Muscular question to Dr. McIntire

[flerc]

It’s incredible, I was sure that this exercise http://www.scoliosis.org/forum/showt...daughter/page4 (#59) should to be excelent and now I realize that may be the worse than may be done, if in fact the muscles are not activated as they should. The only way it would not be dangerous would be avoiding the possibility that back may be buckled. That could be done if the weight is at the same height of the shoulders (ie. hanging from the roof), then the shoulders will be positioned below that weights and the derotatory Schroth exercise would be performed lifting that weights.

[flerc]

Anyway would be something really good a better behavior of the body when weights are lifted. If it’s not so frequent to lift heavy weights, a training would be necessary to be performed in the best way.
But, if it is a neuromuscular defect the problem.. how much a training may help? I have not idea.
Probably scoliosis need 3% instead 1% of vertical force, but only a 2% is developed, because brain is not giving the right orders. I think that a simple proof may be done. I’m sure that if weight is beeing added to my shoulders, my neuromuscular system respond in a perfect way, demanding the necessary and sufficient activity of my muscles so my back would not begins to buckle. That may be demonstrated becouse my height would remains the same. But maybe this not occurs in someone with soliosis. Maybe brain don’t give right orders and height become to decrease.
It’s extremly reasonable to believe that if muscles are not receiving the right orders, stability would be affected, even in adulthood.
I know about good outcomes with Vojta.

[flerc]

Are you quoting the study with that 32kg number? If you are, then I think what is happening is that the 32kg weight is added, and the muscle activation of the various muscles are only 3% of MVC just to maintain an upright posture and/or walk with that weight added. (If I'm understanding correctly).

Yes, I was quoting this study.
When you said ~10-40 N of vertical force, N is Newton? It’s really too few weight. I was doing same proofs yesterday adding weight to my shoulders being sit down and I did feel I must to activate muscles. I’m not so sure, but I think co-contraction is the force of muscles compressing the discs. But I performed other kind of force, trying to make me more tall, something doing with the de-rotatory exercise of Schroth. Multifidus is the muscle that lift the trunk?.

I don’t know exactly how much weight it was, but between 35 and 60 kg and even I felt some disconfort and low pain by some minutes, so I don’t think that the back need few help from muscles when weight is added, but in the other hand, if not weight is never added and so few intervention of muscles are needed to be in a vertical posture, it seems that improve muscular behaviour not be a great help . But all of that may be said about a normal spine as I think it’s mine. A proof with scoliosis should to be done. Maybe the resistance of the back would be lesser. Actually the resistance increase with the number of curves, but scoliosis curve is in other plane and there also should to exist something like a critic angle and beyond it, resistence may decrease in a significant way. I explained about that in my first thread, http://www.scoliosis.org/forum/showt...51-Help!/page3 before question 8) and 9) and after 10) (I remain with the same doubts!). I should to resume that analysis, since nobody seems to want to do it..

If scoliosis imply a back with a few resistance, then the critical weight would be even less, so it seems that adding weight to the shoulders should to be a good exercise, but in the other hand, if the body is an inteligent system (I also believe that) instead of demanding a x% of vertical force without adding weight, it demands an n.x%, with n= 1 or 2 .. but if x is a little number such as 2 or 3 .. anyway should be so few the effort demanded by muscles. That kind of research should to be done.

It’s great to talk with you again!.

[skevimc]

As an adult with moderate Scoli the last paragraph hit home to me: cumulative effect on the muscles over time. Do you think that's why Scoli patients develop tight muscles on one side of their curve over time? I have the tight bulging paraspinal muscle on the convex side of my lumbar curve which tightens more after a long day on my feet. re torso rotation, what I can say is that since learning about it on this forum I love it! Nothing makes my upper back feel so good! I am hopeful that it's helping my daughter as well.

Thanks for your contributions to this forum!

