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Thread: Muscular question to Dr. McIntire

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    Muscular question to Dr. McIntire

    Dr. McIntire, I want to know if I am mistaken in what I think about muscles activity or behavior. I think they have nothing to do in helping the spine to remains straight in the frontal plane.
    The reasoning is very simple: I have not scoliosis, I can remains sitting down in a bench, with my back supported by a wall and I’ll remains with 0į. No matter if I am awake, asleep or unconscious. I am sure that even if I am dead, my spine will remains straight in the frontal plane.
    So I conclude it is not a dynamic problem but static, so lower or heigh tone, strength o weakness, has nothing to do for help a normal spine to remains straight.
    So I conclude there is not any reason to suppose it could help in an adult spine with a frontal curve to reduce that curve.
    During growth, a wrong muscular behavior could lead to increase the curve, as a wrong posture could too. As posture, muscular activity is part of a list of ‘original’ causes, but not current causes. I could remains in a bad posture and I’ll remain with 0į. I could not say the same about normal vertebra shape, ligaments tension, joints rigidity, discs resistance.. so I think that a treatment should to be focused in that static factors (fascias are dynamic or statics?) as I think that length of muscles could also be.
    Do you think am I mistaken? In fact I will be happy if would know that I am mistaken, because my daughter is following a mainly muscle oriented treatment, but I need to know the truth.

    Thanks in advance
    Last edited by flerc; 09-20-2010 at 12:44 PM.

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    Hi. Sorry I have been away from the site for a few days.


    Quote Originally Posted by flerc View Post
    Dr. McIntire, I want to know if I am mistaken in what I think about muscles activity or behavior. I think they have nothing to do in helping the spine to remains straight in the frontal plane.
    I disagree with this assumption.

    Quote Originally Posted by flerc View Post
    The reasoning is very simple: I have not scoliosis, I can remains sitting down in a bench, with my back supported by a wall and Iíll remains with 0į. No matter if I am awake, asleep or unconscious. I am sure that even if I am dead, my spine will remains straight in the frontal plane.
    I am not convinced that is the case. But I can see the point, that if you were perfectly balanced and no force was pushing in any other direction, then yes, you might remain upright. That is a very big 'if'.

    Any deviation from being perfectly straight and you would not remain upright. Ligaments and discs keep the spinal segments within a specific range of motion. But muscles are what keep the spine stable and upright. Otherwise we'd all have great posture because the ligaments and discs would be keeping us upright.

    I see that your question relates specifically to a lateral curve (scoliosis). The ribs would help to keep the thoracic region somewhat straight, but the upper thoracic (neck) and lumbar region would move in almost any direction.

    Quote Originally Posted by flerc View Post
    So I conclude it is not a dynamic problem but static, so lower or heigh tone, strength o weakness, has nothing to do for help a normal spine to remains straight.
    So I conclude there is not any reason to suppose it could help in an adult spine with a frontal curve to reduce that curve.
    During growth, a wrong muscular behavior could lead to increase the curve, as a wrong posture could too. As posture, muscular activity is part of a list of Ďoriginalí causes, but not current causes. I could remains in a bad posture and Iíll remain with 0į. I could not say the same about normal vertebra shape, ligaments tension, joints rigidity, discs resistance.. so I think that a treatment should to be focused in that static factors (fascias are dynamic or statics?) as I think that length of muscles could also be.
    Do you think am I mistaken? In fact I will be happy if would know that I am mistaken, because my daughter is following a mainly muscle oriented treatment, but I need to know the truth.

    Thanks in advance
    The static tissues definitely play an important role. Just like if you break your ankle and are in a cast, the ligaments and tendons will become very tight and when you remove the cast you have to rehab the muscles as well as the ligaments/tendons. The same with scoliosis. If a tendon helps stabilize one specific spinal segment (two vertebrae) and that segment becomes dysfunctional, like a lateral curve, that ligament will adapt as well, perhaps getting shorter on one side while the opposite side gets longer.

    But the muscles of the spine are undoubtedly the most influential factor keeping us upright and stable. A different example showing muscle stability is low back pain. It's been shown that low back pain is associated with dysfunctional muscles. Weak muscles might not have directly caused the injury but they definitely play a role in the recovery and can definitely play a role in the continuation of the injury.

