vestibular testing

[CurvySAT05]

Structural-
I have a question in regards to the theory about strengthening the convexity of the spine. I also agree that strengthening the muscles on the concavity of the spine will cause further spin into the scoliosis progression, but was thinking about the anatomy and biomechanics of the scoliatic spine and something doesnt make sense. Maybe you can help to clarify. On the convexity of the curve you state that these are the "strong" muscles, but it would seem to me (please correct me if I am wrong) that they would actually be weaker because the direction of the curve has elongated them from their "normal" position. On the concave side the muscles are contracted and in essence being "strengthened" all the time the the spine is curved so by stretching the muscles here (as you have suggested), and strengthen the muscles on the convex side of the curve, it would return these to a more natural position and hopefully upright the torso again. It would seem to me that the change in tonus on the convex side would be due to the 3D rotation of the spine "lifting" the muscles, fascia, ribs, and other structures that are surrounding.
Hope that made sense, thanks for helping me to clarify.
Also in regards to this statement

If the spine were bent on a consistant basis you'll end up with uneven compression on the discs, uneven articulation at the facets

I have to agree 100%. I just had fusion surgery 2 weeks ago for a herniated disc at L4-L5 because of curve progression below a prior fusion. There is lots of stress put on the discs below a fusion to begin with, but to add a scoliosis curve on top of that is horrible.

[structural75]

Mandy,
A muscle is at its greatest strength potential in a neutral position... lengthened too much or shortened will physiological weaken the muscle as the actin and myosin filaments loose overlap or 'bottom out'... In the realtive context here, the convex musculature are stronger relative to the concave musculature... as an autonomic neurologic response to prevent further progression. The convex muscles therefore work eccentrically, contract while lengthened, to 'hold' up the curve... preventing or trying to prevent further sidebending. Neither side is particularly strong, but the convex is more 'active', higher tonus output, than the concave (inhibited). It's an issue of tonic functional demand... one side goes to 'sleep' as to not make it worse, and the other gives it all it can to hold it up. I'm not really keen on strengthening the convex side any further for a number of reasons... .

The muscles on the concave side are not necessarily "contracting". In fact they are inhibited... less tonic function (as shown in the EMG tests Gerbo was refering to). They are short as a result of the scoliotic postioning of the spine, which could have been induced by a number of factors.??? ...a muscle can be 'positionally short' without actually having to contract... the fascia will then lay collagen fibers down in this new resting length (shortened) which further 'holds' the curve in that position - enter fascial lengthening/stretching/mobilization/etc.... .

I'm not sure I understand your last couple of sentences on "3D rotation". I'll say this though, Part of the appearance of larger muscles on the convex side comes from the ribs moving back, via their rotation to that side, therefore pushing the musculature into a plane beyond that of the other side.

structural

[gerbo]

The following comment really sends me into a tail spin

I'm just very confused about why this seems so unlikely

good to hear this, you must be human after all (only joking)

I think it is quite logical. Ofcourse, the normal (straight) spine will mostly remain straight through all kind of balancing acts involving brain, nerves, muscles, vestibular system of course.

we are not talking about the normal spine, we are talking about as spine which somehow has developped a scoliotic curve.

As I understand it, you think that compensation mechanisms will inherently aim at straightening the spine, or at least avoiding further bending. I am not so sure about this. The fact that once the curve passes a certain treshold the spine will curve more and more, literally unstoppable without treatment, means that either compensation mechanisms are just failing (that must be your premise) whilst I think it isn't necessarily farfetched to think that compensation mechanisms might help in somehow keeping the body balanced (which is what vestibular system/ eyes and cerebellum are aiming at) but that at the same time these mechanisms have a detrimental effect on the spine. The primary object of the human body is not to maintain its structure at all cost, but will adjust its structure to suit its functional needs.

the development of the secondary curve is an easy example. It seems to me to be a result of the body responding to the inbalance caused by the primary curve. Rather than keeping thhe rest of the spine straight at all cost, the body actually allows a countercurve to develop as a way of balancing things out.

So, this contributes for me to a theoretical explanation why i, unlike you, do not feel too scared of evening out musclestrength on either side of the curve (increasing strength on concave side), as we are doing with the torsorotation exercises, and fortunately limited and early results of studies appear to back this up.

