Treatment: PT using MedX per Mooney & later, McIntire research

[rohrer01]

Already been done. ILE and VAL have no effect on muscle protein synthesis or signalling. Although, there's good evidence to show that a physiologic balance of the three does better than just a bunch of LEU. Go figure, more of a good thing isn't necessarily better. Lots of recent stuff on LEU/BCAA and muscle protein synthesis.

So is it better to consume these before, during, or after exercising? I believe my whey protein powder (containing a combination of several amino acids) says to consume AFTER exercising. Does it really matter?

[Kevin_Mc]

So is it better to consume these before, during, or after exercising? I believe my whey protein powder (containing a combination of several amino acids) says to consume AFTER exercising. Does it really matter?

There are several studies looking at this timing issue. The differences are somewhat nominal, especially in the long term, as long as it is no more than 1hr before or ~2hr post. Protein synthesis and signalling is elevated for a good 30-60 minutes after working out. It begins to decline from there depending on activity type, intensity and duration. So feeding your muscle/body during this metabolically active period is a good thing to do. Especially good proteins, e.g. whey. Incidentally, withholding food is not a good idea during this stage.

Overall, most people consume after just because these protein drinks can be pretty thick and nobody really wants to exercise with that in their belly. I personally do and recommend post-workout water followed by protein. Ideally this is a drink but soy beans or a protein bar type snack is good also. I use a whey powder mixed with milk. The drinks and bars have some carbohydrates as well and this is beneficial in combination with the protein (2:1 or 3:1 carbro ratio is ideal). Exercise+carbohydrate+protein=super metabolic activity.

[Dingo]

Hi Tamztom and AMOM!

I'm going to dig through my links...

ok digging.... digging....

Mooney 2000 paper

Mooney 2003 paper

Mooney 2007 paper

McIntire 2006 paper

McIntire 2008 paper

And last and unfortunately least a a well done, published write-up by a physical therapist on Torso Rotation. Long story short the therapy worked as usual. Sadly the link is dead! Maybe someone knows how to use the dead link to dig this up.
Feb 2005, therapist tries TRS on patient and gets radiologically significant results

And since I'm at it who can forget these x-rays?
Scoliosis reconciles in adolescent female after torso rotation strength training

[rohrer01]

I'm wondering whether or not in the link to the girl who's scoliosis resolves if some of this is postural. Only ONE out of the four x-rays even qualify as scoliosis. It is my understanding that to be considered scoliosis, there has to be a curve >10*. I'm sure the TRS strengthened her, but her case may not have been a true case of scoliosis with curves that small. Just sayin'...

[Dingo]

I'm wondering whether or not in the link to the girl who's scoliosis resolves if some of this is postural. Only ONE out of the four x-rays even qualify as scoliosis. It is my understanding that to be considered scoliosis, there has to be a curve >10*. I'm sure the TRS strengthened her, but her case may not have been a true case of scoliosis with curves that small. Just sayin'...

I haven't talked to that mom in a long time. But if my memory serves me correct it was the girl's rib hump that caught her parents attention.

As far as strength goes I no longer feel that's the most likely explanation for why TRS helps kids. It probably has more to do with the ligaments around the spine or the nervous system or some combination of the two.

But that's up to scientists to figure out, not me.

[Kevin_Mc]

Hi Tamztom and AMOM!

I'm going to dig through my links...
ok digging.... digging....

Mooney 2007 paper

While I wish I could claim 2 first author pubs on the treatment arm of this study, alas, I can not. The 2006 listing was just the first couple of patients in the 2008 study. It was written for the 2005 or 2006 IRSSD conference. It's what we had enrolled at the time the abstracts were due for the meeting. :>

(Dingo, please know that the following critique/rant is not aimed at you.) The 2007 Mooney paper is misleading in how they present their studies. I definitely have a problem with the way they did this. "In our first study we had 12 patients.... In our next study we had 20 patients..." As a scientist who worked very hard at recruitment and had many difficult meetings and realizations about our work and efforts regarding the TRS study; and as someone who continues to work very hard at rehabilitation research, getting railed in grant and manuscript reviews due to lack of numbers or data; and as someone who is passionate about condensing, explaining and bringing science to a 'non-science' audience, I have a real problem with this. With all due respect for Dr. Mooney and his contributions to scoliosis, he and the contributing authors should have known better than to write what they did.