    As it relates to scoliosis, the people who got scoliosis due to polio was due to various spinal and rib cage muscles being paralyzed. As well, other diseases like cerebral palsy or multiple sclerosis can result in severe scoliosis for those bound to a wheel chair. So I'm not sure I'd agree with you that if you continued to remain in a bad posture your curve would stay at 0į.

    Again, I understand the point you're making and you'd probably be correct if we were static. But we are of course very dynamic beings and it is the ability to stabilize while being dynamic that allows us motion. That being said, I am skeptical that scoliosis is caused directly by muscle weakness although I have discussed a way in which this would be possible that I think is physiologically sound. But I tend to think that no matter how the curve starts, muscles will become affected and can/will/should play a major role in any treatment protocol.

    I'm not sure if I answered all of your questions.

  3. #3
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    Just skimming Skevimc's reply, I agree and wanted to encourage you to not discount muscle work - remember I improved 5 degrees and I suspect more improvement will follow - I credit the balance ball chair and hopefully my new Earth shoes for most of this!
    34L at diagnosis; Boston Brace 1979
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    Dr. McIntire, thanks for your reply! Of course you have answered my question, but I’m really hard to convince.
    In fact I understand now that muscles have to do more that I thought, because in cervical zone, they keep the head straight even in the frontal plane. If muscles are not activated, or if them are not enough strong, that part of the spine would bend to side. That is what I think that not happens in thoracic and lumbar zones.
    I agree that we are talking about something dynamic, so a system must to be implied.
    We can refer to it as the Stabilization System Spine (SSS) and we could do a difference between that part of the system (a subsystem) dealing with the sagittal plane (SSSP) and the other dealing with the frontal plane, which in turn we should to distinguish between cervical zone and that about I want to know, dealing with the others zones, that is the Stabilization System of Thoracic Lumbar zone in the Frontal Plane (SSTLFP).

    As in any system, we have it is composed by objects. That is what I was referring as ‘the guilty ones’. As any objects has properties and behavior. We could say that a property of a vertebra is the shape and consistence. I think that the length of muscles is a property and is better to refer to the tone, strength.. as a behavior, to be more consistence with a dynamic point of view. In fact all the system has a structure and a behavior. I think (surely because my ignorance) that only muscular behavior could be seen having to to do with the SSS behavior.
    What I really think is that this behavior has to do with the SSSP but not with the SSTLFP. Of course if SSSP don’t works, we cannot walk or remains sitting down by ourselves, but I think that if we have not scoliosis, we remains with 0į anyway.

    Suppose two twins A and B. A, with scoliosis and the other, B without it. As far as I know is difficult but possible.
    Suppose that the twins are anesthetized and sitting down in different benches, with the back over a wall and the head tied to the wall so it cannot move.
    May be one of the girls have low tone and the other high or maybe only A might have muscular weakness. The result would be the same : muscles would not be activated and B would remains with her spine straight and A with her curve. While head and tailbone remains in the same place, even if the bench vibrates or someone pull the spine to side, I’m sure that B remains with 0ļ in thoracic and lumbar zone.
    So, why the difference? Clearly is not because muscular activity. The SSTLFP are different in those twins and it could only be attributed to the structure not the behavior. We can only be absolutely sure that the structure (not the behavior) is different in those twins.

    I think that rotation will remains in A and when she awakes, the curve will remains exactly the same. Muscular activity will not reduce or increase that curve.
    If we could give the same structure to A that her sister has, she would also have 0ļ, regardless how is her muscular behavior (tension, tone, strength..). That is what common sense (my common sense) says to me.
    So I conclude it is a structural problem and muscular behavior is not one of the current and direct guilty for the curve in frontal plane, that is, it not belongs to the SSTLFP. Only muscular length is part of the SSTLFP (I suppose).

    So the actual goal of a treatment should be to improve that structure and not to improve muscular behavior, which could only be a mean to achieve this goal.
    Surely many things could affect in a positive or negative way to the structure of the SSTLFP, as the state of the SSSP, so muscular behavior surely could be a cause of the bad state of the SSSP, as a wrong posture and gravity force.
    I think that while SSTLFP remains understood, scoliosis remains being a mystery.

    Thanks and please let me see again what I'm not taking into account!
    Last edited by flerc; 09-24-2010 at 01:27 PM.

