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Thread: A few comments on trunk rotational strength training

  1. #46
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    Quote Originally Posted by Dingo View Post

    To be honest I didn't realize until just now that they were using such small movements for this type of PT.

    Maybe Mooney used 36 degrees because from a purely mechanical standpoint it made sense. His goal was to build symmetric muscle mass and small turns can accomplish that. Furthermore if the spine is already twisted too far in one direction why press your luck and rotate it even further?
    Exactly. Maybe the machine was adjusted for the condition (scoliosis) - to the 36 degrees vs 90.

  2. #47
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    Quote Originally Posted by mamamax View Post
    Exactly. Maybe the machine was adjusted for the condition (scoliosis) - to the 36 degrees vs 90.
    This amount is still far larger than you were talking about. In other words, Schroth, your surgeon, and anyone else telling people to avoid torso rotation are not doing it on the basis of any study. So the question remains why are they telling people this.

    There is such a paucity of research for and against that it is impossible to say anything with any certainty.
    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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    "We are all African."

  3. #48
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    And by the way, like Spinecor is standardizing on 20 hours a day for brace wear, 36* is not magical. It is just a point that one researcher chose to standardize on. Nobody did any work to show 36* was right and 29* or 42* or 54* is wrong. It's all up in the air. It may be that if this PT approach works, it will require larger twists., Nobody knows.
    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."

  4. #49
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    back to the drawing board...

    Mamamax

    Exactly. Maybe the machine was adjusted for the condition (scoliosis) - to the 36 degrees vs 90.
    It looks like it's time to fine tune Scott's exercises again.

    Scott does rotations with a large exercise ball. He rotates almost 90 degrees each direction. I'm going to find a way to cut that back to 45 degrees each way but still keep the energy in the movement.

    I'm going to try and fine tune Scott's lying rotation movement as well.

    If he was about eight years old (and I didn't have a MedX) I'd do Scott McIntire's "at home" exercise from his 2008 study. It's probably as close as you can get to a "MedX" type of movement.

    Study: Treatment of adolescent idiopathic scoliosis with quantified trunk rotational strength training: a pilot study.
    Last edited by Dingo; 02-01-2010 at 09:20 AM.

  5. #50
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    Gayle,

    Would you mind PMing me the name of the gym? My son will be in town over some of the summer break, and I'd love to have him try it out.

    Thanks!

  6. #51
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    On the overall question, I think the issue is that Schroth has an overarching theory about scoliosis, but very little of it is backed up with solid research. Not to diss the Schroth folk - even the surgeons don't understand what causes scoliosis.

    BTW, this reliance on a consistent theory is one of the problems that the SEAS folks stated they were addressing. They felt that other exercise practices were bound by their overarching theory, which lead them to include some things that don't work and omit some things that do work, while the SEAS people will include any exercise that's shown promise.

  7. #52
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    Quote Originally Posted by Pooka1 View Post
    Dr. McIntire,

    A few questions:

    1. I realize you have a different post doc area (still within muscle physiology) but are you aware of any other researchers who look at the torso rotation literature and are going forward with more research at this time? That is, is it viewed as a fruitful area of PT-based research?

    2. Some folks here have said they were specifically told torso rotation, twisting, etc. was contraindicated for scoliosis. Do you know the basis for this admonition? I suspect it rests on very little evidence. I mean I don't think people were studying torso rotation enough to say that it should be avoided.

    3. There are many PT approaches out there at the moment for scoliosis. Do you consider Torso rotation to be the most promising at the moment by far?

    Thanks.
    Wow.. I go away for a weekend and come back to this...

    1. Yes.. I know of one PT in TX who is just beginning her PhD. Her project has changed a bit from when I began communicating with her, but I think trunk rotation and para-spinal musculature is the basic idea. I'll ask her if she minds if I say more about her project.

    2. To my knowledge there are camps that say twisting is contraindicated, side bends are contraindicated and extensions are contraindicated. For example, we tended to think that extensions were contraindicated because of thoracic hypokyphosis. So while Mooney et al used back extensions, we avoided them. No scientific reason just theoretical. My assumption is that it has to do with what you think will be aggravating to the spine. Rotation has the potential to increase rib hump when rotating towards the convexity. Is this documented? No. Is this bad? I don't think so. Evidently that Schroth person thinks it is.

