During Episode 16, host Ashley Brewer and CLEAR-certified Dr. J Hartley go back to the basics to discuss what does scoliosis mean? If you or someone you know has recently been diagnosed with scoliosis, this is a great place to start.
As someone who was diagnosed with scoliosis as a teenager, Dr. Hartley is an excellent host for Episode 16. Enjoy the show!
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Hello, listeners. I'm your host, Ashley Brewer. Today I had the opportunity to meet with Dr. J Hartley to record episode 16, What Does Scoliosis Mean? Being diagnosed with scoliosis as a teenager, Dr. J Hartley is no stranger to the topic of scoliosis. In fact, his own daughter has scoliosis, too. When she was facing progressive scoliosis at the age of 12, Dr. J Hartley first found the CLEAR Scoliosis Institute. His daughter went through care at a CLEAR Scoliosis Center, and since care, she has been able to return to two things that she loves: running and soccer. After seeing his daughter's amazing results, Dr. J Hartley also received care and went on to complete his CLEAR certification. As a chiropractor, he has been focusing on scoliosis detection, prevention, and reduction for over six years. His clinic, Hartley Chiropractic and CLEAR Scoliosis Center, is located in St. Augustine, Florida. So without further ado, episode 16 with Dr. J Hartley. Let's 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.
Good morning, Dr. Hartley. Thank you again for joining me on Life Beyond the Curve today.
Thanks, Ashley. It's exciting to be here.
So today we're going to be taking a deep dive into the topic What Does Scoliosis Mean? Since this is a scoliosis podcast, obviously this is a topic that we've talked about many, many times before on the show, but I thought this would be a great episode for people to go back to if they've recently been diagnosed. So let's start with the very, very basics. Can you start by defining scoliosis for us?
So, um, in order to be diagnosed with scoliosis, you have to have two things. One, on the front view x-ray, you have a tilt of, um, 10 degrees or more when comparing the top of the curve, steepest vertebra and the bottom of the curve, steepest vertebra. And they draw a line at the top of the top one, bottom of the bottom one, and where those intersect, the angle that's created is called the Cobb angle. And if that Cobb angle 10 degrees or higher, then you have a scoliosis. There's also a rotational component. And when we look at an individual vertebra from the front, in the middle you have the spinus process, that's like the straight line. And those are like the bumps you feel in the middle of your spine, you know, kind of one bump on top of the other. And if that spinus is rotated and you have the tipping at the same time, then that's considered a scoliosis.
And now, I've often heard scoliosis referred to as a very complex and confusing condition, partly because of that rotation, partly because of the degree of curvature and partly because of progression. So when it comes to classifying scoliosis, there are different levels of severity. And from my time working with CLEAR-certified doctors, it's my understanding that the level of severity of an individual's scoliosis will often help dictate the type of treatment or approach for treatment that that patient would receive. Can you talk to me about the different levels, mild, moderate, severe. I know some people will use very severe or extreme scoliosis. Are you able to shed a little bit of light for someone who's either been newly diagnosed or is just researching scoliosis on what those different levels or severities of scoliosis look like? You've obviously already referenced 10 degrees being a scoliosis. Can you dig a little bit more into that?
So, mild is considered 10 to 25 degrees, a moderate's 25 to 40, severe is 40 degrees and above. And some people may talk about, um, 80 degrees or more as the severe curve. Those are a little bit, um, rare.
Do you work with patients of all of those levels in your office, or what what's the most common for you to see at your clinic?
Yes, I think, um, well when you approach 40 degrees, that is when surgery is commonly recommended. And I think it's probably the most common would be people approaching 40 degrees because they're trying to avoid surgery.
That makes sense. Yeah, for sure.
The other group is the 10 to 25 degree group, because that group they're commonly told, watch and wait. And so some parents want to be more proactive. And so when they do research, they'll discover either my website or the CLEAR website, and they'll say, you know, here are some things we can do prior to getting to the point where surgery is recommended or bracing is recommended. And so I think that's a growing group because people are, are being proactive because when they hear let's watch it and we'll wait, if the curve goes over 25, we might recommend bracing. Or if it goes over 40, we might recommend surgery, CLEAR offers something that you can do proactively trying to prevent that. And the best results are the preventative. You know, it's easier to, to control and reduce the curve from 10 to 25 degrees than it is one from 40 to 80 degrees.
