Welcome!

Hello!  …   This blog is about our family’s experiences, and information and opinions we have compiled in our efforts to care for our daughters’ scoliosis.  I am not a doctor, or a physical therapist, nor do I have any medical training or license of any kind.  The opinions expressed herein, even when stated as if fact, are warranted as no more than one crazy father’s ramblings.  Any health/medical related treatment (or lack thereof) decisions should be discussed with licensed medical professionals and are your own responsibility.

Our twin, 12 year old girls were diagnosed with adolescent idiopathic scoliosis (AIS) over a year ago, now.  We’ve learned much and doubtless have far more to learn.

I hope sharing our family’s experiences, hard-won lessons, and research, will help others accelerate their learning curve and have some additional questions to ask their doctors, which may be beneficial in helping their own children and grandchildren.  When your child has AIS, time is of the essence!!!  In most cases, you have only about 3 years to positively impact the curve, and at least try to avoid progression, before they’re out of the growth stage.  Don’t delay!  Learn as much as you can, as fast as you can.  I’ll try to help.

Comments and sharing with others are encouraged.  Please feel free to share your own experiences and lessons in the comments.

Please see the list of posts, to the right, to find topics of interest ======>

And, please don’t forget to click Follow and enter your email address so you’ll receive notices as new entries are added.

Best Regards,  Brian Willis

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Therapy/Exercises: How to Be Sure They’re Done Without Nagging

In my opinion, even if you don’t believe therapy exercises can help reduce curve progression, torso strengthening exercises should be performed by braced children to help prevent atrophy which could be caused by being braced for 18 to 21 hours per day.

If your daughter or son does have exercises to do, have you fallen into the nagging pattern?  Worse than having to ask them, is that you may have to ask multiple times per day if the answer was “not yet.”  And, this gets irritating for everyone.  Or, perhaps worse, do you get busy and forget to remind them for days at a time?

At first, our daughters were quite diligent but, over time, they became lax… and we started to fall into the patterns described above.  And, no one was very happy about it.

So, what to do?  Here’s what’s working for us, and it’s cheap.

I took the girls to a Dollar store and had them pick out an item that would serve as their daily reminder.  The below is an example chosen by one of our daughters.  I actually combined the bird on a wire with a cork that came with a candle.

Every morning, my wife or I put this on the island in the kitchen.  You can always set a reminder on your phone to be sure you do this.  When that daughter has done her exercises for the day, she takes this from the island and puts it back up on top of the refrigerator.

We no longer have to ask them about their exercises when they’ve already done them because we know.  I think this is the biggest benefit.  They don’t have to feel nagged when they’ve already done what they’re supposed to and we don’t have to hear “Yeeeeessss” with an accompanying eye roll.  😊

My Standard Disclaimer:  I am not, in any way, medically trained and you should seek professional medical advice before making any decisions based on information found here.

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The Curve Journeys to Date

It has been a long journey since our daughters were diagnosed with Scoli in 2013.

For those who are wondering how their curves have progressed, I’ll provide the following tables of data.

Daughter A has a single thoracolumbar curve.  The following shows the history of her in and out of brace x-rays.  This picture isn’t quite complete though.  For various reasons, including a saga with recurring pneumonia, we don’t have an in-brace x-ray, yet, for her new Providence brace after her latest Rigo-Chenau style brace was being outgrown and no longer effective.  I believe the Providence provides a strong correction, but don’t have the proof yet.

Note, x-rays are taken in and out of brace for different reasons.  In-brace x-rays show effectiveness of the braces while out-of-brace x-rays show the true progression of the curve.

Hopefully, the headers are clear but, for example, TL-In is ThoracoLumbar In-Brace.

My other daughter has an S-Curve, so there are separate measures for Thoracic and Lumbar.

They’re 15 now and I’d say another update is that it is harder and harder to get them to do their therapy.  They’re crazy busy with high school and compliance has fallen to about 50% unless I ride them.. which I’m trying to do better about.  It’s hard to see their faces sink, each day, as I remind them to do their therapy… but, still better in the long run.  We have to stay strong in more ways than one.

Disclaimer:  I am not, in any way, medically trained and you should seek professional medical advice before making any decisions based on information found here.

 

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Full Spinal X-Ray at About a Week’s Natural Radiation Exposure!

This is an important update to my earlier post on reducing x-ray exposure.

EOS-imaging now has what they call micro-dose technology which can, purportedly, allow for a full spine x-ray at approximately the same amount of radiation as the natural radiation exposure a person gets just living on earth for a week.  And, this is about 4% (depending on the height of the subject) as much radiation as a standard full spine x-ray!

Radiation Levels

I’ve been told, by an x-ray technician, this method is not advised for initial diagnosis (I’m guessing because there could be subtleties which may not be seen by this method, such as some of the potential causes for functional scoliosis).  However, after the initial diagnosis, this method may be used and has the potential to very significantly limit radiation exposure for children undergoing years of treatment for scoliosis.

