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  • #31
    structural
    quote
    'The more specific one can be at freeing these regions up, the more likely the success of treatments being utilized. The neurologic component that I was "advocating" had to do with micromovements while these regions were being 'freed, lengthened, stretched'... activating/de-activating regions neurologically while you're encouraging effects... through whatever means. So I agree 100%, flexibility is of utmost importance in any treatment, and the more precisely you can work with the flexibility of specific regions the better.'


    You are describing TAMARS treatment.!!

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    • #32
      note to myself; ask "our" osteopath what she knows about TAMARS.

      Comment


      • #33
        Originally posted by structural75 View Post
        .......
        What others have put forth, and what you commonly hear with a PT approach is to strengthen the "weak" muscles. What we're not understanding is that the "weak" muscles are weak for a very functional reason. So the question to ask ourselves is: Is strengthening the "weak" muscles beneficial or harmful, or inconsequential?
        Hello, I am new here. I would very much appreciate a continuation of this concept. I am not very knowlegable about this but I will add my 2 small cents.

        I have recently discovered that I have scoliosis. Ofcourse the PT's are focusing on muscle balance- but long before I read this thread I was wondering about this equalization concept myself.


        For one thing, how can muscle strength be adequately compared side to side side the spine is rotated?
        What about mechanical advantage and it's influence of the apparent muscle strength?

        For example, one of my shoulders is displaced backwards so in testing external rotational strength- how should the shoulders be positioned? Similarly, my pelvis is rotated to the left, so in testing side-lying hip abduction, how should my pelvis be placed? My left hip abductor shows to be weaker but maybe that is helping to counteract the rotation, not cause it- weak hip abductors will allow for pronation which will counteract the spinal rotation. Or is it vice versa-

        I also read previously noted in this thread that the (left) external obliques are responisble for both lateral flexion and rotation to the opposite side and I have worried about that. Bad combination maybe?

        The Pt's I have tried to discuss this with seem to close their ears and just say you can't go wrong with symmetry,and it is obvious to me that they just don't want to think about it. And I wonder, really, is "symmetry" not just a cop out? And define symmetry please- in which position? And which position should I be exercising in?

        I think in this way, maybe only Schroth method is well thought out? But if so, why oh why oh why are there no practioners in most large Canadian cities? Surely if Schroth works it would be all over?

        thanx
        Last edited by whatishappening; 08-19-2011, 08:37 PM.

        Comment


        • #34
          Originally posted by whatishappening View Post
          Hello, I am new here. I would very much appreciate a continuation of this concept. I am not very knowlegable about this but I will add my 2 small cents.

          I have recently discovered that I have scoliosis. Ofcourse the PT's are focusing on muscle balance- but long before I read this thread I was wondering about this equalization concept myself.


          For one thing, how can muscle strength be adequately compared side to side side the spine is rotated?
          What about mechanical advantage and it's influence of the apparent muscle strength?
          Regarding muscle strength, you're correct in that it is pretty difficult to assess this. What makes it even more complicated is that muscles on both sides of the spine participate in moving the spine in both directions. So, even if you found a strength asymmetry, which muscles are the 'weak' ones? The strength part of this problem is done by pre-rotating the trunk in 5 different positions (our study used -36°, -18°, 0°, 18° and 36°). These degrees correspond (roughly) to your shoulders against your hips. So the 0° position is sitting straight forward.positive values are to the right and negative are to the left. At each pre-rotated position you would exert a force in both directions, right followed by left. We used an isometric contraction which means you wouldn't actually move, but you'd exert force like pushing into a brick wall. As you correctly assumed, you can't compare the right and left values at each position (except 0°) because of mechanical advantage. But you CAN compare the 18° left contraction with the -18° right contraction. In essence, you compare the mirror image. Does that make sense? In theory, this then compares the muscle required to rotate the trunk left with the muscle required to rotate the trunk right AND giving them the same approximate mechanical advantage.

          Originally posted by whatishappening View Post
          For example, one of my shoulders is displaced backwards so in testing external rotational strength- how should the shoulders be positioned? Similarly, my pelvis is rotated to the left, so in testing side-lying hip abduction, how should my pelvis be placed? My left hip abductor shows to be weaker but maybe that is helping to counteract the rotation, not cause it- weak hip abductors will allow for pronation which will counteract the spinal rotation. Or is it vice versa-
          Pronation of what? The feet? I'm unclear what you're asking and how pronation would help counteract spinal rotation.

