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skevimc
01-13-2010, 06:21 PM
First off, Iíll tell you that my name is Kevin McIntire and our group did the work on trunk rotational strength asymmetry and strength training. I have been lurking on here from time to time over the last year or so and recently became a member and wanted to introduce myself and make a few comments on trunk rotational strength training. Especially because I have noticed that RST along with other exercise based therapies have been the topics of a lot of passion and debate.

The RST study was my primary dissertation work. It was originally designed as an RCT. But due to recruitment problems we changed it to just a treatment group. That was lesson number 1 and should hopefully address some of the comments of ďwhy wonít doctors or therapists do a long term and/or randomized study.Ē About half of the patients that were somewhat interested in the study declined to participate due to the time commitment involved. Lesson number 2 was that it is extremely difficult to obtain a homogeneous sample. That is, to find one specific type of patient with a specific type of curve. 10-16 yrs old, female, riser 0-3, <=12 months post-menarchal, single thoracic curves >20į. This phenotype is supposed to have a large number of cases but reality is not as straight forward. By the end of the study we had opened up to allow just about everyone in.

I donít believe RST is a panacea. Although I am extremely encouraged by some of the private conversations/results patientís families have shared with me over the last few years.

I believe that at least 75% of people with scoliosis have a rotational strength asymmetry. I donít see this as causative but I do see it as a contributor to the vicious cycle of progression. I also believe that strength asymmetry will be made worse as the curve progresses. (A small cohort of patients with >50į curves had profound strength asymmetry. Not published) Thus, I think trunk strength should be addressed in every patient receiving any type of scoliosis therapy. This should be extended to curves 10į-20į. The "watch and wait" group. I am convinced we are missing a HUGE treatment window.

If I could do the project over, I would follow two principles; strength and specificity. Strength is certainly important, but a more specific stimulus seems obvious to me. In essence, strength training wakes the muscles up (assuming they are asleep) and the specific exercises fine tune. Schroth, Side Shift, SEAS, CLEAR, directional breathing (Dobosiewicz Method)Ö there are probably othersÖ All of these use a specificity component and seek to re-train the neuromuscular system to control and stabilize the spine. The benefit of these therapies is that they are customized to each patient, whereas RST was using sort of the shotgun approach (strengthen everything). This was done intentionally because, from a scientific standpoint, you have to start somewhere. So we went with strength training based largely on the work of Vert Mooney. (BTW, I just read about his death yesterday here on the board. Iím in shock to say the least.) So we wanted to test strength training alone before we added anything else.

I am currently doing a postdoctoral fellowship in a completely different field but am continuing my training in muscle physiology. So follow up studies were not possible for logistical reasons, not because we didnít see promise in the results. I hope to return to the field in some fashion in the future to pick-up where we left off.

I have no monetary interest or investment in any product related to my project. In fact, we were aiming at the exact opposite. Money should not be a reason why someone canít get a treatment. As well, what good is a treatment if you have to come back on a weekly basis for it to be effective? This discriminates against people with no time or ability to make that effort. So we wanted to have a therapy that, after an initial learning/monitored exercise phase, the patient and families could be self-sufficient. We didnít quite accomplish that but we made good headway.

Feel free to send me a message if you have any questions or comments. Iíd be glad to answer whatever I can or give you my opinion from a research perspective. I will say that I am not a clinician, although I have my background and previous work in physical therapy. So of course, donít take anything I say as official treatment advice :). I think the NSF is a great foundation and I'm happy to be a part of this forum.

hdugger
01-13-2010, 06:36 PM
Thanks so much, Kevin. That's all very helpful.

Pooka1
01-13-2010, 07:31 PM
Wow great contribution! Thank you.

Can I ask if you agree with Dr. Mooney's claim in one of the papers that torso rotation is sufficient and bracing is unnecessary even during all growth spurts?

Per other comments I have read, other PT modalities (e.g., Schroth and SEAS) use bracing through growth spurts.

Also, as I am very sure you are aware, in certain connective tissue disorders that are associated with scoliosis, most exercise is contraindicated. An example would be Marfans. To the extent many people with these conditions may not be aware they have them, do you think it is dangerous for lay, untrained people to come on these fora and recommend specific PT modalities in a shotgun approach which is usually accompanied by claims that it works "every time?"

mamamax
01-13-2010, 07:45 PM
Greetings Kevin and welcome to forum. You really got my attention. I've been interested in torso rotation exercise and have wondered how this may improve chest wall/respiratory function and hope you will comment on that. Truly look forward to the contributions you may make to our discussions.

skevimc
01-14-2010, 01:20 AM
Wow great contribution! Thank you.

Can I ask if you agree with Dr. Mooney's claim in one of the papers that torso rotation is sufficient and bracing is unnecessary even during all growth spurts?

Per other comments I have read, other PT modalities (e.g., Schroth and SEAS) use bracing through growth spurts.



I am somewhat familiar with that comment from Mooney. I think it is an overstatement based how preliminary all of our results are and perhaps a bit reckless. These studies are really more like pre-pilot studies. Feasibility studies really. I would never be comfortable applying a blanket statement like that. But I'd also say that I think there is some unnecessary bracing. The trick is to find out exactly who needs what.



Also, as I am very sure you are aware, in certain connective tissue disorders that are associated with scoliosis, most exercise is contraindicated. An example would be Marfans. To the extent many people with these conditions may not be aware they have them, do you think it is dangerous for lay, untrained people to come on these fora and recommend specific PT modalities in a shotgun approach which is usually accompanied by claims that it works "every time?"

My experience lies primarily within AIS, so scoliosis as a result of Marfan's syndrome, for example, wouldn't fit as it would not be idiopathic. Outside of that, I'm not going to comment on what is or isn't appropriate for people to tell other people. That is for the moderators to decide. I have stated that I don't see RST as being 100%.

skevimc
01-14-2010, 01:34 AM
Greetings Kevin and welcome to forum. You really got my attention. I've been interested in torso rotation exercise and have wondered how this may improve chest wall/respiratory function and hope you will comment on that. Truly look forward to the contributions you may make to our discussions.

Great question. Dr. Asher, one of my mentors, really wanted to test respiratory function. We didn't have access to the equipment until half way through the study. This is an outcome measure that is frequently overlooked (clinically and scientifically, everyone is so concerned with Cobb angle. Forrest... trees...:) ). Anyway, I could easily make the case that it would/could improve it. But it would all be theoretical.

You should check out the Dobosiewicz Method. This is a group from Poland that works on 'directional breathing'. I spoke with them at a conference and they gave me one of their articles. It is written in polish so I can't read it but the pictures are pretty interesting. Do a Google Scholar search and see if anything pops up. I think I remember she presented some results at another conference and she had another younger guy working with her, i.e. someone to continue the work. They might have something published by now.

tonibunny
01-14-2010, 01:56 AM
My experience lies primarily within AIS, so scoliosis as a result of Marfan's syndrome, for example, wouldn't fit as it would not be idiopathic.


