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The Complete Guide to Adult Scoliosis After 50 (A Specialist Explains Everything) · Scoliosis with Dr. Chris Gubbels

• 0:00
  SPEAKER_00: If you're over 50 and you've been dealing with back pain that just keeps on returning, and you've been told you have arthritis or disc degeneration or it's just part of getting older, that diagnosis is not necessarily wrong, but it may be incomplete.
• 0:13
  SPEAKER_00: And the piece that's missing may be the very reason that every treatment you've tried has helped temporarily, but the pain keeps returning.
• 0:21
  SPEAKER_00: The problem is no one's actually addressing the underlying structural cause of what you're experiencing.
• 0:27
  SPEAKER_00: So after 18 years of treating scoliosis, I see pattern in adults' consistency.
• 0:32
  SPEAKER_00: Most arrived having done many different treatments that relieve pain, but no one's really done anything that actually addresses the structural cause or explains why this is happening.
• 0:41
  SPEAKER_00: And the reason this gets missed is not because providers are ill-intentionaled or they don't really care, it's because they haven't been specifically trained in dealing with scoliosis in adults.
• 0:51
  SPEAKER_00: And most don't really understand how scoliosis progresses in adults as we age, specifically in adults once we get past the age of 50.
• 1:00
  SPEAKER_00: So in this video, I'm gonna explain in detail what happens with adults with scoliosis after the age of 50, what causes it, why does it progress, how do we know if it's likely to progress, which treatments work, which ones don't, and what you should do at this point.
• 1:14
  SPEAKER_00: And by the end of this video, you will understand your scoliosis in a way you never had before.
• 1:19
  SPEAKER_00: Now, the first thing you need to understand is scoliosis in adults is much different than most people understand.
• 1:25
  SPEAKER_00: You see, when most people think about scoliosis, they think about adolescents and children.
• 1:29
  SPEAKER_00: They think about getting that scoliosis screening by the school nurse or possibly by your pediatrician when you were in middle school.
• 1:35
  SPEAKER_00: But most people don't really think about scoliosis in adults.
• 1:38
  SPEAKER_00: The reality is only about 3% of teenagers get diagnosed with scoliosis.
• 1:43
  SPEAKER_00: And this is a much bigger problem as we get older.
• 1:46
  SPEAKER_00: When you look at 40-year-olds, about 9% of adults over 40 get diagnosed with scoliosis.
• 1:52
  SPEAKER_00: Once we hit 60, it's about 38 to 40% of adults.
• 1:56
  SPEAKER_00: And when we look at adults beyond 70 and the 90s, it's anywhere between 50 up to 68, 70% of adults.
• 2:04
  SPEAKER_00: So although many people think about scoliosis associated with teenagers going through gross spurts, it's actually much, much more common in adults, and it gets more common as we get older and as we continue to age.
• 2:15
  SPEAKER_00: Now, another reason that this gets missed or not really thought of in adults is a lot of people think that scoliosis does not continue to progress beyond skeletal maturity.
• 2:24
  SPEAKER_00: But recent research actually shows that 60% of adolescents that have scoliosis, that their curves continue to progress after they're done growing into adulthood.
• 2:36
  SPEAKER_00: And over time and as we age, a lot of times it actually picks up speed and progresses faster and faster the older we get.
• 2:43
  SPEAKER_00: And so when we look at adults, there's two primary different types of scoliosis in adults.
• 2:48
  SPEAKER_00: You have people that had scoliosis when they were younger that they still have as an adult, and you could have people that had scores and they were younger, they knew they had scoliosis, maybe they got treatment and they didn't think about it, and then as a young adult, it starts to progress, become more painful, and then they're just looking to see like what else could be done.
• 3:05
  SPEAKER_00: Or you have people that had scolus and they were younger, they didn't even know they had it, but a lot of times as an adult, they start to get pain, they get an x-ray, and they find out they have it.
• 3:14
  SPEAKER_00: That's one type of sculptus.
• 3:16
  SPEAKER_00: It's an adolescent scoliosis present in an adult.
• 3:18
  SPEAKER_00: The other type of scoliosis is one that actually develops in adulthood.
• 3:22
  SPEAKER_00: This is called the degenerative de novos scoliosis, meaning it's a new scoliosis, it's a degenerative scoliosis that develops in adults.
