Muscular question to Dr. McIntire

[flerc]

A proof with scoliosis should to be done. Maybe the resistance of the back would be lesser. Actually the resistance increase with the number of curves, but scoliosis curve is in other plane and there also should to exist something like a critic angle and beyond it, resistence may decrease in a significant way. I explained about that in my first thread, http://www.scoliosis.org/forum/showt...51-Help!/page3 before question 8) and 9) and after 10) (I remain with the same doubts!). I should to resume that analysis, since nobody seems to want to do it..

I resumed this issue yesterday and I'm not sure at all, but I believe is all a trigonometric matter and sin(x) is the function of the lateral force and cos(x) the vertical, being x the degrees of the inclination of each vertebra. ie. in a 'simetrical' of 60º, the maximun lateral force would be the half of gravity force. But I'm not sure about the value of gravity force that would be applied in each vertebra. The minimun would be the weight of the vertebra and the maximun the weight of the body upper of the vertebra.
But I not remeber what I did to calculate the resistance of the column. I believe that resistance function is the same in all columns of the exactly same shape, that is, suppose for instance you have 2 identical columns, one of plastic and the other of steel. When you put 1kg in the top of the first, it begin to buckle and the same occurs with the other when you put 100 kg in the top. Then you decrease a x% the curve in both columns, and if now you need 1,x kg to buckle the first, then you'll need 1x0 kg to buckle the other

I made a mistake.. question 8) is for physicists (or engieneers) and 9) for physicians. In fact I really doubt that physicians (surgeons..) know enough about that issues, but they may give information to physicists about the material and characterisics of the spine, needed to know about the resistance.

[flerc]

Now I am a 99% sure that is right the calculus of the lateral and vertical forces in function of the inclination of each vertebra. Is a combination sums and products of sin and cos and is complicate to show it here without drawins, but I suppose is a 'soft' functions as sin and cos are. That is, low variations in degrees leads to low variations of lateral and vertical force. It's not a complex demonstration and surely engineers working in constructions known it and surgeons should to know it!

Which do you think is force in the back, opposing to lateral force? That force would tell us about the resistance of the back. Vertebras and discs not seems to me and I doubt about joints, so I think it should to be ligaments, muscles, tendons, fascias or internal organs and in thoracics curves the rib cage, but what exactly??.. the sternum? A neurosurgeon said me once that it's the responsable of the force opposing to the used in a surgery to stretch the spine, so if it's true, is reasonable to suspect of it.
But a surgeon said me that in adulthood, the flexibility begin to decrease (too credible) because ligaments begin to lose flexibility so is reasonable to suspect of its. An experiment should to be done to know about that.
Which do you think are the muscles that may be opposed to the lateral force?

Thanks in advance and sorry for so many questions!

[Kevin_Mc]

Which do you think is force in the back, opposing to lateral force? That force would tell us about the resistance of the back. Vertebras and discs not seems to me and I doubt about joints, so I think it should to be ligaments, muscles, tendons, fascias or internal organs and in thoracics curves the rib cage, but what exactly??.. the sternum?

I think it's all of the above. Identifying the most influential would probably differ for different people. I would argue that muscles play more of a role in people who work on trunk stability or who work out. And would suggest that for those who don't exercise or are completely sedentary, that the muscles play a much smaller role and are more dependent on the passive structures.

A neurosurgeon said me once that it's the responsable of the force opposing to the used in a surgery to stretch the spine, so if it's true, is reasonable to suspect of it.
But a surgeon said me that in adulthood, the flexibility begin to decrease (too credible) because ligaments begin to lose flexibility so is reasonable to suspect of its. An experiment should to be done to know about that.
Which do you think are the muscles that may be opposed to the lateral force?

I would initially think that the spine extensors, e.g. multifidus, working symmetrically, resist lateral forces. I'd have to look again at my spinal anatomy, but I know there are some muscles that attach to the lateral pedicles or the transverse process. These muscles would be ideally positioned to resist a lateral bending force.

