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Strength and flexibility nexus

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  • #16
    More Clues?

    Upon rising in the morning, I feel shockingly straight and strong - and look fairly straight as well. It is a lovely feeling.

    Rather quickly, gravity takes over - something (for me) that I can actually feel happening. I do physically feel as if I don't have the muscular strength to maintain the benefits of a good night's sleep.

    Interestingly enough, in my youth - when my body was naturally quite stronger, my deformity was barely noticeable and I was quite asymptomatic.

    My core strength is good - in fact, surprisingly better than expected for my individual condition, and age. Where I feel most weakness, is in the thoracic region (chest and rib cage area).

    So, for me - muscle strength and gravity are realities (vs theories), that I can both see and feel. Has anyone ever studied the effect of weightlessness on the mature scoliotic spine? I wonder.

    Thank you for the up thread definition of idiopathic hdugger - found that most interesting.

    Comment


    • #17
      Originally posted by mamamax View Post
      Interestingly enough, in my youth - when my body was naturally quite stronger, my deformity was barely noticeable and I was quite asymptomatic.
      I don't think you can conclude that your curve got worse in lockstep with loss of muscle tone. Curves clearly progress whether or not muscle tone is maintained and even in some cases where muscle tone is increased.

      You mentioned in another thread that your curve was not supposed to progress? Why was it not supposed to progress? What was your Cobb angle at maturity as a teenager?

      The reason I ask is people with curves below ~50* at maturity were told that and their curves progressed anyway to surgery territory.
      Sharon, mother of identical twin girls with scoliosis

      No island of sanity.

      Question: What do you call alternative medicine that works?
      Answer: Medicine


      "We are all African."

      Comment


      • #18
        But some people don't do a lick of meaningful exercise and their curves never progress. In fact that is the current paradigm... under 40* - 50* you are not expected to progress to surgery territory irrepsective of how much exercise you do and don't do.

        Also some curves progress despite multiple licks of meangful exercise.

        So it can't be a lockstep connection between gravity and weakening muscles. Those things are clearly uncoupled in some people (both ways) so there is no generalization to be made. That isn't to say it isn't coupled to some extent in some people.
        Sharon, mother of identical twin girls with scoliosis

        No island of sanity.

        Question: What do you call alternative medicine that works?
        Answer: Medicine


        "We are all African."

        Comment


        • #19
          Originally posted by hdugger
          I'm just trying to figure out the general process. The slow progression in adulthood *feels* like a gravity/muscle thing.
          It's a gravity/BONE thing per the claims as I understand them.
          Sharon, mother of identical twin girls with scoliosis

          No island of sanity.

          Question: What do you call alternative medicine that works?
          Answer: Medicine


          "We are all African."

          Comment


          • #20
            If that is correct then why don't the great run of people who don't work out have their spine start curving and rotating?

            Therefore I think the answer in NOT low muscle tone.
            Sharon, mother of identical twin girls with scoliosis

            No island of sanity.

            Question: What do you call alternative medicine that works?
            Answer: Medicine


            "We are all African."

            Comment


            • #21
              I think you are arguing that muscle is primary at non-growth spurt times. I don't think there is any evidence for that. In fact the opposite.

              In re bone degeneration, that is just a function of continued curvature over time as far as I can tell.
              Sharon, mother of identical twin girls with scoliosis

              No island of sanity.

              Question: What do you call alternative medicine that works?
              Answer: Medicine


              "We are all African."

              Comment


              • #22
                Originally posted by hdugger
                Somewhere in here, there's the role of the loose ligaments. My (ligaments, I think) are so wound up that I think I'd stay upright even if you took my spine out . But, for a bunch of the people with scoliosis, their ligaments don't act as a secondary backup system. And, so, when they go off kilter, their ligaments don't hold them in place.
                It is my understanding that the great run of AIS people, i.e., those with no hypermobility whatsoever, have completely normal ligaments.

                Therefore a ligament connection has been ruled out for he great run of AIS as far as I know.
                Sharon, mother of identical twin girls with scoliosis

                No island of sanity.

