Case study: Non-surgical reversal of scoliosis in a mature adult

[Pooka1]

That's an interesting idea. Do you think it relates at all to the Schroth idea of "derotational breathing"? (I think that's the right term.)

No idea. I don't think what Schroth is doing is what Hawes did just on the basis of results but I have no idea.

Martha talks about alot of breathe type work, yoga requires breathing work, as does the Schroth method. I *think* that leaves out the SEAS person, but I'd have to look again.

Hawes seems to have been motivated to solve her respiratory problems, not reduce her curve. I bet she was blind-sided by the curve reduction as she only sought to improve her breathing I think.

It may turn out that only the people who do the right kind of breathing get any good result with the rest of the PT as a confounder.

[hdugger]

It may turn out that only the people who do the right kind of breathing get any good result with the rest of the PT as a confounder.

That wouldn't explain the SEAS result, though.

[Pooka1]

That wouldn't explain the SEAS result, though.

Okay I read that report.

My main question is how many people were doing these exercises wherein exactly ONE showed a reduction? I mean she can't have been the only person and I suspect she might have been part of a study group.

If she was part of a larger study group and they ONLY mentioned the one success out of many failures then that is not honest.

It is another result that if only one out of many followed the exercise protocol. Then we have to ask why.

Last, this seems completely dependent on continuing the daily PT. I hope she never gets sick or incapacitated.

[hdugger]

Okay I read that report.

My main question is how many people were doing these exercises wherein exactly ONE showed a reduction? I mean she can't have been the only person and I suspect she might have been part of a study group.

Yeah, I actually sent the first three authors an email yesterday asking something like that (except, in a more neutral way ). I also asked if she'd maintained her curve and how much time it required to maintain it.

I'll let you know if I hear back.

The thing is, a sustained reduction in a curve is so unexpected that it doesn't require anything more than a case report, nor does it really matter how many people it works for. I don't think we're looking at a future where exercise completely or even mostly replaces surgery. But, if it works in *some* cases then it certainly should be offered to pre-surgical adults just to see if they respond. If even 1 out of 100 avoided surgery due to exercise, that would be a huge deal.

On the question of sustaining the reduction, I haven't got that far yet There are a bunch of question I would need to answer to evaluate where the risks lie. But, first, I want to figure out what actually works in exercise.

[Pooka1]

You're an excellent mommy.

[mamamax]

Hawes seems to have been motivated to solve her respiratory problems, not reduce her curve. I bet she was blind-sided by the curve reduction as she only sought to improve her breathing I think.

It may turn out that only the people who do the right kind of breathing get any good result with the rest of the PT as a confounder.

I've actually had very similar thoughts. It could be that there is a combination of breathing and PT that work together well. But isn't that basically what Schroth is based on? Spinecor does utilize some sort of PT and may also create a different breathing pattern. You know what? I'm going to write Rivard and Colliard and inquire about that.

[mamamax]

SEAS & Adult Curve Reduction

A few months back I wrote the first author on the paper "Adult scoliosis can be reduced through specific SEAS exercises: a case report", received a nice reply and the following web link for information and full reports: http://www.isico.it/approach/default.htm

The Textbook
THE EVIDENCE BASED ISICO APPROACH TO SPINAL DEFORMITIES
http://www.isico.it/approach/summary.htm

With the publication of Martha's follow up, this becomes ever more interesting to me - maybe interesting to some others also.

Email address for the authors if anyone has further questions is also within the above web page.

[Pooka1]

Okay I scanned their pubs.

That seems to be the only case of a temporary curve reduction.

Now we need to determine how many studies they did involving how many patients over the years wherein exactly one had a temporary curve reduction.

Most importantly, we have to determine if that one patient was part of a study WITHOUT that fact being mentioned. If this turns out to be the case I won't be reading any more papers from that group.

[hdugger]

Most importantly, we have to determine if that one patient was part of a study WITHOUT that fact being mentioned. If this turns out to be the case I won't be reading any more papers from that group.

I believe it's common in medicine to report unusual cases, outside of whatever study they occurred in. So, if I make a concoction to cure the common cold and in the middle of the test it turns one of the participants into a rabbit, I might report on that very odd fact without laying out all the facts of the study. A case study is just that: a case study. It isn't presented to indicate that a result is common or expected. Quite the opposite - it quickly gets out the information that a very unusual event has occurred. Once it occurs, you might then go back and design a new study to see if you could repeat the uncommon occurrence. But I don't have any sense that it's considered underhanded to just report it as a case study.