• 3:31
  SPEAKER_00: Now, in women, this typically happens around the age of 50 or after the onset of menopause.
• 3:36
  SPEAKER_00: And then it usually happens later, maybe in the late 60s, early 70s, when it typically starts to present in adult men.
• 3:43
  SPEAKER_00: The other thing people generally don't understand, especially when they're trying to treat these, is what causes scoliosis to progress in growing teenagers is completely different than what causes scoliosis to progress in adults.
• 3:55
  SPEAKER_00: You see, when you develop an idiopathic scoliosis as a child or a teenager, what's happening is the spine is actually growing deformed and asymmetrical.
• 4:05
  SPEAKER_00: Part of the bone is growing slower, part of the bone is growing faster, and that causes the spine to twist and bend.
• 4:12
  SPEAKER_00: So when we're treating scoliosis in children or teenagers, we're actually doing treatments that work to control and guide the growth and allow the bones to grow more symmetrical.
• 4:22
  SPEAKER_00: But what causes scoliosis to progress in adults is degeneration.
• 4:26
  SPEAKER_00: You see, as an adult, you're in a war with gravity, and as gravity pushes down, the spine starts to break down and decay.
• 4:34
  SPEAKER_00: And so scoliosis progression is a degenerated problem in adults, whereas an asymmetrical growth problem in adolescents.
• 4:41
  SPEAKER_00: And why this is so important is a lot of people try to treat scoliosis in adults the same way they do scoliosis in adolescents.
• 4:49
  SPEAKER_00: But because they're a different condition and they progress differently, we have to treat them and approach them differently.
• 4:55
  SPEAKER_00: Now, the second point you need to understand is what's showing up on imaging and what's usually reported on imaging reports is real.
• 5:03
  SPEAKER_00: But the complete diagnostic picture and the complete evaluation is frequently missing.
• 5:08
  SPEAKER_00: See if you've had X-rays or MRIs and you have scoliosis, you'll probably look at your reports and see that you have some arthritis or degeneration.
• 5:16
  SPEAKER_00: You may see the term like stenosis, which means a narrowing of canal.
• 5:20
  SPEAKER_00: It may even talk about possible nerve impingement.
• 5:23
  SPEAKER_00: Maybe you'll read disc bulge or disc herniation.
• 5:26
  SPEAKER_00: It'll possibly mention that you have scoliosis.
• 5:29
  SPEAKER_00: It may even give you a cob angle or an actual measurement of the size of scoliosis.
• 5:35
  SPEAKER_00: It may possibly mention a loss of the normal curve of the lumbar spine from the side.
• 5:39
  SPEAKER_00: And those are all true and accurate.
• 5:41
  SPEAKER_00: It's not a complete picture of how we evaluate scoliosis or what's also known as spine deformity in adults.
• 5:49
  SPEAKER_00: What's missing is the actual detailed measurements.
• 5:52
  SPEAKER_00: So when you look at scoliosis, we measure the severity of scoliosis, what's known as the cob angle.
• 5:57
  SPEAKER_00: And even a lot of times when we see that the cob angle is measured on X-rays, a lot of times they're not measured by a true specialist in scoliosis.
• 6:04
  SPEAKER_00: So a lot of times when I re-evaluate them, the measurement I will get will be different than what a radiologist may put down.
• 6:10
  SPEAKER_00: A lot of times radiologists don't even put the degree of curvature because they know they may not be doing it very accurately.
• 6:16
  SPEAKER_00: You absolutely have to have the degree of curvature or the cob angle of the scoliosis.
• 6:21
  SPEAKER_00: But the other thing is you have to have a full spine x-ray.
• 6:24
  SPEAKER_00: And we have to measure what's called coronal and sagittal balances.
• 6:28
  SPEAKER_00: You see, when we look at your spine from the front, your upper thoracic spine or lower cervical spine should line up with the center of your pelvis.
• 6:35
  SPEAKER_00: But a lot of times in adult scoliosis, that starts to shift to the side.
• 6:38
  SPEAKER_00: That's called a coronal imbalance.
• 6:40
  SPEAKER_00: And when that gets beyond about four centimeters, that's a high predictor of pain and disability.
• 6:46
  SPEAKER_00: Also, and probably even more importantly, we have to measure what's called your sagittal balance, which is how your spine is balanced when viewed from the side.
