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Thread: The muscular cause of scoliosis

  1. #1
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    The muscular cause of scoliosis

    Recently, also spain doctors with another conclusion about the scoliosis cause. They corroborated with a significant proof with people with curves over 40į, that muscles donít work in a normal way. They think that it suggest that a muscular pathology could be the cause. Could it be because dystonia?

    http://www.redaccionmedica.es/autono...xmtyd5ydfhetr=

    Sorry is Spanish. I could translate what you could not understand.

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    Quote Originally Posted by flerc View Post
    Recently, also spain doctors with another conclusion about the scoliosis cause. They corroborated with a significant proof with people with curves over 40į, that muscles donít work in a normal way. They think that it suggest that a muscular pathology could be the cause. Could it be because dystonia?

    http://www.redaccionmedica.es/autono...xmtyd5ydfhetr=

    Sorry is Spanish. I could translate what you could not understand.
    I did not read the paper but how do they know that muscles not working normally is an EFFECT of a large curve instead of a CAUSE?

    Also, we need your opinion on the post about "SET."
    Sharon, mother of identical twin girls with scoliosis

    No island of sanity.

    Question: What do you call alternative medicine that works?
    Answer: Medicine


    "We are all African."

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    The conclusion reached is that the cause of these patients, usually girls, can not exercise is that your muscles do not function normally and not vice versa as it seemed so far. This finding will help in the investigation of the causes of this disease and to better target the treatment of the patient.

    The recent discovery reformulates it: muscle involvement is not the result of no training due to the deformity of the spine, but muscle involvement may be the real cause of the scoliosis itself. Therefore, the hypothesis resulting from this study is that there may be a general involvement of the whole organism, which causes a decompensation of spinal muscular symmetry and, therefore, the deformity of the spine.

    It was thought that in adolescent idiopathic scoliosis presented respiratory problems caused by the deformity that had acquired the rib cage with curvature of the spine and because of this deformity, physical deterioration was experienced due to lack of training. The recent discovery reformulates it: muscle involvement is not the result of no training due to the deformity of the spine, but muscle involvement may be the real cause of the scoliosis itself. Therefore, the hypothesis resulting from this study is that there may be a general involvement of the whole organism, which causes a decompensation of spinal muscular symmetry and, therefore, the deformity of the spine.


    translation done by http://translate.google.com/# (it is much better than me)

    Interesting post of Set. Iíll give my opinion soon

    Regards

  4. #4
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    Spanish to English translationShow romanization

    STUDY OF HOSPITAL DEL MAR-IMIM
    The cause of scoliosis in adolescents might be a muscle disease

    Updated: 23/03/2010 - 17:52 H
    This finding explains the causes of this disease and its treatment restates

    Editorial. Barcelona
    Researchers from the Services of Pneumology and Orthopaedic Surgery, Hospital del Mar and Hospital Vall d'Hebron, together with the IMIM and CIBER (Center for Biomedical Integrated Network - Lung Disease), have recently published a study in European Respiratory Journal in which they present as a possible cause of scoliosis starting in adolescence primarily muscle involvement. The conclusion reached is that the cause of these patients, usually girls, can not exercise is that your muscles do not function normally and not vice versa as it seemed so far. This finding will help in the investigation of the causes of this disease and to better target the treatment of the patient.

    It was thought that in adolescent idiopathic scoliosis presented respiratory problems caused by the deformity that had acquired the rib cage with curvature of the spine and because of this deformity, physical deterioration was experienced due to lack of training. The recent discovery reformulates it: muscle involvement is not the result of no training due to the deformity of the spine, but muscle involvement may be the real cause of the scoliosis itself. Therefore, the hypothesis resulting from this study is that there may be a general involvement of the whole organism, which causes a decompensation of spinal muscular symmetry and, therefore, the deformity of the spine.

    Scoliosis is defined as a deformation and lateral curvature of the spine that affects the breathing and movement. Complication involves the deformation of the rib cage, back pain, difficulty breathing and an inability to exercise. The current treatment of this disease is based on orthopedic support, rehabilitation or may even need surgery depending on the degree of curvature of the spine.

