Behind The Brace Podcast

In this episode, Dr. Mandy shares some exciting news about her clinic and the new resources coming to the North Dakota area. Listen in to find out helpful tips and be sure to check out the links below for more information!

*****Resource Links You Need:

 *****Transcript*****

 Hi, I'm Dr. Mandy Dietz and you're listening to The Behind the Brace podcast. Each week I'll be sharing conversations and resources to help families and providers navigate the world of scoliosis. This is your place to find hope for a better solution so that you can live your best life.

Welcome back. This is the last episode of the season and I have some really exciting news for you guys. I actually am not really sure who knows and who doesn't know because we've been working on this for quite a long time and I know that we have shared on social media some of the updates in the news with our clinic, but I really wanted to officially let you know that we're taking a break, mostly because as we move into this fall and through the holidays, that we are opening a ScoliCare® clinic here in the state of North Dakota.

And so, that's actually really exciting. And what that means is, as you all know, I've been doing this work for over a decade and we've been using ScoliBrace®, we've been adding new tools, we've added ScoliBalance®, we've done more trainings. But this is different because this is an official ScoliCare® clinic here in our state, in our rural community, which is a huge asset to our families and our patients.

And it really allows us to focus more fully on more specialized care and to be able to bring more trainings, more people in, more rehab therapists, and to be able to reach more people and do more with the tools that we, that we have and that we've been working on. So I wanted to let you know, because there's gonna be some changes as we move, uh, through this next couple of months and into the holidays. So what that's going to look like is right now I am in my current clinic. You guys will still come to the normal space and we'll still be seeing you as we always do, and we'll actually be opening the ScoliCare® Clinic in a new space. So our friends over at Jones Physical Therapy are expanding and they're building a new building. And that's amazing. And we're so excited for them. And what's really fun about it is that in conversation, that space kind of came into our circle and we're actually going to be moving into that space as they move out of that space which is just a blessing to us, honestly, because, Dr. Liz Jones has been such a friend to us and we've coordinated together in the community, and as they move forward and they are growing, we get to move into their space as a ScoliCare® clinic. And I really just couldn't be more excited for that. So that will look like the end of the year.

So as we're going through Thanksgiving and into the Christmas season, the ScoliCare® Clinic will be being built in that space. And then come January 1st, we'll be starting to function out of that space. So in the new year, you'll have to look, um, to our website, into our podcast. We'll have the address, the details, the location.

So if you're a scoliosis patient of ours, you'll be seeing me out of that office in 2026, which honestly seems a little crazy to say that out loud because I don't know where this year went. And then even more exciting as we move into the new year.

We've got a team of people coming over, uh, from Australia that are going to be doing some intensive trainings with us and some new staff members that we're going to be bringing on.

We'll have some additional rehab therapists that are going to be coming in to give some help with some ScoliBalance® tools to our patients, as well as some new staff at the front desk. So you'll be seeing some, new faces and meeting some new people. And then our plan is that as they come over and we do these trainings, um, we get into February.

At the end of February, we're going to do a really big celebration at the new clinic and invite our community and other providers and our patients into the space so that you can see it, you can take a look at it, you can see all the cool new things that we're doing. It's gonna look different than the office that we have right now and be more functional and have just a lot more to offer you.

And so, we'll have the ability to open up that space as well so we can offer some trainings to other people in the community and work with other providers. So there's just a lot of really cool, exciting things that I've been waiting to share until we had some more details. And so as we move into this break, we'll have additional resources that we're going to link.

Like on our social media. So as always, we've got a ton of different podcasts and topics, and so we'll be circling those back a little bit, uh, as you go into the next couple of months so you can still jump on and get information and find the things that you need. And of course, you know, as, as we've talked about before, our goal is really to partner with people in the community and to be able to give some information, uh, to families when they're looking. So we always offer a discovery call. So if you are either a provider or a patient who's wondering if our office can help you, we offer a 15 minute call where we jump on. We can even look at some of your images and talk through the situation just to see if it's something that is appropriate for our office or if we can direct you somewhere else.

So in the meantime, if you're not hearing from us regularly. If you are looking for those resources, all you have to do is jump onto our social media or our website, shoot us an email or even a text message to our office, and we can help you get that scheduled. Also you can email information over to us as well if you're looking for some input on that.

We always love to help with those scenarios. Um, so as we go, please be watching. We'll have an updated website as well. So, new websites, new, uh, location, new address, new faces, new people, lots of really big exciting things. There'll definitely be a little bit of a transition as we're moving from one clinic to the next.

And of course we'll make sure that we're sending that information out to you. So if you are someone who is in our office regularly. Don't worry about that, you'll have the information at hand. If you're somebody that's new here and you are just finding our podcast for the first time feel free to go back to some of our earlier episodes this season.

We've got some really great content. Um, the last week we had Dr. Tara Harding on our podcast and we were able to talk through a lot of different things, regarding hormones and testing and local options that we have. So many things that you can go back and, and just take a peek at while you're waiting for us to come back early next year.

So if you need us, you know where to find us. Hope you guys all have a fantastic holiday and we'll see you next year.

Thanks for spending time with me today. If you could leave a review before you go, that would help us reach more people that need this message. To learn more about the services and resources that we have available, visit us at behindthebrace.com. This show is produced by RAYMA Team Media. To learn more about how they can help you with your podcast, visit raymateam.com.

In this episode, Dr. Mandy has a conversation with her friend, Dr. Tara Harding, on the effect of hormones on scoliosis and what patients need to consider when looking for answers on the internet. This is a MUST LISTEN TO episode for parents of teens, teens, and women in your 20's, 30's, 40's and beyond.

Listen in to find out helpful tips and be sure to check out the links below for more information!

Dr. Tara Harding is the owner of Simply You Wellness and an experienced doctorate family nurse practitioner and fertility coach with patients worldwide. She received her master’s and doctorate degree from George Washington University and has received an additional certification through the American Society of Reproductive Medicine (ASRM) and Marquette Method Certified.

After facing personal health challenges, she decided to leverage her experience and knowledge to help individuals and families improve their health and wellness. As a result,she created a unique approach to healthcare at Simply You Wellness.

Dr. Tara empowers her patients to understand and take control of their health while being a partner in their health journey, supporting them as they navigate the path to optimal health and well-being. Connect with Dr. Tara at simplyyouclinic.com and subscribe to her podcast, Hopeful Hints, at https://simplyyouclinic.com/podcast/ or on Apple Podcasts and Spotify.

*****Resource Links You Need:

 *****Transcript*****

 Hi, I'm Dr. Mandy Dietz and you're listening to The Behind the Brace podcast. Each week I'll be sharing conversations and resources to help families and providers navigate the world of scoliosis. This is your place to find hope for a better solution so that you can live your best life.

Welcome back. This week we have a guest on our podcast that I'm super excited to introduce. Today we have Dr. Tara Harding, the founder of Simple You Wellness. She's a doctorate prepared family nurse practitioner that specializes in hormone health for men, women and children, and integrative women's care.

She's passionate about helping patients move beyond being told everything is normal, and instead uncover the root causes of symptoms like fatigue, weight changes, mood swings, and cycle irregularities. She brings extensive clinical experience, a personalized approach, and a shared dedication to helping patients feel like themselves Again, her clinic is leading the way in transforming how hormone health is addressed, and she empowers patients to be heard, understood, and truly cared for.

Welcome.

Hey, thank you.

Yes, thanks for coming on today. So I'm super excited to have you here because there's a big conversation happening in the scoliosis world that it doesn't have a ton of research behind it, but we know that it's affecting patients that have scoliosis. And as I do more of this work, I've got patients that come in my office, they have questions, and it's not within my, it's not within my specialty.

Specialty. Yes, yes. And I know about it, but it's not something that I have dedicated my career too. Right? So, this is within your wheelhouse. Yeah. So thanks for 

coming on. Yeah. You know, I'd like to just shout out patients, right? Like, I think sometimes patients have to get a degree. You know, we always joke about Dr. Google, but what do patients do when they're left with no answers? You go to one side of medicine and they're told. Everything's fine. Nothing to do here. You can't fix that. You can't change that. That won't help that. That's not FDA approved. And then you go to the other side of the spectrum and it's like, here, take a bazillion things.

I'm gonna cure you overnight and give me this timeframe, this money and everything will be fixed. Right? So patients are really put in a hard spot. From every avenue of healthcare, whether they're young adolescents, um, young women, young men, I mean, really. We could go on and on about that, but it's really hard when you're met with a diagnosis and you get a diagnosis, right, such as scoliosis.

Mm-hmm. And it's like, now what? Yeah. Now what do we do? What do we do here now? 

No, it's hard. Um, in the conversations that I have with patients. You know? Okay. So we all probably do it, even though we say don't do it. But you get a diagnosis and what do you do? You Google it. 

I encourage it. Right, right. I'm gonna say it.

I encourage it. Let's go to the socials. Go. There's great content out there nowadays, right? From good resources and bad resources, but there's a lot out there. 

Yeah. You have to discern the difference. You do, right? You do. So if you have a hard time discerning the difference between resources that are Yeah.

Reputable and resources that are not, sometimes you fall in this crack that can be pretty dangerous. Very. And expensive. And expensive and waste a lot of time. Yep. Actually, so, so that's really, that's why I wanted to have you on and talk about this today, because what I'm finding is, um, so there's this piece of it where patients come in, they're diagnosed with the scoliosis, whether they're a juvenile, adolescent, their kids, right.

They're growing, or maybe even they're adults and they've had scoliosis for a really long time. And they find all of this information, and we do know that there are certain things that come along with that diagnosis. Like for example, just like a quick rundown, right? So we know that kids that are diagnosed with scoliosis, it typically, uh, it tends to show up between the ages of 10 and 14.

It's typically right before or during puberty. There are a lot of changes going on. We know there are some link to hormones, but. We haven't, nobody's been able to really nail it down. Yeah, exactly. We know that oftentimes there are other things that are, that affect that, whether that's like vitamin D levels or sometimes, um, people have been talking, they'll come in and they'll talk about, um, copper levels that are too high or they'll talk about, um, just a lot of different things that we know that oftentimes those patients might struggle with.

But at the same time, there's not really anything in the research or in the science piece of it to say. You know, okay. Like if you have this problem, like say you have this hormone problem or this vitamin D or whatever it might be. We don't know that that for sure makes you have scoliosis, but we do know that patients that have scoliosis oftentimes have those things that are problems.

Yeah. So then what do we do with that? 

Well, if we had a magic wand, we'd have better research and funding for research. Right, right. So we can't, patients have to be very careful about where they're getting their information from. Like you said, is it research back? Like what is there to show that this claim is going to work?

What we do know, as you mentioned, some very key times, 10 to 14 puberty. Hormones are rapidly changing during that time. Nutrients, vitamins, supplements, rapidly changing during that time. So it would make sense that bone formation situations would arise during that time. Right. And genetics, mm-hmm. Go hand in hand.

So not everyone has information of their genetics, but if you do, it's again looking at is there someone in the family that has this diagnosis or other hormonal issues as they progressed in life? And looking back on that. Estrogen, testosterone, thyroid, insulin, cortisol. When people hear hormones, they think like estrogen, like that's the first thing that comes to their head.

Maybe progesterone, maybe testosterone. We're lucky. Thyroid, insulin, cortisol. There's all these different hormones and most we're lucky if we, if patients come in and they've had one or two looked at, never is the full picture being looked at. Then we look at iron, nutrients, vitamin D, magnesium. Let's not forget about gut.

You can take all the things in the world, all of the, whether it's even in a prescription or a supplement, and if your gut health isn't working or not on point, how are you gonna absorb all of that? And is there an absorption issue that's, you know, tailing back to some of these things too. People forget.

Providers, let's just say providers sometimes forget to look at the whole picture and that pivotal time where you're seeing this happen, there is a cascade, rapid cascade of things going on that we could interject and help with. We have to look at them as a whole picture though, right? We have to do the appropriate workup.

These, these children aren't getting in a workup. They're going in. Bringing forward maybe a symptom or a concern and it's being dismissed, or they're not even getting adequate lab levels drawn to look at vitamin D levels, look at nutrient levels, look at their hormones, talk about their periods if they're a female, right?

Like these things just aren't happening, so how can we intervene appropriately to help maybe slow down that process or intervene in that process if they're not even getting a full workup. The conversation's even happening at their provider's office to offer that as an option too. 

And the other piece of that too, is that sometimes it's the other way where, you know, maybe they go to a medical provider and they're not getting the workup, so then they're not doing anything.

But I've also had families where they go somewhere and sometimes it's states away. Right. So we're in North Dakota. Yeah, we're rural, right. That we don't have access to a ton of things, but sometimes I've heard where they go to a facility. They get zero workup, but they get handed a box of whatever supplements or this or that, and it's, you know, $900 a month and woo.

Red flakes. You know what I mean though? Yeah. So then they're just taking things, and maybe it's not harmful to them necessarily, but at the same time, is it addressing what is actually needing to be addressed? Like are we wasting time, resources, money, traveling on things that maybe we don't need that specific piece?

So how do we test so we actually know specifically what one patient needs compared to the other patient, so that we're actually doing. What's best for them in that scenario at that time. 

So, oh my gosh, I got cringey when you were saying all that. So let's back it up. The thing I'll hear too is like, you are too young, so let's just talk about adolescents for now.

You are never too young for a workup. Like it's never too young to look at your thyroid, your vitamin D, your PCOS, and IH like we're never too young to start looking at these things. I don't believe you should be taking something unless you know your body needs it. That to me is so much red flag right there.

Like that seems, I don't know. Can I just say like a money making, like red flag? Money making red flag right there. But let's back up even further. Like we talked about, patients are so desperate, like right, they want to just get answers, they wanna feel better, they'll do anything. It's just a supplement, right?

What's the big deal? What's the big deal with that? The big deals if you don't need it, it could spiral into something more further, like maybe not necessarily bone health, but you might get some other symptoms or things that are a direct sub. Supplements aren't necessarily a hundred percent safe if you don't need them either, right?

I use this example's not for pediatrics, but there's an over the counter, um, hormone supplement, DHEA. If you take that and don't need that, dear Lord, things will happen. But let's talk about the financials of that, right. What if you could do a home test from your home? You don't need to travel for that.

There's a lot of home test things available nowadays where patients can take the control right into their hands themself from the comfort of their home, and do some basic testing. Take that information into a provider and say, help me interpret this and help me navigate what my results show. I don't think you should be just taking a supplement.

'cause it's supplement and it's safe and it's been, you know, marketed by a, b, and C for, it'll, it'll fix this in a direct time. That seems like scary, bad marketing. Right? But, but I wanna validate to patients too, like, you're desperate. Like you're, you want, you want to feel better or you wanna do good for your, your children and you'll do anything for them, right.

Grow a team. This is where the team approach has to come into place and not relying on one person. You have to have a whole team taking care of you or your children. Especially in cases like with scoliosis, we have to have a team. We cannot rely on one person with great marketing. It sounds like good props to them, but like we have to have a whole team approach and not rely on one person, one magic box, one magic kit, one magic way.

The body is a very intricate system. The head's not rolling around over here to the spine, over here, to the toes over here. We have to work together as a team to look at that whole body of what's going on during that time. 

It's really interesting too, because we talk about team approach a lot, like on, on this podcast.

Mm-hmm. We've talked about it a lot, but the thing that this hit my radar actually just recently this year, because the team that we usually talk about is we're talking about like a spinal specialist. So whether they're. They have a brace at our, our office, or they're doing scoliosis rehab at our office.

Or maybe we've got an orthopedic surgeon on board or a neurosurgeon on board if we've got neuromuscular stuff going on, right? And we talk about mental health, so we talk about counselors and how do we process this and how do we do this? And you know, just all of these things. Um. But I didn't really realize, or maybe it was in my head, and I just didn't realize how apparent it was until I started having these families coming in.

And then they're talking about this piece where, you know, they'll go to the pe, their pediatrician, and they're kind of just left with. You know, well let them deal with the spinal stuff and you know, their well-check is good, so don't worry about that piece of it. And then they're kind of left with not a ton of resources and they, they feel a little uneasy, but they really don't know what to do.

And so I hear you talk about like, okay, we can take these tests from home. And then I have people say like, okay, we can take these tests from home. They're like, we don't know what tests to do. Yeah. We don't know. How do we order that? What do we, and then they, they get overwhelmed. Yeah. And then, and then they see this, um.

This something online. Yep, yep. That offers them something and it might be a very long distance away, and it might be this very involved process and they see that and it appears as though it's the answer, but then it's also missing a ton of pieces and they don't get that coordination of care necessarily with their team.

So that's why I'm so excited. That you are here. I was gonna say, 

maybe we should just slip in a hormone expert into this team at this, this point. We'll take care of the testing. Don't do that on your own anymore. Like Right. God, her those days. But like bring it in if you have one. 

And that's what's so exciting about having you here with your clinic because you guys.

Touch a lot of different pieces. Yeah. And can be that other piece of it to really make a cohesive team. 

Absolutely. We're I just, I don't know. We blend eastern and western, we believe in both sides. We believe the patient, but we believe in extensive additional testing. Right. No matter what age you are, like, I don't care if you're a baby, a lactating mom or a adolescent, like your body is telling you something when symptoms are happening.

It, it is your whole body. Every hormones actually impact every organ in your body. That includes tendons, ligaments, bones, like, I mean like everything in our body. So. I often question myself at night when I'm laying awake. Why are providers so hesitant to like acknowledge that or maybe say, Hmm, maybe there's a hormone issue or a thyroid issue going on in this adolescent that we could address and change now and and change the progression of that child's health, overall health, including bones, hormones, impact bone growth information, and osteoblasts and all of that.

Like why is that such like a hard thing to understand? It sounds to me like, like hormones have been, you know, excluded from this conversation when they're really, you know, kind of a important part of bone formation. I don't know. 

