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Thread: torso rotation

  1. #1
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    torso rotation

    http://www.scoliosisjournal.com/content/2/1/9

    This article is of some interest as it confirms the possible contribution of muscle asymetry in the etiology of scoliosis. No, lets be clear, it confirms the existence of a muscle asymetry, with a weakness of rotation towards the concave side confirmed. It is other studies (the Vert Mooney studies, which I quoted before http://www.medxonline.com/downloads/...nscoliosis.pdf) which suggest that dealing with this assymetry (torsorotation exercises) can help to stabilise a curve.

    some observations;1) it is suggested that the assymetry could (additionally?) be due to nonmuscular factors (soft tissue, bone, ligament deformity) and indeed I have often wondered whether the observed improvements could be due to the improved flexibility of the spine as a result of the very specific exercises, rather than the equalising of muscle strength

    2) it is good to see that attempts are made to increase our understanding of the condition and the various factors contributing to it

    3)despite celia's cynism about financial motivations of surgeons; Marc Asher is a spinal surgeon with a large stake in a company producing implants, but still he is looking at possibilities to deal with scoliosis in a non surgical fashion

  2. #2
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    Quote Originally Posted by gerbo
    ....despite celia's cynism about financial motivations of surgeons; Marc Asher is a spinal surgeon with a large stake in a company producing implants, but still he is looking at possibilities to deal with scoliosis in a non surgical fashion

    How pray tell did I get into this discussion????! LOL!!!! I have never accused Dr. Asher of being financially motivated. It was with a very heavy heart that I reported doctors might be financially motivated based on *my* observations.
    Last edited by Celia; 07-10-2007 at 01:51 PM.

    Canadian eh
    Daughter, Deirdre born Oct 2000. Diagnosed with 60 degree curve at the age of 19 months. Serial casting by Dr. Hedden at Sick Kid's Hospital. Currently being treated by Dr. Rivard and Dr. Coillard in Montreal with the Spinecor brace and curve is holding at "2" degrees. Next appointment 2008

  3. #3
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    Oh dear, I wish I understood these things better Is it a sort of chicken & egg senario? Did the muscle asymmetry cause the scoliosis or was it the opposite? Either way, will strengthening the weaker muscles help? Surely it can do no harm.... I'd like to hibernate (with Imogen) for 50 years and wake up when there is an answer. Mind you, who knows what state the world will be in by then?

    Re the doctors alleged motivation.... whilst their true calling is, I am sure, driven by altruism I expect there is some money in the budget for research. Imagine the fame & fortune to be gained through finding a "cure"!

    Laura
    UK based Mum of Imogen, 38 degree curve at 9 years old. SpineCor since 15/6/07, 31 degrees in brace.
    10th December 07 - 27 degrees, 23rd June 08 - 26 degrees, Feb 09 - 24 degrees, Aug 09 - 35 degrees, Jul 10 - 47 degrees, Dec 10 - 50+ degrees.
    Surgery due to take place early December 2011 at the RNOH, England.

  4. #4
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    celia, as you know, it was a bit of a "tonque in cheek" remark. Still; mr asher would loose a considerable source of income if he would "discover" an efficient non-surgical way of treating scoliosis. (not that i think he will, at most this is just a small part of the jigsaw)

    laura; the correct question would be (as nobody can answer the question as you put it); does the muscle asymmetry serve to stabilise the curve, or could it contribute to it getting worse?? I believe it is the latter, specially as both dr mooney and dr asher have shown (in a small group of patients admittingly, so results need to be looked at with lots of care) that treating the inbalance (strengthening the weaker side) appears to be preventing progression.

  5. #5
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    I realize, as you put it, that there is no definitve answer to the question as Laura asked... however there were a couple of thoughts I had in regards to it.
    Still; mr asher would loose a considerable source of income if he would "discover" an efficient non-surgical way of treating scoliosis.
    As would many, many Drs if they chose to consider things that already exist.

