Pilates Miracle?

[TAMZTOM]

Tom! I don't know what "intensity" means and neither will most other patients and parents ready this! Because these authors CHOSE to be cryptic and because the peer reviewers let them get by with it, THEY are responsible if people starting making wild guessing about what "intensity" mean, yes?

"intensity" is ambiguous, not ambivalent in this case. For lay-folk, this could be explained..and I have no doubt that the "intensity" increase would be spelled out when SEAS folk are instructing patients. The targeted audience for that paper--and most others--does not include lay-folk. The targeted audience will know what the researchers meant by "intensity". (E.g., it is commonplace in running physiology to refer to 'increases in intensity rather than mileage'.)

It is the same in surgical papers--the authors are not trying to educate the lay public, they are describing procedures to other practitioners conversant with the chosen technical lingo.

[TAMZTOM]

The other thing is they apparently have determined that the one case report cannot be replicated (for whatever reason). That would have constituted knowing something about PT and how it reduces adult curves if they could apply it widely. So maybe there is something unique about that one patient.

I didn't get that from the paper at all, Sharon! The opposite.

Conclusion
This case report shows it is possible obtaining a significant
improvement of scoliosis in adults with SEAS exercises.
Marty-Poumarat showed that rate of progression in adult
scoliosis is linear [6]. So, it is possible to establish an individual
prognosis repeating x-rays every 4–5 years in adulthood.
When x-rays detect a significant worsening, it is
possible to recover and then to possibly stabilize scoliosis
through SEAS exercises, thus avoiding the need of surgery.

Did I miss something? Limited time here (I'm on multiple kid training duty now...). Can you direct me to whatever you read that suggested this was an odd case?

[Pooka1]

"intensity" is ambiguous, not ambivalent in this case. For lay-folk, this could be explained..and I have no doubt that the "intensity" increase would be spelled out when SEAS folk are instructing patients. The targeted audience for that paper--and most others--does not include lay-folk. The targeted audience will know what the researchers meant by "intensity". (E.g., it is commonplace in running physiology to refer to 'increases in intensity rather than mileage'.)

It is the same in surgical papers--the authors are not trying to educate the lay public, they are describing procedures to other practitioners conversant with the chosen technical lingo.

Yes I see that but it is arguable that the ONE point that a lay person or a researcher would most want to know from that case study is what EXACTLY did the patient do to accomplish such a reduction??? Why did they leave out the most important detail??? If I was a patient and saw that reduction I would try to do EXACTLY what she did. But I can't because they were cryptic. And other researcher can't even hope to replicate the study because they were cryptic.

[Pooka1]

Did I miss something? Limited time here (I'm on multiple kid training duty now...). Can you direct me to whatever you read that suggested this was an odd case?

I am merely opining that they had a real accomplishment with that one woman. If they saw that result more widely then they would have robust and reliable PT solution to reducing adult curves. Yet according to Alistair, they claim they barely know anything. That is inconsistent in my opinion. Only if they don't know why she was the only person to respond like that could they conclude they barely know anything in my opinion.

[TAMZTOM]

Yes I see that but it is arguable that the ONE point that a lay person or a researcher would most want to know from that case study is what EXACTLY did the patient do to accomplish such a reduction??? Why did they leave out the most important detail??? If I was a patient and saw that reduction I would try to do EXACTLY what she did. But I can't because they were cryptic. And other researcher can't even hope to replicate the study because they were cryptic.

It would be awesome for me if the exercise research spelled out everything. E.g., I had to ask Kevin McI for his precise home based protocol because it wasn't in the widely available paper. McI wasn't being cryptic. Neither are the authors of that SEAS paper. The bottom line, as you've said often, is that most folks with other professions simply don't have the time to grapple with the language of another profession.

If I were being sceptical--as I often am--I could suggest a proprietary obfuscation motivated their wording. That would be a stretch in this case. Even ignorant I know fairly accurately what they mean by "intensity".

[TAMZTOM]

I am merely opining that they had a real accomplishment with that one woman. If they saw that result more widely then they would have robust and reliable PT solution to reducing adult curves.

Yes! I think Hdugger made a similar excellent point earlier...to translate to Scottish, dissemination of good ideas sucks.

Yet according to Alistair, they claim they barely know anything. That is inconsistent in my opinion. Only if they don't know why she was the only person to respond like that could they conclude they barely know anything in my opinion.

I don't read posts from surly trolls, so haven't read anything from that one. :-)

[Pooka1]

It would be awesome for me if the exercise research spelled out everything.

Hawes tabled everything she did, when she did it, and the duration of each activity. It was exquisite in its detail. That SEAS case study could have done the same. If they were protecting proprietary info, and we have no evidence of that, then that would reduce my very high opinion of them as researchers.

