation!

Posted by JGD1991:
I have two neices in the Spinecor Brace. They both had vestibular imbalances that are being addressed with home exercises. The reason we brought them to NewYork City for Spinecor was that this was the only office that seemed to address other aspects conected to scoliosis. We also found that most of the other spinecor offices did not offer even the exercise program from spinecor. They offered testing that made sense to us. The Vestibular system controls balance and spinal muscle tone. The fees for the testing ranged from 800-1200 for my neices. This test is a well established medical test and these fees were normal for this test. I' m sure Spinecor also had this type of atitude from patients when they first came out. People were being charged for the spinecor brace and wondering why it should cost the same as a hard brace. Over time people are becoming very happy with results and are glad they found it at almost any price.
In addition, when I was in the new York office for a quartly visit recently with my neices. There was a young child that had been in for 3 months earlier for an examination and had come back for a followup. I was told that the child had a 9 degree curve and was given only vestibular exercises. The parents were expecting that she may have progressed and need a brace only to find out that her curve reduced to less than 1 degree. I was very excited for them and was real happy that we didn't try to cut corners and miss out on any possible benefits from there program.

Everybody has to do what they feel is the right thing to do. I only came on the forum with my coments because I thought people were being guided improperly.

Posted by Celia:
Oh...you're actually a patient ??? I thought you were a chiropractor! These tests are medically established and necessary? According to who ? Do you have studies that show that these eye exercises are nothing but pure fiction ?

Posted by JGD1991:
I'm at work but I found a study for you.

Role of vestibular adaptation in vestibular rehabilitation.
Herdman SJ. Department of Orthopaedics and Rehabilitation, University of Miami, Coral Gables, Florida 33146, USA.

Posted by Karen Ocker:
I see that one of the studies was published in 1979 from Scandinavia; are there any more than 3 such studies?
Unless other studies ---with other populations by other researchers replicate those results there is not enough evidence suggesting validity as a basis for a treatment modality. Also, were there any flaws in the conduction of those studies? There were not very many subjects.

Posted by JGD1991:
I really think that this is going to be the next Ah ha. of course we should have been doing these exercises

Posted by Celia:
I think we may be on to something BIG... so, if I have scoliosis and I train my eyes to move in a certain direction this will straighten my spine ?

gerbo

12-24-2006, 09:39 AM

We know now that it is: not a chiro thing, but an MD, not about the eyes/eye exercises per se, but the inner ears, and that the field is not "bogus, but very much scientifically validated for its importance/relevance in a variety of conditions including scoliosis. There may not be the studies you'd like to see at this time, but it is applicable and relevant nonetheless.

to a patient with scoliosis there is only one issue which determines relevance; and that is whether effort, time and money spend results in stabilisation, improvement or slowing down of progress, which would not have occured without the particular testing/ treatment.

With regards to vestibular testing exercises; if we do not have evidence that it improves matters, we do not have evidence that it doesn't make things worse neither.

Personally i really think that you are a very caring, knowledgeable and responsible practitioner, and i believe that for you this testing is only a small part of your overall approach.

What has been bothering both celia a nd me that it has appeared to us that some chiropracters has been charging their patients an awful lot of money for having the "benefit" of this testing, without being told about the lack of evidence about the method.

Remember that the discussion started following a posting about vestibular testing done by doctorsr in the context of scoliosis, so no issue was taken as such about it being done for scientific reasons and/or for the treatment or diagnosis of other conditions by other practitioners, including yourself.

I mean seriously now, Are there any studies proving the efficacy of the spinecor brace 20 -30 -40 years from now? Do we really know that it is going to stabilize the curve indefinitely/permanently, any moreso than other braces have

no but the available evidence shows impressive results 2 or more years following completion of treatment, and we are awaiting the publication of the next study which is showing results over an even longer period. And i am sure that you know that if a curve can be maintained below 30 degrees by the time growth has finished the chance of deterioration in later life if much smaller that if the curve is above that level folllowing end of growth

regards

gerbo

structural75

12-24-2006, 01:59 PM

Gerbo,
Thank you for that honest and respectful post. I agree and I sincerely hope that the future studies you refered to on the spincor brace show additional promise.

I myself, look forward to it, as well as the potential for more direct studies on neurophysiology as it relates directly to scoliosis.

I'm very sorry that there are practitioners out there who put their financial interests in front of their patients' health. I'm not in any position to judge those said chiros on the matter, but I hope it's not the case.

Although I stand behind the 'factual' and relevant content of previous posts, I am deeply ashamed for being a part of that kind of negative energy on this forum. I never had the intention of taking personal assualt on anyone, but in the heat of the moment it was all I could do to defend legitimate ground. I will continue to support complimentary, alternative and conventional approaches, but my days of poetic slamming are through. It simply serves no purpose if people aren't willing to listen to both sides.

My apologies to everyone on this forum for my role in perpetuating a hopeless "discussion" from the start.

structural

Mom37

12-24-2006, 09:30 PM

I just wanted all to know that my Insurance covered in it full, so I meant 100 percent, and considered it medically necessary. It is something that must be researched and decided upon individually. My understanding was that it was in connection with the whole Spinecor treatment. It is true not all doctors who fit Spinecor use that testing. It is like Spinecor, still being used by some doctors, but not all.

Celia Vogel

12-25-2006, 06:15 AM

Celia,

However, I don't believe there was even a "discussion" in the first place, and that was my point...

True! The rest of us were having a discussion on scoliosis it was pretty clear to all you were out in left field arguing the relevance of vestibular rehab as it pertains to *other* medical conditions.

Celia Vogel

12-27-2006, 06:26 PM

The vestibular system consists of the inner EAR, not the eyes as this poster has wrongfully assumed. It is established in many, many studies done by M.D.s specializing in this field (neurophysiology).

They are FAR more than eye exercises.. had she known what vestibular was she wouldn't make such brash statements. Nobodies "trying" to do anything, they've been "legitimized" already.

We know now that it is: not a chiro thing, but an MD, not about the eyes/eye exercises per se, but the inner ears, and that the field is not "bogus, but very much scientifically validated for its importance/relevance in a variety of conditions including scoliosis.

I never had the intention of taking personal assualt on anyone, but in the heat of the moment it was all I could do to defend legitimate ground.

Posted by Majestnic when she was seeing Dr. D. in New York before switching to Dr. Rivard:

Nicole has specific exercises to do to strengthen her eye muscles. They involve eye tracking, etc.

Posted by LATigner:

My daughter also had the neurological testing done. Dr. Ron Marinaro explained what it was for and we chose to do it - no pressure or other tactics to try and force us. The reason we elected to do the testing is that there is a theory that occular vestibular inbalance is associated with scoliosis. Dr. Ron said that all of the scoliosis patients he has tested have had positive results. He was also clear that it is unknown whether this causes scoloisis or is a result of scoli. But it makes sense to me that if a person's brain does not perceive the vertical plane correctly and thinks they are standing up straight when they are not - this is a deterimental thing.

Yes, the testing added $1200 to the cost but we were willing to try it based on our own research and conversations with Dr. Ron and others. Our daughter has some simple eye excercises to do.

Posted by BlueCrystalMan:

As for the extra testing... the data collected is going toward research, as there is a possible correlation between the ocular vestibular imbalance and scoliosis... the way I understood it is that the mind thinks the patient is out of balance and the brain uses the back muscles to balance a person. Over time, the muscles on one side or the other, depending on the perception of which way the body thinks its falling, get built up and in turn pull the spine that way. The testing determines which side is the more dominant side, and based on the data, eye exercises are prescribed to 'retrain' the brain to eliminate the imbalance. The testing goes toward prescribe specific exercises for the specific curves in his spine.

The exercises prescribed, both for the eyes and the physical part go toward helping to eliminate the curve and its causes. Software is provided to help retrain the brain for a minute every day, and he has to do a spinning exercise in his desk chair while focusing on his thumb in the distance. All this goes toward helping the brain adjust to the fact that my son isn't really off balance.

So personally, the tests made sense, and the data compiled for the greater good of current and future patients, and no I don't think I was scammed at all. Research dictates that they are on the right track, and so far my son's progression in terms of doing his exercises has been tremendous... I can see difference in his balance already both on the exercise ball and when doing his eye exercises.

structural75

12-27-2006, 10:06 PM

Celia,

I thought we laid this one to rest... :confused:

You Said:
The rest of us were having a discussion on scoliosis it was pretty clear to all you were out in left field arguing the relevance of vestibular rehab as it pertains to *other* medical conditions.
:confused: :) What you're calling a discussion consisted of you telling people that vestibular testing/rehab was a bunch of nonsense. You wouldn't let me past first base in terms of having a discussion on its relevance to scoliosis. You clearly felt it was irrelevant.

I will kindly say... It was obvious I was arguing the relevance of vest testing/rehab as it pertains to scoliosis. I used its application to "other" medical conditions (once or twice) to exemplify its scientific validity and proven effect, which was originally discredited by you. You kept telling others and myself there was no evidence that it works, much less has anything to do with scoliosis. So I used "other" scientific applications of it to show its legitimacy and likely relevance to scoliosis, despite the lack of studies specifically in regards to scoliosis.. .

If you hadn't been on my case the entire time, arguing against its validity and relevance to scoliosis, then maybe we could have gone in a more positive and productive direction with the "discussion". My original effort was to support the validity of the vest. testing as it related to scoliosis, and you wouldn't let that happen.

Therefore, I'm a bit confused about the content of your last post here. It seems to point out everything that I've been trying to say this entire time.

I'm not certain why you posted those quotes from me... they seem to make perfect sense, especially in context to your previous assumptions and comments. And the testimonials below them show positive and relevant application of vestibular testing/rehab in cases of scoliosis. Isn't this what I've been trying to say all along???

Our proprioceptive inputs for balance and coordination (which then informs the musculoskeletal systems) comes from both the inner ear and eyes alike (vestibular and occular). I'm pretty certain I mentioned that earlier somewhere... ...not about the eyes/eye exercises per se, but the inner ears, and They are FAR more than eye exercises.. was meant to be a simple correction in the purpose of vest. test, specifically the actual system those "eye exercises" are working to correct. By doing eye exercises, as well as others, they're working to correct the discrepency between the vestibular system (inner ear) and the proprioception of the eyes.

So what seems to still be the problem?

structural

LindaRacine

12-27-2006, 10:56 PM

Celia Vogel

12-28-2006, 03:39 AM

...What you're calling a discussion consisted of you telling people that vestibular testing/rehab was a bunch of nonsense. You wouldn't let me past first base in terms of having a discussion on its relevance to scoliosis. You clearly felt it was irrelevant..

One simply has to look at the length of your posts to know this is total rubbish! Your "poetic slamming" consists of going off on a tirade discussing matters totally unrelated to scoliosis.

...Therefore, I'm a bit confused about the content of your last post here. It seems to point out everything that I've been trying to say this entire time. I'm not certain why you posted those quotes from me... they seem to make perfect sense, especially in context to your previous assumptions and comments. And the testimonials below them show positive and relevant application of vestibular testing/rehab in cases of scoliosis. Isn't this what I've been trying to say all along???

There could only be one of two things: 1) there is something wrong with your mental faculties or 2) you think we're all a bunch of idiots! I personally think it's the former and I would highly recommend having vestibular testing done for yourself :D :cool:

...My original effort was to support the validity of the vest. testing as it related to scoliosis, and you wouldn't let that happen.

In response to this please refer to the following article: "Etiology of Idiopathic Scoliosis by T.G. Lowe and C.H. Rivard et/ al., ," Page 1161 - 1162 under the heading: Neurological Mechanisms, http://www.scoliosis-support.org/uploads/central_vestibular_dysfunction.pdf

Further...*nowhere* in the following quote that you posted previously does it specifically state that the testing should be done for scoliosis. Your arguments are a SHAM!!!!!

Why get vestibular tests ?

1.Vestibular tests are tests of function. Their purpose is to determine if there is something wrong with the vestibular portion of the inner ear. If dizziness is not caused by the inner ear, it might be caused by disorders of the brain, by medical disorders such as low blood pressure, or by psychological problems such as anxiety. Recent studies have suggested that vestibular tests are more accurate than clinical examination in identifying inner ear disorders (Gordon et al, 1996). Hearing pathway tests (audiometry, ABR, ECOG) can also be used for the same purpose, and are frequently combined with vestibular tests. In a cost-effectiveness analysis for evaluation for vertigo it was concluded that hearing testing followed by either posturography or ENG (electronystagmography) was the most effective method (Stewart et al, 1999).
2.To detect central disorders. Recent studies have suggested that internuclear ophthalmoplegia, a central eye movement disorder, is missed by 71% of physicians unaided by quantitative oculomotor testing (Frohman et al, 2003).
3.To decide if more expensive tests like MRI (Magnetic Resonance Imaging) are needed. Vestibular testing is more accurate than clinical symptoms in predicting whether neuroimaging tests will be abnormal.(Levy and Arts, 1996)
4.To document objectively vestibular conditions such as BPPV and Perilymph fistula, which commonly occur after head injury, vestibular neuritis, and Gentamicin ototoxicity, which commonly is a side effect of medication.

structural75

12-28-2006, 07:56 AM

Celia,
you continue w/ the personal attacks...
posted by Celia: There could only be one of two things: 1) there is something wrong with your mental faculties or 2) you think we're all a bunch of idiots! I personally think it's the former and I would highly recommend having vestibular testing done for yourself
"you think we're all a bunch of idiots!"... Don't be silly, I'm only having this dialogue with you ;) . Are you saying people with balance/coordination problems are stupid as well (intellectually challenged)? Vest. testing for me??? maybe I wasn't clear on what the vestibular system was... because I don't have any issues with balance, coordination, proprioception, etc.? :rolleyes: I realize it must be frustrating to try and dig yourself out of the hole you're in, but seriously... act like an adult and move on........ !!
Further...*nowhere* in the following quote that you posted previously does it specifically state that the testing should be done for scoliosis. Your arguments are a SHAM!!!!!
That quote I posted was to point out the purpose/importance of vestibular testing in general. If you have a difficult time seeing the neurologic connection with scoliosis here then maybe I can spell it out to you in another lengthy, "irrelevant" post. Do you see the reason why this keeps going in circles yet?

I acknowledged there aren't formal studies specifically pertaining to vest. testing/rehab in the treatment of scoliosis (hopefully that will change). Clinical successes and relevance, as the ones you highlighted in that previous post, do not need formal studies for confirmation. As for the rest of your posts, I simply won't dignify your attempt at redemption with a response. You're clearly reaching with all your might here, picking my skin out from under your fingernails.

I have a few questions... Do you think scoliosis is more than just a curvature of the spine? Do you believe that it can affect, or can be affected by, other systems in the body? Is there validity in taking a multi-faceted approach, especially in ideopathic cases, to address these other systems? What do you consider relevant in the treatment of scoliosis? So what are the causes of ideopathic scoliosis or the progression of any scoliosis? What would assist bracing to have a better success rate? What is your medical/health training that makes you an expert on musculoskeletal dysfunctions, or the significance/insignificance of the nervous system as it pertains to scoliosis?

Just curious.

Celia Vogel

12-28-2006, 09:56 PM

Celia,
you continue w/ the personal attacks...

Are you saying people with balance/coordination problems are stupid as well (intellectually challenged)? Vest. testing for me???

One of the *many* reasons for getting vestibular tests:

Why get vestibular tests ?

1.Vestibular tests are tests of function. Their purpose is to determine if there is something wrong with the vestibular portion of the inner ear. If dizziness is not caused by the inner ear, it might be caused by disorders of the brain, by medical disorders such as low blood pressure, or by psychological problems such as anxiety.

I may not be an expert but I can tell what is genuine from deception. The spinecor brace is attempting to address the neuromusculo-skeletal side to this scoliosis puzzle and neither vestibular tests nor phoney baloney eye exercises have to be conducted to know that the system is being affected.

Excerpt from Spinecorporation Website:

THE CONCEPT

Scoliosis is not only a deformation of the spinal column, it is also a disease of the neuro-musculo-skeletal system. If it progresses, it can have serious consequences for the patient. This complex system's unstable balance during growth may, perhaps, be governed by the theory of chaos.

Scoliosis is more than a 3D deformation of the spine. It also involves postural disorganization, neuro-musculoskeletal dysfunction and unsynchronized growth patterns all evolving with time. Using these four defining criteria, we can adopt a more specific approach to the static and dynamic properties of scoliosis that evolve over a period of time. Scoliosis is a four-dimensional deformation! Even though the aetiology of scoliosis remains unknown in 80% of cases, technological progress and the creation of multi-disciplinary teams mean that, in addition to the spinal deformation, a child's or adolescent's morphological and postural abnormalities can be recognized, together with their dysfunction, growth and maturation problems. The therapeutic concept of the SpineCor System is closely related to the aetiopathogenic concept. In keeping with this therapeutic concept, the design of this Dynamic Corrective Brace incorporates various independent, yet related, components.

It provides dynamic control of the shoulders and pelvic girdles and thorax, controls movement, and modifies the three-dimensional postural geometry. This allows us to correct the three-dimensional deformation while harmonizing the function and maintaining it over time. More harmonious growth patterns can thus be achieved.

Mom37

12-29-2006, 12:36 AM

Would you mind telling us what insurance company covered the testing? Just curious.

Thanks.

--Linda

I am insured by American Airlines, which self funds our health insurance, but is underwritten by United Healthcare. It was covered in full. Ultimately I paid for it, being self funded, but didn't find any need for concern. It now is a help to us to support further explanation of our daughters symptoms of nystagmus and scoliosis caused by Chiari and Syringomyelia. Information on eye movement evaluation from Dr. D in NYC can be found on www.scoliosissystems.com/neuro.html

structural75

12-29-2006, 08:55 AM

Celia,

Anxiety is not an intellectual deficit, nor do psychological problems necessarily reflect ones intellectual capacities.

Fact or Fiction?
Without neurologic testings, beyond vestibular as well, how does one determine precisely where the neurologic problem might be? How do you treat the neurologic component of this puzzle if you don't know precisely where the dysfunction is? It's like saying you don't need x-rays because you already know that scoliosis is a curvature of the spine, and any trained eye can see that without an x-ray.?? Putting on a brace and hoping for the best is a shotgun approach, as we've seen with unsuccessful bracing attempts.

I think the spinecor brace is certainly adding a general functional neurologic component to the treatment, however it's quite far from being the be all, end all in regards to this aspect.

Celia Vogel

12-29-2006, 10:03 AM

Without neurologic testings, beyond vestibular as well, how does one determine precisely where the neurologic problem might be? How do you treat the neurologic component of this puzzle if you don't know precisely where the dysfunction is?

I've already stated my case and I have nothing further to say to you! If you need further clarification please re-read *any* of the references I've referred to already. Dr. Rivard's article specifically states that no clear cut neurological tests either for diagnosing idiopathic scoliosis or predicting it's progression have been established. Further... please re-read the following:

1: Clin Orthop Relat Res. 1980 Oct;(152):232-6.

Equilibrium factors as predictors of the prognosis in adolescent idiopathic scoliosis.

Sahlstrand T, Lidstrom J.

