The Silicon Valley Method: Scoliosis Treatment Without Surgery
The Silicon Valley MethodTM is a comprehensive non-surgical treatment plan for adolescent idiopathic scoliosis used by Scoliosis Care CentersTM to treat scoliosis and help straighten the spine.
A back brace for scoliosis is typically used for non-surgical treatment. However, in order to assure that your case of scoliosis grows straighter, there are 5 key problems that must be solved. Solve these 5 key problems, and virtually every scoliosis spine will grow straighter! The Silicon Valley Method addresses each of these problems in a comprehensive manner to help maximize every treatment outcome.
Now we realize that this sounds too good to be true, we hear this often enough from parents, and you will likely hear it from the orthopedic surgeon. The truth is, however, that for kids with scoliosis less than 40 degrees, following these 5 steps is currently resulting in a 98% success rate for avoiding surgery in our clinic. Thus, the Silicon Valley Method has been specifically designed to address each of these 5 problems.
What is causing the spine to coil down into a bent and twisted position? What is the powerful force driving scoliosis to become worse so quickly? By stopping this destructive force the spine can be set on a road to recovery.
The Root Cause Problem: Addressing the Driving Force Behind Progressively Worsening Scoliosis
There is another myth commonly believed in today’s scoliosis care. The myth deals with what causes scoliosis. If a child has no congenital anomalies, no obvious genetic syndromes, and no neuromuscular diseases, then their case is categorized as “idiopathic scoliosis”. The myth here is that there is no known cause for idiopathic scoliosis, or that the cause cannot be known. This is a critical point: What in the world is causing the spine to want to coil down into a larger and larger curve as the child grows? Can this mystery force be identified, and can anything be done about it?
Identifying and Treating the Root Cause
There’s another dirty little secret that all the surgeons know: The spinal cord is almost always tight in childhood idiopathic scoliosis. In surgery the tight spinal cord presents a significant problem, that is if the surgeons accidentally over-straighten the spine and make the spine too tall for the tight cord, paralysis may result. This is the main reason that spinal cord monitoring is a routine practice today with scoliosis surgery. The tight spinal cord is also the number one reason that surgeons can’t make the spine perfectly straight when performing a scoliosis fusion surgery. There is no debating the existence of the short spinal cord problem. What is debated is the chicken-or-egg question: Which came first, the tight spinal cord or the scoliosis? And which one causes which?
When our clinic first began treating scoliosis, we quickly became aware of clinical signs of tight nerves; the nervous system was very resistant to stretch in our scoliosis patients. Initially, we assumed that was due to the extreme deformity of the scoliosis placing tension on the nervous system. But then one day a patient walked in with an 18-degree curve (quite small), but with severe signs of nerve tension. It suddenly occurred to us that the nerve tension was PRECEDING the scoliosis… What if this was somehow the root of the problem? A quick scan of the literature revealed that we were not alone in our hypothesis: The idea that a tight spinal cord could explain ALL of the findings of most idiopathic scoliosis cases was first published in 1968 by a neuro-radiologist named Dr. Milan Roth.1 You can find links to some of Dr. Roth’s publications in the References section at the bottom of the page.2–4
What Dr. Roth and many others have recognized is that a tight spinal cord alone is the only requirement necessary for generating scoliosis in a growing spine. Add a hyper-mobile skeletal structure to the mix such as occurs with Ehlers Danlos or Marfans, and the tight nerve problem is severely magnified. Now leading researchers such as Dr. Burwell are placing this hypothesis toward the top of their scoliosis pathology model. 5
Strangely, most doctors do not find much interest in the question of the Root Cause, or the tight spinal cord as a probable root cause for most idiopathic scoliosis. But think about it: If a tight spinal cord can prevent a surgeon from being able to straighten scoliosis, how much more will the tight cord hinder progress when depending on a non-surgical approach? We believe that if you can stop the driving force causing scoliosis, we should see better treatment outcomes. It was with this confidence that we set out to solve the problem of the tight spinal cord, and began inventing ways to treat the problem non-surgically.
Today in our clinic, testing for and treating nerve tension is a routine part of our scoliosis care program: The Silicon Valley Method (or SV Method for short!). We have found that it is possible to quantify nerve tension, treat it, and resolve it. Relieving the spine of the nerve tension that causes scoliosis is a pretty big deal. This means that the driving force causing scoliosis now may be reduced or eliminated in many cases. This ability has been a key ingredient in our treatment formula and has lead to a satisfying 100% success rate in avoiding surgery for cases under 25 degrees.
Why do so many doctors believe it’s impossible to fix scoliosis without surgery? Why does the spine have such a hard time returning to straight after a curvature has set in? The answer is because the spine becomes stuck, trapped, and imprisoned by contractures. What are contractures, why do you have them, and how can you get rid of them?
