E14: Structural vs Nonstructural Scoliosis

E14: Structural vs Nonstructural Scoliosis Image

Dr. Alex Greaux has been in chiropractic for more than 15 years and has been treating scoliosis since 2007. His advanced training and certification in scoliosis-specific chiropractic make him an excellent host for Episode 14 Structural vs Nonstructural Scoliosis.

Throughout Episode 14, episode host Ashley Brewer and Dr. Alex discuss:

  • The true definition of scoliosis
  • Why scoliosis is a complex and confusing spinal condition
  • The difference between structural scoliosis or nonstructural scoliosis, often referred to as functional scoliosis
  • Common signs of scoliosis
  • What to do if you suspect you have scoliosis
  • Why finding a provider with scoliosis-specific experience is imperative to a patient's success

Scoliosis is a complex and confusing condition, but Dr. Alex's experience and expertise really shine throughout this episode. If you or someone you know has recently been diagnosed with scoliosis, make sure you tune in.

Have a question or comment?

Do you have a question for Dr. Alex? Leave a comment below, and we'll make sure it gets to him. We may even cover your question on a future episode of Life Beyond the Curve.

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Episode 14 Transcript

Ashley B (00:00):

Hello, listeners! Ashley Brewer here, your host for episode 14. During this episode, I got to meet with one of the doctors from the CLEAR Board of Directors who practices in Miami, Florida, Dr. Alex. Dr. Alex has been practicing for over 15 years in the field of chiropractic. He also holds a degree in physical therapy from the University of Miami. Struggling to understand the complex and confusing condition of scoliosis eventually led Dr. Alex to complete his CLEAR certification. His clinic, South Florida Scoliosis Center, cares for scoliosis patients on a daily basis. They've worked with patients from Brazil to Croatia, Denmark, Dubai, Honduras, Mexico, Russia, The Bahamas, and Trinidad. One of the things I love about Dr. Alex is how much he cares for his patients. And I know that will come through in our conversation today. Episode 14, Structural Versus Non-structural Scoliosis with Dr. Alex, let's go!

Intro (01:12):

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!

Ashley B (01:53):

Well, Dr. Alex, thank you so much for joining me again today on Life Beyond the Curve. It's always great to have you!

Dr. Greaux (02:01):

Always great to be here. I had a great time last time, and I'm looking forward to additional ones.

Ashley B (02:07):

So the topic for today is kind of, it can get confusing. And that is, we are talking about structural scoliosis versus non-structural scoliosis. So before we dive into the difference between structural scoliosis and non-structural scoliosis, can you first for our listeners define what scoliosis is?

Dr. Greaux (02:32):

Scoliosis by definition is a bend in the spine if you're looking at it from the front, when it should be straight, right? So if you're looking at somebody from the front or you take an x-ray from the front or from the back of somebody, it should be pretty straight. Head lines up with the pelvis, and the spine in between is straight and not deviated. By definition, doctors look to call it by diagnosis when the curve is more than 10 degrees. So anything over 10 degrees, they will start to say, we've measured this Cobb angle at 10 degrees, your official diagnosis is a scoliosis. Which is really where the problem starts, right? Because now we have to determine, okay, you have scoliosis by definition, What's the next step?

Ashley B (03:15):

For sure. And so I know for it to be a true structural scoliosis, which is why you went through all of the training to work with people and help them, um, hopefully reduce that curvature, but there's one complicating element, and that is the element of rotation of the spine. And when there's rotation of the spine, that's when it's truly considered a structural scoliosis and not merely a posture-related issue. So in a recent article that you wrote for CLEAR Scoliosis Institute, you stated that non-structural scoliosis is when the spine appears to be curved, but the curve is most often related to a posture problem or irregularities elsewhere in the body. You go on in the article to talk about the easiest way to tell the difference between something that's really more of a posture or muscle problem, and a true structural scoliosis. Can you talk to me about how you as a doctor tell a difference between those two?

Dr. Greaux (04:24):

Yeah. So I'm gonna make this light and a little deep, because there are some doctors that listen to this podcast. Um, so as, as a doctor, you get advanced training to recognize, um, what condition you're dealing with. And that's really the great thing about CLEAR doctors, is they have so much advanced training that they're able to recognize this and tell you, Hey, this needs to be done because this is your condition, versus somebody who isn't familiar with scoliosis, whether it's an orthopedic doctor or another chiropractor, or just a general physician or a pediatrician, they might not know these things. So the advanced training is really important. So one of the things that you mentioned in the article, yes, I talk about rotation. And what does that mean? So in a true scoliosis, when you're looking at the x-ray, there is a rotational component that happens in the vertebral segments.

