View Full Version : Dorsal Shear Forces

12-22-2008, 09:39 PM
Why is the sagittal alignment of the spine so important in the development of idiopathic scoliosis?
Scoliosis is often associated with flat back and this could play a crucial part in the development of Adolescent Idiopathic Scoliosis.
Research done on dorsal shear forces indicates that backward inclination of vertebrae in the sagittal (front to back) plane has prognostic significance in the progression of AIS.
Study has shown that the spine is more rotationally unstable during application of dorsal shear forces and this could therefore be a factor in the development of AIS.

If this is indeed a factor in the etiology of AIS and its progression, one should then ask if can this be prevented?

Karen Ocker
12-23-2008, 07:12 PM
This is your same ad as yesterday disguised as a "blog".
If you really want answers research the studies on etiology rather than offering the Clear Institute method on your web site.

12-23-2008, 10:16 PM
Maybe FixScoliosis can post the peer-reviewed journal articles showing the efficacy of the method because as far as I know, there is a perfect vacuum of evidence of the treatment.

Blog that why doncha?

I'll start a thread wondering about how these folks can sleep at night after pushing a method that has no proof of efficacy.

There is a reason why Chiro is included on Quackwatch. It could be the damn poster boy for Quackwatch with Homeopathy being a near tie for the looninest nonsense treatment.

12-23-2008, 10:38 PM
If you did read my posts on my blog you would have noticed that they are about what peer reviewed articles has to say about idiopathic scoliosis. There I post comments on what I read and information that I have not seen mentioned elsewhere.
I thought it might be interesting for the public to know some of this information and therefore I began my blog.

It was also suggested by Bagnall in his review paper in Scoliosis journal, that a detailed re-read of the literature would be useful in the search of the etiology of AIS.

It is true that my blog has two links, one to my clinic website and one to clear institute. I believe that being upfront with my background may help people evaluate my comments on the blog as readers may not agree with all my opinions.

If this bother members of NSF forum and they are not interested in reading comments on what research papers actually do say and not just reading abstracts from PubMed, then I can stop making comments on your forum.

12-23-2008, 10:49 PM
Evidence is always welcome.

Paranormal treatments are not exempted from this welcome (though they always exempt themselves for some reason).

Feel free to pony up any evidence any time.

12-23-2008, 11:04 PM
there is a lot of research out there and I believe that there can be better treatment alternatives in the near future that are more effective than bracing.

following article "Neurophysiological basis of rehabilitation of adolescent idiopathic scoliosis." (http://www.ncbi.nlm.nih.gov/pubmed/18432434?ordinalpos=6&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsP anel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum) stated
"All in all, the reflections in this paper highlight that
neurophysiological constraints to control axial posture make
modification of deep rooted anomalies very
complicated. This explains why in order to stop curve
progression, or improve scoliosis, a long-term and
repetitive exercise training should be carried out."

I personally believe that we should at least explore alternative ways of treating idiopathic scoliosis, it does not mean that all of them will be successful.

12-23-2008, 11:08 PM
How many decades has chiro been trying to treat scoliosis?

12-23-2008, 11:19 PM
I am sure that chiropractic profession has tried to fix scoliosis since its beginning and probably without greater success. Lantz did conclude in his study that pure manipulation of the spine in not effective in correcting scoliosis.

Does this mean that we should stop improving and exploring new methods that could work better? I do not think so and I certainly hope that people would strive to come up with a better treatment that produces good results consistently.

12-23-2008, 11:24 PM
Very good, honest answer. To your great credit.

The next time someone comes on here and touts the efficacy of chiro, I'm going to reference your answer that there is no proof (you being a chiro type).

Now let's move on to any type of PT. Any evidence whatsoever that it helps scolisois?

12-24-2008, 07:23 PM
Pooka1, No need to refer to me, they probably will not listen anyway, refer to the source below.

J Manipulative Physiol Ther. 2001 Jul-Aug;24(6):385-93.

Effect of chiropractic intervention on small scoliotic curves in younger subjects: a time-series cohort design. (http://www.ncbi.nlm.nih.gov/pubmed/11514815?ordinalpos=3&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsP anel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum)
Lantz CA, Chen J.
Life University, Marietta, GA, USA.

BACKGROUND: Chiropractors have long claimed to affect scoliotic curves, and case studies abound reporting on successful outcomes. No clinical trials exist,
however, that evaluate chiropractic's effectiveness in the management of
scoliotic curves.
OBJECTIVE: To assess the effectiveness of chiropractic intervention in the management of adolescent idiopathic scoliosis in curves less than 20 degrees.

