Dr. Tony Nalda, Chairman of the CLEAR Board of Directors and elite of the elite when it comes to treating scoliosis, is our co-host for episode 5, Scoliosis in Children. When a child is diagnosed with scoliosis, treatment needs to be taken very seriously because treating children with scoliosis is where we can make the biggest impact in terms of long-term improvement.
For parents, having a child diagnosed with scoliosis can be scary. Parents may have many questions running through their mind after receiving such a diagnosis. Throughout episode 5, Dr. Tony Nalda answers many frequently asked questions and discusses:
The biggest piece of advice Dr. Nalda has for parents is don't watch and wait! Learn more about CLEAR Scoliosis Institute's alternative approach to treating scoliosis by tuning in to episode 5, Scoliosis in Children. Enjoy the show!
If you have questions for Dr. Nalda, have a topic you would like us to cover on a future episode of Life Beyond the Curve, or just want to leave us feedback, please leave us a comment below.
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Hello, beautiful people! Episode Five here for you today. I'm Ashley Brewer, Executive Director of CLEAR Scoliosis Institute. I had the privilege of hosting today's episode with the Chairman of the CLEAR Board of Directors, Dr. Tony Nalda. Now, Dr. Tony is absolutely the elite of the elite in the world of alternative scoliosis treatment, or really just treating scoliosis in general. He has too many certifications to list them all, but I am going to rattle off a few. He has his World Master Certification on Scoliosis and Spinal Deformities from ISICO, his Advanced Scientific Exercises Approach to Scoliosis. He's trained in the Pettibon System with advanced training in functional neurology. He has his ScoliBrace certification, and, in fact, is the lead ScoliBrace trainer in North America. Plus he's on the Board of Directors for Max Living, in addition to being on the Board of Directors for CLEAR. Now, I've been working with Dr. Tony in various capacities for the last 11 years, but I think my favorite part about him is that he has been my personal chiropractor, and he has been the chiropractor for my children. So when we met to discuss scoliosis in children, I honestly could not think of someone better to discuss this topic with or someone that I would trust more with the health of my children. So Episode Five, 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.
Hey, Dr. Nalda, welcome to the show.
Thanks, Ashley, for having me on today, I look forward to sharing any information that can help you or your listeners.
Now I've been in your office a number of times as a patient and with my kids. And so I know that you see people of every age in your clinic from young, young babies to elderly individuals. So today we are going to talk specifically about the kids you see in your office, since our topic is scoliosis in children. Can you share with me a little bit about the different ages that kids may be diagnosed with scoliosis?
Scoliosis in children is very specifically diagnosed with three different kinds of categories, and it sounds simple, but this is really important to understand if you have a child that's been diagnosed with scoliosis, or actually you've gone through scoliosis personally, and you're kind of wondering why you were diagnosed with a certain type of diagnosis and you're an adult now. When we look at scoliosis in children, there's basically three categories. We're looking at infantile scoliosis, juvenile scoliosis, and adolescent scoliosis. And these are exactly what they sound, their diagnosis is based upon the age of patient. So infantile scoliosis is going to be a patient that's diagnosed with a scoliosis that's less than two years of age, or two years of age or younger. When you're between two and roughly about 10 years of age, you're diagnosed with something called juvenile scoliosis. And then when you break 10 years of age, up to adulthood, it's something called adolescent scoliosis. Now, the transition between juvenile and adolescent can be a little bit varying on the age because it really has to do with puberty. When you see somebody start going through puberty, that age could vary, meaning some patients go through puberty a little bit later than others, but it's typically around that 10 to 12 years of age, where that transition happens, where you go from a juvenile scoliosis to an adolescent scoliosis. Now, the reason why these are important, because when we talk about progression, the age has a lot to do with that risk factor.
Now, it's interesting that you bring up age having something to do with risk factor, because previously you've also brought up age having something to do with the impact. And I think it was in a recent blog article that you wrote for CLEAR's website, that you stated that treating children with scoliosis is where you can make the biggest impact in terms of long-term improvement. Let's discuss a little bit about why that is the case.
Treating children with scoliosis is definitely the time we can make the biggest impact. And the reason why is because it's a multi-factoral reason, but there's two main ones. The first one is they're growing and growth by far is the number one risk for progression. So if there's one thing a listener can learn right now is if the patient, if the person that's diagnosed with scoliosis is still growing, the risk of progression is directly related to how much growth they're going to have. And as they get bigger curves, the higher the risk of progression will occur every single time they grow. To make this simple is that if somebody has a 30 degree curve and they still have growth, they have about a 60 to 70% of progressing, every single time they grow, where, when somebody has a 40 degree curve or 50 degree curve, it's like in the 90% range that they're going to progress every single time they grow.