Postural equilibrium factors were evaluated as indicators of the prognosis in 52 patients with adolescent idiopathic scoliosis. The hypothesis was that dysfunction in these equilibrium factors might imply a higher risk for the curve to progress. The postural equilibrium was studied by stabilometry, and the function of the central nervous system was assessed by electoencephalography (EEG) and the vestibular function by electronystomography (ENG). During a follow-up period averaging 2.9 years, ten patients showed progression of the scoliosis. No differences were found in the distribution and frequency of abnormalities between the patients with progressive and nonprogressive scoliosis. Stabilometry, electroencephalography, and electronystomography as used in this study did not seem to be of predictive value for the outcome in the individual case.
PMID: 7438607 [PubMed - indexed for MEDLINE]

If you want to ponder those questions please do so, either by going back to medical/chiropractic/osteopathic school or where ever it is you got your "training".

structural75

12-29-2006, 11:29 AM

Celia,

Thank goodness... !

p.s. - I know you're not answering any of my questions, so take these as retorical.
The spinecor brace is addressing the neuromusculo-skeletal side to this scoliosis puzzle and neither vestibular tests nor phoney baloney eye exercises have to be conducted to know that the system is being affected.
As Gerbo has pointed out many times, how do we know if it's being affected for the better or for the worse? Given that some bracing attempts are not successful, how do we know it's not because the affect on the nervous system is actually harmful in those cases? How long do we wait to find out its actual affect? Maybe testing and specific neurologic rehab would shed some light on this matter, rather than just assuming its affect. Much the same as repeated x-rays show the progress, or lack thereof, of the curvature for confirmation of therapeutic effect. If the testing revealed that neurolgic deficits were worsening then appropriate intervention could happen sooner than later. (In the same way that the studies you referenced on the predictability factor could allow proper intervention BEFORE an ideopathic scoliosis asserted itself. Address the neurologic imbalance and maybe the potential scoliosis won't have an opportunity to occur.?). Just another musing to consider.

Given that every individual is different, we cannot expect a 'one-size-fits-all' approach to affect everyone the same.

Karen Ocker

12-29-2006, 12:10 PM

This Polish study(among others they have done) makes a lot of sense to me especially since my surgeon noted, during one of my abdominal surgeries, that my right rectus abdominus muscle was abnormal. It says nothing about the vestibular system:

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=17108471&query_hl=5&itool=pubmed_docsum

macky

12-29-2006, 08:03 PM

I just read all of this and got absolutely lost. Am I dumb, no I am just a person who has lived with scoliosis for 40 years and was operated on many years ago.

I enjoy reading posts from people who actually are experiencing the scoliosis itself and from parents who are looking to help their little ones, but as far as people who have no idea what it is like to live with it, well please just keep your opinions to yourself. You see you have no first hand experience to back up anything you say as you have not FELT it yourself.

Dont start another getting nasty lession on me either ,as this forum is here to help each other.
If you havent felt the pain, havent felt the brace, havent felt the plaster cast as in my case,,well in my opinion you havent got a clue.

Macky

structural75

12-29-2006, 10:43 PM

Macky,

Why so rude and bitter. Please be clear, you know nothing about me, or my experiences.

Do all, or any of the Doctors helping people with scoliosis have it themselves?... hhmmmm? I work with people with scoliosis so I'd say I have a pretty good idea of what they're going through. Practitioners of any discipline do not need to suffer from a condition to be able to provide assistance to others. My education and profession in the health care/medical field is plenty to "back up" my statements. If you want to share you're personal experiences, that's obviously fine.

People come to this forum for many reasons. Support, comfort, empathy and first-hand experience are among those very important and necessary reasons. I have never attempted to give my "opinions" on those matters. However, some are also seeking input from others on this vast and elusive condition.
parents who are looking to help their little ones
It would be a shame if those parents you speak of didn't do everything they could... clearly surgery alone is generally a temporary fix. And if treatment hasn't changed much in the past thirty years despite the results (surgery + bracing), then I would be curious myself about additional options in management and self-care. Your body is telling you now that it is not a machine or an inanimate object, and you can't continue treating it as such. Just because the curve has been reduced with implants, doesn't mean you're out of the woods.

If you don't agree with non-surgical approaches, then stay out of those threads! But don't be a discouraging obstacle to others who believe in a more comprehensive approach, and aren't too lazy to do all they can to help themselves. And remember, this forum represents only a minute fraction of the population of people throughout the world who are afflicted with this condition. Nobody on this forum, including myself, has the final word on what works, and what doesn't... That is a unique and individual experience.

structural
p.s. - This is the vestibular thread... Did you have anything productive to say about it?

macky

12-30-2006, 05:12 AM

Sorry guys for saying language like I did which I have now edited out.

I knew you would post back Structural and I dont know why. You are so defensive.

What upsets me and really breaks my heart is that all this medical jargon that is going on about non surgical scoliosis fixes, well people dont have any idea at all what the end result will be. It certainly hasnt been around long enough for it to be proof that in years to come the spines will not curve once again.

We all have our opinions and I have as much right to disagree with you as anyone else and to post on here if I want. I wish with all my heart that all the medical research will one day help scoliosis and people will not have to have operations. Until all this is proved, I myself ,and I am allowed to my own opinion, cannot agree.

I am a mum of two adult boys I am not rude or bitter, just a person who has lived with scoliosis for 40 years and it hurts me that people like yourself get up on your soap boxes. You probably mean well but you could also be offering false hope. My surgery, and I was so very lucky even though I have pain which I cope with, was not a tempory fix, it was a permanent one and has not in any way stopped me from living a full life.
Now please I do not want to go on with this. This is my opinion and mine only, and maybe in 10 - 20 years time if I have any proof that any of this will actually be one of the medical discoveries of our time, I may apologise, but I dont think I will have too.

I absolutely do not like putting this opinion on here because everytime I feel like I have to be truthful with my own self and post same, I know I will get abused and I just did. I now know my place and will make sure I keep it from now on.

Macky

structural75

12-30-2006, 06:05 AM

Macky,

I'm only defensive because certain people are offensive toward me. I respect your position to disagree... but it often goes beyond disagreement and becomes insulting and denigrating. Let's please just end the personal insults and I won't have a need to defend. I do it primarily because some of you have driven others off this site in the same manner, and I don't think that's fair or appropriate simply because you disagreed.

I completely understand your point. However I really don't believe that I have suggested the use of any of these non-surgical approaches in exclusivity from surgical ones or as "fixes", but rather as an a compliment to a well rounded and realistic treatment strategy. I strongly believe they have value in combination... so that doesn't put forth "false hope" of any kind. It could very likely increse the longevity of the surgical procedures, minimizing or reducing the likelyhood of problems later on, such as your own. I'm certain that surgery helped you for many years, and since you can't have another, maybe some type (I'm not suggesting vestibular testing for you specifically) of non-surgical approach could bring you a better quality of life and comfort. I wish you the best with whatever you do.

Non-surgical approaches are not new. The Scroth Method has been around for quite some time. It's no less valid than the spinecor brace, which doesn't yet have the longevity that you're asking for. Nobody here knows what the spincor brace will do for someone in 20, 30, or 40 years down the road... so that is still speculative at this point, but clearly worth the effort.

structural

Celia Vogel

12-30-2006, 09:08 AM

Macky,

Don't let structural intimidate you! Keep in mind he is here passionately arguing that we should all give "eye exercises" serious consideration in the treatment of idiopathic scoliosis and even raise it to the level of Schroth therapy and yes it costs big bucks! So....depending on the location of your curve you either move your eyes to the left or to the right spin around in your chair and try to focus on your thumb. Would wiggling the ears and rubbing one's tummy while saying three Hail Marys help :confused: :D

macky

12-30-2006, 04:45 PM

Actually Structural I said it hasnt been around long enough, but I may be wrong again.

Celia you absolutely cracked me up. I am sitting here laughing with tears running down my face, you are an absolute delight. Golly what would we do without people like you on our forum.

Structural get over yourself.

Happy New Year to all my friends here, I love you all and thankyou Celia, boy did I need that.

God bless,
Macky xx

Karen Ocker

12-30-2006, 04:47 PM

This abstract suggests conservative therapy can reduce not eliminate need for surgery:

Pediatr Rehabil. 2003 Jul-Dec;6(3-4):209-14. Links
Effect of conservative management on the prevalence of surgery in patients with adolescent idiopathic scoliosis.Rigo M, Reiter Ch, Weiss HR.
Instituto Elena Salva, Barcelona, Spain. rigo.quera.rehab@eresmas.net

STUDY DESIGN: Retrospective analysis of outcome in terms of prevalence of surgery for adolescent idiopathic scoliosis in patients receiving conservative management. OBJECTIVES: To determine whether a centre with an active policy of conservative management has fewer patients who eventually undergo surgery for adolescent idiopathic scoliosis than a centre where the practice is non-intervention. BACKGROUND DATA: The efficacy of orthoses for the treatment of idiopathic scoliosis was called into question in a recent publication. Because the prevalence of surgery in an untreated group of patients (28.1%) was not significantly different from that in a braced group (22.4%), the authors concluded that bracing appears to make no difference. Based on prior experience, this conclusion is questioned. METHODS: Since 1991, bracing and physical therapy have been recommended for children with adolescent idiopathic scoliosis at a centre in Barcelona, Spain. The scoliosis database was searched for patients with adolescent idiopathic scoliosis who were at least 15 years of age at last review and who had adequate documentation of the Cobb angle. The prevalence of surgery was compared with that of published data from a centre where the practice is non-intervention. RESULTS: From a total of 106 braced cases out of which 97 were followed up, six cases (5.6%) ultimately underwent spinal fusion. A worst case analysis, which assumes that all nine cases that were lost to follow-up had operations, brings the uppermost number of cases that could have undergone spinal fusion to 15 (14.1%). Either percentage is significant statistically when compared to the 28.1% reported surgeries from the centre with the policy of non-intervention. CONCLUSIONS: If conservative management does reduce the proportion of children with adolescent idiopathic scoliosis that require surgery, it can be said to provide a real and meaningful advantage to both the patients and the community. It is contended that conservative methods of treatment should never be ruled out from scoliosis management, because they can and do offer a viable alternative to those patients who cannot or will not opt for surgical
treatment.

From the Schroth Klinik:

1: Stud Health Technol Inform. 2002;91:342-7. Links
Conservative management in patients with scoliosis--does it reduce the incidence of surgery?Weiss HR, Weiss G, Schaar HJ.
Asklepios Katharina-Schroth-Klinik, Korczakstr. 2, D-55566 Bad Sobernheim.

The effectiveness of conservative scoliosis treatment, including bracing, is widely denied. Like any therapeutic intervention, conservative scoliosis treatment including patient education, techniques of brace moulding, and time-consuming follow-ups is reasonable only if the benefits outweigh the strain placed upon the patient by the treatment. The most important benefit of early intervention in scoliosis is prevention of the need for spinal fusion surgery. Retrospective analysis of the incidence of surgery for patients with scoliosis, by comparison with incidence in an untreated control group. Since 1992 the bracing technique according to Cheneau has been applied in parallel with the scoliosis inpatient intensive rehabilitation programme (SIR). For this study we chose from our data base the scoliosis patients who had conservative treatment at our center between 1993 and 1996. All patients, like those of the control group, were at least 15 years of age at the time they were evaluated for the last time. The incidence of surgery of our group was compared with that reported by a center in Ireland. Of 343 female scoliosis patients with a curve angle of 33.4 AE (SD=18.9), 41 (11.95%) had surgery. The incidence of surgery of our collective was significantly lower than the incidence of surgery of the control group which reported an incidence of 28,1%. The AIS matched group of patients (n = 179) had an incidence of surgery of slightly more than 7%. When compared with a matched control group of untreated patients, incidence of surgery was significantly reduced by SIR combined with bracing. So conservative management is indicated in patients with scoliosis.

PMID: 15457752 [PubMed - indexed for MEDLINE]1: Orthopade. 2003 Feb;32(2):146-56. Links
[Conservative treatment of idiopathic scoliosis with physical therapy and orthoses][Article in German]
Weiss HR.
Asklepios Katharina-Schroth-Klinik,Bad Sobernheim.

Opinions differ in the international literature about the efficacy of conservative approaches to scoliosis treatment.Because this divergence of opinion corresponds to a great discrepancy in the standards applied to conservative treatment methods, it is not astonishing that the results of conservative treatment as described in the literature also differ. Scoliosis normally does not have such dramatic effects that immediate surgery would be indicated.Moreover, it is clear from the published literature that it is the functional and physiological impairments of scoliosis patients--including pain, torso deformity, psychological disturbance, and pulmonary dysfunction--which require therapeutic intervention. In Germany the triad of outpatient physiotherapy, intensive inpatient rehabilitation, and bracing has proven effective in conservative scoliosis treatment.Indication, content, and results of the individual treatment procedures are described and discussed. The positive outcomes of this practice validate a policy of offering conservative scoliosis treatment as an alternative to patients, including those for whom surgery is indicated.

This abstract summarizes a search of the literature regarding results of conservative approaches:

1: Phys Ther. 2005 Dec;85(12):1329-39. Links
Effect of bracing and other conservative interventions in the treatment of idiopathic scoliosis in adolescents: a systematic review of clinical trials.Lenssinck ML, Frijlink AC, Berger MY, Bierman-Zeinstra SM, Verkerk K, Verhagen AP.
Department of General Practice, Erasmus Medical Centre Rotterdam, PO Box 1738, 3000 DR Rotterdam, The Netherlands.

BACKGROUND AND PURPOSE: Many conservative treatments are available for adolescents with idiopathic scoliosis, but the evidence for their accepted use is still unclear. The purpose of this study was to evaluate the effectiveness of braces and other conservative treatments of idiopathic scoliosis in adolescents by systematically reviewing the literature. METHODS: The literature was searched in the PubMed, CINAHL, Cochrane, and PEDro databases. Studies were selected if the design was a randomized clinical trial or a controlled clinical trial, if all patients had an idiopathic scoliosis, if all patients were less than 18 years of age during the intervention, and if the type of intervention was a conservative one. Two reviewers independently assessed the methodological quality using the Delphi list and performed data extraction. Analysis was based on the levels of evidence. RESULTS: Thirteen studies met the final inclusion criteria, showing a wide range of interventions such as bracing, electrical surface stimulation, and exercises. DISCUSSION AND CONCLUSION: The authors conclude that the effectiveness of bracing and exercises is not yet established, but might be promising. They found no evidence of the effectiveness of electrical stimulation.

Here's a long term follow-up comparing surgically treated with brace treated:

1: Spine. 2006 Feb 1;31(3):350-4. Links
Outcome at 10 years after treatment for adolescent idiopathic scoliosis.Andersen MO, Christensen SB, Thomsen K.
Spine Section, Department of Orthopaedic Surgery, University Hospital of Odense, Odense, Denmark.

STUDY DESIGN: A total of 215 consecutive patients treated either by bracing or operation received a questionnaire after 9.7 years. OBJECTIVE: The aim of the present study was to elucidate the long-term outcome in a group of brace (BT) or surgical treated (ST) patients suffering AIS. SUMMARY OF BACKGROUND DATA: In adolescent idiopathic scoliosis (AIS), the options are BT or ST and, together with the disease itself, they may both be physically and psychologically demanding. METHODS: The main topics of a questionnaire were demographics, back pain, activities of daily living, and SF-36. RESULTS: A total of 181 replied. The mean age at follow-up was 26.0 years. The level of back or leg pain was relatively low, and the BT patients had more pain than their ST peers. We saw a generally high level of ADL and found no significant difference between BT and ST patients in the present study for any of the SF-36 variables. Compared with age-matched controls, the SF-36 scores were lower in the AIS patients. Brace related questions revealed a significant impact of the disease and the treatment on the patients' lives. CONCLUSIONS: The patients had moderately reduced perceived health status and activities of daily living, and increased pain with the ST patients generally at a better level than the BT.

There are lots of abstracts in the National Library of Medicine from all over the world to be explored. So far I have not found any conservative approach which totally eliminates the need for surgery.

macky

12-31-2006, 05:29 PM

Thankyou Karen so much for going to the trouble of posting that, it was brilliant to read.

It is 2007 over here now and my wish for all on this forum is a healthy and happy one.

Lorraine. xx (Macky)

Celia Vogel

01-01-2007, 09:09 AM

Happy New Year to you Lorraine and I'm glad my last post made you laugh!

This whole thread is quite ridiculous isn't it ? Anyway....I'm still trying to figure out why I was singled out for expressing my views months and months ago and now having to defend myself! As far as anyone is concerned those comments would have remained buried in the Spinecor thread - who in their right mind reads the entire 1000 posts ??? So now we have a separate thread with my words ( a parent's views ) plastered for ALL to see. Do we not live in a democracy and have free speech?? Is there an ethics committee that governs what I say ??? I find this whole thing quite bizarre.

Karen,

Thanks for the studies on bracing! I wonder why the Cheneau isn't offered here in North America ?

macky

01-01-2007, 05:05 PM

Celia I totally agree with you, I actually really and truly thought the same thing.

I am so sorry you had problems a few months ago. I did not read the post you are speaking of as I would not read 1000 posts(haha), but sweety what I have been so glad about is how absolutely wonderful it is that your precious little girl is doing so well. That is the type of thing I absolutely love reading, it makes me so very ,very happy and puts a smile on my face.

We should start a happy, good news, positive thread instead of defending our thoughts all the time on this one.

Yeah for free speech, Yeah for Women and thank the Lord for miracles.

God bless
Lorraine. xx

structural75

01-01-2007, 10:07 PM

Celia/Macky,

Great to hear that you were reimbursed for the costs of the test! I don't have much time right now but we did discuss vestibular testing back on page 59 and 60 of this thread. As for right now... I have visions of sugar plums and fairies dancing in my head :p Clearly it was YOU Celia that read through "1000 posts" to find and reference that discussion. That's where I got the page numbers from... .

I'm still trying to figure out why I was singled out for expressing my views months and months ago and now having to defend myself against this Charlatan! YOU made the following statement, that is why I held YOU accountable for it.
As for vestibular testing....I think it's strictly a chiropractic thing and it's not done in the Montreal office.I simply clarified matters by saying that it was not "strictly a chiro thing", but actually a legitimate M.D. practice. Things persisted because you refused to acknowledge that correction and your biased misrepresentation of it. Plain and simple.

We should start a happy, good news, positive thread instead of defending our thoughts all the time on this one. That's exactly what myself and others have been doing since your onslaught of unintelligible jabber on... "it's a chiro thing" and 'there's no medical validity to this'... All I've been doing this entire time is defending myself against you two and your denigrating attempts at 'free speech'... ! Think twice before opening your mouth Celia... you've 'edited' every post but one on this thread. Did you say something wrong the first time? Or were you just 'fine tuning' your attacks?

Free speech..., I absolutely agree with you both! But the following is clearly not about free speech, but purely meant to belittle others and their efforts. All of you involved should be ashamed for such discouraging efforts.
Linda, I agree with you 100% and all this guff is a real "talk about a lot of rot"
as far as I am concerned.
I know people are looking for a non surgical fix for scoliosis but peoples it just aint gonna happen.
Loved the way you answered that Linda, with your usual finesse.