• 6:54
  SPEAKER_00: Now, normally when viewed from the side, your upper thoracic spine or lower cervical spine should line up right over your palus.
• 7:02
  SPEAKER_00: But in scoliosis, a lot of times we start to shift early and forward.
• 7:06
  SPEAKER_00: And in hyperkyphosis or we're hunched over, that may shift backward.
• 7:10
  SPEAKER_00: So we have to measure if your spine is in balance or out of bounds from the side.
• 7:16
  SPEAKER_00: That's called your sagittal balance.
• 7:18
  SPEAKER_00: And when I get x-rays, some other professionals, that's almost absolutely never measured or even mentioned.
• 7:25
  SPEAKER_00: Those are some of the most important measurements we have to look at and understand when we're understanding how scoliosis can impact someone, and when we're deciding the most effective treatments and what we actually need to be addressing with treatments.
• 7:37
  SPEAKER_00: What's also missing is risk factors of curb progression.
• 7:40
  SPEAKER_00: There's nine different predictors of curb progression that I use when I'm evaluating scoliosis progression.
• 7:55
  SPEAKER_00: Most of the time, what I get is sectionals.
• 7:57
  SPEAKER_00: Maybe you have an x-ray of your lumbar spine, maybe you have an x-ray of the thoracic spine, maybe you have all of those, and if you're lucky, they've been stitched together.
• 8:05
  SPEAKER_00: But you have to have the whole spine.
• 8:07
  SPEAKER_00: So if you have sectionals, you want the lumbar and the thoracic for sure, but ideally the cervical too.
• 8:12
  SPEAKER_00: And if they're in sectionals, most soft doors can actually stitch those together.
• 8:16
  SPEAKER_00: But even better is to have a single full x-ray of the front and the side, and then ideally have x-rays where you're laterally bending to measure how flexible your spine is, because the flexibility of your spine is one of the biggest predictors of how likely we are to actually reduce the size of the scoliosis with treatment.
• 8:34
  SPEAKER_00: So the first step is getting a complete picture of what's actually happening with your spine.
• 8:39
  SPEAKER_00: The second step is knowing what to actually do with it.
• 8:42
  SPEAKER_00: And that's what we're going to talk about in point three.
• 8:44
  SPEAKER_00: Now, if you're watching this video and you're finding this information useful, be sure to hit that subscribe button below and hit that bell icon so you're notified when I release new content on scoliosis and non-surgical scoliosis treatments.
• 8:57
  SPEAKER_00: So point three is three different things that are frequently missed when people are not properly evaluated with adult scoliosis.
• 9:03
  SPEAKER_00: Now, one of the biggest things that's frequently missed are the risks of curve progression.
• 9:07
  SPEAKER_00: As I mentioned, there are nine different predictors that I look at that tell me how likely a curve is to progress.
• 9:13
  SPEAKER_00: Three of those that are the most common are one, there's a lateral asthesis.
• 9:16
  SPEAKER_00: One of the burden was actually sliding or slipping compared to the one below it.
• 9:20
  SPEAKER_00: You see, ligaments hold joints together.
• 9:22
  SPEAKER_00: And when ligaments can no longer hold the joints together, they become unstable.
• 9:26
  SPEAKER_00: When that happens in the spine, you can get what's called a lateral sthesis and the bone starts to slip.
• 9:30
  SPEAKER_00: When you see that, that's the curve that's 100% going to keep progressing without treatment.
• 9:34
  SPEAKER_00: The second one is when you have a high or a really tilted L3 or L4 end plate, meaning the third and fourth lumbar vertebrae are really tilted compared to the horizontal plane.
• 9:45
  SPEAKER_00: And the fourth one is an intercrescent line going through your L4 lumbar vertebrae.
• 9:49
  SPEAKER_00: Basically, where you have a you have a high sitting L5 vertebrae.
• 9:53
  SPEAKER_00: Ideally, when we look at your spine, your lumbar spine, your lowest L5 is sitting really low in the pelvis.
• 9:59
  SPEAKER_00: That tells us your spine is more stable.
• 10:01
  SPEAKER_00: If that's sitting higher in the pelvis, you're more unstable, you're generally more flimsy, but biggest thing you have a higher risk of curb progression because of lack of stability.
