Case study: Non-surgical reversal of scoliosis in a mature adult

[Writer]

Many NSF forum members will know the name of Dr. Martha Hawes, a plant physiologist at the Univ. of Arizona who was diagnosed with scoliosis as a pre-adolescent but refused surgery. Instead, she worked with an osteopath and other non-surgical practitioners. She has written articles about her treatment, one of them in the NSF newsletter The Spinal Connection (vol 18, no. 1, 2002). She has also collaborated with NSF president Joe O'Brien on scoliosis-related publications. Her book Scoliosis and the Human Spine is sold through the NSF Store: proceeds benefit the NSF. Now she has published an update to her accounts of her own treatment.

http://www.scoliosisjournal.com/content/pdf/1748-7161-4-27.pdf

Synopsis of her results:

Increase in height: 2 cm between 1990 and 2005

Improved pulmonary symptoms: Vital capacity in 1996 = 1.6 liters (71% predicted), 2005 = 3.99 liters (115%). Relief from respiratory symptoms including dyspnea and recurrent respiratory infection was maintained.

Improvement in torso symmetry: In 1992, there was a 12+2 cm difference between the left and right hemi-thorax at maximum inhalation, and a 10+1 cm difference at maximum exhalation. By 2005, reduction to 2+2 cm and 1 +1 cm, respectively. Rib prominence reduced from 18 +3 to 11 +2 degrees.

Increase in sagittal plane Cobb magnitude: Cobb angle of the sagittal thoracic curvature increased from 17+2 degrees in 2001 to 33+3 degrees in 2005.

Decrease in coronal plane Cobb magnitude: From 1990 through 2005 the magnitude of Cobb angle for the primary thoracic curve declined by >10 degrees.

[jrnyc]

Hi Writer
i believe you will find a discussion of Hawes results & a thorough debate in the "torso rotation strength training" thread....

jess

[mamamax]

Many NSF forum members will know the name of Dr. Martha Hawes, a plant physiologist at the Univ. of Arizona who was diagnosed with scoliosis as a pre-adolescent but refused surgery. Instead, she worked with an osteopath and other non-surgical practitioners. She has written articles about her treatment, one of them in the NSF newsletter The Spinal Connection (vol 18, no. 1, 2002). She has also collaborated with NSF president Joe O'Brien on scoliosis-related publications. Her book Scoliosis and the Human Spine is sold through the NSF Store: proceeds benefit the NSF. Now she has published an update to her accounts of her own treatment.

http://www.scoliosisjournal.com/content/pdf/1748-7161-4-27.pdf

Synopsis of her results:

Increase in height: 2 cm between 1990 and 2005

Improved pulmonary symptoms: Vital capacity in 1996 = 1.6 liters (71% predicted), 2005 = 3.99 liters (115%). Relief from respiratory symptoms including dyspnea and recurrent respiratory infection was maintained.

Improvement in torso symmetry: In 1992, there was a 12+2 cm difference between the left and right hemi-thorax at maximum inhalation, and a 10+1 cm difference at maximum exhalation. By 2005, reduction to 2+2 cm and 1 +1 cm, respectively. Rib prominence reduced from 18 +3 to 11 +2 degrees.

Increase in sagittal plane Cobb magnitude: Cobb angle of the sagittal thoracic curvature increased from 17+2 degrees in 2001 to 33+3 degrees in 2005.

Decrease in coronal plane Cobb magnitude: From 1990 through 2005 the magnitude of Cobb angle for the primary thoracic curve declined by >10 degrees.

Thank you for posting this Writer.

This 26 page follow up helps answer questions and dispel some myths about the case of Martha Hawes.

Table 2 which shows cobb measurements (using three comparative methods) from 1990-2005 clearly shows a progressive reduction in curvatude - hdugger reports from a recent email to Martha, that she continues to maintain her correction with 1 hour of exercise daily (as is outlined in her memoir).

Table 1 outlines her methods of treatment - none of which involve 4 hours a day of exercising for years and years - a myth that I'm glad to see set to rest in this report. From 1964-1974 she used calisthenics for about 30 minutes daily; 1974-1991Calisthenics, stretching, plus aerobics (biking, jogging) 60 min daily; 1991 Deep tissue massage 60 min daily; 1992-2001 Daily home mobilization exercises (no strengthening or aerobic) + some other intermittent therapy; 2001-2005 daily mobilization, strengthening & aerobic exercise 40-50 min daily.

The work of Martha Hawes not only demonstrates that contrary to past opinion, adult curves can be reduced significantly through non surgical methods - and that reduction can be maintained.

One may only speculate: If we have this well documented case report - how many undocumented cases exist?

[Writer]

Hi Writer
i believe you will find a discussion of Hawes results & a thorough debate in the "torso rotation strength training" thread....

jess
Yes, thanks for the pointer. I'm aware of that thread, but a lot of forum members are unlikely to read 23 pages of discussion before they find the reference. I started a separate thread for this article because I believe it is a milestone publication by a major figure in scoliosis research and deserves its own discussion page.

[hdugger]

Good point on stuff being hard to find in that thread. I'm posting some notes about the report here:

* She may have had JIS rather than AIS - asymmetry noted by age 6, 45 degree curve by age 11. Based on the bulk of JIS reports I've seen, it's very likely she would have progressed to surgery.

* She may have some mild connective tissue disorders. At the least, she mentions pectus excavatum which, along with scoliosis, is seen in some connective tissue disorder.

* Based on the age at which she was diagnosed at 45 degrees, it is equally interesting that she managed to maintain her curvature without progressing.

* She lays out in report a fairly clear summary (on page 5) of the exercises she performed when young to maintain her curve.