Solving The Contracture Problem: Releasing Contractures
Understanding what contractures are will be very important to your non-surgical scoliosis treatment journey.
Releasing Contractures Helps Maximize Alignment in Brace
Here at Scoliosis Care Centers, we are achieving unprecedented in-brace alignment as p[art of the SV Method. How are we doing this? There are a few key problems that must be addressed in order to make such a revolutionary brace. One of the main problems that must be solved first is that of contractures. What are contractures?
Contractures are what cause the spine to become “stuck” into a structurally stiff scoliosis, one which is no longer able to move back into a straight alignment. When the joints of the spine are continually held in a deformed position, they are no longer able to exercise their normal range of motion. This lack of ability to move normally leads to ligaments and muscles growing short on the concave side and long on the convex side.
Contractures are one of the largest obstacles to a scoliosis being able to return to a normal alignment. Surgeons know this, and in scoliosis surgery, it is routine to simply “release” the contractures by cutting away all the contractured tissue which is binding the spine into a coiled-down scoliotic posture. Contractures can also be treated non-surgically, and when they occur in elbows or knees it is common for therapists to use a stretching device to stretch and release the contractures. For the spine, however, no such tool existed for the 3-dimensional contractures of the scoliotic spine, so we invented one.
We call our device for treating contractures in scoliosis the “Scoliosis Flexibility Trainer”, and its sole purpose is to release the contractures of scoliosis, allowing the spine to more freely return to straight alignment. By first treating the contractures, it becomes possible to make a brace that will be much more corrective. This is a key part of our process for bracing growing spines at Scoliosis Care Centers and the Silicon Valley Method.
The spine can only grow as straight as the brace makes it. The straighter the spine is in the brace, the greater potential for improvement. Many braces merely lock the spine in its existing crooked state without providing any significant correction. The Silicon Valley BraceTM is a unique back brace for scoliosis that is distinguished by maximizing correction in-brace so your spine can grow straighter as part of the Silicon Valley Method of treatment.
The Alignment Problem and How a Scoliosis Brace Solves It
The alignment problem is simply this: A spine will grow into the shape that it is held. Think of the young tree trunk; a sapling will grow into whatever shape it is held. The spine is no different. If a spine is being held into a coiled down scoliotic position during growth, then it will solidify into that shape as an adult. Just like a sapling, for a spine to grow straight, it must be held straight 24/7. Only a brace can attain this feat for kids with scoliosis.
A Brace Is the Only Non-Surgical Treatment Proven Able to Straighten Scoliosis
Both clinical experience and published medical literature agree: Bracing can not only help a spine avoid progression, but also help it grow straighter. Some of the more outstanding studies on this matter include Mehta’s “Growth as a Corrective Force”, Weinstein’s BRAIST study in 2013, and the Aulisa study in 2017.
Dr. Mehta has published multiple case studies establishing that holding the spine straight during growth can cause a scoliosis to straighten. Here is one of her published cases as the little boy with an established scoliosis curve grows straight through bracing. 6
Dr. Weinstein’s BRAIST study established that braces are more effective the more they are worn. Of the kids who wore their braces 18.5 hours a day or more, 10% of them progressed beyond 50 degrees, compared to kids who wore no brace at all, in which 60% of them progressed beyond 50. The study was so conclusive that the ethics review board stopped the study prematurely, realizing that it would be unethical to continue a study in which kids were denied a brace prescription.7
The 2017 Aulisa study established that reductions made using a brace can be maintained over 20 years later, establishing better long-term outcomes than some surgical studies. 8
Why Bracing Sometimes FAILS, and What to Do About It
Up to this point, much of what you are reading probably flies in the face of what your doctor may have told you. Most orthopedic surgeons do not have much confidence in bracing. Some possible reasons for this are:
- They are using weak, poorly fit braces (typically the Boston),
- Kids are not wearing the braces
- There was a failure to address the root cause of the problem.
Whatever the case may be, most orthopedic surgeons see only bracing failures, not successes. This continually reinforces their belief in the myth that nothing works except surgery, even undermining the will to try. Below is an example of an actual patient of ours, with actual scoliosis, that was just about as crooked in-brace as she was out of it compared to our brace and the Silicon Valley Method.
Weak, poorly designed and poorly fit braces (which patients don’t wear) are to blame for most of the opinion that braces don’t work. Here is the same patient as above, notice how the Boston brace barely makes a dent, versus the highly-corrective Silicon Valley Brace Method.
Neuromuscular imbalances often occur with Scoliosis. As part of the Silicon Valley Method, we use offset weighted devices that work 3-dimensionally to engage the body’s muscles. This trains the body to keep a straight posture for the long term, thereby enhancing treatment ourcomes.