    I toured Dr. Weiss' facility in Germany. A truly amazing set-up they have. He is very close to my mentor Dr. Asher. We discussed our project with him. I also shadowed their head therapist (Axel Hennes) who is an amazing therapist as well. Never, did they say that sweeping rotations would be contraindicated. Perhaps their ideas have changed now. But I discussed the proposed physiology of our study and Schroth at length. Because we are strengthening, the rotation of the spine should not become unstable.

    I think the worry is that rotations can lead to flexibility. When the overall strategy is to sort of decrease flexibility. We're shooting for rigidity (sort of). Another type of example is with stroke survivors (most of my PhD student peers did stroke research). Stroke survivors have spasticity and causes their arms and legs to remain flexed and mostly un-usable. So a therapeutic idea is to increase range of motion thereby making the joint more functional. HOWEVER, if you increase ROM but don't increase strength, then you have created an unstable range that might expose the joint to injury. Therefore an idea is to strengthen within the functional range of motion and if ROM increases due to strengthening, then it has happened in a more stable way. (Hopefully that makes sense).

    3. "by far"?? No. But I see strengthening as a fundamental principle that many PT protocols are overlooking. That is, strength needs to be the foundation. Then function and form. Get it strong, then teach it specifics. A bad analogy: You wouldn't begin teaching a creative writing course if the students didn't know about spelling and grammar.

    Quote Originally Posted by Pooka1 View Post
    Dr. McIntire, one more question if I'm not over my limit...

    A mother of a patient just wrote: "They taught her to avoid twisting or extra turning as that can increase the torque of the spine."

    Were you aware Schroth is telling people that torso rotation is to be avoided?
    You're never over your limit... it just might take a while to answer. And it never hurts to repeat the question if I'm missing a question or point.

    I was not aware the Scroth people are saying this.

    To answer the basic question floating around here the last couple of days. There is no evidence against any type of exercise of which I am aware. It's all theoretical.


    I'll try to wade through the rest of the thread and answer what I can.

  8. #53
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    Quote Originally Posted by Dingo View Post
    F
    If I understand the machine correctly at the end of a 90 degree turn the user is facing at a right angle. In Mooney's study they rotated left or right 36 degrees which is about a third of that distance. That's a fairly small range of motion.


    Maybe Mooney used 36 degrees because from a purely mechanical standpoint it made sense. His goal was to build symmetric muscle mass and small turns can accomplish that. Furthermore if the spine is already twisted too far in one direction why press your luck and rotate it even further?
    We just followed Mooney's lead. However, I did notice that some of my adult subjects had difficulty reaching the 36į pre-rotated position. As well, for some patients the pre-rotated positions were a bit difficult. There are other trunk rotation strength studies in healthy adults that go out to 54į. Check out S. Kumar and trunk rotational strength. So 36į was used because we weren't sure if the patients would have difficulty.

  9. #54
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    Quote Originally Posted by skevimc View Post
    (snip)

    To answer the basic question floating around here the last couple of days. There is no evidence against any type of exercise of which I am aware. It's all theoretical.
    As I suspected.

    I'll try to wade through the rest of the thread and answer what I can.
    1,000 thank yous. We are very lucky to have a researcher in a relevant field on this forum.
    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."

  10. #55
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    Quote Originally Posted by Pooka1 View Post
    This amount is still far larger than you were talking about. In other words, Schroth, your surgeon, and anyone else telling people to avoid torso rotation are not doing it on the basis of any study. So the question remains why are they telling people this.

    There is such a paucity of research for and against that it is impossible to say anything with any certainty.
    My example was an exaggeration for sake of illustration - which was futile.

    36 degrees is within the range my surgeon was talking about (short rotation) vs long sweeping - 90 degrees.

