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gerbo
07-10-2007, 03:58 AM
http://www.scoliosisjournal.com/content/2/1/9

This article is of some interest as it confirms the possible contribution of muscle asymetry in the etiology of scoliosis. No, lets be clear, it confirms the existence of a muscle asymetry, with a weakness of rotation towards the concave side confirmed. It is other studies (the Vert Mooney studies, which I quoted before http://www.medxonline.com/downloads/articles/measuredresistanceinscoliosis.pdf) which suggest that dealing with this assymetry (torsorotation exercises) can help to stabilise a curve.

some observations;1) it is suggested that the assymetry could (additionally?) be due to nonmuscular factors (soft tissue, bone, ligament deformity) and indeed I have often wondered whether the observed improvements could be due to the improved flexibility of the spine as a result of the very specific exercises, rather than the equalising of muscle strength

2) it is good to see that attempts are made to increase our understanding of the condition and the various factors contributing to it

3)despite celia's cynism about financial motivations of surgeons; Marc Asher is a spinal surgeon with a large stake in a company producing implants, but still he is looking at possibilities to deal with scoliosis in a non surgical fashion

Celia
07-10-2007, 01:40 PM
....despite celia's cynism about financial motivations of surgeons; Marc Asher is a spinal surgeon with a large stake in a company producing implants, but still he is looking at possibilities to deal with scoliosis in a non surgical fashion


:o :o :o How pray tell did I get into this discussion????! LOL!!!! I have never accused Dr. Asher of being financially motivated. It was with a very heavy heart that I reported doctors might be financially motivated based on *my* observations.

RugbyLaura
07-10-2007, 02:33 PM
Oh dear, I wish I understood these things better :confused: Is it a sort of chicken & egg senario? Did the muscle asymmetry cause the scoliosis or was it the opposite? Either way, will strengthening the weaker muscles help? Surely it can do no harm.... I'd like to hibernate (with Imogen) for 50 years and wake up when there is an answer. Mind you, who knows what state the world will be in by then?

Re the doctors alleged motivation.... whilst their true calling is, I am sure, driven by altruism I expect there is some money in the budget for research. Imagine the fame & fortune to be gained through finding a "cure"! ;)

Laura

gerbo
07-11-2007, 02:44 AM
celia, as you know, it was a bit of a "tonque in cheek" remark. Still; mr asher would loose a considerable source of income if he would "discover" an efficient non-surgical way of treating scoliosis. (not that i think he will, at most this is just a small part of the jigsaw)

laura; the correct question would be (as nobody can answer the question as you put it); does the muscle asymmetry serve to stabilise the curve, or could it contribute to it getting worse?? I believe it is the latter, specially as both dr mooney and dr asher have shown (in a small group of patients admittingly, so results need to be looked at with lots of care) that treating the inbalance (strengthening the weaker side) appears to be preventing progression.

structural75
07-11-2007, 02:02 PM
I realize, as you put it, that there is no definitve answer to the question as Laura asked... however there were a couple of thoughts I had in regards to it.

Still; mr asher would loose a considerable source of income if he would "discover" an efficient non-surgical way of treating scoliosis.As would many, many Drs if they chose to consider things that already exist. ;)


laura; the correct question would be (as nobody can answer the question as you put it); does the muscle asymmetry serve to stabilise the curve, or could it contribute to it getting worse?? I believe it is the latter, specially as both dr mooney and dr asher have shown (in a small group of patients admittingly, so results need to be looked at with lots of care) that treating the inbalance (strengthening the weaker side) appears to be preventing progression.

As a generalization, I believe it is actually the asymmetry in muscular tonus that is preventing the curve from worsening, at least at a faster rate... as the bodies own self-regulatory/adaptive and autonomic response to the lateral deviation. If you were to examine the anatomy and function of the soft-tissue/muscular region in question here it is very clear that if both sides, concave and convex, maintained the same tonus levels then the spine would be drawn further to the concave side... because it not only has the hypothetical 'balanced' tonus to match the convex side, but it also has the ever present force of gravity acting downward on it... and we all know that when something leans off-center from a vertical plum with gravity it incurs forces that will continue to push it in that direction... i.e. - gravity.

And keep in mind that the muscles on the concave side of the curve act to 1) extend the spine 2)rotate the spine 3) bend the spine to the same side they are located on. This last one is very important here. If you increase the tonus (i.e. - force of pull within the muscle) of the muscles on the concave side, you will encourage further side bending to that side... i.e. - Increase the concavity.

In scoliosis you will always find an uneven tonus in the muscles along the spine, left vs. right. As a curve progresses that tonus discrepancy will usually increase.. I'd love to see a study documenting that correlation. It is a functional response of our nervous system to slow or stop the curvature as best it can on its own. Conversely, as a curve is 'straightened' you will see the tonus between the two sides begin to equalize again as it becomes more appropriate and functional to do so. A slight bend of the spine will permit a more balnced tonus to exist without detriment moreso than a more moderate or severe bend would. As the moderate/severe bend does not want the concave musclature 'toning up' or else it would draw the spine further into the bend... as that is the action of those muscles on that side.


Either way, will strengthening the weaker muscles help? Surely it can do no harm.... Please don't assume that... I mean this sincerely. It certainly could cause more harm if not properly understood. If someone began doing sideways sit-ups (laying on the side and lifting the torso off the floor) on the concave side of their curvature because they 'heard'/'believed' it was weaker after reading one of these studies... they will surely make matters worse.

So I think a big concern I have in these studies thus far is that they are inconclusive as to the actual reason behind the increase of tonus on the concave side corresponding with a reduction/stability of the curve. All they show is that by doing torsorotation exercises the curve may stabilize/reduce and tonus on the concavity side increases. It doesn't show at all that the reason for these results is due to a strengthening of the concave muscles, but rather just that it is a consequence of the actions performed... which is also somewhat obvious that muscles being utilized during torsorotations are going to increase in physiologic strength... that's kind of a no-brainer, pardon the sarcasm.

This brings me to one of Gerbo's points:

some observations;1) it is suggested that the assymetry could (additionally?) be due to nonmuscular factors (soft tissue, bone, ligament deformity) and indeed I have often wondered whether the observed improvements could be due to the improved flexibility of the spine as a result of the very specific exercises, rather than the equalising of muscle strength
I strongly agree with Gerbo's suspicions/theory here. By doing torsorotations one is inevitably creating length and mobility where it is limited, thereby getting length in the concave soft-tissue/etc. and ultimately reducing/slowing/stopping the curvature.... thereby allowing for a change in tonus of said musculature.

Sorry to make this another one of my usual long-winded repplies... but it really pains me to think that someone might go out and start 'strengthening' the cancavity of their curve only to learn the hard way that maybe these inconclusive studies are being misinterpreted.

Aside from my genuine concerns about the interpretation of these studies, I do agree that it's good that people are looking into other factors involved with this condition.

RugbyLaura
07-11-2007, 03:29 PM
Thank you, Structural, for your reply. It was only long winded because it needed to be :) Unfortunately I only understood about half of it :confused: I think I need a PowerPoint presentation :D

The message I got was "leave it to the professionals". In my daughter's case the professionals (for once it seems) agree; sadly they agree that she will need fusion one day, it's just a matter of time & trying to hold the curve until she's grown as much as possible. Occasionally I find myself clutching at straws and/or being seduced by new possibilities.....

Thanks again,

Laura
ps Gerbo, how did it go today?

structural75
07-11-2007, 09:58 PM
In contrast, female adolescents with idiopathic scoliosis in
the current study showed significant weakness in the neutral position and the two pre-rotated
positions to the concavity in comparison to the mirror trunk position. Although the strength
asymmetry could be the result of either weaker concave side or stronger convex side, the
comparison between healthy female adolescents and the scoliotic patients showed weakness
associated with idiopathic scoliosis in low force contractions to the concave/left sides, but no
difference between two groups to the convex/right sides. After reading this study in its entirety, I did not find ANY conclusions or statements drawn about the "concave side being weaker"... only that rotation "towards" the concave side was weaker, ...which is very different in that the muscles responsible for rotation toward the CONCAVE side lay on the CONVEX side of the spine with the exception of the internal obliques (which again, if you "strengthened would result in making the concavity worse). Meaning that the convex musculature would possibly be the "weak" culprits, not the concave side musculature as has been suggested. Or that the chronic shortening of the tissues on the concaved side (thus inducing the sidebend and rotation) is providing excessive resistance against the rotation to the concavity (as that tissue needs to lengthen and release for the rotation to occur).

I realize that it is the 'other' studies that suggest 'strengthening' the concave side to address this asymmetry, but that does not correspond with the findings of this study... Which merely points out the weakness "towards" the concavity, not within the concaved side itself.

I do agree with the other studies in that strengthening towards the concave side would be very useful, but not strengthening the concave side itself.

So again, misinterpreting or misunderstanding the conclusions of this and other studies could be very detrimental. I think Laura put it best, "leave it to the professionals". And even then, get a second and third opinion. ;)

p.s. - Laura, sorry for the added confusion... I know that probably didn't help matters.

Bish
07-12-2007, 12:17 AM
For once structural I think I may agree with you. There was a lot of focus on right torso rotation when i went to the clear institute. I think it's bologna. As a matter of fact i think it could do damage. I have a right thoracic, left lumbar curve and I get alot of pain in between the curves in my spine. I think right torso rotation could be contributing to an already existing hyperextension in the spine due to the curve/rotation.
As far as attaining muscle symmetry to obtain correction, I think it is the exact opposite. I also believe muscle assymetry is a reaction to the curve. I think if your spine is curved you WANT muscle asymmetry to better support your spine. Assuming that is i geuss, your curve is structurally related instead of a RESULT of muscle asymmetry, although this type of scoliosis seems far and few between. Here is a strange thought/ theory. Most people are of the premise that we want to develop the weaker side.(Which appears not to work) How about concentrating on developing the over developed compensatory muscles to help push the spine back. If and when that happens, the weaker side will begin to take over as a reaction to the spine being straighter.
The crappy thing is the more I get to know, the less it seems I know what to do! Bish

structural75
07-12-2007, 07:10 AM
Dave,
Thank goodness... I don't think I have the energy for another debate.

I have always wondered how the torsorotation exercises are addressing the two rotations in an S curve.??? Where the lower curve rotates one direction and the upper curve rotates the opposite way to counter it. How do the torsorotations isolate each of these opposing rotations? Do you do them to one direction? How do you only rotate the thoracic spine for instance without rotating the lower spine and feed into its rotation? It seems this would be very difficult, if not impossible to do on the machine.

