開課 倒數 , 正式 開始!

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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

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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?

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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

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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?

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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.

The criteria for evaluation of aesthetics in scoliosis

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Our study “Construct validity of the Trunk Aesthetic Clinical Evaluation (TRACE) in young people with idiopathic scoliosis” has recently been published by the journal Annals of Physical and Rehabilitation Medicine.

The aim of this study? Scientifically validate the criteria of evaluation of aesthetics in scoliosis.

Indeed, we recall that aesthetics is recognized as a main outcome in idiopathic scoliosis (IS) treatment, but to date, there are no standard criteria for physicians’ evaluation.

Trunk Aesthetic Clinical Evaluation (TRACE) is a simple 12-point ordinal scale to quantify symmetry as a proxy of aesthetics. TRACE is already diffused worldwide and has been used in clinical research.

” In our study, that included 1553 participants (1334 females, mean age 13 years old), we aimed to validate TRACE and improve it with Rasch analysis – explains prof. Stefano Negrini, Scientific Director of Isico – the statistical technique allows to make more precise measurements.
Let’s take the temperature measurement as an example: is it hot, warm, medium, or a little cold? With this type of analysis we develop a real thermometer, obtaining a numerical data. The same criterion is applied to the measurement of the aesthetics, reliably and effectively, as well as objective because it derives from external observation and not simply from what the patient reports “.


The TRACE ordinal scale has been converted into a Rasch-consistent, interval-level measure of trunk aesthetics in IS patients and can be used to compare different populations.

“TRACE can be used as an outcome measure and in everyday clinical evaluation of IS, even if new developments of the scale are advised – ends prof. Negrini – It is an objective tool, the only one up to now in the literature. The benchmark for the aesthetics in scoliosis which we want to improve more and more with use”

World Master 2020: let’s go!

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On January 16 the World Master Online officially opened, now in its fifth edition. Participants come from all over the world with the entry of countries like Colombia, Armenia, Norway, Egypt and Mongolia for the first time.
It is the only online International Master that offers the possibility of training on the Rehabilitation Treatment of Scoliosis.
Over the years there have been over 200 participants, coming from 50 countries for 5 continents.
The Online course does not stop growing, so much so that one of the ideas in the pipeline is to expand the editions, starting to work alongside the English one in Chinese, as we have been asked several times.
What do they say about the Master? “I recommend the experts interested in Scoliosis conservative treatment join this course“. And also “The content is extensive, up to date and evidenced-based. This course gives clinicians a profound understanding of scoliosis and non-surgical management”.

For more info please visit the website: www.scoliosismaster.org

Scoliosis and pregnancy: it’s possible!

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The Isico blog www.scoliosi.org is a dedicated space where patients can ask questions and swap experiences, but it is also a place where those involved in treating scoliosis can take a more in-depth look at a series of topics and also engage with patients.

Here is one of our published posts

“I have scoliosis, can I have children?” This is a question we are often asked. And we have no hesitation in answering: “Yes, becoming a mother is a great joy that should be experienced without anxiety, even if you have scoliosis”.

It is, in fact, absolutely untrue that if you have scoliosis you can’t have children. A woman with scoliosis can have children. She should simply consult a spine specialist for advice and monitoring of her curve. 

Moreover, just like any other woman, she can, on the basis of specialist advice from a gynaecologist/obstetrician, opt for a natural delivery or a C-section. 

During pregnancy the body produces a hormone, called relaxin, which serves to “soften” the back and the pelvis, allowing the physiological changes that are necessary for giving birth.

During pregnancy itself, there will be no particular problems, as the expanding uterus supports the column and helps to stabilise it. 

After childbirth, however, the back remains very mobile for a few months, and this is the period in which there is an increased risk of a worsening of the curve, not least because the child, no longer supporting his mother’s back from within, will often be in her arms, placing an added strain on her back.
If the scoliosis is severe, it is a good idea to “plan ahead” and take some preventive measures: by working out an appropriate exercise plan before pregnancy, and continuing to do the exercises right up to the birth, it is possible to prepare effectively for the critical postnatal period when, moreover, the mother will probably have less time for doing exercises!

