Ep 150: Back pain & adolescents: posture, stretching, backpacks and more! with Dr David Skaggs

Episode 150 with Dr David Skaggs (part 2)!   This week we discuss everything you need to know about back pain and adolescents.  For example, Dr Skaggs explains when to worry about back pain. He also describes ways to protect our backs---we talk about proper posture techniques, stretching, backpacks and more.

Thank you Dr Skaggs for sharing your knowledge and expertise about pediatric back and spine health.

Dr David Skaggs is the director of Pediatric Orthopedics at Cedars-Sinai Guerin Children's Hospital and the coo-director of the Cedars-Sinai Spine Center.  He is a leader in spine surgery and an expert in the treatment of spinal disorders and deformity in children. 

Dr Jessica Hochman is a board certified pediatrician, mom to three children, and she is very passionate about the health and well being of children. Most of her educational videos are targeted towards general pediatric topics and presented in an easy to understand manner.

For more content from Dr Jessica Hochman:
Instagram: @AskDrJessica
YouTube channel: Ask Dr Jessica
Website: www.askdrjessicamd.com

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Do you have a future topic you'd like Dr Jessica Hochman to discuss? Email Dr Jessica Hochman askdrjessicamd@gmail.com.

The information presented in Ask Dr Jessica is for general educational purposes only. She does not diagnose medical conditions or formulate treatment plans for specific individuals. If you have a concern about your child's health, be sure to call your child's health care provider.

