Martha Hawes improves her scoliosis w exercise

[TAMZTOM]

Test test test

[TOscoliosis]

The implication is unavoidable and comports with Schroth restriction on movement. Is maximising ROM desirable, if the trade-off is increasing force on the curves? Forward flexion makes me wince; even at medical appointments, I don't permit my daughter to do the Adams bending test. Why maximise the distorting torque when there's evidence of rotation even while standing.

QUESTION:

• concave side ligaments must be stretched and misaligned on thoracic curves;
• increasing ROM, without simultaneously applying corrective lateral force, would result in those ligaments being permanently realigned in the overstretched position;
• would this make it much more difficult to correct thoracic curves, or put differently, make stabilization the goal?

I would say that increasing ROM is not desirable if the trade-off is increasing force on the curves. I'm guessing that most people feel similarly. I certainly understand your reluctance to have your daughter do movements that torque her body. At the same time, I don't believe that we should make a choice between increasing range of motion OR stabilizing the spine. I think our goal can be using range of motion exercises as a means of balancing the forces that are acting on the spine, thereby giving it greater stability.

Speaking from my own experience, my goals are to reverse my curvature as much as possible and regain as much normal range of motion as possible. An example: I am working on seated forward bends to increase low back muscle length and to balance my lower body movement habits. I have one or more mirrors set up when I do my seated forward bends to observe how symmetrical my movement is. I usually have a mirror in front of me. I also sometimes place another mirror behind me and tilted so that I can see my back as I bend forward. Working with these mirrors allows me to check my self-perception with a visible reality. I only move into the forward bend as far as is consistent with avoiding rotation and lateral shifting. I have been doing this exercise for a few months now and have noticed several positive outcomes:

My range of motion in forward bend while avoiding rotation or lateral shifting has increased.
My perception of myself is becoming more accurate - when I check myself in the mirror I find my self-perception is closer to matching the view.
The lateral curve in my lumbar spine is straightening. (Images here: Lumbar 2003 + 2011 combined.jpg)

I should say that my self-care approach involves Alexander Technique, receiving Structural Integration treatments and several other exercises apart from seated forward bends. I am very doubtful that seated forward bends done in isolation will straighten a lumbar lateral curve.

[TAMZTOM]

At the same time, I don't believe that we should make a choice between increasing range of motion OR stabilizing the spine.

Is there a choice? (My question was inept, badly couched.) Here's a retry:
If an exercise stretches and realigns already stretched thoracic curve ligaments on the concave side, would this achieve stability at the cost of correction?
Much bracing and exercise literature focuses on stability as if even the mention of correction is taboo. E.g., TR studies emphasise stability, but some of Kevin_Mc's group corrected (from memory, some by 10 degrees). Not statistically relevant, but hugely important. In all endeavours, only a few excel. (That some TR patients improved may in fact answer my question--with those who improved, the ligaments in question did not stabilise in the overstretched position.)

I am working on seated forward bends to increase low back muscle length and to balance my lower body movement habits.

Sitting balances the pelvis and may minimise distorting psoas and associated ligament contribution. Hamstring and knee ligament distorting pull is also removed/lessened. (I was hoping Kevin_Mc would offer some expert advice here as I'm ignorant.) E.g., my daughter does a seated forward bend, head to toes, knees to the side on the floor; she comfortably gets her head to her toes without ANY thoracic rotation. When standing, she rotates: T9 degrees, L8 degrees (this was the LAST time she did the Adams test). In brace (SpineCor), she's at T4, L3, maybe less. ROM here is achieved, but it's misleading as not achieved while standing.

The lateral curve in my lumbar spine is straightening.

Impressive correction on the LC, well done and thanks for the link. Was the later x-ray taken with you in a corrected posture?
My question, however, was regarding thoracic curves. I also meant (but didn't spell it out) structural curves, not compensatory.

[TOscoliosis]

Is there a choice? (My question was inept, badly couched.) Here's a retry:
If an exercise stretches and realigns already stretched thoracic curve ligaments on the concave side, would this achieve stability at the cost of correction?
Much bracing and exercise literature focuses on stability as if even the mention of correction is taboo. E.g., TR studies emphasise stability, but some of Kevin_Mc's group corrected (from memory, some by 10 degrees). Not statistically relevant, but hugely important. In all endeavours, only a few excel. (That some TR patients improved may in fact answer my question--with those who improved, the ligaments in question did not stabilise in the overstretched position.)

