Torso Rotation Strength Training for Scoliosis

[Pooka1]

In re McIntire et al.:

1. they have a study group of 15 patients which is very small. So it is impossible to say whether exercise is doing anythng over and above a control group per se. I suspect that group would fall in line with what is already known about propensity for curve increase based on Risser, age, menarchal status, curve magnitude etc.. They had to show that the propensity to increase was changed by the exercising which they did not (because that would have been mentioned in the abstract as it is the entire game here).

2. Note the sentence, "At baseline there was no significant asymmetry." Doesn't that alone and all by itself undermine the hypothesis that muscle asymmetry is involved here? I'm not sure why they proceeded with the study given that baseline.

3. Again, the biggest problem with this study appears to be premature publication... you won't expect to see a measurable change in a certain percentage of that small group in 4 months. You could have given them ice cream and claimed that stabilized the curve based on the data presented. I don't understand why this is publishable but what do I know?

[Dingo]

Pooka1

Torso Rotation has been shown to improve many curves as well as stabilize. That's why the 4 month and 8 month findings are important.

Not only does this suggest that physical therapy is effective but that muscle imbalance and atrophy plays a part in Scoliosis. How or why this happens is still unknown.

You ask:
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?

This is what McIntire wrote:

Enhancing spine stability is the principle underlying our approach to the management of AIS with quantified rotational trunk strengthening.

BTW, you are right about the recent McIntire study. The sample didn't show a strong torso rotation strength asymmetry. However their analysis was fascinating. They suggest that this probably narrows the strength asymmetry down to the paraspinal muscles.

I believe that's what this recent study found. I'm going to get a copy to learn the details.

[Pooka1]

I would be far more impressed with the 4 month and 8 month findings IF those cases had a previously documented high rate of movement. If they didn't then the lack of a control group prevents any conclusions about exercise therapy slowing progression or exercise therapy decreasing small curves (since we know that happens spontaneously in many cases).

The far more likely explanation is that the curves moved less than or equal to 5* in the 4 month and 8 month periods in the smaller curves. Note the larger curves were not helped. In fact all the exercising patients may fall exactly on the progression potential predicted from the other variables (Risser, age, etc.). This is the one thing they had to show in order to conclude the exercises were accomplishing something. And they did NOT show this, at least in the abstract. I can't overemphasis this point enough. It is the ENTIRE game with this study.

I mean it would be equivalent to me claiming something else prevented curve progression and pick early time points that would certainly miss any measurable movement and then say the treatment worked. Had they had a control group, the progression rates would likely have been IDENTICAL to the study group given the average movement rate and the time period. I'm sorry but this study is ridiculous.

Think about the apparent stability in the non-compliant group at the 8 month mark. You would need patients with documented rates of progression that exceeded at least one point something a month in order to see an effect from exercise at 4 months. Unless they documented high enough rates to see a progression in 4 months and 8 months prior to enrolling patients, their conclusions are obviously not supported by the data. I don't know how else to say it.

I have not seen the entire report but at this point, this study appears to be among the worst that I have seen published in terms of extravagantly going beyond the results and wildly speculating without much if any ground to stand on.

Again, this condition is far too variable to say anything with 15 patients EVEN IF there was a control group of 15 patients to accompany it. Like a broken record, my identical twins continue, after almost two years, to have wildly different curve trajectories. That said, I don't think you have to be the mother of ID twins with wildly different curves to avoid the errors of thinking and analysis in that paper.

I am not trying to discourage you. I am saying the conclusions they reach in that study are obviously NOT supported by the data and I am floored it was published. If I'm wrong, please point out where.

Last, do the various camps within the "muscle asymmetry" group disagree about which muscle groups are asymmetric? Is this study in fact in contradiction to others that did find major muscle asymmetry? Why do some people find major asymmetry and some don't? It sounds like everyone isn't on the same page with measuring the same muscle groups in deciding if there is asymmetry.