Transcript

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Hi everybody. I'm Dr Jessica Hochman, pediatrician and mom of three. On this podcast, I like to talk about various pediatric health topics, sharing my knowledge, not only as a doctor, but also as a parent. Ultimately, my hope is that when it comes to your children's health, you feel more confident, worry less and enjoy your parenting experience as much as possible. Hi everybody. Welcome to episode 150 of Ask Dr Jessica. I have to say I'm pretty excited to say episode 150 because it really feels like a milestone, and honestly, I could not do this without the support of my listeners. So I want to say a sincere thank you to all of you. Today is part two of my conversation with Dr Skaggs, who is a true leader in spine surgery. This week, we talk about everything you need to know about kids and back pain. Dr Skaggs explains when to worry about back pain, and he also talks about how to protect our kids backs. We talk about good posture, stretching, heavy backpacks and more. Thank you so much, Dr Skaggs for taking the time to come on this podcast, and thank you to all of my listeners. I am really grateful for your support. Now on to episode 150 So, Dr Skaggs, I would love to talk with you about back pain in general. Okay, but I realize if you call me, Dr Skaggs, I have to call you doctors. You should call me. David deal, back pain, yes. So let's talk about back pain. And you know, in kids and adolescents, and it's a little bit different. So in the really young kids, they shouldn't be getting back pain too much. The warning signs is, if back pain ever wakes a kid up from sleep, that's a warning sign, get to the doctor, or if back pain stops a kid from doing something they think is fun. To give one example, I had a child who loved horseback riding, they stopped because it hurt too much. I just admitted the kid that day and did an MRI. And sure enough, there was something bad growing in them. Wow, when kids don't, you know, do what they love, we should be concerned if they're complaining of back pain. Now, what are the most common types of back pain that you see in children? Is it the same as adults, the same lower back muscular pain, yeah, so the great, great majority of back pain, and let's say now, you know, teenagers aged 10 to 20, because that becomes much more common. It's just like adults. You know, there's no definite diagnosis. It comes and goes. You know, given enough time, the body heals itself. And so back pain that kind of hurts all over you. Just say, Welcome to adulthood. And generally, if it kind of hurts when you bend forward, say, say, Welcome to adulthood. But if there's a very, very specific pain when they bend backwards in one place in the lower spine, that's when we become concerned about the possibility of a stress fracture for spondylolysis, okay, okay. And what about actually touching the back? Does that give you any clues as to whether or not there's a problem with the spine? Not really. You know, back pain shouldn't hurt when you touch it. You know, maybe if you have a sore muscle, it might. You know, the only thing that really hurts is if you fractured your spine. I'll tell you a story about my daughter. She was a captain of the I shouldn't say that. I'll embarrass her. She jumped horses from Marlborough, and sure enough, she fell off a jump 15 feet in the air, probably landed on her butt. Next thing, I'm seeing her in the emergency room, I'm hitting around her spine, because if you land on your butt, you might break your spine. Say, does it hurt? She goes, Nope, doesn't hurt. Took an x ray. Sure enough, she broke two vertebrae. I said, Kira, how did that not hurt? She said, I didn't want to admit it. So if you break your spine, you know it should hurt if you pound on it, but otherwise, pounding on your spine should not reproduce back pain. That's not a useful diagnostic tool, okay? So it's more about bending backwards producing pain. Yeah, yeah, that's pretty specific. If it hurts when you bend backwards, go see a doctor. Now, what about tailbone injuries? I see quite a few kids that injure their tailbone, and they wonder if they should see a spine surgeon or not, and I know that there's not a lot you can do when you injure the tailbone. So what is your perspective on when we should send them to you? Yeah, when you fall on your tailbone, it's painful for everyone involved, because it could hurt a lot for a really long time. And you know, we could prescribe a special pillow or a donut, but you know, who wants to walk around with a donut in school, like when you want to do that at work, there's no easy answers to, you know, falling on your tailbone and having pain. So in the unusual condition where you fall on your tailbone and it's really hurting, six or 12 months later, a spine surgeon could literally cut out like the bottom, you know, inch of the tailbone to make the pain go away. Wow. But that doesn't happen very commonly. I'm assuming, once in my career, I think, yeah, that's very, very uncommon in general. You just tell the people, keep waiting, keep sitting on a pillow, but it hurts a lot for a long time. Yes, I'm thinking myself, I once fell. I remember I was engaged to my husband. I fell on my tailbone. I. Slipped walking down stairs, and for years, I swear it bothered me. Yeah, I mean, another thing you do is write a prescription for a lot of ice cream to make a little more padding in the area. That's not what I thought you're gonna say, like that. I could go for that. Options. I like ice cream, so in general, because I just, I feel like back pain is such a common complaint that I hear from parents, what is some general advice that I can give to them that might be beneficial? Yes, so if back pain hurts with activities like with playing a sport or lifting weight or moving around, you know that's musculoskeletal, that's mechanical. That's what's common. That's what we don't worry about too much, because it generally just gets better. If it hurts when you're at rest, and particularly if it wakes you up from a deep sleep, that's when we worry. Go to a doctor, get an MRI, very, very uncommon. But that's the red flag. The other red flag is if you have pain that's running down your buttocks or legs or arms, because remember the way the nervous system is, it comes from the brain and the spine, and then the nerves