Top 5 Questions for the Development of the Pediatric Spine

Welcome, you all, to this episode of Look to the Children, sponsored by ChiroSecure and Dr. Stu Hoffman. Just a month ago, we were filming this episode and everything was normal. We were preparing for growth through spring and everything happening. And four short weeks later, there is a pandemic across the world and chiropractors are unfortunately being forced to close in certain states and things are just crazy.

Hopefully, you’ve been tuned into all the stuff that Stu Hoffman has been putting out with ChiroSecure. They’re working really hard to get resources and information to chiropractors as soon as possible. Everything changes every day, which you all know, and it’s so crazy. We work so hard to prepare and figure out what’s coming next and build our teams and offices, and sustain growth and see people and impact as many lives as we can. And then, something totally out of our control really affects all of it and we don’t even know really what’s going to happen tomorrow, let alone a week or two months from now, which can be a very odd place to be, to say the least.

But yeah, we’re at about 70% volume. Really, what’s come out of this and what’s been brought to light is not so much what are we doing now to help people get into the office, but what have we done for the last five to seven years. Do you hear kids screaming throughout this? We have six of them. And just like that, homeschooling was mandatory. And so, they’re enjoying learning right now.

But yeah, what have we been doing the last eight years to just teach chiropractic and speak the truth of what chiropractic is to parents and kids, and educate them to know what we know and what we would do? My kids get adjusted at least every week or get checked for subluxations every week. That’s what I would want for them to experience the best health. So if everybody understood it like I understood it, then they would do the same thing.

And so, how do we convert people and really educate them to understand what it is that chiropractic is? What is the nervous system? Why is it so important? What is the developing spine of a child? Why is that really important? Right from the start of them walking into our office through all of our interactions and our stuff on the walls, and what we’re sending them through SKED messages. We use SKED virtual communication platform to communicate with patients through cell phones, and I’ll talk about that in a minute too, how we’re using that through this COVID-19 stuff.

But yeah, just educating them and those are the people that still come in right now are the people that really get the principle of chiropractic and the power of living subluxation-free, and their nervous system functioning at its optimal potential and we’re making due. We’re helping them get into the office. We’re following all the CDC stuff.

So thankfully, we’re still open. I know a lot of chiropractors that are. They’re just trying to hold on for as long as they can until this whole thing hopefully starts to turn and really talking about what are we going to do to recover when people can go back to work and start moving around again.

We utilize a virtual waiting room, which has been fantastic. So if you haven’t heard of this, we have people message us when they come into the office. With SKED, there is a custom app that no matter what your office is, it’s for your office. The patient can download it. They can see the custom map. They can get push notifications and messages from you. So we let them know that we’re doing this.

They pull into the office, and they can message us. We instantly see it in the office and know, okay, Mrs. Mary and her family is here. We see if there is a room available. If there is, then it’s all sanitized. Then, we message her back and say, come on in procedure room three, Mary, and Mary and her kids come in. They go right to room three.

We’ve been able to maintain still a high volume of visits and there is literally nobody in our waiting room. There’s not even any chairs in our waiting room because of the six-foot rule. We took everything out, and we’re just doing our best. So that’s helped us a lot, even from the perspective of people that are really unsure about this whole thing and they’re not sure if they want to go anywhere. And usually, our office is shoulder-to-shoulder, most of the time, and so they’re like, well, I’m not going there if there’s so many people like there usually is. So creating a solution for them that they know, okay, well now, that’s not how it is anymore in there, and I can come in and out efficiently, and I can go in and out without being really close to a lot of people and abide by all the stuff. And so, it’s just another precaution that makes people feel safer in this environment and what’s happening right now, and allows us to continue to serve them and serve people.

If you want more information on that, you can message me or reach out to me. I’ll be happy to help you figure that out, and send you the stuff that we send people and how we notify them, and all that stuff too.

I just am consistently praying for all of you guys as a profession for chiropractic that we can just continue to survive and push through this and move forward, and just hep as many people as we can get through this time.

My name is Erik Kowalke. I own Higher Health Chiropractic in Michigan, and we do this, first Thursday of every month, look to the children. I’d love to give you guys something, 15-20 minutes on practical stuff that you could take back to your office. What is it today, Thursday? So Friday, maybe or the following Monday, and actually use.

