The “C.L.E.A.R.” in CLEAR Institute stands for “Chiropractic Leadership, Educational Advancement & Research”. Established in 2000, the CLEAR Institute offers an alternative approach to the standard scoliosis treatment options offered by the majority of orthopedic scoliosis specialists. Though most theory on the cause of idiopathic scoliosis posits a central nervous system (brain and spinal cord) dysfunction as the root cause, scoliosis brace treatment and scoliosis surgery focus solely on the scoliosis curve, not the cause. The mission of the CLEAR Institute is to “empower the chiropractic and medical community with the mission of implementing an effective chiropractic system of scoliosis treatment and care….to effectively treat the condition of scoliosis without the use of bracing or by performing surgery.”
The researchers and clinicians at the CLEAR Institute saw a fundamental disconnect between theory and clinical treatment and sought out to develop a scoliosis treatment program that focused on “retraining” the scoliosis brain to “learn” how to hold the spine straighter automatically, referred to as “three dimensional auto-correction”.
The Scoliscore genetic test now allows researchers to study the effectiveness of various scoliosis treatments on patient populations that are genetically predisposed to severe curve progression and determine if a given scoliosis treatment can actually alter the natural course of the condition. Having the genetic predisposition information on each specific patient also allowed the CLEAR Institute doctors to focus their efforts entirely into environmental factor reduction/elimination strategies.
Idiopathic scoliosis is the result of both genetic predisposition and specific environmental factors, which are probably the primary drivers of curve progression. The understanding and identification of the specific environmental factors that drive idiopathic scoliosis are still poorly understood.
Potential Risk Factors for Idiopathic Scoliosis
– Neurotransmitter imbalance from nutritional deficiencies (e.g. selenium)
– Exposure to mycobacterium
– Minor leg length discrepancies
– Specific genetic defects
– Repeated “back bend” activities
– Increased levels of Osteopontin
– Spinal trauma
– Poor postural habits
– Activities that cause repeated compression on the spine
The CLEAR protocols operate under the premise that scoliosis is a complex condition and that there is no one adjustment or therapy which will work in every case. Therefore, the scoliosis treatment must be customized to the particular, specific needs of each individual patient. However, there are key aspects of these protocols which are essential to achieve consistent, measurable progress. That is why CLEAR requires that doctors using CLEAR Scoliosis Protocols be certified for treatment by the CLEAR Institute.
The first step in the CLEAR Protocols involves gathering information about the biomechanical function of the entire spine – not just the area(s) affected by scoliosis. It is an axiom that you can control the middle of a cord by moving the top and the bottom. By the same logic, it is important to understand what is occurring in the neck and hips in order to affect the middle of the spine. To obtain this information, seven small, precise x-rays are necessary, totalling 292 mR of radiation (by comparison, according to the American Nuclear Society, the amount of naturally-occurring, environmental radiation we are exposed to every year is 360 mR, and the National Council on Radiation Protection and Measurements states that the risk of abnormality to an unborn fetus is considered negligible at 5,000 mR or less). A scoliosis x-ray is also necessary if a recent film is not available. These seven views should include three side views of the neck (one with the eyes looking down, one with the eyes looking up, and one with the eyes straight ahead), a side view of the low back, two frontal views of the neck (one with the eyes straight ahead, and one with the eyes looking up), and one frontal view of the low back.
MIX (warm-up or “prehab”)
Before receiving chiropractic adjustments, the patient warms uptheir spine using equipment such as the Wobble Chair (which sits upon a ball-and-socket joint and flexes in every direction to put the spine through a full range of motion), the Cervical Traction (which is used actively by the patient to achieve gentle, repetitive spinal traction), and the Vibrating Traction (which uses a slow, relaxing vibration scientifically proven to relax the ligaments and soft tissues of the spine). A special motorized table with belts that pull (not push!) the scoliotic curves out of the spine, called the Eckard Flexion/Distraction table, achieves the goal of re-structuring and re-modeling the ligaments after they have been relaxed. If the MIX protocols are not followed, the inter-vertebral discs will be rigid and inflexible, and it will be difficult if not impossible to effect structural changes to the spine (think cold verse warmed up Silly Putty).
