Torso Rotation Strength Training for Scoliosis

[hdugger]

Another thought - if the course of JIS is as serious as stated (90% progressing) then a study which simply accepted every JIS patient and showed no progression among any of them would be promising. Not definitive by any means, but certainly promising.

But, not among AIS patients, given the large percentage that don't progress. Among them, there would either have to be a reduction (almost an impossible request) or a really good controlled study.

This, the other side of the coin, is the reason why I don't understand how people can reject alternative treatments because they haven't shown a clear result. A clear result is extremely hard to show, since the most likely result of a good intervention is simply that a curve does not progress, and one can always say that maybe it wouldn't have progressed anyway. Even a controlled studied is so likely to mix in patients with different kinds of etiologies, curves, ages, etc.

[hdugger]

Proponents of conservative treatments will have to somehow control for these types of cases if they are going to claim efficacy.

That's alot to ask of alternative treatments, which aren't generally offered by the kinds of people who normally do studies. Even medical people who do studies have not designed a really good evaluation of the one non-surgical treatment they offer (bracing). And the one definitive experiment they planned now appears to be becoming non-randomized.

I'm not trying to give all alternative treatments a pass - it's very likely that most of them do not work. But, even a very effective treatment would get lost in this muddle.

So, how do we go about figuring out what works? I'd hate to think that there's something out there which will lie unrecognized simply because we're lacking the tools to see it clearly in the muddle?

[txmarinemom]

Maybe it should be used in adult bracing

Seriously, I look forward to reading it - thanks!

rhBMP-2 doesn't even remotely apply to bracing. It requires bone fusion.

Care to have your vertebrae scraped before bracing?

I think not.

[mamamax]

rhBMP-2 doesn't even remotely apply to bracing. It requires bone fusion.

Care to have your vertebrae scraped before bracing?

I think not.

I wasn't being serious Pam - was just trying to make a lighthearted joke & lighten things up a litle - sorry

[mamamax]

But, the problem is clearly the state of the literature. Even a great alternative treatment, so long as it simply stopped progression and didn't reduce a curve, would be unknown given the state of the literature.

True - with the exception of - Martha Hawes. An isolated case some may say - but representative perhaps, of many undocumented cases. Even more noteworthy - that she is an adult case which not only stopped progression but reduced curvature significantly.

[hdugger]

And the yoga woman, and one older teeneger on this forum (whose reduction was still holding the last time I checked). All exercise-related.

One other interesting thing about Hawes and the yoga person is that they did quite a lot of massage. Hawes, I think, was having mainly massage and manipulation during those 4 hours a day. (At least, I recall it being more that than exercise).

So, if those are the tip of the iceberg, then there are likely a much larger group of people who have not have curve reductions but who have not progressed when they otherwise would have. How to discover them, though, is the issue.

With the exception of - Martha Hawes. An isolated case some may say - but representative perhaps, of many undocumented cases. Even more noteworthy - that she is an adult case which not only stopped progression but reduced curvature significantly.

[mamamax]

And the yoga woman, and one older teeneger on this forum (whose reduction was still holding the last time I checked). All exercise-related.

One other interesting thing about Hawes and the yoga person is that they did quite a lot of massage. Hawes, I think, was having mainly massage and manipulation during those 4 hours a day. (At least, I recall it being more that than exercise).

So, if those are the tip of the iceberg, then there are likely a much larger group of people who have not have curve reductions but who have not progressed when they otherwise would have. How to discover them, though, is the issue.

Exactly, the field is fertile but the literature woefully lacking. What is interesting about Martha is, she used many methods. If I remember correctly (will have to check my books), her greatest improvement came when she was working with an osteopath. According to her memoir she maintains her correction with 1 hour of exercise a day. There are many who make such exercise a way of life - would the same correction be maintained with half an hour three times a week? Who knows, its possible I guess.

[tonibunny]

I would agree with that Tonibunny, and that may be why torso rotation is successful for some. I have more serious curves actually, and was told not to do wide sweeping torso rotation exercises - but that exercises involving short rotation would not hurt. If the torso rotation machine could be adjusted to do very short versions of the norm - would it help someone like me .. I wonder.

