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7 Things I Tell Every New Scoliosis Patient on Day One · Scoliosis with Dr. Chris Gubbels

• 0:00
  SPEAKER_00: A doctor told you the degree of your scoliosis, but they didn't tell you what it meant or what to do with it.
• 0:06
  SPEAKER_00: That gap in understanding is one of the first things I address with all my patients.
• 0:11
  SPEAKER_00: Now, after 18 years of treating scoliosis and working with over 6,500 patients, I know exactly which gaps in information keeps people from getting the best possible outcomes.
• 0:21
  SPEAKER_00: One of the things I've realized over the years is that for most patients, the biggest barrier to good outcomes isn't the actual curve.
• 0:29
  SPEAKER_00: It's what they were told or possibly not told before they found the right office or treatment that's holding them back.
• 0:36
  SPEAKER_00: I'm going to walk you through all seven of these.
• 0:38
  SPEAKER_00: The beliefs patients carry in that hold them back.
• 0:41
  SPEAKER_00: And by the end of this, you'll have what you should have had from the very beginning.
• 0:46
  SPEAKER_00: So point one, your child's scoliosis didn't happen because you screwed up.
• 0:50
  SPEAKER_00: Families frequently assume that their child's scoliosis was caused by something that their child did or something that they allowed.
• 0:57
  SPEAKER_00: For example, they may think it's from bad posture or because you're always carrying heavy backpack on one side, or maybe from too much time spent hunched over looking at a phone.
• 1:07
  SPEAKER_00: It's common for parents to feel guilt about missing their child's scoliosis, especially when they seem to come out of nowhere.
• 1:13
  SPEAKER_00: The truth is, scoliosis is not caused by things like bad posture or wearing heavy backpacks on one side or slunching over.
• 1:21
  SPEAKER_00: 80% of schools that are actually idiopathic, which means we don't know the actual cause.
• 1:26
  SPEAKER_00: It's a growth deformity.
• 1:28
  SPEAKER_00: And during rapid growth phases, part of the spine grows differently than the other side, and the spine twists and curves in three dimensions.
• 1:35
  SPEAKER_00: That process happens at a structural level that had nothing to do with posture or bags or screens or anything the family actually controlled.
• 1:44
  SPEAKER_00: And as of today, it's not something that could have been prevented.
• 1:47
  SPEAKER_00: It's actually very common for curves to go unnoticed until they become larger and more visible, especially since we don't have official scoliosis screening programs in the United States, and pediatricians generally have very minimal training on how to actually look for scoliosis.
• 2:02
  SPEAKER_00: This is usually the first place I start with patients because although they may have a diagnosis, most people don't understand why it's happened.
• 2:09
  SPEAKER_00: And a lot of times parents come in feeling guilty that they missed it.
• 2:12
  SPEAKER_00: Every parent I've had this conversation with describes the same thing afterward.
• 2:16
  SPEAKER_00: Not relief that the situation is less serious, but relief that it's not their fault.
• 2:21
  SPEAKER_00: So step one is to stop spending energy on why this happened and to start directing that energy toward what can actually be done.
• 2:27
  SPEAKER_00: And the second thing I go over with every patient is what the degree of curvature actually means.
• 2:32
  SPEAKER_00: So point two, that cob angle number, it's barely half the story.
• 2:37
  SPEAKER_00: The cob angle, it doesn't tell the story.
• 2:40
  SPEAKER_00: It tells you the severity, if it's considered mild, moderate, or severe, and it helps predict how likely the curve is to progress.
• 2:47
  SPEAKER_00: But many times people can focus too much on the cob angle.
• 2:51
  SPEAKER_00: You see, scoliosis is a three-dimensional deformity.
• 2:54
  SPEAKER_00: And when we measure scoliosis on an X-ray, we're only measuring it in two dimensions.
• 2:58
  SPEAKER_00: It doesn't tell you how much rotation is in the scoliosis, it doesn't address the number one concern most patients have, which is how they actually look or their physical appearance.
• 3:07
  SPEAKER_00: Additionally, there are many things we need to consider beyond the cob angle when determining the risk of curve progressing.