You ask a good question. Some people will say that the bulging muscles are due to increased tightness. Others will say that the bulging muscles are due to increased activity and thus, hypertrophy. It is all speculative. And it gets even more so when we start making hypotheses about what the tightness or hypertrophy means. Are the tight muscles deforming the spine? Would loosening them help straighten it? Are the stronger larger muscles pulling the spine out of alignment? Would strengthening the other side help?

My sort of working hypothesis (and I'm not actively involved in this research right now), is that the bulging muscles are due to decreased length. Sort of like if you extend your left arm and bend your right arm, your right bicep will look bigger than your left because of the structure of the muscle in that position. Honestly, it's very difficult to say with any certainty but I know a handful of people are looking at that kind of thing.

I'm glad you feel like torso strengthening is helping your pain/helping you feel better. That is one thing we didn't measure in our studies and I think could be a potential benefit , i.e. pain reduction.

I’m not understanding something. I suppose MVV means Maximum Voluntary Contraction, so it it’s the maximum strength of a muscle. Actually, some people talk about voluntary and involuntary muscles, so I don’t know if the strength measured is the real strength the muscle is developing or only a part. But anyway, it’s difficult for me to believe that when a 32 Kg weight is added to the torso, the strength developed by muscles would be only about a 3%. Maybe in someone as Schwarzenegger, but in a thin and little woman or a boy..

You are correct about MVC. The way this is measured is they have the subject perform a movement, e.g. sit-up for the rectus abdominus. But they stop the motion at a certain degree of flexion and the subject performs a maximal isometric contraction. They measure the force(torque) and the EMG activity. From that point on, all EMG activity is based on that MVC. You raise a good critique of this type of measurement, that is, other muscles could certainly be contributing to the movement that aren't being measured. %MVC is an interesting concept to study muscle activation during tasks, but I think trunk movements might be a bit too complex for this type of analysis.

Are you quoting the study with that 32kg number? If you are, then I think what is happening is that the 32kg weight is added, and the muscle activation of the various muscles are only 3% of MVC just to maintain an upright posture and/or walk with that weight added. (If I'm understanding correctly).

But anyway I suppose may be true in an average case, but something like a critic weight should to exist. That is, the structure of the column is enough strong by itself to support some weight and then muscles should to be activate to not allow a deformity of that structure. That deformity I supposed would be reflected in a height decrease, because an increase of curves or a lost of height in discs.

If the body is an intelligent system as much people believe, it should not allow such deformity so muscles must to help. It’s a very simple proof to do. To Add weight until some height decrease.
Spinal structure sure is very strong, but I cannot believe it could be so incredible. A 14 years old boy of 40 kg, lifted a car of 400 kg. I think that if muscles would have not been activated, the spine would have been broken.
Anyway I’m not understanding, so maybe nothing of that have any sense.

You're correct there is a critical weight at which the spine will collapse. I believe an unsupported spine, i.e. no muscles attached, can only support ~10-40 N of vertical force. Then it begins to buckle. I know that study was done on cadaver spines but I also think someone has looked at a computer model as well. There are obvious problems with both of those types of studies.

Essentially, the torso is so complex with so many muscles and so many different ways/muscle strategies for the body to perform a movement, that it's incredibly difficult to isolate any one muscle as the main culprit of any dysfunction. However, I do believe the body is an intelligent system, and that through training, the muscles will not only become more efficient but more consistent. And I believe there are studies that support the general belief. The trick would be to ensure symmetric activation on both sides of the spine. This is why I think strengthening, from a physiologic perspective, is a good idea. When you try to perform a submaximal task, the body will pick and choose which muscles and even which portions of the muscle to activate. As the task gets harder, the body will recruit more portions of the muscle or more muscles. If you ask the body to perform a maximal effort task, the likelihood is that the body will recruit all available muscles and muscle fibers to help with the lifting. Asking the body to lift a heavy weight many many times, will not only improve the muscle but will improve the body's ability to activate that muscle. These are basic concepts of strength training and, again, why I think strengthening should be a part of any therapy, followed of course, by functional and specific tasks. So the concept is to wake all the muscles up and then teach them specifically what you want them to do.

