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Thread: Treatment: PT using MedX per Mooney & later, McIntire research

  1. #211
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    Quote Originally Posted by Dingo View Post

    It's easy to see how Dystonia could deform the ligaments around the spine. And interestingly enough Dystonia can be treated with isolation exercises.

    Effective behavioral treatment of focal hand dystonia in musicians alters somatosensory cortical organization


    The MedX isolates the paraspinal muscles in the same way that splints were used to isolate the dystonic finger. That's an interesting parallel.

    My hunch is that the MedX helps because it works on the nervous system and this in turn helps the spine recover.

    But until scientists prove one of their hypothesis my mind will remain open.
    This is a nice find and comparison.

  2. #212
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    Quote Originally Posted by Kevin_Mc View Post
    This is a nice find and comparison.
    I owe that one to Google. Maybe... just maybe... 10,000 hours of reading about Scoliosis finally paid off. 8-)

    Dr. McIntire, if scientists have the ability to scan the brains of patients with focal dystonia before and after exercise couldn't they do the same thing on kids with Scoliosis before and after they use the MedX? Maybe there is a simple experiment in there somewhere.

    BTW this is some background information that the researchers included in the Scoliosis/Dystonia study.
    Motor cortical hyperexcitability in idiopathic scoliosis: could focal dystonia be a subclinical etiological factor?
    The relationship between scoliosis and dystonia seems to be reinforced by their association in human clinic. Patients with idiopathic cervical dystonia, a most frequent focal dystonia, develop scoliosis in 39% of cases [37]. Furthermore, scoliosis develops in late childhood or early puberty more frequently among patients with cervical dystonia [38]. Scoliosis is a constant finding in severe forms of dystonia such as dystonia musculorum deformans, and also in other forms of generalized dystonia [39, 40]. Sometimes, scoliosis is the first sign of a dystonia and the deformity progression can be controlled after treating the dystonia, for example, with l-dopa [41, 42].

    A similar alteration in cortical motor excitability to that found in patients with IS has been also described in patients with Parkinson’s disease [43, 44]. The incidence of scoliosis in Parkinson patients is higher than in the normal population varying from 33 to 90% [45–47]. The scoliotic deformity in patients with Parkinsonism is not related to age, disease stage, duration of symptoms, response to l-dopa or the presence of dyscinesia [47].
    Cerebral Palsy and Scoliosis, same thing.

    Before this study I never really knew how strong the connection was.
    Last edited by Dingo; 04-19-2012 at 12:33 AM.

  3. #213
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    Quote Originally Posted by TAMZTOM View Post
    Almost all focused exercise works the nervous system, positively. The Medx isolation facility can work exceptionally well.
    In Tamzin's videos she is extremely focused and well coordinated. I remember you told her to move her back in a particular direction and she knew how to do it. You told her to use her back, not her arms and she did it. That is an amazing accomplishment for a 10 year old. I doubt if I'm that coordinated.

    I wonder if what you're doing isn't so different from the MedX. The MedX isolates the paraspinals and works them. However you've found a way to isolate several different muscle groups and work them.
    Last edited by Dingo; 04-18-2012 at 10:57 PM.

  4. #214
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    Quote Originally Posted by Dingo View Post
    In Tamzin's videos she is extremely focused and well coordinated. I remember you told her to move her back in a particular direction and she knew how to do it. You told her to use her back, not her arms and she did it. That is an amazing accomplishment for a 10 year old.
    That is the proprioception that I mention often.

    I wonder if what you're doing isn't so different from the MedX. The MedX isolates the paraspinals and works them. However you've found a way to isolate several different muscle groups and work them.
    I discussed this a while back on THIS thread. I suggested that doing the same exercise without restraint may work the core better than when doing it with restraint. Kevin understood the theory; you do too. Think "Free weights vs. machines." On some very specific exercises, isolating with machines and restraint may work better for some kids. For those that can isolate without restraint, we need precise EMG to decide; in the absence of that, I observe. Technique must be excellent. (We have not got excellent technique on ALL exercises yet; we will get excellent technique on all exercises.)
    Discussions with AMom have helped me refine some exercises very well. Doesn't matter that we do things differently, the constructive discussions help. The week working with 3sisters and her daughter, and Tamzin, helped me a great deal on technique.
    Last edited by TAMZTOM; 04-19-2012 at 05:30 AM.
    07/11: (10yrs) T40, L39, pelvic tilt, rotation T15 & L11
    11/11: Chiari 1 & syrinx, T35, L27, pelvis 0
    05/12: (11yrs) stopped brace, assessed T&L 25 - 30...>14lbs , >8 cm
    12/12: < 25 LC & TC, >14 cms, >20 lbs, neuro symptoms abated, but are there
    05/13: (12yrs) <25, >22cms height, puberty a year ago

    Avoid 'faith' in 'experts'. “In consequence of this error many persons pass for normal, and indeed for highly valuable members of society, who are incurably mad...”

