Practical questions about exercise and surgery

[hdugger]

deleted post

[Dingo]

if it was me...

hdugger

If it was me I'd do my best to avoid surgery if at all possible. I'm not anti-surgery but I would use it as a last resort. Like I've said before if my son needs VBS or fusion I'll do it.

Why not spend a few hundred bucks on some type of used torso rotation machine and give it 6 months? If your son's curve is stable or gets worse surgery might be his best bet. You can always resell his machine on craigslist. But if his curve starts moving in reverse like Martha Hawes this kind of simple PT could be an easy sollution.

A mom on this board sent me a personal message regarding a conversation she had with a female weight trainer. The woman had been in pain for years and was considering surgery. As a last ditch effort she gave strength training a try. To her amazement the pain and discomfort went away for good. That was years ago.

The other thing to consider is that in another 10 or 15 years there might be procedures available that are much more advanced than fusion. The internal spine brace is in development right now. I believe there are competing versions of this technology.

Internal scoliosis brace diagram

[Dingo]

other exercises

hdugger

Sure, look up torso rotation video on google and there are lots of exercises.

In Dr. McCintire's study on torso rotation he included a simple home exercise for kids to do.

Tie an exercise band to a doorknob and sit in a chair with your BACK facing the doorknob. Hold the other end of the exercise band. Twist left and right and the exercise band provides the resistance. It's the same movement as the MedX machine except it uses an exercise band and a chair. Because you are sitting your pelvis stays locked in place and the paraspinal muscles do all of the work.

I talked to Dr. McCintire about this particular exercise and he seemed to like it a lot. I got the feeling that it's the next best thing to the MedX. Unfortunately my son is only 6 and he is too young and uncoordinated to do this exercise. We do a lying down version.

This is the study that the exercise comes from.
Treatment of Adolescent Idiopathic Scoliosis With Quantified Trunk Rotational Strength Training: A Pilot Study

[Dingo]

blurb from abstract

hdugger

BTW this is from McCintire's abstract. The same thing was mentioned in the Vert Mooney study on torso rotation.

A normal female's trunk strength in flexion and extension decreases from her juvenile to adolescent years, whereas a male's increases.

I remember when I first heard that AIS hit teen girls 10 to 1 over boys. I thought it had something to do with hormones.

Whelp... maybe not. It could be as simple as muscle mass.

This study certainly points in that direction.

Relation between adolescent idiopathic scoliosis and morphologic somatotypes.

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

[mamamax]

Thanks Dingo

Dingo - what do we know about torso rotation in relation to thoracomumbar curves? Anything?

[Karen Ocker]

Torso rotation with a syrinx???

A syrinx is a cyst in the spinal cord. I suggest consulting a neurosurgeon before embarking on torso rotation.

[Dingo]

not much

mamamax

what do we know about torso rotation in relation to thoracomumbar curves? Anything?

I don't think the type of curve matters. It seems to work for any curve.

[mamamax]

Torso Rotation/Strengthening w/Exercise Band

Thanks Dingo - taken at a gradient, the exercise band seems harmless enough - think I'll give it a try & see how it feels. I do remember that Martha used torso strengthening exercises from age 11 to 40 and experienced a long period of stability during that time. As for throacolumbar & torso rotation, yep looks like it could be helpful.

A preliminary report on the effect of measured strength training in adolescent idiopathic scoliosis.
Mooney V. Gulick , Pozos R. J Spinal Disord, 2000;13(2):102-7.

The authors studied 12 adolescent patients with scoliosis (10 girls and 2 boys) who were 11 to 16 years old and had curvatures ranging from 20 degrees to 60 degrees. Seven were right thoracic curves and five were thoracolumbar with double curves. When tested on the MedX Torso Rotation Machine, both sides were unequal in their torso rotation strength all patients. Myoelectric activity was asymmetric in both sides and in abdominal and paraspinal muscles of all patients. These asymmetries were corrected completely with torso rotation, which was associated with significant strength gains. Strength gains ranged from 12% to 40%. A 16-year-old girl with a 60 degree lumbar curve progressed and had surgery. None of the remaining patients progressed, and 4 of the 12 had decreases in their curvatures from 20 degrees to 28 degrees. None of the patients used braces during this study. http://www.spineandsport.com/foundat.../scoliosis.asp

[Dingo]

hdugger

My Dr. (orthpedic surgeon) told us that the only things we had to avoid were car and skiing accidents. Is there a reason to think that simple actions would aggravate it?

A little over 5 years ago I had a disc rupture in my neck. What was left of the damaged disc pressed on my spinal cord and caused constant phantom pain that ran down my right arm all of the way to my finger. The pain in my neck and arm was easily the worst of my life. A few months later I had a single level fusion that eliminated the pain completely.

Anyway... the first time I met my neurologist (before I had surgery) I asked him about options. He told me that I could try PT but he doubted it would help. I asked him if therapy was safe considering my condition. He told me that PT wouldn't damage anything but if a movement caused pain I should stop. I found his response somewhat amusing because I expected something more brilliant or insightful from a neurologist. Evidently even the smartest people haven't discovered a better course of action than "stop if something hurts".

I don't know if this advice about PT applies to a cyst in the spine (it might not) but it's my only experience with a severe back disorder.

[Dingo]

exercise bands

Mamamax

the exercise band seems harmless enough - think I'll give it a try & see how it feels.

