485- Exploring the Connection Between Adolescent Growth Spurts and Disc Degeneration

Welcome to the Evidence Based Chiropractor where each week we deliver the latest chiropractic research and marketing strategies, all in the time it takes to get to your office. Now here's your host, Dr. Jeff Langman.

Hello and welcome to the Evidence Based Chiropractor. I AM your host, Dr. Jeff Langmaid. On today's episode, we're talking research. This is all about how adolescents grow and how it impacts the spinal discs. Great study, lots of take home messages. Clinical pearls as always. We'll dive in in just one moment. Before I get started, big shout out to neccare. I was with them at the park at Parker Seminars at their booth. Best hardware software package for objective assessments of the cervical spine. Bar none. Reliable assessments, exercises for neuromuscular control, proprioception, range of motion and sensory motor integration. You can check it all out@neckcare.com but as I said at the top, we're talking research today. The title of this study, bodily Growth in the Intervertebral Disc. A longitudinal MRI Study in Healthy, healthy adolescents. We'll drop a link down in the show notes. So of course you could go check it out. But on today's episode we're gonna talk about everything. We're basically gonna dig in to what I think is a really fascinating longitudinal MRI study. This was published in the Spine Journal and again, it's basically taking a look at bodily growth during adolescence. And how does that affect the degeneration of spinal discs, spinal specifically in the lumbar spine. And this study is really the first of its kind. It's tracked healthy kids from age 11 to 18 to see how their growth spurts affect their spine. So if you've ever had people, patients, parents in your practice ask, is my child growing too fast? What's the spinal implications here? This research has some serious answers for those questions. And now why does this matter? Well, we know low back pain is increasingly common in kids and teens and can often persist into adulthood, which is not something good to bring with you. Disc degeneration. It's been observed in kids as young as 10 years old and of course it's been linked to future low back pain. And up until this study, which came out this year hot off the press, no studies have ever really looked longitudinally at, at how rapid growth affects disc health using MRI specifically. So this study really aims to fill in that gap by evaluating, examining and checking out whether or not growth, and specifically greater growth during puberty leads to more disc degeneration by the age of 18. So they looked at about 60 kids from age 11 to 18, they collected a whole bunch of data. Height, sitting height, weight, bmi, what they call BSA body surface area, and utilized MRI scans of the lumbar spine disc degeneration. It was then assessed using the Furman P, F, I, R, R, M, A, N, N. I think I got that right. Grading system with grade 3 or higher considered degenerative discs. And the participants were split into three growth categories based on how much their body surface area increased from age 11 to 18. So as we start to dive into that, I'd like you to take a moment and think about what do you think the answers are going to be? We'll get there in just one moment because the question becomes, does rapid growth stratified based upon three growth categories, change how the degenerative grading scale is impacted as somebody goes from age 11 to 18? And the answer was, there was an impact. More growth was correlated with more disc degeneration. By age 18, in the highest growth group, which was greater than or equal to 43% body surface area increase, 76% of those kids had at least one degenerative disc. Now, I want to just recap that real quick. By age 18, 76% of the people had at least one degenerative disc. Now, to be super clear, we know that disc degeneration does not 100% of the time lead to pain. But I don't like the idea as a chiropractor of thinking about kids having degenerative discs before 18. It definitely doesn't set them up for success. While every single one might not be painful, I think clearly we could all say that's suboptimal, to say the least, is having degenerative discs before you even reach skeletal maturity. That is staggering. And in the highest growth group, over three out of four of those kids had degenerative changes. In the lowest growth group, only 10% sowed degeneration. That is a massive swing, 1 in 10 to more than 3 in 4 based upon how much your body grew between ages 11 and 18. They also highlight some of what they call the odds ratios for disc degeneration with every 10% increase. So, in body surface area, the odds ratio was 1.08. For body mass index, it was 1.05. For height, it was 10.5. For sitting height, highly correlated with height, 7.92. And weight, it was 1.51. So here's a direct quote from the study. More relative growth between ages 11 and 18 is significantly associated with the occurrence of disc degeneration in emerging Adulthood. So what are some important factors here? Well, height and sitting height are not really modifiable, but weight is. So maintaining ideal weight throughout puberty can certainly help and