  5. #215
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    Quote Originally Posted by Dingo View Post
    I owe that one to Google. Maybe... just maybe... 10,000 hours of reading about Scoliosis finally paid off. 8-)

    Dr. McIntire, if scientists have the ability to scan the brains of patients with focal dystonia before and after exercise couldn't they do the same thing on kids with Scoliosis before and after they use the MedX? Maybe there is a simple experiment in there somewhere.

    BTW this is some background information that the researchers included in the Scoliosis/Dystonia study.
    Motor cortical hyperexcitability in idiopathic scoliosis: could focal dystonia be a subclinical etiological factor?


    Cerebral Palsy and Scoliosis, same thing.

    Before this study I never really knew how strong the connection was.
    Dingo,
    This is an awesome find! I have "just" been diagosed with cervical dystonia. I am going to get Botox injections to try to break up the muscle mass in my upper left trapezius. I know I have symptoms of dystonia in other muscle groups, too, after looking it up. I have started a thread on "Muscle Dystonia". It would be nice to continue this discussion over there. It's interesting that it can be treated with exercise. That option was not discussed. I was sent to PT for problems with falling too often, especially for my age. It was determined that it was due to stiffnes from the scoliosis and lack of ability to compensate when knocked off balance (proprioception + stiffness). PT said there was nothing to do about that, so wanted to focus on deep muscle massage AGAINST my doctor's advice. I agreed to try it, but felt that he was hitting inflamed nerves and NOT trigger points as he said. The areas he called trigger points sent shooting pains down my legs. In the past, my trigger points were just painful, not radiating. Any thoughts on that as it relates to dystonia? He also knuckled the convexity of my lower curve which was EXTREMELY painful. I'm leary on this as it relates to the muscles. I'm afraid of loosening those muscles causing further collapse. Is my thinking wrong as this relates to dystonia? Can exercise really help this? I am starting a program at the hospital the first of May. I would like to address this if it's possible to treat dystonia this way. Like I said, it would probably be "better" to continue this on the other thread. Thanks!
    Rohrer01

    It's in the Research section under "Muscle Dystonia".
    Last edited by rohrer01; 04-19-2012 at 08:28 AM. Reason: location of thread
    1985 - Dx w/ painful AIS at 16 with 39* upper LEFT thoracic single curve.
    2000 - 41*
    2010 - 46* (T1 - T6) 38* (T6-L2) Now a double thoracic
    2012 - Dx w/ Cervical Muscle Dystonia.
    DDD L5/S1 with left nerve impingement
    Left SI joint dysfunction

  6. #216
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    Quote Originally Posted by rohrer01 View Post
    It would be nice to continue this discussion over there.

    I'm afraid of loosening those muscles causing further collapse.
    Hi Rohrer

    EDITED OUT...HAVING READ YOU OTHER THREAD

    Dingo's research is excellent. He is intrigued by the possibility that TORSO ROTATION innervates neural pathways allowing the body/mind to use the body/muscles correctively/optimally. Schroth seeks the same neurological gains (propriception, etc.). Kevin McI has stated on this thread that many exercises can theoretically work the paraspinals in the way that TR does.

    ...EDITED OUT...

    As for "loosening those muscles causing further collapse", precisely that, according to Katerina Schroth, is exactly what happens BECAUSE the entire torso is in effect being held upright by those lower left lumbar muscles. Overstretched, overworked...they can fatigue and cause progression because there is not much left to hold the torso upright. The thoracic curve is loaded and unsupported.
    Schroth, TR and many other methods, seek to, inter alia, build up the OTHER SIDE! E.g., build your right side erector spinae, QL, psoas, paraspinals; these can then support the convex torso directly above, thus relieving the lower left of some strain. RELIEVING THAT STRAIN ON THE LOWER LEFT ALLOWS THEM TO WORK BETTER! After years of overworking, those strained muscles can atrophy...even result in dystrophy.
    The upper right musculature also has an upright holding function. These can suffer the same fate as the lower left; often the upper right atrophy before the lower left. We work Tamzin's upper left and lower right; we've increased strength there hugely since last June. We can now work symmetrically more often because the lower left and upper right are significantly more relaxed. Her lower left musculature was hard as a brick last June; she can make it as soft as putty now, or, on low intensity exercise, work both sides evenly.
    Last edited by TAMZTOM; 04-19-2012 at 11:17 AM.
    07/11: (10yrs) T40, L39, pelvic tilt, rotation T15 & L11
    11/11: Chiari 1 & syrinx, T35, L27, pelvis 0
    05/12: (11yrs) stopped brace, assessed T&L 25 - 30...>14lbs , >8 cm
    12/12: < 25 LC & TC, >14 cms, >20 lbs, neuro symptoms abated, but are there
    05/13: (12yrs) <25, >22cms height, puberty a year ago

