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Your Child's Scoliosis Curve Is Small. That Is Exactly When to Act. · Scoliosis with Dr. Chris Gubbels

• 0:00
  SPEAKER_00: Almost nobody in the orthopedic world would say this.
• 0:02
  SPEAKER_00: After 18 years, it's obvious we need to think differently.
• 0:06
  SPEAKER_00: Now, if you've been told that your curve is small and there's nothing to worry about, or maybe you've been watching and waiting and you're wondering yourself, is this the right call?
• 0:13
  SPEAKER_00: What I'm about to share with you either confirm what your beliefs are about doing nothing, if that's the right decision, or it's going to give you the clearest picture of what you actually should be doing instead.
• 0:24
  SPEAKER_00: Now, I spent 18 years treating sclerosis and hyperkyphosis, and I've worked with close to about 6,500 different patient cases.
• 0:32
  SPEAKER_00: And the pattern I'm about to describe is the most consistent thing that I've seen across all of them.
• 0:38
  SPEAKER_00: Now, I didn't understand this when I first started out.
• 0:40
  SPEAKER_00: In fact, for a while, I had it completely backwards.
• 0:43
  SPEAKER_00: And what finally changed my thinking and what I believe most providers are still getting wrong is something that I will name before this video ends.
• 0:51
  SPEAKER_00: But what we're going to walk through and what the research and patients have taught me is a question that I started to ask myself and what you can actually do with all of this tonight.
• 1:01
  SPEAKER_00: So point one, patients with the best outcomes are not always the ones that started with the smallest curves.
• 1:07
  SPEAKER_00: Now the assumption most people carry is that the outcome depends on the severity.
• 1:11
  SPEAKER_00: The bigger the curve, the worse the prognosis.
• 1:13
  SPEAKER_00: The smaller the curve, the more time you have.
• 1:16
  SPEAKER_00: And that feels intuitive and it feels logical, but it's only partially true.
• 1:21
  SPEAKER_00: The 15 degree curve, in a purely structural sense, is less severe than a 45 degree curve.
• 1:27
  SPEAKER_00: What the belief misses is the question about trajectory.
• 1:30
  SPEAKER_00: Where is that 15 degree curve going?
• 1:33
  SPEAKER_00: How fast and under what conditions?
• 1:36
  SPEAKER_00: Here's the thing I had to learn through repetition over years of practice.
• 1:40
  SPEAKER_00: The families and the patients who came to me and got the best outcomes were not always the ones with the smallest starting curves.
• 1:47
  SPEAKER_00: Some of them came with 25, 35, even larger curves.
• 1:51
  SPEAKER_00: But they acted immediately.
• 1:53
  SPEAKER_00: They didn't wait for second opinion to confirm what they already knew.
• 1:56
  SPEAKER_00: They didn't wait to see if things got worse.
• 1:58
  SPEAKER_00: They decided the right time to treat was now, and they went all in.
• 2:02
  SPEAKER_00: The families who struggled the most were often the ones who've been seen earlier, told the curves were small, told to come back six months later.
• 2:10
  SPEAKER_00: And then six months became a year, and then a year became two.
• 2:13
  SPEAKER_00: And that curve that was once manageable over time became a clear crisis.
• 2:17
  SPEAKER_00: It's literally one of the most heartbreaking things when someone comes in when their curves are small.
• 2:21
  SPEAKER_00: They decide to wait and see what happens, and then they come back later on.
• 2:25
  SPEAKER_00: And by the time they come back, the curve has gotten so severe it's beyond conservative treatment, and surgery is the only option.
• 2:32
  SPEAKER_00: Curve starts off small, a provider acting in good faith by the standard of care that they were trained in said it's not really a concern you.
• 2:39
  SPEAKER_00: The family trusts that information.
• 2:41
  SPEAKER_00: They wait, then they come back, and the curve is larger.
• 2:44
  SPEAKER_00: They're still told to wait.
• 2:45
  SPEAKER_00: And then one day it's large enough for the told it's time for surgery.