[gerbo]

Truly sorry for that exhaustive reply... I admit it was a bit more than you were asking for.

phew, you can say that again

I wanted to say that I don't encourage further strengthening of the convex side to try and correct the curve

are we confusing our terms here. i think I am strengthening the concave side

This is one reason to be very careful and precise with stretching and so forth. If we stretch/lengthen the concave side in a general manner, it may cause lengthening in the portion of the spine above the concavity as well (where the spine is relatively straight). This could contribute to what I described above, from the other side... ultimately becoming the long convex side of that secondary curve.

I have considered this. However, what i am assuming is that when I "stretch" the concavity, the parts which are really contracted and have restricted movements (round the apex) will hopefully respond and stretch a bit, whilst for the normal part of the spine above the curve, which indeed gets temporarily pushed into a convex curve, this is only part of the normal range of movements and will therefor not really change the relatve length of the ligaments involved in that part of the spine. Hence it is unlikely i change anything structurally there.

Thinking about it, it is actually specifically the action of one of the elastic bands, which pushes the right shoulder downward, which is likely to cause this hopefully functinal curve. and yes, i just have to trust dr rivard here that he has seen it all before and it in never to become "structural"

regards

ps, i do appreciate your view on all this kind of stuff as you clearly do have lots of detailed anatomical knowledge, which does surpasses my make it up as i go along approach.

[Celia]

Gerbo,

Aside the from lengthy sermon that we've just endured on Structural's ad nauseam "theory" as to what happens to the musculature in a scoliotic spine has anything *really* been said as to how this has any practical application in real life ?

[gerbo]

it hasn't celia, I just enjoy it as an interesting discussion/ exchange of views.

(you know me, give me any subject; religion, politics, threatened cultures, global warming and I am always in for an interesting and enlightening discussion. Its a typical dutch thing really. Are germans similar??)

[Celia]

Gerbo,

I enjoy reading your posts and what you're doing makes absolute perfect sense to me Furthermore....you have studies to back up your game plan, which is more than I can say for Structural. I'm sure he'll probably respond by saying that studies are not the "be all end all" and what he's seen in clinical practice is much more relevant.... to that end why doesn't he show us some proof of his incredible "clinical" results. Did he not say in another thread that his own scoliosis has resolved by the use of SI Well Structural....show us some x-rays to prove this.

[gerbo]

now celia, whatever you do, don't get involved with this discussion, you know what you're like..........

[Celia]

I'm just fed up with snake oil salesmen!

[gerbo]

there you go again...

[structural75]

Gerbo,

I do agree with musch of what you're saying... I just don't agree with the analysis/interpratations that have been drawn from the results of the studies. I don't doubt that strength(or is it increased activation 'activation' these doctorsa are noting???? Those are two different things) as shown to improve, but why it is improving is where the theory you described doesn't add up anatomicaly or biomechanically for me. I still am not aware of any muscles on the convex side that pulls it into sidebending on the concave side... so equalizing true "strength" (rather than a demonstrable increase in activation potential) still tells me (and has shown me in paractice by those attempting to do such a thing, real strengthening that is) that it is going to be of detrimant.

It is showing increased EMG output because the postural muscles I referenced are also active for the purpose of stabilization of the spine during gross movement - torsorotations. As you are doing the torsorotations, and lengthening the "weak" muscles rotating into the concavity, you are also asking for them to 'stablize' the smaller segments of the spine to be able to perform this movement with flailing about. I know this might sound like "opinion" to some, but it IS in fact biomechanical and anatomical fact.... . Don't know what else to say without repeating myself.

The primary object of the human body is not to maintain its structure at all cost, but will adjust its structure to suit its functional needs.

Absolutely, I am a firm believer in this fact... The body will always scompromise the musculoskeletal system in an effort to reduce strain/damage on more important physiologically based systems.
In regard to a scoliotic spine... the 'compensations' are not necessarily going to be successful in stopping a curvature, that wasn't what I was implying. And yes, there is an initial inpetus that 'causes' the scoliosis (largely unknown in many cases of IS), followed by the compensation to try and prevent it and 'adapt' to it. The compensations formed by the body are far more intelligent than we could ever come up with because there is no way a human being, doctor or otherwise, could predict and know everything that is being compromised by the primary problem.
Back to your quote... I've said this before, it is for this very reason that I am apprehensive about taking ONE single approach (bracing) at forceful correction of the ideopathic curve... You could very well cause more harm than good by forcing the spine back upright (changing structure at the expense of physiologic functional adaptations) without at least trying to address the underlaying cause(s) and/or related systems that may be in danger... of which the curve was initiated by in the first place. I definitely don't believe that we should be changing structure at all costs, becaue functional physiologic needs surpass skeletal alignment. I think that comment gets right to my point... using forceful corrective techniques at the expense of the real problem at hand is very short-sighted and potentially harmful or futile, as we see so often is the case.