Hi Kevin, thanks for posting, what you have to say is very interesting :)

The trouble with Idiopathic Scoliosis is that there are plenty of people who could have undiagnosed connective tissue disorders. I'm 34 and have spent most of my life believing that I had Infantile Idiopathic Scoliosis, having been diagnosed at the age of 6 months with a 60+/40+ curve. Despite treatment throughout my childhood and several surgeries through my life I have only just been diagnosed as having Ehlers-Danlos Syndrome, which is almost certainly the cause of me developing so severe a scoliosis at such an early age. Given the number of people with scoliosis that I know who have joint hypermobility and other symptoms, I think it's entirely likely that there will be plenty of people diagnosed with AIS who actually have undiagnosed connective tissue disorders.

Pooka1
01-14-2010, 05:46 AM
WHoops! Clicking on the link in the email to this thread response, I did not see Tonibunny's response which makes the same point about misdiagnosed causes of scoliosis (the "AIS" presumption if you will). It seems certain that some fraction of the subject patients in ALL AIS studies in fact do not have AIS but instead a connective tissue disorder of some type which may or may not react differently to PT and bracing. This seems like a potentially large confounder.


(snip) I would never be comfortable applying a blanket statement like that. But I'd also say that I think there is some unnecessary bracing. The trick is to find out exactly who needs what.

"Some" unnecessary bracing is probably an understatement also. :)

As you know, it is very hard to do a controlled study in this field. Braist is trying. Then there is the inherent variability of the condition.


My experience lies primarily within AIS, so scoliosis as a result of Marfan's syndrome, for example, wouldn't fit as it would not be idiopathic.

My point was that most, if not all, cases of emergent Marfans are diagnosed as AIS initially. A kid might have the condition yet not meet the diagnostic criteria until they reach adulthood. For example, my kids do not now meet the diagnostic criteria for Marfans and yet were recommend to get yearly aortic monitoring because they have enough indicators to warrant that. They presently have a diagnosis of "AIS." The incidence rate of Marfans, while very low in the general populace is of course much higher in the scoliosis crowd.

I think people are in danger of taking random advice from fora like this to their detriment though agree with you that it is a moderator issue. And I think both the PT and bracing literature could be cleaner if researchers could somehow identify these connective tissue disorder (and potential) cases as some are known to be resistant to bracing and possibly to PT also. The result is to muddy the study and perhaps artificially skew the results towards apparent lower efficacy.

mamamax
01-14-2010, 05:54 AM
Great question. Dr. Asher, one of my mentors, really wanted to test respiratory function. We didn't have access to the equipment until half way through the study. This is an outcome measure that is frequently overlooked (clinically and scientifically, everyone is so concerned with Cobb angle. Forrest... trees...:) ). Anyway, I could easily make the case that it would/could improve it. But it would all be theoretical.

You should check out the Dobosiewicz Method. This is a group from Poland that works on 'directional breathing'. I spoke with them at a conference and they gave me one of their articles. It is written in polish so I can't read it but the pictures are pretty interesting. Do a Google Scholar search and see if anything pops up. I think I remember she presented some results at another conference and she had another younger guy working with her, i.e. someone to continue the work. They might have something published by now.

Thank you Kevin. Too bad the equipment was not available from the start of that project, though I dare say that if there was an improvement in respiratory function, that this improvement may have been observable in body changes to the chest area. I say this based upon the work of Martha Hawes in relation to her documented work which has focused on improved chest wall/respiratory function over the last 15 years. There is some argument that Martha has engaged many methods - however, her daily focus has been on chest wall/respiratory improvement.

I'm only a tad familiar with the Schroth method of rotational breathing. I'm unfamiliar with the Dobosiewicz Method and would very much like to see the full text version of a paper I recently stumbled across: http://www.ncbi.nlm.nih.gov/pubmed/17108438

I ponder that the literature suggests that most IS patients have some degree of respiratory impairment, along with Martha's documented work, and many anecdotal reports of those who find both spinal improvement along with methods they have used like Yoga, Pilates, Schroth .. all of which do in some fashion improve respiratory function. Something worth further documented investigation in my opinion. Makes me wonder if a focus on respiratory improvement may prove of (at least some) benefit for all.

Dingo
01-14-2010, 08:43 AM
Hi Dr. McIntire

You may be interested to know that another study on what I believe is TRS has already been completed and is awaiting publication.

The effect of asymmetrical weight training on paraspinal muscle activity in scoliosis (http://www.forschungsportal.ch/unizh/p7882.htm)

You might also find this study interesting.

2007: Decrease of electromyographic activity of concave paraspinal muscles in scoliotic girls after specific soft tissue therapy (http://www.scoliosisjournal.com/content/2/S1/S1)


Conclusion: A single session of specific soft tissue therapy decreased the bioelectrical activity of the paraspinal back muscles at the concave side of thoraco-lumbar scoliosis.

aterry
01-14-2010, 08:44 AM
Thanks for posting Kevin. Your discussion of your work and the subsequent questions posted are very helpful.

Dingo
01-14-2010, 08:53 AM
Dr. McIntire do you have any comment on the conclusion from this study? It appears to offer further support for your work on TRS.

Relation between adolescent idiopathic scoliosis and morphologic somatotypes. (http://www.ncbi.nlm.nih.gov/pubmed/9383860)


RESULTS: Patients with progressive adolescent idiopathic scoliosis showed significantly less mesomorphism (mean value of 0.88 +/- 0.51) than control girls (mean value of 1.72 +/- 0.52). CONCLUSION: Adolescent girls with progressive adolescent idiopathic scoliosis have a morphologic somatotype that is different from the normal adolescent population. Subjects with progressive adolescent idiopathic scoliosis are significantly less mesomorphic than control girls. This observation may be of value as a predictive factor for early identification of subjects with adolescent idiopathic scoliosis at greater risk of progression.

Dingo
01-14-2010, 09:02 AM
Dr. McIntire


I have no monetary interest or investment in any product related to my project. In fact, we were aiming at the exact opposite. Money should not be a reason why someone canít get a treatment. As well, what good is a treatment if you have to come back on a weekly basis for it to be effective? This discriminates against people with no time or ability to make that effort. So we wanted to have a therapy that, after an initial learning/monitored exercise phase, the patient and families could be self-sufficient. We didnít quite accomplish that but we made good headway.

I think your effort in this direction is brilliant.

