Torso Rotation Strength Training for Scoliosis

[txmarinemom]

Many cases of IIS will resolve themselves completely by skeletal maturity.

Dingo,

You're doing that thing again ... making facts based on your own theories.

Some things that stick out in my mind about your post:

A) Define "many".
B) If CTDs are prevalent in IIS cases, how do they resolve?

Pam

[tonibunny]

Most cases of IIS do resolve spontaneously, Pam That's a known fact although I don't have any statistics to back it up. In these cases though the scoliosis is very mild. There's a method of measuring the angle of the ribs to the vertebrae (called RVAD, devised by Min Mehta of infant serial casting fame) and usually, kids with a RVAD of under 20 degrees will resolve. Cases of mild scoliosis like this are actually a lot more common than people think, and they need no treatment apart from very regular observation to ensure that they aren't progressing; the children usually just grow out of the curve.

However kids with more serious scoliosis tend to progress relentlessly and it does make me wonder if their scoliosis can have the same etiology as the resolving type. It doesn't seem likely to me. That's a personal feeing rather than being based on anything I've read though!

Truly progressive infantile idiopathic scoliosis is extremely rare. I won't be at all surprised if my scoliosis ends up being attributed to EDS and stops being classed as IIS.

Dingo, I will read your frog study further. My own response to people claiming that scoliosis was due to a balance problem was due to the fact that these people said it was a "response of the body in not being able to deal with being upright" and of course, I wasn't upright when my 62/40 degree scoliosis was first diagnosed!

[mamamax]

Cases which resolve spontaneously are as much a mystery to me as the condition itself.

Postural and/or hysterical scoliosis comes to mind and may play a part in some cases which resolve spontaneously?

Postural Scoliosis — Also known as "hysterical scoliosis," postural scoliosis may be a result of pain, as a patient tilts to relieve the pain. It can be reversed by relieving the pain or by having the patient lie flat. X-rays don't show any abnormality of the vertebrae.
http://www.ucsfhealth.org/adult/medi...sis/signs.html

Children and adolescents develop so-called 'hysterical' scoliosis in response to psychological distress [30,31]. Hysterical scoliosis clinically may be indistinguishable in appearance and magnitude from that caused by other factors, and the diagnosis has been applied incorrectly, for example, in curvatures that develop in response to bone tumors [32-34]. Yet, as with any functional scoliosis, the curvature straightens in response to bending sideways.
http://www.scoliosisjournal.com/content/1/1/3

[tonibunny]

Interesting, but resolving cases of IIS are structural curves, and don't drop out when the child is lifted up or lies flat. They are definitely a physical problem, even if they started off as a response to pain or stress.

An infant's bones are very soft and it could be that assymetric growth on one side of the body catches up with the other whilst the bones are still soft enough to respond (that's just an idea I've had though, and is not based on anything I've read). The fact that infants have such soft bones means that serial casting can often actually CURE scoliosis in children if you get them young enough

[Pooka1]

This IIS discussion is interesting for many reasons.

I have a suggestion... perhaps we can have a new area of the forum for people booting up on the literature. People starting on the long, long journey of trying to get their arms around the literature in some small area of scoliosis (which itself is a huge area). It would be people posting papers and commenting on them but there would be a disclaimer that these were not MD/PhDs and that these people have zero training and patients and parents should know that before reading.

Opinions should fly freely and with gay abandon but counterfactual material should still be out of bounds.

I think that would be fun and I would contribute my lay speculation. I suggest, "Hysterical Scoliosis" as the name of the area of this forum.

The problems with not fire-walling this off from the rest of the forum are legion. People will still stumble into the area and misunderstand but hopefully they will ask questions and be told that it is lay speculation.

The other suggestion about Dingo starting a blog for this material is a good one also. He could post all of that here if appropriately qualified. But that doesn't happen so we need to do something else in my opinion.

[tonibunny]

Hopefully this is what the Research forum here is intended for? It's fascinating to read studies and speculate on various things to do with scoliosis, but everyone should be responsible for making absolutely sure that they don't mislead anyone else. This is why I'm being extra careful to point out where things are my own idea or point of view

Maybe it would be a good idea to have a note on the Research forum, stating that the opinions therein are those of lay people with no medical/orthopaedic training (unless otherwise stated)?