FIX (specific instrument-assisted adjusting)
Mechanical adjusting instruments and specialized drop pieces enhance the precision and effectiveness of chiropractic care, while also reducing the amount of force required to correct the spine. In accordance with CLEAR protocols, almost all adjusting of the neck are performed with the use of such instruments, and the application of these adjustments are correlated with the information obtained from the patient’s x-rays. Follow up x-rays confirm the correction of these areas, neck from the side (lateral cervical x-ray which includes a stress x-ray), front x-ray of the upper body and head (nasium x-ray), and top of the head x-ray (base posterior x-ray if there is 4 degrees or more of atlas rotation).
SET (rehab stage)
Immediately after the adjustment is completed, the spine is “set” in its corrected position to ensure the permanency of the changes. This involves spinal weighting protocols (typically on the head, torso & hips), whole-body vibration therapy, also known as Neuromuscular Re-education (NMR), such as the Vibe and the Scoliosis Traction Chair, and gait therapy which re-trains patterns of moving and walking. In addition, a patient specific scoliosis exercise program is conducted at home twice daily. If the SET or NMR protocols are not followed, any corrections achieved in the spine will be temporary.
After 12 visits, a CLEAR-certified doctor takes a series of post x-rays to validate the effectiveness of the treatment protocol. The specific x-rays which are necessary are limited as much as possible to the patient’s specific condition. For example, if the initial x-ray showed that the patient’s low back was in fairly good shape prior to treatment, a sideways view of the low back might not be necessary. It’s important to keep in mind that not all patients will show a reduction in the severity of the scoliotic curve, as measured by Cobb angle, within this time frame. This is because Cobb angle is a measurement of only one dimension of the spine, and scoliosis is a three-dimensional condition. Before the sideways curve can be reduced or corrected, the spine must be de-rotated and decompressed in the other two dimensions. Treating a complex spinal disorder such as scoliosis is a little like reversing the path of a runaway train. It takes time to first slow down the momentum, then more time is needed to change the course of the condition.
Home Spinal Rehab Program
Every CLEAR doctor emphasizes to their patient the importance of their active participation in the treatment program. Results are not guaranteed – they are earned, by patients who are willing to work alongside of the doctor. The traditional methods of scoliosis treatment, bracing and surgery, are considered “passive” therapies, in that the patient has the procedures done to them; the doctor designs the brace, the doctor performs the surgery. CLEAR Institute’s method, by comparison, should be considered an “active” process – the doctor teaches the patient how to do the procedures, and the patient does them. A small part of the protocols could be considered passive, but the effectiveness of these treatments on their own is limited without the involvement of the patient. The degree of patient participation affects the amount of improvement.
CLEAR Institute’s Position on Bracing Treatment
The CLEAR Institute does not formally endorse any type of bracing. They state that “the cumulative clinical experience the doctors on their Board of Advisors demonstrates that attempting to utilize a brace while the patient is undergoing CLEAR treatment may have an adverse effect, in that the protocols attempt to strengthen the same postural muscles which are made weaker by relying upon the brace”. However, CLEAR maintains that their specialty is not orthotics, but in spinal biomechanics and postural rehabilitation and it is for this reason that, while they do not advocate bracing, they also do not condemn it and that what matters most is that the patient is satisfied with the outcome of treatment.
CLEAR Institute’s Position on Post-Surgical Treatment
Patients who have undergone scoliosis surgery in the past may wish to pursue treatment with a CLEAR-certified scoliosis specialist. However, these patients should not expect any degree of correction, but rather purely symptomatic relief and functional improvement (e.g., treatment to relieve their pain and improve their activities of daily living). The CLEAR Institute also does not recommend that a patient undergo rod removal surgery based on the same principle that muscular atrophy which occurs in braced patients, due to lack of motion, will undoubtedly occur in surgically-treated patients as well. If the muscles responsible for moving the spine are inactive for long periods of time, they will atrophy (shrink), and because rehabilitation of the muscles is a vital part of CLEAR protocols, the patient may be unable to maintain any corrections that are achieved. CLEAR references two articles published in Spine on the topic of spinal implant removal in 2005 by Hahn et al and Deckey et al in 2000 that have discouraging conclusions: “Despite bony fusion, loss of correction between 10 degrees and 26 degrees was observed in three patients after instrumentation removal,” and, “Spinal implant removal after long posterior fusion in adults may lead to spinal collapse and further surgery. Removal of instrumentation should be avoided or should involve partial removal of the prominent implant.”