    Avoid 'faith' in 'experts'. “In consequence of this error many persons pass for normal, and indeed for highly valuable members of society, who are incurably mad...”

  7. #217
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    Quote Originally Posted by Dingo View Post
    Dr. McIntire, if scientists have the ability to scan the brains of patients with focal dystonia before and after exercise couldn't they do the same thing on kids with Scoliosis before and after they use the MedX? Maybe there is a simple experiment in there somewhere.
    It's certainly possible. You know what it comes down to right?... $$

    I didn't want to do a brain (fMRI) study but I DID want to do a muscle (mfMRI) study using MRI. I think I've mentioned it before of scanning the muscles of the spine before and after exercise in order to determine which muscles were active. Doing this before and after treatment was in my dissertation proposal. But lack of $$ and logistical difficulties put an end to that.

    I'd have to look through the data a bit more to see if control of individual paraspinal muscles can be picked up on fMRI. My hunch is that they can't just because of the number of them. The hand and fingers are a bit different because of the size of the area the brain dedicates towards fine motor movements. Hands, fingers, tongue, lips, etc... have relatively large areas of the brain because of the amount of control needed. Google images of "cortical homunculus" and you'll see representation of this. However, perhaps it would just be a nondescript, but still significant, shift in brain activity after training.

    Would definitely be an interesting study. But I can inevitably guess the first major question/critique deals with the chicken or the egg. I would see it working best within a specific rehab type of study that would link it to progression control instead of etiology.

  8. #218
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    Modified Biering–Sørenson tests

    Quote Originally Posted by TAMZTOM View Post
    How was the Sorensen test modified? How long did she hold? It'd be useful to me to compare Tamzin on the test (having just recently started Roman Chair) with your daughter's hold time.
    Thanks
    Tom

    In all previous tests, she lay on an examination table with me seated on/behind her applying controlled pressure to her thighs and buttocks. Her arms were in the genie position. The timer was stopped when her torso dropped more than 5° from the original position.

    Before she began using the roman chair, her best time was 17 seconds. Eight months later, it was 49.37 seconds. Six months later (total of 14 months), I made a mistake and switched from the examination table to the VARC (set at 90°) and her time dropped significantly to 24.23 seconds. We will re-test on the table next month to obtain a comparable reading and I will post her new time.

    I’ve included the links below in case you want to see photos. The first one shows their version of a modified Biering-Sorenson and provides a decent DESCRIPTION of the standard test. The second link has the photo IN the article, but not in the abstract (sorry). And the third link shows the VARC we used last week. (Her heels were restrained instead of her thighs and buttocks.)

    1. The reliability and validity of the Biering-Sorensen test in ...
    www.ncbi.nlm.nih.gov/pubmed/10543003Similar
    by J Latimer - 1999 - Cited by 136 - Related articles
    Spine (Phila Pa 1976). 1999 Oct 15;24(20):2085-9; discussion 2090. The reliability and validity of the Biering-Sorensen test in asymptomatic subjects and ...

    1. Back extension endurance and strength: the effect of variable-angle ...
    www.ncbi.nlm.nih.gov/pubmed/12195070Similar
    by JL Verna - 2002 - Cited by 26 - Related articles
    Aug 15, 2002 – Back extension endurance and strength: the effect of variable-angle roman chair exercise training. Verna JL, Mayer JM, Mooney V, Pierra EA, ...
    2. Baseline values of trunk endurance and hip strength in collegiate ...
    www.ncbi.nlm.nih.gov/pubmed/17273469Similar
    by CL Lanning - Cited by 14 - Related articles
    Lack of trunk and hip strength may predispose athletes to such injuries. ... RESULTS: The average score for the 60-second back-extension endurance test was ...

  9. #219
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    Here is my two cents...

    Quote Originally Posted by Pooka1 View Post
    Tom,

    Do you think the lateral curve reduction drives the rotation reduction or the rotation reduction drove the lateral curve reduction? I can't figure out what the deal is with this from the literature. Maybe I can't find the right papers.