Dr. Greaux (05:19):

So we have, for the doctors out there, we have this thing called the spinus process. It's typically in the center of the spine. On the x-ray, you'll start to see those spinus, those spinus processes rotating to one side or the other. Um, so on an x-ray, the doctor looks for is a rotation of the individual vertebral bodies, not the body itself. So it's a key thing that people have to understand. The rotation of a physical person, if you're looking at somebody's posture, versus rotation of a segment inside the spine are two different things. So here's where it starts to get complicated. I don't want people to get confused. If you're looking at an x-ray, you will see those things in the middle called the spinus process rotate, and that is the first sign that it is a true scoliosis and not a functional scoliosis. So again, that is structural versus functional, okay?

Dr. Greaux (06:15):

So a lot of doctors still don't understand that, and it's a really important key to understand how you're going to treat this condition. So again, on an x-ray, you're going to see spinus rotation now, uh, for appearance, right? Um, how does a parent who doesn't have access to x-rays start to see functional versus structural, okay? Now, usually, and this varies, so don't take this a hundred percent, usually if you notice that the child or patient or whoever you're looking at has a postural discrepancy, and you start to think, Oh, I've seen those apps where it looks like this has scoliosis and I've measured the shoulders, or I see there's a shift here. Usually what happens is if you see a bend in the spine when the patient is standing, if they lie down and that bend goes away, you can pretty much say that is a functional scoliosis, meaning it is as a result of something else going on in the body. We're gonna get into that into a second, because that's the next question. So what causes a functional scoliosis? So again, if a patient, person that you're looking at, examining your son, daughter, uh, your significant other or friend, if, if you have them lay down and you see that that curve goes away again, it's not likely a true scoliosis, and therefore, by definition, non-structural or functional, which essentially means the same thing.

Ashley B (07:44):

So you've referred to functional scoliosis and within functional scoliosis, which is non-structural scoliosis, there are three different categories that are commonly referred to. We've already talked a little bit about postural, but can you get into what other things may cause more of a functional type of scoliosis? The one that would almost appear to go away if you lay down or bend forward?

Dr. Greaux (08:10):

Yeah. So functional scoliosis has a lot of different reasons, right? There's usually some kind of underlying mechanism for it. Uh, it could be something like a short leg, for instance, meaning somebody's leg length is often as a result of that leg length, one being shorter than the other. Think about it, the, the base of the spine, then isn't level. So there's going to be some kind of a shift. So that's the first, most common, um, one is a short leg length discrepancy. The next one is, uh, what's typically called, like, a pelvic obliquity if we're getting technical. But basically what you'll see is when somebody stands versus when somebody sits, the spine shifts, right? So if they sit and all of a sudden there's a big curve in their spine when standing there wasn't, there's some kind of imbalance that has to be addressed there, in through the pelvis, whether it's the mechanics or the position itself.

Dr. Greaux (09:04):

So that's another one. Um, after that, you can deal with people that are in pain, right? So somebody might have severe pain or might have a disc lesion or something like that. And as a result, their body is kicking them into a position to try and make it easier for them. But what happens is it's actually causing this functional scoliosis as a result. So if your back pain hurts, or you have back pain and all of a sudden it makes you bend to one side, that's your body's innate response to try and help you. So it looks like you might have a scoliosis and you don't. Now we're talking about the pain scenario, but if somebody has scar tissue, that's a possibility. If somebody has, what's called a Hemi vertebra or butterfly vertebra, which is, it's almost like a triangle, right? So if you look at the spine from any position, the bones of the spine are shaped like squares, and sometimes you congenitally, meaning from birth, will have a bone that grows different and it might look like a butterfly, or it might look like just a triangle on it's side and all of a sudden, because of that, the spine bends into another position as well.