I would tend to think the torsorotations would only be applicable for C curve type scoliosis (single curve, thus single rotation)... for that reason.

Since you have direct experience, what are your thoughts/experience on this?
Structural

trcylynn
07-12-2007, 01:22 PM
I'm a little confused as well. This article/study was measuring/studying rotation- as in the rib/hump problem/feature of scoliosis correct?

Also (sorry if I mis-quote) what did you mean by not strengthening the concave muscles themselves but the ones that support it or push it (again sorry for the mis-quote).

So if I have a left lumbar curve (as in when I bend over and you look at my back you see a "c") and rotation to the right (as in my right ribs stick out further then my left) what exercises would be appropriate. I was under the same theory that strengthening my right side of my back would help. I can tell my muscles are imbalanced because I am constantly working my left side (I flex my left side inward all day so that you cannot tell how bad my curve is). When looking at my back you can see muscle definition on the left and flab/skin on the right. I used to do plank positions (for the abs/obliques) on my right side (so that I would flex my right as I do my left) but from what I read I'm understanding that this could actually be worsening the curve?

I also try to do back extensions and back exercises because I notice it helps with the pain. But lately I've noticed any time I do a back extension or try to work my lower back my left muscles take over and my right muscles do not work as hard- is there a way to focus on the right? should I focus on the right?

I am thoroughly confused.

Thanks,
Tracy

structural75
07-12-2007, 08:03 PM
Hi Tracy,

I'm a little confused as well. This article/study was measuring/studying rotation- as in the rib/hump problem/feature of scoliosis correct?No, it was using EMG to test the strength of the muscles during rotation. It wasn't measuring rib hump/rotational degrees... it gave the degree of rotation as markers for the starting and ending position of the movements.


Also (sorry if I mis-quote) what did you mean by not strengthening the concave muscles themselves but the ones that support it or push it (again sorry for the mis-quote).The muscles on the concave side of the spine are not the ones that rotate the spine to that side... The muscles on the convex side actually rotate the spine toward the concave side. So in your case for instance, the muscles on the right side of your lumbar spine (the concave side) are actually shortened to begin with and lacking tonus. They cannot contract much further and if they did they would pull your spine into further rotation and sidebending alike... making the curve/rotation worse.

The muscles on the convex side (left) are hypertonic (more toned/stronger) because they are working very hard to resist further sidebending to the right and fighting the rotation to the left as well. So you would first need to begin lengthening the right side so that the spine can come out of its sidebending and rotation as well as strengthen the left side more to assist that process. Over time the right side which has shortened soft tissues and less active will become more active as the spine lengthens/straightens (this is the premise, not everyone can achieve correction as we know. But utilizing this premise/fact will certainly work in your favor to slow, stop or reduce the curve.)

I hope that doesn't confuse you more. A lot of the soft tissue patterns in scoliosis are counter-intuitive... which is what makes it a challenge to understand and treat effectively.

I realize that you notice the overdevelopment of the left side but that has to be that way in order to prevent the spine from getting worse. You're also noticing a hump and the appearance of more muscle because the transverse process of the vertabrae (bony part that sticks out to the sides) are being moved posterior/back on the left due to the rotation... and forward/anterior on the right, causing the appearance of less musculature or a 'sunken' region.

I also try to do back extensions and back exercises because I notice it helps with the pain. But lately I've noticed any time I do a back extension or try to work my lower back my left muscles take over and my right muscles do not work as hard- is there a way to focus on the right? should I focus on the right?Stop focusing on strengthening the right side. It will only make matters worse. Those muscles are inactive for a reason. Again, you're fighting your bodies functional response to the scoliosis... What you want to do is focus on lengthening the right side... open it up... stretch it. Do rotations to the right in the lower spine (i.e. - sit on a chair or the floor and rotate right looking over your right shoulder... reach your left arm across your body in the front and hold onto the outside of your right knee.) Something like that would be far more beneficial than side plank on the right... strengthening the right, etc.... .

Don't get discouraged... it's easy to misunderstand these things... and I know it's even more difficult when you read studies like this and they get misinterpreted/misunderstood... Dealing with this condition takes more knowledge than just reading and analyzing studies... they're useful but it's a god example of the fact that one needs to know far more than what the 'conclusions' are saying. This is not something that I feel should be managed without proper guidance from not just an educated Dr./PT/Physio?whatever... but an exceptional one.

I give you a lot of credit Tracy for being so proactive and motivated to help yourself.. Please don't get discouraged by this... just try and get some really great guidance to move forward. I support your efforts 100%.

Kindly
Structural

Bish
07-12-2007, 08:35 PM
Well I am not 100% sure but I think the premise is this. If I am right thoracic and left lumbar and was perscibed a right torso rotation (with focus on full extension right with resistance), my thoughts would be that the rotation would have a positive effect on the left lumbar and a negative on the right thoracic, because you are rotating in the direction of the existing rotation. But! I think with the thoracic vertabrae having limited mobility because your ribcage is attached, the hard right rotation may be acting against the distortion of the vertebrae in relation to the ribs,and the attempt is to re-align the two. I think it doesn't work because that stress is taken up in the vertebrae in between the two curves. That's my geuss but what do I know. Hahah! Dave

structural75
07-13-2007, 06:02 AM
Dave,
Not much time to reply, but... The thoracic spine, despite the ribs being attached, has much more range of motion in rotation than the lumbars do. This is dictated by the angulation of the facets in the respective regions. The lumbar spine facets are angled in the sagital plane which allows for greater range of motion in flexion and extension whereas the thoracic facets are angled more in the coronal plane which permits a lot of rotation.

Doing the torso rotations to the right would positively influence the left lumbar curve but, as you said, negatively influence the thoracic... And because more rotation takes place in the thoracic, the rotations will more likely be taking place there before the lumbars move.

trcylynn
07-13-2007, 10:34 AM
Thanks Structural,

I have a few more questions.

I visited the specialist yesterday to go over my MRI films (and ask questions I forgot to ask the first time). My 3rd to last disc (before the sacrum bones?) is degenerative. He said the rest of my spine looks ok. He also said my rotation is more severe than my curve. Is that normal? I thought the rotation occured because of the lateral curve but if my rotation is more severe how did that happen?- well maybe not how did it happen but is it common?

I have an appointment with a PT next week. I just recently moved to this area but the PT came recommended from my doctor who is said to be one of the best. (maybe everyone says that though).

Is there something I should look for/watch out for with the PT to evaluate how much he/she really knows? I don't have to commit to this PT and can choose someone else but I don't know who else I would go to.

As far as doing things on my own- Yoga to help stretch/lengthen and rotation (I believe there are some twist poses I have from yoga as well) but focus more so turning/twisting to the right than the left correct?

Thanks again for the help/advice.

~Tracy

structural75
07-14-2007, 02:31 PM
Tracy,

He said the rest of my spine looks ok. He also said my rotation is more severe than my curve. Is that normal? I thought the rotation occured because of the lateral curve but if my rotation is more severe how did that happen?- well maybe not how did it happen but is it common?Yes, that's easily a possibility. Rotation is coupled with sidebending/lateral flexion of the spine but it isn't necessarily proportionate to the bend. In fact, one can have what is called a roto-scoliosis in which there are minor bends coupled with moderate to severe rotations... in those cases the rotations are the most important issue to address. Often you'll see rotations increase as the bends decrease from correction (usually bracing)... This is in large part due to the fact that the soft-tissue restrictions involved holding the spine in the bend are not specifically addressed with a brace and therefor as the spine attempts to straighten out from the bracing forces the restriction in the soft-tissue remains but simply changes its effect on the spinal mechanics... causing a rotation because it is still shortened asymmetrically despite the lessening of the curve.

Also keep in mind that the spine can rotate purely by itself, without bending.


Is there something I should look for/watch out for with the PT to evaluate how much he/she really knows? I don't have to commit to this PT and can choose someone else but I don't know who else I would go to.
You'll have to prepare your questions in advance and be weary if their only approach is to "strengthen" the spine/abdomen. This is not a customized and adequate approach, it's the generic PT type of protocol... Look for one, if need be, who integrates and impliments strength, stretching, balance/coordination type work, proprioceptive activities... etc. The work you do should also be asymmetric, if you find yourself doing exercises that don't speak more to one side or area more than another then ask them why they're not doing it differently. Keep in mind, not everything will entail asymmetric work, but some of it certainly should.

Hope that helps somewhat,...it's difficult and questionable for me to give any specific advice to your particular situation over the internet... This is obviously not the appropriate place for treatment. Just be sure to ask questions when you have them and don't be afraid to question something if it doesn't feel right or make sense to you... You are in charge of your body and you have the right to know and understand why you're doing things.

Best to you,
structural

structural75
07-17-2007, 07:06 AM
The rotations in the spine comes from the lack of tension in both side of the spinal rotators , the paraspinales , ileocostalis muscles. Both sides are weaker. The diaphragm muscle also contributes to expand your concaves area specially in the transcitional vertebraes at level lumbar 1 and 2 .For rotation to occur there must be a difference in tension, unequal, from left to right sides. Whether they are weak or not is usually a secondary functional response, unless the scoliosis is caused by a neurologic deficit of the CNS. If both sides had "lack of tension" equally then it would result in fexion of that portion of the spine. So there is always a disproportionate value of strength/potential in the case of a fixed rotation... one could say they are both weaker but it is the relative relationship that is important here. Also the multifidi and rotatores are significant in this scenario, moreso than the phasic 'movers' of the spine iliocostalis, longissimus, spinalis (superficial paraspinals). They need to be addressed as well but the postural holding of the curve is coming from these deeper more intrinsic slow twitch muscles. The others mentioned are responsible for gross movement while these deeper layers stabilize the vertabrae during the movement.. they also are most influential on the static postural stabilization of the spine - i.e. 'holding the curve'. So you can force correction focusing on these phasic, rather than tonic, muscles... but you also need to get change/length in the deeper tonic ones to have the greatest effect and stability.

BETall, I noticed you are frequently following up my posts with recommendations to Scroth.... I don't mind at all, but are you in disagreement with my recommendations/opinions? Are you a Scroth PT?

Best,
structural

Rayknox
07-17-2007, 09:47 AM
structural,
Whose theory is this?
So if your bicep is stronger than your tricep you have to strengthen your tricep to get a straight arm?

structural75
07-17-2007, 08:45 PM
Ray,
"Whose theory is this?" ... Do you mean mine or the others regarding strengthening? I'm not sure I understand what you're asking... 'My theory', which is hardly my own theory but more a concept and principle thing based on anatomy and biomechanics utilized by many other folks, is to essentially add length/balance to the spine/body before worrying about strength discrepancies. So to your question on the biceps being stronger, we'll also assume it's shorter in relative length as well causing the elbow to chronically be flexed, I personally would lengthen the biceps to create balnced tension across the elbow joint.

