Torso Rotation Strength Training for Scoliosis

[hdugger]

These kids did supervised strength training for 4 months. 4 additional months after training stopped (the 8 month mark) the 12 patients with 20 to 40 degree curves had the same strength and no curve progression. This suggests that the impact of strength training lasts quite a while. BTW if you read the study it indicated that only a few kids did any of the home strength training exercises once the gym strength training was over.

I don't think that's right, Dingo. I think they did exercises under supervision for the first four months, and then did an additional 4 months at home, so, at the 8 month mark, they had just finished their home exercise.

[hdugger]

Yes. So the success rate for a temporary reduction using Schroth is:

1/5,000* = 0.02%.

At that rate it is MORE likely that it was NOT due to the treatment.

* My guess as to how many people tried Schroth.

I'm only looking for data points, not success rates. I can get to those later. Right now, my only question is "is it possible?"

Again, recall that we started this discussion thinking that it couldn't be done, or could only be done with some Herculean effort. Now, again, we've progressed to complaining that it's not happening often enough with 30 minutes of exercise a day.

[Pooka1]

I don't think that's right, Dingo. I think they did exercises under supervision for the first four months, and then did an additional 4 months at home, so, at the 8 month mark, they had just finished their home exercise.

hdugger, do you think the results of that particular study fall under any rational definition of "permanent?"

Also what do you mean by "permanent?"

[Pooka1]

Again, recall that we started this discussion thinking that it couldn't be done, or could only be done with some Herculean effort. Now, again, we've progressed to complaining that it's not happening often enough with 30 minutes of exercise a day.

Are you talking about swimmergirlsmom's daughter? Do we know how much she exercised?

[Pooka1]

By the way we also don't know that a million people didn't try to reduce their curve with 30 minutes a day and fail. The failure rate is important if not more important than the success rate for this type of thing. I suspect there would be more cases if it was only 30 minutes a day for most people. Maybe some small fraction can achieve a reduction with that amount.

[hdugger]

hdugger, do you think the results of that particular study fall under any rational definition of "permanent?"

Also what do you mean by "permanent?"

I do not mean by permanent that a thing is done once and never again and it holds the curve. I mean "a reasonable course of treatment that can keep the curve from progressing". Specifically, I mean anything that I could reasonably see my son doing for the rest of his life to maintain his spine.

For my son, I suspect it would have to be 30 minutes or less, and it would have to allow him to easily regain the reduction if he let up for a week or so.

If the torso rotation did not seem to only work for smaller curves (less than my son's 50 something degree curve) it would fit my requirements perfectly. It's *possible* that it might work for a bigger curve, like his, that is no longer quickly progressing. Possible enough that I might check out the machines up here.

So, yes, this is the kind of thing that I mean by permanent. What I *don't* mean is some kind of maybe passive stretching thing where you stand up afterward and feel very straight but then collapse again within 5 minutes. And I also don't mean a brace that's so uncomfortable to wear that he could not conceive of having it for a lifetime. But, a course of treatment he could easily follow that would keep his spine from hurting him or from going down into the lumbar region is all I need.

[hdugger]

Are you talking about swimmergirlsmom's daughter? Do we know how much she exercised?

Yes, we know. Around 30 minutes a day.

[hdugger]

By the way we also don't know that a million people didn't try to reduce their curve with 30 minutes a day and fail. The failure rate is important if not more important than the success rate for this type of thing. I suspect there would be more cases if it was only 30 minutes a day for most people. Maybe some small fraction can achieve a reduction with that amount.

Again, I'm not really looking for a reduction. I'm using that as a data point to indicate a course of treatment that might be effectively holding a curve for many people, but which, due to the awful state of medical research, will never effectively prove that it can stop progression.

Also, I do not necessarily think that anyone has all the right answers. I suspect some part of the Schroth thing is working, but I have no idea how much. Honestly, I'm rooting for the SEAS treatment because, naturally, I wouldn't want my son to travel to Italy all alone for treatment

No, actually I think the SEAS people sound saner than anyone else in this field. They seem very open to all forms of treatment, each in their own place. Or, again, maybe it's just because I like Italians

[hdugger]

To swim back to something that Pam asked, during the more aggressive part of progression, I think even the exercise practitioners feel that a child should be braced. Noone, to the best of my knowledge, thinks that exercise can hold an aggressively progressing spine.

[Pooka1]

But, a course of treatment he could easily follow that would keep his spine from hurting him or from going down into the lumbar region is all I need.

I assume he has a compensatory curve in his lumbar, yes?

How stable is that expected to be over time absent reduction of the top curve and overall balance of the entire spine?

As far as I can tell, some say the amount of correction is related to the overall health of the lumbar below a T fusion but others say it is the overall balance and not the degree of correction.

I suppose if your son's curve is balanced now then his lumbar is likely to not be adversely affected. I'd like to know the rate of problems of any type below well-balanced T fusions and well balanced unfused large curves.

Just for nothing and you may have noticed but I have been banging on about lowering the surgical trigger angle for T curves if there is any chance whatsoever of having to fuse further into the lumbar. I think it is unethical to have a T trigger angle wherein even some fusions end up entering the lumbar until it can be shown the pedicle screw constructs have obviated the previous lumbar problems.

Having gone through the two cases of my daughters, I have A LOT of questions, especially on my second daughter, about not fusing her earlier and possibly not involving L1.

I don't know if there is some relationship between waiting and longer fusion into the lumbar for T fusions but it certainly seems so in some cases I would certainly like to know. That would be a big consideration for me if I had another kid with a T curve.

[hdugger]

I assume he has a compensatory curve in his lumbar, yes?

How stable is that expected to be over time absent reduction of the top curve and overall balance of the entire spine?

I'm hoping we can get good numbers in his appointment on Tuesday. When he first went in, he had a triple curve - 35, 22, 20 - or something like that. His T curve is *very* high - it's almost but not quite into his cervical vertebrae. Over time, his T increased and (it looks) like the other two decreased so that now they look almost straight to me. Or, maybe it's just that his top one is so big that the other two look small by comparison

I don't know if there is some relationship between waiting and longer fusion into the lumbar for T fusions but it certainly seems so in some cases I would certainly like to know. That would be a big consideration for me if I had another kid with a T curve.

Yes, it's the lumbar thing that worries me. I just wish I understood the mechanics better than I do.

[txmarinemom]

When he first went in, he had a triple curve - 35, 22, 20 - or something like that. His T curve is *very* high - it's almost but not quite into his cervical vertebrae. Over time, his T increased and (it looks) like the other two decreased so that now they look almost straight to me. Or, maybe it's just that his top one is so big that the other two look small by comparison

hdugger,

What are/is the apices/apex of structural curvature?

[hdugger]

hdugger,

What are/is the apices/apex of structural curvature?

You'd think I'd know, but I'm not really sure - it's a vertebrae or two beneath his shoulder blade - maybe T3 or T4? Let me see if I can post an xray or two.

[txmarinemom]

You'd think I'd know, but I'm not really sure - it's a vertebrae or two beneath his shoulder blade - maybe T3 or T4? Let me see if I can post an xray or two.

Okay ... and as a point of reference, T9 is typically about nipple level. My structural curve apex was @ T9. This was the only curve that required fusion.

And have you been told all 3 curves are structural?

[hdugger]

Here's the xray from 2008

http://www.flickr.com/photos/45701845@N05/4195964145/