• 10:11
  SPEAKER_00: The second thing that's frequently missed are the three major sources of pain.
• 10:15
  SPEAKER_00: When we look at adult degenerated squash, there's three areas where pain can come from.
• 10:19
  SPEAKER_00: One is due to big muscle imbalances.
• 10:21
  SPEAKER_00: See, when you have a big curve in your spine, the muscles on the inside are gonna be very short and tight because they've lost their normal length over time.
• 10:30
  SPEAKER_00: The muscles on the outside are gonna be very taut and tense, they're gonna be constantly pulled and stretched, and they're always gonna be working.
• 10:36
  SPEAKER_00: So the muscles on the outside tend to drive pain because they're chronically being worked, they're chronically being stretched, and they're always having to contract.
• 10:43
  SPEAKER_00: So pain from the musculature is one source of pain.
• 10:46
  SPEAKER_00: Another source of pain is pain from the actual discs that are degenerating and from degenerative disc.
• 10:51
  SPEAKER_00: When you have scolicine adults, you start to get a wedging in the disc and the joints on the inside, your facet joints, start to break down decay.
• 10:59
  SPEAKER_00: And you can actually get pain specifically from the degeneration of the disc and from the joints themselves.
• 11:04
  SPEAKER_00: And the third source of pain is from the nerves being compressed or irritated.
• 11:09
  SPEAKER_00: You see, as your spine degenerates, the opening where the nerves come out starts to narrow.
• 11:14
  SPEAKER_00: And that narrowing can put direct pressure on the nerves and is also a major source of pain.
• 11:19
  SPEAKER_00: Now, when the nerves are irritated, a lot of times you're going to get ridiculous symptoms like penguin on the back or the side of your leg.
• 11:26
  SPEAKER_00: And the third thing that's frequently amiss, which also is associated related to how likely we can correct the curve, is spinal flexibility.
• 11:34
  SPEAKER_00: You see, as your spine starts to twist and rotate, at the same time it starts to stiffen and starts to get fixated.
• 11:41
  SPEAKER_00: The stiffer your spine gets, the harder it is to correct or potentially reduce.
• 11:45
  SPEAKER_00: How we can measure the flexibility is with lateral bending x-rays.
• 11:50
  SPEAKER_00: And we can measure how much of that curve reduces when you bend against the curve.
• 11:54
  SPEAKER_00: That's one of the biggest, if not the single biggest, predictor, if we may be able to reduce the curve with proper treatments.
• 12:01
  SPEAKER_00: The next question is what does treatment potential correction actually look like?
• 12:05
  SPEAKER_00: And what kind of goals should adults actually expect from treatments?
• 12:08
  SPEAKER_00: That's what I'm going to answer next.
• 12:10
  SPEAKER_00: So, with the right treatments, what can adults actually hope to achieve or what outcomes should they expect?
• 12:16
  SPEAKER_00: So, first of all, when we look at adults with scoliosis, the primary goals are to reduce or eliminate pain, to stop or dramatically slow the rate of progression, and to improve quality of life.
• 12:27
  SPEAKER_00: But sometimes we can reduce the size of the curve.
• 12:30
  SPEAKER_00: Now, what we're not changing is the actual deformity in there.
• 12:33
  SPEAKER_00: But with scoliosis, there's also a postural collapse.
• 12:37
  SPEAKER_00: And in younger, more flexible spines in adults, we can frequently improve that postural collapse.
• 12:43
  SPEAKER_00: When we look at adults with scoliosis, when we really understand those risk factors for progression, we can typically predict that the adult scoliosis spine will continue to progress or degenerate at a very predictable rate.
• 12:54
  SPEAKER_00: What we're really trying to do with adults is change the natural history of where their spine would go compared to if it didn't have any treatment.
• 13:02
  SPEAKER_00: So if we can actually eliminate or improve pain, if we can stop or solar progression and we can help people do the things they enjoy much longer, 100% of the patients I've seen are absolutely satisfied or happy with those results.
• 13:17
  SPEAKER_00: But as I did mention, sometimes we can reduce the curve.
• 13:20
  SPEAKER_00: For example, I had one adult that came in to see me this year.
• 13:23
  SPEAKER_00: She had a 54-degree curve.
• 13:24
  SPEAKER_00: She was a young adult.
