Scoliosis Reduction Center

Report of Findings

Accurate Diagnosis & Management of Scoliosis

Scoliosis patients often present to Chiropractors

  • Early and accurate detection leading to appropriate treat
  • Mis-diagnosis or inappropriate treatment

This can mean the difference between a fused or unfused spine!

"Scoliosis surgery occurs with the failure of non-surgical management."

Age Ranges

  • Infantile: 0 - 3 Years
  • Juvenile: 4 years to puberty onset (4 - 10 years)
  • Adolescent: Puberty onset to epiphyseal closure (10 - 18 years)
  • Adult: Pre-existing AIS in an Adult OR new onset of Degenerative De Novo Scoliosis (DDS)
  • Late Stage Adult: 50 years plus
spines

Age of Patient

Infantile
Juvenile
Adolescent
Adult
Late Stage Adult
Post-Surgical

Types of Scoliosis and Causes

Neuromuscular

  • Neuromuscular syndromes like: Cerebral Palsy, Marfan's Syndrome, Neurofibromatosis, etc.
  • Normally a connective tissue disorder causing either laxity or contractive problem of the soft tissue
  • Can be neurological issue, like tethered spinal cord, syrinx, etc.

Congenital

  • Hemivertebra (a misshapen vertebra since birth)

Idiopathic

  • Unknown Cause
  • Conscience it is multi-factorial

Types of Adult Scoliosis and Causes

Adolescent Scoliosis in the Adult

  • Either diagnosis as child and now the person is an adult
  • Many cases go undiagnosed because they never progress to a large enough curve as an adolescent, however they do continue to progress as adults till they cause problems

Adult Degenerative De-Novo Scoliosis (DDS)

  • Most commonly De-Novo Scoliosis starts in women around the time of menopause. In men it usually occurs after the age of 70.
  • Pain and disability are the most common symptoms
  • Rapid degenerative change including development of segmental lateral instability (lateral listhesis) and loss of the lumbar lordosis or development of a lumbar kyphosis.
  • Almost exclusively develops in the lumbar and thoracolumbar spine. Scoliosis can develop in adults with no hx of adolescent scoliosis
  • DDS is a disease that worsens over time without intervention

Scoliosis Progression in Adolescents

No matter what the cause is, progression is due to growth.
adolescent risk of progression
The unknown variable is how much progression will occur:
  • some only a few degrees,
  • some 10 - 20 degrees,
  • some 40 - 50 degrees,
  • some 60 - 80 degrees,

The largest curve I have ever seen has been 155 degrees!

Are you experiencing pain?

Yes
No

Scoliosis and Pain

child scoliosis
It is NOT common for children with scoliosis to feel pain, no matter what size the curve is.
  • If anything, a dull mild ache.
  • This is because progression is due to growth, which is elongating.
adult scoliosis
The opposite is true for adults with scoliosis, who will almost always feel pain, even with relative mild progression.
  • This is because progression is due to gravity, which is compressive, which is almost always painful.
What are the Traditional Treatment Options?

Types of Scoliosis and Causes

Neuromuscular

  • Neuromuscular syndromes like: Cerebral Palsy, Marfan's Syndrome, Neurofibromatosis, etc.
  • Normally a connective tissue disorder causing either laxity or contractive problem of the soft tissue
  • Can be neurological issue, like tethered spinal cord, syrinx, etc.

Congenital

  • Hemivertebra (a misshapen vertebra since birth)

Idiopathic

  • Unknown Cause
  • Conscience it is multi-factorial

Scoliosis Progression in Adults

Progression happens because of gravity over time.
  • Compression leads to slow progression, purely depending on the size of the curve.
  • As the curve becomes bigger, the rate of progression increases.
  • As the patient becomes older, the rate of progression increases.

Adolescent Scoliosis in the Adult

adolescent risk of progression

Adult-Onset Scoliosis

adult onset progression

Are you experiencing pain?

Yes
No

Scoliosis and Pain

child scoliosis
It is NOT common for children with scoliosis to feel pain, no matter what size the curve is.
  • If anything, a dull mild ache.
  • This is because progression is due to growth, which is elongating.
adult scoliosis
The opposite is true for adults with scoliosis, who will almost always feel pain, even with relative mild progression.
  • This is because progression is due to gravity, which is compressive, which is almost always painful.
What are the Traditional Treatment Options?

The Traditional Treatment Approach

  • Very black and white
  • It is all based upon the size of the curve and the risk of progression...

If you're diagnosed with a Mild Scoliosis:

10°-25°
adolescent mild scoliosis
Traditional Treatment: Nothing, just "Watch & Wait".
Chance of progressing to a surgical level curve is 30%.