go out. Sometimes there could be something like a disc pushing on the nerves, and if there's nerve pain running down the arms, that's a reasonable time to see a doctor, okay, okay. And then I often get asked about stretching that will help alleviate back pain. Do you have any favorite stretches? Oh, I don't, you know. I think that, you know, if the whole world went to yoga, we'd be happier. You know, I think that the good stretch is the one that people do. I'm not convinced that one is better than the other, you know, I think forward flexion, hamstrings, twisting, bending backwards. You know, I think that a variety of stretches to keep you interested is good. That's such a good point, because I've read that one of the benefits of physical therapy is that you actually do the stretches when you go to the physical therapist. And if you just tell people stretches to do. The odds of them doing them are pretty poor. So I agree with you. I can see that the best stretch is the one that people actually do. Yeah. And it also brings up the idea of, there's a lot of kids now that aren't doing any activities, you know, because as sports has become this magic way to get into college and get a scholarship and make your life good. You know, anyone who's not an Olympic hopeful might not find sports as fun, you know, because they're not the chosen person. So I think that there's an increasing population of kids that aren't doing anything, and the parents are saying, make them do something. I think the best exercise of the best sport is the one that they want to do. It doesn't matter if it's basketball, skiing, volleyball, yoga, anything, whatever they want to do. Make a commitment with friends, make it fun, send people to physical therapy. Like, how does that end? You're not going to go to physical therapy your whole life. We want to create a lifetime habit that is such a good point. I completely agree with you. I feel like physical therapy is great to a point, but even better would be to find a sport that you love and that you enjoy, even as simple as walking. Yes, well, I will actually bring up one exercise that's my particular favorite these days. So many teenagers in particular have poor posture and are leaning forwards a lot. Life is a kyphosing event. We all start to fall forwards more as we age. We all see people with, you know, big bumps in their back. And, you know, how could we fix that? So one way is we get one of those, you know, six inch foam rollers, like it looks like a cylinder, if the audience could picture that. Lay it down on the floor and you lay on top of it, perpendicular to it, so the your arms and legs are perpendicular to the six inch roller. Put it right in the middle of your back, and then try to bend backwards so both your head and your buttocks touch the floor. And we've now done human trials where, on average, if kids actually do this exercise, their spine gets nine degrees straighter over six months as we take x rays before and after. And we are currently running a trial at Cedars Sinai on this. So if anyone has bad posture and want to do exercises and get measured, come on in. Wow. So this is incredible. So I mean, a lot of people ask about how to improve posture, and of course, there's some obvious answers. Stay off the phones, stop playing video games. So much. This is such great advice, because it gives people something active that they can try to do at home. Hey, you know what's interesting? I put this on LinkedIn, and I've written lots of textbooks in the past, and the sales go down over time, and then the internet's a new thing. And I think more and more I'm treating something like LinkedIn, where social media is a textbook. And so I put a picture of someone before and after and how to do this exercise on LinkedIn. You got 760,000 hits, and I could send that to you. I don't know if you could share it with your audience or not. I definitely will be clear in one picture how to. Do this, amazing. Amazing. And how many seconds do you advise that somebody holds that position for 60 seconds? It's not it's not hard, and then it becomes like brushing your teeth. You know, if you do it, you feel better. Amazing. I'm going to start this tonight at my house. I do have a six inch roller that I think has collected a lot of dust, so it's time to invest it and work on my posture. Okay, yeah, I think people really want to improve their posture without having to go to the doctor. You know, it's overkill. You don't really need X rays. We don't really need physical therapy. For most people, we can just do exercises. I get asked by parents a lot on advice for how to help their kids posture. Sometimes parents will say that they use a code word, or they'll tap on the shoulder as a reminder to put their shoulders back. But then I feel like teenagers aren't going to like that very much. Yeah. And you know, I think that the unintended consequence is kids might start tuning out their parents if they tell them to stand up straight three times a day. So the deal we make is say, if you know your child does this for 60 seconds a day, will you agree not to tell them to stand up straight? It's a win win. So win win. Because you know, as you know, there's some really important things, especially as you become a teenager, like drinking and driving, it's an absolute NO. And as a parent, I think you kind of want to store up your, you know, advice for the real important things. You know, not telling someone 1000 times in a year to stand up straight. No. And I agree with you. I always say battle that I choose to pick, hopefully will be emphasized on safety, or else you're fighting with your kids all day long. And who wants that? Love. It. Great advice. So and then, in terms of proper posture positioning, what do you tell families? Do you tell them to lower their shoulders and bring them back. What do you say? So for our listeners, which Jessica is showing his shoulders moving forwards. And sometimes we see this, particularly in you know, young ladies is starting to develop kind of put the shoulders forwards. And we see it all the time. And one way to help with that is, instead of laying backwards on a roller, laying backwards over a ball, like a seven inch ball or a basketball, and then your shoulders will expand and fall backwards as well. Now, another thing that I have no experience with, but some people