What others have put forth, and what you commonly hear with a PT approach is to strengthen the "weak" muscles. What we're not understanding is that the "weak" muscles are weak for a very functional reason. So the question to ask ourselves is: Is strengthening the "weak" muscles beneficial or harmful, or inconsequential?

RugbyLaura
07-18-2007, 01:08 AM
Hi Guys,

Does anyone here have anything to say regarding inversion tables? (see adolescent / other thread).

Thank you,

Laura

Bish
07-18-2007, 01:30 AM
Well I am sure a couple of others will have something to say, but here is my two cents regarding inversion machines. I did have one but it was taking up too much space so I got rid of it.I still do have gravity boots but they are trickier. It gave me limited very temporary pain relief. The theory I have heard floating around as to why it would not be of value in a scoliosis patient, is that a patient with scoliosis generally will have a reduced natural sideways curvature (kyphosis and lordosis) due to (or maybe even a cause of) the lateral curvature in the spine. If the spines natural curvature is already reduced, how can agressive traction only positively effect the lateral curve and not the natural curve of the spine?This is the question. Also there appears to be little or no scientific evidence suggesting it can do anything in a scoliotic patient. Of course knowing that I tried it myself. Hahah.What the heck, go to the store and try it out in the showroom once a day for a week. See if you can get the salespeople all wound up. Best of luck. Bish

RugbyLaura
07-18-2007, 04:07 AM
Thanks Bish, do you mind if I copy this onto the other thread?

Laura

Rayknox
07-18-2007, 08:41 AM
structural,
I need to get you a copy of the reasoning behind the TAMARS treatment. It used to be on the web but I would need to search again for it. I do have hard copy and I can get that if need be. It makes much more sense than the PT approach about muscle imbalance etc. I am not going to start another war with other practitioners as that is all these forums seem to be, but you will find this approach very refreshing.
ray

structural75
07-18-2007, 09:04 AM
Laura,
I would agree with Bish on the inversions table use. It will not only affect the lateral curvature (temporarily) but also the primary and secondary curves of the spine (kyphosis and lordosis). Some people have found it to be relieving of their discomforts temporarily and others not. People have to judge its benefit individually.

This is something to check with your doctor about if one were to think of using it as it should not be used by people with certain conditions that sometimes accompany scoliosis (chiari, etc.).

It may be useful for general decompression of the spine, specifically the assisted rehydration of the discs. But be aware that it is a general affect and that it may place strain on other regions of the spine/pelvis (sacroiliac joints/or hips, knees ankles.

It probably won't do anything in the long-run for the scoliosis, but for some it may help manage some degree of their pain they experience throughout the day. It could possibly also slow any degenerative disc scenarios, but of course that's hard to quantify as is most 'preventative' measures/disciplines.

Final thoughts, use with caution and individual discretion... inversion tables are not for everyone.

Hope that helps in some way.
structural

gerbo
07-18-2007, 10:01 AM
my "feeling" is that loss of flexibility of the spine, which inevitably must be happening when scoliosis develops, is not a good thing and counterproductive and gentle stretching (by trained professionals I hasten to add) might just help the spine to respond better to the corrective forces provided by a brace. One wonders whether the mild (??) traction provided through an inversion table would have a similar beneficial effect. Traction before a brace is applied, to obtain optimum correction, is not an unusual practice, principle seems the same to me.

structural75
07-18-2007, 11:01 AM
The effect of traction is reversed once we resume our normal upright stance in gravity. To have a positive long-term effect with or without bracing it would have to be utilized every day. And because it is a generalized approach, it difficult to predict or know whether the areas that need the lengthening are being targeted or if it is also lengthening the already overstretched areas. The latter is quite likely as those areas often prove to be less resistant to the stretching forces... the areas that need it most are often very stubborn and have developed a 'stronger' resistance/hold against such forces.

Scoliosis definitely can create a loss of flexibility... but I do feel that it isn't the overall flexibility that is of utmost importance but the mobility/flexibility/balance of tension between the left/right and fron/back, etc. ....There are specific regions that need to be brought into or toward relative balnce/length with the opposing overstretched regions.

Of course, all of this is also just a mechanical/static pitcure and approach... inversion tables that is. One must affect change in the nervous systems function through active movement to re-educate the sysytem and develop new firing patterns and such. If you simply invert on a table you're doing nothing to achieve this... It is also limited in that we don't function, neurologically speaking, upside down... so there's no proprioceptive benefit from being invertd that can be transfered to standing on our feet in the upright position, orienting to gravity neurologically.

I think the computerized traction tables (horizontal) would provide the most benefit because the forces involved are monitored very specifically. Whereas the force provided on an inversion table is essentially ones body weight and traction is occuring from the ankles on up... vs. the traction tables which have one strapped in at the pelvis and particular points around the torso, which enable it to limit the traction effect to the spine alone.

Just my thoughts...
structural

gerbo
07-18-2007, 12:29 PM
I am sure Structural that you agree that one approach doesn't exclude the other. Personally I believe that where it might well be the kind of factors which you describe which play a big part in the development of scoliosis, but by the time the scoliosis has become apparant and noticable it could well be that it is very localised and maybe even pure mechanical factors which prevent the spine from straightening again, even resisting the rather brute force of a brace. I am quite sure (but anybody, feel free to correct me)that spinal surgeons need to cut some of the connective tissue/ ligaments surrounding the spine prior to inserting metalwork, in order to straighten the spine out enough. I'd imagine that similar structures could well be preventing the spine from straightening through conservative means, and what follows would be that active attempts to increase the flexibility of the structures involved must be beneficial, if only to give the balancing out/ neurological reprogramming you advocate, a chance to succeed. The consensus seems to be; the more flexible the spine, the more chance there is that any given treatment will be succesful, ergo; increasing flexibility must be a valid part of treatment.

with regards to the inversiontable, and this is me arguing purely theoretically, if traction is considered beneficial, and considering we do not all have access to computerised traction tables; it might just provide us with an easily available and applicable "do it yourself" version.

anyway, our new osteopath will discuss this with some of her "seniors" (professors from osteopath-school), I'll be awaiting her opinion with interest

(structural; aren't we having a lovely civilised discussion ;) ;) )

structural75
07-18-2007, 12:48 PM
Gerbo,
Indeed we are. ;)

I think I'm in agreeance with you here Gerbo... I didn't mean for my previous post to suggest that inversion tables had no benefit.. in fact I'm pretty certain I didn't suggest that. I was only pointing out some of the 'finer' points of its use, to suggest that it is not applicable to everyone, and of course, effects will vary from one person to the next.

I only mentioned the computerized version as it is much more precise and controlable. I have no biased on which one someone uses (obviously the computerized table treatment is administered by a doctor, not something you buy for home use).

Personally I believe that where it might well be the kind of factors which you describe which play a big part in the development of scoliosis, but by the time the scoliosis has become apparant and noticable it could well be that it is very localised and maybe even pure mechanical factors which prevent the spine from straightening again, even resisting the rather brute force of a brace.With you completely on that Gerbo. That was what I was getting at by commenting on the "specific" areas of restriction. The more specific one can be at freeing these regions up, the more likely the success of treatments being utilized. The neurologic component that I was "advocating" had to do with micromovements while these regions were being 'freed, lengthened, stretched'... activating/de-activating regions neurologically while you're encouraging effects... through whatever means. So I agree 100%, flexibility is of utmost importance in any treatment, and the more precisely you can work with the flexibility of specific regions the better. :)

gerbo
07-18-2007, 05:38 PM
you should have said that in the first place :D

oh no, agreement reached, no more heated discussions, no more arguments, no more fights, what will become of us?? :D :D

RugbyLaura
07-19-2007, 01:33 AM
Surely this must mean that rigid bracing is anti-productive? :eek:

Nice to see everyone getting on so well. Hopefully this will continue even when you next disagree :p

Laura

gerbo
07-19-2007, 02:16 AM
i think it means that rigid bracing is likely to be more effective if attention is paid to these factors and that active measures are taken to maintain/ increase flexibility and musclestrength and coordination. Just bracing and nothing else (as seems to be common practice in the UK) is less likely to be effective.

Rayknox
07-19-2007, 08:55 AM
structural
quote
'The more specific one can be at freeing these regions up, the more likely the success of treatments being utilized. The neurologic component that I was "advocating" had to do with micromovements while these regions were being 'freed, lengthened, stretched'... activating/de-activating regions neurologically while you're encouraging effects... through whatever means. So I agree 100%, flexibility is of utmost importance in any treatment, and the more precisely you can work with the flexibility of specific regions the better.'


You are describing TAMARS treatment.!!

gerbo
07-19-2007, 09:25 AM
note to myself; ask "our" osteopath what she knows about TAMARS.

whatishappening
08-19-2011, 08:34 PM
.......
What others have put forth, and what you commonly hear with a PT approach is to strengthen the "weak" muscles. What we're not understanding is that the "weak" muscles are weak for a very functional reason. So the question to ask ourselves is: Is strengthening the "weak" muscles beneficial or harmful, or inconsequential?

Hello, I am new here. I would very much appreciate a continuation of this concept. I am not very knowlegable about this but I will add my 2 small cents.

I have recently discovered that I have scoliosis. Ofcourse the PT's are focusing on muscle balance- but long before I read this thread I was wondering about this equalization concept myself.


For one thing, how can muscle strength be adequately compared side to side side the spine is rotated?
What about mechanical advantage and it's influence of the apparent muscle strength?

For example, one of my shoulders is displaced backwards so in testing external rotational strength- how should the shoulders be positioned? Similarly, my pelvis is rotated to the left, so in testing side-lying hip abduction, how should my pelvis be placed? My left hip abductor shows to be weaker but maybe that is helping to counteract the rotation, not cause it- weak hip abductors will allow for pronation which will counteract the spinal rotation. Or is it vice versa-

I also read previously noted in this thread that the (left) external obliques are responisble for both lateral flexion and rotation to the opposite side and I have worried about that. Bad combination maybe?

The Pt's I have tried to discuss this with seem to close their ears and just say you can't go wrong with symmetry,and it is obvious to me that they just don't want to think about it. And I wonder, really, is "symmetry" not just a cop out? And define symmetry please- in which position? And which position should I be exercising in?