Happy christmas to one and all.

Macky xxxx

This forum was meant for both surgical and non-surgical inquiries and support. Keep your bitterness and insecurities to yourselves, or at least within the confines of your "happy, good news, positive thread". When will either of you get it through your heads that people are utilizing these various methods in combination with the more 'favorably conventional' ones. I don't recall any stark claims recently of people saying this will "fix" the curve by 'itself', or that any of this is meant to be used exclusively. However, based on the "brilliant" studies that you presented here, there is evidence that complimentary, conservative approaches do in fact REDUCE the need for surgery. That's what I, and others, have been supporting all along.

structural

Celia Vogel

01-01-2007, 11:19 PM

... there is evidence that complimentary, conservative approaches do in fact REDUCE the need for surgery. That's what I, and others, have been supporting all along.

I fail to see where you have shown that expensive eye exercises either alone or in combination with other methods can actually reduce the need for surgery. :rolleyes: I don't think you have any right to come here and harass people with your hostile comments! What I said months and months ago was an exchange between parents and quite frankly it was non of your business!

I didn't have to read all 1000 posts because I've been posting all along and I remember the discussion occurred sometime in September. My question to you is how did you know about the discussion on page 23 ????? I don't care what you call yourself ( M.D. I highly doubt! ) but in my books you're one GRADE A NUT!!!!

macky

01-02-2007, 01:41 AM

Once again Celia you crack me up, in a nice way.

If 75 means Structural you were born in 1975 you would be the age of my youngest son and believe me he would not have the audacity to speak to me or anyone else they way you do. You infuriate me because you will not listen and give the people PARENTS and patients who have been through all this the benefit of the doubt that they may know what they are talking about.

To make myself a little clearer I thoroughly believe in bracing to help scoliosis, I must do because I was in one for 6 months.

This is the end of this thread for me. Your attitude toward women Structural leaves a lot to be desired and how did I work that out? When you told me to keep my place. That told me all I need to know. Exactly where is a womans place??mmmm I wonder,

One more thing. Celia would undoubedly know a lot more than yourself as she has a dear little girl that she loves and is doing everything she can to help her. She is a delightful person who has been posting on this forum for a long time and her posts are humorous and interesting and worth reading.

She got it in one, GRADE A NUT, yep little little chickie agrees.

Macky

macky

01-02-2007, 02:18 AM

Now it all makes sense., silly silly me.

I just read your occupation "licensed and certified structural integration pracitioner/visceral manipulation" well there you go, explains everything.

Nothing like a bit of free advertising.

Macky!!!!!

cherylplinder

01-02-2007, 10:43 AM

cherylplinder

01-02-2007, 10:48 AM

I'll say it again. There is nothing wrong with medical research to determine the causes and treatments of scoliosis, but fantastic profit from this research makes this type of testing a financial quest rather than an effort to help patients. You don't have to be a genuis to see that.

Structual, I am tired of your rude posts to people dealing with scoliosis. I invite you to go somewhere else and post.

Celia Vogel

01-02-2007, 11:29 AM

...I simply clarified matters by saying that it was not "strictly a chiro thing", but actually a legitimate M.D. practice. Things persisted because you refused to acknowledge that correction and your biased misrepresentation of it. Plain and simple...

Structural,

Let me clarify things a little further for you ;) this is not a Dr. Rivard M.D./ Dr. Coillard M.D. who are also the INVENTORS of the brace practice/thing! Name *one* orthopaedic surgeon who treats idiopathic scoliosis with eye exercises as an adjunct to other therapies?

You also didn't answer my question about your knowledge regarding the discussion on vestibular testing on page 23.

structural75

01-02-2007, 01:15 PM

Celia,
You also didn't answer my question about your knowledge regarding the discussion on vestibular testing on page 23. When you're logged on to the forum it's page 23, when you're logged off it's pages 59 & 60 that YOU referenced. They are the SAME pages. Does that answer your question directly enough?

If you're so intent on knowing about other surgeons and what they do, pease do the research yourself. As there are thousands of them out there.

Are you arguing with me just for the sake of being "right". Because I think it's safe to say that there are very few right and wrong answers to the problems faced with scoliosis.

Maybe a different perspective would help. There are "theories" on mechanotransduction influencing scoliosis and the uneven growth of endplates, etc., etc.... . Mechanotransduction occurs as the connective tissues exert imbalanced tension on the skeletal body, thereby affecting growth patterns. Stretching, bracing and torsorotations are a few simplistic approaches to assist the correction of this imbalanced mechanotransduction (as does my field of professional studies, but with greater specificity). Why does it seem so off-the-wall to address the neurologic side to this more specifically? By addressing inner ear imbalances (which are either reflecting or influencing irregular muscular/ligamentous tonus), one would be further assisting the process of limiting the uneven mechanotransduction that's influencing growth.

It seems quite logical... after all, the muscular system is being partially controlled autonomically by information being supplied via the nervous system, which is being informed, in part, by the vestibular system & cerebellum (balance and coordination).

Are we really in such a drastic state of disagreement, or just having difficulty accepting mistakes/inaccuracies in comments?

structural75

01-02-2007, 01:25 PM

Cheryl,

I beg your pardon? My initial posts on this forum are anything but rude. They become rude when I get attacked by 'others'.... . I don't like the rude nature of these posts anymore than you do, but let's consider how it began and how it continues to persist with those two individuals making sarcastic and denigrating comments long after I willing "surrendered" to their attacks. I think you're showing a bit of selective favoritism here.

I'm sorry you condemn an entire field of medicine because of a few bad apples out there... but those few 'financially motivated' practitioners do not represent them all, nor does it illigitimize the efforts put forth.

structural

Celia Vogel

01-02-2007, 02:05 PM

.... Why does it seem so off-the-wall to address the neurologic side to this more specifically? By addressing inner ear imbalances (which are either reflecting or influencing irregular muscular/ligamentous tonus), one would be further assisting the process of limiting the uneven mechanotransduction that's influencing growth.

It seems quite logical... after all, the muscular system is being partially controlled autonomically by information being supplied via the nervous system, which is being informed, in part, by the vestibular system & cerebellum (balance and coordination).

Why is it off the wall ?! Because there is lack of proof that what you're doing is actually going to have any affect whatsoever on the scoliosis. This is still an *unknown* field and hence very experimental and patients should not be charged for experimental/unproven efforts.

Excerpt taken from:

Scoliosis. 2006; 1: 16.
Published online 2006 October 18. doi: 10.1186/1748-7161-1-16.
Copyright © 2006 Stokes et al; licensee BioMed Central Ltd.

Biomechanical spinal growth modulation and progressive adolescent scoliosis –a test of the 'vicious cycle' pathogenetic hypothesis: Summary of an electronic focus group debate of the IBSE
Ian AF Stokes,1 R Geoffrey Burwell,2 and Peter H Dangerfield3

1Department of Orthopaedics and Rehabilitation, University of Vermont, Burlington, Vermont 05405, USA
2The Centre for Spinal Studies & Surgery, Queen's Medical Centre, Nottingham, NG7 2UH, UK
3Sherrington Buildings, Ashton Street, Liverpool, L69 3GE, UK

Mechanotransduction in articular cartilage, vertebral growth plates and other tissues and organs

Comment no. 43

Mechanotransduction is the process by which cells convert mechanical energy into electrical or chemical signals [72,73,75]. It lies within the field of mechanobiology that in the skeleton includes the three effects of Hueter-Volkmann, Pauwels and Wolff [85,132-134]. (The Pauwels' effect is where intermittent pressure within the limits of physiological stress and strain stimulates the growth plates of a healthy bone [2,7]). In addition to studies on the intervertebral disc [162,163] there is much recent study of articular cartilage as efforts expand to discover disease-modifying drugs to treat or prevent osteoarthritis [164-167]. According to Ingber [73] mechanical signals may be integrated with other environmental signals – including growth factors and extracellular matrix – and transduced into a biochemical response through force-dependent changes in scaffold geometry or molecular mechanics. Stoltz [168] states that in chondrocytes many genes are regulated up and down by mechanical forces and the response depends not only on the duration and amplitude of the forces, but also on their variations in time. Lammi [169] reviewing articular cartilage states that possible mechanotransduction pathways in chondrocytes activated by load include the integrin-interleukin-4 route, NMDA receptors, and P2Y2 purinoceptors the latter involving ATP [170]. If such load-sensitive receptors are present in chondrocytes of endplate physes variation in gene expression by age, gender and topography may underlie the vulnerability to curve progression under eccentric load. There is preliminary work evaluating the effect of mechanical loads on mRNA expression of rat tibial growth plate cells [20]. Are any of the current methods now being used to study articular cartilage mechanotransduction being applied to endplates?

Response

The mechanical influences on articular chondrocytes and extra-cellular matrix synthesis and degradation are reviewed in Grodzinsky et al [171]. However, I suspect that little of this information can be applied to the very different growth plate chondrocytic phenotype characterized by high rates of proliferation (cycle time about 48 hours), rapid hypertrophy and abundant matrix synthesis, and eventual apoptosis. The mechanisms of mechanotransduction and their effects on cells in each stage of this differentiation cascade (and the rate of differentiation itself) are probably very specific to growth plate chondrocytes.
Moderator: In addition to skeletal tissues, muscles, tendons and ligaments [78,79], mechanotransduction is involved in the senses of touch, balance (spindle receptors and proprioceptors), hearing, baroreceptors (blood pressure), vascular remodeling from fluid shear stress [172] and systemic osmolarity [74]. Little is known about how mechanical input forces delivered to a cell result in a repertoire of output physiologic responses [74,75,172] though recently force-transducing molecules – mechanosensitive ion channels – have been identified in cell membranes with lipids [74] and calcium channels in osteoblasts [173] intimately involved. In certain connective tissues mechanotransduction appears to involve cyclical mechanical strain upregulating extracellular matrix genes suggesting that such genes are possible targets for novel therapeutic intervention [81].

structural75

01-02-2007, 02:36 PM

Celia,
Yes, I understand what you're saying... point taken, but it doesn't mean it's off-the-wall but rather awaiting further exploration. Ideopathic scoliosis itself is still an "unknown" field, seeing as we still don't have definitive answers on its causes, prevention or consistently effective treatments. Just attempting to put a more broad spectrum view on things.

I think many of these are feasible possibilities, including visceral malformation/develpment during the embryonic and fetal stages causing the ribs and/or spine to grow asymmetrically, etc.. While there are no studies proving it is a contributing factor, there are also no studies proving it's not. So it's yet another question that will remain unanswered until more research, studies and knowledge is gained on the matter.

My main concern for treating ideopathic scoliosis without regard for possible causation is that it is unlikely to respond to treatment for very long if the underlaying possible causes are not explored and addressed. And for my clients sake (all of them are also under the guidance/care of orthopods), I can't wait for a study to come out before considering the possibilities unique to them. What I do is very conservative and non-invasive so I'm not concerned about doing harm, as it's never been a problem. In fact its been nothing but helpful to the majority of them.

macky

01-02-2007, 08:47 PM

What I do is very conservative and non-invasive so I'm not concerned about doing harm, as it's never been a problem. In fact its been nothing but helpful to the majority of them. That is a quote from yourself.

How on earth do you know it WILL never be a problem," its been nothing but helpful to the majority of them" HOW LONG FOR WILL IT BE NOTHING BUT HELPFUL, short term, long term, for the rest of their lives.

I could not help but notice how you were so respectful and nice to Gerbo and yet so abusive to women who post here. You cant handle a woman being correct. Of course you knew I was a woman, you had looked back into my posts and quoted from one a few weeks ago so there is the proof of that.

I am not a person who closes their eyes to medial break throughs. In fact one of my most fervent wishes is that there are break throughs in Diabetes which is only one I have hope for.

It is just when people like you just rant and rave and think they know everything about a subject when there is no evidence to back it up long term, it just makes me cringe that some people will believe you, waste thousands on something that will not help them. WILL not because of as I said no long term proof.

I have tried alternate therapies , but the majority of practicioners of those therapies honesly run a mile when they see me, as they cannot help me. I am fine. OK I am in pain, big deal I can cope with that, what I cant cope with are people like you.

It is even getting to the stage that I dont even want to post here on this forum any more because of your comments, and that breaks my heart..

Lorraine. (macky)

structural75

01-02-2007, 10:45 PM

Lorraine,

How do I know? Many reasons (mind you, educated discretion is always used) including the fact that it has been in use for treatment of a variety of conditions for over 60 years with no adverse affects! And it's founder, Dr. Ida Rolf (a Biochemist and researcher at Georgetown University and the Rockefellar Institute), was inspired to create a unique approach to physical dysfunctions due to her son's SCOLIOSIS!!! He is now a grown adult roughly about your age, I presume, and is doing just great!!! He lives in Austria if you want to track him down and ask for yourself. Just as there are no studies "proving" the efficacy of many complimentary therapies, there are NONE proving there ineffectiveness as well (because NOBODY is doing them!). That should leave us all on neutral ground, right?

And this women thing you've made up... put it to rest as you've seriously crossed a line! I never said I didn't know you were female, what the heck are you talking about? I can handle anyone being correct, unfortunately you're not one of them. You don't even have anything to be correct about as you're spurting off insults and jibberish about a whole "lot a rot" and so forth... . In fact, Gerbo and I had a heated discussion of our own not too long ago... through it all we learned a bit about one another and knew when to draw the line in future discussions. In fact, the profession I have chosen was created by a brilliant woman, way ahead of her time. I have tremendous respect for ALL people deserving.

The difference between you and Gerbo in this thread is that he isn't dragging this on with insults as you are. Both he and I alike wanted to end this discussion and then you and Celia kept it going! He also seems to have intelligent, well thought out and productive things to say... just about the only thing you two have done is insult me, my perspective, my experience and discredit things that you're simply against. I'm not "ranting and raving", I'm defending myself from you two. If you actually tried to have a curious dialogue then I could be certain things would look very different.

Bottom line... enough with the insults and denigration, PLEASE!!! I'm fine with you having your opinion, and me having my own. We come from different backgrounds... and so I'll continue to share what I've seen CLINICALLY, and you can share what you read in STUDIES. I have nothing to gain by supporting certain methods on this forum, except to know that someone might be helped by it. That's all the "payment" I need.

For what it's worth, I hope you continue posting on this forum, as you are actually very sweet when you're not attacking others.

structural

Celia Vogel

01-06-2007, 10:28 AM

Structural,

You stated at the start of this thread:

They are FAR more than eye exercises.. had she known what vestibular was she wouldn't make such brash statements. Nobodies "trying" to do anything, they've been "legitimized" already.....I have nothing to gain by supporting certain methods on this forum, except to know that someone might be helped by it. That's all the "payment" I need.

That's all you should get and not a penny more! I'm holding YOU accountable for your false misleading statements that this is *proven* and *legitimate* when in fact there is no basis for these assertions.

structural75

01-06-2007, 12:38 PM

Celia,

I thought we were done with this rediculous arguement... ?

You may analyze my posts further to realize that I was justifying/defending vestibular testing and rehabilitation as a valid, "proven" and "legitimate" form of treatment in its own right (meaning it has applications for a wide variety of conditions that involve the nervous system, and has clearly "proven" its effectiveness in that regard). Nowhere did I say that it was "proven" to "CORRECT" a scoliosis on its own, nor did I claim there were "studies" to "prove" its efficacy or "legitimacy" SPECIFICALLY in regards to scoliosis. Until you can quote me as making that previous statement, get off my back and stop twisting my comments around to suit your slanderous agenda here.

My statements were therefore NOT FALSE by any means. I think it's more than obvious that neurologic testing and rehabilitation in the context of scoliosis is a logical, rational and important factor in treatment programs. I did not say there were studies "proving" its "legitimacy" as it pertains to scoliosis! What I was doing was making a deductive and educated statement about its relevancy and importance to this condition, and that regardless of studies specifically on the topic, it has merit.

And lastly, I was making it clear that vestibular testing and rehab was NOT a bunch of "phoney baloney" as you so eloquently put it. Just because there aren't many studies available on scoliosis specifically doesn't mean that the field in question is "phoney baloney"... give me a break! It IS a legitimate field of practice which has proven valuable to many people with a variety of conditions... there's no reason to exclude scoliosis from that list.

You know, it's obvious by now that we disagree. Leave it at that. I don't care if you're opposed to non-surgical approaches or the like... So unitl you can give me a valid anatomical and physiological reason why something couldn't be helpful, then please mind your own business. You can't just shoot down things that you clearly don't understand. Reading studies is NOT a substitute for proper education and knowledge about the workings of the human body. Nor are they there to offer definitive answers to problems faced, but merely reflect isolative perspectives on consistancies/inconsistancies in order to help practitioners and the like make more informed decisions. (But they aren't always the RIGHT decisions) The fact that few studies have been done to "prove" its efficacy doesn't mean that it's not effective, applicable or legitimate in the context of scoliosis, it simply means that we just don't know enough about it.

Celia Vogel

01-06-2007, 09:39 PM

Structural,

If you treat patients with methods that have no scientific validity or studies to back them up why should insurance companies pay for it? In fact many parents have not been reimbursed for these expenses. You will probably find yourself one day in the same predicament "dr" Copes found himself in.... jail. I'll quote Gerbo here because I think he said it best:

...to a patient with scoliosis there is only one issue which determines relevance; and that is whether effort, time and money spend results in stabilisation, improvement or slowing down of progress, which would not have occured without the particular testing/ treatment....Remember that the discussion started following a posting about vestibular testing done by doctors in the context of scoliosis, so no issue was taken as such about it being done for scientific reasons and/or for the treatment or diagnosis of other conditions by other practitioners....In the context of treatment of scoliosis, there is nothing wrong with vestibular testing as long as it is made clear that it is only of academic interest, patients are advised that there is no evidence at all that "treatment" based on this testing does anything to improve scolosis or helps to maintain a curve, and of course no large additional payments are demanded.

structural75

01-06-2007, 10:40 PM

Celia,
Obviously you're irritated because you just won't let this one rest.

How did we get on the topic of insurance coverage? I'll answer anyhow... I choose not to participate in insurance billing even though I certainly could... none whatsoever. People pay me strictly out of pocket... because it works for them and it doesn't break their bank in the process! Besides, I find that when people are forced to pay out of pocket entirely, they have more of a vested interest in what they're doing and are usually more objective about the results of treatment. If it's not effective for them, they don't keep coming, ...as many often do for chiropractics or pt simply because 'insurance covers it, so why not'.... .

Structural integration is covered by some insurance companies and not others... and the numbers are growing, I simply choose not to involve myself with the hassle for many reasons. (Mind you here, despite my argument for the appropriate use of vestibular testing, I have made clear that I do not do that testing in my practice as that's the domain of an M.D.. I do however utilize a functional approach to vestibular rehabilitation, but it is in no way meant to 'imitate' anything else that might be used elsewhere.)

When did this turn into a debate over the legitimacy of MY chosen profession? Are you trying to tell me that structural integration/visceral manipulation is scientifically invalid??? (I'd say you are.) I'd be happy to offer you a study or two if wish to go there ;) .