I also note that the hours per day required by Hawes (and Elise Miller, as described in other threads) must necessarily include a large amount of time spent trying to figure out what exercises to do as well as time doing exercises which likely had no effect on the outcome. Therefore, we do not yet have a sense of how much exercise per day is necessary until we know exactly which exercises are actually reducing/maintaining the curve.

[Pooka1]

From the 2009 paper on Hawes...


Table 1 outlines her methods of treatment - none of which involve 4 hours a day of exercising for years and years - a myth that I'm glad to see set to rest in this report. From 1964-1974 she used calisthenics for about 30 minutes daily; 1974-1991Calisthenics, stretching, plus aerobics (biking, jogging) 60 min daily; 1991 Deep tissue massage 60 min daily; 1992-2001 Daily home mobilization exercises (no strengthening or aerobic) + some other intermittent therapy; 2001-2005 daily mobilization, strengthening & aerobic exercise 40-50 min daily.

From the previous article:

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).

Okay so she did this for FOUR hours every day for FIVE years. The daily effort spent on this component of her treatment is the ONLY one left out of the table and is therefore conspicuous by its absence. I don't know why it was omitted from the table.

And I don't know why the dates for the various treatments don't match exactly between the two papers. Seems strange.

Hawes is a plant science professor and therefore NOT a nut. I will give her the benefit of the doubt on any differences between the two papers.

But let's not go on saying the 4 hours a day for years is a myth, shall we?

[hdugger]

Good point, Pooka. It's interesting that she relies so heavily on massage/manipulation during what appears to be the period of greatest reduction to the curve. I believe Elise Miller mentioned extensive use of massage (but, I'm not certain - just a vague memory).

Have their been other studies that point to role of massage? Or massage + exercise?

[Dingo]

Martha Hawes is a hero.

I am very surprised that exercise is beneficial after skeletal maturity but Martha's report indicates that it is. Good for her. Obviously if physical therapy helps adults it should be even more beneficial for children. I guess that explains the torso rotation studies (http://www.scoliosis.org/forum/showthread.php?t=8976).

According to this study of 48 children curve patterns can change.
April 2008: Curve pattern changes in idiopathic scoliosis (http://www.scoliosisjournal.com/content/4/S1/O13)


In this study, changes in curve patterns suggest that idiopathic scoliosis is not a fixed deformity, but a dynamic process especially in patients younger than 10 years.

[hdugger]

I am very surprised that exercise is beneficial after skeletal maturity but Martha's report indicates that it is.

I'm shocked, but heartened. We're racing the curve on my son - hoping that something either halts the progression (good enough) or turns it around (fantastic) before he hits the surgery trigger mark.

[Ballet Mom]

I'm shocked, but heartened. We're racing the curve on my son - hoping that something either halts the progression (good enough) or turns it around (fantastic) before he hits the surgery trigger mark.

hdugger,

I was looking at these side shift exercises you mentioned as perhaps something my daughter could use to make sure she doesn't progress when she stops wearing her brace. I thought you might be interested in this study as it says that four of the skeletally mature people in the study had at least a ten degree reduction in their curves. At least this can be added to your list. These results are from doctors, so I personally would trust their Cobb angle measurements.

Also, it's very interesting to me because apparently these side shift exercises were originally desribed by Min Mehta and I personally believe she is an inspired scoliosis specialist.


SIDE SHIFT EXERCISE FOR IDIOPATHIC SCOLIOSIS AFTER SKELETAL MATURITY

T. Maruyama; T. Matsushita; K. Takeshita; T. Kitagawa; K. Nakamura; and T. Kurokawa

Department of Orthopaedics, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173 8605, Japan


Side shift exercise was originally described by Mehta. Since 1986, we adopted it for the treatment of idiopathic scoliosis. Outcome of the side shift exercise for the patients with idiopathic scoliosis after skeletal maturity was evaluated retrospectively. Fifty-three patients with idiopathic scoliosis whose curve was greater than 20 degrees by the Cobb’s method were included in the study. All the patients were treated only by the side shift exercise and their treatment was started after skeletal maturity. Skeletal maturity was diagnosed by Risser’s method as either grade IV or grade V. The study comprised five men and forty-eight women. Twenty-six patients had thoracic curve, eight had thoracolumbar curve, and nineteen had double major curve. Patients were instructed to shift their trunk to the concavity of the curve repetitively while they were standing and to maintain the side shift position while they were sitting. In double major curve, larger curve was the subject of the treatment. The average age at the beginning of the treatment was 16.3 years (range, 13 to 27 years), and the average age at final follow-up was 19.8 years (range, 14 to 33 years). The average follow-up period was 3.5 years (range, one to 11 years). The average Cobb angle at the beginning of the treatment was 33.3 degrees (range, 20 to 74 degrees), and the average Cobb angle at final follow-up was 32.2 degrees (range, 10 to 73 degrees). Curves of four patients decreased 10 degrees or more. Most of long term follow-up studies reported that untreated idiopathic scoliosis progressed even after skeletal maturity. Although the follow-up period was much shorter, results of the present study suggested that the side shift exercise was a useful treatment option for the management of idiopathic scoliosis after skeletal maturity.

The abstracts were prepared by Mr Simon Donell. Correspondence should be addressed to him at the Department of Orthopaedics, Norfolk & Norwich Hospital, Level 4, Centre Block, Colney Lane, Norwich NR4 7UY, United Kingdom.

http://proceedings.jbjs.org.uk/cgi/content/abstract/85-B/SUPP_I/22-d

[leahdragonfly]

[QUOTE=Dingo;87778]Martha Hawes is a hero.