Problems

  • All big curves were once small
  • There is no harm in reducing a small curve, however there is in letting a small curve become large
  • Small curves are easier to reduce
  • If your treatment wasn't an invasive surgery, you would reduce it buy they have nothing to offer

If you're diagnosed with a Moderate Curve:

25°-40°
moderate scoliosis
50% Of Doctors Recommend Boston Brace:

Problem

  • It's a squeezing brace style
  • Boston brace is designed to just try to slow down progression, not reduce or improve the curve.
50% Still Recommend Watch & Waiting Approach:

Problem

  • If you are still growing, then your curve will probably progress even more.
Chance of progressing to a surgical level curve is 66%.

If you're diagnosed with a Severe Scoliosis:

40°+
severe scoliosis
If you are still growing and at risk for progression, they will recommend surgery.

Problems

  • Surgery will reduce the curve but at an ultimate expense: Complete and total fusion of the spine.
  • Future risks are unknown
  • The reason why they wait until 40+ degrees, is because of the risks associated.
  • If there was no risk, they would do surgery way sooner.
If you are not growing, they will still recommend that you "Watch and Wait".

Problems

  • Curves still progress as adults, but slower due to gravity (1 degree per year)

I call all of this the "Limited" approach!

I call it that because the goal of any of the above treatment is either to do nothing, to limit motion with a squeezing brace, or to use surgical rods and screws.
So, what else can be done?

The Traditional Treatment Approach for Adults

If you're diagnosed with a Mild Scoliosis:

10°-25°
Just "Watch &  Wait"
Most say: "Don't worry about it. There's nothing we can do."
adult mild scoliosis

If you're diagnosed with a Moderate Curve:

25°-40°
Just "Watch &  Wait"
Same story here: "Don't worry. There's nothing we can do."
moderate scoliosis adult

If you're diagnosed with a Severe Scoliosis:

40°+
Surgery
  • Now what do you expect? You have severe scoliosis.
  • However, with surgery, the rate of complication is so high that they will only consider it if the person is in dire condition.
  • So, even if your curve is "big enough" to have surgery, you may still be waiting for it to cause enough problems to risk surgery.
  • As you get older, the complication of surgery increases.
adult severe scoliosis

If you have pain at any time, they just treat your pain with typical pain treatments, NOT what is causing it.

Adolescent Scoliosis in the Adult
adolescent risk of progression
Adult-Onset Scoliosis
adult onset progression

I call all of this the "Limited" approach!

I call it that because the goal of any of the above treatment is either to do nothing, to limit motion with a squeezing brace, or to use surgical rods and screws.
So, what else can be done?

How about a FUNCTIONAL approach?

The goal of a functional approach is to reduce the curve but retain the normal function of the spine.
The single largest factor regarding if your curve will progress is related to size. So, reducing the curve is the best way to prevent progression.

Alternate Progression Model for Adolescents

adolescent alternate model
So, how do you reduce your curve?

How about a FUNCTIONAL approach?

The goal of a functional approach is to reduce the curve but retain the normal function of the spine.
The single largest factor regarding if your curve will progress is related to size. So, reducing the curve is the best way to prevent progression.

Alternate Progression Model for
Adults with Adolescent Scoliosis

alt progression adolescent in adult

Alternate Progression Model for
Adult-Onset Scoliosis

alt progression adult onset
So, how do you reduce your curve?

So how do you reduce your curve?

Long Dose vs. Short Dose

Why orthopedic doctors don't believe conservative care works:
Most doctors think of conservative care as injury-style treatment.

Traditional Therapy / Rehab / Chiropractic:

  • Little dose over a long time
  • Not enough intensity to reduce scoliosis

Our Intensive Care approach:

  • Big dose over a short time
  • This type of intensity has a chance.
How else? 

So how do you reduce your curve?

Long Dose vs. Short Dose

Why orthopedic doctors don't believe conservative care works:
Most doctors think of conservative care as injury-style treatment.

Traditional Therapy / Rehab / Chiropractic:

  • Little dose over a long time
  • Not enough intensity to reduce scoliosis

Our Intensive Care approach:

  • Big dose over a short time
  • This type of intensity has a chance.
How else? 

Squeezing vs. Pushing

Traditional Bracing:

  • Uses squeezing to try to slowdown progression.

Corrective Bracing:

  • Pushing trying to reduce your curve

Following Intensive care, we need stability...