• 3:14
  SPEAKER_00: Also, the size of the cob angle is generally not directly correlated with pain levels.
• 3:19
  SPEAKER_00: The cob angle measures lateral bending in one plane.
• 3:22
  SPEAKER_00: It doesn't measure rotation of the apex, it doesn't measure sagittal balance from the side, it doesn't measure flexibility, which actually determines how much correction is possible.
• 3:31
  SPEAKER_00: You see, two patients with a 35-degree curve can have completely different clinical outlooks based on their age, growth status, rotation, and flexibility.
• 3:39
  SPEAKER_00: The cob angle captures none of that.
• 3:41
  SPEAKER_00: See a 35-degree curve in a 12-year-old with high flexibility and with a lot of growth remaining is a completely different situation than a 35-degree curve in a 16-year-old that's near skeletal maturity.
• 3:54
  SPEAKER_00: Same number, everything else that matters is different.
• 3:57
  SPEAKER_00: If the number alone has only been shaping your direction, you're working with an incomplete map.
• 4:02
  SPEAKER_00: Cobb angle is where the assessment starts, not where it ends.
• 4:06
  SPEAKER_00: What matters is trajectory, where the spine is going, at what rate, under what condition.
• 4:12
  SPEAKER_00: Answering that requires rotation at the apex, skeletal maturity, sagittal bounds, coronal bounds, and the flexibility assessment among many other things.
• 4:22
  SPEAKER_00: When you have all of those, the picture is much more clear than with just the cob angle alone.
• 4:27
  SPEAKER_00: So with my first clinic with the new patient, I do a full and detailed scoliosis assessment, which changes the clinical picture in nearly every case.
• 4:36
  SPEAKER_00: Some cases are more urgent than the cob angle initially implied.
• 4:40
  SPEAKER_00: Some are more optimistic.
• 4:42
  SPEAKER_00: Either way, the prognosis is more accurate than with just the cob angle alone.
• 4:46
  SPEAKER_00: So start asking for a full assessment, not just the cob angle or degree of curvature.
• 4:51
  SPEAKER_00: And you'll start asking about the trajectory, not just the current physician.
• 4:55
  SPEAKER_00: But getting a right diagnostic picture is only part of what an initial evaluation covers.
• 5:00
  SPEAKER_00: And the third thing I give every new patient has to deal with the goal given in by other providers and how the goals given to them by our office may be different.
• 5:09
  SPEAKER_00: So if this is the kind of conversation you've been looking for, be sure to subscribe below.
• 5:13
  SPEAKER_00: I post specifically on scoliosis every single week.
• 5:16
  SPEAKER_00: Clinical information built for people navigating this condition actively.
• 5:21
  SPEAKER_00: So be sure to subscribe so you'll have access to all of it and hit that bell icon so you're notified whenever I release new content.
• 5:28
  SPEAKER_00: Now, point three, slow it down is the goal they gave you because they didn't know better options exist.
• 5:35
  SPEAKER_00: People are frequently told that slowing or stopping the progression of sclerosis is the best thing that can be achieved.
• 5:42
  SPEAKER_00: That correction is not possible.
• 5:44
  SPEAKER_00: Families accept this because it comes from a doctor and because it actually sounds responsible and reasonable.
• 5:50
  SPEAKER_00: Stabilization is the realistic ceiling with the standard of treatment at hospitals and orthopedic centers because the type of treatment and braces they use.
• 6:00
  SPEAKER_00: Their braces use what's called three points of pressure that works by trying to squeeze and hold the spine in place.
• 6:06
  SPEAKER_00: And almost none of them offer scoliosis-specific exercises or physical therapy.
• 6:12
  SPEAKER_00: Custom three-dimensional corrective bracing, like the Scully brace, and scolios-specific exercise like Scully Bounce now exist.
• 6:21
  SPEAKER_00: And in most juvenile and adolescent cases with the right tools at the right time, correction is achievable.
• 6:28
  SPEAKER_00: And in many young adults where their spines are still flexible, reduction is also achievable.
• 6:33
  SPEAKER_00: See the goals you were given were defined by the tools your other providers had, not based on the best tools available.
