Hello, and welcome to episode 26 of life beyond the curve. I'm your host, Heather rotunda joining me today to discuss the early signs of scoliosis is Dr. Alex Gray of the south Florida scoliosis center in Miami, Florida. Dr. Alex has been a practicing chiropractor for over 15 years. He received a doctorate in chiropractic and a minor in nutrition from life university, and he also holds a degree in physical therapy from the university of Miami. He has been with clear since 2011 and has certified in both standard and intensive care. It's always a pleasure speaking with Dr. Alex at the episode 26. Here we go.
Speaker 2:You're listening to life beyond the curve. A podcast brought to you by Claire scoliosis Institute. Each week, we interview experts in the industry. Answer your pressing questions and empower you to take control of your scoliosis diagnosis, live life to its fullest. Enjoy the show.
Speaker 3:Welcome back, Dr. Alex, thank you for joining us today.
Speaker 4:Thanks for having me
Speaker 3:Today. We're talking about early signs of scoliosis at clear, we talk a lot about the benefits of early detection. Is it a pretty simple thing to notice the early signs?
Speaker 4:Well, you know, so let's go back and define this a little bit. So early signs of scoliosis are easy for somebody who's trained in it, um, because that's what we're looking for, right? So it's something that we do every day, but, you know, as a parent of daughters, you know, I would always look, but it's something that people need to be on the lookout for them, even, especially if they know that there's some kind of familial type of link, right? So there's supposed to be some type of genetic link, which really hasn't been proven. But you know, if you know that you have scoliosis already and you have kids, it's something that you need to be aware of and start to be on the lookout, right. Because sometimes your physician won't catch it. So, um, it's easy if you know what you're looking for, but if you're not trained, not so easy. So that's a trick question.
Speaker 3:<laugh> okay. So can you, uh, give us an idea of what parents should be looking for?
Speaker 4:Yeah. So again, with scoliosis, um, most people know what scoliosis is, but let's just define it. Right? So any type of abnormal curvature, if we are looking at the spine from the front or back, that goes to the side would be defined as a scoliosis in general, right? There's goes that re of scoliosis, which would make the difference. But in general, if you're looking at somebody, if you see a curve into their spine, that's what a scoliosis is. So that's the first thing. Now it's always, um, something of a mystery for people because all of a sudden they see it and then they didn't, that's when it's really, they didn't see it. And now they see it. That's when it's really noticeable. Right. So if you're looking at somebody you wanna look for, um, first of all, if I'm looking at somebody head to toe, I wanna look at the shoulders first. Right? So if I'm actually analyzing somebody, I'm looking to see, okay, is one shoulder higher than the other? Or do they say equal? So that's one of the giveaways that people notice right away is, Hey, that shoulder's a little bit higher on that side. Uh, the next thing that people notice is with a shirt off, sometimes you notice a protruding shoulder blade, right? So if I'm looking at somebody from the back, those little triangles on each side of the mid back that are called the scapula, sometimes they flare out, right? So that shoulder blade, as it's also known as protrudes out more than the other side. So that's sometimes how people catch it. Um, the other one is ribs. So that's one to look for is you see the ribs more prominent on one side versus the other. If you're looking at somebody from the back, sometimes you see like a larger rib arch or a rib bump on one side versus the other, or even if you're looking at them from the front, sometimes you'll notice the ribs on the front, on one side versus the other protruded a little bit more. Um, that's another really good way to look at it. Uh, another one is an uneven waist sign. So if I'm looking at somebody and you notice that the pelvis on one side is a little bit higher, or the hip is a little bit higher on one side versus the other, those are really like the key visuals that people can start to look for. Right? So, uh, again, for each age, it's a little different, but the easiest thing is if you already have a child that let's say is in that, uh, 10 year old, plus you look for the shoulders, you look for the rib arches, you look for the shoulder blades and you look at the waistline. So it's a really complicated thing, but kind of easy if you start to know what you're looking for. So it varies for age, but that's the general, this is what I'm looking for.
Speaker 3:Okay, great. That's very helpful. So it's scoliosis can develop at any age, right?
