Chiropractor, Dr. T. Foster Bryant, is ScoliCare Naples Florida’s Head Clinician. Dr. T. graduated from Auburn University in 1998 with a B.S. in Exercise Science with honors. While at Auburn, Dr. T. was involved in research related to Exercise Physiology, Biomechanics and Human and Motor Development. After graduating Dr. T. went on to Life Chiropractic University for his Doctorate in Chiropractic. He has been practicing in Naples Florida for over 20 years and grew his family practice with a focus on correction and CBP care.
In this of TechTalk Podcast, Brad Cost, Dr. Jay Greenstein, and Dr. T Foster Bryant sit down to discuss:
Percentages of scoliosis, broken down.
The detection, competition, and solution of scoliosis.
A real life-changing case from Dr. T Foster Bryant’s office.
SHOW NOTES:
4:15 – The love of a grandson. "The reason I became a chiropractor is my grandparents. We had one of the largest, private farms in the state of Alabama, but I watched all my great grandparents and grandparents end up bent over just from working so hard in their lives. Even doing full CBP care, I had all the traction, and I was fully bought in, but I couldn't get those patients to stay up. I certainly couldn't correct scoliosis the way I would like to have done it, so in 2013, ScoliCare was founded. I didn't get trained on the brace until 2015. Dr. Jeb McAviney is the inventor and CEO of ScoliCare. He's a chiropractor, but also has training in pain management and worked in the hospital. He saw both worlds, which I wanted to learn more about the integration, the medical with the chiropractic. I learned about that brace, drove back from Miami, and I started bracing there. It's a world that is experienced. You have to dive into the world because, even though I had seen scoliosis, I knew about that much of what I should be knowing about it. I graduated summa cum laude and had a fellowship in pediatrics, but I still knew very little. In 2018, it shot up for me because I had a patient walk in that looked like my great grandfather. He was bent way off to the side and I was thinking, how am I going to do CBP on this guy? I just could see a malpractice rib fracture coming out of me real fast, so I just decided I'm going to take a kid's corrective three-dimensional brace and design it for an adult. I did it. The company called me to tell me they don't really put adults in these types of braces, but I knew this guy had no other options. We put him in it with a month and he could stand straight up. Fast forward to almost a year and a half ago, we opened here as the first ScoliCare to open outside of Australia. It's just taken off. I feel like it's going to take one interview on TV with seeing someone bent and standing straight up within five minutes in a brace. Now, we have patients flying in from all over the world. Ultimately, ScoliCare is, in its nature, a tech company. It is the technology that is doing this. We've really taken CBP's research, and we've basically built that into a 3D overcorrected brace. I can do about a year's worth of work now in about two weeks to a month in a brace. It's really quite amazing."
7:34 – Biggest competitor is gravity. "At ScoliCare, our focus is working on deformity, scoliosis, hypokyphosis, spondylolisthesis, translation, or people that are just posturally weak and collapsing over. The goal is to objectively evaluate and examine a patient to determine what that person needs. They may not need bracing. They may just need to do what we call scoliosis specific exercise. In lower-level curves, they don't need a big brace to push them, but we can rehab and strengthen it to stop the progression. In mild to moderate curves, they might need braces now to get the actual push. When the cases are really severe, we collaborate with surgeons. Sometimes I'm getting the patient prepped to have the best possible surgery they can have and sometimes it's to get them out of surgical levels, so they never have to have that. In ScoliCare, our focus is the right care at the right time. Chiropractors, pain management, surgeons, spinal surgeons - we work with everyone. Our biggest competitor is gravity and that's a 24/7 thing. For us, it's evaluating each person objectively and figuring out what is the best thing for them to get the fastest results that are going to be sustained."
9:32 - Extreme life-changing case. "This is a case that came in to see us about four months ago. This is her getting out of her car (below, Picture 1) and this is her coming into our door on day one (below, Picture 2). Notice, she cannot hold herself up. She is at this point collapsed. I thought that I could not help this lady, to be honest. We went back into the room, and I asked if she could lay on her back. She said, yes, but I didn't believe her. When she did, I knew I could design a brace because we're elongating or getting someone back up straight. If they can't lay in that position pain-free, I'm not going to be able to get them there. I engineered a brand-new brace for this case, and this is her five minutes after (below, Picture 3). If you notice, my hands are on the front and back of her because she had not stood up on her own in over two years and she was off balance. We don't just brace, we also do exercise. Now, this lady will never be perfect because it was too far gone. However, she can put a brace on, stand up, and walk. These patients will not go out a lot of times because they're so embarrassed - either everyone stares at them, or no one will even look at them. That's special for me because that's how my grandparents ended up and it was emotional for me because, by the time this technology came out, they were way gone. In my own brain, I convinced myself everyone that comes in here is my grandparents now. This is the most enjoyable time in my entire profession."
Picture 1
Picture 2
Picture 3
16:13 – Being recognized by other specialties. "They're certainly much more receptive to me now than me as a chiropractor. I find that the results are winning them over very fast. It's hard to break in with surgeons when you say you're a chiropractor, but surgeons love results just like we do. They can see the results in the objective pre- and post-x-rays, or pre- and post-postural pictures. I'll send them pictures sometimes and they'll just refer the case right over. They don't even question it. I'm in a group called SOSORT, the International Society of Scoliosis and Orthopedic Rehabilitation Treatments, and it’s the top non-surgical scoliosis and spine deformity group of professionals worldwide. To be in that group, you have to know what you're doing and be agreeable to collaborate within professions. One of my surgeons I refer to over on the East Coast of Florida, I can just send him a case with some pictures, schedule him or just talk to him and he’ll take it from there. Once you have these relationships and the trust that comes with them, it's to the patient's benefit because it’s the right care at the right time. We're all working together and it's fun. It feels like I've moved from this world of chiropractic where everyone's eating each other into a blue ocean where we joke by saying our only competition is gravity because the technology of the previous braces didn’t have a goal of correction. Our technology is designed for correction, which creates results that people want to see."
