Quackwatch and Schroth

[flerc]

So what does this say about treatment for people with this kind of scoliosis? I think it was Pooka1 who mentioned a long while back that someone totally corrected under general anesthesia? I suppose you could brace them, but they'd have to be braced FOREVER if there were an underlying connective tissue disorder. Maybe that's why they took both kinds of x-ray when I was a kid?

Who knows? Cerrtainly I don't believe that kind of disorder are always present in every case with a great flexibility. Anyway, Kevin_mc said me in one thread about some kind of exercises getting stronger ligaments and Schroth exercises seems to get higher tone in muscles of the convex side. Also some people (Pilates?) talk about an ‘abdominal brace’ what certainly has much logic. But surely a great understanding about physiology and anatomy would be needed to fully understand this issue. It seems to be scattered all the knowledge needed and nobody is trying to join it.

[rohrer01]

How can you "exercise" a ligament? They are what hold bone to bone. If they are like rubber bands, it's because the make-up of them has the wrong ratio of proteins, there's no fixing that. I can see strengthening muscles to help with some things. But the primary function of muscles are to enable us to move. Don't get me wrong, muscles DO give the body support, but pretty atrophied people can still walk and move normally. The tendons attach our muscles to our bones, so if the tendon is stretchy, too, that would also create a problem. You can't just go in and fix a faulty mixture of proteins. Muscles can only do so much. It also seems logical to me that if too much muscle mass were obtained it could create more weight, giving gravity a chance to pull harder on the faulty ligaments. Remember there is no attachment of muscle to ligament, so the ligaments are basically on their own.

I do have a personal example. It may show that muscle strength "may" help with some areas. I have a HAGL lesion in my shoulder. That is where the humeral ligament is completely ripped off the long head the the humerus (arm bone) where it goes into the shoulder socket. I have to do shoulder strengthening exercises to "hopefully" give my shoulder support and keep it from dislocating. However, there are two more humeral ligament heads that are still attached. Even so, I have to be very careful not to move my arm in certain ways, otherwise it may dislocate. That's what happened to me last year. All of the dislocations caused my shoulder to protect itself and fill up with scar tissue which made it impossible for me to move my arm very much at all. Now that this is "fixed", I'm at risk for more dislocations. So far I haven't dislocated it because I'm very careful. But the muscle strengthening isn't a cure. If I were to get atrophy in those muscles for some reason I'd be right back to dislocating again.

I don't know how you could really apply this to the spine, though. There are so many tiny muscles surrounding the spine. Exercising those muscles would mean you would have to contract them which would bend you in different ways. This bending may be counterproductive to the ligament issue since the ligaments and muscles would have to be stretchy enough to allow contraction of the muscles on the opposite side. It's not like doing bicep curls where you can build a super huge bicep. People with super huge biceps often can't straighten their arms out to the degree of people with smaller ones. The muscle bulk prevents hyper-extension. It would be more like if the normal action of the elbow allowed you to curl your arm both forward AND backward. How would you stabilize the ligaments in the elbow in that case? The spine bends in a 360^o rotation. That's a tough one to overcome. Maybe you could work in one plane only, but then I could see the problem cropping back up in another plane. It would be like a dog chasing its tail.

Am I making any sense?

[LindaRacine]

So what does this say about treatment for people with this kind of scoliosis? I think it was Pooka1 who mentioned a long while back that someone totally corrected under general anesthesia? I suppose you could brace them, but they'd have to be braced FOREVER if there were an underlying connective tissue disorder. Maybe that's why they took both kinds of x-ray when I was a kid?

Sharon was talking about a UCSF patient from many years ago. There was no need to brace her. She was woken up, probably given a PT prescription, and walked away.

[flerc]

How can you "exercise" a ligament? They are what hold bone to bone. If they are like rubber bands, it's because the make-up of them has the wrong ratio of proteins, there's no fixing that. I can see strengthening muscles to help with some things. But the primary function of muscles are to enable us to move. Don't get me wrong, muscles DO give the body support, but pretty atrophied people can still walk and move normally. The tendons attach our muscles to our bones, so if the tendon is stretchy, too, that would also create a problem. You can't just go in and fix a faulty mixture of proteins. Muscles can only do so much. It also seems logical to me that if too much muscle mass were obtained it could create more weight, giving gravity a chance to pull harder on the faulty ligaments. Remember there is no attachment of muscle to ligament, so the ligaments are basically on their own.

I do have a personal example. It may show that muscle strength "may" help with some areas. I have a HAGL lesion in my shoulder. That is where the humeral ligament is completely ripped off the long head the the humerus (arm bone) where it goes into the shoulder socket. I have to do shoulder strengthening exercises to "hopefully" give my shoulder support and keep it from dislocating. However, there are two more humeral ligament heads that are still attached. Even so, I have to be very careful not to move my arm in certain ways, otherwise it may dislocate. That's what happened to me last year. All of the dislocations caused my shoulder to protect itself and fill up with scar tissue which made it impossible for me to move my arm very much at all. Now that this is "fixed", I'm at risk for more dislocations. So far I haven't dislocated it because I'm very careful. But the muscle strengthening isn't a cure. If I were to get atrophy in those muscles for some reason I'd be right back to dislocating again.

