Why is SpineCor not an accepted means of treatment among Orthopedists' in the USA?

[MATJESNIC]

That sounds great. Good luck to you. Your daughter will really like Dr. Deutchman. He is very patient and kind to kids and adults. Does Dr. Smouse's daughter wear Spinecor?
Melissa

[Mom37]

Good question

I will ask next time I talk to them. Shirley

[gerbo]

i'm going back to lurking mode..please put down your chiro-guard...

totally off topic, but knowing that you are likely to lurk around here, and might feel safe to "come out and play"

I have build up my own little pet theory aboutscoliosis being, regardless of initiating factors, a selfperpetuating or selfmaintaining problem, with main factors being 1) posture and movement patterns (in our case corrected through spinecor and ballet) 2) muscle strength assymetry (which I am addressing through targeted measured resistance work.) Nothing too exciting about that as many orthopaedics think on similar lines.

However I am having this bee in my bonnet about the role of ligaments, specially the ones between the vertebrae, holding it all together. Inevitably, in established scoliosis, the ones on the concave side must have shortened, as much as the ones on the convex side must have lengthened. What I wonder is whether it is the shortened ligaments which physically keep the scoliosis in its curved position and resists attempts to straighten, a bit like a contracture in any joint which is kept in an immobilised position.

If that is true, then significant stretching of ligaments need to take place to have some chance of succesfull correction of a curve. I would imagine that a very highly corrective brace would do that, or the bending braces which some people use (providence etc)

I do some stretching with my daughter by using an yogaball, and let her curve over it (sideways, convex down) for 10 minutes every evening.

How would a chiropracter go about trying to lengthen ligaments, any exercises you would suggest?

Interested in your views (honestly)

Anybody else any views???

[sportsdoc]

lol..since that seemed like an invitation..
what you described is much like the theory behind CBP..
However, with one cavit...
what holds bones in place aren't ligaments as many believe..
ligaments's function is to keep joints from going further than its' normal ROM..
It's the muscles and joint structures that keeps bones in certain position in neutral setting..

there was a study with pigs' spine where researchers stapled one side of spinal musculatures and succeeded in creating scoliosis...there were some histological changes with increased fibroblast activities on the concave side....
In CBP, they do what's called global adjusting(contrary to segmental in most other chiropractic spinal manipulation where movements are more segmental) to break down adhesions(fibrosis), fast stretch the ligaments and muscles on the contracted side..then they do mirror image exercise in order to activate and strenthen the convexity side..
high velocity low amplitude manipulation are done on sites known for abundance of mechanoreceptors in hopes(actually, this has been already proven..researchers were able to observe increased reading of the MR with HVLA on anaesthetised patient) to stimulate them(in posturer scoliosis, the cause is inhibition of MR) in mirror image to retrain your brain of what normal position is...that's just the basic premise of the technique..

There are more to it than that...but anyway, this is not a technique class lol..

There has been many successes with posturer scoliosis wit CBP, the data on idiopathic is just not there...there's an effort being made by profession to collect and sort datas and do some controlled studies...but in alternative health care, funding's always an issue..we don't have phalma $$$$ for more research...

I just wish there were more collaborative efforts between main stream health care practitioners and chiros...each hold certain piece of the puzzle and we may just get better view of the picture once all the pieces are fit together..

The main reason why chiros are attracted to spinecor is because it coincides with chiropractic philosophy...it keeps structures healthy and promotes strength...It's like 20hours of constant chiroractic rehab eveyday..

The bottom line is...this is just my theory also...I believe like you, Gerbo, that posturer component is there secondarily...there are therapies geared towards breaking down those fibrotic adhesions, there are techniques to lengthening the soft tissues...combine that with current exercise rehab along with braces like spinecor..I think we could expect much better outcome..
I mean we already do that with other joints...with extremities, we could improve ROM with just 1 or 2 visits...spine musculatures are deeper and less accessible..so it's harder to achieve..but it isn't impossible..just takes a whole lot more effort on practitioner's part...I mean it's going to be gruelling manual labor...only luck is that we are dealing with small children..not full grown linebacker sized adults lol...

