Torso Rotation Strength Training for Scoliosis

[Pooka1]

I would be very interested in hearing an orthopedic surgeon's opinion on this issue. I never see reductions of any kind in a large curve in a mature spine - temporary or permanent - noted as a possible occurrence in any of the literature.

Wait a minute. If us bunnies have read the two articles on Hawes and one on the SEAS woman, what would prevent surgeons from reading/knowing that?

Also, if we have heard anecdotal reports on here about temporary reductions of large curves in adults, doesn't seem likely surgeons have heard it by now also?

So it is obviously possible.

Again, when surgeons say mature (or young) curves can't be reduced with PT (or bracing) I think they mean "permanently" reduced. I think most people can reduce their Cobb angle just by standing funny.

[Ballet Mom]

Wait a minute. If us bunnies have read the two articles on Hawes and one on the SEAS woman, what would prevent surgeons from reading/knowing that?

Also, if we have heard anecdotal reports on here about temporary reductions of large curves in adults, doesn't seem likely surgeons have heard it by now also?

So it is obviously possible.

Again, when surgeons say mature (or young) curves can't be reduced with PT (or bracing) I think they mean "permanently" reduced. I think most people can reduce their Cobb angle just by standing funny.

I suspect that surgeons don't bother themselves too much with studies that are considered outside the normal scope of the standard of care. Too many quacks out there to look into it all and it's really the Europeans and other countries that are interested in exercises to control progression, not the U.S.

By the way, I am definitely NOT saying that these exercises don't work. I'm just explaining the difference in outlook between US surgeons and others. It may very well turn out that the other countries end up being correct.

Anyhow, when you say that surgeons say that young curves can't be reduced with bracing, that is incorrect. I have found any number of young curves that have been reduced by bracing in studies on the internet. Even the Charleston Bending Brace has a case in a presentation on the internet somewhere that shows a kid that reduced back to "no scoliosis" which was presented by an orthopedist at a medical conference. I think it's just not typical. I think they purposely try not to get people's hopes up like the chiropractic industry seems to, because it is relatively rare.

And, our orthotist said when my daughter was given the Charleston Bending Brace that with a good correction, and consistent wearing, she could expect a few degrees of decrease in the curve....which is exactly what has happened.

[txmarinemom]

Again, when surgeons say mature (or young) curves can't be reduced with PT (or bracing) I think they mean "permanently" reduced. I think most people can reduce their Cobb angle just by standing funny.

I think that's exactly correct.

To my knowledge, exercise/PT is rarely (or never) prescribed over bracing as an alternative conservative intervention option. To me, that indicates surgeons view bracing (which is of somewhat questionable efficacy) as the more viable treatment.

Someone tell me if I've missed some vital point in this discussion.

Do we know of surgeons who prescribe exercise instead of bracing?

If there were reproducible data exercise worked, for what possible reason would it be withheld as a treatment?

And, yes ... bending films prove Cobb angle can be temporarily altered, it's just a question of how much.

Regards,
Pam

[mariaf]

And, yes ... bending films prove Cobb angle can be temporarily altered, it's just a question of how much.

I agree completely. I would grant that perhaps a curve can be altered or corrected TEMPORARILY - but how long before it reverts back to it's original position? That's the big question. And of course, there is a huge difference between correcting a curve permanently and correcting it temporarily, the latter of which doesn't serve much purpose (except perhaps to see if one's curve is flexible or not).

[Dingo]

permanent

MariaF

If you read the three studies on torso rotation strength training there is every reason to suspect that the correction is essentially permanent.

Treatment of adolescent idiopathic scoliosis with quantified trunk rotational strength training: a pilot study.

After 4 months of unsupervised home strength training their strengths were unchanged. The 3 patients with baseline curves of 50 to 60 degrees all had main or compensatory curve progression and 2 had surgery. For patients with 20 to 40-degree curves, survivorship from main curve progression of >or=6 degrees was 100% at 8 months, but decreased to 64% at 24 months.

These kids did supervised strength training for 4 months. 4 additional months after training stopped (the 8 month mark) the 12 patients with 20 to 40 degree curves had the same strength and no curve progression. This suggests that the impact of strength training lasts quite a while. BTW if you read the study it indicated that only a few kids did any of the home strength training exercises once the gym strength training was over.

As for a permanent correction in adults I have no idea.

