If You Think Scoliosis Is ‘Just for Kids’… Dr. Jeb McAviney Has a Wake-Up Call.

Spines don’t just bend — they reveal who we are, how we adapt, and where modern medicine is still failing. Today on Crackin’ Backs, we sit down with a man who’s been inside those hidden curves, seen what the X-rays don’t show, and is rewriting the entire narrative around scoliosis.
Meet Dr. Jeb McAviney: chiropractor, researcher, speaker, and CEO of ScoliCare. With over two decades in non-surgical spinal deformity care, Dr. McAviney holds a Master of Chiropractic and a Master of Pain Medicine—he’s also developed breakthrough programs like ScoliBalance® and ScoliBrace® and now sits on the board of the International Society on Scoliosis Orthopaedic and Rehabilitation Treatment (SOSORT).

What we’ll uncover in this episode:

• Why scoliosis is not just a teenage issue—and how adult curves are being ignored.
• The biggest shifts in scoliosis treatment in the last 2–4 years that many clinicians or parents don’t know—and why that lag can be dangerous.
• The emotional and identity weight that sits on someone’s spine—what the image can’t tell you, but Dr. McAviney sees.
• The sacred cows of scoliosis care: What practices will we look back on in 10 years and say, “How did we ever think that was acceptable?”
• The global scoreboard: Which countries are getting scoliosis care right, which ones are shockingly behind, and what explains the difference.

If you’ve ever wondered what your spine really says about you—this is the episode you can’t skip.

 Learn more about Dr. McAviney & join the mission:

• ScoliCare

Tune in now—because the curve in your spine might be writing the story you haven’t yet heard.

We are two sports chiropractors, seeking knowledge from some of the best resources in the world of health. From our perspective, health is more than just “Crackin Backs” but a deep dive into physical, mental, and nutritional well-being philosophies.

Join us as we talk to some of the greatest minds and discover some of the most incredible gems you can use to maintain a higher level of health. Crackin Backs Podcast

Transcript

Dr. Spencer Baron: 0:01

The spines just don't bend. They teach us who we are and how we adapt, where medicine is failing usually or evolving. Now today, we sit down with a man who's seen the hidden truths behind every curve. Dr, Jeb, mcaveny, let's go deeper than angles and X rays. Let's talk about what the world still doesn't understand, especially when it comes to scoliosis. Welcome to the show. Dr mcavney,

Dr. Jeb McAviney: 0:30

thank you so much. Dr Barron, it's a pleasure to be here.

Dr. Spencer Baron: 0:33

Yes, very and you're very interesting, man, that's why we want you on this show. Let me start by asking you, you know, you've spent a life studying curves in the spine and stuff that people don't understand. Some have a different perspective. But what's most what is the most unexpected curve in

Unknown: 0:50

your own life or

Dr. Spencer Baron: 0:52

career that shaped how you see scoliosis today patients and or even the field itself?

Dr. Jeb McAviney: 0:59

So really interesting. You should say that my my partner, we've been together now two years, and when we started dating, I found out that she had a traumatic scoliosis from a car accident, and she actually had a pretty bad injury where she developed a spinal fracture as part of the accident and post trauma, she developed a scoliosis, which puts it into the category of an acquired adult scoliosis, if you like. And when we look at the literature, and hopefully we get to deep dive into a little bit later, we actually find out that it's adults that have a high prevalence of scoliosis compared to teenagers and children. And so I think that that's one of the most revel biggest revelations for me as a chiropractor that treats spines and looks at those spines that have scoliosis, that it is, in fact, in adults where we see a much, much, much higher prevalence of scoliosis compared to children, which is somewhat the opposite of what most clinicians probably think,

Dr. Spencer Baron: 2:05

that that is probably the most profound and interesting thing that I've never known, because I don't know about you, Dr Terry, but you know, we, we've been practicing, you know, some, you know, 35 to 40 years, and we see a lot of patients with that, and we look For kids that have it and think that it stops by age, you know, you know, by their teenage years or early 20s. But obviously that's not true.

Dr. Jeb McAviney: 2:30

Correct, correct. I mean, we understand, for example, adolescent idiopathic scoliosis, the normally develops in teenagers, typically between the ages of 11 and 13 is where it starts to develop, and in childhood, it is the most prevalent form of scoliosis. But what we now see is that as people living longer, and you know, more able to take care of themselves and wanting to live a more full and healthy, happy life as older adults, that we have this concept of degenerative de novo or degenerative onset scoliosis. And to give you a quick statistic, one in three, essentially, we did a systematic literature review, and you can find it on PubMed, and 36.7% of adults over the age of 60 have a degenerative de novo scoliosis. And that's not just adults over 60 with back pain. That's adults, all adults. So you can literally line the room up full of 100 people over the age of 60 and say, no, no, yes, no, no, yes. And so it's a hugely prevalent problem that really most of us unaware of,

Dr. Spencer Baron: 3:42

does your does your significant other know that you're dating her just because she has scoliosis?

Dr. Jeb McAviney: 3:49

Well, as as you would know that your partners and friends often make the worst patients. So so she she sees one of my colleagues, and I tend to stay Yes.

Unknown: 4:05

Smart man, been married 30 years and yeah, I asked my wife when we first did, do you want be my my patient, or you want to be my wife? Because you can't do both exactly?

Dr. Jeb McAviney: 4:19

I used to joke with friends and family that, look, I'll treat you, but I'll charge you double, because then that way you respect me as a chiropractor, as opposed to just your

Unknown: 4:27

friend. Smart man. Smart man.

Dr. Spencer Baron: 4:33

Let me ask you, in the last two to four years, like, what is the biggest shift or breakthrough in scoliosis and the understanding or treatment that most clinicians and parents don't still don't grasp, you know, and why is that lag so dangerous?

Dr. Jeb McAviney: 4:48

So the big shift has been in recognizing that there are treatments, non surgical treatments, that genuinely work for scoliosis, not everything works. And, you know. We know that in the past, there was some controversy about scoliosis bracing. There was some controversy even about scoliosis exercises. But through research, we've gained a better understanding that very specific exercises, scoliosis specific exercises, or the acronym is PC, PSE, these type of exercises now have shown that if you intervene early, particularly in adolescence, and the curves are 25 degrees or below, you can change the natural history if you follow that specific regime of exercise. And the same is true for bracing, the old fashioned Milwaukee brace. We don't use that anymore. We know that if we have good data and we can capture that using 3d scanning and technology really has allowed us to enter this new world of three dimensional scoliosis bracing, where we can apply corrective forces to the spine, that during growth, sometimes we can start to actually improve the scoliosis, or in adults, where they're degenerating, we can stabilize and, in some cases, improve the postural component that leads to, you know, pain and disability. So it's not that the concept of bracing or exercise are new, it's that we now have, through research, been able to define what approaches within those fields work the best. And really, a lot of that has come down to technology, you know, allowing us to refine those things and get better outcomes for patients.