So obviously if somebody's growing, we want to treat a curve before it goes through that state to try to stop that progression from continuing to add and get larger and larger every single time they go through these growth spurts. The second thing is something we called Hueter-Volkmann's Principle, or bone remodeling for a simple, for a simple understanding. Bone remodeling means that bones that are being compressed will, will inhibit growth or inhibit inhibit development and bones that are being traction, these are weight bearing bones, will cause increased growth or increase elongation. So obviously in a curve on the inside of the curvature, you have bones that are being compressed, and on the outside of the curvature, you have half the bone that's being tractioned. So this causes bone asymmetry development. Now this bone asymmetry that occurs during growth will continue to cause more and more progression.
So the more bone asymmetry you have, the greater progression you'll get, the greater progression you have, the more bone asymmetry you develop, and this will cyclically perpetuate itself all throughout their growth years. So that's why treating a curve while they're growing, and while they're progressing will have the greatest impact. Not only influence to how much progression they're going to occur. I mean, I should develop, but also is going to influence how much a huge bone development or how much bone abnormality or deformity they're going to get within the spine itself. These two factors are by far the number one and number two factors, and the reason why we want to treat children as opposed to waiting these curves become bigger and treating adults.
That makes sense. So you mentioned treatment and let's talk a little bit about treating scoliosis. Now, when it comes to treatment, there are two main approaches. There is the traditional approach and then an alternative approach. So as a CLEAR-certified doctor, you obviously practice a more natural, effective approach to treating scoliosis, and we're going to get to that in a little bit, but first let's talk about the traditional approach. I've mentioned that I'm a mom, so let's say my son Azariah, who is 10 years old, was just diagnosed with mild scoliosis. Following the traditional approach, what exactly does that appointment look like? What type of advice am I, as his mom, going to receive?
You know, Ashley, when you talk to me about a mild case, ten-year-old, um, being advised, you know, what happens in a typical appointment like this? Unfortunately, I hear this story way too many times. And in fact, it's one of the most frustrating things that patients deal with after the fact, meaning if they would have known what's happened to their curve now that they're older, 12 or 13, and the curve has progressed, they really wish that first appointment that they were initially diagnosed with a mild scoliosis would have went very differently. But typically this is what happens. If you're diagnosed with a, with a small curve at 10 years of age, let's say, let's say it's a curve of 15 to 20 degrees, and they actually take an x-ray, they diagnose a small scoliosis. More than likely what's going to be done is they're going to recommend, don't worry about it.
Just come back in six months to a year, we'll take another x-ray and we'll see what happens. Now, unfortunately, you can see how that would be very poor advice because a lot of things can happen to a 10 year old in that six month period of time. And the biggest thing is obviously they can grow and the curve can progress. And now they come back six months later and the--as they've gone through a growth spurt, because nobody can predict when a child's going to go through a growth spurt. So they could walk out that orthopedic office a day later, go through a growth spurt, start progressing three, four or five degrees a month and come back in six months and literally have a 20 to 30 degree worsening. And when that happens, everybody, which is, I wish I would have done something sooner, but normally that's not what happened. Traditional approaches, when you look at mild scoliosis cases, they pretty much recommend no treatment for these cases.
Wow. Um, so no treatment. So they're actually doing nothing typically at this stage. So, wow. I just, I can't imagine being told that there's nothing that we can do.
Now, let's say your mild scoliosis is a little bit more severe, so it's closer to 25 degrees. And this is borderline in that moderate range. When you were circling the 25 to 40 degree range and this case they, about some of the doctors, about half the doctors would still would recommend nothing because they don't believe there's nothing you can do to actually manage or influence scoliosis. And especially in a 10 year old, because you're going to say, well, ten-year-olds could have to treat this thing for, you know, four or five years, they're not going to be compliant, there's no way they can do it. So they don't even bother treating it. However, if they do treat it, they, the only thing they really have is something called the Boston brace. And this Boston brace is really just designed to try to hold the curve where it is.
It's not designed to reduce a curve, make a curve smaller. They're just trying to stabilize the curve because the brace is literally a squeezing style brace. And then if that curve continues to progress beyond the moderate stage where it starts going into that 40 to 45 degree range, now they're saying, okay, surgery. So you can see there's like a 15 degree window. So mild cases, less than 25 degrees, they do nothing. Between 25 and 40, half the doctors use a Boston brace, then 40 and greater they're recommending surgery. So there's a little 15 degree window that they would treat a curve, and 15 degrees in a child can happen so fast. I mean, I've seen that happen in less than three to four months. And here you're being told to come back every six months to a year, to take an x-ray and to see what happens. To me, it kind of makes no sense. It seems like you would want to treat something a lot sooner.