Not sure how this makes her a hero. In my book, this makes her extremely lucky--and rare.

[hdugger]

That's very interesting. Thanks, Ballet Mom. Does anyone have access to the full text of the article? I'm trying to see what the initial curve was like in the 10 who reduce their curve, since I'm trying to making data points only for reductions in "significant" curves (which I'm roughly defining as over 35 degrees).

[Dingo]

leahdragonfly


Not sure how this makes her a hero. In my book, this makes her extremely lucky--and rare.

Very few people posess either significant, critical thinking skills or a strong work ethic. Martha Hawes has both. She used these traits to help not only herself, but everyone else with the same affliction. That makes her a hero.

[mamamax]

I count her as hero also. As Dingo stated: Very few people posess either critical thinking skills or a strong work ethic. Martha Hawes has both. She used these traits to help not only herself, but everyone else with the same affliction. That makes her a hero. I agree.

Prior to the published work of Martha, what were we told about adult curves? We were told that there was nothing, absolutely nothing (non surgical) that could reduce them. And now, for the first time in history, we have a documented case that continues to hold correction. I have a feeling we will see continued follow ups throughout the years from her - hopefully, this will be the tip of the iceberg in years to come.

I have heard anecdotal reports of such things, maybe many of us have. Happened with my daughter in fact - a scientifically undocumented small curve disappearing after obtaining pilaties certification and becoming an instructor as a young adult. Maybe such reports are not so rare - but to find an older adult (40+) doing this, scientifically documenting it, and publishing the information - opens the door for more in a place where the literature has been so woefully lacking.

[mamamax]

From the 2009 paper on Hawes...

From the previous article:

http://www.scoliosis.org/resources/spinalconnection_spr2002.pdf


Quote:
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).

But let's not go on saying the 4 hours a day for years is a myth, shall we?

The myth has been - that Martha engaged in 4 hours daily of vigorous exercise for years and years. That has been said many times in this forum.

This paper clarifies that the 4 hours of exercise was passive in nature (traction and sustained pressure applied directly to muscle spasms - and not vigorous (or active) as in aerobics, etc.

I think this distinction is an important one to make for the years 1993-1997.

[Pooka1]

Ti Ed will have to ti-edify (LOL!) me on the cost of massage but let's take $35/hour.

If Hawes paid $35/hour for 4 hours a day for 5 years, not counting leap day that will cost $63,875.

Still less than most surgeries though so there's that.

[hdugger]

I believe it was self-applied - "was used by the patient." That ought to bring the cost down to zero.

The professional massage sessions were much less frequent during that period.

[Pooka1]

Okay I think you are correct upon re-reading that.

So the cost is now far less than surgery. :)

[Pooka1]

And by the way, I don't see how self-applied massage could possibly have affected the curve. She was just doing it for pain anyway. It must be just the PT.

I also wonder if she has radiographs that showed a non-monotonic decrease (i.e., an increase) in the curve over all those years that corresponds to periods when she stopped the PT. There are big gaps in time that we are to believe contained no radiographs. That is, I am asking if any data were omitted. That would be bad as it would change some conclusions about the permanence of this treatment.

[LindaRacine]

I'm trying to imagine how someone can massage their own back.

[Pooka1]

I guess she laid on things or pushed up against things on the wall?

She was just dong it for pain relief apparently.

[Dingo]

LindaRacine


I'm trying to imagine how someone can massage their own back.

This massager is gold
Therapist Select™ Percussion Massager with Heat (http://www.homedics.com/home/massage/handheld-massagers/therapist-select-percussion-massager-with-heat.html)

[LindaRacine]

LindaRacine



This massager is gold
Therapist Select™ Percussion Massager with Heat (http://www.homedics.com/home/massage/handheld-massagers/therapist-select-percussion-massager-with-heat.html)

How that could possibly have had any effect on curve magnitude is beyond me.

[LindaRacine]

Well, that explains it all! ;-)

[hdugger]

And by the way, I don't see how self-applied massage could possibly have affected the curve. She was just doing it for pain anyway. It must be just the PT.

We're far too early into the search to toss any clues aside, IMO. I've noted a few places that two of the data points discuss a combination of PT and massage. Both avenues are worth exploring.


I also wonder if she has radiographs that showed a non-monotonic decrease (i.e., an increase) in the curve over all those years that corresponds to periods when she stopped the PT. There are big gaps in time that we are to believe contained no radiographs. That is, I am asking if any data were omitted. That would be bad as it would change some conclusions about the permanence of this treatment.

Wasn't the stop in PT in the 1990s? I'm seeing xrays at least every four years during that period (1990, 1994, 1998, 2001).

We're not arguing permanence here, though, are we? Ah, I see, because you don't think the massage mattered so you think there's a gap. My suspicion is that the massage was part of the effective treatment, but we don't have any way of knowing.

So, two theories (one assuming massage works and one assuming it doesn't).

If massage does work, then it managed to at least hold the reduction for the 1998 x-ray).

If massage doesn't work, then we throw out the only modality that she did for 4 hours a day and attribute all of the reduction to no more than one hour of exercise a day. Even if she lost the reduction and then regained it (which assumes some less than transparent reporting on her part which I have no reason to suppose) it means that the curve held from 1992 to 1994 (when an xray was taken) without any exercise, and then, even if the curve reduction was partly lost from 1994 to 1997, it had to be regained between 1997 and 1998 with no more than one hour of exercise a day. So, either massage works, which is great, or curve reductions hold, which is great, or one can lose a reduction and gain it back with no more then one hour of exercise a day, which is great. Am I missing some way of looking at it which is bad?

[txmarinemom]

I'm trying to imagine how someone can massage their own back.

