Welcome to the Ask a CLEAR Doctor webpage! Here you can find the answers to commonly-asked questions about scoliosis and the CLEAR treatment process, as well as post your own questions using the form at the bottom of the page.
The CLEAR Scoliosis Institute is a non-profit organization dedicated to advancing chiropractic scoliosis treatment and research. CLEAR has developed an effective chiropractic system of scoliosis rehabilitation, and presents this information in postgraduate courses through accredited universities. Doctors of chiropractic who complete the full postgraduate training program have the option of becoming certified to provide CLEAR scoliosis treatment to their patients. When a chiropractor becomes CLEAR certified, they are allowed to refer to their clinic as a CLEAR Scoliosis Center.
CLEAR was founded in 2000 by Dr. Dennis Woggon BSc DC, who graduated with honors from Palmer College of Chiropractic in 1974. Dr. Woggon has over 40 years of clinical experience in spinal rehabilitation. Originally, the mission of CLEAR was to help chiropractors become better doctors through advanced x-ray analysis and treatment strategies. However, so many people with scoliosis began contacting the organization seeking help that eventually scoliosis became the focus of CLEAR’s work and research.
CLEAR is an acronym that stands for Chiropractic Leadership, Educational Advancement, and Research. The mission of CLEAR is to implement an effective chiropractic system to help people with scoliosis through spinal rehabilitation and research.
The CLEAR Scoliosis Institute is the only non-profit organization in the world dedicated to chiropractic scoliosis treatment and research. CLEAR also has a certification process to ensure the competency and professionalism of all of its doctors. This independent oversight helps to ensure that all CLEAR patients are treated fairly and ethically while receiving the best possible care. CLEAR’s methods are taught in the postgraduate curriculum of an accredited chiropractic university and all of our doctors are members of a Practice-Based Research Network that is registered with the Agency for Healthcare Research and Quality. This network exists to continually evaluate and improve the safety and effectiveness of CLEAR scoliosis treatment.
Chiropractic is a healthcare discipline that focuses upon the diagnosis and treatment of problems affecting the alignment of the muscles and bones in the body. It typically involves the chiropractor using their hands or an instrument to perform adjustments to the joints of the spine and extremities. Chiropractors may also provide various adjunctive therapies, such as massage, exercise, nutritional counseling, and more. Chiropractic is a natural and drugless approach to healthcare that aims to treat the cause of the problem, rather than the outward symptoms.
Chiropractic is very safe for both children and adults. The side effects of chiropractic treatment are almost always mild and temporary in nature, and limited to things like muscle soreness. More serious side effects are extremely rare.
Chiropractors undergo a total of 4,485 class hours in subjects such as anatomy, physiology, neurology, and radiology. By comparison, medical doctors undergo a total of 4,248 hours. All chiropractors must pass National Board Exams and be certified to practice chiropractic by both national and state organizations.
A chiropractic adjustment (sometimes called chiropractic manual therapy) involves the use of the chiropractor’s hands or an instrument. It is applied to correct abnormalities in the alignment and function of the joints of the spine and body. There are many types of chiropractic techniques using different systems for diagnosis and treatment.
General chiropractic care is sometimes helpful in relieving pain and other symptoms associated with scoliosis. If your goal is to reduce your pain or improve function, and your scoliosis is too mild for a brace or surgery, you may want to consider seeing a chiropractor. However, it is important to mention that basic chiropractic care is not recommended for moderate or severe cases of scoliosis (where bracing and surgery are typically recommended). Even in mild cases, traditional chiropractic is not usually effective in reducing the Cobb angle. Scoliosis-specific chiropractic applied by a doctor with advanced training in scoliosis is much more likely to be effective.
CLEAR scoliosis treatment begins with a series of specialized x-rays that expose patients to significantly less radiation than a typical x-ray examination. A total of 76 different measurements are made on these x-rays to measure the alignment of the spine in all three dimensions. Customized treatment and therapies are then applied to the patient based around the measurements.
Treatment involves spinal stretching exercises, gentle traction exercises, massage therapy, vibration therapy, spinal mobilization therapies, precision chiropractic adjustments , scoliosis-specific exercises, whole-body vibration therapy, and balance training exercises. One treatment session may last between 90 and 120 minutes.