That point, because it is so central, needs to be nailed down. If there is major disagreement on this point then there may be little hope for this hypothesis.

[Dingo]

Pooka1

The longterm effects are unknown. Strengh training may continue to work or it might gradually lose it's impact.

However it is not credible to question the 4 and 8 months results. Scientists and physical therapists around the world have all consistently produced the same results.

[Pooka1]

However it is not credible to question the 4 and 8 months results. Scientists and physical therapists around the world have all consistently produced the same results.

Physical therapists are not trained in research. And as we have seen, even folks trained in research produce false results/conclusions a majority of the time.

Without controls or proof the curves would have otherwise progressed absent exercise, they can't conclude that exercise did a thing. Most curves not in a growth spurt would not progress in those time periods. Some smaller curves not only will not progress but would decrease and even spontaneously resolve absent exercise. How do they determine if those things are happening APART from the effects of exercise? And how do they determine that in a 15 patient cohort?

That paper is embarrassing. I am considering writing to the editors about it making the same points I made here. I'll report back if I do that and if I get a response. Exercise therapy might work but you wouldn't be able to determine that from that study design.

Please explain to me exactly how they know the exercises did anything when they don't know the curves are going to progress measurably absent exercise in those time periods? Just because you are studying something doesn't mean it is responsible for any effects you detect. This is why controls are absolutely necessary. ANd even then there is room for doubt. Science is tough.

Please explain the mechanism by which exercise is supposed to work that relates to the known mechanism of vertebral wedging.

Thanks.

[Pooka1]

The longterm effects are unknown.

Yes but we don't need to know the long-term, results when we have the 24 month results, yes?

It is a result to say that ~2/3 of patients will not keep up with even minor PT on a regular basis even to (hopefully) avoid surgery. That is the most interesting, DEFENSIBLE result in the paper as far as I can tell.

If ~1/3 kept up the exercises until at least 24 months, that is approximately FIVE patients. What did these curves do? Does it really matter when discussing FIVE people? I suggest not.

[swimmergirlsmom]

Hi Dingo
I met Dr Mooney in December 2007. That is the month when my daughter was diagnosed with scoliosis (30L, 48T, 28C and Riser 4) and we were told she was on the borderline for surgery so I was busy researching conservative methods. I had found a posting for a Torso Machine related Scoliosis study on the internet, so I drove to Dr Mooney's office since it's only 10 minutes from where I live, but when I talked with him, he said that study had been cancelled. He also said my daughter's curves were likely outside the range where his exercises would help because he found that curves under 40 responded better. I can't quote him because it was over a year ago and I don’t remember exact words, but he said something to the effect of "even if exercises work, you can't get people to do them".

My daughter was very motivated to try exercises because she wants to try everything she can to avoid surgery, so we then looked into Schroth. By Feb 2008 my daughter was doing daily stretching and Schroth exercises, for 30-45 minutes a day. In Sept 2008, we had an xray that showed an approx 16 degree improvement of her Thoracic curve (measured at 32 degrees) and in March 2009 that xray showed it was slightly higher (34 degrees) but still much better than the original curve. My daughter did not do a schroth “pose” but instead just stood relaxed for the xray, because we wanted to see what her curves were in a natural state. It’s possible her curve is corrected even more while actively doing a schroth exercise.

My daughter is now 16 and we obviously do not know what the long term effects will be from doing Schroth exercises, but currently it appears there has been some correction from exercises. We are hoping that she can stay in the 30's and avoid pain and surgery. Right now, she is committed to doing these exercises for life, especially since they are not physically demanding (just require body sensing and concentration). My daughter thinks it’s no big deal to do Schroth exercises for a half hour a day, but then she also works out swimming or cycling 2+ hours a day (5 days a week) so she is very athletic minded.

By the way, I emailed Dr Mooney the Sept 2008 xrays and spoke with him over the phone last October and he was impressed with her results. We may schedule a consultation with him but at this point, we are happy with Schroth exercises and how simple they are (no machine required) so we do not want to change my daughter's current routine.