• 6:40
  SPEAKER_00: Changing the goals sounds small, but it changes every decision that follows, including what brace to choose, which exercise to do, and how to measure whether things are working.
• 6:50
  SPEAKER_00: The goal I set in my clinic for most cases is reduction.
• 6:54
  SPEAKER_00: Stabilization is the floor, not the target.
• 6:57
  SPEAKER_00: When patients understand that, they start asking different questions about their brace, their exercise protocol, and what progress actually looks like.
• 7:05
  SPEAKER_00: Now, one of the reasons the goal is frequently to just keep things from progressing to surgery is that most orthopaedic centers only think about the curve during growth.
• 7:14
  SPEAKER_00: A lot of people actually think that curves don't progress when people are done growing.
• 7:18
  SPEAKER_00: But the research actually shows that 68% of all scoliosis cases that start during childhood or adolescence continue to progress after skeletal maturity in adulthood.
• 7:29
  SPEAKER_00: So the third thing is about the goal.
• 7:31
  SPEAKER_00: The fourth is about something I hear from almost every patient who walks in with a history of treatment that didn't move the needle.
• 7:38
  SPEAKER_00: So point four, if the treatment didn't work, the problem was the treatment, not your spine.
• 7:44
  SPEAKER_00: If the treatment didn't change the curve, the spine is resistant, the case is harder than most, and the patient isn't responding.
• 7:51
  SPEAKER_00: When a treatment doesn't work, there are two possible explanations.
• 7:55
  SPEAKER_00: One, the treatment was wrong, or two, the patient's the problem.
• 7:59
  SPEAKER_00: The second gets offered more than it should.
• 8:02
  SPEAKER_00: Because it actually ends the conversation that requires a change to the protocol or taking ownership by the provider.
• 8:08
  SPEAKER_00: For example, general physical therapy has no peer-reviewed evidence supporting its use as a curve-changing intervention for scoliosis.
• 8:15
  SPEAKER_00: Standard physical therapy is not designed to treat alignment problems.
• 8:19
  SPEAKER_00: Scoliosis is a three-dimensional structural deformity.
• 8:22
  SPEAKER_00: A standard brace, like the Bossum brace, applies compression in just one plane, using what's known as three points of pressure.
• 8:30
  SPEAKER_00: Scoliosis lives in three planes simultaneously.
• 8:34
  SPEAKER_00: And when the tool's wrong, the body isn't failing the treatment, the treatment is failing the body.
• 8:39
  SPEAKER_00: So it's not that the patient was not a good candidate for the treatment.
• 8:42
  SPEAKER_00: It shows that the treatment is not very effective.
• 8:45
  SPEAKER_00: In fact, the research shows that for a brace to be effective at treating and reducing scoliosis, we need to see a minimum of a 30 to 50% reduction of the curve with the brace on.
• 8:56
  SPEAKER_00: If the scoliosis isn't reduced with the brace on, then either it's a curve that cannot be braced or the brace is designed, manufactured, or fitted incorrectly.
• 9:06
  SPEAKER_00: Usually it's the latter.
• 9:08
  SPEAKER_00: Now, this distinction matters more than it might seem because the same spine that didn't respond to the wrong treatment can and frequently does respond to the right one.
• 9:17
  SPEAKER_00: So the question to ask about any prior treatment isn't whether it worked, but whether it was designed to work for this specific condition.
• 9:25
  SPEAKER_00: Scholiospecific exercise and custom three-dimensional corrective bracing are built for scoliosysteformia, and general tools are not.
• 9:33
  SPEAKER_00: Prior outcomes are just evidence of what was possible with those tools, not evidence as what's possible with the spine.
• 9:40
  SPEAKER_00: When I work with patients who came in after years of doing general physical therapy or had a soft brace or standard brace from the hospital with curves that were progressing the entire period, those same spine, when given the right tools and the right protocol, frequently reduced.
• 9:54
  SPEAKER_00: You see, the biology was not the problem in any of those cases.
• 9:57
  SPEAKER_00: It was the tools that were used.
• 9:59
  SPEAKER_00: So stop expecting that your curve is just not responding as the clinical explanation and start asking whether the treatment was specifically designed for scoliosis or even designed to correct scoliosis.
