Life Beyond the Curve Episode 8 will answer the question what is a scoliosis curvature? Dr. Tony Nalda has been seeing scoliosis patients for over 14 years with curves ranging from 10 degrees to 155 degrees, so there couldn't be a better co-host to answer this question.
Throughout the episode, he'll discuss:
If you have questions about what it means to have scoliosis, how scoliosis is classified, or were recently diagnosed and simply want to know more about scoliosis, this is the episode for your. We hope you 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, Life Beyond the Curve listeners. I'm Ashley Brewer, the Executive Director of CLEAR Scoliosis Institute, and I hope you're ready for Episode Eight, where we'll cover the basics of scoliosis and answer the question, What is a scoliosis curvature? When recording Episode Eight, I met with Dr. Tony Nalda, owner of Scoliosis Reduction Center and Celebration Family Chiropractic in Celebration, Florida. He's also the Chairman of the CLEAR Board of Directors, and has been the personal chiropractor for me and my children. Dr. Nalda has been seeing scoliosis patients for over 14 years and worked with many patients with a curve in the 100 degree range, with the largest curve being 155 degrees. He has a plethora of insight and experience to share when it comes to alternative scoliosis treatment. I hope you'll enjoy the show as much as I did. Episode Eight, 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.
Welcome Dr. Nalda. It's so great to have you back on the show again.
Hello, Ashley. I'm really glad to be here.
So you've been in practice for over 20 years and have been seeing scoliosis patients for over 14 of those years, so you are absolutely no stranger to scoliosis. But to kick off this episode and our topic for today, we're going to say that I'm completely unfamiliar with scoliosis. I'd love for you to define scoliosis for me as though I know absolutely nothing about it.
So to define scoliosis very generally, doesn't really do scoliosis justice, but I will just because I think everybody needs to know what the basic definition of what scoliosis is. And scoliosis is when we see a curvature in the spine of 10 degrees or greater by measured by a Cobb angle, and you have to have some associated rotation within the spine itself. And normally it's going to be rotating, rotating into the concavity of the spine. So 10 degrees of curvature with rotation. Typically some signs and symptoms of scoliosis can be really variant depending on the, how old is the patient when they're diagnosed and how big the curve actually is. But typically it's going to be asymmetrical posture. That's the most common finding; uneven shoulders, uneven rib cage, unlevel hips, unlevel waist, unlevel hemithorax, um, and, unequal spaces between the arms and the legs.
You're talking a lot about posture right now. Then I guess my follow up question for you would be what's the difference between an actual scoliosis curve versus something that's simply a posture problem?
The difference between a postural problem that creates a curvature in the spine and true scoliosis that creates a curvature in the spine can be distinguished between a couple of different things. Number one, is that a postural scoliosis, that's not true structural scoliosis, won't show rotation. Typically there's a much less rotation associated in a postural scoliosis. In addition, postural scoliosis can be eliminated through movement, meaning that if a patient will bend to the left or to the right, opposite the scoliosis, you'll see complete resolution of the scoliosis and complete symmetrical range of motion from on each side, bending left or right. Where true structural scoliosis, you will not see complete resolution of those curvatures, meaning that if a person has a left scoliosis in the lumbar spine, when they bend to the left, their spine won't completely bend. It will hold that curve. You'll kill some of the curve in there.
That means there's actually structural scoliosis occurring. So that's number one, they cannot reduce the curve with opposite bending, or they can eliminate the curve completely and show normal range of motion. And then also there's no rotation. Last thing is when we also see postural scoliosis versus actual true scoliosis, is that we don't see any deformity. Now, what I mean by deformity is bone deformity. We're not seeing rib deformity, normal rib arching. We don't see as much waist issues. We don't--waist deformity issues. We don't see as much of that in a postural case, unless it's been there for years and years and years, which is normally not the case. So structural scoliosis isn't the same as having a postural scoliosis. Now, it's interesting that you asked this question because a lot of, um, things I see on the internet saying, Oh, we can treat scoliosis, and they show some pre and post x-rays, what they're truly showing is a pre and post postural change. And because it's a postural scoliosis, they treat it, not a true structural scoliosis that we see in idiopathic scoliosis or adolescent scoliosis. And these postural change respond really well to therapy and treatment, and we definitely recommend that. And there are--I'm not discounting them, but there there's a way to treat a postural scoliosis, and then there's a way to treat a structural scoliosis, and they're not the same.
