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Pooka1
06-24-2009, 07:20 AM
Okay there are a lot of posts on muscle imbalance with the thought that this is somehow the cause and if it can be addressed, progression can be stopped and perhaps reversed.

In my ceaseless efforts to learn how to ride and train horses, I have had the luxury over the years of not only taking a bazillion lessons but auditing five bazillion lessons.

What becomes obvious is that not only does almost every person have a stronger side but EVERY horse has a stronger side.

Lower level riders struggle to feel this sidedness and force themselves to come exactly even.

Upper level horses who are trained to follow/turn from small differences in weighted seatbones will TELL you how uneven you are if you try to ride a straight line without reins or legs... just from weight cues in the seat.

Because most people don't make it out of the lower levels, I suspect one reason is they never even out their sidedness. In some cases, these people CANNOT turn the horse in a particular direction just from their weight because they are so one-sided in their strength.

The points I'm making are as follows:

1. Most people have a strong and weak side.
2. Some people have a VERY marked difference in their strong and weak side.
3. Most people don't have scoliosis.

It is impossible that they all have scoliosis. It is impossible that even those with very marked side to side strength difference have scoliosis. It's too many. The incidence of scoliosis would be much higher in the population if true.

Clearly, any muscle sidedness associated with scoliosis is most likely an effect, not a cause.

And ps... although every horse I've ever ridden had a strong and weak side, I've never met one with scoliosis yet. ;)

MissEmmyF
06-24-2009, 09:50 AM
I don't think it's the "cause" of the scoliosis. I agree that it's most definitely the "effect." Something initiates the scoliosis to begin (no one REALLY knows what causes this), and it then pushes around the muscles and other supporting structures around the spine. However, since the only treatment we have for scoliosis is "symptomatic" (i.e. we treat the symptoms of scoliosis and not the cause of scoliosis), it makes sense to at least aim to make the muscles more even. That's the best and most logical treatment we have right now (aside for people that are at surgical levels where surgery is really the only answer).

Pooka1
06-24-2009, 10:18 AM
I don't think it's the "cause" of the scoliosis. I agree that it's most definitely the "effect." Something initiates the scoliosis to begin (no one REALLY knows what causes this), and it then pushes around the muscles and other supporting structures around the spine. However, since the only treatment we have for scoliosis is "symptomatic" (i.e. we treat the symptoms of scoliosis and not the cause of scoliosis), it makes sense to at least aim to make the muscles more even. That's the best and most logical treatment we have right now (aside for people that are at surgical levels where surgery is really the only answer).

Well two things...

1. I suggest there are any number of folks who appear to think the muscle asymmetry is the cause.

2. It's hard to imagine that building muscle can overcome the pathology that causes wedging when we see that even bracing hasn't been shown to work, whether in a growing child or for an adult spine.

Dingo
06-24-2009, 11:20 AM
Pooka1

You are incorrect. Trunk muscles should not have a strong and weak side.

2000 - Study/Report: A Preliminary Report On The Effect Of Measured Strength Training In Adolescent Idiotpathic Scoliosis (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.

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


The AIS females were found to be significantly weaker when contracting toward their main curve concavity in the neutral and concave pre-rotated positions compared to contractions toward the convexity. These weaknesses were also demonstrated when compared to the group of healthy female adolescent controls.

Several other studies have examined this well known phenomenon.

Pooka1
06-24-2009, 11:28 AM
Pooka1

You are incorrect. Trunk muscles should not have a strong and weak side.


You need to audit a few hundred riding lessons. The only people who are very even are the upper level riders who worked DILIGENTLY at it for YEARS.

Some people are so one-sided who DON'T have scoliosis that I feel we can rule out muscle imbalance on that evidence alone. Some of these people actually LAMED their horses from their one-sided riding. I can point you to a web site of folks who diagnose and fix these horses if you don't believe me.

It's the rule rather than the exception and a big reason why most people never make it to the upper levels in riding in my opinion after doing the auditing.

When you are at the point where you are so one-sided you can lame a horse and you STILL don't have scoliosis, then we need to move on to a new hypothesis in my book. YMMV

Pooka1
06-24-2009, 11:33 AM
Dingo, are you trying to say that muscle asymmetry is the CAUSE of AIS or an effect?

Dingo
06-24-2009, 11:49 AM
Pooka1


Did any of them measure the asymmetry in folks WITHOUT scoliosis?

Yes, the 2007 study compared healthy girls to girls with Scoliosis. As expected the difference between the two groups was large.

Pooka1
06-24-2009, 11:57 AM
Pooka1



Yes, the 2007 study compared healthy girls to girls with Scoliosis. As expected the difference between the two groups was large.

Yes but that is due to the curve. And they didn't find that the kids with AIS were symmetrical. Unless people drawn to riding happen to be atypical, there are very few people who are symmetrical. If they were, we would see far more people making it out of the lower levels.

Is muscle asymmetry the cause or effect of scoliosis in your opinion?

Dingo
06-24-2009, 12:02 PM
Pooka1


Dingo, are you trying to say that muscle asymmetry is the CAUSE of AIS or an effect?

AIS is rooted in a nervous system disorder.
2004 - Study: Melatonin Signaling Dysfunction in Adolescent Idiopathic Scoliosis (http://pico.sssup.it/files/allegati/2004_1469.pdf)

For reasons that aren't yet fully understood this impacts the muscles of the torso.
2006 - Study: Geometric and electromyographic assessments in the evaluation of curve progression in idiopathic scoliosis. (http://www.ncbi.nlm.nih.gov/pubmed/16449906)

I believe this muscle imbalance is a significant factor in the development of spinal curves.

Secondary evidence:

It is well known that child atheletes have high rates of mild scoliosis. This is thought to be the result of muscle imbalances developed from long hours of training.
1986 - Study: Scoliosis in swimmers. (http://www.ncbi.nlm.nih.gov/pubmed/3512101)

As you know three studies (study 1 (http://www.medxonline.com/downloads/articles/measuredresistanceinscoliosis.pdf)) found that strength training controls scoliosis progression and can even reverse many curves. This suggests that the muscles of the spine play a critical role in the development of Scoliosis.

MissEmmyF
06-24-2009, 12:09 PM
Well two things...

1. I suggest there are any number of folks who appear to think the muscle asymmetry is the cause.

2. It's hard to imagine that building muscle can overcome the pathology that causes wedging when we see that even bracing hasn't been shown to work, whether in a growing child or for an adult spine.

I tend to disagree with them then. I don't think it's the cause. I can see how it could be a cause in some special cases though (just not in AIS most likely).

For example, at the advertising agency where I work, our proofreader has one fake arm/hand (since she always wears long sleeves, I'm not exactly sure how much of her arm is actually there, if any of it). So, her other arm/hand obviously does all the work while the other side just kind of remains motionless and in relaxation mode. She is def. developing slight thoracic scoliosis due to this...it's clearly apparent. This would seem to have developed only because of her muscles imbalances (i.e. the arm/hand she uses has become very strong overtime whereas the other side is probably very weak).

Also, my cousin got into a big skateboarding accident when he was 10 and was in a huge waist/leg cast for a long time. Now he's in his 30's and one of his legs is at least an inch or two longer than the other. It's so obvious that when he standing flat on one foot, the other foot only reaches the floor on its tip toe. He doesn't wear a lift in his shoe because the lift would have to be too big (and therefore wouldn't be able to be put in the shoe but would have to be put on the outside instead), so that means he walks around all day being totally off balance. I can't imagine that he won't develop at least slight scoliosis at some point in time due to this.

So, I do think muscle asymmetry can be the cause of scoliosis in some specific instances...just not for the vast majority of people with AIS.