I wish that more people knew about CLEAR and that there are other options because I remember my best friend growing up, she was telling me exactly what you're saying. She had been diagnosed with scoliosis and she was basically like, we just wait until I need surgery. And I'm like, what do you mean you wait until you need surgery? How is that the only option? And now here I am years and years past high school saying there is another option out there for people. And so thinking of back to the basics with scoliosis, what are some of the symptoms or signs that somebody may have scoliosis that either someone can look for themselves or a parent can look for? What are some of those ding, ding, ding, red flags, something might be going on here?
Well, one of the, the problems is that some of the things you don't see until a curve progresses quite a bit. So, um, we do a screening at our office called the Scolimeter and we're, um, doing a measurement of the spine with, uh, basically like a level. And when we do a school screening, we use that. And if that is showing a three degree change in the, in the ribs or more, then that typically means there's a 10 degree curve on the x-ray. When somebody just has a school screening and they're just eyeballing it, by the time you see a rip arch, commonly, that's going to be already at 25 to 40 degree curve. And it's, and it's hard to see. So typically, kids either have a school screening or they are at the pediatrician and they will notice this things. And then they'll either say they're going to watch for a couple of months or they go ahead and do an x-ray. The problem is that's when the curve could actually be growing and getting worse. And so you're missing that opportunity, uh, early intervention.
So you've talked a little bit about using a, is it, what is it a scoliosis scolio. Scoliometer. Okay. I always want to say scoliometer, scoliometer. Okay. So you've talked about using a scoliometer. Can you talk to me about three different tests; one, the Adams test, two, the Risser-Ferguson test, and then you kind of already talked a little bit about the Cobb angle, because I know that those are three fairly common methods that a practitioner would use. If say, if my daughter is diagnosed with scoliosis at a school physical or something, the doctor would then do these tests to confirm a scoliosis diagnosis. Can you talk to me a little bit about the Adams test, Risser-Ferguson test and the Cobb, a little bit more about the Cobb angle measurement?
Yeah. The Adams test is when you're, you have the patient bend down and touch their toes, you're standing behind them, and you will notice that there is an unleveling of the ribs. One rib will be humped or arched, and that's an indication that there may be a scoliosis and commonly people will be, you know, in Florida, we're in our bathing suits more often, but let's say you're, you know, in the Midwest and it's cold most of the time, everybody's wearing layers of clothes, heavy sweaters makes it harder to see these things. And then when Memorial day runs comes around and people put their bathing suits on, all of a sudden, the parent notices that there's a postural shift, a high shoulder, a high hip, and a rib arch. And that's a really common thing, you know, around 12, 13 years old, that you didn't see it when they're 11, and all of a sudden you see it when they're 12. So a lot of these things are noticed by the parents and it may be in between the school, um, scoliosis screening or the pediatrician visit.
It's interesting that you bring up that you're in Florida and I'm in South Dakota. I was just talking to someone a couple of days ago about June being Scoliosis Awareness Month. And he's like, I feel like it's so weird that June is scoliosis awareness month. And in my mind, I'm going, June is the first month we wear bathing suits here in South Dakota. So of course it's going to be Scoliosis Awareness Month, because you're going to be a lot more able to see those things going on then. So sorry for that side tangent. But I thought it was interesting you brought that up.
The, the Risser-Ferguson is, has to do with bone maturity. So when you're, it's a arch that, that appears over the top of the hip or the ileum, and there's a, um, growth play that ossifies. And so when it's not there in, let's say when you're 10 years old, you don't see anything. And then when you're like 12 years old, you may see part of an arch, that would be like a Risser 1. And then as you get older, going to like 14, it'll go from Risser 1 to Risser 2 to Risser 3, Risser 4, Risser 5. And when it's Risser 5, that growth plate fuses onto the ileum. So that tells us how much growing the person has to do.
So I'm gonna, I want to try and put this into like super layman's terms for our listeners. So, and I might totally fluster through this, so just bear with me here. So you're looking at an x-ray of, it's kind of the person's hips, correct? And within that x-ray you can see, semi-see their growth plate area and there's like a little mark, correct?