And how do you debate the "scientific validity" of something that is based on science (biochemistry, fascial plasticity, neurobiology, fluid dynamics, physiology, etc. and GRAVITY - Are you saying the effect of gravity on the human structure is immeasurable or 'unproven'???? Do you mean to say that all of the M.D.s, Physical Therapists, PhDs and the like out there practicing structural integration are doing something scientifically invalid???

Maybe this will calm your ranting and raving... Here is a colleague of mine and an M.D. in Physical Medicine (one of the first few),.. He's one of the research directors for the Kessler Institute as well and has specialized in neurologic dysfunctions for the over 30 years.
http://www.njpainandrehab.com/bios/tfindley_bio.htm

I'll find myself in jail... for what???????? I'm sorry, but re-stating Gerbo's OPINION doesn't do much for me. As for your opinion and accusations...... ????????? Stop waisting peoples time.

structural
p.s. - Studies are STILL NOT the definitive be all, end all in ANY decision making process. At this point Celia, I think a "legitimate" education on the topic at hand is required of you in order to make any potential progress in this discussion. Otherwise it's just a conitinuation of this study, that study and an insult here and there .

Celia Vogel

01-07-2007, 01:08 PM

Despite your feeble attempts to throw this whole discussion into different directions, I think we have made remarkable progress. :)

According to the following link, "dr" Copes was also using Vestibular Rehabilitation before he was thrown in jail.

http://www.quackwatch.org/11Ind/copes.html

Questionable Claims

Copes claims that scoliosis impairs the neurological, hormonal, and nutritional systems and "affects the body down to the cellular level." [8] His "Scoliosis Treatment Advanced Recovery System" ("STARS") includes: "scoliosis muscle stimulation therapy," chiropractic spinal manipulation, "ocular/vestibular therapy," "nutritional/hormonal support," the Copes Lateral Fulcrum Board, and the Copes Dynamic Brace. According to his Web site:

The Scoliosis Treatment Advanced Recovery System is designed to reverse idiopathic scoliosis. Unlike other treatment plans, STARS addresses the full spectrum of symptoms including bone deformities, muscle imbalance, neurological changes, cellular nutrition and cellular hormonal deficits. . . .

With STARS, success comes without the need for painful and sometimes dangerous surgery. . . .

STARS . . . . not only arrests spinal curvature progression, it straightens it.... much like orthodontic braces straighten teeth. Spinal curvatures are reversed while every system in the body is re-educated to hold the straightened spine. . . .

Through years of clinical research, component development and continuous improvement, the STARS methodology has helped patients of all ages and degrees of severity. It is the exclusive scoliosis treatment protocol of Physicians from all around the world. . . .

When patients choose the STARS they enter into the most advanced scoliosis treatment program in the world. With adequate time and dedication, and compliance with all aspects of the STARS program, a patient can be certain they are on the road to non-surgical recovery from scoliosis [9].

Copes advises chiropractors who refer to him to have their patients undergo hair analysis to determine what dietary supplements they need [10]. Hair analysis is not valid for this purpose [11]. Moreover, nutrition is not a factor in the development or treatment of scoliosis. The electrical treatments Copes recommends are also unwarranted. Scientific studies have concluded that bracing is far more effective than electrical treatments [12].

Copes was one of the four initial trustees of the Scoliosis Care Foundation, which was founded by Gary A. Deutschman, D.C., who practices in New York City. After working with Copes for several years, Deutschman developed his own program that he says "offers corrective and palliative therapy for all degrees of spinal curvature." [13]

There is no evidence that chiropractic treatment can reduce or prevent scoliotic curvature. In 2001, for example, researchers at two chiropractic colleges reported that chiropractic intervention had no discernible effect on the scoliotic curves of children ages 6 to 12. The study involved 42 children who were treated for a year with full-spine manipulation. Some were also treated with heel lifts, postural counseling, and/or lifestyle counseling. The scoliotic curves ranged from 6 to 20 degrees. The authors stated that although case reports abound, this was the first published clinical trial of the effect of chiropractic treatment on adolescent scoliosis [14].

gerbo

01-07-2007, 02:30 PM

What you have proposed as your basis for this 'discussion' (studies) is not invalid, but it is not 'clinically' conclusive by any means eitherstudies are important, but only a small part of the big picture

I am sure though that you agree that it is a question of emphasis, and that properly conducted studies are more then just a small part, they must be the major component of the "big picture" which determines whether treatment is safe and effective and therefore worthwhile. The fact that some studies fail to find "unforeseen consequences", as you correctly point out, doesn't mean that this reduces the relevance of studies, it means that we even have to try harder to improve the quality of the studies which get conducted.

If studies sometimes fail to foresee certain consequences, thepicture for treatment without any properly conducted studies must even be bleaker, and risk of onforeseen consequences even larger.

as I have said before "if we do not have evidence somethings works, we do not have the evidence neither that it is not going to do any (unforeseen) harm"

Still, I agree that there is a small part in all this for a bit of experimental or common sense type of work; many major scientific discoveries and breakthroughs started of as an unsubstantiated hypothesis. (but subsequently would have been subject to rigorous scientific studies and validation)

gerbo

Karen Ocker

01-07-2007, 05:34 PM

Dr. G. Deutchman,DC, New York City has this link on his web page:

http://www.scoliosissystems.com/Corner/chiro_vestib.htm

However, my search of the National library of Medicine shows vestibular rehabilitation sometimes useful for dizziness, instability from brain injuries, ear disorders and brain tumors-to name a few. Nothing at all about scoliosis. One reference, by chiropractors discuss "exploration".

structural75

01-07-2007, 06:21 PM

Gerbo,
I understand your point on working harder to perform better studies and I agree... and some things require time to discover their full impact, successful or not.

As you know, I agree they play an important role. But clinical findings are a major compenent in the big picture as well, if not more so than a study (10 -20 people, as one study had that you cited to support something one time, is not enough to constitute a "major componenet"). I'm right there with you Gerbo, but I'm also not the type of person who needs a study to be performed on my shoes, just to show their effectiveness at protecting my feet from the elements. :) Some things are quite logical and based upon data already compiled in related categories. And since ideopathic scoliosis is not genetically derived, at least in many cases that we know, then we must view it for what it is... a condition involving a lateral curvature/rotation of the spine, but not always or necessarily a 'problem' with the spine itself.

I think it's safe to say that there is an adequate amount of education behind the M.D.s practiciing vest rehab to know that people are in good hands. Also, we're talking about proprioceptive exercises (yes, including use of the eyes as well)... when was the last time you heard or read of someone being injured or harmed by such activities???

I know you're intentions are good here Gerbo... I do want to ask this though to know that you're not being hypocritical. Have there been studies done to show the effect (positive/neutral/negative) on "stretching ligaments" along the spine as a complimentary treatment for scoliosis? And are you actually stretching the "ligaments" or the muscles/muscular fascia?(retorical question) I know the stretching you do with your daughter "makes sense" to you, however do you hold yourself and all of your chosen methods to the same standards as you do this current topic? Are there significant studies done to prove the efficacy of that approach and how do you know those tissues you're stretching aren't contracting/bracing to protect something? Etc.....

You can see that this type of questioning could go on and on.... . Perspective is key here, and acknowledging its legitimacey in other disorders involving the neuromusculoskeletal system doesn't really place it very far from scoliosis... would you not agree?

My whole point here being, you cannot base an argument on studies alone. And unless someone has the qualifications to speak of it otherwise, it's a rather mute point.

structural

structural75

01-07-2007, 10:36 PM

Celia,

Quackwatch is your source for info... That explains a lot!

I don't know why or how you can compare me, or a valid medical practice (vestibular rehab), to some chiropractor who thought he was going to change scoliosis with nutrition/hormonal support, muscle stimulation and chiropractic adjustments. Whatever this Mr. Copes was doing sounds absurd... the only valid aspect to his treatment seamed to be the bracing (although I know nothing about the Copes brace specifically so maybe that's a sham too) and the vest/ocular rehab. You've got to be crazy to think that nutrition/hormonal support and electric stim. is going to change a curve... that's NOT my belief.

Working with a central informational component to the source of sympathetic neural activity (vestibular system) in the spine... YES, that makes perfect sense.

My beliefs, experience and practice are rooted quite firmly in the physical and direct nature of the condition, don't attempt to redeem yourself by lumping me or others into this guys category.

I STILL stand behind vestibular rehab in its applicable use in some cases of scoliosis! And you, or anyone else, cannot discredit the field in general, or its potential relevancy in the matter. Your studies/quotes/'research' is strictly black and white - this will 'fix' it by itself and this won't.... However nobody here, including myself, was proposing that it would "correct" a scoliosis by itself... ! And I still haven't seen anything that has been more than mild to moderately consistantly successful in "fixing" scoliosis and it's associated problems. Those statistics might get better however if we look beyond the mechanical aspect alone.

Have you found any of the info on the surgeons out there who have been found responsible for negligence, fraud and deceit as well? Or should I get it for you just to be clear this rediculous display of fraud and negligence goes both ways Celia? You are clearly anti-chiropractic.... yet what we are talking about here is not chiropractics! It's a field of internal medicine. To dismiss it's potential benefit due to your own personal bias, well... .?

Celia Vogel

01-08-2007, 07:06 AM

... From the sounds of a previous poster who was advocating its use and saw the benefits of the work...

I'm sure the same could be said for people who were in the Copes program :rolleyes:

structural75

01-08-2007, 07:27 AM

I'm sure it could... as well as others like the 'wait and watch' approach, surgery, spinecor bracing, scroth, PT, torsorotations, etc. ... As we all know, none of these methods provide consistant, long-term results in every case. Maybe we should investigate those less-than-successful cases as well for fraudulent claims.?

In fact I am a firm believer that the "wait and watch" advice given by many M.D.s is absolute pure ignorant negligence... What about holding those Doctors accountable for misleading people to believe that it will improve on its own only to see them spiral into more unfortunate circumstances?

I see what you're saying Celia, and I don't want to see people get taken advantage of either. Keep in mind that those undergoing spinecor treatment by the Doctors in Montreal are literally in the midst of a 'study' as we speak. We will not know anything about its long-term efficacy for years to come. Hopefully it works... time is of the essence.

Celia Vogel

01-08-2007, 08:26 AM

... Keep in mind that those undergoing spinecor treatment by the Doctors in Montreal are literally in the midst of a 'study' as we speak. We will not know anything about its long-term efficacy for years to come. Hopefully it works... time is of the essence.

Since you don't believe in studies you probably are not *aware* that there is a study showing it's remarkable effectiveness! As for current patients undergoing treatment and having success with the brace *sans* vestibular testing/rehab, please refer to the Spinecor thread.

Why don't you ask dr. Rivard whether he's happy with these tests and report back to us.

gerbo

01-09-2007, 02:24 AM

so, if someone would come to you and say; I've got scoliosis, I have heared that vestibular testing is going to help me, can you please tell me what benefits I could expect? Will it be worth the time, effort and money? What would you advice?

same question for SI?

macky

01-09-2007, 02:50 AM

Celia I love reading all your posts I really do.
,
Structural in another thread you went on and on to a young girl who was aged just 15, you spoke to her like she was a medical university graduate, what we say here, is horses for courses, but you wouldnt understand that.

I am so glad I live here in Australia as quite honestly I have never ever in my 55 years ever read or heard from such a man who under no circumstances will give anyone else a go. I would not like to think that all Americans are as arrogant as this.

Actually answer this structural ,If someone did come to you, say a person with a thoracic curvature of 85 degrees like I had, and they said they had heard that vestibular testing can help their scoliosis, what would you in good conscience say what benefits could they expect??? and dont ramble, straight to the point.

Macky

structural75

01-09-2007, 10:49 AM

Gerbo,
Sorry for the length of this but I'm going to attempt to answer all questions in one post (Lorraine, you'll just have to bear with my "rambling"). Also, under the advice of Celia, I emailed Dr. Rivard and Dr. Coillard on the matter... I received an email back from Dr. Rivard which I'll post this afternoon when I return from work. :)

First, I have not stated that vest test/rehab is "going to help" everyone... is it a structural or functional scoliosis? 1) I would tell them to seek the advice of an M.D. qualified to evaluate them and administer such a test. 2) I would tell them that it may be relevant as a causative factor or it may be a secondary effect of the scoliosis. Is there a diproportionate corelation between possible vestibular imbalance and the degree of curvature? ...testing would be helpful in determining this and help direct further treatment. 3) I would refer them again to a qualified specialist to help determine if they would like to pursue that avenue in combination with others.(does it make sense to them individually?)

As for SI - Again this is never a black and white issue.... what type of scoliosis do they have and what are the realistic outcomes of treatment based on that fact. I would tell them that SI has been shown in clinical settings to reverse the curvature with stabilizing effect, slow or stop its progression, and failed altogether to have any significant impact on stopping progression (not unlike the result outcomes of bracing attempts). The effect of treatment would be noticable within a few visits/hours/sessions of work, if at that point there was no discernable effect treatment would be discontinued.

I have yet to work with someone with scoliosis who did not receive some kind of positive benefit from the work, nor have I ever encouraged anyone to use my approach exclusively, without proper M.D. supervision.

I know studies are your primary source for relevance, but the reality is that there are many more ways to confirm legitimacy of a given method.
Dr. Irene Grant is an Internal Medicine and Infectious Disease Specialist in New York City. She is currently on the teaching faculty at Albert Einstein College of Medicine and Assistant Clinical Professor of Medicine at New York Medical College.
She had a very bad whiplash injury when she was a child, which created problems in her neck, similar to scoliosis. An Osteopath referred her to Structural Integration. Irene says, "After ten sessions I noticed that my posture improved, my chronic neck pain was significantly relieved, and I had much more energy. Further treatments brought progressive freedom. I experienced major changes. The most amazing thing is that I am now pain free."
Irene has been receiving Structural Integration sessions now weekly, for the past two and a half years. "I am very impressed with Structural Integration and have referred a lot of patients to Structural Integration, including Scoliosis patients. Structural Integration is a wonderful method that can rehabilitate and reverse injuries."

The investment in SI is fairly small relative to many of the other approaches and nobody gets roped into months and months, years and years of treatment if there is no positive effect as confirmed by them and there periodic x-ray evaluations.

Macky,
Structural in another thread you went on and on to a young girl who was aged just 15, you spoke to her like she was a medical university graduate, what we say here, is horses for courses, but you wouldnt understand that.Can you please show that post so that I can understand how it was either a) not an attempt to offer helpful advice/input/clarity. or b) was rude or condescending in some nature, as you've previously claimed my posts as being.

I am so glad I live here in Australia as quite honestly I have never ever in my 55 years ever read or heard from such a man who under no circumstances will give anyone else a go. I would not like to think that all Americans are as arrogant as this. First, why is this such a gender issue for you? And why are you always so inclined to dismiss or hold prejudice toward entire populations of people based on your opinion/experience with one? I believe I haven't prevented anyone from expressing their opinions... in fact I just clarified an inaccurate statement by someone and all heck broke loose on me. In fact, it has been you folks that won't "give anyone else a go"... you have consistently belittled other peoples posts on non-surgical topics... I'm just the only one here standing up for the minority.. isn't that what "democracy" is all about?

The rest has been a defense on my part to ward off your attacks and denigration of something I felt had relevance here. If you or Celia would like to call something phoney baloney then simply give evidence to support that belief (i.e. - studies showing that it has no relevance or applicability) I haven't seen those presented yet... just the valid point that there are few studies relating it to scoliosis... and I don't feel that justifies calling it complete phoney baloney. Maybe I just feel your scrutiny is rather extreme.

As per your question... refer to my response to Gerbo above as it was a similar question he asked. Do you have a structural or functional/ideopathic scoliosis? Age is a consideration. Again, no one method will help everyone all the time... or in and of itself. This is not a black and white issue. To be short, it will depend on you're individual case... in the end, I don't do vestibular testing so you would be redirected to a qualified M.D. if you chose to pursue it further. I support its possible contribution to scoliosis, I'm not claiming it is the only one or that it should be used by all or in exclusivity.

Respectfully,
Structural

macky

01-09-2007, 04:25 PM

Have a look at your reply to Scoliosis Gal on the thread Flat Back Syndrome, and you will see what I mean about her having to have a university degree in Medicine for her to understand it, she is only 15 years of age.

I have no gender issue at all, absolutely none, never have, never will. I have two sons for goodness sake. Just people(is that better) who never seem to take in what other people are trying to say. We do hear you, but some of us dont agree.

It has also been said on these forums time and time again how some means of alternate therapy dont work. Now this is by people who have experienced them. Actual people who have actually lived it, and a lot of them.

This is just an example that goes to my thinking, MY THINKING. My son went to an osteopath who has been all over Australia and has his clinic here in
Tasmania. On leaving he felt giddy , in pain, almost passed out and ended up in hospital. He went to the osteopath because of pain in his neck and back. The manipulation done had caused his hospitilisation and this was verified after Xrays were taken and compared to Xrays before he went to the Osteopath. OK you will say that was just one person but one person is one to many. Now he was my son I cant help but wonder how many people I DONT know that things have happened to. I do realise that there probably a lot of people who are helped and you are going to say that but as I said one person wrongly manipulated was enough for me.

Peoples experiences with chiropractors you can see on this forum you can read all that yourself and see how people have spent so much money trying to get help for their scoliosis but all for nothing. I am not saying chiropractors cannot help with other problems.

I have ideopathic scoliosis, which at the time I had the operation was in the very early days of surgery , was regarded as an excellent
correction, which it was.

I am so very thankful that I had such a good mother who supported me with all her love and a good doctor, I dont know what would have become of me without the operation. I know that absolutely no amount of alternate therapies would have helped me.

Macky

structural75

01-09-2007, 06:11 PM

Hi Macky,

I didn't hear Scoliosis_Gal complain... just you? I'm sorry for being accustomed to speaking in those terms.... what do you suggest I do?

I see your point and I'm sorry about what happened to your son. I can certainly see how that would leave a bad impression.

I definitely don't condone what that osteopath had done... But to discredit the rest of them, or majority, who have been a tremendous help to people, often times when M.D.s couldn't do anything for them, is maybe taking it too far. It's not fair to those who practice ethically and responsibly and contribute a great deal to their patients lives and well being. We all know that there are surgeons out there who have left instrumentation in peoples bodies, severely disfigured/disabled individuals and/or left people in more pain than they were originally in. Now I back all of the talented surgeons out there as well... So why don't you feel the same about surgeons? What happened to the "one person is one too many" mentality? It is absolutely no different than osteopaths, chiropractors, etc..... I'm not saying this to get under you're skin... seriously I'm not. I'm just making a point that it's not fair to be selective about what field you hold to more critical standards and what field can be forgiven. It just seems hypocritical to me, and not clearly representative to the rest of them. In every profession there are extraordinarily talented practitioners, and less talented... Results will vary accordingly... just as people look for the best, most experienced and knowledgable surgeons.