Dr. Greaux (10:09):

So there you have four different possibilities just off the top of our conversation. Now there could be scar tissue involved, there could be altered biomechanics involved, but again, the key is finding a doctor who's familiar with treating this condition. Uh, and again, a CLEAR certified doctor has specialty training in this, again, not just a general physician or a chiropractor, because most of them don't see this as much as we do. Most of them don't have the training in this. So it's really important to identify it because you might go in and spend a ton of money on treatment, and at the end realize, well, you know what? You had a Hemi vertebra, it was never going to change, and it was never addressed properly. So we have to figure out what the condition is and then set up what the proper, uh, realistic outcomes are. You know, what, what are we looking at? What changes can we actually make? Is it a pain thing? We just make you feel better, it gets better? Or do you have a Hemi vertebra, and you're not going to be able to change it, right? That's what needs to be identified.

Ashley B (11:07):

And I think it's important that you differentiate that, like, special training that you went through. I am not a chiropractor, but I have been in the chiropractic profession for 12 years. And it wasn't until I started working with CLEAR Scoliosis Institute that I really understood scoliosis, and all--it really is, they say it's a complex and confusing condition. It really is complex and confusing. And that's where the level of training and advanced certification comes in and finding a provider or a CLEAR-certified doctor that has a very thorough knowledge and understanding of scoliosis is really important. So one of the things that I've learned is early detection of scoliosis is very, very important. And that's because it's a progressive condition. So whether it's structural scoliosis or functional scoliosis, can you talk to me about some of those body changes that either parents or a patient themselves may notice as ding, ding, ding, this may be an indicator that scoliosis is actually occurring in the body.

Dr. Greaux (12:18):

Yeah, that's a great question. So first of all, I do want to comment that one of the things that you said there, scoliosis is the most complex spinal condition known to man, right? It is like the most difficult condition that anybody will ever deal with when a spine, because it is so complicated and there are so many variables. Um, so, so that's first and foremost really important that people understand that, which is why that specialty training is necessary. So I'm really glad you pointed that out. So again, when we start to look at scoliosis in general, earlier detection is the best intervention, right? Because the second you see that there's something going on, is the second you realize that, Hey, I gotta do something about it, and the sooner I do it, the better. So, so let's start with, forget visually and forget examination.

Dr. Greaux (13:10):

Now, if you know that you have scoliosis in your family, okay, and this is something that is talked about a lot. Uh, it was believed that scoliosis, there's a genetic component to it. And they thought that there was some kind of lineage that some families have it. They don't really know. But if you know that in your family, you have scoliosis be it yourself, a sister, a mother, brother, cousin, gra-, grandma, sorry, same, same side, uh, has scoliosis, you have to be more aware of this, right? Really important that you're more aware when you have kids that you know that this is going to happen. Even if you have a family member, let them know, Hey, you need to make sure you can get your kids checked. Now, one of the things that they don't realize is there is a Scoliosis Awareness Month. And ironically enough, that Scoliosis Awareness Month is in the summer.

Dr. Greaux (13:58):

So you think it'd be like during school time, what would be best time to check these kids, but it's in the summer. So, uh, look for Scoliosis Awareness Month because that's a great time to get it checked out. Now, if you're going to assess somebody posturally to see, could this person typically have a presentation that I'm not used to? Yeah. So you want to look at what's normal. So normal is your shoulders are balanced, meaning one's not higher than the other, your hips or your pelvis are balanced, again meaning one's not higher than the other. And then the head is centered to the pelvis. So essentially your head should line up with your pelvis and your spine should be in line. One shoulder should not be higher than the other. And one hip should not be higher than the other. So if I'm looking at somebody straight on, that's exactly what it should look like.

Dr. Greaux (14:43):

Even shoulders, even hips, head over pelvis. So that is normal, right? Now, you can look at it from the front. You can look at it from the back. Now, the second you start to see a change in that position is when you should start to see, uh, or start to look at a little bit more and say, Hey, maybe this, maybe this is a scoliosis. Now, ironically enough, mothers have that mother's intuition, that they know when something's wrong. And I hear more and more than I can even say, a mom come in and say, you know what? The doctor missed it. But we were at the beach and I saw the way the bathing suit was hanging on Sally. And wow, I realized it. And that's why I brought her in. Right? So if you have that keen eye and we all look at our kids every day.

Dr. Greaux (15:28):

So, you know, when your kid is moving or shifting or growing, so pay attention to does one shoulder start to get higher. It is typically the right shoulder that goes higher and the left one goes lower. So it is a typical presentation for scoliosis to have that hip hop, I'm sorry, that shoulder higher on the right than on the left. So that's the first thing to look at. The next thing to look at is the pelvis. So the pelvis is the same thing. It kind of rides up on that side and you'll see that one goes a little bit higher than the other. Now with a thoracic scoliosis, meaning in the mid back, you will usually see what's called the scapula, which is part of the shoulder on the back. It looks like a little triangle. It starts to flare out a little bit, right?