• 10:10
  SPEAKER_00: So the fourth thing I addressed was prior treatment.
• 10:12
  SPEAKER_00: And the fifth is for every doll who's been told that treatment is no longer an option for them.
• 10:17
  SPEAKER_00: Point five, adults can be treated with scoliosis bracing.
• 10:22
  SPEAKER_00: Whoever told you otherwise was just ignorant to the latest advances in non-surgical scoliosis treatment.
• 10:27
  SPEAKER_00: Patients are frequently told that bracing is just for adolescents and doesn't work in adults.
• 10:31
  SPEAKER_00: And there's nothing that can be done at their stage but to manage symptoms or possibly surgery.
• 10:36
  SPEAKER_00: You see, the bracing framework that most providers trained in was around adolescent scoliosis during growth.
• 10:43
  SPEAKER_00: And adults weren't typically a part of that model.
• 10:46
  SPEAKER_00: They were completely excluded from by default.
• 10:48
  SPEAKER_00: But what we'd now know is adults absolutely respond to bracing when the braces are designed correctly.
• 10:55
  SPEAKER_00: You see, what causes scoliosis to progress in adolescence is completely different than what causes scoliosis to progress in adults.
• 11:02
  SPEAKER_00: In adolescence, scoliosis is a growth problem.
• 11:05
  SPEAKER_00: So bracing in adolescence is designed to control and guide growth.
• 11:09
  SPEAKER_00: In adult scoliosis, it's a degenerative problem.
• 11:12
  SPEAKER_00: The spine is literally collapsing under the weight of gravity.
• 11:16
  SPEAKER_00: So the braces for adults are designed to support the spine and keep it from collapsing into the curve.
• 11:22
  SPEAKER_00: Also, the bracing protocols are different.
• 11:25
  SPEAKER_00: Four to eight hours daily rather than 20 plus hours.
• 11:29
  SPEAKER_00: And the goals are calibrated for the adult spine, but the mechanism still holds.
• 11:34
  SPEAKER_00: And an adult spine with flexibility still remaining in the soft tissues can frequently be moved and changed.
• 11:40
  SPEAKER_00: So the provider who told you that bracing wasn't an option was telling you what their training covered, not the latest advantages in non-surgical scoliosis treatment.
• 11:50
  SPEAKER_00: Every adult patient I've worked with who was told that they were not a candidate for bracing was told that by someone has little or possibly no training in non-surgical scoliosis treatments.
• 12:01
  SPEAKER_00: And because scoliosis is so prevalent in adults, my largest population base are adults in their 40s, 50s, 60s, 70s, and even their 80s, who've had great results with bracing.
• 12:12
  SPEAKER_00: In fact, my oldest patient was 94 years old.
• 12:15
  SPEAKER_00: She was actually brought to me by her son, who was a chiropractor that heard me speak at a seminar.
• 12:20
  SPEAKER_00: And it was after I treated her for several months, she told me the brace literally gave her reason to go on living.
• 12:27
  SPEAKER_00: Meaning she was so miserable and in such pain from being hunched over, she couldn't do anything she enjoyed before we treated her, and that she just didn't want to go on living anymore.
• 12:37
  SPEAKER_00: Once we gave her a corrective brace and improved her posture and decreased her pain, she could actually do the things she enjoyed, and it gave her a purpose again.
• 12:45
  SPEAKER_00: Now, the primary goal in adults with scoliosis is to reduce pain, stop or slow curve progression, and improve the quality of life.
• 12:53
  SPEAKER_00: But as I mentioned, in younger adults who are more flexible, correction is still possible in most cases.
• 13:00
  SPEAKER_00: So adults who have written out treatment because it's something they were told in a hospital setting should find a provider who actually works with adults specifically before accepting that as the final verdict.
• 13:10
  SPEAKER_00: In fact, I tell most of my older patients with scoliosis, if we can eliminate or decrease your pain, if we can stop or dramatically slow the progression of your scoliosis, and if we can improve your quality of life and help you do the things that you enjoy much longer than if we never did treatment, would you be happy with that?
• 13:28
  SPEAKER_00: And the response is an overwhelming absolutely.
