SOSORT 2020: all Isico’s abstracts “pass the test”

Isico will once again be in the front line at the International SOSORT meeting, this year being held from 27th to 29th April in Melbourne, Australia, during Spine Week (27th April to 1st May, 2020).

“All the abstracts we presented have been accepted” reports Dr Sabrina Donzelli, Isico physiatrist and author of the research paper that is in the running for the SOSORT Award. “This is an extremely gratifying result, considering the number of abstracts submitted, and it underlines the fact that we remain firmly committed to research. We are also delighted and honoured to feature, once again in the list of the “top ten” studies presented”. 

In short, Isico has, once again, received full marks from the global spine rehabilitation community. Let us not forget that last year the Isico study entitled Effect of sport activity added to full-time bracing in 785 Risser 0-2 adolescents with high degree idiopathic scoliosis, which also featured among the top ten “nominations”, went on to win the SOSORT Award.

Here, then, are the studies that our specialists will be presenting this year in Melbourne: Is swimming helpful or harmful in adolescents with idiopathic scoliosis (Dr Alessandra Negrini, physiotherapist); The effect of dance performance on idiopathic scoliosis progression in adolescents (Dr Michele Romano, physiotherapist), ISYQOL, a Rasch-consistent tool for quality of life evaluation in scoliosis patients during adulthood: comparison with the gold standard (Dr Fabio Zaina, physiatrist).

Finally, Dr Sabrina Donzelli will be giving two lectures. The first one, which is entitled Is clinical measurement of the hump helpful for X-ray prescription and a good predictor of the curve? Results from ageometrical study from a large prospective cohort, was also given at the last SRS meeting, while the second is the one that has been shortlisted for the SOSORT Award: Final results of brace treatment of adolescents with idiopathic scoliosis prediction: 30 days out-of-brace is better than in-brace X-ray.

Dr Donzelli at Oxford University

Dr Sabrina Donzelli, an Isico physician, participated some weeks ago in a joint programme in collaboration with the Centre for Evidence-Based Medicine in Oxford, together with other 15 students coming from Egypt, Brasil, Ireland, UK, USA, Ghana, Canada, Hong Kong, Malaysia, Lebano and Italia.

The topic of this demanding course was basic and advanced statistical methods for meta-analysis for health professionals designed to provide an overview of different meta-analysis methods and common problems encountered with extracting data. The module is part of the MSc degree in Medical Statistic provided by the department in  Evidence Based Health Care at Oxford University, Dr. Donzelli was admitted to the program in the Academic year 2019. 

Dr Donzelli is currently a teaching assistant for the online program in Principle and Practice in Clinical Research provided by the Harvard University gathering every year more than 400 students from all around the world.

Isis Navarro at Isico headquarter

Could you tell us about your studies?

I am a PhD Student at Universidade Federal do Rio Grande do Sul. Since 2017, after I completed the SEAS course, I started to have only patients with scoliosis and work just with these patients. In my master’s degree I studied the surface topography as a possibility of easy and three-dimensional tool to evaluate scoliotic patients. I had some publications based on this primary subject.

And I have also some articles accepted for publication:

NAVARRO, ISIS J.R.L.; CANDOTTI, CLÁUDIA T. ; FURLANETTO, TÁSSIA S. ; DUTRA, V. H. ; AMARAL, M. A. ; LOSS, JEFFERSON F. . Validation of a mathematical procedure for the cobb angle assessment based on photogrammetry. Journal of Chiropractic Medicine (Print), 2019.

NAVARRO, I. J. R. L.; CANDOTTI, CLÁUDIA T. ; AMARAL, M. A. ; DUTRA, V. H. ; Gelain, G. ; LOSS, JEFFERSON F. . Validation of the measurement of the angle of trunk rotation in photogrammetry. JOURNAL OF MANIPULATIVE AND PHYSIOLOGICAL THERAPEUTICS, 2019.

What is your profession?

I am a physiotherapist.

Why did you register for the SEAS  course?

I was looking for the SEAS course, and my plan was to travel to Italy to attend the course, but fortunately Michele and Alessandra came to Brazil to teach for the first group in Brazil. I discovered the SEAS approach doing lots of researches on internet, searching for consistent methods of treatment to scoliotic patients to offer to them the best possibility of treatment and results.

What makes the SEAS learning course different from other educational courses and programs?

The more significant advantage of the SEAS course is the clarity of the reasoning behind the technic and the facility to apply what you learned. The SEAS approach allows doing physiotherapy with all type of scoliotic patients, independent of the type or classification of the curve. The teachers were always ready to answer all the questions and help with difficult cases I asked separately.

