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

  1. #46
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    Quote Originally Posted by djjane View Post
    I am curious about the torso rotation to each side, if the curve is on one side, what should we do? Still exercise equally on both sides?

    I read from another thread, saying "when you twist your body clockwise, you strengthen the right back muscles, and counterclockwise(that is twisting to the left), you strenghten the left back muscles." Does this sound right?
    Please correct me if I've got this wrong, but I think this is how it works. The muscles work together (sometimes attached at several points) to contract (shorten if the movement is isotonic/ not shorten if there is no movement, called isometric.) Every time a muscle contracts, the muscle on the opposite side of the joint relaxes (allowing the contraction to occur). When you move in the opposite direction, the ACTIONS of the muscles (contracting & relaxing) switch sides. So, if you are twisting to the left, you are working the muscles on both sides of the spine—the right side is relaxing and the left side is contracting. Depending on which muscles you are working, there could also be other muscles (synergists) that are working to stabilize the action. AND, depending on the motion, you may be engaging multiple muscle groups to complete the action. It seems very complicated to me, so I hope I didn’t make the water muddier.

    Tom is giving me too much credit, I'm at Level 1: Knowledge, yet I'm being forced to act at Level 6: Evaluation. Since he asked, I'll explain what I think is happening. Because of MedX's CTR restraint system, the unit forces the paraspinal muscles (deeper muscles) to do the majority of the work. Add to this the muscles used on the roman chair/VARC and I think paraspinal muscles discussed in the literature refer to the longissimus, iliocostalis, spinalis, semispinalis, splenius, & multifidis (transversospinalis). Yes, the two units work other muscles as well, but other exercises can and have addressed the other muscles—with minimal to no positive results regarding scoliosis. (There are always a few exceptions) I think it is the combination of these groups of muscles that are responding during accelerated, uneven growth. (I am not talking about uneven strength; rather I am suggesting that the additional strength is allowing these muscles to do “their job” during growth spurts.)

    The reason I think the roman chair is an important part of the mix is because research suggests focusing only on the apex of the curve is not as effective as focusing on the curve from top-to-bottom. This explains why I added the “mermaid dip” to the back extension exercise on the roman chair.

    I am hesitant to mention this, but I have a poorly founded idea that CTR works better if the motion begins across the mid-line (frontal), ROM setting #2 or higher. However, I’ve noticed, the higher the ROM number (3, 4, or 5), the more I have to watch her pelvis to make sure she maintains a level seat when turning to a particular side. I’m not sure if that is due to a difference in strength, flexibility, or something I haven’t yet considered.

    It is fairly frightening if one stops to think of what I am doing. I’m operating during the most dangerous stage of learning, I know just enough to be dangerous, but not enough to recognize when I’ve made an error. In spite of minimal knowledge & comprehension, there are a lot of little details in what we are doing….

    I believe asymmetric core torso rotation (CTR) is both being considered by some and rejected by others. I chose to use symmetric CTR because my daughter has two curves (right thoracic & left lumbar). If her workout was asymmetric, which curve would I choose to address? Some would say we should focus on the thoracic curve because it is structural, but since neither curve exists in a vacuum, I’m not sure how I would correct one without making the other worse over a long period of time. (I simply do not have the background to figure that out.) I did consider that symmetrical workouts might make one of those curves worsen, however per the last two x-rays, that has yet to occur. Note: Mooney only tracked one curve in each subject so he couldn’t have noted that occurrence and while McIntire tracked one - three curves in each subject, he did not mention this occurring during his study.

    FYI: Remember, contrary to logic, the concave side has not been shown to have stronger muscles.
    Last edited by AMom; 02-18-2012 at 01:12 PM. Reason: Clarity

  2. #47
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    Quote Originally Posted by AMom View Post
    Some would say we should focus on the thoracic curve because it is structural, but since neither curve exists in a vacuum, I’m not sure how I would correct one without making the other worse over a long period of time. (I simply do not have the background to figure that out.)
    As in fusion, correcting the structural curve drives a correction in the compensatory curve automatically. There is less to compensate for when the structural curve is straightened. In both my daughters, this occurred. One went from a compensatory curve in the 30* range to essentially no measurement by hypercorrecting the structural curve. She technically doesn't have scoliosis any more because neither curve is above 10* and the compensatory curve is not different from 0* although it is untouched surgically. The other kid still technically has scoliosis (structural and compensatory curves >10*).

