The purpose of this section is to help you understand how to approach your doctor, know what questions to ask, and be aware of potential warning signs that could indicate that a doctor might not be the best possible choice for pursuing scoliosis treatment. When speaking with a doctor, always be courteous and respectful but direct; trust your instincts and intuition. You should never feel like you are being pressured into making a decision you are not comfortable with, and all of your questions should be answered to your satisfaction before you proceed with the treatment you have chosen.
Below you can find a list of sample questions to ask your doctor. Every question might not apply in every case; you should read through this list and select the ones that are important to you. Furthermore, you should take a moment before meeting with your doctor and write down any additional questions, not on this list, that you would like answered.
Q: HAVE YOU WORKED WITH SCOLIOSIS CASES LIKE MINE BEFORE, AND CAN YOU SHARE THEIR LONG-TERM RESULTS WITH ME?
Not every chiropractor has the same level of training and knowledge when it comes to scoliosis. Similarly, a surgeon does not become an expert in performing scoliosis surgeries overnight – it takes many operations and many years to acquire experience with the unique aspects of scoliosis surgery. This also applies to bracing – the more scoliosis braces that a doctor has prescribed, the better he or she becomes at crafting the ideal fit that will provide the greatest possible benefit for a specific individual.
While it is true that patient confidentiality laws prohibit the unauthorized sharing of healthcare information, there is some information which can be de-identified and shared, such as x-rays and questionnaire scores. Doctors who have worked with scoliosis for many years should have accumulated testimonials, success stories, research articles, and other sources of evidence to demonstrate the benefits of their chosen approach. You should also insist that the demographics of the shared results (such as gender, age, and curve pattern) match your specific case as closely as possible. It’s important to recognize that the term “scoliosis” encompasses a lot of different conditions. Just like each person is unique, each case of scoliosis is unique. What is best for an adolescent with a double major idiopathic S-curve, might not be the best approach for an adult with a degenerative lumbar C-curve.
Q: ARE THERE OTHER PATIENTS I CAN TALK TO, WHO WOULD BE WILLING TO SHARE THEIR EXPERIENCES WITH ME?
One way to get the information you need, while still respecting patient confidentiality and healthcare privacy laws, is to ask the doctor if there are any patients with cases similar to yours who would be willing to share their experiences with you. You can then provide your contact information, such as e-mail or phone number, to these individuals, who are then free to contact you and share whatever information with you that they would like. While this information should be interpreted cautiously, as every individual has their own preferences and feelings, it is certainly helpful to know if people treated previously by this doctor were satisfied with their experience, and pleased with the results.
Q: CAN YOU SHOW ME HOW TO MEASURE COBB ANGLE?
Measuring the Cobb angle on a scoliosis x-ray is not a difficult task. It is something that anyone can learn to do with a little bit of training. When it comes to scoliosis, a lot of treatment decisions are based almost entirely around this one number, so it is important to ensure that the measurements are accurate. Your doctor should be able to explain to you how the Cobb angle is measured, and allow you to examine the x-rays yourself to ensure everything is correct. Also, the measurement of Cobb angle can differ drastically if different bones in the spine are used as reference points, so make sure the same vertebrae are used when comparing pre and post x-rays.
Q: HOW OFTEN WILL RE-EVALUATIONS BE SCHEDULED, AND WHAT WILL THEY INCLUDE?
A competent doctor should be able to perform an examination of a patient, and establish a prognosis for how well that patient will likely respond to treatment. They should have a reasonable timeline for how long it will take to achieve results, and a plan for how often they will reassess the patient to ensure things are moving forward. If a doctor schedules re-examinations extremely far down the road, it is possible that your time could be wasted following an ineffective treatment regimen. As a patient, you have the right to know if the treatment you have chosen is effective sooner, rather than later. If you decide to wear a brace, you should expect to receive an in-brace x-ray that demonstrates a substantial improvement in the Cobb angle when the brace is worn. If you decide to see a chiropractor, he or she should conduct regular re-examinations and provide objective evidence that the treatment is effective. Avoid signing up for long-term care plans where exams will be done six months or even a year down the line; this is too long to wait for proof of results.
Most importantly, x-rays are mandatory when working with scoliosis; if your doctor does not take regular x-rays of your spine to measure the Cobb angle, this could be considered negligence and potential malpractice. Especially in skeletally immature patients who have the potential for growth remaining, scoliosis must be monitored closely for signs of worsening.
In addition to x-ray, re-exams should also include physical and functional assessments, such as lung capacity testing and posture pictures. Improvements in Cobb angle alone do not always correlate with improvements in cosmetic appearance or lung function, so it is important to have other methods of measuring these aspects of health.
Q: WILL THIS TREATMENT APPROACH GET ME THE RESULTS I AM LOOKING FOR?
Before you can ask this question of your doctor, you have to ask yourself what matters most to you, and what you would most like to get out of treatment. Many people with scoliosis undergo treatment because they want to improve their posture or appearance; others, because they want to prevent things from getting worse down the road. Everyone’s motivations for seeking treatment are unique, and it’s important to understand what yours are.