Are you satisfied with what you have learned? 

Yes. But when you start to practice more and more always news doubts arise. 

If you were asked to recommend the course, what would you say?

The SEAS course is an excellent way to understand the world of scoliosis, its characteristics and the reasoning to treat adequately and accurately. After the course, you will be able to evaluate and treat scoliotic patients based on a method easy to understand and to apply with a high level of scientific evidence.

Michele Romano, professor for a day at the University of Québec

A few weeks ago, Michele Romano, Director of physical therapy at Isico, gave a workshop at the prestigious University of Quebec in Trois-Rivières, Canada.
The lesson was devoted to SEAS (the Scientific Exercises-based Approach to Scoliosis) and took place during a conference organised by the University as part of its annual scoliosis month (this year being held for the ninth time).

“It was a wonderful opportunity” remarked Dr Romano. “The invitation coincided with my recent stay in Quebec, where I was leading a course devoted to our scientific exercises-based approach. The workshop was attended by 60 or more students in the last year of a chiropractic degree course. They gave me a really warm welcome and participated very actively, especially in the practical part of the lesson, asking me numerous questions. They were extremely enthusiastic, to the point of inviting me back next year, perhaps to lead an entire course tailored to their particular training needs”.

Scoliosis in musicians and dancers

Two artistic activities in some ways at the antipodes, maximum mobility on one side maximum immobility on the other, which however have some aspect in common: age of initiation, commitment and sacrifice. And the risk of joint degeneration …!
If we think about the potentially harmful effects or risk factors for pathologies affecting the musculoskeletal system, music and dance are however at the antipodes: music, with its rehearsal sessions, obliges musicians to maintain the same position for long periods positions are often asymmetrical and overload some joints more than others.
Dance, with its dynamism and constant search for hypermobility and spectacular gesture, as extreme, stimulates the joints more dynamically.
The risk of joint degeneration exists, albeit for different reasons for both of these art forms.
The main pathogenetic mechanism that is the mechanism that leads to degeneration and joint pain can be traced back to the intensity of the workloads to which your body is subjected. Often, due to a spirit of sacrifice, the ailments are underestimated or in any case overlooked, because they are considered as a normal consequence of the long sessions of tests or training. Often young artists neglect or even hide their ailments, for fear of having to abandon the activity, or for a competitive question, namely “if I can’t do it, someone else will take my place”. If medical checks are more frequent in dance, there are no fitness visits or periodic checks for musicians.
The study “Scoliosis in musicians and dancers” (H.A. Bird, Sofia Ornellas Pinto) was recently published, in which the authors described and compared three clinical cases: two musicians and a dancer of different ages and with different problems. More than scoliosis alone, the problems that emerged in these three clinical cases concern the locomotor system in a more general view.
The most peculiar case is that of a young cellist, with a passion for both dance and music.
This girl showed marked hypermobility that had favoured success in dance, but due to the onset of adolescent scoliosis, she was advised against continuing with the practice of dance and consequently the girl began to devote herself exclusively to music. However, this activity also exposed the patient to a progressive worsening of the symptoms affecting the musculoskeletal system.

With this case, the authors highlight how harmful the prohibition of the practice can be and even make it worse.
In practice, the young cellist had gone from hypermobility to hyper-immobility, but we know how harmful extremisms can be in both cases.
“In case of pathology affecting the spine or other joints – explains Dr. Sabrina Donzelli, physiatrist from Isico – the first thing is to set up a specific adequate treatment, and above all not to interrupt the activities but rather to integrate and compensate them. There is no denying that sometimes it may be necessary to reduce loads or rehearsal sessions a bit, but these are preventive and temporary choices that offer the conditions necessary for a long artistic career. The risk, in fact, is, that if we neglect, we then arrive at the need to abandon the activity due to the total disability acquired “.

It must be remembered that for some, pubertal growth can be a moment of great fragility, everyone has their own weaknesses: “The best manner is the one which provides personalized training programs – concludes dr. Donzelli – we must teach youngsters to listen to the signals of their bodies and work to compensate for their Achilles’ heel, only in this way those with talent will be able to have a long career full of successes but also of health “.

開課 倒數 , 正式 開始!

Our online World Master has started for a few weeks but has already registered several reasons for satisfaction. Never as for this fifth edition are there participants from all over the world, very different and distant countries.
A magnificent melting-pot of experiences coming from over 40 participants. And so far the participation has been very enthusiastic.

