Clear - 63* -> 15* in a month?

[Pooka1]

http://www.youtube.com/watch?v=1EXx-4wtm9A

A member here posted this on Fix's site asking what is up.

Comments?

[LindaRacine]

Very suspicious that they don't have her doing an Adams Forward Bending Test or show bending films prior to treatment. I suspect that this is a functional scoliosis. I've emailed a few surgeons to see if someone is willing to comment.

--Linda

[Pooka1]

I agree it can't be structural. Someone who knows what the hell they are looking at should look for wedging on the radiograph.

My guess is that she is hyper-hypermobile, basically a contortionist, and can place her body in that configuration at will.

[Pooka1]

Also, I would have guessed she had a much larger Cobb angle than 63* from the initial shots of her walking and skipping. I thought she had at least a 100* curve based on that.

[Pooka1]

Here is the scoliosis page for the chiro's web site...

http://www.janzenandjanzen.com/scoliosis_doctor_san_jose.html

I notice they have FAR less stellar examples on the web page for some reason. I think Linda is correct that the girl in the video does not have a structural scoliosis or they would have put her case on the front page. In fact if that was the usual result they could drop everything else and have every scoliosis patient in the world waiting at their door. We don't observe that though.

[hdugger]

Yeah, that all looks very odd to me. She likely has some neurological thing causing the curve.

Pooka, do you feel like writing to them and getting some clarification?

[LindaRacine]

Hi...

Dr. Serena Hu (UCSF) responded to my email, and tells of a patient who had a very similar story. They did a complete neuro workup and found nothing. She was reluctant to perform surgery, as the patient had a long curve (just like Kaylee), and it meant fusion from the neck to the sacrum. When they had anesthesized her for surgery, and began preparing her back, they found she had a completely straight spine. So, if the patients are indeed the same, Dr. Jantzen did, in fact, help Kaylee. It just wasn't nearly as miraculous as it seems.

And, if one follows the logic, Dr. Hu would be even more of a miracle worker than Dr. Jantzen, as she didn't even have to touch her patient's back! ;-)

--Linda

[hdugger]

Well . . . that's odd. Did the bending xrays show a structural curve? And did the patient still have the curve on standing after surgery?

I'd been arguing that large curves never just reversed. This (if a structural curve) would seem to suggest that they do.

All very odd.

[mamamax]

Hi...

Dr. Serena Hu (UCSF) responded to my email, and tells of a patient who had a very similar story. They did a complete neuro workup and found nothing. She was reluctant to perform surgery, as the patient had a long curve (just like Kaylee), and it meant fusion from the neck to the sacrum. When they had anesthesized her for surgery, and began preparing her back, they found she had a completely straight spine. So, if the patients are indeed the same, Dr. Jantzen did, in fact, help Kaylee. It just wasn't nearly as miraculous as it seems.

--Linda

Linda - could you ask Dr. Hu if this would be typical of the little researched "hysterical" scoliosis? It sounds like it. There are no screening techniques that can diagnose it - yet, when the patient is made to feel "safe" (mechanically, so to speak, in this case with anesthesia), even a previously diagnosed structural curve - will straighten. Just curious what her take may be on that. There is very little research/documentation regarding these cases - she may have come across one.

[LindaRacine]

Well . . . that's odd. Did the bending xrays show a structural curve? And did the patient still have the curve on standing after surgery?

I'd been arguing that large curves never just reversed. This (if a structural curve) would seem to suggest that they do.

All very odd.

I think the point is that it's NOT a structural curve.

[Pooka1]

"Hysterical scoliosis."

That's probably another way of saying "non-structural" scoliosis or "contortionist."

[mamamax]

"Hysterical scoliosis."

That's probably another way of saying "non-structural" scoliosis or "contortionist."

Actually - no it isn't. While the research and documentation is near nill .. there have been cases where previously diagnosed structural curves straighten. And yes, is quite odd.

[LindaRacine]

I've sent another message to Dr. Hu.

According to Moe's Textbook of Scoliosis and Other Spinal Deformities, in the chapter on Hysterical Scoliosis:

"Hysterical scoliosis is a diagnosis of exclusion characterized by a scoliosis with trunk imbalance, the lack of abnormal neurologic or other physical findings, and radiographs demostrating a broad curvature without rotation. The curve resolves in the supine position, and radiographic documentation of that fact is necessary."

There are accompanying photos that show a woman from the back with very obvious trunk assymetry. A second photo shows a flat back when the patient is bent forward. A third photo shows an xray fairly similar to that of Kaylee's (no obvious sign of rotation).

[Pooka1]

http://orthosurg.ucsf.edu/patient-care/spine/scoliosis.html

Postural Scoliosis — Also known as "hysterical scoliosis," postural scoliosis may be a result of pain, as a patient tilts to relieve the pain. It can be reversed by relieving the pain or by having the patient lie flat. X-rays don't show any abnormality of the vertebrae.

[Pooka1]

So it seems the child has postural scoliosis, not structural, as far as we can tell.

There is a reason that chiro site hasn't plastered her case all over their web pages.

[leahdragonfly]

This video is completely bogus. Her posture in the beginning is not consistent with structural scoliosis of 60 degrees. I agree this is not structural scoliosis. Her comment that "Stanford had no idea what this was" tells you it's not ordinary scoliosis. I also think she is having a little too much fun in her vibrating chair.

Shame on whatever practitioner has produced and posted this video. Even if Schroth is legit, this certainly does nothing to help it's reputation.

[Pooka1]

This video is completely bogus. Her posture in the beginning is not consistent with structural scoliosis of 60 degrees. I agree this is not structural scoliosis. Her comment that "Stanford had no idea what this was" tells you it's not ordinary scoliosis. I also think she is having a little too much fun in her vibrating chair.

Shame on whatever practitioner has produced and posted this video. Even if Schroth is legit, this certainly does nothing to help it's reputation.

No it is NOT Schroth. It is a Clear chiro outfit in San Jose, CA.

And yes they should make it crystal CLEAR that this is NOT structural like 99.99999999999999% of the cases out there.

ETA: Yeah my kids had a 57* and 58* curve and didn't look anything like this child, not even the one that had little rotation as this child has.

[hdugger]

I think the point is that it's NOT a structural curve.

Is that usual, though, to only find out that it's not structural on the operating table? Wouldn't a bending xray reveal it before that?

[hope404]

I have heard that single curves are easier to correct using CLEAR techniques then "s" or triple curves.

I'd like to know how fast the curve came upon her...I feel like it was a fast mover..there is no way she would have wanted to dance nor could have danced with that curve.

I would love to hear a neurologists take on the obvious neurological issues she exhibited in the "walking the line" portion of the video...

I've NEVER seen such a drastic drop on a curve using CLEAR....I've seen drops,but not of this magnitude...it does sound like she worked like crazy to get the reduction.

I felt the neurological component of her curve very noteworthy and I do wish SOMEONE would start digging into that neuro. link ......

[LindaRacine]

Dr. Hu's patient did not straighten out in forward bending and bending films.

[mamamax]

I've sent another message to Dr. Hu.

According to Moe's Textbook of Scoliosis and Other Spinal Deformities, in the chapter on Hysterical Scoliosis:

"Hysterical scoliosis is a diagnosis of exclusion characterized by a scoliosis with trunk imbalance, the lack of abnormal neurologic or other physical findings, and radiographs demostrating a broad curvature without rotation. The curve resolves in the supine position, and radiographic documentation of that fact is necessary."

There are accompanying photos that show a woman from the back with very obvious trunk assymetry. A second photo shows a flat back when the patient is bent forward. A third photo shows an xray fairly similar to that of Kaylee's (no obvious sign of rotation).

Thank you Linda - I would think Dr. Hu may have a very unusual patient and one she may wish to document.

I came across an article in Musculoskeletal Radiology (University of Washington); in this article Hysterical Scoliosis is classified as "Transient Structural Scoliosis". http://www.rad.washington.edu/academics/academic-sections/msk/teaching-materials/online-musculoskeletal-radiology-book/scoliosis

The only other references I find are:

Blount Walter P, Waldram David W, Dicus William T 1974 J Bone Jt Surg 1766. The Diagnosis of 'Hysterical' Scoliosis. Here's some interesting discussion regarding their work:


In three patients with pre-existing small structural thoracic scoliosis in whom a new lumbar curve, decompensation, or a limp developed as a manifestation of a conversion neurosis, the curves responded to treatment with a Milwaukee brace and exercises.These curves are difficult to differentiate from structural myogenic curvatures which are always associated with pain and with muscle tightness that does not disappear with suggestion.

