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

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  • #76
    Originally posted by Pooka1 View Post
    Okay I see that. But given the known differences between structural and compensatory curves, their importance in surgical plans, and assuming the goal is to avoid surgery (I know you may not agree with that but patients and parents agree on that), I do not understand how it is possible to get a PT study published much less funded, even a whole spine one, where the two types of curves are not rigorously defined.

    Do you know of any PT or brace study that discusses anything but structural curves? If not I can understand why not. As we have seen on the group, it is a lesser (and perhaps irrelevant) feat to stabilize or reduce a compensatory curve. The pay dirt in terms of avoiding surgery for life is stabilizing or reducing a structural curve.
    I probably agree with you. Given that I'm not extremely current on the PT literature right now, I don't think this distinction is always made. The assumption is that 'curve reduction/stabilization' refers to the primary curve and the compensatory curves are more or less overlooked. I think this was unique to our study that Dr. Asher wanted to include both primary and secondary curves in the publication. As I said, I think this distinction or classification might become more important as PT studies are published. Or at the very least to report as we did.

    Comment


    • #77
      Deciding which types of curves to not doc w/ re: to PT may be premature at this point

      Originally Posted by Pooka1

      "Okay I see that. But given the known differences between structural and compensatory curves, their importance in surgical plans, and assuming the goal is to avoid surgery (I know you may not agree with that but patients and parents agree on that), I do not understand how it is possible to get a PT study published much less funded, even a whole spine one, where the two types of curves are not rigorously defined.

      Do you know of any PT or brace study that discusses anything but structural curves? If not I can understand why not. As we have seen on the group, it is a lesser (and perhaps irrelevant) feat to stabilize or reduce a compensatory curve. The pay dirt in terms of avoiding surgery for life is stabilizing or reducing a structural curve." Pooka1

      Originally posted by Kevin_Mc View Post
      I probably agree with you. Given that I'm not extremely current on the PT literature right now, I don't think this distinction is always made. The assumption is that 'curve reduction/stabilization' refers to the primary curve and the compensatory curves are more or less overlooked. I think this was unique to our study that Dr. Asher wanted to include both primary and secondary curves in the publication. As I said, I think this distinction or classification might become more important as PT studies are published. Or at the very least to report as we did.
      While it is important to differentiate between the types of curves discussed, until it is known how the curves react to PT, I want to know the life of both curves during treatment by PT at different frequencies, intensities, and durations (of time over a period of months)—I want reference points. The response of the compensatory curve (possibly easier to alter) may also be prescriptive with regard to adjusting the focus of the area of spine being treated. I also wonder if the ease of adjusting a compensatory curve might be correlated to amount of structural curve correction achievable. I would like to see the progress of curves specifically documented during both rapid growth and pauses in growth. This will answer the obvious question that arises, can the curve be reduced easier during a pause in growth, or does that have no impact on curve reduction? An interesting question to answer might be how long after maturation is it necessary to continue PT? Another one might be, at what degree is it necessary to continue PT “for life” due to mechanical progression? E.g. do stronger muscles “raise the degree of curve cut-off” with regard to mechanical progression? If so, what level of strength must be maintained to “hold” curves over x-degrees?

      On a related note, I’d like to know which machines (through an appropriate means of testing) recruit the upper paraspinals.

      As usual, I have more questions than answers.

      A Mom

      Comment


      • #78
        Originally posted by AMom View Post
        While it is important to differentiate between the types of curves discussed, until it is known how the curves react to PT, I want to know the life of both curves during treatment by PT at different frequencies, intensities, and durations (of time over a period of months)—I want reference points. The response of the compensatory curve (possibly easier to alter) may also be prescriptive with regard to adjusting the focus of the area of spine being treated. I also wonder if the ease of adjusting a compensatory curve might be correlated to amount of structural curve correction achievable. I would like to see the progress of curves specifically documented during both rapid growth and pauses in growth. This will answer the obvious question that arises, can the curve be reduced easier during a pause in growth, or does that have no impact on curve reduction? An interesting question to answer might be how long after maturation is it necessary to continue PT? Another one might be, at what degree is it necessary to continue PT “for life” due to mechanical progression? E.g. do stronger muscles “raise the degree of curve cut-off” with regard to mechanical progression? If so, what level of strength must be maintained to “hold” curves over x-degrees?
        I think you and McIntire should design a study. I bet it would be the best PT paper out there. :-)

        I can't know but would be surprised if surgeons have not investigated whether straightening a compensatory curve ever helps with a structural curve. And to the extent you can get to 0* much easier with fusion than with either bracing or PT, it is not crazy to suggest the approach of working on the compensatory is not likely to pan out. Of course few things are ever guaranteed and experimental data is always required. I'm just saying I think this experiment has been done and the results are in. That's why surgeons still have to fuse L curves in kids.
        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."

