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Thread: Muscles move the joints, don't they???

  1. #1
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    Muscles move the joints, don't they???

    I am an experienced physiotherapist, and person with scoliosis that has successfully helped my back pain and alignment for a long time with specific strength exercises.

    I've been reading a lot of the posts about exercise, and am wondering why some people maintain that exercise is not likely to be useful to treat the symptoms of scoliosis. I mean - joints don't move themselves, and the spine does not simply hold itself up! People with scoliosis have deformities of the bones that are exaggerated by dramatic weaknesses and lack of joint position sense/body awareness.

    Many of you with scoliosis have said that if you derotate certain body segments and draw yourself tall, your curves appear less noticeable. The problem is, you can't hold it very long!

    Also, some posters have commented that in the morning, their curves are less noticeable or they feel taller/straighter, but that the spine collapses over the course of the day. Much of this is due to the inability of the muscles to maintain spinal elongation.

    So, it makes a great deal of sense that strengthening the muscles in very specific ways (ie. derotating and also strengthening in the lengthened muscle positions in as corrected a position as can be achieved) would be helpful.

    Now, I must state that when I fail to do my exercises for a few weeks, I go crooked again. Strength is unlikely to be maintained without regular exercise, when there is a deformity. BUT, if I do my routine for 30 minutes three times per week, I stay straighter and have little pain.

    Even though I don't know WHY I have scoliosis and WHY my muscle support of my spine got messed up, I can still treat those symptoms by strengthening and elongating my muscles.

    I would love to post a full discussion about why the theoretical and evidentiary basis for exercise is strong, but it will take a bit of time to get the research together and write it.

    I look forward to your comments!

    B.

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    Quote Originally Posted by betty14 View Post
    I've been reading a lot of the posts about exercise, and am wondering why some people maintain that exercise is not likely to be useful to treat the symptoms of scoliosis.
    Can you point to a specific post? I don't recall anyone stating that PT doesn't help with the symptoms of scoliosis. The only claim that is made, and we try to make it often so that the message doesn't get lost, is that nothing is going to permanently reduce one's curves, with the possible exception of surgery. That doesn't mean PT (and other alternative treatments), aren't helpful in terms of pain and cosmesis.

    Regards,
    Linda

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    Quote Originally Posted by betty14 View Post
    I've been reading a lot of the posts about exercise, and am wondering why some people maintain that exercise is not likely to be useful to treat the symptoms of scoliosis.
    I don't recall reading anyone saying that. Can you point out some posts?

    I think the comment is that exercise has never been shown to prevent progression nor has it been shown to permanently reduce curves.

    It might do those things but exercise programs like Schroth which have been around for at least 90 years still don't have much evidence of efficacy.
    Sharon, mother of identical twin girls with scoliosis

    No island of sanity.

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    Hi Linda and Pooka1:

    I don't want to start re-posting things that I have already been posted by others, as I have noted that some of the threads on this site turned combative and unpleasant, which is not therapeutic! So please consider the second paragraph as - that I have gotten that impression from words used and tone of writing.

    In answer to your other comments:

    Yes, the state of the evidence is wanting, that is certainly true. And it is inappropriate for therapists and others to make statements that are misleading such as "curing" scoliosis, or making promises to prevent progression of curves.

    However, in the absence of rock-solid Level 1 evidence, therapists must use best-practice principles - combining the current literature, knowledge of anatomy and physiology, palpation skills, problem-solving skills, and a three-dimensional eye that can only be fine tuned over years of practice.

    I often treat patients with chronic and/or severe back pain at this point in my career, and I can honestly say that the physiotherapy literature that is most helpful and solid is the basic stuff, such as showing that the QL muscle, if not active enough, will allow the lumbar spine to side bend right and rotate left. The studies on "can this exercise cure non-specific low back pain" have historically been so poorly done that the results are useless.

    Pooka1:

    Yes, I know the Schroth method has not been studied rigorously enough at this time. I recently got Christa Lehnert-Schroth's book. Have you read it by any chance?

    It is entitled "Three dimensional treatment for scoliosis - a physiotherapeutic method for deformities of the spine". If you are not in a medical/anatomy/therapy field it would be a difficult read, but still worthwhile. I can tell you it is by far the most comprehensive book on non-surgical scoliosis management I have ever read, and the detailed descriptions of muscle functions around three and four curve patterns are spot on. It is clearly written by a person with the ability to view the body in the sagital, frontal and transverse planes.