Ogilvie James W 1995. Moe's Textbook 3rd Ed, Lonstein Winter Bradford Ogilvie eds. 505-506 Hysterical scoliosis


Lonstein JE 1996 Scoliosis pp 625-683 in Lovell and Winter's Pediatric Orthopedics, Fourth Edition, ed RT Morrissy and SL Weinstein, Lippincott-Raven Publishers, Philadelphia.


Scoliosis & the Human Spine (Hawes): Some children and adolescents develop so-called 'hysterical' scoliosis in association with psychological factors (Blount et al. 1974, Ogilvie 1995e). Hysterical scoliosis clinically may be indistinguishable in appearance from other cases, and it is not uncommon for the diagnosis to be applied incorrectly, for example, in curvatures that develop in response to bone tumors (Bradford and Bueff 1995). The Cobb angle of hysterical scoliosis can be mild to moderately severe (Lonstein 1996, Ogilvie 1995e). Yet, as with any functional scoliosis, the curvature straightens in response to bending sideways. In fact, several surgeons found that 'when there was good rapport, it was possible to eliminate the deformity completely or almost completely by suggestion and gentle manipulation' (Blount et al. 1974). Like in a leg length-associated spinal curvature, the spinal segments have normal flexibility and resume their natural configuration when the body is relaxed. One case of hysterical scoliosis reportedly disappeared after three years of psychiatric treatment (Lonstein 1996).


If anyone has the full text article by Lonstein, I'd be interested in reading that.

[hope404]

I don't know if we can say for sure it is bogus..

.....postural/structural??

I do think it is an unusual situation....if that is her before and after xray...more power to her....I'd like to see what happens as she grows..and once she stops therapy..there is an obvious neuro. issue that I would think would always be present??? How can that be overcome???

[titaniumed]

At 3.51, her illiac crest heights in the before x-ray are way off. Almost as if she was standing on a 3 inch lift with her left foot. If you look at the perpendicularity of the lower spine in relation to her illiac crest heights, it looks pretty good.

If you stood on your left foot, and shifted your hips to the left, the end result would look like her before x-ray.

Why do her illiac crest heights in the after x-ray look so good? What changed in her pelvis????
Ed

[Pooka1]

From the one reference...

"In fact, several surgeons found that when there was good rapport, it was possible to eliminate the deformity completely or almost completely by suggestion and gentle manipulation' (Blount et al. 1974). (Lonstein 1996)."

This is how the chiros apparently straightened the curve.

[Pooka1]

At 3.51, her illiac crest heights in the before x-ray are way off. Almost as if she was standing on a 3 inch lift with her left foot. If you look at the perpendicularity of the lower spine in relation to her illiac crest heights, it looks pretty good.

If you stood on your left foot, and shifted your hips to the left, the end result would look like her before x-ray.

Why do her illiac crest heights in the after x-ray look so good? What changed in her pelvis????
Ed

She climbed down off the ledge and became less hysterical. :)

[titaniumed]

I believe you just hit the pinnacle of the pyramid of comedy. LOL
Ed

[Pooka1]

I believe you just hit the pinnacle of the pyramid of comedy. LOL
Ed

No Ti Ed. You retired the comedy pyramid award. :)

[titaniumed]

Ive been saving this clip from the movie "Napoleon dynamite" which shows the time machine that uncle Rico buys online. It kinda reminds me of the old electrostim machines years ago.

http://www.youtube.com/watch?v=XpyT4pc_0ak

Ed

[Pooka1]

That is arguably one of the funniest movies ever made in my opinion.

A New Yorker reviewer said that "This is Spinal Tap" is arguably the funniest movie ever made.

I say any and all of the mockumentaries are arguably the funniest movies ever made.

[Sherie]

Napoleon D. is one of my favorites too. I love Kips expression as he's inducing the shock. It was sheer genius to produce this movie.

About the video, I hate to make judgments against kids, but it looks bogus to me. I tried and did imitate her walk (i'm kind of weird like that:rolleyes:). I remember when I was looking at Clear's website several years back, there was another "miracle" cure and the girl happened to have a very similar curve.

Can a true structural curve be a single long curve from top to bottom? I've never seen it except in these 2 instances.

[leahdragonfly]

Hi TiEd,

I LOVE Napoleon Dynamite, it's another of my favs along with Austin Powers, Better Off Dead, and The Legend of Ron Burgundy.

Thanks for the comic relief, as usual, it is very welcomed!

[hope404]

In the past few months I have seen two other videos of this same girl.

She posted one, on her own, just showing how the scoliosis made her walk. And another one was footage of her doing therapy, in the clinic, with the majority of the video being of another CP boy receiving therapy.

I think TITANIUMED hit the nail on the head!

"Why do her iliac crest heights in the after x-ray look so good?"

If you look at her xray...where the sacrum goes..so goeth the pelvic girdle ...so goeth the appendages...that xray 100% fits with how she was walking...her sacrum is extremely tipped which would create a nasty gait.
It would be extremely hard to maintain a "FAKE" curve while jumping.

Is it possible the sacrum drove her curve??????

Once they were able to correct the positioning of the sacrum, the rest of the curve followed????

questions questions questions????

[Pooka1]

She commented on her video and also responded to Linda.

http://www.youtube.com/watch?v=1EXx-4wtm9A&feature=player_embedded

What is reprehensible is that they don't say in the video that this case is UNLIKE 99.999999999999% of the cases out there. How common is that curve type? How common is it to reduce a 63* curve to 15* in a month? Clear has been at this for a while and they have exactly one case.

Proof that they know this is not just atypical but possibly singular is that they don't plaster the case all over their web site. Rather they show on their page only minuscule reductions of curves due to correcting posture, building asymmetric musculature to compensate, or just standing differently.

It is reprehensible.

[hdugger]

I'd be OK with publicizing a rare event of reducing a curve - the SEAS people did the same thing. I'm much more troubled about this not being representative of scoliosis cases - i.e., that this is a type of scoliosis that is extremely rare, and that has been seen to spontaneously "cure" with several methods.

[mamamax]

The interesting thing is - if this young woman indeed has Transient Structural/Hysterical Scoliosis, such a condition is virtually indistinguishable from any other case of IS - as we see up thread with Dr. Hu's patient whose structural curves did not straighten with bending xrays, yet straightened once the patient was anesthetized.

What I find worrisome is - the fact that there is no screening technique for this condition, which left untreated transforms into structural deformity - when such could have been avoided with proper diagnoses (which is admittedly difficult). How many such cases are there out there? We simply do not know.

[hdugger]

I believe the "whole body C curve" is extremely rare. In both this case and the Hu case, that was the type of curve.

[mamamax]

I would agree that the whole body C curve is rare. The way they responded, may not be so rare - among the Transient Structural/Hysterical Scoliosis classification. According to what little literature there is on that. Typically such curves (the transient structural/hysterical) according to the available documentation, present as a single thoracic curve - but there have been cases of thoracic/lumbar. And there have been both postural and structural presentations. I'm not saying both patients fall into this classification - but it could be that they do. There has been little follow up on this specific classification - probably because of the difficulty in diagnosing it?

[Pooka1]

- probably because of the difficulty in diagnosing it?

- probably because of the exquisite rarity of it.

[mamamax]

- probably because of the exquisite rarity of it.

exquisitely rare & exquisitely un-evaluated. I wonder what further evaluation the two discussed in this thread might receive.

[Pooka1]

Mamamax, I notice your buddy on the other forum is attributing the reduction to hard work. This means the following:

1. he doesn't understand that this is not AIS but a very rare type of neurological scoliosis,

2. he is saying, but for effort, everyone can reduce their curve this much, and,

3. he is implying that she did some massive amount of work... in one month.

I suggest he has NEVER had a patient reduce a 63* curve to 15* in a month and therefore he shouldn't ignorantly attribute the result to effort to follow Clear's protocol.

And people wonder why chiros have a bad reputation...

[mamamax]

Mamamax, I notice your buddy on the other forum is attributing the reduction to hard work. This means the following:

1. he doesn't understand that this is not AIS but a very rare type of neurological scoliosis,

2. he is saying, but for effort, everyone can reduce their curve this much, and,

3. he is implying that she did some massive amount of work... in one month.

I suggest he has NEVER had a patient reduce a 63* curve to 15* in a month and therefore he shouldn't ignorantly attribute the result to effort to follow Clear's protocol.

And people wonder why chiros have a bad reputation...

You're my "buddy" too Sharon - and up thread you attributed the young woman's improvement to stepping off the ledge and becoming less hysterical.

It would be nice to hear from the treating chiropractor.

[Pooka1]

You're my "buddy" too Sharon - and up thread you attributed the young woman's improvement to stepping off the ledge and becoming less hysterical.

It would be nice to hear from the treating chiropractor.

I was kidding! Your other buddy appears to be serious.