          Originally posted by whatishappening View Post
          I also read previously noted in this thread that the (left) external obliques are responisble for both lateral flexion and rotation to the opposite side and I have worried about that. Bad combination maybe?

          The Pt's I have tried to discuss this with seem to close their ears and just say you can't go wrong with symmetry,and it is obvious to me that they just don't want to think about it. And I wonder, really, is "symmetry" not just a cop out? And define symmetry please- in which position? And which position should I be exercising in?
          What worries you about the external obliques? I would also include that they provide stabilization when rotating the opposite direction. When you look at large muscle EMG during trunk rotations, the internal and external obliques on both sides are very active no matter which direction you're rotating.

          And to all of your questions... "exactly". You're asking the right questions but you are definitely reaching the limits of knowledge for most PTs. Actually, you're reaching the limits of knowledge in general. Positioning definitely affects strength output. This is a main principle of muscle physiology. So obviously if you have the attachment or insertion points of the muscles that are not aligned, you'll have differing muscle lengths and therefore asymmetrical forces. But how much pelvic rotation is required before you can measure a strength difference from side to side? What about rib cage deformities (due to any number of reasons)? How much does this affect muscle length or strength? And these questions are only dealing with the primary movers. How much influence do the smaller stabilizing muscles of the spine have on strength output?

          We approached/justified the trunk rotational training using the force/length relationship as well as the effort and motor unit recruitment relationship. Basically this can be described by saying that the more effort you exert the more motor units/muscle will be recruited to fire. The smaller the effort the more variation in muscle recruitment patterns. So by exercising through the entire range of motion you require the muscles to work in all lengths and by using a near maximum effort you are recruiting the most muscles. I called it the 'shotgun' approach in an earlier thread. Since it's nearly impossible to identify exactly which muscle(s) are the culprit, strengthen them all. AND since we found a strength asymmetry in AIS patients, lets improve strength symmetrically. As well, the more active and strong muscles become, the more efficient and 'healthy' they become.

          Although, if I were to do another study I would want something much more specific to be included. Like side shift, Schroth, directional breathing, etc... These therapies are nice because they are specific and adaptable to the individual curve. Even though they are missing a strength component which I think is fairly important.

          Originally posted by whatishappening View Post
          I think in this way, maybe only Schroth method is well thought out? But if so, why oh why oh why are there no practioners in most large Canadian cities? Surely if Schroth works it would be all over?

          thanx
          Schroth definitely has a very well thought out protocol. However, that protocol also comes with a price, and that is that there aren't as many practitioners. I like a lot of the things the protocol does and it is very well laid out and organized. Although I think they are too strict about avoiding trunk rotations.

          Comment


          • #35
            Originally posted by skevimc View Post
            Schroth [...] Although I think they are too strict about avoiding trunk rotations.
            I have to say, that is a very cool-headed, measured statement about a PT regime that is at direct odds with your dissertation. I admire your restraint. ;-)
            Sharon, mother of identical twin girls with scoliosis

            No island of sanity.

            Question: What do you call alternative medicine that works?
            Answer: Medicine


            "We are all African."

            Comment


            • #36
              Hi, thank you so much for responding. I have to say I did not read that paper in the first post of this thread. Plus, I am really clueless here, I had no idea you were doing a PhD- or any study on rotations.

              PLUS- I just assumed Scroth has derotations? I mean, that is its appeal to me. I looked at old video footage where a group of little girls were being instructed to reduced ther lordosis while retracting their right hips (the retraction is a derotation?) Plus, the little boy in the footage who has padding placed under one buttock, the opposite scapula and the opposite (again) shoulder. Surely that is derotation.

              I assumed Scroth basically does a series of moves that will work the curves backwards to an ideal straight spine through a combination of derotations and lateral displacements. That is what I would like to do.

              And yes, rotational strength would be hugely important to provide the ability to help hold onto those curve /rotation reductions.

              In fact, I have been using the Cybex Torso rotation machine at my local Y for the last 3 months:
              http://www.cybexintl.com/products/st...190/intro.aspx
              (with very bizarre feelings in my torso btw- totally assymetrical/weird feelings that change from week to week)
              I am only at 13.5kg and I keep the rotation to about 20-30 degrees- so far more than 13.5kg makes my sacroilliac joint make noises and I don't think that's good.