[Pooka1]

(Dingo, please know that the following critique/rant is not aimed at you.) The 2007 Mooney paper is misleading in how they present their studies. I definitely have a problem with the way they did this. "In our first study we had 12 patients.... In our next study we had 20 patients..." As a scientist who worked very hard at recruitment and had many difficult meetings and realizations about our work and efforts regarding the TRS study; and as someone who continues to work very hard at rehabilitation research, getting railed in grant and manuscript reviews due to lack of numbers or data; and as someone who is passionate about condensing, explaining and bringing science to a 'non-science' audience, I have a real problem with this. With all due respect for Dr. Mooney and his contributions to scoliosis, he and the contributing authors should have known better than to write what they did.

The peer reviewers were asleep at that wheel.

Mooney had 20 TOTAL patients.

You had 15 in a paper that has been singled out for being objective to your great credit.

There are 35 TOTAL patients and a conscious decision on Mooney's part not to publish the follow up on 12 of them 3 years later and just present them like brand new enrollees in torso rotation.

Formulas and models are not the heart of scientific research. Intellectual honesty is. Mooney was lacking in that. He crossed the line from honest, objective research into biased advocacy.

[Dingo]

While I wish I could claim 2 first author pubs on the treatment arm of this study, alas, I can not. The 2006 listing was just the first couple of patients in the 2008 study. It was written for the 2005 or 2006 IRSSD conference. It's what we had enrolled at the time the abstracts were due for the meeting.

Hi Dr. McIntire. I knew that Vert Mooney's papers were really one, long study. But I didn't realize your 2 papers were 1 study.

I stand corrected. There are 2 torso rotation studies.

[AMom]

She grew 2.2" during the last 14 months

When you get a chance I'd love to see how much your daughter grew over the past 14 months....

I’ve received similar questions from several people so I’m going to answer everyone here. The Ortho only took her height once and I didn’t start recording it until several months AFTER she started the PT. (She had started her growth spurt aproximately 6-7 months prior to changing the CTR from "free standing" to MedX & VARC--as soon as her legs were long enough to fit into the machine.) For consistency sake all height data presented below is from her pediatrician’s file. For reference purposes, her height at home is currently listed at 56.75” and the at the pediatrician’s office it is 56.6”.

Per notes below, she gained 2.2” and over 14 months

12-09-11 53.9”
----------------
01-25-11 54.4”
02-10-11 T33° & L27° Right apical curve T8 – T12 and Left from T12 – L3
06-16-11 T32° & L23° Right apical curve *T7 – T12 and Left from T12 – L3
08-31-11 55.8”
10-10-11 T34° & L20° Right apical curve T8 – T12 and Left from T12 – *L4
04-16-12 T31° & L25° Right apical curve T8 – T12 and Left from T12 – *L4
04-16-12 56.6”
----------------
*I asked if her curve was progressing farther into her lumbar area and the ortho said it was not, he simply chose the top of L4 vs. the bottom of L3. I thought they always chose the same side of the vertebrae when measuring the angle, but what do I know?

[Dingo]

FOUND IT...... i think

Here is a link to what I believe was the write-up (or part of the write-up) by the physical therapist.

Revisiting exercise and scoliosis management
By Amanda N. Geiger, DPT

Our results using an identical testing and treatment protocol as described in the aforementioned studies reveal equally promising results. For example, one 12-year-old female graduate of our program radiographically demonstrated a 5 degrees curve reversal without the use of bracing.

[mariaf]

I'm wondering whether or not in the link to the girl who's scoliosis resolves if some of this is postural. Only ONE out of the four x-rays even qualify as scoliosis. It is my understanding that to be considered scoliosis, there has to be a curve >10*.