    Although there are cases where this condition is associated with neuromuscular diseases or connective tissue, 70 percent of cases are idiopathic, ie with no known cause to this day. Adolescent idiopathic scoliosis occurs in patients aged 11 years of age. It is estimated that between two and three percent of adolescents have some form of scoliosis, and six out of seven patients are female.

    The question that arose in this project was what the real medical cause that prevents patients with scoliosis can easily exercise: the respiratory or muscular involvement? The two types of involvement are often present in this disease but what is the relationship between the two? To find out, we observed the function and exercise capacity of the lungs, respiratory muscles and limbs.

    In the analysis of the data, was that the degree of involvement of the breathing was very mild and not all patients had such involvement. However, muscle involvement was a general symptom, which greatly influenced the ability to exercise.

    In the study, we measured the muscle function of the arms and legs and respiratory muscles and breathing capacity and exercise in 60 patients with adolescent idiopathic sclerosis with a steep angle of curvature (greater than 40 per cent), as well as 25 healthy controls. In these patients, previously ruled the existence of muscular and respiratory problems not associated with scoliosis. An attempt to correlate these variables with body mass index and degree of curvature of the spine, with respect to the reference values of the local population. Finally we assessed the independence or relationship of these variables compared to the other using statistical correlation methods.
    -----------------------------------------------------------------

    In the past, no matter how much I would exercise my weak side, or electrostim my weak side, It seemed impossible to get any results.
    There most definitly is something wrong with the muscles on my lower right side. A muscle problem or a signal problem...
    Ed
    49 yr old male, now 58, the new 53...
    Pre surgery curves C12,T70,L70
    ALIF/PLIF T2-Pelvis 01/29/08, 01/31/08 7" pelvic anchors BMP
    Dr Brett Menmuir St Marys Hospital Reno,Nevada

    Bending and twisting pics after full fusion
    http://www.scoliosis.org/forum/showt...on.&highlight=

    My x-rays
    http://www.scoliosis.org/forum/attac...2&d=1228779214

    http://www.scoliosis.org/forum/attac...3&d=1228779258

  5. #5
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    Google translation

    From the Google translation:

    The conclusion reached is that the cause of these patients, usually girls, can not exercise is that your muscles do not function normally and not vice versa as it seemed so far.
    The recent discovery reformulates it: muscle involvement is not the result of no training due to the deformity of the spine, but muscle involvement may be the real cause of the scoliosis itself.
    That certainly explains why Torso Rotation Strength Training was found to be effective.

    I think what happened was that the TRS studies were so convincing that it caused scientists to rethink their hypothesis' about Scoliosis and muscle asymmetry.

    The researchers involved in these studies are a credit to the field of science.

    The Role of Measured Resistance Exercises in Adolescent Scoliosis

    Treatment of adolescent idiopathic scoliosis with quantified trunk rotational strength training: a pilot study

    They very likely saved my son from a childhood of 18 hour per day bracing and possible fusion. For that I am eternally in their debt.
    Last edited by Dingo; 05-10-2010 at 12:40 PM.

  6. #6
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    If Torso rotation strength training works for adolescents, thatís fantastic and certainly worth a try. Dingo, you are fortunate that you caught this early. I would probably do the same thing.

    A true test of this would be to take a person with documented large curves, and straighten or correct the spine. Age plays heavily here.

    "If" itís a muscle pathology, or signal issue, there are different levels of effectiveness from person to person and muscle group to muscle group. After a few decades of atrophy, it becomes a tough battle.

    After all the years, I do know one thing. Staying active is key. The times that I didnít stay active were painful periods. Degeneration didnít help things either. My spine was like a wooden ladder out in the elements. After 50 years, rebuilding was necessary.

