Side Planks

[jrnyc]

glad you saw the joke...
i know anything that can help scoli is serious...
but it was just getting a little bit extreme to try to
figure out which patient or how many patients benefited
from what....
not right that any study should require such examination
with a tweezers to try to figure out what was what.

jess...and Sparky
(puppy still healing, and licking the surgical wound the
second the cone comes off for any reason...poor baby)

[Alistair]

LOL Jess!

I agree that the article should have been clearer and presented the material in a more useful fashion. They lump and split in non-optimal ways in my opinion. I think it is because spine orthopedics is not their field.

What I have tried to do is deduce what must or is likely the case from what they did present.

But the bottom line is you are right that this study is too small to conclude much and that it needs to be repeated, preferably by someone like Dr. McIntire who is versed in scoliosis orthopedics.

Yes it would be nice to see an independently-led study opposed to what looks like a promotional one.

[flerc]

I continue at the same point really. If the before after x-rays values. are wrong, then inconsistences has no importance as nothing having to do with this, but if they are right, inconsistences also are not important except those leading to think there were more than 25 patients because replication could not seem to be so sure. But anyway would be something fantastic of course even if there were just only one succesful case.. every scoliotic person around the world with a big (specially C) curve should to be aware about this study.

[Pooka1]

I continue at the same point really. If the before after x-rays values. are wrong, then inconsistences has no importance as nothing having to do with this, but if they are right, inconsistences also are not important except those leading to think there were more than 25 patients because replication could not seem to be so sure. But anyway would be something fantastic of course even if there were just only one succesful case.. every scoliotic person around the world with a big (specially C) curve should to be aware about this study.

The potential problems with the study in my opinion are not the measurements but instances of data selection, and the long term. Some people with large curves were subsurgical after the PT. If that holds then they will have avoided surgery. If they have pain that the PT doesn't help then they might still need surgery. The whole issue of does yoga help with pain is left unaddressed in the article which is fine because that wasn't what they were studying. My understanding is degenerative scoliosis is usually a smallish curve accompanied by a lot of damage and pain.

The bottom line is does this allow some people to avoid surgery in the long run and does it address pain well enough to avoid surgery? This study, if if is is completely perfect in its design and completely correct in its conclusions does not answer either of those questions. There should be a requirement when publishing PT articles that they address what people actually care about... avoiding surgery and pain. This does address curvature and people are concerned about that. But only the largest curves with the largest reductions probably will have a noticeable decrease in curvature to the naked eye. Or not.

Just my opinion.

[flerc]

Sure a lot of research is needed and certainly , assuming values are right, scoliosis research should to be focused in this point. Exactly which muscles are improved in such fantastic way.. is diificult to believe it could be paraspinal http://www.scoliosisjournal.com/content/9/S1/O11 tendons or fascias nothing has to do?.. are there an increment in tone or a reduction in lenght or both?.. we have the technology to know what happen when this exercise is done. Anatomy knowledge would have a enormous increment really.
I suppose pain should to decrease with the curve, otherwise, other should to be cause of pain.. I always say to people decided to have surgery because pain, they should to avoid any doubt using for a while a brace (having of course a great reduction in brace) so if pain not changes, curve could not be the cause.

[Alistair]

While the study is obviously flawed, I think, if I had a kid, I'd try to convince them to do this one simple exercise every day. It probably doesn't hurt, and it might actually help. The reasons I think most of the other alternative programs are bad are 1) there's no proof that they work, 2) the people who report on these programs make a lot of money from them, and 3) they involve a large investment of time and money. Side planks are free and involve only seconds a day.

We've been talking about these planks for a while now and just wondered, despite all our doubts, if anyone is actually doing this? If you are, thoughts so far?

[flerc]

We've been talking about these planks for a while now and just wondered, despite all our doubts, if anyone is actually doing this? If you are, thoughts so far?

I just wrote in a Facebook scoliosis group, about how much strange is not knowing about nobody in the world doing this exercise.. if there were a study saying about old bald men recovering 50% of their lost hair just only doing an specific kind massage in the scalp, millons of persons around the world would be doing such kind of massage.. scoliosis is strange in every sense..