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    Quote Originally Posted by flerc View Post
    Dr. McIntire, thanks for your reply! Of course you have answered my question, but Iím really hard to convince.

    ....

    Thanks and please let me see again what I'm not taking into account!
    This is a great comment and makes a lot of sense. I understand your point and you are correct in several areas. I have a few additional thoughts but can not answer right now because it will take some time to type out.

    You seem like you come from a mechanical engineering background. Or something similar. If so, you would really enjoy the work by Ian Stokes. They do computer modeling of the mechanical forces of muscles, tendons, ligaments, discs and vertebrae in scoliosis. Very technical work but very interesting. Type his name into Pubmed if you are interested.

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    Thanks Dr, in fact is not a good notice for me to know that I may be right. It seems to be much more difficult to change the structure than the behavior in this case. Anyway I'm waiting for your thoughts.
    Iím trying to find this work. Nothing could be more interesting for me. I hope I could be able to understand it, but Iíll ask you if I canít.

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    Quote Originally Posted by dailystrength View Post
    Just skimming Skevimc's reply, I agree and wanted to encourage you to not discount muscle work - remember I improved 5 degrees and I suspect more improvement will follow - I credit the balance ball chair and hopefully my new Earth shoes for most of this!
    Dailystrength, thanks for your advice and encouragement. I think that 5į is really a good improvement in an adult. Remember me please what are you doing. I believe I read you was doing Pilates and Alexander, may be? Iím looking for something like the balance ball chair but I think it not exist in my country.
    In fact we are not thinking in discount the current therapy, but I feel itís not enough and something more direct is needed, but we are afraid of those methods even it seems to be the best by far..

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    Quote Originally Posted by skevimc View Post
    This is a great comment and makes a lot of sense. I understand your point and you are correct in several areas. I have a few additional thoughts but can not answer right now because it will take some time to type out.

    You seem like you come from a mechanical engineering background. Or something similar. If so, you would really enjoy the work by Ian Stokes. They do computer modeling of the mechanical forces of muscles, tendons, ligaments, discs and vertebrae in scoliosis. Very technical work but very interesting. Type his name into Pubmed if you are interested.
    I cannot find that work. I saw something but I cannot access it. Should I be registered in Pubmed?
    I continue waiting for your thoughts. In the meantime, I had others too. In fact I think now that muscular behavior should to be included as part of the SSTLFP, but not in an important way..
    If Iím right and the curve of A not increase when she is anesthetized and not decrease when she awakes, muscular behavior seems to not be part of the SSTLFP.
    But what could happens if we push down her shoulders? I think it would not be the same anesthetized or awake, alive or dead. I suppose that muscles if she is awake would be activated to fight against that force and could avoid that the curve increase.
    So I think that probably a little role is developed during day against gravity force, but mainly when lifting weights.

    Regards.

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    Quote Originally Posted by flerc View Post
    I agree that we are talking about something dynamic, so a system must to be implied.
    We can refer to it as the Stabilization System Spine (SSS) and we could do a difference between that part of the system (a subsystem) dealing with the sagittal plane (SSSP) and the other dealing with the frontal plane, which in turn we should to distinguish between cervical zone and that about I want to know, dealing with the others zones, that is the Stabilization System of Thoracic Lumbar zone in the Frontal Plane (SSTLFP).

    As in any system, we have it is composed by objects. That is what I was referring as Ďthe guilty onesí. As any objects has properties and behavior. We could say that a property of a vertebra is the shape and consistence. I think that the length of muscles is a property and is better to refer to the tone, strength.. as a behavior, to be more consistence with a dynamic point of view. In fact all the system has a structure and a behavior. I think (surely because my ignorance) that only muscular behavior could be seen having to to do with the SSS behavior.
    What I really think is that this behavior has to do with the SSSP but not with the SSTLFP. Of course if SSSP donít works, we cannot walk or remains sitting down by ourselves, but I think that if we have not scoliosis, we remains with 0į anyway.

    Suppose two twins A and B. A, with scoliosis and the other, B without it. As far as I know is difficult but possible.
    Suppose that the twins are anesthetized and sitting down in different benches, with the back over a wall and the head tied to the wall so it cannot move.
    May be one of the girls have low tone and the other high or maybe only A might have muscular weakness. The result would be the same : muscles would not be activated and B would remains with her spine straight and A with her curve. While head and tailbone remains in the same place, even if the bench vibrates or someone pull the spine to side, Iím sure that B remains with 0ļ in thoracic and lumbar zone.
    So, why the difference? Clearly is not because muscular activity. The SSTLFP are different in those twins and it could only be attributed to the structure not the behavior. We can only be absolutely sure that the structure (not the behavior) is different in those twins.

