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Wedege vertebra
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Wedege vertebra - October 14, 2005 6:09:00 AM
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christiandrv
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From: Chicago, Illinois
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Hello,
I am seeing a 13 year old male, apparently with no evident history of previous significant trauma, but he has a wedge vertebra at T12. This has given him back pains on and off since last year and an almost gibbus deformity and an S-shaped spine. He was prescribed with heating modalities and william's flexion exervises; and also I was advised by the Physiatrist to use Lehnert-schroth exercises with him.
Does some have any suggestions on how to approach? I have been seeing him for three months now, he is still to be scheduled for an X-ray, but his pains has decreased and he increased in height by about an inch, is that significant?
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crv
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Re: Wedege vertebra - October 14, 2005 6:49:00 AM
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Shill
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From: Madison WI USA
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If its anterior wedging, I sure wouldnt be flexing him through the wedged zone. Not repeatedly or for prolonged durations anyway. I dont know what or whom Lehnert-schroth is. Seems to me he's doing just fine on your program if his pain is down and he is truly taller. Some instruction on how to prevent progression of the deformity would be needed, but other than that, sounds like hes nearly done.
Tell him to stand up tall or sit up tall during the X-ray.
Good Luck,
Steve
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Re: Wedege vertebra - October 14, 2005 7:52:00 AM
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james097
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From: West Vancouver BC
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Lehnert-Schroth is an exercise routine popular in germany for the treatment of idiopathic scoliosis, if I remember correctly. If you don't agree with the Doc just say to him Hast du 'n Meise?
Jim McGregor
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Re: Wedege vertebra - October 14, 2005 9:47:00 AM
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Geert Jeuring
Posts: 92
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From: Möhnesee, Germany
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Hello forum,
In Germany the scoliosis is still a popular treatment cause for pt´s despite all evidence points in the direction that physiotherapy in this case isn´t working. The Lehnert Schroth therapy, like most therapies with the name of the person who invented it, is mostly dogmatic and as far as I´ve found not scientific. If a youthfull person has backproblems it is in my opinion mostly because he or she doesn´t get enough exercise.
Geert mailing from Germany but dutch by nature and norture.
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Re: Wedege vertebra - October 14, 2005 1:48:00 PM
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jma
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From: NY
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Hopefully, the pain will continue to decrease but the exercises should be continuous, even after you are through working with the patient. Hopefully, the x-ray will not show any more s-shaped curvature. The patient is still growing and needs to be monitored.
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Re: Wedege vertebra - October 20, 2005 11:58:00 PM
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christiandrv
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From: Chicago, Illinois
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Thanks for everyone's replies :)
Anyway, it was anterior wedging that he has. I only gave him the first three william's exercises and included core strengthening exercises 'coz I really think training his core ms. would help in preventing the curves' progression.
Right, Lehenert-schroth is a therapy for scoliosis which started in Germany.
how about I give him active extension exercises? any view on this, I am thinking now that we have progressed with the flexion exercises maybe I could start him on back strengthening? Or should I wait until he shows good core ms. tone? :)
Thank you all and God Bless!!!
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crv
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Re: Wedege vertebra - October 21, 2005 12:39:00 AM
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Sebastian Asselbergs
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crv, Geert - remember Klapps Kriechverfahren? Also a german therapeutic model where crawling with modifications is utilized to correct skolioses - you should see the pictures....
As far as the suggestions: all good, but crv, core strengthening is a bit moot. Unless he has shown signs of weakness in his core....moving into extension can be sufficient to help.
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Re: Wedege vertebra - October 21, 2005 4:23:00 AM
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Jon Newman
Posts: 1713
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From: Amherst, WI
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The following may help you in your thought process. Good luck.
[URL=http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15456050&query_hl=1]link 1[/URL]
[URL=http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=12438982&query_hl=3]link 2[/URL]
jon
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[URL=http://www.sonymusic.com/clips/selection/30/064887/064887_03_03_30.wav]Evidence[/URL]
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Re: Wedege vertebra - October 21, 2005 6:28:00 PM
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Geert Jeuring
Posts: 92
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From: Möhnesee, Germany
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Hello Cristian, Extension exercises are probably most accurate because flexion is the major component of the scoliosis. In my opinion it is best trained in a gym becaus here you can meet the progression in strength wit adaquate measures.