I should qualify this by saying that I have yet to see proof that torso rotations can be successful. Dingo is very satisfied with how is son is doing, which is encouraging, and I'm following his progress with interest. I do believe that if torso rotations can be beneficial, it will be in cases such as his with very minor curves.

The one other person that I knew who tried torso rotations was a teenage girl, who used the method in conjunction with the Spinecor brace, and she ended up having surgery despite being very dedicated to avoiding fusion. So I do know for sure that sadly it does not *always* work. This is just one case, but it tells me that the method is not 100% failsafe.

[mamamax]

The one other person that I knew who tried torso rotations was a teenage girl, who used the method in conjunction with the Spinecor brace, and she ended up having surgery despite being very dedicated to avoiding fusion. So I do know for sure that sadly it does not *always* work. This is just one case, but it tells me that the method is not 100% failsafe.

And that is the unfortunate part about it all. Nothing is 100% failsafe for 100% of all people. It's as if every spine is as unique as its owner - and we have not enough knowledge to know, in advance, what will prove adequate and what will prove harmful throughout the entirety of any one lifetime. I personally face thoughts like that every single day. It helps me enormously to know of those like Martha Hawes, and Elise Browning Miller. There was a time when we were told that such things as they have achieved, were unquestionably impossible, and yet as it turns out - the literature was simply lacking (and largely remains so in this area).

This morning I found myself thinking about cases which have spontaneously resolved and I can't help but wonder if the answers in the future will come from more in-depth knowledge of how and why that occurs.

[Pooka1]

It helps me enormously to know of those like Martha Hawes, and Elise Browning Miller. There was a time when we were told that such things as they have achieved, were unquestionably impossible, and yet as it turns out - the literature was simply lacking (and largely remains so in this area).

Hang out with a more informed crowd. A rational person would never say it is impossible to temporarily reduce a curve with PT. I know for a fact Hawes has radiographic proof and I suspect the yoga woman does also that show an exercise-dependent temporary reduction their curves. You can also temporarily reduce a curve by standing funny or wearing a brace.

None of this is on the table or in question. What is in question is ever being able to stop the PT, bracing, standing funny, etc. and maintaining the reduction or even halting the curve especially against a backdrop of bone fide cases of these things occurring spontaneously or due to ice cream consumption.

[Pooka1]

And that is the unfortunate part about it all. Nothing is 100% failsafe for 100% of all people.

And some things aren't even 5% failsafe for 100% of people.

[hdugger]

No, I don't think that's true at all. To the best of my knowledge, the literature only recently stated that it was possible to temporarily hold a curve with exercise. Before that, what we heard is that exercise has no effect at all. That people can hold a curve for months or years is a recent breakthrough, again, to the best of my knowledge.

More importantly, a hold requiring ongoing exercise most emphatically *is* on the table. Go back and read Pam's posts - she would have been willing to exercise for 4 hours a day if it would have held her curve. The teenager on this forum who is holding her curve is exercising for one hour a day - how many people on the forum would be willing to do that, if it meant that they would avoid surgery.

I don't know where you're getting your information that an unnaturally straight spine held in place by surgery is 100% preferred to a naturally straight spine held in place by exercise, but I would very much like to see the data.

Hang out with a more informed crowd. A rational person would never say it is impossible to temporarily reduce a curve with PT. I know for a fact Hawes has radiographic proof and I suspect the yoga woman does also that show an exercise-dependent temporary reduction their curves. You can also temporarily reduce a curve by standing funny or wearing a brace.

None of this is on the table or in question. What is in question is ever being able to stop the PT, bracing, standing funny, etc. and maintaining the reduction or even halting the curve especially against a backdrop of bone fide cases of these things occurring spontaneously or due to ice cream consumption.

[Pooka1]

No, I don't think that's true at all. To the best of my knowledge, the literature only recently stated that it was possible to temporarily hold a curve with exercise. Before that, what we heard is that exercise has no effect at all. That people can hold a curve for months or years is a recent breakthrough, again, to the best of my knowledge.

Well when did Hawes get her radiographic proof of temporary reduction? Wasn't it at least 10 years ago? I could be wrong.

