Muscle physiology questions for Dr. McIntire

[Pooka1]

The claims of Spinecor seem fantastical to this little bunny. You have a doctorate in muscle physiology. Can I ask you to weigh in on this issue?

1. Any brace including Spinecor, unless it is just hanging off the patient, necessarily is restricting motion. Yes/No?

2. Any brace including Spinecor, unless it is just hanging off the patient, if it instantly relieves pain, is taking over for muscle support. Yes/No?

3. Will muscle build or deteriorate if motion is restricted?

4. Will muscle build or deteriorate if a brace is taking over for some support previously provided by muscle?

5. What is the likely outcome of an adult wearing Spinecor for 2 years and then weaning off to NO brace wear? Wouldn't it be a rapid return to pre-brace conditions or worse due to the muscle deterioration?

6. What do you make of the claim of a "dynamic brace?" Does that have any technical meaning whatsoever? In the case of Spinecor, isn't it just repositioning the posture in a relatively loose way and taking over for muscle in doing so?

7. Anecdotally just on this group, Spinecor seems to have more efficacy in the short term for JIS than AIS. Is this due to the ability to position the younger spine more than the older spine? The interesting test is if the correction seen in the JIS years holds through the growth spurt. Some parents preemptively sense the inability of Spincecor to hold during this period and switch their kids to hard braes at that point. This is another point suggesting Spinecor is just a looser brace as opposed to a new and better concept.

Thanks in advance.

[rohrer01]

Sorry Pooka, I don't mean to hijack your thread, but I have a question, too. Would a spinecore brace limit motion and therefore cause atrophy, OR because of its stretchiness, would it be like resistance training and actually build muscle? Thanks!

[hdugger]

Aren't we going both ways on the role of muscles in scoliosis? Either scoliosis is a bone disorder and muscles/exercise cannot halt the progression of curves, and therefore muscle atrophy would not play a role in progression. Or scoliosis is a bone/muscle disorder and muscles/exercise *can* halt progression, and therefore atrophy *would* play a role in progression.

If the loss of muscles speed progression, then doesn't it necessarily mean that building muscles strength slows progression?

[Pooka1]

Sorry Pooka, I don't mean to hijack your thread, but I have a question, too. Would a spinecore brace limit motion and therefore cause atrophy, OR because of its stretchiness, would it be like resistance training and actually build muscle? Thanks!

No that is not a hijack. Anyone who has a relevant question on muscle physiology should post it here. I'm a bit worried McIntire might get flashbacks to his thesis defense so I hope he doesn't feel obligated to answer any question.

I was considering bumping this thread up so he can see it but you saved me the trouble. Thanks.

As to your question, someone correct me if I'm wrong but I don't think Spinecor is very stretchy and so it's not like working out with an exercise band. I think the claim it that it encourages the correct positioning of the spine through positioning of the torso.

[Pooka1]

Aren't we going both ways on the role of muscles in scoliosis? Either scoliosis is a bone disorder and muscles/exercise cannot halt the progression of curves, and therefore muscle atrophy would not play a role in progression. Or scoliosis is a bone/muscle disorder and muscles/exercise *can* halt progression, and therefore atrophy *would* play a role in progression.

Until McIntire comes here to edify us bunnies, I will attempt an answer here.

I think scoliosis is a neurologic and(or) metabolic problem with a bone-remodeling cause or effect that results in loss of normal spine position. I think in periods other than the growth spurt, muscle can only rearrange the deck chairs on the Titanic and only for so long. Abnormal or extra muscle mass during the growth spurt is a bit of an open question as far as I can tell.

If the loss of muscles speed progression, then doesn't it necessarily mean that building muscles strength slows progression?

I think muscle building can hide/delay progression but can't address the underlying drivers of the condition in any permanent way.

Cases like Hawes are a bit rarefied in that she was addressing her thoracic volume due to ancillary health concerns and was pleasantly surprised it seems by the reduction in her Cobb angle. She has an asymmetric/abnormal thoracic volume and her results are probably limited to others with that specific condition. As far as I know, the great run of T curves do not have that asymmetry nor any insufficient volume at the Cobb angle Hawes had/has. Thus her results are almost certainly irrelevant to anyone with a non-thoracic curve and non-abnormal thoracic cavity.