• 13:25
  SPEAKER_00: Her spine was very flexible, but she was also told that she absolutely had to have surgery.
• 13:30
  SPEAKER_00: After just three months, we reduced her curve from the mid-50s into the mid-30s, and she's pretty much 100% pain-free.
• 13:37
  SPEAKER_00: In fact, she went from not even being able to lift about five pounds without severe pain to actually working out with a personal trainer.
• 13:43
  SPEAKER_00: So in adults that have more flexible spines, beyond just reducing pain, and many times we can actually reduce the size of their curves.
• 13:50
  SPEAKER_00: Now, the second part of that is understanding which treatments work and which ones don't work.
• 13:54
  SPEAKER_00: Now, we look at scolicine adults and adults that have pain, things like chiropractic, journal physical therapy, yoga massage, maybe acupuncture, all those things have a lot of health benefits, and they may help reduce pain.
• 14:06
  SPEAKER_00: Also, some of those may actually increase the mobility in the spine, like chiropractic adjustments.
• 14:11
  SPEAKER_00: Those things can be very effective adjunctive treatments to scoliospecific treatments, but on their own, they cannot reduce the risk of curves progressing, and they absolutely can't reduce the size of scoliosis curves.
• 14:24
  SPEAKER_00: There are two treatments that have been found to be very effective in treating adult scoliosis outside of surgery.
• 14:29
  SPEAKER_00: One of those is scoliospecific exercise.
• 14:32
  SPEAKER_00: Now, scoliospecific exercise, things like shroth or Cs or Scully Balance is completely different than traditional physical therapy.
• 14:40
  SPEAKER_00: See, if you go to a traditional physical therapist, they're gonna work to strengthen and stabilize your spine, but in correction.
• 14:46
  SPEAKER_00: With scoliospecific exercises, we actually teach patients how to put their body in a three-dimensional correct position.
• 14:53
  SPEAKER_00: And then we work to strengthen and stabilize their spine, but in that correct position.
• 14:58
  SPEAKER_00: And then we teach them how to hold their body in that correct position while they do things they already do in their everyday life, whether it's things like dishes, whether it's brushing on teeth, or even recreational activities they do.
• 15:09
  SPEAKER_00: The second thing is custom bracing.
• 15:11
  SPEAKER_00: Now, custom bracing for adults is much different than bracing for adolescents.
• 15:16
  SPEAKER_00: And custom bracing is much different than an off-the-shelf symmetrical brace.
• 15:20
  SPEAKER_00: Custom bracing in adults is designed to support and hold and stabilize the spine and keep it from collapsing under the weight of gravity.
• 15:28
  SPEAKER_00: And the research shows that they're highly effective at reducing pain and at dramatically slowing or stopping the rate of curb progression.
• 15:37
  SPEAKER_00: In fact, in one landmark study, they evaluated adults over 15-year periods or adults with degenerated scoliosis.
• 15:44
  SPEAKER_00: And over the first 10 years, they got zero treatment.
• 15:46
  SPEAKER_00: And over the first 10 years, the average patients' adults with no treatment got 15 degrees worse or 1.5 degrees worse per year.
• 15:55
  SPEAKER_00: And then for the last five years, they had them wear custom scoliosis braces on average for about six hours a day.
• 16:01
  SPEAKER_00: And the rate of progression changed down to about 0.2 degrees worse per year.
• 16:06
  SPEAKER_00: So what that means is over the first 10 years with no treatment, the average curve got 15 degrees worse.
• 16:12
  SPEAKER_00: Then over the last five years, wearing a brace part-time, the average curve got one degree worse.
• 16:17
  SPEAKER_00: Now that leads to a dramatically different future.
• 16:20
  SPEAKER_00: And that tells us three things.
• 16:21
  SPEAKER_00: One, the study showed that braces are actually well tolerated.
• 16:23
  SPEAKER_00: I mean it was pretty easy for the patients to wear the brace and they didn't mind wearing them.
• 16:27
  SPEAKER_00: Two, they were very effective at reducing pain.
• 16:30
  SPEAKER_00: And three, they were extremely effective at slowing the natural history or progression of the scoliosis.
• 16:36
  SPEAKER_00: Now, the third thing I want to talk about is why are most people not talked about or told these treatments?
