Side Shift and Hitch Exercises - Maruyama et al.

Side Shift and Hitch Exercises - Maruyama et al.

Study consisted of two groups of patients - 1) younger patients (average age 12.8 years) with part-time bracing supplemented with side-shift exercise and 2) older patients (average age 16.3) who used side-shift exercise after skeletal maturity.

Both groups were compared to the average rate of progression expected for such patients. In the first group, 28% of the curves progressed compared to 48% expected. In the second group, patients showed a decrease of 1 degree a year compared to an expected increase of .25 degrees a year.

Evaluating Medical Research

Evaluating Medical Research

Medical research varies in quality. Some studies are well thought-out and interpreted, and some are not.

There are several things to look at when reading a study:

• Is it asking the right question? In scoliosis, your question might be "How will I feel 20 years after a surgery," but the study might only be asking "How many people required revision surgery." That's part of the answer to how you might be feeling, but it doesn't tell you, for example, how many people did not have surgery but have significant pain that they're dealing with by taking pain medicine. So, focus on what's important to you and decide how well the study addresses that concern.
• Is it designed to answer the question that it's asking? Looking at surgery outcomes again, many studies equate "amount of correction" and "success". So, when trying to find out if surgery is successful, they ask what the degree of correction in Cobb angle was. As a patient, your view of success is going to be broader and include things like pain, function, etc. So, make sure that the study isn't trying to answer a question that it's not designed to answer.
•  How many and what type of patients were included? In general, the more patients, the more likely that the study is generalizable. And, the more the patients are like you, the more likely that the results will apply to you. For example, if you have a teenager going into surgery, a small study of how adults over 30 respond to surgery is probably not relevant for you.
• What is the quality of the evidence? Medical research is graded by the type of study design - some designs are simply better then others. If you're looking at research, look first for the one with the highest-quality design and the most participants.
  
  Designs are graded as follows (from Wikipedia)
  
  

  "US Preventive Services Task Force (USPSTF)[edit]

  Systems to stratify evidence by quality have been developed, such as this one by the U.S. Preventive Services Task Force for ranking evidence about the effectiveness of treatments or screening:^[30]
  • Level I: Evidence obtained from at least one properly designed randomized controlled trial.
  • Level II-1: Evidence obtained from well-designed controlled trials without randomization.
  • Level II-2: Evidence obtained from well-designed cohort or case-control analytic studies, preferably from more than one center or research group.
  • Level II-3: Evidence obtained from multiple time series with or without the intervention. Dramatic results in uncontrolled trials might also be regarded as this type of evidence.
  • Level III: Opinions of respected authorities, based on clinical experience, descriptive studies, or reports of expert committees."

Summary: Active Correction by Side Shift

Summary: Active Correction by Side Shift - M H Mehta

In 1985, Dr. Min Mehta first published a report on using side-shift exercises in her practice. The study follows 35 of her patients who either used side-shift exclusively for at least a year or, in some cases, side-shift plus night bracing.

Looking at the whole group, the average increase was  l° in Cobb angle, 0.6° in apical vertebral rotation, and 0.4° in lower vertebral tilt. Looking at the individual Cobb angles, nine curves (21.4%) had improved (range -5 to -23°), 21 (50%) were unchanged (range -2 to +4°), and 12 (28.57%) were worsened (range +5 to +11°). 

Because there was no control group, and, therefore, no way of knowing how the curves would have progressed after a year without treatment, Dr. Mehta looked more closely at just those children deemed most likely to progress (younger patients with a low Risser). 

Within the high risk group of 10 children, the average increase in Cobb angle per year was  l° (Note that four of these patients also wore a night-time brace.) According to Dr. Mehta "Changes of this order, particularly in children in the high-risk group, may reasonably be regarded as insignificant. They indicate that the treatment does influence the natural history of the early curves by slowing down their rate of progression during a time of rapid growth."

Side-Shift Exercises

Side-Shift Exercises

Side-shift and hitch exercises are simple adjustments done throughout the day without any equipment. They are meant to slow the progression of curves in both the immature and mature spine.

The methods

The side shift or hitch exercises are meant to be repeated throughout the day - at least 30 times a day.

Side shift (for thoracic curves and thoracic/lumbar double major curves)

• Shift the spine towards the concave side of the curve as far as the spine will allow.
• Hold for 10 seconds
• Relax back into rest position

If there is a marked lumbar lordosis, first decrease that curve by tilting the pelvis forward, and then move into the side-shift position.

Hitch (for lumbar and thoracolumbar curves)

• Lift the heel on the convex side of the curve
• Hold for 10 seconds
• Relax back into rest position

* Photos from Side shift exercise for idiopathic scoliosis after skeletal maturity.

Research Links

Primary research, in children and adults, describing method and results

• Active correction by side-shift: An alternative treatment for early idiopathic scoliosis (In Scoliosis Prevention, 1985, pp126 -140)
• Side-shift exercise and hitch exercise
• Side shift exercise for idiopathic scoliosis after skeletal maturity.

Research on device to support exercises

• Monitoring of side shift exercise using an electromagnetic three-dimensional measuring device.

Research to identify underlying mechanism

• Kinesiologic analysis of dynamic side-shift in patients with idiopathic scoliosis.

Research comparing to other conservative treatments

• Treatment of idiopathic scoliosis with side-shift therapy: an initial comparison with a brace treatment historical cohort.

Opinion piece

• Conservative treatment for adolescent idiopathic scoliosis: can it reduce the incidence of surgical treatment?