Muscles move the joints, don't they???

[betty14]

I am an experienced physiotherapist, and person with scoliosis that has successfully helped my back pain and alignment for a long time with specific strength exercises.

I've been reading a lot of the posts about exercise, and am wondering why some people maintain that exercise is not likely to be useful to treat the symptoms of scoliosis. I mean - joints don't move themselves, and the spine does not simply hold itself up! People with scoliosis have deformities of the bones that are exaggerated by dramatic weaknesses and lack of joint position sense/body awareness.

Many of you with scoliosis have said that if you derotate certain body segments and draw yourself tall, your curves appear less noticeable. The problem is, you can't hold it very long!

Also, some posters have commented that in the morning, their curves are less noticeable or they feel taller/straighter, but that the spine collapses over the course of the day. Much of this is due to the inability of the muscles to maintain spinal elongation.

So, it makes a great deal of sense that strengthening the muscles in very specific ways (ie. derotating and also strengthening in the lengthened muscle positions in as corrected a position as can be achieved) would be helpful.

Now, I must state that when I fail to do my exercises for a few weeks, I go crooked again. Strength is unlikely to be maintained without regular exercise, when there is a deformity. BUT, if I do my routine for 30 minutes three times per week, I stay straighter and have little pain.

Even though I don't know WHY I have scoliosis and WHY my muscle support of my spine got messed up, I can still treat those symptoms by strengthening and elongating my muscles.

I would love to post a full discussion about why the theoretical and evidentiary basis for exercise is strong, but it will take a bit of time to get the research together and write it.

I look forward to your comments!

B.

[LindaRacine]

I've been reading a lot of the posts about exercise, and am wondering why some people maintain that exercise is not likely to be useful to treat the symptoms of scoliosis.

Can you point to a specific post? I don't recall anyone stating that PT doesn't help with the symptoms of scoliosis. The only claim that is made, and we try to make it often so that the message doesn't get lost, is that nothing is going to permanently reduce one's curves, with the possible exception of surgery. That doesn't mean PT (and other alternative treatments), aren't helpful in terms of pain and cosmesis.

Regards,
Linda

[Pooka1]

I've been reading a lot of the posts about exercise, and am wondering why some people maintain that exercise is not likely to be useful to treat the symptoms of scoliosis.

I don't recall reading anyone saying that. Can you point out some posts?

I think the comment is that exercise has never been shown to prevent progression nor has it been shown to permanently reduce curves.

It might do those things but exercise programs like Schroth which have been around for at least 90 years still don't have much evidence of efficacy.

[betty14]

Hi Linda and Pooka1:

I don't want to start re-posting things that I have already been posted by others, as I have noted that some of the threads on this site turned combative and unpleasant, which is not therapeutic! So please consider the second paragraph as - that I have gotten that impression from words used and tone of writing.

In answer to your other comments:

Yes, the state of the evidence is wanting, that is certainly true. And it is inappropriate for therapists and others to make statements that are misleading such as "curing" scoliosis, or making promises to prevent progression of curves.

However, in the absence of rock-solid Level 1 evidence, therapists must use best-practice principles - combining the current literature, knowledge of anatomy and physiology, palpation skills, problem-solving skills, and a three-dimensional eye that can only be fine tuned over years of practice.

I often treat patients with chronic and/or severe back pain at this point in my career, and I can honestly say that the physiotherapy literature that is most helpful and solid is the basic stuff, such as showing that the QL muscle, if not active enough, will allow the lumbar spine to side bend right and rotate left. The studies on "can this exercise cure non-specific low back pain" have historically been so poorly done that the results are useless.

Pooka1:

Yes, I know the Schroth method has not been studied rigorously enough at this time. I recently got Christa Lehnert-Schroth's book. Have you read it by any chance?

It is entitled "Three dimensional treatment for scoliosis - a physiotherapeutic method for deformities of the spine". If you are not in a medical/anatomy/therapy field it would be a difficult read, but still worthwhile. I can tell you it is by far the most comprehensive book on non-surgical scoliosis management I have ever read, and the detailed descriptions of muscle functions around three and four curve patterns are spot on. It is clearly written by a person with the ability to view the body in the sagital, frontal and transverse planes.

By the way, the author nor the physicians who wrote forwards to the book are claiming to cure your deformity, and they acknowledge that in some cases surgery may the best or indeed the only option.


Regarding preventing progression: there is not strong evidence for or against this, but at least - the treatment of specific exercises is highly unlikely to cause harm, and the exerciser gets many other health benefits.

Regarding reducing curves: My curves in the morning are small, they would measure much larger if I had x-rays at night due to fatigue causing winding down of the spine. They would consistently measure smaller when i do my therapy regularly. That, to me, is curve reduction. Whether my bony deformity has or will reduce due to bone remodelling over several years remains to be seen, and I doubt that there will be research evidence to that effect in my lifetime!

Good night Ladies!

B.

[SLS]

It might do those things but exercise programs like Schroth which have been around for at least 90 years still don't have much evidence of efficacy.

Yet. And I believe "much" is the keyword here. I truly believe as more people become open and aware to the alternatives which are natural and available to us, we will begin to see much positive evidence.

I am a firm believer in proper exercise and proper nutrition. This is certainly something that could only benefit us, even if it does not "cure" anything. If our bodies aren't strong and healthy, then nothing will be beneficial. It is really our best support system.

This is true for anyone, whether they have scoliosis or not.

[Pooka1]

Yet. And I believe "much" is the keyword here. I truly believe as more people become open and aware to the alternatives which are natural and available to us, we will begin to see much positive evidence.

I am a firm believer in proper exercise and proper nutrition. This is certainly something that could only benefit us, even if it does not "cure" anything. If our bodies aren't strong and healthy, then nothing will be beneficial. It is really our best support system.

This is true for anyone, whether they have scoliosis or not.

Yes I don't disagree. But is seems like the majority of villagers here, new and old, who inquire about PT and want to try it seem to think it can permanently reduce curves or stop progression. There is very little evidence for those things despite decades of trying it.

On the other hand, there is evidence that pain can be reduced I think in some cases, at least temporarily.

If exercise was actually an alternative to surgery we would know it by now. Yet the world is still waiting.

[SLS]

If exercise was actually an alternative to surgery we would know it by now. Yet the world is still waiting.

I am not claiming that exercise is an alternative to surgery, if you are at the point where surgery is necessary, HOWEVER, I do believe that exercise can be a preventative measure.

[Pooka1]

I am not claiming that exercise is an alternative to surgery, if you are at the point where surgery is necessary, HOWEVER, I do believe that exercise can be a preventative measure.

Okay but I think the world is still waiting on evidence for that claim also. And it's not like folks haven't specifically being trying to prove that claim for decades. They have been. That's the issue as I see it. It's not "untried." It appears to be "tried and still not proven." After all this time.

I think the person who designs a PT program that reliably and permanently keeps people of the table will get the Nobel in physiology/medicine. So I just monitor the winners in that category every year to see if there are any breakthroughs with PT and scoliosis. Just my approach.

[SLS]

Sharon, I'm curious about something. First, let's put scoliosis aside. In general, how do you feel about exercise? Do you believe that exercise provides a benefit to general health? Weight training for strong bones, aerobics for a strong heart? Personally, I don't believe that our bodies were made to be sedentary.

I'm not talking about anyone winning any prizes here. I'm talking about BASIC care of our bodies. It seems to me that many people take better care of their cars, than they do of themselves. I guess I see it as preventative maintenance. It's basic and it's logical.

[Pooka1]

Sharon, I'm curious about something. First, let's put scoliosis aside. In general, how do you feel about exercise? Do you believe that exercise provides a benefit to general health? Weight training for strong bones, aerobics for a strong heart? Personally, I don't believe that our bodies were made to be sedentary.

I'm not talking about anyone winning any prizes here. I'm talking about BASIC care of our bodies. It seems to me that many people take better care of their cars, than they do of themselves. I guess I see it as preventative maintenance. It's basic and it's logical.

Are you saying PT is preventative maintenance with anything having to do with scoliosis?

I don't see what you wrote as relevant to a scoliosis forum. We can put scoliosis aside and I can agree with you on those points.

But the context here is PT and scoliosis and whether or not there is any evidence that it can stop progression or reduce curves. The actual claims matter... there is no other way to logically discuss the topic.

What would you say are the actual claims of PT w.r.t. scoliosis?

[SLS]

I am not a PT, I am not a doctor and I am not professionally trained, so therefore all I can offer are my opinions, for what they are worth. Apparently not much.

I also am not here to argue or convince anyone of anything.

I also apologize if I went off topic.

I am going to gracefully bow out of this "conversation".

[MissEmmyF]

I think that if you catch your scoliosis early enough and put into place a very specific exercise program that targets the imbalances of your spine and surrounding musculature (instead of "watching and waiting"), then yes, it's very possible in many cases to experience no more progression and hopefully some regression. Will you have to keep up this program for the rest of your life in order to have continued success? It's probably wise. You can equate it to any other disease that requires maintenance over one's lifetime to keep it in check.

Granted, in some cases, I do think scoliosis comes on like a freight train, so in scenarios like that, I don't think exercise would do much good. I think it depends on each person's unique scenario. And, early prevention is the key.

[Dingo]

Why some people make an effort to misrepresent science and discourage parents and children with Scoliosis is beyond me.

Studies show that strength training can be very succesful at managing and potentially reversing childhood Scoliosis.

Here is a thread with many helpful links including a video
Torso Rotation Strength Training for Scoliosis (http://www.scoliosis.org/forum/showthread.php?t=8976)

Although not yet fully understood it appears that the fundamental problem may reside in the well known strength asymmetry that exists between the right and left side in children with Scoliosis. Put simply one side of the back is stronger than the other.

Dr. Vert Mooney explained this directly (http://medxonline.com/downloads/articles/prelimadolescentscoliosis.pdf).
...there is a consistent asymmetry in torso rotation strength that can be shown with specific strength testing and with myolectric activity. This is definitely abnormal.

Strength training not only corrected this problem but it stopped curve progression and reduced many curves.
Myolectric activity was asymmetric in both sides and in abdominal and paraspinal muscles of all patients. These asymmetries were corrected completely with torso rotation, which was associated with significant strength gains.

Here is a link to one of the many studies on the subject of strength asymmetry
Study: Trunk rotational strength asymmetry in adolescents with idiopathic scoliosis: an observational study (http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2072936)

It is also well known that child atheletes have high rates of minor scoliosis. This is thought to be due in part to strength asymmetry.

Baltimore Washington Medical Center: Scoliosis (http://health.bwmc.umms.org/patiented/articles/who_gets_scoliosis_000068_3.htm)

Young Athletes
Scoliosis may be evident in young athletes, with a prevalence of 2 - 24%. The highest rates are observed among dancers, gymnasts, and swimmers. The scoliosis may have been due in part to loosening of the joints, delay in puberty onset (which can lead to weakened bones), and stresses on the growing spine. There have also been other isolated reports of a higher risk for scoliosis in young athletes who engage vigorously in sports that put an uneven load on the spine. These include figure skating, dance, tennis, skiing, and javelin throwing, among other sports. In most cases, the scoliosis is minor, and everyday sports do not lead to scoliosis. Exercise has many benefits for people both young and old and may even help patients with scoliosis.

Study: Scoliosis in swimmers (http://www.ncbi.nlm.nih.gov/pubmed/3512101)
The high-repetition nature of competitive swimming causes imbalances of musculature in the adolescent athlete. Scoliosis as a musculoskeletal condition of the adolescent can be detected in high incidence among swimmers owing to the training phenomenon.