Dr. Spencer Baron: 6:33

I just want to ask, you know, and Dr Terry, I know you, I know you want to jump in, but, but I am so curious, because we've been practicing so long as chiropractors, and we've seen We've seen it all, and there was a very painful time early on in my my practice that I actually had X rays that were Six months pre and post the the patient's injury, but we noticed that there was a shift in the scolios that the scoliosis got worse, and she was just a, you know, a 16 year old kid. And I had to at back then, I had to refer her out for those damn Harrington rods, those steel beams that keep you rigid from the, you know, the the top of the thoracic to, in her case, to really down below the, you know, at the lumbar spine. You know, that's like, that's like, to me, that was like a death sentence for a kid. Then I remember when I went to chiropractic college in Texas, there was, I found out about Galveston rods. Now those were flexible rods that allowed for better movement, but there was, it's still such a barbaric approach. What do they do? Now, you know, for someone that actually needs and what is that criteria?

Dr. Jeb McAviney: 7:55

So, really interesting. I work with a lot of surgeons. In fact, I even have a joint venture for one of our clinics in Australia with an orthopedic surgeon who's fantastic. And the first thing is they say that surgery is the failure of non surgical treatment, and so a good surgeon will actually want the patient to undergo non surgical treatment, the right treatment, to see if they can avoid surgery. Now that's true in different countries and in different situations, but in Australia, at least, that's somewhat the truth. When it does come to surgical interventions, just like with non surgical there's a window of opportunity to get the best results. So holding on to a patient that's got a 70 or 80 degree curve, and till it becomes 150 degrees, if they get to the surgeon, and 150 degrees, and even the surgery life comes, not going to be great. So there is a time at which surgical referral is more appropriate, and when the surgeons get those curves that, let's say it's over 60 degrees, that tends to be about the time that surgery becomes appropriate, can be a little bit bigger than that. It really depends on where the scoliosis is. So the main goal of surgery is to reduce the curvature so that it doesn't continue to progress after maturation, but also to allow as much flexibility of the spine as possible for normal function. So in the lumbar spine, for example, the surgeons usually don't like to fuse all the way down to the bottom. So if they're using rigid rods, which they still use, but not Harrington, it's called a posterior approach. And they try and shape the rods according to the sagittal plane and reduce the curvature as much as possible, but they'll try not to enter too much into the lumbar spine to allow some flexibility. And then the other thing is spinal cord, or spinal tethering, sorry, and tethering is, instead of using a rod, they use a nylon cord in between the beginning and the end of the curve, and then compress the convexity of the curvature to try. Try and straighten that out. Now, up until recently, that's not been a recognized treatment under the FDA. I'm not sure if that's changed in the last six months or so. It does allow for more movement, but I still think that if you're going to try and stabilize a curve that's out of control, and it's very big. Probably the most common procedure is still the rods that fixate the spine in place, particularly for thoracic curves.

Unknown: 10:32

Do they ever remove their rods? Yes, in time, it's gonna ask that. Yeah, in

Dr. Jeb McAviney: 10:37

the olden days, so a while ago, what they used to actually do was cast the patient in plaster, damage the spine, and put bone graft in and have the patient laid down for six months to stabilize the scoliosis, take the cast off, and then it was actually true spinal bony fusion Without rods. That was the original treatment. So you can then imagine when Harrington came along and, you know, they can have the surgery and be walking within back then a month or two, big difference between that and laying down for six months in a in a cast. So I say that because we do know that if you achieve a bony fusion, you don't necessarily need the rods, but typically they do not take the rods out unless there's a problem with them, because it's an unnecessary surgery. It's another anesthetic. What you're hoping happens is that when the rods are in, that you do get bony fusion, and it's often when you don't get bony fusion and there is movement left that those rods break. And it's at that point in time that, typically, the subsequent confusion is done to, you know, to redress that problem,

Dr. Spencer Baron: 11:51

I had a patient that, a rather tall patient that played volleyball, had the rods in I mean, not the Harrington rods, but something more progressive, and after several years of having them in, and she went, was going to college, and the surgeon goes, Oh, we could actually remove those. I have never heard of that before. How? How common is that? And she's doing fantastic, by the way.

Dr. Jeb McAviney: 12:18

She had the rods removed, yes, yeah. So that's great. I mean, again, I'm not a surgeon, so I'm limited in my expertise about surgery from what I see of those patients that come for non surgical treatment, and unfortunately, I usually get the failures of surgery that come to see me, so I get a bias sample size, but I would say that probably, in her case, she didn't have a screw in every level, because that would be a major surgery to remove a huge amount of hardware. So if there was a minimum amount of hardware in the spine and the surgeon felt that it was safe to remove, then that's probably why she got the outcome. That she did

Unknown: 12:59

good to hear interesting. You know, we also, is it still the statistics that women over are higher than men, yep.

Dr. Jeb McAviney: 13:10

So in the adolescent population, it's about eight times more prevalent in females than is in males. And unfortunately for the ladies, adult onset scoliosis is more prevalent, particularly around the time of menopause, at around about the age of 60 to 70, we see a much higher prevalence in that adult onset of scoliosis. Now obviously men, unfortunately, we don't live as long as the ladies. If we start getting men above sort of 75 into 80, we then start to see the prevalence of degenerative scoliosis become more equally distributed in the much older adult population. And it's really because menopause, in a very layman's terms, if you like, kind of weakens the spine a little bit. The ligaments lose some of the stability. The muscles aren't as strong. That happens earlier for women in their 60s, whereas men, it's that natural decline in strength and stability that often doesn't occur until their 80s. And so that's when we start to see that prevalence of adult onset to kind of become a 5050, ratio in older adults.

