Oct/Nov/Dec 2008

CLEAR Institute Monthly Newsletter


Chiropractic Leadership, Educational Advancement, & Research
Oct/Nov/Dec 2008 Newsletter Content

Scoliosis Correction: Independent of Age, by Dr. Kristin Schafer & Dr. Michelle Kerr
Early Scoliosis Intervention, by Dr. Brian Dovorany
Out of Balance, by Dr. Matthew Schwab




Scoliosis Correction: Independent of Age
by Dr. Kristin Schafer & Dr. Michelle Kerr

Chiropractors have always been fascinated by abnormal curvatures of the spine and have sought to treat the cause through the adjustment. There is a recent trend emerging in regards to how chiropractic care can address the faulty biomechanics of scoliosis and show significant decrease in the Cobb angle. Typically scoliosis is identified in adolescent patients and addressed early on since their bodies are still growing and adapting to their environment. These younger patients respond well to chiropractic care (adjustments and rehabilitation) and are able to become active participants in their care and not prisoners of their brace.

But scoliosis does not discriminate. Scoliosis may be diagnosed more frequently in the adolescent population but that does not mean that scoliosis is not present in the geriatric population. Is a geriatric scoliosis a lost cause? Once you throw an osteoporotic, scoliotic spine into the mix, many doctors are quick to refer out to orthopedic surgeons out of fear of doing further damage to their patient. But does this mean that we cannot correct scoliosis in a geriatric patient?

On Thursday, February 15th, 2007, we had the pleasure of interviewing Marvin, who is 83 years young. About a year ago, Marvin began being treated in accordance with the protocols developed by CLEAR Institute (Chiropractic Leadership, Educational Advancement, and Research), a non-profit organization dedicated purely to scoliosis correction founded by Dr. Dennis Woggon. The CLEAR protocol of treating scoliosis includes "Mix, Fix, and Set." Mixing the spine up loosens up tight ligaments and brings the discs to a more gel-like state to allow for correction. Fixing the spine occurs through chiropractic adjustments. Setting the spine helps it to hold its new position. Each of these steps — mix, fix, and set — is done on each visit, is very involved, and time consuming. At a CLEAR-certified clinic, the average scoliosis patient’s appointment lasts about 2 hours, so as you can see this is no easy undertaking for Marvin.

Here is his story...


Kristin: “Hi Marvin, this is Kristin."

Marvin: “Hi.”

Kristin: “I feel like you’re a rock star. You’re a legend for Dr. Woggon!”

Kristin: “The first thing I want to ask is how old are you?”

Marvin: “Oh! Easy there.”

Kristin: “I just wanted to get an idea so we could tell our class that people of all ages can undergo chiropractic care.”

Marvin: “Uh huh . . . Well, I guess I’m the oldest patient he’s ever had.”

Kristin: “You’re in your eighties, correct?” [Marvin is 83.]

Marvin: “Yeah.”

Kristin: “Can you tell us a little about your scoliosis treatment before you underwent treatment with Dr. Woggon.”

Marvin: “Well, basically I was not doing anything. I went over to Mayo Clinic . . . and there was no help. That’s as much as they told us. I went to different chiropractors around, but none of them really got into the helpful part of this. They just tried a little and that was it.”
Kristin: “How old were you when they caught your scoliosis?”
Marvin: “Oh, it must have been almost 20 years ago. The way that came about was in the fall I was out raking the yard and my back was hurting so terribly that I went to the doctor. He x-rayed and I came back home and … continued working. He called and said off your feet and off your seat (laughs), in other wards on my back. That was the beginning of it. Ever since it’s been getting worse I guess.”

Kristin: “Did you ever consider seeing an orthopedic surgeon?”

Marvin: “Not really, I’ve had far too many surgeries, and different reports we’ve heard about this back surgery and the rod and all have not been very good.”
Kristin: “Did you ever wear a brace?”

Marvin: “Not really, no.”

