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Scoliosis

Clear Scoliosis Institute

Understanding the CLEARTM Protocols

Scoliosis is an incredibly complex condition involving much more than the spinal column. There is no one magic adjustment or therapy which will work in every case. This is the reason why understanding our protocols & especially the science behind them is important. Scoliosis treatment must be customized to the particular, specific needs of each individual patient. However, there are certain key aspects of our protocols which are integral to achieving consistent, measurable success in scoliosis treatment.

It is important that the patient understand the science behind these protocols to take full advantage of their benefits. If your doctor claims to be utilizing the CLEARTM Scoliosis Protocols, but does not follow the protocols outlined below, we recommend that you contact CLEARTM Institute directly at care@clear-institute.org to inquire if they are in fact certified for treatment by CLEARTM. The CLEARTM logo is copyrighted, and we take misuse and/or abuse of CLEARTM certification very seriously.

Part I: Precision X-Rays

The first step in the CLEARTM Protocols involves gathering information about the biomechanical function of the entire spine – not just the area(s) affected by scoliosis. It is an axiom that you can control the middle of a cord by moving the top and the bottom. By the same token, it is important to understand what is occurring in the neck and with the hips in order to affect the middle of the spine. To obtain this information, seven small, precise x-rays are necessary, totalling 292 mR of radiation (by comparison, according to the American Nuclear Society, www.ans.org, the amount of naturally-occurring, environmental radiation we are exposed to every year is 360 mR, and the National Council on Radiation Protection and Measurements states that the risk of abnormality to an unborn fetus is considered negligible at 5,000 mR or less). A scoliosis x-ray is also mandated if a recent film is not available. These seven views should include three side views of the neck (one with the eyes looking down, one with the eyes looking up, and one with the eyes straight ahead), a side view of the low back, two frontal views of the neck (one with the eyes straight ahead, and one with the eyes looking up), and one frontal view of the low back.

Part II: MIX (warm-up or “prehab”)

Prior to receiving chiropractic adjustments, the patient is required to warm up their spine using devices such as the Active Rehabilitation Chair (which sits upon a ball-and-socket joint and flexes in every direction to put the spine through a full range of motion), the Cervical Traction (which is used actively by the patient to achieve gentle, repetitive spinal traction), and the Vibrating Traction (which uses a slow, relaxing vibration which has been scientifically proven to relax the ligaments & soft tissues of the spine). A special motorized table with belts that pull (not push!) the scoliotic curves out of the spine, called the Eckard Flexion/Distraction table, achieves the goal of re-structuring & re-modeling the ligaments after they have been relaxed. It is important to understand that if the MIX protocols are not followed, the intervertebral discs will be rigid and inflexible, and it will be difficult if not impossible to effect structural changes to the spine.

Part III: FIX (specific instrument-assisted adjusting)

Mechanical adjusting instruments and specialized drop pieces enhance the precision & effectiveness of chiropractic care, while simultaneously reducing the amount of force required to correct the spine. According to CLEARTM protocols, almost all adjusting of the neck should be performed with the use of such instruments, and the application of these adjustments should be correlated with the information obtained from the patient’s precision x-rays. Follow up x-rays should confirm correction of these areas, neck from the side (lateral cervical x-ray which should include a stress x-ray), front x-ray of the upper body and head (nasium x-ray), and top of the head x-ray (Base Posterior x-ray of there is 4 degrees or more of atlas rotation).

Part IV: SET (rehab stage)

Immediately after the adjusting is completed, the spine needs to be “set” in its corrected position to ensure the permanency of the changes. This involves spinal weighting protocols (typically on the head & hips), whole-body vibration therapy such as the Vibe and/ or the Scoliosis Traction Chair. In addition to the home exercise program, exercises should be done in the clinic on an exercise ball and on the whole-body vibration platform (which has been shown through research to increase the effectiveness of exercise by 2-3 times). If the SET protocols are not followed, any corrections achieved in the spine will be temporary in nature.