She did really changed her rib cage such that at least one reader felt the end vertebrae changed at some point. She seems to have accomplished the reduced Cobb angle by repositioning/expanding her ribs on one side through all manner of approaches.

[hdugger]

I think muscle building can hide/delay progression but can't address the underlying drivers of the condition in any permanent way.

Wouldn't that therefore mean that muscle atrophy wouldn't have any affect on progression? So, there wouldn't be any "worse due to the muscle deterioration" in your hypothesis, since muscles don't play a role in progression.

[Pooka1]

Wouldn't that therefore mean that muscle atrophy wouldn't have any affect on progression? So, there wouldn't be any "worse due to the muscle deterioration" in your hypothesis, since muscles don't play a role in progression.

Yes I think that's right w.r.t. atrophy. Muscle atrophy as in a brace or just not doing PT I think just allows the normal course of the progression if any progression is destined.

In the opposite direction, I think that muscle development, either just more of it or in an asymmetrical fashion to balance the spine asymmetry, can temporarily hold or hide some amount of any progression that might occur absent that.

[hdugger]

In the opposite direction, I think that muscle development, either just more of it or in an asymmetrical fashion to balance the spine asymmetry, can temporarily hold or hide some amount of any progression that might occur absent that.

So, in the case of a person who manages to hold their curve steady with exercise with 5 years. When they stop exercising, do they quickly return to the curve they had before they started exercising? Or do they return to their curve plus the 5 years of progression they would have had had they not been holding their curve with exercise.

i.e., does the exercise nullify the progressing effect of gravity? Or is gravity remolding the curve in exactly the same way regardless of whether they're exercising or not.

[Pooka1]

So, in the case of a person who manages to hold their curve steady with exercise with 5 years. When they stop exercising, do they quickly return to the curve they had before they started exercising? Or do they return to their curve plus the 5 years of progression they would have had had they not been holding their curve with exercise.

i.e., does the exercise nullify the progressing effect of gravity? Or is gravity remolding the curve in exactly the same way regardless of whether they're exercising or not.

I think we know for a fact that gravity is not the only factor in curve progression or lack of it. Consider that people come out of brace every 6 months and sometimes have progression (though compliance complicates that). Also Even people at 50* which is clearly into gravity enhancing territory can hang there for decades as we have seen in at least two cases here.

That one boy in McIntire's TRS study exercised - reduced the curve - stopped exercising - curve progressed - exercised - reduced the curve. We could ask if his curve was worse when he stopped exercising than when he started though that analysis has problems.

I think gravity can add to progression but the master driver is neurological and/or metabolic with complex hormonal triggers. The reason this nut hasn't been cracked it because it is so complex and seems to involve many systems. If the etiology involves complex feedback looping and multi-component cascades and all kinds of regulation from many factors then it is going to defy solution. Even something as seemingly simple as why an element, Lithium, helps manic depression still defies solution after all these years. And that it just an element. You'd think they could use a Li radioisotope and just trace it but there must be some problems with that or maybe an isotope doesn't exist with a useful half life.

And it's possible scoliosis might be a catchall for a few conditions given the range of signs and symptoms. The connective tissue ones seem to be clearly another animal for example. But most IS cases are benign and either never progress or resolve completely. Only the few ever become problematical. That's the context in which studies should occur as far as I can tell (which isn't far).

[Pooka1]

Wouldn't that therefore mean that muscle atrophy wouldn't have any affect on progression? So, there wouldn't be any "worse due to the muscle deterioration" in your hypothesis, since muscles don't play a role in progression.

Clarifying this point...

In my original post I was referring to the rate of return to the programmed progression. In an atrophied state, it would be rapid. In a normal (non-PT state) it would be somewhat less rapid. In a PT state it would be slow or temporarily nonexistent. In a hyper-PT state, you might see a temporary regression.

Again, for the growth spurt case, these questions are somewhat open in my opinion due to lack of large datasets. PT is not an "alternative" treatment necessarily and is still in the "conservative" column for now for this group in my opinion.

