Don't condemn bracing!

[DrStitzel]

Poor results apparently attributed to half-assed programs leading to half-assed results.

Good results = Good treatment protocols.

Actually, I think it's "Good treatment protocols = Good results"

This also exemplifies the injustice of CLEAR getting blasted on the NSF forum, because the patient didn't take personal responsibility for following the home rehab program.....of course that never gets mentioned in the disgruntled post or series of uninformed attacks that follow.

Everyone wants to put the cart before the horse by jumping right into comparing results, when we should be comparing ideas, theories, and treatment applications based off them. Once the problem and processes are full vetted and agreed upon; THEN we can start comparing treatment outcomes. Measure twice and cut once.

Bracing and surgery are still working under the premise that scoliosis is primarily a spine problem......I think it is primarily a neurological problem with primary effects on the spine. It is a big difference in thought pattern, which results in a big difference in how one approaches the problem, which makes a big difference in how one solves the problem.

I'm not crazy.....just taking the path less travelled and I'm willing to bet that it will make all the difference.

[mamamax]

Good results = Good treatment protocols - or - Good treatment protocols = Good results

Either way - you can't have one without - the other :-) I found the Milwaukee piece by Dr. Winter most compelling. He points to the two instances in history where the brace was effective and outlines the controversy of its effectiveness as a direct result of inadequate protocol. I do think that is relative to other methods as well.

You are right about the fact that we should be sharing/comparing in a positive and productive atmosphere. I don't know why some would rather do otherwise. Another mystery in the universe.

Is scoliosis (IS) primarily a neurological dis-function? It is entirely possible given the role of (and from the perspective of) the central nervous system. Looking at it from that perspective then - rehabilitation would become the treatment of choice. I think it is possible that rehabilitation may be accomplished (in varying degrees) by many methods - none of them simple - and each of them (from surgery to chanting) demanding trade offs of some kind. For certain, there is no one size fits all. Frustrating both for patients and for those who seek to help them.

[DrStitzel]

Is scoliosis (IS) primarily a neurological dis-function? It is entirely possible given the role of (and from the perspective of) the central nervous system. Looking at it from that perspective then - rehabilitation would become the treatment of choice.

And now you fully understand my frustration with bracing methods that are developed entirely on the premise that something is wrong with the spine itself.....I won't mention any names (cough.....Boston Brace...cough........or any other rigid braces).

Spine Cor (which is short for "spine corporation") attempts to integrate NMR (neuro-muscular re-education), but is solely based spinal feedback to the brain. Effective NMR needs to be initiated by the brain.....not simply through feedback loops.

[mamamax]

And now you fully understand my frustration with bracing methods that are developed entirely on the premise that something is wrong with the spine itself.....I won't mention any names (cough.....Boston Brace...cough........or any other rigid braces).

Spine Cor (which is short for "spine corporation") attempts to integrate NMR (neuro-muscular re-education), but is solely based spinal feedback to the brain. Effective NMR needs to be initiated by the brain.....not simply through feedback loops.

I can't say that all rigid bracing methods are developed entirely on the premise that something is wrong with the spine itself (simply don't have the inside education). Though certainly something is. I really would love to know all that has historically gone into design from the medical vs patient viewpoint - and found the Milwaukee discussion up tread fascinating.

I'm not an anatomy major but - the brain + the spinal cord (housed by the spine) = the central nervous system. Any method that works to effect some change to the spine, also in some manner - effects a change in the CNS as the spinal cord and the brain certainly must sense any alteration (I would think).

The brain has 12 cranial nerves and the spine 31 pairs (Cervical 8, Thoracic 12, Lumbar 5, Sacral 5 and Coccyx 1). From there it gets even more complicated :-) Keith Bridwell MD posts a cool flow chart on line (attached).

Point is all these nerve guys talk to each other depending on experience - so as I see it just about everything from surgery to chanting is working with the central nervous system, et al. Of course a spine is not of much use without muscles.

I don't understand all there is to know about NMR (Neuro Muscular Re-education/Rehabilitation), or all the other things that come into play with the Spinecor brace. I do know that I have much more overall back strength out of brace than I did before treatment began. For me this has resulted in dramatically reduced pain (both in and out of brace) just into 10 months of treatment. One day I think I'll try to understand all that better than I do now.

[DrStitzel]

I'm not an anatomy major but - the brain + the spinal cord (housed by the spine) = the central nervous system. Any method that works to effect some change to the spine, also in some manner - effects a change in the CNS as the spinal cord and the brain certainly must sense any alteration (I would think).

