Torso Rotation Strength Training for Scoliosis

[Dingo]

Torso rotation therapy has been repeatedly found to be effective for the treatment of Scoliosis. There are links floating around about this therapy in various new and ancient threads. I decided to post all known links here. If you know of any study or anecdotal information that is either pro or con please post it here for other parents.

September-17-2008 - News Story with Video: MedX torso machine reduces 8 year old girl's curve from 14 degrees to 8 degrees.
Roger Schwab: "We've seen it work on almost every case that we've had."
Main Line Health and Fitness Scoliosis page

May-24-2010 - Before and after x-rays: 10 months of Torso Rotation Strength Training
An 11 year old girl used TRS therapy for one year to treat her Scoliosis. The mother e-mailed me the x-rays and I combined them into one picture.

Therapy is based on these 3 torso rotation strength training studies. All 3 studies found that torso rotation strength training stopped curve progression in all small and moderate curves. Many curves were reduced.

February 2003 - Study: The Role of Measured Resistance Exercises in Adolescent Scoliosis

16 of the 20 patients demonstrated curve reduction, and although some fluctuation occured, none of the remaining 4 patients had a persistent increase in curve. No patient required surgery or bracing.

2006 - Study: Trunk rotational strength training for the management of adolescent idiopathic scoliosis (AIS).

Seven adolescents with AIS (5 female 2 male; mean 14 yrs +/- 2.6 yrs; mean Cobb 28 degrees +/- 6 degrees range 20 degrees -37 degrees) underwent four months of supervised trunk rotational strength training, and repeat strength test. Four individuals showed reduction (>5 degrees) in their original curve, and 3 remained the same (+/-5 degrees).

July 2008 - Study: Treatment of adolescent idiopathic scoliosis with quantified trunk rotational strength training: a pilot study.

Patients received a 4-month supervised followed by a 4-month home trunk rotational strength training program.

Quantified trunk rotational strength training significantly increased strength. It was not effective for curves measuring 50 to 60 degrees. It appeared to help stabilize curves in the 20 to 40-degree ranges for 8 months, but not for 24 months. Periodic additional supervised strength training may help the technique to remain effective, although additional experimentation will be necessary to determine this.

2000 - Study/Report: A Preliminary Report On The Effect Of Measured Strength Training In Adolescent Idiotpathic Scoliosis

Myolectric activity was asymmetric in both sides and in abdominal and paraspinal muscles of all patients. These asymmetries were corrected completely with torso rotation, which was associated with significant strength gains.

March 2007 - The Journal Of Musculoskeletal Medicine
Photocopied Report: Dr. Vert Mooney: Exercise For Managing Adolescent Scoliosis

We combined this experience with that of a physiotherapist in New Zealand who was using the same equipment and the same protocols for a total of 31 patients with adolescent scoliosis. The mean curvature was 29.5 degrees (range 10 to 50) when treatment started and 25.1 degrees (minimum decrease, 4 and maximum decrease 43) when it concluded. ...None of the patients worsened.

In most cases the curvature can be reduced. Brief exercises performed twice a week are adequate. Braces are not necessary.

May-18-2006 - Thread: Gerbo asks Dr. Vert Mooney a few questions about Torso rotation and the longterm effects of this therapy
Gerbo:

Similarly to what i asked a year ago, are you still following your initial study group and has stabilisation been maintained?

Dr. Mooney:

I have followed some and stabilization has been maintained.

December 2 - 2011 Interview
I just conducted an interview with one of the nation's top Scoliosis experts. (you can read it here) After the interview we had an exchange about torso rotation that I found helpful so I'm going to include it here.

Question) Your answer on the ineffectiveness of traction and exercise got me thinking.

"Again, exercising for hours at a time is no match for the braces on your teeth that are constantly pulling."

You are absolutely correct. When my son does torso rotation exercises he performs 3 sets of 15 on each side. The total time he spends exercising is literally a couple of minutes. I don't see how that small amount of stretching could make much difference. Could torso rotation work because of some sort of secondary action? For instance maybe this type of exercise releases hormones that stretch the ligaments in the spine? Maybe some other secondary effect? But you're right, a few minutes of exercise probably isn't enough to have a direct impact on the ligaments.

Dr. Kiester) Reasonably directed exercise is of huge impact which is why the immobilization of body bracing has such negative effects. The amount the ligaments have to stretch to stop the progression of the curve is surprisingly small. Thus a little exercise of an effective kind may even result in some reversal of the deformity. Doing a moderate force of continuous stretching (like putting braces on teeth) is when the goal is complete or near complete restitution of the normal anatomy.

