Muscular question to Dr. McIntire

[skevimc]

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?

You are correct, there is disc wedging. But studies have shown that the amount of disc wedging is minimal in curves up to around 20° or 25°, if I'm remembering that reference correctly. After 25°, the wedging becomes much more noticeable and starts to become permanent. So as the curve increases the risk of permanent damage also increases. This permanent damage does not mean exercises won't be effective, but I believe that curve stability would be the main goal and not curve reduction. If there is no major or permanent damage/wedging to the disc then I think curve reduction would be possible.

I think strengthening COULD be effective in curves up to ~45°. After that, I'm not sure. I guess it depends on what you mean by 'useful'. Will strengthening reduce a larger curve? I do not think so, but several people will disagree with me. Will strengthening stop progression? Potentially. But the exercises would need to be very specific and in combination with other therapies. Will strengthening improve pain? I think this is what strengthening would do the best for larger curves.

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?

I also think rotation is the most difficult and dangerous part of the curve. It is also the most difficult part to control. To answer your question, I can only say "maybe".

[flerc]

rotation

Hi skevimc, I was thinking about rotation that seems to be the worst, and I am not sure if it is the outcome of the curve in the frontal plane. If adults with scoliosis (because a problem in the discs) that never had it before adulthood, has also rotation, then it seems to be only a consequence. Do you know that

But anyway, something is allowing rotation. It is difficult for me to believe that could be ligaments, discs or the pneumatic skeleton, so it seems that only could be muscles and joints.
The Torso rotation machine seems to works. Do you know if the only outcome of this exercise is to have muscles more strong
It is a great pity for me that this machine does not exists in my country

Regards

[flerc]

Rotation

http://www.scoliosispt.net/history.html
It seems a big curve that can be reduced through the activation of some muscles.
Do you know if some rotational muscles are involved in this exercise?

[skevimc]

http://www.scoliosispt.net/history.html
It seems a big curve that can be reduced through the activation of some muscles.
Do you know if some rotational muscles are involved in this exercise?

The Schroth method avoids excessive rotation. From this point of view, they primarily concentrate on de-rotation. In fact, another website for Schroth says that patients with scoliosis should avoid certain rotational exercises.

That being said, their exercises definitely use the rotational muscles. They just don't focus on the strength of the muscles but rather the daily function of the muscles. I really like certain parts of this type of therapy. It concentrates on each component of the curve. Also, it is active correction versus passive correction. An example of passive correction is a brace or surgery.

[flerc]

what can I do?

Thanks Dr.! All I have heard and all I have seen in the last time seem to leads to the same place: rotational muscles. What would you do if you would live in a country without Schroth, Spinecor and Torso Rotation Machine?

[skevimc]

Thanks Dr.! All I have heard and all I have seen in the last time seem to leads to the same place: rotational muscles. What would you do if you would live in a country without Schroth, Spinecor and Torso Rotation Machine?

I think the rotational component of scoliosis is probably the most important and also the most difficult to do anything about. Even surgery has a difficulty with rotation. And I've been thinking about the various hypotheses around scoliosis etiology or progression, and it seems like rotation is the primary deformity. The lateral curve is the most visual and noticeable. But rotation can make a small curve much worse. It's overlooked most of the time, or rather, it's not the primary focus when we discuss curve progression and I think this is a serious mistake. One primary reason is that it is difficult to measure. The method is easy, but getting a really good x-ray is extremely important. Anyway...

To try and answer your question. Are there weight rooms or gyms in your country? (I forget where you live.) Torso rotation machines are in a lot of exercise facilities, but that might not be true in your country. It is possible to do trunk rotations with exercise bands. The most popular one is called thera-band. Just do a serach for thera-band and you'll find a bunch of it. The important part is to get something that is heavy enough. The tension is measured by the color so I suggest the black, gray or gold kind. The resistance is non-linear. For example, the gold band is weighted at 20 pounds (~9kg). This means that it would take 20 pounds of linear force to double the starting length. So a 2 foot piece of gold t-band would require 20 pounds of force to stretch it to 4 feet. Stretching it less than that requires less force and stretching it more than that requires more force. It gets a tad more complicated when you use the force in a rotational movement so now the force becomes torque. It took me a while to figure out, because I'm not mathematically gifted, but I figured out that a trunk rotation required about 1 foot of movement with a 6 to 10 inch moment arm. So taking a 3 foot piece of band, stabilizing in a door, pre-stretching it to 5 feet, doing a trunk rotation to stretch it to 6 feet required 20 pounds of force. However, due to the increased resistance from the moment arm, i.e. the t-band gets the advantage of leverage, this required more effort by the trunk muscles. Approximately double. So moving the 20 pounds of t-band was ~ equal to 40 pounds on the weight machine.

Sorry if this is overly complicated, but it seems to me that you are familiar with mechanical engineering.

I can send you a pdf version of my original article, or I think it's freely available in the scoliosis journal. In the discussion section, I believe there is a description of the home protocol. If not, I think I typed one up for someone a while back and I'll see if I can find it.


Edit: I also think the video on the Schroth website you posted is very good and has very good examples and reasons for the specific exercises.