The brain is the point of origin for nerve impulses (aka: it sends out the marching orders, rather than taking orders), so I don't think you can rely on neural feedback looks from the spine to produce CNS adaptations to a large degree. Some of the sensory integration type theories (which I am a strong supporter of) outline a mechanism in which incorrect afferent messages (incoming) from the body's proprioceptive mechanisms lead to an appropriate, but unfortunately incorrect based off the incorrect original input, efferent (out-going) messages from the brain to the spine resulting in a mal-adaption to gravity. The lateral cortical spinal and anterior spino-cerebellar tracts are prime suspects, but proving it is pretty difficult.

I don't understand all there is to know about NMR (Neuro Muscular Re-education/Rehabilitation), or all the other things that come into play with the Spinecor brace. I do know that I have much more overall back strength out of brace than I did before treatment began. For me this has resulted in dramatically reduced pain (both in and out of brace) just into 10 months of treatment. One day I think I'll try to understand all that better than I do now.

I am very happy to hear your responding to treatment so well, but your case is probably the exception rather that the rule (in terms of increased back strength). They didn't coin the term "brace dependency" for nothing.

[mamamax]

The brain is the point of origin for nerve impulses (aka: it sends out the marching orders, rather than taking orders), so I don't think you can rely on neural feedback looks from the spine to produce CNS adaptations to a large degree. Some of the sensory integration type theories (which I am a strong supporter of) outline a mechanism in which incorrect afferent messages (incoming) from the body's proprioceptive mechanisms lead to an appropriate, but unfortunately incorrect based off the incorrect original input, efferent (out-going) messages from the brain to the spine resulting in a mal-adaption to gravity. The lateral cortical spinal and anterior spino-cerebellar tracts are prime suspects, but proving it is pretty difficult.

So how does exercise work? You know like physical rehabilitation after a stroke? May need to know based on some conversations elsewhere :-)

I am very happy to hear your responding to treatment so well, but your case is probably the exception rather that the rule (in terms of increased back strength). They didn't coin the term "brace dependency" for nothing.

Well see that's the thing. As I understand it - Spinecor is engineered such that brace dependency is not normally a concern. Studies are showing of course, that exercise along with bracing is key to holding any correction post weaning. Something I need to get busy on!

[DrStitzel]

So how does exercise work? You know like physical rehabilitation after a stroke? May need to know based on some conversations elsewhere :-)

Rehabbing the spine is completely different than rehabbing any other part of the body, because it is the only part of the body that is actively orienting itself to gravity. It does this primarily through a series of involuntary reflex arches collectively referred to as "the righting reflexes". I recommend wikipedia"ing" the righting reflexes if you really want to gain a more in-depth understanding of how the spine orients itself to gravity. It will become very obvious how this directly impacts scoliosis and why attempts to only treat the cobb angles (symptom of the underlying condition) are doomed for failure. This is also why forced correction and voluntary movement exercises have almost no effect on the condition.

"Well see that's the thing. As I understand it - Spinecor is engineered such that brace dependency is not normally a concern. Studies are showing of course, that exercise along with bracing is key to holding any correction post weaning. Something I need to get busy on!"

Well, my clinical experience with spine cor patients (which admittedly is only a small percentage of spine cor patients and generally only those not responding well to treatment) have all displayed signs of significant brace dependency.

Spine cor is ahead of the game in a sense that pulls the curve, instead of attempting to push the curve, but it is still forced correction, which means it still will create some type of brace dependency and will have limited NMR value.

The CLEAR rehab system is almost entirely based on re-training the righting reflex systems that neurologically orient the spine to gravity. That is why our approach is so different from virtually anything else that has been developed in terms of previous scoliosis treatment systems.

I'm not surprised by the way everyone reacts and attacks CLEAR's approach. It is completely departed from conventional wisdom and previous attempts in treating the condition, but based on the terrible treatment outcome results of the past approaches.....I think the time for a complete over-haul is long overdue.

[mamamax]

Rehabbing the spine is completely different than rehabbing any other part of the body, because it is the only part of the body that is actively orienting itself to gravity. It does this primarily through a series of involuntary reflex arches collectively referred to as "the righting reflexes". I recommend wikipedia"ing" the righting reflexes if you really want to gain a more in-depth understanding of how the spine orients itself to gravity. It will become very obvious how this directly impacts scoliosis and why attempts to only treat the cobb angles (symptom of the underlying condition) are doomed for failure. This is also why forced correction and voluntary movement exercises have almost no effect on the condition.