• 2:48
  SPEAKER_00: And then that family ends up sitting across from me and they asked a question that I'm going to address directly in this video.
• 2:54
  SPEAKER_00: Now I'm not saying that every small curve needs aggressive treatment.
• 2:58
  SPEAKER_00: And I'm also not saying that every provider who recommended monitoring made a mistake.
• 3:02
  SPEAKER_00: What I am saying is that the standard framing of a small curve, low urgency, has a built-in assumption baked into it.
• 3:09
  SPEAKER_00: And that assumption is that weighting is neutral.
• 3:11
  SPEAKER_00: And in scoliosis, waiting is rarely neutral in the way people imagine.
• 3:15
  SPEAKER_00: You see, every month the curve is not being treated, the spine is actually adapting and changing around it.
• 3:21
  SPEAKER_00: The muscles are compensating, the vertebrae are responding and growing more and more asymmetrical.
• 3:25
  SPEAKER_00: And the window where you can make a meaningful or the most meaningful change with the least amount of effort is narrowing.
• 3:32
  SPEAKER_00: The shift in thinking that changed how I approach every patient is this.
• 3:35
  SPEAKER_00: I remember sitting there telling a patient that their curve was small, and at this point it was not very urgent.
• 3:41
  SPEAKER_00: That they had the option of watching to see if it progressed, or they could use some treatment if they wanted to start.
• 3:47
  SPEAKER_00: And then they asked me, what would I do if it was my child?
• 3:50
  SPEAKER_00: Without even hesitating, I said I'm 100% going to do the most aggressive non-surgical treatment.
• 3:55
  SPEAKER_00: Because even there was a small likelihood that the curve could get worse, why would I wait and see if that happened?
• 4:01
  SPEAKER_00: Because I know curves always respond the best and they're easiest to treat while they're smaller.
• 4:06
  SPEAKER_00: So if this is how I would approach my own child's treatment, if he or she had scoliosis, why would I not also offer the same treatments to my patients?
• 4:15
  SPEAKER_00: So when you stop assuming that starting curve size predicts outcome, you start asking a completely different set of questions.
• 4:22
  SPEAKER_00: Questions about trajectory, about flexibility, about the cost of the next six months of inaction.
• 4:28
  SPEAKER_00: Those are the questions that ultimately lead to decisions that ultimately change outcomes.
• 4:32
  SPEAKER_00: But here's what I had to reckon with at about year five or six into my career.
• 4:36
  SPEAKER_00: You see, I'd been telling myself this story about why some patients came in late.
• 4:40
  SPEAKER_00: And I later realized that that story was wrong.
• 4:42
  SPEAKER_00: Which leads me to point two.
• 4:44
  SPEAKER_00: Most patients who arrived with larger curves were told to wait.
• 4:47
  SPEAKER_00: You see, when I first started seeing patients that had curves 40, 45, or 50 degrees, I assumed that they had simply been missed, that the warning signs really weren't there early on, and the family hadn't really noticed it.
• 4:59
  SPEAKER_00: I just thought it was unfortunate no one had really caught it earlier.
• 5:02
  SPEAKER_00: But the more patients I see, and the more charts I reviewed, and the more I talked to patients about their history and their story, a different picture started to emerge.
• 5:10
  SPEAKER_00: See the majority of patients that came to me with larger, more difficult curves had actually been seen earlier, not necessarily by negligent providers, really by careful, well-meaning clinicians who looked at a minor curve, meaning a curve under 25 degrees, and applied the standard of care threshold that they had been trained and told the family to come back in six months or when it got worse.
• 5:31
  SPEAKER_00: And the families did exactly what they were told.
• 5:33
  SPEAKER_00: They waited.
• 5:34
  SPEAKER_00: And that realization really changed things for me significantly.
• 5:38
  SPEAKER_00: You see, these were not patients who simply fell through the cracks in most of the time.
• 5:42
  SPEAKER_00: They were patients that actually engaged in system of health care that they were trained on.