[Pooka1]

Why some people make an effort to misrepresent science and discourage parents and children with Scoliosis is beyond me.

Well everyone needs a hobby.

Now that I am down to having to actively worry about one kid with scoliosis instead of two, I find I have more free time on my hands. :(

[Dingo]

Pooka1

Now that I am down to having to actively worry about one kid with scoliosis instead of two, I find I have more free time on my hands.

I'm sure you are a good person and as a parent of a child with Scoliosis I understand the stress first hand. All I'm saying is that there is credible, scientific evidence from mainstream researchers that shows that physical therapy can be decisively effective for children with Scoliosis. It makes no sense to me that you don't acknowledge the existence of research that you are fully aware of.

If you said that the "jury is still out", or "the longterm effects are unknown" you'd be right. But that's as far as it goes. A variety of scientists, physical therapists and kids with Scoliosis have all produced consistent, impressive results with torso rotation strength training.

The neurologist, mom and little girl in this video (http://www.youtube.com/watch?v=Xfkn_d3WX_o&feature=fvw) are very credible. Torso rotation therapy produced the type of results for this little girl that the studies suggest are typical.

[Pooka1]

All I'm saying is that there is credible, scientific evidence from mainstream researchers that shows that physical therapy can be decisively effective for children with Scoliosis. It makes no sense to me that you don't acknowledge the existence of research that you are fully aware of.

I don't understand the research.

If you said that the "jury is still out", or "the longterm effects are unknown" you'd be right. But that's as far as it goes.

That's what I have been saying! Maybe it is style. Please point to a comment in this or some other thread that is not equivalent to the "jury is still out." You will not find me claiming PT can't work at all in principle though I don't think it can work permanently in principle.

Similarly, I don't say bracing doesn't work. I say nobody has shown that it works in a properly designed study and the very existence of the BRAIST study of proof of that statement.

A variety of scientists, physical therapists and kids with Scoliosis have all produced consistent, impressive results with torso rotation strength training.

The neurologist, mom and little girl in this video (http://www.youtube.com/watch?v=Xfkn_d3WX_o&feature=fvw) are very credible. Torso rotation therapy produced the type of results for this little girl that the studies suggest are typical.

Did you note what Samdani said? That is identical in content to what I have been saying. IDENTICAL. I am so not a neurologist but he is.

Look, I have felt for some time you are taking my comments personally. If that's true, I don't think it's appropriate. We are all doing the best we can as lay folks.

[mamamax]

I would love to post a full discussion about why the theoretical and evidentiary basis for exercise is strong, but it will take a bit of time to get the research together and write it.


Hi Betty ~

I think we are very lucky to have a physiotherapist among us who has been able to use physical therapy successfully to manage/treat scoliosis. In the past, it has not been my personal experience to work with a physical therapist as knowledgeable as yourself, the one's i have worked with did not specialize in scoliosis nor did they have any first hand experience with the condition. There is a great need for some specialization in this area and i hope the future brings it.

The standard definition of physical therapy as i understand it is: The treatment of physical dysfunction or injury by the use of therapeutic exercise and the application of modalities that are intended to restore or facilitate normal function or development.

It just makes good sense that exercise modified to address those with the dysfunction of scoliosis, would be of great benefit. And we see this with methods like SEAS and Schroth (developed by a physical therapist). The brace that i wear is designed to provide physical therapy just for the wearing. I don't know how that works - i just know that it does work from first hand observation as i unwind.

I'm currently reading a book written by a physical therapist, Beatrice Woodcock. A book which was highly recommended by the surgeon Aurthur Steindler. In Dr. Steindler's forward to her book, he says something that is as true today as it was in 1947:
We all agree that at least a number of the cases must be fused for lack of a better solution of the problem. It is also generally conceded that under all circumstances, correction or improvement must precede any kind of stabilization whether it be surgical, by fusion, or conservative, by muscle training.
Congratulations on your success Betty! Please .. tell us more as many may benefit from your knowledge and experience.

[LindaRacine]

Pooka1



I'm sure you are a good person and as a parent of a child with Scoliosis I understand the stress first hand. All I'm saying is that there is credible, scientific evidence from mainstream researchers that shows that physical therapy can be decisively effective for children with Scoliosis. It makes no sense to me that you don't acknowledge the existence of research that you are fully aware of.

If you said that the "jury is still out", or "the longterm effects are unknown" you'd be right. But that's as far as it goes. A variety of scientists, physical therapists and kids with Scoliosis have all produced consistent, impressive results with torso rotation strength training.

The neurologist, mom and little girl in this video (http://www.youtube.com/watch?v=Xfkn_d3WX_o&feature=fvw) are very credible. Torso rotation therapy produced the type of results for this little girl that the studies suggest are typical.

Dingo...

You're a smart guy, so I'm having difficulty with why you don't seem to understand that the only proof we have is that there are programs that temporarily reduce some scoliosis curves. If you looked at surgery in that same way, one would say that it's about 100% effective. When we have some long-term followup studies, at least we'll know what the potential is.

Regards,
Linda

[mamamax]

What do we know?

Surgeons have acknowledged since 1947 that both fusion and exercise (specific to scoliosis) can both improve and stabilize curves.

Fusion is not permanent given the number of revisions that are done and the continuing improvement that is made regarding instrumentation ... not one type has been found to be successful 100% of the time and not one surgery results in a fully mobile and flexible spine. Hence, on-going generations of instrumentation.

Exercise and/or PT (specific to scoliosis) is not permanent for the exercise needs to continue in order to stabilize any improvement - yet in many cases improvement can be achieved.

Proof of any of this - well someday someone will compile all the information and statistics, but it sure has not been done yet - not in any manner that would equate to a lifetime for any method.

There are no guarantees - there are only choices .. and as one wise lady once said here - nothing is permanent ;)

[Pooka1]

There are no guarantees - there are only choices .. and as one wise lady once said here - nothing is permanent ;)

To say that nothing is permanent completes misses the fact that different modalities have wildly different track records.

For example, if modality "A" works 99% of the time to cure a condition and modality "B" works 5% of the time, saying neither is guaranteed to offer a permanent solution is really obfuscation at that point.

[mamamax]

Heck Sharon - i was quoting you! And thought it a very wise statement at the time.

Also - the statistics have not formally been gathered, so i'm not sure how they can be quoted?? :rolleyes:

Saying that neither method can be stated as permanent method of correction is simply - true, as both require maintenance of some kind, including life style changes - as i see it anyway ... my perspective being from one who must make a choice.

[Pooka1]

Heck Sharon - i was quoting you! And thought it a very wise statement at the time.

"Whatever it is, I'm against it!" -- Groucho Marx as Quincy Adams Wagstaff in "Horsefeathers"

I'm Against It (http://www.youtube.com/watch?v=DtMV44yoXZ0)

Also - the statistics have not formally been gathered, so i'm not sure how they can be quoted?? :rolleyes:

Those aren't meant to be exact obviously. But they evoke the general state of affairs we are discussing. The point is that while your statement is technically true, it glosses over the wildly different track records and expected outcomes of different modalities.

Saying that neither method can be stated as permanent method of correction is simply - true, as both require maintenance of some kind, including life style changes

That is incorrect in at least some cases.

[mamamax]

Sharon - You can be so funny! :D

Yes agree with the last comment, though i think life time trouble free is not all that common.

But really - i do hope Betty will post more about both her personal and professional experience. Would be very beneficial to folks like me.

[Dingo]

LindaRacine

I'm having difficulty with why you don't seem to understand that the only proof we have is that there are programs that temporarily reduce some scoliosis curves

My beef is that parents and children come to these forums for help. When someone suggests there is no credible scientific evidence that physical therapy can stop curve progression or reduce the size of a curve it's not true. Rotation Therapy is not settled science but it's certainly credible science. A few threads ago Pooka1 suggested that interest in Torso Rotation therapy was on the decline. Once again that's not true and there is no evidence to suggest that it's true. I feel that some people are throwing up random flack for no other purpose than to argue or be discouraging.

[Pooka1]

A few threads ago Pooka1 suggested that interest in Torso Rotation therapy was on the decline. Once again that's not true and there is no evidence to suggest that it's true.

Okay what is the evidence that interest in it is not declining?

For example, surgeons who are doing VBS are increasing in number in real time. That would be a very good indicator that VBS is on the rise.

What you posted, if I recall correctly, was one researcher (not Mooney... don't know if Mooney is a surgeon) who published one study who is no longer pursuing it. I saw no mention of a second orthopedic surgeon jumping on board. If that is incorrect, please edify me.

If torso rotation is on the upswing, that would seem to come as news to Samdani based on his comments.

[LindaRacine]

LindaRacine



My beef is that parents and children come to these forums for help. When someone suggests there is no credible scientific evidence that physical therapy can stop curve progression or reduce the size of a curve it's not true. Rotation Therapy is not settled science but it's certainly credible science. A few threads ago Pooka1 suggested that interest in Torso Rotation therapy was on the decline. Once again that's not true and there is no evidence to suggest that it's true. I feel that some people are throwing up random flack for no other purpose than to argue or be discouraging.
Dingo...

I don't think anyone is arguing (I prefer debating) for any purpose other than to give others a clearer picture. While there is evidence that therapies like torso rotation work temporarily, there is not yet a shred of evidence that the effects will be permanent.

Telling people that something "works" could be very damaging. What if someone is struck by your encouragement, and spends thousands of dollars putting his kid through treatment. If that child's curves increase to a surgical level when treatment is discontinued (or even before), will you feel bad about it? I would. I try to give people realistic expectations so that, if treatment X doesn't work, they will have made the decision to try it based on all available information, not just want someone wants them to hear.

--Linda

[betty14]

Wow, can things can certainly get tense on this forum! I noted that in my readings prior to ever making my first post...but risked it anyway.

I think that a big part of the reason for the tension is that people are angry.

I was angry off and on for years that my body had essentially betrayed me....I would not wear a shirt without a collar for years because of my neck contour. I would not wear a bikini because of the skin folds on my trunk.

I was told that all I could do was "watch and wait", and have an x-ray every year. I felt very powerless. Luckily, during all that watching and waiting, my curves did not progress much, but I got more sore every year.

Luckily, in my health field, I had easier access to information (and was able to understand that information), and I was able to apply my own logic to treat myself. More recently, I've had the best success I've had yet by following the Schroth principles. Now I hate shirts with collars and wear a two piece suit because if I maintain my corrective exercises there are hardly any skin creases!

I am a lot less angry about having this rotten condition; in fact I feel empowered that I can do things to help myself. For me, that is the very best part of an exercise based approach to treat my symptoms, and I totally intend to PREVENT progression when I hit menopause and the onset of degenerative scoliosis...but that's another topic altogether.

Thanks to those of you who have welcomed me to your site. I hope to have some interesting and respectful conversations with you!

B.

[Dingo]

Pooka1

VBS is absolutely on the upswing and I'd consider it for my son. Like most spine surgery VBS is probably very lucrative which explains the broad interest.

---

Mooney is an elderly, retired spine surgeon. He was the first to investigate torso rotation therapy and released the first study 6 years ago.

Dr. McIntire from the University of Texas lead the next two studies.

I talked to one of the scientists involved in the study at the University of Kansas. He said the therapy was effective and another study should be starting soon in Texas.

Rotation therapy is clearly not in decline. It started with 1 man 6 years ago and probably a dozen or more have been involved since that time. Everyone produces the same results. Within a decade it will likely be an established, mainstream therapy.

[Dingo]

LindaRacine

Telling people that something "works" could be very damaging. What if someone is struck by your encouragement, and spends thousands of dollars putting his kid through treatment.