If the treating chiro was prepared to admit he has never had another patient react that way to treatment and that all other patients had minuscule reductions that required far more than one month's effort, he would have done so on the video. Just my opinion.

[mamamax]

I was kidding!

Duly noted :-)

I think at the end of the day - that both the chiropractor, and the surgeon - have come across two very unusual cases. If either are actually cases of hysterical scoliosis, maybe it really isn't a laughing matter. Because, while phychosomatic in origin, such cases are no less real and "can" transform into spinal deformity. Further evaluation is needed. Regardless of origin, or treatment - I'm happy for the current outcome of the young woman in the video. Is she representative of all cases - certainly not. I wonder what Dr. Hu decided to do?

[Pooka1]

Because, while phychosomatic in origin,

No the kid on the video has a neuro diagnosis per her comment.

Now maybe most/all postural/hysterical scoliosis cases are in fact neuro cases. That certainly seems likely.

[mamamax]

No the kid on the video has a neuro diagnosis per her comment.

Now maybe most/all postural/hysterical scoliosis cases are in fact neuro cases. That certainly seems likely.

I thought she said she was being tested but that so far, no one had found anything?

An interesting theory yours, I've thought of that also - but how would it explain the structural presentation?

[Pooka1]

I thought she said she was being tested but that so far, no one had found anything?

Here's what she wrote on her video page...


A neurologist is currently treating me and they finally figured out why i have all those weird symptoms.


An interesting theory yours, I've thought of that also - but how would it explain the structural presentation?

That's not "my" theory. Anyway, theory in science doesn't mean a guess as you imply. It would be more of a hypothesis and still, it is too obvious to be any one person's hypothesis. It's like me claiming hamsters are extra cute when they cook jello...

http://cuteoverload.com/2009/12/25/supper/

No one person can claim that as it is too obvious. :)

[mamamax]

Guess I walked into that one!

I'm still wondering what Dr. Hu decided to do??

[Pooka1]

Mamamax, regarding your conversation on the other forum with your other buddy, I think hysterical scoliosis is off the table w.r.t. that patient in the video. She has a neuro diagnosis.

So I think while you find hysterical scolisois an interesting topic, it is irrelevant to that patient (and probably 99.999999999999999999% of patients).

Also, I don't think her scoliosis can be considered structural even though it didn't straighten on bending if it is like Dr. Hu's patient where the curve completely straightened just putting the patient under. That is NOT structural.

The patient in the video apparently has some neurological condition that makes her contort her body that way. If/when it is treated, the curve would correct itself I suspect without any "help" from Clear.

[mamamax]

Mamamax, regarding your conversation on the other forum with your other buddy, I think hysterical scoliosis is off the table w.r.t. that patient in the video. She has a neuro diagnosis.

So I think while you find hysterical scolisois an interesting topic, it is irrelevant to that patient (and probably 99.999999999999999999% of patients).

Also, I don't think her scoliosis can be considered structural even though it didn't straighten on bending if it is like Dr. Hu's patient where the curve completely straightened just putting the patient under. That is NOT structural.

The patient in the video apparently has some neurological condition that makes her contort her body that way. If/when it is treated, the curve would correct itself I suspect without any "help" from Clear.

It will be interesting to see what the treating chiropractor may have to say.

As for everything else - I don't believe ANY of us are so expert that we can make definitive statements either way. HS has been largely ignored by the medical professions .... so, there is no clear cut body of knowledge from which to draw.

I understand Dr. Hu's patient turned out not to be a structural case (it seems) but the case certainly presented that way - and with xray validation. As for Kaylee - again, none of us is really qualified to assess her condition.

All we can do is ponder these things.

[Pooka1]

It will be interesting to see what the treating chiropractor may have to say.

I think the neurologist's opinion is what will be interesting.

[mamamax]

Agreed - if the neurologist were to comment, that would be very interesting also.

[hdugger]

Why are we discussing scoliosis when we could be discussing hamsters cooking jello?

[LindaRacine]

I doubt that surgeons typically look at individual vertebrae for evidence of wedging in scoliosis.

[Pooka1]

Why are we discussing scoliosis when we could be discussing hamsters cooking jello?

Good point.

[mamamax]

Why are we discussing scoliosis when we could be discussing hamsters cooking jello?

I couldn't find any valuable literature ......

[mamamax]

I doubt that surgeons typically look at individual vertebrae for evidence of wedging in scoliosis.

ok, I have to ask - Why?

[Pooka1]

Please pardon this non hamster/jello post...

As has been pointed out a few times, the girl in the video was seated for the radiographs. My question is... why? Is that some sort of a chiro thing?

Also, she is wearing a shoe lift in the later shots. Maybe an extreme leg length discrepancy, in conjunction with her neuro condition, caused the functional scoliosis she has.

[mamamax]

Please pardon this non hamster/jello post...

As has been pointed out a few times, the girl in the video was seated for the radiographs. My question is... why? Is that some sort of a chiro thing?

Also, she is wearing a shoe lift in the later shots. Maybe an extreme leg length discrepancy, in conjunction with her neuro condition, caused the functional scoliosis she has.

:-) I don't know why there are seated xrays - I have heard of them being done before (by surgeons) but I can't remember what the circumstances were - I've never had seated xrays taken myself. Maybe someone else here will know.

I hope they actually measured her leg lengths before prescribing the shoe lift - otherwise it could cause more harm than good. That's what an orthopedic specialist told me many years ago anyway. From my xrays she suspected a difference in leg length, but upon measuring them found no difference.

[LindaRacine]

I'm still wondering what Dr. Hu decided to do??

Decided to do about what?

[LindaRacine]

ok, I have to ask - Why?

It's difficult to see wedging in films, and I would assume that cases such as the one Dr. Hu mentioned are very rare. Functional scoliosis curves almost always straighten on forward bending.

[mamamax]

Decided to do about what?

Her patient. She was prepared for surgery, yes?

[mamamax]

It's difficult to see wedging in films, and I would assume that cases such as the one Dr. Hu mentioned are very rare. Functional scoliosis curves almost always straighten on forward bending.

I see. Thanks. Is wedging seen better with some other procedure? Like an MRI?

[LindaRacine]

Her patient. She was prepared for surgery, yes?


They woke her up and sent her home.

[LindaRacine]

I see. Thanks. Is wedging seen better with some other procedure? Like an MRI?

I don't know. I'm starting my new job tomorrow, so I'll ask one of the surgeons if they ever look for wedging. From what Dr. Hu told me, this is something very rare. I suspect we've made far more of an issue of it here than it's worth.

[Pooka1]

I suspect we've made far more of an issue of it here than it's worth.

Bingo.

....

[titaniumed]

Ok, back to hampsters now.

http://www.flickr.com/photos/victoriabelanger/3116942435/in/set-72157622864971354/

I dont think my cat Bad kitty, would put up with any of this. LOL
Ed

[Pooka1]

Ok, back to hampsters now.

http://www.flickr.com/photos/victoriabelanger/3116942435/in/set-72157622864971354/

I dont think my cat Bad kitty, would put up with any of this. LOL
Ed

GENIUS!

Pure genius.

Maybe that hamster got a new cooking apron for Christmas!

[titaniumed]

A couple of cocktails,rub a little catnip into the hamsters fur, give the command "Go get the mousie", and another Christmas would be destroyed again.

Ahhhh.....

Ed

[Pooka1]

Belated Christmas present for Ti Ed and all the materials engineers (or any engineers) out there...

World's smallest snowman

http://www.npl.co.uk/educate-explore/christmas/

[mamamax]

I don't know. I'm starting my new job tomorrow, so I'll ask one of the surgeons if they ever look for wedging. From what Dr. Hu told me, this is something very rare. I suspect we've made far more of an issue of it here than it's worth.

Thanks Linda. Just color me curious. You know, I don't think I made a big issue out of it - but I do think it was astounding that this patient's scoliosis disappeared after being prepped for surgery. And that it was even more astounding that the curvature presented as structural (from the bending xrays).

How often does that happen and is there even any literature on it? Does it happen often enough that there is a term for it? I also wonder if Dr. Hu followed up with this patient - i.e., did her curve return after being sent home. A most unusual thing - I think.

On a humorous note - if this happens often with Dr. Hu - then where do I sign up for a consult? :-)

p.s. Best of luck on the new job!

[LindaRacine]

Thanks Linda. Just color me curious. You know, I don't think I made a big issue out of it - but I do think it was astounding that this patient's scoliosis disappeared after being prepped for surgery. And that it was even more astounding that the curvature presented as structural (from the bending xrays).

How often does that happen and is there even any literature on it? Does it happen often enough that there is a term for it? I also wonder if Dr. Hu followed up with this patient - i.e., did her curve return after being sent home. A most unusual thing - I think.

