progression in brace

[hdugger]

Ballet and scoliosis

I wanted to post a link to the one article I found on scoliosis and ballet (I'd been holding off, but everyone here seems pretty research-savvy). Here's the official link:

http://www.nejm.org/doi/full/10.1056...98605223142104

And then the group at early onset put up a xerox of the full study:

http://early-onset-scoliosis.com/Doc...n%20Ballet.pdf

This is a study of young women (in their early 20s) in professional ballet companies. They report a 24% prevalence rate of scoliosis, but don't say (on my quick scan) exactly how they're defining it - i.e., are they counting tiny curves? Or are all these curves over 15 degrees.

Anyway, the interesting thing (IMO) is the chart on the 3rd page where they show the age of the first period in the women with and without scoliosis. While it's possible that there's some third thing causing both the delayed onset of periods and the scoliosis, it makes more intuitive sense that the delayed periods are what's increasing the risk of scoliosis.

I only see this one study on this topic, but I do think it might be worthwhile for anyone with a child doing intensive ballet to talk to their orthopedic surgeon and maybe a general GP to get a sense of whether there's something in the intense exercise which is delaying periods and, therefore, increasing the risk of scoliosis. I absolutely wouldn't change any kids' life based just on my (probably) faulty interpretation of the research, but I would raise it with someone qualified who could either lay your fears to rest or (maybe) suggest a less intensive schedule.

[hdugger]

Here's a related study on rhythmic gymnastics and scoliosis

http://journals.lww.com/spinejournal...ymnasts.8.aspx

They talk about a "“dangerous triad”: generalized joint laxity, delayed maturity, and asymmetric spinal loading." which is interesting, because that's kind of the same thing I attributed my son's scoliosis to (along with, maybe, a Vitamin D deficiency).

Time to pump our kids full of hormones to start puberty (really, really just kidding).

[Pooka1]

That ballet/scoliosis paper is a good example, perhaps one of the best examples posted to the group so far, of how difficult it is to tease out causation from correlation. Further, it is remarkable to me how much rank speculation gets published. And in top shelf medical journals.

What seems to be the case in this field and perhaps other medical fields is that the situation is not only more complex than we imagine but more complex than we CAN imagine. Intuition fails.

[Pooka1]

Most published research results are false

It's probably good at this point to remind folks that most published research findings are false. When looking at that ballet/scoliosis paper, realizing that most published results are false is not such a stretch. In fact it appears inevitable.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1182327/

Why Most Published Research Findings Are False
John P. A. Ioannidis

Summary
There is increasing concern that most current published research findings are false. The probability that a research claim is true may depend on study power and bias, the number of other studies on the same question, and, importantly, the ratio of true to no relationships among the relationships probed in each scientific field. In this framework, a research finding is less likely to be true when the studies conducted in a field are smaller; when effect sizes are smaller; when there is a greater number and lesser preselection of tested relationships; where there is greater flexibility in designs, definitions, outcomes, and analytical modes; when there is greater financial and other interest and prejudice; and when more teams are involved in a scientific field in chase of statistical significance. Simulations show that for most study designs and settings, it is more likely for a research claim to be false than true. Moreover, for many current scientific fields, claimed research findings may often be simply accurate measures of the prevailing bias. In this essay, I discuss the implications of these problems for the conduct and interpretation of research.

[Pooka1]

Okay, I went back and scrolled through my original thread where I posted the x-ray pics and this is what I came up with.

First set of x-rays: Oct. 29/09 = 47*

Second set of x-rays: about six months later (Apr. 2010?) chiro guess = 75* you guys say 85*

Third set of x-rays: January 20th. 2011 = 110*

The only accurate measurement I have is from January 20th. and the other two are rough guesses b/c I'm relying on memory, chiro measurement and guesses. I do wish I had asked doctor K. for specifics but it was one of those things that I missed unfortunately. I was dropped the halo-bomb and my mind went blank.

Edit: I dunno, that seems like a bit too much time between the second and third set of x-rays. I'll think about it tomorrow, I'm too tired tonight.

Well, taking only the 47* and 110* as likely to be close to correct, that is a sustained (15 months!) average progression rate of ~4.2* per month. I have not read of a similar case on this group or anywhere. It seems unusual as the surgeon was mentioning to you.

Damn.

[Ballet Mom]

It's probably good at this point to remind folks that most published research findings are false. When looking at that ballet/scoliosis paper, realizing that most published results are false is not such a stretch. In fact it appears inevitable.