So we, we talk about it. Yeah. In a sense of, you know, so we've always kind of known that.

So we talk about it in, in two realms really. Yeah. And this is the conversation we have, but we also don't like, we're limited, right. So you can only specialize in one thing. Yeah. Thank you for that, by the way. Right. Because there's some 

people who think they can do like. 500 things, right? All in one. And really just be a master of none.

Just be a master of none. I like that. Like, like stay in your lane please, please. But that's the thing. It's like, 

so to do a really good job, like at my office, okay, so we work with scoliosis, we work with these patients to do a really good job. And most people who know me locally, I, you know, I was running a chiropractic clinic, I was also doing a scoliosis clinic.

And the farther you get into it and the more that you do, you just realize that. You can't do, you can't be good at all of the things. Absolutely. And if you really wanna serve your patients, and if you really want to provide the best care that you can, you just have to dive into the one realm. Right. And then as we come, come back to that, that's where.

You know, we find this place where we know, we know that hormones come into this, but the conversation we have is limited because we don't have, we don't have all of the resources or the tools. Yep. So we can tell. Families that we know that during puberty, that's where it's the highest amount of progression happens.

So the onset of their menstrual cycle? Yep. Within that first like 18 to 24 months, that's when we see the fastest progression. That's also when kids are growing the fastest and we see the most progression in their scoliosis. But the other piece of it that actually nobody tends to talk about is women.

Postmenopausal women. Ooh, perimenopause. 

Bless the women, 

right? So if we have, say we've got a scoliosis, and even if it's relatively stable throughout their adult life, when they start to hit menopause, we see fast progression in those patients as well. And then it comes back to that hormone piece. Hormone piece, and it's not very well understood necessarily.

And this is where, so from my perspective, I have to say. When we look at a scoliosis patient, we do x-rays, we do very specific exams, we do evaluations. Um, we base our treatment recommendations off of where they're at based off of, um, the clinical guidelines, the research that's provided, evidence-based care.

So we are giving those recommendations. It's not this off the cuff. We're just going to wing in Pinterest 

medicine. That's what I call it. Like everyone thinks I just do Pinterest medicine over here. Yes. I'm like, everything is research based that way. You do. Right. Everything. 

Uh, but that's the piece where it's like, okay, so for those patients that are looking for this piece, yes.

This is where you come in. 

Yes. And I think you like, bless the pediatricians. There's a time and place for them, but this is hormone health is not their specialty. Right. That's why we have to have patients. Really expand their mindset or the OB GYN and the menopause people. Right? That is not always their, you would think, right?

Man, ob, GYN, that's their specialty. It's not, like you said, the, there's just so much going on. There's, it's such a busy field. Keep them, keep these, keep these people on your team, but grow your team to include a true hormone expert that can really dive in. Because menopause is the time where, man, that rapid drop in estrogen, boom, there goes the bone health, right?

Mm-hmm. And that's not, it's like, oh, once you're an osteoporosis, that's done. Here's your, here's your, you know, prescription medicine. That won't actually help much here. But, you know, we'll talk hormones, man. Can I just say it like, put someone on estradiol, progesterone, testosterone as a female, and you can really, really stop that progression.

You gotta catch it right away. Don't wait till you're, you can still bring it in 10 years later. But what if, what if we had a new way of thinking? What if hormones bioidentical were actually safe and could help preserve bone and preserve our quality of life and not wait till a fracture happens? You know, for that, what if that'd be amazing.

And I, there's, there's research, like you said, everything we do is research based. This is not just made up with nothing to back it. And we know too, the two times you're talking about are the most pivotal hormone changes in a woman's life, like the two most pivotal changes. And yes, there is something you can do in those moments to help it.

It's not just Yep, not nothing you can do. Here's your birth control. You know, that's what the teens are usually met with. Here's your birth control or nothing. Mm-hmm. And then here's women. Yep. Menopause is just the way it is, you know? May, here's your unopposed estrogen. You know, if you're gonna get estrogens different than Estrodiol, that's a whole different podcast for a different day.

But, um, you are given one option at that age and one option at that age, and that's all they know. And so really we are trying to change that at both spectrums in our clinic. And I'll just say there's plenty of evidence to back it can help bone, bone, bone support during that time too. And changing the conversations.

Changing the conversations, yes. That we're having. Just even 

open it up so that we can have those conversations. Yes. Uh, what I see in clinic is, and this is where. This is where we struggle because, uh, what I see in clinic is I have women that come in that either didn't know that they have a, had a scoliosis.

Oh. Because think back, okay, so think back 40 years. Like sometimes they, when get diagnosed, you knowm as you 

say that I'm in my high school locker room getting a scoliosis check from the county health nurse. Yes. Like I can just see it. My, my gym, gym t-shirts off. Bend over. Mm-hmm. Got boom, boom. Done. Check, carry on to Ed.

And I'm like, that's it. I thought I could be outta fiad longer here. Right. That's what came to my head as you said that. Do you know they don't even do that anymore? Thank gosh. Thank gosh those are, I actually got sent fun fact I got sent off to the next level. I don't know what that Yeah. To James. You know, I was in a small town.

Ashley got sent to Jamestown to, I don't know what, like the higher up, uh, public health nurse. I don't know what she was, but I had to go get a second check 'cause I think she maybe thought I had it to this day. I mean, do I trust her? Maybe I should have you check me. We can. Maybe I still haven't. 

So that's, that's the hard thing.

Okay. Yeah. So I mean, this is a whole nother topic, but, but at the same time, right? So we're not catching it. No. Back then definitely, definitely we struggled, but even now, today, they don't check for it. Oftentimes I've got patients in full braces, like pre-surgical, they go to a sports physical. They don't even.

They don't even mention it. Yeah. 

I worked with healthcare for 10 years, I could say that. Oh my goodness. Yeah. We don't, we don't, but, and, and duck, you know, 

like not, I really do believe that all healthcare professionals are very well intentioned, blessed. They are, they are. There's so much, there's so much going on.

There's so much 

changing. Right. How do they keep up? I, I don't, that's why I am like. I, I want us all to come together and just say, Hey, you know, I can't keep up with the updated stuff, the research stuff. I can't do it all. You know, here's someone that can do this. Here's someone that can do this. Like, 

yeah, 

people, healthcare providers need to change their mindset too, to be more inclusive and be like, Hey, you need a team.

I can't do it all for you. Um, why don't you go, I don't know what they do or who they are over there, but you know, go check 'em out. Go, go see, go, see what's going on over there. Take this piece, take this piece and go take this piece from me. Yeah, that's not. A bad thing to say, I can't do it all. You can't.

No. You're the first. Like I, it's impossible. It's impossible to do it all like it just is, and I don't want to do it all. And other providers need to change that narrative in their office because it starts there sometimes too. 

I think that that's true. And oftentimes, um. There's not even sometimes time to have those conversations.

No. In those appointments, you don't see 

30 people a day in those settings. Like how, how you're in and out 

and it's a whole thing. That's 

impossible. 

Yeah. Um, so what, what ends up happening? We digress a little bit. Yeah. Gross. So, but what ends up, ends up happening is, is oftentimes these women, forties, fifties, yep.

Either they didn't know they had a scoliosis or. When they were done growing, they're 18. They're not a pediatric patient anymore. They're like, okay, well you're done growing, so you're good. Don't worry about it. Like you're fine. Um, off you go. And so they never have another evaluation. What we know now is that if you have a scoliosis that is 30 degrees or above, when you are done growing, the likelihood of progression through your adult life is higher up to a a degree per year of life.

So if you think about it, so you've got a 35 degree scoliosis. When you're a senior in high school, you never know have another evaluation and all of a sudden you're 47 years old and you're like, man, I don't know where this back pain is coming from. And then they pop into my office. They're like, oh yeah.

Well, I had scoliosis when I was a kid. They told me I was done growing. Don't worry about it. And we take an x-ray and now we're looking at a 65 degree scoliosis. And then guess what happens with that? So. And anybody who's dealing with this, they already know what happens. But for people who don't deal with this or question it, what to question it right now, do I Right?

They're like, gosh, I don't know. I've never had my scoliosis checked on since I was in the gym locker room. Right? What ends up happening is, so now they've got this 60, 65, sometimes I've had people with like 75 degree thoracic curves and they're in their fifties or sixties. They're having all these problems, they're having pain.

They go to the doctor and they say, well, it's not unstable. Surgery is going to be worse for you than not. So, you know, we can try 

an injection. Is that what they throw out? I dunno. So, 

well, sometimes a lot. Sometimes they'll say like physical therapy. Yeah. Or sometimes they'll say, you know, something like that.

Do your, um, symptom management. If that doesn't work, then they send them to the pain management people. Right. So it's whether it's injections or. You know, pain medication or, um, you know, people who are looking for answers typically that they're doing, like cupping, dry needling, soft wave. Like they go down this hole of whole road, all the things, whole road.

Yep. Right. And, and then. Ultimately, like I have these patients line up in my office and they're like, okay, well for the last three years I've been doing dry needling and cupping and PT and soft wave and um, these, uh, b vitamin injections. And I've been doing, you know, like filling in all of these boxes of like just trying to management this because they're not a candidate for surgery.

It's not bad enough, but they also can't clean their shower. Oh. Or pick up their grandkids or empty their dishwasher. And typically what happens is we see that like as you go into like perimenopause, menopause, you get this, this big progression. 

Yep. So like, where's the hormones all time? I'm gonna cringe it over here.

Where's the 

hormones? And that's just, you know, that's the conversation that on my side, I don't have tools for that. So my question to you is, yep. For those patients. What? 

Do you have an appointment? An [email protected] right? But I wanna know like what's right. What would you tell them? I would tell them that we know from research, right?

Like, 'cause that's the thing here, is that when, when those hormone shifts start to change, it impacts your collagen levels, like osteopenia, osteoporosis, that's the diag. That's probably what they're hitting when they see you, right? Yes. And they're told, well, here's your bisphosphonates. Let's look at the research behind those.

Let's just drop it there. But there's a rapid change in estrogen, progesterone, even testosterone, women. We need to have more conversations about testosterone. But that breakdown accelerates. What if we could intercept and slow that acceleration and integrate all those things they mentioned. Great. But I was the whole time like you're missing a hormone piece.

Perimenopause happens 10 to 15 years before menopause. It's a real thing. Many women are told that that's not a real thing. It's a trending topic and that's not it. Estrogen protects bone density. It keeps your collagen and ligaments flexible. It actually helps modulate inflammation. So we've got to control cortisol during that time too, 'cause that bugger will intercept.

And, and cause such chaos in that time too. And then when it, when you have that rapid drop happen and that menopause point too, now the bone thins, now the ligament stiffen and you're, you're probably seeing this in your office, muscle fatigue more easily, like chronic pain. It was better. And now it's flaring, right?

Mm-hmm. That's hormones. That is cortisol. That is thyroid, progesterone. Okay. Let's talk. I wonder how people listening are sleeping good at night if we're not sleeping good at night. Mm. Your body's not going into that moment. It needs to recover and heal. There's actually a lot of. Hormone things happening during that time.

You're sleeping, you're having dreamland. There's a lot of cool things happening in your body during that time. And if, and recovery happening. And if you are not sleeping, that's not happening. So perimenopause, often progesterone, we can bring in bioidentical progesterone during that time, um, because it also is declining.

It's more of a gradual decline during that time too. And it, and we have insomnia during that time, but tissue healing, we know that's very important here is tissue healing. And progesterone is key to tissue healing. Um, when I always tell patients you're not stressed out. Your cortisol though, like, let's talk about what's really happening in that time.

The stupid analogy of like the bear Chas ness in the woods. The bear in 2025 is notifications on your phone, the organizations you're involved and the kids, the husband, the spouse, the work, da da da da da da, like social media. It's just forever. You are being like totally lit up. Your body is constantly in a state of hyper awareness and that cortisol is very, I don't know that I've seen somebody when we've tested their cortisol ever be like.

Bingo. Spot on here. Nothing to work with with this. So we talk about the three best friends a lot, hormones, insulin, cortisol. I've added in a few more besties on the block. Um, iron deficiency anemia in women. The thyroid like, oh, thyroid level's normal. I've been told my thyroid's normal. I've been told my thyroid's normal.

Do you know, you wanna know how many people have normal when they bring those in. Like zero have normal thyroid levels according to our research that we follow in training the thyroid. Especially in this midlife time for women, it, it overlaps with menopausal symptoms, right? Like fatigue, hair loss, weight gain, again, joint pain, flexibility, all that stuff too.

But even the slightest imbalance can further muscle weakness and bone changes with the thyroid. So again, it, it's coming back to having somebody who specializes in this area. Do their workup on you. You still get to keep everybody else. We are very, very team orientated. We are never like, oh, get rid of them.

You know, like, have somebody else that's has the time, gives you more than 15 minutes in the office, gives you the lab workup that's appropriate to look at these. And really sits and looks at that piece of the puzzle that it sounds is very missing, very much so missing in this area, and not relying on just, you know, wait till it's what, what if we can, you know, treat dysfunction, not disease, like let's stop it at the dysfunctional state and not wait till it hits that disease point, especially in that perimenopause, menopause.

There's so many, there's so many things that can be done. And again, we go into vitamin D, that's like we could do a whole podcast from. Mm-hmm. And vitamin D, the ranges even at our local labs are really, really different. Um, many will come and say they were in toxic levels, they stopped taking it, and their levels are like 80 and winter's approaching that is not toxic.

That is just not toxic. Um, they're not taking, they're, oh, they're just taking calcium. No vitamin D with it. Um, the protein intake is not high enough. You know, they're, they're hardly getting even half of the protein intake that they in, we're not doing strength training and muscle resistance training, which is hugely researched nowadays to show can really support bone health, right?

Like that goes back to bone health. Iron, don't get me started on that. I want everyone to go grab their lab levels if they've ever had iron levels drawn and look at those ranges. It's like six to 300 is literally a ferritin range on there. And if they go in to provider with every symptom of iron deficiency and those levels are not in the red, they are not treated.

And that is unacceptable in our eyes. So we are bringing in iron levels and ferritin, looking at the ferritin and the iron. The gut health of that, right? Are you, is your gut healthy enough to take these oral, uh, supplements? Do we have to do some infusions for a hot second before we go back to that? Right?

So it's not just one thing when it comes out, it's nutrients, it's gut, it's hormones, it's everything. And that all ties back. I mean, your bones are literally attached to all of this. You don't have to wait till you have a 75 degree. I think that's what you said, angle change, right? Yeah. Like we can do so much.

What if you have undiagnosed PCOS? There's, there's diseases that cause hormone disruption from teens through throughout your twenties and thirties too. Like what if we could intervene and control your insulin levels that are creating, um, inflammation? What if we could intervene and control your progesterone?

You're not making enough progesterone. You need some extra progesterone in your luteal phase. Like what if we could support that your whole decades before? You, they enter at that perimenopause, menopause and help really intervene and support their body and catch these things sooner instead of having them come in, uh, menopause with these issues.

Right. 

So when you were talking about. The gut health and the supplements. Mm-hmm. So I have this vivid memory, vivid memory from clinic. This was quite a long time ago. Um, we were taking x-rays and I was like, what in the world? What is on these x-rays? Like what is that? Like? I could not quite figure out what was all over this lumbar pelvic x-ray.

So I go back, we're just talking to the patient. Um, it was their Centrum supplements. Oh, yes. Like, you know, those enteric coated like, like filler full? Yes. Just full of fillers. Bad. So like literally scattered buying supplements. Yeah, eating them. Passing them Exactly how they ate them. And so we had to have the conversation of like, okay, look at your X-ray, but.

The supplements you're taking are coming out exactly how you put them in your body. Like they're doing you no good. Just stop buying them. 

Yeah. So there's, there's, let's do a PSA hot second on that. Oh boy. Not all supplements are created equal. They actually found supplements on Amazon tested to not even contain, not to throw Amazon on their bus, but like, we're gonna, they're not containing what they're claiming they contain.

So working with a provider who actually understand what is, what is a high quality supplement. Vitamin D. C multivitamin. Mm-hmm. Centrum, you made me cringe when you said that. Like, everyone go throw your Centrum away. I don't care. They can contact me. I don't take one for the team. 

I'll never forget that.

Nope, nope. Like that is not, that is, that's been shown to be full of fillers. You can read the back of the label. It's like that is not a high quality supplement. So I think the overwhelm comes for patient. Well, what do I take then? Well, I trust this really good company that's selling me this box of.

Amazing supplements that's gonna help me. But do you need all of that? Is that what you need? Is that what you need for everybody? BODY is different. Everyone is so individual, and just like the tides change, so do your hormones. Like you might only need that for so long and not three months, six months, nine months, not 24 months or three years later, you're on the same thing.

Like, did you get a recheck? Did you still need that? What happens after programs end? You know, like. Where is that ongoing support once you buy these magical cure all you know, situations. Where what next? What what again, you should, our goal is that you walk away eventually and you're so in tune with your body that you just know when this happens, it's this, when this happens, it's this, or I need to go see them again.

I have no clue what's going on. Let's recheck that again and you just kind of change your, your mindset that our bodies are forever changing. You know, stressors happen. Um, you know, college happens for these teens, right? High school happens. College happens. Then they enter the workforce like they're, and then they have a traumatic thing happen.

A loss happens. Uh, an illness happens. Like when these things happen, our hormones are changing. So we need to know, oh, this is a, this is a symptom. Symptoms are signals of dysfunction. Let's catch 'em and go in. Not just dismiss them, brush 'em under the rug for a decade, and then be like, I'm, I'm in a black hole.

Now what? You know? Really flipping the script to listen to our body and trust it. You're with your body 24 7, not a healthcare provider. You know, what's that? This isn't right. My hair falling out. I know it looks like I have a lot of hair, but I'm telling you my hair's falling out and not being told by dermatology.