Solving Strength and Conditioning Problem(s) Through Scoliosis-Specific Exercises
There are multiple strength and conditioning problems that must be solved in a successful scoliosis treatment program. Since the solution to all these problems includes some form of exercise, we have grouped them all together in this section. These problems include:
• Core Spinal Muscle Weakness and imbalance.
• Neuromuscular dysfunction – Poor coordination between the brain-body sense of positional alignment and balance
• Reduced lung capacity and function.
• Heart dysfunction.
Exercises aimed at the correction of scoliosis or scoliosis-related problems are referred to as scoliosis specific corrective exercises. Not all exercises are beneficial for scoliosis. Going to the gym and doing sit-ups, will not help improve the alignment. Here we cover scoliosis specific exercise approaches and discuss our experience with the use of each of them.
Schroth Physiotherapy Exercises
Schroth physiotherapy is one of the most tested methods of scoliosis exercises and treatment in existence. It was invented nearly 100 years ago by Katharina Schroth, a physical therapist in Germany. Schroth combines controlled breathing and body posture to help direct the spine back toward its intended straight position. It can be helpful in the management of both childhood and adult scoliosis. Of all the discussed exercises, the Schroth method places the heaviest emphasis on breathing exercises and the restoration of lung capacity. However, it should not be relied upon without a brace if the patient has a growing spine.
A downside to Schroth therapy is that it is very complicated to administer, and some patients find it just plain boring. If the exercises are done incorrectly, it can worsen the curve angle or just be ineffective. Thus, Schroth exercises are often practiced under the guidance of a trained practitioner.
SEAS: Scientific Exercise Approach to Scoliosis
The Scientific Exercise Approach to Scoliosis is an exercise method for scoliosis derived in Italy. SEAS is a more simplified version of scoliosis-specific exercises. These exercises still need to be taught to patients by a trained practitioner. The +advantage to SEAS is its simplicity and its ability to be incorporated into one’s daily posture. Lastly, like Schroth, these exercises should not be relied on exclusively for growing spines and/or scoliotic spines above 25 degrees.
Weighted Device Exercises for Scoliosis
Weighted Device Exercises, also known as Spinal Weighting, is a scoliosis exercise that is practiced among CLEAR, ScoliSmart, Pettibon and Chiropractic Biophysics scoliosis treatment providers. These exercises are designed to train the postural muscles in the back to hold the spine into a straighter posture. In our own clinical experience, we have found this style of exercise to be very useful, and have developed an entire array of our own 3-dimensional weighted device exercises. Like all of the exercise methods mentioned before, spinal weighting should not be relied on as a standalone exercise for treating scoliosis curves over 25 degrees in a growing spine.
Can a SAS suit Substitute for a Brace?
A Scoliosis Activity Suit is somewhat of a cross between a scoliosis exercise and a soft brace. It is designed to be worn 30 minutes or so while performing daily activities or exercises. It is designed to challenge the rotation and alignment of the scoliosis so as to activate muscles that should help correct the curve. This treatment method is relatively new, thus there is little literature that supports if this effective. While it is sometimes referred to as a brace, it should not be mistaken as one in terms of providing correction. Like all the methods motioned prior, the activity suit should not be used as a replacement for a brace in growing spines that have curves over 25 degrees.
Are you concerned about over-exposure to X-rays in your child or teen with scoliosis? This concern is valid, as studies have shown an increased risk of cancer from X-ray exposures taken for scoliosis. Now Standing MRI can eliminate the need for X-rays, and it is 100% radiation free. Thus, imaging scoliosis with MRI is a key part of the Silicon Valley Method.
The Observation Problem
Don’t Do Nothing: Observation ONLY in Growing Curves Over 25 degrees is NOT a Treatment, It is Neglect!
Sadly, we need to address the most common non-surgical “treatment” for scoliosis; Observation, or “watch and wait”. The idea behind this so-called “treatment” is that we should just watch the scoliosis to see if it is getting worse. This management strategy most often results in curves progressing, and leading to full spine fusion surgery. This is still the official management strategy according to the Scoliosis Research Society, and it is quite disappointing that this is sanctioned as good medical treatment. Here’s why:
If a child is over 25 degrees, and Risser 0-2 (skeletally immature), they have a 58% chance of progressing beyond 50 degrees according to the BRAIST study by Weinstein et al. Just observe this risk for progression chart by another author, Nachmenson et al. Here is a case study of a patient who was receiving “observation” treatment. Notice that their curve stays steady from 6 years old till 11. Then the curve suddenly begins doubling in size each subsequent year, resulting in a full spine fusion.