                Question: What do you call alternative medicine that works?
                Answer: Medicine


                "We are all African."

                Comment


                • #23
                  Originally posted by hdugger
                  I'm not quite saying that. I'm saying that the failure of the muscles to hold the (now-wedged and tilted) spine upright against gravity contributes to the progression. If you could hold the spine upright after maturity, or just hold it in exactly the angle that the wedging dictates, it wouldn't progress (I think).

                  Again, that has to be what's happening in adults where the curve reduces due to exercise. The muscles are holding the body in the angle that you'd normally just see lying down - i.e., the angle dictated by the bone + ligaments.
                  Then why do the great run of smaller and moderate curves never progress much, not to mention to surgery territory irrespective of muscle tone?
                  Sharon, mother of identical twin girls with scoliosis

                  No island of sanity.

                  Question: What do you call alternative medicine that works?
                  Answer: Medicine


                  "We are all African."

                  Comment


                  • #24
                    Originally posted by Pooka1 View Post
                    (counting down to the time when McIntire comes on here to administer the dopes slaps to the bunnies... )
                    LOL!!

                    Originally posted by Pooka1 View Post
                    Some questions include:

                    1. can spinal flexibility be increased measurably by exercise?

                    2. is it dangerous to increase spinal flexibility without simultaneously building muscle to hold it?

                    3. might it be good to have a stiff spine if it slows curve progression?

                    4. can muscle be used to artificially stiffen a spine to prevent curve progression? (AKA the $64,000 question)

                    5. what is the most a person should pay for a hard brace? (AKA the $6,000 question)
                    1. Yes it can be measured. Has it??? I know it has in low back pain studies. So I would assume there are some healthy controls in which strength and flexibility changes were measured. PT's frequently asked me if I measured ROM. Unfortunately we didn't. At first we didn't really even think about it. After that it was difficulty with accuracy. There are so many ways to cheat.

                    2. I would tentatively say yes. I base this on some of the work from Shirley Sahrman from Wash U. As I understand it, she was one of the first to begin saying that increasing flexibility or joint ROM without also strengthening could/does create an unstable joint. Especially in a patient population in which weakness plays a significant role.

                    Incidentally, it's also why there is serious debate in the sport medicine world as to whether stretching before activity does any good and if it might actually be somewhat harmful...

                    3. I tend to veer away from this logic for the basic reason that steel (alloy) rods are sometimes not even effective in stopping progression. You can't get much stiffer than that.

                    4. Potentially, in some cases. (how's that for non-committal). My overarching theory for exercise effectiveness has to do with functional strength and flexibility. Martha Hawes gave a talk where she alluded to this idea. We're so focused on stopping any and all movement/progression (usually by limiting motion) that we are overlooking that doing so might actually make the spine more unstable.

                    5. As much as the orthotist/doctor is willing to offer a money back guarantee.

                    Originally posted by hdugger
                    Is it actually gravity that causes a curve to progress? Or is it over-tightened muscles/ligaments on the (I never get this right) concave? side? And what does gravity have to do with rotation?
                    Gravity is a major component. It's why there aren't many, if any, four legged animal models of scoliosis. Also why the chicken model was developed. Bi-pedal.

                    I don't think muscle/ligament stiffness has much, if anything, to do with it.

                    Originally posted by hdugger
                    When children are going through a period of rapid progression, is that the actual spinal bones that are deforming at that pace? It just doesn't seem possible that bones could change that fast. Or, is it the muscles/ligaments doing something at that pace (which seems more likely).
                    If I'm remembering correctly, imaging studies, as well as Ian Stokes work on rat tails, suggest that disc wedging happens first and then vertebrae. And they both happen pretty fast because of the rate of bone turnover. Bones can and do change that fast... even though it doesn't seem possible. But how else would they get taller?

                    Originally posted by hdugger

                    Really, I can't figure out how the whole disorder works
                    Dr. Asher used to tell me "Don't study scoliosis. It'll drive you crazy."