MissEmmyF
06-24-2009, 12:17 PM
but then again, i do think that most people have muscle imbalances...most people do have a strong side and a weak side. and, many people with large imbalances probably never develop scoliosis. i just think the strong side and weak side in people with scoliosis is way more severe and obvious than it is with the average person.

Dingo
06-24-2009, 12:19 PM
MissEmmyF


So, I do think muscle asymmetry can be the cause of scoliosis in some specific instances

From what I have read I don't think a child can get severe scoliosis from a muscle imbalance. I remember reading that something like 80% of competitive javelin throwers have curves of roughly 10 degrees +/-. However these guys aren't getting their spines fused at 40 and 50 degrees.

AIS is rooted in a nervous system disorder. Maybe when the nervous system is messed up the body doesn't know how to correct or respond to muscle imbalances. Somehow the two are working together.

MissEmmyF
06-24-2009, 12:24 PM
Pooka1



AIS is rooted in a nervous system disorder.
2004 - Study: Melatonin Signaling Dysfunction in Adolescent Idiopathic Scoliosis (http://pico.sssup.it/files/allegati/2004_1469.pdf)

For reasons that aren't yet fully understood this impacts the muscles of the torso.
2006 - Study: Geometric and electromyographic assessments in the evaluation of curve progression in idiopathic scoliosis. (http://www.ncbi.nlm.nih.gov/pubmed/16449906)

I believe this muscle imbalance is a significant factor in the development of spinal curves.

Secondary evidence:

It is well known that child atheletes have high rates of mild scoliosis. This is thought to be the result of muscle imbalances developed from long hours of training.
1986 - Study: Scoliosis in swimmers. (http://www.ncbi.nlm.nih.gov/pubmed/3512101)

As you know three studies (study 1 (http://www.medxonline.com/downloads/articles/measuredresistanceinscoliosis.pdf)) found that strength training controls scoliosis progression and can even reverse many curves. This suggests that the muscles of the spine play a critical role in the development of Scoliosis.

I think we're all kind of saying the same thing. So, you think the nervous system disorder is the "initiating" factor for the onset of the dev. of scoliosis. however, the muscles are then affected after the onset, correct?

Dingo
06-24-2009, 12:31 PM
MissEmmyF


I think we're all kind of saying the same thing. So, you think the nervous system disorder is the "initiating" factor for the onset of the dev. of scoliosis. however, the muscles are then affected after the onset, correct?

Yes AIS appears to be caused by a nervous system disorder. An FDA approved blood test is due out as soon as this year (http://www.nationalreviewofmedicine.com/issue/2006/06_30/3_advances_medicine03_12.html)to detect the disorder even before a curve develops.

Pharmeceuticals are being developed to control this nervous system disorder (http://www.recherche-sainte-justine.qc.ca/en/medias/salledepresse/52;jsessionid=a3RAX-fGDns8).

Researchers are also experimenting with Tamoxifen to control Scoliosis (http://www.scoliosis.org/forum/showthread.php?t=8602).

Obviously physical therapy is a preferable treatment for most parents but drug therapies are on the horizon.

LindaRacine
06-24-2009, 01:06 PM
I remember reading that something like 80% of competitive javelin throwers have curves of roughly 10 degrees +/-.

What about the other 20%?

If muscle imbalance causes scoliosis, why isn't it 100%? I have a niece who had special xrays taken of her legs, to measure the bones in her legs. Her leg length discrepancy is 1-1/2", but she has a completely straight spine.

--Linda

Pooka1
06-24-2009, 01:11 PM
What about the other 20%?

If muscle imbalance causes scoliosis, why isn't it 100%? I have a niece who had special xrays taken of her legs, to measure the bones in her legs. Her leg length discrepancy is 1-1/2", but she has a completely straight spine.

--Linda

I think we can rule out muscle imbalance at this point as either a primary, secondary, tertiary or other order cause of scoliosis for any number of reasons not least of which... lame horses don't lie.

Dingo
06-24-2009, 01:52 PM
LindaRacine


If muscle imbalance causes scoliosis, why isn't it 100%? I have a niece who had special xrays taken of her legs, to measure the bones in her legs. Her leg length discrepancy is 1-1/2", but she has a completely straight spine.

AIS is rooted in the nervous system. From your description it's obvious that your niece doesn't have melatonin signaling dysfunction (http://pico.sssup.it/files/allegati/2004_1469.pdf). If your neice had that dysfunction coupled with her leg problem it's possible that she would have a severe case of scoliosis.

betty14
06-24-2009, 03:29 PM
Hi there: I've read all your replies, and see that Dingo has linked to a study on young athletes and scoliosis. There are several more studies out there, showing that scoliosis appears to be more common in certain sports, such as ballet, tennis, swimming etc. (sports with asymetrical loading of the spine). Javelin throwing was also mentioned.

Muscle imbalance ALONE cannot "cause" AIS. It is pretty agreed upon by all the posters so far, and the research community, that AIS is multifactoral and likely has some neurologic components.

Functional scoliosis can certainly be CAUSED by imbalance however (non deformed bones, curves in standing that disappear in supine). This categery contains some of the scoliotic athletes, people with serious trunk imbalances, leg length discrepancy and herniated discs.



In my ceaseless efforts to learn how to ride and train horses, I have had the luxury over the years of not only taking a bazillion lessons but auditing five bazillion lessons.

What becomes obvious is that not only does almost every person have a stronger side but EVERY horse has a stronger side.

Lower level riders struggle to feel this sidedness and force themselves to come exactly even.

Upper level horses who are trained to follow/turn from small differences in weighted seatbones will TELL you how uneven you are if you try to ride a straight line without reins or legs... just from weight cues in the seat.

Because most people don't make it out of the lower levels, I suspect one reason is they never even out their sidedness. In some cases, these people CANNOT turn the horse in a particular direction just from their weight because they are so one-sided in their strength.

The points I'm making are as follows:

1. Most people have a strong and weak side.
2. Some people have a VERY marked difference in their strong and weak side.
3. Most people don't have scoliosis.

And ps... although every horse I've ever ridden had a strong and weak side, I've never met one with scoliosis yet. ;)

As a person who spends nearly all day evaluating joints, muscles, and the integrated function of the body segments, I do agree that most people have differences in muscle balance. Often I am asked the chicken-egg question - did the muscle imbalance cause the problem, or did something ELSE cause the problem that led to the muscle imbalance? Sometimes the question is unaswerable, but the treatment approach is often - doesn't really matter which came FIRST, the point is, you've got the painful condition now, and the imbalances must be corrected to solve the problem.

Re: point #2 above, Pooka1:
Your method for determining this is, I assume, observation of the rider with your eyes. So though you may see something "very marked" you have no way of knowing which tissues the imbalance is. In one rider, it could be a weak arm due to a rotator cuff strain, in another it could be internal scarring from their abdominal surgery that makes their pelvis turn a certain way. In another it might be "habit" or uncoordination, and not strength at all.

I do not think that points 1 and 2 lead automatically to point 3. Stong vs. weak must be detrermined from observation, followed by a comprehensive physical exam including many specific strength tests.

While I don't think imbalance CAUSES scoliosis, it is certainly a hallmark symptom of the disease, and needs to be addressed. The research community does know a lot about the integrated functioning of the musculoskeletal system, but it doesn't know a lot too .... what if muscle training to correct imbalances has an effect on the neurological system such that that effect of the as-yet-unknown cause of bony wedging could be dampenned? Bones are living tissues constantly being degraded and rebuilt and remodelled..... just a thought. Anyone seen an article on this?