[flerc]

Kevin!, sorry I don’t know why I didn’t see your reply before.
It’s really important this issue; some statistics show that curves > 50° has a really serious risk of progression even after growth is finished. I think it seems reasonable to believe that not only because Hueter-Volkmann law (vertebra deformation), but also because this lateral force that is different not only because the degrees but also because the shape, so a more precise ‘critic angle’ may be defined according each case, even with the same degrees. And of course, the most important of all is discovering the best that we can do to oppose to that force in each case.
As always, working symmetrically seems to be good and multifidus seems to be involved. Of course I’m extremely interested in knowing about those muscles.
As always, Thanks for all!

[Kevin_Mc]

As always, working symmetrically seems to be good and multifidus seems to be involved. Of course I’m extremely interested in knowing about those muscles.
As always, Thanks for all!

I came across this article. While not specifically about lateral forces (although I'm sure that article exists somewhere), it is about axial forces and has a nice desription of the lumbar paraspinals.

Arjmand N, Shirazi-Adl A, Parnianpour M. Trunk biomechanics during maximum
isometric axial torque exertions in upright standing. Clin Biomech (Bristol,
Avon). 2008 Oct;23(8):969-78. Epub 2008 May 29. PubMed PMID: 18513843.

The FE model as well as global and local musculatures in the sagittal plane (fascicles on one side are shown) in upright standing posture at initial configuration before application of gravity loads (axes are not to the same scale). ICPL, iliocostalis lumborum pars lumborum; ICPT, iliocostalis lumborum pars thoracic; LGPL, longissimus thoracis pars lumborum; LGPT, longissimus thoracis pars thoracic; MF, multifidus; QL, quadratus lumborum; IP, iliopsoas; IO, internal oblique; EO, external oblique; RA, rectus abdominus. Centers of mass of the head and neck as well as trunk itself are also depicted.

The muscles of the thoracic spine will be fairly similar although wherever you see "lumborum" it would probably be called "thoracic" or "thoracis".

This is an extremely technical article from a biomechanics point of view. It seems like you might be able to understand it. Search for the article in pubmed and then click "related links". Alternatively you could search for it in google scholar and that should give you some good references. As well you can see the articles that have cited this article.

[flerc]

Kevin_Mc, is really very important the information you are giving me. I had not enough time yet and I only found this interesting link http://www.ncbi.nlm.nih.gov/pubmed/18513843
I prefer in this moment to summarize what I believe and wait for your wise comments..I’m thinking aloud although it’s no so simple for me in English..let me know if I’m not being enough clear please.

I think that normal spines only suffering the vertical component, should to have very different mechanisms to fight against gravity force in a right and natural way. With scoliosis, the vertical component is lesser, but the horizontal (lateral), not present in a normal spine seems to be really important and it not seems clear that the body should has a natural mechanisms to fight against it.

In any structure as the human body is, only a force may change this structure. Certainly other forms of energy provoking matter alterations may eventually affect structures without any force, but I cannot imagine it may happen in a body. Something as osteoporosis, affecting the vertebra composition, makes weakest the structure and then it may change because the action of forces.

Of course during growth, the effect of this lateral component should to be greater than in adulthood, but the growth itself is a force so we may think that this component is not necessarily the responsible of progression.
But in adulthood, I cannot imagine other force provoking the structure change (progression) than the gravity force and mainly the horizontal component.
Something as medullar tension, I really doubt may be actually a force. Muscles (and tendons or fascias?) of course may be the other source.

I know the effect that vertical force may do in normal spines. My father was ever until some decades ago, around 5 cmts taller than me but now is the opposite (I’m around around 5 cmts taller). His back is straight as ever, but it seems that discs (and vertebras?) lost height because the action of this force.
But it seems that statistics say that with a curve, the effect of the lateral component occurs before. This force may provoke rotation (leading to a vicious cycle) although (I’m not sure) it may be provoked by also the vertical force.. it’s a known effect in articulated columns as the spine seems to be.

