YOGA AND MUSCLE INJECTIONS
(14 – 18 years old)
A RANDOMIZED CONTROLLED CROSSOVER TRIAL
EVERYONE GETS THE FULL TREATMENT
ONE VISIT REQUIRED
We have been given a grant to study the effects of combining yoga and botulinum toxin on adolescent idiopathic scoliosis (AIS). The study is for young people 14 – 18 years of age and requires only one visit to our offices in Manhattan.
The study adds to the already proven value of yoga in reversing the curves of scoliosis by using botulinum toxin, familiar to most people as “Botox,” made by the Allergan Corporation, although the medication is actually made by several different manufacturers in the United States and Europe.
The most recent peer-reviewed study demonstrates the efficacy of practicing one yoga pose for 1-2 MINUTES daily in reversing lumbar curves in adolescents. It is backed up by two other, earlier peer-reviewed different-authored studies that come to the same conclusion. Essentially, yoga strengthens the muscles of the weaker side, the convex side of the lumbar curve. When these muscles are more or less equal in strength to the muscles on the concave side, the curve is gone or substantially diminished. The treatment is then gradually tapered off. In this study, we also use botulinum toxin to partially and temporarily weaken the stronger side, enabling the weaker side to gain traction and overcome the asymmetrical pull of the stronger side more rapidly.
Botulinum toxin type A is the active ingredient in “Botox” the medication people use to reduce wrinkles on their brows. It has been given over 1,000,000 times to adults, adolescents and children with minimal side-effects. We are injecting it into much larger muscles of the back at the minimally effective dosage. At this writing we have injected it 50 times, without side-effects and with near-spectacular reduction in lumbar scoliosis.
The study requires a minimum of three X-rays: one at the time we begin the treatment, one three weeks later, and another three months after we began. These can be done at a location near the patient’s home and are reimbursed $100 per X-ray. We recommend EOS X-rays, which have only 1/9 the regular X-rays’ radiation (already extremely low). At this writing (February 28, 2023) we have followed 34 patients each of whom has improved 8 – 27 degrees in the X-rays 3 weeks after being taught the yoga pose and receiving the botulinum. In the history of treating scoliosis conservatively, this is noteworthy, even remarkable. Most conservative methods are intended only to stop progression of scoliosis, not to reverse it, and even the successful yoga treatments by themselves would give just 20 – 25% as much correction in that time frame. Only surgery, which is not done unless the curves exceed 45 degrees, gives results like this.
The study protocol has been reviewed and approved by the FDA and the IRB (Institutional Review Board) relevant to this subject matter. These boards approve prospective studies only if they are deemed safe, scientifically cogent, with a reasonable likelihood of success. But the question arises: if the study is randomized and with controls, how can everyone be guaranteed to receive the proper yoga pose and the actual botulinum toxin?
The answer is that this is a crossover study, so the control group receives the actual medicine three months after study onset. The study has three groups:
Group I: Placebo yoga pose and no injection
Group II The correct yoga pose and sham injection.
Group III: The correct yoga pose and botulinum injection.
At that time patients may return to our office, and those in Groups I and II will receive the botulinum injections, and those in Group I will be taught the proper yoga pose.
At that point Group III is done with the study; Groups I and II continue on for another 3 months.
They will have repeat (free) X-rays at 3 weeks and 3 months either in Manhattan or near their homes.
Subsequent treatment and/or injection is determined by consultation between the physician and patient and family.
To apply to join the study at our office in Manhattan, click here to be redirected to IntakeQ to begin the application process. For more information, please call (212) 472-0077, or write firstname.lastname@example.org.
People over 18 years of age, or younger than 14, are also able to receive the botulinum injections, but they will not be part of the study.
WHERE IS THE PROCEDURE DONE AND HOW LONG DOES IT TAKE?
We teach the yoga pose and give the injection in our office in Manhattan’s East Side. It takes about an hour.
HOW MANY PEOPLE ARE CURRENTLY IN THE STUDY?
Right now we have 10 people in the study. Four of them have received botulinum injections. There have been no side-effects. We take temperature, weight, heart rate, respiratory rate and blood pressure before we start, and again 15 minutes after the injections. There have been no significant changes apart from an 18 year-old who ran from Penn Station to our office on a cold day, and had a temperature when he started that soon came back to normal, and was normal 15 minutes after the injection.