It seems to me to be a result of the body responding to the inbalance caused by the primary curve. Rather than keeping thhe rest of the spine straight at all cost, the body actually allows a countercurve to develop as a way of balancing things out.

Yes, I completely agree with that as well... which is primarily why you see secondary curves come about... it's simply counterbalancing the primary... I wasn't suggesting the body would make the spine straight at all costs.. in fact, given the inevitable and unstoppable introduction of a primary curve, the secondary develops to keep the whole body upright... I wasn't just talking about alignment of the spine, this is a whole body adaptation/adjustments. Sorry for the misunderstanding. When I refer to 'straight', which is not a term I like to use anyway, I mean upright in relation to a vertical axis... directly opposing gravity which is the most efficient position.

So, this contributes for me to a theoretical explanation why i, unlike you, do not feel too scared of evening out musclestrength on either side of the curve (increasing strength on concave side), as we are doing with the torsorotation exercises, and fortunately limited and early results of studies appear to back this up.

I'm not opposed to 'activation', just "strengthening". These studies show an increase in activation (tonal activity/ouptut). Whether the doctors want to refer to that as strength or activation is their opinionated choice, not fact. Just as it's my 'opinion' as well. The difference being that I am taking into account the biomechanics of the movement in combination with what those specific muscles are actually doing during that precise movement... as I described before, it is fact that they are lengthening (eccentrically contracting because they are also stabilizing the spine through the range of motion) while you rotate toward the concavity. They contract concentrically (get shorter) while rotating into the scoliotic rotation or away from the concavity.
Because they are being 'activated'/awakened during this elongation/lengthening, the end result will be a reduction in scoliotic curvature/rotation, ...due primarily from the lengthening, not the "strengthening". The test only shows tonal output, what does it say about the new resting length? It doesn't need to say anything because the results of the x-rays showing a reduction in curve means implicitly that those "weak" muscles had to lengthen to achieve that reduction.
Do you see what I am saying here... I don't disagree with the actual results from the studies, I disagree, based on fact, that it is the result of "strengthening" the muslces... that was a secondary effect of exercise at hand.... the muscles didn't have to "strengthen" to become longer and thus reduce the curve/rotation.
I think the main point of confusion in this comes from not understanding the biomechanics that are actually occuring while doing the torsorotations. I think they are a good idea. But, I still don't encourage "strengthening" of the concave side as I've personally seen people who did this in other ways to great detrimant.

Sorry, another long one...

kindly,
structural

[structural75]

Gerbo,

Quote:
I wanted to say that I don't encourage further strengthening of the convex side to try and correct the curve


are we confusing our terms here. i think I am strengthening the concave side

I believe that was in refernce to someone else's question/comment. Yes, we're on the same page here.

I have considered this. However, what i am assuming is that when I "stretch" the concavity, the parts which are really contracted and have restricted movements (round the apex) will hopefully respond and stretch a bit, whilst for the normal part of the spine above the curve, which indeed gets temporarily pushed into a convex curve, this is only part of the normal range of movements and will therefor not really change the relatve length of the ligaments involved in that part of the spine. Hence it is unlikely i change anything structurally there.

It is common thought that stretching will effect the desired tissue, and it does to a degree. But the reality that I have found in my own body and that of others is that the tssue that tends to need it most, is usually also the most reluctant to change due to the chronic contracture in the muscle fibers and fascial smooth muscles, in addition to the extensive strong bonds created throughout the connective tissue. It will certainly be of great benefit, it's a start. But it will affect tension patterns in neighboring tissues up and down the spine. And these fascial tissues, not just the ligaments, do in fact impact the relative positioning of the body. I feel it's important to monitor this effect and respond to it accordingly if needed.

and fortunately limited and early results of studies appear to back this up.