Anyway, I'm going to see if sports rehab gurus could contribute to this dilemma...there are previous works done by European Neuro guys which are ahead of it's time and is being studies by PT's and DC's...one of my long term dream is to bring specialists from all discipline and create a super scoliosis treatment center lol..one can dream right? We'll have Spine Ortho, Neuro, chiros, PT's all working under one roof for same goal...gives me goosebumps just thinking about it...

Disclaimer: Those of you who are allergic to chiro...above is unsubstantiated opinion of mine..so please do not start arguments..If you don't agree, let's just agree to disagree and move on.

[sportsdoc]

oh..i reread and looks like I didn't really go over what we do to lengthen the shortened muscles...
one of the technique I use is Graston. It's derived from ancient chinese technique and basically, I use stainless steel tools to physically break down adhesive fibrous scar tissues(usually used in chronic strain type of injury).
There's also a technique called Active Release Technique which is used with pro-athletes and olympians...basically, you start from proximal tendon and as you glide your thumb distally, take muscles from contraction to elongation...it's a bit harder than described..but use is similar with Graston and utilizing both I get pretty good results..
Then there's muscle energy work. When you stretch a muscle, natural reflex is to contract...instead of just stretching it, what you do is take the joint to end range, hold it there, have the patient contract against your resistance...when they relax, you should be able to take them a bit further, a few degrees...then you keep doing the same until you achieve optimum ROM...on shoulders sometimes, we can gain as much as 20-30 degrees on one session..
In all of the above techniques, accurate knowledge of actions and locations of each muslces is crucial...so the practitioner needs to be very good at palpatory skills...it may seem easy from my description above..but..after I do a few patients, I'm poofed...
then there's the cox technique which is mainly used to treat disc herniation..while treating disc, one of the things we do is to try to work on all aspects of ROM utilizing the technique..each level of vertebrae are isolated manually and using specially designed table, you take the lower extremity through combination of flexion and lateral flextion in order to stretch each segments on all directions..(i'll probably have to purchase a table that does rotation also)...that can effect perhaps T9 down...

All of the above are patented techniques...there are perhaps hundreds who do each technique all across the country...then perhaps handful who does 2 of the above...I don't know of any who does all three..and none of the techniques are utilized by scoliosis docs as far as I know..

they aren't going to cure scoliosis since the correction probably won't hold..but with spinecor to hold and rehab exercise to strengthen the weak elongated side....I feel very good outcome could be expected..

The problem is finding a doc who does all the technique and let alone is willing to do it..it's extremely labor intensive and I doubt that one doc can see more than a handful of patients in a day even if he/she's fit...

there are other techniques that I haven't mentioned...but I don't quite know how to describe them here...perhaps some of you are familiar with Janda...
well..i gotta go..my mother in law is calling me on MSN lol..g'nite people..

[gerbo]

what holds bones in place aren't ligaments as many believe..
ligaments's function is to keep joints from going further than its' normal ROM..
It's the muscles and joint structures that keeps bones in certain position in neutral setting..

however, we do not talk here about "normal rom" and "neutral settings" Put it this way, if a surgeon, who has paralysed his patients for surgery, in which case musclespasm is out of the way, tries to straighten out the spine as much as possible before attaching all kind of metal, what structure prevents him (or her) achieving 100% correction? Bonechanges, if they have occured, surely. Shortened muscles, maybe, but wouldn't all the fibrous tissue between vertebrae not have adapted to the years of abnormal position and resist correction as much, or even more? (as by nature it is much less elastic)

..then they do mirror image exercise in order to activate and strenthen the convexity side..

