Latest / Scoliosis with Dr. Chris Gubbels / They Were Wrong About Your Scoliosis... Here's What "Watch and Wait" Really Costs

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They Were Wrong About Your Scoliosis... Here's What "Watch and Wait" Really Costs · Scoliosis with Dr. Chris Gubbels

• 0:00
  SPEAKER_00: You've been told to watch and wait.
• 0:01
  SPEAKER_00: Your doctor looked at your x-ray and said the curve is small and said it's not really a concern.
• 0:06
  SPEAKER_00: He told you to come back in six months or maybe a year, and that advice felt responsible, it felt cautious, and it felt relatively safe.
• 0:13
  SPEAKER_00: But the reality is that may not have been the best advice possible.
• 0:17
  SPEAKER_00: That advice may be the most dangerous thing that families hear after a scoliosis diagnosis.
• 0:22
  SPEAKER_00: And by the time they realize that, the window for the easiest and the most effective treatments has closed.
• 0:28
  SPEAKER_00: In the next few minutes, I'm going to show you exactly what watch and wait really costs, why so many providers still recommend it, and what you may want to consider doing instead.
• 0:37
  SPEAKER_00: Whether you're a parent who has a child with scoliosis or you're an adult living with scoliosis.
• 0:42
  SPEAKER_00: So you were told the curve is mild and that at this stage no treatment's really needed.
• 0:47
  SPEAKER_00: Maybe you're told that bracing is only for curves between 25 and 40 degrees.
• 0:51
  SPEAKER_00: So, like most reasonable people, you waited, you followed your provider's recommendations, and now the curve is bigger, there's less options for treatment, and you wonder how this happened because you did exactly what you were told to do.
• 1:02
  SPEAKER_00: I'm Dr.
• 1:03
  SPEAKER_00: Chris Goobel, specialist in the non-surgical treatment of scoliosis and head clinician at Scholar Care Denver.
• 1:09
  SPEAKER_00: After 18 years and seeing over 6,500 patients, I'll personally tell you many times the most frustrating and sometimes even heartbreaking cases are the ones that never had to become severe.
• 1:19
  SPEAKER_00: Their curves are spines that could have been corrected earlier when they were first detected.
• 1:23
  SPEAKER_00: So I'm gonna walk you through five realities of watch and weight that your provider likely never told you.
• 1:28
  SPEAKER_00: By the end of this video, you're gonna know exactly how to take control of your scoliosis instead of letting it take control of you.
• 1:35
  SPEAKER_00: So point one, all big curves start off as small curves.
• 1:38
  SPEAKER_00: And this is the truth that changes everything once you hear it.
• 1:41
  SPEAKER_00: Every 40-degree curve was once 20 degrees.
• 1:44
  SPEAKER_00: Was once a 15-degree curve where someone was told that it's not a concern.
• 1:48
  SPEAKER_00: You see, the idea that small curves do not need attention is built on the fundamental misunderstanding of how scoliosis actually works.
• 1:56
  SPEAKER_00: Scoliosis by nature is progressive.
• 1:58
  SPEAKER_00: It's natural for scoliosis to get worse over time.
• 2:01
  SPEAKER_00: And growth is the engine that actually drives scoliosis progression in children.
• 2:06
  SPEAKER_00: And degeneration is the engine that drives scoliosis progression in adults.
• 2:10
  SPEAKER_00: You see, waiting doesn't actually pause the condition.
• 2:13
  SPEAKER_00: It just gives it more time to progress.
• 2:15
  SPEAKER_00: Here's a question every parent needs to ponder.
• 2:17
  SPEAKER_00: If we know that scoliosis is progressive and we know that smaller curves are easier to treat, and we know the spine gets stiffer as the curves get larger, then why would anyone recommend doing nothing while the curve was at its smallest and the spine is at its most flexible?
• 2:31
  SPEAKER_00: I had a patient named Katika, and when her scolios was first identified, it was only 13 degrees.
• 2:36
  SPEAKER_00: They were told it's not a concern to come back and check on it in six months.
• 2:40
  SPEAKER_00: And six months later, when they came back for the check, it was 23 degrees.
