Torso Rotation Strength Training for Scoliosis

[jillw]

Dingo, just catching up on posts and wanted to say that you seem to be doing a good job with your son. Like you, I have only seen studies on JIS that statistically make progression of JIS very likely. I think you are taking a practical approach...maybe the things you are doing won't help, maybe they will. Nonetheless, strengthening exercises, eating a banana, sleeping in the dark, etc only contribute to the overall health of an individual. Worse case scenario your son will be learning healthy habits that may benefit him a lifetime - if it doesn't protect him from scoliosis progression, it may protect him from childhood (or later) obesity or heart disease or make him a better athlete (if that's where his interests lie) or who knows what. Certainly no harm in that! Best case, this will halt or reduce progression in your son's curve. I hope it does. You seem to be taking an informed approach, for example not using or recommending melatonin supplements since there could be a rebound effect and instead taking smaller steps. Very practical.
even those of us without scoliosis could probably benefit from some of your ideas.

[Dingo]

jillw

...if it doesn't protect him from scoliosis progression, it may protect him from childhood (or later) obesity or heart disease or make him a better athlete (if that's where his interests lie) or who knows what. Certainly no harm in that!

Thanks Jill, that's exactly what I'm going for.

The reality is that parent's have to go with what credible scientists think is promising right now. Our kids won't get a second chance. Approximately 50% of Juvenile cases end in fusion and 70% are braced. I'm doing everything I can to keep my kid in the 30% column as long as I can.

[betty14]

Hey, Dingo:

Would you mind posting a brief summary (just point form would be fine) of your situation and what you've been doing with your son? I know you have longer amounts of info. posted in other spots on the forum, but as a newbie, it's hard to find it all and put it together chronologicly. Thanks! B.

[Dingo]

Betty14

I posted my son's background in another thread after his 1st recheck.

Here it is. Melatonin may have helped my son's Scoliosis

I should mention that at my son's 1st recheck it appeared to me that his rotation had gotten worse. The doctor only measured his lateral curve so I have no way to know if that's true or not.

Around a week before my son's 1st recheck we started physical therapy. I posted my son's workout and it's the #9 message in this thread.

Since my original post the strength training portion of his therapy has slightly evolved (we do planks and other core exercises) but it's still basically the same. We never miss a day when he is home and he is visibly and measurably stronger. His next recheck is in about 4.5 months. I'll post the results whether they are good or bad. I'll be overjoyed if he is stable.

[Dingo]

Physical therapists in Oregon tested Dr. Mooney's protocol and produced the same results.

BioMechanics Archives:: February 2005
Revisiting exercise and scoliosis management

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. While we await the results of larger studies currently under way that address exercise-based management of adolescent idiopathic scoliosis, it is intriguing to contemplate that the muscle imbalances associated with scoliosis may be more causative than consequential. Such a possibility provides additional promise for conservative management of adolescent idiopathic scoliosis due to the plasticity of muscle tissue, particularly in the young adult. Thank you for a most welcome publication on a topic of great interest for the conservatively minded practitioner.

[LindaRacine]

Not to rain on your parade... but this is just another study with zero followup. It seems to me that someone would have a few followup cases to report by now.

[mamamax]

Physical therapists in Oregon tested Dr. Mooney's protocol and produced the same results.

BioMechanics Archives:: February 2005
Revisiting exercise and scoliosis management

Dingo - That's an impressive article from the folks out Portland way. Quite an area & home to Portland State University .. I'm tempted to visit them next time I'm there. Here's their web link: http://www.blueskywebdevelopment.com/nwspine/index.php

[Dingo]

mamamax

Right on! I believe that machine on the front of the site is the high end MedX machine.

LindaRacine

Not to rain on your parade... but this is just another study with zero followup. It seems to me that someone would have a few followup cases to report by now.