Unknown: 14:18

Interesting, the reason I ask that is with women. We're dealing and men too. I guess we're dealing, especially the younger crowd. We're dealing with a lot of vanity. We're dealing with emotions. And you know, when you're looking at X rays, you're not just looking at cob angles, you're looking at the person's future. What patterns emotions or human truths Do you consistently pick up that an image alone can't show and how you walk that patient through it?

Dr. Jeb McAviney: 14:44

That's a great question. You could literally and I've seen it happen. Take the X ray into the console for the report of findings, put it upside down and do the whole ROF, and the patient doesn't know the difference. So the X ray is what the. Doctor understands, but what the patient understands is, how do I look in the mirror? You know, how does my waist look? How do my shoulders look? Am I feeling any pain or discomfort? What are people saying about me behind my back? It's all of those other things that relate more to the patient, and I think that that's really important. As clinicians, we recognize, we recognize that it's the patient in front of you with, you know, a problem that needs to be managed in its entirety. So you'd be interested to know that, in fact, one of the reasons that the patients, when they elect to have surgery elected is for cosmetic reasons. You know, we often think that it's some medical reasons to stop cardiopulmonary compromise, and that is true for large curves, but when we talk about patient elected surgery, it's because they don't like the way that they look, and they're willing to undergo the surgery for those reasons, and typically for women, it's thoracolumbar curves, where you see A big shift or a translation of their torso makes the hips uneven. And they hate that. They hate the fact that the dress is unlevel, that it kind of falls down on one side. Or when the shoulders are unlevel because they're looking from the front, they're not looking from the back. You know, they can't see the changes in the atmosphere bending because they're looking at the floor. So our perspective of clinicians is quite different to this perspective of patient. And so we actually developed a scanning technology called brace scan. It's a free online app. We don't get any money for it or anything like that. But it's because patients don't get screened at schools that much anymore, and we wanted them to be able to self diagnose and be self aware of the scoliosis, so they can literally look at the app and the images and say, Do I look like this? And then look at themselves, yes, no, yes, no. And it gives them like a risk factor score. Doesn't diagnose the scoliosis, but it tells them, should they seek some further help about it? But yes. And so managing the patient expectation, I think, is the important thing, because patients will come in with pain and then, you know, that's an expectation that needs to be managed. Or they'll come in with a progression of the curvature, and then fear about that progression, or they come in with a cosmetic complaint, and they're worried about how they look, and then our treatment really should try and match whatever that patient expectation is, so that if we're using exercise and bracing, let's say, in a 20 year old, which wouldn't be seen as typical in the medical world, we might be using that purely for cosmetic purposes to Try and get the hips level, bring that translation out, make them look better and feel better. Now, in the medical world, they don't view it like that. They're looking at bracing or intervention during that period of growth, during a very limited window, whereas we're actually trying to look at what that patient's presented is, and do we have a treatment that can match that expectation in terms of being able to improve cosmesis, pain, etc,

Dr. Spencer Baron: 18:08

what is that website that what the are they?

Dr. Jeb McAviney: 18:12

Scully screen? Dot. Spell that, S, C, O, L, i, s, c, r, e, e n, dot app, or you can just search for Scully screening Google.

Unknown: 18:26

So you got the girl that comes in the young lady and, and she's worried about looking good in her prom dress, or looking good in her bikini and, and that's a huge vanity issue for and especially with nowadays, with all these social medias and stuff like that, and then you go, Well, you need to get a brace. And some of these braces aren't as attractive either. How do you walk them through the emotional What's that emotional conversation like?

Dr. Jeb McAviney: 18:55

It's a complicated situation, and it differs per patient when you've got a supportive family and a supportive network behind you, it really helps. And so we really like to do consults with the family involved so that they get that support. But what I often find is the best for the individual is to break it down into small chunks. If the patient is in front of you, and they're a teenage girl, 1415, to say that you're going to need two or three years of treatment, wear a brace, and you're going to need to have follow up X rays in this whole long journey of treatment is very overwhelming. What I like to say to my patients, which is absolutely the truth is, we'll know within three months if this treatment is working, you know, we'll be able to see are your shoulders leveling out in your posture without the brace. We'll be taking a follow up X ray so we can actually see is the scoliosis staying the same, getting better or getting worse. And then we'll make decisions accordingly. It may take up to two or three years to get to the end of treatment, depending. You how the treatment goes. But let's just start with the first three months, see where we're at and take it bit by bit. And I find that bringing that down into smaller chunks, giving them small hurdles to overcome, really helps them sort of get on board with the treatment, if you like. When it comes to compliance with the brace that is really dependent on a lot of different variable factors. One is the type of brace. Not all braces are the same. Like I said, this kind of Milwaukee brace that comes up here, we just don't use it anymore compliant. I mean, it actually has some research behind it, but the level of compliance is just so low that it's not even worthwhile attempting it, particularly in Western countries. It somewhat depends on the flexibility of the curvature. If the thoracic spine, for example, is extremely stiff and we're trying to use a corrective brace, like a Scully brace, to try and improve the scoliosis in the posture. But there's no flexibility on a bending X ray, then the potential outcome for that is not as good as if the spine was very flexible, and so that patient is going to have a different response and journey to the patient that's very flexible. So I think bringing it into small chunks, working with a patient, trying to almost create that team environment where you're working together with them, that seems to be, at least in my experience, the best way to approach that.

Dr. Spencer Baron: 21:28

What about based on that? I just want to how often I mean, obviously, you address habits like the basic stuff that Dr Terry and I might see is, you know, the kid carries a heavy kid backpack on one side. I mean, is that causing the scoliosis? If they eliminate that, how do you approach that?

Dr. Jeb McAviney: 21:54

So, really interesting. Again, we've got a range of different types of scoliosis, from, you know congenital scoliosis, which obviously Hemi vertebrate that you're born with. For example, most Idiopathic Scoliosis is actually caused by some type of asymmetrical growth of the vertebra. There's still so it ends up being an acquired deformity. You're not born with it, but it deforms over time. There's still some debate as to whether that's genetic, biomechanic, neurological there seems to be more evidence in the genetics camp, but we can't definitively administer a test and say you've got the gene for scoliosis, at least at this point in time. And then we have postural scoliosis, which is the most familiar type to chiropractors. And a postural scoliosis can masquerade as an Idiopathic Scoliosis in children, and it's kind of a double edged sword for us as chiropractors, because they're the ones that if they wear the school bag on one side, or they're doing an asymmetrical exercise, they start to develop this posture that looks exactly the same as a child developing adolescent idiopathic scoliosis, and then we adjust that spine, and it gets better, and we see the posture is better, the translation is better, the pain is better, and we feel as though we've corrected a scoliosis, and in one sense, we have in terms of it being a postural or functional scoliosis. But then we see that patient that comes in that they continue to worsen, even under chiropractic care with an adjustment, and that's because that patient doesn't have a functional curve, doesn't have a postural curve. They've got a true idiopathic type of scoliosis, where it's growth related and probably genetically mediated. So back to your question, with posture and habits and those type of things, if they have a true idiopathic scoliosis, the posture and habits might play a small role in the worsening of the curve, and may play a small role in terms of function in terms of treatment, but it's really in those postural curves where those things are a big factor. Interesting.