Would it be possible for you to film a short video that shows the "at home" exercise you developed for this study? Treatment of Adolescent Idiopathic Scoliosis With Quantified Trunk Rotational Strength Training: A Pilot Study (http://journals.lww.com/jspinaldisorders/Abstract/2008/07000/Treatment_of_Adolescent_Idiopathic_Scoliosis_With. 10.aspx)

Putting a video on YouTube costs nothing and it would help thousands of people around the world who don't have access to a MedX or similar machine. People are visual. :)

skevimc
01-14-2010, 03:57 PM
The trouble with Idiopathic Scoliosis is that there are plenty of people who could have undiagnosed connective tissue disorders. ...
Given the number of people with scoliosis that I know who have joint hypermobility and other symptoms, I think it's entirely likely that there will be plenty of people diagnosed with AIS who actually have undiagnosed connective tissue disorders.


... It seems certain that some fraction of the subject patients in ALL AIS studies in fact do not have AIS but instead a connective tissue disorder of some type which may or may not react differently to PT and bracing. This seems like a potentially large confounder.
....

My point was that most, if not all, cases of emergent Marfans are diagnosed as AIS initially. A kid might have the condition yet not meet the diagnostic criteria until they reach adulthood. ...

The incidence rate of Marfans, while very low in the general populace is of course much higher in the scoliosis crowd.

And I think both the PT and bracing literature could be cleaner if researchers could somehow identify these connective tissue disorder (and potential) cases as some are known to be resistant to bracing and possibly to PT also. The result is to muddy the study and perhaps artificially skew the results towards apparent lower efficacy.

You both make very good points. A misdiagnosed connective tissue disorder seems dangerous for a number of reasons. I think it would be a worthy addition to the exercise studies. Mentioning connective tissue disorders as a screening criteria would be a good thing. As you all have mentioned, it's the undiagnosed cases that might cause problems. There's always room for more research. The more we learn the less we know.



I'm unfamiliar with the Dobosiewicz Method and would very much like to see the full text version of a paper I recently stumbled across: http://www.ncbi.nlm.nih.gov/pubmed/17108438

I ponder that the literature suggests that most IS patients have some degree of respiratory impairment, along with Martha's documented work, and many anecdotal reports of those who find both spinal improvement along with methods they have used like Yoga, Pilates, Schroth .. all of which do in some fashion improve respiratory function. Something worth further documented investigation in my opinion. Makes me wonder if a focus on respiratory improvement may prove of (at least some) benefit for all.



I have the Dobosiewicz paper. I tried to scan it earlier and it didn't turn out so well. I'll tinker around with it and try to send it to you. That abstract was the presentation I saw.


Hi Dr. McIntire

You may be interested to know that another study on what I believe is TRS has already been completed and is awaiting publication.

The effect of asymmetrical weight training on paraspinal muscle activity in scoliosis (http://www.forschungsportal.ch/unizh/p7882.htm)

You might also find this study interesting.

2007: Decrease of electromyographic activity of concave paraspinal muscles in scoliotic girls after specific soft tissue therapy (http://www.scoliosisjournal.com/content/2/S1/S1)

The asymmetrical versus symmetrical exercise was probably one of the most asked questions I received when I would present my work. If they're weak on one side, why not strengthen just that side. The simple answer is that paraspinal muscles on both sides of the spine are active during rotations in either direction? Presumably, while one side is assisting with the movement the other side is assisting stabilization. So exercising in both directions allows the muscles to function in both roles. I have some EMG data but it is probably too messy to publish. EMG filtering and analysis can be pretty complex especially if you have a lot of noise, which I do in several of my trials.

The EMG ratios are very interesting to me. It's hard to know if this change in ratio means anything though, just based on the abstract. There's an article by Cheung et al 2005 linking these ratios to progressive versus non-progressive curves. A significant difference between the ratios for progressive versus non-progressive curves at the lower end vertebral level was found in supine, sitting and standing positions.


Dr. McIntire do you have any comment on the conclusion from this study? It appears to offer further support for your work on TRS.

Relation between adolescent idiopathic scoliosis and morphologic somatotypes. (http://www.ncbi.nlm.nih.gov/pubmed/9383860)

This study was the reason we measured the full somatotype. We didn't find the exact same thing, we found that non-scoliotic girls were more endomorphic. But I'm not confident about the statistical procedure we used. Their cohort was also much larger.




Would it be possible for you to film a short video that shows the "at home" exercise you developed for this study?

Putting a video on YouTube costs nothing and it would help thousands of people around the world who don't have access to a MedX or similar machine. People are visual. :)

That's an interesting suggestion. Researchers and clinicians should definitely begin to use the media outlets that are available. It's one of the reasons I decided to come on the forum here. My interests lie in translational research and I have a passion for scientific communication. Going to the public/patient population with information instead of waiting for it to filter down through changes in clinical dogma could have a pretty big impact on the way we do certain clinical trials. Although, there are also some inherent pitfalls with that as well. We're definitely in an era of major changes.

Pooka1
01-14-2010, 04:04 PM
The more we learn the less we know.

If I didn't know you held a research doctorate before, I would have guessed you did just based on this comment. It's a common sentiment. Research is hard. :)

And of course most published research results are false.

mamamax
01-14-2010, 04:59 PM
I have the Dobosiewicz paper. I tried to scan it earlier and it didn't turn out so well. I'll tinker around with it and try to send it to you. That abstract was the presentation I saw.


Thanks Kevin - I'd enjoy looking over that.

Dingo
01-14-2010, 09:37 PM
Skevimc


That's an interesting suggestion. Researchers and clinicians should definitely begin to use the media outlets that are available. It's one of the reasons I decided to come on the forum here. My interests lie in translational research and I have a passion for scientific communication. Going to the public/patient population with information instead of waiting for it to filter down through changes in clinical dogma could have a pretty big impact on the way we do certain clinical trials.

I just did a quick search on YouTube and over 5 pages of videos popped up for "scoliosis exercise". There is a lot of interest because many of them have thousands of views. A short video with a disclaimer could start helping kids immediately. Many parents can't or won't take their kid to a gym no matter how motivated the child is. However most parents would spring $20 for a few exercise bands.

YouTube: scoliosis exercise (http://www.youtube.com/results?search_query=scoliosis+exercise&search_type=&aq=f)

Pooka1
01-30-2010, 09:27 AM
Feel free to send me a message if you have any questions or comments. I’d be glad to answer whatever I can or give you my opinion from a research perspective.

Dr. McIntire,

A few questions:

1. I realize you have a different post doc area (still within muscle physiology) but are you aware of any other researchers who look at the torso rotation literature and are going forward with more research at this time? That is, is it viewed as a fruitful area of PT-based research?

2. Some folks here have said they were specifically told torso rotation, twisting, etc. was contraindicated for scoliosis. Do you know the basis for this admonition? I suspect it rests on very little evidence. I mean I don't think people were studying torso rotation enough to say that it should be avoided.

3. There are many PT approaches out there at the moment for scoliosis. Do you consider Torso rotation to be the most promising at the moment by far?

Thanks.

mamamax
01-30-2010, 09:46 AM
2. Some folks here have said they were specifically told torso rotation, twisting, etc. was contraindicated for scoliosis. Do you know the basis for this admonition? I suspect it rests on very little evidence. I mean I don't think people were studying torso rotation enough to say that it should be avoided.