I think that at least in adulthood, we should try to avoid all possibilities of muscles incrementing the lateral and rotational forces and trying to make the structure the strongest that may be. And also trying that this forces may be the lesser that may be.. not carrying heavy weights, not jumping, keeping a right posture, not gaining weight.. and making the components opposing to that forces the strongest that may be. I don’t know if it would be possible to do it with ligaments, joints, tendons, fascias.. rib cage..certainly discs are also undergoing the tension.. but muscles seems to be possible to strengthen.

But returning to the example of the twins.. the structure seems to be enough to hold the back ‘straight’.. not incrementing the curve at least being sit down in a static way. And muscles belongs to that structure and surely also in a passive way contribute to holding the back, that is, if it would be cut, the structure would be weakest even in this static position.

So it seems to be important not (only) the strong that muscles may be but their resistance; I thinks it’s not the same. I think that we only may talk about resistant ligaments but not about strong ligaments.. they cannot develop any force as I know.
So my doubt is if muscles may turn more resistant, not only stronger. Increasing the tone increase the resistance?

But anyway the dynamic way, as you said me once is of course very important and I think that the body may be enough intelligent to activate in an unconscious way the muscles needed to fight again the lateral (and rotational?) force. Some disciplines belonging to Physiotherapy talk about unconscious spine muscles and it has sense for me. When I’m stand up or walking, I’m not thinking which muscles I need to activate.. in fact I also not do that when I move my hand, but my intention is to move it and I suppose that my brain knows what to do, but my only one intention is to remains straight, not to move or activate any part of my body, so I think that muscles are activated in some unconscious way.

So if all above is true (or almost true), at least in adulthood, stronger the corresponding muscles to fight against that forces in a static or active way seems to be extremely important. Surely it would be important also during growth, so we should to know about that muscles and the way to improve its.
Also may be that the body is not designed to be able to fight against lateral force as them are not present in a normal spine, so a training would be needed to help the body to realize that he need to fight in an unusual way against gravity force.

Well, it’s enough long by now.. sorry and thanks for your patient.

[flerc]

Only a brief aclaration:

But in adulthood, I cannot imagine other force provoking the structure change (progression) than the gravity force and mainly the horizontal component.
Something as medullar tension, I really doubt may be actually a force. Muscles (and tendons or fascias?) of course may be the other source.

Of course other important forces may be presents as inertial forces (running and stopping suddenly). Even if we live in the moon (when would it be possible?) some activities may trigger some internal forces as some sports.
Maybe my poor understanding about biology lead me to believe that when growth is finished there are not other unconcious internal forces (not unconcious musclar behaviour) that even in absence of external forces (as gravity) may change the structure. . may be?

[Kevin_Mc]

I think that normal spines only suffering the vertical component, should to have very different mechanisms to fight against gravity force in a right and natural way. With scoliosis, the vertical component is lesser, but the horizontal (lateral), not present in a normal spine seems to be really important and it not seems clear that the body should has a natural mechanisms to fight against it.

I understand what you are saying here. I'll respond below.

I think that at least in adulthood, we should try to avoid all possibilities of muscles incrementing the lateral and rotational forces and trying to make the structure the strongest that may be. And also trying that this forces may be the lesser that may be.. not carrying heavy weights, not jumping, keeping a right posture, not gaining weight.. and making the components opposing to that forces the strongest that may be. I don’t know if it would be possible to do it with ligaments, joints, tendons, fascias.. rib cage..certainly discs are also undergoing the tension.. but muscles seems to be possible to strengthen.

This is both right and wrong. While it is important for older adults to be careful with the things they lift it is also important that they remain active. Bones, ligaments, tendons, muscles, etc... all get their strength through use or through force. If you avoid applying force to these structures they will become even weaker. The trick is to find the right amount of force to maintain strength but avoid injury.

So it seems to be important not (only) the strong that muscles may be but their resistance; I thinks it’s not the same. I think that we only may talk about resistant ligaments but not about strong ligaments.. they cannot develop any force as I know.
So my doubt is if muscles may turn more resistant, not only stronger. Increasing the tone increase the resistance?

Ligaments can't exert an active force, however, they can become stronger or provide more resistance. That is, the tensile strength can increase.