• 5:47
  SPEAKER_00: They received advice that sounded reasonable and they followed it.
• 5:50
  SPEAKER_00: It's the system that fell them through a framework that treats waiting as a safe default.
• 5:55
  SPEAKER_00: And in scoliosis, particularly in a growing child, waiting is rarely the safe choice people imagine it to be.
• 6:01
  SPEAKER_00: You see, the problem is not providers' intentions, it's the framework that they work through.
• 6:07
  SPEAKER_00: You see, the framework that the healthcare providers work through is to only try and prevent surgery.
• 6:12
  SPEAKER_00: And surgery is generally only recommended once curves have hit about 40 to 45 degrees.
• 6:17
  SPEAKER_00: Curves smaller than 25 get no treatment at all.
• 6:20
  SPEAKER_00: And curves 25 to 40 may get recommended a brace that's only designed to slow curve progression.
• 6:26
  SPEAKER_00: But zero treatments are typically recommended to actually reduce the size of the curve.
• 6:31
  SPEAKER_00: So if you build your entire model around whether a curve needs surgery as the only thing you're asking, you will systematically underweight everything that happens before that surgical threshold is crossed.
• 6:43
  SPEAKER_00: You see, what I've learned is that monitoring period is not a holding pattern, it's a treatment window or opportunity.
• 6:50
  SPEAKER_00: You see, when a curve is small, there's less boning deformity and the spine is more flexible.
• 6:55
  SPEAKER_00: And the amount of correction that's possible with the right intervention is dramatically greater than when the curve is large and the structures have adapted around it.
• 7:03
  SPEAKER_00: You see, the same type of intervention applied to a 15-degree curve and a 45-degree curve produce vastly different outcomes.
• 7:10
  SPEAKER_00: Not because the patient with a 45-degree curve is beyond help, it's because there's more bone deformity, the spine is less flexible, and the margin for meaningful reduction is narrower.
• 7:20
  SPEAKER_00: Now, one of the great examples I have in practice is a patient named Katika.
• 7:24
  SPEAKER_00: She was first diagnosed with a 13-degree scolius at just 13 years of age.
• 7:28
  SPEAKER_00: Her provider at the time told her family that was not really a concern.
• 7:31
  SPEAKER_00: They come back in six months.
• 7:33
  SPEAKER_00: And six months later, when they came back, the curve was 23 degrees.
• 7:36
  SPEAKER_00: Still, no treatment was recommended, and they were told that it was still not a concern.
• 7:40
  SPEAKER_00: At about 18 months after that, her curve had progressed to 30 degrees.
• 7:45
  SPEAKER_00: Still, monitoring was the recommendation.
• 7:47
  SPEAKER_00: Then roughly a year after that, her curve progressed to 45 degrees.
• 7:51
  SPEAKER_00: And then she was told that she needed surgery and nothing else could be done for her.
• 7:54
  SPEAKER_00: She didn't come into scholar care, and just three months after starting treatment, we were able to reduce her curves from 45 down to 25 degrees.
• 8:03
  SPEAKER_00: Surgery was no longer required.
• 8:04
  SPEAKER_00: Now, outcomes like that are something I'm generally proud of, but I can't really stop thinking, you know, where might a patient's like Katik had been if someone had actually recorded treatment when the curves were only 13 degrees or 23 degrees or even when they were 30 degrees.
• 8:19
  SPEAKER_00: You see, every threshold with a curved progression that was crossed was a threshold that made the work harder and the stakes even higher.
• 8:26
  SPEAKER_00: You see, when you understand that that monitoring window is actually a potential treatment window, every month in that window it carries a cost.
• 8:33
  SPEAKER_00: And this leads jumping to the question that I ask more than almost any other provider.
• 8:37
  SPEAKER_00: The one that patients tend to bring me at the end of their treatments when we've already made pretty meaningful progress.
• 8:43
  SPEAKER_00: And I want to answer that directly.
