Straight talk: Could new scoliosis treatment hold promise?

news-scoliosisChiropractor Dolly Garnecki with patient Kayla Lisa, a 19-year-old Radford University student seeking to reverse her scoliosis through uncoventional care.
PHOTO BY COURTENEY STUART

Judy Blume's 1973 book Deenie plunged a generation of girls into panic over scoliosis, an all-too-common spinal curvature. But some Charlottesville area girls– unlike the book's 13-year old title character– are opting for a therapy that controversially skips the notoriously bulky back brace and, as Deenie found, the cruel taunts of classmates.

"It doesn't have to be this way," says local chiropractor Dolly Garnecki, who denounces braces and surgery as ineffective treatments that put scoliosis sufferers, typically teenage girls, through unnecessary pain.

Kayla Lisa was 11 when her parents learned that she had severe scoliosis.

"I was shocked, frightened," says Kayla's mother, Susan Lisa, who followed doctors orders and had Kayla fitted for a brace to be worn 23 hours a day, removable only for bathing.

Two years later, Kayla's younger sister got the same diagnosis, and each girl wore a brace for several years– with no improvement, says their mother– who recalls hearing the girls crying at night, unable to take full breaths or move comfortably.

While braces have been streamlined since Deenie's day, they still limit the wearer's activities– and the most severe scoliosis cases typically result in surgery to attach a metal rod and fuse the vertebrae, a procedure to lessen pain and improve appearance but which also permanently limits spinal mobility.

"I wasn't going to put them through that," says Lisa, noting that her daughter's spines were straight only while in the brace, but that the curve returned as soon as they removed it. "It wasn't treating the underlying cause of the curvature," she says.

Living in Florida at the time, the family stumbled upon a chiropractor who, like Garnecki, had studied at The Clear Institute, a Minnesota chiropractic academy founded by Dr. Dennis Woggan.

If the treatment Woggan and fellow chiropractor Clayton Stitzel pioneered seems unusual– a special traction chair, vibrating tables, weighted pulley systems to realign the spine, and even special goggles with flashing lights– Lisa says the results convinced her.

"Kayla came out of her first appointment saying, 'Mom, my neck doesn't hurt for the first time,'" recalls Lisa.
Ongoing treatments made the relief last, Lisa says, but when the family moved to Charlottesville last year, they couldn't find a Clear Institute-trained chiropractor– until Garnecki opened her Spinal Health and Wellness clinic on Berkmar Drive in January.

Lisa's daughters– now 19 and 16– have regular appointments as often as once a week, plus nearly an hour of specialized daily exercises aimed, Garnecki says, not only at strengthening muscles to pull the spine into alignment but also at "retraining the brain" to hold the spine straight. Lisa says the treatment is working for both daughters and that the younger one recently saw her curvature, as measured by an x-ray, fall from 55 degrees to 45 degrees.

"I know what kind of pain I was in before," says Kayla, now a rising Radford University junior. "And I feel so much better now."

But not everyone is convinced.

Dr. Mark Abel, head of pediatric orthopedics at UVA, isn't buying the claim that any chiropractic care can erase curves. And in severe curves, 55 percent or more, Abel says there are "irreversible" bone changes.

"The vertebrae are no longer curved; they're wedge shaped," says Abel. "I think that it is impossible to correct the spine through manipulations when dealing with that degree."

It's not just doctors questioning the treatment. David Brown, a chiropractor who is also a Charlottesville city councilor, says he won't treat young patients with severely curved spines ("I'm very conservative when it comes to scoliosis," he says), but instead refers them to orthopedic physicians like Abel.

Abel agrees that chiropractic care and exercise can ease pain by strengthening core muscles, and perhaps keep curves from getting worse; but he doubts significant reversal. He admits, however, that because most parents aren't willing to subject their children to a randomized study, little clinical research exists on either side of the debate.

Garnecki says she's heard such doubts before, and believes research will prove what she says she has seen in her own patients.

"This is really new," she explains. "Most [doctors and chiropractors] haven't even heard of this type of treatment."

Abel, though conceding he's unfamiliar with the Clear Institute, notes that some scoliosis cases stop progressing naturally, so it's not necessarily fair to credit an alternative treatment.

UVA is now part of a long-term national study on back braces, and Garnecki welcomes the data. "We have to keep searching, doing research on what works, being open-minded," says Garnecki.

And Susan Lisa, who has watched her daughters undergo both traditional and alternative treatments, thinks she's already learned something.