    Do you think rotation and lateral curve are in lock step?

    Do you think the sequence of curve progression has to be exactly reversed in curve reduction or is there a better approach?

    I haven't seen this stuff addressed in the literature but maybe you have?

    Last, the curve reduction and derotation you have achieved makes me think you are dealing with either JIS versus AIS or Chiari/SM versus straight AIS. Because of that, no reduction/derotation you achieve would shock me but I would be shocked if you achieved any reduction/derotation with straight AIS.
    Sharon,

    Based on what I’ve read, I don’t think there is a definitive “chicken or egg” answer with regard to drivers.

    Rotation and lateral curve cannot be in lock step. If they were, then a curve of x° would automatically equal a rotation of y°, and that is not happening.

    I don’t know the answer to that question, but would guess it would be easier on the spine if the curve and rotation were corrected in the order they appeared and progressed.

    I don’t see it addressed directly (Tom mentioned he has seen it in Schroth and related literature), but the curve and rotation part is implied by the variety observed.

    My daughter was initially thought to have JIS, but her curve remained very small with almost no rotation while she was young so it was decided (and I agree) that she has AIS (that was accidentally discovered while she was young—we would not have been able to tell she had scoliosis until she was 11yrs). We are TRYING to achieve de-rotation with our supplemental PT, but the results are minimal. We have been able to almost completely flatten the bump in the upper right quadrant of her back, but haven’t been able to do anything at or below the waist line.

    Different methods, but similar reasoning, we (Tom & I) are working from the ends of the curves rather than focusing on the apex. Based on Tom’s descriptions, I would guess his daughter has JIS (these children respond better to bracing). He is more focused than I am and he has gotten much better results than we have achieved.

    A Mom

  10. #220
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    Quote Originally Posted by AMom View Post
    Rotation and lateral curve cannot be in lock step. If they were, then a curve of x° would automatically equal a rotation of y°, and that is not happening.
    I assumed by "lock step", Sharon meant they worsened or corrected together. Not that they moved by the same degree.

    We have been able to almost completely flatten the bump in the upper right quadrant of her back, but haven’t been able to do anything at or below the waist line.
    To which modality do you ascribe the greatest effect (or is it a combo)?

    Based on Tom’s descriptions, I would guess his daughter has JIS (these children respond better to bracing).
    I agree, JIS. But Tamzin's lateral curves did not initially respond to bracing. Her TC is rigid (but I''ve seen it drop to mid 20s in the aborted night-time brace). At the first fitting, however, we know that Tamzin completely flopped, let the brace pull her down after the orthotist said "Relax, let's see what the brace does." This has been addressed. We'll find out in May. From close observation (sight and touch), I suspect improvement on both curves, but I think the upper curve has shortened and moved downwards, the lower curve upwards--this leaves a nasty kink in the middle. The orthotist believes the TC has moved and corrected because of the shoulder girdle derotation clockwise, the thoracic rotation anti-clockwise. I agree, but I also see a lot of translation to the lower ventral ribs (e.g., right back correction translated into front lower right rib worsening).
    We're addressing the worsening lower ventral ribs.
    Last edited by TAMZTOM; 04-21-2012 at 09:19 PM.
    07/11: (10yrs) T40, L39, pelvic tilt, rotation T15 & L11
    11/11: Chiari 1 & syrinx, T35, L27, pelvis 0
    05/12: (11yrs) stopped brace, assessed T&L 25 - 30...>14lbs , >8 cm
    12/12: < 25 LC & TC, >14 cms, >20 lbs, neuro symptoms abated, but are there
    05/13: (12yrs) <25, >22cms height, puberty a year ago

    Avoid 'faith' in 'experts'. “In consequence of this error many persons pass for normal, and indeed for highly valuable members of society, who are incurably mad...”

  11. #221
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    Combination

    Quote Originally Posted by TAMZTOM View Post

    To which modality do you ascribe the greatest effect (or is it a combo)?

    Some exercises I'm willing to start and stop, others I am not, so I can't say EXACTLY what is causing the changes. She does the VARC & MedX (not stopping those two) and additional stretches and exercises based on her particular needs. The addition of a couple of them coincided with the flattening of the bump. The two exercises that seem to be an important part of the mix are: seated rows (w/shoulder pinch at peak of pull) and lat pulls. The PT prescribed them specifically to address the growing bump on her right shoulder and after checking the action, I agreed my daughter could do them, but didn't expect any results (I kept looking for something that would help.) In the meantime, her back flattened out. After months of it remaining flat, I wondered if it really was the exercises that caused the change or a coincidence so I stopped the two exercises for several months and the bump eventually begin rising again. We restarted the exercises and after roughly six weeks, it went back down. From what I can see, there seems to be some correction and the muscle build-up covers up the remaining asymmetry.