Today, we’re going to go over some stuff that might jog your memory, all the way back to school and things that you learned. And this is important stuff to just bring back up, fresh in your mind, to allow you to take better care of kids and educate parents better, and just connect with them and communicate with them better, which is what we’re all about.

I’ll start with the top three reasons kids visit chiropractors, why parents take them there. Actually, I was surprised by this. Number one, it’s earache. So 11.3% of kids visit chiropractors for earache. Number two is neck pain. Number three actually is just a checkup, which I thought was super interesting. These are probably parents that are bringing their kids for wellness care that have seen chiropractors for a long time.

But as a parent, you want to know that your kids is safe. So even parents that don’t want to use drugs and they want to do everything natural, but their kid gets a fever or has symptoms, they’re still wondering are they going to be okay? What’s going on? Kid’s complaining of hip pain, knee pain, leg pain, they limp. Their head is tiled to the side, they’re on screens a lot, they hurt themselves on trampolines. They do all kinds of stuff, and parents are still, well, they’re probably okay, give them a day or two, but it’d be great if I had somewhere to take them where it was easy for me to go in and out. I could come in, they could look it, and give me a professional opinion on what’s happening with my child. There is no better place to do that than chiropractic. If we can fill that need, it was cool to see that it was the third most common reason parents bring their kids in.

It just gives you an opportunity to educate parents on what the health of their kids’ bodies are and how they develop and what they should be looking for, and what are red flags, and what’s normal? And what they can do to just support their kid to grow up healthy.

So if you do Google Ad searches or whatever, or AdWords or you advertise or you do stuff in the office and handouts, I would personally focus on those top three is kid checkups, earaches, and neck pain for kids and what does chiropractor care have to do that with that. How can you help? How can you position yourself as a resource in your community to help with those resources? Because those three areas encompass 30%, 35% of all pediatric visits across the board.

Number two. Which vertebrae is the first to ossify, and why is this so important? I thought this was super interesting and obviously it’s the atlas. Everything is always the atlas. Everything is broccoli once you pass the atlas is what they used to say in school. The atlas vertebrae fully ossifies around the age of seven, which is the first vertebrae to do this.

And then, as you follow down the rest of the cervicals, thoracic lumbar spine, it slowly goes past there. By 25, on average, all the bones are fully ossified by 25. But the younger they are, the more cartilaginous they are, and the more elastic they are, and thought this is something really important to mention.

Typically, people would think the infant spine is more fragile than an adult spine because it’s not ossified. Bone is hard and protective, cartilaginous bone, it’s not as hard. Maybe it’s not as safe.

The ligaments that support the strategy in a child aren’t as strong as an adult and they’ve done cadaver studies and pulling on the spine, how far can the spinal cord stretch before the ligaments start to tear? They’ve done this in cadaver studies. Adults, it’s like two inches, two-and-a-half inches. And kids and infants, it’s like half an inch.

So there is definitely, obviously, it’s not a living person that they’re testing this on, so there’s probably some variables there. But nonetheless, kids’ spinal cords stretch roughly two-and-a-half times less than an adult spinal cord, which just means you’ve got to be very careful if you’re doing any traction stuff with kids. We don’t do any forceful traction, whatsoever. But if you do that, that’s something that you should be aware of.

But if you think about the elasticity of a cartilaginous segment, if you were to hit something that is springy like that. Like if you just think of hitting a spring and you hit it hard, you get a quick reaction but you get a quick force and reaction opposite of what you just did. But if you were to put your finger on that soft and this is where we get into sustained contact adjustments, which [inaudible 00:10:57] all learned and using different motions and stuff that you learned as being a chiropractor and you’re feeling it and adjusting an infant’s spine is because they are mostly cartilaginous when they’re little.

Lighter is always better. It’s amazing what you can do with really, really light touch. Most people think infant adjustments is like rotary breaks going on and stuff. It’s just so not necessarily for what you need to do to correct an infant’s subluxation, especially if you’re on a right segment, your right [inaudible 00:11:26] drive. To right time, it actually moves really easily and you can make significant impacts.