    I think that rotation will remains in A and when she awakes, the curve will remains exactly the same. Muscular activity will not reduce or increase that curve.
    If we could give the same structure to A that her sister has, she would also have 0ļ, regardless how is her muscular behavior (tension, tone, strength..). That is what common sense (my common sense) says to me.
    So I conclude it is a structural problem and muscular behavior is not one of the current and direct guilty for the curve in frontal plane, that is, it not belongs to the SSTLFP. Only muscular length is part of the SSTLFP (I suppose).

    So the actual goal of a treatment should be to improve that structure and not to improve muscular behavior, which could only be a mean to achieve this goal.
    Surely many things could affect in a positive or negative way to the structure of the SSTLFP, as the state of the SSSP, so muscular behavior surely could be a cause of the bad state of the SSSP, as a wrong posture and gravity force.
    I think that while SSTLFP remains understood, scoliosis remains being a mystery.

    Thanks and please let me see again what I'm not taking into account!
    The main thing I would say is that while I think muscles can and should be part of the solution. However, the curve itself, in most cases, will be a result of discs, ligaments, tendons, bones. This would explain why in the absence of muscular tone the curve would still exist. (muscles can cause the spine to curve as has been shown in certain athletes such as swimmers and javelin throwers.) But even in these cases, I would imagine that the curve is maintained even in the absence of muscle tone because of the static tissues.

    Just because the behavior of the muscles is not the primary cause of the curve does not mean that they can not affect the curve in a positive way.

    There are a few other thoughts I have but let me stop here and see if I'm answering the correct things.

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    Itís really a great help for me to talk with you! Iím not sure at all if I understand well. Do you think that muscles could have a dangerous behavior making the curve worst?
    That is what some Meziesrist people says. In fact they say something like that the curve is because of an excessive tone of some muscles. I said them that if it would be the problem, when my daughter is lying down (without gravity force pulling down), the curve would remains and itís not what happens, so I think they are wrong, at least in the sense, that it could be a serious factor affecting the SSTLFP. The problem seems to be that the structure of that system, is failing in some of the statics components.
    It seems that traditional Physiotherapy (since so many decades) and many current methods, focused in the muscular behavior are not going directly to the problem.

    Thanks again and I'll wait for the link and your comments.

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    Quote Originally Posted by flerc View Post
    Itís really a great help for me to talk with you! Iím not sure at all if I understand well. Do you think that muscles could have a dangerous behavior making the curve worst?
    That is what some Meziesrist people says. In fact they say something like that the curve is because of an excessive tone of some muscles. I said them that if it would be the problem, when my daughter is lying down (without gravity force pulling down), the curve would remains and itís not what happens, so I think they are wrong, at least in the sense, that it could be a serious factor affecting the SSTLFP. The problem seems to be that the structure of that system, is failing in some of the statics components.
    It seems that traditional Physiotherapy (since so many decades) and many current methods, focused in the muscular behavior are not going directly to the problem.

    Thanks again and I'll wait for the link and your comments.
    I'm enjoying the conversation as well. Honestly, you are giving me some good things to think about.

    I think it is possible for the muscles to make the curve worse. The problem is that with the complexity of how the muscles act on the spine, it is very difficult to say what movements would potentially increase the curve. This is why I think that symmetrical strengthening is an important component. But ultimately nobody knows. So remember that when someone says to you that strengthening is bad or stretching is bad or anything like that. Nobody knows for sure.

    As far as the curve remaining even if your daughter is asleep. This is a pretty good point. But if excess muscle tone is the primary cause of the curve, the static tissues would still adapt. The discs would begin to wedge, the ligaments would begin to stretch. This is just one possible explanation.

    I think you've made a good point that many physiotherapy methods focus a lot on the muscle component and not as much on the static tissue components.