    Similarly, I would expect if you can get a correction of the structural curve with PT, it will automatically drive a correction in the compensatory curve. It seems to be the physics of it as it doesn't need to compensate as much for the smaller structural curve.

    Last we have seen mention of, and even radiographic proof of, compensatory curves being straightened through PT but the structural curve either didn't change or got a little worse for having done so. That seems to suggest addressing the compensatory curve without a concurrent improvement in the structural curve will not work and may make things worse. So the two approached don't provide symmetrical results.

    Note: Mooney only tracked the structural curve so he couldn’t have noted that occurrence and while McIntire tracked both curves, he did not mention this occurring during his study.
    McIntire reported data on actual compensatory curves or were they really double majors?
    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."

  3. #48
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    Quote Originally Posted by Pooka1 View Post
    As in fusion, correcting the structural curve drives a correction in the compensatory curve automatically. There is less to compensate for when the structural curve is straightened. In both my daughters, this occurred. One went from a compensatory curve in the 30* range to essentially no measurement by hypercorrecting the structural curve. She technically doesn't have scoliosis any more because neither curve is above 10* and the compensatory curve is not different from 0* although it is untouched surgically. The other kid still technically has scoliosis (structural and compensatory curves >10*).

    Similarly, I would expect if you can get a correction of the structural curve with PT, it will automatically drive a correction in the compensatory curve. It seems to be the physics of it as it doesn't need to compensate as much for the smaller structural curve.

    Last we have seen mention of, and even radiographic proof of, compensatory curves being straightened through PT but the structural curve either didn't change or got a little worse for having done so. That seems to suggest addressing the compensatory curve without a concurrent improvement in the structural curve will not work and may make things worse. So the two approached don't provide symmetrical results.

    McIntire reported data on actual compensatory curves or were they really double majors?
    I’ve read about the change to the compensatory curve occurring surgically, but had concerns about applying the theory here because surgery is a passive restraint system that can be focused on a specific portion of the spine, whereas I think of PT as an active restraint system that I can’t apply to only one area—there is quite a bit of “spillage” regarding strength training. Also, the variables are overwhelming, beside the obvious of two different delivery systems, two different levels of control in application, and the unknown cause of scoliosis; there is also a basic deficit in my understanding as to the mechanics of how the muscular system operates in concert to work through.

    Now that isn’t to say I haven’t been considering applying asymmetric CTR’s to her program since before she fit into the unit, but I’m not clear as to how I would focus the strength gain on the structural curve rather than the compensatory curve. Would I do that by raising her arms to 90° in the MedX during rotation, by adding a second workout that stabilizes the shoulders rather than the pelvis (which recruits the lumbar region) during the rotation, or something else? If my attempt to focus the strength gain doesn’t work, can a compensatory curve drive a structural curve? Admittedly, when I laid out the plan several years ago, I put it last in the “line-up” with the naïve hope that by now I would understand how to utilize the technique.

    McIntire included 12 females & 3 males with the following curve patterns, main curves in bold, 1-3 curves per subject:
    8 thoracic curves
    2 double thoracic curves
    5 thoracolumbar/ lumbar curves

  4. #49
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    Quote Originally Posted by AMom View Post
    ...can a compensatory curve drive a structural curve?
    Reading your posts now, AMom, solid stuff...

