Another study connects asymmetry and Scoliosis

[aterry]

I've looked at some of the information posted on this and other threads about side shift exercises. I only found a few photos. I'm not clear about how the person keeps other body parts stable while shifting the spine. It seems to me that the hips and/or shoulders would shift, at least slightly.

In terms of musculature and asymmetry, I can see how these would be variables in the scoliosis puzzle (at least for some patients). But I'm curious about dancers. My daughter is a dancer and I've read on this and other sites that dancers have a higher prevalence of scoliosis than the general population but dancers are quite strong--not muscular like body builders or football players but pound-per-pound my daughter is the strongest person in our family. Also she has done mostly ballet which emphasizes symmetry, yet her convex side is weaker than her concave side and has continued to be so even though she's been doing PT for 6 months. She does have a leg-length discrepancy of 1/4" but I'm not sure how that would relate to the imbalance in muscles. She's been using a lift since diagnosis.

[skevimc]

I've looked at some of the information posted on this and other threads about side shift exercises. I only found a few photos. I'm not clear about how the person keeps other body parts stable while shifting the spine. It seems to me that the hips and/or shoulders would shift, at least slightly.

In terms of musculature and asymmetry, I can see how these would be variables in the scoliosis puzzle (at least for some patients). But I'm curious about dancers. My daughter is a dancer and I've read on this and other sites that dancers have a higher prevalence of scoliosis than the general population but dancers are quite strong--not muscular like body builders or football players but pound-per-pound my daughter is the strongest person in our family. Also she has done mostly ballet which emphasizes symmetry, yet her convex side is weaker than her concave side and has continued to be so even though she's been doing PT for 6 months. She does have a leg-length discrepancy of 1/4" but I'm not sure how that would relate to the imbalance in muscles. She's been using a lift since diagnosis.

Side-shift is a pretty interesting therapy. I've read a bit about it and have some very informal experience with it. You're right in that it is difficult to keep the body parts stable. You move one thing and another thing compensates. It requires quite a bit of assistance at first. Sitting facing a mirror trying to physically and actively straighten the spine. The interesting part about the den Boer paper is that they actually take an x-ray of the 'straight' spine. At any rate, the principles involved are very similar to Schroth and Clear. The idea is to actively use the paraspinal muscles in a functionally meaningful way. With Schroth, they also try to straighten the spine during therapy but they use physical methods such as bars and rod to lean on or apply some external stabilization. Even though the SS therapy paper shows mostly short term success it is another promising therapy.

As far as dancers are concerned. I don't know the specific stats but think that dancers do have a slightly higher incidence. Rhythmic gymnasts definitely do. Depending on how fast she is growing will also have an effect on curve progression. Although it certainly seems contradictory at how strong your daughter is to then say it is because of a strength asymmetry. Who knows how much that plays a role? A lot? Minimal? It'll drive you crazy thinking about it.

[skevimc]

Googling . . . They're calling it side-shifting. Here are some studies:

http://www.springerlink.com/content/u8c5d80y3dl9b8j4/
(with young patients with small curves, compared to a "historical" bracing control and found equiivalent - whatever we think that means

http://www.ncbi.nlm.nih.gov/pubmed/15457756
(in skeletally mature patients - no progression in curve over 4 years)

Not sustainable in that studies have shown that the effect goes away? Or that it's not a reasonable thing to ask people to do?

The idea is to get the patients trained and able to do this on their own. There is a training phase, then an at home phase with interval check-ups to ensure proper form and alignment.

The historical bracing control was a retrospective chart review from the same place that did the therapy.

[LindaRacine]

Hi Skevimc...

Welcome to the forums. I'd love to hear what your connection to scoliosis is. Do you have it, have a child with it, or are you some sort of practitioner?

Thanks!

--Linda

[Dingo]

exercise and scoliosis

This study of 2,387 children found no connection between athletics and Scoliosis.

September 2008: Adolescent Idiopathic Scoliosis and Exercising: Is There Truly a Liaison?