believe in, is you can get a figure, figure of eight, like you on Amazon, get something for $25 just an elastic thing that holds your shoulders back. Some people say it reminds them to be in a good posture. Don't do it too tight, or you might actually hurt your nerves or blood flow. But if it helps, that would be reasonable. It's probably better than telling someone to do it 10 times in a day. That's great. Okay, so it sounds like if we're gonna do anything to help our posture, help our children's posture, we'll get a foam roller, and we'll spend 60 seconds a day doing a really helpful stretch where our head is back and our feet touch the ground. I feel badly. I feel like I'm telling people, exercise, meditate, stretch. There's nothing else left. That's it. Friends, yes, getting together with people in real life. I will gladly hear those reminders any day. So thank you. We all need to be reminded of these things. You know, I read constantly and listen to podcasts and books on tapes. There's certain number of lessons that we know, but you have to have someone tell us, so we do it. It's true. This is true, okay? And then question about so I love the advice on how we can help our posture. I wonder, are there certain things that we think are bad for our posture that might not be so bad? So, for example, backpacks. This comes up all the time for me as a pediatrician, parents want me to write them notes so that they can excuse their kids from having heavy backpacks. Are they so bad for the back so there is some science behind this. You know, we did one of the original studies in, you know, the Los Angeles School District, and we went and we weighed the kids, and we weighed the backpacks, and we took surveys on back pain, and it was linear. The more weight in the backpack, the more likely the child complained of back pain. And, you know, a lot of people are asking, Well, how many pounds can they carry? You know, just the heavier you carry, the more likely you are to have back pain. And you know, for some kids, they can carry 40 pounds with no back pain, no problem. Other kids can't carry 20 without back pain, then they probably should. And we also found it was interesting in schools that provided lockers so the kids could kind of unload. Those kids had less back pain. If you carrying the same backpack around all day, you have more back pain, and that makes common sense. Now, the other thing that parents ask about and we looked into is we also screened these kids for scoliosis and the. Piece of backpacks, whether one shoulder strap or two did not increase the risk of scoliosis. Now, I just got back from a backpacking trip I did three days where I carried a 35 pound backpack, right? And the trick that we did, to de emphasize the weight on our backs, was we carried most of the weight on our hips. That was very important, yes, and you know, real backpackers have known this for decades. You know the weight should be carried on your hips with a big, thick, well padded hip belt, not on your shoulders. That's a great point. Now, the problem is, nobody does that in school. Nobody has a frame pack with a hip belt in school, the same with the wheelies. I want my kids to have a backpack that rolls to take the weight off their backs. And they said, Mom, no one's doing that. Yeah, maybe social suicide. And the other thing is, it's not clear at all that, if you're turning around backwards, pulling a weight behind you, is that really better for your spine? You know? Maybe worse. Who knows? That's a good point. That's a good point. Yeah, before we close, the other thing I wanted to share with the audience, you gave such an interesting tidbit on how pediatricians can tell if somebody is not being honest about their back pain. Do you remember, I've used this before in practice, so I thought it would be great to hear it from you. Yeah. So you know, it's interesting in the adult world, there's this type of insurance where people are paid more to stay sick. It's called workman's compensation, you know. So people actually, you know, maybe financially incentivized not to get better. So one of the ways you can test this is simply push on the top of the head. If they go, Oh, that hurts. You know, they're probably trying to fake you out. The only thing that pushing down in the top of the head should hurt is if you have a cervical spine fracture, and you know about that. Okay, all right, this is a great advice, so anyone listening who is trying, I don't want to encourage people to try to get workman's comp. But you know what's amazing, though, there's studies showing if you do the same type of surgery on someone who has workman's comp versus who doesn't, the people in workman's comp don't get better as well. You know, they are financially incentivized not to get better. Now, you know it's there's many, many, many good things about it, but that's just an interesting scientific tidbit. I so appreciate this conversation. I have to tell you, I've been, while we're talking, I've been trying to maintain good posture, and it's not easy. No, you know what? Actually, you just raised a good point. If any of us try to stand up with a perfect posture, you get tired, and it's not comfortable. And I love that a lot of physical therapists these days are not telling people to sit up perfectly straight, but to move around a lot. I slouch all the time. I think the more important thing is to always be moving and not to sit up straight in a perfect posture. It's just not comfortable, and it doesn't look right. It looks awkward, almost. It looks weird. So keep moving. Keep moving. Yep, that's the secret. Well, this has been so helpful. Any final words of wisdom Not to put you on the spot, but do you have any final words of advice or wisdom that you'd like to share before we close? No, I just really enjoyed talking to you. Jessica, thanks for having me on Likewise. Thank you so much for being here. It's always a pleasure. David, thank you. Have a great day. I said, David, did you catch that? Said, David, thank you for listening, and I hope you enjoyed this week's episode of Ask Dr Jessica. Also, if you could take a moment and leave a five star review, wherever it is you listen to podcasts, I would greatly appreciate it. It really makes a difference to help this podcast grow. You can also follow me on Instagram at ask Dr Jessica, see you next Monday. You.