Torso rotation therapy costs a gym membership. In published studies progression stopped in almost every case and for many children their curve was reduced. If it's not effective a child can always go back to "watch and wait".

there is not yet a shred of evidence that the effects will be permanent
There won't be until several longterm studies have been conducted.
In the meantime Dr. Mooney said that he's followed several children from his first study and it remained effective.

[Pooka1]

Pooka1

VBS is absolutely on the upswing and I'd consider it for my son. Like most spine surgery VBS is probably very lucrative which explains the broad interest.


No it doesn't explain the broad interest. That's really insulting.

The obvious explanation is there is now sufficient evidence to justify other surgeons learning the technique and more insurance companies getting on board.

Most surgeons actually care about their patients I suspect. You obviously don't agree.

[Pooka1]

In the meantime Dr. Mooney said that he's followed several children from his first study and it remained effective.

Why haven't the data been published?

[Dingo]

Pooka1

Why haven't the data been published?

You realize that it wouldn't be particularly useful to publish on perhaps 3 kids out of 20 right? 3 kids out of 20 might have held anyway.

There might be 100 rational reasons for Mooney's decision including that fact that he is retired. You are constantly looking for any reason to be dismissive, argumentative and needlessly discouraging.

[Pooka1]

Pooka1



You realize that it wouldn't be particularly useful to publish on perhaps 3 kids out of 20 right? 3 kids out of 20 might have held anyway.

There might be 100 rational reasons for Mooney's decision including that fact that he is retired. You are constantly looking for any reason to be dismissive, argumentative and needlessly discouraging.

You completely misunderstand.

I am appropriately skeptical as a scientist and rational person should be.

If everyone was appropriately skeptical, we as a society wouldn't have to deal with:

superstition
homeopathy
astrology
the flat earth society
young earth creationism
some of chiro
circuses with animal acts :D
religion
ESP claims
UFO claims
etc.
etc.
etc.

[mamamax]

Wow, can things can certainly get tense on this forum! I noted that in my readings prior to ever making my first post...but risked it anyway.

I think that a big part of the reason for the tension is that people are angry.

I was angry off and on for years that my body had essentially betrayed me....I would not wear a shirt without a collar for years because of my neck contour. I would not wear a bikini because of the skin folds on my trunk.

I was told that all I could do was "watch and wait", and have an x-ray every year. I felt very powerless. Luckily, during all that watching and waiting, my curves did not progress much, but I got more sore every year.

Luckily, in my health field, I had easier access to information (and was able to understand that information), and I was able to apply my own logic to treat myself. More recently, I've had the best success I've had yet by following the Schroth principles. Now I hate shirts with collars and wear a two piece suit because if I maintain my corrective exercises there are hardly any skin creases!

I am a lot less angry about having this rotten condition; in fact I feel empowered that I can do things to help myself. For me, that is the very best part of an exercise based approach to treat my symptoms, and I totally intend to PREVENT progression when I hit menopause and the onset of degenerative scoliosis...but that's another topic altogether.

Thanks to those of you who have welcomed me to your site. I hope to have some interesting and respectful conversations with you!

B.

Betty ~ First off, a big thank you to you! Please continue to share your experience and professional knowledge for there are countless like myself who thirst for it and who may benefit from your sharing.

I have some questions ...

Schroth is to be incorporated into my treatment plan. I have the bible you mentioned earlier but lack the skills to best understand it. While right angle breathing (RAB) has been explained to me more than once, i'm still not getting it. Can you help me better understand that? My upper curve is to the left so i guess the standard directions are reversed in my case?

Also, can you share some statistical information such as curvature improvement in terms of degrees, any height changes, etc, that you have experienced.

[MissEmmyF]

You completely misunderstand.

I am appropriately skeptical as a scientist and rational person should be.

If everyone was appropriately skeptical, we as a society wouldn't have to deal with:

superstition
homeopathy
astrology
the flat earth society
young earth creationism
some of chiro
circuses with animal acts :D
religion
ESP claims
UFO claims
etc.
etc.
etc.

Ok, but you don't seem to be skeptical of many surgical techniques. Are you only "appropriately" skeptical of non-surgical methods?

[Pooka1]

Ok, but you don't seem to be skeptical of many surgical techniques. Are you only "appropriately" skeptical of non-surgical methods?

As all scientists and rational people do, I scale my skepticism to the evidence.

Something like posterior spinal fusion, the "gold standard" of fusion surgery, enjoys a relative large amount of evidence. The modern instrumentation improves on an already good track record for previous generation instrumentation.

Something like PT or bracing to decrease curves or prevent progression enjoys far less evidence to date. Nobody has proven it can't work but we can take into account the number of decades folks have been trying to help scale our skepticism.

Now contrast this with H. pylori causing most stomach ulcers. Before the evidence was in, many were skeptical but we didn't have anything close to evidence ruling it out. We didn't have decades of studies that failed to show ulcers are largely caused by bacteria. We had only a relative few people looking at the problem of whether or not bacteria cause most stomach ulcers.

None of that is the case with PT and bracing.

Skepticism scaled to the evidence. More than just a good idea...

[MissEmmyF]

Ok, so do you think it's beneficial to put into place a specific exercise program when scoliosis is first spotted? Or, do you think "watching and waiting" is just as good?

[Pooka1]

Ok, so do you think it's beneficial to put into place a specific exercise program when scoliosis is first spotted? Or, do you think "watching and waiting" is just as good?

Depends on the size of the curve when first spotted.

For small curves, the evidence to date lines up on the side of watching and waiting, especially since we have evidence that many small curves not only reduce on their own but completely correct spontaneously.

It necessarily follows that anyone doing anything with a small curve outside of a controlled study can never know for sure the treatment did a thing given the relative high rate of spontaneous correction.

Yes? No?

[MissEmmyF]

All large curves start as small curves

[Pooka1]

All large curves start as small curves

That is a penetrating glimpse into the obvious. How does it address anything I wrote?

[MissEmmyF]

Because a lot of small curves don't miraculously straighten on their own...they get larger...thus, the reason for starting a specific exercise program ASAP.

[Pooka1]

Because a lot of small curves don't miraculously straighten on their own...they get larger...thus, the reason for starting a specific exercise program ASAP.

Doesn't "starting a specific exercise program ASAP" simply ASSUME there is evidence doing so will prevent any curves from progressing?

What is the evidence you are assuming?

ETA: Please email the evidence to Samdani since he seems to feel there is no evidence base don his comments on that video Dingo posted.

[MissEmmyF]

i'm not "assuming" any evidence. i just think there are a bunch of promising studies out there. but mainly, i don't see how doing nothing (i.e. watching and waiting) is just as good as being proactive. that makes no logical sense to me. personally, i don't need 100 years of long terms studies just to start doing a practical exercise program.

and, i'm not about to post any studies or anything like that. dingo has posted many links in this thread and in others. anything posted just gets totally picked apart by you, questioned to death, and it's really tiresome and bothersome.

[Pooka1]

i'm not "assuming" any evidence. i just think there are a bunch of promising studies out there. but mainly, i don't see how doing nothing (i.e. watching and waiting) is just as good as being proactive. that makes no logical sense to me. personally, i don't need 100 years of long terms studies just to start doing a practical exercise program.

Effective alternative treatments don't automatically and necessarily exist just because you can't conceive of their not existing.

and, i'm not about to post any studies or anything like that. dingo has posted many links in this thread and in others. anything posted just gets totally picked apart by you, questioned to death, and it's really tiresome and bothersome.

Don't ever go into science. You'll hate it.

[MissEmmyF]

Effective alternative treatments don't automatically and necessarily exist just because you can't conceive of their not existing.



Don't ever go into science. You'll hate it.

I know that. My point was that there are some very promising studies in regard to alternative methods. Are we talking in circles? Do you keep repeating yourself or does it just seem that way?

I actually enjoyed science in high school and college, but thanks for the career advice.

I think most people on this forum believe the same basic stuff, so I'm not quite sure why there's so much debate. I'm not trying to stop anyone from having fusion, especially if they have very large curves. I honestly don't think exercise would help substantial curves. It sucks if surgery is the only answer, but sometimes it is. Thank goodness the technologies for doing so are only getting better.

And, I think most people can agree that if any progress is made with exercising, the exercises will likely have to be continued. So, what's the problem? I'm not telling young children with large curves to start exercising, your problem will be solved, and not to have fusion. I just think it's good to be as proactive as possible. Watching and waiting is the dumbest thing I've ever heard of. I equate it to: "well, your cholesterol is a little high right now, but we're not going to put you on any medicine until it gets worse." Instead of: "hey, you should watch what you eat and start exercising." It's the same thing to me.

In my case, Schroth is exactly what I was looking for because I only have a moderate curve, and it improves my pain and physical appearance. I'm happy to commit a half hour to hour each day to my exercises. Hopefully it will continue to help me over time and stop any progression in the future. It's certainly better than doing nothing.

[Pooka1]

Watching and waiting is the dumbest thing I've ever heard of. I equate it to: "well, your cholesterol is a little high right now, but we're not going to put you on any medicine until it gets worse." Instead of: "hey, you should watch what you eat and start exercising." It's the same thing to me.

But you see that is a very bad analogy because we KNOW eating right and exercising can lower cholesterol because we have EVIDENCE.

In re PT and exercise, we DON'T KNOW that those treatments can reduce a curve permanently or even halt progression for good. Rather have decades of evidence suggesting they can't do those things. Samdani seems to think there is very little evidence for PT halting or correcting curves and this is his field, not mine.

In my case, Schroth is exactly what I was looking for because I only have a moderate curve, and it improves my pain and physical appearance. I'm happy to commit a half hour to hour each day to my exercises. Hopefully it will continue to help me over time and stop any progression in the future. It's certainly better than doing nothing.

I hope it helps you also. Pain is one thing that PT has been shown to successfully address as far as I know.

[MissEmmyF]

more talking in circles...i don't think anyone is saying exercise will reduce a curve "permanently." it's not like, "hey, do these exercises for a few months and then you'll be straight as an arrow." it's more along the lines of "any reduction that you are able to achieve will have to be kept in check by continuing to do the exercises." that's the same thing with any exercise program. if you're trying to build muscles in your biceps, you achieve that over time, and then you stop doing weight lifting targeting your biceps, they will go back to their normal size.

[Pooka1]

That is the case for adults.

But I think the hope of PT with growing kids is to build muscle to not only prevent progression but to reduce curves already present. I think they are suggesting that you do the exercising until maturity and that will reduce or hold the curve even if the kid doesn't exercise any more.

That would be good if true. We'll have to wait and see if that is true.

But if the thought is the kid has to exercise the rest of his life, then what if he can't? IS all the hard work and any gain in reducing the curve lost?

[MissEmmyF]

That is the case for adults.

But I think the hope of PT with growing kids is to build muscle to not only prevent progression but to reduce curves already present. I think they are suggesting that you do the exercising until maturity and that will reduce or hold the curve even if the kid doesn't exercise any more.

That would be good if true. We'll have to wait and see if that is true.



That would be awesome if that were true! It might seem possible as long as you were able to catch the scoliosis early enough and then make the muscles surrounding the spine totally equal in strength.

However, I think scoliosis obviously has other factors to it other than just unequal muscle strength on either side of the spine. I would think any other factors involved in the scoliosis (like anything nuerological, for example) would also have to get fixed.

[Pooka1]

That would be awesome if that were true! It might seem possible as long as you were able to catch the scoliosis early enough and then make the muscles surrounding the spine totally equal in strength.