That is correct. Anything less than 10 degrees is not even considered scoliosis.

I would also think it's safe to say that a great majority of people are not at 0.

[rohrer01]

I haven't talked to that mom in a long time. But if my memory serves me correct it was the girl's rib hump that caught her parents attention.

As far as strength goes I no longer feel that's the most likely explanation for why TRS helps kids. It probably has more to do with the ligaments around the spine or the nervous system or some combination of the two.

But that's up to scientists to figure out, not me.

What I mean is I don't think the girl had a true scoliosis. That's my opinion. Everyone gets stronger with exercise and it appears to have helped her posture. We can all have bad posture days where a "curve" will show up that isn't true scoliosis. Her "curves" were not even in the same place every time. I'm not talking about mechanisms of straightening a truly scoliotic spine. I certainly leave that up to those with more education than myself who have access to study these things. I'm not denying that TRS works, either. I'm just saying this one case doesn't impress me. Amom's daughter and Tom's daughter impress me.

[AMom]

Where is that instruction manual?

I can only speak from my personal experience here. Suffering from pain for so long and doing many different exercises to help strengthen the spine has given me a little insight. IF the Roman Chair exercises end up having no effect on your daughters scoliosis progression, I think you are still doing her a great favor by having her do these exercises. I have found that of all the exercises that I have done, the Roman Chair exercises have given me the greatest pain relief. So you may well be keeping her out of pain and hopefully keeping her curve stable by your exercise routine. It's a win, either way. If she ends up needing surgery, she will be in excellent shape going in and you could be saving her a great amount of pain in the interim.

You are a very dedicated mom and it's great to see parent's like you. I only wish I had the knowledge to keep a better eye on my daughter's scoliosis, because it's out of my hands now. It wasn't until coming to this forum that I have realized how much more proactive I could have been. I just took the doctor's word for everything. She was referred to a general ortho and NOT a scoliosis specialist. He recommended doing NOTHING and she was only 12. I have no idea how bad it is now, but I can see it when I look at her back and she has back pain. Her curve appears to be very similar to mine with the exception that her primary curve seems to be a lower right thoracic and the compensatory curve seems to be the upper left thoracic as it appears much smaller. Her shoulders also appear even and the last time she let me look, she had no significant rotation that I could detect on the Adam's Forward Bending test.

Thank you for your support Rohrer01.

The hope was to hold her curve "as is." If it didn't work, the idea was that she would be in good health and hopefully recover faster from surgery. At 14 months, it is finally safe to say her curve progression is leaning toward "stable."

Don't beat yourself up; there are no guarantees in what we are doing. We are living x-ray to x-ray, just like every other family with an adolescent child who has scoliosis. I routinely run a cost-benefit-ratio analysis and adjust accordingly. Even if it works right now, we may only be putting off the inevitable. When she reaches physical maturity and stops doing the PT the benefits may dissipate and her curve may progress. At that point, we would reassess and look to surgery to avoid the possibility years of pain and continually delayed treatment. I do not have any specialized knowledge; honestly, I am making this up as I go.

Best wishes,

A Mom

[rohrer01]

Amom,
You have a very good and positive attitude. You are definitely doing an excellent job for just "winging it". I've followed this thread off and on for a while now. I see you making small adjustments here and there and trying to figure out the physics behind the "whys" of things. You are definitely an intelligent woman and your little corrections here and there have obviously been the right ones. By the way, how old is your daughter now?

[AMom]

How is she doing?

Amom,
By the way, how old is your daughter now?

We started on this particular journey five years ago. She began using the equipment at 11.3 yrs. She is 12.5 yrs now. We have a long road ahead of us. In the end, she will probably be fine; I on the other hand, may not live through the stress of parenthood.

How about your daughter, I am guessing she is a young adult now, how old is she? How is she doing overall? And you, is there anything that can be done to ease the pain you've talked about? Chronic pain is insidious; it weaves its way into every aspect of life until you are surprised by the moments that aren't painful rather than the ones that are.... (I haven’t read all of the threads on the site, so please forgive me if the question has been asked and answered.)