If anyone would like more details, please PM me and I will gladly give you more info. I seldom log onto NSF because I try not to be on the computer when I’m home, but will do my best to respond to you as soon as I can.

[Pooka1]

Hi Dingo
I met Dr Mooney in December 2007. That is the month when my daughter was diagnosed with scoliosis (30L, 48T, 28C and Riser 4) and we were told she was on the borderline for surgery so I was busy researching conservative methods.

In Sept 2008, we had an xray that showed an approx 16 degree improvement of her Thoracic curve (measured at 32 degrees) and in March 2009 that xray showed it was slightly higher (34 degrees) but still much better than the original curve.

Just curious... did you have the same orthopedic surgeon measure the 48* and the 32*/34*?

Or did a chiro associated with Schroth measure the 32*/34*?

[swimmergirlsmom]

Hi Sharon
The original Dec 2007 xray was read by 3 different Orthopedic Surgeons (45T, 48T and 50T) so we chose the middle number to use when referring to the original thoracic curve measurement, since it's closer to the average.

Both the original 48* and the 32* in Sept were measured by Orthopedic Surgeons. Same ortho office but different ortho surgeon measured the second xray.
There is a very visable difference between the curves on the two xrays, but of course we take into account the plus/minus 5* rule and it could always be a little more plus/minus than that (time of day, different xray technician, error in reading the measurements, etc) so we understand the numbers are not exact.

We're not working with a chiro. We found our Schroth physiotherapist on our own.

The Radiologist at Children's Hospital measured the last xray in March (34*) because in Sept our ortho said my daughter didn't need to come back for a follow up for 3-5 years, so we got the xray Rx from our pediatrician in March.

[Dingo]

swimmergirlsmom

"even if exercises work, you can't get people to do them"

Evidently Dr. Mooney is correct about roughly 2 in 3 people. It's probably the same as weight loss. Most people would like to be thin and they know that diet and exercise work every time. However only a small percentage of people will stick with it for any length of time.

I know two women who had gastric bypass and both are obese.

He also said my daughter's curves were likely outside the range where his exercises would help because he found that curves under 40 responded better.

I'm sorry about that and I'm glad your daughter has done well with Schroth. My son has an 11 degree thorocolumbar curve which isn't bad but he also has a significant rotation and rib hump. Sadly he is just 5 years old. We are doing PT to try and hold it in place until he is 7 or 8 and can use the MedX machine. I believe the generic MedX costs about $6,000 brand new. I will gladly put off some other major purchase like a new car or TV and buy him a MedX. That's a small price to pay for a straight back and it's much easier to be compliant with a machine in the house.

[Pooka1]

I had found a posting for a Torso Machine related Scoliosis study on the internet, so I drove to Dr Mooney's office since it's only 10 minutes from where I live, but when I talked with him, he said that study had been cancelled.

Did he mention why it was canceled?

In my field, lack of results is the reason why studies get canceled.

[Pooka1]

Hi Sharon
The original Dec 2007 xray was read by 3 different Orthopedic Surgeons (45T, 48T and 50T) so we chose the middle number to use when referring to the original thoracic curve measurement, since it's closer to the average.

Both the original 48* and the 32* in Sept were measured by Orthopedic Surgeons. Same ortho office but different ortho surgeon measured the second xray.

Very good. I just wanted to ask because we had a recent case here where an orthopedic surgeon no less who invented a brace was irrationally exuberant in reading an in-brace radiograph.

Can I ask what the surgeons said about this decrease from Schroth? Did they seem surprised? Do you think they now think exercise works to permanently decrease a curve?

The Radiologist at Children's Hospital measured the last xray in March (34*) because in Sept our ortho said my daughter didn't need to come back for a follow up for 3-5 years, so we got the xray Rx from our pediatrician in March.

