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Thread: On muscle imbalance and scoliosis

  1. #61
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    Here is the "causes" section from the wiki page Dingo posted. I bolded the one sentence he took out of the context.

    Causes

    Hypermobility generally results from one or more of the following:

    * Misaligned joints
    * Abnormally-shaped ends of one or more bones at a joint
    * A Type 1 collagen defect (found in Ehlers-Danlos Syndrome, Marfan syndrome) results in weakened ligaments, muscles & tendons. This same defective process also results in weakened bones which may result in osteoporosis and fractures
    * Abnormal joint proprioception (an impaired ability to determine where in space parts of the body are, and how stretched a joint is)

    A hypermobile hand

    The condition tends to run in families, suggesting that there may be a genetic basis for at least some forms of hypermobility. The term double jointed is often used to describe hypermobility, however the name is a misnomer and is not to be taken literally, as an individual with hypermobility in a joint does not actually have two separate joints where others would have just the one.

    A hypermobile hand

    Some people have hypermobility with no other symptoms or medical conditions. However, people with hypermobility syndrome may experience many difficulties. For example, their joints may be easily injured, be more prone to complete dislocation due to the weakly stabilized joint and they may develop problems from muscle fatigue (as muscles must work harder to compensate for the excessive weakness in the ligaments that support the joints).

    Hypermobility may also be symptomatic of a serious medical condition, such as Ehlers-Danlos syndrome, Marfan syndrome, rheumatoid arthritis, osteogenesis imperfecta, lupus, polio, downs syndrome, morquio syndrome, cleidocranial dysostosis or myotonia congenita.

    In addition, hypermobility has been associated with chronic fatigue syndrome and fibromyalgia. During pregnancy certain hormones alter the physiology of ligaments making them able to stretch to accommodate the birthing process. For some women with hypermobility pregnacy related pelvic girdle pain can be debilitating.

    Symptoms of hypermobility include a dull but intense pain around the knee and ankle joints and also on the soles of the feet. The condition affecting these parts can be alleviated by using insoles in the footwear which have been specially made for the individual after assessment by an orthopaedic surgeon.

    [edit] Hypermobility syndrome

    Hypermobility syndrome is generally considered to comprise hypermobility together with other symptoms, such as myalgia and arthralgia. It is relatively common among children and affects more females than males.
    A hypermobile hand

    The current diagnostic criteria for hypermobility syndrome are the Brighton criteria, which incorporates the Beighton Score[3]. The Beighton Score in an individual with HS usually falls between 4-6 out of 9. A diagnosis of Hypermobility Syndrome is only given when hereditary connective tissue disorders (such as Ehlers-Danlos and Marfan) have been ruled out.

    [edit] Causes

    Current thinking suggests that there are four factors: These four factors affect different people to varying degrees and each is explained in detail in the following sections.

    * The shape of the ends of the bones: Some joints normally have a large range of movement, like the shoulder and hip. Both these joints look like a ball in a socket. If you inherit a shallow rather than a deep socket, you will have a relatively large range of movement, but only at these particular joints. If your hip socket is particularly shallow, then your hip may dislocate easily.
    * Weak or stretched ligaments caused by protein or hormone problems: ligaments are made up of several types of protein fibre. These proteins include elastin, which gives elasticity, which may be altered in some people. Also, the female sex hormones alter the collagen proteins. Women are generally more supple just before a period, and even more so in the latter stages of pregnancy, because of the effect of a hormone called relaxin. This hormone allows the pelvis to expand so the head of the baby can pass through. Different races have differences in their joint mobility, which may reflect differences in the structure of the collagen proteins. People from the Indian sub-continent, for example, often have much more supple hands than Europeans.
    * The tone of your muscles: The tone (or stiffness) of your muscles is controlled by your nervous system, and influences the range of movement in the joints. Some people use special techniques to change their muscle tone and increase their flexibility. Yoga, for example, can help to relax the muscles and make the joints more supple. Gymnasts and athletes can sometimes acquire hypermobility in at least some of their joints through the exercises they do in training.
    * Your sense of joint movement (proprioception): if you find it difficult to detect the exact position of your joints with your eyes closed, then you may develop hypermobile joints because you are likely to over-stretch a joint before you notice you are doing so. [1]
    Sharon, mother of identical twin girls with scoliosis

    No island of sanity.