              Anyway, my beef with PTs is they can't say whether I should derotate while exercising and when checking for muscles strenght assymetry they do not seem to care either way what position I am in. Indeed, I have bent over dozens of times this year to have my spine checked and each time I ask them if I should derotate first and they say they don't care- either way.

              I have been derotating on my own but I just hope and pray I am doing the right thing and not going make things worse.

              I am actually shocked that Scroth doesn't derotate.... (that scares me)




              Originally posted by skevimc View Post
              The strength part of this problem is done by pre-rotating the trunk in 5 different positions (our study used -36°, -18°, 0°, 18° and 36°). These degrees correspond (roughly) to your shoulders against your hips. So the 0° position is sitting straight forward.positive values are to the right and negative are to the left. At each pre-rotated position you would exert a force in both directions, right followed by left. We used an isometric contraction which means you wouldn't actually move, but you'd exert force like pushing into a brick wall. As you correctly assumed, you can't compare the right and left values at each position (except 0°) because of mechanical advantage. But you CAN compare the 18° left contraction with the -18° right contraction. In essence, you compare the mirror image. Does that make sense? In theory, this then compares the muscle required to rotate the trunk left with the muscle required to rotate the trunk right AND giving them the same approximate mechanical advantage.
              ok, wow, that is fascinating- I didn't read that anywhere.


              Originally posted by skevimc View Post
              Pronation of what? The feet? I'm unclear what you're asking and how pronation would help counteract spinal rotation.


              well, the forces within the body and the ground reaction forces on the feet must balance or the person would fall over. I feel this within my own body. For me my spine is rotated to the right, in reaction (or because of) my pelvis is rotated to the left and so are my shoulders. So that is 2 rotations to the left and 1 rotation to the right- so the final rotation to the right is occuring at my feet. In fact, for me, this whole jouney began at my feet.

              There is a good book called "The Malalignment Syndrome" by Wolf Schamberger (at least I think it is good, though over my head...)
              You can find pictures on the internet that I believe originated from this book:
              Fig4_RotationPelvis.jpg

              Originally posted by skevimc View Post

              What worries you about the external obliques? I would also include that they provide stabilization when rotating the opposite direction. When you look at large muscle EMG during trunk rotations, the internal and external obliques on both sides are very active no matter which direction you're rotating.

              The extrernal obliques and the lats worry me the most. Ofcourse look, I am not an expert, just a normal person with no physiological knowledge, but the muscles at the outer sides of my my back- either the lats or external obliques- they are the ones that are feeling the most assymmetrical and really bizarre. And I can feel that these same muscles are also responsible for lateral flexion. I think the external obliques are responsible for "ispilateral" flexion and "contralateral" rotation? So in derotating I am strengthening and stretching and I just get scared that I am stretching the wrong one and it will and allow a lateral curve. So, what I am having a hard time explaining is that I wonder if in say rotating to the left, it feels like I am also loosening the veritical resistance of the right extrenal oblique or Lat, and I just hope that is ok. For example right now my left LAT has now been "awakened" and I feel that not only is that muscle derotating (contracted laterally) me but it is also pulling me down on that side. And I am not sure that is good-..



              Originally posted by skevimc View Post
              ... And these questions are only dealing with the primary movers. How much influence do the smaller stabilizing muscles of the spine have on strength output?

              ... I called it the 'shotgun' approach in an earlier thread. Since it's nearly impossible to identify exactly which muscle(s) are the culprit, strengthen them all. AND since we found a strength asymmetry in AIS patients, lets improve strength symmetrically. As well, the more active and strong muscles become, the more efficient and 'healthy' they become.
              Not that I am in a position to agree, but I do agree with this I was wondering what you think about the idea of having the prime movers sort of train the stabilizers (the multifidus etc). Like have the lats and obliques force a certain movement and then in time the smaller muscles will get the idea. Sorry, silly for me to suggest I am sure its more complicated than that but I am curious.