Well, since I'm in school to *be* a massage therapist, I probably shouldn't show y'all this (http://www.theracane.com) (LOL). I have one, and LOVE it.

(Actually, I've posted it before: It works great for trigger points - but that's about it. Much more refined than lying on golf balls/tennis balls/leaning into wall edges - all of which I've been known to do. ;-)

Pam

[titaniumed]

Sharon,

Ti-edify, that has a nice ring to it!

First thing, $35hr is cheap. That will get your toenails painted. A good masseuse is worth much more. I would do 90 minute massages, and I would pay around $120. My last masseuse worked pretty hard on me.

I probably spent $50,000 on maintaining my back from 1986 to 2008. That's 22 years. I started having problems with severe pain when I turned 42. Of course, jumping off 50 foot cliffs on skis didn't help.

I was doing ok with my maintenance, but when I was around 40, I had a doozie of a ski crash which resulted in a level 3 spondy at my apex. Its like a car falling off a bumper jack. It made for an interesting x-ray, I must say. I was doing vertical traction, and heavy Chiro, and it eventually returned to its previous position.

Having twin 50-70 degree curves over the years,and doing the things I did, I guess I'm lucky. I really didn't expect any correction, and knew that I needed surgery some day.

Men are much stiffer than women. I mean, I was tight. I would have girls walk on my back and I would have them put their right foot on my rib hump(upper right back) and their left foot about 2 inches above my waist(lower left back) and hop or de-weight to counter my cork and get an adjustment. This was on the ex-hale. Sometimes,I ended up so tight that I would need a heavier girl, or 2 light ones at the same time.

I don't doubt that one could achieve some correction with an alternative program. It would take many hours per day, doing the right things. I did have some minor correction years ago, but as soon as I slacked off the program, or "jumped off a cliff" I would lose it all. I even skied in my brace years ago. I found that I would get cold from the perspiration, and would really have to bundle up.

Id like to ti-iterate, and say that I went as long as I could. At the time that I finally made my decision to have surgery, my pain was so severe that I didn't think I would live another year. My Chiros and masseuses kept me walking and skiing and my surgeon saved my life.

Now, all I have to worry about is all the cts I've had. If 1 ct = 442 x-rays, Add it all up, and I figure I've had about I've had about 1400 x-rays in my lifetime. Between that and the average 10-15 Wi-fi signals and associated radio frequency coming into my home, you might say, I'm starting to "glow a bit"

Scoliosis is a test of endurance.... Only the toughest, need apply.

Ed

[Pooka1]

How that could possibly have had any effect on curve magnitude is beyond me.

Well if a modified handheld jigsaw can decrease curves per Clear then why not that? :D

[Pooka1]

Here's my best little lay guess as to what explains the decrease in Cobb angle...

There is radiographic evidence that the distance between the anterior of T7 and her chest wall increased. I think we can assume the mobilization exercises she did caused this or were otherwise coincident with it. I think that changed the chest wall configuration to such an extent that it affected the Cobb angle as a consequence. That is, if you can manage to improve the chest cavity volume and symmetry, a reduction in Cobb angle necessarily ensues.

That would be consistent with the lack of targeted exercises to decrease the Cobb angle and that targeted exercises to reduce Cobb angle are ineffective.

I think the focus on the chest characteristics combined with the lack of targeted exercises is hinting at this. They may have even said so... I tried to only skim the article and then only sections so as not to be biased by their thoughts. I looked at the tables and figures and went to the text for basic explanation of those things (what was done not what it means). I'll read it as some point.

If I were a researcher pursuing this, I would focus on studying ways to expand and even out the chest cavity as a means to reduce/stabilize thoracic scoliosis.

And if that is the actual mechanism then that leaves the lumbar folks high and dry unfortunately.

[hdugger]

If I were a researcher pursuing this, I would focus on studying ways to expand and even out the chest cavity as a means to reduce/stabilize thoracic scoliosis.


That's an interesting idea. Do you think it relates at all to the Schroth idea of "derotational breathing"? (I think that's the right term.)

Martha talks about alot of breathe type work, yoga requires breathing work, as does the Schroth method. I *think* that leaves out the SEAS person, but I'd have to look again.

[Pooka1]

That's an interesting idea. Do you think it relates at all to the Schroth idea of "derotational breathing"? (I think that's the right term.)

No idea. I don't think what Schroth is doing is what Hawes did just on the basis of results but I have no idea.


Martha talks about alot of breathe type work, yoga requires breathing work, as does the Schroth method. I *think* that leaves out the SEAS person, but I'd have to look again.

Hawes seems to have been motivated to solve her respiratory problems, not reduce her curve. I bet she was blind-sided by the curve reduction as she only sought to improve her breathing I think.

It may turn out that only the people who do the right kind of breathing get any good result with the rest of the PT as a confounder.

[hdugger]

It may turn out that only the people who do the right kind of breathing get any good result with the rest of the PT as a confounder.

That wouldn't explain the SEAS result, though.

[Pooka1]

That wouldn't explain the SEAS result, though.

Okay I read that report.

My main question is how many people were doing these exercises wherein exactly ONE showed a reduction? I mean she can't have been the only person and I suspect she might have been part of a study group.

If she was part of a larger study group and they ONLY mentioned the one success out of many failures then that is not honest.

It is another result that if only one out of many followed the exercise protocol. Then we have to ask why.

Last, this seems completely dependent on continuing the daily PT. I hope she never gets sick or incapacitated.

[hdugger]

Okay I read that report.

My main question is how many people were doing these exercises wherein exactly ONE showed a reduction? I mean she can't have been the only person and I suspect she might have been part of a study group.