    By the way, the author nor the physicians who wrote forwards to the book are claiming to cure your deformity, and they acknowledge that in some cases surgery may the best or indeed the only option.


    Regarding preventing progression: there is not strong evidence for or against this, but at least - the treatment of specific exercises is highly unlikely to cause harm, and the exerciser gets many other health benefits.

    Regarding reducing curves: My curves in the morning are small, they would measure much larger if I had x-rays at night due to fatigue causing winding down of the spine. They would consistently measure smaller when i do my therapy regularly. That, to me, is curve reduction. Whether my bony deformity has or will reduce due to bone remodelling over several years remains to be seen, and I doubt that there will be research evidence to that effect in my lifetime!

    Good night Ladies!

    B.

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    Quote Originally Posted by Pooka1 View Post
    It might do those things but exercise programs like Schroth which have been around for at least 90 years still don't have much evidence of efficacy.
    Yet. And I believe "much" is the keyword here. I truly believe as more people become open and aware to the alternatives which are natural and available to us, we will begin to see much positive evidence.

    I am a firm believer in proper exercise and proper nutrition. This is certainly something that could only benefit us, even if it does not "cure" anything. If our bodies aren't strong and healthy, then nothing will be beneficial. It is really our best support system.

    This is true for anyone, whether they have scoliosis or not.

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    Quote Originally Posted by SLS View Post
    Yet. And I believe "much" is the keyword here. I truly believe as more people become open and aware to the alternatives which are natural and available to us, we will begin to see much positive evidence.

    I am a firm believer in proper exercise and proper nutrition. This is certainly something that could only benefit us, even if it does not "cure" anything. If our bodies aren't strong and healthy, then nothing will be beneficial. It is really our best support system.

    This is true for anyone, whether they have scoliosis or not.
    Yes I don't disagree. But is seems like the majority of villagers here, new and old, who inquire about PT and want to try it seem to think it can permanently reduce curves or stop progression. There is very little evidence for those things despite decades of trying it.

    On the other hand, there is evidence that pain can be reduced I think in some cases, at least temporarily.

    If exercise was actually an alternative to surgery we would know it by now. Yet the world is still waiting.
    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."

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    Quote Originally Posted by Pooka1 View Post

    If exercise was actually an alternative to surgery we would know it by now. Yet the world is still waiting.
    I am not claiming that exercise is an alternative to surgery, if you are at the point where surgery is necessary, HOWEVER, I do believe that exercise can be a preventative measure.

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    Quote Originally Posted by SLS View Post
    I am not claiming that exercise is an alternative to surgery, if you are at the point where surgery is necessary, HOWEVER, I do believe that exercise can be a preventative measure.
    Okay but I think the world is still waiting on evidence for that claim also. And it's not like folks haven't specifically being trying to prove that claim for decades. They have been. That's the issue as I see it. It's not "untried." It appears to be "tried and still not proven." After all this time.

    I think the person who designs a PT program that reliably and permanently keeps people of the table will get the Nobel in physiology/medicine. So I just monitor the winners in that category every year to see if there are any breakthroughs with PT and scoliosis. Just my approach.
    Last edited by Pooka1; 06-18-2009 at 04:07 PM.
    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."

  9. #9
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    Sharon, I'm curious about something. First, let's put scoliosis aside. In general, how do you feel about exercise? Do you believe that exercise provides a benefit to general health? Weight training for strong bones, aerobics for a strong heart? Personally, I don't believe that our bodies were made to be sedentary.

    I'm not talking about anyone winning any prizes here. I'm talking about BASIC care of our bodies. It seems to me that many people take better care of their cars, than they do of themselves. I guess I see it as preventative maintenance. It's basic and it's logical.

  10. #10
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    Quote Originally Posted by SLS View Post
    Sharon, I'm curious about something. First, let's put scoliosis aside. In general, how do you feel about exercise? Do you believe that exercise provides a benefit to general health? Weight training for strong bones, aerobics for a strong heart? Personally, I don't believe that our bodies were made to be sedentary.

    I'm not talking about anyone winning any prizes here. I'm talking about BASIC care of our bodies. It seems to me that many people take better care of their cars, than they do of themselves. I guess I see it as preventative maintenance. It's basic and it's logical.
    Are you saying PT is preventative maintenance with anything having to do with scoliosis?

    I don't see what you wrote as relevant to a scoliosis forum. We can put scoliosis aside and I can agree with you on those points.

