torso rotation

[skevimc]

wow, that paper is a lot to absorb, thank you!

Please, I would just like to confirm my understanding of how you measured the torque of the isometric contractions: would it be the weight (times the distance) that the subject could "just" raise off the stack? thanx. I'm getting confused over the word "isometric" which I thought meant no movement. My machine works by moving though and it begins prerotated- no stopping at neutral. So I am not sure how I can do an isomtetric contraction on it without loading up the weight, it will be tricky.

The machine we used for testing was a biodex machine with a torso rotational attachment. You are correct that isometric is stationary. The Biodex has a dynamometer that can measure and control many different types of movements and torques.

When people use a weight stack for strength testing they do what is called a 1 repetition max (1RM). Basically, what is the heaviest weight you can lift, 1 time and maintain good form and control. It allows for some obvious subjectivity. But it's used quite a bit in the research world. Albeit usually just to get a starting point for a traning study, e.g. "subjects performed a 1RM leg extension and then trained 3x/week using 80% of 1RM etc..."

I wonder what the results would be like if the subjects first underwent a symmetrical flexibility program- ie, twisting to the left and right for a few weeks before the strength tests?

That's an interesting idea. I was asked frequently about whether or not I measured range of motion (ROM). I never did, and I wish I had. If there's ever a future study, I certainly will. Although I can already see several problems. But that's what a grad student is for.

That is very interesting. The machine at the YW does not give the option of splitting it up since neutral has no stop. But I could modify it be starting at say - 20 degrees and then rotating from there to -40 and neutral and comparing left and right sides that way? Again, do you think this difference may be due to the antagonistic inflexibility?

The difference could certainly be that. Although it would be difficult to say with certainty.

I have seen a golf study showing rotational asymmetry and that book I mentioned, "The malalignment syndrome" also discusses it. The golf study was more about flexibility and range of motion twisting to the right versus the left. It would be very interesting to see if your subjects could be trained to have torsional strength and flexibility symmetry.

I'd be interested to see what kinds of studies have been shown on asymmetry in golfers. It would be a neat comparison of strength developed with different types of contractions. The back swing versus the actual swing and/or follow-through.


[QUOTE=whatishappening;124666]
What do you think about rotating to a maximal contraction- eg 5# to 30 degrees and THEN pulse (oscillate) ever so gently at that point (+/- say 5 degrees). Do you think the pulses would call upon the paraspinals more?

I wouldn't be a big fan of that, especially in a maximal rotation. Your spine and discs are under a lot of stress at that point. Those pulses, if not controlled, would add momentum to the weight and might exceed what your muscles are capable of. I'd think smaller arc movements would be the way to go. Slow contractions with the right weight through 5-10° ROM.

I apologize for my response being sort of disjointed, - it is reflective of my thinking on this subject I am afraid

Welcome to the club. :>

[whatishappening]

Thank you very much for replying skevimc. I was unaware that you had replied because I am subscribed to this thread but didn't seem to get a notification. I got your previous papers and am going through them, thank you.

Here is the golf study "The Effect of Frame Asymmetries on Spine Rotation". This is just a powerpoint presentation- I don't know if any peer-reviewed type of study was done.

http://www.fitgolf.com/wp-content/up...t-research.pdf

I also uploaded a paper- which does look to be peer-reviewed on "Pelvic Assymetry and Trunk Mvement"- table 2 is what is of interest. (sorry- it is too large to upload) Table 2 shows results comparing lateral flexion and axial rotation ROM's of the lumbar and thoracic regions in healthy vs people with lower back pain and it shows assymetries with both groups and greater assymetry with the lower back pain group.

I am scheduled to take a workshop given by the author of the "Malalignment Syndrome" which I am very much looking forward to. I can't help wondering if AIS is functional scoliosis gone awry. Life is assymetric. Maybe with AIS the spine is first to give way to this whereas in other people the slack is taken up more by the limbs- feet, pelvis, shoulders etc. Maybe it is a question of relative flexibilities- the most flexible and weakest being the first area to deform. Like a series of springs with different stiffnesses. Anyway, I am sure people have thought of all of this already. (Edit to add- OK, gee, I just read the flexural-torsional thread and all the finite element analyses that have been done over the years- WOW! So I just wonder if any of these have ever been done to the entire body or what the base of the spine boundary conditions are assumed to be- )


OTOH, I went to a new GP the other day- an old man- old school. He is about the only one who actually wanted to look at my bare back and poke around. He said that the muscles on the left side of my spine (erector spinea or paraspinals) are much bigger than the right side. (My spine is rotated to the right). Also my lower back on the left side (in the vicinity of the quatratus lomborum I guess) is much bigger.

So this begs the question - are the muscles bigger of the left side because they are preventing furthur rotation or is their increased size causing the rotation. Similarily I know for a fact that my RHS tensor fascia latte is much larger on my right side than my left. I know it is responsible for femur interal rotation- so again, cause or preventative- so should I stretch it or not. Aiming for equality in the limbs (and back) could be the worst thing I could do.

