Listen to Life Beyond the Curve Episode 1 to learn more about the answer to the question should I wear a back brace for scoliosis pain?
CLEAR-certified chiropractor, Dr. J Hartley, has a unique story because in addition to treating scoliosis, he also has scoliosis. He was diagnosed as a teenager and upon diagnosis, he was told to simply watch and wait or pursue surgery. Given these two options, he decided to wait. It wasn’t until years later when his own daughter faced progressive scoliosis that he found CLEAR Scoliosis Institute.
During our very first episode of Life Beyond the Curve, Dr. Hartley shares his story and discusses the frequently asked question, should I use a back brace for scoliosis pain? As someone who was recently fitted for a corrective scoliosis brace, Dr. Hartley has a lot to share on this topic. We hope you'll tune in and enjoy the show!
You can learn more by reading Dr. Hartley's blog article, Should I Use a Back Brace for Scoliosis Pain?
If you have questions or topics that you would like to see covered on a future episode of Life Beyond the Curve, leave a comment below.
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I'm Ashley Brewer. Today's host for our very first episode of our brand new podcast. When I had the opportunity to record this podcast, it was simply amazing to hear from our co-host because he not only was diagnosed with scoliosis as a teenager, he was told to simply watch and wait or pursue surgery. When he was given these two options, the option that he decided was to wait. Now for this co-host, it wasn't until years later, when his own daughter was diagnosed with a very progressive case of scoliosis that he found CLEAR Scoliosis Institute, he's now a board certified chiropractic neurologist, he's been practicing for 28 years, and is currently in St. Augustine, Florida. He's specialized in scoliosis detection, prevention and reduction for the last six years. When I recorded this episode, I was with Dr. J Hartley, and I found his story to be so amazing. I hope that everybody listening today enjoys it as well. So episode one, here we go!
You're listening to Life Beyond the Curve. A podcast brought to you by CLEAR Scoliosis Institute. Each week, we interview experts in the industry, answer your pressing questions, and empower you to take control of your scoliosis diagnosis and live life to its fullest. Enjoy the show!
Dr. Hartley, thank you so much for joining us today.
Hi, Ashley. Glad to be here.
Now, Dr. Hartley, this topic is a really interesting one for you because not only do you have scoliosis, but it's my understanding that you were recently fitted for a corrective scoliosis brace. Tell me a little bit more about how you got to where you are today.
Okay. Well, that's a long story, but I had scoliosis as a teenager. When I got to chiropractic school, they diagnosed me with a 68 degree adolescent idiopathic scoliosis. I had no symptoms, and really there wasn't much that they would do for it, but I did come across some corrective biomechanical techniques that worked to stabilize those curves, not just wait until you're hurt, but try to take care of things and make it better before you hurt. So that was always the focus of my practice. There just wasn't a technique out there that matched what my, my dream was. Then, when my oldest daughter was 12, she developed a progressive scoliosis. We were trying things, but it just wasn't working. We took her up to the CLEAR Institute in St. Cloud, Minnesota, she got good results.
Then I actually was so excited about her results, that I went through the treatment and then I actually decided to get certified. At that time CLEAR wasn't into bracing. There really wasn't a good form of bracing out there, but in the last few years, there has been an evolution of that. Now there's a company called ScoliBrace, which makes a 3d super corrective or over-corrected brace, which basically mirror images, your spine three-dimensionally to correct the scoliosis. So I've been doing it at my office for several years, but I'm the one that does the scanning. Recently I was at a school, a CLEAR Scoliosis Institute training that was focused on bracing and the founder and developer of ScoliBrace was there. I had him do a scan of me. The process is you do a three dimensional structural scan of your body. Then an engineer looks at your posture, pictures, x-rays, and flexibility and comes up with the best brace for you. I just had mine made two weeks ago - or the process started. I haven't received it yet, but I've been really excited about the possibility of doing it the last couple of years. I just couldn't scan myself. So I had the opportunity to get scanned and am looking forward to getting it and being able to work on my scoliosis more.
