Scoliosis Gym

[Pooka1]

I would maintain that for those of us with a right thoracic curve the idea should be to strengthen the weaker muscles and not so much the overworked ones. Then the opposite for the left lumbar etc. It is this sort of exercise input and research that is required.

I will venture that any experienced general trainer can tell you exactly how to work whatever muscles you want to work. If you know what muscles you want to work, just tell a trainer and they will give you numerous exercises targeted for those muscles.

My trainer can do that and knows the muscles names to boot.

And if that doesn't help then ask the trainer to work different muscles to see if that works.

There is not an infinite number of things to try though there are many exercises that work certain given muscles.

[Pooka1]

Another way to look at this is surgeons routinely prescribe PT for pain associated with scoliosis in adults before recommending surgery as far as I know. To the extent at least some of these people have managed to avoid surgery suggests that general PT can work. Specialized exercises may not be necessarily or even exist.

Apparently in the US, physical therapists are now doctorate level. These people know the entire range of possible exercises for any of the muscles. I think so much theoretical and empirical work has gone on so far in general physical therapy that it might be shocking at this point if anyone actually found a magic set of exercises that helped much more with scoliosis pain beyond what they are doing know. The list of exercises and the potential muscles is not infinite.

I think you should be able to walk into a PT's office and go through every possible muscle and they would give you at least 5 exercises for each. You can do your own research on your case in real time. If you exhaust what the PT knows then a PT solution may not be in the cards for you. Again, the choices are not infinite.

[LindaRacine]

Apparently in the US, physical therapists are now doctorate level.

The trend is definitely toward DPT. Probably 90-95% of the UCSF PTs are DPTs. I suspect, however, that that's a lot less true in smaller communities.

[Pooka1]

The trend is definitely toward DPT. Probably 90-95% of the UCSF PTs are DPTs. I suspect, however, that that's a lot less true in smaller communities.

Yes and these people know their stuff.

There are not a million ways to exercise muscles in the core so as to hope to decrease pain. I think the thinking that there may be some magic exercise is coming from the curve correcting paradigm, NOT the pain relieving paradigm. The reason why PT will likely never pan out for curve correction is because it is not a problem with muscles and muscles can only do so much.

I think it is known that building core is the best hope for relieving pain and we don't have to wait for any research to keep showing that.

[titaniumed]

Another way to look at this is surgeons routinely prescribe PT for pain associated with scoliosis in adults before recommending surgery as far as I know. To the extent at least some of these people have managed to avoid surgery suggests that general PT can work. Specialized exercises may not be necessarily or even exist.

There are specific exercises that "might" target scoliosis, the only way to know if this allowed people to dodge surgery, would be with a poll or database. Some of our muscles do not respond to exercise. I have always believed that there is a neurological factor, its not just about muscles.

Some notes from Dr Kim at HSS...

https://health.usnews.com/health-new...enetics-impact

It is likely that scoliosis is a result of a combination of genetics and neurological, environmental and behavioral factors. Studies of identical twins have not always demonstrated both twins having scoliosis despite their identical genetic makeup.

An additional level of complexity comes about via research associating scoliosis with different white and gray matter characteristics in the brain responsible for processing position sense (proprioception) and genetics research demonstrating mutations in genes associated with somatosensory feedback to the central nervous system.

Regardless of the specific etiology of scoliosis, if you have it, or suspect you have it, my recommendation would
be to see a spine surgeon who specializes in scoliosis as soon as possible in order to get "plugged in."

Ed

[titaniumed]

Here are a few videos from the masters, Dr's Cotrel and Dr Dubousset. They invented the CD system years ago in 1983. Both of these scoliosis surgeons have been on the scene a really long time.

Getting a 3D perspective....
https://www.youtube.com/watch?v=6i7Jr9vUpko

30 yrs on the CD system.
They talk about their mistakes through the years. Dr Cotrel had a medical problem and could not operate and thus worked with Dr Dubousset on the CD system. Dr Cotrel had a toolmaker make his concepts....He traveled the world and visited everyone in the scoliosis community....The work they did was monumental in the scoliosis world. We all owe these two surgeons a huge thanks you for helping us out.

(slightly delayed audio)
https://www.youtube.com/watch?v=J_ck_PoXqrc

Ed

[LindaRacine]

There are specific exercises that "might" target scoliosis, the only way to know if this allowed people to dodge surgery, would be with a poll or database. Some of our muscles do not respond to exercise. I have always believed that there is a neurological factor, its not just about muscles.

