Tag Archives: back pain

Scoliosis Review: some reports

Regular readers will know that is was my intention to  conduct a lot of research on scoliosis and then publish some results. I am however, getting quite a lot of interest, so rather than sit on research , Ill publish thoughts and theories as i come across reports and Journals;  There is a risk that i can publish something that could be wrong and need to correct it later  However, the  value in people feeding back, digging out reports or treatments,  is worth a  possible public U turn!

regards

Andrew  Stemler ( andrew@crossfitlondonuk.com)

Is physical activity contraindicated for individuals with scoliosis? A systematic literature review

[Sports capacity of patients with scoliosis].

von Strempel A, Scholz M, Daentzer M

Sportverletz Sportschaden. 1993 Jun; 7(2):58-62.

Cobb angle less than 20. No  restrictions

For curves of 20° to 30°, they recommended restriction from what they call  performance sport; but school sports and competitive sports were allowed.

For curves of 30° to 50° or 20° to 30° with progression of 5° in 6 months, they allowed school sports with patients wearing a brace

Recommended these sports,:horseback riding, tennis, table tennis but not “performance sport or competitive sports at club level”. competitive sports allowed at school under the watchful eye of a teacher. For curves of 50° or more, they  recommended endurance sports (eg, cycling, swimming, hiking, jogging)”

Idiopathic scoliosis and spondylolysis in the female athlete. Tips for treatment.

Omey ML, Micheli LJ, Gerbino PG 2nd

Clin Orthop Relat Res. 2000 Mar; (372):74-84.

Scoliosis is not a contraindication to participation in sports and asserted that, unless a scoliosis was severe, it would not reduce physical function..

“Scoliosis is not a contraindication to participation in sports by the young athlete”; and they suggested  examination for underlying pathology (eg, syringomyelia, disk herniation, degenerative spinal disease) if pain accompanied scoliosis.

They also encouraged active strengthening and flexibility exercises for the spine during brace wearing and maintained that sports may be played while the athlete was not wearing a brace. Specifically asserted that swimming and water activity may be helpful to maintain flexibility, strength, and endurance.

Professional volleyball should be avoided, but recreational/amateur volleyball is acceptable.

Spinal deformity in the adolescent athlete.

Wood KB

Clin Sports Med. 2002 Jan; 21(1):77-92.

 “There is no objective evidence in the literature to suggest that active participation in any sport is directly associated with worsening of scoliotic curvatures beyond that of the natural history of the disorder.”

Recommended active exercise for  brace wearers  and encouraged brace wearing during exercise. No study exists showing negative effects of contact sports on the curve of a braced individual.  He encouraged  all athletics  out of a brace, not only for physical benefit, but for psychologic and social well-being!

Spinal deformity and athletics.

Schiller JR, Eberson CP

Sports Med Arthrosc. 2008 Mar; 16(1):26-31.

Recommends flexibility training and indicated that patients with scoliosis treated non-operatively can participate in all sporting activities.

Sport participation while wearing a brace was allowed and that sport participation out of a brace was also possible.

Conditioning should focus on flexibility of the spine and core strengthening and felt that the addition of plyometrics and power lifting after appropriate conditioning was acceptable. Athletes with scoliosis should be encouraged to participate in sport.

For postoperative patients, they maintained that sports participation should be at the discretion of the surgeon.

They did not recommend against torque sports for postoperative patients (eg, gymnastics, ballet, swimming, wrestling, javelin), as had previous authors.

Serial Case Reporting Yoga for Idiopathic and Degenerative Scoliosis: my justification for the side plank

Should  a client with Scoliosis perform the side Plank? I think so, as a strong side plank, when  matched with a strong plank and a good “brace” means the torso is “nice and locked down” ( highly scientific stuff)

The paper, “Serial Case Reporting Yoga for Idiopathic and Degenerative Scoliosis” came to my attention as it was reported In the Wall street Journal. I chased the actual study down to  an obscure Journal

Global advances in Health and Medicine.

So, it  got some people to perform the side plank

“Results: The mean self-reported practice of the side plank was 1.5 minutes per day, 6.1 days per week, for a mean follow-up period of 6.8 months. Among all patients, a significant improvement in the Cobb angle of the primary scoliotic curve of 32.0% was found. Among 19 compliant patients, the mean improvement rose to 40.9%. Improvements did not differ significantly among adolescent idiopathic and degenerative subtypes (49.6% and 38.4%, respectively).

Conclusions: Asymmetrically strengthening the convex side of the primary curve with daily practice of the side plank pose held for as long as possible for an average of 6.8 months significantly reduced the angle of primary scoliotic curves. These results warrant further testing”

My own take on this  is that  no harm resulted from this experiment, and it makes sense to test  strengthening both sides. The core  and torso needs to be braced: lets do it all! I should say the self reporting , does not make this the best evidence ever, but , interesting . The side plank is used by Stuart McGill in the treatment of back pain. It seems safe, if monitored, to use and test.

We will see how my client responds

will this help clients with scoliosis?
will this help clients with scoliosis?

Be careful of your deadlift form: why sport science reports can mislead you

Much of the development of human movement comes from coaches comparing techinques. Better coaches hang out with other coaches, go on their courses, read their blogs, learn, analyse, video, and humbly put stuff up for criticism.  Many sport science papers purport to do the same thing. However, the only value of  a report of an experiment is, if you can reproduce the experiment yourself.

Do you remember those basic physics and chemistry experiments we did at school? We followed the exact doses, mixed , shook, heated and retreated to a safe distance. The instructions told us, how much, in what container , in what proportion. to what temperature.