Well, that's very exciting for you. Now back braces are one of the most common treatments for people suffering from scoliosis pain. So let's just talk through that a little bit. What are the different types of braces out there for individuals with scoliosis who may be experiencing pain?
Okay, well, you have braces that are just for people that have low back pain. The person may just have disc type pain, low back pain, or leg pain, and they're just putting a brace on because it feels better when they put it on. It's kind of holding everything in a place. You'll see somebody, if they work at Home Depot or Lowe's where they just kind of strap it on when they lift something. But if somebody is hurting, a lot of times they feel better when they're wearing that. Okay. That's one kind of brace. For scoliosis, there's the Boston brace, which is kind of like a sleeve and it just tightens your spine. It's more preventing your spine from getting worse than correcting it. If you have a very small curve and you take an X Ray with the brace on, it's going to typically look better from the front view, but from the side view, it doesn't enhance the curves.
You should have a forward curve in your neck, a backward curve in your mid back and a forward curve in your low back. The Boston brace, typically on the x-ray will look like it's straightening you from the front, but if you took an x-ray from the side, it's actually flatting and taking all of those curves out. We know from research in Europe that that mid back curve kyphosis going backward is very important into resolving scoliosis. So when you wear the Boston brace, it actually could be causing scoliosis to be worse when you're out of the brace. Then you have the soft brace, which is companies like SpineCor. They've never really done a study with SpineCor as far as showing correction with the brace. It's meant more for smaller curves. It's meant for staying active and moving with your scoliosis.
But, it's not really a corrective system. Actually the developer of ScoliCare used to work for SpineCor. So he ultimately knows the benefits and strengths of SpineCor, and he chose to develop another brace. The third type of bracing, which was started in Italy by some physical therapists that were working with scoliosis - the theory of it. They were doing serial casting where you actually had to lay casting and material around the body, kind of trying to form it into the correction of the scoliosis and then build a cast off of that. It was very cumbersome. So with the ScoliBrace has done is they've created a structural scanner that makes a hologram of your body. And then you, the engineer looks at that with your posture, pictures and x-rays, and actually mirror images them. So it works on putting your body in the opposite position.
So if you had a lot of flexibility with a small curve and you went in the ScoliBrace, you would actually see a reversal of the curve. That's the theory of it, so it's an over-corrected or super corrective brace. If you have a smaller curve, when you're in the brace, your curve will actually be reversed. If you have a large curve, the curve will all be reduced down, but it's also preserving the sideways curves and reducing the rib arch all at the same time. So that's why they use the term 3D brace.
How can wearing a brace like that help with your normal routine as you go through life on a daily basis, especially if you typically experience pain associated with your scoliosis?
We have a testimonial on our website. The website is drjhartley.com. One of our patients, they did a testimonial on there and she had lower back and leg pain and foot drop, and she went to Mayo and they said, yeah, you have a herniated disc, but you have this adult progressive scoliosis, and there's a lot of instability, there's ligament damage. And we can't just do a small surgery on the disc. We're going to have to do full spinal fusion. And so she was like shocked because she wasn't going there thinking she was going to hear that. So on her way home, she started doing research on scoliosis in her area, and she found my office. She came in and she went through intensive care and also got the ScoliBrace within a few weeks. All of her symptoms resolved, the foot drop went away. She actually spends the summers in New York, so she didn't come back to my office for a year. Her symptoms were gone the whole time, except for when she went back to New York the second year, she forgot the ScoliBrace and her symptoms came back.
Wow, that made that big of a difference for her. That's a pretty remarkable change and unfortunate that her symptoms came back when she took the brace off.
Yeah, so it's not that she wears the brace all the time, like as an adult with a large curve. So an adult with, let's say a 40 degree curve or bigger therapeutically you would wear the brace several hours a day. We actually do some exercises in the brace. We want you to be active in the brace. We have another patient that couldn't wash the car, couldn't cook dinner, couldn't wash the dishes, couldn't do yard work. He got the ScoliBrace, and he went from being able to work 10 minutes at a time in the yard to working two hours of time. So it can have a very significant change. You want to be active in the brace even though it's a hard brace. You can move in the direction of the correction, which helps the correction. So you want to be as active in the brace is possible.