The system of chiropractic that is used by CLEAR relies upon specialized x-rays that are used to measure misalignments of the spine, head, shoulders, and hips. These measurements are combined to create a 3-dimensional representation of the scoliosis. All of the applied adjustments and therapies are then based around these three-dimensional measurements so each patient receives care that is appropriate and specific to their spine. CLEAR doctors also use specialized equipment and therapies to treat scoliosis. The CLEAR Scoliosis Treatment Protocols were developed specifically to help people with scoliosis, and every CLEAR Certified Doctor has received hundreds of hours of advanced training specifically in the field of scoliosis and spinal rehabilitation.
No, although it can be challenging in the same way that a good workout is challenging. CLEAR conducted a study of 3,198 treatment visits, and found that over 95% of the time, patients reported feeling the same or better after treatment. Over 75% of the time, there were no side effects reported as a result of care. The most common side effect was muscle soreness, which occurred after approximately one out of every five visits. No severe side effects were reported after any of the 3,198 treatment visits.
As a non-profit, CLEAR educates and certifies individual doctors in our method of scoliosis treatment. Once a chiropractor becomes CLEAR Certified, they are allowed to call their clinic a CLEAR Scoliosis Center. CLEAR does not own nor control these individual clinics. Each doctor is responsible for setting their own treatment fees. If you are interested in receiving CLEAR treatment, please contact a CLEAR Scoliosis Center directly to inquire about the fees at that location.
Treatment outcomes vary from patient to patient based on a number of factors, including age and curve severity. In the past, patients have experienced improvements in a number of health-related quality of life areas, including pain levels, lung function, physical function, posture, and appearance. Reductions in the misalignment of the spine measured on an x-ray, by Cobb angle and other measurements, are also very common results. Maintaining positive results depends heavily on the patient’s active participation and commitment to their home rehab therapies and daily exercises.
CLEAR has a number of research articles on our approach and several efforts currently underway. The first research article on a preliminary version of our methods was published in BMC Musculoskeletal Disorders in September of 2004. In 2006, it achieved the status of "Most Highly Accessed Article of All-Time" in this journal, and held this position until 2015. Additional research on the CLEAR methods has been presented at international scoliosis research conferences and chiropractic symposiums such as the American Chiropractic College Research Agenda Committee (ACC-RAC) and the World Federation of Chiropractic (WFC). All CLEAR doctors are members of a Practice-Based Research Network that is registered with the Agency for Healthcare Research and Quality, and CLEAR is currently seeking IRB approval for long-term, independent studies on the effectiveness of the CLEAR Scoliosis Protocols.
The CLEAR Scoliosis Traction Chair (STC) was developed by Dr. Dennis Woggon in 2004 as part of the CLEAR Scoliosis Treatment protocols. The STC is a powerful tool in spinal rehabilitation, and can be ineffective or even harmful if used incorrectly. For this reason, it is only available to patients who are under the care of a CLEAR Certified Doctor.
The STC uses a system of straps and bands to correct scoliosis in all three dimensions. The chair includes a vibration component, which is set at a specific frequency to optimize muscle activation and improve posture. The patient performs active exercises while they are in the STC for 30 minutes, twice a day. STC x-rays, taken while the patient is correctly positioned in the STC, demonstrate significant reduction in both Cobb angle and the rotation of the spine.
Yes. However, it is important to note that chiropractic care is outside of the established orthopedic guidelines for scoliosis care. For this reason, CLEAR recommends active co-management with an orthopedic surgeon for any person with severe scoliosis who chooses to receive CLEAR treatment.
CLEAR has helped many adults with scoliosis, from ages 18 to 80, and above. For more information, please visit our Scoliosis in Adults page.
No. In most cases, patients do not need to wear a brace while undergoing CLEAR treatment. With CLEAR treatment, the goal is to activate and strengthen certain core muscles and to re-train the parts of the brain responsible for posture, balance, and coordination. Since wearing a brace changes the way muscles react to gravity, it can sometimes interfere with these goals.
CLEAR offers two treatment options, Standard Care Treatment and Intensive Care Treatment. Standard Treatment is designed for patients who live near a CLEAR Scoliosis Center, and can drive to and from the clinic for their appointments. Intensive Care (IC) treatment plans are intended for patients who do not live near a CLEAR Scoliosis Center and must travel out-of-town to receive care.