Core Exercise vs.
Scoliosis-Specific Exercise

Traditional Exercise:

  • Planks, general flexibility, etc.
  • Core strengthening only

Scoliosis Exercise:

  • Asymmetrical exercises that are designed to address the curve size
  • Isometric exercises, reactive exercises, and self-corrective exercises
How else? 

Squeezing vs. Pushing

Traditional Bracing:

  • Uses squeezing to try to slowdown progression.

Corrective Bracing:

  • Pushing trying to reduce your curve

Following Intensive care, we need stability...

Core Exercise vs.
Scoliosis-Specific Exercise

Traditional Exercise:

  • Planks, general flexibility, etc.
  • Core strengthening only

Scoliosis Exercise:

  • Asymmetrical exercises that are designed to address the curve size
  • Isometric exercises, reactive exercises, and self-corrective exercises
How else? 

So how do you reduce your curve?

Fragmented vs. Coordinated

A Multimodal Approach Is Needed:

  • Therapy
  • Chiropractic
  • Traction
  • Rehab
  • Exercise
  • Vibration
  • Percussion
  • Bracing & Brace Design
  • Self-correction Exercises
  • Isometrics

But this approach can create problems!

Fragmented Approach:

You would have to see many different certified doctors and therapists to get all of these modalities!
This results in in fragmented care, that more than likely, will be competing or counteracting each other.

Coordinated Approach:

One doctor, certified in all of the multiple modalities, is coordinating and prescribing everything to work together.

Slowing Down Your Progression vs. Managing Your Curve Reduction

Slowing Progression:

  • Traditionally, if your curve continues to progress, nothing really changes until it becomes severe enough to warrant the risk of surgery
  • Just trying to slow down progression

Managing Your Reduction:

  • We are trying to get as much reduction as possible. We are managing your reduction.
  • It is a completely different mindset!
How does this all come together?

So how do you reduce your curve?

Fragmented vs. Coordinated

A Multimodal Approach Is Needed:

  • Therapy
  • Chiropractic
  • Traction
  • Rehab
  • Exercise
  • Vibration
  • Percussion
  • Bracing & Brace Design
  • Self-correction Exercises
  • Isometrics

But this approach can create problems!

Fragmented Approach:

You would have to see many different certified doctors and therapists to get all of these modalities!
This results in in fragmented care, that more than likely, will be competing or counteracting each other.

Coordinated Approach:

One doctor, certified in all of the multiple modalities, is coordinating and prescribing everything to work together.

Slowing Down Your Progression vs. Managing Your Curve Reduction

Slowing Progression:

  • Traditionally, if your curve continues to progress, nothing really changes until it becomes severe enough to warrant the risk of surgery
  • Just trying to slow down progression

Managing Your Reduction:

  • We are trying to get as much reduction as possible. We are managing your reduction.
  • It is a completely different mindset!
How does this all come together?

During Active Care (Actively Trying To Reduce Your Curve)

Once we reduce your curve:

  • Every 90 days, we are re-evaluating looking for more opportunity to reduce your curve, with possible modification. 
  • Sometimes we will continue, but other times we may modify the brace to make it more aggressive, do another 1 week intensive, etc...
    • Like braces on your teeth, the orthodontist will keep adjusting the braces until your teeth get as straight as possible. We do the same with our treatment.

After 18 months, and if the child is fully grown, we can consider the weaning process if we are happy with the results.

  • However, some patients continue to try to get more reduction if I think it is possible.

Once we are through active care:

  • We slowly wean down everything and start the correct maintenance care to prevent slow progression over time due to gravity.
  • We figure out your maintenance by slowly reducing your dose of treatment (office care, bracing, home exercises).
  • If there is no progression, we continue to reduce the dose to get your maintenance program to be as little as possible.
  • The smaller your curve becomes, the less you will need to do.

There is no such thing as a permanent cure.

You will always have to maintain.

If there is some regression in the future, we will use another round of intensive care.

See similar case studies

During Active Care (Actively Trying To Reduce Your Curve)

Once we reduce your curve:

  • After 90 days, we are re-evaluating to make sure your curve is holding. 
  • Some adults at this point will just continue with the program for 12 months.
  • Some adults may elect for more reduction.
    • We may modify the brace to make it more aggressive, do another 1 week intensive, etc...
      • Like braces on your teeth, the orthodontist will keep adjusting the braces until your teeth get as straight as possible. We do the same with our treatment.

After 12 to 18 months, we can consider the weaning process if we are happy with the results.

  • However, some patients continue to try to get more reduction if I think it is possible.