I'm out of my league in this. The reason I mentioned PT in relation to stroke is - looks like a case to me where there is brain damage - which is partially corrected through outside influence (exercise by the medical text book definition). So I see a case where the brain receives instruction and reprocesses. Interesting phenomenon.

Well, my clinical experience with spine cor patients (which admittedly is only a small percentage of spine cor patients and generally only those not responding well to treatment) have all displayed signs of significant brace dependency.

Are you certified in Spinecor treatment Clayton? I wasn't aware of that, if so I'm doubly impressed!

The CLEAR rehab system is almost entirely based on re-training the righting reflex systems that neurologically orient the spine to gravity. That is why our approach is so different from virtually anything else that has been developed in terms of previous scoliosis treatment systems.

I'm not surprised by the way everyone reacts and attacks CLEAR's approach. It is completely departed from conventional wisdom and previous attempts in treating the condition, but based on the terrible treatment outcome results of the past approaches.....I think the time for a complete over-haul is long overdue.

Some people naturally attack that which they cannot understand I guess. We've seen some impressive testimonials. And we're certainly looking forward to the most recent publication. Some folks from years back have had less than positive reviews. But things do change as time goes on and methods are often refined. I believe this is true with all methods.

Do I understand that once one has completed a Clear intensive that the at home maintenance amounts to about half an hour a day? That is very similar to the Schroth method in that respect.

Can you comment on Chest Wall improvement relative to the Clear method? I'd be interested in knowing how that factaors into the equation.

[DrStitzel]

Hi Mamamax,

A lot can be taken from stroke rehab research, but keep in mind this fundamental difference. A stroke affected brain is an injured one....a scoliosis affected brain is...well, not getting, receiving, and/or sending the right message to the spine as it attempts to orient to gravity....that part isn't entirely clear yet, but the point is the scoliotic brain isn't injured like a stroke affected brain. Therefore, the rehab concepts are probably similar; the actual implementation is way different.

I am not certified in spine cor, but I do get patients who have used the spine cor brace and seen their curves progress. Most of them also saw their curves increase dramatically once they stopped using the brace......especially if they stopped using the brace cold turkey. To me, that indicates brace dependency, not an increase in spinal strength.

Again, I am only seeing the cases in which the spine cor treatment wasn't successful, so it certainly isn't a 100% fair comparison with the total spine cor population and perhaps their curves would have dramatically increased regardless if they weaned out of the brace vs stop using it all of a sudden. Everyone's scoliosis is their own and that is one of the reasons scoliosis is sooooo difficult to study.

The new CLEAR article will definitely make waves, but all of those with a vested interest (emotional, financial, or otherwise) will pick every inch of it apart and invent ways to discredit the findings regardless of what it determines anyway. So what's the point of arguing results when we should be discussing viable mechanisms and theories that would invariably lead to more effective treatment methods, which would produce better results as a by-product of the very process that lead up to the results. We need to leave this "gotcha type-politics" created by the dueling studies dilemma and come together in a "systems process" type thinking model. That would strip away all the emotional and personal incentive type clutter than drowns out productive conversation. At some point, we're going to have to put all of the "results" from all the studies down and really focus entirely on the process of figuring this out....once that happens the logic and treatment solutions will be self-evident.....and the results will follow.

"Some folks from years back have had some less than positive reviews"......Oh come on....seriously? One sided testimonials by people no one has ever met or ever will meet? How credible is that? Really? Does anyone ever wonder why no positive reviews are ever written even though we obviously have case studies that show very impressive results? Heck the one brave soul from Colorado who did post about her positive results in Dr. Woggon's office was personally attacked by everyone else on the forum and her posts were removed. Who in their right mind would dare post something positive about CLEAR after watching that public beat down? The NSF forum has become a one sided, censored, bully pulpit that has created an environment in which a small group of attack dogs roam the grounds and tear up anything that doesn't fit into their well engrained culture of "this is how we do things around here and if you don't conform to our model of how the world works we'll run you out of town".

The NSF is a good organization and does a lot of good things for patients with scoliosis, but the forum is in desperate need of a leadership and culture change. It doesn't appear to be interested in anything that challenges conventional wisdom or introduces new ideas into the discussion. That isn't healthy, productive, or helpful to any scoliosis patients anywhere.