However, I think scoliosis obviously has other factors to it other than just unequal muscle strength on either side of the spine. I would think any other factors involved in the scoliosis (like anything neurological, for example) would also have to get fixed.

Yes you found a potential problem in that claim if it is the claim.

I wonder if building muscle can ever possibly work to hold the spine in place until maturity if physically holding the spine in place as with a brace hasn't been shown to do so. I mean the claim at that point would have to be that muscle strength is somehow superior than a brace in terms of holding the spine in a particular configuration. It sounds unlikely but what do I know?

[MissEmmyF]

I wonder if building muscle can ever possibly work to hold the spine in place until maturity if physically holding the spine in place as with a brace hasn't been shown to do so. I mean the claim at that point would have to be that muscle strength is somehow superior than a brace in terms of holding the spine in a particular configuration. It sounds unlikely but what do I know?

Yeah, I don't fully understand the whole bracing concept. Don't braces physically hold the spine in place using forced pressure? I don't see how that would do anything in the long-term unless it was on 24/7 for the rest of your life. Otherwise, when you take the brace off, won't everything just sink back into how it used to be? And, worse yet, meanwhile, while wearing the brace, your muscles are atrophying so that they're even weaker than they were to begin with by the time the brace is ready to come off. So, that gives you even less of a chance to "hold" any correction you've made from wearing the brace. Right?? Maybe I'm not understanding something.

I know the SpineCor brace is supposed to be different than any kind of rigid brace because it supposedly is more of a posture rehabilitation device - meaning the straps are there kind of as guidance to "nudge" you into proper alignment. So, I think the objective with this brace is that you actually strengthen your muscles by wearing because you're doing more of the active work and not relying on the brace. But, maybe I'm misunderstanding that too.

[Pooka1]

Yeah, I don't fully understand the whole bracing concept. Don't braces physically hold the spine in place using forced pressure? I don't see how that would do anything in the long-term unless it was on 24/7 for the rest of your life. Otherwise, when you take the brace off, won't everything just sink back into how it used to be? And, worse yet, meanwhile, while wearing the brace, your muscles are atrophying so that they're even weaker than they were to begin with by the time the brace is ready to come off. So, that gives you even less of a chance to "hold" any correction you've made from wearing the brace. Right?? Maybe I'm not understanding something.

I think the claimed mechanism of bracing is to physically hold the spine such that wedging can't occur. I think the claim is the brace can halt incorrect growth on the convex side and allow more growth on the concave side so that using growth, the spine can straighten. That's why braces don't work past maturity except possibly for pain relief.

Therefore braces don't claim to reduce curves but rather prevent progression. It is well known that the curve reverts if the brace comes off and isn't surprising.

I know the SpineCor brace is supposed to be different than any kind of rigid brace because it supposedly is more of a posture rehabilitation device - meaning the straps are there kind of as guidance to "nudge" you into proper alignment. So, I think the objective with this brace is that you actually strengthen your muscles by wearing because you're doing more of the active work and not relying on the brace. But, maybe I'm misunderstanding that too.

Any brace that takes over for muscle (that is ALL BRACES) cannot even in principle build muscle. You can only lose muscle in a brace. All braces. Not just from being restricted in movement but also because the brace is supporting you rather than your own muscles. If Spinecor is ever shown to be effective, it works in the identical manner as hard braces.

[MissEmmyF]

Ok, thanks. That explanation does make sense then.

[mamamax]

Any brace that takes over for muscle (that is ALL BRACES) cannot even in principle build muscle. You can only lose muscle in a brace. All braces. Not just from being restricted in movement but also because the brace is supporting you rather than your own muscles. If Spinecor is ever shown to be effective, it works in the identical manner as hard braces.

eh-hem .. sorry Sharon - Spinecor does not work in the same manner as rigid bracing and does not cause muscle atrophy. That is a fact. A fact well documented on the manufacturer's web page.

[Pooka1]

eh-hem .. sorry Sharon - Spinecor does not work in the same manner as rigid bracing and does not cause muscle atrophy. That is a fact. A fact well documented on the manufacturer's web page.


That is their claim. How did they prove it was a fact? Do you see the problem?

They might as well claim to have invented a perpetual motion machine.

[mamamax]

Well, i see the problem for you as a natural skeptic. But there is no problem for me and for those in treatment.

You propose in essence that the surgeon/inventors Rivard and Colliard are - what? Frauds?

[Pooka1]

Well, i see the problem for you as a natural skeptic. But there is no problem for me and for those in treatment.

You propose in essence that the surgeon/inventors Rivard and Colliard are - what? Frauds?

If most published articles in top shelf journals by top shelf researchers can be wrong, why can't a single claim made by folks trying to sell a brace on a non-peer-reviewed venue be wrong also?

Not everyone is lying. I think few are lying. But folks are routinely mistaken.

[mamamax]

Any brace that takes over for muscle (that is ALL BRACES) cannot even in principle build muscle. You can only lose muscle in a brace. All braces. Not just from being restricted in movement but also because the brace is supporting you rather than your own muscles. If Spinecor is ever shown to be effective, it works in the identical manner as hard braces.

Let's go back to your above statement. Can you produce any evidence of this regarding Spinecore? Or is this just a personal opinion?

[Pooka1]

Let's go back to your above statement. Can you produce any evidence of this regarding Spinecore? Or is this just a personal opinion?



It's how braces work.

Ask yourself if the brace is doing any work that your muscles were previously doing.

Ask yourself if you are restricted from using any muscles you were able to use out of brace.

You can figure this out for yourself.

[mamamax]

Originally Posted by mamamax View Post
Let's go back to your above statement. Can you produce any evidence of this regarding Spinecore? Or is this just a personal opinion?


It's how braces work.

Ask yourself if the brace is doing any work that your muscles were previously doing.

Ask yourself if you are restricted from using any muscles you were able to use out of brace.

You can figure this out for yourself.

Exactly! (i can figure it out for myself)

The brace is acting like a second set of muscles. In areas along my spine that were previously atrophied - these are strengthening and the strength holds out of brace (have been wearing near 3 months at this point). There is no atrophy being experienced - in fact the opposite.

Now - i still would like to know if you have any evidence to provide regarding your above statement.

[Pooka1]

The brace is acting like a second set of muscles. In areas along my spine that were previously atrophied - these are strengthening and the strength holds out of brace (have been wearing near 3 months at this point). There is no atrophy being experienced - in fact the opposite.


The only thing that can build muscles naturally (i.e., excluding anabolic steroids and such) is use. Exercise.

Bracing is the opposite of exercise in that it either proves the support that your body can't and/or it restricts exercise of the muscles.

Braces can't build muscle. They decrease it through restriction and taking over for muscle.

I cite my biochemistry course and knowing what a brace is and does.

[mamamax]

Well, i don't care what your educational background is in - here's the thing: First off - physical therapy can build muscle. This brace is designed in such a manner as physical therapy is not required along with treatment - because, the brace is engineered to create the same effect as physical therapy just in the wearing, along with normal activity. This information is outlined within the manufacturer's web page.

So - that is why myself and others experience the things we do and this is why Spinecor is unlike any rigid bracing.

Your original statement:

Any brace that takes over for muscle (that is ALL BRACES) cannot even in principle build muscle. You can only lose muscle in a brace. All braces. Not just from being restricted in movement but also because the brace is supporting you rather than your own muscles. If Spinecor is ever shown to be effective, it works in the identical manner as hard braces.

Again, i'd like to ask you if you have any evidence/proof of what you say regarding Spinecore. Or, is this just a personal opinion?

[Pooka1]

Well, i don't care what your educational background is in - here's the thing: First off - physical therapy can build muscle.

Precisely what I said.

This brace is designed in such a manner as physical therapy is not required along with treatment - because, the brace is engineered to create the same effect as physical therapy just in the wearing, along with normal activity.

Do you understand how a brace can mimic physical therapy? Feel free to read the Spinecor material before answering.

If so, explain it to me please.

[mamamax]

How about you answer my question first?? :confused:

[Pooka1]

How about you answer my question first?? :confused:

The person making the claim has the burden of proof.

The person doubting the claim gets to sit back and watch the show.

This should not be news. It's debating 101.

Spinecor, through you, are making a claim that the brace works like physical therapy.

I am asking you to take up that burden and prove it.

Do you know the claimed mechanism for how Spinecor mimics PT or not? If you don't understand the mechanism then how can you know if the claim is true or false?

[mamamax]

I know what this brace is doing for me. So do others. I care little about debate rules. If you will answer my question - I'll be glad to answer yours :-)

[Pooka1]

I know what this brace is doing for me. So do others. I care little about debate rules. If you will answer my question - I'll be glad to answer yours :-)

I answered it up-thread.

It is well-known how braces work. You might want to read up on it.

What is unknown is how a particular brace can work like PT.

Extraordinary claims require extraordinary evidence as the late, great Carl Sagan used to say.

[mamamax]

From the brace manual (written by the surgeons/inventors Rivard/Colliard) and incidentally posted at SRS.

Physical therapy is NOT a necessity in the SpineCor program (SpineCor itself may be considered a physiotherapy 20 hours out of 24). However, when the patient is willing to undergo a physio program, or a faster consolidation of the reduction of the curve is desired, the Global Postural Reeducation (GPR) program is considered.

From the manufacturer's web page:

The SpineCor® treatment approach is completely different to that of traditional braces that use 3-point pressure and distraction; it is the first and only true dynamic bracing system for idiopathic scoliosis. SpineCor®’s unique approach to treatment by global postural re-education has been shown to give progressive correction over time which, unlike any previous brace treatment, is extremely stable post brace weaning.

Good night Sharon - other things to do than turn this this tread into a great "debate" about Spinecor. If you truly believe these things to be untrue - please do us all a big favor and write Rivard and Colliard with your concerns and post their answer for us?

Later -

[betty14]

I know that. My point was that there are some very promising studies in regard to alternative methods. Are we talking in circles? Do you keep repeating yourself or does it just seem that way?

I actually enjoyed science in high school and college, but thanks for the career advice.

I think most people on this forum believe the same basic stuff, so I'm not quite sure why there's so much debate. I'm not trying to stop anyone from having fusion, especially if they have very large curves. I honestly don't think exercise would help substantial curves. It sucks if surgery is the only answer, but sometimes it is. Thank goodness the technologies for doing so are only getting better.

And, I think most people can agree that if any progress is made with exercising, the exercises will likely have to be continued. So, what's the problem? I'm not telling young children with large curves to start exercising, your problem will be solved, and not to have fusion. I just think it's good to be as proactive as possible. Watching and waiting is the dumbest thing I've ever heard of. I equate it to: "well, your cholesterol is a little high right now, but we're not going to put you on any medicine until it gets worse." Instead of: "hey, you should watch what you eat and start exercising." It's the same thing to me.

In my case, Schroth is exactly what I was looking for because I only have a moderate curve, and it improves my pain and physical appearance. I'm happy to commit a half hour to hour each day to my exercises. Hopefully it will continue to help me over time and stop any progression in the future. It's certainly better than doing nothing.


Thank you for being a voice of reason, MissEmmyF!
As with most things in life, extremism is usually not the answer.

B.

[betty14]

I wonder if building muscle can ever possibly work to hold the spine in place until maturity if physically holding the spine in place as with a brace hasn't been shown to do so. I mean the claim at that point would have to be that muscle strength is somehow superior than a brace in terms of holding the spine in a particular configuration. It sounds unlikely but what do I know?

Hello, I can supply an answer here. Anotomy and physiology tell us that the muscles and ligaments have numerous types of receptors that are responsible for sensing things such as level of stretch, level or compression, amount of chemical irritants etc.