Kristin: “What obstacles did your scoliosis cause you to face before you started treatment? I know you had back pain while you were raking. Was there anything else, muscle pain, or any emotional parts that was difficult for you?”

Marvin: “Well definitely, it was difficult to face the aging process. (But I thought) I guess I’ll be with my body as I keep working and suffer with pain.”

Kristin: “Did you have any difficulty sleeping or any digestive problems?”

Marvin: “Not that I can blame for that, no.”

Kristin: “What made you want to go to a chiropractor first for your scoliosis care?”

Marvin: “Years ago we were practically against chiropractors, and then when we found out there was no help at Mayo Clinic we realized we had to start approaching different avenues. That’s when we first started turning to chiropractors.”

Kristin: “How did you hear about Dr. Woggon?”

Marvin: “Through another chiropractor.”

Kristin: “How long have you been seeing Dr. Woggon?”

Marvin: “A little over a year now.”

Kristin: “Can I ask what surgeries you have had in the past?”

Marvin: “Oh, I’ve had double hernia surgery twice, right shoulder replacement, prostate cancer removal, I can’t forget I had my neck broken and there was of course an operation for that.”

Kristin: “Were you in a brace for that?”

Marvin: “You bet. You know the halo brace that screws on the head.”

Kristin: “Yeah”
Kristin: “How are you doing today, you sound like you’re active and doing a lot of stuff?”
Marvin: “Quite well for all I’ve been through and for my age I think I’m doing quite well.”

Kristin: “Can you tell me a little bit about what a typical dinner or lunch is for you?”

Marvin: “For dinner we usually have a large salad, a real large one I mean, a veggie, and a meat. Breakfast usually oatmeal, fruit, or juice. And lunch is kind of pick up.”
Kristin: “Do you think you’ve always eaten a pretty balanced diet, or is that something you’ve developed as you’ve gotten older?”
Marvin: “My mother started out always on lots of vegetables. She canned a lot of stuff out of the garden. I’ve always been a vegetable lover.”
Kristin: “Are there any exercises that you do at home that Dr. Woggon gave you?”

Marvin: “Oh boy, you don’t want the long list!”

Kristin: “Are you wearing the head weights?”

Marvin: “Yes, wearing the head weights and doing some neck bending exercises. A lot of it is neck exercises because my head. I’ve got the forward head posture so much. Foot weights lifting. Oh, I don’t know it just goes on and on. It takes me a long time I know that.”

Kristin: “You do not currently use the scoliosis chair at home; you just use it when you’re at the clinic?”

Marvin: “Correct. I’ve been advised that I should get one, but I have not. Neither myself nor my wife are on any prescription medicines. We do take a lot of nutritional supplements so maybe that’s a contribution to our good health.”

Kristin: “I had some fears before I went to Dr. Woggon’s clinic to be worked on. Did you have any fears or concerns before you went to Dr. Woggon’s or once you saw some of the equipment you’d be strapped into?”

Marvin: “None whatsoever, no.”

Kristin: “What do you contribute that to, Dr. Woggon talking to you and explaining the whole process to you?”

Marvin: “Well, I think mostly that I needed help, and I was willing to try most anything. When I went there he said there were 4 stages of scoliosis and you’re in the third one and the next one is wheel chair.”

Kristin: “What was the hardest part of your treatment?”

Marvin: “I don’t know if I considered any of them really hard.”

Kristin: “What impact has your chiropractic treatment had on you and your family?”
Marvin: “Well, they were all in favor of it. I want to continue getting better if I can, so that’s why I’m willing to make the 135 mile trip we make up there every 2 weeks, and you have to be a little dedicated to do that.”

Kristin: “I think so!”
Kristin: “What message do you have for older patients with scoliosis?”
Marvin: “Well, I guess, from my standpoint, you’re never too old to try to get help.”

Kristin: “That’s very well stated.”

Michelle: “I just wanted to ask you, and I know Kristin kind of touched on it . . .”
Marvin: “This is going to be like a cross examination!”