That your vein, like that's happened in our office, like not having to go get hair extensions because your hair's falling out. No one's believing you or that. Chronic pain in women is dismissed so many times as mental health anxiety. Go see the psychiatrist, you know, for this chronic pain situation. And it's like you're learning more about scoliosis and hearing from you.

It's like, ah. Like, I've had a very well known female in my office be like, I was sitting in the, in the waiting room of the mental health place. Like why am I here? I literally have a heart rate of 130 right now. I have a physical symptom that's being dismissed as bad anxiety and panic attacks. I can tell you my hair's falling out.

I have tachycardia and I got sent to mental health, like knock it off. That's a great place. I am so for mental health, but it's, and right, like what? It's that and mm-hmm. And, and, and it's. There's physical symptoms and mental health. Let's touch both of them please. Like, let's not just do one and dismiss the other.

That's not being a real thing 

in this conversation. If I could like put a laser beam into, mm-hmm. Here's this conversation, it would be women in their twenties and thirties because, so what ends up happening? So we talk about like mm-hmm. You know, osteopenia, osteoporosis, all those things. So this is what happens.

So we miss it and, and I'm gonna, okay, we're gonna back up. I'm gonna give a disclaimer. So. From a scoliosis perspective. What this does not mean is like, okay, you go, you do all these things and all of a sudden your congenital curve, right, is magically fixed, right? No, that doesn't happen. You just 

said it congenital, right?

Like, or, 

or say even say you've got a 40 degree curve and. You do all of these things, where's the promise and the expectation, right? So we're not promising that you do all of these things and all of a sudden your scoliosis resolves spontaneously. Right. Right. Or that all of a sudden it 100% is, is gone better magically, you know?

Right. Forever. We have to have reasonable expectations. Yes. But when we look at a person as a whole and their health, this is what I can tell you. When patients come into my office, say, I've got two separate patients. If I've got a patient that works, shift work. They don't exercise, they're drinking 40 to 60 ounces of caffeine, whether that's, um, red Bulls, monsters, coffee, bubblers, whatever, fill in the, fill in the blank, right?

Yeah. Um, they're not eating well. They're stressed out. They've got kids at home. Like all of those pieces, right? Yeah. And then, so I've got a patient who. Some of this is not changeable, right? So say you work at a hospital and you're doing shift work, right? You can't change that, but how do you support your life?

But then there's this other piece where you've got somebody who's sleeping well and they can exercise and their diet is healthy and they're doing these things. If they had the same situation, the patient who has better overall general health is going to do better with any treatment that we give them.

Obviously, because their body can respond to it better, they can adapt to it better. All of those things. So just kind of a disclaimer that what we're talking about isn't just this magical, like, Nope, fix it button, cure that. Like, okay, you no longer have to deal with your scoliosis. Go do this and I'll make it all better.

Right. But the thing that really is, is so sad for me that I just, it tugs at my heart when these patients come in is because. They're told like, don't worry about it. Go on, do your life. It won't affect pregnancies. It won't affect, and And that's true, right? Yeah. Like, okay, you can have scoliosis and you can have a family.

You can have pregnancies, you can have normal childbirth. You can do all these things. You can still run, you're races, you can go work out, you can do CrossFit, you can do all of those things. But they kind of have given an idea of like, okay, you're done. Like you don't have to worry about it. And then. All of a sudden in their forties and fifties, they come in and now we have osteopenia, we have osteoporosis.

That limits what I can do to help them because we can't, we can't put like a hard force into a scoliosis, like say a lumbar or scoliosis that is degenerative, that has some lassis. So like if a bone is shifting off a bone and we've got disc issues and they've got osteopenia, or maybe the beginning of osteoporosis.

There are a lot of things that I can no longer do with that patient. And so now it also, so now they're limited surgically, they're also limited in the realm of what I can help them with and we can still help them. So I never wanna say it's not, um. There's still hope. Like yes, we have managed lots of patients that have increased quality of life, but it still does limit that.

So if I'm, like, if we could have this conversation with people in their twenties and their thirties, and if they could just understand that they have more tools and if they can be proactive and get ahead of it, it opens up doors that they, they don't even know that they need yet. 

You're, you're like talking about what, what if.

Teens knew that they could do that. What if, what if we started at the teens and like educate the teen girls on this stuff and so that as they progress through life and, and they, they know this stuff. Like how empowering is it to like, think teens and 20 year olds could know this so that when they get to that point in life, it's d it looks different than it did for us and our moms and grandmas like a whole different.

Mindset. But you can actually change that process somewhat too, right? Like that's what you're saying too, is like to know that there's more out there than what they've been told. It's like, and to not fall for, I don't know, can I just say it like hard? It's hard. If it looks hard, too good to be true. It is too good to be true.

I don't know. Like it, it, and just to validate that time too, right? Like. We get it. Like you're, you're wanting to fix this and do everything possible, but you don't have to travel for it. You don't gotta go. There's more than one person that can do what that person. Is doing. Mm-hmm. I like a better way to put it, like, you don't have to go all the way across the country.

You can get that right in your backyard if you find the right team that knows what they're doing with that 

and the coordination of it, like you said, yeah, let me take this piece. Yes, I'll take this piece. Yes. And how do we work together? Yeah. Right. Absolutely. I often time, I, I have pa lots of patients where.

Like they see their chiropractor, they come see me for their scoliosis care. And then we've got other providers that are, are on board. And the more we have of that, yep. The better these patients will do, the better outcomes we'll have. And, and sometimes it's not, um. I wanna say too, not every patient that comes in the door gets the thing.

Right. Right. It's not like the, the new thing where everybody gets the same thing sounds very individualized like it should be. Right. 'cause sometimes it doesn't fit. Right. 

Right. And we adjust and pivot, like you said, that shift work person's gonna need a whole different plan than the non shift work person.

Mm-hmm. But it's doable. 

Right? 

It's doable. You're not just out because you do shift work. There's a lot that can be done to work around that lifestyle for you. 

And we talk a lot about like what's the top priority, right? So what can we do right now that will get you the farthest, the fastest? And where do we prioritize our time, our effort, and our money?

Yep. And where are the non-negotiables? Because if we've got a kid who's 10 years old, like say they're 10 or 11 and they're coming in and they've got a. 40 degree curve. Their priority is gonna be a whole lot different than say like, I've got a, an eight or 9-year-old that comes in and their curve is at 15 degrees.

Like, we're gonna treat that different just like we would treat somebody in their thirties or forties. Different and 

Absolutely. And that's 

where we've gotta have the people. And so that's why I'm so thankful that you guys are here. Yeah. And a lot of people don't even know that. Don't that, like, don't, we've got these people.

Yeah. Here, 

I always joke about our office, like if they, if people, some people have heard of us, that's like, wow, what is this? Unicorn. I'm like, there's a clinic like mine in every corner, in every major city. Fun fact, like what I do, we are just very up to date. We are constantly chasing the latest changes, especially in hormone health specifically.

No matter are you went through fertility, are you a teen getting your period? Are you entering perimenopause, menopause, men's health, like we are up to date on that. What is, what is the research showing? What are some options to help optimize you? You don't have to go on an airplane nowadays. And, and there's telemedicine, right?

Like that's the beauty of telemedicine. And our practice has telemedicine too, but many places offer telemedicine. You don't have to tra, you shouldn't have to travel much nowadays to get really high end care and unique other options. Like I feel like I'm not that unique, but I feel like I have to say that because what we do is so different in the area.

Is unique, but really it's just a different view and a different angle and specializing in hormones. 

Is there anything after our conversations today that we didn't talk about that you would want people to know or you feel like would be pertinent to or topic today? 

Yeah, I feel like we could probably have like a 10 part series, you and I on stuff, but.

Hormones are a real thing. I don't care what your age is. Um, we know hormones are forever changing. So whether you're a pediatric, a teen, a young female, young male, perimenopause is real. The the standard of care for menopause has changed. It is here. So if you are a patient, I don't care, male, female, teen, pediatric, whatever, you do not feel good.

You're not getting answers. You don't feel heard. You want a different option. You wanna get a couple different opinions. You have the right to do that. You, you might have been told that this is the only way. There's more than one way, right? Medicine is an art too. We forget that it's not a one size fits all plan, and you are in control of your body.

Nobody, no healthcare provider should be navigating that for you. You should feel good and confident and walk out of that appointment feeling heard, but really good with your plan. And if you do, that's amazing. That's what it should feel like. And if you don't, there's other options out there. There just is, um, in 2025 a time recording this.

Hopefully people will be listening this 10 years from now still. But there's rapid changes happening. We are nerds in my office. You can find me at a conference probably every month and my staff as well. And we are just gonna be able to help walk you through those changes. And because patients are getting that stuff online.

We talked about that earlier, right? So the point is don't become Dr. Google. Go out there, look what's going on. But you're on social media, you're on TikTok, Instagram, Facebook, podcast, YouTube. Great. There's a lot of great providers putting information out there, especially about hormones and advancements and stuff like that.

Patients are catching up with that. Providers are not. So if there's a different road you wanna take as a patient, no matter what your diagnosis is, take it you, you're in control. 

Thank you so much for coming today. I can't tell you how much we appreciate having Oh, yeah. You guys here, you're welcome. In our community and to help, um, we are going to link some.

Different links to my clinic and Dr. Tara Harding's Clinic so that you have access and you've got some resources. So, uh, look on our podcast, you can find, uh, her podcast as well. So we'll include all of that. And as always, if you have any questions, reach out to us. Thank you so much for being here today.

Thank you for having me. Yes.

Thanks for spending time with me today. If you could leave a review before you go, that would help us reach more people that need this message. To learn more about the services and resources that we have available, visit us at behindthebrace.com.. This show is produced by RAYMA Team Media. To learn more about how they can help you with your podcast, visit raymateam.com.

In this episode, Dr. Mandy explains the differing reasons why bracing is used and the intricate pieces of bracing that make each case so unique. If you've ever received differing recommendations from a handful of providers that has left you confused and not sure what to do, then you need to listen to this episode!

Listen in to find out helpful tips and be sure to check out the links below for more information!

*****Resource Links You Need:

 *****Transcript*****

 Hi, I'm Dr. Mandy Dietz and you're listening to the Behind the Brace podcast. Each week I'll be sharing conversations and resources to help families and providers navigate the world of scoliosis. This is your place to find hope for a better solution so that you can live your best life.

Welcome back. This week we're talking about the art of bracing and what you need to be aware of, so lots of conversations around bracing and what that's used for. So last episode, we talked about kind of the details of what that looks like, and just some general basic information. And today I wanna talk about more how it applies to you and how we use bracing. So traditionally speaking, when we're talking about bracing, most of the time we're talking about either juveniles or adolescents, kids that are growing, that are diagnosed with either scoliosis or hyper kyphosis that are wearing a brace because they're growing.

And essentially what that means is when kids are growing, if they've got a scoliosis, if they're not in a corrected position as they grow, that curve can progress. When the spine grows and growth plates continue to grow, when there's pressure on certain sides of that growth plate, the the bone and the spine will actually start to grow in a deformity.

So that's essentially what the goal is for bracing in kids that are growing. And that's why when you go see an orthopedic surgeon or any other primary care provider that works with scoliosis, if you have a child that's got a scoliosis or a hyper kyphosis and they're growing, they're going to put them in a brace.

So that's pretty straightforward. That's general recommendations. Everybody that would see a case like that should be doing that if that's where you're at. And then based on where they're at, specifically with their age and where their growth plates are at, the severity of their curve, lots of different things.

Family history, that's where they determine, you know, are you wearing a brace? How long are you wearing a brace? What kind of brace? So whether that's a brace at night or that's a full-time brace or what that might look like. So that's pretty general, and I would say most people know that that's something that's coming.

If you have a child that's growing with a scoliosis. So here's where the intricate pieces come in because there's a lot of different recommendations across providers, and I've personally had conversations with families and even other providers about these scenarios and then different recommendations and why they might be different.

So that's really what I wanna speak into because there can be some confusion, and I know when parents come in. You come in and you talk to us in our office, and then for whatever reason, whether it's insurance or a second opinion, or maybe there's something else going on, you go see an orthopedic surgeon, they give you a different recommendation.

That orthopedic surgeon says, "Hey, why don't you see our physical therapist while you're here?" And then you go see the physical therapist. And the physical therapist gives a different recommendation from the orthopedic surgeon and from our office, right? And then you're left with three different recommendations.

And they're kind of all similar, but they're also different. And then you leave all of these appointments and it's overwhelming. So I wanna help clear some of that up today because there is different scenarios, and different goals and purposes that play into some of these recommendations. And so I'm gonna speak about a scenario that happened in my office that looking back at that, I was like, gosh, you know, we really should have been more clear in some of this information because it would've been really helpful.

So, say you have a child who maybe is a little bit older, say they're 13, 14 years old, they are more towards the end of their growth. So they measure that. If you're not familiar, they talk about like, Risser sign, right? So Risser 0, 1, 2, 3, 4, 5. So, Risser five done growing. Growth plates are closed.

If you are like Risser one , 2 0 1 2, you know, you're still gonna be growing. You've got that fast growth phase coming up. You know, Risser three. So they base it off of those classifications. So if you're not familiar with that, of course you can always go Google it and you can look and see what it, what it shows as far as the bone and what that means and what that looks like.

So we've had more than one case where somebody will come into our office and they've never been diagnosed with a scoliosis or anything. They come in, we find that they have a scoliosis. We take an x-ray, and it's in this range of say like 27 to 35 degrees. And patient might be between the ages of like 13, 14, 15 , maybe they've already had their menstrual cycle for a while, and we look at their growth plates and they're like a Risser four.

So when we're looking at that and parents are coming in, some of the history of that might be, you know, our child's really active, they're having some trouble with sports, or maybe they're having trouble pitching in softball. They're having pain in their back. They're concerned about their posture.

You know, most of the time it's girls like going into high school that, you know, in a swimming suit, they're like, gosh, you know, this one rib is sticking out, or my shoulder is down. When I put on my clothes, my clothes sit funny. And so they're coming in with these concerns, but then also the parents are maybe new to this too. And they're wondering, okay, well we have this curve, like we don't want our child to have surgery and you know, this is at 28 degrees or 32 degrees, you know, whatever it might be. And so what do we do with this? And so from our lens. So using a ScoliBrace®, when we're looking at that based off of our braces that we provide, that are made through 3D technology that are over corrective, that when we fit you with that brace, we actually get correction in that brace.

When we're looking at that, we approach that scenario from knowing that if you've got a curve that's under 30 degrees, when you are done growing, it's less likely to progress as an adult. So essentially what that means is if you've got a 32, 35, 36 degree curve, even if you're done growing, those curves can progress as you age through your adult life.

So especially if we've got a kid in that range, they're having pain, it's affecting their daily life, even if they're close to done growing. We can utilize that brace to give correction in the brace, and if the patient is compliant, we've been able to get correction of those curves where.

We look at multiple things.

Are we able to reduce pain? Are we able to help correct the posture to make their posture more balanced? So essentially their body functions better, more biomechanically, and also they have less postural issues, meaning that aesthetically then that child is happier with what their posture looks like.

But then also a goal of, can we reduce the curve, keep it under 30, or if it's over 30, can we get it under 30? Even though they might be a little bit older than say what an orthopedic surgeon might brace. And so we've had these conversations and we've chatted about this and then, you know, for whatever reason it might be, they go see an an orthopedic surgeon.

And the orthopedic surgeon is like, "well, they're Risser four. Um, they've had their menstrual cycle for a while and their curve is 27 degrees or 33 degrees, and so essentially they're kind of done growing, so they don't need a brace, you know, no worries. Go see our rehab person. They'll work with you and then we'll see you in six months."

Or maybe, you know, sometimes they might say 12 months. Depends on where they're at. Then they go see the rehab person and they'll show them some exercises and they'll say, okay, here's your exercises. When you come back in three months, six months, or whatever it might be. Then we'll go through them again, and then the family leaves and comes back, and then we get a phone call, talking about saying like, well, the orthopedic surgeon said we didn't need a brace.

The rehab person said that we just need to do these exercises and come back in. Six months, three months, whatever it might be that we don't need to do this regularly. And then it comes back to the conversation we had where we were talking about utilizing a brace and utilizing our specific rehab program that we have, which essentially, depending on the patients as far as like the, how often we see them, but we generally do like a 12 session program initially and hopefully see those, that patient every week for 12 weeks to build on that.

It's very corrective focused and specific, and it's a scoliosis specific exercise rehabilitation program. So as you can imagine coming back from all of these recommendations, we now have three different providers, three different recommendations and three different pieces of information. And the reality is that they're all accurate.

Which is frustrating. And so that might sound odd when I say they're all accurate to you, because when I think of something like, well, somebody has to be right, like who's giving the bogus recommendation, right? But it depends on the lens in which you're looking at it. So when we work with families and when we work with you, we look at what are our concerns?

Where are we at? Right now, let's lay out the information and then let's make recommendations that, first, make sure that, you know, medically speaking, we're doing the right treatment protocols to make sure that you're safe and we're preventing any sort of, you know, negative thing from happening. Meaning we don't want your child to go to surgery.

But then also what are the concerns that you came in with and how do we work with that, right? So, here are the different lenses. So that family that I spoke about, when we come in and we look at through that lens, yes, they're almost growing, done growing, but we still have an opportunity to make change.

We're focusing on being proactive. Reducing the curve as much as possible so that they can have a better long-term prognosis as an adult functioning throughout their life. Especially if they're already having symptoms, if they're already noticing postural effects, if it's already making them self-conscious, if it's already affecting their mental and emotional wellbeing in that sense, right.

As they get older, those things will only continue to progress, right? Because in general, say you had a perfect healthy spine. We all know as we age, things start to have wear and tear. It start to degenerate. It's not uncommon that adults in their fifties, sixties, seventies, have degeneration in their spine, in their joints because you've used them for 60 years.