On a humorous note - if this happens often with Dr. Hu - then where do I sign up for a consult? :-)

p.s. Best of luck on the new job!
Bending xrays do not DX or rule out structural curves.

As I said, I think this is a very rare thing. I don't think it happened to Dr. Hu before this, and I've never heard any other surgeon talk about something like this. My understanding is that this young woman was able to hold the curve because of strong core strength. But, when she was anesthesized, her muscles relaxed and the curve completely straightened.

By the way, it is typical that flexible curves straighten significantly when the patient is face down on the operating table. The first surgery I observed was a teenager. I came in just before they were draping her back, and I noticed how small her curve appeared. I was actually concerned, thinking that the surgeon was operating on a small curve. In reality this teen had a 60-something curve. I suspect this is why we see some people who are able to reduce their curves somewhat with exercise or other alternatives. But, as I've said before, I am certain that those curves return when the treatment is discontinued.

--Linda

[Pooka1]

By the way, it is typical that flexible curves straighten significantly when the patient is face down on the operating table. The first surgery I observed was a teenager. I came in just before they were draping her back, and I noticed how small her curve appeared. I was actually concerned, thinking that the surgeon was operating on a small curve. In reality this teen had a 60-something curve. I suspect this is why we see some people who are able to reduce their curves somewhat with exercise or other alternatives. But, as I've said before, I am certain that those curves return when the treatment is discontinued.

That is very interesting.

I was at first amazed how quickly the compensatory L curve disappeared in my girls; most/all was gone by the first radiograph at Day 4. I assumed the spine quickly straightened over a few days in response to the upper portion being straightened surgically. As I understand what you wrote, the compensatory curve probably disappeared on the table before the surgery and never developed again.

And WRT to PT halting/reducing curves, it seems like maybe the people who do manage temporary haltings/reductions are just the flexible ones. And maybe no amount of PT will halt/reduce a stiff curve.

[hdugger]

And WRT to PT halting/reducing curves, it seems like maybe the people who do manage temporary haltings/reductions are just the flexible ones. And maybe no amount of PT will halt/reduce a stiff curve.

I think that's more or less what the SEAS people suggest, assuming that a "flexible" curve is a curve where a good amount of the curveture is due to muscles and ligaments while a "stiff" curve is mainly due to the shape of the bone. The hypothesis is that exercise can get you back to the point where, when standing, all you see if the effect of the bony curve. For a flexible curve, this will be a big improvement, while for a stiff curve it won't be any change at all.

[mamamax]

I think that's more or less what the SEAS people suggest, assuming that a "flexible" curve is a curve where a good amount of the curveture is due to muscles and ligaments while a "stiff" curve is mainly due to the shape of the bone. The hypothesis is that exercise can get you back to the point where, when standing, all you see if the effect of the bony curve. For a flexible curve, this will be a big improvement, while for a stiff curve it won't be any change at all.

It does seem that way - and then there is Martha, whose curves were quite stiff and her deformity rigid. And yet, for the last fifteen years she continues to progressively reduce the magnitude. So, that is very interesting. From age 11 to 40, she performed a selected set of exercises recommended by her diagnosing physician, and during that time experienced stability and no progression (many of those exercises were torso strengthening exercises).

Then, she began a journey which included work on psoas muscles, traction, osteopathic adjustments, and counseling at a time of intense pain (these seem to be the things that created major change for her as I see it after two readings of her work). She does have three curves as it turns out - one being cervical, which she is now working on - or began working on in 2002 as I understand it.

I've thought of writing her and asking if she had wedging and such. Bone (from the literature) is a living thing which can reshape, even in adulthood - albeit at a much slower rate than when we are young.

How nice it would be to get to a point where something like the MedX machine would hold improvements with 15 minutes 2-3 times a week. Yep, I know how to dream :-)

[Pooka1]

It does seem that way - and then there is Martha, whose curves were quite stiff and her deformity rigid.

What is the evidence for this?

[mamamax]

What is the evidence for this?

It's in the writing about it that she has done.

[Pooka1]

It's in the writing about it that she has done.


You have her book, yes?

Do you remember what the evidence is that her curve is stiff?

Is it just her feeling?

[mamamax]

I have everything written by Martha to this point.

Martha refers to her condition as structural with vertebral rotation and rib deformities which had remained fixed and rigid for decades prior to 1992.

Feel free to write to her and validate that if you like. I'm sure she knows what she's talking about ;-)

[Pooka1]

I have everything written by Martha to this point.

Martha refers to her condition as structural with vertebral rotation and rib deformities which had remained fixed and rigid for decades prior to 1992.

Feel free to write to her and validate that if you like. I'm sure she knows what she's talking about ;-)

I'll take a surgeon's opinion, not Hawes'.

Both my daughters had "structural with vertebral rotation" but were obviously flexible given their correction degree. If "rib deformities" means rib hump as is very likely then my daughters had that also.

The fact that it remained "fixed" doesn't mean it is rigid as far as I know.

Most curves above 50* will progress over the lifetime of the patients and some large percentage of those are likely "rigid" over decades. And yet they move.

The most likely reason she saw a reduction is because her curve was flexible from all the exercise and massage over the years.

[mamamax]

I'll take a surgeon's opinion, not Hawes'.

Both my daughters had "structural with vertebral rotation" but were obviously flexible given their correction degree. If "rib deformities" means rib hump as is very likely then my daughters had that also.

The fact that it remained "fixed" doesn't mean it is rigid as far as I know.

Most curves above 50* will progress over the lifetime of the patients and some large percentage of those are likely "rigid" over decades. And yet they move.

The most likely reason she saw a reduction is because her curve was flexible from all the exercise and massage over the years.

I think you should write to Martha and ask her interpretation of structural, fixed and rigid. Or maybe Linda can call her.

Personally, based on the research she has done (i.e, the publication of Scoliosis and the Human Spine), and her professional affiliations which include surgeons, I believe she well understands the nomenclature and is not in error when describing her condition, which she states was (following exercise from age 11 to 40): structural with vertebral rotation and rib deformities which had remained fixed and rigid for decades prior to 1992.

[Pooka1]

I think you should write to Martha and ask her interpretation of structural. Or maybe Linda can call her.

Personally, based on the research she has done (i.e, the publication of Scoliosis and the Human Spine), and her professional affiliations which include surgeons, I believe she well understands the nomenclature and is not in error when describing her condition.

I think you (and possibly Hawes) are confusing/conflating "structural" and "rigid."

You can and do have structural curves, some large, that that are flexible. It's why some structural curves can be corrected to near zero and others can't be corrected below 30* or more.

I don't care how much research she has done... if a SURGEON hasn't assessed her curve flexibility/rigidity then she can't possibly know FULL STOP.

[mamamax]

I think you (and possibly Hawes) are confusing/conflating "structural" and "rigid."

You can and do have structural curves, some large, that that are flexible. It's why some structural curves can be corrected to near zero and others can't be corrected below 30* or more.

I don't care how much research she has done... if a SURGEON hasn't assessed her curve flexibility/rigidity then she can't possibly know FULL STOP.

We disagree - While I may sometimes be confused by definitions - I think Martha Hawes is well familiar with the nomenclature. Research scientists of her caliber are prone to such things.

She has many xrays documenting her progress throughout the years - and for certain I do know (from her writings) that she has never seen a chiropractor. I wonder who took the xrays and gave her medical interpretation? Someone qualified no doubt. I'll look closer as I go about my reading(s) #3.

Meanwhile .. Here's the SRS definition: Structural Curve - A segment of the spine that has fixed (nonflexible) lateral curvature. http://www.srs.org/patients/glossary.php?alpha=S

[hdugger]

I just wrote Martha to ask if she'd had bending xrays, or anything to indicate the flexibility of the curve. I'll let you know if I hear back.

One thing that I do note, anecdotally from discussions on the board, is people saying they've increased the flexibility of their curve through exercise. I don't have a specific post to point at, though. I just recall people talking about it.

I also don't know if the flexibility referred to by orthopedic surgeons which is measured by bending xrays is the same thing as the bony part of the curve that the SEAS people measure by putting someone into a brace while lying down.

[mamamax]

I just wrote Martha to ask if she'd had bending xrays, or anything to indicate the flexibility of the curve. I'll let you know if I hear back.

One thing that I do note, anecdotally from discussions on the board, is people saying they've increased the flexibility of their curve through exercise. I don't have a specific post to point at, though. I just recall people talking about it.

I also don't know if the flexibility referred to by orthopedic surgeons which is measured by bending xrays is the same thing as the bony part of the curve that the SEAS people measure by putting someone into a brace while lying down.