This seems to be the perceived wisdom, that the convex side is the weaker side, it just doesn't make sense to me. The strong bulky muscles, which must have most influence on the stability of the spine, run lateral to the spine. If they are stronger than the other side, then they should pull that part of the spine towards them, making the convexity face the stronger side. To me this seems confirmed by studies which shows that emg output is bigger on the convex side. There is also the reported change in muscle fibre type, resulting in muscle producing a lower tone on the concave side.
Furthermore, we found in our own daughter that the paraspinal muscles on the convex side felt "thicker" and "harder", and also, when doing targeted exercises using either left or right paraspinal muscles (torsorotation) the rotaion using the concave side muscles was initially much weaker.

high velocity low amplitude manipulation are done on sites known for abundance of mechanoreceptors in hopes(actually, this has been already proven..researchers were able to observe increased reading of the MR with HVLA on anaesthetised patient) to stimulate them(in posturer scoliosis, the cause is inhibition of MR) in mirror image to retrain your brain of what normal position is...that's just the basic premise of the technique..

lost me there


Note to anybody reading all this, can I please apologise profoundly for selfishly riding my own hobbyhorses here and boring everybody sick just ignore me

[Celia]

Note to anybody reading all this, can I please apologise profoundly for selfishly riding my own hobbyhorses here and boring everybody sick just ignore me

You are a funny man !

[sportsdoc]

however, we do not talk here about "normal rom" and "neutral settings" Put it this way, if a surgeon, who has paralysed his patients for surgery, in which case musclespasm is out of the way, tries to straighten out the spine as much as possible before attaching all kind of metal, what structure prevents him (or her) achieving 100% correction? Bonechanges, if they have occured, surely. Shortened muscles, maybe, but wouldn't all the fibrous tissue between vertebrae not have adapted to the years of abnormal position and resist correction as much, or even more? (as by nature it is much less elastic)

Well..I didn't mention the bone changes because in chiropractic there's no way of addressing that. As far as muscle spasms out of the way comment goes...the muscles themselves shorten..there's really not much of activity with chrocnially spasmodic muscles..as you've mentioned, it does give lower reading with emg..but it isn't because it's weak..it's because there's hardly any activity compared to the opposite side. Perhaps strong or weak is probably not the right way to address it...contracted and elongated would be more accurate...I don't think strength is all that of big an issue...as long as all the muscles are toned up...

the rotation using the concave side muscles was initially much weaker.

That would make sense..remember...concave side muscles are already at shortened state and you are trying to shorten it further...

paraspinal muscles on the convex side felt "thicker" and "harder"

What you've probably felt are erector spinae, quadratus lumborum or other big musculatures...those would be responsible for global movements...small muscles such as multifidus responsible for segmental movements are not easily palpable..that is if you could palpate at all...anyway, it wouldn't be easy to explain with just words..at least, it isn't easy for me lol....what you need to do is look at anatomical charts...it'll make sense to you why those large muscles would seem to be larger or stronger than the concavity side...also..on convexity side would be easier to palpate also..it would "stick out" more...especially if there are rotations involved...

lost me there

You wouldn't be the first one..
do some research on proprioception and mechanoreceptors...will make much more sense to you...

[Karen Ocker]

Put it this way, if a surgeon, who has paralysed his patients for surgery, in which case musclespasm is out of the way, tries to straighten out the spine as much as possible before attaching all kind of metal, what structure prevents him (or her) achieving 100% correction ?

Actually, the hardware(screws) are placed in first then the rods are attached and turned to straighten out the spine.
Here's an animation showing the technique:

http://www.understandspinesurgery.co...te2/v_site.asp

[cherylplinder]

Note to anybody reading all this, can I please apologise profoundly for selfishly riding my own hobbyhorses here and boring everybody sick just ignore me[/QUOTE]

You are never boring and usually entertaining!

Did I misunderstand the article on torsorotation you posted?
I also thought that the convex side was the stronger side. I thought I read that swimmers often develop a slight convex curve on their dominant side. I had it all worked out, and it made sense to me.

I had also noted your results doing torsorotation that I thought confirmed my thoughts.
I am confused.

I feel I spend a lot of my life that way - seeking to understand the mysteries of life. AAAhhhhhhhhhhhhhhh!

