spinecor

[sportsdoc]

Dr. Mooney..

I sat next to him during lunch on purpose so I could chat with him a bit lol..
really nice guy...

From his introduction and presentation during the symposium...what I remember is that he was a pretty prominent surgeon for 40 years before he specialized in exercise rehab.

During debate format, it was very obvious his general approach in things were very conservative...which i liked very much personally...

While chatting with him, I could tell he was big in numbers as it is typical with orthos...I have asked his opinion on spinecor..thought it was promising but would like to see more data..he wasn't aware of the new studies..

I've attended patient sessions also...couple of other promient surgeons recommended his methods as well...

I like his methods..but it's limited in that it does not address plasticity issue. His method is probably addressing posturer issues arising from primary scoliosis, thus some improvement. I feel if some type of aggressive soft tissue mobilization could accompany the rehab, the results may even be improved upon...

[cherylplinder]

Is this recommended for all curves? Is it equally effective for thoracic, lumbar, and thoracolumbar ? Pardon my ignorance, I couldn't seem to download the whole article, just a summary.

Sportsdoc,
Do you have any recommendations about where to find this type of therapy in the US?

Gerbo,
Did you just go to a regular gymn?

Thanks guys!

[sportsdoc]

I think during rotation, there are some procedures to isolate specific levels...
so it's not just general rotation...
To find out about clinic that may do this, I'd call Dr. Mooney directly and consult.. see if there are any other clinics that does what he does..

I'm definitely considering his method as well to implement...
whatever helps the patients..I'm all for it...

[sportsdoc]

I find it odd that he wouldn't prescribe bracing.

Probably same reason why most chiropractors are against bracing...
Ridgid bracing basiclally destroys the integrity of neuromuscular balance...it promotes atrophy...
you can't do rehab and ridgid bracing at the same time..they contradict each other...

That's one of the reason why it was easy for me to accept spinecor...it would complement rehab while doing it's own thing...

[Celia]

I'm definitely considering his method as well to implement... whatever helps the patients..I'm all for it...

I think the fact that you're here in the trenches - so to speak - is really admirable and you really seem to care about what might work! I have a feeling you'll do great things!

[sportsdoc]

I think the fact that you're here in the trenches - so to speak - is really admirable and you really seem to care about what might work! I have a feeling you'll do great things!

thanx...I just feel scoliosis basically has all the puzzles laid out..and someone just has to fit the pieces together...we are living in both frustrating and exciting time...

Just read an article today that FDA just approved device used for vertebral body replacement...do you see the significance of that? If it can be done right, with some modifications, even congenital defects like wedge vertebra or even in idiopathic posterior end plate deformity(as some say is what's happening with idiopathic scoliosis) could be treated with this thing..

We are getting closer and closer to being able to treat scoliosis more effectively...both surgically and non-surgically..

it's exciting to be part of that....

and another incentive is, one never knows..my daughter could be developing scoliosis...or even my son...my 2 year old daughter is having EENT consult today for possible surgery on her ear...even though it's minor procedure they have to put her under general anesthesia..which is scary for me..I never thought I'd have to put any of my kids through something so drastic..

I'm paranoid...you know i check my daughter's spine every week? lol...she's under weight and short for her age so I'm worried that she may develop some hip pathology as slow developers do..so I do hip exercise with her...she's on all kinds of vitamins and probiotics...if she develops scoliosis?? I'm just amazed how brave you guys are..

Eversince i've had those 2 rugrats, every story about kids just seems so personal...i cry like an idiot with some news stories that has nothing to do with me...can't even drive at the speed limit...ugh..parenthood...one thing that this forum does for me is it keeps scoliosis personal for me...

anyway, you guys are on my prayer list...

[sportsdoc]

New Guideline

Below is the European guideline on Treatment of Scoliosis...Seems awfully different from US method where largely rehab is totally disregarded...
funny thing is that spine surgeons at the symposium seems to favor rehab as well...
it's the practicing doctors at large who are not accepting of the different methods..
I don't know how to put the whole meeting up here..
it's in pdf..so it'll be up on scolibrace.com sometime next week...

I'm impressed though...although rehab was received favorably, US primarily focuses their efforts on surgical technique...
I'm looking at 2006 meeting abstract and Europeans seem to be looking at various causes and treatment methods...