Again, not that there is any evidence that this is part of a larger study. Just to let you know that this is not considered an improper procedure, should that turn out to be the case.

[hdugger]

It might also be worthwhile to pause and see how far we've come.

A few days of discussion and we've gone from thinking that you can't reduce a curve with anything less then an Herculean 4 hour a day regime, to feeling that it's necessary to obscure a study where only one participant could reduce their curve in 30 minutes a day!

Next, we'll be scoffing at anyone that can't reduce every curve in 15 minutes a day.

That's progress!

[hdugger]

Sorry for the stuttering posts - just trying to make a quick last sweep through the literature before my son gets home tomorrow.

On the question of weighing surgery against continued exercise, I thought the discussion at the end of the SEAS study was quite good:

"This case opens up a new perspective in the approach to
adult scoliosis patients that appear to progressively
worsen. Instead of a fatalistic "wait and see" approach, an
active one could be envisioned and could help in some
cases at least to postpone, and eventually avoid surgery.
The advantage of maintaining spine mobility function
and avoiding the risks of surgery is counterbalanced by
the need of exercising regularly and being followed up
carefully in a specialised Center by a rehabilitation team
[28]. Spinal mobility allow a distribution of static and
dynamic loads all over the spine, avoiding undue overload
on single segments; it also permits to continue activities
of daily life without any of the limitations that
caution impose to fused patients. The final choice is obviously
up to the patient [29,30], made aware of advantages
and disadvantages of each option, understanding the difference
between a risky one-shot treatment and a longterm,
continuous one that requires collaboration and
motivation, while in any case giving the possibility to go
back to the other therapeutic option in case of failure. If
other studies will confirm this case report, exercises could
be considered and discussed with patients, allowing them
to reach the best individual solution for their long term
scoliosis management [30]."

and this

"This case report shows it is possible obtaining a significant
improvement of scoliosis in adults with SEAS exercises.
Marty-Poumarat showed that rate of progression in adult
scoliosis is linear [6]. So, it is possible to establish an individual
prognosis repeating x-rays every 4–5 years in adulthood.
When x-rays detect a significant worsening, it is
possible to recover and then to possibly stabilize scoliosis
through SEAS exercises, thus avoiding the need of surgery."

[tonibunny]

I'm interested in whether curve type affects the effectiveness of exercise-based therapy for scoliosis.

It's known that it is much, much more difficult to cast double curvatures in infantile/juvenile scoliosis because it involves trying to derotate each curve in opposite directions at the same time. It seems to me that it would be extraordinarily difficult for an adult to work on a double major curve with exercises - is there any data on this?

[Pooka1]

where only one participant could reduce their curve in 30 minutes a day!

I think she may have exercised more no? Didn't it say > or = to 30 minutes? Maybe she exercised more than anyone else since there are no other reported cases from that group with a reduction.

[Pooka1]

With regard to the posted discussion, I think they need to address the degenerative changes that seem to occur earlier and more frequently in curved spines versus straight spines.

Yes 85% of adults will have back problems at some point in their life but what if untreated scoliosis causes degenerative changes that result in nearly 100% of the patients getting painful degenerative changes at a far earlier median age than the general population?

As far as I know, a common reason fusions have to be extended is due to imperfect balance achieved in all planes from the procedure. But how does that balance compare to the average untreated curve of 35* or 50*?

Fused areas will never experience any of these problems. If they get the balance right on the thoracic fusions and if the pedicle screws can solve the lumbar extension issue, then I think it is not crazy to suggest this fused population will have less degenerative changes than the average person out in the population.

I'm just a bunny but I would like to see the conservative method proponents address this issue in my lifetime or before I get hit by a bus or at some point.

[Dingo]

minimal effort

hdugger

Next, we'll be scoffing at anyone that can't reduce every curve in 15 minutes a day.

In growing children Torso rotation worked for every child with a small or medium curve in just two short sessions per week. I think a session was something like 5 or 10 minutes. The effort, time and expense involved was minimal.

I'm surprised that exercise has any impact on Scoliosis in fully grown adults. The fact that it does says a lot about how closely the muscles of the back must be involved.