may help preserve disc health over time. And interestingly, as we all know, and it just stated, disc degeneration doesn't always correlate with back pain because some of these people were again, healthy controls. They all started out healthy, but as time goes on, as I like to say, time and gravity are undefeated. So those things add up over time. So those were some of the facts from this study. Now the really interesting part is what does that mean to you? What does that mean to me? What does that mean to us as chiropractors? And how can we take this knowledge and put it into a way that matters to the people in our practice? And that is where things become interesting. We all know that puberty is a critical period for spinal health. Clearly, as we've seen in this study, growth spurts can cause really rapid changes in mechanical loading on the spine. And while many of these teens might not experience pain now, those structural, biomechanical, movement based changes can set the stage for future low back pain. So we, you listening, are in a massively unique position to be able to do a few things, monitor, educate, intervene, provide care when necessary during these really important growth years. So one is that if you're taking care of kids in your practice, it's probably a really good idea to track growth closely. And closely means measurements, not just eyeballing it, especially when there's rapid changes. We all have these people in our practice, these kids, and we're like, oh my gosh, I didn't see you this summer. You shot up 12 inches. Oh my gosh. Yeah, you gained 20 pounds and shot up a foot and a half over the year, whatever it might be. We all know those stories. It's more than just an antidotal statement. That is something you need to take seriously because chances are no surprise, it's really impacting their body and it could really affect their future. Educating families on the importance of spinal health during puberty. Massively important and, and probably underdone in our profession. Encouraging healthy body weight, core essence of what we do as chiropractors, overall health and wellness, postural awareness, movement, variability, sports, stretching, breaks from sitting, and I'm gonna say especially sports. We see kids at this point, just one sport, kids one sided from age 5 and 6. Because everybody's gonna be a pro, nobody's gonna be a pro. Hardly anybody is gonna be a pro. It's really clear who is going to be a pro and and everybody else who's not doing multi sport training is really impacting their ability to really be pain free and move biomechanically appropriate later on in life. So I won't go off on a tangent, but I'm a big advocate. People push their kids super hard just so they can like play college sports. Hey, nothing against college sports, that's awesome. But you can't be one sport. You have to be cross sport and you have to be multidimensional. I've even seen chiropractors, kids that are pushed into baseball and they're like just one sided movement from age 6 to 18. It's like why, you know, so understanding movement variability, really important. There's plenty of experts out there that are better at that than me, but I think it's important for all of us to keep an eye on that. And for athletic teens, helping them manage the mechanical loading through balanced training exercises, spinal assessments, these are all opportunities for you to earn revenue and help people in a completely fair exchange of value. How many people listening right now are really sports focused? You love sfma, you love DNS, you love movement, you love low tech, high tech rehab, you love to have that in your practice. Do you have that as a service offering? Are you talking about it with these kids and their parents? If not, put together a program, put a price on it and help some people because there's a lot of kids out there that really, really need your help. So this study shows a completely clear link between rapid growth and early disc degeneration, even in the absence of symptomatology. And again, we can't change height, but we can influence weight movement education during these development years. And I think there's some really big things. If you're sitting there saying, hey, how do I approach this in the real world? I've given a few examples, but let's go through a few more. One, start assessing teens earlier. Incorporate spinal exams for kids entering adolescence. You can do that in a variety of ways. You can do that in your practice, you can do that at schools, you can do that at training facilities, at sports events. There's a million ways, but it's important. It's not frivolous. It's not like this weird screening where you're trying to get people in. It's actually being able to give them important information that can impact their health later in life. Tracking growth patterns. Again, ask about recent height and weight changes. You have a child that comes in and they're 14. They're in the middle of that 11 to 18 bracket. Ask about height and weight changes, monitor that during RE exams and consider even building growth charts into some of your EHRs. For kids in this population, using posture and movement based assessments, detect subtle compensations that