As an example, when the ankle is sprained and the muscles on the side of the ankle are streched, several things happen. Disrupted receptors sites no longer send the messages effectively to the brain, and the resulting automatic posture responses are lost. At the same time, muscles around an injured joint, even if not injured themselves, become inhibited. So, the person's balance is way off. Specific balance and strength training allows the skills to be re-learned. This is old hat in rehab. literature.

Applying this to scoliosis:
We know that the scoliotic spine's posture, balance, positional sense is way off (who knows WHY). The person's brain has no idea of what "normal" is.
When one applies a brace, this passively holds the person straighter. This may have some benefit to prioprioception, but the muscles are not required to do too much - and the body is designed to move. If one could take a person that has lost their ability to "feel" what a proper joint position or level of muscle tension is, and reteach these skills, motor learning can take place - the brain learns.

As for why some braced people's curves hold, and others' do not likely is due to many factors....as I know many of you have read up on.

One line quoted above I'll repeat:

...the claim at that point would have to be that muscle strength is somehow superior than a brace in terms of holding the spine in a particular configuration....


OF COURSE muscle strengh is superior if you can achieve it! There are muscles large and small, going in all different directions, that precicely hold joints in place and move them is proper sequence when we walk, jump etc...

Clinically, (for my non-scoliosis patients), I often use bracing and exercise together. Bracing helps when the patient is weak and needs the support, and is weaned off of as able.

Cheers,
B.

[mamamax]

Clinically, (for my non-scoliosis patients), I often use bracing and exercise together. Bracing helps when the patient is weak and needs the support, and is weaned off of as able.

Cheers,
B.

Betty ~ i want to be a patient of yours!! Everything you have said makes perfect sense. At 59 this patient was quite weak and had lost several inches of height. My brace, a godsend in terms of postural rehabilitation and lessening of pain. This morning - standing 4 inches taller (out of brace) than when i began my treatment. The physical difference, quite dramatic. Muscles are being retrained and strengthened - it can be done :-) and i'm looking forward to adding Schroth (developed by a PT) to the program!

[Pooka1]

(snip background material of uncertain relevance)
One line quoted above I'll repeat:

...the claim at that point would have to be that muscle strength is somehow superior than a brace in terms of holding the spine in a particular configuration....

OF COURSE muscle strength is superior if you can achieve it!

I don't know why this is so obvious to you. I would say OF COURSE a brace has to be superior to any amount of muscle training.

ETA: What we are talking about here is trying to stop the wedging of bone as far as I can tell. If braces haven't been able to hold the spine such that the growth plates on one side are not able to grow then I don't see how any amount of strength training with the same goal of holding the spine to arrest one side of the growth plate can work.

Clinically, (for my non-scoliosis patients), I often use bracing and exercise together. Bracing helps when the patient is weak and needs the support, and is weaned off of as able.


So you are saying braces provide support that the muscles can't provide. Now if you continue to support the muscle through bracing, will the muscle get better or worse?

Now if you have a brace that RESTRICTS movement of certain muscles, will those muscles get better or worse?

I mean why wean people off braces when they build muscle as Spinecor claims? Why don't folks wear braces instead of exercise to build muscle if that claim is correct?

Can you please explain how braces work in terms of what happens to muscle so we can move on.

[Dingo]

Pooka1

I would say OF COURSE a brace has to be superior to any amount of muscle training.

Do you have any science to back that up? All 3 torso rotation studies produced more positive results than any bracing study I am aware of.

Post a credible bracing study that produced anything close to this.

The Role of Measured Resistance Exercises in Adolescent Scoliosis (http://www.medxonline.com/downloads/articles/measuredresistanceinscoliosis.pdf)

I think you are making up science again.

[Pooka1]

Pooka1



Do you have any science to back that up? All 3 torso rotation studies produced more positive results than any bracing study I am aware of.

Post a credible bracing study that produced anything close to this.

The Role of Measured Resistance Exercises in Adolescent Scoliosis (http://www.medxonline.com/downloads/articles/measuredresistanceinscoliosis.pdf)

I think you are making up science again.

No the problem is there is little science in this area. Obviously my statement is not based on science nor is the statement I was responding to.

I guess I'll try to be clearer I guess.

There are any number of people who make up science but I'm not one of them.

[mamamax]

You know - there is no one size fits all. Dingo - the information you post looks very very promising in certain cases ... what are those cases? The reason i ask is this: i have been told by my specialists (both past and present) to never do torso rotational exercises .. i don't know why, maybe something to do with double curves and the degree of magnitude. I don't know, but will ask.

Bracing alone with Spinecor has some pretty impressive statistics w/5 year follow ups (SOSORT 2009). I do not know if these kids were also using PT specific for scoliosis or not. I suspect they were. I do know that for me, exercise is recommended because (i presume) the brace can provide a lot - but exercise will provide the stability.

[LindaRacine]

Betty ~ i want to be a patient of yours!! Everything you have said makes perfect sense. At 59 this patient was quite weak and had lost several inches of height. My brace, a godsend in terms of postural rehabilitation and lessening of pain. This morning - standing 4 inches taller (out of brace) than when i began my treatment. The physical difference, quite dramatic. Muscles are being retrained and strengthened - it can be done :-) and i'm looking forward to adding Schroth (developed by a PT) to the program!
4"? Really? I hope you'll be able to post before and after pictures or xrays.

--Linda

[LindaRacine]

i have been told by my specialists (both past and present) to never do torso rotational exercises .. i don't know why, maybe something to do with double curves and the degree of magnitude. I don't know, but will ask.

I've never heard a scoliosis specialist say anything about torso rotation exercises being bad for someone with scoliosis.

[MissEmmyF]

I have also been told something to that effect actually - however, it was not in reference to strengthening but was in reference to stretching (i.e. sitting on a chair or the ground, rotating to either side, and holding it for a stretch - it's a common yoga pose that is even in Elise Browning's yoga for scoliosis DVD):

This is what I was told: "Spinal rotation will twist one part of the spine out of the scoliosis pattern but increase twist in the part of the spine above and below that area"

[MissEmmyF]

Also, keeping in line with that, I guess the part I don't fully understand is if you think about it, scoliosis has a rotational component to it...my scoliosis in particular rotates back toward the right...so if i'm doing any type of rotational stuff (whether it be strengthening or stretching) toward that back right side, wouldn't i be "feeding" into the rotation?

[Pooka1]

Also, keeping in line with that, I guess the part I don't fully understand is if you think about it, scoliosis has a rotational component to it...my scoliosis in particular rotates back toward the right...so if i'm doing any type of rotational stuff (whether it be strengthening or stretching) toward that back right side, wouldn't i be "feeding" into the rotation?

That's a very interesting point that I hadn't thought of at all.

I wonder how the curvature is addressed apart from the rotation?

And what about kids who have a curve and very little rotation like my one kid? Would they even be expected to benefit from torso rotation?

At base, I think the idea of torso rotation is to build muscle to prevent progression or, in kids, to correct curvature along with growth. But scoliosis is such a variable and complex three dimensional deformity that even if you had a bunch of kids with a right T curve doing a particular exercise, I don't think you would even expect the same outcome necessarily. Both my kids had a right T curve with apex at T9 but one was very rotated and the other hardly so.

[Dingo]

mamamax
MissEmmyF

the information you post looks very very promising in certain cases ... what are those cases? The reason i ask is this: i have been told by my specialists (both past and present) to never do torso rotational exercises .. i don't know why, maybe something to do with double curves and the degree of magnitude. I don't know, but will ask.

Someone who I happen to like and respect very much wrote me a private message concerned about torso rotation. This person told me that certain well known people in Schroth forbid torso twists even if they are done in both directions.

It would be ironic if scientists ultimately prove beyond any doubt that an exercise that controls Scoliosis had been banned for decades.

Don't get me wrong, it makes logical sense that torso twists could be harmful. Like MissEmmyF pointed out 50% of a child's twists push the deformity further in the wrong direction. But Mooney's study (plus the other 2) show that the spine doesn't necessarily respond the way we'd expect. On page 4 you can see a list of all the different curves this therapy helped. (http://www.medxonline.com/downloads/articles/measuredresistanceinscoliosis.pdf)

By comparison:
It makes logical sense that people with arthritis should avoid exercise. Driving a broken car will only wear it out faster. And yet arthritis doesn't work that way. Today doctors encourage their patients to get as much healthy exercise as they can. Study after study finds that exercise reduces pain and improves the longterm quality of life for people living with arthritis.

[Dingo]

Pooka1

And what about kids who have a curve and very little rotation like my one kid? Would they even be expected to benefit from torso rotation?

As you and LindaRacine have pointed out correctly there are no longterm studies to guide us. However one thing is for sure. Unless your daughter is an anomoly her abs and her back have a left/right strong side and a weak side.

As Dr. Mooney put it, "This is definitely abnormal."

One side of her back is pulling on her spine with 10 pounds of force and the other side is pulling with only 7 pounds. That's a simple explanation with imaginary numbers but that's what is going on inside of her body 24/7.

30 minutes of strength training per week can correct this completely. I would guess (and it's only a guess) that this would help just about any kid's spine stay straight or move to a straighter position. Adults with curves over 30 degrees tend to have slow curve progression as well. It makes sense that this could potentially slow or stop that progression. Of course if the curve gets bad enough gravity takes over and nothing can help but fusion.

[betty14]

Hello:

I just wanted to comment on the torso rotation questions that people have been asking.


Biomechanics of the thorax:

The thoracic spine is very complex, with ten or more joints per segment, once you count the anterior and posterior rib articulations. The orientation of the facet joints allows for quite a lot of rotation per segment; however the rib articualtions add bony stability that reduces that amount. At the bottom of the ribcage the last few ribs float (ie. don't attach to the sternum at the front). This allows the greatest amount of rotation to be at the junction of the thorax and upper lumbar spine.

Motion of the thorax ALWAYS involves a coupling of more than one motion, that is, side flexion always involves rotation, and rotation always involves side flexion. This next bit is complicated: The latest research on biomechanics shows that if you rotate first, the coupled motion is to the SAME side, but if you side bend first, the coupled motion is the the OPPOSITE side. Scoliosis appears to consistently involve side flexion with the ribcage moving posterior on the side of the convexity, which is opposite rotation.


This my understanding from my reading on Shroth therapy:

Derotatation is important, but it must be predeeded by elongation and correction of some of the side bend first, otherwise, one is rotating into a zone where there is no room, because the ribs in the concavity are literally in the way.

This Shroth concept has been around a long time, yet it is completely consistent with the most recent thoracic spine biomechanics research. I find this very exciting, how about you?

Regarding the torso rotation strengthening, I'll be checking out your links, Dingo, when I get a chance. Thanks for posting.

[Dingo]

Thanks for the info Betty!

Motion of the thorax ALWAYS involves a coupling of more than one motion, that is, side flexion always involves rotation, and rotation always involves side flexion.

Let me know if I understood this parrt correctly. If I bend to my side my spine rotates. If I rotate my spine my side will bend. Is that right?

The latest research on biomechanics shows that if you rotate first, the coupled motion is to the SAME side, but if you side bend first, the coupled motion is the the OPPOSITE side.

Ok, let me see if I can understand this one correctly.
If I rotate my spine in clockwise motion (towards my right) which side has the bend in it? My right side?

---

BTW I should add one more link. All kids with Scoliosis have a strong and weak side (left/right) on both their abs and their back. There are quite a few studies that address this but here is one of the more recent. The link includes the entire study.