Yeah, I actually sent the first three authors an email yesterday asking something like that (except, in a more neutral way :)). I also asked if she'd maintained her curve and how much time it required to maintain it.

I'll let you know if I hear back.

The thing is, a sustained reduction in a curve is so unexpected that it doesn't require anything more than a case report, nor does it really matter how many people it works for. I don't think we're looking at a future where exercise completely or even mostly replaces surgery. But, if it works in *some* cases then it certainly should be offered to pre-surgical adults just to see if they respond. If even 1 out of 100 avoided surgery due to exercise, that would be a huge deal.

On the question of sustaining the reduction, I haven't got that far yet :) There are a bunch of question I would need to answer to evaluate where the risks lie. But, first, I want to figure out what actually works in exercise.

[Pooka1]

You're an excellent mommy. :)

[mamamax]

Hawes seems to have been motivated to solve her respiratory problems, not reduce her curve. I bet she was blind-sided by the curve reduction as she only sought to improve her breathing I think.

It may turn out that only the people who do the right kind of breathing get any good result with the rest of the PT as a confounder.

I've actually had very similar thoughts. It could be that there is a combination of breathing and PT that work together well. But isn't that basically what Schroth is based on? Spinecor does utilize some sort of PT and may also create a different breathing pattern. You know what? I'm going to write Rivard and Colliard and inquire about that.

[mamamax]

A few months back I wrote the first author on the paper "Adult scoliosis can be reduced through specific SEAS exercises: a case report", received a nice reply and the following web link for information and full reports: http://www.isico.it/approach/default.htm

The Textbook
THE EVIDENCE BASED ISICO APPROACH TO SPINAL DEFORMITIES
http://www.isico.it/approach/summary.htm

With the publication of Martha's follow up, this becomes ever more interesting to me - maybe interesting to some others also.

Email address for the authors if anyone has further questions is also within the above web page.

[Pooka1]

Okay I scanned their pubs.

That seems to be the only case of a temporary curve reduction.

Now we need to determine how many studies they did involving how many patients over the years wherein exactly one had a temporary curve reduction.

Most importantly, we have to determine if that one patient was part of a study WITHOUT that fact being mentioned. If this turns out to be the case I won't be reading any more papers from that group.

[hdugger]

Most importantly, we have to determine if that one patient was part of a study WITHOUT that fact being mentioned. If this turns out to be the case I won't be reading any more papers from that group.

I believe it's common in medicine to report unusual cases, outside of whatever study they occurred in. So, if I make a concoction to cure the common cold and in the middle of the test it turns one of the participants into a rabbit, I might report on that very odd fact without laying out all the facts of the study. A case study is just that: a case study. It isn't presented to indicate that a result is common or expected. Quite the opposite - it quickly gets out the information that a very unusual event has occurred. Once it occurs, you might then go back and design a new study to see if you could repeat the uncommon occurrence. But I don't have any sense that it's considered underhanded to just report it as a case study.

Again, not that there is any evidence that this is part of a larger study. Just to let you know that this is not considered an improper procedure, should that turn out to be the case.

[hdugger]

It might also be worthwhile to pause and see how far we've come.

A few days of discussion and we've gone from thinking that you can't reduce a curve with anything less then an Herculean 4 hour a day regime, to feeling that it's necessary to obscure a study where only one participant could reduce their curve in 30 minutes a day!

Next, we'll be scoffing at anyone that can't reduce every curve in 15 minutes a day.

That's progress!

[hdugger]

Sorry for the stuttering posts - just trying to make a quick last sweep through the literature before my son gets home tomorrow.

On the question of weighing surgery against continued exercise, I thought the discussion at the end of the SEAS study was quite good:

"This case opens up a new perspective in the approach to
adult scoliosis patients that appear to progressively
worsen. Instead of a fatalistic "wait and see" approach, an
active one could be envisioned and could help in some
cases at least to postpone, and eventually avoid surgery.
The advantage of maintaining spine mobility function
and avoiding the risks of surgery is counterbalanced by
the need of exercising regularly and being followed up
carefully in a specialised Center by a rehabilitation team
[28]. Spinal mobility allow a distribution of static and
dynamic loads all over the spine, avoiding undue overload
on single segments; it also permits to continue activities
of daily life without any of the limitations that
caution impose to fused patients. The final choice is obviously
up to the patient [29,30], made aware of advantages
and disadvantages of each option, understanding the difference
between a risky one-shot treatment and a longterm,
continuous one that requires collaboration and
motivation, while in any case giving the possibility to go
back to the other therapeutic option in case of failure. If
other studies will confirm this case report, exercises could
be considered and discussed with patients, allowing them
to reach the best individual solution for their long term
scoliosis management [30]."

and this

"This case report shows it is possible obtaining a significant
improvement of scoliosis in adults with SEAS exercises.
Marty-Poumarat showed that rate of progression in adult
scoliosis is linear [6]. So, it is possible to establish an individual
prognosis repeating x-rays every 4–5 years in adulthood.
When x-rays detect a significant worsening, it is
possible to recover and then to possibly stabilize scoliosis
through SEAS exercises, thus avoiding the need of surgery."

[tonibunny]

I'm interested in whether curve type affects the effectiveness of exercise-based therapy for scoliosis.

It's known that it is much, much more difficult to cast double curvatures in infantile/juvenile scoliosis because it involves trying to derotate each curve in opposite directions at the same time. It seems to me that it would be extraordinarily difficult for an adult to work on a double major curve with exercises - is there any data on this?

[Pooka1]

where only one participant could reduce their curve in 30 minutes a day!