Cheers,
B.

LindaRacine
06-24-2009, 03:35 PM
Hi there: I've read all your replies, and see that Dingo has linked to a study on young athletes and scoliosis. There are several more studies out there, showing that scoliosis appears to be more common in certain sports, such as ballet, tennis, swimming etc. (sports with asymetrical loading of the spine). Javelin throwing was also mentioned.

Muscle imbalance ALONE cannot "cause" AIS. It is pretty agreed upon by all the posters so far, and the research community, that AIS is multifactoral and likely has some neurologic components.

Functional scoliosis can certainly be CAUSED by imbalance however (non deformed bones, curves in standing that disappear in supine). This categery contains some of the scoliotic athletes, people with serious trunk imbalances, leg length discrepancy and herniated discs.



As a person who spends nearly all day evaluating joints, muscles, and the integrated function of the body segments, I do agree that most people have differences in muscle balance. Often I am asked the chicken-egg question - did the muscle imbalance cause the problem, or did something ELSE cause the problem that led to the muscle imbalance? Sometimes the question is unaswerable, but the treatment approach is often - doesn't really matter which came FIRST, the point is, you've got the painful condition now, and the imbalances must be corrected to solve the problem.

Re: point #2 above, Pooka1:
Your method for determining this is, I assume, observation of the rider with your eyes. So though you may see something "very marked" you have no way of knowing which tissues the imbalance is. In one rider, it could be a weak arm due to a rotator cuff strain, in another it could be internal scarring from their abdominal surgery that makes their pelvis turn a certain way. In another it might be "habit" or uncoordination, and not strength at all.

I do not think that points 1 and 2 lead automatically to point 3. Stong vs. weak must be detrermined from observation, followed by a comprehensive physical exam including many specific strength tests.

While I don't think imbalance CAUSES scoliosis, it is certainly a hallmark symptom of the disease, and needs to be addressed. The research community does know a lot about the integrated functioning of the musculoskeletal system, but it doesn't know a lot too .... what if muscle training to correct imbalances has an effect on the neurological system such that that effect of the as-yet-unknown cause of bony wedging could be dampenned? Bones are living tissues constantly being degraded and rebuilt and remodelled..... just a thought. Anyone seen an article on this?

Cheers,
B.

Betty...

I think the folks in Canada are VERY lucky to have you up there. You're proving to be a really great contributor here. Thanks very much for your participation!

--Linda

Pooka1
06-24-2009, 03:43 PM
Betty...

I think the folks in Canada are VERY lucky to have you up there. You're proving to be a really great contributor here. Thanks very much for your participation!

--Linda

I agree. The loss of Fix is assuaged by the gain of Betty. But we are still in need of a reasonable chiro again.

We need rational folks who can talk about alternative treatments in PERSPECTIVE. They are not so common as can readily been seen.

MissEmmyF
06-24-2009, 03:44 PM
While I don't think imbalance CAUSES scoliosis, it is certainly a hallmark symptom of the disease, and needs to be addressed. The research community does know a lot about the integrated functioning of the musculoskeletal system, but it doesn't know a lot too .... what if muscle training to correct imbalances has an effect on the neurological system such that that effect of the as-yet-unknown cause of bony wedging could be dampenned? Bones are living tissues constantly being degraded and rebuilt and remodelled..... just a thought. Anyone seen an article on this?

Cheers,
B.

I have a question related to this: can muscles over time theoretically reshape bone?

Pooka1
06-24-2009, 03:48 PM
I have a question related to this: can muscles over time theoretically reshape bone?

Well, I think Hawes's case may be evidence that if you exercise FOUR hours a day for SEVERAL years you can get some measurable decrease in your curve that may be due in part to bone remodeling. But more likely I think her curve would revert to the original value if she stopped. I think she exercises one hour a day now but don't really recall.

It amazes me how she kept her job teaching and doing research at the university while getting in all that exercise.

I wish she would post here.

MissEmmyF
06-24-2009, 03:53 PM
Well, I think Hawes's case may be evidence that if you exercise FOUR hours a day for SEVERAL years you can get some measurable decrease in your curve that may be due in part to bone remodeling. But more likely I think her curve would revert to the original value if she stopped. I think she exercises one hour a day now but don't really recall.

It amazes me how she kept her job teaching and doing research at the university while getting in all that exercise.

I wish she would post here.

I've actually read her memoir "Unwinding" which was quite interesting. I don't believe she ever exercised 4 hours a day...I think it was always only 1 hour per day (sometimes 2 hours, but that additional hour was running, not strengthening). It would be interesting to hear from her...

MissEmmyF
06-24-2009, 03:57 PM
Oh, and the other thing I always wondered about is swimming...I would have guessed that would be the most "symmetrical" sport of them all, no? I can understand javelyn (sp?) throwing, but swimming and even ballet shocks me...

betty14
06-24-2009, 04:40 PM
Oh, and the other thing I always wondered about is swimming...I would have guessed that would be the most "symmetrical" sport of them all, no? I can understand javelyn (sp?) throwing, but swimming and even ballet shocks me...


I should totally be spending my afternoon off preparing pelvic floor stuff for work, but I can't resist replying to you about swimming!

Personally, although I love to swim, I would never swim lengths for excercise as a person with scoliosis, for worry that my rib hump would get larger, not smaller, which is my aim with the Schroth style exercises that I do now.
Because swimming is such an aerobic activity, requiring deep, heavy breathing, and air follows the path of least resistance on it's way down, it would only serve to further expand the already overexpanded rib hump. I've always wondered why so many people with scoliosis are told to swim lengths, and since a scoliotic person usually lacks neck rotation to one side, the person could further feed into his curves by always turning the head the same way.

Back to work, B.

MissEmmyF
06-24-2009, 04:53 PM
I should totally be spending my afternoon off preparing pelvic floor stuff for work, but I can't resist replying to you about swimming!

Personally, although I love to swim, I would never swim lengths for excercise as a person with scoliosis, for worry that my rib hump would get larger, not smaller, which is my aim with the Schroth style exercises that I do now.
Because swimming is such an aerobic activity, requiring deep, heavy breathing, and air follows the path of least resistance on it's way down, it would only serve to further expand the already overexpanded rib hump. I've always wondered why so many people with scoliosis are told to swim lengths, and since a scoliotic person usually lacks neck rotation to one side, the person could further feed into his curves by always turning the head the same way.

Back to work, B.

Hmmm, very interesting, that does make complete sense! I guess you'd have to totally focus your breathing into the concave side then and rotate your neck to both sides - which would be really hard to do! So, I can understand now how swimming would exacerbate scoliosis in someone that already has scoliosis, but why is there a high incidence of scoliosis in swimmers? Are people with scoliosis naturally inclined to swim? We know from previous posts that swimming won't CAUSE scoliosis...

Rayknox
06-24-2009, 05:52 PM
Sorry to repeat what I said a long time ago, but maybe someone, someday will investigate the effect of a fall on the end of the spine. (Then they will understand why swimmers get scoliosis. They fall at the side of the pool probably when running.) This causes serious problems when the child is not fully developed.

LindaRacine
06-24-2009, 05:54 PM
I've actually read her memoir "Unwinding" which was quite interesting. I don't believe she ever exercised 4 hours a day...I think it was always only 1 hour per day (sometimes 2 hours, but that additional hour was running, not strengthening). It would be interesting to hear from her...

MissEmmy...