March 2011 - Article by Physical Therapist Scoliosis Success Story

We received a call from a woman, whose 16 year old daughter was suffering from scoliosis. Her curvature had been measured between 40-41-degrees in April 2010.

The protocol was simple: One set of exercise to either side, starting with the weaker of the two. She was to go to muscular fatigue if possible on the weak side, or up to the point where I was satisfied with her effort and concerned that mechanics would break down. In most cases, this meant approximately 7-8 reps, and attempting to move slowly and smoothly. As with all novices, the 'control' aspect is difficult - and particularly with an exercise as demanding as the MedX Torso Rotation.

Come late-November, she visited the doctor and her curvature was tested. The results, as we hoped, were positive: a 6-degree improvement (from approximately 40-degrees; 15% less curve).

[MissEmmyF]

I think I read somewhere on the forum that these types of exercises are more helpful for someone with thoracic scoliosis vs. lumbar scoliosis, right? In other words, the exercises target the muscles higher up in the back and not as much in the lower portion of the back?

[Dingo]

torso rotation

MissEmmyF

The MedX machine stabalizes the pelvis to ensure that the work is done by the back and not the hips. It makes sense that this therapy might be more effective for thoracic curves than lumbar curves, however I'm not sure if that's the case. Torso rotation appears to be effective for virtually any curve of 40 degrees +/- or less. Somehow this therapy must affect the entire back.

Main Line Health And Fitness uses other machines that target the rest of the back and they say they're reducing curves by up to 50%.

Most exciting is that MLME/MLHF has developed a specific protocol utilizing both the Med-X Torso Rotation and Lumbar Extension machines as well as several complimentary Med-X and Nautilus exercise machines.

All children with AIS have trunk rotational strength asymmetry. In English that means one side of the back is stronger than the other. IMHO any machine or exercise that addresses that problem is probably helpful.

Trunk rotational strength asymmetry in adolescents with idiopathic scoliosis: an observational study

[MissEmmyF]

thank you, very interesting...i wonder how many gyms have this type of MedX equipment? and, even if they do, i wonder how many of the trainers at the gyms know how to use them properly to help people with scoliosis?

[Dingo]

I'm not an expert but...

MissEmmyF

If you scroll to page 4 of this study you can see the results of Torso Rotation on a variety of different curve types.

I would call around but I imagine that any large gym would have a MedX or comparable machine. I know that pelvic stabilization is important so if the machine doesn't have that feature it may not be as effective. If you read page 3 of the Mooney study it explains how they used the machine to treat Scoliosis. I don't think it requires any special knowledge or ability and it only takes about 30 minutes per week.

I think a MedX machine costs roughly $6,000 or so. That sounds like a lot until you consider that a brace can cost a third to half that amount. Plus when you reach skeletal maturity you can sell your MedX to someone else. Good luck trying to do that with a custom fitted back brace.

[MissEmmyF]

I actually called the phone number from the Main Line Health & Fitness website (in PA) and spoke with one of the customer service representatives (at least I think that's what she was?). I asked if she knew of any other gyms or physical therapy offices that offer the same scoliosis program but closer to me (in CT)? She didn't know, so she gave me the email address of the Director at MLH&F...I just emailed him, so I'm waiting for him to reply...

I know you do similar exercises with your son using a ball - I'm wondering if this could be as effective as using the MedX torso rotation machine (assuming of course that the pelvis stays in one location and doesn't move)...

[Dingo]

my son's physical therapy

MissEmmyF

I'm wondering if this could be as effective as using the MedX torso rotation machine

My 5 year old uses a large exercise ball and rotates left to right 50 times in the morning and 50 times before he goes to bed. He wears ankle weights to keep him steady and I stand behind him to make sure he goes equal distances in both directions. Unfortunately I haven't found a safe and practical way to stabilize his pelvis.

This develops muscle and it stretches out his back but it probably isn't as effective as the MedX. I'm pretty sure my son is too young to fit into the machine so it's the best we have for now. We do other exercises for both strength training and balance and I hope that makes up for it.

On the plus side we are very consistent. I write everything down in his exercise diary which keeps us disciplined.

I asked if she knew of any other gyms or physical therapy offices that offer the same scoliosis program but closer to me (in CT)? She didn't know, so she gave me the email address of the Director at MLH&F...I just emailed him, so I'm waiting for him to reply...

That is awesome! Let me know if they find you a gym.