              Thank you very much, I really appreciate it.
              Attached Files

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              • #37
                Originally posted by whatishappening View Post
                I am actually shocked that Scroth doesn't derotate.... (that scares me)
                Just want to clarify what you mean when you talk about derotating -- seeing this across a few threads now. It sounds like because your condition is different than most on this forum, you are talking about lining up feet, hips, shoulders in one plane. My hips and shoulders are pretty much even, its everything in between that is rotated. And I'm not just able to derotate for an x-ray.

                But Schroth is very much about looking at scoliosis in 3 dimensions. Rotation is taken into account in every exercise. I think what you are referencing, is that Schroth does not recommend wide sweeping rotations such as in some yoga poses or reaching to grab something that is not right in front of you. The reason is that no matter which direction you twist it will accentuate the differences in the rib cage -- narrow side is compressed even more, wide side is expanded even more. But the breathing exercises are very much about derotating. And another example would be that any supine exercise is done with rice bags placed under the rib hump and opposite hip so that you are starting slightly derotated before you even begin the exercise.

                The thing that's interesting to me is that both torso rotation and schroth can be successful at derotating -- its not that one is right and the other wrong, they just work in different ways.
                1993, Age 13, 53* Right T Curve w/ Left L compensatory
                2010, Age 30, 63* or 68* (depending on the doc) Right T Curve w/ Left L compensatory

                http://livingtwisted.wordpress.com/

                Comment


                • #38
                  Originally posted by whatishappening View Post
                  Hi, thank you so much for responding. I have to say I did not read that paper in the first post of this thread. Plus, I am really clueless here, I had no idea you were doing a PhD- or any study on rotations.
                  It's been a few years since I finished and am researching in a different area right now. I just like to come here because I enjoy this line of research.

                  Originally posted by whatishappening View Post
                  PLUS- I just assumed Scroth has derotations? I mean, that is its appeal to me. I looked at old video footage where a group of little girls were being instructed to reduced ther lordosis while retracting their right hips (the retraction is a derotation?) Plus, the little boy in the footage who has padding placed under one buttock, the opposite scapula and the opposite (again) shoulder. Surely that is derotation.

                  I assumed Scroth basically does a series of moves that will work the curves backwards to an ideal straight spine through a combination of derotations and lateral displacements. That is what I would like to do.
                  Schroth does focus on derotation. In fact, the protocol divides the spine into several parts (depending on curve type). And each part gets its own special exercises all meant to derotate and straighten.


                  Originally posted by whatishappening View Post
                  In fact, I have been using the Cybex Torso rotation machine at my local Y for the last 3 months:
                  http://www.cybexintl.com/products/st...190/intro.aspx
                  (with very bizarre feelings in my torso btw- totally assymetrical/weird feelings that change from week to week)
                  I am only at 13.5kg and I keep the rotation to about 20-30 degrees- so far more than 13.5kg makes my sacroilliac joint make noises and I don't think that's good.
                  The Cybex machine is what we used for our study.

                  Originally posted by whatishappening View Post
                  Not that I am in a position to agree, but I do agree with this I was wondering what you think about the idea of having the prime movers sort of train the stabilizers (the multifidus etc). Like have the lats and obliques force a certain movement and then in time the smaller muscles will get the idea. Sorry, silly for me to suggest I am sure its more complicated than that but I am curious.
                  It's not silly at all. That's actually the exact idea that I have. If you have shoulder pain/tendonitis/instability the PT protocol is to exercise the four stabilizing muscles. Each one controls a basic movement in the shoulder. Extension, flexion, internal and external rotation. You can isolate these muscles by doing a specific exercise AND using a very light weight (<5lbs). There are some very nice studies that show these specific exercises and weights activate the appropriate muscles. These small stabilizing muscles get out of whack for any number of reasons, but the main idea is that, usually due to pain, the muscles stop firing at the appropriate times, the shoulder shifts in the socket slightly and causes impingement. Strengthening those stabilizing muscles usually helps the pain because the shoulder begins to track properly in the joint capsule.

                  Transfer this basic idea to the spine. It certainly gets A LOT more complicated in the spine and there are several assumptions that have to be made. But basically the idea is that strengthening all of the spinal muscles will wake up any muscles that might be dysfunctional. There are lots of open ended questions that can't be answered right now in this area. But this is the basic idea.