I think she may have exercised more no? Didn't it say > or = to 30 minutes? Maybe she exercised more than anyone else since there are no other reported cases from that group with a reduction.

[Pooka1]

With regard to the posted discussion, I think they need to address the degenerative changes that seem to occur earlier and more frequently in curved spines versus straight spines.

Yes 85% of adults will have back problems at some point in their life but what if untreated scoliosis causes degenerative changes that result in nearly 100% of the patients getting painful degenerative changes at a far earlier median age than the general population?

As far as I know, a common reason fusions have to be extended is due to imperfect balance achieved in all planes from the procedure. But how does that balance compare to the average untreated curve of 35* or 50*?

Fused areas will never experience any of these problems. If they get the balance right on the thoracic fusions and if the pedicle screws can solve the lumbar extension issue, then I think it is not crazy to suggest this fused population will have less degenerative changes than the average person out in the population.

I'm just a bunny but I would like to see the conservative method proponents address this issue in my lifetime or before I get hit by a bus or at some point.

[Dingo]

hdugger


Next, we'll be scoffing at anyone that can't reduce every curve in 15 minutes a day.

In growing children Torso rotation worked for every child with a small or medium curve in just two short sessions per week. I think a session was something like 5 or 10 minutes. The effort, time and expense involved was minimal.

I'm surprised that exercise has any impact on Scoliosis in fully grown adults. The fact that it does says a lot about how closely the muscles of the back must be involved.

[hdugger]

Yes, the usual protocol was 40 minutes twice a week.

I'd be interested to know if 30 minutes once a day worked for more of their patients.


I think she may have exercised more no? Didn't it say > or = to 30 minutes? Maybe she exercised more than anyone else since there are no other reported cases from that group with a reduction.

[hdugger]

With regard to the posted discussion, I think they need to address the degenerative changes that seem to occur earlier and more frequently in curved spines versus straight spines.

Yes, looking at that is definately phase 2 in my plan. How does a "natural" spine with a 20 to 30 degree curve compare to a "fused" spine with a 10 degree curve? I have no idea, but I'm hoping someone does.


Fused areas will never experience any of these problems. If they get the balance right on the thoracic fusions and if the pedicle screws can solve the lumbar extension issue, then I think it is not crazy to suggest this fused population will have less degenerative changes than the average person out in the population.

I just don't think we have enough information yet to know. Clearly, there were problems in the older fusions. Although we're hopeful about the newer methods, there simply isn't enough data to say one way or another.

[hdugger]

I thought they addressed the double major somewhere in one of the SEAS studies, but I can't remember which unfortunately. I'll try and look again over the weekend. I also think single thoracic was a problem.


I'm interested in whether curve type affects the effectiveness of exercise-based therapy for scoliosis.

It's known that it is much, much more difficult to cast double curvatures in infantile/juvenile scoliosis because it involves trying to derotate each curve in opposite directions at the same time. It seems to me that it would be extraordinarily difficult for an adult to work on a double major curve with exercises - is there any data on this?

[dailystrength]

hdugger,

I was looking at these side shift exercises you mentioned

SIDE SHIFT EXERCISE FOR IDIOPATHIC SCOLIOSIS AFTER SKELETAL MATURITY


I am curious about "side shift exercises." What may I ask are they?

[hdugger]

I thought I'd posted a link once to the article which actually showed the exercise, but I can't seem to find it.

Here's the textual description:

"Patients are instructed to shift the trunk to the concavity
of the curve repetitively while standing (figure 1)
and to maintain the side shift position while sitting."

I believe they found that side shifting while standing was more effective.

This isn't definitive at all, but it is an interesting and easy exercise to try.

[dailystrength]

Thanks! It's easier than the name sounds.

[reneemarie]

I've been searching for more information on how to work on chest wall expansion. I came across this article regarding Martha Hawes in the Chest Journal.

http://chestjournal.chestpubs.org/content/120/2/672.full.html#ref-4
(http://chestjournal.chestpubs.org/content/120/2/672.full.html#ref-4)
It mentions

"In the current report, the achievement of a significant increase in chest expansion in correlation with the near-elimination of respiratory illness is consistent with a previous study showing that even in middle age, functional defects associated with thoracic scoliosis can be reversed measurably using physical methods."

The study is attributed to: "Block, AJ, Wexler, J, McDonnell, EJ Cardiopulmonary failure of the hunchback: a possible therapeutic approach. JAMA 1970;212,1520-1522" but I am unable to bring up any of the details. Has anyone seen this study before?

[Dingo]

Anybody interested in "Side Shift" therapy might find this interesting.

The 19th Century Debate on Clothing as a Cause of Scoliosis (http://www.uihealthcare.com/depts/medmuseum/wallexhibits/scoliosis/history/debate.html)


Lewis A. Sayre, an orthopedist, studied patients from upper and lower socioeconomic levels. He found that abnormal spinal development was not often seen in girls from lower income families. These girls did not wear corsets; instead, they carried bundles on their heads, which forced them to stand very straight. This balancing act, Sayre concluded, helped these girls develop healthy spines.

Who knows if he was right but it's an interesting observation.

[Pooka1]

Abnormal spinal development was not often LOOKED FOR in girls from lower income families.

[mamamax]

I am curious about "side shift exercises." What may I ask are they?

A member of our forum was discussing this back in 2006 - she wrote to Martha and received some great info on this. The files were to large to post for sharing here, but she had said if anyone wanted it to write her. So I did, and she sent them to me. I'd be happy to pass it on - just send me a PM.

