Our co-host for episode 3 is able to speak from personal experience because he is no stranger to adolescent idiopathic scoliosis. He has scoliosis, his mother has scoliosis, and he has two daughters who have scoliosis.
Adolescent idiopathic scoliosis is the most common form of scoliosis. Classifying a case as idiopathic means the cause is unknown. Throughout episode 3 of Life Beyond the Curve, our co-host Dr. J Hartley discusses:
By sharing from experience, it is our hope that Dr. J Hartley will provide you with the motivation to make a positive change in your life. We hope you'll enjoy the show!
Learn more by reading Dr. Hartley's blog article on Adolescent Idiopathic Scoliosis.
If you have questions or topics you would like us to cover on a future episode of Life Beyond the Curve, please leave us a comment below.
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Hi, everyone. I'm Ashley Brewer, Executive Director of CLEAR Scoliosis Institute and your host for episode three of Life Beyond the Curve. Now our co-host for today is no stranger to scoliosis. In fact, he received his own diagnosis as a young teenager. Now he was introduced to CLEAR many years later when his own daughter faced progressive scoliosis. After receiving CLEAR treatment, his daughter was able to return to running and soccer, which is what inspired our co-host for today, Dr. J Hartley, to return for care himself. Dr. J has been practicing for 28 years and is currently in St. Augustine, Florida. He specializes in scoliosis detection, prevention, and reduction. I know I had a great conversation with Dr. Hartley when we recorded this episode, and I hope you'll leave today's episode feeling just as inspired as I did. So episode three, 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, thanks for joining us today.
Thanks for having me, glad to be here.
Now, Dr. Hartley, last time you joined us, you shared a little bit about your personal story, and I have a feeling that today we'll hear more as we discuss the topic of adolescent idiopathic scoliosis. So AIS, as it's referred to, is the most common form of scoliosis, and classifying a case as idiopathic suggests the cause is unknown. My question for you, Dr. Hartley, is can we narrow down that cause at all?
Sure. There's three theories about idiopathic scoliosis. The word idiopathic means you don't know what it comes from, um, but we know that we, we see some possible triggers for scoliosis in people that are labeled as idiopathic scoliosis. One is hormones. We know that you can look at a chart of hormones and overlay that with a chart of scoliosis as it progresses and it matches up pretty well. So at early onset scoliosis, usually around the first menstrual cycle, the scoliosis is very vulnerable to accelerate. Um, then also later in life after menopause, women go through a period where the curve can accelerate very dramatically. The upper cervical spine, the occiput, C1 and C2, or the equilibrium or, or the control center of your body. And if there's ligament damage, ligaments are the tissue that holds the bones together and helps to keep them stable in that upper neck, if there's damage to those ligaments from birth trauma, falling on your head as a kid, car accident, then that instability in the upper neck can change the nerve signals from the brain to the muscles that are trying to hold everything in place.
And so those people are shown to have an increased risk of scoliosis. And a matter of fact, um, they have done research on this very topic at the university of Washington, um, St. Louis. And it's not just the chiropractic theory. Um, scoliosis surgeons are looking at this idea also. And then there's family history, although they haven't proven a genetic test that can predict scoliosis progression, we know that it runs in families. When I was an intern in California, we had five generations of family in our clinic and all the women had the exact same scoliosis. Um, my mother has scoliosis, two of my daughters and myself. And so, although there's not a, uh, you know, absolute genetic test, there's definitely a family history.
So I'm hearing you say hormones, upper cervical instability, and family history. And you just hinted a little bit at your own family history. Now, when you were diagnosed, it's my understanding that you were told to watch and wait, or pursue surgery and given the two options, you chose to wait. However, today, after all of your training and everything you've been through, knowing what we know about scoliosis, how do you treat adolescent idiopathic scoliosis?
Yeah, well, in my case, um, I knew I had scoliosis as a, as a teenager, but I didn't really know what the numbers meant. Um, and really the only option at that time was, was surgery, um, or just waiting and watching it progress. And when I started chiropractic school, I had a 68 degree curve, although I didn't have any symptoms. Now, luckily I came across some techniques that, intheory, they were bio-mechanicals, so the goal was to, to get your spine in a better position, even though you didn't have symptoms. And unfortunately for me at that time, the CLEAR method had not been developed yet, it was something that doctors were just kind of starting to theorize on. And what it's affected, the way I treat it is, um, I just feel like early intervention is, is the most successful and most important thing you can do. I mean, we help adults live better and, and reduce their curves, but the most dramatic corrections are before puberty.
