Martha Hawes improves her scoliosis w exercise

[Bigbluefrog]

Thanks for sharing all those stretches.
My daughter has scoliosis, and was doing 1/2 hour of schroth therapy a day, since bracing ended she has declined in her PT. Her curve is S shaped but on closer look at her radiographs you can see it is a 4 curves instead of two. The smallest starts with the pelvic, and quite often I can see her hip is forward the SI joint is out of position. Tight Hamstring and calves, the long day of sitting exasperates the tightness. Carrying a heavy book bag adds additional stress.

We stepped up on exercising, and motivating a 16 year old is challenging. I find that when the exercises are done, and done correctly, we see improvement. The start of it is at the base of the spine when that is aligned and balanced the rest of her back improves. Strength training and propioception exercises help with posture.

Your pictures remind me of my daughter, we could see improvement. She stood taller and looked stronger.

I am not familiar with Alexander technique, but it sounds similiar to Schroth therapy.

[TOscoliosis]

Thanks for sharing all those stretches.
My daughter has scoliosis, and was doing 1/2 hour of schroth therapy a day, since bracing ended she has declined in her PT. Her curve is S shaped but on closer look at her radiographs you can see it is a 4 curves instead of two. The smallest starts with the pelvic, and quite often I can see her hip is forward the SI joint is out of position. Tight Hamstring and calves, the long day of sitting exasperates the tightness. Carrying a heavy book bag adds additional stress.

We stepped up on exercising, and motivating a 16 year old is challenging. I find that when the exercises are done, and done correctly, we see improvement. The start of it is at the base of the spine when that is aligned and balanced the rest of her back improves. Strength training and propioception exercises help with posture.

Your pictures remind me of my daughter, we could see improvement. She stood taller and looked stronger.

I am not familiar with Alexander technique, but it sounds similiar to Schroth therapy.

Thanks for your comments BBF,
I wish you and your daughter luck with your work. Yes, I'm currently working with an eleven year old and an eighteen year old and motivation is tricky. Actually, I find motivation challenging sometimes myself, but I aim to do a little bit every day - even if it's only five minutes.

To continue the conversation about treatment:
More and more these days it seems to me that non-surgical scoliosis treatments are focusing on similar themes. They are:
Proprioception training
Muscle conditioning (stretching and strengthening to achieve a more symmetrical musculature)
Posture training

In my opinion the best results will occur when these approaches are integrated, and the closer the integration the more effective the result. In other words, having a routine that involves doing a proprioception exercise, followed by a muscle conditioning exercise, followed by a postural exercise will be less effective than using single exercises which incorporate all aspects at once. My approach is based on the latter style of exercises.

I also believe that success will be based not on the correct choice of exercises per se, but on the detailed supervision of their performance (either by an observer/coach or by self-supervision. I use mirrors for this) Doing fifty repetitions of a standing-leg-lift will be less effective than doing one or two standing-leg-lifts while paying very close attention to their execution so that the movements are done with as close to perfect form as possible.

My approach is very detail oriented. Everyone can do a standing-leg-lift - bring their knee up, then drop it down again. But a correctly performed standing-leg-lift presents a serious challenge.

A correctly performed standing-leg-lift starts with a person standing with their feet together or only slightly apart. The person then brings one knee up until their thigh is horizontal to the floor, then lowers it again. The movement is performed at a smooth, unhurried pace. For the movement to be considered accurate, the pelvis remains still during the movement - it doesn't list to left or right, rotate or otherwise become displaced. Likewise, there is no lateral movement of the supporting leg or flexion at its joints: hip, knee or ankle. It is surprisingly difficult for people without scoliosis. In cases of scoliosis, my experience so far is that one side is closer to being able to perform the movement correctly than the other (no surprise). On the weak leg, the person often feels that they are more likely to fall over than to bring their knee up without a large shifting of their pelvis or leg. In my opinion this reveals how scoliosis is more than a spinal problem. The scoliotic imbalance can be traced all the way down to our feet.

Best to everyone
- Joshua

[TAMZTOM]

The ISICO folk talk about the contribution of three systems to the ultimate Cobb angle - the bony part, the ligament part, and the muscle part. I *believe* their exercises only address the muscular part (that is, I don't think they believe they can change the ligament part, and I'm certain they don't think they can change the bony part).

