Clear - 63* -> 15* in a month?

[hdugger]

I think the they're two different sets of terms:

"structural" vs "functional"
so, if you can do something simple, like sit up straight, and the curve goes away, then it's functional instead of structural

and then, within the structural curve, there is
"rigid" vs. "flexible"
both of these are counted in the overall curve measurement, but one part of it disappears when you do something not simple (like the bending xray or bracing). The part of the structural curve which reduces during these procedures is considered "flexible" and the part that stays is considered "rigid"

[Pooka1]

I think the they're two different sets of terms:

"structural" vs "functional"
so, if you can do something simple, like sit up straight, and the curve goes away, then it's functional instead of structural

and then, within the structural curve, there is
"rigid" vs. "flexible"
both of these are counted in the overall curve measurement, but one part of it disappears when you do something not simple (like the bending xray or bracing). The part of the structural curve which reduces during these procedures is considered "flexible" and the part that stays is considered "rigid"

Sounds plausible to me.

Love,
a bunny

[mamamax]

Structural Curve

See how this is seemingly completely at odds with the first definition you posted?

You mean at odds with the first definition offered by SRS .... yes.

Definition #1 Structural Curve - A segment of the spine that has fixed (nonflexible) lateral curvature. http://www.srs.org/patients/glossary.php?alpha=S

Definition #2: Structural curve - a measured spinal curve in the coronal plane in which the Cobb measurement fails to correct past zero on supine maximal voluntary lateral side bending x-ray
http://www.srs.org/professionals/glossary/glossary.php

It also makes it pretty clear that bending xrays are the diagnostic tool in defining structural (according to SRS). Definition #1 comes from the SRS Patient Glossary - and #2 from the Professional's Glossary.

[LindaRacine]

and for certain I do know (from her writings) that she has never seen a chiropractor. I wonder who took the xrays and gave her medical interpretation? Someone qualified no doubt. I'll look closer as I go about my reading(s) #3.

Meanwhile .. Here's the SRS definition: Structural Curve - A segment of the spine that has fixed (nonflexible) lateral curvature. http://www.srs.org/patients/glossary.php?alpha=S

In her recent paper, Martha states "This included deep tissue massage (1992-1996); outpatient psychological therapy (1992-1993); a daily home exercise program focused on mobilization of the chest wall (1992-2005); and manipulative medicine (1994-1995, 1999-2000)." It seems to me that "manipulative medicine" means chiropractic or osteopathic.

Whoever wrote the SRS definition for structural curve must not have been thinking very clearly.

--Linda

[mamamax]

In her recent paper, Martha states "This included deep tissue massage (1992-1996); outpatient psychological therapy (1992-1993); a daily home exercise program focused on mobilization of the chest wall (1992-2005); and manipulative medicine (1994-1995, 1999-2000)." It seems to me that "manipulative medicine" means chiropractic or osteopathic.

Whoever wrote the SRS definition for structural curve must not have been thinking very clearly.

--Linda

Martha did work with an osteopath & makes it quite clear that she never sought the services of a chiropractor. I want to say this is found both in Scoliosis and the Human Spine and her memoir - one of them for certain.

Believe it or not the two SRS definitions are beginning to make sense. And in thinking about it, they are actually both correct.

Patient definition #1 states that a structural curve is a non-flexible curve.

Professional definition #2 further defines the term non-flexible as: a curve (in the coronal plane) which fails to correct past zero in the supine position with the patient lateral side bending as far as possible. I actually get that. A structural curve then may be flexible but is considered non-flexible when it will not correct (or flex) past zero. Are we dizzy yet?

The problem is, in order to understand what is a structural curve (in its totality according to SRS), both definitions need to be studied - as the patient definition does not define the medical concept of non-flexible which is found within the professional definition.

Personally, I would like to see the patient definition expanded.

[tonibunny]

Interesting. I wonder if anyone would claim that it would be possible to remodel the wedging I had here at L1 and L2.

My x-ray, aged 16

[Pooka1]

Interesting. I wonder if anyone would claim that it would be possible to remodel the wedging I had here at L1 and L2.

