Q: What insurance plans do you accept?
A: We are currently an out-of-network provider. No insurance is needed or accepted.
Q: Where can I learn more about scoliosis and bracing?
A: Please see the resources on our Scoliosis and Gensingen Brace pages.
Q: Where can the office be found?
A: The office can be found at 16430 Ventura Blvd #108, Encino, CA 91436.
Q: What type of curves do we treat?
A: We treat patients with mild, moderate, and severe scoliosis of varying curve patterns. Ray has treated patients with scoliosis Cobb angle(s) starting at 10° and up to 95°. Our patients with kyphosis typically have thoracic Cobb angles ranging from 50°-85° (as measured on a lateral spinal x-ray). We pride ourselves on taking a proactive approach to treatment while others are ‘watching and waiting.’ That said, it’s never too late to improve quality of life, help with pain management and halt further progression.
Q: What should you wear to your appointment?
A: During the initial examination, girls should bring a sports bra with maximum
exposure to the back, while males will be shirtless. For bottoms, any comfortable
pants/shorts are acceptable. During the brace measure, a 3D scan is taken. Tight
fitting bottoms are required to not add extra width to the body (something similar to spandex bicycle shorts is best). During brace fittings, a snug, long t-shirt is required to wear under the brace (seamless if possible).
Q: Will I need a new x-ray? Do you take x-rays in your office?
A: All patients must have a recent entire spine x-ray before their appointment. We do not take x-rays in the office; please note that in-brace x-rays will also need to be taken to check fit/correction before final fitting.
Q: What is in-brace correction, and what factors affect in-brace correction?
A: In-brace correction is the amount (in Cobb angles degrees or as a percentage) that the Cobb angle(s) decreases, as demonstrated by x-ray, while the patient is wearing their brace. This will depend upon several factors: age, curve pattern, spinal stiffness, trunk shift, and brace fit.
Q: When can I expect to start seeing improvement?
A: First, let’s consider improvement. Regarding conservative scoliosis management, progress may be experienced in various ways–Cobb angle reduction, prevention of Cobb angle progression, postural/visual improvements, pain reduction, etc. Regarding Cobb angle and scoliosis, an improvement is considered a reduction of more than 5º as measured on an x-ray. This is because Cobb angle measurements can be subjective and vary according to the time of day taken or equipment variation.
Curve reduction is NOT guaranteed because each patient is unique. The difference in age at diagnosis, curve severity, growth potential, curve flexibility, compliance to the program, etc., play a role. Not every adolescent patient will see curve improvement, although most of our patients do experience improvement in some way, shape, or form. After just a few days of instruction, many adolescents have experienced increased pulmonary function.
Postural improvements can start to show for most patients after a couple of months of consistent exercise. Some patients take longer to see results. Each patient’s body and response are different. The key is consistency and patience. Some adult patients have had pain relief right away, a reduced incidence of headaches, and other symptoms when it comes to pain.
Q: Why is bracing important for scoliosis?
A: Research has shown that when an adolescent reaches skeletal maturity with Cobb angles at 30º or less, progression into adulthood is less likely. Bracing is
recommended for rapidly progressive curves in the growing adolescent. Controlling scoliosis during the adolescent years is essential. Often, time is of the essence.
Q: Will my child need more than one brace?
A: Growth is unpredictable, so the number of braces needed for a growing child will depend on age, stage, and pace of growth. Growth may require a second brace or more. Feedback from parents and children and follow-up photos and x-rays allow us to know when it is time for a new brace or brace adjustments.
Q: Do you brace adults with the Chêneau-Gensingen Brace?
Absolutely! While it is not realistic for adults with scoliosis to expect that brace wear will result in Cobb angle reduction, adults who currently wear the Gensingen Brace report improvement from a variety of symptoms of scoliosis. These include pain relief or reduction, postural improvements, and spinal support.
Q: Do we have to come back for follow-up appointments? If so, when?
A: When patients are braced, follow-ups are necessary except in some
circumstances when the child or adult patient is at skeletal maturity. As the body
changes with growth or as a result of improvements due to bracing and exercise,
padding can be amended for comfort or increased for an extra push to try and
enhance results. if a patient has outgrown the brace (typically at a growth of 5cm
in height) or has increased girth, a new brace will be necessary to avoid loss of
correction and unintended consequences. regular check-ins allow us to monitor
Q: When should a child be braced for scoliosis?
A: The recommendation for bracing for scoliosis is dependent upon one or a
combination of factors, including age, Risser sign, Cobb angle(s), and
estimated potential for progression. Once the initial signs of maturity become
apparent, the potential for a considerable increase in curvature is
possible. Timely brace treatment is necessary when curves are at 25º – even
sooner when scoliosis reaches 20º prior to the primary growth spurt. Parents
should know that a dramatic increase in curvature can occur in only a few weeks
during a growth spurt.
Although not typical, we have had more than one patient
whose curvature has increased in double digits in less than a month, documented by x-ray, and others who have experienced significant progression within just weeks. Each case is determined individually. However, we generally believe in bracing early when there is the opportunity to do so. This is because we have found a better chance of making a positive impact on a growing spine earlier in the process than later.
The decision of when to brace should be yours as a family—waiting until a curve is 25º or beyond (SRS guidelines), or even in the low 20ºs for younger children,
doesn’t always make sense. We’ve braced many children whose parents have
waited, with regrets, when a growth spurt has resulted in a significant increase in their child’s Cobb angle in only a few months.
Q: How does the Chêneau-Gensingen differ from other braces?
A: It is important to note that to attempt to correct scoliosis or counteract curve
progression, several factors come into play. With a 3-dimensional brace, there must be room for corrective movement, in-brace, for the opportunity for a successful outcome at skeletal maturity (as opposed to a simply compressive brace). Because of the corrective voids in the Chêneau-Gensingen brace and the lightweight material, we have had several patients who, in the past, did not tolerate other braces but switched to the Chêneau-Gensingen brace and managed to wear it with greater success.
Unlike other braces, the Chêneau-Gensingen brace aims for overcorrection for patients. With immature, flexible curves. Overcorrection brings the scoliotic’s curve past the midline of the back into the opposite direction of the curve. Overcorrection is good because it can potentially halt scoliosis curve progression and increase the likelihood
of reducing the curve.
Q: Is wearing a scoliosis brace painful?
A: It shouldn’t be physically painful to wear a scoliosis brace. If so, brace adjustment may be necessary. A good brace corrects the scoliosis in-brace to the best possible extent without causing pain.