I think in this way, maybe only Schroth method is well thought out? But if so, why oh why oh why are there no practioners in most large Canadian cities? Surely if Schroth works it would be all over?

thanx

skevimc
08-26-2011, 04:23 PM
Hello, I am new here. I would very much appreciate a continuation of this concept. I am not very knowlegable about this but I will add my 2 small cents.

I have recently discovered that I have scoliosis. Ofcourse the PT's are focusing on muscle balance- but long before I read this thread I was wondering about this equalization concept myself.


For one thing, how can muscle strength be adequately compared side to side side the spine is rotated?
What about mechanical advantage and it's influence of the apparent muscle strength?


Regarding muscle strength, you're correct in that it is pretty difficult to assess this. What makes it even more complicated is that muscles on both sides of the spine participate in moving the spine in both directions. So, even if you found a strength asymmetry, which muscles are the 'weak' ones? The strength part of this problem is done by pre-rotating the trunk in 5 different positions (our study used -36, -18, 0, 18 and 36). These degrees correspond (roughly) to your shoulders against your hips. So the 0 position is sitting straight forward.positive values are to the right and negative are to the left. At each pre-rotated position you would exert a force in both directions, right followed by left. We used an isometric contraction which means you wouldn't actually move, but you'd exert force like pushing into a brick wall. As you correctly assumed, you can't compare the right and left values at each position (except 0) because of mechanical advantage. But you CAN compare the 18 left contraction with the -18 right contraction. In essence, you compare the mirror image. Does that make sense? In theory, this then compares the muscle required to rotate the trunk left with the muscle required to rotate the trunk right AND giving them the same approximate mechanical advantage.



For example, one of my shoulders is displaced backwards so in testing external rotational strength- how should the shoulders be positioned? Similarly, my pelvis is rotated to the left, so in testing side-lying hip abduction, how should my pelvis be placed? My left hip abductor shows to be weaker but maybe that is helping to counteract the rotation, not cause it- weak hip abductors will allow for pronation which will counteract the spinal rotation. Or is it vice versa-


Pronation of what? The feet? I'm unclear what you're asking and how pronation would help counteract spinal rotation.



I also read previously noted in this thread that the (left) external obliques are responisble for both lateral flexion and rotation to the opposite side and I have worried about that. Bad combination maybe?

The Pt's I have tried to discuss this with seem to close their ears and just say you can't go wrong with symmetry,and it is obvious to me that they just don't want to think about it. And I wonder, really, is "symmetry" not just a cop out? And define symmetry please- in which position? And which position should I be exercising in?


What worries you about the external obliques? I would also include that they provide stabilization when rotating the opposite direction. When you look at large muscle EMG during trunk rotations, the internal and external obliques on both sides are very active no matter which direction you're rotating.

And to all of your questions... "exactly". You're asking the right questions but you are definitely reaching the limits of knowledge for most PTs. Actually, you're reaching the limits of knowledge in general. Positioning definitely affects strength output. This is a main principle of muscle physiology. So obviously if you have the attachment or insertion points of the muscles that are not aligned, you'll have differing muscle lengths and therefore asymmetrical forces. But how much pelvic rotation is required before you can measure a strength difference from side to side? What about rib cage deformities (due to any number of reasons)? How much does this affect muscle length or strength? And these questions are only dealing with the primary movers. How much influence do the smaller stabilizing muscles of the spine have on strength output?

We approached/justified the trunk rotational training using the force/length relationship as well as the effort and motor unit recruitment relationship. Basically this can be described by saying that the more effort you exert the more motor units/muscle will be recruited to fire. The smaller the effort the more variation in muscle recruitment patterns. So by exercising through the entire range of motion you require the muscles to work in all lengths and by using a near maximum effort you are recruiting the most muscles. I called it the 'shotgun' approach in an earlier thread. Since it's nearly impossible to identify exactly which muscle(s) are the culprit, strengthen them all. AND since we found a strength asymmetry in AIS patients, lets improve strength symmetrically. As well, the more active and strong muscles become, the more efficient and 'healthy' they become.

Although, if I were to do another study I would want something much more specific to be included. Like side shift, Schroth, directional breathing, etc... These therapies are nice because they are specific and adaptable to the individual curve. Even though they are missing a strength component which I think is fairly important.



I think in this way, maybe only Schroth method is well thought out? But if so, why oh why oh why are there no practioners in most large Canadian cities? Surely if Schroth works it would be all over?

thanx

Schroth definitely has a very well thought out protocol. However, that protocol also comes with a price, and that is that there aren't as many practitioners. I like a lot of the things the protocol does and it is very well laid out and organized. Although I think they are too strict about avoiding trunk rotations.

Pooka1
08-26-2011, 04:54 PM
Schroth [...] Although I think they are too strict about avoiding trunk rotations.

I have to say, that is a very cool-headed, measured statement about a PT regime that is at direct odds with your dissertation. I admire your restraint. ;-)

whatishappening
08-27-2011, 03:23 PM
Hi, thank you so much for responding. I have to say I did not read that paper in the first post of this thread. Plus, I am really clueless here, I had no idea you were doing a PhD- or any study on rotations.

PLUS- I just assumed Scroth has derotations? I mean, that is its appeal to me. I looked at old video footage where a group of little girls were being instructed to reduced ther lordosis while retracting their right hips (the retraction is a derotation?) Plus, the little boy in the footage who has padding placed under one buttock, the opposite scapula and the opposite (again) shoulder. Surely that is derotation.

I assumed Scroth basically does a series of moves that will work the curves backwards to an ideal straight spine through a combination of derotations and lateral displacements. That is what I would like to do.

And yes, rotational strength would be hugely important to provide the ability to help hold onto those curve /rotation reductions.

In fact, I have been using the Cybex Torso rotation machine at my local Y for the last 3 months:
http://www.cybexintl.com/products/strength/12190/intro.aspx
(with very bizarre feelings in my torso btw- totally assymetrical/weird feelings that change from week to week)
I am only at 13.5kg and I keep the rotation to about 20-30 degrees- so far more than 13.5kg makes my sacroilliac joint make noises and I don't think that's good.

Anyway, my beef with PTs is they can't say whether I should derotate while exercising and when checking for muscles strenght assymetry they do not seem to care either way what position I am in. Indeed, I have bent over dozens of times this year to have my spine checked and each time I ask them if I should derotate first and they say they don't care- either way.

I have been derotating on my own but I just hope and pray I am doing the right thing and not going make things worse.

I am actually shocked that Scroth doesn't derotate.... (that scares me)





The strength part of this problem is done by pre-rotating the trunk in 5 different positions (our study used -36, -18, 0, 18 and 36). These degrees correspond (roughly) to your shoulders against your hips. So the 0 position is sitting straight forward.positive values are to the right and negative are to the left. At each pre-rotated position you would exert a force in both directions, right followed by left. We used an isometric contraction which means you wouldn't actually move, but you'd exert force like pushing into a brick wall. As you correctly assumed, you can't compare the right and left values at each position (except 0) because of mechanical advantage. But you CAN compare the 18 left contraction with the -18 right contraction. In essence, you compare the mirror image. Does that make sense? In theory, this then compares the muscle required to rotate the trunk left with the muscle required to rotate the trunk right AND giving them the same approximate mechanical advantage.


ok, wow, that is fascinating- I didn't read that anywhere.




Pronation of what? The feet? I'm unclear what you're asking and how pronation would help counteract spinal rotation.




well, the forces within the body and the ground reaction forces on the feet must balance or the person would fall over. I feel this within my own body. For me my spine is rotated to the right, in reaction (or because of) my pelvis is rotated to the left and so are my shoulders. So that is 2 rotations to the left and 1 rotation to the right- so the final rotation to the right is occuring at my feet. In fact, for me, this whole jouney began at my feet.

There is a good book called "The Malalignment Syndrome" by Wolf Schamberger (at least I think it is good, though over my head...)
You can find pictures on the internet that I believe originated from this book:
1053




What worries you about the external obliques? I would also include that they provide stabilization when rotating the opposite direction. When you look at large muscle EMG during trunk rotations, the internal and external obliques on both sides are very active no matter which direction you're rotating.



The extrernal obliques and the lats worry me the most. Ofcourse look, I am not an expert, just a normal person with no physiological knowledge, but the muscles at the outer sides of my my back- either the lats or external obliques- they are the ones that are feeling the most assymmetrical and really bizarre. And I can feel that these same muscles are also responsible for lateral flexion. I think the external obliques are responsible for "ispilateral" flexion and "contralateral" rotation? So in derotating I am strengthening and stretching and I just get scared that I am stretching the wrong one and it will and allow a lateral curve. So, what I am having a hard time explaining is that I wonder if in say rotating to the left, it feels like I am also loosening the veritical resistance of the right extrenal oblique or Lat, and I just hope that is ok. For example right now my left LAT has now been "awakened" and I feel that not only is that muscle derotating (contracted laterally) me but it is also pulling me down on that side. And I am not sure that is good-..





... And these questions are only dealing with the primary movers. How much influence do the smaller stabilizing muscles of the spine have on strength output?

... I called it the 'shotgun' approach in an earlier thread. Since it's nearly impossible to identify exactly which muscle(s) are the culprit, strengthen them all. AND since we found a strength asymmetry in AIS patients, lets improve strength symmetrically. As well, the more active and strong muscles become, the more efficient and 'healthy' they become.


Not that I am in a position to agree, but I do agree with this :) I was wondering what you think about the idea of having the prime movers sort of train the stabilizers (the multifidus etc). Like have the lats and obliques force a certain movement and then in time the smaller muscles will get the idea. Sorry, silly for me to suggest I am sure its more complicated than that but I am curious.


Thank you very much, I really appreciate it.

livingtwisted
08-28-2011, 12:14 PM
I am actually shocked that Scroth doesn't derotate.... (that scares me)

Just want to clarify what you mean when you talk about derotating -- seeing this across a few threads now. It sounds like because your condition is different than most on this forum, you are talking about lining up feet, hips, shoulders in one plane. My hips and shoulders are pretty much even, its everything in between that is rotated. And I'm not just able to derotate for an x-ray.

But Schroth is very much about looking at scoliosis in 3 dimensions. Rotation is taken into account in every exercise. I think what you are referencing, is that Schroth does not recommend wide sweeping rotations such as in some yoga poses or reaching to grab something that is not right in front of you. The reason is that no matter which direction you twist it will accentuate the differences in the rib cage -- narrow side is compressed even more, wide side is expanded even more. But the breathing exercises are very much about derotating. And another example would be that any supine exercise is done with rice bags placed under the rib hump and opposite hip so that you are starting slightly derotated before you even begin the exercise.