• 13:31
  SPEAKER_00: So stop treating the verd that nothing can be done outside of surgery and start looking for a fighter who specializes in the non-surgical treatment of scoliosis, including adults.
• 13:41
  SPEAKER_00: The fifth thing is for adults who are told treatment is behind them.
• 13:44
  SPEAKER_00: The sixth thing is for everyone who's been using fear of surgery the wrong way.
• 13:49
  SPEAKER_00: So point six being afraid of surgery should make you act now, not watch and wait.
• 13:55
  SPEAKER_00: Fear of surgery means being diligent, monitoring carefully, not doing anything too aggressive until absolutely necessary.
• 14:02
  SPEAKER_00: The medical system reinforces this.
• 14:05
  SPEAKER_00: Wait until the curve is bad enough.
• 14:06
  SPEAKER_00: You see, the threshold for surgery is a number in juveniles and adolescents, and it's pain that's not responding to traditional or conventional treatments in adults.
• 14:15
  SPEAKER_00: And until you cross that threshold, the system asks you to watch and wait.
• 14:20
  SPEAKER_00: Fear becomes the motivation to watch carefully, but not necessarily act in our traditional system.
• 14:25
  SPEAKER_00: The reality is, as a curve that's progressing, is closing the non-surgical treatment window.
• 14:31
  SPEAKER_00: Every month that window stays unused, the margin for meaningful correction gets smaller.
• 14:36
  SPEAKER_00: The spine stiffens, the stop tissue adapts, flexibility decreases.
• 14:40
  SPEAKER_00: Fear of surgery isn't a reason to stay still.
• 14:43
  SPEAKER_00: Fear of surgery should motivate you to act before staying still becomes a decision that ultimately sends you into the operating room.
• 14:52
  SPEAKER_00: So fear of surgery used as a reason to wait is what makes surgery even more likely.
• 14:58
  SPEAKER_00: Patients come in who are close to that surgical threshold, having been motivated by their fear of surgery to wait carefully rather than to act, are the ones I find the hardest to have this timing conversation with.
• 15:10
  SPEAKER_00: Look, fear of surgery is real information.
• 15:12
  SPEAKER_00: It tells you what you don't want, but the most useful thing you can do with it is find out right now why the non-surgical window is still open, what it would take to keep it that way.
• 15:22
  SPEAKER_00: A scoliosis specialist doing a current assessment can answer that question.
• 15:27
  SPEAKER_00: Another six months of watching and waiting cannot.
• 15:30
  SPEAKER_00: What's interesting is the goal of surgery is basically the same as non-surgical treatment options to reduce pain, prevent curb progression, and enhance the quality of life.
• 15:39
  SPEAKER_00: Now, if the outcome is the same, you should only consider surgery when you've exhausted all the non-surgical treatment options.
• 15:47
  SPEAKER_00: So if your biggest fear is that school cells get worse and you'll end up having surgery, you need to realize nothing stays the same.
• 15:54
  SPEAKER_00: Things either get better or they get worse.
• 15:56
  SPEAKER_00: And they don't get better on their own.
• 15:58
  SPEAKER_00: So if you don't act, it's absolutely going to get worse.
• 16:01
  SPEAKER_00: So the sixth thing is about what to do with that fear.
• 16:04
  SPEAKER_00: The seventh is about what you're allowed to expect from every appointment going forward.
• 16:09
  SPEAKER_00: So point seven, you should leave every appointment understanding exactly what's happening to your spine.
• 16:15
  SPEAKER_00: The provider manages the condition, the patient follows the plan, the clinical details are for the clinician to hold.
• 16:21
  SPEAKER_00: You see, medical culture has historically placed the clinician in the position of holding all the information and the patient in the position of just receiving instructions.
• 16:30
  SPEAKER_00: Most patients have actually been trained not to push against that.
• 16:33
  SPEAKER_00: But a patient that doesn't understand what their curve is doing, why the specific treatment plan was chosen, and how progression is actually being measured can't make informed decision.
• 16:42
  SPEAKER_00: They can't notice when something is off between appointments.
• 16:45
  SPEAKER_00: They can't advocate effectively when the plan needs to be changed.