• 2:43
  SPEAKER_00: But they were still told no treatment was needed and it was not really a concern.
• 2:47
  SPEAKER_00: About a year and a half later, they came back for another checkup and it was 30 degrees.
• 2:51
  SPEAKER_00: And at that point, they were told it's still not a concern because she didn't have a lot of growth remaining.
• 2:56
  SPEAKER_00: About 11 months after that, she came back and the curve had progressed to 45 degrees.
• 3:00
  SPEAKER_00: Her providers were shocked.
• 3:02
  SPEAKER_00: The parents were pissed off, scared, and confused about what to do.
• 3:06
  SPEAKER_00: And that's when they came to us as school like there.
• 3:08
  SPEAKER_00: In just three months, we got her curve from 45 degrees down to 25, and surgery was no longer recommended.
• 3:15
  SPEAKER_00: And luckily, we were actually able to reduce the curve enough where it's no longer a major concern.
• 3:20
  SPEAKER_00: But that journey or her journey would have been a lot easier and less stressful on the family if the curves would have first been addressed when they were smaller at 13 or even 23 degrees.
• 3:31
  SPEAKER_00: You see, no doctor would tell a patient with rising blood pressure to come back in a year and see if it got worse, and no doctor would tell someone with early stages of cancer that it's only mild and just watch and wait to see if it spreads.
• 3:43
  SPEAKER_00: But with scoliosis, those standard recommendations are exactly what happens in cases of mild scoliosis.
• 3:49
  SPEAKER_00: And it's been that way for decades.
• 3:51
  SPEAKER_00: You see, if your child has scoliosis of any size and they have significant growth remaining, the question is not whether or not you should act.
• 3:58
  SPEAKER_00: The question is what kind of action is the most appropriate for their individual scoliosis.
• 4:03
  SPEAKER_00: There's always a range of options available, all the way from the most conservative to doing nothing to the most extreme involving surgery.
• 4:10
  SPEAKER_00: What the real goal is is to get the right treatment at the right time.
• 4:13
  SPEAKER_00: But the deeper issue is, watch and wait is not just outdated advice.
• 4:18
  SPEAKER_00: It's a treatment model that was designed for completely different air with outdated treatments.
• 4:22
  SPEAKER_00: And that's the thing most families don't realize.
• 4:24
  SPEAKER_00: The second point I want to get across is that treatment thresholds are decades behind the actual science.
• 4:30
  SPEAKER_00: You see, the traditional orthopedic model follows a rigid set of thresholds.
• 4:34
  SPEAKER_00: Under 25 degrees, no treatment is needed.
• 4:36
  SPEAKER_00: Between 25 and 40, bracing, but only to try and hold or stop the progression of scoliosis.
• 4:42
  SPEAKER_00: And beyond 45 degrees, surgery is the only option.
• 4:45
  SPEAKER_00: Now, these thresholds have been in place for decades, and they're based on old scoliosis braces that are not actually designed to correct the scoliosis.
• 4:53
  SPEAKER_00: They're only designed to try and slow the progression of curves or potentially keep it from getting worse.
• 4:58
  SPEAKER_00: But with modern times, treatments have advanced and changed.
• 5:02
  SPEAKER_00: Scolia Brace, for example, is a three-dimensional corrective brace that uses CADCAM technology, which is computers to both design and manufacture the brace that are actually designed to correct the scoliosis in many cases and not just try and slow them down or keep them from getting worse.
• 5:17
  SPEAKER_00: We also have scolios-specific exercise methods that are evidence-based and also very effective at treating scoliosis.
• 5:24
  SPEAKER_00: You see, the science insurance have moved forward, but the guidelines and treatments recommended by most hospitals has not.
• 5:30
  SPEAKER_00: In fact, a landmark study called the brace study, where most modern-day bracing recommendations come from, doesn't even look at potentially reducing the size of scoliosis.
• 5:39
  SPEAKER_00: They only look to see if when using bracing, they are likely to stop the progression of scoliosis.
• 5:46
  SPEAKER_00: In that study, they don't even mention possibly reducing the size of scoliosis.