I encourage people to ask their doctor about this and, if applicable, to use this site to find the EOS Imaging machine nearest you.  Many Children’s hospitals now have this technology.

Also, I caution to check whether the specific EOS machine, at the given location, has the micro-dose technology.  Many of these locations may pre-date the availability of micro-dose and I haven’t determined if the existing machines were compatible with the new method.

For full disclosure, I have NOT, as of the time of this writing, invested in EOSI (the EOS Imaging Stock) but, having just noticed the investors link on their page, I’m considering it.

My Standard Disclaimer:  I am not medically trained, in any way, and you should seek professional medical advice before making any decisions based on information found here.

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ApiFix: New, Less Invasive, Surgical Treatment for AIS

I found this story about ApiFix on Business Wire, here.  Its a new type of surgical treatment for scoliosis where a ratchet device is inserted.

Though we’re not at a point of considering surgery for our girls, I try to keep up on all new treatments related to scoliosis and will share some of the more interesting items as I can.

Pluses for this approach are supposed to include much shorter and less invasive surgery as well as less stiffness of the back (fewer affected vertebrae).

The video, found at the above link, mentions that this is approved in Europe but not, yet, in the US.

Here’s the ApiFix website.

Personally, my first question was;  How do you avoid over correction if the patient bends too far?  My guess, for what its worth, is that the ratchet is gauged to not be able to go too far for the specific patient.

Regardless, this seems like something to keep an eye on.

Regards

My Standard Disclaimer:  I am not, in any way, medically trained and you should seek professional medical advice before making any decisions based on information found here.

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Exercises and Stretching for Scoliosis

Though our girls wear braces, we don’t put all our “stock” in these.  We believe specific stretches and exercises can actually help the scoliosis.  But, at a minimum, we think brace wearers should do some core strengthening just to offset the atrophy caused by bracing.

What follows is a look into our setup and approach.

To be sure, I’m not trying to suggest that all the items mentioned below are proven to work.  We’re just trying whatever we can that seems to make intuitive sense to us.  And, as per usual, I’m not a licensed practitioner of any kind.  Seek professional advice!

Band Pulls

A staple of our exercise regimen, and very common therapy for back problems in general, is to pull exercise bands, like shown here (we primarily do the first type demonstrated in the prior link).  Having had therapy for back issues of my own, though, I know it’s good to alternate the angle of the pull to target different areas of the back.  So, I mounted a 2×4 that reaches floor to ceiling (screwed into a stud) and attached eyelets at about 1 foot intervals.  The bands are then looped through Jensen Spring clips which can be easily moved from one level to another.  As for the bands themselves, I bought a couple sets of Bodylastic bands then got some extra handles that are a better fit for the girls’ small hands.

Exercise Band Station    Jensen Spring Clip

Lat Machine

This is ideal for us because we get the lat pull-down without the footprint of the larger combo machines.  I believe the lat pull-downs to be an excellent way of activating and strengthening the upper back and paraspinal muscles.  Just start in the elongated position and bring down tightly to chest.  I picked up several light weight plates, ranging from 1.5 to 10 pounds, at a used sports equipment store, making it easy for the girls to adjust the weight to what works for them.  We target a reasonably challenging 15 to 20 reps per set.  When 20 reps become easy, they slightly increase the weight.

Lat Machine

Ed Paget Video

In addition to what I’ve described above, some of what we do with the bands and lat machine are based on the following video from Ed Paget.   This, was actually my first “find” that got me started down the road of trying to help our daughters’ scoliosis through stretching and exercise.  Thank you Ed!

Bench and Bowflex SelectTech dumbells

The SelectTech dumbells are Excellent!  They start at 5 pounds and can be incremented by 2.5 pounds up to 25 before going to 5 pound increments.  We do some bench/chest presses to provide balance (not good to only work the back muscles all the time without at least minimal chest work), as well as for doing back exercises by facing downward on the bench (incline of flat), and raising the weights up.

Bench and Weights

Schroth Wall Bars

The Wall bars, used for Schroth exercises, were the biggest expense.  I bought these from InFitnessEquipment.com.  They come as a kit which you assemble and attach to the wall.  I chose to also install a mirror behind the wall bars as well as on the side walls, which facilitate the Schroth exercises.  I recommend safety backing on the mirrors in case they get broken.

In addition to Schroth exercises, which we learned from Peter Arndt at Spinal Dynamics in Wisconsin, the side wall (low) mirrors are also good for allowing the girls to watch their form to help make sure they’re doing their side planks properly.