        Comment


        • #79
          Originally posted by Pooka1 View Post
          - structural curves have a non-physical (biological, hormonal, metabolic, biochemical, neurological, etc.) driver so no matter what you do to the compensatory curve, that driver is still there.
          Hi Sharon
          Don't know why these posts don't show up in my email any more! Rushing, quick reply...
          Re. my emphasis, your assumption ignores "transient triggers", "biological, neurological, etc...." E.g., assume an asymmetric genetic delay in one growth plate; growth, uneven weight distribution, gravity and posture all exploit that trigger and cause a curve; the genetic delay catches up--the growth plate grows; still got a curve, no genetic driver remains, mechanics takes over...vicious cycle.
          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...”

          Comment


          • #80
            Originally posted by Pooka1 View Post
            Okay I see that. But given the known differences between structural and compensatory curves, their importance in surgical plans, and assuming the goal is to avoid surgery (I know you may not agree with that but patients and parents agree on that), I do not understand how it is possible to get a PT study published much less funded, even a whole spine one, where the two types of curves are not rigorously defined.

            Do you know of any PT or brace study that discusses anything but structural curves? If not I can understand why not. As we have seen on the group, it is a lesser (and perhaps irrelevant) feat to stabilize or reduce a compensatory curve. The pay dirt in terms of avoiding surgery for life is stabilizing or reducing a structural curve.
            Again, replying too quickly...

            What may be informative is, for example, looking at the KING CLASSIFICATION system, the Orthotist's guide (available on the net). Any orthotist who does not pay rigorous attention to the compensatory curve doesn't know what they are doing. Orthotist's guide for the Charleston Night-time bracing system (that is).
            Last edited by TAMZTOM; 02-23-2012, 11:40 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...”

            Comment


            • #81
              Originally posted by Pooka1 View Post
              What did they tell you Tamzin has? A T curve or double major?
              I was going to type "asked and answered", but I'm not sure my humour translates well on the internet. :-) As I said before, the eedjit surgeon in Wales said both were structural simply because they were both over 25 degrees. My reply to him was not polite, although it did make Tamzin smile at the time.

              What does translate is corrective force (surgical, brace, PT); correct a structural curve requires attention to the effect on any compensatory curve. Why do you think even surgeons repeatedly emphasise, "...have to watch that the compensatory curve does not become structural?" There is no necessity for some voodoo ("occult") cause for scoliosis, a simple mechanical trigger can start the vicious cycle.
              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...”

              Comment


              • #82
                Originally posted by Pooka1 View Post
                I think you and McIntire should design a study. I bet it would be the best PT paper out there. :-)
                Seconded. Especially the suggestion on how best to work the upper paraspinals more with whatever method, exercise, protocol...

                And to the extent you can get to 0* much easier with fusion than with either bracing or PT, it is not crazy to suggest the approach of working on the compensatory is not likely to pan out.
                I would never call surgery an easier option.
                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...”

                Comment


                • #83
                  Cruella de Vil strikes!

                  Originally posted by Pooka1 View Post
                  I think you and McIntire should design a study. I bet it would be the best PT paper out there. :-).

                  I think that falls under cruel and unusual punishment.

                  Imagine a child going through the "more" and "why" stages or the most annoyingly inquisitive, persistent grad student and you've got me. Why would you suggest such a thing, he seems like a nice man.

                  McIntire will never speak with you again.

                  Comment


                  • #84
                    Originally posted by TAMZTOM View Post
                    Hi Sharon
                    Don't know why these posts don't show up in my email any more! Rushing, quick reply...
                    Re. my emphasis, your assumption ignores "transient triggers", "biological, neurological, etc...." E.g., assume an asymmetric genetic delay in one growth plate; growth, uneven weight distribution, gravity and posture all exploit that trigger and cause a curve; the genetic delay catches up--the growth plate grows; still got a curve, no genetic driver remains, mechanics takes over...vicious cycle.
                    I think the claim is the forces of gravity only become significant above about 30* which would correspond with the claim that if you can get to maturity at less than 30* then you probably don't have to worry about ever needing surgery. Of course folks have larger curves than 30* that just hang there for decades so stiff-ocity must come into play at some point. :-)

                    I am reminded of the claim that if you stay prone for the growth spurt you will not develop scoliosis that you would develop otherwise. Of course that treatment is too draconian to try even and I am not convinced it is true if it was never tested.
                    Last edited by Pooka1; 02-23-2012, 08:13 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."