Speaker 4:Yeah, absolutely. So, um, that's one of the things that we were talking about here. So when we go through different categories of scoliosis, there's an infantile scoliosis, which is, uh, from zero to three years old, then you have juvenile scoliosis, which is three to nine old, and then you have adolescent scoliosis, which would be nine to 18 year old, and then you would have adult, right? So most of the scoliosis are classified as, uh, idiopathic. They would say, uh, the most common is adolescent idiopathic scoliosis. So first of all, idiopathic is they don't know what causes, right. And then the timing would be infantile, juvenile, adolescent, or adult. Meaning when did you first see it? Were they zero to three years old? It would be infantile. Juvenile would be three to nine, adolescent, nine to 18 and an adult anytime after. So technically when they catch it is how they determine, Hey, this is a juvenile scoliosis and that's based off of age.
Speaker 3:Okay. Uh, so going back to what you were talking about with, uh, infantile scoliosis, how common is it in infants and is it treatable that young?
Speaker 4:So infantile scoliosis is, um, it's usually something that starts actually in utero. Um, really when the spine is developing and the most common cause, uh, is a Hemi vertebra, which is a, a fancy way of saying the bones that make up the back are a square. It becomes like a triangle. So if you think of a square stacked, one on top of the other, you would see how the building is, is normal. However, if you have a triangle shaped block in between the squares, you could see how that would force an angle in. So, um, most of the time when you see an infantile case it's starts like that. However, there are times that it's not right and then it's managing it properly. So infantile scoliosis is probably the rarest of all the scoliosis is I think it's less than 1% is what it happens, uh, or the percentage of when it actually happens. And really when you see that immediately, you go to somebody who knows what they're doing, right. So find a clear doctor, uh, or go to somebody that you trust. Um, that's knowledgeable in this because, uh, it's not a common thing and it has to be managed properly. Can it be worked on absolutely. You need a proper diagnosis though. So you gotta go to somebody who knows what they're saying, what they're doing, which is why I said find a clear doctor because they're extensively true, trained in scoliosis, above and beyond most doctors. So unless it's our specialty, um, you know, I, I would try and find somebody who specializes it because, uh, again, infantile would say zero to three years old, you got a brand new life that you're dealing with. You wanna make sure that you get them the appropriate treatment.
Speaker 3:Right. Okay. Uh, now this may wind up as a bit of a trick question because I know treatment is personalized to each patient's individual curve, but does the clear treatment you provide change based on severity or is it the same treatment just for longer when it comes to advanced cases?
Speaker 4:Yeah. So that's one of the most commonly asked questions when people just start to inquire, um, the, the key here is that every single patient is different. Every single scoliosis is different, even when it's the same type of curve, meaning if it's an Sur or a C curve or three curves, they still react different. So every person gets their treat and curtail to them based off of what we find. So, um, there is no one cookie cutter, which is why this is so difficult and why so many doctors don't do this treatment because it's a lot of work. So treatment is personalized to make sure that we first address the type of curve, the size of the curve and the risk of progression. Right? So if you have somebody who's, um, an adult and they're not growing anymore, and they have a 30 degree curve, you're gonna treat it a little different than a six year old that has a 30 degree curve that has an extreme high risk of progression. So treatment is curtailed based off of multiple factors. So is it different from case to case? Absolutely.
Speaker 3:Okay. Uh, I get, I hear a lot from a lot of patients. Um, and one of the most frequently asked questions. I get, um, whether it's adults who missed the earth and you've been dealing with scoliosis for years, or their parents of children who have more severe cases of scoliosis, is it ever too late for clear treatment?