    Quote Originally Posted by Gerbo
    laura; the correct question would be (as nobody can answer the question as you put it); does the muscle asymmetry serve to stabilise the curve, or could it contribute to it getting worse?? I believe it is the latter, specially as both dr mooney and dr asher have shown (in a small group of patients admittingly, so results need to be looked at with lots of care) that treating the inbalance (strengthening the weaker side) appears to be preventing progression.
    As a generalization, I believe it is actually the asymmetry in muscular tonus that is preventing the curve from worsening, at least at a faster rate... as the bodies own self-regulatory/adaptive and autonomic response to the lateral deviation. If you were to examine the anatomy and function of the soft-tissue/muscular region in question here it is very clear that if both sides, concave and convex, maintained the same tonus levels then the spine would be drawn further to the concave side... because it not only has the hypothetical 'balanced' tonus to match the convex side, but it also has the ever present force of gravity acting downward on it... and we all know that when something leans off-center from a vertical plum with gravity it incurs forces that will continue to push it in that direction... i.e. - gravity.

    And keep in mind that the muscles on the concave side of the curve act to 1) extend the spine 2)rotate the spine 3) bend the spine to the same side they are located on. This last one is very important here. If you increase the tonus (i.e. - force of pull within the muscle) of the muscles on the concave side, you will encourage further side bending to that side... i.e. - Increase the concavity.

    In scoliosis you will always find an uneven tonus in the muscles along the spine, left vs. right. As a curve progresses that tonus discrepancy will usually increase.. I'd love to see a study documenting that correlation. It is a functional response of our nervous system to slow or stop the curvature as best it can on its own. Conversely, as a curve is 'straightened' you will see the tonus between the two sides begin to equalize again as it becomes more appropriate and functional to do so. A slight bend of the spine will permit a more balnced tonus to exist without detriment moreso than a more moderate or severe bend would. As the moderate/severe bend does not want the concave musclature 'toning up' or else it would draw the spine further into the bend... as that is the action of those muscles on that side.

    Either way, will strengthening the weaker muscles help? Surely it can do no harm....
    Please don't assume that... I mean this sincerely. It certainly could cause more harm if not properly understood. If someone began doing sideways sit-ups (laying on the side and lifting the torso off the floor) on the concave side of their curvature because they 'heard'/'believed' it was weaker after reading one of these studies... they will surely make matters worse.

    So I think a big concern I have in these studies thus far is that they are inconclusive as to the actual reason behind the increase of tonus on the concave side corresponding with a reduction/stability of the curve. All they show is that by doing torsorotation exercises the curve may stabilize/reduce and tonus on the concavity side increases. It doesn't show at all that the reason for these results is due to a strengthening of the concave muscles, but rather just that it is a consequence of the actions performed... which is also somewhat obvious that muscles being utilized during torsorotations are going to increase in physiologic strength... that's kind of a no-brainer, pardon the sarcasm.

    This brings me to one of Gerbo's points:
    Quote Originally Posted by Gerbo
    some observations;1) it is suggested that the assymetry could (additionally?) be due to nonmuscular factors (soft tissue, bone, ligament deformity) and indeed I have often wondered whether the observed improvements could be due to the improved flexibility of the spine as a result of the very specific exercises, rather than the equalising of muscle strength
    I strongly agree with Gerbo's suspicions/theory here. By doing torsorotations one is inevitably creating length and mobility where it is limited, thereby getting length in the concave soft-tissue/etc. and ultimately reducing/slowing/stopping the curvature.... thereby allowing for a change in tonus of said musculature.

    Sorry to make this another one of my usual long-winded repplies... but it really pains me to think that someone might go out and start 'strengthening' the cancavity of their curve only to learn the hard way that maybe these inconclusive studies are being misinterpreted.

    Aside from my genuine concerns about the interpretation of these studies, I do agree that it's good that people are looking into other factors involved with this condition.

  6. #6
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    Thank you, Structural, for your reply. It was only long winded because it needed to be Unfortunately I only understood about half of it I think I need a PowerPoint presentation

    The message I got was "leave it to the professionals". In my daughter's case the professionals (for once it seems) agree; sadly they agree that she will need fusion one day, it's just a matter of time & trying to hold the curve until she's grown as much as possible. Occasionally I find myself clutching at straws and/or being seduced by new possibilities.....