[gerbo]

I also thought that the convex side was the stronger side.

sorry if i confused, maybe i did not understand you

yes indeed, from all i have read and seen; the paraspinal muscles on the convex side are the stronger ones.

what i am still trying to work out is whether this has a detremental effect on the scoliosis (this is what i think) or whether it actually supports the scoilosis and is beneficial (which others have suggested)

gerbo

[cherylplinder]

sorry if i confused, maybe i did not understand you

yes indeed, from all i have read and seen; the paraspinal muscles on the convex side are the stronger ones.

what i am still trying to work out is whether this has a detremental effect on the scoliosis (this is what i think) or whether it actually supports the scoilosis and is beneficial (which others have suggested)

gerbo

I felt the same because of the data on swimmers and atheletes. Their dominant sides have a convex curve. Also, you witnessed Lisianna's(sp) weakness on her concave side. That one study indicated benefit from strenghtening the weaker side, although it has been a while since I read it. I have been looking for a machine for Rachel to use. I think it makes sense.
Thanks so much for the info!
Cheryl

[gerbo]

I have been looking for a machine for Rachel to use. I think it makes sense.

phone the medx company and ask whether they have any record of one of their machines being used in your vicinity

Alternatively, we found a torsorotation or torsotwist machine in our local gym, which is doing a similar/ same job. Main problems we had to overcome were

1) even initial resistance without any weight added was considerable, so we had to be very careful
2) ensuring equal or initial even more exposure to the weaker side, we clearly did not want to train convex side too much
3) correct positioning, body as straight as possible and pelvis fairly fixed (basically using my hands to stabilise pelvis when she twists)

hope you succeed

gerbo

[gerbo]

Geometric and Electromyographic Assessments in the Evaluation of Curve Progression in Idiopathic Scoliosis.
Spine. 31(3):322-329, February 1, 2006.
Cheung, John MD, PhD *; Veldhuizen, Albert G. MD, PhD *; Halberts, Jan P. K. MA, PhD +; Sluiter, Wim J. PhD *; Van Horn, Jim R. MD, PhD *
Abstract:
Study Design. The natural history of patients with idiopathic scoliosis was analyzed radiographically and electromyographically in a prospective longitudinal study.

Objectives. To identify changes in geometric variables and the sequence in which these changes occur during curve progression in the natural history of patients with idiopathic scoliosis. In addition, to study the relationship between several geometric variables and electromyographic (EMG) measurements to determine their predictive value as risk factors to curve progression of the scoliotic deformity.

Summary of Background Data. The main area of concern in treating children with adolescent idiopathic scoliosis is the unpredictability of curve progression during the early development of the deformity.

Methods. The changes in radiographic geometric and EMG variables between the first presentation and consecutive 4-6-month follow-up periods were analyzed in 105 patients with idiopathic scoliosis. Statistical analyses were performed to elucidate in more detail how spinal geometry evolves during curve progression.

Results. Curve severity was associated with remaining growth potential expressed as an increasing spinal growth velocity (SGV). With increasing SGV, an enhanced EMG activity at the lower part on the convex side of the curve expressed as EMG ratio was found. High EMG ratio was associated with increased axial rotation and diminished kyphosis before the rapid increase in Cobb angle. Lateral deviation, wedge angle, and axial rotation all increased during periods of progression. Changes in tilt angle and lordosis were not associated with curve progression.

Conclusions. In the natural history of idiopathic scoliosis, SGV and EMG ratio at the lower end vertebra are prominent risk factors of curve progression. The asymmetric muscle activity is associated with increased axial rotation, which in its turn is associated with increasing Cobb angle and diminishing kyphosis. The combination of these variables provides insight in the physiologic and 3-dimensional biomechanical evolution of the natural history of curve progression in idiopathic scoliosis.

(C) 2006 Lippincott Williams & Wilkins, Inc.

this article, recently published is interesting as it confirms the link between increased emg activity on convex side and worsening scoliosis

I have read the full article, the author thinks this is due to increased strength on the convex side "in an attempt to correct the curve", as i said before, I think it is counterproductive and actually worsens the curve.

Not totally sure yet what the answer is, but will keep on looking for one

gerbo

[cherylplinder]

Gerbo,
You are a gem! It seems that this may be very important in the progression of scoliosis.
More than fascinating!
Cheryl