Whether or not muscles exert more resistance (passive?) if the tone is increased is a good question. There are some studies that look at this and it seems to be that both answers are correct. Sometimes increased tone increases resistance and other times it decreases resistance. I'm not as familiar with this line of research to know when this happens. But I know I've read studies about muscle tone after strength training. It would be interesting to know the answer.

But anyway the dynamic way, as you said me once is of course very important and I think that the body may be enough intelligent to activate in an unconscious way the muscles needed to fight again the lateral (and rotational?) force. Some disciplines belonging to Physiotherapy talk about unconscious spine muscles and it has sense for me. When I’m stand up or walking, I’m not thinking which muscles I need to activate.. in fact I also not do that when I move my hand, but my intention is to move it and I suppose that my brain knows what to do, but my only one intention is to remains straight, not to move or activate any part of my body, so I think that muscles are activated in some unconscious way.

Yes, the brain and spinal cord can control many of these movements. The technical term for it is called "continuous motor program" (I think). They are a mix between a reflex, which is controlled in the spinal cord, and an intentional movement which of course is controlled by the brain. I think there are two schools of thought as to what part of the nervous system controls this movement, either the spinal cord or the brain. Certainly the brain can ultimately control the movement, but it's quite possible that the spinal cord senses and controls the paraspinal muscles throughout the day.

This is where the line of research dealing with proprioception in scoliosis patients comes in. Is there a deficit in the way an AIS patient controls the movement or senses movement of the spine.

So if all above is true (or almost true), at least in adulthood, stronger the corresponding muscles to fight against that forces in a static or active way seems to be extremely important. Surely it would be important also during growth, so we should to know about that muscles and the way to improve its.

My hypothesis is that it's the control during growth that suffers and that plays a very important role in the progression. This hypothesis does not support any trigger for the curve. But just plays an important role in the viscous cycle.

Also may be that the body is not designed to be able to fight against lateral force as them are not present in a normal spine, so a training would be needed to help the body to realize that he need to fight in an unusual way against gravity force.

This is a way to look at it I hadn't really thought about before. Or at least not directly. The idea that the spine is not well equipped to deal with lateral forces beyond a certain limit. And so even training might be a difficult task because the forces are not usually encountered even in the healthy spine. If this were true, the forces that would start the curve wouldn't need to be that big... Hmmm.. I'll need to think about that a bit more.

[flerc]

This is both right and wrong. While it is important for older adults to be careful with the things they lift it is also important that they remain active. Bones, ligaments, tendons, muscles, etc... all get their strength through use or through force. If you avoid applying force to these structures they will become even weaker. The trick is to find the right amount of force to maintain strength but avoid injury.

Yes!! I'm absolutely convinced is something good. Even I'm worry because this is the last year my daughter going to school, so is difficult she continues then carrying backpacks all the days. Today I read about some France method doing something similar.
As you says, we must to know the right amount of force and I believe that in this case, if the body is doing the effort to remains straight and can do it, injury should to be avoided.. may I be wrong?
Even she started again some months ago with same kind of dance, similar but more soft and informal than what she did some years ago (really hard) and I think it should to be good.

Ligaments can't exert an active force, however, they can become stronger or provide more resistance. That is, the tensile strength can increase.

Great!! Exercise is the way to do it? How it is possible? I have heard something about increasing tha amount of blood..but it seemed only a theory for me.

Whether or not muscles exert more resistance (passive?) if the tone is increased is a good question. There are some studies that look at this and it seems to be that both answers are correct. Sometimes increased tone increases resistance and other times it decreases resistance. I'm not as familiar with this line of research to know when this happens. But I know I've read studies about muscle tone after strength training. It would be interesting to know the answer.

We must to know that!! If streghtening muscles increase the tone, it would say as the convenience or not in doing that.

Yes, the brain and spinal cord can control many of these movements. The technical term for it is called "continuous motor program" (I think). They are a mix between a reflex, which is controlled in the spinal cord, and an intentional movement which of course is controlled by the brain. I think there are two schools of thought as to what part of the nervous system controls this movement, either the spinal cord or the brain. Certainly the brain can ultimately control the movement, but it's quite possible that the spinal cord senses and controls the paraspinal muscles throughout the day.