Milan, 13-14 January 2005
2nd International Conference on Conservative Management of Spinal Deformities
1st Consensus Meeting of the
Study group On Scoliosis Orthopaedic and Rehabilitative Treatment

Systematic application of the treatment modules with respect to Cobb angle and maturity:

I. Children (no signs of maturity) 6-10 (12) years of age
a.< 20° Cobb: Observation (6 – 12 Month intervals)
b.Cobb angle 20-25°: Out patient physiotherapy with treatment free intervals (with low progression risk).
c.More than 25°: Out patient physiotherapy, scoliosis intensive rehabilitation programme (SIR) when available and brace (part time 12-16 hours [low risk, low effort])

II. Children and adolescents, Risser 0-3, first signs of maturation, less than 98% of mature hight
a.progression risk less than 50%: Observation (3 Month intervals)
b.progression risk 50%: Out patient physiotherapy
c.progression risk 60%: Out patient physiotherapy, scoliosis intensive rehabilitation programme (SIR) when available + relative brace indication (16 – 23 hours [low risk]).
d.progression risk 80%: Out patient physiotherapy, scoliosis intensive rehabilitation programme (SIR) when available + absolute brace indication (23 hours [high risk])

III. Children and adolescents presenting with Risser 4 (more than 98% of mature hight).
a.less than 30° according to Cobb: Observation (6 – 12 Month intervals)
b.30 - 35° according to Cobb: out patient physiotherapy
c.more than 35° according to Cobb: Out patient physiotherapy, scoliosis intensive rehabilitation programme (SIR) when available + brace (part time, about 16 hours are sufficient [low risk, low effort])
d.for brace weaning: Out patient physiotherapy, scoliosis intensive rehabilitation programme (SIR) when available + brace with reduced wearing time.

IV. Beginning with Risser 5 (more than 99.5% of mature hight)
a.more than 35° according to Cobb: Out patient physiotherapy
b.more than 45° according to Cobb: Out patient physiotherapy, scoliosis intensive rehabilitation programme (SIR) when available.
V. Adults with Cobb angles > 45°: Out patient physiotherapy, scoliosis intensive rehabilitation programme (SIR) when available

VI. Adolescents and adults with scoliosis (more than 20° according to Cobb) and chronic pain: Out patient physiotherapy, scoliosis intensive rehabilitation programme (SIR) when available with a special pain programme (multimodal pain concept / behavioural + physical concept)

[sportsdoc]

WEDGED VERTEBRA EXPANDED BY BRACE
J. Cheneau; G. Engels
e-mail: cheneauj@wanadoo.fr
A tiny wedged vertebra by a six years old girl has become nearly symmetrical after
two years of bracing. We discuss over the apparently unknown possibility that braces give
to lead an elective growth of the shorter side of a vertebra by scoliotic and Scheuermann
patients.

That was from 2006 meeting abstract...exciting or what? I know it's anecdotal...but the possibility is just so exciting...couldn't wait'til next week to post lol...I'm getting goosebumps...

[Karen Ocker]

american vs European guidlines

Sportsdoc:

Could you post the American guidlines so that an easy comparison can be made at the various stages?

Thanks

[sportsdoc]

pardon my ignorance but I'm not aware of any body that publishes actual standardized guideline for everyone's use..it varies by text and groups a little..US does not have specific guideline..more like rule of thumbs in my opinion and it totally excludes physiotherapy or rehab...bracing and surgery are the only things considered. Problem with that is there are lack of interest in the area and that means no funding available which means no studies...considering how much most physicians are in dark with subject of scoliosis..and the fact that those who manage the condition ie spine surgeons totally lack knowledge and interest in rehab, US is in dark ages with scoliosis management
Below are couple of examples of some exisiting guidelines..
my guess is that it's been pretty constant for many years....
it's really explicit in most texts..they just totally shut the door on anything non-brace or non-surgical...
now..there are brace guidelines and surgical guidelines lol...




One potential treatment algorithm for juvenile idiopathic scoliosis is as follows:
Observation for curves less than 25° with follow-up radiographs at regular intervals
Bracing for curves that range from 25-40° and at least consideration of bracing (based on curve flexibility) for curves from 40-50°
Bracing for smaller curves that demonstrate rapid progression to the 20-25° range
Surgical intervention for inflexible curves that exceed 40° or virtually any curve that exceeds 50°.

__________________________________________________ _


below is from publication of American Academy of Family Physicians


TABLE 3
Treatment and Referral Guidelines for Patients with Scoliosis

AGE Risser grade X-ray/refer Treatment


10 to 19 0 to 1 Every 6 months/no Observe
10 to 19 2 to 4 Every 6 months/no Observe
20 to 29 0 to 1 Every 6 months/yes Brace after 25 degrees
20 to 29 2 to 4 Every 6 months/yes Observe or brace*
29 to 40 0 to 1 Refer Brace
29 to 40 2 to 4 Refer Brace
>40 0 to 4 Refer Surgery§

--------------------------------------------------------------------------------

*-- If the patient is Risser grade 4, probably only observation is warranted.

§-- If the patient is Risser grade 4, surgery can be delayed.

Information from references 5, 7, 8, 10, 11, 20 and 21.