The CLEAR methods have demonstrated success with non-idiopathic cases of scoliosis, such as congenital malformations like hemivertebrae, and neuromuscular conditions such as cerebral palsy. These cases do tend to be more complex, and CLEAR recommends that individuals with congenital or neuromuscular scoliosis receive treatment from an Intensive Care (IC) Certified doctor.
Yes. Patients as young as three years old tend to have no problem with the majority of CLEAR therapies and exercises. Most young children have very flexible spines, and respond wonderfully to the CLEAR treatment protocols.
CLEAR Certified Doctors perform special tests as part of the initial examination that are designed to evaluate whether or not CLEAR is the right approach for that patient. Every CLEAR doctor performs this evaluation before accepting a patient and beginning treatment. If it turns out that CLEAR isn’t the right choice for you, we will assist you in finding an orthopedic surgeon or other scoliosis specialist who can help.
Treatment plans vary from person to person, depending upon the severity of their scoliosis, their risk for progression, and other factors. It can be as short as a few months for an adult with a mild scoliosis, or as long as several years for a young child with a severe scoliosis. Please consult with a CLEAR Certified Doctor for more information on your specific situation.
The CLEAR exercise program is customized to each patient’s specific spinal configuration. It includes scoliosis-specific exercises, stretches, spinal mobility exercises, balance training exercises, gentle traction, and reactive postural remodeling exercises. In some instances, patients may need to obtain a Scoliosis Traction Chair for home use.
The exact amount of exercises that need to be performed each day varies from patient to patient, depending upon the severity of the scoliosis and other factors. Typically, the range is 30 minutes to one hour each day.
Yes! The advanced system of three-dimensional x-ray analysis, precision spinal adjustments, and exercise therapies used by CLEAR doctors can be beneficial in the treatment of other spinal conditions. The CLEAR protocols are not limited to the treatment of scoliosis. Contact your local CLEAR Certified chiropractor to find out if he or she can help!
All CLEAR doctors undergo a certification process to ensure that every person who undergoes treatment at a CLEAR Scoliosis Center receives the best possible care. In most cases, CLEAR recommends receiving Standard Treatment at a CLEAR clinic within driving distance. If this is not possible, the Intensive Care program was designed to ensure that people could travel to receive care over a one or two week time frame.
The CLEAR Certification Process begins with over forty hours of lecture training followed by a written examination. Doctors who achieve a passing grade are then permitted to sign up for twenty hours of hands-on training in a group setting. This is followed by five days of one-on-one clinical training, and another certification examination conducted on a mock patient in a practical setting. Last, the applicant must submit a case study on a scoliosis patient to CLEAR for independent peer review. This allows the doctor to apply for Standard Treatment Certification. Intensive Care Certification requires another five days of one-on-one training, five more case studies, and an additional written examination. Both levels of certification require annual renewal to maintain in the form of additional workshops and case study submission.
The term "scoliosis" is commonly used to describe a sideways curve in the spine. However, it is more accurate to think of scoliosis as a helix. It is three-dimensional, and affects more than just the spine. Scoliosis can also affect the lungs, muscles, brain, and other parts of the body.
Most people suspect scoliosis from postural evaluations, although x-rays are the only way to detect scoliosis for certain. Screening for scoliosis is most commonly done with the Adam’s Forward Bending Test. There is also new research being done on tests that can help identify if a person is at risk for developing scoliosis.
The experience of living with scoliosis varies from person to person. One person with severe scoliosis might not have any noticeable pain or problems, while another person with mild scoliosis can have pain and poor lung function. Generally, more severe scoliosis is associated with more chronic pain and disability. Side effects associated with scoliosis often include pain in the neck, back, hips, and legs, as well as headaches. It can cause changes in posture and the symmetry of the body, and also influence the function of organs such as the lungs.
It’s very difficult to predict whether or not a specific case of scoliosis will worsen. Typically, larger curves in younger patients have the greatest risk, and smaller curves in older patients have the least. Most cases of scoliosis above 25 degrees should be considered to be at risk for worsening over time, especially if the spine is still growing.
Scoliosis is not typically painful, although it can lead to pain over time. Muscle pain is more common in people with scoliosis, especially older adults. However, sharp, localized pain along the spine can be a warning sign of a more serious underlying condition. If you are experiencing pain and are concerned it may be related to your scoliosis, please consult with a scoliosis specialist.
