How is CLEAR different from other scoliosis treatment options?
As someone living with scoliosis, or as a parent with a child with scoliosis, it can be difficult to sort through all the various scoliosis treatment options to make the best decision for you or your loved one. We’ve put together this list of many popular non-surgical treatment options, as well as how we feel they compare to the CLEAR method, to help you understand all of your choices when it comes to scoliosis treatment.
Watching & Waiting
Watchful waiting, or observation only, is the traditional first course of action in orthopedic scoliosis treatment. The experience of wearing a brace can be socially and emotionally traumatizing, so many orthopedic doctors prefer to only brace curves with a high probability of getting worse (those over 20 degrees, in children with a great deal of potential growth remaining). When a case of scoliosis is initially detected, if it is not considered severe enough to warrant brace treatment, the scoliosis is monitored through regular x-rays; if it shows signs of worsening, the next step is typically a rigid brace.
All big curves started out small, and that even small curves can still be a source of pain & discomfort, reducing the body’s ability to perform at its full potential. Over time, the small imbalances from a mild cases of scoliosis – even one that shows no signs of getting worse – can lead to bigger problems. It makes sense that a disease is most easily treated before it has a chance to progress, and mild cases of scoliosis often respond extremely well to the CLEAR methods, in patients of all ages. For these reasons, we feel that CLEAR offers a much more proactive approach than just watching & waiting.
Traditional Rigid Orthopedic Bracing
Someone with moderate scoliosis presenting to an orthopedic hospital in the United States is most likely to be given a Boston brace, which is an off-the-shelf (pre-fabricated) symmetrical design that is modified and fitted for each patient with the use of pads and cut-outs. It achieved common usage in the 1970’s, and was recently evaluated in one of the largest research studies ever undertaken on the topic of scoliosis (the BrAIST trial). The results of this study were interpreted as evidence that bracing “works,” in that it helps to reduce the chance that a scoliosis will progress to the level of requiring surgery, assuming the patient is willing to wear the brace for at least fourteen hours every day for several years. When bracing compliance is measured objectively, using an electronic sensor, it was found that only 14.5% of patients could stand to wear the brace for the prescribed amount of time (https://www.ncbi.nlm.nih.gov/pubmed/26310101).
CLEAR was founded to provide an alternative to bracing, because we believe there is a better way. While bracing may prevent some cases of scoliosis from getting worse, wearing one can come with physical, social and emotional side-effects. Bracing does not address other problems that may be associated with scoliosis, like breathing difficulties, shoulder asymmetries, headaches, balance issues, or hip, knee & leg pain. It can also cause problems with the spine & posture in other ways, like reducing the good curve in the neck (the cervical lordosis), and these problems have been shown to persist even after the brace is removed. CLEAR’s goal is to provide a more comprehensive approach to scoliosis treatment, that address the whole person and not just the Cobb angle.
Since chiropractors are considered doctors of the spine, it shouldn’t surprise anyone that many people with scoliosis visit chiropractors for help with their condition. However, what should surprise you is just how little training chiropractors receive in scoliosis as a part of their formal education, and the fact that many of the techniques commonly used by most chiropractors to treat scoliosis (such as electrical muscle stimulation) have been shown to be ineffective or even harmful. Some scoliosis patients have experienced excellent results from traditional chiropractic care, and that’s wonderful – but finding the right chiropractor shouldn’t be a matter of luck.
CLEAR recognizes that different chiropractors have different techniques for treating scoliosis, and not all of them are equally effective. Back in the 1990’s, we set out to understand what works and what doesn’t, so that we could standardize the chiropractic treatment of scoliosis to ensure consistently excellent results. Our Certification Process ensures that our doctors stay up-to-date and informed about the latest in scoliosis treatment and research. Also, in the unfortunate event that a patient is disappointed by any aspect of their care or the results that they receive from a CLEAR Certified doctor, we exist to serve as an advocate for the patient and to ensure that appropriate standards of care were followed.
Dynamic (“soft”) Bracing (i.e. SpineCor)
The idea of a non-rigid, elastic brace that is less bulky and can be worn beneath the clothes is very appealing to many teenagers. The general idea is that dynamic braces are designed to encourage motion in directions that are good for the body, and to restrict it from moving in ways that would cause the scoliosis to get worse. They are designed for mild, flexible curves, and are often prescribed in conjunction with some form of exercise therapy. Research suggests soft braces are slightly less effective than rigid braces, though, so they shouldn’t be used in cases of severe or progressive scoliosis. Many (non-CLEAR) scoliosis chiropractors utilize these types of soft braces in their clinics.