So if you've got a curve in your spine, it's more likely that you're going to start to see those changes in that breakdown. Faster as you age, especially if those curves are over 30 degrees. So we're looking at it from that lens of how can we best serve you using the tools that we have that we know are effective?

And so if we shift over to say, the orthopedics point of view, they're looking at that as. Okay, this child is almost done growing. They've had their menstrual cycle. The curve is either it's right under 30 or over 30, right in that area. And so knowing that they're, say like a Risser four, it's less likely that you're going to have progression of that curve.

So when they're looking at it from, is this kid going to end up having to have surgery? Unlikely is the answer. So from their perspective of what they're evaluating is, is this a child I'm gonna have to do surgery on if we don't intervene? If the answer's no, they typically don't do anything with that. And also depending on what braces they provide at their facility, oftentimes the braces that they might have available to them are more stabilization braces.

So they may not actually get correction of the spine and the braces they have to offer. And so if that's the case, then they're right. It's not worth having a brace because it's not going to do anything to make it better. And if there's a low risk of it getting worse, they wouldn't use that brace. So that makes sense.

So they're giving a solid recommendation, even though it might be different then the recommendation we've given. And then fast forward, so say now you're done with the orthopedic surgeon. You go see the rehab physical therapist that they have there, and maybe they've had some courses in say, Schroth or some scoliosis training or some other PSSE program that's different, right?

So each program is different and the applications are different. And especially if you're coming from a distance, right? If you are driving 400 miles, one way to go to this specialty hospital. There is almost a 0% chance that you're coming back weekly to see these rehab specialists. So they have to fit their program differently because it's just not realistic that people coming from a long way away are going to be able to come in regularly or build a program around that.

So that being said, that's a piece of it, right? But then they also aren't familiar in the rehab programs that we have available in our office. And that conversation comes up where they'll say, you know, I'm not familiar with that program, so I don't know, based on our program, you shouldn't have to come in as often, but we can't speak to each other's programs because we're not necessarily familiar with it, and we're not trained in that.

So then you hear a different recommendation from yet another provider who's doing the rehab. And you can even potentially, I had this happen once where the orthopedic doctor had made a recommendation for rehab and then when that patient got to the physical therapist's office, the physical therapist was like, oh, actually no, I don't agree with that recommendation.

After seeing you, this is what we need for rehab. And then that conversation comes in of like, well, the orthopedic doctor knows the general consensus of rehab, but based off of my evaluation, it really needs to look like this. And so it can get really confusing and really muddled. And so that's what I want to just open up the conversation about because it's not always, it's never actually black and white.

Every single patient, every single scoliosis, every single presentation is different. I have never had one, like more than one patient that I have managed or gave recommendations to exactly the same. It just doesn't happen because you have different activities. Patients live different distance distances from you.

There's different abilities for compliance based off of your life. Other medical diagnosis and, just like so many different factors, and underlying family history. And in addition to that, you know, one of the things that has recently come up, and this is knowledge really for anybody across the board, whether you're a parent, whether you're a provider, listening to this, there's even scenarios where I was just having a conversation about this with another provider, so.

If you approach every scoliosis case the same, there is no doubt that at some point something really not great will happen because they are not the same. So I recently had the conversation of there was one patient in one office that was, I believe, I can't remember the exact age, but I think it was like 13 years old.

And had a double curve. The curves were, you know, relatively midline, so like under 30 degrees. So based off of an orthopedics recommendation, maybe not bracing, classification yet. And so this provider had managed this case a certain way and they actually saw some changes in the curve and the patient had gone on and not had any progression and not had any additional problems. And so when we were having this conversation, it's like, okay, so if we have a patient who's 13, they haven't gained a grown in six months, so they haven't gained any height in six months. They've had their menstrual cycle for two years. They're a Risser four.

They're almost done growing at that like 13 and a half. So they're like early in the stages, right? When you manage that scoliosis, they have a really low risk of it progressing. So it worked out well for them. But then on the flip side, there was another office that had a 13-year-old who hadn't had her menstrual cycle yet.

She was a Risser two, so she hadn't had her really fast growth phase yet, so she's still growing. And her curves were just under 30 degrees. So kind of in that same realm, they looked very similar, but there was a completely different history there because she had been growing in the last six months.

And so you stack all those things together and you've got a kid who hasn't had their menstrual cycle yet, which is so to backtrack. The onset of the menstrual cycle for the first like 18 to 24 months is when the most progression happens. If I didn't say that. So that's important to know. So if you haven't had your menstrual cycle yet, your growth plates are still at a Risser two, meaning you have a lot of growth left, you have been growing in the last six months.

Those curves are just like in those twenties, right under 30 degrees. That patient was managed in a very similar way, except in a four to five month period of time. That patient had progression and now is in a place, you know where they need a brace. So you can have two kids seemingly the same, but the underlying factors are different and you'll have two totally different outcomes.

And so you can't use this like box to kind of fit people in to what do you need to do with this? Because if you don't know the intricacy of all of the underlying factors. You really could guide somebody in a way that could be really detrimental to not just their health, but like leading to a surgery that could have been prevented.

And so some of these conversations are the things that I wanted to talk about because we do a lot in our office with bracing that maybe don't fit within the box, but we are able to really help people in ways that's, you know, outside of the box of what you might be able to get in a hospital or a different facility or a different bracing facility and things of that nature. So in addition to that, there's some other cases along with that where we talk about, you know, adults with degenerative cases where they're old enough now that, you know, surgeons don't really wanna touch it, they don't wanna do a fusion. It's not completely unstable in their spine, but it's affecting them day to day and they just don't have the ability to do the things they wanna do.

And so those are cases where we've done adult bracing for those cases, and we're not worried necessarily. About the cob angle. So when we talk about like, oh, you have a 45 degree curve. When we're looking at that, our goals are different. We're taking the patient in front of us and we're figuring out what can we do to help them with the things that are most important.

So if that same patient went to go see a surgeon, they're not likely going to brace an adult. They're not likely going to use their braces to be able to help with some of the things that they're experiencing. And most often they'll say, well, if it's not bad enough, we're not gonna do a surgery. So then patients are just left with not a whole lot of options other than you know, some traditional physical therapy and then eventually pain management, where we can have that same patient come into our office and we can have the conversation about, okay, what's, what are our goals here? And we've really been able to utilize that brace in a way that we can help adults have more stability.

We can use that brace to get more global balance, meaning that if we constantly feel like we're falling forward when we walk, we can help bring their body back and over their pelvis. But then we can also use that to help stabilize. So say they've got a double curve. They're leaning to their left or they're leaning to the right, we help stabilize and get them up upright and straight, and then we can utilize that brace to do some rehab and strengthening in that position.

And we've seen some great results where people that weren't able to even like bend over and tie their shoes or get their shoes off or be able to unload the dishwasher or even vacuum, are now able to do those things, or to pick up their grandkids. I can't tell you how many times I've had that conversation about, you know, well, I can't pick up my grandkids.

If I get down on the floor to play, I can barely get myself back up again. And so it may not be within the box of what the mainstream community might use, but we have been able to use the brace that we provide along with our rehab programs to really be able to help those people gain their quality of life back and their daily activities.

The same goes with different neurological conditions. So it may not be that, say, you know, we've got a patient with either like cerebral palsy or Parkinson's or MS or different neurological conditions that we know are associated with a higher incidence of scoliosis or hyper kyphosis.

Obviously we're not taking away the condition that's creating the scoliosis, right? So if we have cerebral palsy or if we have a different neurological condition that's creating a scoliosis, that condition's still going to be there, but we can provide a brace to help keep that patient more stable, more upright, keep their spine corrected while they're in their brace, and to help utilize that to gain strength and to create a rehab program that fits their specific situation that they can do, that can be really helpful.

And so out of all of those things, when we look at how we utilize our brace, there is an art to working with families and patients and finding the spot that really helps them utilize the tools that we have to get the results that they want. And it can be really confusing when you're hearing other things, but that's where I really want people to start to recognize that there's a different lens in which we're looking at that.

And so you have to take into consideration who you're seeing, where you're going, and what their lens might be and what they're looking at as far as what are they trying to prevent, and how are they giving you those recommendations. Because in that scenario I presented to you at the beginning, that family got three different recommendations.

And again, they were all accurate, but we have to come back to what are we trying to accomplish? What's important to the patient? What are our goals? And then based on those, how do we move forward? Because if your goal was simply to avoid surgery, or if your goal was to simply not have progression, then those recommendations are absolutely right.

Then you know what, you probably don't need a brace and you probably don't need to do rehab very often because you've pretty much already obtained those goals based off of where you're at. But if your goal is to reduce your pain and symptoms. Increase your activity to be able to have less injuries while you're playing sports, to correct your posture so that you're more comfortable with how your body looks and all of those things.

And to help reduce the curve so that long-term as an adult, it's less likely to progress and cause you problems, then those recommendations might not necessarily be the ones you want to follow. And so it's really about opening up the conversation within your family and other providers as well to understand the information about scoliosis and hyper kyphosis, what that means, and then how do you make your decisions off of that?

Because you can have recommendations that are completely different and also be accurate, but it may not fit what you want for you and your family and what your goals are. So this is a very in-depth conversation to have. But I wanted to just kind of scratch the surface of it to open up the conversation.

And I know that there's going to be people that listen to this and they're gonna say, well, what about fill in the blank? And so if you're one of those people that you're like, gosh, well what about this? I really do urge you to send us a message because those questions are important and I think having clarity or even knowing what to ask is really important.

And one of the things that we offer in our office is what's called the discovery call. So if you have a situation scenario that you're really looking for some guidance or just some information, if you reach out to us, we have a free 15 minutes discovery call where we chat with you. We get some information ahead of time and we can talk through the scenario to see, okay, is our office something you know, that's for you or do we feel like you need to be seen somewhere else? And then can we direct you to that place. And so it's really worth that conversation. We always have our website and on our socials you can send a message and we can connect with you that way. If you have any additional questions or if you want some more information, we can provide that.

We will be back in the next couple of weeks with some new episodes, and until then, I hope you have a great week.

Thanks for spending time with me today. If you could leave a review before you go, that would help us reach more people that need this message. To learn more about the services and resources that we have available, visit us at behindthebrace.com. This show is produced by RAYMA Team Media. To learn more about how they can help you with your podcast, visit raymateam.com.

In this episode, Dr. Mandy explains the basics of bracing such as:

Listen in to find out helpful tips and be sure to check out the links below for more information!

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 *****Transcript*****

 The Basics Of Bracing That Every Patient Needs To Consider

Hi, I'm Dr. Mandy Dietz and you're listening to The Behind the Brace podcast. Each week I'll be sharing conversations and resources to help families and providers navigate the world of scoliosis. This is your place to find hope for a better solution so that you can live your best life.

Hi, welcome back. This week we are going to talk about the basics of bracing that every patient needs to know about. There's been quite a few questions and just some conversation regarding bracing, and we've covered this in the past a few years ago, but a lot of the protocols and different clinics have changed some of the things that they're doing with bracing.

And even in our own office, we're using bracing differently than we had 10 years ago. So I wanna go through just kind of the basics of: what is bracing, what do we use it for, and what does that look like. I know when patients come into my office, they have a lot of questions. Of course, this is typically something that they haven't been familiar with.

So unless you have a strong family history or you've been through that experience yourself as a parent and now bringing your child in, a lot of these things seem pretty foreign. So the things that I wanna talk about are, what does getting a brace look like? What are the steps involved in that? What are some of the different options and what comes along with it?

So we use bracing in our office. So the ScoliBrace® is very specific. It's a 3D over corrective brace. We make that brace using 3D imaging, so it's an actual 3D image of your body, it's custom to you, and it's made in an over corrective way. What that means is it's very specific, so no brace is the same.

And even if you say had, you know, a thoracic curvature and the next patient has a thoracic curvature, your braces are going to look different because you and your body are different. So it's made specific for you and we have that shipped to us. We have you come in, we do a brace fitting, we tailor that brace, we modify it to make sure that it's more comfortable for you to wear as comfortable as it can be.

And then there's also a lot of other options. So parents that come in talking about brace options have shared some of the experiences that they've had at different clinics. And so I wanna talk a little bit about that because. Just because you have a hard brace doesn't mean that all of those braces are similar or the same, or function the same way.

And so some of the things that come up in conversation are patients that go in, they get casted for braces, so it's like a plaster casting that they'll do at different facilities and then they make a brace off of that casting. Most of the time, then once you get that brace, they'll add some different padding inside of it and things like that.

Sometimes they'll use measurements. So I've had some patients where they've not had to do the, the plaster casting, but they've laid down and, you know, straightened their spine as much as they can. They've taken different measurements on their body and then they've formed a brace based off of that.

And then I have had some patients that have had like the 3D scan in different facilities that have had braces made off of those as well. So a lot of the ways that the brace is utilized and made for a patient is dependent on the provider that's making it. So, for example, you know, if you're casting a patient or if you're doing measurements on a patient, you know, those are a little bit more subjective, so everybody does it a little bit differently.

So the consistency can be a little different depending on, you know, if you're seeing different people when you go or how they're trained or the different types of ways that they may do it in their own facility. And then in addition to that, depending on how they utilize that brace once it's there.

So I'm going to speak mostly about what we do in our office. But all of those are different scenarios that I've heard families and patients talk about, that we've actually seen and, and talked and worked with different, orthotists and rehab people and things like that as well. So some of the questions that come up is about the closure on the brace.

So the majority of our braces that we use, we've actually only had front closure braces in our office, which means that on the front of the brace you've got some Velcro straps. You've got a little guide that goes in and you put the brace on, and then it closes in the front. That way you can take it on and off.

You're able to maneuver that if you need to loosen it after you eat or if you need to. Take it off to use the restroom, things like that. I do know that some braces, they have it close in the back. Those are braces that sometimes, you know, depending on how that works, parents have talked about, um, you know, having to assist to get the braces on and off, which if you have small children that don't wanna wear their brace, obviously that can be a benefit because they might not be able to just whip it on and off and take it off when you're not paying attention.

But it can also be a hindrance too, because if you have a lot of trouble getting it on and off, especially if kids are at school, that can be something that can affect their compliance and whether or not they wear it. So the majority of our braces, when you're coming in, we have front closures. So the brace opens up, you put it on, you, Velcro it shut, and you're able to change that as you need to throughout the day.

So in our braces, so ScoliBrace®, you'll take those braces off when you're active. And so that means anything like, you know, volleyball, basketball, running, if you're biking, you know, any sort of active time swimming, you know, we want you to be active. We want you to be strong. The only time that we have you wear a brace when you're being active is if we're incorporating that into a rehabilitation plan.

And that can actually be really beneficial. But we use it in specific ways and it wouldn't be all of the time. So, for example, I just actually had an athlete come in my office this week and one of her main goals is to be able to continue running and to be able to prevent injury. So we talked about utilizing a brace that corrects her spine, hold her in her correction, but then doing some of those core stabilization exercises.

So she's actually strengthening her body in a corrected position so that she can maintain her strength and help prevent injuries when she doesn't have her brace on. And so sometimes we'll utilize that, even as adults. Um, I've had adult patients that one of their goals would be to, you know, run, run, jog, a half marathon.

And so part of her training would be that we would do part of the walking part of the jogging, in her brace, either on the treadmill. Or down the road for the first mile or two to get her body moving and, and strengthening in those movements in her corrective brace. And then obviously, you know, she's not wearing her brace for a 10 or 13 miles, but once she worked that into her routine, then she would take her brace off and she would complete her training after that.

But that was really helpful to be able to help her body stay in that corrected position and get the maximum benefit of the brace. But essentially you get the time out of the brace to be active. Most patients actually say that sleeping in it is the most comfortable time, which surprised me as a provider.

Obviously I haven't worn a brace, so I'm not exactly sure what it would be like to sleep in it myself, but a lot of the patients that I work with say that the easiest time to wear the brace is when they're sleeping. It takes a little bit to get used to, but over time, that's probably easier because there's not gravity, we're not standing up.

And when you're lying down, your curve's reduced. So it's probably more comfortable. So once you get used to actually having the brace on, the sleeping time can be the easiest time to wear it. The other things that have come up over conversation is how often do we need a new brace? And so obviously that answer depends on the circumstance, but, generally speaking, I'll kind of break it down into like juveniles, adolescents, so like kids that are growing, usually 12 to 18 months you'd have a new brace if somebody is growing really quickly. I did have a couple of patients that needed a new brace, but then 10 months, but they had hit a massive growth spurt, so they had grown a lot in that period of time.

But for the most part, generally 12. 13, 14, maybe 15 months. As long as the brace is still doing what we want it to, you'll get at least a year out of that brace and then potentially, you know, need a new one depending on where your child is at for growth. Now, for adults, that looks a little bit different and it's dependent on what our goals are, what your goals are, and what clinically our goals look like.

I've had some adult patients that have had their braces for three, four years. Over time, they do start to break down. You know, they're made out of materials that aren't meant to sustain 10 years, right? So the material will get a little bit weaker the longer that you wear it, the more that you use it.

But I've had some patients that have gotten a really long life out of their braces. And then in other times too, if we've got a really specific goal, for example, we've got some braces that are made specifically for adults that have a hard time standing up straight. So you've probably all kind of seen people, whether it's at the grocery store or Walmart, where they have to hold onto a cart and try to hold themselves up and push themselves up.

If we've got an adult that is using a brace for that situation, sometimes even in a short period of time, say 12 months or 15 months, we may get really great results and that patient may not need that specific type of brace anymore. And then we might build another brace that may address, say, for example, their scoliosis or some other spinal condition, that was kind of secondary to our original goal. And so sometimes we'll build an additional brace depending on what we're working on.

The other conversation is about skin comfort. What do we wear underneath our brace? What does that look like? The braces that we provide in our office, it comes with two shirts that are underneath their skin tight.

They don't have any seams, and they've got little flaps for underneath your armpits that help protect your arms and your skin from the plastic on the brace. They're a material that really helps wick away sweat and mostly really comfortable. I have a few patients that may not like the feel of them, kind of like a sensory problem, where they feel like it feels too much on their skin and so they might choose something else.