So let's talk about the other end of the spectrum. Let's say that I'm not satisfied with that as a mom and that somehow I end up in your office. What does your alternative approach to treating scoliosis look like?
So obviously almost every patient I see that comes into my clinic is looking for something else and they want to be more proactive. And I honestly believe that's the wise approach when it comes to scoliosis, almost every other problem that we deal with, we don't let them get big and then treat, we don't let problems get more severe and then treat it. In any other condition, we always want to treat the problem before it becomes severe because the outcome is so much better. And that is also true with scoliosis. So our assessment in our approach to treatment is completely different. We never want to see a curve get bigger under any scenario. So we would just, typically will moderate curve monitor, monitor curves, or watch and wait or look at things for a little bit. Curves are less than 15 degrees. Once you start breaking 15 degrees, we normally want to start treating a scoliosis.
And the reason why, there is no reason to wait. There is no harm in taking a 15 degree curve and reducing it to seven or even zero, which has happened in the clinic. There's no harm to that. A straighter spine just means the patient's better for whatever reason. However, letting a 15 degree curve become 25, 35, 45 or 55, there is a lot of harm to that. So reducing a small curve to smaller that say, theoretically, wasn't going to progress, still there's no harm. The person is still going to be better with the straighter spine. So our assessment number one, is that we don't watch and wait for nearly as long. We treat curves much sooner in the process. Number two is our goal is not just trying to hold the curve to prevent them from getting, from getting so severe where they need surgery.
And that's literally the definition of success when it comes to traditional conservative treatment is you can have a curve that comes in at 25 degrees, they put a Boston brace on it, and let's say it progresses to 45, but they didn't have surgery. That's considered success, where our goal is not to just hold the curve where it is, we want to actively reduce the curve, actively reduce a curve as much as possible during growth. So we will apply treatment therapy, rehabilitation, corrective bracing, anything that we can do to get the best possible outcome. And the reason why we want to reduce it as much as possible while they're growing and developing, so when they move into adult phase, they actually have the smallest possible curve because we know adult curves can still progress as well. But we also know the smaller the patient has or the smaller the curve the patient has as an adult, the slower it progresses as an adult due to gravity.
So there's two main benefits. We can reduce the curve during growth and we can set them up for better success or a better outcome as adults. So in this phase or in this assessment, in, in this, in our approach is that we're actively trying to reduce the curve every single time. And the, the, the model is very typical or very similar to like using braces on your teeth. You know, you don't go in and get braces put on your teeth and, and hope that your teeth stay the same. The orthodontist will put on a set of braces to try to push the teeth or pull the teeth back into a better alignment. And then every 90 days, they're trying to make it straighter and straighter and straighter. So when 18 months to two years later, you have the straightest set of teeth possible. We're very much the same way.
We're not only trying to initially reduce the curve, but then every 90 days we're modifying therapy, modifying treatment, modifying exercises, modifying bracing to get the very best possible outcome, not to say, okay, we're just happy that we're holding it, we're just happy it's not progressing too much. We want to reduce it as much as possible. So that's the really the approach there. It's completely different mindset. And therefore, since we have this such a corrective mindset or a reduction mindset, and that's our definition of success, we're much more aggressively monitoring to see how much reduction we can actually achieve with any given patient at any given time.
And you've achieved that reduction with hundreds of patients, if not thousands, in your clinic. I would love to hear the stories of one or two kids that you've seen at Scoliosis Reduction Center.
So before I kind of talk to you about any particular testimonial of a patient, because there's one thing that we have to understand what we do with scoliosis in kids. There's pretty much two types of patients. Patient one is going to be the most common type of patient I see in my office, and that's the case that's already progressed beyond surgical numbers, 40 45, 50, 55, 60 degrees plus. These patients are, obviously our goal is very specific as we want to reduce the curve to get them below surgical thresholds. I've seen lots of cases this way. And unfortunately, this is my largest percentage of patients that walk in my door that their cases are already surgical. And the reason why, cause they do exactly what their orthopedic surgeons already told them. They've watched and wait, they've worn a Boston brace, and the curves progressed. And now they're looking at now, they're told they need surgery and they don't want it.
We have great response with patients like this. And then one of my patients that brings into mind was actually a patient that their mom actually had rod fusion. She had rod fusion and her young boy was diagnosed with scoliosis. They brought her in from an evaluation for me, and it was around 40 ish degrees or so was just in that borderline surgical. And I of course recommended our CLEAR treatment. The mom was kind of hesitant and said, well, you know, um, they know she knows that the brace didn't work for her. She wore a Boston brace and ended up having surgery. So she decided to just wait a little bit, but she waited. And of course the curve progressed, um, to almost 50 degrees. We've been now been treating this boy for over three years. We've weaned him from his brace and now he's sitting well below 30 and his posture looks great.