Because of the wide variety of treatments & therapies that are provided in conjunction with dynamic bracing, it’s difficult to make accurate comparisons between this approach and CLEAR. Some programs that utilize soft braces may be similar to CLEAR; others, quite different. The most important point to remember is that larger curves (above 25-35 degrees) cannot be effectively treated by a soft brace. CLEAR requires a bit more of an active commitment in regards to patient participation; while someone wearing a soft brace will wear generally be told to wear it between 16-23 hours each day, it’s a passive therapy that only requires the patient’s time to put it on and take it off. The CLEAR program is designed to re-train the muscles and the brain, and to re-model the soft tissues such as the ligaments and discs; this requires an hour or two of daily active exercises in the beginning. Dynamic bracing may be a good choice for a patient with a small, non-progressive curve, who isn’t highly motivated to do exercises on a regular basis. Both CLEAR and soft bracing tend to be very well accepted by teenagers, in terms of social and emotional concerns.
Many patients ask if CLEAR and SpineCor bracing can be done in conjunction. We have explored this in the past with chiropractors who were both CLEAR certified and SpineCor certified. Unfortunately, SpineCor’s leadership in North America made the decision not to allow doctors to participate in both programs simultaneously. Until this decision is reversed, exploring the combined effect of CLEAR and SpineCor is not possible.
The majority of the ScoliSMART doctors were previous members of CLEAR, and they base many of their treatment protocols around the information that CLEAR presented at its seminars several years ago. Unlike CLEAR, ScoliSMART is a for-profit organization, and does not have a standardization or certification process – nor do they have the support of an accredited chiropractic university. They utilize traditional chiropractic adjusting procedures, as well as a soft brace (like SpineCor), called the Scoliosis Activity Suit, or SAS. Chiropractors outside of CLEAR are not permitted to prescribe the Scoliosis Traction Chair for their patients, so the ScoliSMART doctors often disparage this particular therapy.
The CLEAR network consists of over 40 certified doctors who continually communicate and collaborate with each other to enhance the results of the CLEAR scoliosis protocols. CLEAR doctors attend seminars taught by many different organizations including ScoliSMART, and share whatever information they learn with the rest of the group to ensure that CLEAR patients receive the best possible care and the most accurate, up-to-date information. If you are trying to decide between these two different chiropractic scoliosis treatment approaches for yourself or your loved one, please consider using our list of Questions to Ask Your Doctor to help you in making your decision. The ScoliSMART doctors are located in Wisconsin, Pennsylvania, New York, and Michigan, and their website is www.TreatingScoliosis.com.
The most common night-time braces are the Providence and Charleston braces, which are sometimes also called “side-bending” braces. This is because they force the wearer to bend very far to the side, too far to be practical for wearing during the day. While the social stigma and physical limitations of daytime bracing are avoided, these types of braces often make it very difficult to sleep at night.
They are typically prescribed for single “C”-shaped curves that involve the lower (lumbar) spine. There is some controversy regarding night-time bracing, as evidence of their effectiveness is limited. Most scoliosis specialists prefer to work with either rigid braces or the SpineCor brace. There may be some specific types of small curves for which night-time bracing is advantageous compared to full-time rigid bracing, but in general, night-time bracing is not an effective option for most people with scoliosis.
Physiotherapeutic Scoliosis-Specific Exercises (PSSE’s, i.e. Schroth, SEAS, etc.)
Not to be confused with general physical therapy, scoliosis-specific exercises are developed by practitioners with years of advanced training in scoliosis and spinal disorders. CLEAR Institute and its doctors have had the privilege of studying with & learning from the lead instructors of many of these European-based schools of physiotherapy, and several CLEAR doctors incorporate aspects of these exercise programs into their treatment. Despite decades of biased and unscientific condemnation of exercise-based approaches to scoliosis from the orthopedic community, there is a growing body of evidence that suggest scoliosis-specific exercises are universally beneficial for patients of all ages – whether performed alone, or in conjunction with bracing or other therapies.
While for many years these therapies were only available to people in Europe, many brave pioneers have worked tirelessly to bring these treatment options to the United States and other parts of the world. PSSE’s have no side effects, and are effective in addressing many aspects of health that are not addressed by bracing (such as mobility, pain, lung function, balance, and posture). CLEAR believes that due to the evidence of effectiveness of scoliosis exercises, they should be an important part of any scoliosis rehabilitation routine, and indeed, specific spinal exercises are an essential part of the CLEAR protocols.
One way in which CLEAR’s system of scoliosis exercises differs from the European-based schools involves our reliance upon x-ray analysis and specialized exam protocols to guide our doctors in prescribing the exact exercises for each patient. X-ray exposure is always a concern in working with scoliosis, and physical therapists in some parts of the world are limited in their ability to take x-rays. Chiropractors, as primary care providers, do not have these same restrictions. In particular, the chiropractors involved with CLEAR are trained in specialized x-ray analysis techniques that grant them a unique insight into spinal biomechanics and how individual spines react to various exercises, adjustments, and other therapies. We believe our unrestricted access to x-rays and our specialized understanding of spinal biomechanics enhances the effectiveness of our approach, and allows us to customize the exercises we prescribe for each individual patient to maximize their value and efficacy.
