Clear - 63* -> 15* in a month?

[hdugger]

I happen to have, if not a hamster joke, at least a funny hamster story.

I had a friend, a preschool teacher, who had a hamster named Elvis as a classroom pet. She often put Elvis in his little plastic hamster ball and let him roll around the classroom. One day, at the end of class, she couldn't find Elvis. She was looking around the hallways when she ran into a new teacher, who helpfully asked her what she was looking for.

She said "I've lost Elvis?"
Other teacher "Elvis?"
She "Yes, he was just in my classroom, and now I don't see him anywhere. Have you seen him?"
Other teacher . . . (long pause) "I think he's dead."
She: "Dead! Dear god, how did he die!"
Other teacher "I think it was drugs"
She "Drugs! Dear god, how did they get drugs into that plastic ball?"
Other teacher . . . long pause "plastic ball?"

I believe they eventually sorted it out

[mamamax]

A few corrections/clarifications:

* Because the standard treatment for scoliosis is surgery, there's a tendency to compare other treatments to it on the basis of "permanence." That's not, in general, how we evaluate medical treatments. Many diseases are "managed" - think of asthma and blood pressure medicines, or even diet and exercise for obesity. For any disease, like scoliosis, in which there is no cure, all solutions are imperfect. Surgery, while permanent, also permanently disfigures and has a host of serious risks. (And, in up to 25% of the cases, is not even permanent.) Exercise, while needing ongoing applications to "manage" the disorder, is less risky and less disfiguring (if, big if, it avoids surgery).

* I think it's misleading to refer to exercise as "being studied for hundreds of years." Surgery, too, was studied for hundreds of years, and the first few hundred of years worth of results were pretty terrifying. We've only seen acceptable results within the last 50 years or so, and only good results in the last 5 years or so.

* Likewise, as surgery has advanced, exercise has also advanced. It's only within the last 10 years that I've seen reports of patients being able to hold a curve reduction with exercise.

Agreed ... And would have to say large advances are being made in both areas.

You know, sometimes the discussions we have here can get quite deep. I find that this can result in strange dreams. My dream of a few nights past: I was in the future - about 200 years from now. I had scoliosis. The standard treatment was for a doc to come to the home and perform brain surgery. It as real simple, took less than five minutes, required no anesthesia and there was no pain - and the treatment was permanent leaving the spine perfectly flexible.

This leads me to have a deeper appreciation of Sharon's ability to know just when we need a good hamster joke. Thanks Sharon!! The original hamster dance must be legendary - and the Elvis offering from Heather ain't bad either!

[RitaR]

We all knew Elvis lived on . . . now we find out he's been in school. Let alone near a plastic ball...Ha!

[mamamax]

ok then ... where were we? Having trouble getting the hamster dance out of my head :-)

[hdugger]

I think we were on rigidity and exercise.

I know that Martha's book talks about reducing the rigidity of a curve, since the definition of scoliosis includes the idea of a rigid curve. But . . . I wonder if that's the most useful course of inquiry. While I understand what she's getting at, I'm not certain exactly what role rigidity plays in curves which are reducible with exercise.

I hypothesize that a curve has to be flexible before exercise can reduce it, but I don't have any evidence. The SEAS people suggest something similar (that exercise reduces the flexible part of the curve, which they think is contributed to by muscles and ligaments), but that's also just a hypothesis on their part.

To test it would require more than our current methods seem to allow. I mean, really, doctors can't even show that bracing works after all these years of studies.

I think the thing we're really trying to understand, beyond grappling with these more complex ideas is, if exercise can reduce a curve, what kind of curve can it reduce? Again, I'm using reduction of curve as the tip of the iceberg of an exercise which can keep a curve from progressing.

If I go over my data points (in my head - I must get a better method of keeping them straight!), I believe that 4 of the 6 are under 30, and two are over. That jibes with what I'd expect - that the same people who see better correction in surgery also see better results with exercise. But, I don't know what the underlying reason is. It could be rigidity. But it might also be that the vertebrae are less compromised in the young. Right now, I'm not sure the underlying cause matters. What probably does matter is identifying the group of people most likely to benefit from exercise, so that it's possible to use that group to finetune the methods.