    Question: What do you call alternative medicine that works?
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  2. #62
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    Hyperextended joints, also called double-jointedness, and apparently in the medical terminology is known as “joint laxity”, is actually fairly common. You just have to be attuned to notice it. I see people all the time, especially in the school system, that in my mind I’m thinking, “Oh, what a great ballerina they would have made”. I wouldn’t consider it abnormal, and neither does the medical field. Obviously, if you are far to one side of the spectrum of joint laxity, you may be able to be clinically diagnosed with some syndrome. However, most of these people with a clinical syndrome wouldn’t be able to keep up with the rigors of ballet or gymnastics. They would have pain and/or dislocated joints.

    You think that scoliosis is 10 fold higher in competitive, Bulgarian rhythmic gymnasts because "pre-scoliotic" children are attracted to this intense sport?
    The Soviet system chose those children, the children didn’t choose it. Bulgaria, as a former communist country was very close to the Soviet Union, and like all good communist countries screened the children at a very early age into ballet and rhythmic gymnastics, based on many measurements. You can see the Kirov Ballet’s (now known as the Mariinsky) results from this very young screening as every member of their ballet is hyperextended (and the same height too!), very deliberately. Look at the right leg of every member of the Kirov’s corps de ballet, each knee joint clearly shows the hyperextension:

    http://media.photobucket.com/image/k...ngSwanLake.jpg

    Here are a couple of pictures (the two lower pictures) that quite clearly shows the difference in looks between a straight-legged ballerina and a hyperextended ballerina. There is a significant difference in look. And ballet loves the hyperextended look, it is a sought after trait.

    http://apricot.wordpress.com/2008/07...on-and-ballet/

    The Soviet system believed and still believes that talent is wasted in a less than perfect body for the endeavor and will only train those whose measurements “measure up”.

    In the United State, anyone who wants to with the money to afford it can be trained, but here as Pooka says, those kids with the hyperextended joints will get better scores and are therefore more likely to continue on than those without those joints. Certainly, to make it to the highest levels of the sport, it seems to be a requirement. Look at these Russian rhythmic gymnasts’ noticeably hyperextended elbows from some of the Olympics and world games:

    http://2pat.files.wordpress.com/2008...russia_gym.jpg

    http://www.upi.com/enl-win/0b8d456b4...fd5bbc957a66f/

    Just this weekend at the ballet studio, one of the moms whose daughters compete in both rhythmic gymnastics and ballet was complaining that the rhythmic gymnasts seemed to get higher scores just because they had hyperextended joints. She was concerned that her daughter did not have these joints.

    Here’s another study that states
    IS (idiopathic scoliosis) patients, practising gymnastics or not, showed a higher JL (joint laxity) than the control group practising gymnastics or not. Furthermore, the groups practising gymnastic activities did not show higher JL levels than the other groups. Children with a high JL could be drawn toward gymnastics because of their ability to adapt to the constraints of this sport. Girls with a high JL may therefore be prone to developing IS. The fact that most teenagers with IS practise gymnastics could be related to a higher JL.
    http://www.ncbi.nlm.nih.gov/pubmed/16895527?ordinalpos=1&itool=EntrezSystem2.PEntrez. Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.P ubmed_Discovery_RA&linkpos=2&log$=relatedarticles& logdbfrom=pubmed

    I actually believe that it’s the double-jointedness that is a possible indicator for potential scoliosis, not just generalized limberness and flexibility. Lots of gymnasts and ballet dancers are super limber without the hyperextended joints. I think a study should be done to see if it’s the doublejointed kids more prone to scoliosis than just all the kids who are limber doing gymnastics and ballet. This would explain why rhythmic gymnasts have a higher incidence of scoliosis than in regular gymnastics, because the look of the hyperextension is more highly valued in rhythmic gymnasts than in regular gymnastics and so there are more of these kids with hyperextended joints in that sport.