I don't know how you could really apply this to the spine, though. There are so many tiny muscles surrounding the spine. Exercising those muscles would mean you would have to contract them which would bend you in different ways. This bending may be counterproductive to the ligament issue since the ligaments and muscles would have to be stretchy enough to allow contraction of the muscles on the opposite side. It's not like doing bicep curls where you can build a super huge bicep. People with super huge biceps often can't straighten their arms out to the degree of people with smaller ones. The muscle bulk prevents hyper-extension. It would be more like if the normal action of the elbow allowed you to curl your arm both forward AND backward. How would you stabilize the ligaments in the elbow in that case? The spine bends in a 360^o rotation. That's a tough one to overcome. Maybe you could work in one plane only, but then I could see the problem cropping back up in another plane. It would be like a dog chasing its tail.

Am I making any sense?

This is what I talked with Kevin http://www.scoliosis.org/forum/showt...ular+querstion I think was here where he said me about how to make ligaments stronger..

[rohrer01]

Okay, I reread that thread, mostly. I do remember it. You were saying something "similar" to what I just asserted. The difference being that I'm talking about individuals with connective tissue disorder. You can't change the make-up of faulty tissues throughout the entire body. So the conversation was on the premise that the connective tissues (tendons and ligaments) were of normal make-up of proteins.

Dr. McIntyre basically said that the tendons and ligaments allow us movement and that the muscles are what hold us upright.

If that were true then the "atrophy theory of bracing" would be true and kids curves would worsen after bracing, which doesn't happen very often.

Then he backpedaled a little bit when you started talking about this SSS system and he gave more credit to the underlying structures, such as the discs, bones, and ligaments. He basically said that if you cast an arm or a leg that after a time the muscles, tendons, and ligaments need to be rehabilitated because the ligaments shorten and the muscles atrophy. (This did happen to my shoulder and it had to be gradually stretched out - but my recovery was amazingly fast.)

If that were true in scoliosis, bracing would not only halt progression but eliminate the curve altogether.

So here we have it. NO ONE is quite sure. So by referencing a case where there seems to be an underlying connective tissue disorder, I was merely suggesting another possible CAUSE. Of course this is not the cause in everyone. But in light of Pooka1's comment:

How will any change in the curve between standing and laying down ever be relevant to letting a person avoid surgery? We have a person on this group who worked out a lot and she had two large NON-structural curves. She STILL needed surgery if only to hope to save her lumbar.

This sounded like a case of hysterical scoliosis that was surgically fused.

But Linda's comments below about hysterical scoliosis and the other case mentioned by Pooka1 seem contradictory IF and only IF the one Pooka1 mentioned did, in fact, have hysterical scoliosis:

Most peoples' curves flatten out somewhat when the patient lies supine. It's also hysterical or functional scoliosis if the curves flatten completely.

Sharon was talking about a UCSF patient from many years ago. There was no need to brace her. She was woken up, probably given a PT prescription, and walked away.

Does hysterical scoliosis and non-structural curves (where no structural curve exist) go hand in hand? Can a hysterical scoliosis lead to a structural curve?
Makes me wonder if both cases WERE hysterical scoliosis and IF they were, why was one sent home with PT and one fused surgically? OR was there a connective tissue disorder on one of the patients and not the other? These would be good things to know and investigate with regard to idiopathic scoliosis. As far as my experience goes, no one ever checked my flexibility, other than to touch my toes so they could look at my back. I never had my flexibility checked until I was an adult with pain. As an adult I was told I was loose jointed. Shouldn't that be something that they check for before labeling someone with IS? Or does it even matter.

I just can't see how stretchy ligaments can be overcome. In the areas of my spine where I was actively moving as a child, I used to be straight. The area that curved was an area of the spine that can't be exercised. Muscles in and around the shoulder girdle can be exercised, but those around the spine itself can not. So if there were indeed loose connective tissues, I can see why it would collapse there. It would be a rare occurrence, which is the case with me.

I need to stop. I'm having a brain full of contradictions!!! If hysterical scoliosis could be treated with PT, like Schroth, why couldn't two non-structural curves be treated the same way? I'm not saying the girl made the wrong choice. Maybe they would have to keep up the PT for life, which many people don't want to do. I don't know. My head is going to explode. I know that MY curve is stuck where it is. I'll probably take it to my grave.

[Pooka1]

Rohrer! Let me try to clear this up.

The case of probable hysterical scoliosis was what Linda mentioned... they put the girl under, the curve disappeared. She was woken up and sent home. Another probable case of hysterical scoliosis was that girl who ended up at a chiro place instead of with a surgeon so the chiros of course ignorantly took credit for curing her curve when she was in fact talked out of it. The chiros probably never at any point realized the curve wasn't structural. They had her case up on their web site for a while but took it down eventually. Maybe they were getting hammered over not being able to help anyone else with a 60* curve reduce it to 15* in a month. LOL.

http://www.scoliosis.org/forum/showt...nth&highlight=

Chiro has never brought a 60* curve down to 15* and especially not in a month so we know the curve wasn't structural.