Now, you hinted at something, you said that you had no symptoms. So is that something that is actually common with adolescent idiopathic scoliosis?
So it's actually rare for, um, teenagers with, um, AIS to have symptoms. It's actually more of a red flag that something else is going on. You know, um, although pain may be under reported, you know, like if you really pry into a kid with scoliosis, they might tell you a little bit more about symptoms, but in general, um, as far as like having a orthopedic diagnosis or a neurological diagnosis, most AIS patients are asymptomatic.
So if they are typically asymptomatic, what are, um, some of the things that they do struggle with or what would cause someone to say, Hey, does this person potentially have adolescent idiopathic scoliosis?
Yeah. So usually when they're at a school or pediatric pediatric screening, um, they'll bend forward and they'll see a rib arch on one side and then they'll get referred to usually a children's hospital. Um, I do work with pediatricians and other chiropractors, so they will sometimes get referred to me. But typically if it's a large curve, they'll go straight to the children's hospital. They'll tell them whether they think they need surgery or not. Um, and typically today, you know, it's either bracing, watching and waiting, or surgery. Those are the options available.
Those are the traditional methods. Now you had talked a little bit about when you were diagnosed, the CLEAR method didn't exist. So obviously that's something that you specialize in. So knowing everything that you know about the CLEAR method, the CLEAR approach, what are some of the things that you would do in your clinic to treat someone who has AIS?
Well, it's just the most exciting time is when we catch somebody before puberty, because we know that if we can reduce and stabilize the curve before they hit puberty, then it's going to greatly reduce the chance of it taking off. And if it does take off, typically it's going to be more under control than if they were just, you know, watching it and not working on improving the neurology and the biomechanics of the body.
Now, what would that patient actually do, like in your clinic? What, what does that look like? Talk me through if I came in and I had AIS.
If it's a smaller curve, like less than 20, 25 degrees, then we're typically going through a process in the office called Mix, Fix, & Set, which is a warmup of the spine, um, a very specific chiropractic adjustment in the set, which are stabilizing exercises. And they go through that process either twice a day for two weeks or three times a week for four weeks. And they're also given home exercises to do. And in that process, our goal is to one, make sure the curves not progressing, two, to get a 30% reduction of the curve. Now, the smaller the curve is, the greater chances that we could get to the point where it doesn't, they don't even have scoliosis. So if somebody comes in with somewhere between a 15 to 25 degree curve, there's a chance that they may actually get below 10 degrees. If they're below 10 degrees, then they're no longer considered to have scoliosis. If they have a large curve, you know, 30 to 60 degrees, our goal is again to make sure it's not progressing, reduce it, and then stabilize it, um, so it doesn't continue to grow, especially through, uh, the puberty years.
Now with my work here at CLEAR, one of the things that I know that patients have said to me again and again, that's a big benefit of the CLEAR approach is something you just talked about, which is that you can provide the patients with home exercises, so things that they can do at home to help with this. Now I have a 13 year old daughter and I don't know how easily I would be able to get her to do some of this home stuff. So how do you work with teenagers and kids to get them to incorporate this into their life?
Well, one way to do it is incorporate, you know, their TV time and gaming into their exercises. So they'll want to do their exercises more if that's the only time they get to game, watch TV. So we've found that that is pretty good. And, um, so if they're using a scoliosis chair at home or they're doing their, what we call their spinal weighting or mirror image exercises, if they get to watch TV during that time, sometimes that motivates them. Um, but it takes a lot of education. Um, it's a, it's a lifestyle, especially if you have a larger curve, you know, we're gonna reduce the curve, but you're going to always have to do home exercises to take care of it.
Yeah. And are you typically seeing those patients back in your office again, once they're doing those exercises at home, or what does that look like?