Martha described the training as "intensive." I don't think an hour a day would ever be considered intensive.

http://www.ncbi.nlm.nih.gov/pubmed/11502678?ordinalpos=14&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsP anel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum

Regards,
Linda

betty14
06-24-2009, 05:54 PM
Sorry to repeat what I said a long time ago, but maybe someone, someday will investigate the effect of a fall on the end of the spine. (Then they will understand why swimmers get scoliosis. They fall at the side of the pool probably when running.) This causes serious problems when the child is not fully developed.

Hi Rayknox:
Could you expand on that? Did something like this happen to you or your child?
B.

Pooka1
06-24-2009, 06:50 PM
MissEmmy...

Martha described the training as "intensive." I don't think an hour a day would ever be considered intensive.

http://www.ncbi.nlm.nih.gov/pubmed/11502678?ordinalpos=14&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsP anel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum

Regards,
Linda

4 hours a day for 4-5 years (http://www.scoliosis.org/resources/spinalconnection_spr2002.pdf)

"From January 1993, one of the authors (WJB) provided instruction, support, and evaluation of posture and movement. Sustained pressure applied directly to muscle spasms, or manual traction to stretch the torso,was used by the patient to relieve pain as needed (4 h daily through 1997)."

Pooka1
06-24-2009, 06:54 PM
Oh, and the other thing I always wondered about is swimming...I would have guessed that would be the most "symmetrical" sport of them all, no? I can understand javelyn (sp?) throwing, but swimming and even ballet shocks me...

There is something wrong with that study. Has it ever been repeated?

It requires far more proof than has been shown to date.

Ballet, as well as gymnastics, does not pull equal numbers from all body type categories. There might be some skewing towards people who have some connective tissue disorder, I don't know.

Dingo
06-24-2009, 07:52 PM
It is well known that child atheletes have high rates of Scoliosis. Many different studies have documented the connection.

Google (www.google.com) offers a free web based service that people can use to find information on this and many other subjects. :)

Baltimore Washington Medical Center page on 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.

Pooka1
06-24-2009, 07:59 PM
I don't think they have controlled for body types who do well and therefore stay in the sport. It's nuanced points like this and a million more that result in most published reports being false. The situation is more complex than anyone probably presently imagines. It's hard to design a study that truly answers complex questions.

Also, as Betty pointed out, the scoliosis that is largely being discussed is NOT AIS in those child athletes. Apples and oranges.

And last, I think ballet, gymnastics, and swimming, like riding, all work towards evening out the sidedness everyone has. If there are small, non-AIS scoliosises then they just haven't evened themselves out. Nor has most of the rest of the population.

betty14
06-24-2009, 08:48 PM
And last, I think ballet, gymnastics, and swimming, like riding, all work towards evening out the sidedness everyone has. If there are small, non-AIS scoliosises then they just haven't evened themselves out. Nor has most of the rest of the population.


I think the above sports vary a lot in their "even-ness", if that's a word, on the spine.
Swimming, is relatively even if the breathing direction is always varied.
Riding seems pretty even.
Gymnastics and ballet, however, are quite uneven activities, as the dancer or gymnast usually has a preferred side for jumping, landing and twisting. Add that to being female, premenarchal, and training heavily, and having some causative factors for AIS, it's not suprising that rates of AIS or functional scoliosis are higher.

Pooka1
06-24-2009, 09:18 PM
Gymnastics and ballet, however, are quite uneven activities, as the dancer or gymnast usually has a preferred side for jumping, landing and twisting. Add that to being female, premenarchal, and training heavily, and having some causative factors for AIS, it's not surprising that rates of AIS or functional scoliosis are higher.

Do you actually mean to imply these activities can CAUSE AIS even just in a contributory fashion? Wouldn't that run counter to PT as a treatment for scoliosis?

While we might have some correlation (not necessarily though), that certainly doesn't imply causation. This is more complex than we can even imagine at present in my opinion.

betty14
06-24-2009, 10:19 PM
Do you actually mean to imply these activities can CAUSE AIS even just in a contributory fashion? Wouldn't that run counter to PT as a treatment for scoliosis?

While we might have some correlation (not necessarily though), that certainly doesn't imply causation. This is more complex than we can even imagine at present in my opinion.


What I mean is this:

Scoliosis likely has several as-yet-unknown or at least un-firmly prooved causes (I'll call this the X factors)

It is suspected that several things may contribute to scoliosis, such as heavy training in young girls or boys where the spine gets asymmetrically loaded...

Let's say child A has the "X factor". Maybe she'd be destined to get mild AIS.

But is Child A also is a ballet dancer, with several suspected contributing factors like poor nutrition, overtraining, delayed menarche, maybe then she'd get moderate AIS.

Lets say child B has two "X factors". Maybe severe scoliosis needing surgery.

Lets say child C has no "X factors", and has all the same contributing factors as child A. Maybe this person gets a functional scoliosis only. Or maybe nothing at all.

You're right, it's very complex. There must be reasons why degrees of curves vary so much. I think of the contributing factors as synergists (I hope I have the right word there, maybe I mean enzymes?). In any case, the contributing factors only matter much in the presence of factor X. Otherwise we'd all have scoliosis!



Wouldn't that run counter to PT as a treatment for scoliosis?

Nope!

B.

aterry
06-25-2009, 10:26 AM
Just the simple fact that it's estimated that 1 in 5 dancers has scoliosis tells me that something is going on. I wonder why there haven't been studies focused just on ballet, say. (or maybe there have been and I just haven't come across them). I think it's irresponsible of the dance world not to alert families that children taking dance are at greater risk; regardless of whether it's causal. If I'd known I'd have been on top of the pediatrician to do more frequent and more thorough screening. As it was the pediatrician did a screening at age 13 and then checks every year but missed the diagnosis completely. It was a dance teacher who noticed the asymmetry in the muscles--not the curve, when my daughter was 16.

sed78
06-25-2009, 11:26 AM
Scoliosis can be hard to spot if you don't know what you are looking for. Of course I feel like I can detect scoliosis in people because I know exactly what to look for...I have my own rib hump, uneven hips, torso rotation, one shoulder higher up and more forward, etc!

In some sports the body and body form are very important - such as gymnastics and ballet, for instance. Not so in other sports - think basketball, softball, etc. In gym. and ballet., as well as swimming, you body shape is important and you also tend to spend a lot of time in very form fitting clothing.

Don't you think, in well balanced curves, it would be much easier to spot them in a swimmer/gymnast/dancer? Could it be there are higher detection rates in these girls for the reasons stated above? I would think that studies would try to control for this somehow, but I have not read the literature to see how they account for this.

--Steph

aterry
06-25-2009, 12:29 PM
I take your point about form fitting clothes but my daughter wore such clothing for years with no one picking up on it. Just 3 months before detection she had a session with an alignment specialist who didn't notice it, so I'm not sure the dance world is attuned to look for the condition. If it's simply that the detection rates are higher in dance wouldn't that lead to the possibility that the occurrence of scoliosis in the general population approaches 1 in 5 with a lot of undiagnosed people walking around? I haven't read anything like that although I have read that many people with smaller curves--under 25, say--never notice the condition, or don't notice it until late in life.

LindaRacine
06-25-2009, 01:10 PM
Scoliosis can be hard to spot if you don't know what you are looking for. Of course I feel like I can detect scoliosis in people because I know exactly what to look for...I have my own rib hump, uneven hips, torso rotation, one shoulder higher up and more forward, etc!

In some sports the body and body form are very important - such as gymnastics and ballet, for instance. Not so in other sports - think basketball, softball, etc. In gym. and ballet., as well as swimming, you body shape is important and you also tend to spend a lot of time in very form fitting clothing.