    Basic mechanics will demonstrate that, yes, indeed, a compensatory curve can drive a structural curve. Sharon, I don't know who you've been taking advice from on that point, but they're wrong.
    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. #50
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    Quote Originally Posted by AMom View Post
    So, if you are twisting to the left, you are working the muscles on both sides of the spine—the right side is relaxing and the left side is contracting. Depending on which muscles you are working, there could also be other muscles (synergists) that are working to stabilize the action. AND, depending on the motion, you may be engaging multiple muscle groups to complete the action. It seems very complicated to me, so I hope I didn’t make the water muddier.
    Actually, after trying 'home-brew' TR on myself at home, I wasn't entirely sure which muscles were contracting, or supposed to contract. Is the MedX protocol to intentionally contract the left when rotating in that direction?
    It'd be pedantic to split hairs on the contribution of each muscular system--the paraspinal muscles are well worked. Symmetric exercise (after, e.g., a McIntire-type period equalising strength both sides) theoretically can exert balancing/stablising/corrective pull/force on the spine. A big plus for TR. The lumbar spine facets, being functionally different from those of the thoracic spine, are less susceptible to lateral distorting force while doing TR (again, I'm paraphrasing a McIntire answer to my prior question on the other thread). Regarding the other muscles used, see below...

    I am not talking about uneven strength; rather I am suggesting that the additional strength is allowing these muscles to do “their job” during growth spurts.)
    The paraspinals and the other muscles all doing their job is what (in my opinion) enables some kids to stabilise or correct. (As I've mentioned to you in emails) Pilates has some core exercises that resemble those done on the VARC (Tamzin does these daily, incorporated into her routines, with "RAB"). The paraspinal main target of TR is perhaps one area we could increase (hence my continuing interest in TR).

    [QUOTE]The reason I think the roman chair is an important part of the mix is because research suggests focusing only on the apex of the curve is not as effective as focusing on the curve from top-to-bottom. This explains why I added the “mermaid dip” to the back extension exercise on the roman chair.[]QUOTE]
    The concept of unwinding the spine from the ends of the curves towards the apex appeals theoretically; I discussed this at length with our orthotist and have seen the results already--Tamzin's rotation is less towards the ends of the curves, but not changed much at the apex. I'll qualify that by adding that the entire curve 'seems' to be untwisting--the former 'kink' around T10 - T11 now gone, replaced by a smooth transition from one curve to the other. She can exercise without any rear prominent ribs when using RAB much easier now than before. Because her brace exerts shoulder pressure, the thoracic apical rotation may 'appear' unchanged as the right scapula isn't as flat as before (we'll address that again later).

    I am hesitant to mention this, but I have a poorly founded idea that CTR works better if the motion begins across the mid-line (frontal), ROM setting #2 or higher. However, I’ve noticed, the higher the ROM number (3, 4, or 5), the more I have to watch her pelvis to make sure she maintains a level seat when turning to a particular side. I’m not sure if that is due to a difference in strength, flexibility, or something I haven’t yet considered.
    I'll try this out! Thanks. As said before, I'm concerned about Tamzin's seeming poor ROM when doing a TR like exercise.

    It is fairly frightening if one stops to think of what I am doing. I’m operating during the most dangerous stage of learning, I know just enough to be dangerous, but not enough to recognize when I’ve made an error. In spite of minimal knowledge & comprehension, there are a lot of little details in what we are doing….
    I'd feel in safer hands letting you work with Tamzin rather than many 'professionals'...and I'm VERY protective re. Tamz. :-)

    I chose to use symmetric CTR because my daughter has two curves (right thoracic & left lumbar). If her workout was asymmetric, which curve would I choose to address?
    With the different facets mentioned above, hitting the TC would seem the logical choice?

    Some would say we should focus on the thoracic curve because it is structural, but since neither curve exists in a vacuum, I’m not sure how I would correct one without making the other worse over a long period of time. ... I did consider that symmetrical workouts might make one of those curves worsen, however per the last two x-rays, that has yet to occur.
    Your concern with exercise translating detrimentally to the other, non-targeted curve is well placed. However, if one goes only on the two studies, doing symmetric TR could worsen BOTH curves. Clearly you've achieved the opposite with your kid, improvement and/or stability on both curves (during some heavy growth too). Also clear is that you are one in a thousand and thus to be commended.