I'm one of those folks.

Questioning the advice (given to me by a surgeon), I was told that large sweeping rotations were to be avoided - but that short rotations "probably would do no harm." This advise was given relative to a conversation about exercise in general, and was based on my right thoracic, left thoracolumbar pattern.

I was not told that the twisting exercise (large sweeping rotation), was contraindicated for scoliosis ... I was told it was contraindicataed for me and my curvature pattern/condition (and we must understand that in my specific case, age may be a factor - don't know, didn't ask).

Again, the advice also indicated that short rotations were not an exercise issue for me. It's my understanding that the MedX machine involves short rotation. The studies interest me enough that I will visit a facility out in Portland Oregon next time I am out there.

I didn't think much about that really until we began discussing such things here. Now I would like to know more - thanks for listing this as a question Sharon.

Pooka1
01-30-2010, 04:47 PM
I don't see how your surgeon can be basing any of those comments (what's okay and what isn't) on any evidence.

mamamax
01-30-2010, 06:46 PM
I don't see how your surgeon can be basing any of those comments (what's okay and what isn't) on any evidence.

I'll convey your concerns next I see him :D

Pooka1
01-30-2010, 06:54 PM
I'll convey your concerns next I see him :D

Thanks but be sure and use my screen name, not my real name. :)

But seriously, since you are interested in this torso rotation stuff, maybe you can ask him to pony up the research articles that he is basing his comments on.

mamamax
01-30-2010, 07:10 PM
Thanks but be sure and use my screen name, not my real name. :)

But seriously, since you are interested in this torso rotation stuff, maybe you can ask him to pony up the research articles that he is basing his comments on.

No prob. Honestly I don't think he just pulled this advice out of the air - certainly he has a reason for it - I'll find out what that reason is. Our conversation was relative to an exercise program I was trying to put together for myself - which did not involve the MedX machine.

Yes, I am interested in the MedX and its current and future rehab applications.

Pooka1
01-31-2010, 09:56 AM
Dr. McIntire, one more question if I'm not over my limit...

A mother of a patient just wrote: "They taught her to avoid twisting or extra turning as that can increase the torque of the spine."

Were you aware Schroth is telling people that torso rotation is to be avoided?

mamamax
01-31-2010, 06:04 PM
There are many exercises that Schroth recommends patients not do. Because they can worsen the condition. These are covered in the book that I have which is written by By Christa Lehnert-Schroth, who is a Physical Therapist.

This could explain why my surgeon said something similar about wide sweeping rotation, also stating that short rotation would probably be ok - maybe he knows a bit more about these things than the average surgeon.

Here's an example of exercises not recommended by Schroth for scoliosis patients: http://www.schrothmethod.com/about/yoga-for-scoliosis-menu.

In the example - note the wide sweeping rotation of the spinal twist. I do not believe the MedX machine operates in the same manner, and that it can be modified to short rotational movements.

Pooka1
01-31-2010, 06:34 PM
From that link, they say avoid "Twisting the torso."

Therefore they are saying not to do torso rotation.

More verbiage indicating torso rotation is completely out per Schroth...


2) AVOID ALL ROTATIONS OF THE SHOULDER GIRDLE AND RIB CAGE AGAINST THE PELVIC GIRDLE

The central segment, the rib hump, is enlarged as it rotates backwards into the existing curvature, regardless of whether the rotation is to the left or right side.

Spinal Twist - Ardha Matsyendrasana (photos in sidebar at left)
This exercise is excellent for straight, normal backs. In it, the internal organs are squeezed, that is, freed of waste.

However, people with scoliosis should absolutely avoid the Spinal Twist. A scoliotic body usually has three or four contortions (counter-rotations) between the pelvis, rib cage, and shoulder girdle. These are exacerbated by twisting the shoulder girdle against the pelvic girdle while the middle section, the rib cage, is ignored.

That middle section is precisely where the prominent rib hump is located, and on the other side the rib valley. Whether the torso is twisted left or right, the rib hump and the rib valley will increase. If you twist so far that you can hear your spine crack, that is a sign that the spinal rib joints are moving further into an abnormally twisted state. It does no good to do this movement once to the right and once to the left: it is counterproductive in both cases.

Triangle - Trikonasana
To be completely avoided in scoliosis, because here the shoulder girdle is twisted against the pelvic girdle and the middle section (which thereby creates a rib hump) must follow after the more comfortable side.
Other inappropriate twisting exercises for scoliosis

* Bharadvajasana - Seated twist
* Marichyasana - Sage twist

mamamax
01-31-2010, 06:48 PM
so - my question to Kevin is:

Does the MedX (to his knowledge), rotate the shoulder girdle and rib cage against the pelvic girdle.

And if so, can it be modified to do so in a "harmless" fashion for the scoliosis patient (i.e., very short rotations vs long and wide sweeping)?

Pooka1
01-31-2010, 06:57 PM
so - my question to Kevin is:

Does the MedX (to his knowledge), rotate the shoulder girdle and rib cage against the pelvic girdle.

And if so, can it be modified to do so in a "harmless" fashion for the scoliosis patient (i.e., very short rotations vs long and wide sweeping)?

Torso rotation EQUALS, IS, IN OTHER WORDS, to "rotate the shoulder girdle and rib cage against the pelvic girdle. Short versus long twisting is still all twisting which is OUT per Schroth.

I don't think we need a PhD in rehab therapy specializing in muscle physio to teach us English.

There is no room to disagree whatsoever. Schroth and torso rotation are at complete odds in terms of claims about this PT. Therefore someone is right and someone is wrong. The question is, which camp is right and which camp is wrong.

I suggest there is no evidence case for either camp to decide the matter.

mamamax
01-31-2010, 07:13 PM
Torso rotation EQUALS, IS, IN OTHER WORDS, to "rotate the shoulder girdle and rib cage against the pelvic girdle. Short versus long twisting is still all twisting which is OUT per Schroth.

I don't think we need a PhD in rehab therapy specializing in muscle physio to teach us English.

There is no room to disagree whatsoever. Schroth and torso rotation are at complete odds in terms of claims about this PT. Therefore someone is right and someone is wrong. The question is, which camp is right and which camp is wrong.

I suggest there is no evidence case for either camp to decide the matter.

I don't think it is that simple Sharon.

The Schroth examples are of very very long twist/rotation. This is not the same thing as very very short twist/rotation. As my doctor pointed out when we were discussing exercise options for me.

Schroth is not saying never twist the torso - they are saying to not do exercises which involve a long twist/rotation, as per their example.