Don't you think, in well balanced curves, it would be much easier to spot them in a swimmer/gymnast/dancer? Could it be there are higher detection rates in these girls for the reasons stated above? I would think that studies would try to control for this somehow, but I have not read the literature to see how they account for this.

--Steph
Interesting point. It's certainly possible that there's a lot of undetected scoliosis.

Dingo
06-25-2009, 03:33 PM
1992 - Study - The thoracolumbar spine in young elite athletes. (http://www.ncbi.nlm.nih.gov/pubmed/1533052)


Due to the increased interest in physical fitness and to the fact that athletes start their training at younger ages the risk for injuries to the growing individual has increased. The spine, as with the rest of the skeleton, is at greater risk of injury during growth, especially during the adolescent growth spurt. Back pain is more common among athletes participating in sports with high demands on the back than other athletes and nonathletes. Disc degeneration, defined as disc height reduction on conventional radiographs and reduced disc signal intensity on MRI, has been found in a higher frequency among wrestlers and gymnasts than nonathletes. Abnormalities of the vertebral bodies including abnormal configuration, Schmorl's nodes and apophyseal changes are common among athletes. These abnormalities are similar to those found in Scheuermann's disease. Athletes with these types of abnormalities have more back pain than those without. Spondylolysis has been found in higher frequencies than expected among athletes representing many different sports. Spondylolysis has been reported in up to 50% of athletes with back pain. Scoliosis has been found in up to 80% of athletes with an asymmetric load on the trunk and shoulders, such as javelin throwers and tennis players. The scoliosis, however, is a small curvature and does not cause back pain.

I can boil that study down to one sentence.

Intense, physical training can damage the growing spine.

Dingo
06-25-2009, 03:42 PM
June 2000 - Study - Scoliosis in rhythmic gymnasts. (http://www.ncbi.nlm.nih.gov/pubmed/10828918)

Results:

A 10-fold higher incidence of scoliosis was found in rhythmic gymnastic trainees (12%) than in their normal coevals (1.1%).

Conclusions:

This study identified a separate scoliotic entity associated with rhythmic gymnastics. The results strongly suggest the important etiologic role of a "dangerous triad": generalized joint laxity, delayed maturity, and asymmetric spinal loading.

I should note that exercise, sports and gymnastics probably aren't harmful unless they are taken to an extreme. A girl isn't going to get scoliosis from gymnastics class or from playing volleyball. However if a young girl practices every day for 2 hours to get onto the US Olympic team she's probably in the danger zone.

Pooka1
06-25-2009, 04:17 PM
I take your point about form fitting clothes but my daughter wore such clothing for years with no one picking up on it. Just 3 months before detection she had a session with an alignment specialist who didn't notice it, so I'm not sure the dance world is attuned to look for the condition. If it's simply that the detection rates are higher in dance wouldn't that lead to the possibility that the occurrence of scoliosis in the general population approaches 1 in 5 with a lot of undiagnosed people walking around? I haven't read anything like that although I have read that many people with smaller curves--under 25, say--never notice the condition, or don't notice it until late in life.

This is a good point and again highlights how studies that rely on self-reporting like that Danish twin study are garbage in - garbage out.

We know separately that there is a two-three fold under-reporting of scoliosis in that twin study because only about 1% of the twins self-reported as having scoliosis. That study was large enough that we would expect the global percentage (2-3%) to apply. Yet it did not.

In other words, we can be confident that the Danish twins study missed more scoliosis cases than it detected by a factor of two to three. And yet it was published. I blame the peer reviewers.

Pooka1
06-25-2009, 04:23 PM
June 2000 - Study - Scoliosis in rhythmic gymnasts. (http://www.ncbi.nlm.nih.gov/pubmed/10828918)

Conclusions:

This study identified a separate scoliotic entity associated with rhythmic gymnastics. The results strongly suggest the important etiologic role of a "dangerous triad": generalized joint laxity, delayed maturity, and asymmetric spinal loading.

"Generalized joint laxity." That is NOT normal.

This is my point that there is a strong selection in certain endeavors for certain body types and attributes. They winnow themselves. The kids who stay generally have those attributes. Certain of those attributes have a KNOWN correlation with certain connective disorder disorders.

In other words, it should not be surprising that "generalized joint laxity" is OVER-represented in ballet and gymnastics (or whatever). These people are self selecting and skewing the percentages away from that in the general population.

Dingo
06-25-2009, 04:38 PM
Pooka1


In other words, it should not be surprising that "generalized joint laxity" is OVER-represented in ballet and gymnastics (or whatever). These people are self selecting and skewing the percentages away from that in the general population.

You think that scoliosis is 10 fold higher in competitive, Bulgarian rhythmic gymnasts because "pre-scoliotic" children are attracted to this intense sport?

Very interesting hypothesis.

Maybe cigarettes don't raise the risk of lung cancer. People who are biologically prone to lung cancer like the taste of cigarettes.

Makes perfect sense to me. :)

Pooka1
06-25-2009, 05:04 PM
Pooka1



You think that scoliosis is 10 fold higher in competitive, Bulgarian rhythmic gymnasts because "pre-scoliotic" children are attracted to this intense sport?


Not so much attracted to but do well in and therefore stick around to be counted.

I bet the incidence of scoliosis in the kids who try it and then quit it quickly for lack of the correct body type is the same as the general population.

Perhaps you think "general joint laxity" is normal?

Pooka1
06-25-2009, 05:04 PM
Makes perfect sense to me. :)

My actual point might make far more sense than what you think my point is.

Dingo
06-25-2009, 05:10 PM
Pooka1


I bet the incidence of scoliosis in the kids who try it and then quit it quickly for lack of the correct body type is the same as the general population.

You are probably correct. I doubt that the risk for Scoliosis goes up measurably except for the most competitive, child atheletes. Sports probably don't have a negative impact on most kids. In fact they are probably beneficial when not taken to an extreme.

Douglas Kiester thinks so (http://www.scoliosis.org/forum/showthread.php?t=8948).

LindaRacine
06-25-2009, 05:20 PM
I agree. The loss of Fix is assuaged by the gain of Betty. But we are still in need of a reasonable chiro again.

We need rational folks who can talk about alternative treatments in PERSPECTIVE. They are not so common as can readily been seen.

How about someone from here:

http://www.chiroevidence.com/

Pooka1
06-25-2009, 05:38 PM
You are probably correct. I doubt that the risk for Scoliosis goes up measurably except for the most competitive, child athletes.


Let me take another swing here.

I am suggesting that the population of kids who stick with these sports because they do well in them are the kids with "general joint laxity." They have a huge advantage over normal kids and so stay with the sport OUT OF PROPORTION with their numbers in the general population.

They self-select. These kids who stay have a higher incidence of "general joint laxity" GOING IN, at the STARTING GATE. Saying the sport caused the "general joint laxity" is to miss what is actually going on as that is not normal and we KNOW it is associated with certain connective tissue disorders.

Let me give you an example... Michael Phelps, the most decorated Olympic athlete of all time. He has several characteristics of Marfans and indeed has his heart valves and aorta checked every year just like my girls who have less characteristics of Marfan's than he seems to have. His arm span is several inches longer than his height, he might have over-extendable elbows, and he has a long waterline so to speak. These confer an advantage on him in swimming as we have seen.

Now did his swim training produce these advantageous characteristics or did he stay with the sport because he was beating the pants off the other competitors at least in part due to his physical advantages?

Is that clearer?

Pooka1
06-25-2009, 05:39 PM
How about someone from here:

http://www.chiroevidence.com/

Wow that looks promising!

I hope they tackle the problem of "subluxations" and how no two chiros can look at a radiograph and agree on where they are.

Dingo
06-25-2009, 07:21 PM
Pooka1

They self-select.