Once you know what you want, you should have a conversation with your doctor, and ask him if the treatment he or she is recommending is likely to be able to achieve the goals you have. As an example, impairments in lung function are the most common reasons for scoliosis-related work disability. However, even when surgery reduces the Cobb angle, it does not always improve lung function, and bracing can further reduce the ability of the body to breathe in and out. If your scoliosis is causing pain, you want to make sure that your treatment can help to relieve and reduce your suffering. The goal of treatment should be not only to reduce the Cobb angle, but also to provide you with the best possible emotional and physical well-being.
Q: WHAT ARE THE CHANCES OF SUCCESS?
No method of scoliosis treatment has a 100% success rate. Scoliosis is perhaps the most complex spinal condition that a doctor can work with. We know relatively little about all of the causes and factors that influence scoliosis. If your doctor appears over-confident, this could be a warning sign. A good doctor will be honest and realistic about what to expect, and what the chances of success might be.
With some programs, the degree of improvement is influenced by the degree of participation on your part. Even the best-designed brace in the world does not help a patient who refuses to wear it. Similarly, exercises are only beneficial if they are performed regularly. Be sure to have an honest conversation regarding the level of commitment and dedication that you are willing to dedicate to your chosen treatment method; if you do not have the time required to follow through, it may be better to select a different approach.
Q: WHAT CAN I DO TO IMPROVE THE CHANCES OF SUCCESS?
Some treatment approaches are passive; something that the doctor does to the patient, and there is very little that the patient can do to actively participate or get involved. In wearing a brace, for example, the patient can ensure that they don the brace properly and wear it for the recommended number of hours, but can do little else to improve their chances of success. With exercise-based approaches to scoliosis, the answer to this question is more evident: doing the exercises correctly and faithfully will certainly improve the chances of success. There may be other important considerations, regarding activities of daily living, workstation ergonomics, restrictions in sports or other activities, or additional potential influences that must be taken into account. Be sure to understand in advance what you can do personally to help (or hinder) your chances for success.
Q: WHAT IS THE PLAN IF THIS APPROACH DOESN’T WORK?
It’s always good to have a backup plan. Especially when working with cases of scoliosis in teenagers, who still have some potential for growth remaining, if one method doesn’t achieve the expected results, you cannot go back in time and attempt a different approach. If you decide to pursue scoliosis bracing, and it does not prevent the scoliosis from getting worse, will you decide to have surgery, or pursue an alternative approach? Similarly, is your chiropractor open to the possibility that if chiropractic care doesn’t work, you might need a referral to an orthopedic surgeon for bracing or surgery? It’s best to discuss and consider these possibilities in advance, so that no unpleasant or unexpected surprises arise.
The primary concern of your doctor should be ensuring that you receive the best possible care – not “chiropractors versus orthopedic surgeons,” but “us versus scoliosis.” If your medical doctor refuses to work together with your chiropractor (or vice versa!), you may want to consider switching doctors.
Q: WHAT ARE THE POTENTIAL SIDE EFFECTS OF THIS APPROACH?
Every treatment carries with it the risk of potential side effects. Immobilizing the spine can have negative effects upon the discs and the muscles. Scoliosis surgery, while generally regarded as safe, still carries with it the risk of wound infections, blood loss, and neurological deficits. Chiropractic care is no exception – some experts believe that certain types of adjustments have a small risk of causing vertebral hemorrhaging and stroke. Whatever treatment approach you decide upon, make sure you understand the potential side effects in advance.
Q: HOW WILL THIS TREATMENT AFFECT MY QUALITY OF LIFE?
The Cobb angle is not the only factor involved in scoliosis treatment; indeed, it is not even the most important. In a recent survey of scoliosis experts and patients, Cobb angle was not even in the top ten most important factors to consider when working with scoliosis. Much more important is how the treatment will affect your physical and emotional well-being – what doctors refer to as your health-related quality of life. If bracing were 100% guaranteed to prevent scoliosis from getting worse, some teenagers might still not consider it worth the social anxiety and isolation caused by wearing a brace around their friends and peers in high school. If the goal of treatment is to prevent problems from developing down the road, but the treatment causes problems to develop right now, the trade-off might not be worth it for some people.
Many people living with scoliosis are concerned about their appearance, posture, and the symmetry of their bodies – not every treatment method can improve these factors. If it is important to you, make sure your doctor knows it, and your chosen treatment method can help you with it.
Q: WHAT IS THIS TREATMENT DESIGNED TO AFFECT, OTHER THAN THE COBB ANGLE?
Most methods of scoliosis treatment are overly concerned with the Cobb angle, despite the fact that health cannot be measured with just one number. Will this treatment improve your lung volume? Reduce your pain levels? Help you sleep better at night? Increase your ranges of motion, and your body’s ability to function? All of these factors should be important to you when selecting a method of scoliosis treatment.
Q: HOW WILL I BE ABLE TO TELL THE TREATMENT IS WORKING, AND HOW SOON?