                    Comment


                    • #85
                      Originally posted by TAMZTOM View Post
                      Again, replying too quickly...

                      What may be informative is, for example, looking at the KING CLASSIFICATION system, the Orthotist's guide (available on the net). Any orthotist who does not pay rigorous attention to the compensatory curve doesn't know what they are doing. Orthotist's guide for the Charleston Night-time bracing system (that is).
                      A brace fitting protocol is just that, a protocol. To my knowledge it is based purely on first principles fo inducing hypokyphosis, straightening a structural curve, and not exacerbating a compensatory curve. It is not the result of trying various things empirically and arriving at some best solution.

                      And even if it is true that a structural curve can be worsened by exacerbating a compensatory curve (and I have not seen evidence for that), it doesn't then follow that even straightening a compensatory curve to 0* will help a 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."

                      Comment


                      • #86
                        Originally posted by TAMZTOM View Post
                        I was going to type "asked and answered", but I'm not sure my humour translates well on the internet. :-) As I said before, the eedjit surgeon in Wales said both were structural simply because they were both over 25 degrees. My reply to him was not polite, although it did make Tamzin smile at the time.
                        1,000 apologies! I remember you said that. I think I forgot it because but my kids had compensatory curves >25* and one is now completely straight through that area although untouched surgically.

                        What does translate is corrective force (surgical, brace, PT); correct a structural curve requires attention to the effect on any compensatory curve. Why do you think even surgeons repeatedly emphasise, "...have to watch that the compensatory curve does not become structural?" There is no necessity for some voodoo ("occult") cause for scoliosis, a simple mechanical trigger can start the vicious cycle.
                        Well actually I am not aware of anyone ever mentioning that except Hey and my mentions of Hey saying that. I don't think surgeons ever mention that issue to parents. The two patients with collapsing compensatory curves are presumably not common in the grand scheme.

                        Now on the basis if the preponderance of long fusions in adults versus children, I have banged on about how earlier fusion appears to saves levels and Hey says the same thing.
                        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."

                        Comment


                        • #87
                          Originally posted by TAMZTOM View Post
                          I would never call surgery an easier option.
                          Touché. :-)

                          I meant that the surest way to hope to hit 0* is surgery.

                          ETA: I think 100 out of 100 kids would opt for a T fusion if it saved them from an L fusion for life.
                          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."

                          Comment


                          • #88
                            High (&amp; low) paraspinal exercise, asymmetrically (&amp; symmetrically)

                            AMon/ Kevin_Mc/ anyone in the know:

                            Started reading articles on concavity and convexity fibre activity (Type 1 deficit on the concavity). Strength endurance and endurance are distinct from strength. Would an increased number of asymmetric repetitions with less weight benefit CTR users more than symmetrically increasing the pure strength/weight lifted?

                            I'll research and test this over a few months, asymmetrically on Tamzin, symmetrically on myself. We already do the exercises listed in the below abstract (except front-press) but don't do CTR on a MedX or Cybex. The muscles can be targeted in many ways so input from all 'exercisers' could prove useful (i.e., not just MedX or Cybex TR users).
                            Tamzin has an in-brace x-ray scheduled next Friday, then another (at my discretion) two months later; specific focus on the upper paraspinals incorporated into her training may provide useful information on any curve changes within that period.
                            While performing Schroth R.A.B., Tamzin has regularly performed lat pull-downs for many months (approx. 50:50 symmetric/asymmetric to redress asymmetry); varying the width of the hold, hand position and angles of the bands used and the lat-pull down machine varies the muscles targeted.

                            The 2nd article corroborates the earlier (AMon) information about high/low TR effects.
                            http://www.ncbi.nlm.nih.gov/pubmed/20811080
                            http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1079862/
                            Last edited by TAMZTOM; 02-24-2012, 08:49 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...”