    Ed
    49 yr old male, now 58, the new 53...
    Pre surgery curves C12,T70,L70
    ALIF/PLIF T2-Pelvis 01/29/08, 01/31/08 7" pelvic anchors BMP
    Dr Brett Menmuir St Marys Hospital Reno,Nevada

    Bending and twisting pics after full fusion
    http://www.scoliosis.org/forum/showt...on.&highlight=

    My x-rays
    http://www.scoliosis.org/forum/attac...2&d=1228779214

    http://www.scoliosis.org/forum/attac...3&d=1228779258

  7. #7
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    Has anyone investigated as to whether or not there are any muscles actually missing? I ask this because it was discovered after 30 years during an EMG that I have a major muscle in my foot that is missing. No one ever noticed it and like skevimc (I think that's his name) mentioned on another thread, the body has many, many backup mechanisms to maintain function. However, if small muscles of the spine that are the underlying muscles were missing, who would notice unless you were particularly "looking" for that muscle group and it wasn't there. That may account for some of the muscle assymetry. Exercise would be more difficult, but the "backup" muscles may be able to be trained to make up for some of the deficit in people with smaller curves. OR it could be just neurologic and the signals aren't getting to the muscles as has been suggested. In this case the muscles would atrophy. Just a thought.

  8. #8
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    Quote Originally Posted by the subject study View Post
    In the study, we measured the muscle function of the arms and legs and respiratory muscles and breathing capacity and exercise in 60 patients with adolescent idiopathic sclerosis with a steep angle of curvature (greater than 40 per cent), as well as 25 healthy controls. In these patients, previously ruled the existence of muscular and respiratory problems not associated with scoliosis. An attempt to correlate these variables with body mass index and degree of curvature of the spine, with respect to the reference values of the local population. Finally we assessed the independence or relationship of these variables compared to the other using statistical correlation methods.
    If I'm understanding this, a better control group would be AIS patients with mild curves. They should compare those against the patents with large curves to nail down cause and effect.

    And they are going to have to explain the kids with AIS who are very competent at sports including those requiring bilateral strength.

    ETA: They are also going to have to address the one study at least that found NO bilateral asymmetry in muscle strength.
    Last edited by Pooka1; 05-10-2010 at 02:38 PM.
    Sharon, mother of identical twin girls with scoliosis

    No island of sanity.

    Question: What do you call alternative medicine that works?
    Answer: Medicine


    "We are all African."

  9. #9
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    I'm very optimistic as far as the future holds for scoliosis. Its great that awareness has risen and people are thinking about this on many levels.

    When I was dxd back in 1974, I was told to stop weight training. They just didnít know, and I saw and read some very concerned faces... I feel sorry for my old Doctors, my situation probably bugged the heck out of them. They also were not totally positive on the bracing issue either at that time.

    I'm actually very optimistic about the whole package. I'm not talking about scoliosis, I'm talking about all of it. Cancers, MS, ALS, PLS, Parkinson's, etc, etc, etc. We have come to a point of accelerated growth in these areas, (medical research) and it will be great to hear about future developments, breakthroughs, and ultimately "cures". This truly is everyone's war on terror, and deserves support and financing. I'm sure Bill and Melinda Gates are doing the right thing.

    Brain and CNS research needs to be accelerated. It would help answer many questions.
    Ed
    49 yr old male, now 58, the new 53...
    Pre surgery curves C12,T70,L70
    ALIF/PLIF T2-Pelvis 01/29/08, 01/31/08 7" pelvic anchors BMP
    Dr Brett Menmuir St Marys Hospital Reno,Nevada

    Bending and twisting pics after full fusion
    http://www.scoliosis.org/forum/showt...on.&highlight=

    My x-rays
    http://www.scoliosis.org/forum/attac...2&d=1228779214

    http://www.scoliosis.org/forum/attac...3&d=1228779258

  10. #10
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    Quote Originally Posted by titaniumed View Post

    A true test of this would be to take a person with documented large curves, and straighten or correct the spine. Age plays heavily here.


    Ed
    In our study, we had 3 patients with curves larger than 45į. None of them responded to treatment and two went to surgery within the year. The third was lost to follow up but almost certainly ended up in surgery. My thought is that ~45į is a threshold for anything muscular to control, i.e. muscles will do very little once the curve gets that big. The biomechanics for the muscles to effectively contract/control vertebral levels are most likely severely messed up. However, the Cobb angle also might not be the best threshold but probably vertebral rotation at the apex. I think that probably affects muscular biomechanics more than later deviation.