    Thanks again,

    Laura
    ps Gerbo, how did it go today?
    UK based Mum of Imogen, 38 degree curve at 9 years old. SpineCor since 15/6/07, 31 degrees in brace.
    10th December 07 - 27 degrees, 23rd June 08 - 26 degrees, Feb 09 - 24 degrees, Aug 09 - 35 degrees, Jul 10 - 47 degrees, Dec 10 - 50+ degrees.
    Surgery due to take place early December 2011 at the RNOH, England.

  7. #7
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    In contrast, female adolescents with idiopathic scoliosis in
    the current study showed significant weakness in the neutral position and the two pre-rotated
    positions to the concavity in comparison to the mirror trunk position. Although the strength
    asymmetry could be the result of either weaker concave side or stronger convex side
    , the
    comparison between healthy female adolescents and the scoliotic patients showed weakness
    associated with idiopathic scoliosis in low force contractions to the concave/left sides,
    but no
    difference between two groups to the convex/right sides.
    After reading this study in its entirety, I did not find ANY conclusions or statements drawn about the "concave side being weaker"... only that rotation "towards" the concave side was weaker, ...which is very different in that the muscles responsible for rotation toward the CONCAVE side lay on the CONVEX side of the spine with the exception of the internal obliques (which again, if you "strengthened would result in making the concavity worse). Meaning that the convex musculature would possibly be the "weak" culprits, not the concave side musculature as has been suggested. Or that the chronic shortening of the tissues on the concaved side (thus inducing the sidebend and rotation) is providing excessive resistance against the rotation to the concavity (as that tissue needs to lengthen and release for the rotation to occur).

    I realize that it is the 'other' studies that suggest 'strengthening' the concave side to address this asymmetry, but that does not correspond with the findings of this study... Which merely points out the weakness "towards" the concavity, not within the concaved side itself.

    I do agree with the other studies in that strengthening towards the concave side would be very useful, but not strengthening the concave side itself.

    So again, misinterpreting or misunderstanding the conclusions of this and other studies could be very detrimental. I think Laura put it best, "leave it to the professionals". And even then, get a second and third opinion.

    p.s. - Laura, sorry for the added confusion... I know that probably didn't help matters.

  8. #8
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    Hi Guys

    For once structural I think I may agree with you. There was a lot of focus on right torso rotation when i went to the clear institute. I think it's bologna. As a matter of fact i think it could do damage. I have a right thoracic, left lumbar curve and I get alot of pain in between the curves in my spine. I think right torso rotation could be contributing to an already existing hyperextension in the spine due to the curve/rotation.
    As far as attaining muscle symmetry to obtain correction, I think it is the exact opposite. I also believe muscle assymetry is a reaction to the curve. I think if your spine is curved you WANT muscle asymmetry to better support your spine. Assuming that is i geuss, your curve is structurally related instead of a RESULT of muscle asymmetry, although this type of scoliosis seems far and few between. Here is a strange thought/ theory. Most people are of the premise that we want to develop the weaker side.(Which appears not to work) How about concentrating on developing the over developed compensatory muscles to help push the spine back. If and when that happens, the weaker side will begin to take over as a reaction to the spine being straighter.
    The crappy thing is the more I get to know, the less it seems I know what to do! Bish

  9. #9
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    Dave,
    Thank goodness... I don't think I have the energy for another debate.

    I have always wondered how the torsorotation exercises are addressing the two rotations in an S curve.??? Where the lower curve rotates one direction and the upper curve rotates the opposite way to counter it. How do the torsorotations isolate each of these opposing rotations? Do you do them to one direction? How do you only rotate the thoracic spine for instance without rotating the lower spine and feed into its rotation? It seems this would be very difficult, if not impossible to do on the machine.

    I would tend to think the torsorotations would only be applicable for C curve type scoliosis (single curve, thus single rotation)... for that reason.

    Since you have direct experience, what are your thoughts/experience on this?
    Structural

  10. #10
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    I'm a little confused as well. This article/study was measuring/studying rotation- as in the rib/hump problem/feature of scoliosis correct?

    Also (sorry if I mis-quote) what did you mean by not strengthening the concave muscles themselves but the ones that support it or push it (again sorry for the mis-quote).