Less is always more for kids, But really, visualization is super important when you’re adjusting an infant or a kid, knowing that, okay, what segments am I adjusting? Is it ossified? Is it not ossified? It is cartilaginous? Typically, the last parts of the bones to ossify completely are the transverse processes and the spinal processes.

So when you’re adjusting those, those are the segments typically we focus on and we get levers on to adjust the spine. So if you’re using those as levers, knowing those are the last ones to ossify, that should just be in your mind as you’re adjusting it. That will allow you to provide a better, more specific adjustment to those areas of the spine. Not only, one, to stay safe. But number two, just to be really intentional with what you’re adjusting, where you’re adjusting, and how you’re moving a bone.

Number three. When does the sacrum start to ossify? I think is really cool to teach kids. They’re always fascinated around that they have more bones than their parents do, and their sacrum has multiple segments. Whereas, their dad’s or parent’s sacrum is all fused together. It actually starts to ossify, I thought this was really interesting, six to eight months, it starts to ossify but they start to fuse themselves together around puberty. And then, it’s fully ossified and fully fused together around age 25, like all the other bones in the spine. But six to eight months before that, it’s all cartilaginous, separate segments. And then, right around puberty is when they start to fuse together.

Why is all of that important? Because if those segments are subluxated and misaligned and they’re never checked and they go all the way through puberty, and now those segments are starting to fuse themselves together, you lost your opportunity to do anything positive to the sacrum, aligning the sacrum segments, so they fuse together properly without something else compensating for it and we’re going to get the compensations in a minute. This is super, super important to educate your parents on.

But as a parent, I would want to know, man, it would make sense that I get my kid checked, and their spine is aligned up and all of the sacral bones are lined up. Knowing that they’re going to fuse together when they hit puberty and they’ll never be able to adjust them segment-to-segment again, you can adjust them as one unit, but S2 to S3 or S4, they’re fixed where they are. That’s important. Most parents have no clue that even exists. If you’re not telling them, nobody is telling them. They don’t even know that’s a thing. So that’s super, super interesting, and important to educate parents on.

When did the spinal curves form in children? This will jog your memory, if you’re not super familiar with this. So in-utero, you have actually cervical curve, thoracic kyphosis curve, and you have the sacral kyphotic curve. And then, once the baby is born, now baby is immersed in fluid. Babies born, they actually lose their cervical curve because the muscles aren’t strong enough for the weight of the head. Now, they have to support itself versus floating around in the fluid, so they lose their cervical curve typically right after birth. But they retain their thoracic curve and their sacral curve, so that’s the normal curve that’s there up until a couple months.

And then, once they hit three months or so and they start to hold their head up, the muscles are strong and the cervical curve starts to come back. Lumbar curve starts to form maybe when they’re crawling and their stomach is hanging down, that helps form it. But mostly, when they start to stand and walk and the way that upper body is pushing down, then the lumbar curve starts to form.

This whole time, the thoracic curve is still there. The sacrum curve is still there. And then, you get the lordosis and the lumbar spine, and the cervical spine throughout that process. So that’s important to educate your parents too. It’s just an interesting thing to know what’s happening with your kid. And so, if you saw parents, you can educate them, like at three months, hey, actually now is when your kid’s cervical curve is forming. Little Johnny is on the floor, doing tummy time and he is looking up. That helps strengthen the muscles in and along his spine. It helps form his cervical curve. It’s really important that you put your kid down and let them crawl around, and they look up and they look around. It’s so important for development.

All of those stages, and the parents will be like wow. Guaranteed, nobody is telling them that. And then, they’re going to look to you for a resource. And guess what? The next time they’re home and their kid is crawling around the floor and their friends are over or their grandparents are over, or whatever and they say, “Guess what? It’s really good for their,” they’re going to reeducate them on that, what you told them, and they’re going to say, “I learned this at my chiropractic office,” and it just helps spread the message of education and healing, and body function and anatomy through all these different people that you might not know but now they know and you just spread your network. It’s the best way to market is through education and getting people to talk about it.

What is the most common developmental problem of the developing spine? As you all may know, scoliosis for sure is the most common, and scoliosis can be congenital right from birth. But most common, it’s more adolescent and they actually call it idiopathic adolescent scoliosis, which means they’re not really sure why it happens.