Results. In 99 cases (athletes: 48, nonathletes: 51), AIS was radiographically confirmed (Cobb angle >10°). No statistically significant difference was found between athlete and nonathlete adolescents (P = 0.842), athlete and nonathlete boys (P = 0.757), and athlete and nonathlete girls (P = 0.705), as far as the prevalence of AIS was concerned. The mean value of the Cobb angle of the main scoliotic curve was not statistically different between male athletes and nonathletes (P = 0.45) and female athletes and nonathletes (P = 0.707). With the Cobb threshold reset at 20°, no statistically significant differences were detected either.

250,000 years of natural selection ensures that any normal level of physical/sports activity is going to be safe, if not beneficial for children.

Extreme, competitive athletics may be a different story. And of course athletics that require children to move in an "unnatural" way could in theory be harmful. However only a tiny percentage of children engage in that type of activity.

[turtlelover]

Another study related to sports

The practice of physical and sporting activity in teenagers with idiopathic scoliosis is related to the curve type.

Meyer C, Haumont T, Gauchard GC, Leheup B, Lascombes P, Perrin PP.
Nancy-University, University Henri Poincaré, Nancy 1, Balance Control & Motor Performance, UFR STAPS, Villers-lès-Nancy, France.

Idiopathic scoliosis (IS) is correlated with a muscular disequilibrium of the spine and an alteration of balance control, efficient performance of the latter being necessary for physical and sporting activities (PSA). However, the type of the IS curve has different effects on muscle and on balance control according to the primary curve location. This study aimed to determine the relationships between IS type and PSA practice. One hundred and sixty-nine girl adolescents with IS [double major curve (DMC) scoliosis: n=74; single major curve (SMC) scoliosis: n=95] and 100 age-matched control girl adolescents completed an epidemiological questionnaire informing on curricular and extracurricular PSA. Adolescents with DMC scoliosis practised more PSA than those with SMC scoliosis. Moreover, among all PSA referenced, gymnastic activities are the most practiced PSA both in IS teenagers, whatever the curve type, and in controls. Besides, teenagers practising gymnastics were more numerous in those with DMC scoliosis than those with SMC scoliosis and controls. The highest proportion of adolescents with DMC scoliosis practising PSA, especially gymnastics, could be linked to the fact that they are less subject to scoliosis-related biomechanical repercussions leading to a better balance control, which is essential in these PSA.

PMID: 18248544 [PubMed - indexed for MEDLINE]

[turtlelover]

Asymmetry

Spine (Phila Pa 1976). 1990 Feb;15(2):61-4.
Handedness and scoliosis convexity: a reappraisal.
Goldberg C, Dowling FE.

Department of Orthopaedics, Our Lady's Hospital for Sick Children, Crumlin, Dublin, Ireland.
The handedness of 254 girls with idiopathic scoliosis, minimum age eight years at diagnosis, attending Our Lady's Hospital was related to their scoliosis convexity. Curve patterns were assigned to right or left on the basis of the convexity of the low thoracic component only, regardless of primary curve. The curve pattern matched handedness in 82%. Of 228 right-handed children, 197 had a right convex curve pattern; of 26 left-handed children, 12 had a left convex pattern. The correlation between scoliosis configuration and handedness was statistically significant. This is in contrast to the findings of previous studies, which have considered convexity only, without reference to the configuration of the whole spine. The implication of this finding is that scoliosis is associated with cortical functions.


I have NO qualifications to make comment on any study, but I don't understand why the researchers assumed scoliosis was associated with cortical function. My not everyday muscle use?

[Bigbluefrog]

so most of the right handed children would have a major curve on the rt thoracic?

[tonibunny]

Looks like the majority of righthanded children had a right thoracic curve. But then, so did over half of lefthanded children too.....I don't understand how they have decided that "the implication of this finding is that scoliosis is associated with cortical functions."

12 out of 26 children isn't 82% is it? When you break it down, only about 46% of the lefthanded kids had lefthanded curves - ie less than half of them!