Dr. Spencer Baron: 24:04

Man, I'm dying to ask this one, sorry. Man, I'm sorry, but, but I do. How often is it a leg length discrepancy? There's long leg syndrome, where you might put a, do you ever put a heel lift in? A little heel lift in or a big to balance out the start from the ground up.

Dr. Jeb McAviney: 24:24

Yep. Now I do a lecture on leg length inequality and scoliosis. It goes for about two and a half hours. So yeah, I'll give you the abridged version, and nothing show the answer is that there are types of scoliosis that are caused by true leg length inequality. And we would say that that scoliosis is secondary to the true leg length inequality. We see it a lot in France, for example, they play a lot of football, soccer over there, and you know, they get injuries to the legs, and the legs often grow at a disproportionate rate. So. I don't know if you ever been on holidays there, but you see a lot of teenage boys walking around with casts on their legs. It's because, it's because of the soccer culture over there, but So in a case like that, we might have a true leg length inequality. Putting a shoe lift in is absolutely a legitimate treatment. What sometimes happens, however, is that we get a scoliosis, particularly in the lumbar spine, that doesn't have a large leg length inequality with it, and what we actually see is a pelvic or sacral obliquity caused by some type of deformity within the sacrum, and that's somewhat hidden, and that's where taking a specific type of X ray called a Ferguson's X ray, which is something that is taught in the chiropractic biophysics field of scoliosis management by chiropractors, really helps to highlight that the interaction between sacral obliquity and leg length inequality. And so then we can get a match where we have a sacred obliquity that matches the leg length inequality. We lift the leg and that gets the sacrum level. Sometimes we get a mismatch where we have a sacred obliquity but the legs are level. And then we have to make a decision, well, what do we care more about? Do we care more about getting the sacrum level, or we happy to unbalance the legs and so and then it comes to, well, is that purely a lumbar curve, or do we have a compensatory thoracic and if we unbalance the legs, are we going to cause a problem in the thoracic spine? So I think the simplest take home message for chiropractors would be, if you see a leg length inequality, you have a pelvic obliquity associated with that, and it's a mild curvature without any major thoracic component, then probably it's safe to use a lift. Aside from that, it it might require a little further investigation to see if a lift is going to be appropriate or not.

Dr. Spencer Baron: 26:59

I had a I had a female patient about 20 years ago that she would only have pain when she would sit in class. And we did the X rays, and we saw that. We saw that there was no pelvis, the hemispheres, they weren't asymmetrical. The you know, you would see the operators were even and balanced and all that, but the one of the the the one side of the pelvis didn't mature. I've never seen that before. It didn't mature as as quick. Now mind you, I mean, it was, you know, a minor amount, but all I did was, and I'd been treating her for a couple of weeks, and all I did was take and because it was a female, I made sure I took, you know, one of the, you know, Vogue or L magazines, and it was only about what, you know, a quarter of an inch, and I had her sit on one side and underneath the issue, no pain, yeah, and it compensated was almost like a, like a heel lift for her, for her butt.

Dr. Jeb McAviney: 28:07

And we, we use those. Call them issue lifts. And so issue lifts are using in a case, for example, where you have a mismatch, so you might have equal femoral head heights, but then you take the Ferguson's X ray, and so if this is my sacrum laterally, my sacrum doesn't sit like that. It sits at like a sacral base angle of 45 or 40 degrees. Yeah. If I just take an AP lumbar X ray, my my beam is going like this, or even diverging down onto it, so I can't see like, if that's tilted in this plane I can't see because I'm looking at it like that. It's hard to actually see, right? So this is where we learn in CVP, is that you actually take a modified one, where you've got a beam hitting the femoral heads like that, and diverging beam kind of going up, or a true Ferguson's where you shooting along the plane line of the disc. And in that case, what you would actually see is, is that tilted left or right in terms of obliquity. Now, in your case, what you're talking about is the patient seated. So you probably see it a bit more, because the sacred comes up into the line of the central ray of the X ray, yeah. And so now you're actually getting a better understanding of what's happening at the sacral obliquity. And therefore you're seeing something that's more related of the sacrum. It's obliquity, and how that relates to the spine, which is somewhat independent of the legs. It can be because of the legs, it can be because of the sacrum. And increasingly, we see that the problem is we don't see what we don't see. And if we are taking an x ray, standard set of x rays. It's out of plane, and so we just don't see it. So we don't see it. It's not there, right? We would see it if we did 3t 3d C, T scans of every patient. But obviously we can't. And it's a very interesting area of research that has been neglected. And, you know, hopefully. Be we can bring some more data and shed some more light on that in the future. But, yeah, it's a very good observation. Dr, Barron,

Dr. Spencer Baron: 30:09

okay, Terry, I'm done interrupting you.

Unknown: 30:12

No, you're not, but thank you for at least putting it out there. Yeah, Doc, what's some of the hardest truths about scoliosis that you wish you could actually say openly to parents, coaches, even surgeons, right that, but rarely do, because it challenges the standard narrative.