                  Originally posted by mehera View Post

                  But Schroth is very much about looking at scoliosis in 3 dimensions. Rotation is taken into account in every exercise. I think what you are referencing, is that Schroth does not recommend wide sweeping rotations such as in some yoga poses or reaching to grab something that is not right in front of you. The reason is that no matter which direction you twist it will accentuate the differences in the rib cage -- narrow side is compressed even more, wide side is expanded even more. But the breathing exercises are very much about derotating. And another example would be that any supine exercise is done with rice bags placed under the rib hump and opposite hip so that you are starting slightly derotated before you even begin the exercise.

                  The thing that's interesting to me is that both torso rotation and schroth can be successful at derotating -- its not that one is right and the other wrong, they just work in different ways.

                  Yes. It's the extreme rotations they want you to avoid. Good clarification.

                  Comment


                  • #39
                    Originally posted by skevimc View Post
                    strengthening all of the spinal muscles will wake up any muscles that might be dysfunctional.

                    Great! I have added it to the record of Assumptions/Facts to be taken into account.
                    Is not possible to know with something as EMG, if really some muscles (and which of them) are dysfunctional?

                    Comment


                    • #40
                      Originally posted by flerc View Post
                      Great! I have added it to the record of Assumptions/Facts to be taken into account.
                      Is not possible to know with something as EMG, if really some muscles (and which of them) are dysfunctional?
                      Definitely put it under the assumption category.

                      People have tried and even presented as evidence the ability to use surface EMG measurement to show paraspinal muscle activation. The reality is that surface EMG is very sensitive to noise and measures anything and everything directly below the electrodes (not to mention general lab noise (lights are 60 hz)). I'm not sure how deep it is able to measure. But given what I've seen with how active the larger muscles are when performing a trunk rotation, I have little doubt that the smaller muscles are just as active, i.e. all muscles are activated doing some type of work. The surface EMG would pick all of this activity up. So to be able to say that any difference seen in EMG signal is a result of a specific muscle would be pretty weak evidence.

                      Measuring these muscles is possible with fine-wire EMG. This involved inserting the electrode into the actual muscle of interest and there are some really nice studies that have been done in healthy adults determining which muscles are activated during various trunk movements, including rotations. These studies also show the wide variation of activity patterns for the various trunk movements. Another weakness of this technique is that it measures only a portion of the total muscle (a few fascicles). The body can and does vary which fascicles it uses for any given movement. So the repeatability of the technique could be a weakness. Although with training, I believe, this variation becomes less, i.e. more consistent muscle pattern activation.

                      There is another really neat way to measure muscle activity that I hope to be able to research someday. It uses MRI. In fact, when I came to Stanford/Palo Alto VA I was hoping to do a project on this very thing. It's called muscle function MRI (mfMRI). Basically, you scan a certain area of someone, e.g. T5-T9. Take them out of the MRI, have them perform one exercise a bunch of times or with a heavy weight. Quickly put them back in the magnet in the same position and scan the same area. When you look at the before and after images, the muscles that were activated will be a different color. It's a very nice technique that has been confirmed with different type of EMG. The other great part about this technique is that the change in color (from white to dark grey or vice versa can't remember which direction) is linear with the amount of work performed. So the main movers will have the most change in color and the muscles that didn't work as hard, will be slightly less. So, if you have the range of muscle color change for any given muscle (which can be somewhat standardized) you can fairly accurately estimate how active the muscle was. This technique has been used in patients with low back pain so it definitely has the resolution and sensitivity to tell if there are dysfunctional muscles.

                      Comment


                      • #41
                        Originally posted by skevimc View Post
                        Definitely put it under the assumption category.
                        In fact I not do a distinction between facts and assumptions. I also record the foundations of each of them and the percentage of reliability for me. In this case I gave it a 90%, it seems too logic for me and consistent with other assumptions.

                        Originally posted by skevimc View Post
                        There is another really neat way to measure muscle activity that I hope to be able to research someday. It uses MRI. In fact, when I came to Stanford/Palo Alto VA I was hoping to do a project on this very thing. It's called muscle function MRI (mfMRI). Basically, you scan a certain area of someone, e.g. T5-T9. Take them out of the MRI, have them perform one exercise a bunch of times or with a heavy weight. Quickly put them back in the magnet in the same position and scan the same area. When you look at the before and after images, the muscles that were activated will be a different color. It's a very nice technique that has been confirmed with different type of EMG. The other great part about this technique is that the change in color (from white to dark grey or vice versa can't remember which direction) is linear with the amount of work performed. So the main movers will have the most change in color and the muscles that didn't work as hard, will be slightly less. So, if you have the range of muscle color change for any given muscle (which can be somewhat standardized) you can fairly accurately estimate how active the muscle was. This technique has been used in patients with low back pain so it definitely has the resolution and sensitivity to tell if there are dysfunctional muscles.