But essentially, as long as you're wearing something under the brace that is relatively skin tight and doesn't have a bunch of seams, that works really well underneath those braces to help protect your skin, make it a little bit more comfortable, make it easier to get the brace on and off. One thing that can make it extremely difficult that I've seen in a couple of, you know, younger kids where if they like to wear, say a t-shirt underneath their brace, sometimes that cotton and then it's looser, it'll get kind of balled up around their sides or like maybe underneath their armpits. And there's two things that happen with that.

First of all, it makes it hard to get the brace in the correct place because there's a lot of material that bunches up underneath the brace. But then also if it's, bunched up and like overlaid on each other and then the brace puts that pressure on your skin, you can actually get skin irritation in through there, which can make the skin red and make it itchy. And if it's there long enough, can actually open up the skin a little bit. So we don't recommend big, bulky things underneath the brace, but something more tight fitting. And so a lot of patients will find their own shirts, their own things that they wear underneath that.

So those are kind of the basics of, you know, when we're talking about braces, those are the big things that seem to come up in conversation. But then also, the feel of the brace, how different braces are made, and then the types of braces that we have. So in our office for ScoliBrace®, we use braces for a lot of different things.

Most of the patients that come in, they're diagnosed with a scoliosis, and so we have a ScoliBrace® that we use that addresses a scoliosis. There are quite a lot of patients that have what's called a hyper kyphosis, so that front to back curve. So, people that have too big of a curve where they're bending over in the front.

We also have what's called a Kypho brace to help hold them up and hold them straight and reduce that curve. So that's different than a scoliosis brace. We do sometimes have patients that both have a hyper kyphosis and they also have a scoliosis. And so we have a hybrid brace that we can use for that.

And so each brace has its own intention. The same when we were talking about adults having trouble standing up or maybe their weight is too shifted forward. We have a brace that helps to hold them up and to help give them support so they can stand up straight and they can function and move and walk in a better way.

So they're each specific to their own condition, their own diagnosis, the patient, and it's custom made for the patient. So we can really tailor that in and we can really get that to a place that's helpful for the main goals that we have with that patient. Now, there are a lot of conversations about braces and comfortability. So, as you can imagine, it would be the same as if you are going to the dentist and then you need to go to the orthodontist, right? If you get braces on your teeth, when they initially put them on and they initially tighten them, they don't typically feel the best because they're actually moving your teeth right.

But over time, you start to get used to them and then you might go in, have your braces tightened again. It might be a couple of days of not feeling the best, and then you know, you get past that. So think of scoliosis bracing in a very similar way. So when we are making a custom 3D brace for ScoliBrace®, we're making that brace over- corrective because we actually want to get correction in your spine, meaning that if you've got a 30 degree thoracic curve and a 25 degree lumbar curve, when you get that brace on, we want to bring those curves down so we're not just holding it in that position. We're actually gaining correction when you have the brace on. And then based off of that assessment and that correction, so once you've had the brace on for 30 days, we do an x-ray of you in the brace. See where we're at with our correction, make sure we don't need to modify anything, and then we base our goals of correction off of that.

But we're always aiming for correction, not just keeping you in the same place. So of course with that, when you get a new brace, there's going to be a period of time just like with braces on your teeth where it doesn't feel the most comfortable, but as you wear it and you wean your way into it full-time or part-time or whatever that might be for you, your body starts to get used to it.

Your posture starts to settle into it and it gets easier. And that's where when we're talking with parents oftentimes. We'll, notice that, say for example, we had a family that went and they were casted, so they did the plaster casting and they were fitted with a brace. And when they came back, you know, one of the things they said, they were like, oh yeah, this is way more comfortable.

They can wear it. It doesn't bother them. They have, you know, zero symptoms they can put it on. It's like they're not even wearing anything. And upon further assessment, what we realized was, is that that brace wasn't actually changing anything in the spine. It was simply holding them in that position, which makes sense why it was way more comfortable, but it also wasn't doing, at least from a corrective standpoint, it wasn't doing a good enough job to actually correct the spine and hold it in correction. It was simply holding it in the hopes of it not getting worse. So, when we're talking about bracing and that conversation comes up about whether you have soreness or stiffness or you're getting used to that.

Um, and the comfortability. We obviously try to make our braces as comfortable as possible, and most people, once they're used to them. It's no big deal. They put it on, they take it off, they can sleep in them. They can, you know, walk around, go to Walmart, go to Target. Oftentimes, you know, they can even sit in a car for them, you know, as a passenger for a short period of time and not have any issues.

It's just about getting used to it. So that's a big conversation to have when you're talking about braces and what the intent is. And then also too is to make sure that anytime you are dealing with a brace, that they're doing an brace assessment and an x-ray. To make sure that the brace is doing what we want it to do.

So is the goal just to hold it where it's at and prevent progress, you know, prevent it from getting worse? Or is the goal to correct it to actually get correction and try to reduce the curve in the spine and then whatever that goal is, is the brace doing what we're -hoping it will do? And if not, then what do we do with that?

So it doesn't matter the provider that you're seeing. Some of the questions that you can ask them are related to this. Like, what type of a brace -does it open in the front or the back? You know, what are you going to give us that they can wear under it? And then in addition, our braces have, it's a called an eye button, but essentially it's a wear monitor.

So it's this little button that goes in the brace and based off of temperature, it tracks the time that you have the brace on. And this is huge for our patients because oftentimes what we perceive, the time we're wearing the brace and what the actual time is, is different because we get busy in our day.

And so we may be, you know, estimating we're in a brace maybe 16 hours a day, but in reality it might only be 12 hours a day. Or you know, we've had some, somebody that, they're really busy, they're in sports, they're in school, and they're like, gosh, like I really think I'm wearing it 12 hours a day. And then we come in and we pull the monitor, and they're averaging only about nine hours a day. And then when we walk through the reports and we kind of look at the weeks, they're like, oh gosh, yeah, that makes sense. You're right. I am only wearing it for nine hours a day. So that is a huge part of something that we use in our clinic that is really beneficial because we can accurately get the data for how much time you're wearing your brace, and that's really important to know so that we can set realistic goals for what you're going to get out of that brace.

And I don't know right now, I haven't heard of any other facilities that have been able to provide that resource to their patients. I might be wrong in that, but so far I haven't heard of any. But those would be questions that, you know, I would be talking to with your provider as far as, you know, how do they fit their brace?

What does that brace gonna look like? Do you have an ability to track the time that they wear it? What kind of things do you provide for them to wear underneath that? Do you take x-rays? And if you do, at what point in time do you do that? And then based off of those, how do we change the brace moving forward?

So those are kind of like the nitty gritty details of the brace and how it functions, how we make it, what we use it for. Next time we're on, I'm really gonna be diving into the art of bracing. And essentially what that means is. We have bracing and there's some very, you know, set in stone protocols, but there's a whole lot of places in between that, in that gray area that we can use bracing for that's really helpful. And as we've been doing this over the last 10, 11 years, we've seen some really great results in areas where maybe a brace wouldn't have been used previously, and we've had some really great success with that. So the next time we're coming in, we're gonna be talking about that, what that means for you, what that could look like, and just different opportunities that you have.

So until then, you can find us on our social media. We've got our websites linked below. Have a great week, and we'll talk to you next time.

Thanks for spending time with me today. If you could leave a review before you go, that would help us reach more people that need this message. To learn more about the services and resources that we have available, visit us at behindthebrace.com. This show is produced by RAYMA Team Media. To learn more about how they can help you with your podcast, visit raymateam.com.

In this episode, Dr. Mandy shares guidance on how to handle the delays and disruptions that come up when life happens and you're trying to handle brace wear at the same time.

Listen in to find out helpful tips and be sure to check out the links below for more information!

*****Resource Links You Need:

 *****Transcript*****

 Hi, I'm Dr. Mandy Dietz and you're listening to The Behind the Brace podcast. Each week I'll be sharing conversations and resources to help families and providers navigate the world of scoliosis. This is your place to find hope for a better solution so that you can live your best life.

Welcome back. This episode is called How to Manage Your Scoliosis When You Can't Be At a hundred percent. I'm actually really excited to do this episode because these are real conversations I have in my office every day, all week, like months and months on end, and it's just real life, real people situations because as I'll tell you when you come into my office or in any conversation, there's this very nice box of diagnosis, look at the x-rays, look at the situation, get all the data. It's this very scientific process, and you put it up on the screen and you say, you know, okay, based on all of these things, this is the recommendation. This is the best treatment approach. This is how we do this. And it, at least for me, it makes me feel really good, right?

Like I'm that analytical. I like to see it out on paper. It makes me feel good to know that this is the data, this is how you do it, and if we follow the plan, everything should go as expected, and this is what we should see. But what I've learned in working with real humans is that there's also a human part to it, and life is messy and things happen and it doesn't always go to plan, even though, that can stress me out a little bit, right? As I'm sure anybody listening to this can attest to is that when things do not go according to plan, it can be stressful and it makes us uncertain and we're not as sure how to make decisions.

And so what do we do with some of these things and how do we take this very like nice linear process, where we can lay all of the black and whites out, and then how do we incorporate all the gray areas of actual life and how things are going for you and combine it together to make something work? Like that's the magic in it, right? That's where being a good clinician is being able to look at the perfect scenario, look at what's in front of us, and combine the two to get the best result that we can.

And so I'm gonna share just a few things. Some of these things might, some of these things might trigger you. If you're listening to this and you're relating to a story, it's not necessarily about you, but if it kind of triggers you, it might mean that you need to pay attention to it. And a lot of these things that I'm talking about are things that I've also experienced in different ways in my own life. But these are really the scenarios that patients come into my office with.

So first of all, I'm gonna put a disclaimer out here that this isn't to validate any of your excuses, just like any of my excuses as to why I should be doing things that I shouldn't be doing. So we all have this tug of war with what's realistic in our life and sometimes, you know, if we're just making excuses as to why we can't do something, so I'm not saying that you shouldn't be doing your stuff or you shouldn't be doing the recommended treatment or any of those types of things. But I am saying that there are times in life when we just can't do all of the things that we should be doing. And if you're a perfectionist, at least even like in my own mind and a lot of the patients that I work with, it's kind of this thought of I either have to do it perfectly -the scenario has to be perfect, it has to be. At the right time, it has to be the right space. I have to be feeling a certain way. I need to have a certain amount of time in my schedule. It like everything needs to be perfect in order to either start it -or to be able to continue it. And the reality is that time passes anyway.

And if you don't start, you'll never get started. And so there's, there's a few situations in there that we'll kind of talk about that may or may not follow that exact line. But the first thing that I want to talk about is if you have a delay or a disruption. So at least I'm speaking specifically about my office now.

So a lot of patients come in and the first thing we determine is, do we need a brace? Do we not need a brace? Where are we at in that regard? And then we follow that appropriately. And then we look at the next layer of things and we say, okay, now that we have that figured out, and any under other underlying medical things that we need to, you know, discern and make sure.

Are handled appropriately. We look at is ScoliBalance® appropriate for you? So that's our scoliosis specific rehabilitation program. And is that appropriate for you? And if so, what does that look like? What would be an appropriate prescription of care for your situation?

And then we also look at other things like coordinating other providers. So like, are they seeing other providers and are, are we coordinating with them? And how are we working that together? Because when we're looking at this, right, a lot of people have different things going on, so they might be seeing a physical therapist or they might be seeing a chiropractor, they might be seeing, like a fitness coach or a personal trainer or different things like that.

And so when we're starting something in our office, we have to be able to communicate with those people so that everybody's kind of on the same page of what are we doing to help you move forward? And I would say a majority of people have more- like it's more than just me or our clinic working with them. And so that's an important piece of that. How do we make this work in your life?

Now, once we have that laid out, obviously with any type of care, if you're at a hundred percent, that's the best case scenario, right? So say we've got somebody wearing their brace, so if they're supposed to be wearing their brace full time, so they're wearing their brace full time.

They're doing their ScoliBalance® program. They're doing, they're at home stuff, right? They're at, you know, full capacity. They're able to fit it into their day. Um, they're able to continuously work through that, and they're checking the boxes and, you know, doing all of their things at a hundred percent.

Obviously we get the best results that way, but there are multiple instances where we have a disruption or a delay or something happens. I've had patients come in as adults that were really wanting to get after their scoliosis and you know, maybe they're in that family stage and then they find out they're expecting another baby.

Well, we can't, we can't use a brace when you're, you know, pregnant. Right? So then it's like, okay, we have this little bit of a delay. But then instead of going to, "okay, well we're just going to not do anything right now until down the road, then we talk about," okay, well we can't use this tool, but what tools do we have left that we can use to help you continuously gain ground?

Until we can come back to that initial plan. Or, for example, I've had quite a few patients that have had injuries. So whether we had somebody who had a surgery, so with an abdominal surgery, they were out a couple of months. Obviously we're not utilizing a lot of the tools that we're having if you have a surgery and you're in the hospital and you're recovering from incisions and stuff like that. Or we've had people that have had some pretty serious illnesses where maybe they ended up in the hospital for a week and they had to come back out of the hospital and they had to get better and they had to heal.

And so in all of those situations, it's gonna be a little bit different for everybody. You know, what can we utilize? Um, or example, a broken leg. Multiple people that have either had like fractures in their legs or fractures in their feet or, because a lot of the people we work with are active, right? So athletes, if they are playing football and something happens, or I've had somebody that does cheer and they were thrown up and they had a fall, and so now all of a sudden we have a concussion that we have to deal with in addition to the scoliosis.

There's just these nuances that come about real life, that doesn't make it perfect on paper. And so what do we do about that? How do we work with that?

So no time is the perfect time. I will tell you that. It doesn't matter who comes in my office, there's never a perfect time to start. The key is getting started and then making realistic and reasonable decisions.

So, for example, it's summertime. Well, we're coming out of summertime and into the fall. So sports, busy season, into like football and all of the things and traveling teams. Um, so there's lots of things going on. And so one of the things that often comes up is it's like, oh, this sport's coming up. We're gonna be traveling a lot. We've got all these trips planned. You know, should I start? And so when we're talking about some of these recommendations, the thing that I ask families and that we kind of come back to is, would we do anything different? So if we're making a decision about care and we're looking into the future, whether it's: do we need to do a test? Do we need to do a brace? Do we need to do a rehab? Doesn't matter what it is, would we do anything different? Because if the answer is no, then maybe we don't do that thing. If the answer is yes, then it would be appropriate to do the thing. And so, for example, I had somebody pop in the other day and they were asking if we should start before or after something.

And one of the questions I asked them was, I was like, okay, so you're gonna be gone. You were traveling, you're in and out. Like if we sat down and did all of the x-rays and did all of the things, um, and I will, I'm going to preface this with, this was not a highly progressive case and this was not a kid.

So if you're listening to me, and this is you're 11-year-old with a 40 degree curve, this is not for you. Right. This does not apply.

So this was an adult with a stable scoliosis who'd been dealing it with it for, you know, her whole life. And, uh, the conversation was like, do we start now or do we wait? And so the conversation we had was, okay, if we saw you right now and we laid out this program and we got the first few visits in and we showed you these things, would you be able to realistically and physically do these things while you're traveling?

And after like real contemplation, the answer was no. You know, they wouldn't be likely to be able to do any of that over the next month anyway. And so in that specific case, then the answer was like, okay, well then we're going to wait and we're going to have them come in when they do have the space and they're actually going to be able to do that.

And so we postponed that for a couple of months just to be able to make sure that they had the capacity to do that, but in a different scenario. We had -also an adult. So kids are different. I'm gonna preface that kids are different. Don't take some of the things I'm saying in relation to your kids. Ask your provider specific questions if you're worried about that.

But this additional scenario. It was an adult scoliosis her whole life, same type of thing. And they're going on, uh, a trip, right? So they're traveling, they have a lot of things going on. And so the conversation we had was, okay, where are you at? How are you doing? And would we do anything different? And for them, the conversation was, "oh my gosh, I'm in so much pain. I don't know that I'm gonna be able to make the trip. I don't know that I'm gonna be able to handle the sitting and the driving, and all of those things." And so, in this scenario, the answer was Okay. Then we get started like right away, as soon as we can. We fit in as much as we can to try to gain as much ground before she has to do this thing.

And then we set up realistic expectations. So obviously if you're traveling and you're on planes and you're driving and you're on trains and all of those things, you're not going to be able to do some of these things at a hundred percent in that scenario. But it doesn't have to be perfect to help.

And so in that situation, we were able to really give her some key things, as she was coming into the office and then we were having her do things at home. We could assess those and then we really honed it in, like, okay, what are you gonna be doing on your trip? What are the things that are bothering you? And we tailored a program specifically to her and then we gave her very select things to do while she was traveling.

And when she came back, she was really happy to report that she was able to make the trip. She didn't really have a whole lot of trouble driving. They did the things that we talked about. You know, she made sure that after so much time she had gotten up, she did the different exercises that were like really easy to do in the sense of she could do them standing beside her car in a parking lot if she needed to, so that she could enjoy that trip and not be in pain the whole time.

So when we got back and we talked about that, like that's something where maybe we're doing something at 50% or 60%. Sometimes in our mind we think that that's not beneficial or that's not helpful, or we push it off because we think we, we can't hit the mark. But in reality, that might be the thing that changes your ability to enjoy some of the things that you're doing or to be able to start to make progress.

And so that's really why I wanna talk about these because almost everyone that comes in feels like it's gotta be a certain way, a certain time, a perfect fit to start. And it, it just doesn't always. But in that same right, we're very realistic that like if I've got a senior in high school and they're finishing their track season and they're in the middle of state track and they're in the middle of graduation and they have their grad party and all of their family's coming to town, and then they're leaving on like their family like celebration, vacation Memorial Weekend, right?