• 5:51
  SPEAKER_00: So, based on that, the bracing used to recommend it in the orthopedic world is only to try and prevent surgery.
• 5:57
  SPEAKER_00: It's not actually designed to try and correct or reduce the size of the curve.
• 6:01
  SPEAKER_00: I recently heard a prominent person in the orthopedic world admitting that their own thresholds or recommendations are probably outdated.
• 6:09
  SPEAKER_00: And they probably need to start exploring treatments that are earlier before curves hit 25 degrees.
• 6:13
  SPEAKER_00: And they also really need to consider non-surgical treatment options beyond 45 degrees before surgery is recommended.
• 6:20
  SPEAKER_00: You see, they know their model is broken.
• 6:22
  SPEAKER_00: It just hasn't filtered down to the recommendations that most families are receiving yet.
• 6:26
  SPEAKER_00: Now we've treated multiple patients with curves between 45 and 60 degrees with custom bracing and scoliosis-specific rehabilitation models.
• 6:34
  SPEAKER_00: Patients that were told their only option was surgery and nothing else could be done to reduce the size of the curve.
• 6:40
  SPEAKER_00: We have an entire case series actually demonstrating this.
• 6:43
  SPEAKER_00: Even research on older adults with degenerative scoliosis shows that custom bracing and scoliospecific exercise can be effective at stopping or slowing the progression of scoliosis, reducing pain, and even in some adult cases reducing the size of scoliosis.
• 7:00
  SPEAKER_00: Now, that same research that talks about treating scoliosis in older adults also says we'd be even more effective at treating adults with scoliosis when they were younger and their curves were more flexible.
• 7:10
  SPEAKER_00: Think of it this way: if the only tool you had was a hammer, everything looks like a nail.
• 7:14
  SPEAKER_00: For decades, the only tools they had in the orthopedic world were observation, bracing to try and slow the progression of scoliosis or surgery.
• 7:22
  SPEAKER_00: So mild curves got observation only, moderate curves got poor bracing, and severe curves always got surgery.
• 7:28
  SPEAKER_00: And now we have a full toolbox of non-surgical treatment options that can be applied at every stage in the patient's journey.
• 7:35
  SPEAKER_00: But many providers are still reaching for the same limited tools because that's what they were initially trained on.
• 7:40
  SPEAKER_00: In fact, I talked to the providers in the orthopedic world all the time that have no idea or very limiting understanding of the non-surgical treatment options like scoliosis-specific bracing or bracing that actually works to reduce the size of the scoliosis.
• 7:54
  SPEAKER_00: Now I was at a prominent research conference and the president of the Scoliosis Research Society, which is the International Society for Surgery for Scoliosis Speaking, and one of the people in the audience raised their hand and they asked, in their experience, why so many surgeons were unaware of the non-surgical treatment options for scoliosis.
• 8:13
  SPEAKER_00: And the speaker said that's because in the orthopedic world, people that are very involved in research or clinical research are very aware of the most effective non-surgical treatment options.
• 8:25
  SPEAKER_00: But the average provider is just doing clinical work and they have their nose down doing surgeries, but not really aware of and exposed to the non-surgical treatment options.
• 8:34
  SPEAKER_00: So if you've been told that your only options are to watch and wait, do bracing that's only designed to slow or stop the progression of scoliosis or surgery, and that outside of surgery nothing can be done to reduce the size of the curve, you haven't been given the full picture.
• 8:48
  SPEAKER_00: There's an entire spectrum of non-surgical treatment options that you haven't been told about, and you owe it to yourself and your child to explore.
• 8:56
  SPEAKER_00: You see the thresholds are outdated and the toolbox for treating scoliosis has rapidly expanded.
• 9:01
  SPEAKER_00: But there's still another myth buried inside the watch and wait philosophy that almost nobody talks about, and it's doing real damage to families every day.
• 9:10
  SPEAKER_00: So if you're a parent and have a child with scoliosis or you're an adult with scoliosis, and this is one of the first times where you've heard someone challenging some of the traditional recommendations or advice that you've been given, I put out videos every week that actually break down what actually works for scoliosis.
• 9:24
  SPEAKER_00: So you can make the most informed decisions, not just following standard protocols.