Michelle: “How are you doing now vs. when you first started care with Dr. Woggon? What improvements or changes have you seen? I know you’ve got the changes on your x-rays, but what have you noticed?”




[The x-rays below were taken of Marvin, in descending order, in January of 2006, March of 2006, October of 2006, and March of 2007).

Marvin: “Well, I’ve got age against me of course, so even if I’m getting better one way I’m aging. So I think I’m holding my own lets say.”
Michelle: “Thank you so much Marvin for taking the time to talk to us. I hope this gets the word out to people that you can treat scoliosis at any age and that chiropractic can help it if you do the right things."
Marvin: “ . . .When I was gone on vacation last fall when I got back I had gone down hill. I told him when I was gone how I was too busy and I didn’t do my therapy like I should have. He said he could tell. This was one of the things he has so much trouble with especially with young people. They won’t do their therapy. So that’s very important.”

Michelle: “Yeah, it is definetly very important.”

Marvin: “You have to be dedicated otherwise you aren’t going to get help.”

Michelle: “I like that it puts the patient's health care back in their own hands, that they have some control over it.”

Michelle: “Is there anything else you want to ask us?”

Kristin: “You can cross examine us!”

Marvin: “No not really, but I’ll say it’s been a pleasure talking to you, and I hope that anything I’ve said has been helpful.”

(Kristin asked the questions previously agreed upon questions & Michelle typed.)



Scoliosis tends to get the reputation that it is a childhood disease and after hearing Marvin’s story this is clearly not the case. We need to address scoliosis in all ages and not be fearful of addressing structural changes in the geriatric spine. Marvin believes that Dr. Woggon saved his life by being the first person to address his scoliosis and save him from serving the rest of his life in a wheelchair. Marvin calls Dr. Woggon his “hero” and in response, Dr. Woggon always replies that Marvin is his hero.










After speaking with Marvin, we are both moved and inspired by his story. We are often disheartened when chiropractors inform us that chiropractic cannot do much for scoliosis except for address symptomatic care in adolescents. We hope they know that they have the power to correct scoliosis through chiropractic care and rehabilitation. We feel chiropractors need to look at the spine globally in addition to a patient’s individual subluxations. Scoliosis is not something that should be ignored nor taken lightly. It requires the attention of a doctor who is willing to put their heart into their care and inspire their patient to become an active participant.

Dr. Michelle Kerr & Dr. Kristin Schafer are recent graduates of Palmer College of Chiropractic in Florida, and as students, helped to found the Scoliosis Mentorship Program.


Early Scoliosis Intervention
by Dr. Brian Dovorany

Scoliosis is a disease of the neuro-muscular system that has long challenged health care professionals worldwide. The current treatment options or lack of any treatment for most families dealing with an early detection of this disease can be very frustrating. In most cases children diagnosed with scoliosis are told they have it and the healthcare team will monitor it to see if it gets worse. This would be similar to having a doctor tell you that you have a highly progressive cancer but we will wait until it spreads before we can do anything for you. Statistically, scoliosis is progressive in most cases.

So where does this leave a child who have been diagnosed with scoliosis below 25 degrees? The general medical approach is to wait until the curve reaches 25 degrees at which time the orthopedic specialist will recommend bracing. The most common form of bracing is a hard brace which is to be worn on average 22 hours daily until skeletal maturity or until the curve advances to 40 degrees then they will push for surgical intervention.

What medical practitioners typically don't tell you is that once the curve reaches 25 degrees the likelihood of progression is 68% even with bracing attempts. So that leaves nearly 70% of the families with a highly progressive disease that ends up involving surgical intervention, a highly invasive surgery with significant post surgical ramifications. I don't know about you, but if my daughter was offered this solution as the only option, I would be very frustrated, scared, and disappointed in our healthcare system for not coming up with a better alternative to effectively combat scoliosis other than bracing and surgery.