[mamamax]

I've been searching for more information on how to work on chest wall expansion. I came across this article regarding Martha Hawes in the Chest Journal.

http://chestjournal.chestpubs.org/content/120/2/672.full.html#ref-4
(http://chestjournal.chestpubs.org/content/120/2/672.full.html#ref-4)
It mentions

"In the current report, the achievement of a significant increase in chest expansion in correlation with the near-elimination of respiratory illness is consistent with a previous study showing that even in middle age, functional defects associated with thoracic scoliosis can be reversed measurably using physical methods."

The study is attributed to: "Block, AJ, Wexler, J, McDonnell, EJ Cardiopulmonary failure of the hunchback: a possible therapeutic approach. JAMA 1970;212,1520-1522" but I am unable to bring up any of the details. Has anyone seen this study before?

Looks like this one is a pay for view only - or something a good medical library would have. Maybe an email to Martha would work?

[mamamax]

Anybody interested in "Side Shift" therapy might find this interesting.

The 19th Century Debate on Clothing as a Cause of Scoliosis (http://www.uihealthcare.com/depts/medmuseum/wallexhibits/scoliosis/history/debate.html)



Who knows if he was right but it's an interesting observation.

Hey - that was an interesting article! I think Sharon nailed it though ... How often did the lower income population present to the medical community compared to the more affluent in the 1800's? For that matter didn't the more affluent spend time on things like proper posture - balancing books on their heads for practice? Weak debate I'm thinking - merit though perhaps in the fact that "fashion" corsets certainly could make the condition worse.

Suppose there's any grant money for studying "book balancing" in a young population not wearing corsets?

[mamamax]

I thought I'd posted a link once to the article which actually showed the exercise, but I can't seem to find it.

Here's the textual description:

"Patients are instructed to shift the trunk to the concavity
of the curve repetitively while standing (figure 1)
and to maintain the side shift position while sitting."

I believe they found that side shifting while standing was more effective.

This isn't definitive at all, but it is an interesting and easy exercise to try.

I've been gifted with 16 pages of Mehta's work, including photographs and xrays. Within this he also states that the side shift exercise can be useful in preventing progression in the adult population. If you (or anyone else) would like a copy just send me a PM. Unfortunately the size of this file exceeds upload limits provided by this forum.

[Dingo]

Lewis A. Sayre, an orthopedist, studied patients from upper and lower socioeconomic levels. He found that abnormal spinal development was not often seen in girls from lower income families.

It says that he studied girls from both backgrounds. It didn't say that he ran a family practice and based his opinion on his wealthier than average clientele. He may (or may not) have been right but there is no reason to assume that his hypothesis was based on a rookie mistake.

There is every reason to believe that lower income girls from that era were more physically active and muscular than girls from the middle and upper classes.

This study from 1997 provides support for Dr. Sayre's hypothesis
Relation between adolescent idiopathic scoliosis and morphologic somatotypes. (http://www.ncbi.nlm.nih.gov/pubmed/9383860)


Subjects with progressive adolescent idiopathic scoliosis are significantly less mesomorphic than control girls.

[Pooka1]

Yeah, I actually sent the first three authors an email yesterday asking something like that (except, in a more neutral way :)). I also asked if she'd maintained her curve and how much time it required to maintain it.
.

It's been almost a year. Do you know if that patient maintained the reduction in her curve?

[hdugger]

It's been almost a year. Do you know if that patient maintained the reduction in her curve?

So, to clarify, the SEAS folk sent me information the first time I wrote (a year ago) showing both that the first case study patient had continued to reduce her curve over two years with a moderate amount of exercise (30 minutes of exercise three times a week).

A follow-up cohort (34 patients) had also done well a year after starting the exercise program. Of the 34, 19 had decreased their curve more than 5 degrees, and the remainder had stayed the same. Noone had progressed. Note that these are all adult patients who are showing pretty significant decreases - for example, a 53 year old patient whose curve went from 68T, 45L to 58T, 39L.

I just wanted to set the context, because my quote in your post makes it sound like I never heard from them about the follow-up. So, yes, I heard from them and they've shown (in a case study with two years worth of follow-up and then in a cohort study with one year's worth of follow-up) that adults can both hold and reduce a curve with minimal targeted exercise. Which is a pretty stupendous result.

So, having set that context, no, I didn't send them a follow-up email to ask about continued studies because I was satisfied with the first follow-up. For me, it answered the question of whether one could design an exercise program which would hold (and might even reduce) a significant curve in an adult patient, having shown a reduction which was maintained with exercise for two years in the initial patient and reductions and/or maintainance for one year in the follow-up cohort.

[Pooka1]

What happened to that one patient they singled out?

[hdugger]

The original case study? That's the one they'd followed for 2 years who had continued to reduce her curve over the two years with 30 minutes of exercise three days a week.

Here initial numbers were: 35T, 47L before any treatment. At the end of her second year of minimal exercise (in 2009), they were 28T, 26L. She also reduced her pain enough that she was no longer facing surgery.

[Pooka1]

So that one patient was the only person in that cohort that was started at least 2 years ago? Why do they only have a group doing it for one year?

[hdugger]

So, the context again. The SEAS people aren't a group of people who just do research. They're practitioners who run a treatment center. So, like anyone who does regular treatment, normally they go about their business without publishing everything that happens. And, again, like anyone who does regular treatment, when they see something really unusual, they publish a case study.

So, this was a case study that occurred as part of their regular treatment, not an individual result plucked out of an experiment. And this result came as a great surprise to them. They weren't trying (and didn't expect) to reduce curves as part of their treatment. They were just trying to hold curves and reduce pain.

*After* they got this unusual result, they decided to run a cohort. That's the 34 people noted in the experiment. And they track the results of the entire cohort for the year (which followed a year after their initial case study).