In 2020 the Master has doubled.
On January 23, the first Chinese edition officially started for about twenty participants, organised in collaboration with the Hong Kong Foundation HKCCF.
These are the first words of the official announcement: 開課 倒數 , 正式 開始, or countdown to the first lesson!
A remarkable commitment on our part supported by the local organisation, which could prove to be the starting shot and be replicated in the future for editions in other languages!

Friends and bracing

Adolescence and bracing are two challenges that can be difficult to face simultaneously. And, in our view, this is perfectly natural and understandable.
Adolescence is usually perceived as a difficult phase during which young people are still immature, tend to be irrational, and struggle to control their emotions. However, research studies focusing on the development of the adolescent brain have recently debunked these myths, allowing adolescence to be understood, from a more modern perspective, as a life stage characterised by numerous possibilities, great creativity, and a desire to experiment.

However, it is also a time of great changes, and it is these that make this a period in which youngsters are particularly vulnerable. Their increasing need for freedom and independence sees them looking outside their immediate family; accordingly, friends assume a more and more central role, becoming the basis and starting point for building their self-awareness and personal identity.

At this age, then, finding yourself faced with the prospect of wearing a rigid brace for up to 23 hours a day certainly isn’t easy.

A young person who has just been prescribed a brace can experience many different emotions, which vary from individual to individual: some will feel angry, others sad; some may be fearful or feel ashamed.

Shame is an emotion that stems from the fear that others will judge us.

What are my friends going to say when they see me in a brace? What will they think if they find out I have scoliosis? 

In adolescence, precisely because this is a time when we are still working out who we are, we can be particularly sensitive to the opinions of others; we want to fit in, and we fear rejection. 

For these reasons, having to wear a brace can be seen as an obstacle to the formation of friendships and early romantic attachments. It becomes a secret to be kept strictly within the family.
Some youngsters try to keep their brace hidden under their clothes and avoid physical contact with others, to the point of avoiding those activities in which their brace would have to be exposed, and thus depriving themselves of a whole series of experiences. In this way, they become victims of their own secret.

Hiding a brace takes some doing. Is it really the best thing to do?

Even though hiding is a natural and automatic response when we feel ashamed, it is also the most harmful. Instead, the least natural and least automatic (i.e. “coming clean” and showing yourself) is the most beneficial! When you find out that you have to wear a brace, the best thing to do is to tell your friends and classmates about it immediately. Although this might seem difficult, it is far easier than trying to keep the fact a secret. Start by telling your closest friends, and then gradually share the news with everyone else.

You really have nothing at all to be ashamed of. Quite the opposite: you should be proud of what you are doing to have a healthy back!

Living “In self-correction”. Is it possible?

First of all, what is self-correction?

Kids who have scoliosis and perform SEAS exercises regularly know well what it is.
Scoliosis modifies the physiological position of the column and causes a deformity in the three planes of space.

Seen from behind, there is that curve that is easily recognizable in radiographies: the spine, instead of being straight, bends to the side.

Seen in profile, the curves that are normally present (lumbar lordosis, dorsal kyphosis, cervical lordosis) and which guarantee elasticity and the ability to absorb the recoils, are modified, often diminishing: those who have scoliosis usually seem more straight than the other kids. Finally, seen from above, the column rotates on itself, making the so-called “hump” come out, which is nothing but a part of the ribs or back muscles that move backwards to the side. Practically back, while bending sideways, twists. All these changes result in a loss of height.

Self-correction is a correction of all these anomalies. The goal is to take back the spine where it should be if there was no scoliosis, in a physiological position.

Self-correction allows the patient to achieve greater symmetry and a more well-balanced back in the sagittal plane. 
Acquiring the technique from the outset and applying it as often as possible in daily life should be the goal. 

The movements that make up the self-correction have strange names: translation… derotation… kyphotisation… antigravity support…

At the beginning, performing them is as difficult as pronouncing them. Still, starting with a good awareness of your body and your deformity in space, you gradually become confident, and kids manage to “unroll” their column by straightening it in a few tenths of a second.

It is the self-correction that makes every single scoliosis-specific exercise effective, because without it every exercise would be devoid of the therapeutic purpose, thus becoming a simple sport exercise.

The difficult thing for physiotherapists is not so much choosing the most suitable exercises, but the best self-correction for that particular kid in that moment of his growth and his therapy. Unfortunately, a poorly chosen, poorly adapted, poorly performed self-correction, could even make the exercises harmful.

As soon as kids learn how to perform their self-correction in the exercises, the therapist begins to ask them something that seems difficult to achieve: maintaining this correction in everyday life.