I'm not throwing in four visits and this massive, challenging, expanded rehab program in the six to eight weeks over that period of time, right? We have to tailor it specifically to who's in front of us, and that's where we really have that power and ability to create a plan and a program for the people coming into our office so that you can fit it into your real life.

And you've gotta have some dedication and you've gotta fit it into your routine. But we also make it realistic. We're not making these two hour long, at home programs that you need to go through. We're making it so that you can get the maximum benefit in a way that works in your life. And so that's gonna look different for everybody.

One of the other things that comes up, I shouldn't say all the time, but it feels like it's all the time. It's quite a bit actually. And it's across the board for lots of ages and it's kind of in the sense of like, we can't fix it. So, why deal with it? And I will say that most of the time these scenarios are people that aren't having pain, right?

Because if people are having pain or they're not able to do what they love, it kind of flips that switch pretty quickly where they're like, okay, I wanna be able to do the things I wanna do. But in the scenarios we're like, well, gosh, okay, we, you know, we are in our thirties, we have this 40 degree curve. It's not like we're gonna fix it, so why would we deal with it? That's where we really have the conversations about- and on a personal level for everyone, right? Everybody has a different period of time in their life and what's important to them and how that fits into their life from a time-wise and a financial piece, and all of those things.

But what's our goal with that? And so I really want to encourage people who maybe feel a little bit defeated or maybe feel like they don't have the ability to expand those areas in the sense of, you know, kind of looking at it from the sense of, well, we can't fix it, so why deal with it type situation is, even if you can't say like, quote unquote, fix it. It's about maximizing your body's ability to do the things that you wanna do, and to also protect the potential of your future.

Meaning that what we do now determines, you know, what happens down the road- 10, 15, 20 years. And there's a couple of examples that I wanna share with you today because I think it's something that it's easy to not think about, and I see this all the time with kids, right?

So if I've got somebody who's 14 sitting in my office and I'm trying to talk to them about the importance of their rehabilitation program and the importance of their brace, and they're young, they're healthy, they don't have pain, they're an athlete, and their curve is like right in the middle of the road. So it's not surgical, but it's also like just significant enough that the research shows it'll continue to progress throughout their adult life. But in their mind when they're sitting in front of me, it doesn't seem like it's a big deal. And so when I'm bringing up and I'm like, Hey, okay, but what about when you're 40? What about when you're 50? What about when you're 60 and maybe you still wanna be running, maybe you don't, but maybe you do. All of those things, it's hard for them to think about the future because it seems so far away and we're all like that. Honestly, like if I think about the things in my life, it's, it's easy to just kind of not think about 10 or 15, 20 years down the road.

But there's two scenarios that popped up over the last few weeks that really brought this to mind, and one of them was, somebody was talking about a family member that they had, had a really mild scoliosis, and they kind of knew it. It was like they ran in, it, ran in the family, and I think it was a, it must have been their grandparent. I think that had the scoliosis and so now they're older, right? They're in their eighties, like mid to late eighties and having a lot of trouble with it, and it's really affecting their ability to be mobile and to do things. But when you're in your eighties, you don't have a whole lot of surgeons knocking at the door saying, "Hey, we're gonna do a surgery" because you're in your eighties. And most of the time people aren't in the best health to be able to go under anesthesia and do all that, and their recovery would not be great. So they get stuck in this place where they don't have a whole lot of options because they can't undergo the surgical intervention, and they're already in a place where it's affecting their mobility.

But when they're 40, they're not thinking about when they're 85 most of the time. And so this is one that I really just wanna talk to you about is if you find yourself in the place where you're like, gosh, I mean, we can't fix it anyway. Like, why would we mess with that? That's why you mess with that.

That's why you take advantage of the tools that you have in front of you. And it's not like, I, I likened it to like a bodybuilder not too long ago actually. So think about, say you lift weights, and I'm sure everybody has probably seen like people who do these bodybuilding competitions, right? Most of the time people who do those, right? They have this really intensive, uh, program for a period of time. And then they do the bodybuilding competition. We all see the photos and we're like, holy smokes. I didn't know people could look like that. And then after that, right? You can't maintain that forever. They go back, most of the time they go back to more like normal life and their body looks a little bit different.

But when we're talking about some of the scoliosis things, it's almost in my brain, it kind of, connects like that, where if we have an initial diagnosis, especially as a kid, right? We have this like intensive treatment time where maybe we're doing bracing or we're doing rehab, or we're doing all these things, and then when you become an adult or as an adolescent when it's less severe or it's not surgical and we know it's not progressing, we get to this place where we're like, oh, well why would we mess with that?

So you don't have to go after it in the intensity like you would if we're worried about this high progression, but at the same time, there's a happy medi, right? Like normally bodybuilders don't go from like bodybuilding and then not working out and eating McDonald's in a six pack of Coke every day, right. And gaining 150 pounds. Like there's this middle ground where I think a lot of the people I talk to feel like it's like all in or none. And really our job is, and this is what has been really, really impactful to see is that when we're working with patients, we have this more intensive time of care where we're really working through that. And I've been doing this long enough now that some of those kids that were like 10 years old coming in, they're now graduating from high school, they're going to college.

Actually, one of my patients, this is totally side note, but she's like graduating from college, get, you know, got married, all of the things, and I'm looking at some of these things and it's. It's something that we can help incorporate it into day-to-day life as you move forward, which then protects your future of what you can do when you're 40, 50, 60, 70, even in your eighties.

And it doesn't have to look like the intensive time of treatment and care, but we find something that fits for you and all periods of life are gonna look a little bit different. So even though it might not be something we can completely fix, we can maximize your ability to be strong, to have flexibility, to not have symptoms, to be able to do the things that you love to do, to not have problems as you move forward or try to minimize those problems. You know, we can't obviously guarantee like you'll never have a problem, but we try to minimize those by giving you all of the tools and all of the things that you need so that you know that you've done the things that you can do in order to help protect yourself as you get older.

And so, this is a huge piece of this. We'll probably do more on this later actually, but, I find the most power in that because sometimes we can't fix the things in front of us, but there are things that we can do to make it better and to help support ourselves and to make our future better.

And so that's a really big key piece. Even if we can't completely fix it. We can make that better. And so I'm gonna leave that with you. We always have information on our page where you can connect with our office. You can ask questions. If you have a case that you want us to look at, make sure to reach out and let us know.

And we'll be back in a few weeks with another episode.

Thanks for spending time with me today. If you could leave a review before you go, that would help us reach more people that need this message.

To learn more about the services and resources that we have available, visit us at behindthebrace.com. This show is produced by RAYMA Team® Media. To learn more about how they can help you with your podcast, visit raymateam.com.

In this episode, Dr. Mandy addresses the different types of patients she sees in her clinic. If you have scoliosis as a secondary diagnosis, have osteoporosis, are a woman in menopause, or even have spine issues from a traumatic injuries - then you need this episode.

Listen in to find out helpful tips and be sure to check out the links below for more information!

*****Resource Links You Need:

 *****Transcript*****

 Hi, I'm Dr. Mandy Dietz and you're listening to The Behind the Brace podcast. Each week I'll be sharing conversations and resources to help families and providers navigate the world of scoliosis. This is your place to find hope for a better solution so that you can live your best life.

Welcome back. This episode is called "Are You Someone We Can Help?" This week, I wanna talk a little bit about who we see in our office and what that looks like, and if it's something that could potentially help you. The majority of the patients that we see in our office are pediatric patients -so adolescents that have scoliosis, maybe have been diagnosed with scoliosis, or maybe they are worried that they might have scoliosis and haven't gotten a diagnosis yet.

The research shows us that up to 5% of the population of adolescents are affected by scoliosis and of that population, 10% of those patients actually have a really significantly delayed diagnosis. Which can be really important and can affect the treatment options, in a very, very big way because if we miss a diagnosis of a progressive scoliosis, sometimes that might change our options from being able to manage that with a rehabilitation program and potentially a brace to that Scoliosis now becoming surgical.

And instead of talking about how do we stabilize this and get correction of this scoliosis, we're now talking about how do we delay surgery or how do we prepare for a surgery and then a post-surgical recovery. So those are really important things to note. Of course, you know, the adolescent population is what we mostly think of when people think about scoliosis, they're, they're thinking about, you know, like in our generation, if we had the scoliosis checks in our schools. Which they don't typically do anymore. But, you know, as adults we're thinking about that. Like, oh yeah, we got checked for scoliosis when we were kids, and if something showed up, then they gave us a note, we went home to our parents and then we went to the doctor.

So I think that's what comes to mind when we're talking about scoliosis. And I will say that that's a, a very large part of my practice is working with kids. You know, mostly, I would say between the ages of like 10 to 16 and through there, we definitely have kids that we're seeing under the ages of 10.

Uh, the big thing to note with those age groups is if there's a history of scoliosis in your family or if you have any sort of indicators with your child that there might be a possibility of a curve. Especially if they're under the age of 10, make sure that they're getting checked appropriately, early and often because you wanna catch that ahead of time instead of finding it down the road maybe when they're 12, 13, or 14.

Because typically at that time, it's now a little bit less manageable, especially if it's progressed. So in addition to that population, we also see a lot of patients that have scoliosis as a secondary diagnosis. And so what that means is that someone has a primary diagnosis of something else, like for example, cerebral palsy or some other neurological diagnosis that affects muscle tone, or flexibility and increase in flexibility in their body, their joints and spine. In addition to that, it could potentially be secondary diagnosis to degeneration if we're talking about adults. So if we think about adults in their like fifties, sixties, or seventies. If we have a lot of degeneration, if we have a lot of spinal problems then sometimes what can happen is, is you can actually get a scoliosis or a kyphosis from something like that. So an example might be if we have an accident or something like that and the spine starts to degenerate.

It doesn't always just stay in the spot that it's supposed to. It can become unstable and then we get a scoliosis and those things tend to be really painful. And so a lot of patients come in, in that population in pain. And so the initial diagnosis would be whatever the injury would be, but then the scoliosis comes next or the kyphosis comes next.

In addition to that, one of the things that I really wanted to bring up today that might, might not be on everybody's, um, you know, at the front of their mind is sometimes we have kids and adults, I should say, with different types of leg length inequalities. So essentially you might know somebody that maybe in like third grade they fell off of a slide and broke their leg.

Or if you have like an athlete and they have a fracture in their leg somewhere and it hits the growth plate, it can affect how the bone grows. Or you might have a leg length inequality from something else, like a medical condition, uh, or something of that nature where one of the legs actually grows longer than the other.

It's not extremely common, but it is something that happens and that can cause a scoliosis. So if you think about like a building, right? If we have like a 10 story building. If at the very bottom, if we have a six inch difference, by the time you get to the top, that whole building is going to be leaning over.

It's the same thing with the structure of our spine and our body. So if something happens to one of our legs where it doesn't grow the same as the other, or if we have some type of condition that affects the growth of one of your legs that can actually create that tip on the base of your pelvis and then a scoliosis forms.

So I work with quite a few patients that are younger, that have had that happen. So most of the time it's something that happens like early on, like maybe grade school, or something from birth that causes the bones to grow not quite how they should. So that's something that we definitely want to address early.

So most parents, if they're told this, they're not necessarily told that that problem can create a scoliosis. It's something that just shows up down the road. So if you're a parent or if you know somebody that has had something like that happen, or there's a problem in like the leg length equality of, of somebody, you know, if give them a heads up because most of the time doctors don't talk about that and then they get like a year or maybe two years down the road and they just happen to find, they're like, oh, you have a scoliosis.

Well, we know that that's an indicator that can show us that a scoliosis is much more likely if you have an unstable base. The same thing can be for something going on with the, the pelvis or in your hips. So it would be things like hip dysplasia or if you have any sort of traumatic injury to your pelvis.

So whether that's an accident or you know, something from birth or something that comes from a different type of condition. Anything with the legs, anything with the pelvis. It's actually responsible for almost half of the scoliosis cases that show up in that low to low back into the middle back because it shifts your pelvis and then your body tips to try to compensate from that.

And over time it develops into a scoliosis. So if you have any sort of indication that that's something that's coming about, make sure that you have a proper assessment to make sure that your spine is developing, growing appropriately. And that's, you know, obviously for children when they're growing, but we can have those same types of injuries as adults if you have an accident and have a, a fracture in your leg or if you have a surgery or even sometimes I have seen adults, if they have a hip replacement or a knee replacement, sometimes that can affect the structure of your legs and your pelvis, and then over time, a scoliosis can develop even as an adult.

So those are things that aren't talked about a whole lot, but are really important because I keep seeing it over and over in my clinic and people just aren't made aware of it.

In addition... so a lot of times when I'm talking to people, they think that we work mostly with really significant or severe cases, so surgical cases or cases that need braces, and we actually see a really large, uh, group of adults.

Well, not just adults, adults and children that have more mild cases. So if you aren't needing a brace, if it's not a surgical recommendation, oftentimes you're just told like, okay, you know, you're lucky counting your blessings, you're on your way. We don't need to do any of these interventions. Over time, even those mild cases can develop into a more significant, I don't wanna say problem, but a more significant, has more of a significant effect on your life. So maybe you're not having pain or a lot of symptoms and maybe it's not preventing you from doing the things that you want, but over time you might notice it more or you might notice how your clothes fit a little bit differently.

A lot of women that come in will talk to me about how they look in a bathing suit because their rib cage might be shifted. They might feel like their posture's a little distorted or one shoulder's higher than the others. So more of an aesthetic effect. And those are a lot of things that we can pretty easily do an assessment and give some treatment recommendations and work through that. And they use that in conjunction to the things that they're already doing.

So, most of these people are already doing, you know, whether it's chiropractic care or maybe they're doing some massage or physical therapy or acupuncture or you know, yoga, any of, any of those types of things. But what we recommend and really help implement are scoliosis specific things that can actually correct the posture.

It can actually correct the imbalances that they see, and if they are having any sort of symptom or any sort of noticeable change in how their body's functioning, it can really show them how to incorporate those things in their day-to-day life so they can use it as they do normal things. So that is a huge population of people we see, and I think a lot of people just aren't aware that we have the ability to help with even those more minor things that you can pretty easily work through and then just carry those tools with you in the future.

A couple of additional things, and this is one that just recently I started talking to patients about in my office, and nobody's talking about this one either really, until it's a big problem. So, perimenopause, menopause, and osteoporosis are things that really affect scoliosis. It wasn't until I started seeing more of an adult population, a lot of these patients are patients that either maybe had a more significant scoliosis but didn't have surgery, or maybe they had a, a more mild scoliosis. And when they were turning 18 and being discharged from their pediatric provider, they just said, okay, you know, you're done growing, things are stable. You're, you're good. Go on your way.

But what they don't talk about, and what a lot of people don't know is that even with those more mild cases. When your hormones start changing, when you start going into that like perimenopause and menopause, we start to see some changes. And so if we have any changes in bone density, we have changes in hormones, we can actually see progression of a scoliosis in that period of time.

And that's often where I'll see women coming in, in their fifties or maybe in their sixties, and they'll come in and they'll tell me that they've got, you know, really bad low back pain or some other type of symptom that's affecting them or they'll kind of have a story of, you know, they told me I had a curve when I was younger. It wasn't a big deal. I've just noticed over the last five years or eight years that it's slowly gotten worse and I've been noticing this more, and now I'm having these troubles. And I would say most of these patients have not had any type of scoliosis follow up. Mostly because they weren't told that they needed to.

And so we don't really have x-rays, even sometimes I've had patients where they had an x-ray 35 years ago, but have had no x-rays or no evaluation since then. So we will get the, maybe the report or maybe they have the report from when they're a kid, and then we'll do the new x-ray and we'll see where they have like 20 degrees of progression from when they were a young adult over their lifespan.

And now as an adult they have this really high unstable degenerative curve and they have a lot of pain. And so when we go back and we look at that and we think about when that started to happen, typically it's when they start to go into menopause. And when I ask these questions, a lot of them might say that they have had an osteopenia diagnosis or an osteoporosis diagnosis.

And we link all of those things together and they're really big risk factors for progression of the curves for having a lot of changes in the curves and women just aren't made aware of it, they, it's not something that is top of conversation. And sometimes I think even in the history, like maybe we go to our OB's or our primary care doctors, and we might be talking about this, but if we were diagnosed at a young age, like maybe in high school that we had scoliosis, or maybe they did the scoliosis check, and they're like, ah, don't worry about it. It's not bad enough. It's not at the forefront of our mind. And now, you know, 30 years later we're in front of our whatever doctor we're seeing, and we might be talking about our, our women's health and different things.

And that's not something that always comes up because I've had a lot of patients say, gosh, like I didn't even, I didn't even talk to my OB about the fact that I had scoliosis. And it's not something that I find that our primary healthcare doctors bring up either in that stage. Which is really interesting because the more I talk to women in my office, I'm like, gosh, we should be having that conversation with women this age.

Just like we're having the conversation with teenagers as their curve may or may not be progressing. So we've been able to help a lot of patients with things like that even at a later stage. So I bring that up, we're gonna have another topic on this where it'll go really more in depth with this, but if this is something that you find yourself in. I would just say if you're in that stage and you know that you have any sort of history of scoliosis, make sure that you have that evaluated and that you have it checked and do it early if you can. And if you kind of miss that part of your life, like it's never too late to come in and get it checked because we wanna make sure that you're stable.

So one more group of patients that we see in our office, and this is kind of more of a group of people too that is also not talked about are people that have more traumatic injuries, so that could look like a lot of different things actually. Um, I've had really young kids or kids in their twenties that have been either like on a motorcycle or a dirt bike or doing like motocross stuff, and maybe they take a jump and they land on the other side and they land wrong or they hit wrong and they have an injury where maybe now they've got a compression fracture in their upper back, or I've seen a compression fa fracture in their lower back.