[AILEA]

I’ve been always wondering, why things and treatments are so different for scoliosis, depending which "School of thought"the doctor belongs to. It’s quite difficult when you are not a doctor and you must make such decisions.
If he belongs to the American, you know what he is going to said:
-Boston, Milwaukee 23/7, or a bending brace
-No brace, no exercise can reduce your curves.
-You must do some exercise to prevent your muscles getting weak
-If your Cobb angle reach 40º: surgery
But if he belongs to the European:
-Cheneau (and derivates), Lyones, Boston and Milwaukee
-A good brace could reduce your curvature, although the goal is to stop it
-It’s important to make exercise, to strength all the muscles; there are several physiotherapy treatments and rehabilitation exercises. Specific exercises you should do, and others that you may avoid (regarding the thread about swimming, if you swim, choose crawl, better than butterfly or breast stroken)
-If your Cobb angle reach 40º or 50º you may have surgery unless you are pain free, well-balanced, done growing and don’t have esthetical problems
Why can’t they reach an agreement? Scoliosis is scoliosis, and it doesn´t depend on where are you from, or it shouldn’t.

[gerbo]

Is this recommended for all curves? Is it equally effective for thoracic, lumbar, and thoracolumbar ? Pardon my ignorance, I couldn't seem to download the whole article, just a summary.

go to this link http://www.scoliosis-support.org/mod...showtopic=2505 and "useful link nr 5" should get you to the full article.

Gerbo,
Did you just go to a regular gymn?

as medx machine is not available in the uk I had to find a regular gym with similar equipment, I was lucky to find one locally which has got a "torsotwist" machine, which is essentially ythe same. As I understand it, the medx machine is better because it holds the pelvis steady whilst you are "twisting", a task which i do myself by holding on to lisanna's hips whilst doing the exercise

[gerbo]

[]

Below is the European guideline on Treatment of Scoliosis

You're to rosy re european concensus, there isn't any at all, this has been produced by a selfselected group of health professionals who promote this approach, they do not necessarily represent the concensus opinion. Every european country seems to have its own views and approaches and also within countries there are big differences of opinion. For that matter, in the UK the general opinion is still on the lines of observe, brace and operate and nothing else helps, and it is quite similar in holland, although physio is more promoted there, if only to keep the muscles in a reasonable condition.. A physical therapy type of approach seems bigger in central and eastern europe but whether they have any better results is unclear........ all in all, its a mess still out there, and nobody seem to know what's best (and that is why there are so many different approaches)

[Celia]

Except for the Vert Mooney study, there isn't one article that shows that exercise alone reduces curves - I'm not even sure if the Vert Mooney study touches upon permanent correction. Was there was a long term study on these chidren to show what happened to their curves Could someone ask him ??? The Schroth method requires a permanent life style change - i.e., continuous exercise which for some can be a bother - so it's no surprise to me that orthopaedic doctors don't prescribe exercise as a means to reduce curves. I don't see why the adolescent growth spurt has to be feared - as Min Mehta has shown, growth can be a corrective force. I think the time to do these exercises or resistance training would be during the crucial growth spurt (or whenever there is growth) because at that point, the correction could conceivably be permanent - this is all theoretical of course.

[Karen Ocker]

exercises for scoliosis:studies, opinions and trials

This is reference to exercises:

http://www.orthospine.com/?frameSrc=..._kyphosis.html

Can exercises correct a Scoliosis?



One must be aware that scoliosis curves can neither be improved nor their progression prevented by exercises. However exercises for spine stabilization are beneficial for most people with spine problems. After careful evaluation by a spine specialist most patients with scoliosis are encouraged to participate in athletics without reservation (swimming and bicycling are probably better than running).



It is mostly recommended to engage in aerobic exercises with limited amount of resistance (no more than 40 lbs.). Gym exercises can be pursued with upper extremity work outs in sitting and supine positions, using free weights or machines (nautilus or cybex) to indirectly strengthen the supportive musculature of the back. Lower extremities exercises should avoid excessive work in deep knee or hip flexion. Keeping in shape, maintaining normal weight, eating a balanced diet and avoiding smoking are all part of a healthy back regimen

Here's a recent summary of studies/outcomes with alternative treatment:

http://www.ncbi.nlm.nih.gov/entrez/q...=pubmed_docsum

Recent study on alternatives:

http://www.ncbi.nlm.nih.gov/entrez/q...=pubmed_DocSum

Here's an interesting Japanese study with physio:
http://www.ncbi.nlm.nih.gov/entrez/q...=pubmed_DocSum

This talks about exercise and bracing for kyphosis as being helpful
:
http://www.ncbi.nlm.nih.gov/entrez/q...=pubmed_DocSum