"As a mom," she says, "it gives me great peace to know there is a method of treatment that is bringing relief."
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5 comments

The author of this article needs to realize that chiropractors also use the title Dr. as well as medical doctors. Please show respect

Subtle comments/plug Heather. Perhaps you have a 30 min infomercial you could down load to the comments section as well. Please see my retort to the Chicago Tribune article you refer to in the comments section after reading the article.
Both Schroth and Alexander techniques are without question well thought out, researched, and experience approaches to the treatment of spinal deformities. They are a significant step in the right direction as opposed to the treatment options of bracing and surgery. However the Achilles heel in both approaches still remains that posture and control of the spine in relation to gravity is still almost entirely controlled by involuntary reflex arcs through the "Righting Reflexes". Anyone can consciously force themselves to stand up straighter, but there is no long-term value in that approach because it doesn't re-educate the involuntary reflex aches. So the spine assumes the exact same original position once the person stops consciously correcting their posture. Furthermore, Schroth still requires the use of spinal bracing which has been proven completely ineffective in studies as recent as those in Spine 2007 by Drs. Weinstein and Dorlan.
Dr. Abel's comments on vertebral wedge deformity at 55 degrees have no scientific merit and is based solely on his personal opinion. While vertebral body adaptation does occur in many adult scoliosis patients, it is relatively rare in skeletally immature scoliosis patients and therefore irrelevant to this article.
Obviously smaller curves have a better treatment prognosis than larger curves, so an early stage scoliosis intervention program would certainly be advisable for spinal curvatures of any size in skeletally immature patients, but, for reasons unknown, that has not become the medically accepted practice.
Everyone needs to drop the "turf war" stuff and start re-focusing on what is best of the patient. An early stage scoliosis intervention program is desperately needed, spinal bracing is worthless, and the surgical fusion seems to have a worse long-term effect than the disease itself. www.fixscoliosis.com is a new forum that creates a meeting place for all non-surgical approaches for the treatment of scoliosis to meet and exchange ideas and information. Patients and doctors are welcome to join, interact, share, and learn from each other. IT IS ALL ABOUT THE PATIENT, NOT EGOS!

Retraining the brain to move the body in better alignment sounds very much like the Alexander Technique, and strengthening core muscles similar to Pilades. No matter what the problem these two techniques will substantially improve a person's alignment. I wonder if Dr. Abel is right and if mild cases may be helped with noninvasive procedures but more severe cases need medical treatment. It's so difficult, as a parent, watching one's child go thru pain and suffering. I hope research will bring new hope to children with this condition in the future.

Our clinic offers a physical therapy approach that uses exercise to treat scoliosis. The Schroth Method has been used successfully in Europe for decades. One of our patients and a therapist from our clinic were recently interviewed by a reporter from the Chicago Tribune. See her story here:
http://tinyurl.com/tribscoli

We recently published a four-year case history of a patient who experienced a reduction in her curve. Find the link here:
http://www.sdwpt.com/services/scoliosis.php

Patients (adults and children) come to us from across the US. We've helped people avoid surgery. Want more info? Contact us at info@sdwpt.com

By the way, here is my responce to the Chicago Tribune article for those whom don't want to dig through the maze of links to find it.

"Bravo on an excellent article featuring a non-bracing, non-surgical approach to scoliosis treatment. The Schroth method is a well respected system of treatment and has served as a trail blazing foundation for many physiotherapy based programs such as CLEAR Institute, FITS, and SEAS.
A couple of areas in the article make me pause with concern. The Scroth certified physical therapist, Ms. Cindy Marti, commented that she would never recommend exercise alone in place of a brace, even through the most recent research indicates that bracing has no effect on the natural progression of scoliosis and does not prevent the need for surgery. A 2007 study published in SPINE by Drs. Dolan and Weinstein concluded that observation only or bracing showed no clear advantage of either approach. Furthermore one can not recommend one approach over another to prevent surgery. They gave the recommendation for bracing a grade "D" relative to observation only because of "troublingly inconsistent or inconclusive studies on any level."
In addition, Ms. Marti and Dr. Gupta indicated that maintaining the strength of spine muscular may play an important role in controlling the spinal curvature. While muscular imbalance/unilateral weakness in the scoliotic spine is most likely a compensatory response and not a cause, the aforementioned necessity of using a spinal brace instead of relying on exercise will actually cause the spinal muscles to become weaker due to the disuse of the spinal muscles (resulting from dependency on the brace). Contradiction of philosophies and lack of understand of the condition is nothing new to scoliosis patients, but subtleness of it is concerning.
Perhaps the most concerning aspect of the article is the implication that any physiotherapeutic based program needs the endorsement of Dr. Gupta, simply based on his credentials as an orthopedic surgeon. Dr. Gupta has no special training or qualifications to provide expert opinions on any scoliosis treatment options other than surgery and possibly bracing protocols. Dr. Han Weiss, director of the Schroth clinic in Germany, published a highly regarded article in a 2008 edition of Disability and Rehabilitation. The study found "no evidence has been found in terms of prospective controlled studies to support surgical intervention from the medical point of view...... Until such evidence exists, there can be no medical indication for surgery. The indications for surgery are limited for cosmetic reasons in severe cases and only if the parent and family agree with this."

What is a scoliosis patient to do? No one really knows that this point, but early intervention with a physiotherapy based program (no bracing) seems to be the safest bet that this point."

It is not my intension to condemn the efforts of other medical professional whom are working in the good faith of their patients, however closer evaluation of this article reveals many obsolete and false assumptions/misconceptions about the disease and it's treatment.

Clayton Stitzel DC
Co-Director, CLEAR Institute