This is where the line of research dealing with proprioception in scoliosis patients comes in. Is there a deficit in the way an AIS patient controls the movement or senses movement of the spine.

Yes, proprioception is one of the other factors that should to be improved.. if it's possible. Much non surgical methods are advocated to that.. Of course I have not any way to demonstrate it, but in my experience some kind of Yoga lead to a great .. body conscious.. even being unconcious.. I know it sounds ridiculous and may have nothing to do with proprioception but I believe that even I have not scoliosis if I would not have this 'unconcious body concious' I would have a terrible back pain. I may say I do only some hours of exercise in years, I remains sit down many hours every day and I have (even it not seems) a considerable overweight, but I'm sure I adopt the posture I need and I do the vertebral adjustment in the way and moment I need it.
In other forum I knew a woman with a big curve that said me she do the same (not because Yoga) and she is fine.

My hypothesis is that it's the control during growth that suffers and that plays a very important role in the progression. This hypothesis does not support any trigger for the curve. But just plays an important role in the viscous cycle.

I do not believe that discovering the first/s trigger/s would be the most important of all.

This is a way to look at it I hadn't really thought about before. Or at least not directly. The idea that the spine is not well equipped to deal with lateral forces beyond a certain limit. And so even training might be a difficult task because the forces are not usually encountered even in the healthy spine. If this were true, the forces that would start the curve wouldn't need to be that big... Hmmm.. I'll need to think about that a bit more.

Certainly I also have never thought it in a direct way before.. The thought emerged just when I began to thinking aloud.. it's difficult for me to have ideas in other way and I cannot thinking aloud if I know that nobody would heard me.. and I think you are the only one with enough interest and patience to do it.

[Kevin_Mc]

Great!! Exercise is the way to do it? How it is possible? I have heard something about increasing tha amount of blood..but it seemed only a theory for me.

Tendons and ligaments grow strong in the direction of their resistance force. So tendons become stronger in the direction of the force the muscle pulls. Ligaments get strong in the direction that resists the stress that the bones/joints try to move apart. If you stop stressing these, then the collagen in the tissues becomes unorganized and weaker.

Yes, proprioception is one of the other factors that should to be improved.. if it's possible. Much non surgical methods are advocated to that.. Of course I have not any way to demonstrate it, but in my experience some kind of Yoga lead to a great .. body conscious.. even being unconcious.. I know it sounds ridiculous and may have nothing to do with proprioception but I believe that even I have not scoliosis if I would not have this 'unconcious body concious' I would have a terrible back pain.

Not ridiculous at all. Proprioception is a weird thing and even researchers have a hard time describing it/agreeing about it/understanding it/etc.... But it's definitely a real thing and has a lot to do with how healthy our body is.


I wanted to post these two articles for you.

1: Shi L, Wang D, Driscoll M, Villemure I, Chu WC, Cheng JC, Aubin CE.
Biomechanical analysis and modeling of different vertebral growth patterns in
adolescent idiopathic scoliosis and healthy subjects. Scoliosis. 2011 May
23;6:11. PubMed PMID: 21605404; PubMed Central PMCID: PMC3118970.

2: Clin J, Aubin CÉ, Lalonde N, Parent S, Labelle H. A new method to include the
gravitational forces in a finite element model of the scoliotic spine. Med Biol
Eng Comput. 2011 Aug;49(8):967-77. Epub 2011 Jul 5. PubMed PMID: 21728065.


The first is available for free on Scoliosis Journal. The second might be harder to get (but we can figure something out if you PM me your email address ;>). They both have information in it that you would find interesting for sure.

[flerc]

Thank you very much Kevin!! I just sent you my address. Of course I have much interest in read it.

[flerc]

Kevin_Mc, I’ll send you some questions about that extremely important article.. how many different issues must to be analyzed in order to understand the scoliosis problem.. and all of them so important. I see the ‘scoliosis system’ as a table of (exactly) 7 legs, and all of them should to be straight. Some of them may be more important than others, but even depending on the case, the priority may be different.