[txmarinemom]

These kids did supervised strength training for 4 months. 4 additional months after training stopped (the 8 month mark) the 12 patients with 20 to 40 degree curves had the same strength and no curve progression. This suggests that the impact of strength training lasts quite a while. BTW if you read the study it indicated that only a few kids did any of the home strength training exercises once the gym strength training was over.

As for a permanent correction in adults I have no idea.

Dingo,

I hate to point out this detail, but 4 months (or even 8 months) isn't permanent - and I don't know why you have "every reason to suspect" it is.

Certainly, I can understand why you'd want it to be. There's nothing wrong with that.

Regardless, it isn't anywhere NEAR a fact at this point in time. If it *becomes* a fact, I'd expect the medical community to give those studies more weight.

In the meantime, there's nothing wrong with exercise ... it just isn't a cure.

Regards,
Pam

[Pooka1]

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I hate to point out this detail, but 4 months (or even 8 months) isn't permanent - and I don't know why you have "every reason to suspect" it is.

There's a reason why there are no follow studies in some of these cases.

[hdugger]

If there were reproducible data exercise worked, for what possible reason would it be withheld as a treatment?

I don't think we're at the "reproducible data" stage for exercise - I think we're at the "an interesting thing which has recently been seen in case studies" stage. I am somewhat surprised, though, that doctors are not following up on the work as, again, it is the first time that significant curves in mature spines have shown a reduction, to the best of my knowledge. But, no, I don't think there is a set course of exercise that can be prescribed yet. Still just glimmers.

But, if there were all manner of things that would decrease a curve on xray - like standing funny or eating ice cream - then we'd have people coming in here all the time telling us that there curve had suddenly measured 20 degrees less. To my knowledge, that has never happened, except in these few cases where some form of exercise appears to have made a difference.

[Pooka1]

I don't think we're at the "reproducible data" stage for exercise -

But Schroth surely is! They have been around for circa 90 years!!!

What's their excuse???

[Pooka1]

I
But, if there were all manner of things that would decrease a curve on xray - like standing funny or eating ice cream - then we'd have people coming in here all the time telling us that there curve had suddenly measured 20 degrees less. To my knowledge, that has never happened, except in these few cases where some form of exercise appears to have made a difference.

In my opinion, the reason they aren't crawling out of the woodwork and researchers are not clamoring to publish it is because it is temporary. That is essentially an interim finding that as far as anyone knows is NOT related to the final result absent continued ice cream eating, standing funny, PT, rakish angle breathing, etc. etc.

[hdugger]

Again, when surgeons say mature (or young) curves can't be reduced with PT (or bracing) I think they mean "permanently" reduced.

I think we use the term "permanently" differently, but I have not read in the regular medical literature that curves can be reduced for long periods of time by continued exercise. If I'm missing mainstream literature that includes this caveat, I'd appreciate some links.

[txmarinemom]

But Schroth surely is! They have been around for circa 90 years!!!

What's their excuse???

Thank you for not making me say that.

[hdugger]

The reason they aren't crawling out of the woodwork and researches are not clamoring to publish it is because it is temporary (in my opinion). That is an interim finding that as far as anyone knows is NOT related to the final result absent continued ice cream eating, standing funny, PT, rakish angle breathing, etc. etc.

We only have the tools we have. Right now, the standard tool for measuring curve progression, stabilization, or reduction, is the Cobb angle. If, as in at least three of these data points, repeated xrays show a Cobb angle reduced by more than 10 degrees, it is assumed that something has reduced the curve. If you're finding that people eating ice cream are showing a sustained reduction in their curve of more than 10 degrees, I encourage you to publish your findings. Right now, though, the only reports I'm reading of a sustained reduction sans surgery are in these few data points who all attribute it to exercise.

As to the continued exercise, that's all I'm looking for. A curve reduction sustained by continued exercise. Maybe that doesn't interest any other researchers, but it certainly interests me.

[hdugger]

But Schroth surely is! They have been around for circa 90 years!!!

What's their excuse???

One of our data points is using Schroth to reduce her curve and hold the reduction.

As to the general state of publishing, though, it's what we've talked about all along--it's almost impossible to prove that a treatment has held a curve. That's why we're looking at these extreme cases - where a treatment actually reduces a curve. It's the only thing that can be heard in all this noise.

[Pooka1]

One of our data points is using Schroth to reduce her curve and hold the reduction.

Yes. So the success rate for a temporary reduction using Schroth is:

1/5,000* = 0.02%.

At that rate it is MORE likely that it was NOT due to the treatment.

* My guess as to how many people tried Schroth.