Lots of things to talk about. To start with the question of thoracic curve ligaments. In your post you wrote that "there are already stretched thoracic curve ligaments on the concave side." I'm not sure that this is accurate. There are certainly stretched ligaments associated with a thoracic spine curve. However, all thoracic ligaments except for the intertransverse ligament run sagittally, i.e. up and down the spine more or less in the middle.

In the case of the intertransverse ligament, it is stretched on the convex side of the spine, not the concave. Here are some images to explain: scoliosis xray example.jpgconcave.gifSpinal ligaments.gif

The X-ray image shows what I'm talking about. It's difficult to read the detail at normal size, but if you enlarge the image it will be easier. Look at the spaces between each vertebra (where the disks would be). Notice that on the concave side the spaces are closer together and that on the convex side the spaces are wider apart. The lateral ligaments would be stretched on the convex side, not the concave.

Impressive correction on the LC, well done and thanks for the link. Was the later x-ray taken with you in a corrected posture?

Thanks. No, my intention for my posture is consistent with all images: "Stand naturally upright, without forcing posture." It is important to maintain consistency with how I pose for images, otherwise they are less useful for monitoring my progress. Lumbar 2003 + 2011 combined.jpg

More about structural vs. compensatory curves, and sitting vs. standing exercises later ...

[TAMZTOM]

In your post you wrote that "there are already stretched thoracic curve ligaments on the concave side." I'm not sure that this is accurate.

Nice one, thank you. Re. my accuracy, you are very tactful--I'll be blunt, 'My assumption was idiotic'.

[Kevin_Mc]

Is there a choice? (My question was inept, badly couched.) Here's a retry:
If an exercise stretches and realigns already stretched thoracic curve ligaments on the concave side, would this achieve stability at the cost of correction?
Much bracing and exercise literature focuses on stability as if even the mention of correction is taboo. E.g., TR studies emphasise stability, but some of Kevin_Mc's group corrected (from memory, some by 10 degrees). Not statistically relevant, but hugely important. In all endeavours, only a few excel. (That some TR patients improved may in fact answer my question--with those who improved, the ligaments in question did not stabilise in the overstretched position.)


Sitting balances the pelvis and may minimise distorting psoas and associated ligament contribution. Hamstring and knee ligament distorting pull is also removed/lessened. (I was hoping Kevin_Mc would offer some expert advice here as I'm ignorant.) E.g., my daughter does a seated forward bend, head to toes, knees to the side on the floor; she comfortably gets her head to her toes without ANY thoracic rotation. When standing, she rotates: T9 degrees, L8 degrees (this was the LAST time she did the Adams test). In brace (SpineCor), she's at T4, L3, maybe less. ROM here is achieved, but it's misleading as not achieved while standing.

TOscoliosis already said it, that the stretched concave ligaments might be an assumption. I felt sure I had come across a study by some of the 3d modeling guys that gave the coordinates/morphometrics of the various ligaments and muscles of the spine. But I couldn't find it yesterday. I think I may have been thinking about a study that reported only the muscles. At any rate, I couldn't find anything that reported any difference in ligaments. It is put forward as a hypothesis, i.e. stretched or tight ligaments, but I'm not sure if it's been quantified per se. If anyone has a reference though...

And as TOscoliosis also pointed out, the ligaments' position might not make it possible to be stretched on the concave. When you add in rotation, it also confounds this measurement somewhat. The ligaments on the vertebral body versus the ligaments on the various processes would also be a consideration. But again, since the wedging occurs towards the concavity, that makes the concave side shorter. However, I was wondering how much the axial rotation stretches the ligaments relative to the level above or below. At that point I stopped thinking about it.

We focused on stability because the goal was to stop progression. Reducing the curve for some would appear to be a bonus (assuming these weren't just self-correcting curves). At any rate, it takes quite a bit of effort to permanently stretch/lengthen a ligament. Increased ROM can come from a number of different places. Reduced neural inhibition is a big one (e.g. gamma-motor neurons and golgi bodies). When we increase ROM I doubt that tendon/muscle/ligament length plays much of a role but rather it is improved tissue quality (collagen structure/arrangement) and control (neural). Perhaps some others.

Sometimes it seems that when we think about 'stretching' the ligaments we imagine that these become loose and floppy. And I don't think this is the case. Increased ROM might be associated with improved stability due to better control and strength.

I have no idea if I've answered your questions at all. I'm a bit scattered right now.