[Alistair]

I don't read posts from surly trolls, so haven't read anything from that one. :-)

"sono molte di piω le cose che non sappiamo di quelle che sappiamo"
Stefano Negrini, medical director at ISICO (the SEAS people as you call them), 21/05/2010

I don't know any surly trolls, and I'm certainly not one. Why don't get hold of a vocabulary and translate that tamztom.

This forum has become a discussion between the ever optimistic tamztom and the more realistic pooka1 (I believe I've found myself agreeing a lot more with the latter than the former in past discussions), I would like to see more people participating..

[jrnyc]

i see name calling coming from only one person on here...
it casts a very negative light on the person using such words...
talk about "repugnant"

Alistair, i agree with you....the scoli i live with presents me with little optimism at the moment...
reality doesn't mean the same to everyone...depending on who is doing the looking...

jess

[Pooka1]

"sono molte di piω le cose che non sappiamo di quelle che sappiamo"
Stefano Negrini, medical director at ISICO (the SEAS people as you call them), 21/05/2010

It is very good of them to admit their ignorance.

"True knowledge exists in knowing that you know nothing." -- Socrates

"The first principle is that you must not fool yourself, and you are the easiest person to fool." -- Richard Feynman

For me in my research career, the more I knew (or thought I knew), the more I realized how much I didn't know. It is easy to be convinced of something that turns out to be wrong. The problem can expand faster than the gain in knowledge. Idiopathic scoliosis fits this paradigm in my opinion. The more they know, the bigger the problem might appear.

Skepticism is not negativism. It is simply the best way to hopefully avoid going down the wrong path. You can learn from your mistakes but even better is to see the impending mistake before it is committed. That is as educational as making the mistake which is also educational. There is more snake oil in alternative treatments for scoliosis than you can shake a stick at. That situation can only arise when medicine has yet to crack the nut.

It is not crazy to try safe things including conservative (as opposed to alternative) treatments when the clock is ticking. But definitive statements are not appropriate in what is essentially a series of science experiments being conducted with bracing and PT. These are experimental treatments and should be discussed as such in my opinion. They differ from, let's say insulin therapy for diabetes wherein they are not still researching if insulin shots can treat that condition. Research continues because efficacy has not been shown definitively. These are clearly experimental treatments and it is misleading to talk about them in other ways. I think the ISICO researchers seem to agree with that to their great credit. They certainly appear to be approaching this is a very correct way.

My personal opinion is that eventually a class of patients will be identified who can predictably avoid surgery through either bracing or PT during the growth spurt. I think it will be massively dominated by the JIS cases and have much fewer AIS cases. And I do think a few adults have avoided surgery through unremitting PT for life. I am just not sure these treatments will ever totally avoid surgery for all kids or adults for many, many reasons variously discussed in these threads.

That's one layperson's unlettered opinion. :-)

[jrnyc]

adults avoiding surgery using exercise to feel better....yes...
adults avoiding surgery using exercise to reduce curve(s) or to prevent
progression of curve(s)...no
that is just my opinion...

and...what of the unknowns...the old "correlation doesn't prove cause" thing....?
how to PROVE which people, young or old, would not have had curves progess anyway, regardless
of exercise....?

jess

[jrnyc]

could you please refer me to the proof for these adult patients...??
somewhere i could read the numbers of people who have succeeded
with this "cure" that Tamz writes of...?
i have only read of one or two patients...not thousands of any patients,
not large numbers of any patients, certainly not large numbers
of adults...and i have never read of large numbers, thousands, of
kids...but i would be willing to do the reading if i knew where to locate
the studies...
if the studies are not available to lay people...if they are published only
in medical journals, i could ask the surgeon i will be seeing soon if he would
let me read them in the medical journals he gets at his office...

thanks....

jess

[TAMZTOM]

Since we're looking at "experiments", choices and facts, I've pasted the below from Martha Hawes.