I don't know if I read all through this thread when trawling everything in the early dark ages. I wish I had!
I read the ISICO stuff a while ago and have been wrestling with those three systems ever since, Hdugger. What has become apparent is that exercise can change the ligament part and enable so-called structural curves to correct. Constant ASCs and side-shifting has radically increased the flexibility/mobility of Tamzin's thoracic "structural" curve. As you say, bone is equally flexible or inflexible in everyone, i.e., doesn't really change significantly. Our exercises haven't done zip to the bone, but they've loosened whatever soft tissue structures (ligament, tendon, muscles, etc.) were stopping the curve being able to SIGNIFICANTLY correct. Surgeons do this all the time before ops: they have patients perform "flexibility inducing EXERCISES" to allow maximum correction during the op. Are surgeons really just closet exercise junkies!
This increased exercise induced curve mobility can destabilise the spine: surgeons slap in some rods; alternatively, why not just bulk up the paraspinals with healthy exercise to hold the spine in the new alignment? Highly corrective bracing must also mobilise the curve, stretch those soft tissue structures. The problem there is that this passive force, when removed, leaves the spine unsupported--one can't just simply THEN start working the muscles and mind to support the spine--it takes constant work, i.e., normal muscular movement during everyday life. There's a spate of interest now in performing exercises while wearing braces--this seems wise to me.

Am I missing something? Is fusion surgery actually changing the fixed, bony structure? Or is it just keeping the spine from bending against the force of the ligaments and muscles?

I think you're spot on, Hdugger.

[Pooka1]

Surgeons do this all the time before ops: they have patients perform "flexibility inducing EXERCISES" to allow maximum correction during the operation

Tom, they don't do this all the time. They never do it as far as I can tell from the testimonials. Or at least I can't recall anyone writing that.

You are generalizing from one set of amateurs in the early 1990s who were dabbling in spinal fusion at the beginning of a new instrumentation era. The ONLY place I saw that was in the article you posted.

I have NEVER seen a testimonial where anyone, kid or adult, was told to do exercises for the purpose of increasing flexibility prior to the operation. Adults are sometimes told that being in better shape which is not the same thing. For both my kids, the main reason they did the bending films a few days prior to surgery was to determine which curves were structural and to determine the fusion endpoints as far as I know.

In terms of changing the bone, osteotomies are used (wedge, Smith-Peterson, whatever). So some fusions do involve changing the bone shape to get a better correction. But that seems to be limited to adults who wait until their vertebra wedge. As I understand it, most kids who get treated in a reasonable time frame do not have wedged vertebrae and therefore don't need the bone remodeling osteotomies. Linda will correct me if I'm wrong.

[TAMZTOM]

Tom, they don't do this all the time. They never do it as far as I can tell from the testimonials.

Sharon, these flexibility exercises are done worldwide. See Cotrel. They are commonly done in Canada, UK and all over Europe. I've discussed them with our spine surgeon--both spine surgeons actually. I agree, I should not have written ALL THE TIME. This may be a translation issue--"all the time" in the UK can mean "often".

You are generalizing from one set of amateurs in the early 1990s who were dabbling in spinal fusion at the beginning of a new instrumentation era. The ONLY place I saw that was in the article you posted.

I am not generalising from one set of amateurs. The horrendous results from that Mengele-like experimentation in the abstract I posted on another thread are nothing to do with the point I make in this thread about the widespread use by surgeons of flexibility exercises before surgery. I actually believe you have posted about the flexibility exercises surgeons use pre-op.

I have NEVER seen a testimonial where anyone, kid or adult, was told to do exercises for the purpose of increasing flexibility prior to the operation.

Elisa's kid. Halo traction, etc. Those are flexibility inducing procedures. it is simply not true to suggest that increasing flexibility of the soft tissue structures prior to surgery is not a widespread practice.

What that abstract did demonstrate, however, is that there are cowboys out there performing surgery. I have no doubt that there are also excellent surgeons who perform excellent surgery. Most folk don't have the option to shop around for the best surgeon--the poor surgeon would be sorely taxed for time anyway!

I haven't had time today yet to read the spine articles you linked on the other thread. I will read them.

[Pooka1]

Sharon, these flexibility exercises are done worldwide. See Cotrel. They are commonly done in Canada, UK and all over Europe. I've discussed them with our spine surgeon--both spine surgeons actually. I agree, I should not have written ALL THE TIME. This may be a translation issue--"all the time" in the UK can mean "often".

Okay but I can't recall a single testimonial about someone being asked to exercise before surgery for the expressed purpose of increasing flexibility to get a better correction. That to my knowledge is determined from the bending films and I am not aware of any evidence that flexibility can be increased through any exercise for the purpose of getting a better correction during fusion. Maybe Linda knows.

Do you have a citation where surgeons tested this? I have never seen a paper on this.

I actually believe you have posted about the flexibility exercises surgeons use pre-op.

I am blanking on that unless you mean the bending films done immediately prior to determine aspects of the curves and fusion planning. The only exercises I have seen mentioned pre-op were for adults to get in the best shape possible because they have a harder time. Kids usually sail through irrespective of fitness/flexibility, even sedentary couch potatoes like mine. :-). That's not actually fair.. their joints hurt if they do too much which is probably linked to their connective tissue deal.