Dr. Greaux (16:12):

If you're already seeing that flare out, you mean, it means the curve has already progressed, okay? So the sooner you catch it, the better. So if you start to see that, that's a great, uh, alarm system, right? There's a lot of apps out there that allow you to, uh, just take a picture of your kid and you can just draw a line across to your shoulders and make sure they're balanced into the pelvis. Um, you know, we do it in the office here where it, when a patient comes in, we take a picture and we show them what's center mass and what shifted. So they understand visibly. And then we take the x-ray. So the key is to look for, if you're examining your kid, you go ahead and you stand them up and look from the front, look from the back. You want to make sure their shoulders are balanced, their pelvis is balanced. And then at the back, you're going to do a, you're going to look at their shoulder to see if there's any type of flaring out. Right? So that's the key thing.

Ashley B (17:01):

So let me ask you a question. Cause I'm a mom, I have a 14 year old, a 10 year old and a 3 year old. And I feel like if I noticed these things in any of my kids, I would be like, Adella, why are you doing that? Just stand up straight, like, stop standing like that. Your posture is weird and funky. Do you find moms come into your office and say that? And, like, the kids aren't able to adjust themselves to make it appear normal?

Dr. Greaux (17:25):

Spoken like a true mom. Like, that is exactly what happens. They sit there and they'll fight with a kid and the kids say, but mom, I'm sitting up straight, dad, I'm doing it. And they can't. So that is exactly what's going on. This is not by choice. Their body's putting them in that position. So it's something that needs to be addressed, but that's exactly how people catch it, right? I'm gonna really quickly reference like another tool, um, on the phone, if you have an iPhone, because I do, and I'm not pitching iPhone, there's a, essentially a, a level or there's an app in the app store called a Scoliometer. So scoliometer is scolio, S C O L I O and then M E T E R. And it's a really simple way, especially if you know that you have it in your family, to measure your child, and it'll run you through a step-by-step process where you basically have your kid bend over and you put the, the level right where their spine is and it takes measurements. And that measurement typically, when you see seven degrees on that level, you start to say, Hey, now you really have a scoliosis, but any deviation, uh, seen, other than zero, you should get it looked at, go to a professional, somebody that's trained. And it's a really easy way to manage and monitor. I don't even know the fee and I know there's a bunch of them out there. So any one of them works, essentially. It's just making sure that you have some kind of tool to help you,

Ashley B (18:48):

Or if you suspect it, you go to a professional, somebody who knows what they're doing. So, so you've talked about the posture-type things that we would notice and differences that we would notice there. And we've also talked about it being a complex, confusing condition that often involves rotation of the spine. And for that reason, we often hear scoliosis referred to as a three dimensional condition. Can you explain exactly what that means?

Dr. Greaux (19:19):

Yeah. So again, when we're dealing with the scoliosis, it is the most complex spinal condition. And this is why, if it is not, um, if you're not with somebody who knows what they're doing, it really can become a disaster. Part of our treatment protocol in office is to address not just the fact that you have a bend in your spine, but that there is a rotatory component to it, or rotation that happens in the spine. Uh, if you happen to come in for treatment, you'll notice it. Part of the exercise is what they're doing is they're doing de-rotation of the spine and elongation of the spine. That is the only thing that will help try and reduce a curve. Right? So why has traditional bracing, for instance, not been successful in treatment while traditional braces originally were just kind of built to push the spine to center.

Dr. Greaux (20:17):

So if you look at a scoliosis and a typical scoliosis looks like an S shape, you think that, Hey, it's really easy, just push on the high side on each part of the curve, right? And push to the middle, and that's how you get it in. Well, it's much more complicated than that, than that, but essentially with a brace, that's what they did. They said, let's put this can around you and hold it tight, and just hope that, you know, it doesn't get bigger, right? So that was a component, but it doesn't work that way because there's actually a rotation that's going on. So in our treatment protocols, whether we're using bracing, whether we're using, um, you know, home exercises and what we do in office, the whole goal is to deal with eliminating that rotation. Right? So it's really important that it's addressed with a professional that knows how to do it.