                        Wonderful!! It should to be used soon. That is the kind of proofs that should to be done. It seems to me similar to thermography http://www.actabio.pwr.wroc.pl/Vol4No1/3.pdf but of course it should be different and with much precision

                        Comment


                        • #42
                          Skevimc, Thank you for responding

                          That MrI is a great idea!

                          Skevimc, I have been looking around here for your torso rotation paper- do you have one? I was wondering what loads you used.

                          Also I am wondering how you handled accidental "cheating"- which is what I think I have been doing-
                          .. For one thing, subtle differences in the pressure applied to the inner thigh and chest pads
                          ...Also, I feel that I am using my spine differently in the 2 directions- because I use it differently in real life: any single vertebre assumes a difference amount of the total turning angle depending on which way I turn. And because of the chest and hip pads on the machine- maybe I am grippping too hard but I get the feeling that I am really only rotating using say L2-T7- because the chest pads I think end around T7?

                          anyway, that is why I would really like to read your paper, thanx.



                          I think what I will try next time is to lower the load to the minimum (5#) and try to focus on turning with only 1 or 2 vertebrea at a time.

                          In reading your explanation of needing to use low loads to work rotator cuff muscles, I wonder then, by using large loads on this torso machine, maybe the paraspinals (all those tiny criss-crossing muscles between vertebrea) are not even being worked? I don't even feel anything in the erector spinea- I just feel it on the outer edges of my back. I started at 5# 3 months ago and have progressed to #15. 15# is too easy for a "normal" workout- but I am going to try your program and see what happens. Just btw, I was told by the trainer at the gym that the management there considers it a "high risk" machine. I see 20 year old boys on that thing whacking out the full rotations (that would be maybe 75 degrees in one direction!) with a full weight rack (- maybe 150#). Like, I doubt they are using their paraspinals.

                          Also, the weird thing I feel on that machine is each week a different area feels it- say lower right or upper left back. But that muscle/feeling feels it it both directions- like the same muscle on the opposite side of the body feels nothing going in "its direction". Eg- one week the left lat will feel it going both right and left and the right lat will feel nothing in both directions. The following week it may be just the right lat feeling it- again in both directions while the left lat feels nothing.

                          Comment


                          • #43
                            Originally posted by mehera View Post
                            Just want to clarify what you mean when you talk about derotating -- seeing this across a few threads now. It sounds like because your condition is different than most on this forum, you are talking about lining up feet, hips, shoulders in one plane. My hips and shoulders are pretty much even, its everything in between that is rotated. And I'm not just able to derotate for an x-ray. ....
                            Thank you for responding Mehera, I mean rotated about the vertical axis, yes. I wonder if all people with lateral scoliosis do not have rotated hips or shoulder gridles? It's remarkable because the pattern of the sand bags in that old Scroth video footage follows my rotations.



                            I agree with staying away from extreme rotations. I have also dropped out of yoga- I feel the side bent torso rotations poses such as triangle and triconassana are just way too imprecise. Thank you for pointing out the effect of rotation on the rib cage.

                            Comment


                            • #44
                              Originally posted by whatishappening View Post
                              Skevimc, Thank you for responding

                              That MrI is a great idea!
                              It is indeed. It's full of technical and logistical and budgetary issues. But its power and possibilities are pretty impressive.


                              Originally posted by whatishappening View Post
                              Skevimc, I have been looking around here for your torso rotation paper- do you have one? I was wondering what loads you used.
                              This is a link to the strength asymmetry paper.
                              http://www.scoliosisjournal.com/content/2/1/9

                              That is an open access journal so you should be able to get it with no problem. Our training study might be a bit harder to get. Send me a private message with your email and I'd be happy to send you a pdf.

