Isico will be at the forthcoming ISSLS Annual Meeting in Kyoto (June 3 to 7), a training event of the highest scientific and cultural level aimed at those dealing with spinal disorders. 

Founded in 1974, the International Society for the Study of the Lumbar Spine (ISSLS) is a non-profit organisation whose purpose is to bring together those individuals, throughout the world, who, by their contributions and activities both in the area of research and clinical study, have, or are developing, an interest in the lumbar spine in health and in disease.

With just 260 members worldwide, it is an exclusive society in which Isico is represented by Prof. Stefano Negrini as a member since 1997 and Dr Fabio Zaina since 2010. These two specialists will present different studies in Kyoto: Prof. Negrini will be giving an oral presentation (Identification through movement analysis of chronic low back pain pathological spinal movement patterns and their sensitivity to change during exercise treatment) and presenting a poster, and Dr Zaina will also be giving a poster presentation. In addition, both appear as co-authors of other posters being presented at the event.

Alessia Mancini, 17,  a patient at our centre since she was just 10 years old, has become the star  of a brief video recounting her exciting and remarkable journey. Although the video last only a few minutes, this is long enough to convey the  heartwarming story of this young patient, a dancer who loves nothing more than dancing en pointe!

Despite the uphill battle she faced, Alessia, her head full of dreams and fortunate enough to be able to draw on great strength of character, proved equal to the challenge. Now, through a collaboration with a young director, Riccardo, and a young director of photography and video operator, Sophia, a video has been made telling Alessia’s inspiring story.

“It all began years ago, when my parents noticed that my back, which had three scoliotic curves, the worst one measuring 40 degrees, was getting worse” Alessia begins. “We consulted Isico, where I was prescribed a brace, to be worn for 23 hours a day”.

For Alessia, who was already passionate about dancing, it was like being told to wear a suit of armour.  

“I love dancing” Alessia goes on, “and in fact I hope to dance professionally. In the end, I can say that I have been helped, in my pursuit of this ambition, both by my dancing and by my treatment, which came to an end a month ago, when I was finally told I could leave the brace off for good”.

For Alessia, living day in day out with her brace has been like living constantly in the company of both a friend and an unwelcome companion, an experience that she first recounted a few years ago when she entered, and won, the “Concorsetto”, a national competition organised  by Isico and open to our brace-wearing patients.

“I have always felt best able to express myself through art” Alessia tells us. “It was wonderful to be invited by Sophia and Riccardo to make this video about my story, and the important part that dance has played in it. Working with them was a fantastic experience. They are both wonderful artists who really managed to bring out my qualities, both as a dancer and as a person. In this way, they helped me to connect with the audience, and I hope I may serve as an example for the many others that find themselves in a similar position”.

The director. Riccardo, 22, from Naples. “I study directing and screenwriting at the national film academy in Bologna and I directed this video” Riccardo says. “I was struck by Alessia’s story and by what a strong person she is. Thanks to her outstanding qualities, it proved easy to create a story that conveyed, through music, dance and expressions, the many challenges this girl has overcome. All this has been a new experience for me, different and very stimulating”.

Riccardo’s meeting with Alessia came about thanks to Sophia, 23, a young mother and photographer: “I was fascinated  by the idea of  taking true stories, like Alessia’s, and bringing them to life through cinema. Late one Sunday night — it was midnight —, I called Alessia and Riccardo and told them that I had decided that, rather than doing the planned photoshoot, two days later we would instead be filming a video. I had realised that simple photos were not enough. I wanted to recreate Alessia’s seven-year experience through a full range of audiovisual stimuli.

Even though it was all a race against time, both Riccardo and Alessia did an absolutely wonderful job, giving it their very best” .

Thank you so much, Alessia, for sharing your story, and Riccardo and Sophia for making such a beautiful video!

What’s the best way of fastening a rigid brace (Cheneau or Sforzesco type) by yourself? Is it best to do it standing up, or lying down? And, most important, is it even possible?!

Let’s start by making one thing clear. When a person with scoliosis is standing up, their curve will be more marked than when they are lying down, because in the recumbent position the spine will be straighter as an effect of the absence of the compressive force of gravity.

And this is a good reason to fasten your brace lying down: it means your spine will be   blocked in a straighter position, and held in that position for all the time you keep the brace on .

If, on the other hand, you do up your brace standing up, then you will be blocking your spine in a less corrected position. 

Another good reason for doing up your brace lying down is that you will be able to position it better on your pelvis; basically, before fastening it, you will need to bend your legs, raise your pelvis slightly and slide your body down a bit: this will allow you to position the brace perfectly; furthermore, in this way, you will often find that you eliminate the minor discomfort you can get when your brace doesn’t sit perfectly at certain points of your body.
To begin with it can seem tricky doing up a brace lying down, but in actual fact, if you do it properly, it is the easiest way.

First of all, don’t look at what you’re doing!

This may sound like strange advice, but, if you think about it, in order to look at what your hands are doing you obviously have to raise your head, and this is probably why you are having trouble doing up your brace: after all, in this position, your abdominal muscles will be contracted, and this has the effect of increasing the volume of your tummy, making it impossible to close the fastenings; what’s more, the more you struggle, the more you will raise your head, making the task even more difficult for yourself!

