First off, Iíll tell you that my name is Kevin McIntire and our group did the work on trunk rotational strength asymmetry and strength training. I have been lurking on here from time to time over the last year or so and recently became a member and wanted to introduce myself and make a few comments on trunk rotational strength training. Especially because I have noticed that RST along with other exercise based therapies have been the topics of a lot of passion and debate.

The RST study was my primary dissertation work. It was originally designed as an RCT. But due to recruitment problems we changed it to just a treatment group. That was lesson number 1 and should hopefully address some of the comments of ďwhy wonít doctors or therapists do a long term and/or randomized study.Ē About half of the patients that were somewhat interested in the study declined to participate due to the time commitment involved. Lesson number 2 was that it is extremely difficult to obtain a homogeneous sample. That is, to find one specific type of patient with a specific type of curve. 10-16 yrs old, female, riser 0-3, <=12 months post-menarchal, single thoracic curves >20į. This phenotype is supposed to have a large number of cases but reality is not as straight forward. By the end of the study we had opened up to allow just about everyone in.

I donít believe RST is a panacea. Although I am extremely encouraged by some of the private conversations/results patientís families have shared with me over the last few years.

I believe that at least 75% of people with scoliosis have a rotational strength asymmetry. I donít see this as causative but I do see it as a contributor to the vicious cycle of progression. I also believe that strength asymmetry will be made worse as the curve progresses. (A small cohort of patients with >50į curves had profound strength asymmetry. Not published) Thus, I think trunk strength should be addressed in every patient receiving any type of scoliosis therapy. This should be extended to curves 10į-20į. The "watch and wait" group. I am convinced we are missing a HUGE treatment window.

If I could do the project over, I would follow two principles; strength and specificity. Strength is certainly important, but a more specific stimulus seems obvious to me. In essence, strength training wakes the muscles up (assuming they are asleep) and the specific exercises fine tune. Schroth, Side Shift, SEAS, CLEAR, directional breathing (Dobosiewicz Method)Ö there are probably othersÖ All of these use a specificity component and seek to re-train the neuromuscular system to control and stabilize the spine. The benefit of these therapies is that they are customized to each patient, whereas RST was using sort of the shotgun approach (strengthen everything). This was done intentionally because, from a scientific standpoint, you have to start somewhere. So we went with strength training based largely on the work of Vert Mooney. (BTW, I just read about his death yesterday here on the board. Iím in shock to say the least.) So we wanted to test strength training alone before we added anything else.

I am currently doing a postdoctoral fellowship in a completely different field but am continuing my training in muscle physiology. So follow up studies were not possible for logistical reasons, not because we didnít see promise in the results. I hope to return to the field in some fashion in the future to pick-up where we left off.

I have no monetary interest or investment in any product related to my project. In fact, we were aiming at the exact opposite. Money should not be a reason why someone canít get a treatment. As well, what good is a treatment if you have to come back on a weekly basis for it to be effective? This discriminates against people with no time or ability to make that effort. So we wanted to have a therapy that, after an initial learning/monitored exercise phase, the patient and families could be self-sufficient. We didnít quite accomplish that but we made good headway.

Feel free to send me a message if you have any questions or comments. Iíd be glad to answer whatever I can or give you my opinion from a research perspective. I will say that I am not a clinician, although I have my background and previous work in physical therapy. So of course, donít take anything I say as official treatment advice . I think the NSF is a great foundation and I'm happy to be a part of this forum.