  3. #63
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    joint limberness

    Ballet Mom

    Interestingly enough my son is both visibly "tight" and yet he also has what appears to be joint hypermobility in his hips.

    His torso has been very stiff since birth. He strongly favored sleeping on one side when he was younger. He even used to run in a visibly stiff manner.

    However when he sits down to stretch his legs move in crazy ways. We just learned about this a few weeks ago. When he spreads his legs his feet naturally rotate inwards to the floor and his toes point at each other.

    It's painful to watch but to him it's effortless. Something like 10% or 15% of young children have hypermobility but they tend to outgrow it as they get older. I hope Scott does because it's creepy.

    Why he is both hypermobile and hyperstiff is a mystery to me.

  4. #64
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    Hi Dingo,

    The amount of hyperextension definitely varies by joint in the body. My daughter's elbows are extremely hyperextended and her knees are less hyperextended. For ballet, it would be better the other way around. My daughter actually used her "creepy" elbows as a show and tell project in elementary school and freaked out all the other kids....

    However, every joint in her body is hyperextended and she has completely natural hip turnout (a must for ballet). Amazingly enough though, she had a hard time developing her splits because her muscles in her legs were stronger than most of the other girls. She is considered a "jumper" in ballet.

    I've even heard that some ballet students have one knee hyperextended and not the other. Just goes to show why this scoliosis field is so hard to pinpoint the exact causes, it's all so variable by individual.

  5. #65
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    toes pointed at each other

    Ballet Mom

    Is their a name for what my son's legs do?

    When he sits down and spreads his legs to stretch his feet fall inward and his toes point at each other.

  6. #66
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    Hi Dingo,

    It actually probably isn't anything but a young boy's flexibility. However, turnout of the hips would probably cause the legs to turn with an outward rotation, not inward. Perhaps, you could point it out at either his next physical or mention it to his orthopedist...the orthopedist would certainly know. It could possibly be intoeing, however, you'd probably notice this more when he was standing or walking:

    http://www.childrensorthopaedics.com/intoeing.html

    Just be warned though....my son started to intoe noticeably during the 5th and 6th grades and I took him to our pediatriacian who has an orthopedics specialty and the doctor started talking about surgery. i.e. cutting the bones and rotating them to fix the intoeing. I told him absolutely not, that I wouldn't even consider it. And wouldn't you know, that my son's intoeing isn't even noticeable anymore, it basically fixed itself with his future growth.

    The doctor did mention that most of the fastest runners are slightly intoed.

  7. #67
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    @ Balletmom

    Wow that was certainly very interesting and informative!

    So at least rhythmic gymnastics and swimming tend to favor abnormal body types. There are probably other sports. I mean when the most decorated Olympic athlete ever needs yearly screenings for emergent Marfans then that likely says something about the confluence between swimming and Marfanoid characteristics.

    Maybe there is some rarefied body type that excels in dressage because so few ever make it out of the lower levels despite years of lessons. I am not sure what it is other than being a male... the male pelvis is such that they can sit much more effectively much easier. It's very annoying.

    The top women tend to be all over the map in body type so I don't know if there is one type for women. It might just be those women got spitting mad enough and determined enough to get to the top out of sheer frustration. Just a wild guess.
    Last edited by Pooka1; 06-26-2009 at 09:19 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."

  8. #68
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    in-toeing

    Ballet Mom

    Interesting link on in-toeing.

    For whatever reason it only shows up when he sits down and stretches. He stands and walks (at least visibly) like every other kid.

    I assume it will slowly go away as he gets older.

    No way would I want surgery for this.