[flerc]

First of all, thanks for your explanation. I’ll take a time to read it in a deep way. But I want before, to say you something I have just thought and I’m afraid to forget it.
I think that Torso rotation exercises should to be done in the absence of gravity force. It’s difficult to get something like that, but the same outcome could be reached doing this exercise lying down. Do you think it might be possible? The ‘reason’ is that it seems to be impossible to keep the spine straight during a long time standing up with the gravity force, but is possible, if we are talking of a very flexible spine, being lying down.
As it seems to be incorrect to strech the spine without derotate it, I suppose that it could not be the best to derotate it without strech it.
The other way could be with a dynamic brace holding a straight posture, but Spinecor don’t exist in Argentina.
I hope you can send me your article.

It’s always something really good to talk with you.

[foofer]

It's also something really good to read these discussions.

I received an inversion table for Xmas and have been using it in the evenings- just breaking into it slowly. After a long day of compressing, it really does feel unique to invert- I feel so much longer being upside down, and I'm wondering if you might know what position the scoliotic spine assumes when inverted- gravity now working in the opposite direction?

Thanks ahead of time...

[livingtwisted]

Amy, that's a great question. I've placed a mirror behind my inversion table so that I can see what happens when I'm upside down, at least from the front anyway. I definitely look longer and straighter while upside down, and more so now than when I first started doing it so I guess I've gained some flexibility. From what I can tell the muscles still hang on to what they know even upside down, it just looks like a less exaggerated version of my same curve. But it would be good to know from an expert what's happening.

[scolio1964]

Rotation

Please excuse my ignorance, but can someone explain what rotation is?

Thank you!

[skevimc]

It's also something really good to read these discussions.

I received an inversion table for Xmas and have been using it in the evenings- just breaking into it slowly. After a long day of compressing, it really does feel unique to invert- I feel so much longer being upside down, and I'm wondering if you might know what position the scoliotic spine assumes when inverted- gravity now working in the opposite direction?

Thanks ahead of time...

For sure disc decompression happens. It would only be a guess about how much and what effect that would have. I know that horizontal x-rays are different than vertical x-rays with the horizontally measured curves being smaller. So it would stand to reason that a complete inversion would reduce it at least that much if not more because of the added traction. It would be an interesting thing to look at and would be pretty easy to role an inversion table into an x-ray room.

[skevimc]

Please excuse my ignorance, but can someone explain what rotation is?

Thank you!

Rotation either means vertebral rotation. Which is looking at the individual bones of the spine from the top down. The vertebral apex of the curve is rotated towards the convexity. So a right thoracic curve has vertebrae that are rotated clockwise.

OR rotation means performing a rotational movement of the spine, i.e. a twisting motion.

Does that make sense?

[scolio1964]

Rotation either means vertebral rotation. Which is looking at the individual bones of the spine from the top down. The vertebral apex of the curve is rotated towards the convexity. So a right thoracic curve has vertebrae that are rotated clockwise.

OR rotation means performing a rotational movement of the spine, i.e. a twisting motion.

Does that make sense?

Seems like most of the people in this group are WAY more intelligent that I am. I don't have an engineer's mind!! LOL. No, it really doesn't make sense. Do all kids with scoliosis have rotation? Our doctor has never mentioned it. I've never heard the word until joining this group. My daughter right should blade sticks out further than her left and when she bends over, her right side is further up than her left side. Does that mean her spine has rotated? She has a 36 degree thoracic curve and currently has worn a Boston brace for 3 years. Her curve recently progressed from 27 degrees to 36 degrees. I've been looking into exercises or even the VBS, so I'm trying to get information about everything I can. She's 14 and still growing.

Thanks for your help!!

[Pooka1]

Seems like most of the people in this group are WAY more intelligent that I am. I don't have an engineer's mind!! LOL. No, it really doesn't make sense. Do all kids with scoliosis have rotation? Our doctor has never mentioned it. I've never heard the word until joining this group. My daughter right should blade sticks out further than her left and when she bends over, her right side is further up than her left side. Does that mean her spine has rotated? She has a 36 degree thoracic curve and currently has worn a Boston brace for 3 years. Her curve recently progressed from 27 degrees to 36 degrees. I've been looking into exercises or even the VBS, so I'm trying to get information about everything I can. She's 14 and still growing.

Thanks for your help!!

No this is not a matter of intelligence. It is rather a matter of specific knowledge. Completely different.

The spine can be abnormal in these planes:

1. front-back - this is the normal Cobb angle plane. Any angle >10* is scoliosis.
2. side-side - this is the sagittal plane and is whether the spine is bent too far forward or too far back.
3. Transverse - looking straight down on the spine. In a normal person, the vertebrae are not rotated with respect to one another in this plane. If they are rotated as in a scoliosis, they will be rotated in the direction of the convexity again looking straight down from the top of the spine.

In re rotation in specific cases, it is not a lock-step thing with Cobb angle as far as I know. Thus you can have a 40* curve with a little or a lot of rotation.

Also there is the Adam's forward bending test which I think measures some amalgam of both curve magnitude and rotation but I don't know that. Our surgeon never once measured the slope of my daughters' back on the forward bending test so I assume it is both not relevant to the treatment and is not relevant to surgical correction like say determining the lowest instrumented vertebrae is.

[Pooka1]

Here's a paper from 1969 explaining how rotation is measured.

It is notable because there are physical bounds on rotation given the Cobb (see table 1) which is not so surprising.

http://www.ejbjs.org/cgi/reprint/51/2/223

With my daughters, one had a huge rotation and the other barely so at similar Cobb angles. So there is definitely a range in rotation for a given Cobb angle.