2007 - Trunk rotational strength asymmetry in adolescents with idiopathic scoliosis: an observational study (http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2072936)

Conclusion:
This preliminary study measured trunk rotational strength in a group of adolescent healthy females and a group of adolescent idiopathic scoliosis females. Scoliosis patients were significantly weaker when rotating towards the concavity of the spinal curve in the neutral position and when pre-rotated 18° and 36° toward the concavity and then contracting towards the concavity, i.e. away from neutral, termed "low force". In contrast, the healthy group did not show weakness in the low force arc. In addition, low force arc trunk strengths on the concave side in scoliotic individuals were also significantly lower than those on the left side in the healthy subjects. These findings may help future researchers develop effective new approaches for the management of idiopathic scoliosis.

[betty14]

Hi Pooka1:
I'll try to respond to each of your questions:

I don't know why this is so obvious to you. I would say OF COURSE a brace has to be superior to any amount of muscle training.

A brace, if properly designed for the person's curves, could straighten and derotate the spinal segments within the limits of bony deformity and any hypo-mobile segments, if present. The patient would be passively held in a corrected alignment. This may offer pain relief due to reduced stretch and over-work in various areas. The wearer may get an improved awareness of alignment, and as he or she grew, would continue to be straighter. As you know, some people's curves hold, others' progress anyway, once the brace is removed.

In a normal body, the muscles work to hold the spine upright against gravity. This is clearly lost in a scoliotic spine. What we don't know is cause vs. effect. Are the messed up muscles a victim of the cause(s), or is there something abnormal with the muscles??? Don't really know.

In any case, having your muscles hold you straighter is much better that a passive support only. For one thing, the muscles, ligaments and joint capsules all contain tons of receptors for stretch/compression/level of tension etc.. They are constantly getting input from the environment, transmitting that to the CNS, and there is quick response in terms of minute postural corrections. I saw a lengthy post you made about horses where you spoke of that.

The brain of the scoliotic person does not know what a good posture is, because they are never in a good posture. Because the various muscles have precice directions of pull, the goal of muscle training is to learn what good posture is, and activate those muscle patterns regularly, and get enough bulk and strength to maintain it. You know how when a person with a flexible scoliotic spine lays down and their curves are much smaller due to the gravity-eliminated position? Well, the goal is to train the muscles to hold that posture once the person stands up.

If a person was ONLY braced, he would get much less stimulation and chance for motor learning and strengthening. Perhaps a rigorous and specific exercise routine COMBINED with some static bracing will turn out to be a useful approach.


ETA: What we are talking about here is trying to stop the wedging of bone as far as I can tell. If braces haven't been able to hold the spine such that the growth plates on one side are not able to grow then I don't see how any amount of strength training with the same goal of holding the spine to arrest one side of the growth plate can work..

we know that bones require forces to be exerted on them to be healthy, and grow properly. It is well known that scoliotic spines show areas of low bone density; indeed we are at increased risk for osteoporosis. When a bone is immobolized and weight bearing is restricted, such as a leg in a cast, bone density declines. It comes back to normal once the person is able to load the bone via weight bearing and muscle forces. Spine and hip bone density has been shown to increase in people with osteoporosis by performing specific spine strengthening exercises.
The idea is that if a person is able to strengthen sufficiently to maintain improved posture, he may be able to effect the bony growth and remodelling to prevent some of the progression of deformity over the lifespan. (Obviously, there is no strong evidence of this at this time; however on a personal note, I tend to take a proactive approach, rather than watching and waiting to see if I'll get more pain and deformity)



So you are saying braces provide support that the muscles can't provide. Now if you continue to support the muscle through bracing, will the muscle get better or worse?.

There seems to be conflicting evidence and professional opinions on that. I have had some of my PT (non-scoliotis) patients come to me saying their doctor would not write a script for the back brace I recommeded because he or she was afraid they would get weak. I have also had patients who felt the brace made them "feel" their abdominals more because of the tactile stimulation.


I mean why wean people off braces when they build muscle as Spinecor claims? Why don't folks wear braces instead of exercise to build muscle if that claim is correct?

Can you please explain how braces work in terms of what happens to muscle so we can move on.

The idea behind the Spinecor is totally different from other bracing products, because it is dynamic, not static. They are trying to overcome the obstacles of reduced activity and reduced opportunity to develop proprioception. A static brace just holds you. You can be lazy in it - no motor learning and strengthening would take place. A dynamic brace is postulated to coax you into aligment when you fall out it, and keep your muscles working. The ideas behind it are sound, and time will tell if those sound ideas translate to ongoing clinical success.



B.

[Pooka1]

A brace, if properly designed for the person's curves, could straighten and derotate the spinal segments within the limits of bony deformity and any hypo-mobile segments, if present. The patient would be passively held in a corrected alignment. This may offer pain relief due to reduced stretch and over-work in various areas. The wearer may get an improved awareness of alignment, and as he or she grew, would continue to be straighter. As you know, some people's curves hold, others' progress anyway, once the brace is removed.

Correct me if I'm wrong but the brace is designed to hold the spine such that the growth plates on the convex side physically cannot grow and allows room on the concave side so that the wedging doesn't occur. This is a mechanical mode of action that has zip to do with muscle. Indeed muscle mass must shrink with brace usage as movement is restricted and the brace takes over some support that the muscles/ligaments/tendons were doing before the brace.

In a normal body, the muscles work to hold the spine upright against gravity. This is clearly lost in a scoliotic spine. What we don't know is cause vs. effect. Are the messed up muscles a victim of the cause(s), or is there something abnormal with the muscles??? Don't really know.

What I thought is going on is some abnormality in the bone growth in the spine along the growth plates. Wedging occurs and the muscles adapt to it. The asymmetric muscling is a result of the spine wedging, not a cause.

In any case, having your muscles hold you straighter is much better that a passive support only. For one thing, the muscles, ligaments and joint capsules all contain tons of receptors for stretch/compression/level of tension etc.. They are constantly getting input from the environment, transmitting that to the CNS, and there is quick response in terms of minute postural corrections. I saw a lengthy post you made about horses where you spoke of that.

I think the question is which provides more mechanical leverage to stop the wedging... muscle or a brace? I have no study to cite but my feeling is that a brace must be superior because it is constantly working when on. Muscle relaxes unless you are using it. So just from a duration standpoint, bracing has to be superior.

The brain of the scoliotic person does not know what a good posture is, because they are never in a good posture. Because the various muscles have precise directions of pull, the goal of muscle training is to learn what good posture is, and activate those muscle patterns regularly, and get enough bulk and strength to maintain it. You know how when a person with a flexible scoliotic spine lays down and their curves are much smaller due to the gravity-eliminated position? Well, the goal is to train the muscles to hold that posture once the person stands up.

But we still don't know if muscle is ever enough to stop the bone wedging, even in body builders.

If a person was ONLY braced, he would get much less stimulation and chance for motor learning and strengthening. Perhaps a rigorous and specific exercise routine COMBINED with some static bracing will turn out to be a useful approach.

But I'm questioning the ability of any amount of stimulation of muscle to prevent bone wedging.

(snip)

The idea is that if a person is able to strengthen sufficiently to maintain improved posture, he may be able to effect the bony growth and remodelling to prevent some of the progression of deformity over the lifespan. (Obviously, there is no strong evidence of this at this time; however on a personal note, I tend to take a proactive approach, rather than watching and waiting to see if I'll get more pain and deformity)

I used to think braces and PT operate in opposite fashions but I am thinking twice about that. I think they are both trying to hold the spine to arrest the asymmetrical plate growth. This makes sense that we have little evidence either works if they are using the same mode of action.

There seems to be conflicting evidence and professional opinions on that. I have had some of my PT (non-scoliotis) patients come to me saying their doctor would not write a script for the back brace I recommeded because he or she was afraid they would get weak. I have also had patients who felt the brace made them "feel" their abdominals more because of the tactile stimulation.

Feeling your abs in a tight brace isn't really relevant to working/building muscle, yes?

The idea behind the Spinecor is totally different from other bracing products, because it is dynamic, not static. They are trying to overcome the obstacles of reduced activity and reduced opportunity to develop proprioception. A static brace just holds you. You can be lazy in it - no motor learning and strengthening would take place. A dynamic brace is postulated to coax you into aligment when you fall out it, and keep your muscles working. The ideas behind it are sound, and time will tell if those sound ideas translate to ongoing clinical success.

If you are able to move around more then you are possibly not arresting the right areas of the growth plates. That would explain the lack of evidence for efficacy to date.

[betty14]

Correct me if I'm wrong but the brace is designed to hold the spine such that the growth plates on the convex side physically cannot grow and allows room on the concave side so that the wedging doesn't occur. This is a mechanical mode of action that has zip to do with muscle.
...
What I thought is going on is some abnormality in the bone growth in the spine along the growth plates. Wedging occurs and the muscles adapt to it. The asymmetric muscling is a result of the spine wedging, not a cause.
...
I think the question is which provides more mechanical leverage to stop the wedging... muscle or a brace? I have no study to cite but my feeling is that a brace must be superior because it is constantly working when on. Muscle relaxes unless you are using it. So just from a duration standpoint, bracing has to be superior.



I'm not sure that your following comment is completely true: "(what) is going on is some abnormality in the bone growth in the spine along the growth plates. Wedging occurs and the muscles adapt to it. The asymmetric muscling is a result of the spine wedging, not a cause."

I believe you are referring to a recent study that suggested that vertebral body wedging may be due to a primary disturbance of growth involving asymmetrical growth plates?

While the above may be true, it is likely that the "vicious circle" mechanism is also at work. The growth disturbance causes wedging. That causes a small curve in that local area. That causes asymmetrical loading and abnormal muscle function. That in turn causes more abnormal bone modelling, which causes a greater deformity. Because the deformity is greater, the muscle function becomes even worse. More asymmetrical loading, the bones respond with asymmetrical growth, and on and on..... here's a (poor) diagram, you'll have to add the line and arrow going from 4 back to 1 in your mind:

1) wedging
V
V
2) curve
V
V
3) asymmetrical loading of the bones
V
V
4) asymmetrical bone growth
V
V
Back to 1)


As far as non-surgical options go, we can target point #2 with a brace or point#3 with exercise. Since point#3 is my specialty, I will speak about that.

We KNOW that muscles effect bones (search rehab or muscle/bone physiology literature for details). Bones respond to strain imparted on them by contracting muscles, and new bone is constantly being formed in reponse to that. So it has more than "zip" to do with bone growth.

I think that future research will start to show that a specifically applied set of exercises can in fact slow down curve progressions in certain scoliotic individuals, and/or help them maintain their status for a long time. It remains to be seen which subset of people would benefit MOST from such an approach.



Feeling your abs in a tight brace isn't really relevant to working/building muscle, yes?.

The above quote refers to standard back braces worn by some non-scoliotic people with back pain.

If you have a brace on, it touches you and presses into your tissues. Some people find this tactile stimilation very effective, reporting that "now I can really feel those muscles are there and turn them on better". This is highly relevent to working muscle.

[Pooka1]

We KNOW that muscles effect bones (search rehab or muscle/bone physiology literature for details). Bones respond to strain imparted on them by contracting muscles, and new bone is constantly being formed in response to that. So it has more than "zip" to do with bone growth.

Okay I'll give you that but there is still no proof the scoliosis cycle can be broken by exercise.

I think that future research will start to show that a specifically applied set of exercises can in fact slow down curve progressions in certain scoliotic individuals, and/or help them maintain their status for a long time. It remains to be seen which subset of people would benefit MOST from such an approach.

Okay but then would you agree that the answer isn't Schroth or any of the present exercise regimes since some of these have had decades and decades to show some efficacy?