Okay, so if we're talking about a true structural scoliosis, which you just mentioned, it's my understanding that scoliosis curves can be located in different areas of the spine for different patients. What are those areas and how are they defined?
Ashley, you're exactly right. There's different locations of scoliosis and where they're diagnosed and that kind of adds to the diagnosis. So thoracic scoliosis are typically the apex of the curvature. The apex of the curvature's designed as the most horizontal bone that's within the curve itself. So if a curve extends from T4, let's say, to T10, and T6 is the most horizontal bone within that curve, the apex would be T6. So a thoracic scoliosis is where the apex is within the thoracic spine. A thoracolumbar scoliosis is the where the apex is injunction between the thoracic and the lumbar spine at T11, T12, L1 area. A lumbar scoliosis will be a curvature that has the apex of curve in the lumbar spine. And the last and the most uncommon is a true cervical scoliosis. And that's where the apex of the vertebra will be in the cervical spine from C1 to C7. Now different curves respond differently to scoliosis cases, and most patients will have multiple curvatures, meaning very few people only have one curve, meaning a thoracic curve.
Typically you have a thoracic curve and a lumbar curve, or they'll have a lumbar curve, a thoracic curve, and a cervical curve, or they'll have a thoraco lumbar curve and and upper thoracic curve. So most patients will have more than one curve. In fact, if you really think about it, it's impossible for somebody to have one curve only cause that means they're bent over. Most patients, if you count the compensating curves back to neutral, they're going to have three or more curves. The most I've ever seen in patients have been 12 and believe it or not, I had a patient to have 12 curvatures from the skull to their sacrum, uh, lots of small curves that were going all the way up and down the spine. Um, pretty interesting, but most, most of the patients that I see or have anywhere between three and seven.
It's so interesting to see how our bodies adapt and change when there's something going on or really just something wrong. Uh, let's transition just a little bit and talk about x-rays for a second. So, because there is rotation involved in scoliosis, it's what's known as a three dimensional condition, but it's most frequently measured on an x-ray, which is only two dimensional. So let's talk about some of the challenges involved with scoliosis being a three dimensional condition when you're looking at a two dimensional image to determine the extent of the condition.
Ashley, you're exactly right. When you're looking at scoliosis on an x-ray, you're only looking at a two dimensional image of a three dimensional problem. Now, why does that create issues? The most common people, the most common problem people see in a scoliosis of course is this bend. But unfortunately, what most data suggesting that the bend is not the initial problem; they actually believe the initial problem is rotation. Now, when the spine rotates, it rotates on a plane that normally reduces the sagittal alignment of the, of the spine, meaning from the side, and then you see the bend from the front. So we take an xray front to back or back to front, let's say, you're just going to see the bend from that plane. But if, when you look from the side, you're going to notice that there's a diff--there's problems in the alignment from the side.
Well, it's impossible just to unbend the spine if you're not going to de-rotate it and also correct the sagittal misalignments as well. So this can be very challenging for pa--for doctors that are just trying to apply bending techniques, let's say, to a spine that has rotation and sagittal misalignment, and you're just trying to unbend it; it normally doesn't lead to a successful outcome. And in fact, most of old, old brace designs like Boston brace design, squeezing brace designs, that's exactly what they do. They just try to unbend the spine. And that's why the success rate is so poor. So that's number one is that when you can address it, three-dimensionally, you can create a treatment plan that's three-dimensional, meaning the treatment plan will now address all three components, rotation, sagittal misalignment, and A to P misalignment. When we can deal with all three of those components, we're going to get the very best outcome in getting a reduction and stabilization in this patient.