Advanced European-style Rigid Bracing
Compared to the US, there are many more scoliosis braces available in Europe, and there is mounting evidence that the additional attention to detail and specialized nature of these braces drastically increases their effectiveness compared to older TLSO’s. The Chéneau brace, for example, has become the gold standard for many new brace designs which are now becoming available in the United States. A comprehensive review of many of these braces is accessible here (http://tees.openrepository.com/tees/bitstream/10149/560332/2/560332.pdf).
If you decide to pursue bracing for your scoliosis, we highly recommend that you research whether these options might be available to you. It may even be worth the time to travel to receive a fitting for one of these specialized brace designs, rather than accept the traditional TLSO prescribed to you by your local orthopedic scoliosis center. However, many of the same concerns with bracing do persist even in advanced brace designs. The success of these braces is judged primarily by its ability to prevent progression; not necessarily to correct the scoliosis, or to improve the patient’s quality of life. They still have some social, physical, and emotional side-effects which some teenagers may dislike, and they require a high level of compliance to be effective. Through the CLEAR treatment, we strive to provide a comprehensive improvement in all aspects of the patient’s well-being, and to do so with a minimum of negative side effects or demands upon the patient’s time. CLEAR requires active participation, but for only about 90 minutes each day, rather than 20 hours of bracing, and our goal is to reduce the scoliosis, and not simply prevent it from getting worse. Rather than push the spine passively back into position, we aim to actively engage the muscles and re-train the postural system of the body & brain to work together in a more natural & balanced fashion. While it might seem tempting to combine CLEAR with rigid bracing, it’s important to consider that the differences in the goals of each treatment sometimes interfere with one other. Additional time & research is needed before we can know if a combined approach could be beneficial.
ScoliBrace Mirror Image (Hyper-corrective) Bracing
One of the most promising new brace designs to emerge in the field of chiropractic scoliosis correction is the ScoliBrace “hyper-corrective” brace, created by Dr. Jeb McAviney. A traditional TLSO such as the Boston brace is considered a symmetrical brace, in that it aims to re-align the shoulders over the hips and restore the posture to a state of symmetry. A hyper-corrective brace, in contrast, aims to actually “over-correct” the scoliosis, and push the body even farther in the opposite direction. This approach is innovative and novel, in that it actually engages the body’s postural muscles rather than simply immobilizing them. When the body is moved into a “mirror-image” position, the weak muscles on the opposite side of the spine must work harder to help the body maintain its balance. The spinal discs are also being “opened up” on the wedged side, allowing nutrients and water to flow into the parts of the disc that need them the most.
CLEAR has been encouraging its doctors to explore this new brace design, and many have begun to report very promising results. While no research has been published to-date, these preliminary experiences suggest that with the right brace design, it may be possible to combine CLEAR and rigid bracing without the two protocols interfering with one another, and combine the passive benefits of bracing (such as soft-tissue remodeling of the discs and unloading of the vertebral endplates) with the active benefits of CLEAR (sensorimotor re-integration and activation of the postural muscles). We look forward to sharing future research!
Yoga, Pilates, and other movement-based therapies focused around awareness of the body can be very beneficial in improving flexibility, reducing tension & stress, and alleviating pain. However, it’s important to recognize that some maneuvers may be detrimental for certain types of scoliosis. This is why – just like with physical therapy – it’s important to select a scoliosis-specific program, such as Elise Miller’s Yoga for Scoliosis or Karena Lineback’s ScolioPilates.
There’s no reason that CLEAR’s protocols should not be combined with scoliosis-specific yoga or Pilates, and in fact this is often encouraged by many CLEAR doctors. If you are doing yoga or Pilates alone, it’s important to be realistic about the results you should expect. Benefits such as pain relief, reduced muscle tension, better function & flexibility, and improved breathing are all been commonly reported by people going through these programs, and just like with scoliosis exercises, there’s really no chance of any side effects (beyond some minor muscle soreness, like with any good workout) assuming the curve pattern is taken into account and the maneuvers are properly performed. . However, it’s unlikely that there will be a significant correction in the actual curvature. In cases of progressive scoliosis, particularly in adolescents, you shouldn’t count on yoga or Pilates alone to prevent the scoliosis from getting worse.
We hope this information has been helpful. Do you have any experience with any of these methods? Can you think of any additional therapies that we haven’t included here? Please share with us in the comments below!