When Observation CAN be the Right Choice
Hopefully, it is clear by now that observation only in growing spines over 25 degrees is a bad idea. However, this is not to say observation isn’t an important part of treatment. In curves that are between 7 and 20 degrees, sometimes there can be uncertainty as to whether or not a true scoliosis curve exists. In such cases, close observation may be an acceptable course of action. For example, a child with a 12-degree c-curve may have just been standing funny, or have a slight curve that will never progress.
By following up with an image in 3 months to see if it is changing, it can be determined if there is a true problem. Even in the case above, however, waiting 1 year could allow an unacceptable amount of progression of the 12-degree curve. This could result in the curve doubling in size. So if observation only is being used, it should only be used for curves under 20 degrees, and the observation frequency should be every 3 months, not one year.
Observation is Performed Way Too Infrequently
Another major problem with observation is that a full spine X-ray is required to measure the status of the scoliosis. Because an X-ray is a harmful form of ionizing radiation, which leads to higher rates of cancer in those who have had scoliosis X-rays, doctors have developed protocols which are aimed at reducing the number of X-rays used in managing scoliosis. The problem with this is that there is pressure to NOT look at the spine, and too much time in-between images allows unexpected worsening of scoliosis.
This problem has a simple solution. Use Standing MRI instead of X-ray to monitor or “observe” the changes in scoliosis. You can jump to our section here on how Standing MRI can be used to screen for scoliosis, monitor a curve once it has been discovered, and guide scoliosis treatment to help provide the best treatment possible.
How Standing MRI Helps Solve the Observation Problem
As discussed above, dependency on X-ray to observe or manage scoliosis is paired with efforts to use as few images as possible. While under-utilization of X-ray is good for avoiding radiation, it is bad for helping a spine to grow straighter. Replacing scoliosis X-rays with a standing MRI solves several problems:
1. The risk of cancer from ionizing radiation is eliminated.
2. Observation frequency can be increased from once a year to once a quarter (every 3 months) or more. This allows a much closer watch on the progress of the curve. Frequent observation is critical, for as you will see below, curves can double in size over a one year period. This kind of exponential worsening during the adolescent growth spurt is commonplace in scoliosis and is to blame for all too many scoliosis surgeries.
3. Treatment quality can be guided using a standing MRI. When prescribing a back brace for scoliosis and scoliosis exercises, the alignment in the brace and the effect of the exercise can be measured with MRI.
Scoliosis can worsen rapidly as the child’s rate of growth increases, doubling in size or worse during a growth spurt. The tendency in medicine is to not watch these curves closely enough because X-rays must be used, and there is a belief in the myth that nothing will help other than surgery. These problems are easily solved through the use of standing MRI. Observation should never be used as a treatment alone in curves over 25 degrees. Instead, curves should be treated when they are small, since treating curves 25 degrees and under has a 100% success rate for avoiding surgery using the Silicon Valley Method at our clinic. What this treatment looks like will be explored in the subsequent sections.
Alternative Scoliosis Treatment Methods
Scoliosis Care Centers’ doctors and staff are familiar with a wide variety of scoliosis treatment methodology. The Silicon Valley Method is frequently the treatment option of choice, but the staff is also familiar with the scoliosis treatment types below.
3D Scoliosis Traction
1. Roth M. Idiopathic scoliosis caused by a short spinal cord. Acta Radiol Diagn (Stockh) 1968;7:257–71. Read article here.
2. Roth M. Neurovertebral and Osteoneural Growth Relations, A concept of normal and pathological development of the skeleton. Univerzita J.E. Purkyne, Brno: Radiodiagnositic Clinic, Medical Faculty, 1985. 101 p. Read article here.
3. Roth M. Morphology and development of the spine: Plea for a doubt. Rivista di Neuroradiologia 1998;11:313–20. Read article here.
4. Roth M. Idiopathic scoliosis from the point of view of the neuroradiologist. Neuroradiology 1981;21:133–8. Read article here.
5. Burwell RG, Clark EM, Dangerfield PH, Moulton A. Adolescent idiopathic scoliosis (AIS): a multifactorial cascade concept for pathogenesis and embryonic origin. Scoliosis Spinal Disord 2016;11:8. Read article here.
6. Mehta MH. Growth as a corrective force in the early treatment of progressive infantile scoliosis. J Bone Joint Surg Br 2005;87:1237–47. Read article here.
7. Weinstein SL, Dolan LA, Wright JG, Dobbs MB. Effects of bracing in adolescents with idiopathic scoliosis. N Engl J Med 2013;369:1512–21. Read article here.
8. Aulisa AG, Guzzanti V, Falciglia F, Galli M, Pizzetti P, Aulisa L. Curve progression after long-term brace treatment in adolescent idiopathic scoliosis, Comparative results between over and under 30 Cobb degrees – SOSORT 2017 award winner. Scoliosis Spinal Disord 2017;12:36. Read article here.