So, practitioners running a treatment center see and publish an unusual event amongst their regular patients, and then follow up more experimentally with a cohort who they report fully on. Textbook science. And pretty interesting results. It's enough to make a half-Italian very proud :)

BTW, maybe I'm getting deja-vu-ish with my flu, but I'd swear we had this exact same discussion a year ago. Quite alright - it's an interesting study to bring forward every year - but I am wondering if I'm going to start seeing Punxsutawney Phil.

[Pooka1]

So, this was a case study that occurred as part of their regular treatment, not an individual result plucked out of an experiment. And this result came as a great surprise to them. They weren't trying (and didn't expect) to reduce curves as part of their treatment. They were just trying to hold curves and reduce pain.


So was she the only patient who was given the exercises to try at that time? Or were other patients given those same exercises at the same general time and had different results?

So while they may not have been running a trial, they very likely had SEVERAL people doing the prescribed exercises wherein exactly one showed this improvement, yes?

Are people in the experimental group getting similar results or is she really unique in reducing the curve this much given the same PT?

[Pooka1]

So, the context again. The SEAS people aren't a group of people who just do research. They're practitioners who run a treatment center. So, like anyone who does regular treatment, normally they go about their business without publishing everything that happens. And, again, like anyone who does regular treatment, when they see something really unusual, they publish a case study.

So, this was a case study that occurred as part of their regular treatment, not an individual result plucked out of an experiment. And this result came as a great surprise to them. They weren't trying (and didn't expect) to reduce curves as part of their treatment. They were just trying to hold curves and reduce pain.

*After* they got this unusual result, they decided to run a cohort. That's the 34 people noted in the experiment. And they track the results of the entire cohort for the year (which followed a year after their initial case study).

So, practitioners running a treatment center see and publish an unusual event amongst their regular patients, and then follow up more experimentally with a cohort who they report fully on. Textbook science. And pretty interesting results. It's enough to make a half-Italian very proud :)

BTW, maybe I'm getting deja-vu-ish with my flu, but I'd swear we had this exact same discussion a year ago. Quite alright - it's an interesting study to bring forward every year - but I am wondering if I'm going to start seeing Punxsutawney Phil.


http://www.scoliosisjournal.com/content/3/1/20


Since many years we propose specific exercises for adult scoliosis [11,12] according to the SEAS protocol [13-17], and our experience seems to sustain this possible treatment, even if we still lack data on its effectiveness.

So it seems like they were giving these exercises out for many years and then this patient responds? So while they may not have been running a study at the time (not clear) this patient seems to be the only one in that time period who responded dramatically.

That is more consistent with something unique about this patient than anything to do with the efficacy of the PT, no? Maybe she exercised much more than she wwas told or maybe she has something unique in her physiology.

[Pooka1]

From the paper...


B.I. started performing SEAS exercises 30 minutes every day at home, and came to the Center every two months to check and intensify her exercises. In one year B.I. recovered her posture, and according to radiographs, she was even better than at the end of bracing treatment (March 2007, RT 32°, LL 28.5° – Figure ​Figure6).6).

So she did 30 minutes a day for at least a year. Perhaps none of the other patients actually stuck with that regime.

[Bigbluefrog]

I'm trying to imagine how someone can massage their own back.

we give amber massages with a massager hand held....it helps stimulate the weaker muscles.

So it is possible a family member could help with that.

[Bigbluefrog]

I've been searching for more information on how to work on chest wall expansion. I came across this article regarding Martha Hawes in the Chest Journal.

http://chestjournal.chestpubs.org/content/120/2/672.full.html#ref-4
(http://chestjournal.chestpubs.org/content/120/2/672.full.html#ref-4)
It mentions

"In the current report, the achievement of a significant increase in chest expansion in correlation with the near-elimination of respiratory illness is consistent with a previous study showing that even in middle age, functional defects associated with thoracic scoliosis can be reversed measurably using physical methods."

The study is attributed to: "Block, AJ, Wexler, J, McDonnell, EJ Cardiopulmonary failure of the hunchback: a possible therapeutic approach. JAMA 1970;212,1520-1522" but I am unable to bring up any of the details. Has anyone seen this study before?
when doing schroth exercises they measured lung function with air peak flow meter...my dd lung function improved capacity over the week of therapy.
it is measurable..

Also expansion of lungs and volume of air is measurable, encourage your children to play wind instruments to develop lung capacity.

Two of my children outgrew asthma..by swimming and playing trombone and clarinet.
Sorry piano or guitar will not be effective.

[Bigbluefrog]

So, the context again. The SEAS people aren't a group of people who just do research. They're practitioners who run a treatment center. So, like anyone who does regular treatment, normally they go about their business without publishing everything that happens. And, again, like anyone who does regular treatment, when they see something really unusual, they publish a case study.

So, this was a case study that occurred as part of their regular treatment, not an individual result plucked out of an experiment. And this result came as a great surprise to them. They weren't trying (and didn't expect) to reduce curves as part of their treatment. They were just trying to hold curves and reduce pain.

*After* they got this unusual result, they decided to run a cohort. That's the 34 people noted in the experiment. And they track the results of the entire cohort for the year (which followed a year after their initial case study).

So, practitioners running a treatment center see and publish an unusual event amongst their regular patients, and then follow up more experimentally with a cohort who they report fully on. Textbook science. And pretty interesting results. It's enough to make a half-Italian very proud :)

BTW, maybe I'm getting deja-vu-ish with my flu, but I'd swear we had this exact same discussion a year ago. Quite alright - it's an interesting study to bring forward every year - but I am wondering if I'm going to start seeing Punxsutawney Phil.
thanks for reposting it! good review for those of us willing to try alternative methods.