Thanks! Look forward to her reply.

And I do note the SRS definition above pretty much sums up the term "structural."

[Pooka1]

Meanwhile .. Here's the SRS definition: Structural Curve - A segment of the spine that has fixed (nonflexible) lateral curvature. http://www.srs.org/patients/glossary.php?alpha=S

This definition is obviously incomplete. Here's why:

1. My one kid counterbent her STRUCTURAL cure in the Charleston. Therefore her STRUCTURAL curve was flexible.

2. Both girls counterbent their STRUCTURAL curves just prior to surgery to identify the last instrumented vertebrae. Something obviously changes upon bending or else they wouldn't need bending radiographs for this purpose and if something changed in the STRUCTURAL curve then it flexed.

[mamamax]

This definition is obviously incomplete. Here's why:

1. My one kid counterbent her STRUCTURAL cure in the Charleston. Therefore her STRUCTURAL curve was flexible.

2. Both girls counterbent their STRUCTURAL curves just prior to surgery to identify the last instrumented vertebrae. Something obviously changes upon bending or else they wouldn't need bending radiographs for this purpose and if something changed in the STRUCTURAL curve then it flexed.

ok then .. maybe we should write SRS and ask them to "complete" their published definition. They seem to make it pretty clear that a structural curve is non-flexible. How can (according to the SRS definition) a curve be both structural (non flexible) and flexible at the same time?? That's a little confusing.

[Pooka1]

That's a little confusing.

Bingo.


.....

[Pooka1]

By the way, Linda's comment, more than anything I could possibly say, blows that definition completely out of the water...


By the way, it is typical that flexible curves straighten significantly when the patient is face down on the operating table. The first surgery I observed was a teenager. I came in just before they were draping her back, and I noticed how small her curve appeared. I was actually concerned, thinking that the surgeon was operating on a small curve. In reality this teen had a 60-something curve. I suspect this is why we see some people who are able to reduce their curves somewhat with exercise or other alternatives. But, as I've said before, I am certain that those curves return when the treatment is discontinued.

[mamamax]

Here's a little more from SRS:

Structural curve - a measured spinal curve in the coronal plane in which the Cobb measurement fails to correct past zero on supine maximal voluntary lateral side bending x-ray

http://www.srs.org/professionals/glossary/glossary.php

[Pooka1]

Here's a little more from SRS:

Structural curve - a measured spinal curve in the coronal plane in which the Cobb measurement fails to correct past zero on supine maximal voluntary lateral side bending x-ray

http://www.srs.org/professionals/glossary/glossary.php

See how this is seemingly completely at odds with the first definition you posted?

[hdugger]

I think the they're two different sets of terms:

"structural" vs "functional"
so, if you can do something simple, like sit up straight, and the curve goes away, then it's functional instead of structural

and then, within the structural curve, there is
"rigid" vs. "flexible"
both of these are counted in the overall curve measurement, but one part of it disappears when you do something not simple (like the bending xray or bracing). The part of the structural curve which reduces during these procedures is considered "flexible" and the part that stays is considered "rigid"

[Pooka1]

I think the they're two different sets of terms:

"structural" vs "functional"
so, if you can do something simple, like sit up straight, and the curve goes away, then it's functional instead of structural

and then, within the structural curve, there is
"rigid" vs. "flexible"
both of these are counted in the overall curve measurement, but one part of it disappears when you do something not simple (like the bending xray or bracing). The part of the structural curve which reduces during these procedures is considered "flexible" and the part that stays is considered "rigid"

Sounds plausible to me.

Love,
a bunny

[mamamax]

See how this is seemingly completely at odds with the first definition you posted?

You mean at odds with the first definition offered by SRS .... yes.

Definition #1 Structural Curve - A segment of the spine that has fixed (nonflexible) lateral curvature. http://www.srs.org/patients/glossary.php?alpha=S

Definition #2: Structural curve - a measured spinal curve in the coronal plane in which the Cobb measurement fails to correct past zero on supine maximal voluntary lateral side bending x-ray
http://www.srs.org/professionals/glossary/glossary.php

It also makes it pretty clear that bending xrays are the diagnostic tool in defining structural (according to SRS). Definition #1 comes from the SRS Patient Glossary - and #2 from the Professional's Glossary.

[LindaRacine]

and for certain I do know (from her writings) that she has never seen a chiropractor. I wonder who took the xrays and gave her medical interpretation? Someone qualified no doubt. I'll look closer as I go about my reading(s) #3.

Meanwhile .. Here's the SRS definition: Structural Curve - A segment of the spine that has fixed (nonflexible) lateral curvature. http://www.srs.org/patients/glossary.php?alpha=S



In her recent paper, Martha states "This included deep tissue massage (1992-1996); outpatient psychological therapy (1992-1993); a daily home exercise program focused on mobilization of the chest wall (1992-2005); and manipulative medicine (1994-1995, 1999-2000)." It seems to me that "manipulative medicine" means chiropractic or osteopathic.

Whoever wrote the SRS definition for structural curve must not have been thinking very clearly.

--Linda

[mamamax]

In her recent paper, Martha states "This included deep tissue massage (1992-1996); outpatient psychological therapy (1992-1993); a daily home exercise program focused on mobilization of the chest wall (1992-2005); and manipulative medicine (1994-1995, 1999-2000)." It seems to me that "manipulative medicine" means chiropractic or osteopathic.

Whoever wrote the SRS definition for structural curve must not have been thinking very clearly.

--Linda

Martha did work with an osteopath & makes it quite clear that she never sought the services of a chiropractor. I want to say this is found both in Scoliosis and the Human Spine and her memoir - one of them for certain.

Believe it or not the two SRS definitions are beginning to make sense. And in thinking about it, they are actually both correct.

Patient definition #1 states that a structural curve is a non-flexible curve.

Professional definition #2 further defines the term non-flexible as: a curve (in the coronal plane) which fails to correct past zero in the supine position with the patient lateral side bending as far as possible. I actually get that. A structural curve then may be flexible but is considered non-flexible when it will not correct (or flex) past zero. Are we dizzy yet?

The problem is, in order to understand what is a structural curve (in its totality according to SRS), both definitions need to be studied - as the patient definition does not define the medical concept of non-flexible which is found within the professional definition.

Personally, I would like to see the patient definition expanded.

[tonibunny]

Interesting. I wonder if anyone would claim that it would be possible to remodel the wedging I had here at L1 and L2.

My x-ray, aged 16 (http://www.flickr.com/photos/62533471@N00/3627183527/in/set-72157619673664833/)

[Pooka1]

Interesting. I wonder if anyone would claim that it would be possible to remodel the wedging I had here at L1 and L2.

My x-ray, aged 16 (http://www.flickr.com/photos/62533471@N00/3627183527/in/set-72157619673664833/)

While you do hear a lot of loose talk around here about bone remodeling going on all the time, I guess nobody has figured out a way to remodel the wedging conservatively. That's why surgeons do osteotomies as I understand this (which I'm not sure I do.)

[tonibunny]

While you do hear a lot of loose talk around here about bone remodeling going on all the time, I guess nobody has figured out a way to remodel the wedging conservatively. That's why surgeons do osteotomies as I understand this (which I'm not sure I do.)

Indeed, Sharon. I'd be fascinated to see x-rays from any case where a conservative method has completely remodelled noticeably wedged vertebrae.

[mamamax]

I wrote to Martha - specific to structural vs functional curves. I've received a response from her this morning. This particular correspondence is something I consider private correspondence, I did not request permission to share it in forum, and so I am not going to cut and paste her comments here.

My original message was not to question her, but rather to learn more about structural and functional curves. Her response does find me pondering many things and after further reading of her work, and some thought over morning coffee - I would like to suggest that concern regarding structural vs functional curves may be - a moot point in my opinion (when discussing Hawes' curves). And here's why:


"Controlled clinical studies are consistent with the possibility that nonstructural and structural scolioses are functionally interchangeable at least in early stages of spinal deformity. Thus, in a group of patients hospitalized for spinal fusion surgery, the spinal rigidity that defines "structural" scoliosis was significantly reduced by an exercise program lasting only eight days (Dickson and Leatherman 1979)." Hawes, 2006 Scoliosis and The Human Spine pg 15. I highly recommend this book - and will purchase the 2010 update myself.

If we study Martha's most recent publication (presented in December 2009 to Scoliosis Journal) - those who understand more about these things than myself, will be able to see that her case (from text, pictures, and xrays) is not consistent with what is described as a functional curve(s). Full text found here: http://www.scoliosisjournal.com/content/pdf/1748-7161-4-27.pdf

So - maybe (based on the references above) it is more important that we pay attention to those things which may affect an interchange between something that appears structural but begins to perform functionally following things like exercise. In Martha's case, her journey involved seeking to relieve a restricted breathing condition and her condition has been improved through chest wall expansion/improvement with a secondary benefit of curvature reductions.

