AN OPEN LETTER TO BIOMECHANICS MAGAZINE
By Greg E. Bradley-Popovich, DPT, MSEP, MS, CSCS & Amanda N. Geiger, DPT
© 2004
Published in February 2005 issue of Biomechanics Magazine
Dear Editor:
As physical therapists specializing in the treatment of spinal conditions, we were pleased to read a physiotherapeutic perspective on adolescent idiopathic scoliosis featured in the BioMechanics supplement, Scoliosis Management. In the article by Richards and Cassella, the authors review two studies that examined the effects of exercise and a complement of other interventions for the reduction of curve progression in patients with idiopathic scoliosis. An important omission from this brief overview is the work of Vert Mooney, MD, and colleagues who have demonstrated in two peer-reviewed articles the effectiveness of exercise in the management of the scoliotic adolescent. Importantly, this research challenges the closing statements by Richards and Cassella in which the authors conclude, “Existing evidence does not suggest that exercise alone can prevent curve progression in adolescent idiopathic scoliosis. Designing a study involving exercise alone, therefore, would be ethically questionable.”
Although deemed preliminary, the data reported by Mooney et al. suggest that truncal strengthening to address rotary strength asymmetry can prevent or partially reverse curve progression when used as the sole intervention. In the first study1, Mooney and co-workers studied twelve adolescents with idiopathic scoliosis who had curvatures ranging from 20˚-60˚. Patients were tested on a computerized torso rotation dynamometer (MedX, Ocala, FL). In addition to rotary strength asymmetry, asymmetric myoelectric activity was found in all patients. Following the torso rotation strengthening program of 4 months, asymmetries were completely corrected and significant strength gains were found (12%-40%). Moreover, 4 of the patients had a reduction in their curvatures and 7 had no further progression. One patient with a 60˚ curve required surgery.
Combining data from the first study, Mooney and Brigham completed a second study2 with a total of 20 adolescent participants examining the benefits of a progressive resistive training program for torso rotation and lumbar extension. The major curve of each participant, which ranged from 15˚ to 41˚, was investigated. The study revealed that 16 out of 20 patients demonstrated a reduced curve while none of the participants had an increase in their curves. Pre- and post-treatment mean curvatures were 28˚ and 23˚, respectively. In addition, no patient required surgery or bracing.
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˚ curve reversal without the use of bracing.
While we await the results of larger studies currently underway 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 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 spinal practitioner.
References
1. Mooney V, Gulick J, Pozos R. A preliminary report on the effect of measured strength training in adolescent idiopathic scoliosis. J Spine Dis 2000;13(2):102-107.
2. Mooney V, Brigham A. The role of measured resistance exercises in adolescent scoliosis. Orthopedics 2003;26(2):167-171.
Sincerely,
Greg E. Bradley-Popovich, PT, DPT, MS, CSCS
Amanda N. Geiger, PT, DPT
NW Spine Management
Portland, Oregon