• 9:29
  SPEAKER_00: So to make sure you're notified when we release new videos on scoliosis, make sure you subscribe below and hit that bell notification so you're notified.
• 9:37
  SPEAKER_00: Point three is mild does not mean minor.
• 9:39
  SPEAKER_00: And confusing the two costs families every single day.
• 9:43
  SPEAKER_00: See the word mild might be causing more damage in the scolios world than anything else.
• 9:47
  SPEAKER_00: Because when a parent or patient hears mild, they hear not serious.
• 9:51
  SPEAKER_00: And that's simply not what that word means.
• 9:54
  SPEAKER_00: I think in a child or an adolescent with significant growth remaining, it'd be more appropriate to exchange the word mild to early phase of scoliosis.
• 10:03
  SPEAKER_00: Mild scoliosis means the curve is between 10 and 25 degrees.
• 10:07
  SPEAKER_00: That's just telling you where the curve is measured right now.
• 10:09
  SPEAKER_00: It has nothing to deal with where the curve is potentially going.
• 10:13
  SPEAKER_00: Because a mild curve in a 10-year girl still has significant risk of progression.
• 10:17
  SPEAKER_00: Whereas a mild curve in a 16 or 17-year-old girl has a minimal risk of progression.
• 10:22
  SPEAKER_00: But when providers use the word mild without giving proper context, parents may inaccurately hear that means they can relax.
• 10:29
  SPEAKER_00: And they hear that treatment can wait.
• 10:31
  SPEAKER_00: For many families, that false insecurity is the beginning of a curve that could have been managed conservatively that becomes a curve and needs more invasive treatments.
• 10:40
  SPEAKER_00: The majority of scoliosis cases are not even diagnosed until they become moderate.
• 10:44
  SPEAKER_00: That's because the signs of mild scoliosis are really hard to detect.
• 10:48
  SPEAKER_00: And many of the signs don't become more prominent until the curves get larger or bigger.
• 10:53
  SPEAKER_00: Now there's almost no parents that know what to look for for scoliosis, though we're actively going around and checking their kids for scoliosis.
• 10:59
  SPEAKER_00: And in the United States, we no longer have any scoliosis screening programs.
• 11:03
  SPEAKER_00: And because of that, many cases are missed when they're smaller and they only get picked up when they're larger or more severe.
• 11:09
  SPEAKER_00: When you start to see major deformities in the body, like a high shoulder, major rib pumping, or you know, possibly a ribcage sticking out.
• 11:16
  SPEAKER_00: A lot of times parents don't even notice the curves until it's summertime and they see their kids with their clothes off or in bathing suits, things like that.
• 11:23
  SPEAKER_00: And by the time the curve becomes visibly obvious, or the child is starting to experience some kind of pain, the curve is almost always progressed to moderate or more severe.
• 11:32
  SPEAKER_00: And then unfortunately, another scenario that we see frequently is the child was actually diagnosed and the curve was mild, but because the parents were told not to do anything, they didn't do anything, they just checked it and it kept getting worse and worse.
• 11:44
  SPEAKER_00: Then at some point for the parent, they can obviously see that their child's spine is progressing and it's getting more severe, and that's when they start to seek out specialty conservative care.
• 11:53
  SPEAKER_00: So if your child has been diagnosed with mild scoliosis, be sure to ask these three questions.
• 11:59
  SPEAKER_00: One, how much growth does my child have remaining, and what is their current skeletal maturity level?
• 12:04
  SPEAKER_00: Two, based on the curve location, size, and remaining growth, what is the estimated risk of curve progression?
• 12:10
  SPEAKER_00: And three, what treatment options are available for their spine right now at their current stage, not just when the curve gets worse?
• 12:17
  SPEAKER_00: And if your provider cannot adequately answer all three of those questions, or you've been told there's nothing you can do to actually reduce the size of the curve, you're not getting complete evaluation or complete recommendations.
• 12:28
  SPEAKER_00: So now you understand what mild actually means and what questions you need to ask.
• 12:32
  SPEAKER_00: But there's a practical reality about watch and wait that nobody talks about.