• 16:41
  SPEAKER_00: Well, the reality is you don't learn about scoliosis treatments or non-surgical scoliosis treatments in professional school.
• 16:48
  SPEAKER_00: As a copyright school, physical therapy, medical school, you don't learn about these.
• 16:52
  SPEAKER_00: The only ones that may be aware of these are surgeons that specialize in scoliosis.
• 16:58
  SPEAKER_00: But even out of surgeons, the majority of those do not.
• 17:00
  SPEAKER_00: And I didn't always understand why.
• 17:02
  SPEAKER_00: And then I was at a research conference, and there was the president of the SRS, which is the Scoliosis Research Society.
• 17:08
  SPEAKER_00: So this is the president of the International Society for Scoliosis Surgery.
• 17:13
  SPEAKER_00: And she was presenting to SOSORT, which is the International Society for Non-Surgical Scoliosis Treatment.
• 17:19
  SPEAKER_00: And a physical therapist raised her hand and she stood up and she asked the president of the SRS, I talked to a lot of orthopedic surgeons, but almost none of them tend to be aware of non-surgical scoliosis treatments like scoliospecific exercise or bracing.
• 17:33
  SPEAKER_00: But yet here at this seminar, we see a lot of surgeons that are well aware.
• 17:37
  SPEAKER_00: She said, Why is that?
• 17:38
  SPEAKER_00: And then the president of the SRS responded, she goes, Because the majority of providers out there are just doing practice every day.
• 17:45
  SPEAKER_00: They're just seeing patients and they're not very aware of the research.
• 17:49
  SPEAKER_00: She goes, the providers that are very aware are researchers or they're clinical researchers.
• 17:54
  SPEAKER_00: And the vast majority of practitioners or surgeons are not part of research or are not clinical researchers.
• 18:01
  SPEAKER_00: And I've actually seen this for myself.
• 18:03
  SPEAKER_00: There's actually one surgeon in Denver I met that was very, very aware of non-surgical treatment in adults like bracing and scalato-specific exercises.
• 18:13
  SPEAKER_00: But he was a researcher because as a researcher, he was exposed to these things.
• 18:17
  SPEAKER_00: So the reason these things are not generally talked about or presented is most providers, actually almost all the providers, just don't know them or understand them.
• 18:26
  SPEAKER_00: You have to go to someone that actually specializes at a high level in non-surgical scoliosis treatment.
• 18:33
  SPEAKER_00: So now that you have all this information, what do you do next?
• 18:36
  SPEAKER_00: So point five, I want to go over three things that you can do right now from your home.
• 18:40
  SPEAKER_00: Step one, you should gather all your previous images if you have those.
• 18:44
  SPEAKER_00: And what you want to look for in your reports to the best of your ability, you want to actually identify do you have a risk of curved progression?
• 18:51
  SPEAKER_00: Do you have a series of x-rays over the years?
• 18:53
  SPEAKER_00: And if so, does it actually show or measure your curve getting worse?
• 18:57
  SPEAKER_00: Now, two, if you don't have recent x-rays or you've never had full spine x-rays, the second step is you actually need to go get full spine x-rays of your spine from the front and your side.
• 19:07
  SPEAKER_00: And ideally, you want to go to someone that specializes in non-surgical scoliosis treatment and have them evaluated.
• 19:14
  SPEAKER_00: If you have those and you're not near someone, you can actually request a discovery call in our office and I'll review them with you and I will tell you the severity and the risk-curve progression and what treatments you're a candidate for.
• 19:25
  SPEAKER_00: And the third thing is if you have degenerative scoliosis and you've never seen someone that actually specializes in the non-surgical treatment of scoliosis, you need to actually go in and see a specialist and get another opinion on what's going on with your spine, what's the severity of your spine, how likely is it to progress, and what treatment options are you a candidate for?
• 19:44
  SPEAKER_00: But now that you have a full understanding of scoliosis on adults, the next question you probably have is why does my pain keep returning?
• 19:51
  SPEAKER_00: And what exact treatments are there that have been shown to provide lasting relief?
• 19:55
  SPEAKER_00: And that's exactly what I'm going to talk in the next video you should watch.
• 19:58
  SPEAKER_00: And you can see that in the description below or in the end cap.
• 20:03
  SPEAKER_00: I'll see you there.