[Kevin_Mc]

Is there a choice? (My question was inept, badly couched.) Here's a retry:
If an exercise stretches and realigns already stretched thoracic curve ligaments on the concave side, would this achieve stability at the cost of correction?
Much bracing and exercise literature focuses on stability as if even the mention of correction is taboo. E.g., TR studies emphasise stability, but some of Kevin_Mc's group corrected (from memory, some by 10 degrees). Not statistically relevant, but hugely important. In all endeavours, only a few excel. (That some TR patients improved may in fact answer my question--with those who improved, the ligaments in question did not stabilise in the overstretched position.)


Sitting balances the pelvis and may minimise distorting psoas and associated ligament contribution. Hamstring and knee ligament distorting pull is also removed/lessened. (I was hoping Kevin_Mc would offer some expert advice here as I'm ignorant.) E.g., my daughter does a seated forward bend, head to toes, knees to the side on the floor; she comfortably gets her head to her toes without ANY thoracic rotation. When standing, she rotates: T9 degrees, L8 degrees (this was the LAST time she did the Adams test). In brace (SpineCor), she's at T4, L3, maybe less. ROM here is achieved, but it's misleading as not achieved while standing.

TOscoliosis already said it, that the stretched concave ligaments might be an assumption. I felt sure I had come across a study by some of the 3d modeling guys that gave the coordinates/morphometrics of the various ligaments and muscles of the spine. But I couldn't find it yesterday. I think I may have been thinking about a study that reported only the muscles. At any rate, I couldn't find anything that reported any difference in ligaments. It is put forward as a hypothesis, i.e. stretched or tight ligaments, but I'm not sure if it's been quantified per se. If anyone has a reference though...

And as TOscoliosis also pointed out, the ligaments' position might not make it possible to be stretched on the concave. When you add in rotation, it also confounds this measurement somewhat. The ligaments on the vertebral body versus the ligaments on the various processes would also be a consideration. But again, since the wedging occurs towards the concavity, that makes the concave side shorter. However, I was wondering how much the axial rotation stretches the ligaments relative to the level above or below. At that point I stopped thinking about it.

We focused on stability because the goal was to stop progression. Reducing the curve for some would appear to be a bonus (assuming these weren't just self-correcting curves). At any rate, it takes quite a bit of effort to permanently stretch/lengthen a ligament. Increased ROM can come from a number of different places. Reduced neural inhibition is a big one (e.g. gamma-motor neurons and golgi bodies). When we increase ROM I doubt that tendon/muscle/ligament length plays much of a role but rather it is improved tissue quality (collagen structure/arrangement) and control (neural). Perhaps some others.

Sometimes it seems that when we think about 'stretching' the ligaments we imagine that these become loose and floppy. And I don't think this is the case. Increased ROM might be associated with improved stability due to better control and strength.

I have no idea if I've answered your questions at all. I'm a bit scattered right now.

[TAMZTOM]

I have no idea if I've answered your questions at all.

Yes, you did, thoroughly. Dredged me out of ignorance, again. It may seem tedious explaining these things to half-wits like myself, but it really does help my daughter (as I treat her). Thanks.

[Pooka1]

Tom, this is not about intelligence. It is about esoteric bits of knowledge.

Einstein likely didn't have a damn clue about any of this. You are light years ahead of him on this. :-)

[TAMZTOM]

Tom, this is not about intelligence. It is about esoteric bits of knowledge.
Einstein likely didn't have a damn clue about any of this. You are light years ahead of him on this. :-)

Cheers Sharon. I loathe my ignorance. :-( That loathing has always fuelled my learning though, so I'll keep at it until she's fixed! :-)

[Pooka1]

Cheers Sharon. I loathe my ignorance. :-( That loathing has always fueled my learning though, so I'll keep at it until she's fixed! :-)

I think we all wish we were orthopedic surgeons or scoliosis researchers when we hear the diagnosis. Feeling helpless is the only rational first response to hearing your child has scoliosis.

You can accumulate specific knowledge like any surgeon or researcher and you specifically are well on your way. That's part of being an advocate for your child as all parents are. :-)

[TOscoliosis]

Tom, this is not about intelligence. It is about esoteric bits of knowledge.

Einstein likely didn't have a damn clue about any of this. You are light years ahead of him on this. :-)

Yes, he was probably too busy with relativity to have much time for muscles and ligaments!