                    Originally posted by Pooka1 View Post
                    I have gotten the distinct impression wedging is veyr hard to image.
                    It is. There are a lot of wedging studies using x-rays and MRI's. It's all theoretically possible based on the calculus they present. But in practice it's much more difficult. I think the group in Montreal (Aubin??) do quite a bit with imaging and validating their techniques using cadavers. To quantify wedging in a clinical setting wouldn't be easy to do without serious automation and equipment.

                    Originally posted by hdugger
                    And, here's another thought I had about gravity. Why is it that kyphosis rarely progresses in adults while scoliosis does? Shouldn't gravity work equally on both types of curves?

                    As I understand it, because of the rotational component, this usually contributes to the flat back or hypokyphosis. As the curve progresses, the vertebrae rotate, laterally deviate and shift slightly forward. The motion I use to roughly imagine this is, hold your hand like your holding a drink in front of your body. This is a vertebrae. Then hinge your wrist out. Rotation, lateral and frontal deviation.

                    Originally posted by Pooka1 View Post
                    I think kyphosis progresses in adulthood.
                    If you mean the general population, it does. This is partially a result of micro fractures in the vertebral body due to osteoporosis.

                    Originally posted by Pooka1 View Post
                    No it is just a physical limit of the muscles. My girls went from 57*/58* to ~5*/0*. Therefore it was physically possible with external force and metal support. It was not physically possible with internal force (muscle).
                    Yep. If exercise is effective at all, the target population is definitely in the mild to moderate range. After that, the curve is a different monster.

                    Originally posted by Pooka1 View Post
                    Note how they only claim delay as opposed to prevention. They seem to acknowledge that the stability will be lost when they stop exercising.

                    I hope they follow these women though time to document what happens if they do and don't exercise after the year.
                    This was our finding as well. Apparent control during training. Loss of control without training.

                    Comment


                    • #25
                      Thanks for those answers! But especially thanks for going easy on us....

                      Pamplona has the running of the bulls.

                      NSF has the spanking of the bunnies.
                      Sharon, mother of identical twin girls with scoliosis

                      No island of sanity.

                      Question: What do you call alternative medicine that works?
                      Answer: Medicine


                      "We are all African."

                      Comment


                      • #26
                        Originally posted by hdugger
                        sorry, sloppy writing. What I meant is that I think the gravity/muscle thing is what wears down the bones. So, the kind of thing Mamamax sees happening during the day (and which my son also reports) can't be bone, since it gets worse during the day and better overnight. That has to be the muscles failing to hold the spine in place against the force of gravity. Over time, that failure starts to wear down the bones, but it doesn't start out being bone.

                        Looking at the adults who have reduced their curves, they have to be somehow using their muscles to more effectively fight against gravity. They're not rebuilding their bones.

                        This is more or less what the SEAS people say - standing, unsupported, you're seeing the effect of bones + ligaments + muscle. Probably first thing in the morning you see more like what you see lying down - just ligaments and bone. So the difference between lying and standing is the part of the curve that's caused by muscle action. And, it's also the part of the curve that exercise can effect.
                        I agree - gravity plays an important role as the body ages, there are long term affects.

                        As for progression - as an adolescent I have vivid recall of a period in time where I suffered muscle spasms in the evening. They were horrid. Now I cannot prove it, but I'm betting that was a period of progression during a growth spurt. And that was incidentally, the only time I've ever experienced such spasms.

                        I spent several decades fairly asymptomatic. I never was one to exercise but I stayed active. It wasn't till I was 59 (following a decade of far less activity) that things got ugly with pain present from morning till night (much worse at night). And that pain definitely felt muscular in nature.

                        Bracing has turned that completely around, and I have noticed that my back is generally stronger (out of brace). Some may not want to believe that - but for me it is true. This leads me to ponder my future treatment methods and I believe that for me, the right exercise for my curvature pattern, would be beneficial - based my improvement over the last 10 months.

                        As for bones - we do know that exercise is also good for maintaining overall bone health.

                        Someone once posted an epiphany (for me) See Here.

                        Truly, as has been said - until technology takes a major leap forward - diet & exercise is the best thing we have going for us.