[hdugger]

I'm in agreement with Toni. I think a forum labelled "Research" with a disclaimer at the top is an adequate wall. It's certainly more safeguarded than most of the information on the net. Beyond that, you have to trust that adults are capable of reaching their own conclusions.

Beyond posting research, I'd be very interested in gathering some rough data. Specifically, I'd like to start gathering *any* information on people who have reduced a significant curve without surgery. We'd have to define both what is a significant curve and how "reduction" is measured.

I don't mean this to replace peer-reviewed research, but I would like to have some datapoints that we could look at to begin to get a rough handle on this.

Pooka, are you in agreement that a "significant" curve (whatever we define that to be) never spontaneously reduces? Do we need to confine it to adolescent and adult only? Or can we include juvenile? If we can agree on that, we can look at these data points without worrying about a control group, since the natural progression of the disorder is the control (i.e., since scoliosis curves never reduce on their own, any evidence of a reduction is a data point).

[txmarinemom]

Most cases of IIS do resolve spontaneously, Pam That's a known fact although I don't have any statistics to back it up. In these cases though the scoliosis is very mild. There's a method of measuring the angle of the ribs to the vertebrae (called RVAD, devised by Min Mehta of infant serial casting fame) and usually, kids with a RVAD of under 20 degrees will resolve. Cases of mild scoliosis like this are actually a lot more common than people think, and they need no treatment apart from very regular observation to ensure that they aren't progressing; the children usually just grow out of the curve.

However kids with more serious scoliosis tend to progress relentlessly and it does make me wonder if their scoliosis can have the same etiology as the resolving type. It doesn't seem likely to me. That's a personal feeing rather than being based on anything I've read though!

Truly progressive infantile idiopathic scoliosis is extremely rare. I won't be at all surprised if my scoliosis ends up being attributed to EDS and stops being classed as IIS.

Well, I stand corrected. Apologies, Dingo. Looks like I'm the poo-poo head today(or whatever it was that hdugger said that was so funny).

Carry on ...

[mariaf]

Most cases of IIS do resolve spontaneously, Pam That's a known fact although I don't have any statistics to back it up. In these cases though the scoliosis is very mild. There's a method of measuring the angle of the ribs to the vertebrae (called RVAD, devised by Min Mehta of infant serial casting fame) and usually, kids with a RVAD of under 20 degrees will resolve. Cases of mild scoliosis like this are actually a lot more common than people think, and they need no treatment apart from very regular observation to ensure that they aren't progressing; the children usually just grow out of the curve.

However kids with more serious scoliosis tend to progress relentlessly and it does make me wonder if their scoliosis can have the same etiology as the resolving type. It doesn't seem likely to me. That's a personal feeing rather than being based on anything I've read though!

Truly progressive infantile idiopathic scoliosis is extremely rare. I won't be at all surprised if my scoliosis ends up being attributed to EDS and stops being classed as IIS.

Dingo, I will read your frog study further. My own response to people claiming that scoliosis was due to a balance problem was due to the fact that these people said it was a "response of the body in not being able to deal with being upright" and of course, I wasn't upright when my 62/40 degree scoliosis was first diagnosed!

Hi Tonibunny,

I'm interested in this because my son was diagnosed with IIS before age 2. I do know quite a few children who are that young and have scoliosis that did not resolve on its own (a lot of the kids in Mehta casts fall into this group). On the flip side, I also know a few IIS cases that did resolve on their own.

I don't know if I would say "most" IIS cases resolve on their own, but maybe you're right - it just surprised me, I thought that it was a portion of them but not the majority - I could be wrong. Although you say a lot of these were mild curves so, yes, I would agree those tend to be self-resolving more often. Maybe I'm thinking of kids who are diagnosed with, say, a curve in the 30's or even 40's - if I had to guess, I would not say most of these curves resolve on their own. Again, I could be completely wrong.