may indicate increased spinal not everything needs to be a five alarm fire. It's important to be nuanced. And the better you are clinically, the more subtle you are in terms of understanding what's going on, the better you can intervene, highlight what's going on and provide the necessary guidance and care for these people. Also promoting spinal mobility, core strength to support these growing bodies. Let people know dynamic movement, movement variability, really, really important because this isn't always about short term symptomatology. It's really about reducing the risk in the future for hangups, pain and challenges that could really alter somebody's life. So it's important to explain Disc degeneration is silent. It's often not painful until it's not. So detecting things early, understanding what's going on and monitoring is a really important thing that all of us can do. Emphasizing to all the parents in your practice that spinal health and adolescence can predict outcomes in adulthood. These are directly correlative and it doesn't mean that somebody needs to come in your practice seven days a week, four times a day or else, whatever the case may be, don't get extreme with this stuff. Take it and utilize it in the paradigm that you teach, educate and practice in your practice. Also share the facts that early degeneration at 18 has been linked to back pain in the mid-30s from prior studies in the same cohort. So you could have healthy growth charts in your practice. You could host spinal workshops for parents of middle schoolers. You could collaborate with pediatricians, school nurses. You can become a thought leader. There is nobody talking about this. You have an opportunity to own this space. Most medical doctors are not talking about lumbar disc health in 13 year olds, but you can. And this study gives you the science, the credibility and hopefully the clarity to be able to do this with confidence so you can help people avoid advanced interventions later on. That's not selling on fear. It's actually empowering people to make the best decisions today. And the best decisions today might be, we'll check you again next year, that's no problem. But ultimately understanding the nuances of, of what's going on, I don't think any of us, I think we all can agree that if somebody's going in before they even reach skeletal maturity with degenerative discs. They're probably not setting themselves up for success. And I'm sure regardless of how you approach practice, there are some things that you could say, I could do this. Here's how I would approach that. Great. Take this information, run with it and ensure that people know about it. This is also great information to share with your local healthcare providers. If you're building relationships, this is great information to share across all of your social media channels. It just gives you an opportunity to connect with people with where they're at. And again, we've all seen these kids that all of a sudden that growth spurt takes, oh my gosh, you can just look at the basketball team basically in your basketball football team and swim team, probably depending upon where you practice. These are kids that typically are growing tall fast and potentially adding weight fast. And that's an impactful thing for us to be aware of, to monitor, and to help guide people through that process. So I hope this information was powerful for you. Before we wrap up, I want to say a few words about turncloud minimalist design without being sparse. If you're looking to simplify your workflow with an intuitive application that needs no user manual, think about that. Think about an EHR that needs no user manual. That's TurnCloud. You can learn more connect with their team@TurnCloud.com Additionally, if you've not left a rating or review for this podcast, I would deeply appreciate it if you did. So you can scroll on down, tap how many stars leave a line of text. That would be awesome. Also, I wanna give a special shout out to the entire team at Parker Seminars. I was fortunate to go out there and speak with unbelievable people. Gary Vaynerchuk, Andrew Huberman, myself. Couldn't believe I was there. I had the opportunity to speak stand room only if you are in the room. Thank you so much for taking time out of your day to do so. It was I thought there'd be maybe 20 or 30 people in my room and to have a completely full room with hundreds of chiropractors and many standing around the edges was absolutely awesome. I was honored to speak at their seminar and also to speak about patient reactivations. If you'd like to reactivate more of your patients, head over the smartchiropractor.com, check out what we have going on with Patient Pilot. It is probably the easiest, fastest money you can make in your practice while also most importantly helping more people. So check it out@thesmartchiropractor.com other than that. I hope you have a fantastic week in practice and I will talk to you soon.

Thank you for joining us on this episode of the Evidence Based Chiropractor. If you want to grow your practice, come back for next week's episode. If you want to grow faster, visit the evidencebasedchiropractor.com and join our MD Marketing membership today.

Sam.