The first step is to do it here and there during the day: it is suggested to remember it for example at the sound of the bell at school, in the elevator, walking… Slowly, one is simply asked never to relax completely, until he accomplishes to live in self-correction.

But… is it possible?

Many kids confirm that it is possible, so much so that towards the end of the therapy many say: “Relaxing on the side of the curve annoys me, I don’t feel right on that side…”.

At this point, the most important goal of the therapy has been achieved, and the back of these kids will remain stable, without the risk of starting to bend again during adulthood.

Sweet dreams… even if braced: a new Isico study affirms it

Maintaining a normal sleep-wake rhythm is an important factor when facing brace-therapy because it can affect the treatment itself and improve it.
A factor on which investigated the study of Isico “Actigraphy-based Sleep Parameters and Rest-activity Circadian Rhythm in a Young Scoliotic Patient Treated with Rigid Bracing: A Case Study”, recently published by Yale J Biol Med. 

“Patients treated with a brace, especially in the early stage of the treatment, often report both physical discomfort (pain, excoriations, difficulties in breathing) and psychological issues (depressed mood, social isolation) that can both affect sleep – explains dr. Francesco Negrini, a physician at Isico – We studied actigraphy-based sleep behaviour in a 14-year-old male patient affected by severe idiopathic scoliosis and treated with a rigid brace (Sforzesco brace) 23 hours per day. Rest-activity Circadian Rhythm (RAR) and sleep parameters were studied through actigraphy for seven consecutive days in July 2018. Sleep parameters were also objectively monitored for seven consecutive nights with an actigraph”.

The Actiwatch 2 is a widely used actigraph worn on the non-dominant wrist that has the capability to determine both RARs but also sleep parameters. 
Among the data collected through the Thermobrace sensor, it was found a very good compliance to treatment in the period analyzed, with an objectively reported compliance of 22.8 hours per day.

Adhesion, therefore, to the treatment, good tolerance of the brace during sleep and full activity and movement during the day. These are the data confirming that the patient was not affected in the sleep-wake rhythm by particular difficulties due to the wearing of the brace.

“The correct expression of circadian rhythmicity, together with good sleep behavior, are key factors for the body homeostasis – ends dr. Francesco Negrini – RAR’s characteristics, sleep quantity, and quality were all comparable to the normative age-matched data reported in the scientific literature. Conservative treatment for scoliosis could be a suitable clinical choice to avoid sleep complaints and sleep-related issues”.

The pubertal growth spurt: why is it the main risk for scoliosis?

Scoliosis is known to be a condition that evolves with growth, the latter being a process that starts on the day we are born and ends when we achieve complete bone maturation (that is to say, at between 16 and 18 years of age, depending on our sex as well as various other subjective factors).
Over this long period of time, however, there are some phases in which the rate of growth speeds up, and these are the times when scoliosis is most at risk of worsening.

One of these phases is the “pubertal growth spurt”, a period of marked and rapid physical transformation that starts with the onset of puberty.

In females, the pubertal growth spurt usually starts at the age of around 11-12 years, as opposed to 13-14 years in males.

In this phase, their growth surges, even to the point of becoming twice as fast as before: whereas youngsters grow at a rate of 5-6 cm each year prior to puberty, during the pubertal growth spurt, they can grow by as much as 10-12 cm per year.

The main difference between these two phases is that prepubertal growth mainly involves the lower limbs, whereas in puberty the extra centimetres gained in height are almost entirely attributable to trunk growth. Therefore, in individuals who already have trunk asymmetries or mild curves, this period demands the utmost vigilance, as the situation can worsen very rapidly.

It is worth pointing out that we are talking about young adolescents, who look after their own personal hygiene and will often tend to close the bathroom or bedroom door when they are showering or getting dressed.
This means that parents, however attentive, may only get the chance to really observe their kids’ backs in the summer months, when they are at the sea or swimming pool.
This explains why, in many cases, changes aren’t spotted until months after they have occurred and the scoliosis has already got worse.

The pubertal growth spurt is thus the most dangerous period of growth for those affected by adolescent scoliosis; in early-onset forms (infantile and juvenile scoliosis) it is also necessary to be highly vigilant in the periods 0-3 and 7-8 years, respectively, as these, too, are periods of rapid growth.

In any case, our advice is always to have a paediatrician or family doctor check a child’s back before the start of these rapid growth phases, in order to allow, if necessary, a timely referral to a spine specialist.
If there is already a family history of scoliosis it is recommended to have the youngster checked directly by a spine specialist every 3-4 months.