This often isn’t the case in sport science journals. Sport scientists  casually say they are testing the efficacy of , say,  the deadlift and squat but often fail to explain what they mean. This frequently means back specialists often prescribe or ban  movements where there is no correct understanding about what the movement is and how to perform it. I often see clients who have been banned from performing movements they do well and perfectly, and being set drills and movements, which, clearly, the  instructor had not the faintest idea of the correct form or the correct mechanics .

The picture here is from a leading book on back issues and is supposed to be the correct form of the deadlift. It is, unfortunately not brilliant, (probably for all the best reasons), but, if you  deadlifted in this way, you would , eventually, overload your back ( as always, poor form needs to be mixed with  repetition and  escalating load weight  to be truly nasty).

This is not an attack on sport scientists ( I do that elsewhere). After all,  all research is useful , it is a plea to look for the instructions or method in the report you are reading. Can you reproduce what they did? If not, treat the information with caution.

We will post later the correct way to deadlift.

And maybe you should twitch

inspired by  a re-reading this report:
Effectiveness of Transcutaneous Electrical Nerve Stimulation for Treatment of Hyperalgesia and Pain

and talking to a former (100% cured,) Backaholic, i was  encouraged to drag out from the bottom of the wardrobe, my old “Bodi-tek” machine.

I  bought  a “Bodi tek”  years  ago  (seriously, 2001, 2002) when I thought it would improve my Martial arts.

In my favour i only used it once. I sat there covered in those patches. Twitching.

However,  there is, at certain levels, a validity to the electro stimulation of muscles and, well, according to the report above, some use in the therapeutic relief of pain.

To be honest,  as I write, I am reminded that , about 2 years ago, when  a sales rep from “firefly” came a calling, I got this machine out again, slapped it on various leg lower leg muscles and it seemed to help my achilles tendonopathy ( along with massage, trigger point therapy and some taping) So, if we, in the future, ask you to lie on the massage couch for a short while, hook you up,  and make you  twitch, you’ll know the reason why.

Interesting to see if we can effect the piriformis  thinking about it.

Turn the pain into science

So, you have tweaked you back again!  Now your whole day consist’s of finding positions of comfort and seeing what moves hurt.

Don’t think of this as suffering,  Think of this an an experiment. Of course you are the only participant so no drug company can use your results, ( without re validating them) but, its interesting science nevertheless.

if you have been reading this blog you will have had several bracing strategies discussed. You probably ignored them or just skim read them.

Now its time to experiment. Does bracing your abs stop the pain: is sucking you abs in or pushing them out pain relieving. If so, how much in and how much out. Is it mild engagement or hard engagement ? Experiment with the anti shrug. Does pulling your shoulders down help?

Now, if possible get up and walk, swing your arms.

Move.

Does that help?

Do you find that if you lie down or lean against something it helps, but its a bit of a pig to get moving again?

What back movements hurt or help: does moving into flexion hurt, or extension? Can you find a neutral spine? does it help.

Now pay attention to your bum. Does one cheek hurt more than the other. Does it feel dull?   Is one leg sore compared with the other

What movements create pain. if theses are limb movements can you reduce the pain by  bracing your abs more, because, if you can, you could well have discovered, that for example, every time you move your leg, you actually move your back too! Thats a lot of work for your poor back.

Observe, experiment, record.Learn.

Unless your doctor has diagnosed “cancer of the back”, the chances are that the  LBP you suffer from is what 98% of others suffer from. You can fix it!

As always if you cannot find a  position of ease  check out  RED FLAGS , so see your doctor who may want to screen you for other possibilities. but if you simply have LBP, start to sort the issues.

So I screwed my back again

I always like re -injuring my back, as it really helps me cut through the academic and medical bullshit.

Its very common for us to over sympathise with  and “forgive” back pain sufferers .

We should not.

Every single bit of “normal”  back pain  is self inflicted. (m not talking about the weird obscure stuff that effects  a teeny proportion of back sufferers). Im talking about our old friend , the non specific back pain stuff that is now costing the NHS loads of money.

Anyway , today  I pulled my back in gymnastics. Obviously i could go on a campaign: one that bans gymnastics, and  stops gymnasts from holding high office. Gymnasts should be rounded up and shot. Certainly banned from schools,

You will find lots of campaigns like this: Ban Crossfit, ban strength training, Olympic weightlifting . If you come across someone  trying to ban something, look at their personal involvement and see if their conclusion is reasonable. Being knocked down by a car, does not justify a ban on cars: iI may justify a lower speed limit, more education for pedestrians etc.

So, I screwed my back doing gymnastics? Well, actually yes and no. Here is the whole story.

1) over the last month, my focus has slipped. I found myself more and more in my slumping place, slumping. I have done no “good core” enhancing exercise. My hip and shoulder flexibility regimes have wobbled.

2) On wednesday I booked  myself quite a tough day: 3 hours driving ( I rarely drive) and 8 hours standing about ( i was an extra in film set)

3) On thursday, apart from one gymnastic training session ( 1 hour) i slopped around the flat. I slumped and hunched.

4) On thursday night, i had a terrible night: I got up late on Friday, and  after skipping breakfast I went to gymnastics. I did my normal 1 hour session 10  to 11), but as warm up and  planned to start my coached session straight after. I had felt my 1st back twinge at 10.50, but continued  after a quick rest.  At 11.10m, my  coached session began and at 11.20 a slightly wrong back flick, brought the pain flashing up. While I could still move. I stopped.

So here was the story. Id stopped all my recommended exercises and began slumping. In short, i wasn’t building up my back balance as Stuart McGill tells us to do, and I was “spending” back capacity like water. That said, I had still got through my basic “back buck spending” sport. and then, at the end of a terrible week, i thought i should push my luck by adding an extra hour.

I’m a pratt and  I deserve every scrap of pain!!