There is increasing concern that most current published research findings are false. The probability that a research claim is true may depend on study power and bias, the number of other studies on the same question, and, importantly, the ratio of true to no relationships among the relationships probed in each scientific field. In this framework, a research finding is less likely to be true when the studies conducted in a field are smaller; when effect sizes are smaller; when there is a greater number and lesser preselection of tested relationships; where there is greater flexibility in designs, definitions, outcomes, and analytical modes; when there is greater financial and other interest and prejudice; and when more teams are involved in a scientific field in chase of statistical significance. Simulations show that for most study designs and settings, it is more likely for a research claim to be false than true. Moreover, for many current scientific fields, claimed research findings may often be simply accurate measures of the prevailing bias.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1182327/

Perhaps you can explain why this same comment and quote would not be applicable in research studies that you agree with, such as Scoliscore and Braist.

[Pooka1]

Perhaps you can explain why this same comment and quote would not be applicable in research studies that you agree with, such as Scoliscore and Braist.

I don't "agree" per se with any study.

I ACKNOWLEDGE whether studies are either well designed and well controlled and well reasoned or they are not. You merely perceive that as me "agreeing" with it.

Scoliscore looks tight but more research is needed. In some fields like molecular biology, it is easier to be "tight" but that doesn't mean they are necessarily correct. In other fields like bracing and PT efficacy for AIS, it seems damn near impossible to produce a tight study for several reasons not related to the talent of the researchers.

There are no results for BrAIST as of yet. The import of that study is the open admission that there is a consensus among surgeons that the question of bracing efficacy is STILL open. After all these years. And BrAIST will not be the end all study on that.

Science works best by disproving false claims. It can prove true claims but that is generally harder. So it is easier to take apart a bracing study or disprove the conclusions than it is to prove any positive claim in a bracing study due to the known and unknown confounders.

This stuff cannot be approached in a simplistic manner.

[scolio1964]

I wanted to post a link to the one article I found on scoliosis and ballet (I'd been holding off, but everyone here seems pretty research-savvy). Here's the official link:

http://www.nejm.org/doi/full/10.1056...98605223142104

And then the group at early onset put up a xerox of the full study:

http://early-onset-scoliosis.com/Doc...n%20Ballet.pdf

This is a study of young women (in their early 20s) in professional ballet companies. They report a 24% prevalence rate of scoliosis, but don't say (on my quick scan) exactly how they're defining it - i.e., are they counting tiny curves? Or are all these curves over 15 degrees.

Anyway, the interesting thing (IMO) is the chart on the 3rd page where they show the age of the first period in the women with and without scoliosis. While it's possible that there's some third thing causing both the delayed onset of periods and the scoliosis, it makes more intuitive sense that the delayed periods are what's increasing the risk of scoliosis.

I only see this one study on this topic, but I do think it might be worthwhile for anyone with a child doing intensive ballet to talk to their orthopedic surgeon and maybe a general GP to get a sense of whether there's something in the intense exercise which is delaying periods and, therefore, increasing the risk of scoliosis. I absolutely wouldn't change any kids' life based just on my (probably) faulty interpretation of the research, but I would raise it with someone qualified who could either lay your fears to rest or (maybe) suggest a less intensive schedule.

Ok - that is interesting. My daughter fractured her wrist at the end of October last year. The doctor who treated her said that her fracture was like that of a much younger child. I even showed her x-ray to her scoliosis doctor because it was an x-ray of her wrist and hand and I wanted him to see her growth plates. He commented that it looked like a fracture they see in younger children. I am going to take a copy of this article to her pediatrician. Although I know her scoliosis is inherited, could it be getting worse because she has not started her period which is affecting her bones? WOW!!

[Ballet Mom]

I don't "agree" per se with any study.

I ACKNOWLEDGE whether studies are either well designed and well controlled and well reasoned or they are not. You merely perceive that as me "agreeing" with it.

Scoliscore looks tight but more research is needed. In some fields like molecular biology, it is easier to be "tight" but that doesn't mean they are necessarily correct. In other fields like bracing and PT efficacy for AIS, it seems damn near impossible to produce a tight study for several reasons not related to the talent of the researchers.

There are no results for BrAIST as of yet. The import of that study is the open admission that there is a consensus among surgeons that the question of bracing efficacy is STILL open. After all these years. And BrAIST will not be the end all study on that.