    FYI: Remember, contrary to logic, the concave side has not been shown to have stronger muscles.
    I was under the impression that many believe the opposite, i.e., the convex side was stronger. E.g., many right TC and left LC kids have packed muscle near the apical segments of each curve. One common mistake is to believe that because of the muscle mass, it must be stronger, when it's actually over-stretched and actually (often) weaker than the concave, under-developed side.

    Thanks for your in-depth observations and thoughts on all this.

    Regards
    Tom
    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...”

  6. #51
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    Quote Originally Posted by AMom View Post
    McIntire included 12 females & 3 males with the following curve patterns, main curves in bold, 1-3 curves per subject:
    8 thoracic curves
    2 double thoracic curves
    5 thoracolumbar/ lumbar curves
    Right but what I am asking is if he reports measurements on the compensatory curves for for either the thoracic curves or lumbar curves. I have never seen a paper track what the compensatory curve is doing in a scoliosis case.

    There is a reason our surgeon never told us the measurements on the compensatory curves. They are not relevant unless the structural curve is untreated in which case either the structural or compensatory curves might later collapse as seen in those cases I posted from Hey's blog.
    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."

  7. #52
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    Quote Originally Posted by TAMZTOM View Post
    Basic mechanics will demonstrate that, yes, indeed, a compensatory curve can drive a structural curve. Sharon, I don't know who you've been taking advice from on that point, but they're wrong.
    Tom, can you explain the evidence for this statement?

    The only evidence I am aware of is compensatory curves responding to changes in the structural curve (in both directions) as in fusion or untreated progressing single curves.

    But we don't see the structural curves responding to any changes in the compensatory curve. An example is the recent set of radiographs posted by a member here whose compensatory curve improved but the structural curve stayed the same or even got a little worse. Also, there are other testimonials of compensatory curves that decreased through PT with no change in the structural curve.
    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."

  8. #53
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    Quote Originally Posted by Pooka1 View Post
    Tom, can you explain the evidence for this statement?

    The only evidence I am aware of is compensatory curves responding to changes in the structural curve (in both directions) as in fusion or untreated progressing single curves.

    But we don't see the structural curves responding to any changes in the compensatory curve. An example is the recent set of radiographs posted by a member here whose compensatory curve improved but the structural curve stayed the same or even got a little worse. Also, there are other testimonials of compensatory curves that decreased through PT with no change in the structural curve.
    Sharon,
    If what you say is true, what is driving my compensatory curve to catch up with my primary sturctural curve? It went from very small to nearly similar angles (less than 10*). You can take a look at the x-rays and see. The compensatory is moving much more rapidly than the primary curve....????

  9. #54
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    Structural or Compensatory

    Quote Originally Posted by Pooka1 View Post
    Right but what I am asking is if he reports measurements on the compensatory curves for for either the thoracic curves or lumbar curves. I have never seen a paper track what the compensatory curve is doing in a scoliosis case.

    There is a reason our surgeon never told us the measurements on the compensatory curves. They are not relevant unless the structural curve is untreated in which case either the structural or compensatory curves might later collapse as seen in those cases I posted from Hey's blog.

    Trunk rotational strength asymmetry in adolescents with idiopathic ...
    www.ncbi.nlm.nih.gov › Journal List › Scoliosis › v.2; 2007


    1. Trunk rotational strength asymmetry in adolescents with idiopathic ...
    www.ncbi.nlm.nih.gov › Journal List › Scoliosis › v.2; 2007Similar
    by KL McIntire - 2007 - Cited by 1 - Related articles
    Jul 9, 2007 – The purpose of this study was to determine trunk rotational strength asymmetry ..... the effect of measured strength training in adolescent idiopathic scoliosis. .... Treatment of adolescent idiopathic scoliosis with quantified trunk ...

    I don't think it worked, but I tried to copy a link to the full article on line.