• 16:50
  SPEAKER_00: Compliance without comprehension is one of the most consistent features in the cases I've seen go wrong.
• 16:55
  SPEAKER_00: So if you've been leaving your appointments more confused than when you arrive, the problem isn't the complexity of the condition.
• 17:02
  SPEAKER_00: The problem is in the overall care and educational model.
• 17:05
  SPEAKER_00: You see, what I get every patient on day one isn't just recommendations and a schedule.
• 17:10
  SPEAKER_00: I give them a framework.
• 17:12
  SPEAKER_00: Here's what your curve is doing.
• 17:14
  SPEAKER_00: Here's what the treatment does to it.
• 17:15
  SPEAKER_00: Here's what I want you to look for and watch between visits.
• 17:18
  SPEAKER_00: Here's where our checkpoints are.
• 17:20
  SPEAKER_00: Here's what we're actually going to check.
• 17:22
  SPEAKER_00: And here's how we know if the treatment is working.
• 17:24
  SPEAKER_00: You're allowed to ask what your current measurements are.
• 17:27
  SPEAKER_00: You're allowed to ask what the monitoring protocol looks like and when the next x-rays will be taken.
• 17:32
  SPEAKER_00: And also what to expect or hope to see when those x-rays are taken.
• 17:36
  SPEAKER_00: A good provider answers all these questions very clearly.
• 17:39
  SPEAKER_00: In fact, patient education is one of the key components of effective scoliosis treatment.
• 17:45
  SPEAKER_00: You see, every single patient who's had a meaningful outcome in my practice has one thing in common.
• 17:50
  SPEAKER_00: They understand exactly what we're doing and why.
• 17:53
  SPEAKER_00: When a patient knows and understands what the exercises they're doing structurally actually do to them, when they know how to track their progress, they tend to stay engaged throughout the treatment.
• 18:05
  SPEAKER_00: You see, understanding is actually part of the mechanism of improvement.
• 18:09
  SPEAKER_00: So stop accepting confusion as normal and start expecting clarity as the standard.
• 18:14
  SPEAKER_00: Now, here are three things you can do today.
• 18:16
  SPEAKER_00: Write down which of these seven things you recognize in yourself.
• 18:20
  SPEAKER_00: Guilt that something you did caused this, the cob angle is your whole story, the goal of just slowing it down, the assumption that your body is the problem, not the treatment, the verdict that treatment is behind you and there's something you can do for it, fear being spent on watching instead of acting, and leaving appointments without a clear picture of what's actually happening.
• 18:40
  SPEAKER_00: Write down what each of these is actually costing you.
• 18:42
  SPEAKER_00: And then write down one specific question for each one you recognize.
• 18:46
  SPEAKER_00: You don't need the answer to these right now, but you do need these questions ready before your next appointment with a scoliosis specialist.
• 18:52
  SPEAKER_00: And if you haven't had an evaluation with a provider who specialized specifically in non-surgical scoliosis treatments, book that appointment.
• 19:01
  SPEAKER_00: Bring these seven questions with you.
• 19:03
  SPEAKER_00: See which ones actually get addressed clearly.
• 19:06
  SPEAKER_00: These seven things should be the standard.
• 19:08
  SPEAKER_00: They should be part of every first appointment.
• 19:10
  SPEAKER_00: The fact that most patients come to me having never heard them is a gap that our practice actually exists to close.
• 19:16
  SPEAKER_00: And now you have them, and that changes what you ask for and what you accept from every appointment going forward.
• 19:22
  SPEAKER_00: And now that you know what that initial office visit should look like, the next thing most always want to understand is what the early signs of scoliosis actually are and whether or not they're visible before someone's ever diagnosed with scoliosis.
• 19:36
  SPEAKER_00: You see, most families tend to find out after the fact that the signs were there.
• 19:42
  SPEAKER_00: They simply just didn't know what to look for.
• 19:44
  SPEAKER_00: And in my video on the early warning signs of scoliosis, covers every single one of them.
• 19:50
  SPEAKER_00: The link is on the end screen and in the description below.
• 19:53
  SPEAKER_00: Watch that one next.
• 19:55
  SPEAKER_00: I'll see you there.