I support the studies.. don't worry. The word "appear" is operative here... This is why I think so. The study shows two definitive things 1)Tonus increased in the weaker, concave musculature. 2)A reduction, stopped or slowed progression occured as confirmed by x-rays.
If there was a proven reduction in curvature then that would absolutely have to mean that certain 'shortened' tissues/muscles/ligaments along the spine (on the concave side, as I described earlier) had to lengthen in order to achieve the reduction. You can't get a reduction in curvature or rotation without certain tissues lengthening to permit this. The muscles that lengthened to allow this reduction to happen are the same ones that showed an increase in tonus on the concavity (strength as the Drs refer to it). So it's the 'interpretation' of the findings that I don't agree with because the Drs, according to your accounts, have made no reference to this change in length even though it undoubtedly and necessarily took place. "Strengthening" the muscles alone without changing their resting length will not reduce a curve or rotation... it it physically impossible... tissues have to change length for the spine to move.

The following is why I don't only read studies, or base my actions solely on them... they are subject to interpretation, even by the people conducting them. It would have been just as easy to do the same exact study without the EMG intent/use and conclude that torsorotations can help in that:

3) scoliosis either stabilises or even (marginally) improves (based on proper measurements with xrays etc)

as a result of lengthening of the concave musculature during torsorotations to the concave side. The results would have been the same without EMG measurements and it would be known fact by the DRs that a reduction is the result of tissue lengthening/unwinding. For kicks, they could have done it again with an EMG test to find out what the tonal changes were as well, but biomechanically speaking, they were not the cause of the effect.

Regrads,
Structural
ps-thank you for the pleasant exchanges! Agreeable or not.

[structural75]

Celia,
Here is a "practical application". Enjoy !
http://www.massageandbodywork.com/Ar...anagement.html

structural

ps-Can't wait for your feedback! I'm sure it will be loaded with pleasantries, optimism and positivity! Also, it doesn't take a world reknowned surgeon to visually asess my spine and know that it is perfectly straight... one vertabrae in alignment over the next, no rotation, no changes in said alignment during flexion/extension. ... cheers!

[zuma]

Hi All

I am new on this forum and have been following this thread with interest. I am really pleased that things have calmed down and you are all expending your energies on trying to answer one another questions and not trading blows. I understand all sides of the debate and do not profess to be knowlegable to take any side in the debate. However i do have one point that i feel has been missed which is the patient.

I feel reading the posts on this thread that something fundamental has escaped our attention and it was only from reading the last post that it sunk in with me sorry structural i'm not singling you out in any way shape or form it was just something you said that got me thinking, again sorry for quoting you and no one else its like i said its something you mentioned reasonated with me. You quoted the following

I definitely don't believe that we should be changing structure at all costs, becaue functional physiologic needs surpass skeletal alignment. I think that comment gets right to my point... using forceful corrective techniques at the expense of the real problem at hand is very short-sighted and potentially harmful or futile, as we see so often is the case.

I don't know your history (sorry i'm new) but i have a rather large Kyphosis which was diagnosed in the dim dark days when no one addressed kyphosis seriously as it was the powers that be determined kyphosis as too dangerous to operate on and allternative treatments were not availablle. So i was told sorry there's nothing can be done you have to learn to live with it go away and stop bothering me. Well try telling that to a 13 year old who has to endure endless bullying day in and day out, at school and out of school, pretty much all the time so my teenage years were not pleasant and i would not want any one to experience the treatment and bullying i recieved which ended in me contemplating suicide on a number of ocassions and i still suffer from dark depressions now and i'm almost 40.

I understand you are coming from a purely clinical perspective which is the point i am so badly trying to get to, we have to look deeper and tackle the issues from more of a human perspective (again, Structural i'm sorry i'm not saying you don't because i can see by your posts you are a compassionate and passionate man in your field) and not be so clinical and analytical about things. We need to think out of the box and address the needs of the patient both psycologically, clinically and humanly

I thankyou for taking the time to read to this post and sorry for its length. I hope you can understand my english and the context it is written in

peace be with you all

Z

[structural75]

Gerbo,
On the shoulder issue... Wouldn't it be more beneficial to elevate the lower shoulder rather then add more compression to the spine by compressing the higher one. Length vs. compression... of an already overly compressed spine. It just adds to the force of gravity pushing downward. I'm not surprised that secondary curves are appearing after the fact... I humbly believe that is a sign of progression overall rather than a positive sign of improvement. I don't want to sound discouraging, just concerned about what is be labeled as 'acceptable'.

Also note, it is the tilt/bend of the ribcage/spine that causes one shoulder to be higher than the other, rather than an actual elevation/depression of the 'shoulder' itself.

What are your thoughts on that?
structural