                        Finding the right diet and the right exercise is of course, quite a personal journey for a personal (idiopathic/one's own) condition.

                        Comment


                        • #27
                          Originally posted by mamamax View Post
                          As for progression - as an adolescent I have vivid recall of a period in time where I suffered muscle spasms in the evening. They were horrid. Now I cannot prove it, but I'm betting that was a period of progression during a growth spurt. And that was incidentally, the only time I've ever experienced such spasms.
                          Mamamax, you mentioned you were told that your curves would not progress. Can you tell us what the angles were when you were done growing?

                          Lots of people were told the same thing and yet they progressed, sometimes to surgery territory.

                          Old paradigms need to be revised.
                          Sharon, mother of identical twin girls with scoliosis

                          No island of sanity.

                          Question: What do you call alternative medicine that works?
                          Answer: Medicine


                          "We are all African."

                          Comment


                          • #28
                            Originally posted by Pooka1 View Post
                            Mamamax, you mentioned you were told that your curves would not progress.
                            It was my parents who were told this - at my age of 11 (1960). And the statistics on that are lost to time - at a time when my parents believed everything told to them by doctors ;-)

                            Interestingly enough, that experience is something I only have vague recall of after questioning my dad about my history while he was still alive. So basically Sharon, I went untreated - and wait and watch was elevated to bury-head-in-sand.


                            Can you tell us what the angles were when you were done growing?
                            My next experience came in my mid 20's with a family doctor referring me to an orthopedic surgeon (have no idea whether or not he was an SRS member), and this would have been in the mid 70's. This guy scared me so much I seriously thought he was insane. So I didn't pay much attention to his diagnosis - in my 20's you know, I was full throttle, asymptomatic, and right about everything.

                            Unfortunately I did not keep his xrays. I want to say the thoracolumbar was in the 40's at that time (though it was referred to as lumbar and the compensatory thoracic was not discussed in terms of degrees). Being asymptomatic at the time, and faced with doctor/surgeon who was practically screaming at me that I must have surgery immediately or be in a wheelchair by age 50 and on my way to dying of congenital heart failure (which turned out not to be true) ... well I chose to revert to tactics learned in my childhood - bury my head in the sand & dismiss said Dr as a nut case (he really could have had a better bed side manner .. I think they actually teach that in medical school now).

                            Comparing this to R42 over L57 in April of last year - hey, the diagnosis in 1960 was - wrong. I sometimes wonder if in the end we will find that progression simply cannot be predicted with any real accuracy. And let's face it - gravity takes it toll over time, especially with someone not concerned with fighting it with strengthening exercise.

                            Hence, the work of Martha Hawes becomes dear to me - for it appears that adult history can in fact, be altered.


                            Lots of people were told the same thing and yet they progressed, sometimes to surgery territory.

                            Old paradigms need to be revised.
                            A-MEN!!!
                            Last edited by mamamax; 02-06-2010, 03:31 PM.

                            Comment


                            • #29
                              AIS Rate of Progression

                              Today's risk of AIS progression attached (source: SRS).

                              Sharon - can you (or anyone else) find the data from 1960?

                              Just curious, would like to know.

                              Comment


                              • #30
                                Originally posted by hdugger
                                BTW, if what I'm hypothesizing is true, then the two times that exercise can really help are:

                                1) Before the big growth spurt starts
                                2) After maturity

                                Since those are the two times when muscles are driving the progression (although they end up affecting the bones)

                                I don't think that muscles are driving it during the growth spurt, but I can't really figure out what is.

                                This is side-stepping curves where there's obvious bone degeneration. That's clearly a bone thing.
                                If the best scientific minds to date cannot figure this out - then we wait for future generations ;-)

                                There is publication (from 2006) which seeks to "test" the vicious cycle theory. I read it when I'm plagued by insomnia ... it will make one dizzy. Here it is, for what it's worth (or not).

                                http://www.ncbi.nlm.nih.gov/pmc/arti...5/?tool=pubmed

                                bty - I'm in agreement with your hypothesis :-)

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