Originally posted by flerc
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Muscular question to Dr. McIntire
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34L at diagnosis; Boston Brace 1979
Current: 50L, 28T
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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!
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No brace since progression
Originally posted by scolio1964 View PostDoes 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!Daughter dx'd 3/10 at age 11: T13 L21
Progressed to T21 L27 in 12/10
Initiated TRS and nightly melatonin in 1/11
"Stable" at T20 L24 since 4/11
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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
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Originally posted by flerc View PostDuring 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.
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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?
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Originally posted by flerc View Post
The same percentages would be present in someone with scoliosis?
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?
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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!Resilience
treated w Milwaukee Brace FT for 3 yrs
currently 46 with 35 LL and 40 RT curves
8 yr old diagnosed w Scoli 8/10 with 27 LL and 27 RT
11/10 TLSO Full Time
4/11 22 LL and 24 RT on waiting list for VBS at Shriners Phila
12/11 curves still in the 20s but now has some rib cage changes from the brace
VBS 4/25/12 with Dr. Samdani. Pre Op: 29 RT and 25 LL Post Op: 17 RT and 9 LL
10/13: 15 RT and 10 LL
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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.
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Originally posted by Resilience View PostAs 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!
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.
Originally posted by flerc View PostI’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..
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).
Originally posted by flerc View PostBut 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.
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.
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Originally posted by skevimc View PostAre 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).
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!.
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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.
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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.
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Originally posted by flerc View PostYes, 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?.
The multifidus provides primarily an extension force and a very small rotational force. So if you're laying on your stomach, then yes, the multifidus would help with that.
Originally posted by flerc View PostI 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 .
Originally posted by flerc View PostBut 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!.
Yes, I always enjoy your input as well. I just wish I had more time to respond.
Originally posted by flerc View PostAnyway 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.
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Originally posted by skevimc View PostYes, N=Newtons. And yes, it isn't much weight at all. I believe Stokes was the one who published this. While it is a very small amount of weight, remember that these studies were done on cadaver spines with only ligaments attached. So I think the primary idea was to show how important the muscles are in maintaining an upright posture.
Originally posted by skevimc View PostThe multifidus provides primarily an extension force and a very small rotational force. So if you're laying on your stomach, then yes, the multifidus would help with that.
I think that adding weight to the shoulders when they begin to go up, would be a great exercise.
Originally posted by skevimc View PostAn important thing to remember is that our bodies are in almost constant motion and thus there are forces being applied to the spine almost continuously. The more complex our task, the more force applied. Walking is more than standing. Walking up stairs is more than walking level. Bending down to tie your shoe is even more. We burn nearly 25% of our daily calories just moving around throughout the day. And probably 90% of those movements will require some form of spine stabilization. Without stabilization, we wouldn't move very much.
But if is small the percentage of M V F(force) (I’m not sure if all force is contraction) needed to move, how much important is to improve muscles strength or optimal coordination?. If a great force exists inside the back (THE TIGER’S DEN http://www.antigymnastique.com/us/livre-presse.html ) even if this force is not implied in an optimal way it may be enough to assure stability.
It’s a coarse example, but when I carry my portfolio with around only 2 kgs, is the same if I use my 5 fingers or I use only 3 of them. Also if I would have much or less strength, I would carry it anyway. But I’ll cannot be sure that some problem in my hand may arise because I not carry it in the right way.
Originally posted by skevimc View PostI'll need to look back at your previous thread to fully understand what you're saying. But I think I follow it enough to say that, it is my personal belief that the scoliosis spine causes the muscles to have different force producing capacities. So if the load to maintain an upright posture is changed, then the muscles might have to work harder or differently.
It seems so logic that muscles because the curve may not perform the same force that without it. Could be may done a test to know if muscles are atrophied because altered biomechanics?
But also may be that more force would be required because the resistance of the spine could be lesser because the curve, so the critical weight could be lesser and then, more force would be needed for spine stabilization.
But again, if the body is enough intelligent, more force would be performed, supposing that anyway the MVF is enough high, but of course, if we can help it in that sense, we should to help it.
Originally posted by skevimc View PostThat is part of my hypothesis. There is a certain amount of force needed, and the muscles are not doing this. This dysfunction is either a result of altered biomechanics because of the curvature, because there is a muscle pathology, i.e. the muscles aren't 'healthy' or because the brain isn't controlling them properly. I feel that the muscles work fine and the brain can control them and that the dysfunction is because of altered biomechanics which have cased a bigger problem by atrophying muscles. But it wouldn't surprise me if there were also some type of neuromuscular issue as well. But I doubt this would be in all cases.
I have read that is a complex system. Something like a brain image of the body and the right posture, the propioception and vestibular system and the neuromuscular activation to perform the behaviour ordered by the brain. A failure in this system would lead to an inefficient muscular behaviour, regardless how much force could have muscles. Some people say that propioception is always altered because scoliosis.
Continuing with the coarse example, if my portfolio may change her weight (in some way it happen because vertical movement) and my body not realize that changes or not respond in the right way or moment, I may drop it or not, but risks of problems in my hand or arm seems so probable to occurs.
I think that proofs using devices like that (sorry is in Spanish) http://www.efdeportes.com/efd48/propioc.htm should be done in all scoliosis people to determine if a failure exists in this system or not. I also believe that not always is present and I suppose it may explain why people with similar degrees to other with pain have not pain.. even flexibility may be other reason.
Originally posted by skevimc View PostYes, I always enjoy your input as well. I just wish I had more time to respond.
http://www.scoliosis.org/forum/showt...e-guilty-ones&
http://www.scoliosis.org/forum/showt...-be&highlight=
http://www.scoliosis.org/forum/showt...-do&highlight=
http://www.scoliosis.org/forum/showt...-vicious-cycle
Actually I only may talk about that issues with you and nothing is more interesting for me, so not be worry for the delay. I really apreciate very much your responds!
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