Pooka1
01-31-2010, 07:15 PM
Schroth is not saying never twist the torso

Yes they are. Here is a direct quote:


AVOID ALL ROTATIONS OF THE SHOULDER GIRDLE AND RIB CAGE AGAINST THE PELVIC GIRDLE

(emphasis added to draw your attention to the relevant word)

Pooka1
01-31-2010, 07:17 PM
You are trying to argue that "all" does not mean "all." You will never succeed at this hopeless endeavor. :)

mamamax
01-31-2010, 07:19 PM
Yes they are. Here is a direct quote:


AVOID ALL ROTATIONS OF THE SHOULDER GIRDLE AND RIB CAGE AGAINST THE PELVIC GIRDLE
(emphasis added to draw your attention to the relevant word)


I think that is taking one sentence out of context - and not applying it to the entire article.

Pooka1
01-31-2010, 07:19 PM
I think that is taking one sentence out of context - and not applying it to the entire article.

I posted the ENTIRE context in one of the posts. Even if I failed to do that (which I didn't), point to where the context was needed to interpret "all."

Why are you avoiding the obvious? What's the problem with accepting that Schroth and Torso Rotation are at complete odds? Why is that impossible for you to accept? I don't get it. :confused:

mamamax
01-31-2010, 07:28 PM
Why are you avoiding the obvious? What's the problem with accepting that Schroth and Torso Rotation are at complete odds? Why is that impossible for you to accept? I don't get it. :confused:


They site an example of what they are talking about. The example is: of a long sweeping rotation. That is what they are talking about.

An exaggerated movement.

That's how I read it anyway - and it makes sense to me, especially in light of what my surgeon also discussed with me.

Would be nice if we could get a Physical Therapist to comment on this.

Pooka1
01-31-2010, 07:35 PM
They site an example of what they are talking about. The example is: of a long sweeping rotation. That is what they are talking about.

An exaggerated movement.

That's how I read it anyway - and it makes sense to me, especially in light of what my surgeon also discussed with me.

Would be nice if we could get a Physical Therapist to comment on this.

It's important to read what is actually there. They said "ALL." Perhaps we can agree that "all" includes "short," yes?

There is no difference whatsoever between the examples cites, the pictures shown, and torso rotation in a med-ex machine. The common denominator is opposite movement of the shoulders with respect to the pelvis about a central vertical axis.

As with everything, boil it down. We could cut out 90% of our less productive exchanges if you would do this one thing.

mamamax
01-31-2010, 07:59 PM
It's important to read what is actually there. They said "ALL." Perhaps we can agree that "all" includes "short," yes?

There is no difference whatsoever between the examples cites, the pictures shown, and torso rotation in a med-ex machine. The common denominator is opposite movement of the shoulders with respect to the pelvis about a central axis.

As with everything, boil it down. We could cut out 90% of our less productive exchanges if you would do this one thing.

Yes - we would hardly exchange any ideas if we both saw things the same way :D

The word ALL bty - appears as an instruction regarding which yoga poses not to do.

You see no difference between the yoga pose and the MedX rotation?

I do. One (yoga) is an exaggeration of the movement and the other (MedX) is not an exaggerated movement.

We may just have to agree to disagree on this one and hope that someone with more knowledge than either of us (like a Physical Therapist) stops by to make more sense of it all.

Pooka1
01-31-2010, 08:01 PM
You see no difference between the yoga pose and the MedX rotation?

No.

...


...

mamamax
01-31-2010, 08:05 PM
Do the yoga pose.

Then sit in a chair and rotate the torso say 1 to 2 inches back and forth in either direction.

big difference.

Pooka1
01-31-2010, 08:13 PM
Then sit in a chair and rotate the torso say 1 to 2 inches back and forth in either direction.

This description does not match what what little girl on the video was doing AT ALL. Is the girl on the video doing "torso rotation?"

I suggest NOBODY who is doing torso rotation would consider "1 to 2 inches back and forth in either direction" to be torso rotation PT.

mamamax
01-31-2010, 08:37 PM
1-2" rotations could be considered a rotational exercise, especially in a rehabilitation situation.

The little girl in the video is doing more than that: http://www.wcsh6.com/news/health/story.aspx?storyid=92954&catid=8

And far less (as I see it) than in the yoga pose.

Pooka1
01-31-2010, 08:43 PM
[COLOR="Navy"]1-2" rotations could be considered a rotational exercise, especially in a rehabilitation situation.

I doubt that and anyway the context of our discussion is torso rotation PT for scoliosis. Schroth says no and torso rotationists(:)) say YES. Someone is wrong as a metaphysical certainty. I am further suggesting no one in that field would include 1 to 2 inches of twist to be torso rotation PT for scoliosis.


And far less (as I see it) than in the yoga pose.

She appears to be twisting about as much as the yoga photos to me. Anyway she's doing far more than 1-2 inches.

leahdragonfly
01-31-2010, 08:50 PM
I have only been loosely following this thread, but I want to shed some light on the above argument by clarifying the MedX exercise above with some facts.

I swim regularly at an athletic club, and I recently decided to add in some weight training on resistance machines. I received an hour of training on the proper use of the machines with a personal trainer last week. Just so happens my club has a MedX Rotary Torso Machine. It says right on it in large letters, and I was also told by the trainer, that "the largest range of motion that doesn't result in pain" is the recommended method of performing the exercise. When I was shown the exercise, it was demonstrated to sit with one's hips and knees pointing straight forward, and the starting position is with the shoulders and torso facing 90 degrees to (whichever) side, then making what I would call large sweeping motions to the 90-degree position (in the opposite direction) of the shoulders in relation to the pelvis. This range of motion is FAR more than "just a few inches" in either direction. And BTW, I too have seen the video of the little girl, and she is moving way more than a few inches in eather direction.

Pooka1
01-31-2010, 08:58 PM
Thanks for that, Gayle. Facts are always in order. :)

Considering even the minuscule amount of research there is on torso rotation, I don't think Schroth has a leg to stand on in suggesting it should be avoided. That is to say, I think we know enough to say it doesn't exacerbate curves.

Dingo
01-31-2010, 09:29 PM
For what it's worth this is from the original study on torso rotation by Dr. Vert Mooney.

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


To allow standardized evaluation for this study, torso rotation was restricted to 36 degrees in each direction.

If I understand the machine correctly at the end of a 90 degree turn the user is facing at a right angle. In Mooney's study they rotated left or right 36 degrees which is about a third of that distance. That's a fairly small range of motion.

To be honest I didn't realize until just now that they were using such small movements for this type of PT.

Maybe Mooney used 36 degrees because from a purely mechanical standpoint it made sense. His goal was to build symmetric muscle mass and small turns can accomplish that. Furthermore if the spine is already twisted too far in one direction why press your luck and rotate it even further?

Dingo
01-31-2010, 10:00 PM
Leahdragonfly


Just so happens my club has a MedX Rotary Torso Machine.

You are one of the few people on this board who have access to a MedX.

Why not have your daughter try it for 6 or 8 weeks and see if there is any difference? It's only twice per week, a few minutes each time. I'm sure Dr. McIntire would give you some pointers. Worst case scenario it will make no difference at all.