Some notes from Dr Kim at HSS...

https://health.usnews.com/health-new...enetics-impact

It is likely that scoliosis is a result of a combination of genetics and neurological, environmental and behavioral factors. Studies of identical twins have not always demonstrated both twins having scoliosis despite their identical genetic makeup.

An additional level of complexity comes about via research associating scoliosis with different white and gray matter characteristics in the brain responsible for processing position sense (proprioception) and genetics research demonstrating mutations in genes associated with somatosensory feedback to the central nervous system.

Regardless of the specific etiology of scoliosis, if you have it, or suspect you have it, my recommendation would
be to see a spine surgeon who specializes in scoliosis as soon as possible in order to get "plugged in."

Ed

Ed...

In all non-congenital scoliosis, the vertebrae within the curve become wedged in the coronal plane. So, one might train the muscles to hold the curve a little straighter, but you're never going to unwedge those vertebrae. WedgedVertebrae.jpg

[burdle]

and sometimes- like - now - i just cant cope with it. and i hate.myself for saying so but it is very hard.

[burdle]

I will venture that any experienced general trainer can tell you exactly how to work whatever muscles you want to work. If you know what muscles you want to work, just tell a trainer and they will give you numerous exercises targeted for those muscles.

My trainer can do that and knows the muscles names to boot.

And if that doesn't help then ask the trainer to work different muscles to see if that works.

There is not an infinite number of things to try though there are many exercises that work certain given muscles.

this really isnt the case with physios in uk. for one thing a gp is unlikely to refer you for scoliosis pain. The ones on Nhs Have no training in Scoliosis or how it manifests. They will give you the same treatment as if you turned up with a functional scoliosis. and really they should be giving exercises that do not put strain on the curve
most are arrogant and will not even contemplate that you.might need a targeted approach. Pooka1, remember my article ? that was published in the private physio journal as finally i have made my private physio understand that we need more ! Remember we are not the ecperts. We should not have to tell a physio which musclescto work. A physio shoud be telling us.

[Pooka1]

this really isnt the case with physios in uk. for one thing a gp is unlikely to refer you for scoliosis pain. The ones on Nhs Have no training in Scoliosis or how it manifests. They will give you the same treatment as if you turned up with a functional scoliosis. and really they should be giving exercises that do not put strain on the curve

Burdle what I am saying is to the extent that people with pain from scoliosis have been able to avoid surgery with PT, AND given there is no specific PT for pain from scoliosis, then we can conclude that the garden variety PT is effective for scoliosis pain. Specialized PT for scoliosis may not be better than general PT and may not even ever exist because there may be no specialized PT possible given the finite number of muscles and ways to build core which is what I understand is what is relieving the pain in these patients. There is a finite number of ways to build a finite number of muscles. A given patient working with a PT person can probably exhaust all possibilities within a year. If none of them help then there is no PT solution for their pain.

Once again, I think people are subconsciously importing the "specialized PT" claimed to be needed for curve straightening to the pain arena and I don't think it makes sense to do that. Linda can correct me if I am wrong but the people who avoid surgery by doing PT for their pain are largely just building core muscle. It works for them and may work for you.

most are arrogant and will not even contemplate that you.might need a targeted approach. Pooka1, remember my article ? that was published in the private physio journal as finally i have made my private physio understand that we need more ! Remember we are not the experts. We should not have to tell a physio which muscles to work. A physio should be telling us.

I think there is enough evidence that a non-targeted general approach will help people. That may be why they are pushing back on searching for a targeted approach which may not be better than a general approach and may not even exist to find. A physio can tell you which muscles to work to build core. I may have to re-read your article. Can you please send it again.

[burdle]

Burdle what I am saying is to the extent that people with pain from scoliosis have been able to avoid surgery with PT, AND given there is no specific PT for pain from scoliosis, then we can conclude that the garden variety PT is effective for scoliosis pain. Specialized PT for scoliosis may not be better than general PT and may not even ever exist because there may be no specialized PT possible given the finite number of muscles and ways to build core which is what I understand is what is relieving the pain in these patients. There is a finite number of ways to build a finite number of muscles. A given patient working with a PT person can probably exhaust all possibilities within a year. If none of them help then there is no PT solution for their pain.