The thing that's interesting to me is that both torso rotation and schroth can be successful at derotating -- its not that one is right and the other wrong, they just work in different ways.

skevimc
08-29-2011, 12:38 PM
Hi, thank you so much for responding. I have to say I did not read that paper in the first post of this thread. Plus, I am really clueless here, I had no idea you were doing a PhD- or any study on rotations.


It's been a few years since I finished and am researching in a different area right now. I just like to come here because I enjoy this line of research.



PLUS- I just assumed Scroth has derotations? I mean, that is its appeal to me. I looked at old video footage where a group of little girls were being instructed to reduced ther lordosis while retracting their right hips (the retraction is a derotation?) Plus, the little boy in the footage who has padding placed under one buttock, the opposite scapula and the opposite (again) shoulder. Surely that is derotation.

I assumed Scroth basically does a series of moves that will work the curves backwards to an ideal straight spine through a combination of derotations and lateral displacements. That is what I would like to do.



Schroth does focus on derotation. In fact, the protocol divides the spine into several parts (depending on curve type). And each part gets its own special exercises all meant to derotate and straighten.




In fact, I have been using the Cybex Torso rotation machine at my local Y for the last 3 months:
http://www.cybexintl.com/products/strength/12190/intro.aspx
(with very bizarre feelings in my torso btw- totally assymetrical/weird feelings that change from week to week)
I am only at 13.5kg and I keep the rotation to about 20-30 degrees- so far more than 13.5kg makes my sacroilliac joint make noises and I don't think that's good.


The Cybex machine is what we used for our study.



Not that I am in a position to agree, but I do agree with this :) I was wondering what you think about the idea of having the prime movers sort of train the stabilizers (the multifidus etc). Like have the lats and obliques force a certain movement and then in time the smaller muscles will get the idea. Sorry, silly for me to suggest I am sure its more complicated than that but I am curious.


It's not silly at all. That's actually the exact idea that I have. If you have shoulder pain/tendonitis/instability the PT protocol is to exercise the four stabilizing muscles. Each one controls a basic movement in the shoulder. Extension, flexion, internal and external rotation. You can isolate these muscles by doing a specific exercise AND using a very light weight (<5lbs). There are some very nice studies that show these specific exercises and weights activate the appropriate muscles. These small stabilizing muscles get out of whack for any number of reasons, but the main idea is that, usually due to pain, the muscles stop firing at the appropriate times, the shoulder shifts in the socket slightly and causes impingement. Strengthening those stabilizing muscles usually helps the pain because the shoulder begins to track properly in the joint capsule.

Transfer this basic idea to the spine. It certainly gets A LOT more complicated in the spine and there are several assumptions that have to be made. But basically the idea is that strengthening all of the spinal muscles will wake up any muscles that might be dysfunctional. There are lots of open ended questions that can't be answered right now in this area. But this is the basic idea.




But Schroth is very much about looking at scoliosis in 3 dimensions. Rotation is taken into account in every exercise. I think what you are referencing, is that Schroth does not recommend wide sweeping rotations such as in some yoga poses or reaching to grab something that is not right in front of you. The reason is that no matter which direction you twist it will accentuate the differences in the rib cage -- narrow side is compressed even more, wide side is expanded even more. But the breathing exercises are very much about derotating. And another example would be that any supine exercise is done with rice bags placed under the rib hump and opposite hip so that you are starting slightly derotated before you even begin the exercise.

The thing that's interesting to me is that both torso rotation and schroth can be successful at derotating -- its not that one is right and the other wrong, they just work in different ways.


Yes. It's the extreme rotations they want you to avoid. Good clarification.

flerc
08-30-2011, 11:03 AM
strengthening all of the spinal muscles will wake up any muscles that might be dysfunctional.


Great! I have added it to the record of Assumptions/Facts to be taken into account.
Is not possible to know with something as EMG, if really some muscles (and which of them) are dysfunctional?

skevimc
08-30-2011, 12:45 PM
Great! I have added it to the record of Assumptions/Facts to be taken into account.
Is not possible to know with something as EMG, if really some muscles (and which of them) are dysfunctional?

Definitely put it under the assumption category.

People have tried and even presented as evidence the ability to use surface EMG measurement to show paraspinal muscle activation. The reality is that surface EMG is very sensitive to noise and measures anything and everything directly below the electrodes (not to mention general lab noise (lights are 60 hz)). I'm not sure how deep it is able to measure. But given what I've seen with how active the larger muscles are when performing a trunk rotation, I have little doubt that the smaller muscles are just as active, i.e. all muscles are activated doing some type of work. The surface EMG would pick all of this activity up. So to be able to say that any difference seen in EMG signal is a result of a specific muscle would be pretty weak evidence.

Measuring these muscles is possible with fine-wire EMG. This involved inserting the electrode into the actual muscle of interest and there are some really nice studies that have been done in healthy adults determining which muscles are activated during various trunk movements, including rotations. These studies also show the wide variation of activity patterns for the various trunk movements. Another weakness of this technique is that it measures only a portion of the total muscle (a few fascicles). The body can and does vary which fascicles it uses for any given movement. So the repeatability of the technique could be a weakness. Although with training, I believe, this variation becomes less, i.e. more consistent muscle pattern activation.

There is another really neat way to measure muscle activity that I hope to be able to research someday. It uses MRI. In fact, when I came to Stanford/Palo Alto VA I was hoping to do a project on this very thing. It's called muscle function MRI (mfMRI). Basically, you scan a certain area of someone, e.g. T5-T9. Take them out of the MRI, have them perform one exercise a bunch of times or with a heavy weight. Quickly put them back in the magnet in the same position and scan the same area. When you look at the before and after images, the muscles that were activated will be a different color. It's a very nice technique that has been confirmed with different type of EMG. The other great part about this technique is that the change in color (from white to dark grey or vice versa can't remember which direction) is linear with the amount of work performed. So the main movers will have the most change in color and the muscles that didn't work as hard, will be slightly less. So, if you have the range of muscle color change for any given muscle (which can be somewhat standardized) you can fairly accurately estimate how active the muscle was. This technique has been used in patients with low back pain so it definitely has the resolution and sensitivity to tell if there are dysfunctional muscles.

flerc
08-30-2011, 03:10 PM
Definitely put it under the assumption category.
In fact I not do a distinction between facts and assumptions. I also record the foundations of each of them and the percentage of reliability for me. In this case I gave it a 90%, it seems too logic for me and consistent with other assumptions.



There is another really neat way to measure muscle activity that I hope to be able to research someday. It uses MRI. In fact, when I came to Stanford/Palo Alto VA I was hoping to do a project on this very thing. It's called muscle function MRI (mfMRI). Basically, you scan a certain area of someone, e.g. T5-T9. Take them out of the MRI, have them perform one exercise a bunch of times or with a heavy weight. Quickly put them back in the magnet in the same position and scan the same area. When you look at the before and after images, the muscles that were activated will be a different color. It's a very nice technique that has been confirmed with different type of EMG. The other great part about this technique is that the change in color (from white to dark grey or vice versa can't remember which direction) is linear with the amount of work performed. So the main movers will have the most change in color and the muscles that didn't work as hard, will be slightly less. So, if you have the range of muscle color change for any given muscle (which can be somewhat standardized) you can fairly accurately estimate how active the muscle was. This technique has been used in patients with low back pain so it definitely has the resolution and sensitivity to tell if there are dysfunctional muscles.


Wonderful!! It should to be used soon. That is the kind of proofs that should to be done. It seems to me similar to thermography http://www.actabio.pwr.wroc.pl/Vol4No1/3.pdf but of course it should be different and with much precision

whatishappening
08-31-2011, 01:43 AM
Skevimc, Thank you for responding:)

That MrI is a great idea!

Skevimc, I have been looking around here for your torso rotation paper- do you have one? I was wondering what loads you used.

Also I am wondering how you handled accidental "cheating"- which is what I think I have been doing-
.. For one thing, subtle differences in the pressure applied to the inner thigh and chest pads
...Also, I feel that I am using my spine differently in the 2 directions- because I use it differently in real life: any single vertebre assumes a difference amount of the total turning angle depending on which way I turn. And because of the chest and hip pads on the machine- maybe I am grippping too hard but I get the feeling that I am really only rotating using say L2-T7- because the chest pads I think end around T7?

anyway, that is why I would really like to read your paper, thanx.



I think what I will try next time is to lower the load to the minimum (5#) and try to focus on turning with only 1 or 2 vertebrea at a time.

In reading your explanation of needing to use low loads to work rotator cuff muscles, I wonder then, by using large loads on this torso machine, maybe the paraspinals (all those tiny criss-crossing muscles between vertebrea) are not even being worked? I don't even feel anything in the erector spinea- I just feel it on the outer edges of my back. I started at 5# 3 months ago and have progressed to #15. 15# is too easy for a "normal" workout- but I am going to try your program and see what happens. Just btw, I was told by the trainer at the gym that the management there considers it a "high risk" machine. I see 20 year old boys on that thing whacking out the full rotations (that would be maybe 75 degrees in one direction!) with a full weight rack (- maybe 150#). Like, I doubt they are using their paraspinals.

Also, the weird thing I feel on that machine is each week a different area feels it- say lower right or upper left back. But that muscle/feeling feels it it both directions- like the same muscle on the opposite side of the body feels nothing going in "its direction". Eg- one week the left lat will feel it going both right and left and the right lat will feel nothing in both directions. The following week it may be just the right lat feeling it- again in both directions while the left lat feels nothing.

whatishappening
08-31-2011, 02:06 AM
Just want to clarify what you mean when you talk about derotating -- seeing this across a few threads now. It sounds like because your condition is different than most on this forum, you are talking about lining up feet, hips, shoulders in one plane. My hips and shoulders are pretty much even, its everything in between that is rotated. And I'm not just able to derotate for an x-ray. ....

Thank you for responding Mehera, I mean rotated about the vertical axis, yes. I wonder if all people with lateral scoliosis do not have rotated hips or shoulder gridles? It's remarkable because the pattern of the sand bags in that old Scroth video footage follows my rotations.



I agree with staying away from extreme rotations. I have also dropped out of yoga- I feel the side bent torso rotations poses such as triangle and triconassana are just way too imprecise. Thank you for pointing out the effect of rotation on the rib cage.

skevimc
08-31-2011, 02:20 PM
Skevimc, Thank you for responding:)

That MrI is a great idea!


It is indeed. It's full of technical and logistical and budgetary issues. But its power and possibilities are pretty impressive.




Skevimc, I have been looking around here for your torso rotation paper- do you have one? I was wondering what loads you used.