    But the context here is PT and scoliosis and whether or not there is any evidence that it can stop progression or reduce curves. The actual claims matter... there is no other way to logically discuss the topic.

    What would you say are the actual claims of PT w.r.t. scoliosis?
    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."

  11. #11
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    I am not a PT, I am not a doctor and I am not professionally trained, so therefore all I can offer are my opinions, for what they are worth. Apparently not much.

    I also am not here to argue or convince anyone of anything.

    I also apologize if I went off topic.

    I am going to gracefully bow out of this "conversation".

  12. #12
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    I think that if you catch your scoliosis early enough and put into place a very specific exercise program that targets the imbalances of your spine and surrounding musculature (instead of "watching and waiting"), then yes, it's very possible in many cases to experience no more progression and hopefully some regression. Will you have to keep up this program for the rest of your life in order to have continued success? It's probably wise. You can equate it to any other disease that requires maintenance over one's lifetime to keep it in check.

    Granted, in some cases, I do think scoliosis comes on like a freight train, so in scenarios like that, I don't think exercise would do much good. I think it depends on each person's unique scenario. And, early prevention is the key.

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    Physical therapy for Scoliosis

    Why some people make an effort to misrepresent science and discourage parents and children with Scoliosis is beyond me.

    Studies show that strength training can be very succesful at managing and potentially reversing childhood Scoliosis.

    Here is a thread with many helpful links including a video
    Torso Rotation Strength Training for Scoliosis

    Although not yet fully understood it appears that the fundamental problem may reside in the well known strength asymmetry that exists between the right and left side in children with Scoliosis. Put simply one side of the back is stronger than the other.

    Dr. Vert Mooney explained this directly.
    ...there is a consistent asymmetry in torso rotation strength that can be shown with specific strength testing and with myolectric activity. This is definitely abnormal.
    Strength training not only corrected this problem but it stopped curve progression and reduced many curves.
    Myolectric activity was asymmetric in both sides and in abdominal and paraspinal muscles of all patients. These asymmetries were corrected completely with torso rotation, which was associated with significant strength gains.
    Here is a link to one of the many studies on the subject of strength asymmetry
    Study: Trunk rotational strength asymmetry in adolescents with idiopathic scoliosis: an observational study

    It is also well known that child atheletes have high rates of minor scoliosis. This is thought to be due in part to strength asymmetry.

    Baltimore Washington Medical Center: Scoliosis

    Young Athletes
    Scoliosis may be evident in young athletes, with a prevalence of 2 - 24%. The highest rates are observed among dancers, gymnasts, and swimmers. The scoliosis may have been due in part to loosening of the joints, delay in puberty onset (which can lead to weakened bones), and stresses on the growing spine. There have also been other isolated reports of a higher risk for scoliosis in young athletes who engage vigorously in sports that put an uneven load on the spine. These include figure skating, dance, tennis, skiing, and javelin throwing, among other sports. In most cases, the scoliosis is minor, and everyday sports do not lead to scoliosis. Exercise has many benefits for people both young and old and may even help patients with scoliosis.
    Study: Scoliosis in swimmers
    The high-repetition nature of competitive swimming causes imbalances of musculature in the adolescent athlete. Scoliosis as a musculoskeletal condition of the adolescent can be detected in high incidence among swimmers owing to the training phenomenon.
    Last edited by Dingo; 06-18-2009 at 02:13 PM.

  14. #14
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    Quote Originally Posted by Dingo View Post
    Why some people make an effort to misrepresent science and discourage parents and children with Scoliosis is beyond me.
    Well everyone needs a hobby.

    Now that I am down to having to actively worry about one kid with scoliosis instead of two, I find I have more free time on my hands.
    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."

  15. #15
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    Trt

    Pooka1

    Now that I am down to having to actively worry about one kid with scoliosis instead of two, I find I have more free time on my hands.
    I'm sure you are a good person and as a parent of a child with Scoliosis I understand the stress first hand. All I'm saying is that there is credible, scientific evidence from mainstream researchers that shows that physical therapy can be decisively effective for children with Scoliosis. It makes no sense to me that you don't acknowledge the existence of research that you are fully aware of.

    If you said that the "jury is still out", or "the longterm effects are unknown" you'd be right. But that's as far as it goes. A variety of scientists, physical therapists and kids with Scoliosis have all produced consistent, impressive results with torso rotation strength training.

    The neurologist, mom and little girl in this video are very credible. Torso rotation therapy produced the type of results for this little girl that the studies suggest are typical.

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