It is not credible to assume that the consistent, positive results produced by a variety of scientists and physical therapists aren't real. Morover these results combined with the results of other studies implicate muscle imbalance as a cause of Scoliosis. In cases of progressive scoliosis this is rooted in a nervous system dysfunction. How this dysfunction might lead to a muscle imbalance may remain a mystery for years to come.

[LindaRacine]

mamamax

Right on! I believe that machine on the front of the site is the high end MedX machine.

LindaRacine



It is not credible to assume that the consistent, positive results produced by a variety of scientists and physical therapists aren't real. Morover these results combined with the results of other studies implicate muscle imbalance as a cause of Scoliosis. In cases of progressive scoliosis this is rooted in a nervous system dysfunction. How this dysfunction might lead to a muscle imbalance may remain a mystery for years to come.

Dingo...

I never questioned the results. I'm questioning the lack of followup.

I think there may be real benefit from this type of program, if it allows people to avoid surgery. But, since there's a complete lack of followup from 100% of these studies, it leads me to think that the effects may be temporary. I know you talked to Dr. Mooney who claimed he was having good long-term results, but until those results are published, and validated by another center, I'm going to continue questioning them.

--Linda

[Dingo]

LindaRacine

I never questioned the results. I'm questioning the lack of followup.

You are 100% correct, there have been no longterm studies published on this therapy. However the first official study was released in 2003 so this is a new concept.

In the following study kids used a MedX machine for 4 months followed by 4 months of exercises at home. When scientists returned at the 2 year mark 2/3rds of children had stable curves and 1/3rd had worsened. Obviously it's impossible to know how many kids continued exercising after the initial 4 months because after that everything was done (or not done) at home. It's also possible that curve stabilization requires strength training on a MedX or similar machine until skeletal maturity. At home exercises might not be enough. Right now nobody knows.

I've never talked with Dr. Mooney but I quoted Gerbo who had written to him. I did talk to one of the scientists involved in the study that I linked to. He mentioned that a new study was starting in Texas very soon but he wasn't involved in it. I can only hope it will be larger and longer than the previous studies. On the downside if it's a longer study we may not get the results for many years to come.

[Dingo]

I have a copy of the recent McIntire study on Torso Rotation strength training mentioned above and one thing really stood out.

At the end of 32 training sessions (4 months) on the MedX machine conducted in a gym patients switched to unmonitored home strength training. The 4 month home program consisted of just 1 exercise. The child was instructed to tie a gold colored Thera-Band to a door knob, sit in a chair, hold the Thera-Band and rotate against the resistance. Patients were instructed to perform 3 sets of 15 repetitions to the left and to the right 3 to 5 times a week. This would take roughly 3 minutes.

How was compliance?

Although the patients were instructed in the home-based strength exercise program previously described, we did not effectively monitor their compliance. Our impression through retrospective inquiries was that only about one-third of them were reasonably compliant.

These kids knew that they were being studied and yet very few did their exercises at home. To me this calls into question whether it's possible to accurately study home strength training. Perhaps any strength training program would be helpful but it's hard to know because most teens aren't motivated enough to do it.

The results:
After 4 months on the MedX machine all children had stable curves. After an additional 4 months of home strength training (which 2/3rds of kids didn't do) all children still had stable curves. This lead the authors to remark,

Thus, it seemed that the supervised strength training effect lasted at least 4 months.

Put simply the impact of the MedX lasted an additional 4 months after training stopped.

From their discussion:

This finding is preliminary for 3 reasons. First, compliance with the 4-month home-based strength exercise was low. Second, no emphasis was placed on continuing the home training after the 8-month followup. And third, our protocol did not provide for additional supervised training intervals, which could be anticipated to result in further strengthening and thus added spine stabilization. If further investment is to be made in attempting to develop rotational trunk strengthening as a nonoperative treatment option for AIS, better monitoring of compliance with the home-based program and further experimentation to determine the optimum dose of strength training will be needed.