    So if I have a left lumbar curve (as in when I bend over and you look at my back you see a "c") and rotation to the right (as in my right ribs stick out further then my left) what exercises would be appropriate. I was under the same theory that strengthening my right side of my back would help. I can tell my muscles are imbalanced because I am constantly working my left side (I flex my left side inward all day so that you cannot tell how bad my curve is). When looking at my back you can see muscle definition on the left and flab/skin on the right. I used to do plank positions (for the abs/obliques) on my right side (so that I would flex my right as I do my left) but from what I read I'm understanding that this could actually be worsening the curve?

    I also try to do back extensions and back exercises because I notice it helps with the pain. But lately I've noticed any time I do a back extension or try to work my lower back my left muscles take over and my right muscles do not work as hard- is there a way to focus on the right? should I focus on the right?

    I am thoroughly confused.

    Thanks,
    Tracy

  11. #11
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    Hi Tracy,
    I'm a little confused as well. This article/study was measuring/studying rotation- as in the rib/hump problem/feature of scoliosis correct?
    No, it was using EMG to test the strength of the muscles during rotation. It wasn't measuring rib hump/rotational degrees... it gave the degree of rotation as markers for the starting and ending position of the movements.

    Also (sorry if I mis-quote) what did you mean by not strengthening the concave muscles themselves but the ones that support it or push it (again sorry for the mis-quote).
    The muscles on the concave side of the spine are not the ones that rotate the spine to that side... The muscles on the convex side actually rotate the spine toward the concave side. So in your case for instance, the muscles on the right side of your lumbar spine (the concave side) are actually shortened to begin with and lacking tonus. They cannot contract much further and if they did they would pull your spine into further rotation and sidebending alike... making the curve/rotation worse.

    The muscles on the convex side (left) are hypertonic (more toned/stronger) because they are working very hard to resist further sidebending to the right and fighting the rotation to the left as well. So you would first need to begin lengthening the right side so that the spine can come out of its sidebending and rotation as well as strengthen the left side more to assist that process. Over time the right side which has shortened soft tissues and less active will become more active as the spine lengthens/straightens (this is the premise, not everyone can achieve correction as we know. But utilizing this premise/fact will certainly work in your favor to slow, stop or reduce the curve.)

    I hope that doesn't confuse you more. A lot of the soft tissue patterns in scoliosis are counter-intuitive... which is what makes it a challenge to understand and treat effectively.

    I realize that you notice the overdevelopment of the left side but that has to be that way in order to prevent the spine from getting worse. You're also noticing a hump and the appearance of more muscle because the transverse process of the vertabrae (bony part that sticks out to the sides) are being moved posterior/back on the left due to the rotation... and forward/anterior on the right, causing the appearance of less musculature or a 'sunken' region.
    I also try to do back extensions and back exercises because I notice it helps with the pain. But lately I've noticed any time I do a back extension or try to work my lower back my left muscles take over and my right muscles do not work as hard- is there a way to focus on the right? should I focus on the right?
    Stop focusing on strengthening the right side. It will only make matters worse. Those muscles are inactive for a reason. Again, you're fighting your bodies functional response to the scoliosis... What you want to do is focus on lengthening the right side... open it up... stretch it. Do rotations to the right in the lower spine (i.e. - sit on a chair or the floor and rotate right looking over your right shoulder... reach your left arm across your body in the front and hold onto the outside of your right knee.) Something like that would be far more beneficial than side plank on the right... strengthening the right, etc.... .

    Don't get discouraged... it's easy to misunderstand these things... and I know it's even more difficult when you read studies like this and they get misinterpreted/misunderstood... Dealing with this condition takes more knowledge than just reading and analyzing studies... they're useful but it's a god example of the fact that one needs to know far more than what the 'conclusions' are saying. This is not something that I feel should be managed without proper guidance from not just an educated Dr./PT/Physio?whatever... but an exceptional one.

    I give you a lot of credit Tracy for being so proactive and motivated to help yourself.. Please don't get discouraged by this... just try and get some really great guidance to move forward. I support your efforts 100%.