Elisa's kid. Halo traction, etc. Those are flexibility inducing procedures. it is simply not true to suggest that increasing flexibility of the soft tissue structures prior to surgery is not a widespread practice.

Halo traction is extremely rare and only used in the case of huge curves as far as I can tell. And that is actually part of a operative procedure... they do the release and then put them in traction prior to the fusion . Or at least that's what happened with Elias. He didn't exercise. I don't think exercise is possible in traction but I don't know that.

I will review the surgery testimonials of the kids and see if anyone was told to exercise prior to fusion to increase flexibility. Maybe you are right and I am not remembering.

[TAMZTOM]

Do you have a citation where surgeons tested this? I have never seen a paper on this.

From memory, Sharon, I believe I posted stuff to Tamzin's thread when I first found the Cotrel protocol for increasing flexibility/reducing immobility pre-surgery. Based on that reading, I discussed with our surgeons their use of exercises to increase flexibility. There is almost a fear of letting these exercises loose on the scoliotic public to avoid destabilising spines. This fear is well grounded, without passive support (e.g., a brace or surgical rods), spines would/could destabilise after these exercises. Surgeons use them to ensure they get the maximum correction. My interest is to achieve the safest degree of flexibility/mobility that Tamzin can hold with muscle, re-aligned ligament, etc. (I believe I asked you whether you could find any papers or info on the full Cotrel exercises.)

I am not capable of innovative thought in the field of scoliosis. Everything I post in here is LEARNED from somewhere else. Instead of there being some vast divide between 'the surgery group' and 'the exercise group', I see this flexibility/mobility issue as extremely important to both to achieve the best correction possible.

[Pooka1]

From memory, Sharon, I believe I posted stuff to Tamzin's thread when I first found the Cotrel protocol for increasing flexibility/reducing immobility pre-surgery. Based on that reading, I discussed with our surgeons their use of exercises to increase flexibility. There is almost a fear of letting these exercises loose on the scoliotic public to avoid destabilising spines. This fear is well grounded, without passive support (e.g., a brace or surgical rods), spines would/could destabilise after these exercises. Surgeons use them to ensure they get the maximum correction. My interest is to achieve the safest degree of flexibility/mobility that Tamzin can hold with muscle, re-aligned ligament, etc. (I believe I asked you whether you could find any papers or info on the full Cotrel exercises.)

Did I find anything? I don't remember. Did they determine exercising had a measurable effect on flexibility?

I am not capable of innovative thought in the field of scoliosis. Everything I post in here is LEARNED from somewhere else. Instead of there being some vast divide between 'the surgery group' and 'the exercise group', I see this flexibility/mobility issue as extremely important to both to achieve the best correction possible.

I completely agree. If some surgeons showed that doing exercises prior to surgery increased flexibility and therefore correction then every surgeon should be prescribing them. But it seems like nobody is just judging from the testimonials. We need to see some controlled studies to see if it helps.

I don't know what controls flexibility in the spine. I don't know why some kids have flexible curves and others don't.

[TAMZTOM]

Did I find anything? I don't remember. Did they determine exercising had a measurable effect on flexibility?

I found the paper I was looking for before anyone could respond, Sharon. Posted it on Tamzin's thread. And yes, it had a measurable effect on flexibility. That there are no anecdotal testimonies on it being done could be attributable to the horrendous lack of practical dissemination of good science into medicine; the beneficial stuff that could be done gets so damn diluted down the chain. Makes me angry that there's knowledge out there that just stays out there.

I completely agree. If some surgeons showed that doing exercises prior to surgery increased flexibility and therefore correction then every surgeon should be prescribing them.

I'll find the study in the thread or my notes....rushing right now.

I don't know what controls flexibility in the spine. I don't know why some kids have flexible curves and others don't.

Two curves with opposing rotations can make the spine rigid--between T12 and T7 is a focal point for those rotations to hit each other head on, the result, rigidity. IV disks, locked processes, soft tissues, ligaments..the entire kitbag of stuff can make the damn things immovable. This is one of the reasons I've harped on about the necessity of derotationg before any sustainable correction is possible. E.g., one can bend or stretch all you like, but if those opposing rotations are still clashing, looser ligaments and muscles won't achieve squat. I believe Tamzin's current thoracic curve flexibility--that you've seen photos of--is attributable to our technical rigour to ensure that her thoracic side-shift is performed AFTER maximum derotation of the upper thorax in an a/c direction, while her hip-hitched lumbar side-shift is performed with an opposite c/w movement. This unwinds the spine before the lateral correction of both curves, this movement by necessity stretching and/or re-aligning the anterior ligament in particular. She then holds as much of the correction as she can in the interval between ASC+SS (every 8 minutes all day) and this retains some of the "ligamentous creep" correction.
That's what we do...I don't "know" this will work for anyone else as I just made it all up for Tamzin. :-)