RESULTS: There was no discernable effect on the severity of the curves as a function of age, initial curve severity, frequency of care, or attending physician.
CONCLUSION: Full-spine chiropractic adjustments with heel lifts and postural and lifestyle counseling are not effective in reducing the severity of scoliotic curves.

So if pure manipulation dosent work, we need to explore new and better ways of helping people affected with Idioparhic Scoliosis.

12-24-2008, 07:36 PM
That seems like a good reference.


Happy Holidays.

12-24-2008, 08:09 PM
as for PT and effectiveness in treating scoliosis, would be best answered by a PT who knows what they are talking about.
I may have missed or overloked a vital paper in my search for information.

PubMed is a good place to start to look for information.
some writers that are intersting in this area are some Italians
Smania, Negrini and Romano

their abstracts sound very good, but upon reading some of the actual papers, the results are really not that exiting.

Maybe a PT could answer this question better than me.

I will post some thoughts about bracing in my next comment...

12-24-2008, 08:23 PM

I have read some papers on PT. I agree that Italian group is putting stuff out there and I further agree with your assessment of the forcefulness (or complete lack thereof) of their results.

I don't think there is much evidence that PT can help scoliosis. For example, even Schroth realizes this and thus pushes the Cheneau brace.

Speaking of Schroth, I did a cursory analysis of Weiss' papers from a search in pubmed. I'd be interested in your opinion on my analysis...


I searched pubmed for Weiss HR + scoliosis and indeed the three pages of pubs that Writer mentioned showed up.

These are 57 publications in various journals, most with Weiss as first author, dating from 1991 to 2008 inclusive. There are 4 review articles, all since 2002, amazingly (or not amazingly if this field is very different than mine). I have no idea which are peer reviewed and which are not (except of the recent one which indeed is peer reviewed as Writer claimed).

I tried to determine how many of these 57 were novel research on Schroth exercise or Cheneau bracing (i.e., Weiss' putative or most favorite field) of these articles which cover more than a few subjects. As far as I can tell, there are 14 (maybe a few more) that fit into that category. I determined this from the title in some cases when obvious or from the abstract.

Most of these 14 articles make a positive case for either Schroth exercise or the Cheneau brace. I don't know how many of these are in good, peer-reviewed journals.

Some questions I have include:

1. There seems to be a high chance of data selection in any/all retrospective studies. Were all cases that matched controls included or just some?

2. What does it mean that surgery was avoided? That is, was the length of time after skeletal maturity sufficient to be confident that surgery was avoided forever? What happens if the exercises are stopped?

3. Given Schroth has 90 years of data, why are the bulk of Weiss' pubs NOT novel research papers? Why all the reviews? Why all the papers critiquing surgery or other treatment modalities instead of papers on studies supporting Schroth?

12-24-2008, 09:36 PM
my understanding is that ALL journals listed in PubMed are peer-reviewed.
it does not include all good peer-reviewed journals, but they cover the vast majority.
that is why it so popular.

Pooka1, I will get back to your question in a few days.

great holidays to everybody :)

12-28-2008, 08:07 AM
I am sure that chiropractic profession has tried to fix scoliosis since its beginning and probably without greater success. Lantz did conclude in his study that pure manipulation of the spine in not effective in correcting scoliosis.

Oh, puh-leeze.

They haven't shown ANY long term (more than DAYS) success. They still charge a pretty penny to convince patients/parents they CAN cure it.

AND they continue to prey on the uneducated ... and take their money without qualms.

12-29-2008, 01:41 AM
Hi Pooka1

Do you happen to have the list of articles that you are referring to, makes it easier for me to check if I actually have the full articles? I have some of Weiss articles but not all of them. Many of his papers are published in “Stud Health Technol Inform” and I do not have any of them.

You are correct in your thought that in retrospective studies there is a high chance of data selection, it is therefore of outmost importance that data selection process with criteria for inclusion/exclusion is highlighted in respective papers.

As for your third question why majority of Weiss are not conducted/published as novel research papers.
I believe that the following abstract might help to illustrate the difficulty in getting good randomized controlled trials conducted when it comes to scoliosis.

Preference assessment of recruitment into a randomized trial for adolescent idiopathic scoliosis. (http://www.ncbi.nlm.nih.gov/pubmed/19047704?ordinalpos=2&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsP anel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum)

Dolan LA, Sabesan V, Weinstein SL, Spratt KF.
J Bone Joint Surg Am. 2008 Dec;90(12):2594-605.