As for the birth itself, epidural anaesthesia may be well possible.
It depends mainly on whether the woman has had spinal fusion surgery, and, if so, on which part of the spine: if the surgery was performed at the level of the dorsal spine and the lumbar spine is free, then there will be no problem. 
If, instead, the lumbarlevel was also involved in the surgery, the anaesthesiologist will establish which was the last vertebra involved and, on this basis, decide whether or not an epidural is possible.

A Christmas Carol from Isico

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Our very best wishes for Christmas and 2020: a whole new year for each of us to “shape” as we like! 

Our greetings come to you with a story.
More than just a trip down memory lane (to the bike rides and dripping lollipops of our youth), “Liquorice Wheels” is a story of hope: a reminder that things work out for the best, most of the time!

Thanks to Roberto Angero, father  of a young Isico patient, who shared with us “his” story and we want to share this story with you as our Christmas Carol for this year.

Liquorice Wheels

Every kid in town would stop to watch him, especially when he reared up for more than a dozen consecutive pedal turns. He could do that – we counted them! He would lift his BMX like a tamed horse and then, balancing on the back wheel, would twist the handlebars, first right and then left. He could steer while rearing, too, and even jump up onto the pavement.

In the afternoon, after homework, we would wait for him on the playing field. He was always the last to appear, and you couldn’t leave without him. Simone was the one with the best bike — the best not because it was new, but because it had belonged to his cousin, who had been in a gang war.

That’s what he used to tell us at least. Simone showed us all the scratches the bike had acquired during various raids, but the thing that amazed us was that sticker on the crossbar with “Iron Maiden” written on it. Simone told us that only gang leaders had that sticker. I believed it because I once saw one on my brother’s friend’s Vespa. Surely, he must have been a gang leader, too, because everyone else just had a Garrelli scooter, and no sticker! Once everybody had arrived at the playing field, we could leave, with Simone in the lead. Elisa, who had a Graziella (ladies’ bicycle), was the prettiest in the group, but she would only ever talk with Simone, and sometimes with Sandrino, too. Filippo, instead, rode a red Saltafoss (mountain bike) with a gearbox, and I remember that he used to make us laugh a lot because he could imitate all our teachers. 

Then there was Tommy, who always brought the ball, which he kept in a plastic bag hanging from his handlebars. Jessica, meanwhile, used her mother’s bike, which had a basket, and she could barely reach the pedals. I remember she wasn’t as pretty as Elisa, and she also wore a strange body brace because she said she had a crooked back, but she always had a great supply of sweets. Sandrino was always the one with a new bike — he used to say that his father was rich —, but he never let anyone have a go. On just one occasion he let Elisa have a ride in exchange for a kiss on the cheek, but that was the one and only time. He was very possessive with his belongings.

The group also included Carlo and Marco, the “little twins”, who were inseparable. They had identical bikes, and they both rode one-handed because the other hand was always holding a lollipop, which dripped to the elbow. Actually, they weren’t twins at all. They had been friends since kindergarten, but they did look very similar, maybe because of all the time they spent together! Then there was me. With my gold coloured bike. Always bringing up the rear. 

Simone usually led the group, and we all fell in behind him, including me, of course. We moved in single file, except for Carlo and Marco, who rode side by side. Whenever Simone decided to go faster, we all had to speed up, but we made sure we never overtook him. We used to go round town that way. Our town, Somma, seemed very little at the time, and we felt like the whole place belonged to us.

There was a group of younger kids that we often encountered, and when we did Simone would rear up, leaving them astonished. On the other hand, we were always careful to avoid the older groups. We were scared of them, although Simone always said that they would never stick around if his cousin were with us! Our bike ride usually ended up at Paradise Street, which was legendary! It was a hilly road that made for a thrilling ride. We would all stop at the top of the first hump. We kept in line, except for Marco and Carlo, and no one ever went before Simone did. The second to go was always Filippo, who would imitate our maths teacher as he careered headlong down the hill, leaving us doubled up with laughter. Brilliant!

Gradually, all the others followed suit, racing down like there was no tomorrow. Jessica and I, on the other hand, almost never took part because we were afraid of falling off. Well, I was afraid of falling off. Jessica didn’t want to ruin her mother’s bike, or so she said! So, we would wait for the others, eating sweets together. After Paradise Street, we would make our way to the playing field. Tommy would get the ball out, while Simone and Filippo formed the teams. These were never even, of course. I always ended up with Marco, Carlo and Jessica. They weren’t much good at football and, what’s more, they always put me in goal. The other team always scored loads of goals, and at the end of the match Simone would tell me I had been lucky because, if his cousin had been there, they would have scored many more. And I let myself believe it.