• 12:36
  SPEAKER_00: And it has to do with what actually happens to the spine itself while you're waiting.
• 12:40
  SPEAKER_00: So point four, every month you wait, the spine gets harder to treat.
• 12:44
  SPEAKER_00: Here's the part that makes watch and wait so costly.
• 12:47
  SPEAKER_00: You're not just waiting for the curve size to get bigger, you're also waiting for the spine to get stiffer.
• 12:52
  SPEAKER_00: And as the spine gets stiffer, it gets harder to treat.
• 12:55
  SPEAKER_00: You see, as scoliosis progresses, the vertebrae actually grow more asymmetrical, the disc wedge, the ligaments tighten, and the spine becomes more and more rigid.
• 13:04
  SPEAKER_00: A flexible 20-degree scoliosis is a completely different challenge than treating a 20-degree stiff or rigid scoliosis.
• 13:12
  SPEAKER_00: You see, spinal flexibility is the biggest predictor or determining factor for how easy it is or how likely it is to reduce the size of the scoliosis.
• 13:22
  SPEAKER_00: It's also one of the biggest predictors of how effective bracing will be to treat the scoliosis.
• 13:26
  SPEAKER_00: So every month without treatment is a month that the spine continues to progress and get stiffer.
• 13:31
  SPEAKER_00: And that stiffness is never going back to where it once was.
• 13:34
  SPEAKER_00: And in adults, the effect of weighting is even more pronounced because the spine is already degenerating and it's already at a certain level of stiffness.
• 13:42
  SPEAKER_00: So the longer adult waits, the stiffer and more unstable the spine gets, and the more limited the treatment options are.
• 13:48
  SPEAKER_00: Now we regularly see adults in their 20s and 30s and sometimes even 40s, where their spines are still flexible enough for meaningful reduction in their curve size.
• 13:57
  SPEAKER_00: I recently had one patient come in where her spine had a 52 degree scoliosis.
• 14:01
  SPEAKER_00: She was in severe debilitating pain.
• 14:03
  SPEAKER_00: She couldn't almost do any of her normal daily functional activities, and she was told surgery was the only option for her.
• 14:09
  SPEAKER_00: Now, because she was young and her spine was still relatively flexible, we were able to reduce her curve from 52 degrees down to just 34 degrees in three months.
• 14:18
  SPEAKER_00: And she's completely pain-free at this point.
• 14:20
  SPEAKER_00: And at this point, there's not a surgeon out there that would even recommend surgery.
• 14:24
  SPEAKER_00: You see, she went from being unable to lift even five pounds to being able to do all of her daily activities, and she's currently working out with a personal trainer.
• 14:32
  SPEAKER_00: But I also see older adults whose spines have become really rigid over decades of untreated progression, and many times their treatment goals have shifted from reducing the size of the curve to slowing or stopping the curve progression, reducing pain, and enhancing quality of life.
• 14:48
  SPEAKER_00: Now, in both cases, conservative treatment is really valuable, but the outcomes are completely different.
• 14:53
  SPEAKER_00: And the biggest difference is almost always how long they went before they sought out treatment.
• 14:57
  SPEAKER_00: So if you or your child has scoliosis and you're currently in this watch or weight holding pattern, stop waiting and start getting better information.
• 15:05
  SPEAKER_00: You do not necessarily need to start aggressive treatments tomorrow, but you do need to get a proper evaluation from a provider who specializes in the non-surgical treatment of scoliosis.
• 15:14
  SPEAKER_00: Not just a general orthopedic doctor and definitely not just a pediatrician.
• 15:18
  SPEAKER_00: You need someone who will fully assess progression risk, evaluate spinal flexibility, and present a full range of options available at your current stage.
• 15:27
  SPEAKER_00: Now doing nothing may still end up being a decision you choose, but it needs to be an informed one.
• 15:32
  SPEAKER_00: So the curve gets bigger, the spine gets stiffer, and the treatment window narrows.
• 15:36
  SPEAKER_00: And all the while you're following advice that you are given in good faith.
• 15:40
  SPEAKER_00: But here's the shift that puts you back in control.
• 15:42
  SPEAKER_00: Point five.