Doctors involved with CLEAR-Institute, a non profit organization dedicated to finding a cure for scoliosis, have developed a system that can effectively reduce and stabilize scoliosis without bracing or surgery. In fact, the majority of the scoliosis cases treated by the CLEAR methodology have been the result of family's not wanting surgery or who bracing attempts have failed. This means a huge portion of scoliosis cases that have been reduced and stabilized using CLEAR protocols have been above the 40 degree level. This is a profound discovery because the program was originally designed to correct scoliosis. Meaning take scoliosis generally above 30 degrees Cobb angle and correct it to an ideal level of 5 degrees or less. The problem is that the majority of cases over 30 degrees have not corrected to this ideal 5 degrees or less range. Now this is in no way a failure because a non surgical method has the consistent ability to reduce and stabilize this highly progressive disease. This tremendous accomplishment will most likely revolutionize the treatment for this disease. It is also considered a major accomplishment if we are able to stop progression let alone reduce the actual curve measurement without using bracing, casting, or surgery. The average reduction of curves over 30 degrees in most CLEAR certified clinics is 30-50% with good stabilization rates.

I am writing this article in an effort to inform families with early detection of scoliosis, you can be proactive. The status quo of watching and waiting for the inevitable train wreck is no longer your only option. The CLEAR-Institute has developed a scoliosis treatment option that is ideal for curves under 30 degrees. The reason for the lack of a complete correction with curves above 30 degrees is due to the inherent nature of scoliosis as a feed forward mechanism. Meaning once the curve progresses to 30 or above, the "crankshaft phenomenon" kicks in, which creates massive rotation coupled with lateral flexion and compression. This phenomenon is very difficult to undo. When a curve reaches the 30 degree mark, the chance that a curve progresses skyrockets. This is also why a 50 degree curve may reduce to 30 using the CLEAR method, which is fantastic, but the scoliosis still remains alive. It has not been fully corrected and therefore has the innate potential to want to continue to grow.

By attacking the scoliosis before it reaches this pivotal point of 30 degrees we can typically correct the scoliosis. We are able to reduce the curve to an ideal 5 degrees or less, thus defeating the disease rather than only taming it. Imagine having the opportunity to fix the problem before it spirals out of control giving you the freedom to go about your life without having to constantly worry about what the scoliosis is doing or what it will become. The CLEAR scoliosis program can and will become the first line of defense against childhood scoliosis. At some point CLEAR doctors providing this technology to their communities will be the standard recommendation for children diagnosed with scoliosis. We have the potential to be the "cure."


About the Author:
Dr. Dovorany has been in active practice in Green Bay , WI, for over 11 years and specializes in scoliosis treatment. Dr. Dovorany is Co-chair of the CLEAR-Institute's Board of Advisors education committee and is recognized nationally as one of CLEAR Institute's leading teachers for advanced scoliosis corrective treatment.



Out of Balance!
by Dr. Matthew Schwab

Balance dysfunction has been shown to occur with scoliosis, especially those with progressive curves. There are numerous asymmetries associated with progressive scoliosis, including muscular, ligamentous, brain stem, visual and vestibular righting reflexes, etc. In order for balance to be optimum the human body needs constant communication and harmony between the visual, somatosensory, vestibular, and the appropriate motor commands to react to this constant feedback within its environment. Currently CLEAR Institute is investigating this dis-harmony from a slightly different approach. One observation noted by Dr. Dennis Woggon is a flexion malposition at the skull and first vertebrate, or atlas. On X-ray evaluation what has been observed over repeated analysis is a flexion-malposition at the C0/C1 articulation when the scoliosis is in it’s progressive, or active state. By progressive I mean skeletal growth is driving the progression at a faster rate than normal. Clearing that up is important since without active intervention, scoliosis, being a dynamic condition is either getting better or getting worse, it doesn’t stay the same. This C0/C1 anatomical area is important since there are many important spinal cord tracts at this location giving us feedback and proving crucial motor commands for postural control.
In this brief overview we would like to educate you on several stability indicators that may assist you and your health care practitioner as to what may be causing your imbalance and just why it is where it is. First of all there are two main types of balance, static and dynamic. An example of static balance would be trying to open your house door with 1 arm while holding onto a bag of groceries. An example of dynamic balance would be walking on unstable terrain that moves as your heel strikes the surface. This then is now a dynamic environment forcing a reaction of the calf and toe musculature to quickly cause a reaction from the bottom up. How well and how fast you react is a measure of your balance capability.