Is it possible that if the chest wall is improved, that the spine also improves?

IF so, this would explain why certain exercises are appearing to provide improvement in curvature. Schroth, Pilates, Yoga, MedX torso rotation, (maybe SEAS which I have not studied) - all improve chest wall expansion. While there is possibly ample anecdotal evidence of this - Martha is the only one with a scientific fifteen year follow up regarding chest wall expansion/improvement and secondary cobb angle improvement (which continues to progressively improve).

Food for thought :-)

[Pooka1]

(snip...) I would like to suggest that concern regarding structural vs functional curves may be - a moot point in my opinion (when discussing Hawes' curves).

As far as I could tell, what was on the table was NOT structural versus functional but rigid structural versus flexible structural. Hawes clearly has a structural curve. The question is.... is it rigid or flexible and have all those years of PT and manipulation increased or preserved flexibility and what is the significance of that, if any.


(snip...) In Martha's case, her journey involved seeking to relieve a restricted breathing condition and her condition has been improved through chest wall expansion/improvement with a secondary benefit of curvature reductions.

I agree. I think she was doing stuff to improve her respiratory situation and was blindsided by the curve reduction.

[hdugger]

Getting the spine to be flexible is just a small part of the equation, IMO. Many of the adolescents on this forum had very flexible curves before their surgery - that is, with their body bent in a certain way, their curve greatly reduced. So, a large percentage of their curve was "flexible." But, if that "flexible" part of the spine collapses into the curve when you stand back up normally, then it contributes to the overall size and progression of the curve, whether it's stiff or flexible. That is, as long as you can't reduce your standing curve, it doesn't really matter how flexible your spine is, IMO. I believe in the study you quoted, their spine was more flexible, but their standing curve was the same.

People with truly non-structural curves (i.e., not just flexible curves but actual functional scoliosis) *can* stand up straight. People with structural curves, whether flexible or not, cannot. That's the difference.

So, the role of a successful exercise program is two-fold. First, for stiff, inflexible spines, it has to make them more flexible. Second (and apparently much more difficultly), once the spine is flexible the exercise program has to help you hold yourself in a more upright position. I've seen a fair amount of reports of people decreasing the amount of curve seen on a bending xray. But I've seen very few reports (just the 8 data points I mention) of people being able to hold that reduction of curve while standing.

[Pooka1]

That's an interesting analysis.

I was just watching some of those POSNA videos and one guy mentioned flexibility. He said amount of the curve that can be bent out (i.e., bending radiograph) is overall flexibility.

Beyond the question of PT holding/reducing curves, the question of PT changing flexibility is interesting if it changes the bending out potential of a curve to such an extent that the lowest instrumented vertebra choice changes (i.e., most distal vertebra that is leveled upon bending). And if that is the case, is that good or bad? That is, does increasing flexibility apparently shorten or lengthen a fusion based on vertebral leveling?

[mamamax]

As far as I could tell, what was on the table was NOT structural versus functional but rigid structural versus flexible structural. Hawes clearly has a structural curve. The question is.... is it rigid or flexible and have all those years of PT and manipulation increased or preserved flexibility and what is the significance of that, if any.

From the literature alone, it would be logical to conclude that exercises "can" improve a structural curve. Maybe that improvement is in fact something (an interchange) that can be defined as a flexible structural curve. From Hawes, 2006 Scoliosis and The Human Spine pg 15, referencing Dickson and Leatherman 1979:

Controlled clinical studies are consistent with the possibility that nonstructural and structural scolioses are functionally interchangeable at least in early stages of spinal deformity. Thus, in a group of patients hospitalized for spinal fusion surgery, the spinal rigidity that defines "structural" scoliosis was significantly reduced by an exercise program lasting only eight days


I agree. I think she was doing stuff to improve her respiratory situation and was blindsided by the curve reduction.

And that is possibly important to all of us, whether we seek no treatment and have breathing problems - or seek non surgical methods - or even for surgical patients (some do experience reduced breathing function).

Chest wall expansion/improvement does appear to have an important spinal connection.

So maybe any exercise that improves the chest wall - is good for all?

[LindaRacine]

From the literature alone, it would be logical to conclude that exercises "can" improve a structural curve. Maybe that improvement is in fact something (an interchange) that can be defined as a flexible structural curve. From Hawes, 2006 Scoliosis and The Human Spine pg 15, referencing Dickson and Leatherman 1979:

Controlled clinical studies are consistent with the possibility that nonstructural and structural scolioses are functionally interchangeable at least in early stages of spinal deformity. Thus, in a group of patients hospitalized for spinal fusion surgery, the spinal rigidity that defines "structural" scoliosis was significantly reduced by an exercise program lasting only eight days

[/COLOR]
The use of the word "improve" is deceptive. What the referenced study found was "the exercise programme and not the traction was responsible for rendering the spine less rigid."

That is, this study showed no decrease in curvature.

The bottom line, at least to me, is that people have been studying the role of exercise in the treatment of scoliosis for hundreds of years, and no one has yet to show that any decrease in curvature can be permanent. With that said, I personally think that a small percentage of scoliosis patients may be able to avoid surgery by the continuous participation in exercise programs. The downside to that is that the exercise program may only lead to a delay in needing the surgery. That delay might be detrimental, in that age significantly increases the incidence of complications, and the longer one waits, the higher the risk of a longer fusion (vs. a shorter fusion).

[mamamax]

Linda -

If a rigidity is lessened by exercise - is this not an improvement?

If you have a copy of the book which contains the passage I offered, you will see that this is not in reference to cobb angle reduction but rather, in reference to a discussion regarding structural and functional curves. I'm not sure why you are referencing traction, exercise was the key component.

Bty, I did not underline the word "improve" for emphasis in my original posting .. you're doing so (to my message) in a reply was a little deceptive ;-)

We can see that there is a potential important connection between chest wall improvement and and the spine through the work of Hawes over a period of fifteen years. This connection may explain why we see improvement in those who engage in exercise that improve the chest wall.

Have people been studying the role of exercise which improves chest wall in relation to scoliosis for hundreds of years? I don't think so.

[LindaRacine]

Linda -

If a rigidity is lessened by exercise - is this not an improvement?

If you have a copy of the book which contains the passage I offered, you will see that this is not in reference to cobb angle reduction but rather, in reference to a discussion regarding structural and functional curves. I'm not sure why you are referencing traction, exercise was the key component.

Bty, I did not underline the word "improve" for emphasis in my original posting .. you're doing so (to my message) in a reply was a little deceptive ;-)

We can see that there is a potential important connection between chest wall improvement and and the spine through the work of Hawes over a period of fifteen years. This connection may explain why we see improvement in those who engage in exercise that improve the chest wall.

Have people been studying the role of exercise which improves chest wall in relation to scoliosis for hundreds of years? I don't think so.
This is the entire abstract of the referenced study:


Cotrel traction, exercises, casting in the treatment of idiopathic scoliosis. A pilot study and prospective randomized controlled clinical trial.

Dickson RA, Leatherman KD.

A pilot study of ten individuals with adolescent-onset idiopathic scoliosis demonstrated that a week of Cotrel traction and exercises did not improve curve correction obtained by the application of an elongation, derotation, flexion (EDF) cast. There was, however, a significant improvement on lateral bending correction during this period. A prospective, randomized, controlled clinical trial showed that the exercise programme and not the traction was responsible for rendering the spine less rigid.


As far as I know, there is no proof that flexibility has any permanent effect on curve improvement.

[Pooka1]

As far as I know, there is no proof that flexibility has any permanent effect on curve improvement.

And for all we know, increased flexibility might be detrimental if the rigidity is slowing the progression. That is the progression is faster/more extreme after starting then stopping PT than that associated with never having started.

It's a bunch of unknown unknowns. Speculation is futile.

[mamamax]

This is the entire abstract of the referenced study:


Cotrel traction, exercises, casting in the treatment of idiopathic scoliosis. A pilot study and prospective randomized controlled clinical trial.

Dickson RA, Leatherman KD.

A pilot study of ten individuals with adolescent-onset idiopathic scoliosis demonstrated that a week of Cotrel traction and exercises did not improve curve correction obtained by the application of an elongation, derotation, flexion (EDF) cast. There was, however, a significant improvement on lateral bending correction during this period. A prospective, randomized, controlled clinical trial showed that the exercise programme and not the traction was responsible for rendering the spine less rigid.


As far as I know, there is no proof that flexibility has any permanent effect on curve improvement.