After Scott started doing my best at home "imitation" of the MedX torso rotation movement my wife and I noticed a difference in about a month.

mamamax
02-01-2010, 06:07 AM
To be honest I didn't realize until just now that they were using such small movements for this type of PT.

Maybe Mooney used 36 degrees because from a purely mechanical standpoint it made sense. His goal was to build symmetric muscle mass and small turns can accomplish that. Furthermore if the spine is already twisted too far in one direction why press your luck and rotate it even further?

Exactly. Maybe the machine was adjusted for the condition (scoliosis) - to the 36 degrees vs 90.

Pooka1
02-01-2010, 06:34 AM
Exactly. Maybe the machine was adjusted for the condition (scoliosis) - to the 36 degrees vs 90.

This amount is still far larger than you were talking about. In other words, Schroth, your surgeon, and anyone else telling people to avoid torso rotation are not doing it on the basis of any study. So the question remains why are they telling people this.

There is such a paucity of research for and against that it is impossible to say anything with any certainty.

Pooka1
02-01-2010, 06:38 AM
And by the way, like Spinecor is standardizing on 20 hours a day for brace wear, 36* is not magical. It is just a point that one researcher chose to standardize on. Nobody did any work to show 36* was right and 29* or 42* or 54* is wrong. It's all up in the air. It may be that if this PT approach works, it will require larger twists., Nobody knows.

Dingo
02-01-2010, 09:16 AM
Mamamax


Exactly. Maybe the machine was adjusted for the condition (scoliosis) - to the 36 degrees vs 90.

It looks like it's time to fine tune Scott's exercises again.

Scott does rotations with a large exercise ball. He rotates almost 90 degrees each direction. I'm going to find a way to cut that back to 45 degrees each way but still keep the energy in the movement.

I'm going to try and fine tune Scott's lying rotation movement as well.

If he was about eight years old (and I didn't have a MedX) I'd do Scott McIntire's "at home" exercise from his 2008 study. It's probably as close as you can get to a "MedX" type of movement.

Study: Treatment of adolescent idiopathic scoliosis with quantified trunk rotational strength training: a pilot study. (http://www.ncbi.nlm.nih.gov/pubmed/18600146)

hdugger
02-01-2010, 10:12 AM
Gayle,

Would you mind PMing me the name of the gym? My son will be in town over some of the summer break, and I'd love to have him try it out.

Thanks!

hdugger
02-01-2010, 10:16 AM
On the overall question, I think the issue is that Schroth has an overarching theory about scoliosis, but very little of it is backed up with solid research. Not to diss the Schroth folk - even the surgeons don't understand what causes scoliosis.

BTW, this reliance on a consistent theory is one of the problems that the SEAS folks stated they were addressing. They felt that other exercise practices were bound by their overarching theory, which lead them to include some things that don't work and omit some things that do work, while the SEAS people will include any exercise that's shown promise.

skevimc
02-01-2010, 12:04 PM
Dr. McIntire,

A few questions:

1. I realize you have a different post doc area (still within muscle physiology) but are you aware of any other researchers who look at the torso rotation literature and are going forward with more research at this time? That is, is it viewed as a fruitful area of PT-based research?

2. Some folks here have said they were specifically told torso rotation, twisting, etc. was contraindicated for scoliosis. Do you know the basis for this admonition? I suspect it rests on very little evidence. I mean I don't think people were studying torso rotation enough to say that it should be avoided.

3. There are many PT approaches out there at the moment for scoliosis. Do you consider Torso rotation to be the most promising at the moment by far?

Thanks.

Wow.. I go away for a weekend and come back to this... :)

1. Yes.. I know of one PT in TX who is just beginning her PhD. Her project has changed a bit from when I began communicating with her, but I think trunk rotation and para-spinal musculature is the basic idea. I'll ask her if she minds if I say more about her project.

2. To my knowledge there are camps that say twisting is contraindicated, side bends are contraindicated and extensions are contraindicated. For example, we tended to think that extensions were contraindicated because of thoracic hypokyphosis. So while Mooney et al used back extensions, we avoided them. No scientific reason just theoretical. My assumption is that it has to do with what you think will be aggravating to the spine. Rotation has the potential to increase rib hump when rotating towards the convexity. Is this documented? No. Is this bad? I don't think so. Evidently that Schroth person thinks it is.

I toured Dr. Weiss' facility in Germany. A truly amazing set-up they have. He is very close to my mentor Dr. Asher. We discussed our project with him. I also shadowed their head therapist (Axel Hennes) who is an amazing therapist as well. Never, did they say that sweeping rotations would be contraindicated. Perhaps their ideas have changed now. But I discussed the proposed physiology of our study and Schroth at length. Because we are strengthening, the rotation of the spine should not become unstable.

I think the worry is that rotations can lead to flexibility. When the overall strategy is to sort of decrease flexibility. We're shooting for rigidity (sort of). Another type of example is with stroke survivors (most of my PhD student peers did stroke research). Stroke survivors have spasticity and causes their arms and legs to remain flexed and mostly un-usable. So a therapeutic idea is to increase range of motion thereby making the joint more functional. HOWEVER, if you increase ROM but don't increase strength, then you have created an unstable range that might expose the joint to injury. Therefore an idea is to strengthen within the functional range of motion and if ROM increases due to strengthening, then it has happened in a more stable way. (Hopefully that makes sense).

3. "by far"?? No. But I see strengthening as a fundamental principle that many PT protocols are overlooking. That is, strength needs to be the foundation. Then function and form. Get it strong, then teach it specifics. A bad analogy: You wouldn't begin teaching a creative writing course if the students didn't know about spelling and grammar.


Dr. McIntire, one more question if I'm not over my limit...

A mother of a patient just wrote: "They taught her to avoid twisting or extra turning as that can increase the torque of the spine."

Were you aware Schroth is telling people that torso rotation is to be avoided?

You're never over your limit... it just might take a while to answer. And it never hurts to repeat the question if I'm missing a question or point.

I was not aware the Scroth people are saying this.

To answer the basic question floating around here the last couple of days. There is no evidence against any type of exercise of which I am aware. It's all theoretical.


I'll try to wade through the rest of the thread and answer what I can.

skevimc
02-01-2010, 12:10 PM
F
If I understand the machine correctly at the end of a 90 degree turn the user is facing at a right angle. In Mooney's study they rotated left or right 36 degrees which is about a third of that distance. That's a fairly small range of motion.


Maybe Mooney used 36 degrees because from a purely mechanical standpoint it made sense. His goal was to build symmetric muscle mass and small turns can accomplish that. Furthermore if the spine is already twisted too far in one direction why press your luck and rotate it even further?