[mamamax]

Beyond the question of PT holding/reducing curves, the question of PT changing flexibility is interesting if it changes the bending out potential of a curve to such an extent that the lowest instrumented vertebra choice changes (i.e., most distal vertebra that is leveled upon bending). And if that is the case, is that good or bad? That is, does increasing flexibility apparently shorten or lengthen a fusion based on vertebral leveling?

That is a great question. Did you ask your surgeon - or will you? I think the answer from a surgical standpoint would be most interesting.

[hdugger]

That is a great question. Did you ask your surgeon - or will you? I think the answer from a surgical standpoint would be most interesting.

Anecdotally, everything I've heard suggests that flexibility gives a better correction in surgery. But I have no idea what effect is has on curve progression (Linda's question). The most flexible people (adolescents) have the most curve progression, but presumably that's mapped more to growth then to flexibility.

[mamamax]

Anecdotally, everything I've heard suggests that flexibility gives a better correction in surgery. But I have no idea what effect is has on curve progression (Linda's question). The most flexible people (adolescents) have the most curve progression, but presumably that's mapped more to growth then to flexibility.

And that is my understanding also. What caught my attention was Sharon's questioning how increasing flexibility may shorten or lengthen a fusion based on vertebral leveling. Something to ponder I think - and an interesting observation.

[mamamax]

I think we were on rigidity and exercise.

I know that Martha's book talks about reducing the rigidity of a curve, since the definition of scoliosis includes the idea of a rigid curve. But . . . I wonder if that's the most useful course of inquiry. While I understand what she's getting at, I'm not certain exactly what role rigidity plays in curves which are reducible with exercise.

I hypothesize that a curve has to be flexible before exercise can reduce it, but I don't have any evidence. The SEAS people suggest something similar (that exercise reduces the flexible part of the curve, which they think is contributed to by muscles and ligaments), but that's also just a hypothesis on their part.

To test it would require more than our current methods seem to allow. I mean, really, doctors can't even show that bracing works after all these years of studies.

I think the thing we're really trying to understand, beyond grappling with these more complex ideas is, if exercise can reduce a curve, what kind of curve can it reduce? Again, I'm using reduction of curve as the tip of the iceberg of an exercise which can keep a curve from progressing.

If I go over my data points (in my head - I must get a better method of keeping them straight!), I believe that 4 of the 6 are under 30, and two are over. That jibes with what I'd expect - that the same people who see better correction in surgery also see better results with exercise. But, I don't know what the underlying reason is. It could be rigidity. But it might also be that the vertebrae are less compromised in the young. Right now, I'm not sure the underlying cause matters. What probably does matter is identifying the group of people most likely to benefit from exercise, so that it's possible to use that group to finetune the methods.

Yes, that is where we were. The relationship between rigidity and exercise. And it would appear that the answers to this may differ between the young and the old (or skeletally immature and mature).

I don't know. Martha - three curves. Diagnosed at age 11. No progression from age 11 to 40 doing (selected) exercises faithfully as prescribed by her diagnosing surgeon. These exercises were from a program outlined in Ponseti & Friedman. More about that found here (on page 6): http://www.scoliosisjournal.com/cont...-7161-4-27.pdf

No curvature progression from childhood to adulthood - and no curvature reduction either, with exercise.

One would think her curves were more flexible (less rigid) with this exercise than they would have been without (based upon literature) - if so, the flexibility did not appear to cause any harm from childhood through adulthood. If anything this may have kept her from progressing. Seems so anyway - what was she diagnosed at in childhood 40 something degrees thoracic? I think most literature regarding that magnitude in an eleven year old supports continued progression?

Improvement only came about as an adult and as a secondary result of exercises which were targeted to improve her chest wall. Then we find things reversing. She also worked on psoas muscles and had some osteopathic adjustments. So - the exercise changed in adulthood to something targeted towards addressing chest wall - she worked on the psoas involvement - and also had osteopathic adjustments .. following years of a standardized exercise program which may have played an important role in stabilization.