• 15:43
  SPEAKER_00: Replace watch and wait with stay ahead of the curve.
• 15:46
  SPEAKER_00: I'm gonna give you a completely different framework for how you think about scoliosis.
• 15:50
  SPEAKER_00: It starts with one phrase I tell every patient and family who walks through my door.
• 15:54
  SPEAKER_00: The name of the game is to stay ahead of the curve.
• 15:56
  SPEAKER_00: You see, staying ahead of the curve means rejecting the old reactive model where you only respond after the problem has escalated.
• 16:03
  SPEAKER_00: It means adopting a proactive model where you monitor, assess, and intervene at the earliest appropriate stage.
• 16:10
  SPEAKER_00: For smaller curves and growing children, that means active observations and regularly scheduled checkups every three to six months, and scoliospecific exercises to strengthen and stabilize the spine in correction.
• 16:21
  SPEAKER_00: Also, for mild curves between 10 to 20 degrees, part-time or nighttime bracing only may be an option.
• 16:27
  SPEAKER_00: The point is there's always something you could actively be doing.
• 16:30
  SPEAKER_00: And the range of appropriate treatment at each stage can be pretty wide.
• 16:34
  SPEAKER_00: But one option that's almost never the best choice is to do nothing.
• 16:37
  SPEAKER_00: Think of scoliosis management like maintaining a house.
• 16:40
  SPEAKER_00: You don't just wait for the roof to cave in before you call someone.
• 16:43
  SPEAKER_00: You inspect it regularly, you fix small problems before they become big ones, you invest in prevention because the cost of replacement is much bigger than the cost of small repairs and maintenance.
• 16:54
  SPEAKER_00: Watching and waiting is the equivalent of just skipping regular evaluations and doing zero maintenance on your house until the problems become catastrophic.
• 17:01
  SPEAKER_00: Sometimes smaller problems never get bigger, but when it does, the damage is far more expensive and more stressful than it ever needed to be.
• 17:09
  SPEAKER_00: In fact, this last year there was a study done in Canada where they looked at the actual out-of-pocket cost for families where their scoliosis was not detected in time to give bracing and the curve was not being detected until surgery was recommended.
• 17:23
  SPEAKER_00: And for the average family that did not get bracing recommended that could have, it cost them$23,000 out of pocket.
• 17:30
  SPEAKER_00: So tonight, take one step from watching and waiting towards acting.
• 17:33
  SPEAKER_00: So if you are just told to watch and wait your child's scoliosis, but then exactly when their last exits were taken and when their next appointment is scheduled.
• 17:40
  SPEAKER_00: If there's no scheduled follow-up, call tomorrow and get one on the calendar for at least for the next three to six months.
• 17:46
  SPEAKER_00: Don't let observation turn into abandonment.
• 17:48
  SPEAKER_00: And if you're an adult and you've known you've had a scoliosis for a while, but it's been years since you've been checked, get on the phone, call, schedule an employment at Scholaric Care or some other specialist in the non-surgical treatment of scoliosis, go in and get your scoliosis fully evaluated from the front and the side, not just for the severity of the curve, but also your spinal balance.
• 18:08
  SPEAKER_00: That way you know if your curves have been progressing and if there's something you can do to get on top of it.
• 18:13
  SPEAKER_00: You see, watching and waiting was never meant to be a treatment.
• 18:15
  SPEAKER_00: It was literally a holding pattern created in an air where there were no effective conservative treatment options between observation and surgery, or bracing that could only potentially slow the progression that could not actually fix the curves.
• 18:27
  SPEAKER_00: The good news is that air is over.
• 18:29
  SPEAKER_00: You have options now.
• 18:30
  SPEAKER_00: Stay ahead of the curve and change the entire trajectory of your or your child's scoliosis.
• 18:36
  SPEAKER_00: Now, if you want to understand the structural reasons scoliosis pain gets worse over time and what actually works to stop it, go watch my video on why scoliosis pain keeps getting worse.
• 18:46
  SPEAKER_00: I'll connect it directly in the comment section below and at the end of this video.
• 18:50
  SPEAKER_00: I'll see you there.