We had talked about it in a more general way but I always forget to ask to you in a direct way, about the first scoliosis cause theory I have heard, telling that (because a specific reason) sometimes the body activate some muscles provoking in a direct way the rotation of some vertebras. Would it be possible? I even think that in adulthood it may happen in some cases. At least it would be a rational explanation.

Of course we must to be skeptics about what we read in forums (except what you say) but I talked during months with an adult women with a curve near 40º saying that even degrees of the curve not increase, rotation didn’t stops. Certainly she didn’t do any attempt to avoid that kind of progression, but anyway she finally said that was so terrific, affecting organs that she get fusion. Then other people commented very similar cases.

I think that during growth, every change may occurs because different causes.. it’s as making an sculpture.. but when it is finished.. how many sources of strange changes may be? I cannot imagine something different to gravity force (or other kind of external forces), known changes as ‘weaknesses’ of components (vertebra, disc, muscles, ligaments..) or muscles pulling in the wrong way.. I’m not sure about organs..

Something as hormonal issues as seems to happens with menopause, I believe that only might provoke something as vertebra ‘weakness’.. although I'm not so sure.. I saw (she gave me) the x-ray of a women around 50 y.o who told me that some years ago her curve increase (she believes because the great depression after her divorce) to 50º. I think that if vertebral wedge would have increased enough in order to provoke the increase of the curve, it would be clearly visible in the x-ray and I may say that even making an effort to see it, it really not seems to be something significant. But anyway may be a known cause.

We may also think in changes in weight, muscular mass .. but congenital scoliosis seems increasing less than idiopathic ones in adulthood. Some reason should to exist for all that. I believe that something abnormal occurs only in idiopathic ones, and remains after growth, so the differences between those both kinds of scoliosis should to be analyzed.

Of course I’m extremely interested to know what happens when growth is finished, because I may say that my daughter is at least so close to this, but I’m sure is a fact that is incomparable more simple to analyze it than during growth, when everything seems to be possible even because the growth itself. Maybe an unknown cause remains after growth and who knows if it would not be the first cause.

See you.

[flerc]

Tendons and ligaments grow strong in the direction of their resistance force. So tendons become stronger in the direction of the force the muscle pulls. Ligaments get strong in the direction that resists the stress that the bones/joints try to move apart. If you stop stressing these, then the collagen in the tissues becomes unorganized and weaker.

I believe I'm wrong surely, but I suppose that someone with a normal spine, some kind of specific movements should to be do in order to lead ligaments to resists the stress when bones/joints try to move apart.
It would not occurs only remaining in a vertical position, standing up, sit down or walking.
But with scoliosis, I suppose that the lateral force tend to move bones and joint by simply being stand up or sit down.
In fact in a normal spine, perpendicular forces (in the sagital plane) do the same effect, because the normal curves but I suppose in different ligaments.
An excercise provoking a little increment in the curve would increase more the ligament resistance?

[gail govan]

proprioception comments

Tendons and ligaments grow strong in the direction of their resistance force. So tendons become stronger in the direction of the force the muscle pulls. Ligaments get strong in the direction that resists the stress that the bones/joints try to move apart. If you stop stressing these, then the collagen in the tissues becomes unorganized and weaker.




Not ridiculous at all. Proprioception is a weird thing and even researchers have a hard time describing it/agreeing about it/understanding it/etc.... But it's definitely a real thing and has a lot to do with how healthy our body is.


I wanted to post these two articles for you.

1: Shi L, Wang D, Driscoll M, Villemure I, Chu WC, Cheng JC, Aubin CE.
Biomechanical analysis and modeling of different vertebral growth patterns in
adolescent idiopathic scoliosis and healthy subjects. Scoliosis. 2011 May
23;6:11. PubMed PMID: 21605404; PubMed Central PMCID: PMC3118970.

2: Clin J, Aubin CÉ, Lalonde N, Parent S, Labelle H. A new method to include the
gravitational forces in a finite element model of the scoliotic spine. Med Biol
Eng Comput. 2011 Aug;49(8):967-77. Epub 2011 Jul 5. PubMed PMID: 21728065.