[JMayor]

what about evidence that it reduced the curve? I am desperately trying to find a way to reduce my curves and get rid of my scoliosis.
Read a thread I started about a chiro who guaranteed to me in an email that his method would reduce my scoliosis by at least 5 degrees. He has a website you can read about what he does. here is the link to the thread:
http://www.scoliosis.org/forum/showthread.php?t=9112
what do you think?

[LindaRacine]

I have a copy of the recent McIntire study on Torso Rotation strength training mentioned above and one thing really stood out.

At the end of 32 training sessions (4 months) on the MedX machine conducted in a gym patients switched to unmonitored home strength training. The 4 month home program consisted of just 1 exercise. The child was instructed to tie a gold colored Thera-Band to a door knob, sit in a chair, hold the Thera-Band and rotate against the resistance. Patients were instructed to perform 3 sets of 15 repetitions to the left and to the right 3 to 5 times a week. This would take roughly 3 minutes.

How was compliance?



These kids knew that they were being studied and yet very few did their exercises at home. To me this calls into question whether it's possible to accurately study home strength training. Perhaps any strength training program would be helpful but it's hard to know because most teens aren't motivated enough to do it.

The results:
After 4 months on the MedX machine all children had stable curves. After an additional 4 months of home strength training (which 2/3rds of kids didn't do) all children still had stable curves. This lead the authors to remark,


Put simply the impact of the MedX lasted an additional 4 months after training stopped.

From their discussion:

Hi Dingo...

But, the authors go on to say that the results didn't hold at 24 months.

Also, the fact that 2/3 of the kids didn't comply with continued exercise of about 15 minutes a week is pretty telling. I think there are some people who will comply with an exercise program for a long time, but there are more who won't. If 15 minutes a week would hold a reduced curve in place, I think most of us would jump at it. I doubt, however, that 15 minutes a week could make a dent.

Regards,
Linda

[Dingo]

LindaRacine

But, the authors go on to say that the results didn't hold at 24 months.

You can't expect 4 months of strength training to hold a child's curve until skeletal maturity.

4 months of strength training at just 30 minutes per week held every curve for 8 months. That's the best results I've ever read.

[Pooka1]

You can't expect 4 months of strength training to hold a child's curve until skeletal maturity.

Then this is a case of premature publication.

4 months of strength training at just 30 minutes per week held every curve for 8 months. That's the best results I've ever read.

Dingo, I suspect many curves don't appear to move fast enough to see a measurable increase in 4 months. The highest rates are during the growth spurt. If they controlled for this one thing I think the data would be far less muddy. Also, most curves will not progress to surgery territory no matter what you do and don't do. That's the biggest reason why they need a control group.

Consistent with thought that 4 months is an insufficient time is that ~2/3 of the curves remained stable despite these kids not exercising reliably. Stable here means subsequent measurement less than or equal to 5*. Essentially, they created a control group "on the fly" in the middle of the study. Not good form but instructive nonetheless. It seems the "control" group fared as well as the study group based on what you write. (I'll look at the report in a minute).

What is the underlining hypothesis here? Is it that kids who develop AIS have weaker muscles than normal kids and that muscle can prevent the vertebral wedging that goes on to produce the curve?

I think we know that wedging is the issue because direct stapling to prevent growth in certain areas in fact does just that. So the question is... can exercise or external bracing for that ever hope to provide enough constant pressure to certain areas of the vertebrae in a very targeted fashion to prevent wedging? I mean even if the mechanism of muscle asymmetry caused by a nervous system malfunction is 100% correct, it DOES NOT follow that building muscle is sufficient to prevent wedging once the process gets started. There may be some time window very early but then you have to have the kid exercising from a very young age all the way through the growth spurt with no guarantees. And here I agree with you that this is going to be very hard to study due to lack of compliance. It may work but we will never know. Some things are just like that unfortunately. Essentiually, the cure is harder than the disease so to speak.