BACKGROUND: Randomized controlled trials are powerful tools to evaluate the outcomes of clinical treatments. However, these trials tend to be expensive and time-consuming, and their conclusions can be threatened by several limitations. This study estimated the strength of three common limitations (underenrollment, selective enrollment, and nonadherence to protocol) in a proposed study of adolescent idiopathic scoliosis. METHODS: Patients with scoliosis and their parents were asked to complete a web-based survey about their preferences concerning a hypothetical randomized trial. Adolescents without scoliosis and their parents also participated. Surveys included questions about treatment preference, likelihood of participation, required risk reduction, and propensity to drop out or choose a different treatment while enrolled in the study. RESULTS: Ninety adolescents and eighty-three parents participated. Observation was preferred to bracing by the majority of subjects. Overall, 33% of the parents and adolescents would both agree to participate in the hypothetical trial. Of the subjects who would not agree to participate, the majority would rather share the decision-making responsibility with the physician than have the treatment chosen in a random fashion. Many of the subjects would consider changing treatments during the course of the trial if they were not satisfied with the outcomes; the majority of parents who preferred bracing would consider crossing over to the bracing arm if their children were randomized to observation. CONCLUSIONS: Recruitment into a randomized trial of bracing compared with observation for the treatment of adolescent idiopathic scoliosis may well be problematic, considering the relatively small percentage of families who said they would consider randomization. Additionally, the threat of nonadherence to protocol may be strong and must be addressed in the protocol of the trial. Most families wanted to make the treatment decision with the physician in lieu of randomization; therefore, the role of the physician in patient recruitment and retention should not be underestimated.

These might be reasons why Weiss is not producing that much novel research and I believe that they certainly are factors for other therapies not doing it.

12-29-2008, 07:42 AM
No I don't have any of the articles.

I think the results of that article you posted are reasonable and expected. It may be a long time before anything is known about the efficacy of bracing. Maybe never. I think the surgical routes, both fusion and non-fusion will be the obvious and more efficacious treatments in the future. I think they are now.

Quackwatch wrote back to me about Schroth. I posted the response in the Non Surgical section of the Adult section but here it is again (written by a Quackwatch consultant)...

"I have done several PubMed and OVID searches on Schroth and Scoliosis. All I can find is a handful of abstracts (around 30). None are of controlled studies. Several studies are prospective looks at the Schroth method, but none have large numbers of patients, none have long term follow up and none have controls. And only abstracts can be found- no actual articles. From the best I can tell, most of the "journals" in which these articles appear are not peer reviewed. A majority of the articles are written by HR Weiss, the medical director of a Schroth clinic. Many of his articles attack surgery for scoliosis with untrue "facts." He does not appear to be an unbiased researcher. Most important- there are no prospective, controlled studies which would indicate there is any basis for the use of the Schroth method."

And by the way, it isn't clear if pubmed only carries peer-reviewed journals.

12-29-2008, 10:48 PM
Hi Pooka1

You don’t need to have any of his articles; I have a few of them in my collection of articles related to scoliosis and the spine.
I was just wondering if you have the names of the few articles that you were interested in and I can see if I have them and see what we can learn from them.

As for the reply to you form Quackwatch:

I do not know what Quackwatch stance is on Weiss HR, but I am surprised and disappointed by their lack of proper research on his articles. They should have at least read them before taking a stance.
They say that they can only find abstracts and no articles. We must understand that these journals are not charity organizations so one must purchase these articles, price ranging between $15 – 35 per article or subscribe to them.
A quick look at the journals that Weiss HR is published in, one can see many reputable peer reviewed journals, out of 8 different journals that has published his papers 6 are peer reviewed and I do not know the status of the remaining two, but I would suspect that they are also peer reviewed.
I do not believe that Weiss HR is not biased, but neither is any surgeon for that matter. This is why papers are subjected review of their professional peers, to weed out any unsubstantiated claims. I do believe that his papers will have substantial references to get published in respected journals and they should be published so that an academic debate can take place to ensure that the future patients will get the best treatments developed/available.

I also found this regarding PubMed. most are peer reviewed, but not all. :(
link below

FAQ Peer-Reviewed/Refereed Journals in PubMed (http://www.nlm.nih.gov/services/peerrev.html)

01-25-2009, 09:24 PM
Getting back to the start of this thread, Dorsal Shear Forces, I’ve made 3 posts on my blog with few illustrations, that may help to explain dorsal shear loads and how they are unique to humans and what influence they can have.

I suggest that you read them in this order.
1. The Human Spine and Idiopathic Scoliosis
2. Dorsal Shear Forces and Idiopathic Scoliosis
3. Dorsal Shear Loads affects rotational stability in the spine

This knowledge highlights the importance of the sagittal alignment the development of thoracic idiopathic scoliosis and why it is unique to humans.

I hope you'll like it.