It has also been said on these forums time and time again how some means of alternate therapy dont work. Now this is by people who have experienced them. Actual people who have actually lived it, and a lot of them.
I see your point here as well, and I agree that no therapy is garaunteed to work for everyone, and some are more effective than others(I don't support EVERY alternative therapy, especially for its application to scoliosis. In fact, there are several that people regularly utilize and promote here that I wouldn't recommend for scoliosis).
I can only speak accurately and with confidence that SI work has proven beneficial to many with scoliosis, whether they are posting their results on this forum or not. (Again, this forum only represents a fraction of the millions affected by scoliosis) Now I could be wrong on this because I haven't checked lately, but I don't believe anyone has claimed to have negative results from SI on this forum. In fact it doesn't seem as though many have even tried it... they tend to be drawn to the more 'commercially' driven 'therapies' such as pilates and yoga.
Sometimes they don't work, I agree... yet unless people fully understand my chosen profession and what we are doing, I don't believe they have the ability to say it doesn't work. ...it definitely has for many... which is why the M.D. in the quote from my previous post refers patients to it. She doesn't need studies, her personal experience and that of her patients is plenty to show her that it works.

Peoples experiences with chiropractors you can see on this forum you can read all that yourself and see how people have spent so much money trying to get help for their scoliosis but all for nothing. I am not saying chiropractors cannot help with other problems.Just to be clear with you Lorraine, I personally don't think 'most' people need to undergo chiropractics or any other treatment for indefinite periods of time like that... I think it's predatory and unnecessary unless someones condition/occupation causes such strain that they have to do something on a regular basis to maintain. I also don't think 'adjusting' bones without regard for the soft tissue is an effective approach for scoliosis, given that it is the tissue that moves and orients our skeletal system. Just my opinion... I'm sorry many have been convinced otherwise.

To conclude, which is long overdue, I'll leave you all with Dr. Rivard's email reply to me. It doesn't say anything very conclusively... as we know. But this is the end of my contribution on this topic because it's gotten way too negative for my liking.
(I have removed parts of my personal email for obvious reasons: public forum!)
From :Charles Hilaire Rivard <chrivard@gmail.com>
Sent : Tuesday, January 9, 2007 8:10 AM
To : "Ryan Flowers" <@hotmail.com>
Subject : Re: Spinecor Brace & Vestibular Affect

| | | Inbox

Hello M Flowers,

Many studies, mostly by the Japenese people, are telling us that the scoliosis patient

are showing some abnormality in their vestibular system, but no body up to now can tell us

If it's a consequence or one of the aetiologic factor.of the scoliosis. Dr Lamiantia in New-

York is doing vestibular testing on all his scoliosis patient and we are still waiting him to gave

us some results of those exam that he is doing for two to three years now.

In summary I hope that SpineCor Brace could change the vestibular system but

I don't have any proof yet.

Best regards

Charles H, Rivard M.D.

macky

01-10-2007, 12:37 AM

Goodbye and god bless.

Macky

Celia Vogel

01-10-2007, 04:04 AM

Until now, it was my belief that the NSF was a place for parents or patients to discuss issues without having to justify or defend their statements to medical practitioners. On Christmas Eve, bits and pieces of a light frivolous conversation which took place between parents in September 2006 was used to prove a point - the purpose of which is still unclear to me. The debate that ensued has no doubt left many people hurt in the process. The one person I sincerely hope is not hurt is Dr. Rivard because I have the greatest admiration and love for him.

structural75

01-10-2007, 08:30 AM

Celia,

I'm deleting all previous posts on this matter, as it is clear that it got us nowhere. I don't see how Dr. Rivards feelings would be hurt??? I think having his opinion on the matter is probably what you're most concerned with so I'll leave his reply to me on here.

As for this forum, you're right, it is for parents and patients to discuss issues. It is also a place for people to start becoming informed about what is out there. That is why there are headings for Non-Surgical Treatments and options, as we both agree should be used in combination with conventional approaches. I would hope that people would be able to post info and advice on those topics in the future without undergoing the harsh scrutiny, denigration and criticism that so often takes place. If it is ok for people to use a dvd to help their scoliosis, then why is not alright to undergo guided treatment from trained professionals? I am personally more skeptical and concerned about folks using a dvd without knowing/understanding the specific requirements for their particular scoliosis. But that's just me....

Celia Vogel

01-10-2007, 08:46 AM

I don't understand how erasing all your previous posts and leaving dr. Rivard's reply will clarify matters for people since the continuity of the discussion will be lost and the thread will make no sense whatsoever. As for your stance on vestibular testing, you have stated numerous times that you don't do this kind of testing on your own scoliosis patients so I find your arguments hypocritical and motives unclear.

structural75

01-10-2007, 09:14 AM

Celia,

For Pete's sake Celia! This is crazy... I'm trying to suggest we wipe the slate clean and free from the personal attacks that have "hurt" peoples feelings and stick to objective comments as Gerbo suggested initially. The thread would make perfect sense if you did the same, then all unnecessary remarks will be gone and the objective parts of our discussion will remain. We still probably disagree but that's perfectly OK with me... really. Why do you now have a problem with that... In fact I think that when you look at the posts in their continuous form it is clear that we were all guilty of making offensive remarks... why do you want all of that to remain if it's upsetting you and others? I can't seem to do anything right here... .

I dont' do vestibular testing (outside the scope and qualifications of my practice), but as an individual and professional I find it's use relevant to scoliosis. I have no motive other than to support something that I believe (as does Dr. Rivard) to be an important aspect to treatment in some cases. I'm just not of the belief that we stick people in braces and leave it at that. There is more to scoliosis than that and I feel people get better correction when we address several components to the problem at hand.... that's all. No hidden agenda here. I don't perform back surgery or fit braces, but that doesn't mean I can't support their use!

This was my concluding post on christmas eve... which was followed by several more of its kind to try put a close to our arguement.
Celia,

I'm finished with this cyclic debate. I honestly didn't know of your previous discussion (or at least I hadn't bothered to read it). The discussion you had with another member is still there (I presume) for others to read... the context is pretty straight-forward. ... I surrender!!!!!

I said:
I'm perfectly fine with you using that quote over and over again, just remember that there is a sentence preceeding the one you keep highlighting which clarifies my position more accurately. This is also the belief of the chiros of scoliosissystems in NY... use of the spinecor brace along with other methods, not "in and of itself". That is known as a comprehensive approach.

By the way, I know that a concern you had involved the financial appropriateness of the matter, and I completely understand and share the concern. Yet there are also organizations/people who are not doing this for financial reasons. Here is a non-profit group: http://www.vestibular.org/index.php

structural

structural75

01-10-2007, 09:21 AM

Well, too late... I began erasing them before getting those responses. I thought the same but I guess it's for the best to remove as much negativity as possible. Not only have I been personally slaughtered on this thread by folks who don't know me, but now others are jumping at any opportunity they can to discredit me elsewhere... :(

....that's unfortunate, but it will not prevent me from contributing to future posts.

Take care

CurvySAT05

01-10-2007, 12:14 PM

Okay...I have a question and anyone can answer...but please no debate or argument involved in the reply. I have noticed in this discussion that Vestibular Testing and Vestibular Rehab have been talked about as two separate things. I wonder, what is the difference between the two (obviously the two must cross at some point) and is it possible to do the vest. rehab with no previous testing?
Thanks to whoever replies...I was a little confused. :)

structural75

01-10-2007, 12:57 PM

Hi Curvy,

Vestibular testing is a diagnostic procedure to determine the state of functioning of the vestibular system (in the same way that an MRI gives a visual assesment/information but doesn't actually treat anything). The tests will determine many things such as neurologic activity being fed to the cerebellum via the inner ear, potential disturbances in those signals, inner ear and ocular(eye) coordination and synchronicity, etc....

Vestibular Rehabilitation is what might follow testing if they were to find an imbalance that was contributing to or being influenced by the problem at hand. Rehab uses the results of the testing to specifically address the unique imbalances within that individuals inner ear/nervous system/ocular synchronization.

I had included rehab in the discussion just because I thought it was important to make the ditinction that you just asked about. The testing that is done is not a treatment of any sort, just a specific type of diagnostic/assesment.

Hope that helps.

structural

CurvySAT05

01-10-2007, 01:22 PM

Okay, I understand better now. I looked it up online and see that the rehab is used for things like Vertigo, Vestibular neuritis (inflammation if the inner ear nerves), and other things. I wonder, do these conditions cause a physical deformity of the vestibular system, or just a physical displacement of sorts (dont know if that is what I am trying to say) that causes the body to become imbalanced? Does the rehab help to correct the deformity/displacement (idk what it is, sorry) or does it help to train the body to recognise the new location and accomodate better to its new surroundings as "normal"?
Sorry for all the questions...have been thinking about these but didnt want to get into the fuss. Am going to school to become a PA.

structural75

01-10-2007, 03:03 PM

It gets pretty complex, but in short... Disturbances within the inner ear (including some of the examples you mentioned, but not necessarily a deformity) can disrupt the signals being sent from the inner ear to the brain to the postural, tonic musculature of the spine. To put it another way... If the inner ear is dysfunctional for one reason or another, its interpretation of what is level/horizontal etc. is disturbed, thereby causing an imbalance in tonic function of the vertebral muscles... which are autonomically responding to align the spine vertically according to that proprioception. If the vestibular system is sending a skewed inaccurate signal, the spine will deviate from the central axis even though it 'thinks' it's straight. The cerebellum is the rear and lower portion of your brain that controls equilibrium, coordination, etc. and receives these messages from the vestibular system.

The eyes are also at play here.... if the inner ear and eyes are receiving different information (the eyes are level but the inner ear says you're not - or vice versa), this will also potentially lead to the same problem. The eyes are also 'hardwired' to the suboccipital muscles, which are tiny muscles located at the base of the skull where it meets the cervical spine in the back. They help to move the head instantaneously when you move your eyes and ultimately orient the head on the neck so that your eyes are level.

The rehab is aimed at correcting or minimizing the imbalance/problem/interpretation of the signals. By resolving or minimizing the vest. system disturbance, the body will be better able to naturally find its proper orientation and the signals creating or contributing to muscular/soft tissue imbalance will begin to equalize.

Try this... If you're fingers are sensitive enough you can feel it yourself. Sit upright or lay down. Place your fingers on both sides of the back of the neck, just below your head (C1,C2). Now move your eyes all the way to the left and right without actually turning your head. You will feel these muscles engage as you move your eyes, but not your head.

Sorry, it just seemed like something fun would be refreshing ...

Curvy, sorry if my language is too technical... if you don't understand me please just let me know.. I don't want to be talking over anyones head.

Regards,
Structural.

gerbo

01-10-2007, 03:51 PM

but remember (and I am sure that structural agrees with this) that although this is a fascinating and attractive theory, it has never been shown in practice that this "vestibular rehabilitation" makes any difference to the outcome of the treatment of scoliosis. It is also possible that noted disturbances are a result of the scoliosis rather than "the" or "a" cause.

CurvySAT05

01-10-2007, 04:57 PM

Structural...I had to reread some of the statements a couple times, but ultimately I was able to understand what you are saying. I am going to school to become a Physicians Assistant and have already taken Medical Terminology so can (for the most part) break down the words.
I was reading what you were saying about the tonic changes of the spinal musculature and thought about a test that I have seen before called a surface EMG (sEMG). It uses the same technology as an EKG or ECG (whichever you prefer to call it) to detect imbalances in spinal musculature. I was wondering if you had ever heard of this type of test and what your thoughts are on it. Also, could something like this be used kinda in reverse to determine tonic changes before doing vestibular testing so as to possibly save money?
Is it right of me to assume that if you are talking about scoliosis as a tonic muscular change of the spine (either from car accident, falling, or other etiology that causes muscular imbalance) that it is a functional curve that can be stabilized, because the etiology is all muscular? I know that chiros commonly say that the vertebra are "subluxated" and manipulate them. You say that you practice SI, what is this and how does it help to correct the deformity? Sorry if you have already gone over this...I didnt catch it between all the other posts.
Mandy

structural75

01-10-2007, 07:53 PM

Hi Gerbo,

Yes, I certainly agree with you... I think we've agreed on that several times before. Remember, I am not contemplating the "cure" for scoliosis here. I believe this is one relevant factor in some cases that is worth consideration and use, along with others. I think I'd be one of the first on this forum to express the belief that ideopathic scoliosis affects far more than just one system, or one specific aspect of a system, in the body. I hope I can have an intelligent and peaceful exchange with someone here without further hassle... please.

I know the following doesn't apply to you Gerbo, but I think it clearly shows the importance of what we (Curvy and I) are talking about. It could possibly help many from escalating to more serious states, and I think anything to help children in the future is worthwhile to consider.

This study does in fact show that vestibular imbalances are known/proven to occur prior to the onset of an ideopathic scoliosis. So it's not completely outrageous to consider the possibility that some who have ideopathic scoliosis already actually had this to start.

ARE ASYMMETRIC OTOLITH VESTIBULO-OCULAR REPONSES A PREDICTIVE FACTOR FOR IDIOPATHIC SCOLIOSIS IN CHILDREN?

Sylvette R. Wiener-Vacher, and Dominique Antolini., Nn. 1

In idiopathic scoliosis spinal deformities start to develop at the time of the initial rapid growth at the onset of puberty. A suggested cause of IS is a disequilibrium in the otolith vestibular control of the trunk muscles. Supporting this hypothesis our previous results (2) showed that 67% of children with IS, but no other inner ear or neurological abnormalities, had an asymmetry of their otolith vestibulo-ocular reponses to the Off Vertical Axis Rotation test. These were significatively greater than in a control age-matched
group of normal children. We suggested that this asymmetry was a central otolith vestibular system disorder and could lead to a vestibulospinal system imbalance, which would then provoke IS.

The goal of this study was to determine if this asymmetry exists prior to the appearance of the spinal deformities. Our preliminary results show that the vestibulo-ocular asymmetry appears before the spine starts to show any significant clinical and radiological deformity. In patients at risk for IS(e.g. a family with IS history) screening for otolith functional asymmetry could be used as predictive factor of scoliosis and help for earlier prescription of IS preventative treatment.

1 Thanks to the Cotrel Foundation (Fondation de France) for supporting this research.

2 S.R. Wiener-Vacher, K. Mazda. Asymmetric otolith vestibulo-ocular responses in children with
idiopathic scoliosis. J. Pediatr 1998 ;132:1028-1032.

structural75

01-10-2007, 09:32 PM

Mandy,
Yes, I'm familiar with EMG testing. Its primary usefulness is in showing before and after tonic changes following various therapeutic intervention. Unfortunately it will not be of use as a replacement/precursor to vestibular testing. Even someone with a non-scoliotic spine and normal vestibular function can end up with unequal EMG tonic output readings, as we all usually have dominant sides of preference in our bodies. The following explanation is also the primary reason why EMG testing wouldn't be very helpful.

In scoliotic spines there is an uneven tonus and development between the sides naturally. (Barring any possible neurologically derived ideopathic scoliosis) I'm sure you've heard this discussed by other folks before... One side appears to be overdeveloped relative to the other. The convex side will develop greater tonus and mass as a functional response of the body to try and self-correct the curve...

For Example: As it bends to the right, the musculature on the left side of the spine will eccentrically contract(elongate while contracting, such as lowering your arm doing a bicep curl) to attempt to prevent the curve from going further (as gravity pushes downward). This constant use of the muscle will cause it to increase in both tonus and mass. In the right bend scenario here, the musculature on the right side of the spine will be autonomically inhibited by the nervous system thus causing atrophy and decreased muscle mass/development on the concave side. If the body didn't do this autonomically and you increased the tonus of the muscles on the concave side it would actually end up pulling the spine further into a sidebend..., making it worse. So all of this change in tonus is, first and foremost, a necessary and functional compensation/adaptation by the body and nervous system to attempt to self-correct the curve in resistance to gravity and the internal forces that are causing it. Functionally speaking, it would be impossible and unhealthy to have equal tonus left to right in a scoliotic spine. That's why I cringe when I hear people talk about trying to "strengthen" the concave side of their curve. It will be a major impediment to any form of correction. And therefor it won't give you any accurate indication of what the vestibular system is doing. It could possibly be normal for some, when EMG will definitely, always show a difference.

I think one of the factors that is commonly ignored is gravitational influences. Once a spine begins to curve gravity amplifies the progress because the spine is no longer self supporting (vertebrae are no longer stacked in relative alignment in the vertical plane) This is just my opinion now, but I think that this is one of the factors involved in why some progress and others don't... or why some progress faster. How able is each individuals body to resist that force...? Some are more adaptable than others and some have more severe internal forces acting on it than others.
I know Gerbo... just theories at this point... no studies.

more in another post...

structural75

01-10-2007, 11:51 PM

Mandy,

Part II :)

Unless there is a known neurologic disorder, I don't believe ideopathic scoliosis is necessarily caused soley by muscular tonal imbalances. Usually there is a more primary condition present that will end up influencing/dictating the neurologic tonus output to the muscular body. Other systems preceed the muscular body such as the ligaments, organs, joints, cranial system, nerves, etc.. In the case of accidents as you mentioned, injury to one or more of these more primary components will end up causing an autonomic muscular response in an effort to brace or protect the compromised region. If it's a disc or soft tissue surrounding some vertabrae then the muscles will respond with irregular tonus to postion the spine in such a way as to protect/inhibit/restrict certain movements. If these underlaying problems can be addressed properly, then there is probably a good chance that you can stop and/or reduce the curvature with stabilizing effects. These would be "functional" forms of scoliosis. It's impossible to cast generalities about the ability to stabilize them all, but some are certainly amenable to change.

As for subluxations.... that's opening a can of worms... :eek: . I don't know that I'm willing to go too far with this one given my most recent experience on 'chiropractic' issues. Let's just say that I don't think it's as black and white as subluxation theories suggest. Vertabrae have natural ranges of motion. They can become 'fixated' in any number of ways within any degree of movement. Again, this is the bodies way of protecting/bracing that region to prevent further irritation of something, further excessive range of motion at that joint, or as a result of chronic asymmetric loading on the joint. Sometimes these fixations are mechanically induced (sudden movements and the back 'goes out'. And others are neurologically induced as the ligaments and such inform the nervous system that there is too much stress/load on the vulnerable joint and there is a need for muscular stabilization/contraction, thus fixating it into position.

Scoliosis puts tremendous strain on the individual segments of the spine as well as the whole. At some point it is not unlikely to develop fixations in specific regions or transition zones of the curve where these forces tend to be the greatest. Adjustments of an intelligent sort may be helpful in re-establishing proper mobility and/or reducing pain associate with it. However, as long as the curve remains present, these forces will always exist and therefore any long-term effect of the adjustment might prove futile. I think it has its place, but it doesn't seem to present a viable option for correcting the curvature as a whole... seeing as it's being held in place by enormous quantities and spans of fascial and muscular tissues. Just my thoughts... .

I know these posts are a bit too long... sorry folks. But you ask some good questions Mandy. Hope that was helpful in some way. As for SI... I'd be happy to describe its intent and how it works with scoliosis, but I'm not certain if others will feel it's a bit of advertising or promotion on my part. Maybe I'll private message you about it.