Science works best by disproving false claims. It can prove true claims but that is generally harder. So it is easier to take apart a bracing study or disprove the conclusions than it is to prove any positive claim in a bracing study due to the known and unknown confounders.

This stuff cannot be approached in a simplistic manner.

So we'll just let Scoliscore, with all its financial backers and financial incentives, change the treatment of scoliosis even though researchers can't prove or disprove bracing to your standards, one way or the other. We'll let everyone get rich associated with that test and too bad for the kids who probably would have been helped with bracing.

And yet Scoliscore's results are not accurate, they are simply put in large ranges in order to not treat great numbers of kids. And so if it turns out that they were "wrong" and their expensive test does not end up being the great redeemer for kids with scoliosis as they claim, they and their investors just say "oops, that's science" and take the money and run. Sounds like a great way to run medicine.

Did you order the study and find out why the researchers did their strange manipulations of the study to get the results they wanted to get?

[Pooka1]

These are paranoid conspiracy accusations, not valid arguments.

What is the proof for these paranoid accusations?

[Ballet Mom]

These are paranoid conspiracy accusations, not valid arguments.

What is the proof for these paranoid accusations?

LOL!! Back to that.

You refuse to recognize that people respond to financial incentives. Scientists are apparently above common man.

Anyone in the financial industry could tell you that this is the way the world works.

[Pooka1]

LOL!! Back to that.

You refuse to recognize that people respond to financial incentives. Scientists are apparently above common man.

Anyone in the financial industry could tell you that this is the way the world works.

So your conclusion is every single medical paper out there is known to be false by the researchers doing the research in order to make money.

That is paranoid.

That certainly goes on but you can't simply "know" it goes on in any particular case without EVIDENCE.

[Pooka1]

Also based on your universal claim, none of the bracing studies are true where the inventor is making money. Since you obviously don't believe that then you are being inconsistent.

[Ballet Mom]

Ok - that is interesting. My daughter fractured her wrist at the end of October last year. The doctor who treated her said that her fracture was like that of a much younger child. I even showed her x-ray to her scoliosis doctor because it was an x-ray of her wrist and hand and I wanted him to see her growth plates. He commented that it looked like a fracture they see in younger children. I am going to take a copy of this article to her pediatrician. Although I know her scoliosis is inherited, could it be getting worse because she has not started her period which is affecting her bones? WOW!!

My daughter has a good friend in her ballet class. She is one month apart in age from my daughter. This friend has a tiny bone structure...it runs in her family. Her grandmother looks like a breath of wind would blow her away. She is an absolutely gorgeous ballerina.

She will turn sixteen in a few months. She hasn't had her first period. She is growing fast right now, she has suddenly become noticeably taller than my daughter, and my daughter has always been taller than her by several inches. She is taller than her mother by probably five inches, she is as tall, if not taller than her dad. They say they have no tall people in her family. Her legs and extremely long, just like a young kids. The long bones are known to grow longer than normal in serious ballet students with delayed menarche, and it is very noticeable in her. I will be curious when she stops growing.

She does not have any injuries or scoliosis even though she actually does more ballet than my daughter because she is schooled online and has much greater flexibility in her schedule than my daughter.

My daughter had her first period when she was thirteen. She has a slightly larger bone structure than her friend and weighs more. She had a couple of periods, and then secondary amenorrhea. She went on birth control pills last year for almost eight months in order to take a powerful medicine which can cause birth defects. She had her period for those eight months. As soon as she stopped taking them, she went back to amenorrhea. She is still growing also and will be sixteen in a few months. She was diagnosed with scoliosis when she was twelve.

All of the girls I've known with scoliosis were diagnosed way before this age. So I question how much the lack of periods affects scoliosis other than having a longer period of time to have to wear a brace due to the longer growth associated with intense ballet.

Definitely talk to your daughter's doctor. If you're concerned about progression, it might be good to modify her schedule so that she hopefully stops her growth earlier.

[hdugger]

Ok - that is interesting.

My one strong caution is that these are just a few studies, and medical research is notoriously poor. (I used to be in medical research - I've forgotten too much to be able to interpret studies well, but I know enough to know that the research is, overall, pretty crappy compared to most other research.) So, I'd use medical research the same way you use your own observations - to note a possible trend or link between two things. Your doctor will be able to help interpret it through their years of training and experience.

That said - yes, I thought it was very interesting too. I see *a lot* of kids doing ballet on this forum. That's clearly in part because scoliosis is associated with a particular body type (tall and lean) which ballet also picks from, but it seems probable that there's something else going on as well.