Hello Cristian, yes I´ve been been confronted with klapsches Kriechen, wie even have a couple of the felt pads at the school where I teach. It appears to be retrograde in evolutionary terms.
Hello Jon, in Article one the basic assumption that scolioses causes pain is critical(why should it cause pain?). This is thematised in link 2 where pain is mentioned in the title but can´t be found back in the conclusion.
In The Backpain revolution is a x-ray of a senior citizen with a mega scoliosis. The x-ray was made because of stomachproblems, she doesn´t complain about backpain.
Geert
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Re: Wedege vertebra - October 21, 2005 6:43:00 PM
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avalon
Posts: 181
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Schroth is perhaps not scientific but I looked at the site and it made sense to me and it seems to work?
Saudi Med J. 2005 Sep;26(9):1429-35. Related Articles, Links
The efficacy of Schroth s 3-dimensional exercise therapy in the treatment of adolescent idiopathic scoliosis in Turkey.
Otman S, Kose N, Yakut Y.
Professor, School of Physical Therapy and Rehabilitation, Hacettepe University, Samanpazari 06100, Ankara, Turkey. Tel. +90 (312) 3051507. Fax. + 90 (312) 3243847 / 3111131. E-mail: sotman@hacettepe.edu.tr/ asotman@superonline.com.
OBJECTIVE: To determine the effectiveness of 3-dimensional therapy in the treatment of adolescent idiopathic scoliosis. METHODS: We carried out this study with 50 patients whose average age was 14.15 +/- 1.69 years at the Physical Therapy and Rehabilitation School, Hacettepe University, Ankara, Turkey, from 1999 to 2004. We treated them as outpatients, 5 days a week, in a 4-hour program for the first 6 weeks. After that, they continued with the same program at home. We evaluated the Cobb angle, vital capacity and muscle strength of the patients before treatment, and after 6 weeks, 6 months and one year, and compared all the results. RESULTS: The average Cobb angle, which was 26.1 degrees on average before treatment, was 23.45 degrees after 6 weeks, 19.25 degrees after 6 months and 17.85 degrees after one year (p<0.01). The vital capacities, which were on average 2795 ml before treatment, reached 2956 ml after 6 weeks, 3125 ml after 6 months and 3215 ml after one year p<0.01. Similarly, according to the results of evaluations after 6 weeks, 6 months and one year, we observed an increase in muscle strength and recovery of the postural defects in all patients p<0.01. CONCLUSION: Schroth s technique positively influenced the Cobb angle, vital capacity, strength and postural defects in outpatient adolescents.
PMID: 16155663 [PubMed - in process]
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Re: Wedege vertebra - October 22, 2005 2:47:00 AM
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Jon Newman
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From: Amherst, WI
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Hi Geert,
You picked out the points I did but there is also this in the second link
[QUOTE] Axial pain was correlated with age (r = 0.63); however, it was not correlated with curve magnitude. [/QUOTE]Also, while pain and age were correlated as was age and flexibility, I don't think flexibility alone sufficiently explains pain as
[QUOTE] Every 10 degrees increase in curve magnitude over 40 degrees results in a 10% decrease in flexibility [/QUOTE]Perhaps using the Schroth method changes a pain experience in some way other than changing posture or flexibility. I understand, interestingly enough, that breathing exercises are a big part of their program.
Christiandrv, could the person have stood taller because they had less pain versus had less pain because they stood taller?
jon
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Re: Wedege vertebra - October 22, 2005 7:30:00 AM
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Geert Jeuring
Posts: 92
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From: Möhnesee, Germany
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Hello Jon, the real question is: is a scoliosis a pathological thing or isn´t it. Of course there is the Quasimodo - kind which can cause some trouble but actually it is very rare. I´m concerned with a big group of adolescents over here that are diagnosed with scoliosis and suffer not because of their curvature but because of the nozebo - effect coming with the diagnosis. I´m almost confronted on a daily basis with people wit LBP which is in their minds is related to their bad back (scoliosis). It is very hard to get it out of their heads.
In my personal opinion the concept of painprovoking scoliosis goes wrong at the base. Why should a spine which has in saggital view 3 beautifull curves cause pain wenn it has these curves in an posterior-anteriorview. The premisse major simply is wrong. Just because we tend to inspect patients from behind or from up front the concept of symmetry is wrong. Looking on the inside there is only one heart which slight of center, the kidneys aren´t symmetrical, we have a master eye etc.