  11. #56
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    Question for Kevin

    Hi there, I read these threads with interest and have a question based on a thought you had in one of your recent posts (sorry I don't have that "quote" function thing down). My daughter wears a Rigo-Cheneau full-time. She does not do Schroth therapy--she is too young and so we simply have not looked into it. BUT we were advised (by our orthotist, not the surgeon who does not discourage any type of exercise for the reasons you have cited--no evidence that anything aggravates scoliosis) that she not do gymnastics (rotation/twisting), which was not an issue for us because she has no interest in it so I did not ask "why?". You had a comment that maybe the Schroth folks advise against the twisting because it may promote flexibility and thus encourage curvature I suppose. It caught my attention because my daughter's really good results with this brace are attributed (by all), in large part, to her flexibility (which at this stage, comes mostly from her young age). Does that give you any cause to re-think or is that consistent in some way I am not thinking of? Just trying to keep you busy Thanks
    Last edited by mamandcrm; 02-01-2010 at 05:39 PM.
    mamandcrm

    G diagnosed 6/08 at almost 7 with 25*
    Providence night brace, increased to 35*
    Rigo-Cheneau brace full-time 12/08-4/10
    14* at 10/09 OOB x-ray
    11* at 4/10 OOB x-ray
    Wearing R-C part-time since 4/10
    latest OOB xray 5/14 13*
    currently going on 13 yrs old

    I no longer participate in this forum though I will update signature from time to time with status

  12. #57
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    Quote Originally Posted by mamamax View Post
    My example was an exaggeration for sake of illustration - which was futile.

    36 degrees is within the range my surgeon was talking about (short rotation) vs long sweeping - 90 degrees.
    There is zero evidence long sweeping motions should be avoided.
    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. #58
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    Quote Originally Posted by mamandcrm View Post
    You had a comment that maybe the Schroth folks advise against the twisting because it may promote flexibility and thus encourage curvature I suppose. It caught my attention because my daughter's really good results with this brace are attributed (by all), in large part, to her flexibility (which at this stage, comes mostly from her young age). Does that give you any cause to re-think or is that consistent in some way I am not thinking of? Just trying to keep you busy Thanks
    Thanks for the question.

    It doesn't cause me to rethink because I think rotation is probably a good thing.... or at the very least not a bad thing, because I'm basing it on strength.

    I think there is a thought among some therapists that too much flexibility can be a bad thing. Especially when spinal stability is the goal. As well, with the Schroth therapists, their statement is that no matter which way you rotate, at least one part of the spine is being rotated further, thus allowing more freedom for the spine to progress.

    I think rotation is arguably one of the most vicious components of scoliosis. Which might be another reason people are inclined to avoid rotation. A 35* curve with 5* rotation looks much different than the same size curve but 15* of rotation. However, it is for this reason that I think rotation is important to address. Brace management usually uses some sort of rotation control, or theoretical de-rotation. And surgery definitely addresses rotation. Why would a therapy avoid rotation?

    But again... it's mostly theoretical.... can't we all just get along?

    Hopefully I addressed your question. If not, please re-ask.

  14. #59
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    Thank you for your comments Kevin and yes I think the rotational element (in regards to scoliosis) is something important to address.

    Here's what one of our Physical Therapist members said about such things some months back (thank you Betty14) ...

    The doctor is likely saying that torso rotation exercise might put too much stress on the spine because it is known that discs can be injured by rotational forces. I would be concerned about anyone doing high velocity or large amplitude rotational motions for that reason as well. Slower, controlled motions are not injurious to discs however.

    Personally, I would very much like to use the MedX with a Physical Therapist, preferably Schroth trained, modified to suit my individual curvature. Maybe one day :-)

  15. #60
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    Quote Originally Posted by Dingo View Post
    Mamamax



    It looks like it's time to fine tune Scott's exercises again.

    Scott does rotations with a large exercise ball. He rotates almost 90 degrees each direction. I'm going to find a way to cut that back to 45 degrees each way but still keep the energy in the movement.

    I'm going to try and fine tune Scott's lying rotation movement as well.

    If he was about eight years old (and I didn't have a MedX) I'd do Scott McIntire's "at home" exercise from his 2008 study. It's probably as close as you can get to a "MedX" type of movement.

    Study: Treatment of adolescent idiopathic scoliosis with quantified trunk rotational strength training: a pilot study.
    Thank Dingo - and you may be correct. You certainly have been so far in regards to your son's specific case. You have a great doctor - wonder what he would say?

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