It depends how far away they live. You know, we see patients from other states and countries. So if they're from closer by, we may, after they've gone through their initial intensive care, we may see them once a week to once a month. If they're a patient that's coming from further away, then they may come back in three months or six months. And then we'll evaluate is the curve continuing to improve, is it slightly worse. And then we may, you know, we'll evaluate any adjustments to their care that we need because it's a monitoring process. We know that some people's curves may continue to progress up until age 21, other people, their curves, you know, will stabilize closer to age 14. So we don't know which one each individual patient is. So it's very important to monitor it very closely. We've seen patients that, let's say they went to a children's hospital and were braced, and at 14 they just take the brace off. And then we, they come to us a year or two later, the curve may, in some cases, even have doubled in size in that short time that they stopped wearing the brace. So it's very important to monitor these very closely. Um, you know, probably until you're, you know, like a freshman or sophomore in college.
Yeah, so you just talked about the disease being progressive. So, naturally, people who have AIS are concerned about the progression. Now, what are some activities that someone could participate in that could actually accentuate the AIS?
So when, when you're in utero, your body's held with a thoracic fetal curve or what we call a kyphotic curve, so your body's kind of like in a C curve. When you start to stand up, the mid back, you want to maintain that C curve, okay? And so any sports that hyperextend the middle back, so the worst case scenario would be like rhythmic gymnastics. The body's completely hyperextended. If you already have a scoliosis, it'll make the scoliosis worse. They did a study in Australia and what they looked at was people that already had scoliosis. And then which sports they did, then they looked at how much the scoliosis progressed. And it was a very good study, very well done. And the ones that were the worst were rhythmic gymnastics, ballet, gymnastics, aggressive swimming. So like, if you're doing competitive swimming where you're swimming like, you know, two hours, twice a day, and also volleyball. If you think about, when you reach back to slam a volleyball or to serve, you're putting that mid back in hyperextension. And so that can drive that curve that is already there to get worse.
So, is that something that you would try and steer patients away from? I know that might be something that I know my daughter, for instance, might not want her life to change a ton as a result of scoliosis. How do you handle that?
So it's really how passionate the person is about the sport. Um, we also use ScoliBrace in our office, and one of their philosophies is that if you're allowed to have, let's say, four hours a day out of the brace, and if you only use an hour or two of that for your sport, but you're keeping up with your, all your other exercises in your brace time, then they're allowed to do that sport. But if they just are not doing anything else in continuing to do those sports, then it's gonna make it worse. So they may, um, be asked to take 90 days off of the sport, or if they're wearing the brace, they may be allowed to continue with the sport. Um, so it's really a case by case basis. And you know, the more passionate the person is about the brace--about the sport--I think the brace is more important because it'll offset some of those things they may be doing to damage the scoliosis during those growing years.
Well, I think the good news for individuals who are diagnosed today, versus maybe like you were told, you only had the two options, either surgery or watch and wait. The good news for people today is that there is hope. And that is really what this show is all about. So Life Beyond the Curve is about helping people with scoliosis truly live their life to its fullest. Now, if you had one piece of advice for someone who has, or is affected by adolescent idiopathic scoliosis, what would that be?
The biggest thing is early, early intervention. The quicker you can start working on it, the quicker you're reducing the curve and stabilizing it, the lower the curve is going to be. Um, when your body is going through puberty, you have hormones that are being released that are actually magnifying the curve, in both the disc and the bone. And you can use those growth factors to your advantage, if you start working on it early, but the longer you wait and those growth factors settle in, it gets harder to make a change. So you want to know where you're at on the progressive chart, realize you have progressive scoliosis and then set a plan to stabilize it and reduce it.
Awesome. So you've mentioned early intervention multiple times. So if you, um, are listening and thinking, I need to find a CLEAR-certified doctor, you can go to clear-institute.org, click on the purple Find A Doctor button at the top of the page, search by your location, and you'll find the doctor nearest you. So Dr. Hartley, thank you so much for joining us today. We hope to have you again in the future. Thank you. Awesome. And one more time for you guys. If you are looking for a CLEAR doctor, you can find a CLEAR doctor by going to clear-institute.org, click on the purple Find A Doctor button at the top of the page, search by your location, and find the doctor nearest you. We hope you enjoyed our show on adolescent idiopathic scoliosis. There's more to come next week.