This is a link to the strength asymmetry paper.
http://www.scoliosisjournal.com/content/2/1/9

That is an open access journal so you should be able to get it with no problem. Our training study might be a bit harder to get. Send me a private message with your email and I'd be happy to send you a pdf.

McIntire KL, Asher MA, Burton DC, Liu W. Treatment of adolescent idiopathic
scoliosis with quantified trunk rotational strength training: a pilot study. J
Spinal Disord Tech. 2008 Jul;21(5):349-58. PubMed PMID: 18600146.




Also I am wondering how you handled accidental "cheating"- which is what I think I have been doing-
.. For one thing, subtle differences in the pressure applied to the inner thigh and chest pads
...Also, I feel that I am using my spine differently in the 2 directions- because I use it differently in real life: any single vertebre assumes a difference amount of the total turning angle depending on which way I turn. And because of the chest and hip pads on the machine- maybe I am grippping too hard but I get the feeling that I am really only rotating using say L2-T7- because the chest pads I think end around T7?

anyway, that is why I would really like to read your paper, thanx.


I don't think we discuss the 'cheating' component in the paper, although I know exactly what you mean. At some point every patient tried to cheat a bit. It seems like people try to cheat for two main reasons. 1. they are going too fast. 2. the weight is a bit too heavy. (and 3. would be a combination of 1 and 2.). The best thing to do is to drop the weight a bunch and do several sets of very slow controlled movement. Focusing hard maintaining posture. To take a page from the schroth and side-shift (and others) protocols, you want to visualize and focus on the part of your back you are trying to control. I would drop the weight to around 5-10 pounds (1 or 2 plates) and make each direction take 2-3 seconds. So 3 seconds up and 3 seconds down. With a session or two of doing it this way, you could start adding some weight again. But again, going slow and concentrating.




I think what I will try next time is to lower the load to the minimum (5#) and try to focus on turning with only 1 or 2 vertebrea at a time.

In reading your explanation of needing to use low loads to work rotator cuff muscles, I wonder then, by using large loads on this torso machine, maybe the paraspinals (all those tiny criss-crossing muscles between vertebrea) are not even being worked? I don't even feel anything in the erector spinea- I just feel it on the outer edges of my back. I started at 5# 3 months ago and have progressed to #15. 15# is too easy for a "normal" workout- but I am going to try your program and see what happens. Just btw, I was told by the trainer at the gym that the management there considers it a "high risk" machine. I see 20 year old boys on that thing whacking out the full rotations (that would be maybe 75 degrees in one direction!) with a full weight rack (- maybe 150#). Like, I doubt they are using their paraspinals.

Also, the weird thing I feel on that machine is each week a different area feels it- say lower right or upper left back. But that muscle/feeling feels it it both directions- like the same muscle on the opposite side of the body feels nothing going in "its direction". Eg- one week the left lat will feel it going both right and left and the right lat will feel nothing in both directions. The following week it may be just the right lat feeling it- again in both directions while the left lat feels nothing.


I didn't read this last part before I responded to the first part, so I think your idea to drop the weight is right on.

If done improperly, the machine could definitely be high risk. Using a full load and doing a full rotation could be extremely dangerous if they aren't in control of the weight stack, i.e. if they are lifting really fast and letting it drop really fast. The forces applied to the discs during a rotation are pretty high and without proper support it's a sure way to really injure yourself. It's another reason why we divide the training exercises into 2 separate 'arcs'. When you are pre-rotated to the right (for example) and you are contracting to the left to the neutral position, you can lift nearly 2 times the amount of weight as from the neutral position all the way to the end of your range of motion. So by exercising each of those force arcs separately and with different weights, you make sure you can control the weight and that the weight isn't too heavy or too light for the corresponding muscles.

The issue around the rotator cuff muscles and/or paraspinal muscles is an important one. I am >95% sure that, given no injury, the stabilizing muscles are activated during maximal contractions. How they are active and how much they can be trained during a maximal contraction is another question. It's during a pathologic condition that these might not be activated. With a heavy load, the prime movers can serve to stabilize the joint. So if there is some reason the body doesn't want to use those stabilizing muscles, then it wouldn't have to. And in fact, might very well 'choose' an different muscle pattern in order to accomplish its goal. And perhaps this is why it feels different from time to time. Muscles are weak and fatigued so the body is trying different combinations out to see what works best.

Most of the above is theoretical, but it makes physiological sense to me.

whatishappening
09-04-2011, 03:15 AM
wow, that paper is a lot to absorb, thank you!

Please, I would just like to confirm my understanding of how you measured the torque of the isometric contractions: would it be the weight (times the distance) that the subject could "just" raise off the stack? thanx. I'm getting confused over the word "isometric" which I thought meant no movement. My machine works by moving though and it begins prerotated- no stopping at neutral. So I am not sure how I can do an isomtetric contraction on it without loading up the weight, it will be tricky.

I'm glad you mentioned in the disucssion that you didn't think the natural spinal vertebrea rotation played a role- I was going to ask you why you wouldn't add/subtract it from the equipment angles.

For what it's worth, for me anyway, I just assumed it was because I am so used to turning to the right that I am weaker to the left more because of flexibility issues- I think you mentioned that when saying one reason is antagonist muscles- like it is difficult to extend the leg when the flexors are short. I wonder what the results would be like if the subjects first underwent a symmetrical flexibility program- ie, twisting to the left and right for a few weeks before the strength tests?


But also in my case I am coming to realize that the whole left side of my body- shoulder and arm included is not as sharp-





......I don't think we discuss the 'cheating' component in the paper, although I know exactly what you mean. At some point every patient tried to cheat a bit. It seems like people try to cheat for two main reasons. 1. they are going too fast. 2. the weight is a bit too heavy. (and 3. would be a combination of 1 and 2.). The best thing to do is to drop the weight a bunch and do several sets of very slow controlled movement. Focusing hard maintaining posture. To take a page from the schroth and side-shift (and others) protocols, you want to visualize and focus on the part of your back you are trying to control. I would drop the weight to around 5-10 pounds (1 or 2 plates) and make each direction take 2-3 seconds. So 3 seconds up and 3 seconds down. With a session or two of doing it this way, you could start adding some weight again. But again, going slow and concentrating.



Thank you :)




............ It's another reason why we divide the training exercises into 2 separate 'arcs'. When you are pre-rotated to the right (for example) and you are contracting to the left to the neutral position, you can lift nearly 2 times the amount of weight as from the neutral position all the way to the end of your range of motion. So by exercising each of those force arcs separately and with different weights, you make sure you can control the weight and that the weight isn't too heavy or too light for the corresponding muscles.


That is very interesting. The machine at the YW does not give the option of splitting it up since neutral has no stop. But I could modify it be starting at say - 20 degrees and then rotating from there to -40 and neutral and comparing left and right sides that way? Again, do you think this difference may be due to the antagonistic inflexibility?





............
None of these studies have shown a rotational strength asymmetry in the healthy adult population and no conclusive evidence indicates that isometric trunk rotational weakness or asymmetry is prognostic or pathologic for low back pain. It is, also unknown whether a trunk rotational strength asymmetry exists in healthy adolescents.


I have seen a golf study showing rotational asymmetry and that book I mentioned, "The malalignment syndrome" also discusses it. The golf study was more about flexibility and range of motion twisting to the right versus the left. It would be very interesting to see if your subjects could be trained to have torsional strength and flexibility symmetry.

I guess I need to read more instead of asking you all these questions, I apologize, just limited a bit wit time here. I will email you for the pdf, thanx.







............ The issue around the rotator cuff muscles and/or paraspinal muscles is an important one. I am >95% sure that, given no injury, the stabilizing muscles are activated during maximal contractions. How they are active and how much they can be trained during a maximal contraction is another question. It's during a pathologic condition that these might not be activated. With a heavy load, the prime movers can serve to stabilize the joint. So if there is some reason the body doesn't want to use those stabilizing muscles, then it wouldn't have to. And in fact, might very well 'choose' an different muscle pattern in order to accomplish its goal. And perhaps this is why it feels different from time to time. Muscles are weak and fatigued so the body is trying different combinations out to see what works best.



What do you think about rotating to a maximal contraction- eg 5# to 30 degrees and THEN pulse (oscillate) ever so gently at that point (+/- say 5 degrees). Do you think the pulses would call upon the paraspinals more?

I have decided to take a pause on this machine as a training device for the moment and will just use it to compare left and right. I have seen a new Chiro who seems to think my body (pelvis/spine/shoulders) should come to some sort of ideal equilibruim first-(& btw first he said I had scoliosis probably existing from childhood, then he changed his mind and said it is functional and now he is saying my whole body is very "twisted" and he is not sure why- maybe from nerve entratpment at the si joint or maybe born like this or from a shoulder injury)

I have been doing something else- just sitting, turning about 5 degrees max to either side, over about 5 seconds. I recall my pilates teacher saying "small movements work the small muscles". I am also reading a Feldenkrais book that basically says the same thing, and that the movements should be done very slowly- like you said.

And in just sitting there and turning very slowly max 5 degrees either way, I did in fact feel the erector spinea or the paraspinals or some muscle direcdtly beside the spine, but only on the left side regardless of which way I am turning. I tried again tonite but I also feel the large muscles now.


I was thinking of repeating the exercise with a theraband wrapped around my torso at the level of the vertebrea I want to work and tie the ends to a door knob- just enough to provide light resistance. ?

thank you very much- I apologize for my response being sort of disjointed, - it is reflective of my thinking on this subject I am afraid :)

skevimc
09-06-2011, 01:35 PM
wow, that paper is a lot to absorb, thank you!

Please, I would just like to confirm my understanding of how you measured the torque of the isometric contractions: would it be the weight (times the distance) that the subject could "just" raise off the stack? thanx. I'm getting confused over the word "isometric" which I thought meant no movement. My machine works by moving though and it begins prerotated- no stopping at neutral. So I am not sure how I can do an isomtetric contraction on it without loading up the weight, it will be tricky.


The machine we used for testing was a biodex machine with a torso rotational attachment. You are correct that isometric is stationary. The Biodex has a dynamometer that can measure and control many different types of movements and torques.

When people use a weight stack for strength testing they do what is called a 1 repetition max (1RM). Basically, what is the heaviest weight you can lift, 1 time and maintain good form and control. It allows for some obvious subjectivity. But it's used quite a bit in the research world. Albeit usually just to get a starting point for a traning study, e.g. "subjects performed a 1RM leg extension and then trained 3x/week using 80% of 1RM etc..."




I wonder what the results would be like if the subjects first underwent a symmetrical flexibility program- ie, twisting to the left and right for a few weeks before the strength tests?