So when you say that, do you mean like active, like doing sports or what do you mean by active?
Everybody's individual depending on where your curve is, the brace is built a little bit differently, but a lot of people with, like, let's say adult degenerative scoliosis, that's a lower cut brace, and people can do pretty much everything with it on.
Awesome. That's great to hear. Now we're talking today about braces associated with pain, but is pain. The only reason that you would use?
When we take the X rays and we see, hey, this is a scoliosis patien, and then we do our orthopedic tests. We start to see that a lot of the people don't have the typical orthopedic tests for back and leg pain. Then we start to think the scoliosis is the pain is coming from the scoliosis. So if the pain is coming from the scoliosis, if we just put them in a normal back brace, like you see a guy wearing at Home Depot that may help them feel a little bit better, but it's not going to help to stabilize the scoliosis. The 3D brace in an adult helps to reduce the pain, but it's also helping to reduce the cause of the pain.
Okay. Now, you've talked a couple of times about an over corrective brace or a super corrective brace. So can a brace used by itself actually fix scoliosis?
Well, it depends how big the curve is. If you have a smaller curve, like if you braced the patient with a, let's say a 15 or 20 degree curve, and they were nine years old or 10 years old, then there's a chance that just bracing may create a significant improvement in the curve. Now, the CLEAR method, or mix, fix, set, is a combination of mix, which is getting the spine more pliable to change it back to normal, fix which is a very specific adjustment, and set which your exercises, which get everything to your spine to hold. So when you talk to bracing people and people at the ScoliBrace, if the patient is under the care of a CLEAR-certified doctor and they're using ScoliBrace, they're going to see more flexibility in changes than they would if they weren't. It's just like I've had patients get scoliosis surgery with severe curves, like patients that have a 90 degree curve, and then we ended up referring them for surgery. The surgeon told the patient that this was the easiest surgery that I ever had done because of the flexibility and strength that they had developed before the surgery. So, when you combine the brace, which is stabilizing and correcting with the CLEAR method, which is flexibility and strengthening, it's like a match made in heaven.
Bracing in and of itself is not a part of the CLEAR method. However, what we've found in working with the doctors that we work with is that it supports and helps that entire process. So in evaluating a patient, what are some of the different things that you look for to determine whether or not the patient would be a good candidate for a corrective brace?
Well, if we're looking at an adult, which are more of the people that have the scoliosis pain, one of the biggest things we look for is lateral listhesis. That's where the vertebra, one vertebra on the top, just slide sideways, and you can see some very significant ones where like one quarter of the width of the vertebra is hanging off of the other vertebra. So there's a constant stress there that just doesn't go away. Then the patient will tell you, you know, when I wake up in the morning or at three o'clock in the afternoon, I just always get that pain. So we'll recommend that they put the brace on when they wake up or before they get that three o'clock pain. And it's kind of, it's breaking that pain cycle. It's not going to correct the fact that they have that damaged ligament or lateral listhesis in they're back, but it helps to stabilize. It gives the body a chance to heal and regenerate because the body's working so hard with that ligament instability. There's a lot of toxins that get built up in that area and a lot of neurological pain reflexes, so there's just a constant pain cycle. And when they put that brace on, it gives everything a chance to rest and heal. And then when they do their other exercises that we've given them, there's less toxins and pain there. So it just works well together.
You know, that's really interesting. Because when I first kind of started in this and started hearing about bracing, my immediate thought was that it would actually cause more pain, not work to alleviate the pain, but what you're saying there is it allows the body to rest and heal. And that makes a lot of sense. So that's very, very interesting. Now I want to go back to a question that I asked you and I kind of feel like I heard the answer, but maybe not correctly. Can a brace alone fixed scoliosis? I think what I heard you say is that it depends on the degree of the curvature, is that correct?