[Dingo]

handedness and hair whorl

tonibunny

12 out of 26 children isn't 82% is it? When you break it down, only about 46% of the lefthanded kids had lefthanded curves - ie less than half of them!

On a possibly unrelated topic hair whorls seem to correlate with handedness. Wiki: Hair whorl

Roughly 90% of right handed people have a clockwise hair whorl while 10% have a counterclockwise hair whorl.

Among left handed people the number is evenly split. Half have a clockwise whorl, the other half have a counterclockwise whorl.

Is that roughly the same way curve types were distributed?

BTW I should add that nobody knows for sure what causes left and right handedness. To complicate matters further disease and misdevelopment can trigger left handedness. For example half of all premature babies are born left handed and children exposed to meningitis are much more likely to be left handed. In addition older mothers are more likely to have left handed babies probably because they have more difficult pregnancies.

[tonibunny]

Now that is really interesting Dingo! Yes, it is roughly the same as the curve patterns.

Here in the UK, you sometimes get people who appear to be righthanded but are in fact naturally lefthanded. This is because until quite recently, being lefthanded was discouraged and children were forced to write with their right hands. This was the case with my boyfriend, who had all sorts of problems with dyspraxia and finally had various tests done when he was in his 30s - and it turned out that he was naturally very left-orientated. The educational psychologist who tested him said that he might not have ended up with so many problems if he'd been allowed to use his left hand as his brain wished him to.

Did this ever happen outside the UK? If so, I wonder if it has any bearing on these sorts of results. If so, the correlation between righthandedness and right thoracic curves might not be so strong.

[Dingo]

lefties

Tonibunny

Did this ever happen outside the UK?

My uncle who is about 70 years old was born left handed but was trained to be right handed in school. He grew up in America so retraining lefties must have been a worldwide phenomenon.

[mamamax]

Tonibunny - Yeah! I'm one of them - tried to be a lefty and was retrained to be a righty. Maybe this explains a lot

Wondering how this factors in - and doubt there is any study of it.

[Bigbluefrog]

We are seeing a chiropractor in addition to bracing and PT therapy for her scoliosis.

One day I thought her curve looked worse...the curves seemed increased....
the concave areas more pronounced.

the chiro...explained the muscles are stretched on the concave side and tight on the convex side. He rec. stimulating the relaxed fibers of muscle with massage/ tapping. I started to do that 3 times a day...and it looks better.

Why aren't more doctors interested in this asymmetrical dysfunction with muscle fibers with regards to idiopathic scoliosis. I can see a difference after 3 days.
http://journals.lww.com/spinejournal...lescent.8.aspx
And I have read an article regarding the study of the muscle fibers being different after taking a biopsy of both sides.

http://www.springerlink.com/content/hb81tujr8flvvj4a/

[michael1960]

Bigbluefrog

I just read your post. We are also seeing a chiropractor, doing some PT, and bracing (two braces) too.

I find your comments very interesting regarding the "curves seemed increased". And the chiro's explanation that the muscles are stretched on the concave side (inside part of the curve) and tight on the convex side (outside part of the curve). Can you elaborate on this? We have worked with 4 orthopedic surgeons and 3 chiros and I get different explanations of muscles being stretched vs tight. Some have said the muscles on the concave side are tight and need to be stretched and the muscles on the convex side are stretched and need to be tightened.

I read the studies in the links you provided but really did not understand the relevance (probably my lack of understanding the muscle structure).

So, to make sure I understand, the chiro had you massage/tapping the muscles on the convex side (right side of the spine for someone with a right thoracic curve).

We will be doing another 2 week treatment in June to see if we can continue to reduce the curve (right thoracic curve).

I would appreciate you sharing as much as you can on your chiro treatment either here, in a new thread, or send me a PM. And any further explanation of the stretched vs tight muscles. Also, when discussing therapy, what is the recommendation on what muscles should be "stretched" and what muscles should be "strengthened".

Sorry for all the questions but we have experienced something very similar to you when using a chiro and I would like to learn from your experience. It may help us in our upcoming 2 week treatment.

Thank You
Michael