I have read that muscles that are relatively atropied (unused) are marbled with more fat that healthy muscles. So maybe the band of thicker "muscle" on the LHS of my spine is "bad" muscle that is riddled with fat! But my first thought ofcourse is that the muscles are larger because they are preventing furthur rotation, and if that is the case, then the spine is behaving as if it has a mind of its own and it is not really functional afterall. Physiotherapists keep saying we need to start with the pelvis and the spine will follow, but maybe in AIS it is vice versa- the pelvis is following the spine?



Endless.

Thanx

[Dingo]

Quick Scott update

Today Scott had his 8 year old checkup.

First the good news. Scott's curve measured essentially the same as last year.

Now the bad news. Scott's doctor has a new, high tech computer that precisely measures curves. Last year's curve was remeasured at exactly 18.6 degrees. This year he measured 20.2 degrees. We thought he was 15 degrees last year and visibly improved this year. The only thing I can imagine is that his rotation (which appears to have progressed) made his S curve appear worse then it actually was in the machine. Other than that I dunno. Maybe my eyes are deceiving me.

Anyway stability +/- isn't what I'm looking for. I'm retooling Scott's torso rotation exercises towards stretch and less on strength. I think that's the general direction that the latest science points. The fact that tightness/stiffness has been a problem for Scott since he was an infant makes the concept that deformed/tight ligaments are involved believable to me.

[Dingo]

Addendum

Scott was diagnosed with a 10 degree curve +/- at the age of 5. Assuming that number was correct he progressed roughly 4.3 degrees to age 6 and another 4.3 degrees by age 7. Over the last year he progressed 1.6 degrees which is within the margin of error.

I have to credit the slowdown or stability with torso rotation because it's the only major treatment difference between those years.

[Dingo]

Addendum part 2

Tonight when Scott was taking his shower and drying off I watched his back carefully. I tried to be as objective as possible and looked at it from several angles. His spine was straight as an arrow. His rotation was terrible but he does not have a noticeable S curve. If it's there it was tiny.

I think somehow he must have rotated a few degrees left or right during the X-ray. The X-ray (which is flat) picked up his rotation which has always been very bad.

Either that or somehow his muscles and skin hide the S curve which really is 20 degrees. I can't discount that possibility and a doctor might be able to explain why I can't see it. But I can't see a visible curve and I'm a naturally critical person.

[leahdragonfly]

Hi Dingo,

I am sorry to hear you got some bad news about Scott's progressive measurements, especially the recent 20 degrees. What does his doc have to say about his treatment now that he's over 20 degrees?

You mentioned that his x-ray was flat, but I hope you meant 2 dimensional, not that his x-ray was taken laying down, right? All scoli x-rays should be taken standing.

You also mentioned that his back looks straight but rotation is very visible. How does he do with the Adams forward bending test? Does it reveal asymmetry? Are you thinking that the x-ray is wrong, or just that his curve is not visible from the outside? I know Leah's curve measured between 18 and 21 for a period of time (at age 8) after bracing and before surgery, and it was hidden very well except for some very subtle signs that I could see.

I will be very curious to hear your reply.

[Dingo]

Leahdragonfly

I didn't see the tech take the x-ray but I'm sure she did it properly. Scott goes to the best doctor in Phoenix.

Scott's rotation was bad from his first visit at age 5. When Scott did the Adam's test yesterday I could see the doctor's aide wince as she looked. It's always been bad relative to the size of his curve.

But I can't see an S-curve. When Scott began TRS I could clearly see a mild S in his back but within 2 or 3 months it was not visible.

That leaves 2 possibilities.

A) It's really there but it's being hidden by skin and muscle. Maybe TRS builds muscle which is why the curve appeared to disappear over a few months.
B) His rotation is bad enough that unless he stands perfectly straight to the machine it will show up as a curve because an x-ray is flat, not 3d. Scott doesn't have a tight curve, it's long and gradual so maybe he was turned a little and that's how it showed up.

Maybe a combination of both.

I felt that his S curve had improved. But I guess I should be happy that he was at least stable. In my opinion his rotation did worsen over the last year but that wasn't measured.

Because Scott's S-curve was still inside the margin of error after a 12 month period his doctor suggested that we continue watch and wait until next year.

[Dingo]

hdugger

After talking to my mother who worked in a doctor's office I'm not so sure Scott is really at 20 degrees. When Scott had his x-ray the technician had him back up to a screen. He has a large rotation in his spine and a noticeable rib hump on the right side. In order to stand parallel to the screen he would stand slightly crooked because of his rib hump. That must be why his spine looks straight with his shirt off but crooked in an x-ray.

I watched 3 other kids go in for their visits and I couldn't see a rib hump through the backs of their shirts. Scott's rotation is obvious even through his shirt. In that regard I think he's got a worse case than most.