More importantly, a hold requiring ongoing exercise most emphatically *is* on the table. Go back and read Pam's posts - she would have been willing to exercise for 4 hours a day if it would have held her curve.

I'm almost 100% sure Hawes's radiographic evidence was known before Pam's surgery.

The teenager on this forum who is holding her curve is exercising for one hour a day - how many people on the forum would be willing to do that, if it meant that they would avoid surgery.

What do you mean by "on the table?" I assume most if not all people who do targeted exercises 4 hours a day can temporarily reduce their curve. If Hawes can do it why not everyone? Yes I am assuming that and have no evidence but I would be surprised if that were not the case.

And even if you can get people to exercise for 4 hours a day for several years just to get to a (This is not necessarily a fact... it is second hand)to maintain it, even if you can get people to try to do that, life's vagaries will eventually intervene. I have used the example of when I had Dengue Fever. Or people who have emergency surgery. I had a ruptured ectopic and had a quick cut through all my stomach muscles. I couldn't straighten up for a few weeks much less do PT. Combine that with the time it takes to lose muscle tone (less than 2 weeks) and you have people failing for no fault of their own. Nobody seems to want to recognize that.

I don't know where you're getting your information that an unnaturally straight spine held in place by surgery is 100% preferred to a naturally straight spine held in place by exercise, but I would very much like to see the data.

Never said that. I said surgery is the only proven way to permanently reduce a curve. You eventually get released by the surgeon. I do not consider PT a permanent solution because you can never stop it if you want to maintain the correction. Dr. Samdani, as of ~2009, claims there is no proof PT can permanently reduce a curve. He could be wrong but at least this is his game.

[hdugger]

Never said that. I said surgery is the only proven way to permanently reduce a curve. You eventually get released by the surgeon. I do not consider PT a permanent solution because you can never stop it if you want to maintain the correction. Dr. Samdani, as of ~2009, claims there is no proof PT can permanently reduce a curve. He could be wrong but at least this is his game.

I don't think I'd realized before that this was your entire argument - that exercise is not a solution because it must be continued in order to maintain the cure.

You could say the same thing about many disorders - for example, people must exercise and watch their diet to maintain their weight. We are not, in the latter example, saying that stomach stapling is the only avenue because continual diet and exercise are too much to ask of people. We assume that the "natural" method of diet and exercise, even though difficult for some, is preferred to a risky surgery that forever changes the way the body operates. Certainly, we do not say that every overweight person should have their stomachs stapled - we save that for those who have been shown unable to effectively use diet and exercise to maintain a healthy weight. Same thing here - if exercise is actually effective in holding a curve, you'd strongly recommend that everyone exercise and save surgery for those for whom the exercise regime failed.

As to what happens if you have a period when you can't exercise - well, you start exercising again afterward and regain the muscle tone. I'm not certain why this would be an argument for surgery.

BTW, this is not my argument against exercise. My argument is that I don't believe we've yet found an exercise regime that will hold a curve even if followed faithfully. But, should we find one, I believe it would be offered as an acceptable alternative to surgery, just as diet and exercise are now offered as an acceptable treatment for many disorders.

[hdugger]

Well when did Hawes get her radiographic proof of temporary reduction? Wasn't it at least 10 years ago? I could be wrong.

I'm almost 100% sure Hawes's radiographic evidence was known before Pam's surgery.

I'd consider that recent. You suggested that a rational person would know that exercise could temporarily reduce a curve. I was saying that, in fact, through years and years of rational literature the exact opposite was stated - that exercise had no effect.

The problem with Hawes results are that she doesn't really know exactly what she did "right." If she had a clearly outlined set of steps that people could successfully follow, I'm certain at least some people would follow them.

And even if you can get people to exercise for 4 hours a day for several years just to get to a point where you "only" have to exercise one hour a day to maintain it, even if you can get people to try to do that, life's vagaries will eventually intervene.

And, to return to the topic at hand, that's why the torso rotational studies are interesting. If one could exercise for 15 minutes a day and hold a curve, I think many people would find that attractive. I know that that is not always the case, as Toni noted. But I would like to hear from more people who have tried it to get a sense of what the limits are.