[Pooka1]

I just wrote in a Facebook scoliosis group, about how much strange is not knowing about nobody in the world doing this exercise.. if there were a study saying about old bald men recovering 50% of their lost hair just only doing an specific kind massage in the scalp, millons of persons around the world would be doing such kind of massage.. scoliosis is strange in every sense..

Is your daughter doing side planks? Maybe there is your answer. Maybe they aren't doing it and maybe they are and not talking about it.

[flerc]

If people are doing it, I hope they'll talk about it.
The case of my daughter is too much unusual I think. She is not looking for something for her curve, she trust in her physiatrist and don't want to talk about scoliosis.. specially with me.
I must to be very careful when I propose something, mainly because my wife is always against trying something new, but this time I said her about this study and she commented to my daughter, who did the side plank some seconds but she injured (nothing serious) her wrist. She doesn't like Yoga but she likes to do the bridge which seems to be more dangerous (specially with a big curve) and never nothing wrong happened, but this excercise is really very demanding, so I will not talk again about the side plank for a while. I'm trying to convince a Iyengar Yoga teacher I know to come to my house only to teach this pose to my daughter.. I hope I can.

[Alistair]

ISICO's (Italian Scientific Spine Institute) official response to this "study" might be of interest:

Serial Case Reporting Yoga for Idiopathic and Degenerative Scoliosis
Dear Editor:
We would like to compliment the authors for this interesting attempt to study the effects of a
specific yoga pose on scoliosis.1 We strongly support research providing good evidence in relation
to conservative scoliosis treatment.2 Nevertheless, we have serious concerns about this paper’s
results and conclusions. It has been considered worldwide by various media as proof of yoga’s
effectiveness but has too many flaws to engender confidence.
Inclusion criteria are not consistent with the literature: (1) Curves that are not scoliosis were
included: by definition, 6 degrees Cobb is not scoliosis,3,4 and we don’t know if Adam test, a crucial
sign to define scoliosis, has been performed.5 This diagnostic flaw completely impairs the content
of the paper. The curve pattern confirms this impression, being half right thoracolumbar, which is
very infrequent in real scoliosis but not in postural imbalance. (2) Adolescent and adult scoliosis are
both included. The former has a high risk of sudden progression, while the latter does not. These
totally different populations are never treated together in scientific papers.3 (3) Idiopathic and
degenerative types of scoliosis are mixed: again, these relate to very different populations.
Degenerative scoliosis is usually lumbar, not thoracolumbar,6 and is much less severe than
idiopathic scoliosis.
Other relevant limitations include the following: (1) The follow-up radiograph schedule is
unclear, ranging from 3 to 22 months, with very short- and medium-term results mixed together.
(2)Due to the progressive trend of adolescent scoliosis, end growth evaluation is needed to evaluate
the effectiveness of treatment. (3) The authors define secondary curves as more severe than primary
ones. This is surprising and contrary to the literature; it is not clear how they were defined. (4)
Noncompliant patients had 0.45% positive results performing the pose 4 times or fewer per week,
whereas compliant patients experienced 40.9% positive results with 5 to 7 repetitions. This is a
striking difference. How was the threshold for compliance defined and was it done a priori or posthoc?
(5) The claim of better quality of life (QoL) with yoga versus bracing is not supported by
existing data. A recent randomized controlled trial7 clearly demonstrated that bracing doesn’t
reduce QoL compared to observation.
Based on these relevant methodological flaws, the authors should be more cautious: yoga
cannot be considered an alternative to any effective treatment3, such as physiotherapeutic scoliosisspecific
exercises (PSSE), bracing, and surgery. The correct conclusion of this paper should have
been that the use of yoga warrants further study and that it is not possible to draw any conclusions
about its effectiveness. Moreover, it should be studied in contrast to PSSE, the standard of care for
scoliosis treatment not requiring bracing.3,8 Today, yoga is considered a generalized physiotherapy
not specific for scoliosis9 as it lacks self-correction, the most important and specific part of
scoliosis rehabilitation.10 Conversely, some yoga poses (like the one studied here) could
significantly increase the generic stabilizing effect of exercises,8 another key point of PSSE.10
Minnella Salvatore, MD, Zaina Fabio, MD, Romano Michele, PT, and Negrini Alessandra, PT,
ISICO (Italian Scientific Spine Institute), Milan, Italy; Negrini Stefano MD, Prof, Department of
Clinical and Experimental Sciences, University of Brescia, Italy, and IRCSS Don Gnocchi
Foundation, Milan
References
1. Fishman L, Groessl E, Sherman K. Serial case reporting yoga for idiopathic and
degenerative scoliosis. Glob Adv Health Med. 2014;3(5):16-21.
2. Negrini S, De Mauroy JC, Grivas TB, et al. Actual evidence in the medical approach to
adolescents with idiopathic scoliosis. Eur J Phys Rehabil Med. 2014 Feb;50(1):87-92.
3. Negrini S1, Aulisa AG, Aulisa L, et al. 2011 SOSORT guidelines: Orthopaedic and
Rehabilitation treatment of idiopathic scoliosis during growth. Scoliosis. 2012;7(1):3.
4. Hresko MT. Clinical practice. Idiopathic scoliosis in adolescents. N Engl J Med. 2013 Feb
28;368(9):834-41.
5. Bunnell, W. P. Selective screening for scoliosis. Clin Orthop Relat Res. 2005;(434):40-5.
6. Aebi M. The adult scoliosis. Eur. Eur Spine J. 2005 Dec;14(10):925-48.
7. Weinstein SL1, Dolan LA, Wright JG, Dobbs MB. Effects of bracing in adolescents with
idiopathic scoliosis. N Engl J Med. 2013;369(16):1512-21.
8. Monticone M1, Ambrosini E, Cazzaniga D, Rocca B, Ferrante S. Active self-correction and
task-oriented exercises reduce spinal deformity and improve quality of life in subjects with mild
adolescent idiopathic scoliosis. Results of a randomised controlled trial. Eur Spine J. 2014
Jun;23(6):1204-14.
9. Bettany-Saltikov J1, Parent E, Romano M, Villagrasa M, Negrini S. Physiotherapeutic
scoliosis-specific exercises for adolescents with idiopathic scoliosis. Eur J Phys Rehabil Med. 2014
Feb;50(1):111-21.
10. Weiss HR1, Negrini S, Hawes MC, et al. Physical exercises in the treatment of idiopathic
scoliosis at risk of brace treatment—SOSORT consensus paper 2005. Scoliosis. 2006 May 11;1:6.