I find your horse "theory" that started this thread fascinating.
I find your self selection theory equally fascinating. :D

betty14
06-25-2009, 09:51 PM
Not so much attracted to but do well in and therefore stick around to be counted.

I bet the incidence of scoliosis in the kids who try it and then quit it quickly for lack of the correct body type is the same as the general population.

Perhaps you think "general joint laxity" is normal?


In fact, "generalized joint laxity" IS a normal phenominon

People's connective tissue varies a great deal in terms of proportion of stiffer connective tissue to more elastic connective tissues.

On the stiffer end, are the kids with tissues that feel tight and stiff. They often complain that they feel stiff after exercise.

On the loose end are the people that can do party tricks with their shoulders and contort themselves through tennis raquets.

These are all variations of normal.

It does make sense that people on the looser end of the spectrum may have greater problems with scoliosis, as they have have less passive resistance to joint motion, and actually need to rely on muscle support more to control joint position.

Since more flexible people are desirable in gymnastics and ballet, these people probably are more likely to go farther in these sports.

So maybe Dinga and Pooka1 are both right. What the heck?

B.

Pooka1
06-25-2009, 09:54 PM
In fact, "generalized joint laxity" IS a normal phenomenon!

Then why is it a diagnostic characteristic of certain connective tissue DISORDERS?

Pooka1
06-25-2009, 09:59 PM
Since more flexible people are desirable in gymnastics and ballet, these people probably are more likely to go farther in these sports.

So maybe Dinga and Pooka1 are both right. What the heck?

B.

That's what I'm saying!

It is beyond obvious that certain body types and characteristics confer an advantage on certain folks in certain sports and activities. See Michael Phelps example. It stands to reason that the folks who are edging into the ABnormal end of the spectrum are going to have more advantage in certain activities.

The population that end up staying in a particular activity tend to be the folks who excel in it and is DISsimilar to the general population.

I don't see how anyone can argue with that.

betty14
06-25-2009, 10:27 PM
Then why is it a diagnostic characteristic of certain connective tissue DISORDERS?

It may be A charateristic of certain disorders, but not the ONLY characteristic.

Also, I suspect there may be histologic differences in the tissues defined as "normal" lax and "abnormal" lax. That's just an educated guess however.

Dingo
06-26-2009, 12:59 AM
Wiki: Joint hypermobility aka generalized joint laxity (http://en.wikipedia.org/wiki/Hypermobility)

Causes: :D :D :D

Gymnasts and athletes can sometimes acquire hypermobility in at least some of their joints through the exercises they do in training.

LindaRacine
06-26-2009, 01:09 AM
You may all know this already, but the collagen and elastin of people with scoliosis is different than people without scoliosis.

Lorraine 1966
06-26-2009, 01:42 AM
I didnt know that Linda, but find it interesting. Why? is that? I am probably showing my lack of understanding here but I am genuine.

Regards
Lorraine.

Pooka1
06-26-2009, 07:22 AM
Wiki: Joint hypermobility aka generalized joint laxity (http://en.wikipedia.org/wiki/Hypermobility)

Causes: :D :D :D

You take the one speculative sentence (without a reference) out of a page that is 99.99999% about disorders and think you made some point?

You continue to show an inability approach the literature in a credible and honest fashion. Get a grip.

Pooka1
06-26-2009, 07:26 AM
Here is the "causes" section from the wiki page Dingo posted. I bolded the one sentence he took out of the context.

Causes

Hypermobility generally results from one or more of the following:

* Misaligned joints
* Abnormally-shaped ends of one or more bones at a joint
* A Type 1 collagen defect (found in Ehlers-Danlos Syndrome, Marfan syndrome) results in weakened ligaments, muscles & tendons. This same defective process also results in weakened bones which may result in osteoporosis and fractures
* Abnormal joint proprioception (an impaired ability to determine where in space parts of the body are, and how stretched a joint is)

A hypermobile hand

The condition tends to run in families, suggesting that there may be a genetic basis for at least some forms of hypermobility. The term double jointed is often used to describe hypermobility, however the name is a misnomer and is not to be taken literally, as an individual with hypermobility in a joint does not actually have two separate joints where others would have just the one.

A hypermobile hand

Some people have hypermobility with no other symptoms or medical conditions. However, people with hypermobility syndrome may experience many difficulties. For example, their joints may be easily injured, be more prone to complete dislocation due to the weakly stabilized joint and they may develop problems from muscle fatigue (as muscles must work harder to compensate for the excessive weakness in the ligaments that support the joints).

Hypermobility may also be symptomatic of a serious medical condition, such as Ehlers-Danlos syndrome, Marfan syndrome, rheumatoid arthritis, osteogenesis imperfecta, lupus, polio, downs syndrome, morquio syndrome, cleidocranial dysostosis or myotonia congenita.

In addition, hypermobility has been associated with chronic fatigue syndrome and fibromyalgia. During pregnancy certain hormones alter the physiology of ligaments making them able to stretch to accommodate the birthing process. For some women with hypermobility pregnacy related pelvic girdle pain can be debilitating.

Symptoms of hypermobility include a dull but intense pain around the knee and ankle joints and also on the soles of the feet. The condition affecting these parts can be alleviated by using insoles in the footwear which have been specially made for the individual after assessment by an orthopaedic surgeon.

[edit] Hypermobility syndrome

Hypermobility syndrome is generally considered to comprise hypermobility together with other symptoms, such as myalgia and arthralgia. It is relatively common among children and affects more females than males.
A hypermobile hand

The current diagnostic criteria for hypermobility syndrome are the Brighton criteria, which incorporates the Beighton Score[3]. The Beighton Score in an individual with HS usually falls between 4-6 out of 9. A diagnosis of Hypermobility Syndrome is only given when hereditary connective tissue disorders (such as Ehlers-Danlos and Marfan) have been ruled out.

[edit] Causes

Current thinking suggests that there are four factors: These four factors affect different people to varying degrees and each is explained in detail in the following sections.

* The shape of the ends of the bones: Some joints normally have a large range of movement, like the shoulder and hip. Both these joints look like a ball in a socket. If you inherit a shallow rather than a deep socket, you will have a relatively large range of movement, but only at these particular joints. If your hip socket is particularly shallow, then your hip may dislocate easily.
* Weak or stretched ligaments caused by protein or hormone problems: ligaments are made up of several types of protein fibre. These proteins include elastin, which gives elasticity, which may be altered in some people. Also, the female sex hormones alter the collagen proteins. Women are generally more supple just before a period, and even more so in the latter stages of pregnancy, because of the effect of a hormone called relaxin. This hormone allows the pelvis to expand so the head of the baby can pass through. Different races have differences in their joint mobility, which may reflect differences in the structure of the collagen proteins. People from the Indian sub-continent, for example, often have much more supple hands than Europeans.
* The tone of your muscles: The tone (or stiffness) of your muscles is controlled by your nervous system, and influences the range of movement in the joints. Some people use special techniques to change their muscle tone and increase their flexibility. Yoga, for example, can help to relax the muscles and make the joints more supple. Gymnasts and athletes can sometimes acquire hypermobility in at least some of their joints through the exercises they do in training.
* Your sense of joint movement (proprioception): if you find it difficult to detect the exact position of your joints with your eyes closed, then you may develop hypermobile joints because you are likely to over-stretch a joint before you notice you are doing so. [1]

Ballet Mom
06-26-2009, 11:07 AM
Hyperextended joints, also called double-jointedness, and apparently in the medical terminology is known as “joint laxity”, is actually fairly common. You just have to be attuned to notice it. I see people all the time, especially in the school system, that in my mind I’m thinking, “Oh, what a great ballerina they would have made”. I wouldn’t consider it abnormal, and neither does the medical field. Obviously, if you are far to one side of the spectrum of joint laxity, you may be able to be clinically diagnosed with some syndrome. However, most of these people with a clinical syndrome wouldn’t be able to keep up with the rigors of ballet or gymnastics. They would have pain and/or dislocated joints.