Most of the time, it’s structural instead of functional. So you can get functional scoliosis, structural scoliosis. Functional is if one leg is shorter than the other or something like that. You all remember Adam’s test to see Adam’s test, they bend forward. If it’s functional, it’ll straighten out. If it’s structural, it won’t.

So structural scoliosis, and if you’re not a chiropractor and you have kids and you think they have a curve in their spine and they bend forward and they still have a curve in their spine, that’s structural scoliosis, which by definition means muscles are contracting in the spine, pulling it to one side. Typically, in a thoracic spine. Idiopathic means they don’t know why it happens.

But if you really think about the innate intelligence of the body, it is so smart, we don’t know anything else in the world that can compete with the computing power of the brain. We don’t even really understand all that it does. As a previous engineer, I worked on diesel engines and all kinds of stuff, and I thought it was cool to take them apart and see how they worked. Once you start working with the human body, you realize how little we actually know about what it does and how amazing and fascinating the brain and the nervous system really is.

So knowing that, with the human body, the brain and the nervous system is the most sophisticated complicated electrical nervous system in the entire world. We don’t know why the muscles are contracting. Well, it’s probably not contracting because it just doesn’t know what it’s doing and it’s screwing it up, or it’s doing something wrong. It’s probably contracting for a reason.

So if you look at balance, just really simply, like let’s say when you’re walking or your child is walking, how do they not just tip over and fall? Well, they’re using all their senses including vision to bring information in and process in their brain and communicate down to their muscles. So they’re moving the right muscles and contracting the right muscles, and not contracting the right muscles as the right time. So they stay balanced and their body weight is staying centered as they’re walking. Just that, and alone, the gait pattern is amazing and incredibly complex.

But if you have subluxations in your spine and the spine isn’t aligned straight and the joints, 110 joints in the spine aren’t moving properly, then the body has to adapt to that. So we go back to the sacral segments fusing once they hit puberty. Well, if those segments aren’t lined up properly and that’s affecting the base of the spine and the lumbar spine is curving, thoracic spine. It’s all compensations maybe from there. Maybe from upper cervical atlas occiput C2. Maybe from somewhere else in the spine, it’s compensating. But if one bone is misaligned or several bones are misaligned and it’s making your cervical spine, your occiput go like this.

If you walk around with your head tilted to the side, the information that’s coming at you through visual sensory information is tilted. So your brain is going to respond, and you’re going to start veering that direction or veering this direction. The body doesn’t want to do that. The body wants the eyes to be level at the horizon to get the proper information in, so it can give the proper information out to walk effectively.

So if you’re subluxated and your spine is stuck like this, your brain is smart enough to know, okay, well, if I can track the muscles in the thoracic spine on the left, it’s going to help pull the spine back this way, and that’s going to level out the eyes, so the information that I am perceiving when I start walking is now correct and I can keep the spine and the body balanced. But it had to curve the spine to do that, and it had to do that because it had to contract the muscles on one of the side of the spine. I see that probably as the most common, which is so fascinating. That’s where we get into primary and secondary subluxation.

So whatever initially causes primary, secondary is compensating for that. It doesn’t mean it’s not asymptomatic or symptomatic. Most of the time, the secondary subluxations are more symptomatic than the primary subluxations, which is what chiropractors, as we adjust and we analyze the spine, we’re usually finding subluxations in places that are opposite or not where it hurts the most. Which means you need to even educate more on what we’re doing and why we’re doing it because if they come in with mid-back pain, you start adjusting their neck, you don’t touch their mid-back and you don’t tell them and you say, okay, have a great day, you’re going to get better. They’re going to go home and say that guy is crazy. He didn’t even touch my mid-back.

But if you can educate them about how does it actually function? If you have mis-alignments in your cervical spine, it is going to compensate in your thoracic spine. And if it compensates in your thoracic spine through muscle contraction, it’s probably going to become symptomatic with the inflammation and irritation on the nerve roots and everything else that’s going on, but it doesn’t mean we’re not getting to the right place. But if I adjust the secondary compensation, I don’t fix the primary, it’s just going to keep coming back because the body actually needs it to be there to function optimally, which sounds crazy. But the body is putting the subluxations there and contracting the muscles, creating the imbalance to allow something else to function better that it prioritizes over that part of the body because sensory information and level horizon, and being able to function and move and walk is a higher priority to the brain than some muscle contraction and balance in the thoracic spine, which is just fascinating.