                            Comment


                            • #89
                              Originally posted by TAMZTOM View Post
                              AMon/ Kevin_Mc/ anyone in the know:

                              Started reading articles on concavity and convexity fibre activity (Type 1 deficit on the concavity). Strength endurance and endurance are distinct from strength. Would an increased number of asymmetric repetitions with less weight benefit CTR users more than symmetrically increasing the pure strength/weight lifted?
                              In part and in theory, yes. It's one reason we included the 'burn out' phase at the end. To fully fatigue the muscles in order to activate all fibers AND to train the muscles in an endurance capacity. As far as asymmetric exercises providing a better result than symmetric, I generally feel that the TRS protocol operates under the assumption that there are paraspinal muscles that are not operating properly or outright inactive (shown by a disuse atrophy phenotype on the concave side). So the plan is to force the muscles to become active and stronger which will allow the body to begin using them naturally. Or I guess another way to put it is that, under the assumption that the body has the tools needed to stabilize the spine - it just isn't using them, then the exercise/strength training 'forces' the use of these tools. So that when needed to provide stability due to some external force, they are able to respond appropriately.

                              If the above hypothesis is true, then I'd say it would be theoretically possible for any activity to activate these muscles. This fits in with the fact that many curves will autocorrect. If stabilizing muscles play any role in AIS progression, then if, during the watch and wait period, they become active and begin stabilizing the spine appropriately, then you get an autocorrection. But for those that don't autocorrect, an intentional focus on paraspinal activation needs to happen (TRS for example). And if that doesn't work, then an even more focused protocol aimed at stabilizing specific areas of the spine might need to be utilized (e.g. Schroth or side-shift). I also mention that I'm not sure if this would work for every curve. I think there are several primary etiologies for AIS and depending on the one a person has will depend on their success of any given treatment.

                              Comment


                              • #90
                                Thanks for the bearing with the cause--i.e., enlightenment. I think your grad. students must like you really. :-)

                                Originally posted by Kevin_Mc View Post
                                It's one reason we included the 'burn out' phase at the end.
                                I've read the abstract of your pilot study and the later study. Haven't seen the full 'protocol' indicating specifics, such as the "burn out phase at the end". Is this available on the net?

                                Excuse any stupidity in the following Q's--don't slam me though, just ignore them if a deficit in brain fibre is apparent.


                                To fully fatigue the muscles in order to activate all fibers AND to train the muscles in an endurance capacity.
                                As mentioned, I haven't read the "burst" details. Re. Type 1 deficit: e.g., when doing weights, I used to work up and down (from 100 lbs to 305lbs, then back to 100 lbs, up to 100 reps. 20 lbs increments, decreasing reps on the way up and vice versa. Strength. Later, mixed workouts and did sets of 50 - 100 lbs till bored. Endurance. My other daughter'll do 10 - 11 miles long run 1 x wk, low end aerobic stimulus chilling at 7:45 /mile, steady, low heart rate. When I say "endurance" as opposed to strength, I was suggesting that type of emphasis. Upping the cadence (running) or tempo (weights) would work speed and probably strength endurance as distinct from lower end endurance in both examples. Regarding scoliosis, to induce Type 1 use, the subject would exercise (with any appropriate paraspinal working exercise) for...for...quite a while and often (perhaps daily--for pure strength increases, heavier exercise on the same muscle group every 3 days or so)?

                                As far as asymmetric exercises providing a better result than symmetric...
                                If I remember correctly, when asking you similar questions before, you replied that, after the strength had been equalised on both sides (i.e., asymmetric), you commenced symmetric exercise. Muscles work on both sides when rotating in either direction therefore "scatter-gun" the lot of them. Were you able to measure EMG activity to assess development of Type 1 on the concavity or did you use equalising strength as a proxy? Presuming that all sessions were sub-max, especially during the "burst", an equal 'effort' could have succeeded as masquerading for endurance equalisation?

                                ...I'd say it would be theoretically possible for any activity to activate these muscles.
                                In my dark mental state, I'd agree. (Just thinking aloud here.) Even at your "5% paraspinal use", TR, in addition to increasing ROM, could provide enough stimulation to induce auto-correction. Because of the main muscles used, TR has more benefit for lumbar or lower curves than thoracic curves. My opinion is that even when the lower curve is compensatory, stability and/or correction there can increase the progression threshold for a higher structural curve. AMon's suggestion to vary the CTR hand and arm position is intriguing, but who would do the study? Can you kick some good grad. students onto the job?

                                But for those that don't autocorrect, an intentional focus on paraspinal activation needs to happen (TRS for example). And if that doesn't work, then an even more focused protocol aimed at stabilizing specific areas of the spine might need to be utilized (e.g. Schroth or side-shift).
                                Agree again (my daughter does Schroth daily). Hitting the higher curves with Schroth too is more 'esoteric' than with lower curves--RAB, some wall-bar (body weight and band exercises) and some lying-on-the-side exercises with supports work well.
                                Last edited by TAMZTOM; 02-24-2012, 07:05 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...”

                                Comment

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