So, it’s important to relax and try doing it the following way: 

Lie down, bend your legs, keeping your feet flat on the floor. Pressing down with your feet, slide your trunk downwards. Now straighten your legs. Remember, you don’t need to look at your hands, or at the straps, as you can easily feel these with your fingers without needing to raise your head. Start by closing the middle one, then, still feeling with your fingers, find and close the bottom one. Feel to see whether these first 2 already need to be tightened, and when you have checked that all 3 are tightly closed, without raising your head, close and secure the sternal fastening, using either the Velco or the screw provided. At this point, if you lift your head and raise yourself up you will find, like magic, that the brace is perfectly closed and that all the black markers are in the right place, confirming that the brace is correctly closed: perfect!

Why not try it? After all, if you can learn to do this by yourself, you can be freer to come and go as you please without needing to ask for help. Lying down really is the way to get the better of your scoliosis!

It’s a fact: full-time brace wearers who do sport are more likely to see their scoliosis improve compared with those who don’t do sport. This is the result of the study entitled “EFFECT OF SPORT ACTIVITY ADDED TO FULL-TIME BRACING IN 785 RISSER 0–2 ADOLESCENTS WITH HIGH DEGREE IDIOPATHIC SCOLIOSIS”,which will be presented at the forthcoming SOSORT meeting, taking place in San Francisco from 25 to 27 April.

Conducted in over 700 patients, the study, which is the only one of this kind in the literature, has been shortlisted, along with another Isico study, for the prestigious SOSORT Award. 

“Our study included 785 patients with a mean age of 12 years, presenting curves averaging 40°, who wore their brace for more than 20 hours a day” explains Alessandra Negrini physiotherapist at Isico , who conducted the research. “We assessed them through X-rays taken 6 and 18 months after they were prescribed bracing therapy and specific exercises for their scoliosis.” 

Exactly a year ago, Alessandra Negrini presented another study at SOSORT which focused on patients with milder curves (up to 25°), who did not wear a brace: “That research provided confirmation that sport reduces the chances of scoliosis worsening” Alessandra Negrini says. “Instead, in the present study, which involved a larger sample of patients with more severe curves, we calculated odds ratio (OR) values (i.e. the likelihood of improvement) in order to compare the results recorded by patients who did sport at least twice a week with those of patients who did not do any sport, or did sport just once a week. A curve reduction of more than 5 Cobb degrees was taken as an improvement”.  

“Thanks to this large sample, we were able to show, beyond doubt, that the impact of sport, albeit slight, is positive” Alessandra Negrini says, adding, “in other words, the improvement obtained by those who do sport compared with those who do not was small, but cannot be ascribed to chance. We can thus say that sport, while not constituting a therapy, does contribute to improvements recorded by patients who wear a rigid brace (the Sforzesco or Sibilla types)”. 

The study did not show any one sport to be superior to others in terms of having a positive impact: “We weren’t able to analyse the impact of volleyball as opposed to swimming or dance, for example, because youngsters make their own choices and often change sports,  or practise more than one sport at the same time, and at present we still know little about this aspect” says Alessandra Negrini. “What we plan to do soon, however, is evaluate what happens over time. Judging by the data collected to date, we can say that patients who wear a brace full time benefit from doing sport; in addition, at the 18-month follow-up, we found that the chances of improvement increased with increasing weekly frequency of sporting activity. On the basis of these results, which support recently published guidelines on scoliosis treatment (https://www.ncbi.nlm.nih.gov/pubmed/29435499), doctors can certainly recommend regular sporting activity in these patients”.

The Isico study “Adolescent agonistic tennis and spinal diseases, what’s the connection? Results from a cross-sectional study” contradicted the idea that asymmetrical sports are harmful: in the literature, tennis, like other asymmetrical sports, is considered a possible cause of back pain and, in the worst cases, a cause of worsening scoliosis.

“Tennis is played by many adolescents the world over” says Dr Fabio Zaina, an Isico physiatrist and author of the study, “and despite the lack of available relevant data, it has always been considered risky for individuals affected by scoliosis, and in any case a cause of back pain. We set out to verify whether spinal disorders really are more common in competitive tennis players compared with those who do not practice this sport”.

The study compared 100 competitive tennis players (50 girls) with 200 young students of the same age (12 years). The data collected showed no differences between the two groups. 

“Another study of ours has already shown that swimming, which has always been considered one of the best sports for those with back pain or scoliotic postures, can in fact induce back pain”  – Dr Zaina points out – “In that study, we therefore disproved a commonly held belief, just as we have done here. Another aspect worth taking into account is that nowadays players usually use very lightweight racquets, and there is also much more recourse to compensatory gymnastics. All this means that asymmetrical exertion is much less of a problem than it was in the past”.

So what is the ideal sport we should be getting our kids to practice?

“There is no such thing as an ideal sport”  – Dr Zaina tells us – “However, there are a few things we can say, namely: there are no prohibitions with regard to who can participate in asymmetrical sports; swimming is not a panacea for all ills; artistic and rhythmic gymnastics can encourage the progression of curves or give rise to back pain in those who are already predisposed to these problems; and, finally, neither soccer nor volleyball present particular problems. Obviously, we recommend that individuals with a family history of scoliosis have specialist check-ups, at least from the age of nine years onwards, and as a rule we suggest they avoid, if possible, those sports that can favour the progression of scoliotic curves.

Basically, we need to remember that the best thing is to get plenty of physical exercise, while bearing in mind that sports involving considerable mobilisation of the spine (artistic and rhythmic gymnastics and swimming, for example) will put us at greater risk, especially if there is a predisposition there, whereas weight-bearing sports will help us to strengthen the spine as they require us to overcome the force of gravity”.