Scoliosis… and the French

Chatting to a Czech woman about sore throats a while back, she told me that in the Czech Republic they standardly take a swab of your throat to see what infection you have so they know what anti-biotic, if any, can be used. In the UK, they just give you a general anti-biotic on a suck it and see basis.

A Hungarian woman many years ago old me that in Hungary that doctors take some blood fresh oxygenated from your arteries and put it in your veins and it clears up acne and lots of other issues.

Doctors in non-English speaking countries do things differently… sometimes better and it can be quite a blind spot in English speaking medicine. “it’s not in the literature” they say… well it’s not in the English Literature.

I want to look a little in this blog at what we might be missing in Scoliosis from the French side of things.

In this video: “No Matter the Etiology, Scoliosis is always a deformity in the Horizontal Plane”, done by the French Doctor Jean Dubousset MD: https://www.youtube.com/watch?v=wT5NZfyIpbY he talks about the importance of the “Horizonal Plane” (also known as the transverse plane or the axial plane)   https://pubmed.ncbi.nlm.nih.gov/30665877/ – what this is, is basically just “looking from the top”.

(For reference, the Sagittal (longitudinal) plane is looking from the side and the Coronal plane (frontal) plane is looking from the back or the front).

The way they “look from the top” is to use an advanced X-ray machine – the EOS – and get it to build a 3D-model from which they “look from the top”. 19:54 (19 Mins 54 Seconds) is a good example of the view he is referring to. My thinking is that you can get a very close – in some ways a better version – to this by using palpation: Put some oil/lubricant on the patients back and palpate the spine to feel the twists & dips of the vertebrae that should not be there – it is this view that the ASMI therapist works with: vertebrae-pair by vertebrae-pair the full length of the spine.

Early on in the video 3:12 he shows the Scoliosis model produced by Lewis Sayer back in 1877 using the Horizonal plane as the driver: “When he was pushing in the brass rod it create the scoliosis, and when he pulled, the scoliosis disappeared !”

Dubousset rightly laments the modern fixation with X-rays:  merely a projection, a shadow a 2 dimension shadow of a very 3 dimensional issue and the “addiction” orthos have to the Cobb angle. This is similar to my approach: To explain scoliosis to patients I use a piece of kitchen roll, roll it into a column, over-twist it so it buckles and show a shadow of that against a wall like finger shadow puppet – the shadow looks like scoliosis. The reality is Scoliosis is a 3D twist, it’s 2D shadow just looks like a curve.

At 4:00 he introduces his “Scoliosis Formula”: Compression (in the horizonal plane) with inter-vertebral rotation = Scoliosis

The ASMI, as well as doing lots of inter-vertebral de-rotation – detorsion, to get the vertebrae back in line, also, while it does that, it reduces the compression – lots of patients walk out taller than they walked in.

At 4:55 he introduces his techniques: a distraction brace to elongate the spine and a bipolar internal distraction rod – a surgically inserted rod that has a self-ratcheting mechanism that elongates the spine over time driven by the movement of the patient. His results 5:48 are very impressive.

The compression, he thinks is even at a cellular level, as an ASMI therapist seeing and feeling this deep tightness release, I’d tend to agree.

One of the parts of the video that made me like this doc is at 7:12 he talks about CT scans and how the level of radiation for a child or adolescent is unacceptable. So far, in the world of scoliosis, I see that Chiros and Ortho’s take X-rays and CT scans like teenagers take selfies – it’s a refreshing and welcome change to see an Ortho concerned about radiation risk.

At 10:42 Dubousset tells how, back in 1980 in Chicago at the annual SRS meeting (Scoliosis Research Society – better named as Scoliosis Surgery Society) “Nobody understood ! nobody understood” as he tried to explain to the horizontal plane… hardly a surprise sadly !

At 14:10 he introduces his scoliosis brace that works to detorsion the vertebrae – the Gerald Dauny brace – that I have not seen before. It’s a carbon fibre based brace that provides torque (rotational pressure) to the spine while the user is breathing.

At 23:44 he shows something really interesting: 2 Scoliosis curves that are both 10 degrees. He shows them from above, one looks even and balanced, the other is higgledy-piggledy.

“The first one will not progress and get worse, the 2nd one will” he declares.

You can spot these super important (but ignored by all but ASMI therapists & Dubousset) “higgledy-piggledy” vertebrae by the palpation technique I explained above. The ASMI can de-higgledy-piggledy the vertebrae and so prevent progression… as well as reduce the 10 degree curve.

At 24:58 in his soft tissue talk he is basically talking a similar language to the ASMI’s best friend… Rolfing: 26:02… “from the foot to the head” – pure Rolfing talk. “poorly documented, ignored by the surgeons…” … but very much part of the scoliosis equation.

At 35:14 he says something quite profound : ”It is not the reduction of the Cobb angle that is the major Gold Standard, no no, it is the harmony and balance in the space” – I myself used to have severe scoliosis and my life was a mess. I had constant discomfort in my body. Rolfing was the first thing that allowed me to have an “in-body experience”, such was my dis-jointed feeling. The ASMI treatment turbo charged that. I still have a residual curve – I barely notice – It used to dominate my life. I now have harmony… and I like it. Here is an ASMI treated Scoliosis patient talking about this sort of thing and how it has effected her life: https://youtu.be/WW5RCDxM9fM

By 33:04 he has just talked about the importance of living in your body, being balanced and able to do things and asks the question: Has your scoliosis treatment improved this ? To gauge it he has some simple functional tests – walking up some stairs, walking while talking on a phone. I quite like this. I’ve had ASMI patients who walked up the stairs before the first ASMI treatment holding the banister tightly and using an infant’s style two feet on one step technique. A few sessions later they run up the stairs, even skipping over some steps. I show dramatic before and after pictures of the back with obviously huge curve improvements and explain these other highly significant functional life improvements to a standard ortho and it is rejected out of hand: “unless you give that patient cancer with unnecessary X-rays I am not interested , I am addicted to the Cobb angle which I call the gold standard, (but is better named the radium standard) . If you do show me X-rays… I’ll come up with another excuse to protect my income from doing unnecessary  operations” . So once again, it is refreshing and welcome to see an ortho not even just note these things, but rate them very highly.

2nd French video: https://www.youtube.com/watch?v=3gW4pa4U63g Dr Derek Lee has a son who has scoliosis (VBT Surgery) and this got him interested in looking into scoliosis and doing a series of interviews with Scoliosis Surgeons. Like other docs, he ignores the ASMI and deletes comments about the ASMI, but apart from that, some interesting things come out of his interviews.

In this one he talks to the French Doctor Dr. Jean-Claude de Mauroy, MD, who uses the Lyon Method.

At 31:40 Dr. Jean-Claude talks about the Schroth method being invented 100 after the Lyon method. He says something I also say: The famous Big Yellow book of Schroth has some amazing before and after photos (as good as the ASMI’s before and after pictures today) … but all the best Schroth before and after pics are the old ones in black & white – this is because a lot of the Scoliosis back then was caused by Polio – which weakens the muscles… and this responds well to physiotherapy. The results patients get today from Schroth are nowhere as impressive.

What is a bit amusing is that though the Lyon Method is not based around the horizontal plane thinking at all, both doctors though, when talking about the French historical antecedents of their approaches… use the same picture ! “look my technique goes back centuries !”

It is an open question: What else is going on in Finland, Hungary… non-English speaking countries that may be really good that we don’t know about in the English speaking medical world ?

New videos by Dubousset:

https://www.youtube.com/watch?v=yLhnWKeo-Y8

https://www.youtube.com/watch?v=lKwbcyHVlWg