The other case I discussed was a woman with two large non-structural curves. She is on the group and was fused about two years ago. She agreed to have her T curve fused to try to save her lumbar from getting structuralized. It was a VERY unusual case! I have never read anywhere of someone with two large non-structural curves like that.

[rohrer01]

Rohrer! Let me try to clear this up.

The other case I discussed was a woman with two large non-structural curves. She is on the group and was fused about two years ago. She agreed to have her T curve fused to try to save her lumbar from getting structuralized. It was a VERY unusual case! I have never read anywhere of someone with two large non-structural curves like that.

So do you know if this woman had hysterical scoliosis? If not, HOW could someone have two non-structural curves without it being hysterical? That's why I brought up the connective tissue disorder because I couldn't think of any other reason to have two non-structural curves. It doesn't make any sense.

[Pooka1]

So do you know if this woman had hysterical scoliosis? If not, HOW could someone have two non-structural curves without it being hysterical? That's why I brought up the connective tissue disorder because I couldn't think of any other reason to have two non-structural curves. It doesn't make any sense.

I agree it makes no sense! She was able to bend both of them out. I don't know if there was rotation. It is not hysterical because those seem to be large c-shaped curves that involve the whole spine. This woman had what looked exactly like a double major curve. Of course it wasn't a double major because she bent both curves out! It is the strangest case ever. But because the curves were large, the advice was to fuse the thoracic even though it wasn't structural. That is my understanding of her case. Maybe she will comment.

[flerc]

Which is the definition of hysterical scoliosis?: A) frontal curve not present in the absence of gravity force.
B) forntal curves without rotation. C) long flexible C-shaped curves? D)curves with normal vertebral shape E) Any combinations of previous definitions

[flerc]

Dr. McIntyre basically said that the tendons and ligaments allow us movement and that the muscles are what hold us upright.

If that were true then the "atrophy theory of bracing" would be true and kids curves would worsen after bracing, which doesn't happen very often.

I don’t know if I’m following you. Sure he said this? The case of the twins I explained said exactly the opposite and he liked it. I believe atrophy implies a change in length and tone. I don’t know if necessarily would imply to be worse.

[Pooka1]

You can google various definitions of hysterical scoliosis but they all involve non-structural curves that can be resolved via anesthesia or just talking it out and so are irrelevant to scoliosis cases which involve structural curves. The two cases discussed on the group were both large C curves involving the whole spine it seems. One resolved with anesthesia and the other with talk (although she was doing chiro).

As rare as hysterical scoliosis is, the one case on the forum of the doubly false false double might be even rarer yet. It is not structural but doesn't appear to be hysterical.

[flerc]

He basically said that if you cast an arm or a leg that after a time the muscles, tendons, and ligaments need to be rehabilitated because the ligaments shorten and the muscles atrophy. (This did happen to my shoulder and it had to be gradually stretched out - but my recovery was amazingly fast.)

If that were true in scoliosis, bracing would not only halt progression but eliminate the curve altogether.

Sorry, surely I don’t understand this.. it seems to me the opposite you said previously. Sure also brace can stop progression and reduce curves.
Certainly shorten ligaments and muscles could explain many things.

[flerc]

You can google various definitions of hysterical scoliosis but they all involve non-structural curves that can be resolved via anesthesia or just talking it out and so are irrelevant to scoliosis cases which involve structural curves. The two cases discussed on the group were both large C curves involving the whole spine it seems. One resolved with anesthesia and the other with talk (although she was doing chiro).

As rare as hysterical scoliosis is, the one case on the forum of the doubly false false double might be even rarer yet. It is not structural but doesn't appear to be hysterical.

Yes, I was confusing hysterical with non structural. I suppose it should to be difficult to see the difference between both. ‘A non-structural deformity of the spine that develops as a manifestation of a psychological disorder. ‘. But which specific kind of psychological disorder? If this is not well known, probably kids with non structural curves should to follow a psychology therapy. I’m sure emotional disorders has much to do.. hysterical scoliosis should to turn into structural ones if they are not solved or something should to be wrong in scoliosis theory!.. or am I missing something?

[flerc]

Does hysterical scoliosis and non-structural curves (where no structural curve exist) go hand in hand? Can a hysterical scoliosis lead to a structural curve?

VH law says that bone growth is lesser where higher is pressure.. or something like this, right? Then if someone has a curve REGARDLESS the cause, concave side is suffering a greater pressure so growth is lesser than in the convex side. This is the scoliosis vicious cycle as I know. For me very much incomplete, but anyway it was showed in animals as rabbits by researchers as Sastre (Fed Machine), so a non structural curve (hysterical or postural.. something else?) should to turn into a structural one if it is not solved in time. Which is the reason to not believe that psychological disorders are the IS cause? (supposing is only one in every case).

[flerc]

it was showed in animals as rabbits by researchers as Sastre (Fed Machine)

..if you didn't know it http://www.ncbi.nlm.nih.gov/pubmed/15456046