  9. #69
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    Pooka1,

    I suspect that most sports have some physical trait or traits that provide an advantage to the person who has them and often those traits are outliers i.e. unusual like Phelps. That is why the Soviet system would screen their kids and decide which sport they would go into for them. Unfortunately, that doesn't provide for sheer talent, determination and drive which is what the US relies on!

    I suspect someone, somewhere has probably already figured out the secret formula for dressage...

    Dingo,

    I would just run it by his ortho at his next x-ray appt., I'm sure the orthopedist will quickly tell you what it is and whether it is a concern. Probably it won't be a concern, but I'm all for letting the doctors know anything that concerns me and see what that might trigger in their minds. Usually nothing, but it puts my mind at ease.

  10. #70
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    Quote Originally Posted by Lorraine 1966 View Post
    I didnt know that Linda, but find it interesting. Why? is that? I am probably showing my lack of understanding here but I am genuine.

    Regards
    Lorraine.
    Sorry, Lorraine. I'm pretty clueless when it comes to things other than bone and discs. If you do a PubMed search on scoliosis and elastin, you'll see a bunch of different studies.

  11. #71
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    Pooka- I'm mainly interested in the horseback riding aspect of this post... I am an equestrian as well and in all pictures you can see my lower back shoving out to the left side... I favor equitation over the other disciplines and am trying to correct my "center" on the horse. Have you read centered riding or something along those lines? I read somewhere that the author had scoliosis as well and was wondering if the book is worth reading.

    I think a lot of the riders are imbalanced in the sense that some people are left handed others are right handed and you favor one side. I think if people without scoliosis trained to have both sides equal they wouldn't be so imbalanced but that is completely my opinion with absolutely no evidence to back it.

    I have a month or so before I'm allowed to ride again (shoulder surgery) so I'm trying to get back in shape and would love to know if you know of anything that can help me be more centered when riding... I would hate to hurt all of my horses backs by sitting heavy to one side because of my stupid back... Mechanically I have no problem- I do well at shows horses respond well I've riden experienced horses but I know I am not as good as I could be with my back the way it is and I'm sure at times my signals while riding are confusing.

    Thanks in advance for any riding advice you can give!!

  12. #72
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    @riding

    Quote Originally Posted by trcylynn View Post
    Pooka- I'm mainly interested in the horseback riding aspect of this post... I am an equestrian as well and in all pictures you can see my lower back shoving out to the left side... I favor equitation over the other disciplines and am trying to correct my "center" on the horse. Have you read centered riding or something along those lines? I read somewhere that the author had scoliosis as well and was wondering if the book is worth reading.
    I have both of Sally Swift's Centered Riding books. She died recently... I posted a thread about it. Huge loss.

    I think those two books are among the best out there for suggesting effective visualizations. Almost everyone, not just scoliotics, is imbalanced. Some people with straight spines are so imbalanced that they can lame a horse as I previously stated. I am saying this so that you do not feel singled out as a scoliotic in terms of trying to achieve evenness... everyone struggles with it.

    I also want to tell you that I know of at least one FEI dressage rider with scoliosis (lumbar) who trained in Europe with a top guy. She has learned specific things she has to do with her seat, hip and shoulder to maintain evenness. She is a professional rider and trainer so there is hope you can achieve evenness.

    I think a lot of the riders are imbalanced in the sense that some people are left handed others are right handed and you favor one side. I think if people without scoliosis trained to have both sides equal they wouldn't be so imbalanced but that is completely my opinion with absolutely no evidence to back it.
    I think you are generally correct but I don't think it is always your handedness being the dominant side. Also, work on the ground likely won't translate to evenness in the saddle. I know plenty of folks who are very fit, athletic, aerobic, etc. who struggle as much as the next person in terms of balance in the saddle. There is no substitute for wet saddle blankets.

    I have a month or so before I'm allowed to ride again (shoulder surgery) so I'm trying to get back in shape and would love to know if you know of anything that can help me be more centered when riding... I would hate to hurt all of my horses backs by sitting heavy to one side because of my stupid back... Mechanically I have no problem- I do well at shows horses respond well I've ridden experienced horses but I know I am not as good as I could be with my back the way it is and I'm sure at times my signals while riding are confusing.
    First, again, EVERYONE struggles at first with not confusing the horse. You are not alone. A good instructor with a VERY good eye can help you be even.