Dr. Jeb McAviney: 30:38

Oh, okay, I'll answer this in two parts. The hardest truth as a chiropractor is realizing you can't help every scoliosis, and you need to be careful, because as chiropractors, we're passionate about what we do, and we want to help everyone. But there are times at which even with the best tools in the world, which I feel that we have, at scholarly care, there's still a proportion of people that are going to get worse, and so knowing that, you've got to be very careful of you know, under promising and over delivering, that you match the patient's expectation, and if they have an unrealistic expectation, try to bring that expectation back into check so that the patient, you know, It's happy with the outcome they get, even if that might be treatment for a period of time, allowing the spine to grow, delaying surgery, but knowing surgery is inevitable. Now, thankfully, it's less than 10% of the scoliosis patients that we see that end up in that situation, because our philosophy is to give them the right treatment at the right time, and I feel that we get pretty good results doing that, in terms of, for parents, coaches and other people, it's, I think the biggest truth for scoliosis is there's a limited window of opportunity to get the best result. You know, if you stick your head in the sand and hope that it's going to go away. Or, you know, think, Okay, well, bracing treatment looks horrible. I'm going to avoid that for two, three years and, you know, go get massage instead. Or do do Pilates. The problem is, is that three years later, the scoliosis may have gone from 30 degrees, which is relatively easy to treat, by the way, with you know, the new types of braces that we use and scoliosis specific exercise, compared to a 60 degree curve, which is borderline surgical and is not going to respond anywhere near as well to bracing an exercise as a 30 degree curve would. So even though the curve might be small, I think, for parents and for other health professionals. Send them to someone who has an expertise in scoliosis. Don't just hold on to that patient, try and get an expert opinion and see if something can be done earlier rather than later. And I think that truth holds solid for whether it's, you know, infantile, juvenile, adolescent, whether it's a degenerative scoliosis. You know, sometimes we see that lateral lasthesis and a 10 degree curvature, but we'll start intervention before that curve becomes big, because we know that as soon as we've got evidence of instability in the spine, the patient's entering menopause and starting to get back pain. They're really bad signs that that scoliosis is going to continue to worsen. And if we intervene when the curve is small, you know, the spinal probably outlast the patient. But if we wait until the curve is big, the treatment is not as effective, and it's going to be more difficult to manage.

Unknown: 33:37

Interesting, you know, one thing I've always been fascinated is how the different world views different things. And you live and work in Australia, you've lectured in states. You left lecture in Europe. What countries do you think are leading the research and the treatment? What ones are lagging behind? And what do you think explains all these the differences and how it's universally treated.

Dr. Jeb McAviney: 34:03

I think in America, in the USA, you have a very progressive medical system in terms of, you know, you're at the forefront. There's a lot of cutting edge technology. There seems to be a culture of embracing new technology and new advances and and that's why, you know, my company, scholar care, we're actually franchising the business in the US, because the US market seems to be very open to new ideas, new technology, and it's also very research driven. And, you know, so I think the US is very open to it. Australia is a little more conservative in terms of it comes from that more traditional British medical model, and that is a lot more of an appeal to authority, where you know, if the surgeon says, do this, then do this. And so people are more likely to follow the. The advice of the surgeon, rather than independently seek out their own, you know, information compared to the US. And so I think that that's good. It does open a little can of worms, because unfortunately, not everyone out there is trying to give the best advice. And, you know, some people have their own agenda in mind, but I think in general, you know, the the public is smart enough. They can they can smell when something's off, and they know if you're legitimate in what you're trying to achieve. Europe is interesting because Europe is really the birthplace of a lot of the scoliosis specific exercise programs I'm actually a board member of so sort. So sort is essentially the world's leading non surgical scoliosis society, and that society is really about looking at the evidence and trying to figure out which School of Exercise, what type of brace offers, what? It's not to say that one's better than the other. It's about giving each of those schools, each of those programs, the opportunity to come together once a year, collaborate, publish research and try for the betterment of our patients, you know, share that knowledge and so, yeah, different in different countries, you know, I think unfortunately in Europe and the UK, sometimes the ultra socialized aspect of medicine does stifle innovation a little bit, whereas in the US, you have a much more private market. So, you know, innovation is kind of encouraged. So yeah, hopefully that answers.

Unknown: 36:42

But it's interesting that we hear when somebody has cancer or somebody has a problem, the FDA and sometimes the United States squelch is that, and they go outside the the United States to get innovative thoughts. You know, whether it's like I use cancer, but then I'm also watching this Netflix series about using psychedelics, and they have to go to Mexico. So, I mean, so I was, you know, I was curious to say, on the scoliosis side, that you're saying the US is actually more innovative than outside. So that's, that's interesting to hear that.

Dr. Jeb McAviney: 37:20

Yeah, I think in the US is innovative, and it's the population is is open to it. I think that's a big part of it, because you don't have socialized medicine to the same degree as we do in Australia or Europe, not necessarily criticizing socialized medicine, but when you've got treatments in place that are already paid for by the government, and then you've got a private treatment that you have to dig into your own pocket, you know, if you're struggling a little bit, you know, you're probably not going to dig into your own pocket to try something that's a little more innovative or new. And so I think the culture in in the US of A is more likely to do that, whereas in Australia and Europe, it's not so much the case in saying that, however, I mean, particularly, for example, in the social group, there's a lot of like minded clinicians that are driving innovation. AI is the buzzword everywhere, and we're embracing AI in terms of diagnosis and curve patterns and things like that. We're actually running a project in Australia with University of Technology Sydney, which is like our MIT. And so we're looking at AI for curve classifications and outcomes and things of that nature. We've done joint programs with our colleagues in Italy and isico, looking at, you know, how does scoliosis affect pregnancy, or how does scoliosis affect the low back pain population? So, I think, you know, in the world of scoliosis, there is actually a lot of innovation across many, many countries that's going on. And I'm happy to say that it's a fair amount of collaboration as well. Interesting.

Dr. Spencer Baron: 39:04

You know, I think we need to define innovation so I clearly understand because innovation could be more surgical techniques, and innovation could be also more conservative approaches, kind of like what you do. But how do you mean that innovatively? Because the United States, you know, we, Dr Terry and I, we see, you know, more surgeons wanting to do surgery or giving medication, whereas we look, you know, across the ocean, and we think that you all have a different perspective. Or, you know, even, even, you know, I don't even have patients traveled to, you know, the islands that they do, more conservative management, you know, than than surgical. So innovation, in your perspective, is what