• 8:44
  SPEAKER_00: Now, before I do that, if this is the kind of information that you're looking for in scoliosis and you want to keep getting more of it, be sure to subscribe and hit that bell icon so you're notified when we release new videos specifically about helping you navigate scoliosis.
• 8:58
  SPEAKER_00: I want to make sure you have access to all the best information.
• 9:02
  SPEAKER_00: Now, on to point three.
• 9:03
  SPEAKER_00: Sooner is almost always better.
• 9:06
  SPEAKER_00: Now I've heard that question from patients sitting in my office after their child's curves have actually finally started to respond to treatment and the curves have started to reduce.
• 9:14
  SPEAKER_00: I heard that from adults in their 40s, 50s, 60s, and older who are seeing progress they didn't think was possible.
• 9:20
  SPEAKER_00: I've heard it from teenagers who came in close to that surgical threshold and they're seeing their scoliosis slowly decreasing in size over time.
• 9:28
  SPEAKER_00: But it's asked with the particular weight of someone who's grateful for the results that they now have, but they're also left wondering what might have been different if they had started treatment early on.
• 9:39
  SPEAKER_00: And the honest answer, the one that I get every time, is almost always yes, but not absolutely always.
• 9:46
  SPEAKER_00: You see, there are cases where the biology was so aggressive, regardless of the timing and treatment, that the curve is likely to continue to progress.
• 9:54
  SPEAKER_00: But in the majority of cases, the answer is absolutely yes.
• 9:58
  SPEAKER_00: Earlier treatment on a smaller, more flexible curve would have meant less intensive treatment, faster progress, and in many cases a smaller final curve.
• 10:08
  SPEAKER_00: In fact, the relationship between earlier action and better outcomes in scoliosis is consistent enough that I stake my entire clinical approach on it.
• 10:17
  SPEAKER_00: Now, I want to give you a way to assess where you're at right now.
• 10:20
  SPEAKER_00: So ask yourself these questions honestly.
• 10:23
  SPEAKER_00: Do you have a scoliosis diagnosis or a suspected scoliosis diagnosis that you're currently monitoring without accurate treatment?
• 10:31
  SPEAKER_00: Has someone told you that your curve or your child's curve is not large enough yet to do anything about it?
• 10:38
  SPEAKER_00: Have you been watching the curve for six months or more without seeing a provider who specializes specifically in scoliosis treatment?
• 10:46
  SPEAKER_00: Now, if the answer is yes to any of those, you are in that window.
• 10:50
  SPEAKER_00: And that window likely has not closed.
• 10:52
  SPEAKER_00: But the window is not indefinitely open, and the quality of what's possible inside it changes as the curve progresses or changes over time.
• 10:59
  SPEAKER_00: Now I'm not saying this to create fear, but what I am saying is the question, should I be doing something right now, is the most viable question you can be asking.
• 11:08
  SPEAKER_00: Now I've never had a patient do something positively for their health and later say that they wish they would have waited, that they regretted taking action.
• 11:16
  SPEAKER_00: They're always happy they did something to start to address the problem early on.
• 11:21
  SPEAKER_00: So what is acting at the right time actually look like in practice?
• 11:25
  SPEAKER_00: Because it's not a single moment, it's not one appointment or one decision.
• 11:29
  SPEAKER_00: And the answer to that question is the thing 18 years of practice finally taught me to say so clearly.
• 11:34
  SPEAKER_00: And that brings me to point number four.
• 11:36
  SPEAKER_00: Timing is the single biggest factor that separates patients who get the best outcomes compared to those that don't.
• 11:43
  SPEAKER_00: Now, that was something that I could not fully articulate in my early years.
• 11:48
  SPEAKER_00: Even though I was watching it play out right in front of me through every consultation, every single patient, I kept looking for really more clinical variables, a curve pattern, structural characteristics about different curves to really explain why some patients dramatically got better and others maybe did not.
• 12:03
  SPEAKER_00: And yes, all those variables tend to matter, but they're not the biggest one.
• 12:08
  SPEAKER_00: The biggest one is timing.
• 12:10
  SPEAKER_00: And timing is not really a clinical measurement, it's a decision.