For the sake of clarity I'd like to keep talking about ligaments and muscles. I hope this helps the conversation. Tom wrote: "Sitting balances the pelvis and may minimise distorting psoas and associated ligament contribution. Hamstring and knee ligament distorting pull is also removed/lessened."

In regards to "Hamstring and knee ligament distorting pull etc." - Your point makes sense that sitting on a chair is likely to lessen the impact of overly tight or unbalanced hamstrings. The idea of ligaments in the knee pulling is a tricky one, and I'm not sure it's accurate. The role of ligaments is to resist movement not to initiate it. I've not heard of a situation where a person's leg was out of balance because one or other of their knee ligaments was acting on any bone to pull it out of position. Ligament problems are most commonly linked to being sprained or torn as a result of strong forces acting on them as they try to keep bones in normal position.

"Sitting balances the pelvis" - Let's assume here that you're using "pelvis" loosely to include the soft tissue structures in and around the pelvis as well as the bony structure of the pelvis itself. (If we were being strictly anatomical the pelvis, being a bony structure, is not elastic enough to be either balanced or unbalanced by the position we are in.)

I would agree that the soft tissue structures which originate in, or connect with, the pelvis, will change in length, position and tone depending on whether we're standing, sitting etc., and that sitting is usually easier than standing in terms of balance and muscular effort. However, it wouldn't be accurate to say that sitting balances the pelvis as a rule. For many people, sitting does not alleviate their balance difficulties. For a few people it makes things worse.

"Psoas and associated ligament contribution" - I think your interest in the role of the psoas muscle for posture makes a lot of sense, although I would think about it in relation to other lower body muscles as opposed to ligaments. This is because muscles and ligaments are very different from each other in terms of their function and structure.

Functionally, muscles and ligaments can be said to act on the body in exact opposite ways: the main role of muscles is to contract and pull bones in relation to each other to create movement. The main role of ligaments is to resist the movement of bones beyond an unhealthy range of motion. It's true that muscles contribute to the stability of the body, but they do this is in a more relational way than ligaments. Speaking of the psoas muscle, its contribution to stability of the spine is most often linked to evenness of tone between left and right psoas. (It is also true that certain ligaments play a role in movement, but that's an exception that we don't have to go into here.)

Structurally, ligaments are simpler tissues made up mostly of collagenous fibres. Collagen gives ligaments their strength to resist force. Muscles are more complex tissues with a closer relationship to our nervous system which suits their more active role in the body.

[Kevin_Mc]

"Sitting balances the pelvis" - Let's assume here that you're using "pelvis" loosely to include the soft tissue structures in and around the pelvis as well as the bony structure of the pelvis itself. (If we were being strictly anatomical the pelvis, being a bony structure, is not elastic enough to be either balanced or unbalanced by the position we are in.)

He can clarify if needed, but I think he's saying that the seated posture 'balances' the pelvis in that, if there is any tilt of the pelvis, sitting helps to eliminate that by lining up the ischial tuberosities, i.e. making the pelvis level.

[TOscoliosis]

He can clarify if needed, but I think he's saying that the seated posture 'balances' the pelvis in that, if there is any tilt of the pelvis, sitting helps to eliminate that by lining up the ischial tuberosities, i.e. making the pelvis level.

Thanks Kevin. That makes a lot of sense to me. Is that what you were getting at Tom?

Actually, I do a lot of my scoliosis self-care routine seated on a wooden stool in order to have both sitting bones (ischial tuberosities) at the same level. With both feet flat on the floor, my legs bent to about 90 degrees and a couple of inches apart, and my sitting bones on the stool I have a starting point for working on lower limb and torso symmetry.

[TAMZTOM]

He can clarify if needed, but I think he's saying that the seated posture 'balances' the pelvis in that, if there is any tilt of the pelvis, sitting helps to eliminate that by lining up the ischial tuberosities, i.e. making the pelvis level.

Yes, balances and, importantly, removes distorting pull from everything downwards of the pelvis.
Tamzin, seated on floor, knees to the floor, has ZERO T and ZERO L rotation; standing, she is circa. 10 degrees.
Ergo
Pelvis and lower ligaments, bone, muscles and tendons are mightily involved in thoracic rotation and curvature.

Hamstrings are definitely tighter than desired. Re. the knee ligament contribution TOSCOLIOSIS isn't sure about, I'll try to find the link to the research paper suggesting relevance.

PS: Kevin_Mc...we had a meeting with Andrew Mills of SpineCor today. I discussed symmetric TR with him.