We just followed Mooney's lead. However, I did notice that some of my adult subjects had difficulty reaching the 36į pre-rotated position. As well, for some patients the pre-rotated positions were a bit difficult. There are other trunk rotation strength studies in healthy adults that go out to 54į. Check out S. Kumar and trunk rotational strength. So 36į was used because we weren't sure if the patients would have difficulty.

Pooka1
02-01-2010, 12:11 PM
(snip)

To answer the basic question floating around here the last couple of days. There is no evidence against any type of exercise of which I am aware. It's all theoretical.

As I suspected.


I'll try to wade through the rest of the thread and answer what I can.

1,000 thank yous. We are very lucky to have a researcher in a relevant field on this forum.

mamamax
02-01-2010, 04:50 PM
This amount is still far larger than you were talking about. In other words, Schroth, your surgeon, and anyone else telling people to avoid torso rotation are not doing it on the basis of any study. So the question remains why are they telling people this.

There is such a paucity of research for and against that it is impossible to say anything with any certainty.

My example was an exaggeration for sake of illustration - which was futile.

36 degrees is within the range my surgeon was talking about (short rotation) vs long sweeping - 90 degrees.

mamandcrm
02-01-2010, 05:36 PM
Hi there, I read these threads with interest and have a question based on a thought you had in one of your recent posts (sorry I don't have that "quote" function thing down). My daughter wears a Rigo-Cheneau full-time. She does not do Schroth therapy--she is too young and so we simply have not looked into it. BUT we were advised (by our orthotist, not the surgeon who does not discourage any type of exercise for the reasons you have cited--no evidence that anything aggravates scoliosis) that she not do gymnastics (rotation/twisting), which was not an issue for us because she has no interest in it so I did not ask "why?". You had a comment that maybe the Schroth folks advise against the twisting because it may promote flexibility and thus encourage curvature I suppose. It caught my attention because my daughter's really good results with this brace are attributed (by all), in large part, to her flexibility (which at this stage, comes mostly from her young age). Does that give you any cause to re-think or is that consistent in some way I am not thinking of? Just trying to keep you busy:) Thanks

Pooka1
02-01-2010, 05:43 PM
My example was an exaggeration for sake of illustration - which was futile.

36 degrees is within the range my surgeon was talking about (short rotation) vs long sweeping - 90 degrees.


There is zero evidence long sweeping motions should be avoided.

skevimc
02-01-2010, 11:52 PM
You had a comment that maybe the Schroth folks advise against the twisting because it may promote flexibility and thus encourage curvature I suppose. It caught my attention because my daughter's really good results with this brace are attributed (by all), in large part, to her flexibility (which at this stage, comes mostly from her young age). Does that give you any cause to re-think or is that consistent in some way I am not thinking of? Just trying to keep you busy:) Thanks

Thanks for the question.

It doesn't cause me to rethink because I think rotation is probably a good thing.... or at the very least not a bad thing, because I'm basing it on strength.

I think there is a thought among some therapists that too much flexibility can be a bad thing. Especially when spinal stability is the goal. As well, with the Schroth therapists, their statement is that no matter which way you rotate, at least one part of the spine is being rotated further, thus allowing more freedom for the spine to progress.

I think rotation is arguably one of the most vicious components of scoliosis. Which might be another reason people are inclined to avoid rotation. A 35* curve with 5* rotation looks much different than the same size curve but 15* of rotation. However, it is for this reason that I think rotation is important to address. Brace management usually uses some sort of rotation control, or theoretical de-rotation. And surgery definitely addresses rotation. Why would a therapy avoid rotation?

But again... it's mostly theoretical.... can't we all just get along?

Hopefully I addressed your question. If not, please re-ask. :)

mamamax
02-02-2010, 06:06 AM
Thank you for your comments Kevin and yes I think the rotational element (in regards to scoliosis) is something important to address.

Here's what one of our Physical Therapist members said about such things some months back (thank you Betty14) ...



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

Personally, I would very much like to use the MedX with a Physical Therapist, preferably Schroth trained, modified to suit my individual curvature. Maybe one day :-)

mamamax
02-02-2010, 06:09 AM
Mamamax



It looks like it's time to fine tune Scott's exercises again.

Scott does rotations with a large exercise ball. He rotates almost 90 degrees each direction. I'm going to find a way to cut that back to 45 degrees each way but still keep the energy in the movement.

I'm going to try and fine tune Scott's lying rotation movement as well.

If he was about eight years old (and I didn't have a MedX) I'd do Scott McIntire's "at home" exercise from his 2008 study. It's probably as close as you can get to a "MedX" type of movement.

Study: Treatment of adolescent idiopathic scoliosis with quantified trunk rotational strength training: a pilot study. (http://www.ncbi.nlm.nih.gov/pubmed/18600146)

Thank Dingo - and you may be correct. You certainly have been so far in regards to your son's specific case. You have a great doctor - wonder what he would say?

Dingo
02-02-2010, 08:37 AM
Mamamax


You have a great doctor - wonder what he would say?

To the best of my knowledge my son goes to the best Scoliosis specialist in Phoenix. After his diagnosis I asked him if exercise would help. He shook his head and told me that exercise wouldn't help. I like his doctor a lot but since we don't agree on exercise I don't bring it up.

Skevimc


A 35* curve with 5* rotation looks much different than the same size curve but 15* of rotation.

You are sure right on that one. My son has a small, 10 degree curve but a significant rotation. His rotation has never been measured but I can see his rib hump through all but the thickest of shirts. If it wasn't for the rotation his Scoliosis wouldn't even be visible. Scott is 6 years, 4 months old. I'm counting the months down until he turns 8. At that point we'll be on a road trip to Los Angeles to see if he fits in a MedX. :)

Dingo
02-02-2010, 09:02 AM
Skevimc

I wonder if you have an opinion on this. Braces work by applying a force to the ribs which in turn push and rotate the spine into place. Does this suggest that increasing strength in the chest could potentially help stabilize the spine?

I guess what I'm asking is does the chest provide a counterforce to help the spine stay in alignment?

titaniumed
02-02-2010, 01:11 PM
Ive never mentioned this here but I think that I will chime in with something important.

Back in 1971 when I was 13, the freestyle skiing craze was taking off and I was definitely interested. One thing that was really neat back then was the "helicopter" which is a jump with a 360 degree spin while skiing forward.

I asked one of the old pros how to learn to do it, and he told me that in order to do a helicopter, you have to be able to do these on the lawn in your backyard with your ski gear on. So, after about 10000 attempts, of bending down clockwise, and counter-rotating, counter-clockwise and jumping up, I finally figured it out. It takes a lot of force to be able to do this, and was able to perform a helicopter on the lawn with full ski gear on, and complete a full circle. 190cm skis, jumping up about 2 inches.

I have no idea how this affected my scoliosis, it happened before I was diagnosed at age 15.

You might say that was an "extreme example" of trunk rotational strength training. Ski poles also helped with the process.

I have always felt better skiing, as it builds up quite a few muscles....
Im sure all my hard crashes jumping didn’t help through the years.