Yeah. I mean the Italians, which kind of started this idea of a 3D hard brace, they have some longterm research now, which doesn't include much exercise. It shows that if people have a proper fitting brace, meaning two things determine whether a brace works good - your in brace X-ray like, how much extra correction you got in the brace on the x-ray, and also how many hours a day you wear it. So the better the in brace correction and the more hours you wear it, the better the correction. So if it's a small, less complicated case, then some of those people do good in the brace, but if it's a more complicated case or a larger curve, then they're going to do much better if they're combiningexercise and the specific chiropractic with the brace.
Yeah. So it sounds like it works well together. The CLEAR method and bracing work well together, I've heard you say more flexibility, more changes.
We don't like to use the term fix because scoliosis is like something that you're susceptible to get during your life. You may go through different periods of time of it getting worse or better. So, if a child, you know, completely gets the scoliosis resolved before puberty, and then when they come out of puberty, they still don't have a scoliosis, chances are that really was a fixed scoliosis. Okay. But what usually happens is let's say you're at 40 degrees and they're recommending surgery and you go through our method and the bracing, and a year later you're stable, like 25 degrees, right? Your scoliosis wasn't fixed. You had a reduction of the scoliosis, it's stable at a smaller curve. We're going to recommending a certain number of hours in exercises of bracing and exercises, just as prevention, kinda like retainer. If you were to get orthodontic work done at a dentist
Out of curiosity, you've referenced like several hours a day. What, how often does an average person who has a brace? How often do they wear it?
If they're going through puberty, we're going to be recommending 20 hours a day. If they're an adult at the beginning, they may use the brace, just like we use an adolescent to try to get as much correction as possible, but eventually we're wearing it more as an exercise and maintenance of the curve. So they can be, like I said earlier, putting it on prior to those painful times. Our practice is near the beach. So the patient will tell us before they come and see us that if I walk more than a hundred yards, a half a mile, a mile, whatever the pain gets unbelievable. So we might have those patients go for their morning, walk with the brace on and they never get that pain in the morning. Then usually at three or four o'clock in the afternoon, they also get the pain. So we will have them put the brakes back on at that time. And then they may do some exercises at another time during the day with the brace on. So it prevents that pain cycle from ever happening. And so those are, and then if it's a younger person, as they're weaning off the brace, they may wear less. So the first step would be after 12 to 18 months, they're holding the correction. They may just start to not wear it at school. Then the next step would maybe they only wear it at night. You know, something like that. So
You mentioned night, you mentioned 20 hours a day. So that means they can sleep in it?
Wow. That's amazing. I don't think I would've ever thought that. That's awesome. So, now let's transition a little bit like into advice. So if you had one piece of advice on using a brace with scoliosis, whether it's for someone who's currently in a brace or someone who's just pursuing their different treatment options, what would that advice be?
Well, if we're talking about a young person, you have these hormones in your body. So if you start the bracing before you go through puberty, then you can actually use those hormones to make the correction. So early intervention is very important. If you are an older adult, the curve can go through a dramatic increase. So you might have an adult that has a 10 or 15 degree curve. They're not aware that they have some ligament damage or a lateral listhesis , because the curve is just small, but then they may go through a dramatic acceleration of the curve. It might go from 10 to 20 to 30, then 40 degrees in a matter of months or years. And so the sooner they get diagnosed and determine if a brace would help in their situation, the earlier the curve can be stabilized. So they won't grow and progress.
Awesome. So intervention sooner rather than later, sounds like the way to go. So thank you so much for joining us, Dr. Hartley. We hope to be able to have you join us again in the future.
All right. Thank you, Ashley.
Now I know that many of you are listening in your car or listening at the gym. You can give us a call at (866) 663-7030 for help finding a CLEAR doctor, nearest you, who can perform a complete evaluation and determine whether or not you're a good candidate for a corrective brace. Again, that phone number is (866) 663-7030. And we definitely hope to hear from you soon.
Well, everybody thank you for joining us on our first episode of life, beyond the curve. There's more to come next week!
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