That's an interesting idea. I was asked frequently about whether or not I measured range of motion (ROM). I never did, and I wish I had. If there's ever a future study, I certainly will. Although I can already see several problems. But that's what a grad student is for.




That is very interesting. The machine at the YW does not give the option of splitting it up since neutral has no stop. But I could modify it be starting at say - 20 degrees and then rotating from there to -40 and neutral and comparing left and right sides that way? Again, do you think this difference may be due to the antagonistic inflexibility?


The difference could certainly be that. Although it would be difficult to say with certainty.



I have seen a golf study showing rotational asymmetry and that book I mentioned, "The malalignment syndrome" also discusses it. The golf study was more about flexibility and range of motion twisting to the right versus the left. It would be very interesting to see if your subjects could be trained to have torsional strength and flexibility symmetry.



I'd be interested to see what kinds of studies have been shown on asymmetry in golfers. It would be a neat comparison of strength developed with different types of contractions. The back swing versus the actual swing and/or follow-through.




What do you think about rotating to a maximal contraction- eg 5# to 30 degrees and THEN pulse (oscillate) ever so gently at that point (+/- say 5 degrees). Do you think the pulses would call upon the paraspinals more?

I wouldn't be a big fan of that, especially in a maximal rotation. Your spine and discs are under a lot of stress at that point. Those pulses, if not controlled, would add momentum to the weight and might exceed what your muscles are capable of. I'd think smaller arc movements would be the way to go. Slow contractions with the right weight through 5-10 ROM.

[QUOTE=whatishappening;124666]
I apologize for my response being sort of disjointed, - it is reflective of my thinking on this subject I am afraid :)

Welcome to the club. :>

whatishappening
09-16-2011, 04:39 PM
Thank you very much for replying skevimc. I was unaware that you had replied because I am subscribed to this thread but didn't seem to get a notification. I got your previous papers and am going through them, thank you.

Here is the golf study "The Effect of Frame Asymmetries on Spine Rotation". This is just a powerpoint presentation- I don't know if any peer-reviewed type of study was done.

www.fitgolf.com/wp-content/uploads/Pelvic-alignment-research.pdf

I also uploaded a paper- which does look to be peer-reviewed on "Pelvic Assymetry and Trunk Mvement"- table 2 is what is of interest. (sorry- it is too large to upload) Table 2 shows results comparing lateral flexion and axial rotation ROM's of the lumbar and thoracic regions in healthy vs people with lower back pain and it shows assymetries with both groups and greater assymetry with the lower back pain group.

I am scheduled to take a workshop given by the author of the "Malalignment Syndrome" which I am very much looking forward to. I can't help wondering if AIS is functional scoliosis gone awry. Life is assymetric. Maybe with AIS the spine is first to give way to this whereas in other people the slack is taken up more by the limbs- feet, pelvis, shoulders etc. Maybe it is a question of relative flexibilities- the most flexible and weakest being the first area to deform. Like a series of springs with different stiffnesses. Anyway, I am sure people have thought of all of this already. (Edit to add- OK, gee, I just read the flexural-torsional thread and all the finite element analyses that have been done over the years- WOW! So I just wonder if any of these have ever been done to the entire body or what the base of the spine boundary conditions are assumed to be- )


OTOH, I went to a new GP the other day- an old man- old school. He is about the only one who actually wanted to look at my bare back and poke around. He said that the muscles on the left side of my spine (erector spinea or paraspinals) are much bigger than the right side. (My spine is rotated to the right). Also my lower back on the left side (in the vicinity of the quatratus lomborum I guess) is much bigger.

So this begs the question - are the muscles bigger of the left side because they are preventing furthur rotation or is their increased size causing the rotation. Similarily I know for a fact that my RHS tensor fascia latte is much larger on my right side than my left. I know it is responsible for femur interal rotation- so again, cause or preventative- so should I stretch it or not. Aiming for equality in the limbs (and back) could be the worst thing I could do.

I have read that muscles that are relatively atropied (unused) are marbled with more fat that healthy muscles. So maybe the band of thicker "muscle" on the LHS of my spine is "bad" muscle that is riddled with fat! But my first thought ofcourse is that the muscles are larger because they are preventing furthur rotation, and if that is the case, then the spine is behaving as if it has a mind of its own and it is not really functional afterall. Physiotherapists keep saying we need to start with the pelvis and the spine will follow, but maybe in AIS it is vice versa- the pelvis is following the spine?



Endless.

Thanx :)

Dingo
10-17-2011, 08:56 PM
Today Scott had his 8 year old checkup.

First the good news. Scott's curve measured essentially the same as last year.

Now the bad news. Scott's doctor has a new, high tech computer that precisely measures curves. Last year's curve was remeasured at exactly 18.6 degrees. This year he measured 20.2 degrees. We thought he was 15 degrees last year and visibly improved this year. The only thing I can imagine is that his rotation (which appears to have progressed) made his S curve appear worse then it actually was in the machine. Other than that I dunno. Maybe my eyes are deceiving me.

Anyway stability +/- isn't what I'm looking for. I'm retooling Scott's torso rotation exercises towards stretch and less on strength. I think that's the general direction that the latest science points. The fact that tightness/stiffness has been a problem for Scott since he was an infant makes the concept that deformed/tight ligaments are involved believable to me.

Dingo
10-17-2011, 09:46 PM
Scott was diagnosed with a 10 degree curve +/- at the age of 5. Assuming that number was correct he progressed roughly 4.3 degrees to age 6 and another 4.3 degrees by age 7. Over the last year he progressed 1.6 degrees which is within the margin of error.

I have to credit the slowdown or stability with torso rotation because it's the only major treatment difference between those years.

Dingo
10-18-2011, 12:36 AM
Tonight when Scott was taking his shower and drying off I watched his back carefully. I tried to be as objective as possible and looked at it from several angles. His spine was straight as an arrow. His rotation was terrible but he does not have a noticeable S curve. If it's there it was tiny.

I think somehow he must have rotated a few degrees left or right during the X-ray. The X-ray (which is flat) picked up his rotation which has always been very bad.

Either that or somehow his muscles and skin hide the S curve which really is 20 degrees. I can't discount that possibility and a doctor might be able to explain why I can't see it. But I can't see a visible curve and I'm a naturally critical person.

leahdragonfly
10-18-2011, 08:24 AM
Hi Dingo,

I am sorry to hear you got some bad news about Scott's progressive measurements, especially the recent 20 degrees. What does his doc have to say about his treatment now that he's over 20 degrees?

You mentioned that his x-ray was flat, but I hope you meant 2 dimensional, not that his x-ray was taken laying down, right? All scoli x-rays should be taken standing.

You also mentioned that his back looks straight but rotation is very visible. How does he do with the Adams forward bending test? Does it reveal asymmetry? Are you thinking that the x-ray is wrong, or just that his curve is not visible from the outside? I know Leah's curve measured between 18 and 21 for a period of time (at age 8) after bracing and before surgery, and it was hidden very well except for some very subtle signs that I could see.

I will be very curious to hear your reply.

Dingo
10-18-2011, 09:23 AM
Leahdragonfly

I didn't see the tech take the x-ray but I'm sure she did it properly. Scott goes to the best doctor in Phoenix.

Scott's rotation was bad from his first visit at age 5. When Scott did the Adam's test yesterday I could see the doctor's aide wince as she looked. It's always been bad relative to the size of his curve.

But I can't see an S-curve. When Scott began TRS I could clearly see a mild S in his back but within 2 or 3 months it was not visible.

That leaves 2 possibilities.

A) It's really there but it's being hidden by skin and muscle. Maybe TRS builds muscle which is why the curve appeared to disappear over a few months.
B) His rotation is bad enough that unless he stands perfectly straight to the machine it will show up as a curve because an x-ray is flat, not 3d. Scott doesn't have a tight curve, it's long and gradual so maybe he was turned a little and that's how it showed up.

Maybe a combination of both.

I felt that his S curve had improved. But I guess I should be happy that he was at least stable. In my opinion his rotation did worsen over the last year but that wasn't measured.

Because Scott's S-curve was still inside the margin of error after a 12 month period his doctor suggested that we continue watch and wait until next year.

Dingo
10-18-2011, 06:13 PM
hdugger

After talking to my mother who worked in a doctor's office I'm not so sure Scott is really at 20 degrees. When Scott had his x-ray the technician had him back up to a screen. He has a large rotation in his spine and a noticeable rib hump on the right side. In order to stand parallel to the screen he would stand slightly crooked because of his rib hump. That must be why his spine looks straight with his shirt off but crooked in an x-ray.

I watched 3 other kids go in for their visits and I couldn't see a rib hump through the backs of their shirts. Scott's rotation is obvious even through his shirt. In that regard I think he's got a worse case than most.

Maybe Scott's doctor will have one of those new 3d x-ray machines next year.

Regardless this year we're working on his rib hump because to my eyes that's the only thing I can see.

scolio1964
10-18-2011, 07:19 PM
I am interested in having my daughter do the torso rotation. How could I find somewhere that does it? I have no idea where to look. My daughter currently wears a brace. She has a pretty noticeable rib hump that she'd like to get rid of. We live near Houston, Texas.

Thanks!

Dingo
10-18-2011, 11:28 PM
Scolio1964

Most good gyms should have some type of torso rotation machine. The machine used in the first study was the MedX machine. Here is a video of it. MedX Torso Rotation (http://www.youtube.com/watch?v=BhJPxBQBCXA)

My son uses a machine just like this one. Rotary Torso (Machine #18) (http://www.youtube.com/watch?v=xVCceRCz5cU) It takes a few minutes 3 times per week.

My advice is buy a machine. I can't quite remember the exact cost but my son's put me back like a hundred bucks or so.

I don't want to sound negative on TRS. Mostly I was shocked that my son's curve had been remeasured by a computer and put in the 20 degree range. That's not good. However the fact that he was stable after a year of growth and no bracing is good. I hope to do better this year because my son is larger and more coordinated.

I honestly thought his lateral curve was headed to 0 degrees after a year of TRS. Now I know to watch his rotation. If that doesn't go down I know it's time to look at what I'm doing. Maybe add weight, maybe better form, etc. etc.

Scott lifts 20 pounds which is a little less than half his body weight. We might get to 25 pounds over the course of the next year.

leahdragonfly
10-19-2011, 08:16 AM
After talking to my mother who worked in a doctor's office I'm not so sure Scott is really at 20 degrees. When Scott had his x-ray the technician had him back up to a screen. He has a large rotation in his spine and a noticeable rib hump on the right side. In order to stand parallel to the screen he would stand slightly crooked because of his rib hump. That must be why his spine looks straight with his shirt off but crooked in an x-ray.