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    You are the only one in the world that really understands me. Sometimes I think that all professionals are blinded by the paradigm of her own discipline and cannot see any more. Fortunately is not your case.
    I always thought that Scoliosis problem was never analyzed according Problem Solving principles. Physiotherapy made an assumption and goes deep in that direction. That is what all disciplines do.
    In fact I think that physiotherapy, even if muscular behavior not belongs to the SSTLFP, is good but in an indirect way.

    In my country all says that abdominal muscles help to maintain the spine straight. I donít know why, but it really seems to be good for the SSSP. Is strange but I know someone without scoliosis and with an herniated disc and instead of surgery he decided to do some specialized exercises and he said me he not need surgery any more, he has not more pain. I donít know how could it be, but it seems that some exercises reduce disc pressure. I think that surely SSSP and SSTLFP are system with a high coupling, in fact, many components are common to those systems, so is logic to suppose that what could be good for one of them could be fine to the other too.

    But of course scoliosis need something overwhelming, and there only are 2 scoliosis physiotherapy methods ignoring muscular behavior as I know..

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    Quote Originally Posted by flerc View Post
    You are the only one in the world that really understands me. Sometimes I think that all professionals are blinded by the paradigm of her own discipline and cannot see any more. Fortunately is not your case.
    I always thought that Scoliosis problem was never analyzed according Problem Solving principles. Physiotherapy made an assumption and goes deep in that direction. That is what all disciplines do.
    In fact I think that physiotherapy, even if muscular behavior not belongs to the SSTLFP, is good but in an indirect way.

    In my country all says that abdominal muscles help to maintain the spine straight. I donít know why, but it really seems to be good for the SSSP. Is strange but I know someone without scoliosis and with an herniated disc and instead of surgery he decided to do some specialized exercises and he said me he not need surgery any more, he has not more pain. I donít know how could it be, but it seems that some exercises reduce disc pressure. I think that surely SSSP and SSTLFP are system with a high coupling, in fact, many components are common to those systems, so is logic to suppose that what could be good for one of them could be fine to the other too.

    But of course scoliosis need something overwhelming, and there only are 2 scoliosis physiotherapy methods ignoring muscular behavior as I know..
    Your friend with the herniated disc is a good example of how muscles and static tissues work together. There can be any number of ways a disc can become herniated or injured in some way. Falling down or twisting too hard or a car accident. And sometimes it just happens over a long period of time. Whatever the case, the injury or pain comes from the disc. This is what is wrong. When there is pain, the spine muscles begin to act differently. Some become very tense and have a very high tone. The body does this to try and protect itself from more pain and injury. The problem with this is that it actually hurts the body more because the muscles actually help to pinch the disc more. By doing Phys Ther. you can relax the muscles and strengthen them so that they stabilize the dynamic spine. Once the muscles are working and stabilizing properly the herniated disc is unloaded and can reduce the inflammation.

    However, if the disc is ruptured or torn, exercise might help a little bit but the pain will not go away because the static tissue is damaged. So for scoliosis, if there is wedged discs or vertebrae, exercises will not be as effective. This is also why I am in favor of performing exercises on patients during the 'watching and waiting' period (~10-20į). But I know there are money issues with doing that.

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    Of course 'watching and waiting' can not be the outcome of a logic reasoning. But there is another 'watching and waiting' with a variable range for each surgeon but in average it is between 40į and 50į when not a great pain or progression exists.
    It seems that the same people is only able to say Ďstrengthens your back and good luckí. Really good luck would be needed to follow that advice..

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    Quote Originally Posted by skevimc View Post
    So for scoliosis, if there is wedged discs or vertebrae, exercises will not be as effective.
    Forgive my ignorance but, wedged discs (in frontal plane) not exist always with scoliosis?
    Do you think that abdominal strengthening could be something useful even with a big curve?

    When there is pain, the spine muscles begin to act differently. Some become very tense and have a very high tone. The body does this to try and protect itself from more pain and injury. The problem with this is that it actually hurts the body more because the muscles actually help to pinch the disc more. By doing Phys Ther. you can relax the muscles and strengthen them so that they stabilize the dynamic spine. Once the muscles are working and stabilizing properly the herniated disc is unloaded and can reduce the inflammation.
    It seems that improving muscular behavior could only avoid to go worst, but can not reduce the curve, as surely could be done improving the length.
    My only doubt is about rotation. I'm not sure at all, how much could it be reduced being stand up or lying down, awake or asleep. Do you think that muscular behavior could have something to do?

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