                              McIntire KL, Asher MA, Burton DC, Liu W. Treatment of adolescent idiopathic
                              scoliosis with quantified trunk rotational strength training: a pilot study. J
                              Spinal Disord Tech. 2008 Jul;21(5):349-58. PubMed PMID: 18600146.


                              Originally posted by whatishappening View Post
                              Also I am wondering how you handled accidental "cheating"- which is what I think I have been doing-
                              .. For one thing, subtle differences in the pressure applied to the inner thigh and chest pads
                              ...Also, I feel that I am using my spine differently in the 2 directions- because I use it differently in real life: any single vertebre assumes a difference amount of the total turning angle depending on which way I turn. And because of the chest and hip pads on the machine- maybe I am grippping too hard but I get the feeling that I am really only rotating using say L2-T7- because the chest pads I think end around T7?

                              anyway, that is why I would really like to read your paper, thanx.
                              I don't think we discuss the 'cheating' component in the paper, although I know exactly what you mean. At some point every patient tried to cheat a bit. It seems like people try to cheat for two main reasons. 1. they are going too fast. 2. the weight is a bit too heavy. (and 3. would be a combination of 1 and 2.). The best thing to do is to drop the weight a bunch and do several sets of very slow controlled movement. Focusing hard maintaining posture. To take a page from the schroth and side-shift (and others) protocols, you want to visualize and focus on the part of your back you are trying to control. I would drop the weight to around 5-10 pounds (1 or 2 plates) and make each direction take 2-3 seconds. So 3 seconds up and 3 seconds down. With a session or two of doing it this way, you could start adding some weight again. But again, going slow and concentrating.


                              Originally posted by whatishappening View Post
                              I think what I will try next time is to lower the load to the minimum (5#) and try to focus on turning with only 1 or 2 vertebrea at a time.

                              In reading your explanation of needing to use low loads to work rotator cuff muscles, I wonder then, by using large loads on this torso machine, maybe the paraspinals (all those tiny criss-crossing muscles between vertebrea) are not even being worked? I don't even feel anything in the erector spinea- I just feel it on the outer edges of my back. I started at 5# 3 months ago and have progressed to #15. 15# is too easy for a "normal" workout- but I am going to try your program and see what happens. Just btw, I was told by the trainer at the gym that the management there considers it a "high risk" machine. I see 20 year old boys on that thing whacking out the full rotations (that would be maybe 75 degrees in one direction!) with a full weight rack (- maybe 150#). Like, I doubt they are using their paraspinals.

                              Also, the weird thing I feel on that machine is each week a different area feels it- say lower right or upper left back. But that muscle/feeling feels it it both directions- like the same muscle on the opposite side of the body feels nothing going in "its direction". Eg- one week the left lat will feel it going both right and left and the right lat will feel nothing in both directions. The following week it may be just the right lat feeling it- again in both directions while the left lat feels nothing.

                              I didn't read this last part before I responded to the first part, so I think your idea to drop the weight is right on.

                              If done improperly, the machine could definitely be high risk. Using a full load and doing a full rotation could be extremely dangerous if they aren't in control of the weight stack, i.e. if they are lifting really fast and letting it drop really fast. The forces applied to the discs during a rotation are pretty high and without proper support it's a sure way to really injure yourself. It's another reason why we divide the training exercises into 2 separate 'arcs'. When you are pre-rotated to the right (for example) and you are contracting to the left to the neutral position, you can lift nearly 2 times the amount of weight as from the neutral position all the way to the end of your range of motion. So by exercising each of those force arcs separately and with different weights, you make sure you can control the weight and that the weight isn't too heavy or too light for the corresponding muscles.

                              The issue around the rotator cuff muscles and/or paraspinal muscles is an important one. I am >95% sure that, given no injury, the stabilizing muscles are activated during maximal contractions. How they are active and how much they can be trained during a maximal contraction is another question. It's during a pathologic condition that these might not be activated. With a heavy load, the prime movers can serve to stabilize the joint. So if there is some reason the body doesn't want to use those stabilizing muscles, then it wouldn't have to. And in fact, might very well 'choose' an different muscle pattern in order to accomplish its goal. And perhaps this is why it feels different from time to time. Muscles are weak and fatigued so the body is trying different combinations out to see what works best.

                              Most of the above is theoretical, but it makes physiological sense to me.