Your doctor should have ways to determine if your treatment will most likely be effective, or not. Competent orthopedists take in-brace x-rays to ensure that the fit and design of the brace is effective; scoliosis surgeons will take special bending or traction x-rays to evaluate how much correction to expect from the surgery. A chiropractor should be no different – if they cannot demonstrate objective improvement on an x-ray, and you do not feel any improvement in your pain or symptoms, you should consider finding a different chiropractor. There are many different braces, and many different chiropractic techniques – not all of them are equally effective when it comes to treating specific cases of scoliosis. For this reason, it is important to have a plan established before you begin care, and to be prepared to select a different treatment method if the first does not work within a pre-set timeframe.
Q: WHAT PERCENTAGE OF YOUR PATIENTS HAVE SCOLIOSIS?
This is a very important question to ask. Orthopedic surgeons and chiropractors can both specialize in different things; by definition, specializing in one thing means paying less attention to others. If a chiropractor specializes in nutrition, they might not be the best choice for scoliosis rehabilitation. Make sure you select a doctor who sees at least 50% scoliosis patients; the more patients they work with, the better they become in managing those types of cases.
Q: WHAT MEETINGS AND CONFERENCES DO YOU REGULARLY ATTEND?
If your doctor is an orthopedic surgeon, they should be attending meetings of the SRS, IMAST, ISSD, AAOS, NAS, or similar. There are meetings specifically on the topic of scoliosis in very young children (ICEOS). Doctors who prescribe braces or exercises should be familiar with SOSORT. Chiropractors should be aware of Parker Seminars, CBP or CLEAR. All of these organizations sponsor events where the brightest minds in the fields of surgical and conservative management of scoliosis present their research on the most cutting-edge treatment methods. They are opportunities for educational advancement and learning that are extremely valuable for clinicians and scientists alike. If your doctor has never attended one of these meetings, that could be considered a warning sign. If they have never even heard of any of these organizations, watch out!
Q: WHAT DO YOU KNOW ABOUT THE RESEARCH ON NEW METHODS OF TREATING SCOLIOSIS?
Innovation and advancement are positive forces; there is no excuse for a doctor to be ignorant of the latest research occurring in their field. Some doctors dismiss new methods as lacking in research or validity; this is true. Every new technique, when it is first introduced, lacks evidence of its effectiveness. However, no evidence of effect is not the same as evidence of no effect. William Paley famously stated, “There is a principle which is a bar against all information, which is proof against all arguments, and which cannot fail to keep a man in everlasting ignorance—that principle is condemnation prior to investigation.” An open-minded doctor who has his or her patients’ best interests at heart will be an ally in your search for good quality information, and should be able to point out additional treatment options which you might not be aware of.
Q: WHAT ARE MY OTHER OPTIONS IF I DECIDE NOT TO DO WHAT YOU RECOMMEND?
This can be a powerful question. If your doctor’s response is “There’s nothing else you can do, this is the only thing that can help you,” this could be considered a warning sign that your doctor isn’t putting your interests ahead of his or her own. At the very least, your doctor should be able to provide you with recommendations for referral to another scoliosis specialist who might be able to guide you in a different direction.
Q: WHAT WOULD YOU DO IF YOU WERE IN MY SHOES (OR IF THIS WERE YOUR SON/DAUGHTER)?
This is one of the best questions you can ask your doctor. It asks them to consider not only the scoliosis, but how the scoliosis and the treatment might affect your life and your future. Will this really be the best approach for you? Would he or she feel comfortable living with the long-term side effects of the treatment, or of doing nothing? This question also helps provide you with insight into your doctor’s level of empathy. If they can do a good job of placing themselves in your shoes and understanding what is important to you, they will most likely be able to provide you with the advice that is most appropriate for your specific situation.
Q: WHAT IS THE WORST/BEST CASE SCENARIO?
This question should help you to frame your expectations. Most cases of scoliosis can never be completely “cured,” but they can be successfully managed and controlled. You should know what degree of correction you might potentially expect, and also how the treatment might affect other aspects of your health, such as your pain levels, lung function, sleep quality, and physical activities.
It’s also important to know if there is a chance that the treatment will be ineffective, and to understand what the limitations of the treatment approach may be. Being aware of this possibility – as uncomfortable as it may sound – will be helpful in planning for and dealing with the worst-case scenario, if it comes up.
Q: WILL YOU CONTINUE TO WORK WITH ME IF I PURSUE OTHER OPTIONS?
Some doctors may refuse to work with certain patients; outside of the ER, doctors do have the right to dismiss patients or refuse to accept patients. If you are interested in being co-managed by two or more doctors, it is extremely important that the doctors are on good terms and communicate effectively. Poor communication in healthcare leads to duplication of tests and procedures, missed or delayed diagnoses, and aggravation for the patient.
Q: ARE THERE ANY OTHER SCOLIOSIS SPECIALISTS IN THE AREA THAT YOU WOULD RECOMMEND I SPEAK WITH?
If your doctor has been in practice for several years, chances are they have an established network of scoliosis specialists that refer patients back and forth, depending upon the patient’s preferences and individual case presentation. Consulting with more than one doctor helps to broaden your understanding of the various approaches to scoliosis treatment, and can make it easier to decide upon which treatment method you prefer by looking at comparisons and contrasts. Also, if your doctor is unwilling or unable to refer you to any other scoliosis doctors, this could be a warning sign as well.