Kind Regards,
structural

gerbo

01-11-2007, 02:58 AM

Yes, I certainly agree with you... I think we've agreed on that several times before. Remember, I am not contemplating the "cure" for scoliosis here. I believe this is one relevant factor in some cases that is worth consideration and use, along with others. I think I'd be one of the first on this forum to express the belief that ideopathic scoliosis affects far more than just one system, or one specific aspect of a system, in the body. I hope I can have an intelligent and peaceful exchange with someone here without further hassle... please.

its just that me (like you) want to make sure that people who read your explanation understand this, so that they do not spend a disproportionate amount of effort, time and money on treatment based on this theory.

And don't worry, i'll keep it peaceful, you've got an interesting perspective on things so don't want to have any "arguments"

tonibunny

01-11-2007, 05:46 AM

Hi Structural,

I've followed this discussion with interest, but was wondering how problems with the vestibular system could explain idiopathic scoliosis in infants who have yet to sit upright? I was first diagnosed with scoliosis at the age of 6 months, with two idiopathic curves of about 62 degrees (thoracic) and 40 degrees (lumbar); my mother noticed there was a problem before I even sat up, so it's difficult to see how vestibular problem could have been responsible. Is it likely that infantile idiopathic curves have a different pathology to adolescent idiopathic curves?

gerbo

01-11-2007, 11:32 AM

I know Gerbo... just theories at this point... no studies.

Interesting theory, but my "theory of the relevance of muscular imbalances in scoliosis" goes different.

I think that we both recognise that a muscular imbalance develops as scoliosis develops and that they are somehow linked.

You are saying that

The convex side will develop greater tonus and mass as a functional response of the body to try and self-correct the curve...

suggesting that somehow the body will try to correct the curvature of the spine. I don't believe this; I believe that the body isn't bothered whether the spine is straight or bend, it hasn't got an inbuild blueprint dictating that the spine needs to be straight. I think however that the body will try to keep itself balanced, regardless of what happens to the spine.

If that is true, then the greater tonus etc on the convex side isn't necessarily beneficial to the spine, and could even be detrimental. To me it makes perfect sense that a mass of muscular tissue, lateral to the spine, which has a higher tonus and might move and contract with a higher strength due to its greater mass and different histological composition, could well, through its many attachements to the spine and its connecting tissue, pull the spine towards it and thereby exacerbating the curve. So instead of stabilising the curve, I think the muscle imbalance actually exacerbates the curve, contributing to the vicious cycle which inenevitably makes scoliosis worse.

Functionally speaking, it would be impossible and unhealthy to have equal tonus left to right in a scoliotic spine. That's why I cringe when I hear people talk about trying to "strengthen" the concave side of their curve. It will be a major impediment to any form of correction.

This is were a little bit of "proper" evidence comes in
vert mooney's study confirmed a emg differential between concave and convex side of the curve (other studies have done the same).

mark asher (reputable spinal surgeon) also studies rotational strength and found this was weaker towards the concave side

both findings fitting in with the known weakness of muscles on the concave side we are talking about.

This then even becomes more interesting once both mooney and asher address this strength differential. These are the torsorotation exercises which strengthen rotational strength towards the concave side.

Findings are that
1) emg differences even out
2) rotational strength equalises (concave side becomes stronger) and most importantly, contradicting

That's why I cringe when I hear people talk about trying to "strengthen" the concave side of their curve. It will be a major impediment to any form of correction

3) scoliosis either stabilises or even (marginally) improves (based on proper measurements with xrays etc)

Indeed, just a theory, like yours, worth considering though I think.

structural75

01-11-2007, 11:33 AM

hi tonibunny,
Just to be totally clear on this, although I do find the vestibular component relevant in some cases, I definitely don't believe that it is the primary cause or influence in all ideopathic cases. I just believe that it is playing a role (for which we're unable to determine accurately at this point - primary or secondary), and is worth looking into and possibly addressing. Every case is so different than the next that I don't think there are many generalities possible with this condition.

... just like some are structural (fusion), or a boney anomoly (extra rib or hemi vertabrae), etc.. Some are neurologically induced - alteration in motor function or neural deficits beginning prior to birth... . It certainly doesn't sound to me as though yours was caused by vestibular imbalances. There are so many potential aeteologies for IS, vestibular dysfunction is only one possibility... I'm not suggesting it's always the culprit.

Kind Regards,
Structural

tonibunny

01-11-2007, 11:58 AM

That's fine Structural, I'd guessed as much - thanks for clarifying things :)

structural75

01-11-2007, 02:58 PM

Hi Gerbo,

I want to say first off that I wish you could hear me speak these words because I mean them in the most sincere of ways... no offense at all meant by the following. :)
First, I'm not suggesting that uneven tonus is"beneficial" for the spine, just an inevitable self-adaptation with many consequences, good and bad.

I see what you're getting at, but it's completely biomechanically incorrect.
There is NO muscles lateral to the spine that is capable of bending it to the opposite side as you're suggesting. It is simply anatomically, biomechanically impossible. Please take the time to look through an anatomy atlas to confirm this for yourself. If you can find ONE muscle that performs the action of bending the spine to the opposite side of its loacation, please let me know(My three surgical atlases and lab dissection experiences have not found this to exist). The musculature/soft tissue on the right side of the spine (attaching amongst the vertebrae, ribs, pelvis) laterally flexes (sidebends) the spine to the right, and vice versa. Simple as that. If that said musculature increased in tonus and mass (mass will reflect its need for use) and acted in a consentric fasion (shorten while contracting), it will indeed pull the spine into a sidebend to the same side.
This is were a little bit of "proper" evidence comes in
"Proper" evidence begins with understanding proper muscular/soft tissue action. I'm very sorry, but the theory you've proposed is flawed right from the start, as there are NO muscles capable of doing what you claim they do.
In other words, if the spine is bending left (C curve), the muscles on the convex side(right) will usually present with more tonus/development due to their effort to prevent further left sidebending (gravity pushing downwards is part of this equation as well as the internal forces). Our spine cannot bend to one side and effectively 'float' in space without having eneven muscular tonus... eventually the muscles will fatigue on one side, causing a demand for greater mass/histological changes and a build up of more collagen fibers (connective tissue) to add strength to meet the demands necessary to try and preventthe imbalance from getting worse.

I wish there were another professional or PT, whom who people respect, to confirm this biomechanical inaccuracy. I certainly don't mean this with any offense, but it is impossible for the muscles on the convex side of the curve to pull it further into the concavity. What you're "thinking" is not very well matched with what is anatomically possible.

suggesting that somehow the body will try to correct the curvature of the spine. I don't believe this; I believe that the body isn't bothered whether the spine is straight or bend, it hasn't got an inbuild blueprint dictating that the spine needs to be straight. I think however that the body will try to keep itself balanced, regardless of what happens to the spine.
Well, I find it hard to believe that the body doesn't care whether the spine is laterally bent. The bodies musculoskeletal system is striving for the most efficient balance and biomechanics possible, the same way it seeks a homeostatic state physiologically. Homeostasis is a scientifically credited phenomenon, why wouldn't that apply to the rest of our being/physical body? Besides, barring abnormalities/conditions, when was the last time you saw a child, shortly after learning to walk, walking around with their spine bent to the side constantly? Children have the most efficient and upright posture of us all. It's not until the slings and arrows of misfortune hit us in life that we begin to deviate from this starting point.

If it didn't matter to the body, or it somehow didn't know how to orient itself most efficiently and stabily (enter the purpose of the vestibular system/cerebellum :) ) then why aren't we all walking around as adults bent every which way(w/out scoliosis of course)? And why does every imbalance in one direction have a compensatory correction in the opposite if the body didn't have a sense of what's ideal? Furthermore, when you consider that structure influences function, and function influences structure(as seen in severe instances with cardiothoracic complications with sever scoliosis)... it is far more stressful on all systems of the body to manage anything but a vertical positioning... Also, the articular facets of the entire spine (joints of the vertabrae) are NOT positioned or designed for that type of chronic 'functional' positioning that you're suggesting is not bothersome. I mean the entire morphology of the shape of our vertebral bones would not fair well if this were the case... you would end up with tons of people herniating discs, disc pertrusions/extrusions, degeneration, stenosis, etc.. . I think the body is far more intelligent than you're 'theory' is giving it credit for.

Also Gerbo, we develop our prmary and secondary curves (anterior - posterior/ kyphosis - lordosis) as we learn to crawl, sit and walk. The development of those curves are beautifully written into us somewhere ;) ??? We were meant to have them for proper function of the spine, is that not part of some "blueprint"? After all, we're NOT born with them, they develop late during infancy. How do cells know what to differentiate into during embrtologic development? This is all part of what we could call a "blueprint".

vert mooney's study confirmed a emg differential between concave and convex side of the curve (other studies have done the same). Of course it would confirm a difference in tonus... I agree that's the case.

mark asher (reputable spinal surgeon) also studies rotational strength and found this was weaker towards the concave side I'm unclear about direction here.. ?Could you clarify this for me? What direction in relation to the concavity... concave on the right with right rotation? Is that what you mean?

The rest... Yes, you can strengthen both sides and move towards equalizing EMG readings in a rotational manner. The torsorotations are helping to lengthen the inhibited short weak side, and dynamically engage the long, overactive strong side. When a muscle is shortened to capacity (the weak/inhibited ones on the concave side) it naturally lacks physiologic capability to strengthen beyond a certain point. As is the case when the "stronger" bunch on the convex side... they are 'locked long', also compromising their strength potential as well. So In doing torsorotations toward the concave side you are lengthening those concave muscles, therby giving them a greater physiologic range of motion and thus increasing their strength. The benefit comes from their lengthening which will help reduce the severity of the rotation aspect of the scoliosis. The strength aspect is a secondary functional effect.
3) scoliosis either stabilises or even (marginally) improves (based on proper measurements with xrays etc)
Is it the lateral curve or the rotation that is shown to improve using torsorotations, or both?
Yes, absolutely.. torsorotations done properly will help scoliosis, I agree. The biomechanical reason that curves/rotations will possibly improve is because the deep postural muscles that are responsible for rotating the spine are also the same ones responsible for sidebending it as well. For instance, a rotation to the RIGHT is caused by the multifidi and rotatores on the LEFT(there are more, no need to mention them all). At the same time, those multifidi and rotatores on the LEFT (same ones/same side) will also sidebend the spine to the LEFT. So when you do a torsorotation toward the concavity and presumably against the natural scoliotic rotation, as you described, this is being achieved by the engagement/contraction of the multi/rotat. on the convex side, all the while lengthening the ones on the concave side... giving them a more dynamic range of motion and creating length in them which will potentially reduce the amount of sidebending they are causing and increasing their strength potential and "normal" tonal activity. I agree with the end result of those findings, but you're interpretation of the findings is a little off.
2) rotational strength equalises (concave side becomes stronger) and most importantly, contradicting

Quote:
That's why I cringe when I hear people talk about trying to "strengthen" the concave side of their curve. It will be a major impediment to any form of correctionMy statement is anatomically and biomechanically sound and correct, it's not my opinion, its just anatomical fact. The strength aspect is a secondary effect of what you're doing because the primary muscles on that concave side are lengthening, not contracting when you rotate to that side. If you were to actually "strengthen" those muscles, via shortening contractions, you would end up rotating further away from the concavity... into the scoliotic rotation. Or in the case of sidebending, if you contracted the already shortened muscles on the concave side to "strengthen" them, you would FURTHER sidebend into the concavity. This is what I'm saying is NOT GOOD, and it will exacerbate or hinder other corrective attempts being made.

Sorry for the lenght of that one... it just isn't as simple as you might think.
kindly,
structural

Bish

01-11-2007, 04:00 PM

I think you are definetly on to something here. In regards to your statements on equalizing muscle strength in a scoliotic spine. Despite the fact that logic might suggest equalizing muscle strength to straighten the spine is the way to go, I believe this may be the major flaw in attempts at many types of treatments for scoliosis. I know in my case T11 and possibly others have slight wedge shape to them, the convex side is overdeveloped and I think it is that way to compensate for a structural problem not common to a straight spine. To attempt to equalize convex and concave musles could in fact complicate the problem and or increase the degree of rotation. Nay sayers may want to think about why all these trestment programs are not yielding conclusive results. All the best, Dave

structural75

01-11-2007, 04:01 PM

Gerbo,
Truly sorry for that exhaustive reply... I admit it was a bit more than you were asking for.

I wanted to say that I don't encourage further strengthening of the convex side to try and correct the curve... I'm of the opinion that we should look to 'lengthen' the shortened aspects of the curve first, before looking to add strength anywhere. Strength will inevitably come through functional use of the spine as long as equilibrium in length is being achieved between sides. Much like wringing a towel out by twisting it... as you twist further, the length of the towel gets shorter... unraveling the twist/bends will add length and functional strength/activation will follow suit.

Also, I read your post on spincor thread. I'm glad to hear you're daughter is improving. Just wanted to comment on the secondary curve that was detected. When it's not structurally induced, I've seen and heard from others the same occurence. In many of those cases we've had success reducing and eliminating the secondary curve... with some of the 'logic' I was describing in the previous post.

That 'tension' arising from the convex side transmits all the way up and down the spine longitudinally, as many of those muscles span lengths well beyond the local region... and the fascia of course is completely continuous. So strain/pull around the convexity is transmitted into the spinal segments above on the same side thus pulling it into a sidebend on that side... creating a concavity above the convexity. ...Yet another good reason not to further attempt to strengthen the convex side more.

This is one reason to be very careful and precise with stretching and so forth. If we stretch/lengthen the concave side in a general manner, it may cause lengthening in the portion of the spine above the concavity as well (where the spine is relatively straight). This could contribute to what I described above, from the other side... ultimately becoming the long convex side of that secondary curve.

Regards,
Structural

structural75

01-11-2007, 05:03 PM

Gerbo,
I enjoy conversation with you, even if we don't always, or rarely, see 'eye to eye'.(had to get a little ocular/vestibular reference in to keep this post on topic.... :) )

The following comment really sends me into a tail spin... :confused: suggesting that somehow the body will try to correct the curvature of the spine. I don't believe this; I believe that the body isn't bothered whether the spine is straight or bend, it hasn't got an inbuild blueprint dictating that the spine needs to be straight.
Do you truly believe this? If the spine were bent on a consistant basis you'll end up with uneven compression on the discs, uneven articulation at the facets... just to name a couple. We all know what happens when these situations present themselves... disc problems, facet issues... . How is it that the body wouldn't be bothered by that. Sounds irritating to me, I can only imagine what my body would think. It's" blueprint" is called the cerebellum, that important part of the brain in the back... ! That is what tells us to orient the spine in a "straight" fashion.

Why is the body not capable of trying to autonomical self-correct the curvature?(I'm not saying that it is always successful, but it is certainly trying to resist efforts otherwise.. or else we'd find ourselves bent over on the ground.) It's no different than you're body keeping you balanced as you walk and stand... I think it's obviously bothered when we start to lose balance, that's how you can stand in line at the grocers without thinking about not falling over. It simply wants, ad knows, that it needs to be as erect and aligned as possible for efficient, functional and easeful being.

I'm just very confused about why this seems so unlikely.. after all, what we refer to as 'compensations' are the reflection of this process.

kindly,
structural

CurvySAT05

01-11-2007, 06:48 PM

Structural-
I have a question in regards to the theory about strengthening the convexity of the spine. I also agree that strengthening the muscles on the concavity of the spine will cause further spin into the scoliosis progression, but was thinking about the anatomy and biomechanics of the scoliatic spine and something doesnt make sense. Maybe you can help to clarify. On the convexity of the curve you state that these are the "strong" muscles, but it would seem to me (please correct me if I am wrong) that they would actually be weaker because the direction of the curve has elongated them from their "normal" position. On the concave side the muscles are contracted and in essence being "strengthened" all the time the the spine is curved so by stretching the muscles here (as you have suggested), and strengthen the muscles on the convex side of the curve, it would return these to a more natural position and hopefully upright the torso again. It would seem to me that the change in tonus on the convex side would be due to the 3D rotation of the spine "lifting" the muscles, fascia, ribs, and other structures that are surrounding.
Hope that made sense, thanks for helping me to clarify.
Also in regards to this statement
If the spine were bent on a consistant basis you'll end up with uneven compression on the discs, uneven articulation at the facets
I have to agree 100%. I just had fusion surgery 2 weeks ago for a herniated disc at L4-L5 because of curve progression below a prior fusion. There is lots of stress put on the discs below a fusion to begin with, but to add a scoliosis curve on top of that is horrible.

structural75

01-11-2007, 07:54 PM

Mandy,
A muscle is at its greatest strength potential in a neutral position... lengthened too much or shortened will physiological weaken the muscle as the actin and myosin filaments loose overlap or 'bottom out'... In the realtive context here, the convex musculature are stronger relative to the concave musculature... as an autonomic neurologic response to prevent further progression. The convex muscles therefore work eccentrically, contract while lengthened, to 'hold' up the curve... preventing or trying to prevent further sidebending. Neither side is particularly strong, but the convex is more 'active', higher tonus output, than the concave (inhibited). It's an issue of tonic functional demand... one side goes to 'sleep' as to not make it worse, and the other gives it all it can to hold it up. I'm not really keen on strengthening the convex side any further for a number of reasons... .

The muscles on the concave side are not necessarily "contracting". In fact they are inhibited... less tonic function (as shown in the EMG tests Gerbo was refering to). They are short as a result of the scoliotic postioning of the spine, which could have been induced by a number of factors.??? ...a muscle can be 'positionally short' without actually having to contract... the fascia will then lay collagen fibers down in this new resting length (shortened) which further 'holds' the curve in that position - enter fascial lengthening/stretching/mobilization/etc.... .

I'm not sure I understand your last couple of sentences on "3D rotation". I'll say this though, Part of the appearance of larger muscles on the convex side comes from the ribs moving back, via their rotation to that side, therefore pushing the musculature into a plane beyond that of the other side.

structural

gerbo

01-12-2007, 09:33 AM

The following comment really sends me into a tail spin

I'm just very confused about why this seems so unlikely

good to hear this, you must be human after all :rolleyes: :rolleyes: (only joking)

I think it is quite logical. Ofcourse, the normal (straight) spine will mostly remain straight through all kind of balancing acts involving brain, nerves, muscles, vestibular system of course.

we are not talking about the normal spine, we are talking about as spine which somehow has developped a scoliotic curve.

As I understand it, you think that compensation mechanisms will inherently aim at straightening the spine, or at least avoiding further bending. I am not so sure about this. The fact that once the curve passes a certain treshold the spine will curve more and more, literally unstoppable without treatment, means that either compensation mechanisms are just failing (that must be your premise) whilst I think it isn't necessarily farfetched to think that compensation mechanisms might help in somehow keeping the body balanced (which is what vestibular system/ eyes and cerebellum are aiming at) but that at the same time these mechanisms have a detrimental effect on the spine. The primary object of the human body is not to maintain its structure at all cost, but will adjust its structure to suit its functional needs.

the development of the secondary curve is an easy example. It seems to me to be a result of the body responding to the inbalance caused by the primary curve. Rather than keeping thhe rest of the spine straight at all cost, the body actually allows a countercurve to develop as a way of balancing things out.