Yep, it's essentially the same thing as a MedX but it costs practically nothing and you can do it at home. I think you can buy exercise bands with different resistances. McIntire mentioned that by pulling the band tight you can double the resistance... or something like that.

I tried it with my son but he couldn't move his body correctly. This exercise doesn't take a lot of coordination but it requires more than what a 6 year old has. My 8 year old son could probably do it with ease.

[mamamax]

Mamamax



Yep, it's essentially the same thing as a MedX but it costs practically nothing and you can do it at home. I think you can buy exercise bands with different resistances. McIntire mentioned that by pulling the band tight you can double the resistance... or something like that.

I tried it with my son but he couldn't move his body correctly. This exercise doesn't take a lot of coordination but it requires more than what a 6 year old has. My 8 year old son could probably do it with ease.

That's a good exercise Dingo! I used the exercise band & chair last evening before going to bed. Just did 10 reps and could feel the affect this morning and throughout the day. Was a little sore, but I swear I felt as if I was standing a little straighter (if it's a placebo effect, I'll take it).

Actually I'm as out of shape as an old lady can get, so it would not be unusual to feel the effects of just ten reps - and I think this exercise definitely targets the parspinals. Done as you suggested the rotations were quite small which my surgeon had said would be fine (vs long sweeping rotational exercises).

Isn't the real MedX routine done for about 15 minutes or so? I would imagine that really would create some soreness the next day. Since I'm older I'm going to continue with just 10 reps a day until I don't feel any affect, then I'll increase it. Also will be adding a Schroth exercise I've learned before and after - which basically elongates the spine.

I think you came up with a good one here and thanks again for posting the suggestion!

[Dingo]

MedX

Mamamax

Thanks but all of the credit goes to Dr. McIntire.

I believe the children in the studies used the MedX twice per week for just a few minutes each time. Maybe 5 or 10 minutes.

Was a little sore, but I swear I felt as if I was standing a little straighter (if it's a placebo effect, I'll take it).

My wife and I noticed a difference in Scott's back after a couple of weeks. At about the one month mark we knew for sure that something had improved. The biggest difference seemed to be a reduced rib hump or reduced rotation. Some of that improvement may have been extra muscle that evened out the appearance of his back, we dunno. But at the 6 month mark he measured a 10 which was a 1 degree improvement. I could have sworn that he improved a lot more but I'll take a -1 any day. Because he was stable we put off his next recheck for 1 year which will be his 7th birthday.

[tonibunny]

Hey Dingo,

It's fab news that Scott's back looks better I have questions - I'm not being critical, I'm genuinely curious! I think it's extremely encouraging that you can see a cosmetic improvement in his back, and that the curvature has not got any worse.

What's the Scoliometer degree of his rotation? I'm amazed that he has a rib hump at all with a 10 degree curve, but I guess that could only happen if he has a lot of rotation Is it at all possible that the x-rays have been measured incorrectly and that he actually has a larger curve?

This is an x-ray of a 10 degree scoliosis, and it's so difficult to see how it could cause a noticeable hump, especially one that is so prominent that you can discern a reduction. Logically it seems to me that any rotation would manifest itself in a slight imbalance rather than a hump:

http://www.uihealthcare.com/depts/me...ges/lumbar.jpg


Also, how did the doctor measure a 1 degree improvement accurately, given that there is a 5 degree margin of error?

Toni xx

[Pooka1]

Also, how did the doctor measure a 1 degree improvement accurately, given that there is a 5 degree margin of error?

Toni, I think the surgeon just read the first and second radiographs and got numbers. I'm very sure the surgeon simply said, "No change." I think he would have said "No change" if the second reading was within +/- 5* of the first reading. Further, I would bet my house and in fact my entire net worth that the the surgeon did NOT say, "Improved curve" implying it is real... re-readings by surgeons are +/- 2-3* as far as I know. It can't be more exact than that.

Now in contrast to the surgeon's opinion, how lay parents interpret one degree decreases in curves is driven by emotions, not science or medicine and it is understandable. The main danger is when a kid is doing some type of therapy and that therapy is credited with the one degree decrease or any decrease in small curves in little kids. And in this particular case, the danger of other parents being mislead is off the charts as the lay parent is a true believer (TM) in the therapy absent any real evidence.

[Dingo]

Scott

Tonibunny

Scott's initial measurement by the radiologist was 12 degrees, his Scoliosis specialist called the same x-ray "10ish". So like you said there is a +/-5 degrees on every measurement.

Scott's rotation was pretty bad which I guess is lucky because if it wasn't they would have missed his curve. In his first and most recent X-rays Scott's spine was nearly straight, just like your example. His curve has always been hard to see even when I look closely but I can see his rotation through all but the thickest shirts. At shower time I try not to look at it because it makes my heart sink.

I should note that his 6 month X-ray did not look like your example. Between his initial diagnosis and first recheck his rotation had slowly spread from his middle back up into his thoracic region and down into the top of his lumbar area. When the doctor put the film up his curve appeared to have grown by about half or more. Then he looked at us and said it was 11 degrees. I couldn't believe it! I was overjoyed and mystified at the same time. I think the +/- 5 variation might have worked in Scott's favor that day.

We had started strength training about a week before his first recheck and we've been doing it ever since. 6 months later at his 2nd recheck I had no worries at all. His rotation was down and his curve was practically invisible. I wouldn't have been surprised if the doctor called it 5 degrees. He called it 10 and stable which was good enough for me.