Once we are through active care:

  • We slowly wean down everything and start the correct maintenance care to prevent slow progression over time due to gravity.
  • We figure out your maintenance by slowly reducing your dose of treatment (office care, bracing, home exercises).
  • If there is no progression, we continue to reduce the dose to get your maintenance program to be as little as possible.
  • The smaller your curve becomes, the less you will need to do.
  • Remember: Gravity is the cause of progression.

There is no such thing as a permanent cure.

You will always have to maintain.

If there is some regression in the future, we will use another round of intensive care.

See similar case studies

Case Studies

Even though every case is different, see the results we've been able to get for patients like you.

Infantile
Juvenile
Adolescent
Adult
Late Stage
Post Surgical

Infantile Case Studies

Congential

  • Coming soon...

Neuromuscular

  • Coming soon...

Idiopathic

  • Coming soon...

Summary

  • We use intensive therapy to achieve a rapid reduction in your curve
    • All the therapy is coordinated by one doctor.
  • We then prescribe home therapy and coordinate with local doctors to stabilize the reduction
  • If needed, we design a brace to match all therapy that is performed
    • Brace is a corrective brace to help reduce the curve
  • During Active Care, we re-evaluate every 90 days to make sure it is stable, and make adjustments to care, home care, brace, etc. to get as much of a reduction as possible.
  • Once through Active Care, we slowly wean to find the appropriate maintenance care.

Juvenile Case Studies

Congential

  • Coming soon...

Neuromuscular

  • Coming soon...

Idiopathic

  • Coming soon...

Summary

  • We use intensive therapy to achieve a rapid reduction in your curve
    • All the therapy is coordinated by one doctor.
  • We then prescribe home therapy and coordinate with local doctors to stabilize the reduction
  • If needed, we design a brace to match all therapy that is performed
    • Brace is a corrective brace to help reduce the curve
  • During Active Care, we re-evaluate every 90 days to make sure it is stable, and make adjustments to care, home care, brace, etc. to get as much of a reduction as possible.
  • Once through Active Care, we slowly wean to find the appropriate maintenance care.

Adolescent Case Studies

Congential

  • Coming soon...

Neuromuscular

  • Coming soon...

Idiopathic

  • Coming soon...

Summary

  • We use intensive therapy to achieve a rapid reduction in your curve
    • All the therapy is coordinated by one doctor.
  • We then prescribe home therapy and coordinate with local doctors to stabilize the reduction
  • If needed, we design a brace to match all therapy that is performed
    • Brace is a corrective brace to help reduce the curve
  • During Active Care, we re-evaluate every 90 days to make sure it is stable, and make adjustments to care, home care, brace, etc. to get as much of a reduction as possible.
  • Once through Active Care, we slowly wean to find the appropriate maintenance care.

Adult Case Studies

Mild

  • Coming soon...

Moderate

  • Coming soon...

Severe

  • Coming soon...

Summary

  • We use intensive therapy to achieve a rapid reduction in your curve
    • All the therapy is coordinated by one doctor.
  • We then prescribe home therapy and coordinate with local doctors to stabilize the reduction
  • If needed, we design a brace to match all therapy that is performed
    • Brace is a corrective brace to help reduce the curve
  • During Active Care, we re-evaluate every 90 days to make sure it is stable, and make adjustments to care, home care, brace, etc. to get as much of a reduction as possible.
  • Once through Active Care, we slowly wean to find the appropriate maintenance care.

Late Stage Case Studies

Mild

  • Coming soon...

Moderate

  • Coming soon...

Severe

  • Coming soon...

Summary

  • We use intensive therapy to achieve a rapid reduction in your curve
    • All the therapy is coordinated by one doctor.
  • We then prescribe home therapy and coordinate with local doctors to stabilize the reduction
  • If needed, we design a brace to match all therapy that is performed
    • Brace is a corrective brace to help reduce the curve
  • During Active Care, we re-evaluate every 90 days to make sure it is stable, and make adjustments to care, home care, brace, etc. to get as much of a reduction as possible.
  • Once through Active Care, we slowly wean to find the appropriate maintenance care.

Post-Surgical Case Studies

Examples

  • Coming soon...

Summary

  • We use intensive therapy to achieve a rapid reduction in your curve
    • All the therapy is coordinated by one doctor.
  • We then prescribe home therapy and coordinate with local doctors to stabilize the reduction
  • If needed, we design a brace to match all therapy that is performed
    • Brace is a corrective brace to help reduce the curve
  • During Active Care, we re-evaluate every 90 days to make sure it is stable, and make adjustments to care, home care, brace, etc. to get as much of a reduction as possible.
  • Once through Active Care, we slowly wean to find the appropriate maintenance care.
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