In 80% of cases, scoliosis is termed idiopathic, which means that no direct cause can be found. Scoliosis can be caused by congenital malformations in the bones of the spine, neuromuscular disorders such as cerebral palsy, and by instances of trauma such as motor vehicle crashes and some surgeries.
Scoliosis is familial, which means it has a tendency to run in families. It has been associated with various genes, but the condition of scoliosis is not truly genetic.
There are dozens of scoliosis brace types used around the world. The Boston brace is the most commonly used brace in the U.S. This list reviews the most popular and widely-used braces in the United States and Europe in 2014.
The largest study ever conducted on the topic of bracing concluded that bracing is usually effective in preventing the Cobb angle from progressing to surgical levels if the brace is well-designed and worn for over 12 hours every day. However, there are still some cases of scoliosis that continue to get worse in a brace.
The decision of whether or not to wear a brace for your scoliosis should not be taken lightly. Consult with a scoliosis specialist to determine if wearing a brace is right for you. It’s important your expectations and goals match the most-common outcomes of the treatment you select.
Most people do not need to wear a brace while they undergo CLEAR treatment.
The most common type of scoliosis surgery is a spinal fusion combined with instrumentation (rods anchored to the spine with hooks and/or screws). This type of surgery can be performed from the back or the front. New types of “growth-friendly” surgeries include distraction-based types (growing rods and expanding prosthetic ribs), compression-based systems (vertebral stapling and tethering), and guided-growth systems (such as the Luque trolley and Shilla methods).
As written by Michael Neuwirth MD in his book The Scoliosis Sourcebook, “In virtually all cases, scoliosis, even advanced scoliosis, is not a surgical emergency that demands instantaneous treatment. No one ever has to have an operation for scoliosis; it is merely a treatment option. When push comes to shove, scoliosis is not a ruptured appendix, a bleeding ulcer, or any other kind of surgical emergency.”
It is important to have a detailed and thorough discussion with an orthopedic surgeon and other scoliosis specialists to ensure all options are being explored. Once performed, spinal fusion cannot be reversed.
CLEAR takes a total of seven precision “spot” views of the spine, along with a standard scoliosis film, in order to develop a customized treatment plan for each individual.
CLEAR’s x-rays are taken according to standardized protocols that allow for advanced three-dimensional measurements to be made. This allows CLEAR doctors to develop customized treatment plans that take into account the patient’s unique spinal configuration. Medical x-rays tends to be taken to evaluate for fractures or pathology, and cannot be measured in the same manner nor with the same level of precision.
The combined radiation dose from these x-rays is significantly less than a typical x-ray examination.
No. It is not possible to effectively implement the CLEAR protocols unless the doctor is able to accurately measure the spine in all three dimensions.
No. Due to the specialized nature of the x-rays and the analysis, only x-rays taken by a CLEAR doctor can be used to develop a CLEAR treatment plan.
X-rays are the most common imaging procedure used in the United States at 74%, yet account for only 11% of total radiation exposure resulting from medical imaging. By comparison, CT scans account for only 17% of all medical imaging, but are responsible for nearly half of all patient radiation exposure. For more, please read our CLEAR X-Ray Safety document.
Digital Motion X-ray, or DMX, is a special type of dynamic x-ray imaging system which was used to help develop the CLEAR Scoliosis Treatment Protocols. DMX essentially creates a “movie” of the spine, allowing CLEAR doctors to evaluate the effect of adjustments, exercises, and therapies as they happen.
Every year, nearly 3 million people seek out chiropractic treatment for scoliosis. It is the most common spinal problem seen in school-age children. As doctors of the spine, it is vital that every chiropractor understands how to manage scoliosis cases effectively.
The demand for scoliosis treatment methods, other than bracing and surgery, has never been greater. There are nearly 50 CLEAR Scoliosis Centers around the world today. Understanding scoliosis will give you new insight into methods of spinal rehabilitation that will improve the level of service you can provide to your patients. CLEAR is the only non-profit organization in the world dedicated to advancing chiropractic scoliosis treatment and research.
CLEAR has developed a system to support the chiropractic profession in managing cases of scoliosis. When you refer a patient to a CLEAR Scoliosis Center, the doctor will prepare a treatment plan and detailed packet of information and refer the patient back to you. This information is meant to provide you with a “blueprint” to continue building on the results achieved. For more information, please contact [email protected].
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Please note that we cannot provide treatment advice or answer questions about individual cases of scoliosis. For information about your specific case, please consult a healthcare professional.