19:30 – Bracing for correction. "I don't know how much you'll get out of this, but I chose an older type of brace. TLSO bracing is the standard bracing that people have been using since the 70s. It's called a thoracic-lumbar-sacral-orthosis, but it means this is a generic shell and the orthotist puts padding in by what they see on the x-ray. There's really no shape that is actually working to de-rotate the spine. When we look at a spine that has scoliosis and spine deformities, they are 3D in nature. When you look down this brace, you can see the level of the curves that are grabbing the patient and putting them into a completely over-corrected mirror image position. We're basically rehabbing those ligaments and strengthening the muscles as we're changing. Adjustments cannot correct scoliosis, but neither can exercise. It's the combination of de-rotating the spine, the elongation. If you have a three-dimensional problem, you cannot change it without a three-dimensional solution. That's our braces’ goal. It's not just to stop the progression, it's to get correction. When we have any patient come in, we'll put them in their brace, take an X-ray, and measure the correction they get in their brace. Then we put our brace on, take an X-ray, and measure the correction. It's really dramatic. It doesn't take much education for the patient, child, or even the doctor when they see it. The key is just getting the word out there, but we can't get it out fast enough because there are so many cases. Even if they knew, we wouldn't be able to handle the load of the cases that could come in."
22:39 – Percentages of scoliosis cases, child vs adult. "That's an interesting question. I would say probably 30% of the practice is kids, 20% of the practice is middle-aged, and the rest are adults. We don't think about how many of these cases are missed and are worsening as they're aging. We start to bend and buckle. That's the fastest progression. I feel like those people are neglected. I would say adults are definitely our primary, but I was fishing the Everglades one day and saw an alligator with scoliosis. I tried to track him down and thought if I could get him into an x-ray, we could brace an alligator. I'll brace anyone."
24:06 – Working for the patient. "I've got cases where you'll see someone bent over on a walker, but we can put them in a brace and get them up pretty immediately. The result is so dramatic. Sometimes we'll have some resistance from doctors, like neurosurgeons and pediatric spine surgeons, but we must make friends out of them because we need them. I'm in a group called SOSORT, where we recommend surgeons that are in the SRS, Scoliosis Research Society, because it's a higher level of understanding and those surgeons are typically collaborative. Again, we want to work with everyone. At the end of the day, if a surgeon doesn't like what I'm doing, I really don't care because I don't work for them. I work to get the best results for the parents and kid or the adult that comes in here. As a function of that, I make the strongest braces in the entire company. They only make the strongest braces for a couple of us because you have to deal with the objections and difficulty of working through it. At the end of the day, it all comes down to results."
30:30 – Detecting scoliosis. "To have scoliosis, you have to have two things: a 10° or greater angle measurement of a Cobb angle on x-ray and rotation. A scoliometer is a really simple tool that tracks scoliosis. When I run a scoliometer down someone's back, the ball moves and that tells me there's rotation. I'm going to tell you that almost every case should be found by the pediatrician or chiropractor. If you have this tool, run it down someone’s back and you see rotation, you need to X-ray. Pediatricians don't have an x-ray in their office, so they'll say it's looks like a little scoliosis, but not to worry about it. Never take that as an answer. A lot of my cases will walk in, believe it or not, at 70 years old, bent to the side, MRIs out the wazoo, injections for years. I'll take an x-ray and they'll have a double curve, completely compressed spine, and they’ve never been told. The x-ray machine is the gold standard to evaluate bony condition and it should be done, but it's not. A scoliometer and x-ray can tell you 100% if you have scoliosis."
32:54 – Overall percentage of scoliosis. "The estimated percentage of scoliosis now is around 3-5% for those that are ten years or younger, around 30% for those under 30 years old, around 50% for those around 60 years old, and 80% for those around 90 years old. The trend is the older we get, the more likely we have scoliosis. You're collapsing under the forces of gravity."
33:33 – Being structurally sound. "If you're heavier, you're putting more load on the structure, and it can't hold up as much. Thinking about this, we've seen some horrible things fall due to the structure not being held up well. The twin towers, the bridge that was recently hit, the Miami building that was not structurally sound that fell and killed people. We understand that from an engineering perspective. Unfortunately, doctors don't understand your spine is the engineered structure that holds you up against gravity. When that distorts, all those soft tissues in between (the discs, nerve, and facets) get smashed and that's where the pain's coming. The problem is we're chasing symptoms and not fixing the cause of the problem."
35:19 – The process at ScoliCare Naples. "As a chiropractor, we're trained to understand the spine, but we also understand we cannot change those things well. They're very honest about what they can do, and it's really simple. They can go through our website, send me x-rays, and I'll do a free review for them on the x-rays. I reach out to the doctor or patient, and they can call to get scheduled. A lot of our patients will just fly in, and we'll book a longer time. We do their x-rays, scan for the brace, and order it. They will stay here typically in Naples for about a week. As a SOSORT member, we don't just brace because we're strengthening at the same time. They meet with Scoliosis Balance, which is our scoliosis-specific exercise. It takes some really great elements from Schroth Therapy, scientific exercise approach to scoliosis, and CBP. We focus on training the scoliosis patient to know their own rehab, so they don't have to get it from us. There are too many people to help. We're training and educating them. It's a team approach. Erin, my wife, runs that side of it. She sends their exercises and we do Zoom calls with our patients that are out of state. It really works well with the tech we have now."
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· Call: 239-513-9004