Schroth Wallbars2        Side Wall Mirrors2

Vestibular/Stability Disc

Some believe standing on one of these inflatable balance disks and performing other tasks, like tossing a ball with someone or balancing something on your head, helps to condition and train your paraspinal muscles for subconscious, balanced support… So, we’re trying to mix some of this into our routine.  We actually have two of these so the girls can stand on them and toss a ball or bean bag back and forth.

Vestibular Disc

Exercise Balls

Also common for back therapy is to do exercises using Exercise Balls.  These can be used for sitting leg raises, walk out bridges (back planks) and walk-out front planks.  The instability added by doing these exercises on the balls helps to better engage all the muscles.  Though not exact, ball exercises we’re doing are similar to the following:

Stretching:  Elongation

These are obviously used for decompression/elongation.  We try to use it a few minutes at a time about 3 days per week.  Be gentle.  One need not go full inversion to achieve the goal.

Inversion Table

Stretching: Concavities

We also do some side-lying stretching for opening up the girls’ concavities.  The best illustration of this I found online follows.  This must be done very carefully, particularly for “S” curves.  I’ve seen many illustrations where they show the entire body being arched to one side.  While that may be great for a person with a single thorocolumbar curve, it likely exacerbates the compensatory lumbar curve for a person with an S curve who is doing this to stretch out her thoracic concavity.  Note, in the below illustration, how the top leg is raised and upper hip brought cranially, to have a straightening effect (toward the floor) for the lumber curve while a bolster is used to move the thoracic curve toward the ceiling.  We must assume the subject has a typical S curve (with the thoracic convexity on the right and lumber convexity on the left), for this to be effective.

Scoli Side Stretch2

For stretches like the above, it’s good to have an assortment of bolsters on hand.

Assorted Bolsters

Stretching: Hamstrings

More recently, I’ve read it is important to stretch out the hamstrings.  To support the back while doing this, we lay on the floor near a door frame and leg up to 90 degrees (foot on door frame) then hold there as tolerated before switching to the other side and repeating.

Found a good illustration at Fitness-training-at-home.com

Hamstring Stretch

Sources/Costs

We didn’t spend much on most of this, other than the Schroth wallbars.  Yard sales, Craigslist, and used sporting goods stores are your friend.

Track It!

I’ve heard it said in the project management world that “what doesn’t get measured, doesn’t get done.”  I recommend making a spreadsheet of whatever exercises you intend to do and checking them off each date.  Ideally, this spreadsheet has date columns so you can see what was done each day over time.

In Closing

This actually doesn’t cover all we do, but it does pretty well cover our setup.  I’ll try to post more about other stretching and exercises in the future.

If anyone would like me to go into more details about any of the specific exercises, please comment accordingly and I’ll try to do so in a future post, or amend this one.

My Standard Disclaimer:  I am not, in any way, medically trained and you should seek professional medical advice before making any decisions based on information found here.

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Spinal Dynamics and Schroth – Part 2

As described in this post, we went to Spinal Dynamics to learn Schroth (and some SEAS) therapy, last year.  So, what is Schroth, and what does it do?

Disclaimer

Before continuing, since I get into some detail about therapy methodology, I need to reemphasize I have no medical training of any kind, much less any Schroth certifications.  I’m sharing share an introductory overview from a layman’s perspective, to help others who are interested in Schroth learn more about it.  Please see a licensed Schroth therapist for practical application and make no medical decisions based upon information herein.

My sources of info? 

  • I read and recommend “Three-Dimensional-Treatment for Scoliosis.” This is not a clear and concise “how to” book.”  After walking you through a lot of technical and conceptual info, it does walk you through several Schroth exercises.  Unfortunately, the correct application of Schroth is very specific to the degree, location, and direction of curves and rotation of the particular patient’s spine.
  • We took our girls to see Dr. Peter Arndt, DPT, at Spinal Dynamics in Wisconsin for one week, 30 hours, of Schroth and SEAS therapy.  (though, any inaccuracies in my understanding or recollections should not reflect poorly on him)
  • Online research (Gotta love the net!)

Schroth in a nutshell, as I see it: Learn to achieve and recognize (i.e. “feel”, a.k.a. proprioception) the proper elongated, straightened, and de-rotated position for your spine and hold it while breathing, engaging your torso muscles, and performing other activities.  In so doing, you strengthen and activate weak muscles in the target position.