So that's obviously patient one is to get that kind of response, to take them out of the surgical realm into this realm that's nonsurgical. The other type of patient is going to be the patient that their curve is below surgical threshold. Meaning they're 30, 25, 20 degrees. Obviously we, number one goal is not to let that curve progress, but if we're reducing the curve, we normally don't deal with these cases only don't deal with a surgical option. Meaning these patients very rarely, if they're in active treatment in our clinic, ever have to face a decision saying, Oh, am I going to do surgery or not? Our decisions are more like, how much do we want to reduce the curve? And so therefore, when we deal with small curves, our options are so much greater and our expectations are so much greater because we know not only can we never let them have a surgical level curve, but even greater than that, our goals are to try to reduce them as much as possible.
And one story that comes to mind was I had a young boy again, it came in relatively young, around eight years of age with about a 22 degree scoliosis and a thoracic curve. And, you know, it was pretty much told not to worry about it, come back next year and let's take an x-ray and you know, the parents wanting to be more proactive about that. So we treated them, put them through intensive care therapy, home exercises. Within six months, this boy had a curve that was under five degrees. Under five degrees. So, I mean, if you're ever going to take a curve that's scoliosis and say that you've cured scoliosis, this is as close as you can do to it. I mean, we pretty much no longer diagnosed with scoliosis. So we weaned him from treatment and now we're just monitoring the curve and the curve has not progressed, about a year and a half later has not progressed beyond five degrees.
So the argument here is obviously, well, what if that curve would've never progressed? Well, that is true, but we still reduced a curve and they're better off with a straight curve. And their posture looks better. The shoulders are level, the ribs are more in alignment. So there's no harm that happened to that eight year old just by reducing the small curve to even smaller. And that's the second type of patient that we have. So it's the curves that are not surgical that we're trying to reduce to as low as possible. And then, of course, there's those surgical cases that we're trying to reduce to below surgical. And the last type of patient is the super severe cases, super severe cases, meaning they're 80, 90, or 100 degree scoliosis cases. And unfortunately, I've seen lots of these. The largest curve ever treat has been 155 degrees.
With this size curve, we're not really reducing them below surgical level. I mean, most cases we're not getting that type of change in a patient, but I still have patients that refuse surgery, meaning for whatever reason, they do not want to have it. They don't want the risk of it, they don't want--their parents, they don't want to go through it. They don't want their kids to go through it. They don't want to have a life with a rod. To them, their scoliosis is less risky than surgery. So these patients, we're reducing their curve as well. But our goal is to manage the reduction and not let it slowly progress back up to these higher curvatures. So even our expectation is not to get them below surgical. For a lot of these patients, we can help them achieve their goals just by reducing that curve and not letting it continue to progress like it was under traditional approaches.
Now the goal here at Life Beyond the Curve is helping people with scoliosis truly live their life to its fullest. And just thinking about everything that we've talked about today and, and me being a parent personally, I can imagine all of the myriad of emotions that come with your child being diagnosed with scoliosis. So if you had just one piece of advice for a parent of a child who has recently been diagnosed with scoliosis, what would that be?
If I had one piece of advice for a patient that's recently diagnosed with scoliosis, or a parent of a child that's been recently diagnosed with scoliosis, it would be one thing:don't watch and wait. I mean, there is no benefit to watching and waiting your curve get bigger. There is zero, there is none. I can't think of one thing that's going to benefit a person from watching a curve, even if the curve doesn't progress. If you have a 20 degree curve and let's say it doesn't get one degree worse as a child, there's still no benefit to letting it sit at 20 degrees because we know it's going to progress as an adult slowly over time. So, and it makes much more sense to reduce a curve while they're young. So my number one response would be is, one more piece of advice is don't watch and wait. Treat a curve when it's small, small curves are easier to reduce, small curves are easier to get small. And of course, if you have--treat a small curve, you'll never have a big curve. And that's really the whole concept.
Don't watch and wait. I absolutely could not agree with you more. Dr. Nalda, thank you so much for joining us today on Life Beyond the Curve. We're going to have you again on a future episode and I am already looking forward to that. So if you are a parent and you are listening and your child has recently been diagnosed with scoliosis, or maybe you've heard those infamous words, simply watch and wait, but you aren't satisfied with that answer, here's what you can do. Go to clear-institute.org, click on the purple Find a Doctor button at the top of the page. You'll be able to enter your location, and that's where you can find the CLEAR certified doctor nearest you.
There is more to come next week. We will see you soon.