Exactly - and that is why this study was referenced in a section discussing functional and structural curves - to show reference in the literature that exercise was shown to lessen rigidity. Anyone who has the book can see this - page 15.

Can you give us the full study that shows that exercise did this in 8 days?

Lets not talk about permanent - it leads to a rather depressing discussion ... since there is no proof that anything is.

We all know the importance of maintenance.

Interested in your response to my post #105 (outside said study)

[LindaRacine]

[COLOR="Navy"]

If a rigidity is lessened by exercise - is this not an improvement?

As I said above, there's no way of knowing. It could be detrimental.


[COLOR="Navy"]Have people been studying the role of exercise which improves chest wall in relation to scoliosis for hundreds of years? I don't think so.

Every time we post data that shoots down one of your theories, you focus on a new one. I'm fine with you chasing all of these things, but I still think it's irresponsible to try to convince others to join you until there's some proof that it's going to work on a large scale.

[mamamax]

Linda -
You state to me ...

Every time we post data that shoots down one of your theories, you focus on a new one. I'm fine with you chasing all of these things, but I still think it's irresponsible to try to convince others to join you until there's some proof that it's going to work on a large scale.
That is really interesting.

Firstly I don't see any "we" shooting down one of my theories. What I see is a discussion. Secondly, I'm not trying to convince anyone of anything - I have simply been involved in a discussion.

Is there some reason I should not discuss things like everyone else here?

[Pooka1]

I'm fine with you chasing all of these things, but I still think it's irresponsible to try to convince others to join you until there's some proof that it's going to work on a large scale.

In my little opinion, Mamamax is bush league in that regard compared to certain other players in this sandbox who are truly reckless and dangerously mislead innocent peeps.

[mamamax]

Thanks Sharon :D

I do my best :-)

[Pooka1]

Thanks Sharon :D

I do my best :-)

What are buddies for? :)

[mamamax]

What are buddies for? :)


High-Five

Think it's time for a hamster joke :D

[Pooka1]

I don't have a joke but I have the original "Hamster Dance"

http://www.webhamster.com/

[hdugger]

A few corrections/clarifications:

* Because the standard treatment for scoliosis is surgery, there's a tendency to compare other treatments to it on the basis of "permanence." That's not, in general, how we evaluate medical treatments. Many diseases are "managed" - think of asthma and blood pressure medicines, or even diet and exercise for obesity. For any disease, like scoliosis, in which there is no cure, all solutions are imperfect. Surgery, while permanent, also permanently disfigures and has a host of serious risks. (And, in up to 25% of the cases, is not even permanent.) Exercise, while needing ongoing applications to "manage" the disorder, is less risky and less disfiguring (if, big if, it avoids surgery).

* I think it's misleading to refer to exercise as "being studied for hundreds of years." Surgery, too, was studied for hundreds of years, and the first few hundred of years worth of results were pretty terrifying. We've only seen acceptable results within the last 50 years or so, and only good results in the last 5 years or so.

* Likewise, as surgery has advanced, exercise has also advanced. It's only within the last 10 years that I've seen reports of patients being able to hold a curve reduction with exercise.

[hdugger]

Damn! I missed the transition to hamsters again! I must start paying better attention to the topic!

[mamamax]

I don't have a joke but I have the original "Hamster Dance"

http://www.webhamster.com/

LOL and falling on the floor!! Thank you Sharon - forwarding this to a lot of people I know who could use a little stress relief!

Beautiful!

[Pooka1]

Damn! I missed the transition to hamsters again! I must start paying better attention to the topic!

You snooze, you lose. However in this case, regarding hamsters, it's always a win.

[RitaR]

I love the hamsters - thanks for the smile. Yes, definitely needed that.
Thanksagain...

[hdugger]

I happen to have, if not a hamster joke, at least a funny hamster story.

I had a friend, a preschool teacher, who had a hamster named Elvis as a classroom pet. She often put Elvis in his little plastic hamster ball and let him roll around the classroom. One day, at the end of class, she couldn't find Elvis. She was looking around the hallways when she ran into a new teacher, who helpfully asked her what she was looking for.

She said "I've lost Elvis?"
Other teacher "Elvis?"
She "Yes, he was just in my classroom, and now I don't see him anywhere. Have you seen him?"
Other teacher . . . (long pause) "I think he's dead."
She: "Dead! Dear god, how did he die!"
Other teacher "I think it was drugs"
She "Drugs! Dear god, how did they get drugs into that plastic ball?"
Other teacher . . . long pause "plastic ball?"

I believe they eventually sorted it out :)

[mamamax]

A few corrections/clarifications:

* Because the standard treatment for scoliosis is surgery, there's a tendency to compare other treatments to it on the basis of "permanence." That's not, in general, how we evaluate medical treatments. Many diseases are "managed" - think of asthma and blood pressure medicines, or even diet and exercise for obesity. For any disease, like scoliosis, in which there is no cure, all solutions are imperfect. Surgery, while permanent, also permanently disfigures and has a host of serious risks. (And, in up to 25% of the cases, is not even permanent.) Exercise, while needing ongoing applications to "manage" the disorder, is less risky and less disfiguring (if, big if, it avoids surgery).

* I think it's misleading to refer to exercise as "being studied for hundreds of years." Surgery, too, was studied for hundreds of years, and the first few hundred of years worth of results were pretty terrifying. We've only seen acceptable results within the last 50 years or so, and only good results in the last 5 years or so.

* Likewise, as surgery has advanced, exercise has also advanced. It's only within the last 10 years that I've seen reports of patients being able to hold a curve reduction with exercise.

Agreed ... And would have to say large advances are being made in both areas.

You know, sometimes the discussions we have here can get quite deep. I find that this can result in strange dreams. My dream of a few nights past: I was in the future - about 200 years from now. I had scoliosis. The standard treatment was for a doc to come to the home and perform brain surgery. It as real simple, took less than five minutes, required no anesthesia and there was no pain - and the treatment was permanent leaving the spine perfectly flexible.

This leads me to have a deeper appreciation of Sharon's ability to know just when we need a good hamster joke. Thanks Sharon!! The original hamster dance must be legendary - and the Elvis offering from Heather ain't bad either!

[RitaR]

We all knew Elvis lived on . . . now we find out he's been in school. Let alone near a plastic ball...Ha!

[mamamax]

ok then ... where were we? Having trouble getting the hamster dance out of my head :-)

[hdugger]

I think we were on rigidity and exercise.

I know that Martha's book talks about reducing the rigidity of a curve, since the definition of scoliosis includes the idea of a rigid curve. But . . . I wonder if that's the most useful course of inquiry. While I understand what she's getting at, I'm not certain exactly what role rigidity plays in curves which are reducible with exercise.

I hypothesize that a curve has to be flexible before exercise can reduce it, but I don't have any evidence. The SEAS people suggest something similar (that exercise reduces the flexible part of the curve, which they think is contributed to by muscles and ligaments), but that's also just a hypothesis on their part.

To test it would require more than our current methods seem to allow. I mean, really, doctors can't even show that bracing works after all these years of studies.

I think the thing we're really trying to understand, beyond grappling with these more complex ideas is, if exercise can reduce a curve, what kind of curve can it reduce? Again, I'm using reduction of curve as the tip of the iceberg of an exercise which can keep a curve from progressing.

If I go over my data points (in my head - I must get a better method of keeping them straight!), I believe that 4 of the 6 are under 30, and two are over. That jibes with what I'd expect - that the same people who see better correction in surgery also see better results with exercise. But, I don't know what the underlying reason is. It could be rigidity. But it might also be that the vertebrae are less compromised in the young. Right now, I'm not sure the underlying cause matters. What probably does matter is identifying the group of people most likely to benefit from exercise, so that it's possible to use that group to finetune the methods.

[mamamax]

Beyond the question of PT holding/reducing curves, the question of PT changing flexibility is interesting if it changes the bending out potential of a curve to such an extent that the lowest instrumented vertebra choice changes (i.e., most distal vertebra that is leveled upon bending). And if that is the case, is that good or bad? That is, does increasing flexibility apparently shorten or lengthen a fusion based on vertebral leveling?

That is a great question. Did you ask your surgeon - or will you? I think the answer from a surgical standpoint would be most interesting.

[hdugger]

That is a great question. Did you ask your surgeon - or will you? I think the answer from a surgical standpoint would be most interesting.



Anecdotally, everything I've heard suggests that flexibility gives a better correction in surgery. But I have no idea what effect is has on curve progression (Linda's question). The most flexible people (adolescents) have the most curve progression, but presumably that's mapped more to growth then to flexibility.

[mamamax]

Anecdotally, everything I've heard suggests that flexibility gives a better correction in surgery. But I have no idea what effect is has on curve progression (Linda's question). The most flexible people (adolescents) have the most curve progression, but presumably that's mapped more to growth then to flexibility.