So, this contributes for me to a theoretical explanation why i, unlike you, do not feel too scared of evening out musclestrength on either side of the curve (increasing strength on concave side), as we are doing with the torsorotation exercises, and fortunately limited and early results of studies appear to back this up.

gerbo

01-12-2007, 09:57 AM

Truly sorry for that exhaustive reply... I admit it was a bit more than you were asking for.

phew, you can say that again :eek: :eek:

I wanted to say that I don't encourage further strengthening of the convex side to try and correct the curve

are we confusing our terms here. i think I am strengthening the concave side

This is one reason to be very careful and precise with stretching and so forth. If we stretch/lengthen the concave side in a general manner, it may cause lengthening in the portion of the spine above the concavity as well (where the spine is relatively straight). This could contribute to what I described above, from the other side... ultimately becoming the long convex side of that secondary curve.

I have considered this. However, what i am assuming is that when I "stretch" the concavity, the parts which are really contracted and have restricted movements (round the apex) will hopefully respond and stretch a bit, whilst for the normal part of the spine above the curve, which indeed gets temporarily pushed into a convex curve, this is only part of the normal range of movements and will therefor not really change the relatve length of the ligaments involved in that part of the spine. Hence it is unlikely i change anything structurally there.

Thinking about it, it is actually specifically the action of one of the elastic bands, which pushes the right shoulder downward, which is likely to cause this hopefully functinal curve. and yes, i just have to trust dr rivard here that he has seen it all before and it in never to become "structural"

regards

ps, i do appreciate your view on all this kind of stuff as you clearly do have lots of detailed anatomical knowledge, which does surpasses my make it up as i go along approach.

Celia Vogel

01-12-2007, 10:14 AM

Gerbo,

Aside the from lengthy sermon that we've just endured on Structural's ad nauseam "theory" as to what happens to the musculature in a scoliotic spine has anything *really* been said as to how this has any practical application in real life ? ;) :D

gerbo

01-12-2007, 10:30 AM

it hasn't celia, I just enjoy it as an interesting discussion/ exchange of views.

(you know me, give me any subject; religion, politics, threatened cultures, global warming and I am always in for an interesting and enlightening discussion. Its a typical dutch thing really. Are germans similar??)

Celia Vogel

01-12-2007, 10:43 AM

Gerbo,

I enjoy reading your posts and what you're doing makes absolute perfect sense to me :p Furthermore....you have studies to back up your game plan, which is more than I can say for Structural. I'm sure he'll probably respond by saying that studies are not the "be all end all" and what he's seen in clinical practice is much more relevant.... to that end why doesn't he show us some proof of his incredible "clinical" results. Did he not say in another thread that his own scoliosis has resolved by the use of SI :confused: Well Structural....show us some x-rays to prove this.

gerbo

01-12-2007, 10:51 AM

now celia, whatever you do, don't get involved with this discussion, you know what you're like.......... ;) ;)

Celia Vogel

01-12-2007, 11:18 AM

I'm just fed up with snake oil salesmen! :)

gerbo

01-12-2007, 11:27 AM

there you go again... :eek: :eek: :D :D :D

structural75

01-12-2007, 02:43 PM

Gerbo,

I do agree with musch of what you're saying... I just don't agree with the analysis/interpratations that have been drawn from the results of the studies. I don't doubt that strength(or is it increased activation 'activation' these doctorsa are noting???? Those are two different things) as shown to improve, but why it is improving is where the theory you described doesn't add up anatomicaly or biomechanically for me. I still am not aware of any muscles on the convex side that pulls it into sidebending on the concave side... so equalizing true "strength" (rather than a demonstrable increase in activation potential) still tells me (and has shown me in paractice by those attempting to do such a thing, real strengthening that is) that it is going to be of detrimant.

It is showing increased EMG output because the postural muscles I referenced are also active for the purpose of stabilization of the spine during gross movement - torsorotations. As you are doing the torsorotations, and lengthening the "weak" muscles rotating into the concavity, you are also asking for them to 'stablize' the smaller segments of the spine to be able to perform this movement with flailing about. I know this might sound like "opinion" to some, but it IS in fact biomechanical and anatomical fact.... . Don't know what else to say without repeating myself.
The primary object of the human body is not to maintain its structure at all cost, but will adjust its structure to suit its functional needs.Absolutely, I am a firm believer in this fact... The body will always scompromise the musculoskeletal system in an effort to reduce strain/damage on more important physiologically based systems.
In regard to a scoliotic spine... the 'compensations' are not necessarily going to be successful in stopping a curvature, that wasn't what I was implying. And yes, there is an initial inpetus that 'causes' the scoliosis (largely unknown in many cases of IS), followed by the compensation to try and prevent it and 'adapt' to it. The compensations formed by the body are far more intelligent than we could ever come up with because there is no way a human being, doctor or otherwise, could predict and know everything that is being compromised by the primary problem.
Back to your quote... I've said this before, it is for this very reason that I am apprehensive about taking ONE single approach (bracing) at forceful correction of the ideopathic curve... You could very well cause more harm than good by forcing the spine back upright (changing structure at the expense of physiologic functional adaptations) without at least trying to address the underlaying cause(s) and/or related systems that may be in danger... of which the curve was initiated by in the first place. I definitely don't believe that we should be changing structure at all costs, becaue functional physiologic needs surpass skeletal alignment. I think that comment gets right to my point... using forceful corrective techniques at the expense of the real problem at hand is very short-sighted and potentially harmful or futile, as we see so often is the case.
It seems to me to be a result of the body responding to the inbalance caused by the primary curve. Rather than keeping thhe rest of the spine straight at all cost, the body actually allows a countercurve to develop as a way of balancing things out.Yes, I completely agree with that as well... which is primarily why you see secondary curves come about... it's simply counterbalancing the primary... I wasn't suggesting the body would make the spine straight at all costs.. in fact, given the inevitable and unstoppable introduction of a primary curve, the secondary develops to keep the whole body upright... I wasn't just talking about alignment of the spine, this is a whole body adaptation/adjustments. Sorry for the misunderstanding. When I refer to 'straight', which is not a term I like to use anyway, I mean upright in relation to a vertical axis... directly opposing gravity which is the most efficient position.
So, this contributes for me to a theoretical explanation why i, unlike you, do not feel too scared of evening out musclestrength on either side of the curve (increasing strength on concave side), as we are doing with the torsorotation exercises, and fortunately limited and early results of studies appear to back this up.I'm not opposed to 'activation', just "strengthening". These studies show an increase in activation (tonal activity/ouptut). Whether the doctors want to refer to that as strength or activation is their opinionated choice, not fact. Just as it's my 'opinion' as well. The difference being that I am taking into account the biomechanics of the movement in combination with what those specific muscles are actually doing during that precise movement... as I described before, it is fact that they are lengthening (eccentrically contracting because they are also stabilizing the spine through the range of motion) while you rotate toward the concavity. They contract concentrically (get shorter) while rotating into the scoliotic rotation or away from the concavity.
Because they are being 'activated'/awakened during this elongation/lengthening, the end result will be a reduction in scoliotic curvature/rotation, ...due primarily from the lengthening, not the "strengthening". The test only shows tonal output, what does it say about the new resting length? It doesn't need to say anything because the results of the x-rays showing a reduction in curve means implicitly that those "weak" muscles had to lengthen to achieve that reduction.
Do you see what I am saying here... I don't disagree with the actual results from the studies, I disagree, based on fact, that it is the result of "strengthening" the muslces... that was a secondary effect of exercise at hand.... the muscles didn't have to "strengthen" to become longer and thus reduce the curve/rotation.
I think the main point of confusion in this comes from not understanding the biomechanics that are actually occuring while doing the torsorotations. I think they are a good idea. But, I still don't encourage "strengthening" of the concave side as I've personally seen people who did this in other ways to great detrimant.

Sorry, another long one...

kindly,
structural

structural75

01-12-2007, 04:00 PM

Gerbo,
Quote:
I wanted to say that I don't encourage further strengthening of the convex side to try and correct the curve

are we confusing our terms here. i think I am strengthening the concave sideI believe that was in refernce to someone else's question/comment. Yes, we're on the same page here. :)

I have considered this. However, what i am assuming is that when I "stretch" the concavity, the parts which are really contracted and have restricted movements (round the apex) will hopefully respond and stretch a bit, whilst for the normal part of the spine above the curve, which indeed gets temporarily pushed into a convex curve, this is only part of the normal range of movements and will therefor not really change the relatve length of the ligaments involved in that part of the spine. Hence it is unlikely i change anything structurally there. It is common thought that stretching will effect the desired tissue, and it does to a degree. But the reality that I have found in my own body and that of others is that the tssue that tends to need it most, is usually also the most reluctant to change due to the chronic contracture in the muscle fibers and fascial smooth muscles, in addition to the extensive strong bonds created throughout the connective tissue. It will certainly be of great benefit, it's a start. But it will affect tension patterns in neighboring tissues up and down the spine. And these fascial tissues, not just the ligaments, do in fact impact the relative positioning of the body. I feel it's important to monitor this effect and respond to it accordingly if needed.

and fortunately limited and early results of studies appear to back this up.I support the studies.. don't worry. ;) The word "appear" is operative here... This is why I think so. The study shows two definitive things 1)Tonus increased in the weaker, concave musculature. 2)A reduction, stopped or slowed progression occured as confirmed by x-rays.
If there was a proven reduction in curvature then that would absolutely have to mean that certain 'shortened' tissues/muscles/ligaments along the spine (on the concave side, as I described earlier) had to lengthen in order to achieve the reduction. You can't get a reduction in curvature or rotation without certain tissues lengthening to permit this. The muscles that lengthened to allow this reduction to happen are the same ones that showed an increase in tonus on the concavity (strength as the Drs refer to it). So it's the 'interpretation' of the findings that I don't agree with because the Drs, according to your accounts, have made no reference to this change in length even though it undoubtedly and necessarily took place. "Strengthening" the muscles alone without changing their resting length will not reduce a curve or rotation... it it physically impossible... tissues have to change length for the spine to move.

The following is why I don't only read studies, or base my actions solely on them... they are subject to interpretation, even by the people conducting them. It would have been just as easy to do the same exact study without the EMG intent/use and conclude that torsorotations can help in that: 3) scoliosis either stabilises or even (marginally) improves (based on proper measurements with xrays etc)as a result of lengthening of the concave musculature during torsorotations to the concave side. The results would have been the same without EMG measurements and it would be known fact by the DRs that a reduction is the result of tissue lengthening/unwinding. For kicks, they could have done it again with an EMG test to find out what the tonal changes were as well, but biomechanically speaking, they were not the cause of the effect.

Regrads,
Structural
ps-thank you for the pleasant exchanges! :) Agreeable or not.

structural75

01-12-2007, 04:08 PM

Celia,
Here is a "practical application". Enjoy :) !
http://www.massageandbodywork.com/Articles/OctNov2003/scoliosismanagement.html

structural

ps-Can't wait for your feedback! I'm sure it will be loaded with pleasantries, optimism and positivity! :) :) Also, it doesn't take a world reknowned surgeon to visually asess my spine and know that it is perfectly straight... one vertabrae in alignment over the next, no rotation, no changes in said alignment during flexion/extension. ... cheers!

zuma

01-12-2007, 04:32 PM

Hi All

I am new on this forum and have been following this thread with interest. I am really pleased that things have calmed down and you are all expending your energies on trying to answer one another questions and not trading blows. I understand all sides of the debate and do not profess to be knowlegable to take any side in the debate. However i do have one point that i feel has been missed which is the patient.

I feel reading the posts on this thread that something fundamental has escaped our attention and it was only from reading the last post that it sunk in with me sorry structural i'm not singling you out in any way shape or form it was just something you said that got me thinking, again sorry for quoting you and no one else its like i said its something you mentioned reasonated with me. You quoted the following

I definitely don't believe that we should be changing structure at all costs, becaue functional physiologic needs surpass skeletal alignment. I think that comment gets right to my point... using forceful corrective techniques at the expense of the real problem at hand is very short-sighted and potentially harmful or futile, as we see so often is the case.

I don't know your history (sorry i'm new) but i have a rather large Kyphosis which was diagnosed in the dim dark days when no one addressed kyphosis seriously as it was the powers that be determined kyphosis as too dangerous to operate on and allternative treatments were not availablle. So i was told sorry there's nothing can be done you have to learn to live with it go away and stop bothering me. Well try telling that to a 13 year old who has to endure endless bullying day in and day out, at school and out of school, pretty much all the time so my teenage years were not pleasant and i would not want any one to experience the treatment and bullying i recieved which ended in me contemplating suicide on a number of ocassions and i still suffer from dark depressions now and i'm almost 40.

I understand you are coming from a purely clinical perspective which is the point i am so badly trying to get to, we have to look deeper and tackle the issues from more of a human perspective (again, Structural i'm sorry i'm not saying you don't because i can see by your posts you are a compassionate and passionate man in your field) and not be so clinical and analytical about things. We need to think out of the box and address the needs of the patient both psycologically, clinically and humanly

I thankyou for taking the time to read to this post and sorry for its length. I hope you can understand my english and the context it is written in

peace be with you all

Z

structural75

01-12-2007, 04:39 PM

Gerbo,
On the shoulder issue... Wouldn't it be more beneficial to elevate the lower shoulder rather then add more compression to the spine by compressing the higher one. Length vs. compression... of an already overly compressed spine. It just adds to the force of gravity pushing downward. I'm not surprised that secondary curves are appearing after the fact... I humbly believe that is a sign of progression overall rather than a positive sign of improvement. I don't want to sound discouraging, just concerned about what is be labeled as 'acceptable'.

Also note, it is the tilt/bend of the ribcage/spine that causes one shoulder to be higher than the other, rather than an actual elevation/depression of the 'shoulder' itself.

What are your thoughts on that?
structural

structural75

01-12-2007, 05:17 PM

Hi Zuma,

I'm so glad you brought that up... :) I know my posts tend to be quite clinically based, as certain others insist I keep the info/commments objective and "scietnific". I definitely don't mind you quoting me on this... guilty as charged :) .

One of the aspects of my work that drew me to it was its regard for the pychological and emotional being within us all. It differs in many ways from other therapies, but most importantly is that it not only has a strong scientific basis, but it also acknowleges the client as a human being(I don't use the word 'patient' because I feel it has a passive, subordinate and disempowering tone to it - 'one who waits' and is at the mercy of others to assist them. I believe self-empowerment is an important and vital component to treatment, healing and health overall.)

There is much more info on Structural Integration and this aspect to it on the websites of several of the schools, so I won't bog you all down with it here.

One of the reasons I advocate the work to people is due to this fact of addressing and interacting with the emotional and psychological aspects. I know that physical conditions such as scoliosis and kyphosis can have a significant impact on these aspects of ones life. Add a rigid brace to the picture and it only amplifies matters. So I thought that recommending the approach could be helpful to people in this regard at the same time they are dealing with the physical aspect. It is never to suggest that SI will work for everyone to the same degree. But it certainly offers something that physical therapy, chiropractics, pilates, etc. doesn't address, the emotional/psychological influences and factors.

I wish I could speak more freely in those regards, but certain folks here have a hard enough time letting me share objective comments alone. Hope you can see my point and position here.

Again, Thank you for putting those thoughts out here, I think it was an important reminder to us all.
Kind Regards,
structural

Celia Vogel

01-12-2007, 05:51 PM

Structural,

I cannot accept the pictures on the website you referred to as proof that SI works, you see....there is no "tonus" or muscle mass in that young man's convex side. :) His shoulders are level in all the pictures! He never had scoliosis to begin with and is simply positioning his hips in such a way to look as though he's in a slant. I'm afraid you'll have to do better than that - I want proof that your scoliosis resolved.

zuma

01-12-2007, 05:54 PM

Hi Structural

thanks for the prompt reply

in regars to your quote I wish I could speak more freely in those regards, but certain folks here have a hard enough time letting me share objective comments alone. Hope you can see my point and position here. I certainly do see your point and sympathise to some extent with you

I think we should all think out of the box and look at each and every option available and be in a position that we can objectively pick and choose or combine therapies/bracing or surgeries available to gain the best possible treatment for the loved ones we are trying to help who are suffering.

Knowing what i know now if my daughter was showing any signs or symptoms of contracting then dodgy gene i inherited from my family (kyphosis runs through my mothers side of the family tree) i would be exploring all avenues open which inludes both established and alternative treatments in order to gain the best and most appropriate treatment for her

I understand the forthright arguments put across in this thread are borne out of the love we have for either a family member or a desire to do the best we can for either a patient or a client (i don't have an issue with what ever terminology is used) its all one to me. Ultimately would not be here unless we were either a family member or a a sufferer and i do hate having to either pigeon hole or label someone

Peace be with you all
Z

Celia Vogel

01-12-2007, 06:05 PM

...One of the aspects of my work that drew me to it was its regard for the pychological and emotional being within us all. It differs in many ways from other therapies, but most importantly is that it not only has a strong scientific basis, but it also acknowleges the client as a human being...

If the way you treat people on this board is any indication of your *compassion* for your fellow man - I pity your clients. Keep in mind that you have deleted a lot of your abusive remarks to me in attempts to whitewash this thread.

macky

01-12-2007, 07:12 PM

I certainly wish I had kept a separate folder of my own, so I could now bring it forth and show people what your abusive remarks to Celia and myself have been like. To the point I have ended up in tears and almost stopped posting.
I would love to see these Xrays of your 27degree curve as well ??????

Now Zuma
Firstly I am sorry if it seems as if I was trading blows with Structural but a lot has been changed on this thread by him and as Celia said "whitewashed".

Much more importantly I was so sad to read that you were diagnosed way back in the dark ages when no one addressed the seriousness of your kyphosis. I was operated on in 1966 with harrington rods and all that followed plaster, brace and all. Honestly I do consider myself so lucky even though I have pain now, but what you must have gone through and still are, must be terrible., honestly I am so very sorry, my heart goes out to you.

I did enjoy what you said in your posts and am glad that you have decided to register as a member.

God bless,
Macky xx

structural75

01-12-2007, 08:02 PM

Hi Celia & Macky,

I am absolutely not going down this road again with you. This is precisely how the first arguement began... you didn't like what I have to say and ..... well the rest was obvious. I'm sorry for getting personal about things, but I was responding to personal attacks that were started by you.

I don't want to waste anyone elses time, nor my own, exchanging words in that way again. Gerbo, Mandy and I were having a discussion... please let us continue without being interrupted with such rude and unproductive remarks.

Neither of you are in any position to question my integrity or previous curvature. I owe you nothing on that matter.

As a professional myself, I would never attempt to evaluate the "tonus" of an individuals tissue from a photograph, nor is the photograph in question of the quality to even try. If you question its legitamacy, contact any of the individuals referenced in the article for more information to satisfy your demands... .

And my deleted personal remarks... as Gerbo suggested to us both early on, I thought it best to eliminate the bulk of "hurtful" and personal remarks that I made in response to yours. I openly said that I was doing it and why... so it wasn't an attempt to whitewash the thread. I thought leaving more objective and non-personal content would be the most appropriate and compasssionate thing to do and I even subtley suggested that you do the same to clear the air. If you feel those remarks of yours are worthwhile to have here then that's your decision... please don't pin that on me.