    Quote Originally Posted by rohrer01 View Post
    Has anyone investigated as to whether or not there are any muscles actually missing?
    To my knowledge no one has specifically studied this. However, there have been several MRI and biopsy studies looking at the muscles of the back in AIS patients and I don't recall reading anything about missing muscles. As well, if this were a common thing, surgeons would have noticed a while ago and would probably have studied it or at least reported the finding somewhere.

  11. #11
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    Quote Originally Posted by skevimc View Post
    In our study, we had 3 patients with curves larger than 45į. None of them responded to treatment and two went to surgery within the year. The third was lost to follow up but almost certainly ended up in surgery. My thought is that ~45į is a threshold for anything muscular to control, i.e. muscles will do very little once the curve gets that big. The biomechanics for the muscles to effectively contract/control vertebral levels are most likely severely messed up. However, the Cobb angle also might not be the best threshold but probably vertebral rotation at the apex. I think that probably affects muscular biomechanics more than later deviation.


    Too bad there wasnít an easier way to monitor rotation. I donít know the accuracy of reading "shadows" on coronal x-rays, and CT's emit way too much radiation....My post op CT's show approx 30 degree rotation at each apex. I posted those on one of my threads. I donít know what my pre-surgical rotation was, however my hospital has pre-surgical CT's. I should go down and pressure them to burn that disc for me. Just a thought.

    Since biomechanics of the muscles are hampered in curves larger than 45 degrees, does age play a part? Does a 13 year old with a 45, have these elevated muscular issues?

    I wonder if the biomechanics are screwed up from the start? I guess EMG studies would need to be performed on patients from the start and followed through the years.

    Do the EMG readings correlate to curvature?

    Do voltages drop with progression? Do voltages increase upon correction?
    Ed
    49 yr old male, now 58, the new 53...
    Pre surgery curves C12,T70,L70
    ALIF/PLIF T2-Pelvis 01/29/08, 01/31/08 7" pelvic anchors BMP
    Dr Brett Menmuir St Marys Hospital Reno,Nevada

    Bending and twisting pics after full fusion
    http://www.scoliosis.org/forum/showt...on.&highlight=

    My x-rays
    http://www.scoliosis.org/forum/attac...2&d=1228779214

    http://www.scoliosis.org/forum/attac...3&d=1228779258

  12. #12
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    Mabe a little off topic, but if the muscles can't work to hold a spine with a curve >45*, then why in the heck am I having so much trouble finding someone to help me with my 46* cobb AND severe PAIN?? So very frustrating!! I know I have rotation also because when I stand "straight" and look in the mirror, my belly button is about an inch off center to the right, and my left hip appears higher. ???? This is something the doctor NEVER even looked at, in fact they never even had me put a gown on except for the X-ray! ???? Just venting.

  13. #13
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    Rohrer

    X-rays are the first choice for diagnosis. It tells the most with the least amount of effort, and only takes a minute.

    Unfortunately for some of us, finding the right surgeon can really take some time. Its not easy.

    Why donít you e-mail your x-rays to a few surgeons? That would be an easy way of getting a few opinions. If they say they can help you, you can move on to step B.
    Ed
    49 yr old male, now 58, the new 53...
    Pre surgery curves C12,T70,L70
    ALIF/PLIF T2-Pelvis 01/29/08, 01/31/08 7" pelvic anchors BMP
    Dr Brett Menmuir St Marys Hospital Reno,Nevada

    Bending and twisting pics after full fusion
    http://www.scoliosis.org/forum/showt...on.&highlight=

    My x-rays
    http://www.scoliosis.org/forum/attac...2&d=1228779214

    http://www.scoliosis.org/forum/attac...3&d=1228779258

  14. #14
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    Quote Originally Posted by titaniumed View Post
    Too bad there wasnít an easier way to monitor rotation. I donít know the accuracy of reading "shadows" on coronal x-rays, and CT's emit way too much radiation....
    The pedicle shadows, I think, are reasonably accurate but certainly have limitations. I'm sure there are reliability studies. I'd imagine the consistency of the x-ray tech would be of crucial importance. We began measuring rotation late in our study and I could never really get them excited about including it in the article. It was just one more data point. So it got scrubbed. But I think the data is somewhere in a spread sheet back at KU.