• 12:13
  SPEAKER_00: You see, patients who get the best outcomes act before the situation actually demands on it.
• 12:20
  SPEAKER_00: They do something before they're in the crisis.
• 12:23
  SPEAKER_00: That decision-making process is a repeated process across their entire arc of all their entreatments.
• 12:30
  SPEAKER_00: It's what separates the outcomes that are generally good from the ones that are just acceptable.
• 12:35
  SPEAKER_00: Now, across over 6,500 patients, the families and the individuals with the best outcomes share common characteristics.
• 12:42
  SPEAKER_00: It's not that they started with the easiest curves, some of them actually came up with pretty significant or more severe curves.
• 12:48
  SPEAKER_00: What they share is taking action to address the problem.
• 12:52
  SPEAKER_00: You see, the patients that are the most successful, as soon as they learned something needed to be done, they did it immediately.
• 12:59
  SPEAKER_00: When they saw progress, they stayed the course.
• 13:02
  SPEAKER_00: When they hit a difficult stretch, they didn't stop and return six months later to find the curve had actually progressed and got more severe.
• 13:09
  SPEAKER_00: They stayed in the process consistently and with a clear eye on what they were trying to achieve.
• 13:15
  SPEAKER_00: See the patients that tend to struggle the most are not always the ones with the hardest cases biologically.
• 13:20
  SPEAKER_00: They're the ones that wait or demand a crisis to motivate them, that engage in a cycle of treatment and then withdraw, then come back months later to realize the ground under them has literally shifted and we're not talking about the same treatment or outcomes anymore.
• 13:33
  SPEAKER_00: See, the biology in those two different cases is often very similar, but the outcomes typically are not.
• 13:38
  SPEAKER_00: So stop framing every appointment or intervention as a discrete event or asking whether it was worth it in isolation.
• 13:46
  SPEAKER_00: Scoliosis treatment is not like taking a medication for an acute infection.
• 13:50
  SPEAKER_00: And when you complete a course, the problem simply resolves or goes away.
• 13:54
  SPEAKER_00: Start asking a different set of questions at every stage of the process.
• 13:58
  SPEAKER_00: Not is this curve bad enough to treat, but what is the optimal time to treat a curve?
• 14:03
  SPEAKER_00: Not when do I need to worry, but what does proactive engagement look like right now?
• 14:08
  SPEAKER_00: At this curve size, at this current age, with my specific anatomy right now.
• 14:12
  SPEAKER_00: Those questions, when asked consistently, lead to completely different decisions.
• 14:17
  SPEAKER_00: And different decisions lead to different outcomes.
• 14:20
  SPEAKER_00: That's the shift.
• 14:21
  SPEAKER_00: From reactive to proactive, from waiting for a threshold to choosing to act, to choosing to act before the threshold becomes the defining constraint.
• 14:29
  SPEAKER_00: Now I understand this viewpoint or philosophy is probably coming very clear, but I want to make this as concrete and actionable as possible.
• 14:36
  SPEAKER_00: So here's what you can actually do with this information today.
• 14:39
  SPEAKER_00: That brings me to point five.
• 14:41
  SPEAKER_00: The one specific action that you can take today that actually puts you in the right side of the timing question.
• 14:46
  SPEAKER_00: You see, everything in this video comes down to a single operational reality.
• 14:50
  SPEAKER_00: The patients who get the best outcomes act before the situation absolutely demands it.
• 14:55
  SPEAKER_00: The one thing standing between most people and the best outcome is the transition from understanding the problem to taking that concrete first step.
• 15:03
  SPEAKER_00: So I want to make that first step as specific and immediate as possible.
• 15:08
  SPEAKER_00: Because the patients that shift from monitoring to active treatment early are the ones who come back with the outcomes that matter the most.
• 15:15
  SPEAKER_00: Not just smaller numbers on an x-ray.
• 15:17
  SPEAKER_00: Adults who can garden again, travel again, or walk without pain.