Once again, I think people are subconsciously importing the "specialized PT" claimed to be needed for curve straightening to the pain arena and I don't think it makes sense to do that. Linda can correct me if I am wrong but the people who avoid surgery by doing PT for their pain are largely just building core muscle. It works for them and may work for you.



I think there is enough evidence that a non-targeted general approach will help people. That may be why they are pushing back on searching for a targeted approach which may not be better than a general approach and may not even exist to find. A physio can tell you which muscles to work to build core. I may have to re-read your article. Can you please send it again.

I don't think there is any evidence that a non-targeted approach helps anyone-. People do not use PT to avoid scoliosis surgery as much as use it to alleviate pain when surgery is not an option. There may be a few who have the option of putting off surgery by using PT but that is quite different. I am not talking about PT for straightening a curve- this is the trouble - everyone is quick to jump on this as a reason for not having targeted PT. But we still need targeted PT that takes into account wasted muscles around curves etc. How can anyone conclude that people are avoiding surgery by building a core muscle? These people just don't elect for surgery and then go down a different route altogether!

There are thousands of us all complaining about the same thing - NO TREATMENT- unless you are at surgery levels- for the pain. In UK if you are not over the 50 degree threshold you will not be officered surgery. So you are lumped in with everyone else for pain relief which means non targeted. Evidence of no effectiveness is not the same as no evidence of effectiveness. How can PT be a one size fits all?. How can PT for non-specific back pain be effective for a scoliosis when there is a specific?. I think that a strong core will help everyone but the method of getting one IS different for people with a scoliosis. Why should a scoliotic have to 'risk' exacerbation of pain ( if not curvature) by accepting something so non-targeted?

Look at the numbers on the Facebook groups saying the same thing. A lot are desperate for surgery because they are being offered nothing else that works. And look at the people crowding in like Scolismart etc who can take advantage of the vacuum.

"AND given there is no specific PT for pain from scoliosis, then we can conclude that the garden variety PT is effective for scoliosis pain. " I would challenge this we can't conclude anything of the sort unless we have the majority of scoliosis sufferers saying that doing PT is effective for their pain. If all they are offered is garden variety that is all they can do- ask them if it helps the pain? Where is the research saying that it does?

[Pooka1]

I don't think there is any evidence that a non-targeted approach helps anyone-. People do not use PT to avoid scoliosis surgery as much as use it to alleviate pain when surgery is not an option. There may be a few who have the option of putting off surgery by using PT but that is quite different. I am not talking about PT for straightening a curve- this is the trouble - everyone is quick to jump on this as a reason for not having targeted PT. But we still need targeted PT that takes into account wasted muscles around curves etc. How can anyone conclude that people are avoiding surgery by building a core muscle? These people just don't elect for surgery and then go down a different route altogether!

Burdle, addressing "wasted muscles around the curve" *IS* building core. They are one and the same. It is known which muscles are around the curve and a PT can give you 10 exercises to address each one. There is no ground for "specialized/targeted" PT to stand on. It is all occupied already by general PT.

There are thousands of us all complaining about the same thing - NO TREATMENT- unless you are at surgery levels- for the pain. In UK if you are not over the 50 degree threshold you will not be offered surgery. So you are lumped in with everyone else for pain relief which means non targeted. Evidence of no effectiveness is not the same as no evidence of effectiveness. How can PT be a one size fits all?. How can PT for non-specific back pain be effective for a scoliosis when there is a specific?. I think that a strong core will help everyone but the method of getting one IS different for people with a scoliosis. Why should a scoliotic have to 'risk' exacerbation of pain ( if not curvature) by accepting something so non-targeted?

The method is NOT different for people with and without scoliosis. Everyone has to work to build muscle. Everyone has to be careful to avoid injury. If something hurts don't do it unless a PT knows it is safe and you should do it. Look at the PT articles on scoliosis. They are taking routine equipment (torso rotation machine) or routine practice (yoga/Fishman) and just trying it. They are not inventing new stuff. There is no new stuff. All these articles are using known methods to build core.

A PT can target the muscles around the curve. How can PT be one size fits all? Because there are x number of muscles that can be exercised in y ways. ALL those ways are known. A curve does x to some muscles and y to other muscles. All that is known. Everything is known. If there is a set of exercises that helps pain in people with scoliosis, it will come from the KNOWN set of PT exercises that constitute core building. Core is the term for the muscles in the torso which is what is relevant to scoliosis.