Regardless this year we're working on his rib hump because to my eyes that's the only thing I can see.

Hi Dingo,

I don't mean to rob you of hope, but it would be very apparent to your orthopedist (and the radiologist) if Scott had been standing crooked or turned in the x-ray. There are many bony landmarks they look at to see whether or not the child was standing improperly. I know once Leah had to have an x-ray repeated because Dr Betz noticed she was slightly turned in the x-ray, and we didn't want to make any treatment decisions based on an x-ray that anyone had any doubts about. When we repeated it the measurement was unchanged, but I certainly could not have slept at night wondering "what if" if we hadn't repeated the x-ray.

Sounds like TRS will at least give you something to focus on instead of just idly watching Scott's curve progress. I truly hope it will stop at 20. Thanks for the updates.

Dingo
10-19-2011, 09:05 AM
Leahdragonfly

It's certainly possible that Scott's X-ray gave the correct degree. The new computer measures the curve within a tenth of a degree so maybe it has a system to correct for any imperfection in the way that a child might stand.

But to be honest the more I think about it the happier I am. Curve progression tends to accelerate the larger a curve becomes and 20 degrees is the danger zone. For Scott to be stable at 20 degrees after a year of growth and without bracing is a really good sign.

When Scott started TRS at age 7 he barely fit into the machine and had to sit on a foam cushion I purchased. He was also uncoordinated and used a lot of momentum to keep the weight moving. This year he's bigger and more coordinated. Last night we focused on form and slow movements and the same weight felt MUCH heavier to him. My sense is that it's going to be a more productive year.

Dingo
10-19-2011, 10:16 AM
hdugger

In the Torso Rotation studies every child with a mild to moderate curve held or improved their curve including children going through a rapid growth spurt.

SEAS and Scroth I'm not sure.

Pooka1
10-19-2011, 07:57 PM
The curve doesn't appear to be very progressive it seems.

If the 15* curve was really 18.6* then maybe the 10* at Age = 5 was really 13.6*.

So in 3 years the curve progressed only 20.2* - 13.6* = 6.6*. That is 2.2* a year on average during a time when I am sure he grew quite a bit. And it only is just outside the measurement error over that three years.

I have no idea about JIS but plenty of folks would take that progression for an AIS case over what is usually seen, especially in growth periods where you see that progression rate PER MONTH, not per year. A progression rate of only 2.2* a year over three years might indicate a benign curve per se and may be a more important indicator than even that the curve is 20* now. Also curves about that large have spontaneously regressed, some completely, per that one study which is not to "prove" the PT was doing nothing but just to throw out there about there still being good reason to hope for the best.

It's a question for some very experienced pediatric surgeons who have looked at several JIS TL curves.

Maybe the other JIS parents have a feel for this.

Pooka1
10-19-2011, 08:24 PM
Also, in the two years before you got the machine, assuming the curve at age 5 was really 13.6*, it only progressed 5 degrees to 18.6* in 2 years. That's two years of a "progression" that may not even be real because it is in the noise. If the first measurement was taken early in the day and the last was taken late, it would really be hard to even say the curve progressed over those two years I would think.

Again, I am not trying to discount the PT. I am just saying you might be doing PT against a background of a stable or quasi-stable curvature which is all good.

Dingo
10-19-2011, 11:48 PM
Pooka1

I believe Scott's original curve was measured at 10 degrees when he was 5.... I think. If it was remeasured by the computer program it might come up different today. Whether that would be more or less then 10 degrees I don't know. Scott's pediatrician noticed his rib hump at age 4 during a routine Adam's test but no x-ray was taken at that time.

Looking back on this last year I would say that Scott's form during exercise was sloppy. This was largely due to 3 factors.

A) Scott was very small and just barely fit into the machine
B) At 7 years old Scott was not fully coordinated
C) I didn't put a major emphasis on good form because of A and B and I assumed that doing TRS was good enough even without great form. For the most part all I focused on was keeping his movements smooth in order to keep his back safe.

After his doctor visit on Monday our new focus has become good form on every rep.

As this video shows (http://www.youtube.com/watch?v=BhJPxBQBCXA) the MedX forces good form by locking down the lower body. This lockdown feature is not an accident. If you perform this exercise with sloppy form the lower body and arms do the work and the back goes along for the ride.

I've already reworked Scott's therapy so that he will sit just as solid as the guy in the MedX video. Put simply I sit close and hold him in place. We tried it on Tuesday and because his lower body was taken out of the equation the weight became twice as hard to lift. The other thing we're focusing on is SLOW MOVEMENTS like the guy in the video. This makes therapy much more challenging because there is no momentum to help push the weight. Slow movements are also safer.

Dingo
10-20-2011, 10:58 PM
Scott did his TRS tonight and my wife and I spotted him in a way that ensured close to the same form as the guy in the MedX video in the post above.

We had to drop his weight back to 15 pounds or about 33% of his body weight and even at that amount it was a struggle. We may go back to 13 or 14 pounds.

The guy in the MedX video is pulling 60 pounds or what looks like approximately 33% of his body weight. You can see on his face that the weight is heavy and he has to work extremely hard to finish his reps.

So for anyone doing TRS 33% of your body weight might be a good number to work towards. If you can do significantly more you might be engaging the wrong muscles or using momentum.

rohrer01
10-21-2011, 12:26 AM
Ouch! That guy looked like he was in a lot of pain doing those exercises. Wow, I don't know if I would even want to attempt a machine like that for the simple fact I'm a big baby. I suppose if you start light and work your way up, but still.... This machine looks different than other Torso Rotation devices that I've seen. It was definitely very specific.

Dingo, I hope your little guy is stable or corrected. It's good you've got him in the habit of exercising at a young age. Hopefully he'll keep it up in adulthood.

Like I mentioned before, my youngest son had a small curvature at a very young age that spontaneously corrected. He does have some spina bifida occulta in some of his vertebrae, not sure how many, the doc didn't tell me. It makes me wonder if that isn't somehow related to the original curvature. My son is grown now and works out pretty regularly and is very muscular (not overly muscled, but very toned). I hope he keeps it up.

Dingo
11-01-2011, 10:28 PM
Scott has been doing his torso rotation with "MedX" form and slow movements for 2 weeks. At first he struggled and grunted to lift 33% of his weight. After two weeks it's no trouble at all. We do 3 sets of 15 reps in each direction, 3 times per week.

Scott weighs about 45 pounds and he lifts 15 pounds. If he increases the amount he lifts by 1 pound per month he will hit 50% of his body weight within the year even if he grows rapidly. Time will tell but I think 50% of his body weight might be where we are headed.

BTW it takes two adults to spot Scott properly. I sit close and hold his leg with one arm to keep his pelvis stationary. I use my other arm to hold the machine to ensure smooth motion. His mother stands behind both of us and gently applies pressure to Scott's shoulders to make sure he doesn't get out of position and use his arms to do all the work. It sounds complicated but it works very well and it's simple to do. If he was older we could use the MedX which locks down his body but he's far too small.

For anyone out there doing TRS with a juvenile it takes careful spotting for your child to mimic the movement of the MedX.

Oh yeah and Happy Halloween! Scott is in the Mickey Mouse Hat, his older brother is wearing the squirrel helmet and glasses. The Pirate and Ninja are kids from across the street. 8-)

1104

TAMZTOM
11-14-2011, 09:10 AM
[QUOTE=structural75;46779]Stop focusing on strengthening the right side. It will only make matters worse. Those muscles are inactive for a reason. Again, you're fighting your bodies functional response to the scoliosis... What you want to do is focus on lengthening the right side... open it up... stretch it.

Very interested in Structural75's analysis. I'm ignorant, so please excuse any daft questions. After having done Schroth with my daughter for 4 months, I agree with the above.

Do rotations to the right in the lower spine (i.e. - sit on a chair or the floor and rotate right looking over your right shoulder... reach your left arm across your body in the front and hold onto the outside of your right knee.)

The problem here, for a right thoracic, left lumbar double curved patient, would be the increased rib-cage rotation. Certainly works the lumbar, but at the expense of the thoracic?

TAMZTOM
11-14-2011, 09:17 AM
I've read more posts now so apologies for the above question...already answered in the subsequent posts.

TAMZTOM
11-14-2011, 09:58 AM
[QUOTE=structural75;46875]...the rotations are the most important issue to address. Often you'll see rotations increase as the bends decrease from correction (usually bracing)... This is in large part due to the fact that the soft-tissue restrictions involved holding the spine in the bend are not specifically addressed with a brace and therefor as the spine attempts to straighten out from the bracing forces the restriction in the soft-tissue remains but simply changes its effect on the spinal mechanics... causing a rotation because it is still shortened asymmetrically despite the lessening of the curve.

Explains so much, so well. Thanks.

Look for one...who integrates and impliments strength, stretching, balance/coordination type work, proprioceptive activities... etc.

This is how we've been working, great to see another poster--clearly a knowledgeable one--reason it all so well

The work you do should also be asymmetric, if you find yourself doing exercises that don't speak more to one side or area more than another then ask them why they're not doing it differently. Keep in mind, not everything will entail asymmetric work, but some of it certainly should.

4 months ago, my daughter's muscular and postural asymmetry was apparent. Schroth (as we interpreted it for ourselves straight from the book itself) was our starting point. As overstretched muscles relaxed and dormant muscles grew, we observed changes to the curves while exercising with the same RAB. We changed the RAB and mixed in more symmetrical work. This, for example, caused less distortion to the LC when working the TC. We'd also read and reasoned that promoting muscular symmetry either side of the spine has a straightening effect on the spine. We seem close to muscular symmetry now (the overstretched musculature has regained some strength now, as well as significant increases on the dormant 'concavities'.) With each muscular gain, proprioception has to shift again (e.g., these last few days, as our 'observing skills' increase, we've identified and resolved insidious or persistent, almost instinctive, asymmetric muscular/scoliotic pulls while doing some exercises.

PS: we have had no PT, orthopaedic, chiropractor, spine surgeon...no input at all yet on how to do any of this. We did 3wks 2 days of Schroth in London, but the PT was dangerous...basically, we learned how NOT to do Schroth from her.

TAMZTOM
11-14-2011, 03:06 PM
Schroth exercises, I believe, only de-rotate on one side of, for example, a thoracic curve. All I know of the Torso Rotation theory is what I've read in this forum thread. Am I correct that TR would have a person with a thoracic curve exercising/rotating/de-rotating both ways?