Torso Rotation Strength Training for Scoliosis

[Pooka1]

1992-2001 Daily home mobilization exercises (no strengthening or aerobic) + some other intermittent therapy;

No duration listed for this one. Why?

[hdugger]

That is very interesting. Thanks so much for posting the report, Writer.

A few other points I'm pulling out of the report:

* She may have had JIS rather than AIS - asymmetry noted by age 6, 45 degree curve by age 11. Based on the bulk of JIS reports I've seen, it's very likely she would have progressed to surgery.

* She may have some mild connective tissue disorders. At the least, she mentions pectus excavatum which, along with scoliosis, is seen in some connective tissue disorder.

* Based on the age at which she was diagnosed at 45 degrees, it is equally interesting that she managed to maintain her curvature without progressing.

* She lays out in report a fairly clear summary (on page 5) of the exercises she performed when young to maintain her curve.

* Activity between 1992 and 2001 are detailed in the paper (and, I believe, also covered in detail in her previous report)

[hdugger]

One last idea/hypothesis

When we talk about the number of hours that Elise Miller and Martha Hawes spent initially reducing their curve, I think we forget that they were researchers and not practioners. That is, they were trying all kinds of different things to figure out what worked for them. I don't believe the amount of time they spent accurately reflects the amount of time needed to reduce/maintain a curve once we understand exactly what exercise are needed.

There's also no way of knowing how much of the one hour of daily exercise is actually necessary to maintain the reduction. We have two other data points that suggest that less time is needed. As we learn more, we may be able to hone in exactly which exercises are reducing the curve and maintaining the reduction. Until then, it's likely that all of these amounts of time include as least some unnecessary exercises.

[Pooka1]

From the 2009 paper on Hawes...

Table 1 outlines her methods of treatment - none of which involve 4 hours a day of exercising for years and years - a myth that I'm glad to see set to rest in this report. From 1964-1974 she used calisthenics for about 30 minutes daily; 1974-1991Calisthenics, stretching, plus aerobics (biking, jogging) 60 min daily; 1991 Deep tissue massage 60 min daily; 1992-2001 Daily home mobilization exercises (no strengthening or aerobic) + some other intermittent therapy; 2001-2005 daily mobilization, strengthening & aerobic exercise 40-50 min daily.

From the previous article:

http://www.scoliosis.org/resources/s...on_spr2002.pdf

From January 1993, one of the authors (WJB) provided instruction, support, and evaluation of posture and movement. Sustained pressure applied directly to muscle spasms, or manual traction to stretch the torso,was used by the patient to relieve pain as needed ( 4 h daily through 1997).

Okay so she did this for FOUR hours every day for FIVE years. The daily effort spent on this component of her treatment is the ONLY one left out of the table and is therefore conspicuous by its absence. I don't know why it was omitted from the table.

And I don't know why the dates for the various treatments don't match exactly between the two papers. Seems strange.

Hawes is a plant science professor and therefore NOT a nut. I will give her the benefit of the doubt on any differences between the two papers.

But let's not go on saying the 4 hours a day for years is a myth, shall we?

[oojackapivvy]

Off on a slight tangent, something I've often said over the years that I'd like to see in a good quality study of exercise based therapies (should such a thing be done) is bending xrays done before commencement of the therapy, as I'd like to see the correlation between that and the success of the therapies. If it would give a measure of the potential for success (which Cobb angles alone clearly will not), that could be valuable, perhaps particularly in cases where the curve is not showing signs of being progressive in adulthood, but the person is concerned with the cosmesis.

[hdugger]

Yes, that's a very good point. In the SEAS study, they suggest something similiar. They show a graphic of a hypothetical curve measured in three postures - standing (hypothetically 40 degrees), lying (hypothetically 30 degrees), and lying while braced (hypothetically 20 degrees).

And the attribute the following effects on each measurement:

When standing (SR), the curve is effected by posture, ligaments, and the underlying bony curve.

When lying out of brace (LR), the postural element is removed an the curve is affected by the ligaments and the underlying bony curve.

When lying in brace (CR), both the postural and the ligament elements are removed and the curve is affected only by the underlying bony curve.

What they therefore claim is that, while you cannot correct the fixed bony curve, you can use exercise to affect the postural collapse. In adults, the idea is that reversing the postural collapse will reduce the amount of further bony degeneration.

Again, this is all hypothetical, but it does make some intuitive sense. It would also mean, I think, that those most likely to show a great curve reduction with surgery would also show the greatest improvement with exercise, although I *think* that surgery takes you back to the CR curve, while exercise would only take you back to the LR curve.

Off on a slight tangent, something I've often said over the years that I'd like to see in a good quality study of exercise based therapies (should such a thing be done) is bending xrays done before commencement of the therapy, as I'd like to see the correlation between that and the success of the therapies. If it would give a measure of the potential for success (which Cobb angles alone clearly will not), that could be valuable, perhaps particularly in cases where the curve is not showing signs of being progressive in adulthood, but the person is concerned with the cosmesis.

[oojackapivvy]

Ah, that ties in well then with what I have often said over the years which is that it would not surprise me if exercise therapies can/do work on the postural element.