Maybe Scott's doctor will have one of those new 3d x-ray machines next year.

Regardless this year we're working on his rib hump because to my eyes that's the only thing I can see.

[scolio1964]

I am interested in having my daughter do the torso rotation. How could I find somewhere that does it? I have no idea where to look. My daughter currently wears a brace. She has a pretty noticeable rib hump that she'd like to get rid of. We live near Houston, Texas.

Thanks!

[Dingo]

Scolio1964

Most good gyms should have some type of torso rotation machine. The machine used in the first study was the MedX machine. Here is a video of it. MedX Torso Rotation

My son uses a machine just like this one. Rotary Torso (Machine #18) It takes a few minutes 3 times per week.

My advice is buy a machine. I can't quite remember the exact cost but my son's put me back like a hundred bucks or so.

I don't want to sound negative on TRS. Mostly I was shocked that my son's curve had been remeasured by a computer and put in the 20 degree range. That's not good. However the fact that he was stable after a year of growth and no bracing is good. I hope to do better this year because my son is larger and more coordinated.

I honestly thought his lateral curve was headed to 0 degrees after a year of TRS. Now I know to watch his rotation. If that doesn't go down I know it's time to look at what I'm doing. Maybe add weight, maybe better form, etc. etc.

Scott lifts 20 pounds which is a little less than half his body weight. We might get to 25 pounds over the course of the next year.

[leahdragonfly]

standing crooked in x-ray?

After talking to my mother who worked in a doctor's office I'm not so sure Scott is really at 20 degrees. When Scott had his x-ray the technician had him back up to a screen. He has a large rotation in his spine and a noticeable rib hump on the right side. In order to stand parallel to the screen he would stand slightly crooked because of his rib hump. That must be why his spine looks straight with his shirt off but crooked in an x-ray.

Regardless this year we're working on his rib hump because to my eyes that's the only thing I can see.

Hi Dingo,

I don't mean to rob you of hope, but it would be very apparent to your orthopedist (and the radiologist) if Scott had been standing crooked or turned in the x-ray. There are many bony landmarks they look at to see whether or not the child was standing improperly. I know once Leah had to have an x-ray repeated because Dr Betz noticed she was slightly turned in the x-ray, and we didn't want to make any treatment decisions based on an x-ray that anyone had any doubts about. When we repeated it the measurement was unchanged, but I certainly could not have slept at night wondering "what if" if we hadn't repeated the x-ray.

Sounds like TRS will at least give you something to focus on instead of just idly watching Scott's curve progress. I truly hope it will stop at 20. Thanks for the updates.

[Dingo]

Leahdragonfly

It's certainly possible that Scott's X-ray gave the correct degree. The new computer measures the curve within a tenth of a degree so maybe it has a system to correct for any imperfection in the way that a child might stand.

But to be honest the more I think about it the happier I am. Curve progression tends to accelerate the larger a curve becomes and 20 degrees is the danger zone. For Scott to be stable at 20 degrees after a year of growth and without bracing is a really good sign.

When Scott started TRS at age 7 he barely fit into the machine and had to sit on a foam cushion I purchased. He was also uncoordinated and used a lot of momentum to keep the weight moving. This year he's bigger and more coordinated. Last night we focused on form and slow movements and the same weight felt MUCH heavier to him. My sense is that it's going to be a more productive year.

[Dingo]

hdugger

In the Torso Rotation studies every child with a mild to moderate curve held or improved their curve including children going through a rapid growth spurt.

SEAS and Scroth I'm not sure.

[Pooka1]

The curve doesn't appear to be very progressive it seems.

If the 15* curve was really 18.6* then maybe the 10* at Age = 5 was really 13.6*.

So in 3 years the curve progressed only 20.2* - 13.6* = 6.6*. That is 2.2* a year on average during a time when I am sure he grew quite a bit. And it only is just outside the measurement error over that three years.

I have no idea about JIS but plenty of folks would take that progression for an AIS case over what is usually seen, especially in growth periods where you see that progression rate PER MONTH, not per year. A progression rate of only 2.2* a year over three years might indicate a benign curve per se and may be a more important indicator than even that the curve is 20* now. Also curves about that large have spontaneously regressed, some completely, per that one study which is not to "prove" the PT was doing nothing but just to throw out there about there still being good reason to hope for the best.

It's a question for some very experienced pediatric surgeons who have looked at several JIS TL curves.

Maybe the other JIS parents have a feel for this.

[Pooka1]

Also, in the two years before you got the machine, assuming the curve at age 5 was really 13.6*, it only progressed 5 degrees to 18.6* in 2 years. That's two years of a "progression" that may not even be real because it is in the noise. If the first measurement was taken early in the day and the last was taken late, it would really be hard to even say the curve progressed over those two years I would think.

Again, I am not trying to discount the PT. I am just saying you might be doing PT against a background of a stable or quasi-stable curvature which is all good.