[flerc]

I’m not understanding something. I suppose MVV means Maximum Voluntary Contraction, so it it’s the maximum strength of a muscle. Actually, some people talk about voluntary and involuntary muscles, so I don’t know if the strength measured is the real strength the muscle is developing or only a part. But anyway, it’s difficult for me to believe that when a 32 Kg weight is added to the torso, the strength developed by muscles would be only about a 3%. Maybe in someone as Schwarzenegger, but in a thin and little woman or a boy..

But anyway I suppose may be true in an average case, but something like a critic weight should to exist. That is, the structure of the column is enough strong by itself to support some weight and then muscles should to be activate to not allow a deformity of that structure. That deformity I supposed would be reflected in a height decrease, because an increase of curves or a lost of height in discs.

If the body is an intelligent system as much people believe, it should not allow such deformity so muscles must to help. It’s a very simple proof to do. To Add weight until some height decrease.
Spinal structure sure is very strong, but I cannot believe it could be so incredible. A 14 years old boy of 40 kg, lifted a car of 400 kg. I think that if muscles would have not been activated, the spine would have been broken.
Anyway I’m not understanding, so maybe nothing of that have any sense.

[Resilience]

As an adult with moderate Scoli the last paragraph hit home to me: cumulative effect on the muscles over time. Do you think that's why Scoli patients develop tight muscles on one side of their curve over time? I have the tight bulging paraspinal muscle on the convex side of my lumbar curve which tightens more after a long day on my feet. re torso rotation, what I can say is that since learning about it on this forum I love it! Nothing makes my upper back feel so good! I am hopeful that it's helping my daughter as well.

Thanks for your contributions to this forum!

[skevimc]

The same percentages would be present in someone with scoliosis?

The same basic percentages would probably be the same. These certainly wouldn't change a large amount if the AIS pattern is different. I would also say that, any change seen, would most likely be a result of altered/asymmetrical muscle length due to the curve. But again, we're talking about a difference in the 1-5% of MVC range. Equivalent to a couple of pounds in a really strong person.

The alternative argument is that, the asymmetrical difference would be compounded over the course of time. For example, if the obliques are firing at different levels during walking. While the percentage of strength is low, it's the cumulative effect of the force. So if the right side is 2% MVC and the left side is 5% MVC while walking over the course of days/weeks/months, when the average person walks ~6 miles/day, that could start to add up. But is that small amount of force difference enough to influence the spine?

[flerc]

yes, it seems we can trust in common sense.

In standing, ES, psoas and QL are virtually silent! In some subjects there is no detectable EMG activity in these muscles (Andersson et al., 1996)
During walking rectus abdominis has a average activity of 2% MVC and external oblique 5% MVC (White & McNair, 2002).
Co-contraction in standing is less than 1% MVC rising up to 3% MVC when a 32 Kg weight is added to the torso. With a back injury it is estimated to raise these values by only 2.5% MVC for the unloaded and loaded models (Cholewicki et al., 1997).
During bending and lifting a weight of 15 kg co-contraction increases by only 1.5% MVC (van Dieen et al., 2003b).

The same percentages would be present in someone with scoliosis?

[skevimc]

During movement, muscles that are ‘not working’ are just as important as muscles that are working!

http://www.cpdo.net/lecture_notes/cs....ppt#265,1,The Myth of Core Stability

That's an interesting lecture/presentation. It definitely hits on the concepts I have talked about here and in the other articles, i.e. assuming progression is driven from the rotation of the vertebrae, it is rotational strengthening that would be the most beneficial. This is also assuming that improving rotational stability can help reduce/control progression. Too many assumptions for sure, but still shows that if PT or exercise has any hope of working for AIS, the movements and strengthening HAVE to be functional and specific.

[flerc]

During movement, muscles that are ‘not working’ are just as important as muscles that are working!

http://www.cpdo.net/lecture_notes/cs....ppt#265,1,The Myth of Core Stability

[Anna's mom]

No brace since progression

Does your daughter wear a brace? If so, which brace does she wear? Is she still growing?