My x-ray, aged 16

While you do hear a lot of loose talk around here about bone remodeling going on all the time, I guess nobody has figured out a way to remodel the wedging conservatively. That's why surgeons do osteotomies as I understand this (which I'm not sure I do.)

[tonibunny]

While you do hear a lot of loose talk around here about bone remodeling going on all the time, I guess nobody has figured out a way to remodel the wedging conservatively. That's why surgeons do osteotomies as I understand this (which I'm not sure I do.)

Indeed, Sharon. I'd be fascinated to see x-rays from any case where a conservative method has completely remodelled noticeably wedged vertebrae.

[mamamax]

Chest Wall Improvement = Spinal Improvement?

I wrote to Martha - specific to structural vs functional curves. I've received a response from her this morning. This particular correspondence is something I consider private correspondence, I did not request permission to share it in forum, and so I am not going to cut and paste her comments here.

My original message was not to question her, but rather to learn more about structural and functional curves. Her response does find me pondering many things and after further reading of her work, and some thought over morning coffee - I would like to suggest that concern regarding structural vs functional curves may be - a moot point in my opinion (when discussing Hawes' curves). And here's why:

"Controlled clinical studies are consistent with the possibility that nonstructural and structural scolioses are functionally interchangeable at least in early stages of spinal deformity. Thus, in a group of patients hospitalized for spinal fusion surgery, the spinal rigidity that defines "structural" scoliosis was significantly reduced by an exercise program lasting only eight days (Dickson and Leatherman 1979)." Hawes, 2006 Scoliosis and The Human Spine pg 15. I highly recommend this book - and will purchase the 2010 update myself.

If we study Martha's most recent publication (presented in December 2009 to Scoliosis Journal) - those who understand more about these things than myself, will be able to see that her case (from text, pictures, and xrays) is not consistent with what is described as a functional curve(s). Full text found here: http://www.scoliosisjournal.com/cont...-7161-4-27.pdf

So - maybe (based on the references above) it is more important that we pay attention to those things which may affect an interchange between something that appears structural but begins to perform functionally following things like exercise. In Martha's case, her journey involved seeking to relieve a restricted breathing condition and her condition has been improved through chest wall expansion/improvement with a secondary benefit of curvature reductions.

Is it possible that if the chest wall is improved, that the spine also improves?

IF so, this would explain why certain exercises are appearing to provide improvement in curvature. Schroth, Pilates, Yoga, MedX torso rotation, (maybe SEAS which I have not studied) - all improve chest wall expansion. While there is possibly ample anecdotal evidence of this - Martha is the only one with a scientific fifteen year follow up regarding chest wall expansion/improvement and secondary cobb angle improvement (which continues to progressively improve).

Food for thought :-)

[Pooka1]

(snip...) I would like to suggest that concern regarding structural vs functional curves may be - a moot point in my opinion (when discussing Hawes' curves).

As far as I could tell, what was on the table was NOT structural versus functional but rigid structural versus flexible structural. Hawes clearly has a structural curve. The question is.... is it rigid or flexible and have all those years of PT and manipulation increased or preserved flexibility and what is the significance of that, if any.

(snip...) In Martha's case, her journey involved seeking to relieve a restricted breathing condition and her condition has been improved through chest wall expansion/improvement with a secondary benefit of curvature reductions.

I agree. I think she was doing stuff to improve her respiratory situation and was blindsided by the curve reduction.

[hdugger]

Getting the spine to be flexible is just a small part of the equation, IMO. Many of the adolescents on this forum had very flexible curves before their surgery - that is, with their body bent in a certain way, their curve greatly reduced. So, a large percentage of their curve was "flexible." But, if that "flexible" part of the spine collapses into the curve when you stand back up normally, then it contributes to the overall size and progression of the curve, whether it's stiff or flexible. That is, as long as you can't reduce your standing curve, it doesn't really matter how flexible your spine is, IMO. I believe in the study you quoted, their spine was more flexible, but their standing curve was the same.

People with truly non-structural curves (i.e., not just flexible curves but actual functional scoliosis) *can* stand up straight. People with structural curves, whether flexible or not, cannot. That's the difference.