[skevimc]

Been away on vacation for the last week.

I'll answer from a purely muscle physiology standpoint as I know very little about the rationale for spinecor.

The claims of Spinecor seem fantastical to this little bunny. You have a doctorate in muscle physiology. Can I ask you to weigh in on this issue?

1. Any brace including Spinecor, unless it is just hanging off the patient, necessarily is restricting motion. Yes/No?

Yes.

2. Any brace including Spinecor, unless it is just hanging off the patient, if it instantly relieves pain, is taking over for muscle support. Yes/No?

Maybe. Relief of pain can come from assisting muscle or from a purely mechanical point of view. This is somewhat of a semantics argument and I think the answer for your intended meaning is "yes".

3. Will muscle build or deteriorate if motion is restricted?

Deteriorate outside of the restricted range of motion. It's possible that it could build within the restricted ROM, but there would need to be specific effort.

4. Will muscle build or deteriorate if a brace is taking over for some support previously provided by muscle?

If nothing is done to prevent it, the muscles will certainly atrophy.

5. What is the likely outcome of an adult wearing Spinecor for 2 years and then weaning off to NO brace wear? Wouldn't it be a rapid return to pre-brace conditions or worse due to the muscle deterioration?

Assuming no other countermeasures are taken, e.g. muscle strengthening/re-training, I would think it would return to the previous condition.

6. What do you make of the claim of a "dynamic brace?" Does that have any technical meaning whatsoever? In the case of Spinecor, isn't it just repositioning the posture in a relatively loose way and taking over for muscle in doing so?

This question is interesting. I'm answering these in order and not looking ahead to the next question. As I've answered some of them I have thought "unless there is some type of dynamic bracing". I would say that dynamic bracing does have a technical meaning but whether or not a product holds up to that meaning is the issue. A brace could prevent range of motion for various reasons, after knee surgery for example, so this brace acts to protect the repaired ligaments, i.e. mechanical, but offers little muscular support. This would allow the muscles to function and strengthen after surgery while providing mechanical support. This is what I would consider dynamic. The opposite would be a static brace as with a cast; essentially allowing no functional movement.

7. Anecdotally just on this group, Spinecor seems to have more efficacy in the short term for JIS than AIS. Is this due to the ability to position the younger spine more than the older spine? The interesting test is if the correction seen in the JIS years holds through the growth spurt. Some parents preemptively sense the inability of Spincecor to hold during this period and switch their kids to hard braes at that point. This is another point suggesting Spinecor is just a looser brace as opposed to a new and better concept.

Thanks in advance.

Hmm... So I can't really speak to Spinecor rationale specifically. But I would think that, even if it is a sound concept, a 'loose' fitting brace doesn't offer the relative peace of mind that a rigid brace might offer. This is more of a societal perception/bias though. I think exercise therapy gets the same bias. I've left physiology at this point so I'll stop my answer.

There is one exception I see for some of these answers. In joints that are experiencing pain, muscles will tense up and become dysfunctional. Applying a brace could help the muscles relax thus allowing proper function once the pain subsides. Kind of like the reasons muscle relaxers are prescribed. The spasm causes pain, so remove the spasm which removes the pain. I think of tennis elbow straps or patella tendon straps. These are applied in order to relive pain and allow the muscles to relax and reduce inflammation of the painful area.

Overall though, the body will learn to depend on any additional support it gets regardless of the joint. Dynamic or static bracing would all need some type of additional and intentional training in order to really improve the situation. I would be skeptical to view a brace alone as a treatment. Although certainly can be a very helpful tool.

I see that there are other questions. I'll get to them

[Pooka1]

1,000 thank yous for fielding those questions! I hope you had a great vacation and sorry you had to return to another dissertation defense.

6. What do you make of the claim of a "dynamic brace?" Does that have any technical meaning whatsoever? In the case of Spinecor, isn't it just repositioning the posture in a relatively loose way and taking over for muscle in doing so?