    I just think you might need to consider that some of your difficulty in learning is shared by everyone including those with no spine problem. In other words, this is such a universal problem for folks trying to learn to ride that it's hard to say how much the scoliosis per se is affecting your balance over and above a random person. But if you have a noticeable curve, it likely is.

    Again, you need a good set of eyes on the ground and some exercises that can help you constantly check that you have even weight on your seatbones when needed and can shift the right amount of weight to each seatbone with correct timing.

    A test of evenness is to pick a spot to ride to, ride "legs away," and just use your two seat bone weights to stay on the line. Do this in walk, trot and canter if you can.

    Thanks in advance for any riding advice you can give!!
    I don't know how much I helped but you're welcome!

    Good luck.
    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."

  13. #73
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    The Soviet system chose those children, the children didn’t choose it. Bulgaria, as a former communist country was very close to the Soviet Union, and like all good communist countries screened the children at a very early age into ballet and rhythmic gymnastics, based on many measurements. You can see the Kirov Ballet’s (now known as the Mariinsky) results from this very young screening as every member of their ballet is hyperextended (and the same height too!), very deliberately.
    I wanted to add a study that I came across that pertains to this comment I made earlier in this thread about the Soviet and Bulgarian screening systems and I have highlighted the relevant comment that backs up my comment, in case anyone was interested:

    2.15 Scoliosis And Rhythmic Gymnastics

    P. Tanchev, A.Djerov, A.Parushev, D.Dikov
    University Hospital of Orthopaedics "Gorna Bania", 56, N.Petkov St., 1614 Sofia, Bulgaria. Phone: 00359 2 55 01 42; Fax: 00359 2 55 30 63
    In a survey of 100 girls, aged 11-15, having been trained actively in rhythmic gymnastics at least for a period of 5 years, we found a fivefold higher incidence of adolescent idiopathic scoliosis (AIS). These data were compared to the results from a screening of 4800 students of the same age, carried out in Sofia by the same examining team in 1996.

    A detailed familial and past diseases anamnesis was registered in all the probands. General physical and meticulous back examinations were carried out, and X-rays were taken in all the AIS suspected cases. Special attention was paid to the presence of generalised joint hyperlaxity, which had been usually the main criterion for the primary selection of 5-year-old-girls to start training in rhythmic gymnastics. Eating regimen, weight-height relations, growth and maturing development (delayed menarche or secondary amenorrhea) were assessed too. Intensity, duration and specific moments of the training process were carefully analysed, and a significant asymmetric loading and an extreme physical overloading of the body were found.

    This study supports the multifactorial origin of AIS, and strongly suggests the important role of the following aetiologic triad in disturbing the growth of vertebrae and intervertebral discs: generalised joint hyperlaxity as a hereditary characteristic; delayed maturing caused by physical, dietary and psychic stresses; and persistent asymmetrical overloading of the growing spine. These findings in girls, practising rhythmic gymnastics, generate a hypothesis which needs to be juxtaposed on the characteristics of non-gymnast patients with AIS.

    http://www.ndorms.ox.ac.uk/pzs/Group_2/Tanch.html

    Interesting that the results still come out as multi-factorial. There is room for an infectious trigger there, in my mind!

  14. #74
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    thought i'd throw my 2 cents in...not any survey or study, just experience...

    when my back curves, i am not equally ANYTHING anymore..including strong...the side my worst curve is on (left) is my weaker side..always has been...affected my ballet turns & other movements...can lift more weight with right than left, etc...sooooooooo.....

    in my own particular body, this is true...dont know about anybody else's body....

    also, common sense would say curved & crooked body (my own) is unequal in all things....but again, just my opinion & experience...and the chicken (scoli) came before the egg, at least in my case....

    jess

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