And so, based on where that mark is, it will tell you where the individual is within their growth phase in life.
So if your curve, and this is shown to be less accurate, you know, and typically if you would go to Children's Hospital and let's say you had a 30 degree scoliosis, and you're 14 years old previously, they would just say, you know, you're a Risser 5, you're done growing, you're 14 years old, we don't need to do anything. But there are still a percentage of those people that the curve continues to progress. So it's important to watch that through high school and even the beginning of college. We have had patients that continued to progress at different points in there. So just because it classically, if you're a Risser 5, you're 14, they think the curve's not going to increase. That doesn't necessarily mean that it's not going to increase. It's still something that needs to be monitored, um, very closely. If you have a large curve and you're like, Risser 1 or 2, then that's very concerning because if you're 12 years old, you're, you're Risser 1 and you have a 40 degree curve, there's a likelihood that that curve is going to progress. So, so that patient is, is, you know, very much in danger of ending up getting scoliosis surgery with a larger curve.
So you kind of already described the Cobb angles. So because we're on Risser-Ferguson test and you just brought up scoliosis progression, let's stay right there, because I think progression of scoliosis is one of the things that makes it difficult to understand. And a lot of people don't fully understand what it means when we say that scoliosis is a progressive condition. You were just hinting at it, where when that individual is a Risser 1, they already have a very large curve. They are at a high probability for growth because for growth, both of their body and their curve, because their body is growing. Can you kind of explain that concept a little bit more?
Well, there's, there's growth factors that are laid down into the curve, and typically they're more active on the outside of the curve. So it, whatever curve you have, it's going to tend to become a larger curve, um, as you go through puberty. So, um, and if you are a progressive scoliosis case, some people feel guilty, you know, did I miss something, but it can be simply as, you go to the pediatrician, they really don't see anything. Cause there really isn't anything there. And then you go back six months later and all of a sudden you have this rib arch and, and we've seen these things progress very rapidly. I've seen x-rays, you know, over a two to three month period of time, a curve increased 25 or 30 degrees. So, um, it's not that anybody did anything wrong. You're, if your body's predestined to have this progressive growth of scoliosis, it's just something that you have to detect and then take action as early, as you can,
I was talking to somebody just yesterday about that and about how we as parents, um, we, we know our kids and we know how they sit, we know their posture, we know everything about them. And so I was saying, if I, all of a sudden saw my daughter and her right shoulder was way higher, what appeared to be almost overnight, which is kind of what you're explaining is possible. Now, obviously it happens over time, but it can seem like it happens overnight. Thinking of me as a mom, I'd be like, Oh, Adella, stop sitting like that, stop standing like that, like fix yourself here. But they can't, if it is a true scoliosis.
Right. Or we'll have parents, you know, or my mom always told me to, you know, straighten up type of thing, but it's a subconscious thing, it's out of your control, and, um, you know, that's why people like us exist.
So we kind of stuck to the basics for this episode and we need to wrap up, but I do want you to give some advice. So if there is someone listening who suspects they may have scoliosis, or has just recently received a scoliosis diagnosis, what would your greatest recommendations for them be, Dr. Hartley?
Well, the best thing is to, you know, get started right away and to monitor the curve. So if a doctor tells you, I think I see something, maybe we'll do an x-ray in a couple months, I'd go ahead and get that x-ray sooner, because you miss that opportunity to try to correct the problem so that you can use these growth factors in your, in your, um, as part of the correction. If the curve gets over a certain amount, then it's going to be harder to correct. So, um, you want to be proactive, get checked ASAP, find out where you're at and then look at what your options are.
Yeah. So if you are listening to this show today, and maybe you were told, watch and wait was your only treatment option. I'm here today with Dr. J Hartley, who is telling you there is another approach. There is another option and that is being proactive. So if you want to find a CLEAR-certified doctor near you, you can simply go to clear-institute.org and click on the purple find a doctor button to find the doctor nearest you. So, Dr. Hartley, it is always a pleasure to meet with you. And I look forward to having you again on another episode.