You think that scoliosis is 10 fold higher in competitive, Bulgarian rhythmic gymnasts because "pre-scoliotic" children are attracted to this intense sport?

The Soviet system chose those children, the children didn’t choose it. Bulgaria, as a former communist country was very close to the Soviet Union, and like all good communist countries screened the children at a very early age into ballet and rhythmic gymnastics, based on many measurements. You can see the Kirov Ballet’s (now known as the Mariinsky) results from this very young screening as every member of their ballet is hyperextended (and the same height too!), very deliberately. Look at the right leg of every member of the Kirov’s corps de ballet, each knee joint clearly shows the hyperextension:

http://media.photobucket.com/image/kirov%20ballet%20swan%20lake/Liness17/Repertorio/BolshoiDancersPerformingSwanLake.jpg

Here are a couple of pictures (the two lower pictures) that quite clearly shows the difference in looks between a straight-legged ballerina and a hyperextended ballerina. There is a significant difference in look. And ballet loves the hyperextended look, it is a sought after trait.

http://apricot.wordpress.com/2008/07/04/hyperextension-and-ballet/

The Soviet system believed and still believes that talent is wasted in a less than perfect body for the endeavor and will only train those whose measurements “measure up”.

In the United State, anyone who wants to with the money to afford it can be trained, but here as Pooka says, those kids with the hyperextended joints will get better scores and are therefore more likely to continue on than those without those joints. Certainly, to make it to the highest levels of the sport, it seems to be a requirement. Look at these Russian rhythmic gymnasts’ noticeably hyperextended elbows from some of the Olympics and world games:

http://2pat.files.wordpress.com/2008/08/_44954680_russia_gym.jpg

http://www.upi.com/enl-win/0b8d456b43c99f2a1a7fd5bbc957a66f/

Just this weekend at the ballet studio, one of the moms whose daughters compete in both rhythmic gymnastics and ballet was complaining that the rhythmic gymnasts seemed to get higher scores just because they had hyperextended joints. She was concerned that her daughter did not have these joints.

Here’s another study that states
IS (idiopathic scoliosis) patients, practising gymnastics or not, showed a higher JL (joint laxity) than the control group practising gymnastics or not. Furthermore, the groups practising gymnastic activities did not show higher JL levels than the other groups. Children with a high JL could be drawn toward gymnastics because of their ability to adapt to the constraints of this sport. Girls with a high JL may therefore be prone to developing IS. The fact that most teenagers with IS practise gymnastics could be related to a higher JL.

http://www.ncbi.nlm.nih.gov/pubmed/16895527?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsP anel.Pubmed_DiscoveryPanel.Pubmed_Discovery_RA&linkpos=2&log$=relatedarticles&logdbfrom=pubmed

I actually believe that it’s the double-jointedness that is a possible indicator for potential scoliosis, not just generalized limberness and flexibility. Lots of gymnasts and ballet dancers are super limber without the hyperextended joints. I think a study should be done to see if it’s the doublejointed kids more prone to scoliosis than just all the kids who are limber doing gymnastics and ballet. This would explain why rhythmic gymnasts have a higher incidence of scoliosis than in regular gymnastics, because the look of the hyperextension is more highly valued in rhythmic gymnasts than in regular gymnastics and so there are more of these kids with hyperextended joints in that sport.

Dingo
06-26-2009, 01:44 PM
Ballet Mom

Interestingly enough my son is both visibly "tight" and yet he also has what appears to be joint hypermobility in his hips.

His torso has been very stiff since birth. He strongly favored sleeping on one side when he was younger. He even used to run in a visibly stiff manner.

However when he sits down to stretch his legs move in crazy ways. We just learned about this a few weeks ago. When he spreads his legs his feet naturally rotate inwards to the floor and his toes point at each other.

It's painful to watch but to him it's effortless. Something like 10% or 15% of young children have hypermobility but they tend to outgrow it as they get older. I hope Scott does because it's creepy. :)

Why he is both hypermobile and hyperstiff is a mystery to me.

Ballet Mom
06-26-2009, 03:00 PM
Hi Dingo,

The amount of hyperextension definitely varies by joint in the body. My daughter's elbows are extremely hyperextended and her knees are less hyperextended. For ballet, it would be better the other way around. My daughter actually used her "creepy" elbows as a show and tell project in elementary school and freaked out all the other kids.... :)

However, every joint in her body is hyperextended and she has completely natural hip turnout (a must for ballet). Amazingly enough though, she had a hard time developing her splits because her muscles in her legs were stronger than most of the other girls. She is considered a "jumper" in ballet.

I've even heard that some ballet students have one knee hyperextended and not the other. Just goes to show why this scoliosis field is so hard to pinpoint the exact causes, it's all so variable by individual.

Dingo
06-26-2009, 03:15 PM
Ballet Mom

Is their a name for what my son's legs do?

When he sits down and spreads his legs to stretch his feet fall inward and his toes point at each other.

Ballet Mom
06-26-2009, 03:41 PM
Hi Dingo,

It actually probably isn't anything but a young boy's flexibility. However, turnout of the hips would probably cause the legs to turn with an outward rotation, not inward. Perhaps, you could point it out at either his next physical or mention it to his orthopedist...the orthopedist would certainly know. It could possibly be intoeing, however, you'd probably notice this more when he was standing or walking:

http://www.childrensorthopaedics.com/intoeing.html

Just be warned though....my son started to intoe noticeably during the 5th and 6th grades and I took him to our pediatriacian who has an orthopedics specialty and the doctor started talking about surgery. i.e. cutting the bones and rotating them to fix the intoeing. I told him absolutely not, that I wouldn't even consider it. And wouldn't you know, that my son's intoeing isn't even noticeable anymore, it basically fixed itself with his future growth.

The doctor did mention that most of the fastest runners are slightly intoed. :)

Pooka1
06-26-2009, 04:20 PM
Wow that was certainly very interesting and informative!

So at least rhythmic gymnastics and swimming tend to favor abnormal body types. There are probably other sports. I mean when the most decorated Olympic athlete ever needs yearly screenings for emergent Marfans then that likely says something about the confluence between swimming and Marfanoid characteristics.

Maybe there is some rarefied body type that excels in dressage because so few ever make it out of the lower levels despite years of lessons. I am not sure what it is other than being a male... the male pelvis is such that they can sit much more effectively much easier. It's very annoying. :mad: :)

The top women tend to be all over the map in body type so I don't know if there is one type for women. It might just be those women got spitting mad enough and determined enough to get to the top out of sheer frustration. Just a wild guess. :D

Dingo
06-26-2009, 04:46 PM
Ballet Mom

Interesting link on in-toeing.

For whatever reason it only shows up when he sits down and stretches. He stands and walks (at least visibly) like every other kid.

I assume it will slowly go away as he gets older.

No way would I want surgery for this.

Ballet Mom
06-26-2009, 05:25 PM
Pooka1,

I suspect that most sports have some physical trait or traits that provide an advantage to the person who has them and often those traits are outliers i.e. unusual like Phelps. That is why the Soviet system would screen their kids and decide which sport they would go into for them. Unfortunately, that doesn't provide for sheer talent, determination and drive which is what the US relies on!