    I haven't located any literature to support the occurrence. Can anyone explain what is happening?

    It isn't the first time I was wrong. I am definitely happy to be wrong this time!

  12. #222
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    Week Off

    I gave my daughter a week off from PT after her x-rays--thought she would enjoy the break.

    She didn't even notice!

    When we started back up she seemed HAPPY to be back in the weekly routine. (This isn't to say she never complains!) I think this is because she is trying to come up with an experiment she can do regarding scoliosis & PT that she can use for her next year's school science fair. Since she's plateau’d, we've been "mixing up" her workout (ROM, weight, rep.s, eccentric components, arm positioning) and she wants to pick one and try it for an x-ray period to see if it will make a difference. lol Do you think we will be able to find an ortho to be her Designated Supervisor!?! (unlikely!) If we do, do you want to take bets we won't be able to get the county to sign off on the Human Subjects Form?

    Good idea, one with lots of "buy in" from the student, but not one that is likely to fly in a school setting. Too dangerous.

    A Mom

  13. #223
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    Quote Originally Posted by AMom View Post
    I gave my daughter a week off from PT after her x-rays--thought she would enjoy the break.

    She didn't even notice!

    When we started back up she seemed HAPPY to be back in the weekly routine. (This isn't to say she never complains!) I think this is because she is trying to come up with an experiment she can do regarding scoliosis & PT that she can use for her next year's school science fair. Since she's plateau’d, we've been "mixing up" her workout (ROM, weight, rep.s, eccentric components, arm positioning) and she wants to pick one and try it for an x-ray period to see if it will make a difference. lol Do you think we will be able to find an ortho to be her Designated Supervisor!?! (unlikely!) If we do, do you want to take bets we won't be able to get the county to sign off on the Human Subjects Form?

    Good idea, one with lots of "buy in" from the student, but not one that is likely to fly in a school setting. Too dangerous.

    A Mom
    LOL. She has already won though because she is thinking scientifically. That's the best prize.
    Sharon, mother of identical twin girls with scoliosis

    No island of sanity.

    Question: What do you call alternative medicine that works?
    Answer: Medicine


    "We are all African."

  14. #224
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    Need a good ortho in CA

    It is time to find a good ortho my daughter and I am comfortable with instead of tolerating the one we have for the sake of convenience. (We had a good ortho for years, but he retired suddenly so we used the only one in our town while looking for a replacement. Somewhere over the last year, I became distracted and quit looking.) We live in the middle of California and would prefer someone in the southern region, but would consider northern California. I don’t want her to take an extra x-ray mid-cycle, as long as I bring her x-rays with me, does anyone know how much of a problem that will be when establishing with a new ortho? Should we wait and schedule an appointment close to the time she is due for her next x-ray? Speaking of x-rays, I’d rather the new doc didn’t have an antique x-ray machine.

    Can you share some referrals? I’d like to schedule an appointment with a couple of guys and then my daughter and I can make the decision together. Experience and consistency are important, but so is a willingness to answer questions of the family.

    Knowing you will come through; I am saying, “Thank you!” in advance.

    A Mom

  15. #225
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    Need an ortho in CA

    Quote Originally Posted by AMom View Post
    It is time to find a good ortho my daughter and I am comfortable with instead of tolerating the one we have for the sake of convenience. (We had a good ortho for years, but he retired suddenly so we used the only one in our town while looking for a replacement. Somewhere over the last year, I became distracted and quit looking.) We live in the middle of California and would prefer someone in the southern region, but would consider northern California. I don’t want her to take an extra x-ray mid-cycle, as long as I bring her x-rays with me, does anyone know how much of a problem that will be when establishing with a new ortho? Should we wait and schedule an appointment close to the time she is due for her next x-ray? Speaking of x-rays, I’d rather the new doc didn’t have an antique x-ray machine.

    Can you share some referrals? I’d like to schedule an appointment with a couple of guys and then my daughter and I can make the decision together. Experience and consistency are important, but so is a willingness to answer questions of the family.

    Knowing you will come through; I am saying, “Thank you!” in advance.

    A Mom
    This is the 3rd year in a row I have been completely self-centered for one entire day. I read books, watched movies, and did nothing more strenuos than give kisses and hugs. The children finished their chores without being asked and have been sweet all day. My husband made all of my favorites for dinner this evening. Very relaxing day. Are you folks relaxing too?

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