[MissEmmyF]

Dingo: My 5 year old uses a large exercise ball and rotates left to right 50 times in the morning and 50 times before he goes to bed. He wears ankle weights to keep him steady and I stand behind him to make sure he goes equal distances in both directions. Unfortunately I haven't found a safe and practical way to stabilize his pelvis.

Me: I'm assuming he does this standing? Does it help at all if he does it while he's sitting on the edge of a chair or stool?

Dingo: This develops muscle and it stretches out his back but it probably isn't as effective as the MedX. I'm pretty sure my son is too young to fit into the machine so it's the best we have for now. We do other exercises for both strength training and balance and I hope that makes up for it.

Me: Yeah, I would think a MedX machine would be way too hard/big for him since he's so young! What other strength training exercises do you do with him? For balance, you use the balance board, right?

Dingo: On the plus side we are very consistent. I write everything down in his exercise diary which keeps us disciplined.

Me: Yeah, that definitely helps. I write down everything I do each day too and it helps to keep me motivated.

Dingo: That is awesome! Let me know if they find you a gym.

Me: I'll definitely let you know! Just curious, how old was your son when you spotted his scoliosis and do you know what his curve(s) measures? Have you seen any changes in his back since starting all the exercises?

[Dingo]

therapy

MissEmmyF

Does it help at all if he does it while he's sitting on the edge of a chair or stool?

If he was older and more coordinated sitting might be a good idea. With little kids you have to make it as easy as possible and right now he would flop over. We do it standing because it's so much easier. Plus when you do it standing it stretches out the entire spine. If you do it both ways you'll see what I mean.

For balance, you use the balance board, right?

Yep, we use this balance board 15 minutes per day. He does it while he watches SpongeBob. His record has increased to about 10 seconds without tipping. He usually lasts about 2 to 5 seconds at a time. If nothing else this works his core muscles and it's better than lying on the couch.

What other strength training exercises do you do with him?

We've got it down to a system.

Every day
Morning: 50 rotations in the morning (25 left, 25 right)
Afternoon: 15 minutes on the balance board
Bedtime: 50 rotations, sit down and stretch for a few minutes followed by a couple minutes of massage with a device like this on his spine. All spine growth takes place at night so if there was ever a good time to stretch out it's bedtime.

We do a different strength training exercise each late afternoon except on Sunday. I try to keep workouts down to 10 minutes or less. We do all exercises slowly and with very light weight. Scott weighs 38 pounds and most of the time we lift just 20% or 25% of his body weight. According to the American Academy of Pediatrics strength training is safe for children as young as 7. My son is almost 6 so that's early but we are being very cautious.

Monday: lying rotations
We do an exercise very close to the one in the video except we use a 3 pound dumbbell instead of a ball. In our version he uses a small pad like this instead of a Bosu Ball. He lays on the reverse side without the spikes. We place it under his shoulders and head instead of his middle back. My son's feet are in the same position but they are supported by the couch. We do 5 sets of 10.

Tuesday: 5 sets of Supermen (10 seconds each), 5 sets of leglifts to keep his abs balanced.

Wednesday: Lying Dumbbell Rows
We do this exercise but on a low, narrow bench to strengthen his middle back. We use two 4 pound dumbbells. 5 sets of 10.

Thursday: Dumbbell Press
This exercise doesn't directly work his back muscles. We work out his chest to keep him balanced. We use two 4 pound dumbbells and do 5 sets of 10. BTW, the girl in this video is doing them too fast and with bad form. Obviously we lift slow not fast. In addition we start the dumbbells low at his abs, not at shoulder level with his elbows out. He pushes the dumbbells up and stops when they are right above his shoulders. Elbows IN not out the entire way up and down. It's easy to get a shoulder injury if your elbows are out.

Friday: Lat Pull Downs
We already had this machine at our house. This works out his back and even his ab muscles. This woman uses a grip that is much too wide. Never use a grip much wider than your shoulders. Shoulder width or narrower is what your body was built for. We use 11 pounds (used to use 10) and do 5 sets of 10.

Saturday: Same workout as Tuesday

Sunday: No strength training on Sunday

Ok, is any of this working? After 1 month my wife and I noticed a visible reduction in his rotation. We hope we aren't imagining his improvement. There is always a chance that the extra muscle his body grew is hiding the curve/rotation. Perhaps strength training has improved his posture and this is hiding his rotation/curve. We can't know for sure until his next doctor visit in 5 months. Right now I am very optimistic. If this works I'll try and post his x-rays.