This question is interesting. I'm answering these in order and not looking ahead to the next question. As I've answered some of them I have thought "unless there is some type of dynamic bracing". I would say that dynamic bracing does have a technical meaning but whether or not a product holds up to that meaning is the issue. A brace could prevent range of motion for various reasons, after knee surgery for example, so this brace acts to protect the repaired ligaments, i.e. mechanical, but offers little muscular support. This would allow the muscles to function and strengthen after surgery while providing mechanical support. This is what I would consider dynamic. The opposite would be a static brace as with a cast; essentially allowing no functional movement.

Wow I may have actually understood that distinction! Good explanation.

Now while it is relatively easy imagine that a dynamic brace can work that way on a knee, is there some known way that a body brace like Spinecor can possibly function in a way that protects one thing (correct spine position) while furnishing less/no muscle support or otherwise restricting ROM? I suggest the testimonials on youtube and on this group of instant pain relief suggest that they are taking over for weary muscle. And for the great run of kids with no pain prior to wearing Spinecor, it seems like it must operate in the same way. That is, Spinecor can't sense if there is pain or not and work differently depending on that answer.

7. Anecdotally just on this group, Spinecor seems to have more efficacy in the short term for JIS than AIS. Is this due to the ability to position the younger spine more than the older spine? The interesting test is if the correction seen in the JIS years holds through the growth spurt. Some parents preemptively sense the inability of Spincecor to hold during this period and switch their kids to hard braes at that point. This is another point suggesting Spinecor is just a looser brace as opposed to a new and better concept.

Hmm... So I can't really speak to Spinecor rationale specifically. But I would think that, even if it is a sound concept, a 'loose' fitting brace doesn't offer the relative peace of mind that a rigid brace might offer. This is more of a societal perception/bias though. I think exercise therapy gets the same bias. I've left physiology at this point so I'll stop my answer.

There is one exception I see for some of these answers. In joints that are experiencing pain, muscles will tense up and become dysfunctional. Applying a brace could help the muscles relax thus allowing proper function once the pain subsides. Kind of like the reasons muscle relaxers are prescribed. The spasm causes pain, so remove the spasm which removes the pain. I think of tennis elbow straps or patella tendon straps. These are applied in order to relive pain and allow the muscles to relax and reduce inflammation of the painful area.

This is what Spinecor is addressing in the adult population in my opinion and why they claim only (potential) pain relief for this crowd.

Overall though, the body will learn to depend on any additional support it gets regardless of the joint. Dynamic or static bracing would all need some type of additional and intentional training in order to really improve the situation. I would be skeptical to view a brace alone as a treatment. Although certainly can be a very helpful tool.

Well I see Spinecor is agreeing with you on this now.

http://www.spinecorporation.com/Engl...apyprogram.htm

They are claiming you have to do their exercises and ONLY their exercises. Someone correct me if I'm wrong but the previous claim was that the brace itself was such that exercises were unnecessary because it was a dynamic brace. I guess they had to abandon that claim what with the Spinecor brace actually being a brace and all.

[Back-out]

Pooka

They are claiming you have to do their exercises and ONLY their exercises. Someone correct me if I'm wrong but the previous claim was that the brace itself was such that exercises were unnecessary because it was a dynamic brace. I guess they had to abandon that claim what with the Spinecor brace actually being a brace and all.
__________________

No, as I understand it they encourage many forms of sports and exercise. Hence all their lit showing kid dancers etc.

As for the brace being enough, they DO want you to exercise, hence that's part of their fitting, I just didn't get that far. Didn't even (at the time) make the connection between the brace and the exercises.

Still do NOT see how it can help with advanced lumbar curves.

[Pooka1]

Pooka


No, as I understand it they encourage many forms of sports and exercise. Hence all their lit showing kid dancers etc.

As I understand the previous claims, they say you can continue these activities in this brace if you like. They didn't claim VERY specific exercises were necessary as they now claim. The blowback must have be huge for them to change positions on that.

[mamamax]

In looking for answers to the original proposed questions ... I'd be interested in what someone with an in-depth knowledge on the subject at hand may say about all this. Someone like: Charles H. Rivard, M.D. Now that, would be interesting - and probably more accurate than speculation from those without any specific experience in the mechanics of a bracing system that remains ... little understood by the lay community ;-)