• 15:21
  SPEAKER_00: Teenagers who avoid surgery, who go on to live a life without scoliotis impact the quality of their physical life.
• 15:27
  SPEAKER_00: So here's what I want you to do based on where you are in your current situation.
• 15:31
  SPEAKER_00: Walk through these steps today.
• 15:32
  SPEAKER_00: So step one, write down your current status.
• 15:36
  SPEAKER_00: What is the most recent cobangle measurement that you have on record?
• 15:39
  SPEAKER_00: When was that measurement last taken?
• 15:41
  SPEAKER_00: Do you actually have a recent measurement?
• 15:42
  SPEAKER_00: That's important information.
• 15:44
  SPEAKER_00: It means you're making a decision based on a current map.
• 15:46
  SPEAKER_00: Step two, know when your last formal scoliosis evaluation was.
• 15:51
  SPEAKER_00: If it's been more than six months since your last spinal x-rays and you're growing juvenile or adolescent, you need updated x-rays.
• 15:58
  SPEAKER_00: And if you're an adult with scoliosis and it's been a year or two more since your last x-rays, you'll also likely need a new exam on x-rays.
• 16:04
  SPEAKER_00: Step three, identify who conducted the evaluation.
• 16:08
  SPEAKER_00: Was it a pediatrician, a general orthopedic surgeon, a general healthcare provider, general chiropractor, or PT, or a provider that actually specializes in treating scoliosis.
• 16:18
  SPEAKER_00: Now that distinction matters considerably.
• 16:21
  SPEAKER_00: See scoliosis especially.
• 16:23
  SPEAKER_00: General providers apply general frameworks.
• 16:25
  SPEAKER_00: A scoliosis specialist applies scoliosis-specific framework.
• 16:29
  SPEAKER_00: And the difference in what they notice and what they recommend and what they can offer is substantial.
• 16:34
  SPEAKER_00: Step four, ask yourself honestly whether you're in a monitoring pattern or an active treatment pattern.
• 16:41
  SPEAKER_00: And if the answer is monitoring, ask what specific criteria you are given for when monitoring becomes treatment.
• 16:47
  SPEAKER_00: And if no one's given you that clear criteria, that's a gap worth addressing directly.
• 16:51
  SPEAKER_00: Step five, if you have not had a dedicated evaluation with the scoliosis specialist, book one.
• 16:57
  SPEAKER_00: Not a follow-up with the same journal provider that you've already been seen in a monitoring, but a dedicated evaluation who's someone who specializes in scoliosis treatment.
• 17:06
  SPEAKER_00: Ideally, someone who specializes in non-surgical scoliosis treatment.
• 17:10
  SPEAKER_00: Someone that gives you your detailed, accurate assessment of your current scoliosis, the severity, the risk of progression, and directly answer whether active treatment makes sense for you right now.
• 17:20
  SPEAKER_00: And that appointment is the first step that puts you on the right side of the timing question.
• 17:25
  SPEAKER_00: No, it took me 18 years in over 6,500 patients to be able to say with a level of clarity what the biggest factor in scoliosis outcomes actually is.
• 17:34
  SPEAKER_00: It's not the curve you start with, it's the decision you make about when to act.
• 17:39
  SPEAKER_00: Every patient that I've ever seen who looked back at their experience and said they wish it'd done something sooner is making that same point.
• 17:47
  SPEAKER_00: See, the window is likely open right now.
• 17:50
  SPEAKER_00: What you do with it is the variable that changes everything.
• 17:53
  SPEAKER_00: And now that you know that timing is the variable, the most important thing you can do is understand what watch and wait may be actually costing you.
• 18:01
  SPEAKER_00: That's what this next video covers.
• 18:03
  SPEAKER_00: And it connects directly with everything we just talked about.
• 18:06
  SPEAKER_00: It's called Watch This If You Are Told to Watch and Wait on Scoliosis.
• 18:10
  SPEAKER_00: There'll be a link here right on the end screen and in the descriptions.
• 18:13
  SPEAKER_00: I'll see you there.