Disclaimer: I am not a doctor, physical therapist or medical professional. Always consultant with a physician before starting any exercise program.

[trcylynn]

When I was in college I got a membership to a Y that had a torso machine- it was not the same as shown- very generic- but I held my pelvis in place and facing straight ahead. The machine worked my obliques so well and my back felt great! I unfortunately have not found this machine anywhere at the gyms I belong to now...

I tried creating my own torso rotation strength training by using the pulley system they have at the gym and trying to keep my hips forward and rotate from my trunk but I worry that using a cable is using more of my arm strength than core strength.

One of my PTs had me doing something similar where I would hold my back straight (as in flex my obliques and abs so that my back looked straighter) then I would bend to the side (holding it "straight") and rotate- it was one of the hardest things I've ever done and I didn't use any weights!

My back is feeling and looking awful again so I think I need to invest my time in training it like I used to. Just the bonus of aiding the pain was enough to keep me motivated at the time.

[Dingo]

one note on my son's strength training

One note on my son's strength training

Although I'm completely sold on torso rotations, nightly stretching and the balance board I'm still working out the bugs on Scott's strength training. Our goal is to make his left side as strong as his right and the front of his body as strong as his back. How we we do that may evolve over time.

[MissEmmyF]

One note on my son's strength training

Although I'm completely sold on torso rotations, nightly stretching and the balance board I'm still working out the bugs on Scott's strength training. Our goal is to make his left side as strong as his right and the front of his body as strong as his back. How we we do that may evolve over time.

Understandable. I'm impressed you were able to come up with such a comprehensive program for a 5 year old - not to mention the fact that he is motivated enough and likes it enough to continue doing it each day! That's awesome.

[MissEmmyF]

When I was in college I got a membership to a Y that had a torso machine- it was not the same as shown- very generic- but I held my pelvis in place and facing straight ahead. The machine worked my obliques so well and my back felt great! I unfortunately have not found this machine anywhere at the gyms I belong to now...

I tried creating my own torso rotation strength training by using the pulley system they have at the gym and trying to keep my hips forward and rotate from my trunk but I worry that using a cable is using more of my arm strength than core strength.

One of my PTs had me doing something similar where I would hold my back straight (as in flex my obliques and abs so that my back looked straighter) then I would bend to the side (holding it "straight") and rotate- it was one of the hardest things I've ever done and I didn't use any weights!

My back is feeling and looking awful again so I think I need to invest my time in training it like I used to. Just the bonus of aiding the pain was enough to keep me motivated at the time.

Hmmm, good to know, thanks for sharing. I suppose a generic torso rotation machine (compared to a MedX brand torso rotation machine) is better than nothing! Unfortunately, I don't belong to a gym right now, so I'll have to start looking around to see what's out there.

[Dingo]

Oblique abdominal training

I've done reading that suggests that the oblique abdominal muscles might be a muscle group that children with Scoliosis could focus on.

It is well known that children with AIS have muscle asymmetry. Put simply one side of the back and one side of the abs are stronger than the other (left vs. right). This is one reason that Dr. Mooney became interested in torso rotation strength training.

The oblique abdominals are one of the most important muscle groups that rotate the torso.

2007 - Study: Trunk rotational strength asymmetry in adolescents with idiopathic scoliosis: an observational study

Multiple muscle groups are involved in rotating the trunk. Among the most important muscle groups for trunk rotation are the oblique abdominal muscles. It is possible that the measured strength asymmetry is a result of altered biomechanics of the oblique abdominal muscles due to the asymmetrical torso.

It's possible that even without access to a MedX it may still be beneficial to strength train the oblique abdominals.

Here is a video of a woman working her oblique abdominals with an exercise called the Side Plank.

[Dingo]

Study from The Netherlands

Another study that suggests that Dr. Mooney's theory of symmetrical strength training is sound.

February 2006 - Study - Geometric and electromyographic assessments in the evaluation of curve progression in idiopathic scoliosis.

In the natural history of idiopathic scoliosis, SGV (remaining growth) and EMG (muscle imbalance) ratio at the lower end vertebra are prominent risk factors of curve progression. The asymmetric (imbalanced) muscle activity is associated with increased axial rotation, which in its turn is associated with increasing Cobb angle and diminishing kyphosis.

Translation: The more growth that remains + the greater the muscle imbalance = more spine rotation which in turn leads to a larger cobb angle.

Obviously this is an average of 105 kids. Every spine "breaks" a little differently.

Dr. Douglas Kiester told me essentially the same thing. First the spine rotates and then growth pushes out the lateral curve.