Dr. Jeb McAviney: 39:56

innovation is not sticky. Into old treatments based in Dogma. I would say that, you know, traditionally, the type of brace that's used in a hospital is a TLSO, thracolumba, sacral orthosis. The best known brand of that would be a Boston brace. And that was like, you know, the evolution of surgery from lying down in a cast for six months to rods at the time when the Boston brace was invented by Dr Hall in the 1970s was kind of a revelation. You know, instead of this sort of, you know, external skeleton that you had to wear in a Milwaukee brace, you now had a plastic brace that you could just put on, and they had a shelf of them in the hospital. They'd pull one off and they'd cut it, mold it, and fit it to you, very convenient, but unfortunately, not particularly effective. And so that was a form of innovation, but in fact, you know, it didn't work out that well, and it kind of led to the demise of bracing in America for a long time, but with other new technologies, 3d scanning technology. And I'll, if I go on for too long, just wind me back. But a quick story was, I've been interested in this for a very long time. My father's a chiropractor, my sister's a chiropractor, my mom's a nurse. So I come from a, you know, a very holistic background, and I grew up in my dad's chiropractic clinic, and his passion was scoliosis. So he would show me these cases, and we'd think about it. We draw diagrams of different traction machines and ideas for bracing and all that from maybe the age of 15 or so. So it's always been something in in my brain that that's been fostered. Anyway, the big limiting factor is, in the old days, you have to take a plaster cast of the patient, take that cast, fill it with a like a concrete composite, not concrete, but a plaster composite, sorry, and then carve out a brace, and then wrap that in plastic and then bake it. So it's really determinant on the skill of the practitioner, the outcome for that brace, and therefore the patient, to standardize something and to make it so that you then learn, not based on the skill of the person, but the outcomes is really what I wanted to achieve, and that could only be achieved through technology. You can't do it by hand, because I could teach both of you how to make a scoliosis brace for a patient that you presented, and all three of us will make a different brace if we do it by hand, so there won't be any real standardization there. So I don't know if you remember Microsoft released the Microsoft Connect with the fruit ninja game where you're chopping up fruit. You guys remember that? Yeah, well, that actually used a laser, and like a scatter plot laser, to create a 3d scan, like a 3d model. And before Microsoft released the SDK, I was kind of involved with some programmers. We hacked the Microsoft Connect and turned it into a low cost 3d scanner, and so that allowed us to do 3d scanning for a couple of $100 instead of 10s of 1000s of dollars, which is what was required when you were using the traditional orthopedic architect type scanners. And so from that, we were able to then capture the body in 3d put that into computer aided design, create algorithms that were consistent, and then look at the outcome of those algorithms. And if the outcome was good, then we continue down the road. If the outcome was bad, then we shelved that, moved on, and that allowed us to embrace technology as the way in which we could bring standardization to the field of scoliosis bracing, and we were one of the first groups to ever do that. And so, and that's led to lots of other things. Now we're experimenting with 3d printing. We've actually been trying that since 2016 and certainly right now, at this point in time, it's coming somewhat commercially viable, and AI, of course, and lots of other things. So yeah, in the field of innovation and technology, there's, there's a lot happening in scoliosis.

Dr. Spencer Baron: 44:10

We talk about a patient you talked earlier, about a patient's emotional perspective about why they would get surgery, whereas the doctor is usually consumed by the more clinical perspective of we need to straighten this out. We need to do the surgery. We need to but how do you approach a patient emotionally and or psychologically and certain patterns that you see again and again, that oftentimes clinicians misinterpret or underestimate?

Dr. Jeb McAviney: 44:36

I think being a chiropractor really helps. You know, we have a different level of empathy. And we, you know, able to relate to patients very well and and I think the number one thing is defining what the patient expectation is. And we talk about, you know, posture, which essentially is cosmetics, pain and progression. The three P's. And essentially, the patient is coming in with one of those things at the forefront of their brain. So if I've got a patient that's coming in and the main concern is how they look, and I'm asking them about their pain the whole time, well I'm not matching you know what they're interested in. They might have a one out of 10 pain. Pain is not a concern, but I'm the clinician, and I'm thinking, well, you must have pain because you've got this, this and this, but I'm missing, you know what they're really there for? And that is, they really don't like the way that they look. So then I need to change the way that I communicate, the way that I interact with that patient. It should be about, okay, well, Jenny, I can see that you don't like your shoulders. Why don't we teach you an active self correction and you know, if you do the rehab program, this is the type of thing we're going to do. We're going to teach you to lift the shoulder, bring this one down, rotate your ribs around, and come back, see that you're in the opposite position now. And she sees that now, relax, but just relax halfway and see that you look much better. Oh yeah, look much better. Well, that's the type of treatment that we're going to try to do to see if we can influence your curvature. That's how we would approach it is to try and match that patient expectation. Rather than say, Hey, Jenny, that's going to get worse. You're going to embrace so, you know, here's a referral. Off you go. It's different approach in that way.

Dr. Spencer Baron: 46:23

So on that same conversation, how do you how would you redesign that whole scoliosis, scoliosis pathway, you know, from screening to conservative care, you gave us a snapshot of the communication you would have with the patient for that, you know, that recovery or that period of correction, but from start to finish, how is how would you urge every clinician, doctor to manage that patient from and that system? What would that

Dr. Jeb McAviney: 46:59

be like? I think, first of all, our doctors need to be educated a little more about scoliosis. I'm not sure what colleges you or universities you both went to, but most give a one to two hour lecture on scoliosis in the five years of chiropractic school. So there's not a depth of knowledge about chiropractic. So the first thing, I think, is that we need to increase that level of understanding within the profession. And there's, you know, online courses and things like that that we do chiropractic biophysics, you know, run a two day course on scoliosis management. So, but wherever you can get some more information about scoliosis. I think increasing that level of understanding is important. And then I think it's about looking at scoliosis as something that a patient will have, even if you have successful treatment. And it's about managing the condition rather than curing it. And if we look at management across the lifetime, there's going to be periods at which the patient presents with, you know, different goals. If they've got a juvenile scoliosis, obviously they've got a risk of the adolescent growth spurt, it's going to grow and get out of control. So we're going to have to be pretty on top of treatment during adolescence to try and keep that curve down, but then once the patient's matured, probably from the age of 20, 3040, they're not going to have that that many problems. They're not going to need full time bracing and rehab and intensive treatment every sort of day for the rest of their life. We need to employ those strategies when they're most appropriate, but that same patient, when they you know, maybe they're a juvenile, they had successful treatment. It's been stabilized, and there's been minimal management, just keeping an eye on the curve and some basic exercises to maintain the spine throughout their 20s and 30s and 40s, but then getting into this sort of 50s menopause is starting to have an effect, and maybe now the curve is starting to get painful again. They might just need scoliosis specific rehabilitation to help deal with that, or perhaps the curve is starting to worsen because there's a lysthesis there, and they might need part time intervention with a brace to try and stabilize it. So I think it's about that journey. It's about understanding scoliosis in its entirety over the lifetime of the patient, understanding at different periods of time, patients will either need different treatments or perhaps no treatment at all, but it still needs to be managed throughout the life. And I think the other important thing is doing that without catastrophization. We don't want the patient to feel as though they're burdened with this horrible disease and, you know, compound and negative psychological effect. We just want them to understand that they have this condition. It can be well managed. We're here to help, and they should live a normal life, but they just need. Also take care of, you know, that's fine, like everyone does, but in a more specific way, when they have a scoliosis.