[Pooka1]

ISICO's (Italian Scientific Spine Institute) official response to this "study" might be of interest:

Serial Case Reporting Yoga for Idiopathic and Degenerative Scoliosis
Dear Editor: (snip)

Alistair, thanks for posting that.

I think at this point it is very clear why the article wasn't published in a journal like Spine.

The authors are not orthopedic surgeons and it shows. In contrast, the ISICO guys ARE orthopedic surgeons. And it shows in their comments.

[flerc]

Here is what they responded to SEAS http://www.gahmj.com/doi/pdf/10.7453/gahmj.2014.084

[flerc]

Certainly if SEAS would have something to do with a scientist aproach, they should to be interested in the before after x-rays values and not so much in why was included a 6º case against the scoliosis definition and so on. If they think are right, they should to be working to determine which tissue involved in this exercise is able to fight against the gravity force, something I never saw they did in a scientist way. They seems to be very much interested in trying to emphasize that Yoga is not a scoliosis treatment instead of knowing about this exercise.. why it seems to be doing something that never none of their exercises achieved to do.

[Pooka1]

The pain doctors did not rigorously separate the structural from the compensatory curves. Co-mingling them on one graph is nonsense FULL STOP. If they did that. It isn't clear. There is some massive confusion about primary and secondary curves demonstrated in the paper. Secondary curves are not larger than primary curves. Also the issue of the largest curves appeared to be the degenerative ones, not the AIS ones which I don't think comports with reality.

[flerc]

Ok, we may conclude they have not idea about what scoliosis means. And what? Does it turn the Side Plank exercise less efective?