Speaker 4:No, absolutely not. So, um, again, I've been doing this for a really long time and a lot of the clear doctors, um, and I have have exp areas infants, basically a again, how we were talking infantile cases up through my oldest patient was 92 years old. Right. So it runs the gambit on age. Uh, it's never too late. What does change is, um, the curve flexibility, right? So anybody who's under 18 years old because they're growing, there's a lot more, more flexibility as opposed to somebody who's in their seventies, eighties, nineties, who has, uh, maybe some scar tissue or some arthritic change. Um, but again, there's always something that can be done. The key here is quality of life, right? So we're not just looking to say, Hey, I want to try and reduce a curve as much as possible. I wanna be able to give somebody quality of life. I want somebody to be able to function properly, to not have the issues. Most scoliosis don't cause discomfort, but let's say you do have it. I want you to be able to have quality of life when it comes to that. So you can play with your grandkids. Uh, if you're an, an adult, you can be in the yard. If you're an adult, uh, you can work and have quality of life at work and not have to worry about your neck mid back or lower back bothering you because of that. So in the quality of life phase, we mostly see it in adults, ironically enough. Um, I get a lot of patients that are older women that are 40 to 70 that went UN undiagnosed. And all of a sudden they realize they have a little bit of a curve because their tailor caught it. So their pant legs, a it shorter than the other side and the tailor has to address it, or the sleeve on the, on the arm has to be addressed. So I ironically comes out of vanity where they notice it and they say, Hey, I notice my body shift. They all wanna work on this. So, uh, it's never too late. You just have to make sure you find the right qualified doctor, um, so that you, and get the appropriate treatment to get the changes, to get the treatment that you want and need.
Speaker 3:Okay. Uh, do you have any final thought or piece of advice that you'd like to leave with the listeners today?
Speaker 4:Yeah. This particular podcast that we're doing today is early signs of scoliosis. So, um, one of the things that I wanna point out is this, there used to be screenings that went on at schools, uh, and they were done regularly. And I think most of the schools in my area, I'm in south Florida, um, they've stopped the funding for the screenings. Uh, it used to be done by Easter seals down here by us and they even off the program. So, uh, it's usually private schools and charter schools that do it in our area. Now they've asked me to come do it in a bunch of different schools, and we do offer that service because the earlier you catch it, the better the prognosis is, meaning the more you can do with a curve. So I would encourage everybody, especially if you already are an adult and have a scoliosis, and maybe you're listening to this because you have kids, uh, maybe you're a nurse listening to this or a doctor, make sure that you're thorough in checking people. If you're, if you have scoliosis in your family or you personally have it, and you have kids, you wanna look in that eight to really 14 year old range, right? When they rapid growth spurts happen, particularly more common in females. Again, we've talked about that in the past, but be conscious of the fact that because it's in your family, you might have a child or a grandchild that has it as well. And know that the earlier you catch it the better. So don't count on the schools to do it anymore because it used to go, if you remember in school, you would all line up in PE, they'd take your shirt off. They'd have you bend over. That was called Adam's test. And the reason they stopped doing that is they found that once they do that test and they see it, it's now called the too late test, right? So now they're saying, oh, it's way too large at this point to do anything about it. And it's, uh, an immediate referral to a surgeon, uh, for possible surgical intervention, right? So the sooner you can catch it, the better there's some apps on the phone as well that you could probably find that's basically like a scoliometer, which is a fancy way of saying a level where you would put the level or your phone with the app on, on the person's back when they're laying down and you would see it lean one way or the other, because there would be rotation. So that's another trick that I didn't mention was you could find some apps that do it, but again, the easiest way, find a cl find a qualified, clear physician, because they're gonna be able to tell you, Hey, uh, there is, or there isn't, and the sooner you find it, the better the prognosis for the case. So I would encourage everybody early detects is key. Make sure you're always checking and know that you're looking for a couple different signs, but, you know, if you catch it super important for girls, it's usually right before their first mens, when they have a really fast growth spurt. So again, that varies on age, but 11 to 14 is usually when it happens for boys, it usually happens a little bit different, but again, from birth, you wanna start to look, if it's an infant really easy, just, you know, when you have'em on their belly and you have their back exposed, just see if the spine bends one way or the other, that would be an infantile case. And for a juvenile case, once they're weight bearing and they're walking, then you can start to use the tips that we looked at with a high shoulder, the high hip, uh, or their shoulder protruding, uh, the scapular protruding, uh, really important. So again, I encourage early detection is the key. It's so much easier to manage a case that's caught earlier than later.
Speaker 3:Great advice. Thank you so much for joining us today, Dr. Alex, I always learned so much from you. We look forward to having you me back on a future episode.
Speaker 4:Hey, always a pleasure. Have a great day.
Speaker 3:You too.
Speaker 1:If you'd like more information on scoliosis, you can find additional podcasts, articles, blog posts, and much more information by 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 more to come next week.