In re Martha Hawes, she exercised 4 hours a day for 4-5 years and got some reduction. She is one person who did a program that few other people would even attempt and we don't know where her curve is today.

If you have a brace on, it touches you and presses into your tissues. Some people find this tactile stimulation very effective, reporting that "now I can really feel those muscles are there and turn them on better". This is highly relevant to working muscle.

Yes but simply finding the muscles as through tactile stimulation doesn't mean you are working/building them. Statements like yours add to the general confusion that a brace can build muscle which is of course impossible. Braces do some or all of the work of muscle and(or) restrict muscle so muscles can only get smaller in brace. Yes/No?

[mamamax]

In re Martha Hawes, she exercised 4 hours a day for 4-5 years and got some reduction.

Please? Give me your source on this (i.e. 4 hours a day for 4-5 years). Thanks.

[aterry]

This reply relates to the parts of this thread about torso rotation exercises. I took my daughter to Dr Boacie on Monday. Mostly because it had been suggested that she see a SRS specialist. My daughter's main issue is pain. He suggested PT for the pain. I asked specifically about torso rotation exercises and he said not to do that because, "it puts too much stress on the spine." He said that aerobic exercises are the best--running (?really?) and swimming. To tell you the truth he didn't seem to have much insight into the exercise aspect.

[MissEmmyF]

This reply relates to the parts of this thread about torso rotation exercises. I took my daughter to Dr Boacie on Monday. Mostly because it had been suggested that she see a SRS specialist. My daughter's main issue is pain. He suggested PT for the pain. I asked specifically about torso rotation exercises and he said not to do that because, "it puts too much stress on the spine." He said that aerobic exercises are the best--running (?really?) and swimming. To tell you the truth he didn't seem to have much insight into the exercise aspect.

Really?? Running puts a ton of stress/pressure on the spine due to the impact. And, as Betty shared, swimming is also "bad" for people with scoliosis. Funny he recommended aerobic work over strengthening work when her weak muscles are likely causing her pain.

[LindaRacine]

This reply relates to the parts of this thread about torso rotation exercises. I took my daughter to Dr Boacie on Monday. Mostly because it had been suggested that she see a SRS specialist. My daughter's main issue is pain. He suggested PT for the pain. I asked specifically about torso rotation exercises and he said not to do that because, "it puts too much stress on the spine." He said that aerobic exercises are the best--running (?really?) and swimming. To tell you the truth he didn't seem to have much insight into the exercise aspect.
I'm guessing that's because surgeons are used to dealing with tangible results, and so far, there is no definitive research that shows that any specific exercises help or hurt.

--Linda

[MissEmmyF]

I'm guessing that's because surgeons are used to dealing with tangible results, and so far, there is no definitive research that shows that any specific exercises help or hurt.

--Linda

Well, PT has been proven to be helpful in pain management I believe. So, since she went in there complaining of pain, it seems some sort of PT strengthening regime should be prescribed...not aerobic activities that are actually detrimental to scoliosis.

[MissEmmyF]

I'm guessing that's because surgeons are used to dealing with tangible results, and so far, there is no definitive research that shows that any specific exercises help or hurt.

--Linda

Furthermore, I don't see how "running" or "swimming" would have a tangible outcome...

[betty14]

This reply relates to the parts of this thread about torso rotation exercises. I took my daughter to Dr Boacie on Monday. Mostly because it had been suggested that she see a SRS specialist. My daughter's main issue is pain. He suggested PT for the pain. I asked specifically about torso rotation exercises and he said not to do that because, "it puts too much stress on the spine." He said that aerobic exercises are the best--running (?really?) and swimming. To tell you the truth he didn't seem to have much insight into the exercise aspect.

Surgeons usually provide a written protocol, that the physiotherapist must follow after surgery, to protect the surgical areas and ensure good healing, but outside of that, they are usually not very involved, unless they work in a team setting where they interact closely with rehab staff, where there might be a detailed protocol. An average protocol might say "no such-and-such first 4 weeks", "avoid greater than X degrees of motion in this direction for 8 weeks". Each individual phsysiotherapist has a wide range of possible manual and exercise options within those guidelines. Surgeons are surgery experts, but not rehabilitation experts.

Personally, I cannot run more that a few minutes before I have to stop due to left knee pain. My thoracolumbar area moves too abnormally to allow my knee to move properly (there has been much research on running biomechanics, and I also treat many runners). As per swimming, I would never swim lengths regularly, since the heavy breathing involved would serve to further expand my rib hump area, which I do not want. When physicians suggest such exercises, they are promoting general fitness, not rehabilitation.

The doctor is likely saying that torso rotation exercise might put too much stress on the spine because it is known that discs can be injured by rotational forces. I would be concerned about anyone doing high velocity or large amplitude rotational motions for that reason as well. Slower, controlled motions are not injurious to discs however.

Cheers.
B.

[MissEmmyF]

Surgeons usually provide their written protocol, that the physiotherapist must follow after surgery, to protect the surgical areas and ensure good healing, but outside of that, they are usually not very involved, unless they work in a team setting where they interact closely with rehab staff. They are surgery experts, but not rehabilitation experts.

Personally, I cannot run more that a few minutes before I have to stop due to left knee pain. My thoracolumbar area moves too abnormally to allow my knee to move properly (there has been much research on running biomechanics, and I also treat many runners). As per swimming, I would never swim lengths regularly, since the heavy breathing involved would serve to further expand my rib hump area, which I do not want. When physicians suggest such exercises, they are promoting "general fitness", not rehabilitation.

The doctor is likely saying that torso rotation exercise might put too much stress on the spine because it is known that discs can be injured by rotational forces. I would be concerned about anyone doing high velocity or large amplitude rotational motions for that reason as well. Slower, controlled motions are a different matter.

Cheers.
B.

Aterry, in regard to what Betty says above, did your Dr. recommend you to a PT in order to help deal with the pain (in more specific ways as opposed to just running and swimming for general fitness)?

[betty14]

Yes but simply finding the muscles as through tactile stimulation doesn't mean you are working/building them. Statements like yours add to the general confusion that a brace can build muscle which is of course impossible. Braces do some or all of the work of muscle and(or) restrict muscle so muscles can only get smaller in brace. Yes/No?

If you would kindly re-read the following, as it was written by me in a previous post:

The (following) refers to standard back braces worn by some non-scoliotic people with back pain.

If you have a brace on, it touches you and presses into your tissues. Some people find this tactile stimilation very effective, reporting that "now I can really feel those muscles are there and turn them on better". This is highly relevent to working muscle.

The above was prefaced by exactly to what I was refering, and I did not use the word "build". I'm not sure how that adds to the "general confusion". You did ask, did you not, about how braces work? Before one can understand how a scoliosis brace might work, it is useful to know how a brace in general might work (ie. learn the normal before the abnormal).

Re: the last sentence in your response, I believe that static vs. dynamic bracing and potential effects on muscle were covered in post #85. As you know, no one has yet ponied up the high level research to prove these things beyond a shadow of a doubt!;)

Cheers,
B.

[Dingo]

betty14

The doctor is likely saying that torso rotation exercise might put too much stress on the spine because it is known that discs can be injured by rotational forces. I would be concerned about anyone doing high velocity or large amplitude rotational motions for that reason as well. Slower, controlled motions are not injurious to discs however.

I'm not a physical therapist but it is my understanding that slow exercise is immensely safer for the joints than fast exercise.

It's easy to understand why.

What wears out tires on a car faster?
A) Slowly breaking into a controlled stop
B) Punching the breaks hard and skidding to a stop

Obviously B because any rapid change in movement is going to create friction and lead to damage.

I doubt very much that slow, steady torso rotation is harmful to the discs unless other problems are present.

BTW that's one challenge for small children doing physical therapy. Young kids want to do everything fast and sloppy. It takes a lot of effort to get the right, steady movement out of a little kid. On the plus side my son's coordination for PT probably doubled inside of a month. But it definitely takes patience.

[MissEmmyF]

betty14



I'm not a physical therapist but it is my understanding that slow exercise is immensely safer for the joints than fast exercise.

It's easy to understand why.

What wears out tires on a car faster?
A) Slowly breaking into a controlled stop
B) Punching the breaks hard and skidding to a stop

Obviously A because any rapid change in movement is going to create friction and lead to damage.

I doubt very much that slow, steady torso rotation is harmful to the discs unless other problems are present.

BTW that's one challenge for small children doing physical therapy. Young kids want to do everything fast and sloppy. It takes a lot of effort to get the right, steady movement out of a little kid. On the plus side my son's coordination for PT probably doubled inside of a month. But it definitely takes patience.

Wait, do you mean the correct answer then is "B" (not "A" as you said) or am I missing something?

[Pooka1]

If you would kindly re-read the following, as it was written by me in a previous post:

The (following) refers to standard back braces worn by some non-scoliotic people with back pain.

If you have a brace on, it touches you and presses into your tissues. Some people find this tactile stimilation very effective, reporting that "now I can really feel those muscles are there and turn them on better". This is highly relevent to working muscle.

I didn't recall the "turn them on better" part from your original post. Did you add is as an edit? Maybe I'm just not remembering.

The above was prefaced by exactly to what I was referring, and I did not use the word "build". I'm not sure how that adds to the "general confusion". You did ask, did you not, about how braces work? Before one can understand how a scoliosis brace might work, it is useful to know how a brace in general might work (ie. learn the normal before the abnormal).

I have no idea why scoliosis braces would differ from other braces in terms of restricting muscles and doing the work of muscles.

Re: the last sentence in your response, I believe that static vs. dynamic bracing and potential effects on muscle were covered in post #85. As you know, no one has yet ponied up the high level research to prove these things beyond a shadow of a doubt!;)

Static versus dynamic? Does that equate to loose versus tight? In the context of scoliosis, if it is loose, you aren't restricting the growth plates at least part of the time. The entire premise of Spinecor is faulty in this and likely other respects irrespective of what the inventors claim.

And w.r.t. beyond a shadow of a doubt, PT as a treatment for scoliosis (apart from pain) hasn't left the starting gate in terms of evidence in hand as far as I know. In decades and decades.

[Dingo]

MissEmmyF
Wait, do you mean the correct answer then is "B" (not "A" as you said) or am I missing something?

DOH! :confused:
Thank you!
Yep, I meant B. I fixed it.

[MissEmmyF]

MissEmmyF


DOH! :confused:
Thank you!
Yep, I meant B. I fixed it.

Haha, ok, great! That is what I thought but then I was second guessing myself. Thanks!

[Pooka1]

If you would kindly re-read the following, as it was written by me in a previous post:

The (following) refers to standard back braces worn by some non-scoliotic people with back pain.

If you have a brace on, it touches you and presses into your tissues. Some people find this tactile stimilation very effective, reporting that "now I can really feel those muscles are there and turn them on better". This is highly relevent to working muscle.

This is what you wrote...

"I have also had patients who felt the brace made them "feel" their abdominals more because of the tactile stimulation."

[betty14]

I didn't recall the "turn them on better" part from your original post. Did you add is as an edit? Maybe I'm just not remembering..

The post you read that in (85), was not edited.


Static versus dynamic? Does that equate to loose versus tight? In the context of scoliosis, if it is loose, you aren't restricting the growth plates at least part of the time. The entire premise of Spinecor is faulty in this and likely other respects irrespective of what the inventors claim...


"Static" does not mean "loose" and "dynamic" does not mean "tight". Above, you state that "static" equates to "loose", which is a reason why Spinecor's premise is faulty.

Since you did not know that Spinecor is a dynamic brace, and in fact do not know what dynamic bracing actually means, I have a hard time understanding how you know so surely that their premise is faulty.