I suspect someone, somewhere has probably already figured out the secret formula for dressage... ;)

Dingo,

I would just run it by his ortho at his next x-ray appt., I'm sure the orthopedist will quickly tell you what it is and whether it is a concern. Probably it won't be a concern, but I'm all for letting the doctors know anything that concerns me and see what that might trigger in their minds. Usually nothing, but it puts my mind at ease.

LindaRacine
06-26-2009, 11:41 PM
I didnt know that Linda, but find it interesting. Why? is that? I am probably showing my lack of understanding here but I am genuine.

Regards
Lorraine.

Sorry, Lorraine. I'm pretty clueless when it comes to things other than bone and discs. If you do a PubMed search on scoliosis and elastin, you'll see a bunch of different studies.

trcylynn
07-02-2009, 05:18 PM
Pooka- I'm mainly interested in the horseback riding aspect of this post... I am an equestrian as well and in all pictures you can see my lower back shoving out to the left side... I favor equitation over the other disciplines and am trying to correct my "center" on the horse. Have you read centered riding or something along those lines? I read somewhere that the author had scoliosis as well and was wondering if the book is worth reading.

I think a lot of the riders are imbalanced in the sense that some people are left handed others are right handed and you favor one side. I think if people without scoliosis trained to have both sides equal they wouldn't be so imbalanced but that is completely my opinion with absolutely no evidence to back it.

I have a month or so before I'm allowed to ride again (shoulder surgery) so I'm trying to get back in shape and would love to know if you know of anything that can help me be more centered when riding... I would hate to hurt all of my horses backs by sitting heavy to one side because of my stupid back... Mechanically I have no problem- I do well at shows horses respond well I've riden experienced horses but I know I am not as good as I could be with my back the way it is and I'm sure at times my signals while riding are confusing.

Thanks in advance for any riding advice you can give!! :)

Pooka1
07-02-2009, 06:17 PM
Pooka- I'm mainly interested in the horseback riding aspect of this post... I am an equestrian as well and in all pictures you can see my lower back shoving out to the left side... I favor equitation over the other disciplines and am trying to correct my "center" on the horse. Have you read centered riding or something along those lines? I read somewhere that the author had scoliosis as well and was wondering if the book is worth reading.

I have both of Sally Swift's Centered Riding books. She died recently... I posted a thread about it. Huge loss.

I think those two books are among the best out there for suggesting effective visualizations. Almost everyone, not just scoliotics, is imbalanced. Some people with straight spines are so imbalanced that they can lame a horse as I previously stated. I am saying this so that you do not feel singled out as a scoliotic in terms of trying to achieve evenness... everyone struggles with it.

I also want to tell you that I know of at least one FEI dressage rider with scoliosis (lumbar) who trained in Europe with a top guy. She has learned specific things she has to do with her seat, hip and shoulder to maintain evenness. She is a professional rider and trainer so there is hope you can achieve evenness.


I think a lot of the riders are imbalanced in the sense that some people are left handed others are right handed and you favor one side. I think if people without scoliosis trained to have both sides equal they wouldn't be so imbalanced but that is completely my opinion with absolutely no evidence to back it.

I think you are generally correct but I don't think it is always your handedness being the dominant side. Also, work on the ground likely won't translate to evenness in the saddle. I know plenty of folks who are very fit, athletic, aerobic, etc. who struggle as much as the next person in terms of balance in the saddle. There is no substitute for wet saddle blankets.


I have a month or so before I'm allowed to ride again (shoulder surgery) so I'm trying to get back in shape and would love to know if you know of anything that can help me be more centered when riding... I would hate to hurt all of my horses backs by sitting heavy to one side because of my stupid back... Mechanically I have no problem- I do well at shows horses respond well I've ridden experienced horses but I know I am not as good as I could be with my back the way it is and I'm sure at times my signals while riding are confusing.

First, again, EVERYONE struggles at first with not confusing the horse. You are not alone. A good instructor with a VERY good eye can help you be even.

I just think you might need to consider that some of your difficulty in learning is shared by everyone including those with no spine problem. In other words, this is such a universal problem for folks trying to learn to ride that it's hard to say how much the scoliosis per se is affecting your balance over and above a random person. But if you have a noticeable curve, it likely is.

Again, you need a good set of eyes on the ground and some exercises that can help you constantly check that you have even weight on your seatbones when needed and can shift the right amount of weight to each seatbone with correct timing.

A test of evenness is to pick a spot to ride to, ride "legs away," and just use your two seat bone weights to stay on the line. Do this in walk, trot and canter if you can.


Thanks in advance for any riding advice you can give!! :)

I don't know how much I helped but you're welcome! :)

Good luck.

Ballet Mom
09-26-2009, 06:51 PM
The Soviet system chose those children, the children didn’t choose it. Bulgaria, as a former communist country was very close to the Soviet Union, and like all good communist countries screened the children at a very early age into ballet and rhythmic gymnastics, based on many measurements. You can see the Kirov Ballet’s (now known as the Mariinsky) results from this very young screening as every member of their ballet is hyperextended (and the same height too!), very deliberately.

I wanted to add a study that I came across that pertains to this comment I made earlier in this thread about the Soviet and Bulgarian screening systems and I have highlighted the relevant comment that backs up my comment, in case anyone was interested:

2.15 Scoliosis And Rhythmic Gymnastics

P. Tanchev, A.Djerov, A.Parushev, D.Dikov
University Hospital of Orthopaedics "Gorna Bania", 56, N.Petkov St., 1614 Sofia, Bulgaria. Phone: 00359 2 55 01 42; Fax: 00359 2 55 30 63
In a survey of 100 girls, aged 11-15, having been trained actively in rhythmic gymnastics at least for a period of 5 years, we found a fivefold higher incidence of adolescent idiopathic scoliosis (AIS). These data were compared to the results from a screening of 4800 students of the same age, carried out in Sofia by the same examining team in 1996.

A detailed familial and past diseases anamnesis was registered in all the probands. General physical and meticulous back examinations were carried out, and X-rays were taken in all the AIS suspected cases. Special attention was paid to the presence of generalised joint hyperlaxity, which had been usually the main criterion for the primary selection of 5-year-old-girls to start training in rhythmic gymnastics. Eating regimen, weight-height relations, growth and maturing development (delayed menarche or secondary amenorrhea) were assessed too. Intensity, duration and specific moments of the training process were carefully analysed, and a significant asymmetric loading and an extreme physical overloading of the body were found.

This study supports the multifactorial origin of AIS, and strongly suggests the important role of the following aetiologic triad in disturbing the growth of vertebrae and intervertebral discs: generalised joint hyperlaxity as a hereditary characteristic; delayed maturing caused by physical, dietary and psychic stresses; and persistent asymmetrical overloading of the growing spine. These findings in girls, practising rhythmic gymnastics, generate a hypothesis which needs to be juxtaposed on the characteristics of non-gymnast patients with AIS.

http://www.ndorms.ox.ac.uk/pzs/Group_2/Tanch.html

Interesting that the results still come out as multi-factorial. There is room for an infectious trigger there, in my mind!

jrnyc
09-26-2009, 10:05 PM
thought i'd throw my 2 cents in...not any survey or study, just experience...

when my back curves, i am not equally ANYTHING anymore..including strong...the side my worst curve is on (left) is my weaker side..always has been...affected my ballet turns & other movements...can lift more weight with right than left, etc...sooooooooo.....

in my own particular body, this is true...dont know about anybody else's body....

also, common sense would say curved & crooked body (my own) is unequal in all things....but again, just my opinion & experience...and the chicken (scoli) came before the egg, at least in my case....

jess