    Kindly
    Structural

  12. #12
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    Hi again

    Well I am not 100% sure but I think the premise is this. If I am right thoracic and left lumbar and was perscibed a right torso rotation (with focus on full extension right with resistance), my thoughts would be that the rotation would have a positive effect on the left lumbar and a negative on the right thoracic, because you are rotating in the direction of the existing rotation. But! I think with the thoracic vertabrae having limited mobility because your ribcage is attached, the hard right rotation may be acting against the distortion of the vertebrae in relation to the ribs,and the attempt is to re-align the two. I think it doesn't work because that stress is taken up in the vertebrae in between the two curves. That's my geuss but what do I know. Hahah! Dave

  13. #13
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    Dave,
    Not much time to reply, but... The thoracic spine, despite the ribs being attached, has much more range of motion in rotation than the lumbars do. This is dictated by the angulation of the facets in the respective regions. The lumbar spine facets are angled in the sagital plane which allows for greater range of motion in flexion and extension whereas the thoracic facets are angled more in the coronal plane which permits a lot of rotation.

    Doing the torso rotations to the right would positively influence the left lumbar curve but, as you said, negatively influence the thoracic... And because more rotation takes place in the thoracic, the rotations will more likely be taking place there before the lumbars move.

  14. #14
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    Thanks Structural,

    I have a few more questions.

    I visited the specialist yesterday to go over my MRI films (and ask questions I forgot to ask the first time). My 3rd to last disc (before the sacrum bones?) is degenerative. He said the rest of my spine looks ok. He also said my rotation is more severe than my curve. Is that normal? I thought the rotation occured because of the lateral curve but if my rotation is more severe how did that happen?- well maybe not how did it happen but is it common?

    I have an appointment with a PT next week. I just recently moved to this area but the PT came recommended from my doctor who is said to be one of the best. (maybe everyone says that though).

    Is there something I should look for/watch out for with the PT to evaluate how much he/she really knows? I don't have to commit to this PT and can choose someone else but I don't know who else I would go to.

    As far as doing things on my own- Yoga to help stretch/lengthen and rotation (I believe there are some twist poses I have from yoga as well) but focus more so turning/twisting to the right than the left correct?

    Thanks again for the help/advice.

    ~Tracy

  15. #15
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    Tracy,
    He said the rest of my spine looks ok. He also said my rotation is more severe than my curve. Is that normal? I thought the rotation occured because of the lateral curve but if my rotation is more severe how did that happen?- well maybe not how did it happen but is it common?
    Yes, that's easily a possibility. Rotation is coupled with sidebending/lateral flexion of the spine but it isn't necessarily proportionate to the bend. In fact, one can have what is called a roto-scoliosis in which there are minor bends coupled with moderate to severe rotations... in those cases the rotations are the most important issue to address. Often you'll see rotations increase as the bends decrease from correction (usually bracing)... This is in large part due to the fact that the soft-tissue restrictions involved holding the spine in the bend are not specifically addressed with a brace and therefor as the spine attempts to straighten out from the bracing forces the restriction in the soft-tissue remains but simply changes its effect on the spinal mechanics... causing a rotation because it is still shortened asymmetrically despite the lessening of the curve.

    Also keep in mind that the spine can rotate purely by itself, without bending.

    Is there something I should look for/watch out for with the PT to evaluate how much he/she really knows? I don't have to commit to this PT and can choose someone else but I don't know who else I would go to.
    You'll have to prepare your questions in advance and be weary if their only approach is to "strengthen" the spine/abdomen. This is not a customized and adequate approach, it's the generic PT type of protocol... Look for one, if need be, who integrates and impliments strength, stretching, balance/coordination type work, proprioceptive activities... etc. The work you do should also be asymmetric, if you find yourself doing exercises that don't speak more to one side or area more than another then ask them why they're not doing it differently. Keep in mind, not everything will entail asymmetric work, but some of it certainly should.

    Hope that helps somewhat,...it's difficult and questionable for me to give any specific advice to your particular situation over the internet... This is obviously not the appropriate place for treatment. Just be sure to ask questions when you have them and don't be afraid to question something if it doesn't feel right or make sense to you... You are in charge of your body and you have the right to know and understand why you're doing things.

    Best to you,
    structural

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