You may be qualified, having read studies, to pass on information about a lack of strong evidence to date for this treatment, but you do not have enough knowledge to say The entire premise of Spinecor is faulty in this and likely other respects irrespective of what the inventors claim.... The quote above (second of the three)shows that you have little knowledge of how bracing functions (and why should you have, really, since your field of study is not human physiology or biomechanics etc.)


Disclaimer:
I do not work for Spinecor, and have never referred a patient for one of their braces, and in fact have little interest in scoliosis bracing in general. However I think people should provide information and criticism within the limits of their knowledge base.

Cheers,
B.

[Pooka1]

Since you did not know that Spinecor is a dynamic brace, and in fact do not know what dynamic bracing actually means, I have a hard time understanding how you know so surely that their premise is faulty.

Are you suggesting that "dynamic brace" has a scientific definition??

What is it in your opinion and what is the evidence apart from the claims that it is "dynamic?" What EXACTLY makes Spinecor a dynamic brace other than it is not a hard brace? It seems like "dynamic" means loose enough so that you can move around a little but are restricted enough to make folks think the brace is doing something.

You may be qualified, having read studies, to pass on information about a lack of strong evidence to date for this treatment, but you do not have enough knowledge to say . The quote above (second of the three)shows that you have little knowledge of how bracing functions (and why should you have, really, since your field of study is not human physiology or biomechanics etc.)

Maybe NOBODY has the expertise that you think exists. If they did then we would know a priori whether hard braces or Spincor should or should not work.

I googled "dynamic brace." As far as I can tell, that is not a scientific term. Correct me if I'm wrong.

[betty14]

What is it in your opinion and what is the evidence apart from the claims that it is "dynamic?" What EXACTLY makes Spinecor a dynamic brace other than it is not a hard brace? It seems like "dynamic" means loose enough so that you can move around a little but are restricted enough to make folks think the brace is doing something..

No, dynamic does not mean: loose enough so that you can move around a little but are restricted enough to make folks think the brace is doing something..

It sounds as though you really do not know the purported mechanism of action of dynamic bracing. All you would need to do is check the manufacturer's website, and also read some studies or acticles. I thought you did this exhaustively already???

All I'm saying is, while you have sufficient knowledge to tell others about study results that you are aware of, you have insuffiecient knowledge to claim that the entire premise is faulty, since you clearly do not understand the premise.

And the scientific term for me is Betty14, in case you wondered!

[Pooka1]

No, dynamic does not mean:

It sounds as though you really do not know the purported mechanism of action of dynamic bracing. All you would need to do is check the manufacturer's website, and also read some studies or acticles. I thought you did this exhaustively already???

All I'm saying is, while you have sufficient knowledge to tell others about study results that you are aware of, you have insuffiecient knowledge to claim that the entire premise is faulty, since you clearly do not understand the premise.

Okay instead of continually telling me what dynamic bracing is NOT could you please tell me the scientific definition of "dynamic bracing?" I am not interested in corporate claims.

And I want to know the mechanism and the actual difference. You could have every term coined in the world but if the actual difference is you can move around a little more in one brace versus the other then that's the point, yes?

And by the way, we have building empirical evidence that the claim is faulty.

If we can have a field like chiropractic that gives out "Doctor" titles that is based on something call "subluxations" yet no two chiros can agree on exactly where the subluxation is on a radiograph, then I don't think that bodes well for scientific claims in the PT field where they aren't even trying to hand out "Doctor" titles.

And the scientific term for me is Betty14, in case you wondered!

I was wondering what the correct term was!

[trcylynn]

Betty-

I scrolled through most of this quickly hoping that I would have found something more specific on exercises- if I missed it please forgive me.

I would like to know what you mean by exercises in elongated positions. Everything you are saying about exercise and strengthening makes sense to me and while I'm rehabing two rotator cuff surgery shoulders I'd like to work a little on my back again... Currently I am doing side planks (right arm down raising right back off the ground my scoliosis is a "C" in the lumbar looking at me from the back). I can flex my left obliques to look straighter but as you stated previously I'm not strong enough to keep it up throughout the day.

Also, do you have any experience or knowledge of shoulder blades interfering with the ribcage due to scoliosis? After my shoulder surgery if I try to keep my shoulder blades in and down (in their proper position) I find that at times I can feel them "catch" on my rib cage- so far no one has heard of this or can tell me why- only my PT believes me when I mention it because he can feel and hear it while we stretch.

On another note... (not directed at anyone really)
Overall if something worked perfectly to "cure" scoliosis nobody would be debating it anymore and the person that discovered it would be rich.

To me, if I can lessen my pain and lessen the appearance of my curve I could really care less what it measures to be in an xray. If I live long and healthy with no more pain and my lower disc degeneration stops because of a healthy spine and no one can really tell I have scoli without an x-ray what does it matter if the measurement still says 30 degrees? Even if it requires me to stay active in my exercises and stretches- what harm does that really do? I think most people can use more exercise in their lives this just gives me more of a reason to do it. I'm more upset about the pain and appearance than anything else- solve that for me and I'm a happy camper. :)

[betty14]

Hi trcylynn:
I replied to you yesterday, but don't know what happened. Perhaps it was deleted by someone? In any case, I'll try again...

Betty-I would like to know what you mean by exercises in elongated positions. Everything you are saying about exercise and strengthening makes sense to me and while I'm rehabing two rotator cuff surgery shoulders I'd like to work a little on my back again... Currently I am doing side planks (right arm down raising right back off the ground my scoliosis is a "C" in the lumbar looking at me from the back). I can flex my left obliques to look straighter but as you stated previously I'm not strong enough to keep it up throughout the day.

Elongated mean getting your spine as straight and tall as you can before exercising. A scoliotic spine is shortened because of the rotation and side bending, and if you exercise in that position, you're not really doing much to change your posture. If I don't do my exercises for a few days, or slouch lazily for a long time (like a long car ride), my spine gets crooked and I get deep skin creases across my back. If I do my exercises regularly, with the focus on making my muscles support my spine to make me taller and untwisted, then I can maintain a back that is straight enough that few people would notice that I have scoliosis.

I'm very surprised that you do side planks given two cuff surgeries and scoliosis, as it is an extremely hard exercise. I would wonder if it would be too difficult to control all those body parts at once, and if it's not done precisely enough, there would be no positive postural effect on the spine. There are tons of variations to work the spine muscles that don't require such shoulder load at the same time.


Also, do you have any experience or knowledge of shoulder blades interfering with the ribcage due to scoliosis? After my shoulder surgery if I try to keep my shoulder blades in and down (in their proper position) I find that at times I can feel them "catch" on my rib cage- so far no one has heard of this or can tell me why- only my PT believes me when I mention it because he can feel and hear it while we stretch.

There must be a mechanical reason for that. The blades can never sit perfectly on a deformed ribcage, unfortunately. I suspect that you may have some adhesions in and around your myofascial tissues (ie. scarred bits in the muscles and connetive tissues) that lie between the blade and ribcage.


To me, if I can lessen my pain and lessen the appearance of my curve I could really care less what it measures to be in an xray. If I live long and healthy with no more pain and my lower disc degeneration stops because of a healthy spine and no one can really tell I have scoli without an x-ray what does it matter if the measurement still says 30 degrees? Even if it requires me to stay active in my exercises and stretches- what harm does that really do? I think most people can use more exercise in their lives this just gives me more of a reason to do it. I'm more upset about the pain and appearance than anything else- solve that for me and I'm a happy camper. :)

I could not agree more. Taking charge of your health is so important. Hope my answer helps somewhat..

Cheers, B.

[aterry]

Betty, I just want to thank you for your posts. I find them very interesting.

[dailystrength]

I would like to vouch for the PT exercise program - I have a 49 degree curve and my Dr. is not for surgery due to negative long-term outcome studies, and I started a PT program (core, de-rotation, flexibility) that has helped me feel better and it also stabilized my spine in a 6-mos. follow-up x-ay. My current question is about heel lifts and whether or not they help or are detrimental... see Heel Lift thread. Anyway, I'm all for a routine I can do at home that won't keep draining my wallet. Thanks!

[loves to skate]

my Dr. is not for surgery due to negative long-term outcome studies
Is your Dr. an SRS spine specialist? Is he using long-term outcome studies from several years ago when Harrington rods were used? I saw a Neurosurgeon first and he told me that there was only a 60% chance of a positive outcome. When I saw Dr. Rand, an SRS spine Ortho/Neuro Surgeon, he told me he has better than a 92% positive outcome. Also, the Neurosurgeon I had seen admitted to me that indeed, Dr. Rand has better than a 92% positive outcome.
Sally

[betty14]

I would like to vouch for the PT exercise program - I have a 49 degree curve and my Dr. is not for surgery due to negative long-term outcome studies, and I started a PT program (core, de-rotation, flexibility) that has helped me feel better and it also stabilized my spine in a 6-mos. follow-up x-ay. My current question is about heel lifts and whether or not they help or are detrimental... see Heel Lift thread. Anyway, I'm all for a routine I can do at home that won't keep draining my wallet. Thanks!

Hi dailystrength:

Here's what me collegue, a PT and certified pedorthist, has to say about heel lifts:

In general, one has to be very careful with lifts, because the response of the body could be very different than anticipated. A new pain could be created, or existing pain may become worse. She does them rarely, for example if a leg has become apparently shortened because it can no longer straighten all the way, or if a person cannot achieve active correction of their poor lumbo-pelvic / lower extremity alignment. She monitors closely the responses to different things tried, and recommends that you don't do other new things at the same time. Never leave a lift in if it starts to cause problems.

Cheers, B.

[dailystrength]

Bettina, Thank you so much for this answer!

[dailystrength]

Is your Dr. an SRS spine specialist? Is he using long-term outcome studies from several years ago when Harrington rods were used? I saw a Neurosurgeon first and he told me that there was only a 60% chance of a positive outcome. When I saw Dr. Rand, an SRS spine Ortho/Neuro Surgeon, he told me he has better than a 92% positive outcome. Also, the Neurosurgeon I had seen admitted to me that indeed, Dr. Rand has better than a 92% positive outcome.
Sally

Thanks for your reply, Sally. Yes, my Dr. is on the SRS list- I looked it up last evening, and furthermore he is the Head of the surgical divsion, so I'm thinking a second opinion would be worthless. He says this based on a 50-year follow up of surgical vs. non-surgical patients and their level of pain. So, I thought if I wait until my next x-ray next May, and all the PT/yoga/etc. has not alleviated the pain/dysfunction, then maybe he'll recommend it then. I can still function fine, I just have to take many breaks while cleaning, etc. Don't know if surgery would make me worse or better off... I guess I just want to explore all options. It's all so very "individual", it's hard to know what's right for any one person. And you are right; he could be using follow up from the "old days' of surgery. But aren't Harrington rods still used? By the way I am so impressed with your experience w/Dr. Rand.

[Pooka1]

But aren't Harrington rods still used?

Not for years as far as I know.

Linda would know the exact years.

[LindaRacine]

In the U.S., Harrington rods are used only rarely, since the early 90's.

--Lin

[loves to skate]

Thanks for your reply, Sally. Yes, my Dr. is on the SRS list- I looked it up last evening, and furthermore he is the Head of the surgical divsion, so I'm thinking a second opinion would be worthless.

I'm not so sure that a second opinion would be worthless. Just because a Dr. is the head of a surgical division doesn't mean that he is the best. It just means that he was willing to take on the extra work involved with being the head of the division.
Sally

[dailystrength]

Interesting, Sally -- thank you.