Her case is complex in that she does have thoracic, lumbar, and cervical curves to deal with. But the fact that continued reduction comes with continued exercise targeted towards the chest wall is interesting because the exercises like Schroth, Pilates, and Yoga (and others) also result in chest wall improvement. Whereas the exercises like she was prescribed in childhood, do not.

Bracing - while controversial, I have experienced benefit from that - as a skeletally mature adult. Naturally I'm drawn towards learning more and it appears that from the literature, exercise may be beneficial in both brace weaning and in helping maintain any correction achieved.

Yes, agree - identifying who does best with what is important in making our choices. I'm grateful for what we are discovering - the future will hold more to draw from. The Psoas muscle involvement in scoliosis may prove an interesting topic of discussion.

Sunday Morning Addendum: This is only a discussion and exploration into what I "think" I may see based on personal observations. What do I know beyond shadow of doubt? Answer: Nothing. Except that the hamster dance is a super great stress buster :-)

Reference: Hamster Dance provided by our resident research scientist Pooka1
http://www.webhamster.com/

[Pooka1]

I happen to have, if not a hamster joke, at least a funny hamster story.

I had a friend, a preschool teacher, who had a hamster named Elvis as a classroom pet. She often put Elvis in his little plastic hamster ball and let him roll around the classroom. One day, at the end of class, she couldn't find Elvis. She was looking around the hallways when she ran into a new teacher, who helpfully asked her what she was looking for.

She said "I've lost Elvis?"
Other teacher "Elvis?"
She "Yes, he was just in my classroom, and now I don't see him anywhere. Have you seen him?"
Other teacher . . . (long pause) "I think he's dead."
She: "Dead! Dear god, how did he die!"
Other teacher "I think it was drugs"
She "Drugs! Dear god, how did they get drugs into that plastic ball?"
Other teacher . . . long pause "plastic ball?"

I believe they eventually sorted it out

Excellent.

Hamster stories, and of course a motion to adjourn, are always in order.

[Pooka1]

That is a great question. Did you ask your surgeon - or will you? I think the answer from a surgical standpoint would be most interesting.

I have enough salient questions in the time allotted... I would never ask him moot questions.

I'm just saying that I think it could be dangerous if PT changed the last instrumented vertebra choice from what it should be to something other. That could be a serious mistake.

[Pooka1]

No curvature progression from childhood to adulthood

This is seemingly more and more common as we have 2-3 cases just in this sandbox of even large curves holding from adolescence into adulthood for decades.

Though certainly not common, it is clear at this point that you can never assume a brace or PT or chanting or whatever held even a large curve just because you were doing that treatment. Doing nothing achieves the same result in some cases.

[hdugger]

I'm just saying that I think it could be dangerous if PT changed the last instrumented vertebra choice from what it should be to something other. That could be a serious mistake.

Isn't the last instrumented vertebra chosen from the bending xrays, where any part that doesn't resolve is the fixed part of the curve and that's what they fuse to? I'm not sure I understand how being more flexible would make the fusion longer? If that were the case, wouldn't you encourage young people to wait until they're older to have surgery, since they'd be less flexible then?

[Pooka1]

Isn't the last instrumented vertebra chosen from the bending xrays, where any part that doesn't resolve is the fixed part of the curve and that's what they fuse to? I'm not sure I understand how being more flexible would make the fusion longer? If that were the case, wouldn't you encourage young people to wait until they're older to have surgery, since they'd be less flexible then?

I'm wondering if the flexibility increases "artificially" from PT such that the fusion would be shorter than it should be.

I know of at least a few cases where the fusion ended too soon (only fusing the top of double major curves) and that was not stable. So not going low enough is problematic and anything that might compromise the choice of that last fused vertebrae seems like a potential problem.

I have no idea what I'm talking about, obviously... just bunny wondering.

[hdugger]

Only fusing part of a double major curve just seems like negligence, to me. In the case that I'm aware of, bending xrays weren't even done so flexibility didn't play into it.

The only information I have on the topic is doctors (including my own) recommending PT/stretching, including some who specifically recommend it in order to increase flexibility before surgery. I'm assuming they don't think they're doing harm to the patient. Without any other information, I'm likely to rely on that recommendation.