    He states on page one, paragraph four, "The 3 patients with baseline curves of 50 to 60 degrees all had main or compensatory curve progression and 2 had surgery. For patients with 20 to 40-degress curves, survivorship from main curve progression of ≥6 degress was 100% at 8 months, but decreased to 64% at 24 months." There are repeated references to the "main" curve's action throughout the article. I am used to hearing the structural curve being refered to as the "main curve," as in, "Her main curve is 34 degrees and this one/ the compensatory curve is now 27 degrees."

    FYI: Every ortho we've been to has measured both the structural and compensatory curve, giving us both measurements.

    I know there can be two structural curves, but due to verbal experience and the comment at the beginning of the article, assumed some of the curves were compensatory curves. I can see I may have been in error.

    Will you confirm my mistake?

  10. #55
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    Quote Originally Posted by rohrer01 View Post
    Sharon,
    If what you say is true, what is driving my compensatory curve to catch up with my primary sturctural curve? It went from very small to nearly similar angles (less than 10*). You can take a look at the x-rays and see. The compensatory is moving much more rapidly than the primary curve....????
    I have posted cases from Hey's blog about collapsing compensatory curves. You are yet another example of that. Why the compensatory curve collapses in some cases and not the structural curve is anybody's guess.

    This is why folks with untreated T curves need to watch the compensatory lumbar curves even after maturity to avoid the need for long fusions extending into the lumbar when they could have avoided that with a T fusion.
    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."

  11. #56
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    Quote Originally Posted by AMom View Post
    Will you confirm my mistake?
    I can't confirm your mistake because I find the thing confusing. I am a little shocked he referred to compensatory curves at all when there is no evidence that I am aware of that addressing that addresses the structural curve. Maybe he was just throwing a wide net to see what he catches. And even though he does mention compensatory curves, I am not sure he is reporting out the data for anything other than the structural curves. Since we have anecdotal evidence that decreases in the compensatory curve through PT either does nothing to the structural curve or might make it slightly worse presumably if it is stiff, I would like to hear what McIntire was thinking.
    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."

  12. #57
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    Things are backward here in the UK, AMom. Is TR used extensively in the USA? It'd be interesting to hear from others.
    Last edited by TAMZTOM; 02-19-2012 at 03:10 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...”

  13. #58
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    Quote Originally Posted by TAMZTOM View Post
    Things are backward here in the UK, AMom. Is TR used extensively in the USA? It'd be interesting to hear from others.
    How do you know things are backward in the UK and not in the US? Sometimes I wonder. There is no consistancy with PT, bracing, or surgery criteria here. It all depends on which doctor you go to. I know you aren't addressing me, but I don't think TR is commonly used here in the US as it is "believed" that NO physical therapy methods have any effect on scoliosis other than for pain relief. Refer to the information section of this website and see. You can also go to many other websites of big name places, such as Mayo Clinic and the Scoliosis Research Society, and I believe they say the same thing.

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    How do I locate a particular post?

    [QUOTE=Pooka1;135712]I have posted cases from Hey's blog about collapsing compensatory curves.... [QUOTE]

    Can you tell me how to find Hey's blog on collapsing compensatory curves and the following two discussions mentioned on the NSF site? I am especially interested in the ones induced by PT.

    1)An example is the recent set of radiographs posted by a member here whose compensatory curve improved but the structural curve stayed the same or even got a little worse.

    2)Also, there are other testimonials of compensatory curves that decreased through PT with no change in the structural curve.

    A Mom

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    Quote Originally Posted by AMom
    Can you tell me how to find Hey's blog on collapsing compensatory curves and the following two discussions mentioned on the NSF site? I am especially interested in the ones induced by PT.
    1)An example is the recent set of radiographs posted by a member here whose compensatory curve improved but the structural curve stayed the same or even got a little worse.

    2)Also, there are other testimonials of compensatory curves that decreased through PT with no change in the structural curve.

    A Mom
    I'll send you a PM on who these people are.
    Last edited by Pooka1; 02-19-2012 at 04:45 PM.
    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."

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