And even though they're young and they have no history of a scoliosis or a kyphosis, now all of a sudden we have an issue with the spine and they have lots of pain and they have other things going on that are affecting them. And this is also something that you know, that maybe they go in, they go to the doctor, they go to the emergency room, whether they're in a brace, they're in a cast, they get healed up, they go to PT, they're discharged.

Nobody really talks to them about the long-term effects of what can happen to their spine after an injury like that, especially as they age. Sometimes those traumatic injuries might be more so in adults. So whether that's a car accident, whether we are having, you know, we have a fall on the ice, or I've seen like somebody fell out of a tractor in the wintertime and ended up having a fracture on one of their vertebrae in their spine.

Things like that. So really any sort of trauma to the spine has an effect on it, obviously. And so whether it's somebody who's young or whether it's somebody who's in their 20s, 30s,, even fifties or sixties, right? That can affect how the spine functions. It can affect the presentation, the biomechanics, and if there's a fracture, something that changes the bone over time.

If that isn't protected, stabilized, and if we don't deal with that, that's where it's not immediate. Right? Not in three months or six months even necessarily. But when I see people come into my office, they'll say something like, oh yeah, you know, five or six years ago I had this thing happen, or you know, I had this accident and it didn't really bother me, but over the last couple years it's been getting worse.

And then sure enough, we take an x-ray and where that x-ray might have been when they had that fracture and where it is now, we've seen degeneration and we can actually have. You know, a scoliosis that comes from that, or even that, you know, kyphosis problem, um, because we've got the fracture on the front of that vertebrae.

So that's something too that I really wanna share with people because it's not always just a straightforward diagnosis, that we talk about. Like June is scoliosis Awareness Month, and most of the time the picture that comes up are young kids. They might be in a brace. Um, they were talking about, you know, idiopathic scoliosis is always at the kind of top of mind of everybody.

But there's all these other situations that come into play with that. And so that's why this week I just really wanted to talk about, you know, are you someone that we can help?

Because it's not always straightforward. It's not always the clear cut scoliosis diagnosis. And then so sometimes people feel like, oh, I'm on the fringe of this diagnosis.

It's not the norm- like, I don't wanna say normal, but it's not the typical presentation that people think of. And even the providers that you're seeing may not be aware that there are things that you can do to help that. Mostly because we haven't had these resources in our community up until, you know, the last 10 years.

And so, just not even being aware that some of those things can be connected in ways that we can work with the providers you're already seeing. So for example, if you've got a neuromuscular scoliosis, we work with the team of providers that you're seeing as well. So you might have a neurologist on board, you might have a physical medicine doctor onboard. You might be seeing a PT for other things like gross motor or high tone or low tone, things like that. And so that's where we're, and in, in addition to, not in replacement of, but these are the, the things that can really help you day to day that can give you the tools as you move forward in life.

Because as you know, if you have something going on in your spine, it's not something that just magically goes away. So we have to try to incorporate that into your day-to-day activity and how do you manage your health as you move forward? So I'm super excited that I was able to share these things with you today.

This is something that's just been, you know, rolling through my head over the last couple of weeks as I've been seeing patients in and out of my office, and these different conversations have been coming up, because most people just don't know that the resources are there and are available. So we'll have some links attached to this episode so that you can kind of check out what we have to offer.

Just a reminder too, we do complimentary discovery calls. And essentially what that is, is if you contact our office and you're not sure if it's something that we can help you with, we schedule just a 15 minute call. And if you have x-rays or CT scans or MRIs or anything like that, we'll have you shoot those over ahead of time. And then also just fill out like a, you know, a quick questionnaire kind of just telling us about your history. And then we just jump on the phone with you and we talk through a few things to see, you know, is this a place for you that we can. Help you or do we feel like we need to refer you someplace else? Is it a good fit? So if you're interested in that, just get ahold of our office. You can find us, we've got all the links here, whether that's through our email or our social media or, or through our office. So, we will be back in, the next couple of weeks with some more information and thanks for listening.

Thanks for spending time with me today. If you could leave a review before you go, that would help us reach more people that need this message. To learn more about the services and resources that we have available, visit us at behindthebrace.com.

This show is produced by RAYMA Team Media. To learn more about how they can help you with your podcast, visit raymateam.com.

This week we are talking about Braces and school. So as we get ready to go back to school in the next couple of weeks here, one thing that we talk a lot about in our office is we have new classes, we have new teachers. We sometimes have new schools if we're going from middle school to high school or elementary school to middle school.

And so what does that look like and how do we need to approach that so that we are successful. Listen in to find out helpful tips and be sure to check out the links below for more information!

*****Resource Links You Need:

 *****Transcript*****

 Hi, I'm Dr. Mandy Dietz and you're listening to the Behind the Brace podcast. Each week I'll be sharing conversations and resources to help families and providers navigate the world of scoliosis. This is your place to find hope for a better solution so that you can live your best life.

Welcome back. This week we are talking about Braces and school. So as we get ready to go back to school in the next couple of weeks here, one thing that we talk a lot about in our office is we have new classes, we have new teachers. We sometimes have new schools if we're going from middle school to high school or elementary school to middle school.

And so what does that look like and how do we need to approach that so that we are successful? So one thing that I have noticed is of course the first week of school there's a little bit of leeway because we're trying to figure out class schedules. We're trying to figure out how our week goes, and especially for those kids that are in middle school or high school, we've got a whole new set of classes.

Where's my locker? Or can I even fit my brace in my locker? Do I have a locker? Some of those schools do not even have lockers. So what do we do with our brace and how do we manage that? So the first week, we kinda give some leeway. Kids get to go to class, figure out their schedules, and then we come in and we talk about the struggles they might be having.

Now, when I say struggles, it's mostly about trying to find a way to make the brace wear work with their classes and where they have to go in the school. Now, obviously if they're in elementary school, they are in the same class, they have the same teacher. It's actually pretty, it's actually easier because they're just there and they take it off if they go to gym class and they might take it off if they have a field trip or recess or, you know, something of that nature.

Um, and then put it right back on. So, for an elementary, aged child, the best thing that you can do is make sure that you're talking to the school counselor and their teacher before they go to school, so that way they can have that discussion and kind of figure out how do we need to make this work throughout our day?

And then that way they're not surprised. That's one of the biggest things I would recommend to you. If your child has one specific teacher all day long, make sure they know that ahead of time. Now, I will say a lot of families end up having, what's called it's 5 0 4 plan. And so basically it's just accommodations, meaning that the school knows that they have a scoliosis brace and they're wearing it to school, and they have specific accommodations for that so that they can be successful in wearing their brace.

So that goes through all grades, whether you're elementary, middle school, or high school. So that's definitely an option. I've had some parents say that they're like, nah, we don't need one. You know, our school's small enough, the teachers are really good about it. Like, we don't need to do a 5 0 4 plan. And so I think that's where really you kind of get to choose if you are having trouble, in a specific class, teacher, school. That's where I would say it's time to reach out to the counselor. Talk about doing a 5 0 4 plan. That way it's written down, it's in writing. The school knows what you're, you know, working towards and everybody's on the same page so that you have accommodations to make sure that this brace wearing is successful.

Because the last thing we wanna do is put in a ton of hard work at home. You know, wearing it overnight while you sleep. And then missing out on the entire day of school because there's not great communication with the school or the teachers or the staff. So that's an option to you. You don't have to use it.

Just be aware that if you need it, that's something that your provider and the school can work together with you on. And my experience has been is that schools are really willing to work with you, but they can't help you if they don't know about it. So if you're struggling, you just need to be able to connect with the right people.

So I would start with the counselor. If they aren't available or if they can't help you, if you're not getting anywhere there, you know, then go up into, whether that's the principal or somebody else in that area that can get you the information or at least connect you with the right person to get, the right people together to have the conversation and get it put into place.

Now, when we're talking about middle school and we're talking about high school. These kids are a little bit more independent. They're going to different classes. They generally have gym, they've got lunch, they've got lockers. They're doing all of the things. I have found that they're a little bit more reluctant to talk to their teachers about it. Especially if you have a kid who doesn't really want anybody to know that they have scoliosis. And so we want them to be successful in wearing their brace if they need to be wearing it to school. Sometimes what that looks like is having a conversation again with either the counselor or maybe their home-based teacher.

I guess depending on the size of your school, if you have a really like small community school, then obviously it will be easier for you because you'll already know all of these people. In bigger schools, that's where we have to really make sure that we're getting the communication to the right people because we don't always know all of the teachers. We don't always know who's going to be and which classes at what time. And we wanna reach out to the team so that they know what's going on.

In high school, a similar thing as middle school, there's definitely the ability to have different accommodation plans and the one thing about the accommodation plan is a lot of the high schoolers will ask me, will everybody know if I have an accommodation plan?

Will they know if I have a 5 0 4 plan? Because they don't want, a lot of times that attention. And so I really reassure them, it's something that the school has in writing so that everybody can come back to it. Everybody knows what the expectations are and so that way everybody has the same standards.

So for example, if you're wearing your brace and you're sitting in class in a desk and your arms are starting to bother you, or a part of the brace is starting to push on, say like, your hip and you need to stand up and take a break. What I've heard from students is they're like, well, nobody, nobody else is standing up. I'm not gonna stand up in class. Like, my teacher won't let me stand up. And when I ask them, I say, well, does your teacher know that you have a brace? And they're like, well, no, my teacher doesn't know that. And so that's where that communication is important, because when they're coming back into my office and we're talking about the fact that, Hey, we we're not getting enough time in your brace, and then they're saying that they have to take it off during certain classes.

They really wouldn't have to take it off for that class if the teacher or the staff in that class knew what was going on, they would be allowed to very quietly stand up, maybe go down the hall, get a drink of water, get some movement, come back in and sit down. Not being disruptive, but they wouldn't even necessarily have to be like a big conversation about it. They would just know that and know that if they stand up and do that, that it's because they need a break from their brace for a couple of minutes. So that's where I'm really encouraging families to reach out to the school ahead of time and to reach out to the teachers ahead of time, because I've seen situations where brace wear is fantastic in every other scenario, but then we look at our wear time monitors and they're supposed to be in it full time and they're only hitting maybe 13, 14 hours in the day. And when we talk through it, the times that we're missing are in certain classes because of either the. Seating options or, because they're afraid that they won't be able to, uh, move in a certain way or they'll say, oh, I have to pick something up.

I don't want them to know that I have this situation going on. And, it's really unfortunate because it affects the success of the care that we're providing and it creates stress for the student. So even though they think they're avoiding a stressful situation by not talking about it, it's actually creating more stress because now every single day it's coming up over and over again.

Where if we have that one conversation at the beginning, it might be stressful in that moment, but then it's planned out for them so they don't have to have that recurring stress every day about this battle in their head about, do I wear the brace? Do I not wear the brace? What if we do this today? Or what if I do this today?

And so that's, that's huge, especially for our older students and especially if they're driving. I found that if students are driving themselves to school, they're putting on their brace, they're going to class, they're really self-sufficient and sometimes we forget that they probably still need a little bit of support, uh, in that communication with different people in the school.

And so, talking to your student, your child, about those scenarios oftentimes it just comes up off the cuff over dinner or doing dishes or whatever it might be. When I've talked to these patients in my office, they'll share this information with me when we're doing really benign things. It just comes up naturally and then we're like, oh, hey, that's why we're really struggling with this time or this time. That makes sense now. And most of the time it has a really easy answer. So when we're going back to school, this is, you know, the key things are, uh, having communication early. Making sure that that first week we have a plan. So if a day is not going how we want it to go, then what can we do with that brace if we need to take it off.

And so a lot of students can either put that in a counselor's office if they don't have a locker. Uh, they can also put it in like the main office, they have a spot where they can put braces, like where the school secretaries are at. And so just talking about that as well, sometimes especially for like gym, music, orchestra, those are kind of the places where, if you have like choir or band, orchestra, stuff like that, technically yes, you can leave your brace on, but I have some students who try to leave it on and they struggle with that a bit. And so, talking about those types of classes of if I need to take it off in the middle of the class, where do I go and how do I do that?

And just having a place so they know if they need to take it off, they can go to this place, take it off, put it under the desk, behind the chair, behind the door, whatever it might be. And then when they're done, put it right back on and go. So early conversations definitely some leniency in the first week as they get used to their new schedule.

And then, also letting them know that, if you do have a plan, so if you set up a plan and you're getting into that second, third, fourth week of school and we're finding that the plan isn't working, it's okay to go back and have that conversation again and just say, Hmm, this is not working right now, what's another idea? Because there's lots of solutions and schools are really willing to help for my experience once they know what the parameters are and what the goals are, and to be able to help them be successful because there's more things that we do in school than just learn, right? We have to go about our day and take care of our health and all of those other things.

So as we're going back to school this year, really think about some of those people that are at your school, and if you don't know them, you can jump on the website and, and thinking about, you know, who are the counselors, who are the office staff, um, what type of classes are they taking? Uh, kind of talking through what might be some scenarios that they might run into and some possible solutions to those just so that it's not like a last minute trying to catch up, working from behind conversation.

We're now, we're like four weeks into school in crisis mode, and we haven't worn our brace because we weren't prepared ahead of time. So, really good conversations to have. Just a reminder to everybody that anyone that wears a brace is going through the same thing. You are not alone. It is not individual.

It is across the board. Anyone that's wearing a brace is going into the same scenario where they have new classes, new teachers, possibly new schools, and working that out. And it's very normal. Um, and very um. Able to be addressed in a certain way. So I hope it's encouraging to you to be able to have some of these resources and think through some of these things as you move forward.

And hopefully school is super successful in the first couple of weeks and everybody can get their braces on and worn and get into a routine as we move forward. So have a great week and we'll see you next episode.

Thanks for spending time with me today. If you could leave a review before you go, that would help us reach more people that need this message. To learn more about the services and resources that we have available, visit us at behindthebrace.com.

This show is produced by RAYMA Team Media. To learn more about how they can help you with your podcast, visit raymateam.com.

We are finishing up some of our episodes after Scoliosis Awareness Month and right before we go back to school this fall. And one of the things that we really wanna talk about is the emotional component of a scoliosis diagnosis.

Listen in to learn more and be sure to check out the links below for more information!

*****Resource Links You Need:

 *****Transcript*****

We are finishing up some of our episodes after Scoliosis Awareness Month and right before we go back to school this fall. And one of the things that we really wanna talk about is the emotional component of a scoliosis diagnosis. And it's easy to be focused on the physical part, the diagnosis part, looking at the x-rays, looking at the spine, talking about whether you need a brace or not need a brace or surgery might be a conversation that comes up.

There's typically a lot of conversations in those initial weeks following a diagnosis, and if you are having that diagnosis and that conversation with your teenager or with your child, to be aware that there's also a very big emotional piece to that, that they're not going to be able to probably tell you about or even recognize that they need support in that space. And I see that a lot with the patients that we work with and I really, really am passionate about the fact that we need to talk about it a little bit more.

Because as adults, we get caught up in the diagnosis and the what do we do next phase of that diagnosis.

And that's the focus, right? Because a scoliosis diagnosis can be a little overwhelming. There's a lot of information, especially if you weren't expecting it or if you are not familiar with scoliosis, if this is something new to the conversations that you've had , it's just easy to focus on that piece of it because we have to figure out a plan.

I also want everyone to know that in the midst of that, we also have to have a plan for the emotional and mental health of the patient, whether that's, maybe that's yourself or maybe that's a child that you are working with as well.

So, what does that look like? How do we get emotional and mental support surrounding the diagnosis?

Obviously everybody's needs are different and people handle things differently. I can say across the board, kids don't have the tools or the skills to be able to process those emotions and to be able to work that out with themselves. So finding the right support is going to be extremely helpful, not just for you and your family, but also for the providers that are working with you as well.

And what I mean by that is in a lot of scenarios, if a child isn't handling the news well, if they're not feeling like they can talk about it or maybe they don't know how to talk about it, there's a lot of big feelings that come with that, especially if we're talking about surgery or a brace. Oftentimes they don't even know or understand, or they can't put a word to what they're feeling or how to even explain it to somebody.

And so, if they're caught up in that and we're coming to appointments and we're trying to get them into a brace full-time and possibly doing, , rehab appointments where they're coming in more frequently. If they're not able to process those emotions, we can't be as productive in those appointments and we can't be as productive in wearing the brace because every time they're trying to put the brace on, or every time they're trying to do the things that they need to do at home, those emotions come up and can be the focus and they can really inhibit their success as far as going through treatment.

So when we're talking about that piece of it, it's about, you know, identifying if and when your child needs support, and then where do we find that support? So that can look different for a lot of different people.

What we recommend is you start somewhere where they might be comfortable, and that's for yourself as well. So if you're an adult listening to this and you feel like that emotional or that mental support hasn't been there in your life across the board from either from the, when the diagnosis initially happened or after a surgery or any of those scenarios, you start with some place that is reasonable.

So for a teenager it might be maybe a school counselor, or maybe it's somebody at their church, whether it's a pastor or maybe it's, , a friend at their church or someplace that they can have those conversations and feel comfortable talking about those. Now those are obviously, you know, pretty easy supports where it's very general.

Sometimes we run into instances in which we need more support. And then there's counselors that are available that are really skilled in working with teenagers, adults, across all sorts of different scenarios and helping them be able to process and work through some of those emotions. And really what I found is when kids can work through that and they can actually, be able to communicate about what they're feeling and maybe put some words to what they're feeling with some help from a counselor, then when they come in to do the appointments that they need to do, whether that's for a brace or that's for rehab, or anything else that we're doing, they're really able to focus and be more productive because they don't have all the background noise going on.

And so oftentimes it can be unavoidable, right?

If we get new news or if it's something new that we're working on. But I have seen people over 12 months, 18 months, 24 months, really not have the support that they need and not be able to move forward in their care because that emotional piece just wasn't connected and they didn't have the support that they needed.