So, the role of a successful exercise program is two-fold. First, for stiff, inflexible spines, it has to make them more flexible. Second (and apparently much more difficultly), once the spine is flexible the exercise program has to help you hold yourself in a more upright position. I've seen a fair amount of reports of people decreasing the amount of curve seen on a bending xray. But I've seen very few reports (just the 8 data points I mention) of people being able to hold that reduction of curve while standing.

[Pooka1]

That's an interesting analysis.

I was just watching some of those POSNA videos and one guy mentioned flexibility. He said amount of the curve that can be bent out (i.e., bending radiograph) is overall flexibility.

Beyond the question of PT holding/reducing curves, the question of PT changing flexibility is interesting if it changes the bending out potential of a curve to such an extent that the lowest instrumented vertebra choice changes (i.e., most distal vertebra that is leveled upon bending). And if that is the case, is that good or bad? That is, does increasing flexibility apparently shorten or lengthen a fusion based on vertebral leveling?

[mamamax]

As far as I could tell, what was on the table was NOT structural versus functional but rigid structural versus flexible structural. Hawes clearly has a structural curve. The question is.... is it rigid or flexible and have all those years of PT and manipulation increased or preserved flexibility and what is the significance of that, if any.

From the literature alone, it would be logical to conclude that exercises "can" improve a structural curve. Maybe that improvement is in fact something (an interchange) that can be defined as a flexible structural curve. From Hawes, 2006 Scoliosis and The Human Spine pg 15, referencing Dickson and Leatherman 1979:

Controlled clinical studies are consistent with the possibility that nonstructural and structural scolioses are functionally interchangeable at least in early stages of spinal deformity. Thus, in a group of patients hospitalized for spinal fusion surgery, the spinal rigidity that defines "structural" scoliosis was significantly reduced by an exercise program lasting only eight days

I agree. I think she was doing stuff to improve her respiratory situation and was blindsided by the curve reduction.

And that is possibly important to all of us, whether we seek no treatment and have breathing problems - or seek non surgical methods - or even for surgical patients (some do experience reduced breathing function).

Chest wall expansion/improvement does appear to have an important spinal connection.

So maybe any exercise that improves the chest wall - is good for all?

[LindaRacine]

From the literature alone, it would be logical to conclude that exercises "can" improve a structural curve. Maybe that improvement is in fact something (an interchange) that can be defined as a flexible structural curve. From Hawes, 2006 Scoliosis and The Human Spine pg 15, referencing Dickson and Leatherman 1979:

Controlled clinical studies are consistent with the possibility that nonstructural and structural scolioses are functionally interchangeable at least in early stages of spinal deformity. Thus, in a group of patients hospitalized for spinal fusion surgery, the spinal rigidity that defines "structural" scoliosis was significantly reduced by an exercise program lasting only eight days

[/COLOR]

The use of the word "improve" is deceptive. What the referenced study found was "the exercise programme and not the traction was responsible for rendering the spine less rigid."

That is, this study showed no decrease in curvature.

The bottom line, at least to me, is that people have been studying the role of exercise in the treatment of scoliosis for hundreds of years, and no one has yet to show that any decrease in curvature can be permanent. With that said, I personally think that a small percentage of scoliosis patients may be able to avoid surgery by the continuous participation in exercise programs. The downside to that is that the exercise program may only lead to a delay in needing the surgery. That delay might be detrimental, in that age significantly increases the incidence of complications, and the longer one waits, the higher the risk of a longer fusion (vs. a shorter fusion).

[mamamax]

Linda -

If a rigidity is lessened by exercise - is this not an improvement?

If you have a copy of the book which contains the passage I offered, you will see that this is not in reference to cobb angle reduction but rather, in reference to a discussion regarding structural and functional curves. I'm not sure why you are referencing traction, exercise was the key component.

Bty, I did not underline the word "improve" for emphasis in my original posting .. you're doing so (to my message) in a reply was a little deceptive ;-)

We can see that there is a potential important connection between chest wall improvement and and the spine through the work of Hawes over a period of fifteen years. This connection may explain why we see improvement in those who engage in exercise that improve the chest wall.

Have people been studying the role of exercise which improves chest wall in relation to scoliosis for hundreds of years? I don't think so.