In my opinion most scoliosis´s don´t need treatment just encouragement to enter sports.
Geert
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Re: Wedege vertebra - October 22, 2005 8:06:00 AM
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Jon Newman
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From: Amherst, WI
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Geert I think we are on the same page. Scoliosis is often a suboptimal condition. Whether it's pathological depends on how one uses the word.
My points above, regarding pain, were meant to illustrate that those who have pain without obvious cause are being helped although it may have little to do with the treatment's affect on scoliosis directly. One can see how they might confuse the two when someone stands taller with less pain but the quotes above seem to shed some light on the observations of the other study (link 1).
A revealing study might be to use the technique on asymptomatic scoliotic patients. If they too improve then perhaps there is an effect on the condition past its effect on pain.
jon
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Re: Wedege vertebra - October 22, 2005 12:38:00 PM
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james097
Posts: 178
Joined: January 27, 2005
From: West Vancouver BC
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Nobody using botox in America yet?
Jim McGregor
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Re: Wedege vertebra - October 22, 2005 1:41:00 PM
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jma
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From: NY
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Interesting article. Looking foward to reading it when it gets published. Wondering how exactly the 3 dimensional exercise therapy works.
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Re: Wedege vertebra - October 22, 2005 10:30:00 PM
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avalon
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[QUOTE]I understand, interestingly enough, that breathing exercises are a big part of their program.[/QUOTE]Breathing is a efficient tool with scoliosis. I'm using it with motion/movement (but not Schroth technique). You can change a shape if you use pain free movement but creates more problem with immobility. The traditional approach of scoliosis is brace and absence of sports/movement. it is a pity.
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Re: Wedege vertebra - October 23, 2005 2:30:00 AM
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Jon Newman
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[QUOTE] Breathing is a efficient tool with scoliosis. [/QUOTE]Are you using it to change the shape of the scoliotic spine in a permanent fashion or for some other purpose? Even the Schroth folks advocate brace wearing although the brace is different then was an orthopedic MD might prescribe.
jon
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[URL=http://www.sonymusic.com/clips/selection/30/064887/064887_03_03_30.wav]Evidence[/URL]
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Re: Wedege vertebra - October 23, 2005 6:43:00 AM
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Diane
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Lots of epaxial spinal muscles (the ones associated embryologically with vertebral development of bone and cartilage, that form from the same pool of mesoderm, and do not require large amounts of hard drive to run) attach to ribs/attach ribs to spine. The cage is very distortable, like a basket. It makes sense to me to treat it with some very slowly applied forces from the outside and deep breathing (slowly applied forces from the inside). One has to learn to treat in conjunction with a moving target anyway, treating the cage or spine.. why not learn to take advantage of it as best one can and incorporate breathing into treatment? The epaxial muscles themselves can be awfully variable from person to person, apparently. Ratios of tendon to muscle fibre, presence or absence, assymetries etc, can all be present, as well as unconscious useage/functional tension playing a role. I don't know the first thing about Lehnert-Schroth, but I think breathing and exercise would likely be more useful than passive bracing especially early on.
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Re: Wedege vertebra - October 23, 2005 6:36:00 PM
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avalon
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Jon,
As Diane said it, breathing is fully integrated in our body. We are taught that thoracic cage is rigid but it is false. Scoliosis is often treated with a huge battle against deformations. We use braces but it creates muscular resistance and skin problems because the scoliosis will sit on/against them.
But... If the spine falls on the right side, is it the right side that is weak or the left?
About breathing: try to shot a soccer ball while you expiring and then while inhaling (after a full extension/flexion). Which was the easiest and the most efficient?
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Re: Wedege vertebra - October 24, 2005 5:07:00 AM
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christiandrv
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From: Chicago, Illinois
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I agree with everyone. The principle in approaching the problem should be to emphasize proper posture, breathing and exercise/activity. I think my patient stood a bit taller because he has less pain.
I am wondering though about the use of botox? as mentioned by one of our friends here.
Avalon, if the spine falls on the right side, its because the left side is weak, was I right? although the right side would also have some form of weakness. :)
Thanks for everyone's input! Rarely do we get up to date research literature here in the Philippines.
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crv
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