Part V: Follow-up exams

After 12 visits, a CLEARTM-certified doctor will take a series of post x-rays to validate the effectiveness of the treatment protocol. The specific x-rays which are necessary are limited as much as possible to the patient’s specific condition. For example, if the initial x-ray demonstrated that the patient’s low back was in pretty good shape prior to beginning care, a sideways view of the low back might not be necessary. It’s important to keep in mind that not every patient will show a reduction in the severity of the scoliotic curve, as measured by Cobb angle, within this time frame. This is due to the fact that Cobb angle is a measurement of only one dimension of the spine, and scoliosis is, in fact, a three-dimensional condition. Before the sideways curve can be reduced or corrected, the spine must be de-rotated and de-compressed in the other two dimensions. Treating a complex spinal disorder such as scoliosis is a little like reversing the path of a runaway train. It takes time to first slow down the momentum, then more time is needed to change the course of the disease.

Part VI: Home Spinal Rehab Program

It is imperative that every CLEARTM doctor emphasizes to their patient the importance of their active participation in the treatment program. As stated by Hippocrates, the Father of Medicine, “The patient must combat the disease along with the physician.” Results are not guaranteed – they are earned, by patients who are willing to work alongside of the doctor. The traditional methods of scoliosis treatment, bracing & surgery, are considered “passive” therapies, in that the patient has the procedures done to them; the doctor designs the brace, the doctor performs the surgery. CLEARTM Institute’s method, by comparison, should be considered an “active” process – that is to say, the doctor teaches the patient how to do the procedures, and the patient does them. A small part of our protocols could be considered passive modalities, but the effectiveness of these treatments on their own is limited without the involvement of the patient. In other words, your degree of participation determines the degree of improvement. Every CLEARTM-certified doctor is instructed to make this clear (no pun intended) to the patient prior to beginning care.

CLEARTM Institute’s Position on Bracing Treatment:

It is important to state that CLEARTM Institute does not formally endorse any type of bracing. In fact, the cumulative clinical experience of the doctors on our Board of Advisors demonstrates that attempting to utilize a brace while the patient is undergoing CLEARTM treatment may have an adverse effect, in that our protocols attempt to strengthen the same postural muscles which are made weaker by relying upon the brace. On the other side of the coin, however, we readily concede that our specialty is not in orthotics, but in spinal biomechanics & postural rehabilitation. It is for this reason that, while we do not advocate bracing, we also do not condemn it. What matters most is that the patient is satisfied with the outcome of treatment.

CLEARTM Institute’s Position on Post-Surgical Treatment:

Patients who have undergone scoliosis surgery in the past may wish to pursue treatment with a CLEARTM-certified scoliosis specialist. However, these patients should not expect any degree of correction, but rather purely symptomatic relief & functional improvement (e.g., treatment to relieve their pain and improve their activities of daily living).

CLEARTM Institute also does not recommend that a patient undergo rod removal surgery. While no CLEARTM doctor has worked personally with a patient who has had surgery to remove the spinal instrumentation, our understanding of biomechanics leads us to conclude that the same muscular atrophy which occurs in the brace, due to lack of motion, will undoubtedly occur in surgically-treated patients as well. If the muscles responsible for moving the spine are inactive for long periods of time, they will atrophy (shrink), and because rehabilitation of the muscles is a vital part of our protocols, the patient may be unable to maintain any corrections that are achieved. Research articles published in Spine on the topic of spinal implant removal in 2005 by Hahn et al and Deckey et al in 2000 have discouraging conclusions to make, stating respectively: “Despite bony fusion, loss of correction between 10 degrees and 26 degrees was observed in three patients after instrumentation removal,” and, “Spinal implant removal after long posterior fusion in adults may lead to spinal collapse and further surgery. Removal of instrumentation should be avoided or should involve partial removal of the prominent implant.”