In the end, I think everyone has had enough and they have all seen that the bulk of the abusive comments were initiated by the two of you... I was just responding (and sincerely wish I had not). This most recent occurrence (just prior to this post) is anther example of your unsolicited abuse. I beg you to please, please stop because it is affecting other people as well.

Kindly,
Structural

Celia Vogel

01-12-2007, 09:28 PM

...Neither of you are in any position to question my integrity or previous curvature. I owe you nothing on that matter....

Of course not, I didn't expect you to. ;)

structural75

01-12-2007, 10:09 PM

Celia,

His shoulders are level in all the pictures! He never had scoliosis to begin with and is simply positioning his hips in such a way to look as though he's in a slant.
Uneven shoulders don't occur in all cases of scoliosis.

I noticed your edit on this post and I just wanted to say that I think accusing that young man of being a fraud is not very kind or appropriate here. It also would imply that all those involved in the article and treatment were also frauds... I can't imagine that those folks would be so monstrous as to do such a thing (seeing that I know David Davis and his efforts are genuine and very personally based).

I was wondering, did you read the article or just look at the pctures? The article referenced a senior practitioner (David Davis) of 25 years who's wife has scoliosis. Why would he lie and create deceit like that?

These are good people, with very good intentions.

structural

macky

01-13-2007, 02:19 AM

OK Structural," you Gerbo and Mandy were having a discussion please let us continue without being interupted by such rude and unproductive remarks."
Sorry ,I thought on this forum anyone was allowed to state their comments in regard to a certain thread, whether to agree or disagree.
Exactly when did they make you a moderator?

As you told me in an earlier post "to keep my place" well I will, and one day you may realise that what I have been trying to get across to you was correct. It is difficult to understand how a person who has scoliosis actually feels, scoliosis that is bad enough to effect their lives that is. We all have different opinions about alternate therapies because of the way they have affected our lives.

But, hey, you know it all, at how old?

Macky

macky

01-13-2007, 02:26 AM

I wont post again, but how your attitude has changed.

"I beg you to please, please stop because it is affecting other people as well"
Such a different tone to a lot of your other posts, making it now look like it has been Celia and I that have been bullies.

Macky

zuma

01-13-2007, 04:46 AM

Hi Everyone

Thanks for those kind words Macky they were truly appreciated. I have been following this thread since it began and only registered a day ago so i did read all the posts in the context they were written

My thoughts are you are all passionate about the subject and all have different ideas on the best approach to either the paticular issues facing you or the diffferent approaches to try and treat this horrible condition we all have. I would'nt try to proffess to be an expert in this field, i was told there is nothing can be done by a so called proffesional so i got on with my life.

If you want my opinion for what its worth (which probably is'nt much) i think we should all take a step back, read the post go away think about the response and then post a reply. I think deep down we all respect one another as if we did'nt we would not be so passionate in our responses

Z

Celia Vogel

01-13-2007, 05:27 AM

Structural,

I can't comment on the intentions of the people who put up that website and of course this is just my very humble opinion, but it doesn't look as though the young man had scoliosis to begin with.

structural75

01-13-2007, 11:11 AM

Macky,
I'm in agreeance with you that it is your right to post your opinion and comments, as it is for everyone here. My tone has changed in that I don't want to be a part of the mud slinging any more. People were hurt by the commetns that we all made, regardless of who initiated... this time I did not initiate them, that I can say with certainty. I'm accepting of the fact that you don't agree, but I don't believe it justifies adding personal insulting remarks. If we want to avoid hurting one anothers feeling and keep this objective, then I see it best to state our cases/beliefs/opinions and leave it at that. I don't appreciate being called a "snake oil salesman", but replying with a hurtful remark will not help the situation.(I know you are not the one who said it). I don't wish to make anyone look like a "bully", the most recent remarks speak for themselves.... I can't help that.?

I asked you to keep your place because you jumped into the conversation with some pretty harsh remarks, even though we hadn't exchanged any words with one another before that. It was in reference to speaking about the 'clinical' aspect of things, of which I think I have a sound ability to do so. If anyone wants to question the info I put forth, that's great... but it isn't fair to discredit clinical information if we don't have the knowledge of it in the first place. You have played a very important role on this forum and hope to see you continue offering your support, compassion and experiences. Please let others do the same in the relevant areas that pertain to them and their experiences.

Celia,
I don't know what to say... really. That link I posted was an article that was published in a national magazine, not a website created by gosh knows who.?? It is true that not everyone with scoliosis presents with uneven shoulders. And I think it's fairly clear from visual analysis alone that he has it, what else would you call a lateral deviation of the spine? I also don't believe that people would write an article on scoliosis with someone who didn't have it. If you're really convince that he didn't have it then I'm sure there is a way to contact him and/or his parents to find out. I'm not sure what else to say about this.

structural

structural75

01-13-2007, 01:07 PM

To Gerbo & all others following the previous discussion,
Just wanted to be clear that we were disussing a type I biomechanic (as Gerbo presented) and corrective approach. Other variations occur, although less common... type II. The one presented by the two of us and the studies were type I.

Thanks.
structural

Bish

01-13-2007, 01:47 PM

Hi Structural,
I do tend to agree that many of your thoughts and theories appear to have much validity. Some of these may be so theoretical that they cannot be proven. This does not mean that they are incorrect, nor correct of course. I do think it is important to think outside the box and I respect that. It is likely a person such as yourself, may one day find the most effective remedy or cure for this disease (condition), call it what you will.
Obviously there is a lot of emotional involvement in discussions on this site, as many peoples lives have been severely affected by this condition. Many people here have spent thousands of dollars, time and emotional investment on various proffessional or psuedo proffessionals proffessing to have the answers but falling short of results. I am sure many have seen these practitioners who have all the jargon down pat and proffess these scientific theories as fact. It sounds great but it has not been proven to work. I am not suggesting this is you, but I am sure you understand why you have a large bullseye on your head in this forum.
I think you are bringing to the table some important thoughts and ideas and encourage your continuing to do so.
In regards to this desire for proof of results that everyone is hitting you up for, it is surely because most of us have have heard the talk alot but have never seen true results. I am not trying to undermine your integrity or intelligence here but If you have true results that you have induced a change in your own condition, or that of your patients, please show us! Do us all a favour! Hell if I had them I would show the world! If it can be proven to have some results I will try SI and if it works I will be eternally greatful to you. All the best, Dave

pamela salmon

01-13-2007, 05:47 PM

I first saw Dr. Deutchman in May of 2006 and my ten-year-old in August. We both had Vestibular testing and I have a Spinecor brace. We did our exercises and used the WVB platform by Soloflex. At our last visit in December of 2006, both of our curves were within normal range and I was pain fee. Before going to Dr. Deutchman, I went to Garden State Spine and Pain. Both Chiropractors there treated me for three years, telling me they were making me better. I had great pain which they relieved for a day or two. They charged me more than my co-pay and had GHI pay their MD. I had great pain for years before going to them. Finally I went to Dr. Deutchman and they refused to ever see me again!

structural75

01-13-2007, 08:25 PM

Hi Dave,
but I am sure you understand why you have a large bullseye on your head in this forum
Thanks for the post Dave. I do indeed understand why I have a bullseye on my head... but what really confuses me is the following.

There have been many a folks on this forum reporting and advocating their use of pt, yoga, pilates and such as an adjunct complimentary treatment for scoliosis. I thought I was just adding SI to the list as another applicable and effective form of treatment (and less commonly known) . I don't recall making any claims about a 'cure' or promising anyone that this was the 'answer' to their situation. None of these other methods have been 'proven' to help scoliosis in studies either. So why the scutiny against SI? SI has been around for 50+ years, and it has shown in studies to have a positive impact on the structural organization and efficiency of the human body, among other things. No ther haven't been studies done specifically in regards to scoliosis yet, but the same is true for those other methods. Also, SI has been shown to remain unparalleled and unequaled in its ability to dramatically alter posture and structure. Now that has predominately been in populations of people without scoliosis, but its relevance and applicability to scoliosis is extremely direct, and has been used as an adjunct to treat scoliosis since its inception. It differs in many ways from other therapies, one being that it works primarily with the fascial network which is responsible in part for the shape and positioning of our structure. Now I'm not saying this to suggest superiority over other methods, but to point out that its primary intention and affect is on the structural orientation of the body and its functional capacities. I think both of those fit very beautifully into the needs of scoliotic individuals, especially ideopathic. Furthermore, there are senior instructors teaching SI courses specifically for addressing scoliosis... Why would they be doing such a thing if it was only 'theoretical' (and possibly 'incorrect')?

I'm not sure how the anatomical/biomechanical info I put forth in previous posts became 'theoretical'. It was a description of positional relationships of the soft tissue in a scoliotic spine... that info is just simple logic and fact. I wasn't suggesting I knew the 'cause' of ideo. scoliosis, just relating how to use that said anatomical reality of the tissue to develop a treatment strategy, manually or otherwise. In fact, that same knowledge is what is informing the good Drs in Montreal and elsewhere as to how to fit the brace on each individual. Essentially working to reverse the scoliotic pattern. The main difference between what they are doing and what SI practioners are doing is that the Drs. use plastic/nylon/elastic braces to attempt to 'force' or move the curve back, and we are using our hands to do it by changing the specific regions of tissue that would enable the same thing to occur. For instance, I have people laying on a specific side in a counter-rotation to the scoliotic one, while I treat the specific tissue that is responsible for the rotation. Does this sound 'theoretical' or 'incorrect'? Results will always vary, and just like bracing, you really don't know how each individual is going to respond to treatment until it actually begins. And if someone were to use any number of complimentary treatments and they functioned better as a result but the curve didn't reduce or stop progressing, does it mean that it is the fault of the treatment or a testament to the tenacity of their case? This happens quite frequently with bracing but people continue their use.... ? Just some thoughts to consider regarding equality in scrutiny.

There's obviously more to it than that, but hopefully that gets the idea across. I think using the brace in combination with a highly specific approach like that could and is in fact very beneficial. I'm not twisting anyones arm to go and do it... that is for others to decide on their own based on further inquiry and desire.

After all, I feel that in order to develop an 'effective' treatment strategy, you have to first understand what is actually going on in the body. That was really my intent in the discussion with Gerbo... I failed to see the reality of biomechanic sense in the theory he proposed because it doesn't jive with what is actually taking place. I'm happy that he's getting results and find some aspects of his treatment strategy important, but I just can't agree with how he's reaching the conclusions.

Long one again, I know.... :o

Kind Regards,
structural

ps- As for the 'proof' of my own case... I have presented folks with things they've asked for in the past and they only return to demand something else... it's never satisfying enough for them. I was even told to ask the Drs. in Montrel themselves... so I did and posted his reply. Even that didn't suffice in the end. Why would I now want to pay to expose myself to more radiation to get a cd, to then upload for everyone to see? I can see the reply already... "How do we know that's your spine?"... I'm not jumping through anymore hoops for anyone, especially this one. I'm happy to answer question if folks have them, or give a reference and such, but otherwise if people aren't willing to do the leg work themselves to find out more,(with all due respect) then maybe they should just walk away from this discussion or topic and leave things at that.

structural75

01-14-2007, 10:57 AM

Hi Gerbo,

Thought you might find this of general interest.

This quote comes from an article in the journal Spine, "Intraoperative Long-Latency Reflex Activity in Idiopathic Scoliosis Demonstrates Abnormal Central Processing, a possible cause of idiopathic scoliosis" by Maguire and others, Spine vol. 18 #12, 1993, pp 1621-26.

"The clinical manifestations of idiopathic scoliosis are well known, yet its causes remain unclear. Several factors have been proposed, including abnormal structural elements of the spine, dysfunctional spinal musculature, genetic factors, alterations of collagen metabolism, and abnormalities of the central nervous system. The most promising investigations appear to implicate the central nervous system, especially those areas involved with postural equilibrium. Spinal cord reflexes play an integral role in the maintenance of posture. These complex polysynaptic segmental reflexes are regulated by a variety of descending suprasegmental systems, by peripheral afferent impulses and within the spinal cord by a network of interneurons and propriospinal neurons."

The article goes on to say that the abovementioned reflex activity can be measured electrically by recording EMG. They studied 37 cases of idiopathic scoliosis and 8 cases of neuromuscular scoliosis (three CP, three muscular dystrophy, and two other neuromuscular disorders) by recording late reflex activity during spinal surgery for correction of scoliosis. What they found was that "long-latency complex polysynaptic activity" was present in all 37 patients with idiopathic scoliosis, and absent in all 8 patients with nonidiopathic scoliosis. (These late reflexes are also unknown in normal subjects).

In other words, when you stimulate a nerve in the leg, you can record electrical responses from a muscle in the leg. You get an early response, say 5 milliseconds, by direct stimulation, and around 35 ms you get some later responses called H-reflexes and F-waves, which involve an impulse first going to the spinal cord and then bouncing back down the same nerve, or being relayed through a reflex arc in the spinal cord. In these idiopathic scoliosis patients ONLY, there are late responses ranging from 20 -243 ms in latency and lasting up to 4 seconds. It sounds to me like a ringing effect, a failure of damping. It's like a car with bad shocks, bouncing up and down long after you hit the bump, when the bouncing should have damped out quickly.

Possibly showing that many of the 'exercise' methods being used (torsorotations, pilates, yoga, pt, swimming, etc.) are actually achieving their affect through re-coordination/synchronization of proprioceptive capacities of the nervous system via movement, more-so than through "strengthening" of muscles... which would be an inevitable by-product of these activities anyway in any individual. Just another thought to ponder... :) . It could be quite likely that we're overlooking the primary affect of these exercises and only seeing their secondary effect... which is sometimes the case in 'studies' because in order to do a study we have to first create a hypothesis... ask ourselves a question about a specific variable and leave the rest in the shadows.

Regards,
structural

Bish

01-14-2007, 03:30 PM

Hi Structural,

You stated you haven't made any claims about SI's success with scoliosis but didn't you say you eliminated your own scoliosis? And for your info, I am as scheptical about other treatment programs as well. If I were not I would be running all over the country spending money and time chasing pipe dreams. I have to ask for proof of some kind! I have heard lots of people on this forum saying swimming or yoga or whatever worked for pain relief for them............. prior to their operation. So I can only guess it did not affect the curve proggression.

You also mentioned some SI practitioners specifically working with scoliosis patients, but in my eyes this does not validate its success.Evidence would validate its success. I am sure you would agree that a surgeon who is a scoliosis "specialist" is not even headed in the right direction as far as a "cure".

Also as far as the many "facts" you have presented in regards to biomechanics etc., There application to scoliosis remains theoretical until we can prove otherwise.

In regards to your not wanting further Xrays, my hope would be that you would reconsider. If you can validate it you would confirm you are a walking medical miracle. Honestly,I hope it is true. One Xray could give scientific validity to SI's application in scoliosis. Not only that you wouldn't have to argue with everyone! You could be doing the world a service and increase your business. I spoke to a radiologist in my area that has been doing it for 20 plus years. He said he has never seen an adult seek treatment and end up with a reduced curvature. This does not mean it didn't happen of course, but I thought it was interesting.
Anyways all the best, Dave

P.S If I wanted to give it a shot (SI) who or what would I look for in a practitioner.

structural75

01-14-2007, 06:15 PM

Hey Dave,

Thanks again Dave... I do appreciate your comments and I understand where you're coming from. And just so you know, I really don't want, nor am I looking for, more business from being on here. I initially came here to share my experiences both professionally and personally. No agendas.

I don't recall making any claims about a 'cure' or promising anyone that this was the 'answer' to their situation.
To clarify, this was what I had said regarding 'claims'. I simply stated that it has been shown to be clinically effective(whether effective meant slowing the progression, stopping it, or reducing it to some degree). Which I feel warrants inquiry or exploration for others, depending on the aetiology of their specific case. If others dom't feel that is warranting enough, that's OK by me... it's your decision ... I'm just here sharing experience, which is also valid whether I post pictures or not. Surely many would reply, as they have before, that 'one' case is not suffice... they want studies... so why bother, really? Also, I didn't claim it would reduce an adults scoliosis... that would more likely apply to younger folks.

The bottom line is that I don't have visual documentation to show you, as I don't go around collecting photographs or x-rays from clients around the world, nor do I take pctures of my clients personally because then I would be placing the emphasis on how they looked rather than how they felt/functioned.. I leave that to the Drs and proper x-rays. I admit, this is a major obstacle in the path of those trying to spread the word about the work. In the meanwhile, I'll keep working with my clients, and folks here can keep searching... .

My understanding of the non-surgical threads here is that it is a place for therapies that assist in the treatment of scoliosis, I didn't realize that there was a gauntlet one must pass before sharing useful information on the matter. And if there was, I think I've presented enough sound clinical reasoning to pass.
Also as far as the many "facts" you have presented in regards to biomechanics etc., There application to scoliosis remains theoretical until we can prove otherwise.
Dave, come on now... Unless someone here can prove that those 'facts' on biomechanics are incorrect, then I think they sit on solid ground. Again, they are objective observations on the positional relationships of muscles/tissue in a scoliotic spine... and those relationships must and do in fact change for a curve to reduce as in both sugery and bracing alike. Those two methods force the change, other approaches work more gently and dynamically to invite and encourage the change (communicate with the nervous system). That biomechanic premise is currently being used in the spinecor brace... The Drs. assess the same thing that I was describing and then fit the brace in a manner to counter those forces arising from the tissues. The main differences are 1)duration of treatment (the brace is worn for many, many hours/days/weeks/months vs. manual treatment lasting for short intervals of time) and 2) the tool applied to the body (plastic/elastic/nylon vs. human hand) and 3) specificity (bracing is generalized and non-receptive, as the vector of forces applied can potentially deviate, as is the case when the 'phantom' secondary curves arise out of nowhere - manual approach is highly specific in its intention and location of work performed, also receptive to the tissue). They are both doing the exact same thing, although the manual approach also works extensively with tissue strain patterns within the legs, up into the pelvis and so forth. I think they make for an intelligent and effective combination... but that's just my experiences... no studies for you at this point.

I have at least put forth sound logic and fact (biomechanical) to support the method I was suggesting, and even others as well. It was my intent to not make claims about somethings usefulness (in whatever sense of the word) without a solid bases of factual, anatomical, clinical reasoning. I think that's deserving of some degree of respect or credibility. Bracing works on a similar premise, it's just an approach that maintains constant force in opposition to the curve with hopes that the soft tissue will yield enough to produce desirable and effective results.

I guess I got carried away with the 'anatomy lesson' and so forth because my concern is that people will hear that "strengthening" the concave side is beneficial and turn around and go to pilates class, lay on their side over the barral and start doing side body 'crunches' to try and "strengthen" the concavity. This would be an incredibly detrimental and unfortunate misunderstanding of the 'studies' findings and will certainly make things worse.

There's probably not much more to say on this matter... thanks for the dialogue.

best regards,
structural
ps- If I presented pictures/evidence then I would be emphasising a false pretense that SI will reduce all ideopathic curvatures in children and adolescents. That is not my stance, intention or desire...
Evidence would validate its success Wasn't the article I referenced evident of its potential and reality of claims? I don't understand???