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                              • #45
                                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.

                                I'm glad you mentioned in the disucssion that you didn't think the natural spinal vertebrea rotation played a role- I was going to ask you why you wouldn't add/subtract it from the equipment angles.

                                For what it's worth, for me anyway, I just assumed it was because I am so used to turning to the right that I am weaker to the left more because of flexibility issues- I think you mentioned that when saying one reason is antagonist muscles- like it is difficult to extend the leg when the flexors are short. 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?


                                But also in my case I am coming to realize that the whole left side of my body- shoulder and arm included is not as sharp-




                                Originally posted by skevimc View Post
                                ......I don't think we discuss the 'cheating' component in the paper, although I know exactly what you mean. At some point every patient tried to cheat a bit. It seems like people try to cheat for two main reasons. 1. they are going too fast. 2. the weight is a bit too heavy. (and 3. would be a combination of 1 and 2.). The best thing to do is to drop the weight a bunch and do several sets of very slow controlled movement. Focusing hard maintaining posture. To take a page from the schroth and side-shift (and others) protocols, you want to visualize and focus on the part of your back you are trying to control. I would drop the weight to around 5-10 pounds (1 or 2 plates) and make each direction take 2-3 seconds. So 3 seconds up and 3 seconds down. With a session or two of doing it this way, you could start adding some weight again. But again, going slow and concentrating.

                                Thank you



                                Originally posted by skevimc View Post
                                ............ It's another reason why we divide the training exercises into 2 separate 'arcs'. When you are pre-rotated to the right (for example) and you are contracting to the left to the neutral position, you can lift nearly 2 times the amount of weight as from the neutral position all the way to the end of your range of motion. So by exercising each of those force arcs separately and with different weights, you make sure you can control the weight and that the weight isn't too heavy or too light for the corresponding muscles.
                                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?




                                Originally posted by skevimc paper View Post
                                ............
                                None of these studies have shown a rotational strength asymmetry in the healthy adult population and no conclusive evidence indicates that isometric trunk rotational weakness or asymmetry is prognostic or pathologic for low back pain. It is, also unknown whether a trunk rotational strength asymmetry exists in healthy adolescents.
                                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 guess I need to read more instead of asking you all these questions, I apologize, just limited a bit wit time here. I will email you for the pdf, thanx.






                                Originally posted by skevimc View Post
                                ............ The issue around the rotator cuff muscles and/or paraspinal muscles is an important one. I am >95% sure that, given no injury, the stabilizing muscles are activated during maximal contractions. How they are active and how much they can be trained during a maximal contraction is another question. It's during a pathologic condition that these might not be activated. With a heavy load, the prime movers can serve to stabilize the joint. So if there is some reason the body doesn't want to use those stabilizing muscles, then it wouldn't have to. And in fact, might very well 'choose' an different muscle pattern in order to accomplish its goal. And perhaps this is why it feels different from time to time. Muscles are weak and fatigued so the body is trying different combinations out to see what works best.
                                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 have decided to take a pause on this machine as a training device for the moment and will just use it to compare left and right. I have seen a new Chiro who seems to think my body (pelvis/spine/shoulders) should come to some sort of ideal equilibruim first-(& btw first he said I had scoliosis probably existing from childhood, then he changed his mind and said it is functional and now he is saying my whole body is very "twisted" and he is not sure why- maybe from nerve entratpment at the si joint or maybe born like this or from a shoulder injury)

                                I have been doing something else- just sitting, turning about 5 degrees max to either side, over about 5 seconds. I recall my pilates teacher saying "small movements work the small muscles". I am also reading a Feldenkrais book that basically says the same thing, and that the movements should be done very slowly- like you said.

                                And in just sitting there and turning very slowly max 5 degrees either way, I did in fact feel the erector spinea or the paraspinals or some muscle direcdtly beside the spine, but only on the left side regardless of which way I am turning. I tried again tonite but I also feel the large muscles now.


                                I was thinking of repeating the exercise with a theraband wrapped around my torso at the level of the vertebrea I want to work and tie the ends to a door knob- just enough to provide light resistance. ?

                                thank you very much- I apologize for my response being sort of disjointed, - it is reflective of my thinking on this subject I am afraid
                                Last edited by whatishappening; 09-04-2011, 03:29 AM.

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