APART FROM THE STUDY, HOW MANY TIMES HAVE YOU USED BOTULINUM TOXIN?
I have injected botulinum toxin over a thousand times. I’ve done the injections for scoliosis in various back muscles 50 times now.
WHAT ARE THE OVERALL RESULTS SO FAR?
On the average, patients’ curves are reduced 9 – 16 degrees in 3 weeks. Our most dramatic results so far are 27 degrees improvement in 3 weeks and 33 degrees improvement in 4 1/2 months.
WHAT ARE THE LONG-TERM RESULTS?
Most patients retain the initial benefit and build on it by continuing the yoga. Positive changes seem to occur in the muscles of the “weak” side which produce 2.5 to 5.5% improvement that continues as long as the yoga pose is done daily. So far this is tru for patients older and younger than the study age as well.
IF A PAPER IS PUBLISHED, WILL PATIENTS’ NAMES OR LIKENESSES APPEAR IN IT?
No, there will not be mention of any names or other identifiable characteristics in any resulting publications. This fact is stated in the IRB and in the FDA permissions, and is actually against the law (HIPAA). It is also stated in the patient information document that patients and I, the treating physician, must sign before we begin any treatment.
Dr. Fishman is a physician with advanced Board in Rehabilitation Medicine, currently on the staff at Columbia University Medical School. He has over 100 publications including 12 books and many peer-reviewed research articles. He is past President of the New York Society of PMR and has a graduate degree in Philosophy from Oxford University in England. He also studied yoga extensively with B.K.S. Iyengar in India. For more about Dr. Fishman, click here.
A New Resource: YIP.guru (Yoga Injury Prevention)
What are the major causes of yoga injuries, in which poses, and what are the major injuries?
A 33,000 yoga teacher and student study.
On the basis of this, and 40+ years devoted to medicine, teaching yoga, and using yoga for medicinal goals, we have constructed a website, YIP.guru (Yoga Injury Prevention), which physicians, therapists, teachers and practitioners of yoga can use to see which poses are contraindicated by common medical and orthopedic conditions, and also which poses will benefit people with a large variety of medical and orthopedic issues, including pregnancy. Click here to access YIP.guru
YIP.guru (Yoga Injury Prevention)
Piriformis Syndrome Study Published
We have recently completed a double blinded randomized controlled study comparing botulinum injection to placebo in people for whom the electromyographic evidence favored piriformis syndrome.
The entire study was published in Muscle and Nerve: Click Here
Electrophysiologically identified piriformis syndrome is successfully treated with incobotulinum toxin A and physical therapy.” Fishman LM, Wilkins AN and Rosner B. Muscle and Nerve. 2017; Aug;56(2):258-263. doi: 10.1002/mus.25504. Epub 2017 Apr 2
Rotator Cuff Syndrome Discovery
We stumbled upon a series of maneuvers which activates muscles that perform the actions of the torn supraspinatus muscle. Then a process akin to operant conditioning prompts the same muscles to be active whenever the torn muscle would be brought into play, perpetuating the substitution so that people may painlessly and powerfully lift the arm in ways that previously were prevented by the torn muscle.
Our Earlier Research using Yoga Poses to Reverse Scoliosis
We have found a simple yoga pose which, done one time daily, reverses nearly every case of scoliosis we have encountered. We published a small series of adolescent idiopathic scoliosis patients’ and degenerative scoliosis patients’ successes with this simple method, and are currently studying more advanced methods with more complex curves. Additional details may be found here.
Emboldened by this early success, we conducted a larger study, and published the results in November 2017:
We published a third article in 2021:
Surprising to some, the method works almost as well for adults with degenerative scoliosis as it does for adolescent idiopathic scoliosis.
Therefore we are continuing to study the patients we are honored to treat with this non-invasive, do-it-yourself-at-home method that takes just minutes a day, and works for almost everyone.
Those interested should make an appointment at our office: (212)-472-0077, or write the office. For those unable to visit the office in-person, we have taught the method with equal success via Skype and Zoom.