    Quote Originally Posted by titaniumed View Post
    Since biomechanics of the muscles are hampered in curves larger than 45 degrees, does age play a part? Does a 13 year old with a 45, have these elevated muscular issues?
    Hampered biomechanics is just my hypothesis. But yes, I'd say that age does play a role, in some way, most likely in terms of spinal growth or growth plates.

    Quote Originally Posted by titaniumed View Post
    I wonder if the biomechanics are screwed up from the start? I guess EMG studies would need to be performed on patients from the start and followed through the years.
    I would say that biomechanics are not screwed up from the start. This is why I think exercise/strength training could really help the smaller curves. Starting at around 35į, the vertebrae begin to shift and stretch (or shorten) muscles enough to affect function. This change in muscle length puts the muscle in a sub-optimal position to exert maximum force. (It's a well known concept called the length-tension curve). As an example, put your arm/elbow at 90į. Find the maximum weight you can still lift with your arm in this position. Now fully extend your arm and try to lift the same weight. It's pretty much impossible without compensating in some way, i.e. dipping your shoulder, swinging the weight, etc... Our muscles have a preferred operating length. If you go outside of this preferred length, then the muscle has a hard time operating effectively. It might try to exert force, but in the case of the spine, if one muscle doesn't work it will recruit another muscle. Over time, if that muscle doesn't learn how to operate correctly, then the body would continue using the other recruited muscles. This would eventually lead to atrophy in the affected muscle.

    So... hypothetically... as the curve progresses, the vertebral musculature lengthens or shortens at various levels of the curve, e.g. the apex. As this happens, the muscles become less able to control that individual spinal segment. Globally, the body is still able to function reasonably well. But locally, the paraspinal muscles are not controlling the individual levels as well. In cases of self-resolving scoliosis, the muscles 'wake up' and begin to be used effectively. In progressive cases, the muscles never wake up or wake up too late (larger curve) to be able to adequately support the vertebrae.

    Quote Originally Posted by titaniumed View Post
    Do the EMG readings correlate to curvature?
    Do voltages drop with progression? Do voltages increase upon correction?
    There are studies linking some EMG parameters to progressive curves compared to stable curves. The convex side is higher than the concave side. I saw this in walking and while performing trunk rotations (unpublished data). I would make the hypothesis that the larger the curve, the larger the difference/ratio at the apex. But I'm not sure if that would really be the case.



    Quote Originally Posted by rohrer01 View Post
    Mabe a little off topic, but if the muscles can't work to hold a spine with a curve >45*, then why in the heck am I having so much trouble finding someone to help me with my 46* cobb AND severe PAIN?? So very frustrating!!
    Let me stress that this is just my working hypothesis. I think it's fairly accurate to say that the biomechanics and muscle force is altered in larger curves, but whether or not that translates in to an inability to control those curves or spinal segments is unknown.

  15. #15
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    Skevimc,
    Thanks for chiming in today, and volunteering the information. Its appreciated.

    I can continue, but I'm tired and post surgical fatigue is pointing me in the direction of a nap...

    This weather pattern right now is creating "bear traps". The tightening of the paraspinal muscles in my mid back. I donít know why, but it seems like low pressure combined with cold acts as a catalyst. As soon as the storm passes, I'm fine.

    I will be glad when winter is over.
    Ed
    49 yr old male, now 58, the new 53...
    Pre surgery curves C12,T70,L70
    ALIF/PLIF T2-Pelvis 01/29/08, 01/31/08 7" pelvic anchors BMP
    Dr Brett Menmuir St Marys Hospital Reno,Nevada

    Bending and twisting pics after full fusion
    http://www.scoliosis.org/forum/showt...on.&highlight=

    My x-rays
    http://www.scoliosis.org/forum/attac...2&d=1228779214

    http://www.scoliosis.org/forum/attac...3&d=1228779258

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