Dr. Spencer Baron: 50:09

We talked about what treatments were rendered or believed in, you know, from 5060, years ago, and that evolution, what what do you see in the next 10 years, or what do you imagine that treatment or that approach will evolve to?

Dr. Jeb McAviney: 50:29

So I can tell you the goal that I have, and I don't know if I'll see it in my lifetime with scholar care, my my company, and that is that we've gone from innovating in 3d scanning to 3d printing. And bracing, through to screening and all of those things. What I envisage is someone uses an app to screen whether it's an adult or a child. They then say the high risk. They click the app, they find the nearest clinic. They go to the clinic, they stand in a booth that does the 3d scan, some form of X ray or ultrasound. You know, we're involved in research for both of those. Instantly, the AI classifies the scoliosis, determines what type of treatment they need. By the time they step out of the booth, the brace has been 3d printed, and they've got the exercise prescription. There they then go and start their exercises. Three months later, they step back in the booth, the 3d scan does all the 3d assessment says, Okay, you're 15% better. Now we're going to change the brace by 15, 20% by the time you're out of the booth, it's printed. You got a new one. And that cycle continues so that the patient is constantly getting the best updated treatment as they go, and there's very little error in terms of it, because we've got aI running those algorithms and doing that. That's where we hope to get to in the future. But you know, it's happening fast.

Unknown: 51:56

You know, when you're talking about that, I have Invisalign and, you know, they scan my mouth, and then I get these computer printouts, and they send me these little braces I put in, and then every month or two, they rescan. And it sounds like a very similar model.

Dr. Jeb McAviney: 52:13

It is. And you know, one of our doctors, Dr T foster Bryant, who's down in Naples, in Florida. I think maybe you've met him at FCA. He actually talked at FCA this year. Is one of the speakers in the breakout rooms. He says that. He says it's like Invisalign for the spine. You know that? You know we put these braces on. I mean, he's in a population of a lot of older adults, and they want to stay active, they want to be doing pickleball, they want to be going up fishing, they want to do all those things, but they can't, because gravity is winning. It's pulling the spine down to the ground. But by adding a brace, and, you know, the reporter findings to an adult with degenerative scoliosis, in my opinion, is pretty simple. It's your spine is deteriorating, wearing out, it's unstable. You need scaffolding. And you can either choose to have scaffolding internally, which is surgery, or scaffolding externally, which is the brace. And the beauty of the braces, if it doesn't work, can take it off. You know, you're not stuck with it if it doesn't work. So why don't we try that first? And if it doesn't work, we can always go for internal scaffolding, and that's literally how I discuss the treatment option when the patient is appropriately qualified for that treatment. I suppose

Unknown: 53:33

you know you spent your whole life in scoliosis, sounds like even from your father and as a kid. So I'm going to flip a little bit. What has scoliosis taught you about the adaptability of the human body, the resilience of the human spirit that no textbook has ever captured.

Dr. Jeb McAviney: 53:52

Scoliosis is humbling. As a clinician, I think that you know you come out of chiropractic school pretty cocky and wanting to, wanting to correct spines and change lives, and there's no doubt that we do those things as chiropractors, but scoliosis sometimes gets in the way of that, you know, and so you've got to be able to eat humble pie a little bit and, and, yeah, just sort of temper that. And I think that's hard, particularly as a young chiropractor, I came straight out of high school and went into chiropractic college from high school. So our system is a little different in Australia. So from high school, you can go straight into your undergrad bachelor's degree, and then you do a master's in chiropractic. So I think I graduated by the time I was 22 so you can imagine being a young chiropractor and then trying to deal with scoliosis. It's humbling. And I think that, you know, it's really important to help us understand that there is a, you know. A right treatment at a right time. As a chiropractor, what we do is amazing, just in general, you know. And I mean, either not about yourselves, but I certainly can tell that I haven't been adjusted if I haven't for a week or two. And that's a different philosophy to, you know, having back pain or whatever. And so from a general health point of you, that's great, but that doesn't necessarily translate into chiropractic changing the outcome for scoliosis, and that's also a little humbling, you know, coming from a chiropractic family and chiropractic background, knowing how good chiropractic is for us as human beings, knowing that in the world of scoliosis, it has a place, but it's a limited place in terms of what it can achieve as an outcome.

Dr. Spencer Baron: 55:46

I love this show because it's it deals so, so deeply into stuff that Dr Terry and I see all the time, but our specialties is often in sports, and we may overlook some of the things that you really, really focus on now we're going to enter some of our favorite parts of the program. It's our rapid fire questions. I got five of them for you, and I'm wondering if you're ready for this. Are you ready?

Unknown: 56:13

Okay, like always says, Okay, Doc, you said that was so much confidence.

Dr. Spencer Baron: 56:28

Sure, I scared him about it, but here we go. Now. These are rapid fire questions, so if you can answer briefly, that would be great, but it all is about you. So you obviously travel constantly, and you're teaching school leaders around the world. What? What is the most Dr, Jeff mcavenny, thing that you always pack that has nothing to do with your clinical work?

Dr. Jeb McAviney: 56:50

Oh, my my pillow. I hotel pillows, messes my neck up and, yeah, no, my pillow is the number one thing that I pack

Dr. Spencer Baron: 57:09

that's so perfect for you. You practice what you preach. Very good.

Unknown: 57:14

So how big is your pillow? Because that was kind of take up half your suitcase.

Dr. Jeb McAviney: 57:19

It's a big it's a big pillow. It's a proper chiropractic contour pillow. And, yeah, yeah, sometimes, sometimes it's the reason I have to pay more for my baggage. All right,

Unknown: 57:36

does your does your gal? Does she pack a pillow too? Because I don't know how women could pack a pillow and all the stuff that they carry,

Dr. Jeb McAviney: 57:43

there's shoes and hair dryers and other things associated with that luggage.