The first is available for free on Scoliosis Journal. The second might be harder to get (but we can figure something out if you PM me your email address ;>). They both have information in it that you would find interesting for sure.

I am a 67 year old woman with a scoliosis which I imagine started when I had a compression fracture which I heard occur but which was not discovered by the doctor whom I consulted because my right leg was paralyzed after this fall. I continued with my work after my leg recovered its function, never thinking that the breaking of the bone which I heard within my body could have been a vertebra. Disconnection from reality, this.
In the long series of events since this injury and the time I was finally so disabled with pain that I had to leave my profession I was without a diagnosis and all was a mystery. It has not been too long since I realized Muscles and Proprioception have played a huge part in my downhill course and now my hopefully uphill return to health. Therefore I share this with you. Propriocetption is so imortant because it is going on all the time and constantly informing us in the subconscious realm of where everything is in detail. In my case, I am certain that the imbalance in my body began with my feet where the second metatarsal is longer than the first and I walk on the outer edges of my feet which I have done since I was a little child. this phenomenon was recognized by a Doctor Morton in (1970?) adn is called Morton's foot. In the detail in which you think, it is easy to see how this malpositioning of the walking will result in the rapid reorganization of the small muscles of the spine so that over-all body balance can be maintained. As those small muscles respond for years to the unfortunate mal-balance, then graduallay the larger ones such as the ilio-psoas and the muscles of the buttocks such as the gluteal muscles and the piriformis come into the picture. they all add their stressed-out voices to the chorus until it is hard to untangle. Growth brings increase in weight, so the system is dynamic and always adjusting for good or bad in ways that it is hard to imagine.
It has been infinitely helpful to me to review the muscles, and I can suggest a book which is in English but is illustrated, with every muscle shown systematically and the points within the muscles which stay contracted if there is unbalance or injury. If these places can be released so the muscle can relax, then there is the chance for less pain and better function. The title of the book is the Trigger Point Therapy Workbook by Clair Davies. The European therapy method, Scroth method, is a treatment of choice for scoliosis and it might be helpful to you to look into that method. It has been used in Europe for over twenty years. there are now therapists in the US who have gone overseas to learn the method. It is amazimng to me how even as professionals we get locked into a certain frame of reference and then stand confused when something outside our area of expertise comes along. As a dentist, I studied the body, and the spine, and seem to have forgotten that this system is such a dynamic and all pervasive and interdependent system. Good luck to us all. Gail

[whatishappening]

............ In my case, I am certain that the imbalance in my body began with my feet where the second metatarsal is longer than the first and I walk on the outer edges of my feet which I have done since I was a little child. this phenomenon was recognized by a Doctor Morton in (1970?) adn is called Morton's foot. In the detail in which you think, it is easy to see how this malpositioning of the walking will result in the rapid reorganization of the small muscles of the spine so that over-all body balance can be maintained. As those small muscles respond for years to the unfortunate mal-balance, then graduallay the larger ones such as the ilio-psoas and the muscles of the buttocks such as the gluteal muscles and the piriformis come into the picture. they all add their stressed-out voices to the chorus until it is hard to untangle. Growth brings increase in weight, so the system is dynamic and always adjusting for good or bad in ways that it is hard to imagine. .......

I have Mortons feet. Discovered by my pedoratrist. In fact my back problems first surfaced as foot problems. And my feet aren't the same: the first metatarsal does not bend to 90 degrees on the right foot. Long story but this may have caused my rotated spine- among about another dozen possibilities. I got into orthotics in January. That is when things got so much worse. Unlike you I rolled onto my big toes- you could even see thier inside edges were all calloused. So the orthotics propped me up and basically rotated my pelvis furthur counterclockwise- and I think this was basically either wringing out my L4 nerve or my IT band like a washcloth.

I had no idea that the human body was a dynamic self-adjusting machine before all of this. Which makes its scarey in deciding how to tamper with it- like some mad scientist.