Sorry for the delay in answering your question! Haven't been here for awhile. No, my daughter has never worn a brace. Our doc recommended a Boston brace in Dec 2010, but then a second opinion from a doc in Cincinnati conflicted with this recommendation. The Cincy doc (who came highly recommended) said he did not brace anymore and the ONLY solutions he gave us was to participate in their bracing study (to be randomly placed in the bracing or "wait and see" group) and to "do whatever we felt comfortable with". Very frustrating!!
She is still growing and is at her peak growth spurt right now. Going back for follow-up appt. next week. We know she has grown since her last visit, so we are praying for continued stability in her numbers!

[flerc]

Dailystrength, thanks for your replay. Is good to know that you are fine and trying to improve your spine and that you can combine stretching and strengthening. I failed to do this with my daughter. It's really very interesting what you are doing to improve your posture. A great postural therapist said me that we should to be conscious of our bones. It's difficult to get a good outcome if the posture is not improved and I think that the best for that is the Spinecor. http://www.correctscoliosis.com/corrective_movement.php
Surely is the best help that the bodie could has to remember the right posture, and that posture requires the spine to be the most straight that the spinal structure allows and probably it's impossible to do without some external help at the beginning. But of course, what you are doing should to works too.

Best regards!

[dailystrength]

I think that 5° is really a good improvement in an adult. Remember me please what are you doing. I believe I read you was doing Pilates and Alexander, may be? I’m looking for something like the balance ball chair but I think it not exist in my country.
In fact we are not thinking in discount the current therapy, but I feel it’s not enough and something more direct is needed, but we are afraid of those methods even it seems to be the best by far..

Hi Flerc, Sorry I've been off for a while - did I answer this? Yes, I started with Pilates, and now I do only stretches and walking in the lower-heel shoes (Earth brand), and using the balance ball chair. I am scheduling my August x-ray soon so that will tell if this is helping. I sit up and try not to slouch into my curves, and stare at a photo of my spine at my work desk so I can see which areas need to straighten. We shall see if it is helping.

[scolio1964]

Sorry to hear about your daughter's recent progression. My daughter is 12 and recently progressed from 17T 21L to 21T 27L. We found a gym near our house that has a cybex torso rotation machine. Fortunately for us, there is also a physical therapist on site who was willing to do some research and develop a treatment plan for our daughter. I recommend checking out this site's thread titled "Torso Rotation Strength Training for Scoliosis". Lots of great info and links! This treatment makes sense to me as there is ample evidence of assymetrical back strength in AIS patients. We are giving it a try!

Does your daughter wear a brace? If so, which brace does she wear? Is she still growing?

[Anna's mom]

We are trying torso rotation exercises!!

Seems like most of the people in this group are WAY more intelligent that I am. I don't have an engineer's mind!! LOL. No, it really doesn't make sense. Do all kids with scoliosis have rotation? Our doctor has never mentioned it. I've never heard the word until joining this group. My daughter right should blade sticks out further than her left and when she bends over, her right side is further up than her left side. Does that mean her spine has rotated? She has a 36 degree thoracic curve and currently has worn a Boston brace for 3 years. Her curve recently progressed from 27 degrees to 36 degrees. I've been looking into exercises or even the VBS, so I'm trying to get information about everything I can. She's 14 and still growing.

Thanks for your help!!

Sorry to hear about your daughter's recent progression. My daughter is 12 and recently progressed from 17T 21L to 21T 27L. We found a gym near our house that has a cybex torso rotation machine. Fortunately for us, there is also a physical therapist on site who was willing to do some research and develop a treatment plan for our daughter. I recommend checking out this site's thread titled "Torso Rotation Strength Training for Scoliosis". Lots of great info and links! This treatment makes sense to me as there is ample evidence of assymetrical back strength in AIS patients. We are giving it a try!