In practice, Schroth is based on certain key principles such as:

  • Adjusting pelvis and shoulders to achieve a capital “I” position (i.e. pelvis and shoulders level and in alignment)
  • Elongation (a subtle stretching of the spine to help straighten… basically, standing up tall)
  • Counter rotation (e.g. a typical S curve comes with a rib hump on the upper right back, this is rotated forward)
  • Controlled Respiration

In our training, the pelvic adjustments included:

  • A slight tilt forward (to 1 o’clock)
  • Raising the tail up, to achieve proper lumbar lordosis if to flat
  • Shifting right or left, depending on the curve, to achieve proper side to side alignment.
  • Pelvic counter rotation (going counter to whatever the lumbar rotation is with the scoliosis)

More about the counter rotation…

The aim during the counter rotation movements is to correct the rotation caused by the scoliosis.  An S curve, for example, has two convexities and two corresponding prominences (e.g. the places where the back “sticks out” such as the thoracic area, known as the rib hump.)  The following image shows a top down view of the Thoracic region of an atypical S curve (thoracic convexity on the patient’s left).  The red arrows (added to this image by me) indicate how, during Schroth, the patient attempts to engage the torso muscles (and breath) to counter rotate the spine, reducing the prominence of the rib hump.  Meanwhile, the reverse is attempted in the lumbar region (where the prominence is on the opposite side), through pelvic positioning.

RibHump with Arrows

The Respiration component…

After all the above, upon achieving the most straight and de-rotated position attainable, the patient performs breathing exercises.  The inhalation is the final stage of de-rotation as the patient attempts to direct the breath (breathing motion) into the areas opposite the prominences.  Schroth refers to this as Rotational Angular Breathing (RAB).  Then exhalation is what I would classify as isometric, resistive breathing.  The exhale is resisted through pursing of the lips, or other such methods, which can create a hissing sound and aid the patient in creating that isometric tension to help engage all the muscles.  This is repeated several times per position.

The above steps are performed in various positions including supine, side-lying, sitting, and standing.  Mirrors are used to help look for and achieve proper alignment.

Benefits?

In addition to the strengthening of muscles that may atrophy as part of scoliosis, I believe Schroth and SEAS are, in part, about self-bracing. Personally, I have only minor scoliosis but had an injury leaving me with a couple degenerated lumbar discs. To improve my health, I’ve learned to continuously self-brace. Simply put, I’m aware of (proprioception as they refer to it in Schroth) my body’s position and I built the habit of holding my torso muscles slightly engaged at nearly all times to keep myself in a good and well-supported posture.

Through practice of Schroth and SEAS, our daughters are, in effect, learning to self-brace, with all the benefits that come from bracing only without brace related atrophy. Ideally, this becomes habitual for them like it has for me and it will continue to benefit them throughout their lives.

Common Criticism

A common criticism levied against Schroth is that it is aimed at addressing only the cosmetic appearance of scoliosis (e.g. reducing the visible rib hump).  I believe this criticism misunderstands the role of the

“visible” in Schroth.  In my opinion, the visible aspects are only tools in achieving the aims.  An aim, for example, is to de-rotate the spine.  A visible cue, for seeing if this is being accomplished, is the reduction of the visible rib hump.

Oh yeah, a quick bit about SEAS….
While I’m sure there’s more to it, given the training we received, I saw SEAS as more practical application of the above principles while performing activities.  This, I think, helps train the person to be able to habitually hold corrective positions while engaging in day-to-day activities.  Examples include rising from sitting to standing and back, or tossing a ball, all while holding corrective positions.

About Spinal Dynamics of WI

I can’t provide any comparisons with other clinics but everyone we encountered at Spinal Dynamics seemed friendly, knowledgeable, experienced, and professional and I think they were worth the trip from Cincinnati to Wisconsin.

In closing

I still view all exercises and therapy as complimentary to bracing as recommended by our doctor.  Our girls wear Rigo Cheneau style braces (which are complimentary to Schroth) about 21 hours per day and perform daily stretching and exercises of which Schroth is a part… but not all.  I hope to cover more on the variety of exercises we use, in later posts.

My Standard Disclaimer:  I am not, in any way, medically trained and you should seek professional medical advice before making any decisions based on information found here.

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Could One Yoga Pose Improve Scoliosis Cobb Angles?

I found a link on the Scoliosis Warriors Facebook page, today, to an article on Medical News Today about a study regarding doing side planks to treat scoliosis.  I’ve had my daughters doing side planks as part of their exercise routine for a few months now, but we’re doing a balanced approach (same amount of time on each side).  In this study, abstract found here, they had the patients only do the side plank with the convexity downwards.

According to the abstract, all 19 patients (some with AIS and some with degenerative scoliosis), saw improvement.  I’m trying to obtain the full study to see if more details are given, like what to do about an S curve with (i.e. with a convexity on each side).  I’ll make an update if I find something material.

Side Plank

Update (6/9/2015):  A friend provided the complete study, mentioned above.   While providing more details about the specific measures and improvements of those in the study, insufficient details are provided to be sure of precisely replicating the treatment based on the various curve types.  To get advice specific to your curve, you likely need schedule an appointment with Dr. Fishman.  For our part, we continue to keep side planks as part of our therapy regimen.

Disclaimer:  I am not, in any way, medically trained and you should seek professional medical advice before making any decisions based on information found here.

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