Unknown: 57:48

Oh, yeah, I'll have a small little bag. My wife will have two big, large packs that go, Hey, we're going away for the weekend. Yeah.

Dr. Spencer Baron: 58:01

Patient told me yesterday that that it to tell his wife, who is also a patient, to keep packing those bags heavy like she does, because it keeps me in business treating his low back, right? Question number two, you're, you're an Aussie, you've got to settle this now, what's, what stereotype about about Australians is absolutely true, and which one just drives you insane?

Dr. Jeb McAviney: 58:29

Well, we do love a shrimp on the barbie. That's absolutely true. We don't, we don't ride kangaroos to school.

Dr. Spencer Baron: 58:39

That was beautiful. You know, it's funny, you can have someone with an Australian accent or a British accent, and why do they sound more credible than maybe? Dr, Terry and I with a regular American actor, so he can say anything. I believe it, right.

Unknown: 58:55

I asked him, Is it a shrimp on the barbie, or is it a prawn on a Barbie?

Dr. Jeb McAviney: 59:00

We say prawn, but we understand

Unknown: 59:07

American. Oh, I hate when you say shrimp on the body. That shrimp, they're prawns. I'm like, yeah, it doesn't sound as good.

Dr. Spencer Baron: 59:16

Question number three, what's the one ritual you complete, you do to completely disconnect. You know, the thing that, like, you know, recharges your soul when the world thinks you're still on.

Dr. Jeb McAviney: 59:29

I'm a big an advocate of cold plunging, so I've got a cold plunge that's, um, set at two and a half degrees Celsius. So I don't know what that is, but I think it's under 40 in your Fahrenheit. So it's very cold, and fortunately or unfortunately, I'm I have that personality where I can really disconnect. And my I've been in it over 17 minutes at one point in time, but then suffered for a few days afterwards. So now I just try and stick to under five minutes. Just OH. Yeah, to wake me up and settle me down. But, and even when I'm in the US, I try and do it. I was recently, about six months ago, I was at Lake Tahoe, and so I went and I did my my cold plunge in the lake up there, which was phenomenal, beautiful scenery and and that was cold, that was under 40 degrees in the lake. That was, yeah,

Unknown: 1:00:22

God bless you.

Dr. Spencer Baron: 1:00:25

Certainly not for 17 minutes. I'm sure,

Dr. Jeb McAviney: 1:00:28

yeah, I don't recommend that. That's a little a little crazy, but under five minutes in the cold plunge is perfect. I mean, there's nothing else really to think about, you know, just get your breathing under control. You know, try not to worry about the pain in your fingers and your toes and really just try and suffer

Dr. Spencer Baron: 1:00:48

through it. Very good question number four, what's Well, we may already know the answer that, but what's one tiny daily habit, not not a clinical not an academic one, but you know, one that surprisingly keeps you grounded, insane, in a life that obviously never slows down. Yeah.

Dr. Jeb McAviney: 1:01:06

I mean, the daily habit is, I suppose that I love a cup of coffee. You know, in Australia, I think we, we have pretty good coffee over here, so taking the dog for a walk, getting a cup of coffee, you know, I need to be better at that. I'm probably more consistent with my cold plunge than than that. But I really do enjoy that. And I live in a beautiful part of Australia and Cronulla beach, and so getting out in the mornings and having a walk, it really makes you realize how lucky you are. I mean, in in this world, you know, I'm very lucky to privilege to be where I am. And so I do think that that helps to keep me grounded is to have that ritual as often as I can do it.

Dr. Spencer Baron: 1:01:48

So great. Question number five. Now, granted, this question number five has a Part A and Part B, in a sense, but what's something that people constantly ask you about scoliosis that makes you think, oh, no, not this again. And what's the one question you secretly wish they would ask you instead, I'm

Dr. Jeb McAviney: 1:02:08

going to flip that on its head a little bit. I get to lecture a lot in the US all around the world, but state conventions and I've done more than 200 lectures in the US at different places now, and inevitably, at the end of every lecture, I get a chiropractor that comes up to me and goes, Oh, great presentation. But have you heard about this? And then they'll tell me about their technique, and it'll be and I'm not discriminating against any technique, but at one conference, someone will say, Well, you know, I adjust the Atlas like this, and I cure scoliosis. And then, literally, the next weekend, I'll be in another conference, and someone say, Well, you know, have you heard about adjusting on the high side of the rainbow? And I do this and I cure scoliosis. And then someone will say, Well, I adjust the sacrum this way, and I cure scoliosis. And and I feel like I'm like, great guys. And my answer that is fantastic. Let's work together. Get the X rays, get the cases, send them to me, and we'll publish it together. Because if we can find a way as chiropractors that we could avoid having to do what I do, it's better for the patients, inevitably. I mean, after 200 lectures, and probably this happening 30 or 40 times, no one's ever come to me with a case and case study that we've been able to publish. So, yeah, so that's, that's the one thing. And then the one thing that I wish I could just say is there is hope for patients with scoliosis. We might not always be able to straighten up the spine, but if we work towards that, and the patient is able to get the right treatment at the right time, then you know, we'll get the best outcome possible, whatever that is, you know,

Dr. Spencer Baron: 1:03:46

Dr Jeff mcaveney, that was super informative. And there are already, I'm sure, Dr Terry's thinking of the same thing of patients that we want them to hear this, this lecture or this podcast, because it was stellar, and even refer people to Scully. What was it?

Dr. Jeb McAviney: 1:04:07

Only care. So we have a network goalie care. We have a network of clinicians in the USA. We have five scholarly care franchises. So if they go to scholar care.com they can see those. We also have a network of chiropractors that use our bracing system, which is called Scully brace. So they can go to scullybrace.com and they can find someone who might be using our technology in their local area as well. Fantastic.

Dr. Spencer Baron: 1:04:33

Thank you so much. We really appreciate you, especially all the way across the water in Australia. Thank you for being on the show.

Dr. Jeb McAviney: 1:04:41

I really appreciate the invitation. It was a pleasure. Thank you.

Dr. Spencer Baron: 1:04:47

Thank you for listening to today's episode of The Kraken backs podcast. We hope you enjoyed it. Make sure you follow us on Instagram at Kraken backs podcast. Catch new episodes. Shows every Monday. See you next time you.