Research has been done that has outlined a hierarchy of balance difficulties for varying curve patterns in individuals with scoliosis. Interestingly, individuals with two opposing curvatures, or a double major scoliosis (DMS) often exhibit the best control of balance in both static and dynamic scenarios. For static control of balance the individuals with curve patterns lower in the body (Lumbar scoliosis) often have the most difficult time balancing. The next worse scenario is the curvatures that encompass both the thoracic and lumbar spine (Thoracolumbar scoliosis), preceeded by a single thoracic curve (Thoracic scoliosis), and lastly the double major curve patterns (Double major scoliosis). In summary, from best to worst in a static balance setting, they are as follows, Double Major Scoliosis, Thoracic Scoliosis, Thoracolumbar Scoliosis, and lastly Lumbar Scoliosis.

For dynamic balancing, as mentioned earlier individuals with a double major scoliosis exhibit the least difficulty. The next best is Lumbar scoliosis, followed by Thoracolumbar scoliosis, and lastly Thoracic scoliosis. The interesting observation here is that individuals with the higher curvatures (Thoracic scoliosis) revealed the greatest imbalance. The next question one might ask is, why are individuals with DMS curve patterns performing the best with regards to balance? One key reason is the position of the head and neck. The closer the head is positioned over the body, such as in DMS, the body’s vestibular input is more symmetrical thus enabling better balance control. In summary, from best to worst in a dynamic balance setting are DMS, Lumbar scoliosis, Thoracolumbar Scoliosis, and lastly Thoracic Scoliosis.

Urge your doctor to check your balance in several different settings, including with eyes open and closed. If compromised, it could be not only an indicator of scoliosis, but an explanation as to why you are having difficulty balancing and, depending upon the balance test, an indicator as to the location of the major curvature. CLEAR methods address these balance difficulties through addressing all the curvatures of the spine, especially the head and neck. As pointed out earlier the position of the head and neck is paramount in enabling the body to achieve optimum balance. This is one of the reason’s why CLEAR Institute methods incorporate treatment methods to restore cervical lordosis and the reduction of forward head posture. There are several other reasons to address this area as well. One of them is the neck (cervical spine musculature) is a virtual warehouse of receptors that continually give us feedback about our ever changing environment. In fact, while walking the body relies heavily on feedback from the neck. Thus, if abnormal neck alignment is present the body has a difficult time receiving this information in a two-way communicative process during every day tasks such as walking. Lastly, since the upper neck has been shown to commonly have misalignment at the C0/C1 area in cases of scoliosis, and this area has important spinal cord tracts for body control, this is addressed through precise adjustments verified through x-ray analysis.

In summary, it is crucial that not only balance be tested in several settings with this information applied, but the proper restoration of curves (especially head and neck) is achieved through appropriate treatment to improve inherent balance difficulties within the scoliosis population.

About the Author:
In addition to being a member of the CLEAR Institute Board of Advisors, Dr. Matt Schwab is a member of the American Academy of Spine Physicians and is also certified with the SpineCor dynamic brace. His office specializes in advanced, non-surgical methods of treating scoliosis.




"Make good health your prime goal in life because without it, you won't be able to achieve any other goals."

- Joseph Mc Fadden (1922-1997)
Diplomat, Professor of Journalism, & Father of Five




--------------------------------------------------------------------------------
Permission freely granted to copy & distribute this information without financial gain.