Another tangent, what is it with xray techs who insist on trying to make you straight? I'm truly fed up with fighting them! In particular, because I have such severe sagittal imbalance (it's got to be close to 30cm again), serious coronal imbalance and massive rotation, if I'm made to stand with my knees and hips bent to bring my spine vertical, and my right knee especially bent to drop my right hip and re-centre my weight with my head over my sacrum, this gives a totally artificial picture of things.

I find myself wondering is it any surprise that they did not restore enough lordosis in my 2002 revision, given that they were relying on the xray I had done prior to it, where I had to fight with the tech to be allowed to stand with my knees even partially straightened, as she insisted that I'd hang off the film and refused to do 2. The result is that they worked from a measurement of 19.7cm of sagittal imbalance (as I finally found out earlier this year), when it was definitely over 30cm.

As it happens, the technical issues of having an un-removable anterior rod, and having a short, sharp 45 degree kyphosis over T10-L3, meant it was almost impossible to restore enough lordosis no matter what measurement they worked from, but had they had the accurate measurement, perhaps they'd have fused to the sacrum then, rather than only L4, and I might well not be facing a second full magnitude revision. Mind you, if they had, perhaps I'd now be whining that I wished they could have stopped short and left me some flex

In any case, I'm certainly not at all surprised to read that you can get significantly different measurements based on the posture even while standing. How many times does it make the difference between surgery or not - and that can actually be just as bad a thing if it means spending more time classed as borderline and being refused as if it gets you over-measured and rushed off too soon.

[Dingo]

Swiss study

Swiss researchers appear to be wrapping up a study on strength training and Scoliosis. My sense is that this is another torso rotation study.

The effect of asymmetrical weight training on paraspinal muscle activity in scoliosis

Paraspinal EMG measurements on the convex side of the scoliotic curve have been demonstrated to be enhanced. At present, most scoliotic patients are trained symmetrically which possibly further enhances the muscular imbalance. The present study therefore aims to investigate whether asymmetrical training will be superior compared to symmetrical training in terms of muscle balance in the spine of scoliotic patients. The project is divided into two studies: The first study investigates the immediate changes in paraspinal EMG in scoliotic patients during symmetrical vs. asymmetrical exercises. In the second study, scoliotic patients will be randomly assigned to a symmetrical or an asymmetrical weight training for 3 months and functional outcome, pain, paraspinal EMG, trunk strength/endurance will be compared.

[hdugger]

Hey, you've been hiding data points from me, back there in the initial post of this discussion

From http://www.medxonline.com/downloads/...nscoliosis.pdf

Two data points

14 years old - original curve 45, final curve 32
14 years old - original curve 50, final curve 32
Length of study - four months

[Pooka1]

I don't think surgeons say temporary reductions are impossible. I don't think any surgeon would claim they never occur. There are too many of them, even one in this little sandbox to have remained unknown to the orthopedic community. It strains credulity to suggest that.

ETA: Spontaneous reductions and complete resolutions have been known for some years. I think the thing that surgeons claim has no evidence is the exercise-induced claim of reduction and the complete lack of evidence that it is a permanent reduction even if it can be shown to be due to exercise.

Recall Samdani was completely unfazed by that girl's 8* reduction from torso rotation. It wasn't like he was wowed and then said he didn't think it was permanent. It was like he simply doesn't think these cases are dispositive of anything.

Just my impression.

[jrnyc]

re: latest publication concerning martha hawes...thoracic, thoracic, thoracic...any evidence anywhere of curve reduction of LUMBAR...??!!!!

just askin'......

jess

[Dingo]

Vert Mooney study

jrnyc

Check out page 4 of the Vert Mooney study. It appears to work for just about any curve type. However this was in children, I'm not sure about adults.

The Role of Measured Resistance Exercises in Adolescent Scoliosis

[Dingo]

website

hdugger

Hey, you've been hiding data points from me, back there in the initial post of this discussion

Yeah at this point the links are scattered over pages of this thread.

I'm going to make a website that contains all of this info. Hopefully it will be done in a few weeks.

[hdugger]

I would be very interested in hearing an orthopedic surgeon's opinion on this issue. I never see reductions of any kind in a large curve in a mature spine - temporary or permanent - noted as a possible occurrence in any of the literature.

As to the 8 degree reduction, that was in a small curve in a young patient. Yes, reductions absolutely happen in those curves - that's been noted in the literature. That's why we're only looking at significant curves in AIS or adult scoliosis cases.

If someone can find me a case of a spontaneous reduction lasting several months or years of a significant curve in an AIS or, preferrably, adult spine, I would very much like to see it.

I don't think surgeons say temporary reductions are impossible. I don't think any surgeon would claim they never occur. There are too many of them, even one in this little sandbox to have remained unknown to the orthopedic community. It strains credulity to suggest that.

ETA: Spontaneous reductions and complete resolutions have been known for some years. I think the thing that surgeons claim has no evidence is the exercise-induced claim of reduction and the complete lack of evidence that it is a permanent reduction even if it can be shown to be due to exercise.

Recall Samdani was completely unfazed by that girl's 8* reduction from torso rotation. It wasn't like he was wowed and then said he didn't think it was permanent. It was like he simply doesn't think these cases are dispositive of anything.

Just my impression.

[hdugger]

I thought the SEAS study and the patient on this forum both reduced lumbar curves, but I don't have the time right now to go back and check.

re: latest publication concerning martha hawes...thoracic, thoracic, thoracic...any evidence anywhere of curve reduction of LUMBAR...??!!!!

just askin'......

jess