In those days, evening always came far too fast. You started to hear someone’s mum calling in the distance, usually Sandrino’s, and we knew it was time to call it a day. 

Simone was always the first to go home, quickly followed by Elisa. Tommy would put the football back in its bag, while Filippo would do one of his famous imitations, such as our religious education teacher in a temper, screaming at everyone in a falsetto voice.

Those were the last laughs of the evening. I had to go home, too. I usually said goodbye to Jessica first who, in exchange, gave me a liquorice wheel, while the twins went off together as usual, happily challenging each other to an armpit raspberry contest!

Today, 30 years later, sitting on a bench near those places (now gone) where we used to play, I am lost in thought. The memories of the past blend with thoughts of the present. I find myself remembering how I was always the last one and Simone the cool one.

No one would think that seeing him today: once the blond “golden guy”, now he is overweight, grizzled and balding. He doesn’t have a secure job, and is constantly looking for some “cousin” to liven up his dull life. I also thought about everyone else. For example, about Marco and Carlo, who, years later, still seek each other out just like they did as small children: a brotherly bond that will last forever. I think about Elisa, who used to run after a thousand cool guys like Simone, in the futile hope of finding her Prince Charming among them. Today, she’s still as beautiful as ever; after three divorces, she has now moved on to yet another flashy entrepreneur. Tommy hasn’t changed either: he’s just as “public-spirited” as he always was. Back then he was the one who always thought to bring a ball, now he’s the one likes to get a round of beers in for everyone, especially if Filippo is there. Filippo still loves to entertain everyone, and the more beer he drinks, the more he shoots his mouth off, cracking us all up! Unfortunately, we’ve seen little of Sandrino since his dad’s company went bankrupt, and he had to start learning to get by on his own. By all accounts, he’s not doing too well: he drives a dilapidated van now and has maybe even moved away.

And so that just leaves me. I used to feel like I was at the back of the queue in life, but now I have come to realise I am the luckiest of the bunch. I still have my old friends, but mainly I have Jessica, my lovely wife — now with a perfectly straight back —, who has been by my side all these years, making sure I’m never short of love and affection, or sweets! There’s no point hiding the fact: I’ve always been mad about her!


— 

MARTA, BRACE AND MEDALS

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Marta Pagnini is a former Italian gymnast, captain of the Italian National Rhythmic Gymnastics Team, a Knight of the Order of Merit of the Italian Republic and a member of the Air Force Military Corps and … she has scoliosis!

Discovered when she was thirteen years old initially treated with only exercises, she had to surrender to the corset when she was already 18 and was risking sporting qualification to the competitive activity. Given the late development due to gymnastics and her growth not yet completed, the brace was still an option.
After the inevitable initial moments of fatigue, pain and despair, within a few months, she got used to it and understood that the brace was her ally. She had hoped she wouldn’t have to wear it, but once accepted, everything went downhill. Marta was lucky to have a coach who understood and tried to understand; thus, she was able to express herself to the fullest, feeling at ease despite scoliosis.
Marta has won countless medals, and it was sports activity that was also in the sleeve against the disease: it helped her to keep the physical fitness, elasticity and muscle tone, doing a lot of good to her back.

Martha is living proof of what has been demonstrated recently by an ISICO study, Winner of the SOSORT Award 2019, on over 700 patients according to which those who wear a full-time brace and practice sport are more likely to improve than those who are sedentary. (Effect of sport activity added to full-time bracing in 785 Risser 0-2 adolescents with high degree idiopathic scoliosis).

«Playing sports several times a week, even at a competitive level, has positive effects for those who wear a rigid brace and it makes no sense to forbid it to those who have scoliosis “, underlines Alessandra Negrini, physiotherapist in Isico, who has conducted the research. «Sport is not a therapy so that in the presence of a pathology of the spine it is essential to associate it with a specific treatment. Without any doubt, it has a positive impact: once a week it is irrelevant, from two upwards, the positive effect is much more marked. Not quitting is fundamental, also because competitive spirit is a deep passion and can make therapies easier to accept.»

Marta has recently become patient in our Milan headquarter, where she follows our specific exercise approach to scoliosis with SEAS exercises.