And that's really what we're ultimately looking for. So a two dimensional x-ray, doesn't always give the best picture. So what do I recommend? I definitely recommend that you at least take opposing views, mean take an extra from the front and take an x-ray from the, from the side. In addition, that motion x-rays can also be very indicating in terms of how structural the spine is, like I mentioned earlier, and also not just limiting those x-rays, but looking at patient's posture, at their rib differences and their postural differences can help you look at what's happening, three-dimensionally in the spine. Once you do that, then you have to do those with every reassessment to determine whether the patient's improving or not improving to the treatment plan that's associated and reducing those each one of those components of the spine.
When it comes to treatment plans, you see patients all across the board. I mean, you mentioned earlier a 155 degree curve, but scoliosis ranges from mild to severe. I'd love to hear a little bit about one of your mild cases. And then hear some more about one of your more extreme cases as well.
I see patients in all range sizes like you, like you stated, from mild to severe. And a lot of times when we see mild cases, our goals are very, very high, meaning our standards to not re--not only try to hold the curve and prevent that big--from becoming surgical, but our goal is to try to reduce the curve as much as we can possibly reduce it. Mild cases respond very well, and we normally can reduce curves. I've had many cases that we can reduce beyond, um, the surgical, I'm sorry, the scoliosis diagnosis threshold. Um, one patient comes to mind. I had a young adult come in with a patient--uh, she was a dental hygienist and she had a scoliosis as a child. Um, it was relatively mild, it was about 14 or 15 degrees. The orthopedist told her not to worry about it, so she didn't.
Um, 15 years later, she was in the 30 degree range, and that's more of a mild to moderate degree range, but she was experiencing pain now because the scoliosis was affecting her ability to work. So we treated her, reduced her curve, and by the time we were done treating it, we actually had her curve below 10 degrees. It was around seven degrees. So we took a case that was considered to be scoliosis and were able to move her below the surgical threshold or the diagnosis threshold of 10 degrees. Now, do I still think she has scoliosis? Of course I do. Even though her number is there, she's working on maintaining it and stabilizing that reduction. Extreme cases, unfortunately, I've dealt with my fair share of extreme cases. The biggest curve I've ever dealt with has been 155 degrees. And unfortunately I've dealt with a lot of scoliosis in the a hundred degree range.
Um, and one patient that comes in mind was a patient that was being, being managed by a doctor that did not specialize in scoliosis. And the case continued to progress until about 98 degree curvature. At this time they were referred to me and we started treating. Um, the patients are reducing the scoliosis. Now the good news is that this patient was at least still developing and growing, so we're able to reduce the curve. We're able to get the 90 degree curve down to about 76 degrees. And we're still holding that reduction of about 20 degree reduction. Even though this case is still surgical, the family and the child, they're both like this, well, this child is almost an adult at this point, um, they're both opting out of surgery to stay there--they're content with the changes they've gotten and the postural changes they've improved. So they don't want to take surgery at this point. So I'm happy to help them assist them and then develop a maintenance program to try to maintain that reduction over time. And those are two opposite cases in very extreme, different cases, but understanding is that all cases are different, but our goal is not only to just try to hold a curve, our goal is always to reduce the curve as much as we can.
So even though every single scoliosis case is different, like you mentioned, I'm sure there's probably a theme in the advice that you give to people. So if someone is listening to our show today and they suspect they may have scoliosis, what's one piece of advice that you would give them?
You know, Ashley talking about somebody that, that suspects they have scoliosis, my number one bit of advice for them would be, is to have it evaluated, not to wait and think that it's there, think it's going to be a problem because there's only one thing that we know when scoliosis is left untreated, it worsens. Either worsens fast as a child or slow as an adult, but it's worsening and worsened curves normally don't provide us any benefit. So the only the best thing to do is to always try to reduce a curve while it's small, because you're going to get a better reduction while it's small than while it's large.
That's awesome advice, Dr. Nalda, thank you so much for joining us again on the show today. I'm definitely looking forward to having you on another future episode. Now, for our listeners, if you are listening and want more information on scoliosis, you can find additional podcasts, articles, blog posts, and much more information by simply visiting clear-institute.org. If you've recently been diagnosed and would like to find a CLEAR-certified doctor, click on the purple Find a Doctor button at the top of the page, search by your location, and find the doctor nearest you.
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