I do agree that in some cases of non-resolving IIS, a known or suspected CTD is involved.

So, Pam, the jury may still be out - I'm not entirely sure you deserve the title of "poo poo head" today

I don't think anyone knows for sure the percentage of IIS cases that resolve on their own - although if there are any statistics out there that anyone is aware of, I'd be interested in learning more.

[tonibunny]

Hi Maria

I also know a fair few kids with IIS. The ones we know via the support groups, though, are those that need treatment. My own consultants have both told me that I'm one of the unlucky minority that had a progressive curve, and it's well documented that minor curves are relatively common. By minor, I mean really minor - often not much more than 10 degrees. I wouldn't be surprised if there are cases which aren't even diagnosed before they resolve.

The following book reckons that 96% of cases of infantile scoliosis resolve spontaneously, which has really surprised me even though I knew that the majority of all cases do!:

http://books.google.co.uk/books?id=V...liosis&f=false

A quick Google on the subject shows that one of the mums in the Infantile Scoliosis Group was told by her child's consultant that 85% of cases resolve, and even that seems like a surprising proportion. Whatever the true statistic, it's agreed to be a lot, anyway.

I was at Stanmore when Min Mehta started trialling her casts, however I was treated by her colleague Mr Edgar instead. I was already over 2 when she started doing the casts, and my curves were far too large for her to try to treat (I believe she initially tried them out with curves under 40 degrees). I started out with Minerva casts and later on I did have EDF casts, but they were intended to control my curves rather than to try to get them to resolve. I met Min Mehta several times as she'd come round the children's ward and have a look at me every now and then

[mariaf]

Hi Maria

I also know a fair few kids with IIS. The ones we know via the support groups, though, are those that need treatment.

It's funny, tonibunny, after I posted, that same thought occurred to me - that even though I know of quite a few IIS cases that require treatment (i.e., not self-resolving), the parents of kids whose curves did resolve on their own are probably not on the support groups

But, WOW, 96%! I had no idea the percentage of self-resolving curves was that high.

[jrnyc]

96% of WHAT!!!?? wish mine had resolved...how come mine didnt...now i feel absolutely cheated!!

[tonibunny]

Ah, we're the extra lucky ones four percent, baybee!

[mamamax]

Bone Remodeling in relation to Torso Rotation & Bracing in General

Dingo - interested in your thoughts.

This review article will present our work regarding osteopontin (OPN) function in bone remodeling and its application to tissue engineering in bone. OPN, one of the major non-collagenous bone proteins, has an important role in bone remodeling. Our study suggested that OPN acts not only as a trigger for osteoblast early differentiation but activates osteoclast resorption.
http://www.sciencedirect.com/science...9357877c450b98

There seems to be a phenomenology that relates to bone remodeling and some observations that have been made (references below).

• Bone remodeling is triggered “flexure” vs stress
  
• Repetitive dynamic loads placed on bone trigger remodeling
  
• Dynamic bone remodeling may apply to the vertebra of the spine in that maintaining equal pressures on both sides of the vertebra during motion may work towards modeling into more normal shape (for both children and adults).

This may help explain why some things (depending upon application) work, why some don't??







REFERENCES (If anyone can find these full articles, I would like to read them)

Frost, H. M., Bone remodeling and its relation to metabolic bone diseases, C. Thomas, Springfield, IL, 1973.

Frost, H. M., Bone modeling and skeletal modeling errors, C. Thomas, Springfield, IL, 1973.

[txmarinemom]

Okay, so ... I'm out the door to take my last final of the semester, but ...

I was just running some quick searches and found some interesting information that kind of ties into this. I'll have to look more when I get home from school.

I'm sure there's more current info out there, but here's an abstract that makes a link between rhBMP-2 (the bone morphogenetic protein many adult patients receive during fusion) osteogenesis (bone formation, simply put) and osteopontin.

Like I said, I'm in a rush, but I'll pull the full article when I get home. Maybe it's relevant, maybe not. I'm not even sure what it might be relevant TO (heh), but you can kick it around in my absence.

Mamamax, I should have access to the article you're looking for too if you want me to try to get it.

Pam