She is skeletally mature now, yes?

[leahdragonfly]

Hi Dingo,

You have mentioned your son's significant rotation several times. Have you considered purchasing a Scoliometer (available from this website for about $49) to monitor his rotation at home? Apparently it is very easy to use, and it measures the degree of rotation at the largest portion of the rib hump. Some orthopedists use this in lieu of x-rays for routine monitoring of small curves such as your son's. It might be a way to ease your mind in between check-ups.

Take care,

[swimmergirlsmom]

Can I ask what the surgeons said about this decrease from Schroth? Did they seem surprised? Do you think they now think exercise works to permanently decrease a curve?

She is skeletally mature now, yes?

Hi Sharon
We don't think that exercise has "permanently" decreased our daughter’s curve - I believe if she were to stop doing the exercises, it is likely that some or all of the "correction" would be lost, especially since she is skeletally mature and has not been growing since she started these exercises. My daughter intends to continue doing the Schroth exercises for life, and thankfully many of the exercises can be incorporated into every day living activities once you are experienced with Schroth, so we hope she will be able to continue with the exercises to maintain her curve.

Originally when my daughter was diagnosed, we were told by the orthos that it is impossible to improve the curves of an adult spine. When we had the 32* xray measurements read by the ortho, he had the old 48* xray right next to it, and he did not say anything to imply an improvement or permanent decrease in curves. We don’t know if in his mind he just didn’t want to give us false hope or if he had never seen results like this before, but he stayed cool and said it was “good news, you’re not too much worse” and that is all he would say. He had previously wanted to monitor my daughter every 6 months when she was 48* and skeletally mature, but after the 32* appt, he said my daughter could now come back in 3-5 years instead, so that was the only possible sign of “improvement” that the ortho gave us. Since she is not in the “surgery range” now, we just went to our pediatrician for the xray request in March. We will monitor my daughter’s spine once a year with a new xray, for the next two years while she is still at home. If she increases into the 40’s again, we will go back to the ortho.

It appears that schroth exercises have decreased my daughter's curve approx 14-16* for now and we don't know if she will be able to decrease it more or if the curve will increase (whether or not she does her daily Schroth exercises). Only time will tell what the long term results will be, so I am just sharing our current 17 month experience.

[Pooka1]

Hi Sharon
We don't think that exercise has "permanently" decreased our daughter’s curve - I believe if she were to stop doing the exercises, it is likely that some or all of the "correction" would be lost, especially since she is skeletally mature and has not been growing since she started these exercises. My daughter intends to continue doing the Schroth exercises for life, and thankfully many of the exercises can be incorporated into every day living activities once you are experienced with Schroth, so we hope she will be able to continue with the exercises to maintain her curve.

Well that sounds rational.

But I'm wondering if anyone associated with Schoth told you she could stop exercising and would maintain the correction?

Also, did anyone say had your daughter started exercising while there was growth remainig that she could have permamently reduced her curve absent continued exercise?

Originally when my daughter was diagnosed, we were told by the orthos that it is impossible to improve the curves of an adult spine. When we had the 32* xray measurements read by the ortho, he had the old 48* xray right next to it, and he did not say anything to imply an improvement or permanent decrease in curves. We don’t know if in his mind he just didn’t want to give us false hope or if he had never seen results like this before, but he stayed cool and said it was “good news, you’re not too much worse” and that is all he would say.

Well that is interesting. I wonder if he thinks she might never progress at this point past the 48* because you got it down to 32*/34* but I'm just guessing.

It appears that schroth exercises have decreased my daughter's curve approx 14-16* for now and we don't know if she will be able to decrease it more or if the curve will increase (whether or not she does her daily Schroth exercises). Only time will tell what the long term results will be, so I am just sharing our current 17 month experience.

I agree Schroth reduced her curve about that much but would really like to know if the people at Schroth are telling you it is permanent.

Thanks for typing that testimonial.