Look at the numbers on the Facebook groups saying the same thing. A lot are desperate for surgery because they are being offered nothing else that works. And look at the people crowding in like Scolismart etc who can take advantage of the vacuum.

It is understandable that people want non-surgical treatment that works. As far as I know, general PT core building has allowed people to avoid surgery due to pain. Maybe Linda can comment. And we have to consider that no conservative treatment may be effective for some people. If PT is ever exhaustively studied, the answer could well be it is not effective in any form for many people because no amount of muscle building can overcome the bone wedging.

"AND given there is no specific PT for pain from scoliosis, then we can conclude that the garden variety PT is effective for scoliosis pain. " I would challenge this we can't conclude anything of the sort unless we have the majority of scoliosis sufferers saying that doing PT is effective for their pain. If all they are offered is garden variety that is all they can do- ask them if it helps the pain? Where is the research saying that it does?

Maybe Linda has some sense of the number of people who can avoid surgery by doing PT for pain.

I do not believe there is any non-garden variety PT. The so-called "targeted"PT will just be a subset of the garden variety that was available all along. To the extent that as you say one size doesn't fit all, it may be that a given subset that works for one person may not work for the next. This research could be done, a PT regime found that helps some people,and it still might not help you. Just like bracing doesn't help everyone. So everyone is going to have to experiment a bit. But luckily it is not infinite and I think you could determine FOR YOURSELF if any core exercises help your pain within a year.

There is no guarantee PT, even targeted, will help a given patient with pain. The only hope for some may be surgery.

[Pooka1]

Here is the SRS stating the obvious... the point is building core and increasing flexibility and ALL that is known how to do...

http://www.srs.org/patients-and-fami...ults/scoliosis

Exercises aimed at strengthening the core muscles of the abdomen and back and improving flexibility

-------------------------

According to the University of Maryland med site, a targeted regime for adult scoliosis pain exists... https://www.umms.org/ummc/health-ser...dult-scoliosis

Physical Therapy

Physical therapy and exercise is an important part of treating adult scoliosis. A well-designed exercise program can also provide pain relief in many patients. A physical therapist will develop an appropriate exercise routine for your case. It is essential that you stick to the plan.

Typical advice includes:

Learning correct body mechanics in order to maintain erect posture that counteracts the effects of the scoliosis
Doing regular non-jarring exercises, such as swimming
Maintaining high levels of activity
Doing your daily stretching exercises and deep breathing (for lung expansion)

If PT fails a given patient, it is not necessarily due to doing the wrong exercises. It may be due to PT not being able to help some patients.

[burdle]

Here is the SRS stating the obvious... the point is building core and increasing flexibility and ALL that is known how to do...

http://www.srs.org/patients-and-fami...ults/scoliosis



-------------------------

According to the University of Maryland med site, a targeted regime for adult scoliosis pain exists... https://www.umms.org/ummc/health-ser...dult-scoliosis



If PT fails a given patient, it is not necessarily due to doing the wrong exercises. It may be due to PT not being able to help some patients.

Exactly -SRS are just pushing a strong core - that is the same advise for everybody - with or without scoliosis with or without pain. That's helping nobody!
It might not necessarily be due to doing the the wrong exercises but it not unreasonable to conclude that there might be better exercises for someone with scoliois if the garden variety don't work. You can only conclude that it might be that PT maybe cant help some patients IF those patients have tried targeted exercises.

[Pooka1]

Exactly -SRS are just pushing a strong core - that is the same advise for everybody - with or without scoliosis with or without pain. That's helping nobody!
It might not necessarily be due to doing the the wrong exercises but it not unreasonable to conclude that there might be better exercises for someone with scoliois if the garden variety don't work. You can only conclude that it might be that PT maybe cant help some patients IF those patients have tried targeted exercises.

Strong core is the ONLY possible advice for people with scoliosis. That is what works for people with scoliosis if PT can help.

By targeted I think you mean which of the known exercises work for pain. Why can't you just try some and see? There is not an infinite number of things for you to try. You don't need to wait on someone finding a targeted group of exercises that may still not work for you.

I really think the charlatans and their magic PT for curve reduction have completely derailed the issue of PT for pain.