So all of that comes back to kids are just the perfect scenario to check and correct spinal subluxations because if you can keep it all lined up there, you’re just preventing so many compensations and secondary mis-alignments, causing further nervous interference and organ dysfunction, and brain-to-body imbalance that they are probably going to have or potentially could have because of this throughout the rest of their life and you’re fixing it with something so easy as a specific scientific chiropractic adjustment when they’re little, and it’s just awesome and fun. And seeing kids when they’re asymptomatic, knowing that you’re helping them with a healthier, happier life as they grow up is something that’s probably the most rewarding thing you can do in life.

So that was a lot of stuff. Hopefully, you can take some notes and bring some of that back to educate your parents around and the kids, get the kids involved. Educate them. Once you start talking about spinal curves, you just let them take the conversation. [inaudible 00:23:11] like what shape do you think is curved like your cervical spine? And they’ll start talking about fruit, and then you just go down that rabbit hole with bananas and smile bones because that’s how kids remember. You can relate it and you start talking, let them drive the conversation on how they want to learn it. And the parent is sitting there the whole time, soaking all of that in, learning all of that, right along with you. And then, they’ll typically start to ask questions as the kids start to evolve and learn more, and educate more. It’s super fun.

So appreciate you guys. I want to tell you what we’re talking about, next time. So the first Thursday in May, we’re talking about… Let me see what my notes are here. We’re going to do case history stuff. Case history on infants and kids. One of the important things that we look for in case histories, and how does that give you information to communicate care plans and recommendations and adjusting protocols and information to parents through that case history and information that you get? So we’re going to talk about that in May, but appreciate you all viewing this, if this is your first time.

Again, we just thank ChiroSecure and Dr. Stu Hoffman for putting this on, and their just devotion to the chiropractic profession. Thank you to all the associations and the ICA for putting out such good information that we can use to educate our parents, and the people that are coming in, the patients and our team members. Just thank you for everybody that’s just working overtime. All of this came out of nowhere. You’re spending more time working on something now that you didn’t even see coming, a month ago or two months ago. Everybody is losing sleep, and just trying to figure this all out.

Anything that we can do for you, don’t hesitate to reach out. We work with SKED automated appointment reminder system, so we have really cool protocols right now just to keep people engaged. If you’re forced to close or reduce hours significantly, so, so, so important to stay engaged with your patients. We are sending them push notifications through the SKED app. We’re notifying them through text messages. You can customize all of that stuff.

Bring them hope. People need hope right now more than anything. They’re just getting fear everywhere. So if you can be clever, and be fun, and give them hope and light in this time through automated reminders, even if they… You’re closing and they had an appointment today at 2:00, send them a message saying normally we would see you today at 2:00, but we’re just thinking about you guys, praying this all gets resolved. And then, just give them some hope and change it up. Keep them in your mind. You want them still thinking about your chiropractic office through this time because there is not much you might be able to do right now in the thick of it, but the goal really would be to recover as fast as possible when this whole thing clears up. So that’s the difference between going back to your normal volume within a week or two when this clears, versus maybe six, 12, 18 months to get back to your normal volume is how hard you’re working right now to stay engaged with your patients.

I’d be sending them letters, if you’re not texting them through a platform like SKED. I would be mailing them things, sending them letters, snail mail, email, doing videos on your Facebook pages. Whatever you can do to stay engaged with them, educate them, inform them on what’s going on, what you’re doing in your office to stay safe and keep them safe and abide by all the CDC recommendations. Just don’t close and just sit back and wait for this to clear itself. You’ve got to be proactive. You’ve got to be engaged. You’ve got to go after it because it’s going to be the difference between recovering in a week or two versus a year or more, or maybe unfortunately some of you, never.

We just thank you again. Again, Erik Kowalke from Higher Health Chiropractic, and thank you ChiroSecure, and we will look forward to seeing you guys in May.

Today’s pediatric show, Look to the Children, was brought to you by ChiroSecure.

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