How frequent is spinal pain in children?

https://www.sciencedirect.com/science/article/abs/pii/S1413355524000042

I continue to listen to a series of research podcasts, catching up from 2015 and on. All I can say is that we have some amazing colleagues doing serious research and enlightening our day to day practices.

This particular piece of research caught my attention because I've been thinking about children a lot recently. We have a crop of new babies coming in to the office, the children are back in school dragging heavy backpacks and happily crashing into each other in their fall sports.

Over the last 30 years of practice I feel that at times I have been fighting an uphill battle in the area of chiropractic pediatrics, trying to convince many parents and the community at large that children do develop spinal problems fairly early, fairly frequently, and that we are currently operating by a false narrative that back pain is not something that happens to children but rather to adults, and that if a child is complaining about pain, it is usually a psychological reason behind it. Up until recently we've not really had much research data to back this up.

This brand-new study (January 2024), from Brazil, indicates that a whopping 30% of adolescents may complain of spinal pain that could be at times disabling. What's most interesting looking through the fine print of the paper is that the pain pattern is really quite similar than adults already. (Objective factors, risk factors etc.) these numbers fly in the face of our current cultural understanding of spinal pain in children, much less our healthcare intervention resources. Having had the pleasure and privilege of working with individuals from birth to natural death over 30 years, I can say without a doubt that I have been shocked by the types of finding I've seen in rather young children over the year. But ultimately, as time goes by, I see the continuum of presentation between my adult patients and the history of their 1st trauma much more clearly now. When I see the children taking tumbles on the playground, falling down the stairs, and wrestling with the siblings I realize that none of us adults could do this and still get out of bed the next day. To be fair children's neuromusculoskeletal systems are more pliable and a little more resilient than ours, but they do not magically survive some of these injuries without some potential long-term residuals that will manifest episodically into adulthood.

I am most excited about another 10 year longitudinal initiative started in Denmark, currently underway. It will start screening a very large swath of schoolchildren starting in preschool and through high school, looking at a variety of metrics from pain to motor control to balance to visual efficiency. I think were going to get a wealth of data as to how children develop pain over time and what the risk factors are in their history, as well as what early signs in their other developmental milestones may be useful to flag them for early intervention. Those little people are genuinely our most precious resource and it's time we stop writing off their back pain as just something in their heads.

THE MONSTER LURKING IN THE BACKPACK

Although it seems impossible it's already that time of year... I'm seeing mountains of pens, highlighters, folders, and backpacks lining up the entrance shelves of my local general store. The munchkins are already on week 2 of the great school year !

Parents may be tempted to skip over this blog entry because we've become numb to the fact that backpacks can be a problem. We really shouldn't be. There's so much at stake for long-term spinal health and stability that will be irreversible if we don't pay attention to it at this stage. The research article below from 2018 took some interesting measurements that actually quantify the mechanical stress load on the developing spine. The results are not encouraging. However picking a backpack with the right features and occasionally dropping it on the scale before letting you munchkin out of the door can help you mitigate the worst of the problem.

Here is a bit of basic math that illustrates the extent of the problem. According to the authors of the article, the multiplication factor of the weight of the backpack on the actual spinal structure such as a developing disc is anywhere between seven and 11. In plain English, if you have a backpack of 10 pounds, the actual load on the spine is anywhere between 70 and 110 pounds, and a backpack of 20 pounds anywhere from 120 to 220lbs. This is really quite astounding but explains why so many kids will come home saying they're sore everywhere in their back and shoulders. This is even more of a problem if your child has to walk any distances with their backpacks, either from classroom to classroom, walking to and from school, and to and from the school bus.

You only have two real decent strategies to mitigate the issues: first select a backpack that has good padding, wide padded shoulder straps, a waist strap, and all adjustable straps in the waist band, shoulder straps, and possible chest strap. Arguably you will probably get some pushback from you kid about the look they want versus the functionality you want as a parent. Second, grab your kids backpack every so often when they come home from school and put it on your home scale. Wait until a couple months into the school year to do that because the amount of things they have to carry will change, and you'll have a more authentic idea of how much they're hauling around by the time activities and sports roll around. When you start seeing numbers that amount to the same weight as your child, it is time to ruthlessly review which contents get to stay and which ones get to go. Also remember to reach out to the teachers and share your conundrum. Some will be willing to be practical and adjust their homework to tasks that do not involve the dragging of larger textbooks home

https://pubmed.ncbi.nlm.nih.gov/30204924/

CHIROPRACTIC TO REDUCE C SECTION RATES: WHY IT MATTERS

Long-term risks and benefits associated with cesarean delivery for mother, baby, and subsequent pregnancies: Systematic review and meta-analysis - PMC (nih.gov)

For the last three years, I have been incorporating the concepts of the Spinning Babies midwifery teachings in the care of our expecting moms. The idea behind the system is that the fetus is meant to proceed with a smooth descent into the pelvic outlet as long as there is no obstacle to the process. The latter being a pretty significant caveat. In addition to intra-uterine sources ( cord and placental position), the anatomy of the mother’s bony pelvis, pelvic muscles and ligaments, abdominal wall and pelvic floor has a huge role in either allowing or interfering with a smooth descent to an uncomplicated vaginal delivery with little to no stress to the child. Early on, the midwife developer of the Spinning Babies method recognized the importance of body workers as an adjunct to midwives in that process. Dr. Carol Phillips, who incidentally was my first pediatric chiropractic teacher at Northwestern, was the main source of information.

The current rates of C-section worldwide range anywhere from 15% to a whopping 45%. The stakes are high to keep it closer to 15% and there is no reason why that number should feel unreachable. The research on the long term rates of C-sections on overall pediatric and long term health outcomes are sobering. It is important for expecting moms and dads, and their support system, that there are lots of things you can do to prepare for a non surgical birth outcome and lots of resources at hand

Neurodeflective disorders , milestones and children's chiropractic

I am always interested in keeping up with chiropractic pediatric research because I feel that the future of our profession so much intersects with the future of our kids health and thriving. I found out about this most recent research article through 1 of our chiropractic research podcast, and I have listed both references at the bottom of this blog.

The research article focused on tracking traditional pediatric milestones through the chiropractic care intervention of 37 children's with neurodeflective disorders (the newest term coined to describe the spectrum of children with nonnormative neurological development for any reason). What was interesting and may be unique about this article is that it focused on the improvement in some of these traditional milestones (speech, social, gross and fine motor etc.) with the only variable being the chiropractic intervention, without some of the rehab therapy specific to each category (speech therapy, physical therapy, occupational therapy, sensory integration therapy, behavior modification therapy). The podcast producer theorizes that there is a grossly underutilized rule of chiropractors addressing subtle spinal functional lesion in the pediatric population, which will not manifest as pain, but have enough of an impact on neurological circuitry to interfere with normal neurological progression of expected milestones. The author also is strongly pushing for a better coordination of care and cooperation of chiropractors with their rehab counterparts in the above-mentioned specialties, with the idea that chiropractic will restore some degree of neuronal circuitry integrity, which then allows rehab specialists to maximize the benefit of their therapies in the affected pediatric population. This would be a refreshing departure from the current relative lack of cooperation between chiropractors and pediatric occupational therapy, physical therapy, speech and behavioral therapy.

https://vertebralsubluxationresearch.com/2022/07/10/1830-chiropractic-brain-development/

https://podcasts.apple.com/nz/podcast/understanding-and-changing-neurodevelopmental/id1360919805?i=1000596043004