Dr. Greaux (21:01):

Even our braces are different. It's some of the doctors use what's called a ScoliBrace. These braces are considered a corrective style brace. They are modeled after a Rigo Chenault style brace. It is the most effective bracing method out there. Uh, it is far more, uh, correcting than any of the braces out there. Uh, it is just an example of treatment to help, not just maintain a curve, but reduce the curve, right? Because everybody wants to say, Hey, I want to get this curve as low as possible. What do I do? Well, we got to figure out what needs to be done. But the eliminating eliminating that rotation is a key component. Now think of the spine. When you go to a doctor, they usually take one x-ray, right? And that x-ray is you from the front. And they want to say, Oh, look, you got a scoliosis, but it doesn't tell you anything. Right? Our doctors are trained specifically to look at it from the front, from the side, from the back, because look top to bottom, over somebody's head who has a scoliosis, and you will see that the spine rotates, the ridge rotate. That three dimensional component makes it really complicated, and it has to be addressed properly to make your best attempt at helping to reduce a curve.

Ashley B (22:13):

So you've hinted a little bit at the way that you treat scoliosis in your clinic and talked a little bit about your pre treatment approach. Does that approach change? If you're dealing with a true structural scoliosis with rotation versus more of the functional scoliosis, that's more related to a posture, another imbalance, or is it similar?

Dr. Greaux (22:36):

No, I it's, it's absolutely different, but it's also similar. And I know I'm giving you both answers there, but you got to address the problem. Like, what is the cause of the condition first? There is some things that we will be doing that will overlap, and then there might be completely different things that we're not doing. Right? Um, so again, it's really making sure that you get the proper diagnosis and it has to be done by somebody who actually understands this condition and deals with it on a regular basis, which is why, again, it's so important to sit here and say, you got to find a specialty-trained doctor. These CLEAR doctors are advanced in that they have so much more additional training in this. So obviously I'm going to put emphasis on seeing these doctors, however, if not go to a scoliosis specialist, uh, somebody who knows what they're doing and not just somebody who sees one every year, right? That's not a specialist. I mean, we do this all day, every day, you know? So it's, again, a matter of going to the best person that can do best for the patient, whether it's your child, whether it's yourself, whether it's a family member, a loved one, it doesn't matter. Just make sure you get them to the right clinician.

Ashley B (23:43):

So if somebody listening today suspects or notices postural changes, either in themselves or in their child, what if you could just give them one piece of advice, what advice would you give? Say to me as a parent, if I notice something is off with my child's posture?

Dr. Greaux (23:59):

Well, the first thing I would do is really easy: call CLEAR Institute, go to the website, find a doctor that's close to you. Look and see if there's one close to you, if you're lucky enough to have one close to you, go to them. Okay. That's the first step. Okay. If not, you know, find a specialty-trained physician that does this, right? But I will tell you, you've got the apps as resources to see, you start to notice something you want to say, Hey, I want to get this, checked out, get an x-ray, okay? Find somebody who will take an x-ray. And sometimes people are really conservative, but I got to tell you, you got to get this done the sooner, the better, the second you know your diagnosis, the second you know this is what you're dealing with, the better the outcome for you, because the sooner you get to it, the more chance you have of managing the condition correctly.

Ashley B (24:47):

I think that is very well said. Um, early detection is key and find someone who deals with scoliosis on a regular basis. So, Dr. Alex, it's always great to have you on the show. Thank you so much for joining us today.

Dr. Greaux (25:03):

Thank you for having me, have a great day.

Ashley B (25:05):

Yeah, you, too. Thank you much. If you're looking to find a CLEAR-certified doctor near you, like Dr. Alex mentioned in today's episode, you can call (866) 663-7030. Again, that number is (866) 663-7030, or you can simply visit clear-institute.org. There's more to come next week.


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Author: Dr. Alex Greaux

Dr. Greaux has been a practicing Chiropractor for over 15 years. He received a Doctorate in Chiropractic from Life University and a minor in nutrition from the same. He also holds a degree in Physical Therapy from the University of Miami. He has been certified to treat scoliosis since 2007, and in this capacity has helped countless scoliosis patients achieve successful curve reduction results. In 2013, he realized the unique distinction of being CLEAR™ certified in Intensive Care Treatment of Scoliosis. Throughout his career, Dr. Greaux has had the good fortune of working with the NBA Miami Heat, rehabilitating injured players, as well as treating numerous college and high school athletes. Dr. Greaux is a member of the International Chiropractic Scoliosis Board.
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