And that is my understanding also. What caught my attention was Sharon's questioning how increasing flexibility may shorten or lengthen a fusion based on vertebral leveling. Something to ponder I think - and an interesting observation.

[mamamax]

I think we were on rigidity and exercise.

I know that Martha's book talks about reducing the rigidity of a curve, since the definition of scoliosis includes the idea of a rigid curve. But . . . I wonder if that's the most useful course of inquiry. While I understand what she's getting at, I'm not certain exactly what role rigidity plays in curves which are reducible with exercise.

I hypothesize that a curve has to be flexible before exercise can reduce it, but I don't have any evidence. The SEAS people suggest something similar (that exercise reduces the flexible part of the curve, which they think is contributed to by muscles and ligaments), but that's also just a hypothesis on their part.

To test it would require more than our current methods seem to allow. I mean, really, doctors can't even show that bracing works after all these years of studies.

I think the thing we're really trying to understand, beyond grappling with these more complex ideas is, if exercise can reduce a curve, what kind of curve can it reduce? Again, I'm using reduction of curve as the tip of the iceberg of an exercise which can keep a curve from progressing.

If I go over my data points (in my head - I must get a better method of keeping them straight!), I believe that 4 of the 6 are under 30, and two are over. That jibes with what I'd expect - that the same people who see better correction in surgery also see better results with exercise. But, I don't know what the underlying reason is. It could be rigidity. But it might also be that the vertebrae are less compromised in the young. Right now, I'm not sure the underlying cause matters. What probably does matter is identifying the group of people most likely to benefit from exercise, so that it's possible to use that group to finetune the methods.

Yes, that is where we were. The relationship between rigidity and exercise. And it would appear that the answers to this may differ between the young and the old (or skeletally immature and mature).

I don't know. Martha - three curves. Diagnosed at age 11. No progression from age 11 to 40 doing (selected) exercises faithfully as prescribed by her diagnosing surgeon. These exercises were from a program outlined in Ponseti & Friedman. More about that found here (on page 6): http://www.scoliosisjournal.com/content/pdf/1748-7161-4-27.pdf

No curvature progression from childhood to adulthood - and no curvature reduction either, with exercise.

One would think her curves were more flexible (less rigid) with this exercise than they would have been without (based upon literature) - if so, the flexibility did not appear to cause any harm from childhood through adulthood. If anything this may have kept her from progressing. Seems so anyway - what was she diagnosed at in childhood 40 something degrees thoracic? I think most literature regarding that magnitude in an eleven year old supports continued progression?

Improvement only came about as an adult and as a secondary result of exercises which were targeted to improve her chest wall. Then we find things reversing. She also worked on psoas muscles and had some osteopathic adjustments. So - the exercise changed in adulthood to something targeted towards addressing chest wall - she worked on the psoas involvement - and also had osteopathic adjustments .. following years of a standardized exercise program which may have played an important role in stabilization.

Her case is complex in that she does have thoracic, lumbar, and cervical curves to deal with. But the fact that continued reduction comes with continued exercise targeted towards the chest wall is interesting because the exercises like Schroth, Pilates, and Yoga (and others) also result in chest wall improvement. Whereas the exercises like she was prescribed in childhood, do not.

Bracing - while controversial, I have experienced benefit from that - as a skeletally mature adult. Naturally I'm drawn towards learning more and it appears that from the literature, exercise may be beneficial in both brace weaning and in helping maintain any correction achieved.

Yes, agree - identifying who does best with what is important in making our choices. I'm grateful for what we are discovering - the future will hold more to draw from. The Psoas muscle involvement in scoliosis may prove an interesting topic of discussion.

Sunday Morning Addendum: This is only a discussion and exploration into what I "think" I may see based on personal observations. What do I know beyond shadow of doubt? Answer: Nothing. Except that the hamster dance is a super great stress buster :-)

Reference: Hamster Dance provided by our resident research scientist Pooka1
http://www.webhamster.com/

[Pooka1]

I happen to have, if not a hamster joke, at least a funny hamster story.

I had a friend, a preschool teacher, who had a hamster named Elvis as a classroom pet. She often put Elvis in his little plastic hamster ball and let him roll around the classroom. One day, at the end of class, she couldn't find Elvis. She was looking around the hallways when she ran into a new teacher, who helpfully asked her what she was looking for.

She said "I've lost Elvis?"
Other teacher "Elvis?"
She "Yes, he was just in my classroom, and now I don't see him anywhere. Have you seen him?"
Other teacher . . . (long pause) "I think he's dead."
She: "Dead! Dear god, how did he die!"
Other teacher "I think it was drugs"
She "Drugs! Dear god, how did they get drugs into that plastic ball?"
Other teacher . . . long pause "plastic ball?"

I believe they eventually sorted it out :)

Excellent.

Hamster stories, and of course a motion to adjourn, are always in order. :D

[Pooka1]

That is a great question. Did you ask your surgeon - or will you? I think the answer from a surgical standpoint would be most interesting.



I have enough salient questions in the time allotted... I would never ask him moot questions.

I'm just saying that I think it could be dangerous if PT changed the last instrumented vertebra choice from what it should be to something other. That could be a serious mistake.

[Pooka1]

No curvature progression from childhood to adulthood

This is seemingly more and more common as we have 2-3 cases just in this sandbox of even large curves holding from adolescence into adulthood for decades.

Though certainly not common, it is clear at this point that you can never assume a brace or PT or chanting or whatever held even a large curve just because you were doing that treatment. Doing nothing achieves the same result in some cases.

[hdugger]

I'm just saying that I think it could be dangerous if PT changed the last instrumented vertebra choice from what it should be to something other. That could be a serious mistake.

Isn't the last instrumented vertebra chosen from the bending xrays, where any part that doesn't resolve is the fixed part of the curve and that's what they fuse to? I'm not sure I understand how being more flexible would make the fusion longer? If that were the case, wouldn't you encourage young people to wait until they're older to have surgery, since they'd be less flexible then?

[Pooka1]

Isn't the last instrumented vertebra chosen from the bending xrays, where any part that doesn't resolve is the fixed part of the curve and that's what they fuse to? I'm not sure I understand how being more flexible would make the fusion longer? If that were the case, wouldn't you encourage young people to wait until they're older to have surgery, since they'd be less flexible then?

I'm wondering if the flexibility increases "artificially" from PT such that the fusion would be shorter than it should be.

I know of at least a few cases where the fusion ended too soon (only fusing the top of double major curves) and that was not stable. So not going low enough is problematic and anything that might compromise the choice of that last fused vertebrae seems like a potential problem.

I have no idea what I'm talking about, obviously... just bunny wondering.

[hdugger]

Only fusing part of a double major curve just seems like negligence, to me. In the case that I'm aware of, bending xrays weren't even done so flexibility didn't play into it.

The only information I have on the topic is doctors (including my own) recommending PT/stretching, including some who specifically recommend it in order to increase flexibility before surgery. I'm assuming they don't think they're doing harm to the patient. Without any other information, I'm likely to rely on that recommendation.

[Pooka1]

Only fusing part of a double major curve just seems like negligence, to me. In the case that I'm aware of, bending xrays weren't even done so flexibility didn't play into it.

I can think of two cases from this group and two from another group where it either the kid seemed to have a double major (based only on the stated T and L curves). One of those cases is an adult and it could possibly have been they just or they didn't go down low enough on a T curve.

In two cases there was a post op trunk shift left and at least one of the kids when into a brace post op to try to stabilize that. Maybe both kids did. I hope they report back... that would be good if that works. The other two people have a boatload on damage to the lumbar, one in a few short years, seemingly from not fusing the lower curve also but maybe due to bad balance in one or more planes.

[Pooka1]

http://www.youtube.com/user/janzenandjanzen

Apparently, the chiros are dabbling in neurology now. And there is still no admission that they understand this is not structural.

[hdugger]

I'm getting something about tennis elbow at that link.

[Pooka1]

Sorry. You have to select the two newest videos added at the top right.

Not sure why the general link goes to the tennis elbow video. :confused:

[Pooka1]

http://www.youtube.com/user/janzenandjanzen#p/u/2/dyNrxq-PKmQ

She seems to deliberately drop her left shoulder when she bends forward. And then to flatten her back she just brings it level with the right shoulder. They didn't really get this on the video so I'm just guessing from what can be seen.

And still no admission that the chiros understand this is an exquisitely rare non-structural scoliosis. If I were that kid's mother, and knowing about the other seemingly similar case that straightened upon being anesthetized, I would bring my kid to a surgeon to be put under to see if that would work. No need for endless exercising (and endless payments).