Impact of Spine Surgery on Signs and Symptoms of Spinal Deformity
Pediatr Rehabil. 2006 Oct-Dec;9(4):318-39
Hawes, M.
University of Arizona, Tucson, AZ 85721, USA.
“Pediatric scoliosis is associated with signs and symptoms including reduced pulmonary function, increased pain and impaired quality of life, all of which worsen during adulthood, even then the curvature remains stable. Spinal fusion has been used as a treatment for nearly 100 years. In 1941, the American Orthopedic Association reported that for 70% of patients treated surgically, outcome was fair or poor: an average 65% curvature correction was reduced to 27% at greater than two year follow-up and the torso deformity was unchanged or worse. Outcome was worse in children treated surgically before age 10, despite earlier intervention. Today, a reduced magnitude of curvature obtained by spinal fusion in adolescence can be maintained for decades. However, successful surgery still does not eliminate spinal curvature and it introduces irreversible complications whose long-term impact is poorly understood. For most patients there is little or no improvement in pulmonary function. Some report improved pain after surgery, some report no improvement, and some report increased pain. The rib deformity is eliminated only by rib resection, which can dramatically reduce respiratory function even in healthy adolescents. Outcome for pulmonary function and deformity is worse for patients treated surgically before the age of 10 years, despite earlier intervention. Research to develop effective non-surgical methods to prevent progression of mild, reversible spinal curvatures into complex, irreversible deformities, is long overdue.”

Surgery seems to have improved, but not well enough. More must be done for those who choose surgery and for those who have no realistic choice. Bracing MAY be better for many who do not have the opportunity and support to optimise the use of exercise, but, like surgery, bracing can have dramatically adverse consequences. Exercise treatment can clearly work for some, JIS, AIS, kids, adults, teens, girls, boys. It does not work for all and this is large part due to ignorance, lack of communication and dissemination.

Even in our short experience, we've been exposed to negligent surgeon advice, orthotist advice, physical therapist advice. Our experience is common--in fact, it is the norm. There is merit in all of these treatments and they are all also flawed. If one parent decides surgery is the best option, this forum should afford sensible discussion of experience and current knowledge. The same goes for bracing and exercise. All else is a puerile waste of time. Some folk need to get over themselves, grow up a bit and start helping.

My kid will exercise to treat her scoliosis. It has taken us a year to develop some measure of insight. We have not totally discounted the use of a brace, but are loathe to try it again. Increased curve flexibility may, for example, enable a SpineCor brace to effect a greater correction, possibly avoid disk wedging, but we'd have to weigh that against e.g., detrimental compression, scapula winging, rib compression, pulmonary restriction, relative lack of neuromuscular integration. Surgery COULD become necessary so I will continue to read, learn from others with experience of all three fields. We proceed not on myth, accepted 'wisdom' or hope, but on what we see is working and expect to continue to work.

[Pooka1]

adults avoiding surgery using exercise to feel better....yes...
adults avoiding surgery using exercise to reduce curve(s) or to prevent
progression of curve(s)...no
that is just my opinion...

and...what of the unknowns...the old "correlation doesn't prove cause" thing....?
how to PROVE which people, young or old, would not have had curves progess anyway, regardless
of exercise....?

jess

Hey Jess,

While there are curves that reach high angles and then just hang there, sometimes for years, most don't and continue to progress. So while you are right about not being able to know if PT holds smaller curves, it is probably the case that it is holding larger curves that stop progressing after demonstrated recent progression or reduce. Those things don't happen some much in the natural history so it is likely the PT that is doing that.

But of all the adults who try this, we only know of a literal handful who have sigificant reductions. Presumably more have smaller reductions and even more have halted progression during the PT. What we don't know is the failure rate... it could be that only a small precentage who try to use PT to hold or reduce their curve are ever succesful. It would be helpful if somehow someone tried to estimate how many people successfully avoided surgery with unrelentling PT.

Kids using PT during the growth spurt is a different matter. That seems like a more open question than the adult situation.

ETA: The main difference between kids and adults when it comes to PT is that targeted work during the growth spurt might be shown to keep kids subsurgical for life. At least that is my understanding of the research on PT and kids. They can then quit the PT if they like after the growth spurt. The situation for adults is they are looking at PT for life if it works. That's a whole 'nother ball game and a far larger total commmitment.

Sharon

[TAMZTOM]

I saw the actress Rebecca Romijn on a talk show a couple of years ago and she said she had had scoliosis since she was a teen. But since taking up Pilates, it has disappeared. Her words were (I'm paraphrasing): Pilates straightened my spine right up! Does anyone believe this could have been possible?

On the Pilates front, my daughter recently started doing right-side planks. She's done several private Pilates classes and many group sessions before ballet, but never side-planks. The exercise corrects the comp. lumbar curve as she prepares; she rises from the floor using her right side, tighter oblique and quadratus muscles. The thoraclumbar fascia snaps into alignment, this in turn aligning all the interweaving muscles and pull on the lumbar spine transverse processes. When in full plank, the lumbar curve is gone completely, the thoracic curve almost completely straight too. She does them in sets, 8 x 10 - 15 seconds. She is becoming very adept at holding some of the corrected alignment after finishing this and all other exercises. After some practice, she can now derotate the thorax a/c and lumbar spine c/w during the exercise.
If side-planks are considered Pilates, we're in!