In my later years, I skied with various braces. The abdominal support forced the rib cage upwards, and was of value. My surgeon commented on my physique, and told me that my surgery would work well due to the shape that I was in.
Ed

skevimc
02-02-2010, 01:11 PM
Skevimc

I wonder if you have an opinion on this. Braces work by applying a force to the ribs which in turn push and rotate the spine into place. Does this suggest that increasing strength in the chest could potentially help stabilize the spine?

I guess what I'm asking is does the chest provide a counterforce to help the spine stay in alignment?

The ribcage and sternum are both prime candidates for affecting the spine. The leverage the ribs would be able to exert on the vertebrae could be significant. But how to harness that power?

Two types of muscles (excluding the paraspinals) are over the rib cage. The prime movers such as pecs, lats, rhomboids, int. & ext. obliques, etc... And the intercostals, the muscles in between the ribs that assist with breathing.

I think that any muscles have the potential to 'help' stabilize in some way. Breathing therapy is based, in part, on strengthening the intercostals. Strengthening the pecs, which insert on the sternum could, in theory, apply force to the spine via the ribs. I'm just now reminded about a fine wire EMG study done on the intercostals a while back. It found that the intercostals on the concave side (I think) weren't firing. However, this was done in polio patients I believe.

Here it is. Horn, CV. Electromyographic investigation of muscle imbalance in patients with paralytic scoliosis. 1969. PMID 5385060

titaniumed
02-02-2010, 01:26 PM
Another thing I forgot to mention is that when skiing hard at very high altitudes, breathing hard is something that seems to happen very often!

I also agree that muscles help stabilize. I have felt it, for years.
Ed

Pooka1
02-02-2010, 01:29 PM
I think the same is true for riding and specifically dressage. It's all core... the rest is commentary.

trcylynn
02-08-2010, 04:59 PM
Dingo-

Maybe it is listed somewhere else in this board but can you describe the modified rotation exercise you have your son do?

I used to use one of the oblique machines at the gym and would focus on keeping my back straight (ie "suck in" pull the muscles so that I appeared straight and then very slowly do the exercise) my curve did not get worse and I actually felt and looked better. I unfortuenatly do not have access to that type of machine and would like to modify some of the exercises I used to do at the gym at home.

Thank you!

leahdragonfly
02-08-2010, 07:58 PM
Well Dingo, you'll be so diasppointed, but the MedX torso rotation machine at our gym does not even come close to fitting Leah, and she is a sl. taller than average girl. It does not have any ability to adjust the height of the seat. She would need to sit on her car booster! Also, her legs are way to short, even with the leg pieces adjusted as close as possible. It is not possible for her to anchor her pelvis and do the exercise. Not sure how the little girl in the video was able to fit in the machine. The personal trainer did tell me this machine is an older version, so maybe the new ones can be adjusted to fit a kid.

Oh well, at least we tried. It's doing great in exercising my torso.

Dingo
02-09-2010, 08:27 AM
trcylynn

Because Scott is too young and uncoordinated to do the real thing we do a lying down version of torso rotation.

Here is a video of it.

Video: Scott lying rotation (http://img97.imageshack.us/i/rotators3.mp4/)

In this demonstration video he uses a 1 pound weight. Normally he uses a 5 pound weight and I sit close and hold his shoulders to keep his form solid. He rotates about 45 degrees in each direction which is roughly the same distance they used in the studies (36 degrees).

One thing we've added since this video was taken is ankle weights. We velcro them together and lay them over his lower stomach. This helps keep his bottom flat against the ground.

Scott weighs 40 pounds and 5 pounds is the highest weight he can do with good form and without struggle. He does 3 sets of 20 reps, 3 mornings per week. Maybe in a few more months we'll move up to 6 pounds.

Dingo
02-09-2010, 08:32 AM
Leahdragonfly


The personal trainer did tell me this machine is an older version, so maybe the new ones can be adjusted to fit a kid.

That is awful news!

You could always try the "at home" exercise from Dr. McIntire's 2008 study. It's the exact same movement as the MedX but you use a chair and an exercise band.

Treatment of Adolescent Idiopathic Scoliosis With Quantified Trunk Rotational Strength Training: A Pilot Study (http://journals.lww.com/jspinaldisorders/Abstract/2008/07000/Treatment_of_Adolescent_Idiopathic_Scoliosis_With. 10.aspx)

turtlelover
02-09-2010, 09:06 AM
We are using a Cybex Machine vintage 'Galileo'. The height adjusts on the seat, theoretically it would be easy to modify the machine to accept a smaller body with a thicker pad. It doesn't lock your pelvis, but what we do is I keep my hands in front of her knees so they can't slide forward.

Also with regard to discussion about Psoas... The Cybex machine encourages the operator to clamp their legs to the pad in front. Squeezing your legs together like that, would I think, activate the Psoas. Bonus.

The Med X is a great machine, but it has a huge footprint and weighs a lot. Not many homes have room for it...

Margaret has been on "vacation from her machine" for 2 stints since we had started torso rotation therapy for her back. Both times she complained of pain after a week of not exercising. The first time it caught me off guard. I had not planned an alternative exercise regimen. The second time we used a ball, weights and a theraband. There is NO comparison between the machine and alternatives.

Just my 2 cents. Cybex is working for us.

Dingo
02-09-2010, 09:28 AM
Turtlelover

Didn't your machine cost just a couple of hundred bucks plus shipping?

I should add that your daughter's continued improvement helps me sleep at night. :)

skevimc
02-09-2010, 12:03 PM
You could always try the "at home" exercise from Scott McIntire's 2008 study. It's the exact same movement as the MedX but you use a chair and an exercise band.



My first name is Kevin. :) Scott is my uncle.

turtlelover
02-09-2010, 05:02 PM
I found it for $500 and had it shipped U Ship for $200 from central Florida to Eastern North Carolina.

Kevin, do you have any thoughts in comparing the two machines?

Thank you Dingo, about Margaret. And thank you Dr. Kevin. If Dingo hadn't pointed me in the direction of your work and papers, Margaret would likely have continued to progress. I owe you guys a lot.

skevimc
02-09-2010, 05:52 PM
Kevin, do you have any thoughts in comparing the two machines?



I like both machines. The Med-X is nice because of the lower body stabilization and weight increments of two pounds. But the Cybex is a nice machine and I actually prefer to workout on the Cybex when/if I do rotations. I agree that using the thighs to squeeze feels like a good addition. The Cybex just feels better to me... It's a personal preference.

Dingo
02-09-2010, 09:39 PM
My first name is Kevin. Scott is my uncle.

DOH! :)

I combined your name with my son's name (Scott).

skevimc
02-10-2010, 11:10 AM
DOH! :)

I combined your name with my son's name (Scott).

Haha. Yeah...:) I saw you do it a few threads ago and figured you linked our names.