So I really encourage families talk about it openly. Have that conversation. Ask them how they're doing and you'll know too, like, you know, how your kid normally acts if either seeming like they're withdrawn or they're quiet and maybe they're not interacting as much. Or, talking to the providers that are working with them as well, if they're noticing that they're withdrawn or maybe not engaging in conversation or not able to participate in parts of their care. Those are all really big red flags that they just need some extra support, and it can be a lot of different options. Now, obviously it's easiest if you have a counselor that you can find and you can get them in, and they have that like outside person that they can have conversations with and that they can utilize throughout their care. That's a fantastic resource. If you don't have that availability, there are other places, whether that's at school, a school counselor , a church, um, something like that. Just some place that they can get that support.

And the other piece to that isn't necessarily as prevalent where we're from because we live in a really rural area. But there are some online support groups. I always caution people, there's two sides to support groups, right? The online forums that you can find, whether it's on Facebook or Instagram, social media, different things like that is obviously when you join a group, you don't exactly know the background of that group or who's running the group, and so you wanna make sure that you find those resources and that they actually fit your needs. If you jump into a scoliosis support group online and every post is about super scary, horrific outcomes of people's stories, that's not going to be a benefit to you necessarily as far as giving you the resources that you need, it might actually just increase your anxiety and make you worry more.

So I really am an advocate for good resources and support groups. Be careful as you're digging through social media options and things like that, that you're finding things that are encouraging and good for you. And obviously there are some scary parts to a scoliosis diagnosis, especially if it's significant.

So we don't wanna be naive and we don't want to only focus on things that have fantastic outcomes, right? We wanna know. The other side of the coin as well. And sometimes that does include some negative things or maybe outcomes that aren't the best. But it shouldn't be the focus because we wanna find ways to get some solid ground on the new information that you have so that you can move forward in positive ways and to focus on the things that you can control. And then really just gather information as you go through that from trusted providers. So there's a couple of online groups that we have available and I'll link those underneath, um, the episode so that you can find those.

And if you would like to join those, you can go into them. See if it's something that works for you.

The other thing that you can do too is, sometimes depending on where you're located, there might be local events where, whether it's more for like teenagers or sometimes even parents of teenagers that have scoliosis. There can be some meetups in some groups where you can meet other families that are dealing with some of the same things. So you can look for those resources as well. Sometimes in especially bigger cities, you might find some groups that have those accessible to you where you can actually go do something fun, like maybe go bowling, um, and then catch up and get to know people that are walking that same path as you.

And so as far as making those connections to the resources that you need, there's lots of options, locally we've got some really great counselors that have been, instrumental in the care of some of our patients to be able to really help them get to a place where they've been able to process through some of the big emotions so they could make better decisions about their care, and it's just been fantastic to see.

So if you have questions, even regarding maybe something related to more of a mental, emotional, component to your care, um, you can find more information on our website. Reach out to us. We're happy to share information and resources even if you're not a patient of ours.

We'd love to see if we can help direct you if you feel like you are just kind of lost or not finding what you need, so feel free to go to our website and look through some of that information and let us know if you need anything. We'll be back next week. We're going to talk about one of the biggest things that we see going back to school is how do we take a brace back to school, and what do we need to know about that and who do we need to talk to?

So we'll be back with that next week, and until then, I hope you have a great week.

Thanks for spending time with me today. If you could leave a review before you go, that would help us reach more people that need this message. To learn more about the services and resources that we have available, visit us at behindthebrace.com. this show is produced by RAYMA Team Media. To learn more about how they can help you with your podcast, visit raymateam.com.

This week we are talking about post surgical options and really specifically, how can we take care of ourselves after we have scoliosis surgery. So this can be related to any age really, whether you are younger just coming out of a surgery or whether you've had surgery 30 or 40 years ago.

Listen in to learn more and be sure to check out the links below for more information!

*****Resource Links You Need:

 *****Transcript*****

Welcome back. This week we are talking about post surgical options and really specifically, how can we take care of ourselves after we have scoliosis surgery. So this can be related to any age really, whether you are younger just coming out of a surgery or whether you've had surgery 30 or 40 years ago.

We see a lot of different types of patients come through our office that have lots of different experiences. And one of the things that is a common theme is. That we've had a surgery and there's follow-up at least probably, you know, for the first one, two, maybe three years, depending on the surgeon or when the surgery was done.

I'm finding that right now kids that are having surgery are having a little bit longer of follow-up than they used to 40 years ago. And then what happens after that? Because at some point in time the surgeon will assess you and, you know, either deem the surgery successful or, uh, give recommendations for additional care and then discharge you from their care.

So what do you do after that? I have seen lots of different experiences with surgery overall, for the most part. The kids that have had surgery that we've worked with, whether preparing them for surgery, and then seeing them after surgery have had relatively successful results from their surgery when we couldn't avoid that surgery.

And a lot of them are still active, they're still doing sports. And that's probably the biggest question. And now I will say I am not a surgeon, so the things that I'm sharing with you are experiences clinically and just from conversations I've had with. Parents and families and patients that we've worked with.

Just for some information to first let you know that sometimes surgery really is the better option, and I say that from a place of, you know, obviously really trying to diagnose early, give the appropriate care and recommendations as early as we can so that we can get ahead of it and prevent surgery at all costs.

Because surgery is obviously a big decision, it's a big procedure. There are risks with that and you know, can have different health, implications with that. And so of course that's not. Necessarily something that is just chosen flippantly. It's something that we have to come to a decision at some point if a scoliosis has progressed to the point where it's not safe to not have surgery.

And I don't think that that's talked about really enough, at least. From my experience of the population that I've been working with, and maybe that's just here in the state of North Dakota because we're more rural and maybe the awareness, isn't quite there. But I find when I talk to other providers, that's also somewhat of a common theme.

So we're not on one side or the other necessarily. You know, not all surgeries. Are preventable , sometimes we end up with curves that are really highly progressive and the danger of not having surgery when you need a surgery is that as you get older, your scoliosis continues to progress. And then a lot of those adults that I'm now seeing that didn't have the surgery, that maybe they weren't recommended to have surgery, but it's progressed now into their adult life.

They're really struggling with some things because it continues to progress and can become unstable. Now I know everybody has probably had some type of a story where they know somebody who's had a surgery and then maybe have had some complications afterwards or some undesirable results afterwards, things like that.

And so there's both sides of this, and it's really not black and white. There's a lot of gray area. There's medically very, uh, specific guidelines for when surgery is necessary and what the research says. Um, but it's really about what's best for you and your family. And so I wanted to talk about that too because I think that there's a lot of, fear surrounding those decisions.

And we wanna know that , you know, we're making the right decisions. So, once we've come to that conclusion that a surgery is necessary and you've had the surgery, now what? Now what can we do to help keep ourselves healthy? And of course, normal health habits are super important. I love that some of the surgeons that have worked with our families and patients are talking about that with them now about, you know, how do you make healthy choices and your foods, um, getting good sleep, staying active, getting exercise that's appropriate for you.

Making sure that you are taking care of your body in ways that are really helpful for anyone. Not just if you have a surgery, but even more important if you have had a surgery or some type of procedure that, um, has put your body in a position where it needs some healing and it needs some strengthening.

So all of those general habits are really, really important. So focus on those for sure. If you haven't been doing those, definitely start with that. From a physical perspective, some of the things that I can see...

when I'm working with patients is post-surgery. Obviously there's some loss of flexibility. If your spine is now fused or if you've even had a tether in through there, it changes how your body works to some extent. And so the examples that I have for you today, most of those patients have had rods and they've had them in the last few years so it's either like a younger population that are coming back from that, or patients that are now in their forties or fifties that had surgery when they were young, uh, adolescents. And so, flexibility, stiffness, pain, some of the normal daily activities, you know, up going up and down stairs, picking up things, carrying things, stuff like that.

And so one of the things that we've been able to implement in our office that I think is really important to talk about is our Scully balance Rehab programs that we use. For patients across the board, we've been able to implement those for patients that have had surgery. And what we've noticed is, you know, first and foremost, they've gained strength.

They've been able to increase their flexibility, their normal day-to-day things that they were struggling with have gotten better over time. And so that's really been helpful. Now the question is once you have surgery, what types of things are safe for you to do and your surgeon will guide you with that.

So some of those questions where it's like, can I still play volleyball? Can I still play basketball? Can I still dance? That's going to be specific to you, your diagnosis, the surgery that was done, the outcome of your surgery, and really, uh, focus in on the recommendations of the care team that you saw and what they've recommended for you as you move forward.

As far as the rehab programs that we have to offer, those are tailored very specifically to your needs. So you are not going to have the same rehabilitation program that the next patient would, or that a patient who hadn't had surgery would have. And those are assessed off of x-rays and evaluations and an exam that gives us very specific details about how your body's functioning, how your body's working, what are you having trouble with, if you're having trouble with anything. And I say that because you don't have to be having trouble with something to want to try to get stronger and to be able to build your health and help your body heal and, um, get strong after a big procedure like that.

So, that being said, we make it specific to what your goals are. So if, for example, you are having pain and if that's your goal, we work on that based off of our findings and we help implement that for you both in the office with us and then also at home to go through your day-to-day. Say if you are coming back from a surgery as a high school student and you're an athlete, if your goal is to.

Get back to a sport that you love, then that would be coordinated in your plan. How do we make this as specific for you as possible so that we can get you healthy and strong and back to doing the things that you love to do, and hopefully not having any pain or any, uh, restrictions as far as you know, what your body's able to do just from a movement perspective of how you feel during the day. So that's the goal with the rehabilitation programs that we have to offer. They've been really powerful for patients across the board.

Young patients post-surgery, older patients post-surgery and then also even, you know, in that like 25 to 45 range when we are still, whether we're young parents or we're, you know, active adults.

We've been working with patients in that sense as well, where you don't have to be necessarily working specifically to. Like a sport or necessarily working specifically to, um, address pain or a symptom, but you just wanna be healthy and strong. And so those goals are different for everybody. And, tailored specific to you. So this is, uh, an option and a program that I really am hoping reaches the right people because I am finding more and more through even parents bringing their kids in for scoliosis, checks or scoliosis treatment. Finding that now as an adult, they haven't had any care for their scoliosis for 20, 30 years perhaps and may have some challenges that they want to work through, but they're just not aware that there's anything there for them. Or maybe they've tried other things and it's helped here and there, but hasn't been really specific. So, from that perspective, that's a huge option post-surgical, where once you are cleared by your team and your, uh, surgeon, that we can start working, on those, those programs with you.

As far as other health options, the care team that you are most comfortable with that, you know, can work alongside either us and also the surgical team that you saw, is key. And the communication between that team is really important.

But those are providers that, uh, we see lots of different providers. Some people work with, physical therapists, chiropractors, acupuncturists. Sometimes they're doing different types of modalities, like soft wave or dry needling, things like that and all of those things can be really helpful.

I know people talk about yoga and swimming different things, uh, at gym, like having gym memberships and trainers and, and all of those things. So I think that across the board you can have a care team that is really dedicated to helping you achieve your goals wherever you might be. Whether you are in young and in high school coming off of a surgery or if you are older and have had a surgery years ago.

And that's where we can kind of help tailor that of, you know, filtering out what your goals are, what we're working with, and then who best fits your team right now at this point. And then how do you expand that team as we start making progress on those goals.

So there's some information we are going to link at the bottom of this episode here that talks about ScoliBalance , what it is. You can go on the website, read about that, find providers in your area. Obviously if you are in the state of North Dakota, our office is providing those services right here to you.

But if you're listening from another state or another country there's also an option on the website where you can find a provider and it will tell you their qualifications, how many certifications they have and whether or not they're doing ScoilBalance  or ScoliBrace in their office.

And there's just a wealth of information. So please reach out if you have any questions. We love to do discovery calls with our patients so that we can give some information. Really get to know you and answer any questions that you have. So look for that below and check that out and hopefully have a great week.

We will be back next week talking about some additional resources for you. And until then, have a great week.

Thanks for spending time with me today. If you could leave a review before you go, that would help us reach more people that need this message. To learn more about the services and resources that we have available, visit us at behindthebrace.com. This show is produced by RAYMA Team Media. To learn more about how they can help you with your podcast, visit raymateam.com.

In this episode, Dr. Mandy discusses:

Listen in to learn more and be sure to check out the links below for more information!

*****Resource Links You Need:

 *****Transcript*****

 Hi, I'm Dr. Mandy Dietz and you're listening to the Behind the Brace podcast. Each week I'll be sharing conversations and resources to help families and providers navigate the world of scoliosis. This is your place to find hope for a better solution so that you can live your best life.

Welcome back. This week we are talking about how a scoliosis diagnosis can affect your child's day-to-day life. The last few episodes we've been talking about scoliosis, how we detect scoliosis, who's at risk, and treatment options regarding bracing and different things like that. So today I wanna talk a little bit about what it means moving forward after a diagnosis.

A lot of patients that we see are extremely active when you're younger. Obviously it's playing, maybe it's recess or, recreational sports, things like that. We have some patients also that are really competitive athletes, so whether that's dance or wrestling, football, lifting, lots of different, uh, activities, softball, gymnastics.

The list goes on.

Swimming also is a really big one where, a lot of the swimmers that we see definitely, have some questions about that and how that might affect their sport or how they move forward with that. So we'll talk about that today as well.

First I just wanna kind of go back and talk about, you know, who's typically affected by this.

So kids between the ages of 10 and 14 are really at the highest risk of progression because that's when they're growing the fastest. Five percent of the adolescent population is affected by scoliosis, and so we wanna make sure that we are aware of that, and we're looking at our health and our kids and making sure that we have ways to check their spines because they're not typically doing it in schools anymore.

And so sports physicals are a big part of that. And if you've got an athlete, you know that every year you're doing a sports physical. So make sure that you are asking those questions when you're in the physical, if they're not bringing that up on their own.

So once you have a diagnosis, typically speaking, you don't have to change a whole lot as far as activity unless you have something else going on.

And so an example of that might be if you're an athlete and you're having pain, then that tells us that there's something going on in your body. And so there's two different sides of how we treat scoliosis. There's more of a functional piece of that, and then there's a structural piece of that. So, the structural piece is what's shown on x-ray, whether or not you need a brace, whether or not we might be doing rehab, things like that as far as how do we get your curve stable, first of all, and then can we gain correction in that curve.

The other piece of that is the functional piece, so that would be pain, stiffness, trouble sleeping, trouble doing certain activities, um, things of that nature. I would say a large portion of the people that I see at least come in and they may not have glaring symptoms. So it's not always that we'll have a 13 or 14-year-old come into the office and they're having, you know, massive headaches or extreme low back pain or, really big symptoms like that.

Most of the time they actually tell me that they don't notice anything. If I say, "do you have pain anywhere? Are you noticing anything? Has anything changed?" They usually say like, "Nope, nope, we haven't experienced that."

Now that doesn't mean that it doesn't happen, but I really want to, you know, show that just because you have a scoliosis doesn't mean that you're going to have extreme pain.

And the level of the pain that you have doesn't always necessarily tell us the severity of the scoliosis. So somebody with no symptoms could have a really significant curve and somebody that has really extreme symptoms could have a lower curve, but just isn't adapting to that well. So that's why for sure, regardless of symptoms and regardless of if you're noticing things like that from a functional side, you wanna make sure that you've got really good evaluations and you wanna make sure that you have x-rays.

So, just a tip that I'm throwing out there for you, because a lot of people think that pain and severity go hand in hand and they really don't. I have noticed that, you know, over the time that we've worked with patients is that you really can't link those things together. I've had some really severe scoliosis cases and they don't have symptoms at all.

So depending on the sport that they have, and depending on the level of the sport that they have, will guide your provider in how you may need to change or alter some of their activities. So for example, if you have, uh, a wrestler or a football player, and if he has a kyphosis and the spine is coming forward on itself, normal activities can be day-to-day things, um, even still playing the sport. But what might change is, at least in my experience, the lifting piece of that. So a lot of the wrestlers and a lot of the football players and really any athlete in high school these days are doing some sort of lifting and strengthening program, at least most of the high school athletes that we work with.

So some of that piece might change. Like you're not going to load the top of your spine with 150 pounds to do back squats if you have an issue in your spine. That doesn't mean that you can't strengthen those muscles. We just have really in depth conversations with their trainers or with the student or the athlete who's, who's doing the lifting, and we find different ways that they can strengthen without loading their spine.

And that's really one of the biggest things that I've seen lately is the lifting piece of the higher level sports. Um, even up into college because they want that strength so that we can prevent injuries and they can be faster and they can be stronger. But we need to be conscious of whether it's a scoliosis or a kyphosis, how they're using their bodies and, and making sure that they're not doing a ton of work in the office, whether that's with a brace or with rehab.

And then going into the gym and compromising their spine, and not getting anywhere because that's frustrating for everyone. As far as the rest of the activities, so summertime activities, going to the lake, going to the pool, being outside, playing volleyball, any of those sports, most of the time kids can continue to do those sports.

I would say most kids are not practicing something multiple days a week, multiple hours at a time. The only time I've come into that, um, where it's maybe become a topic of conversation is if somebody's, for example, doing dance and they're dancing every single day and they're extremely competitive and they're dancing for anywhere from three to five hours every single day.

If they have a significant curve and that's impacting or affecting their ability to complete their treatment, or if it's affecting how their body's responding to treatment, then sometimes that might become a conversation. But those are in more extreme and rare cases. So generally speaking, as long as your child isn't experiencing pain or extreme symptoms, we can find a way to manage the treatment that they need for their scoliosis and still be able to participate in all of the activities that they would normally participate in.

Regarding family time, it's the same scenario. I know especially when kids get braces, the first question is, you know, we have a lake house, or we like to go out on the river in the summertime and so it does become tricky because if you're in a bathing suit and they don't wanna wear their brace, if they would have a brace all day long, we have to figure out where the balance is for that. So obviously, if you're supposed to be wearing a brace full time we can't have a child out of their brace every single day in the summer for 12 to 14 hours a day.

But we can compromise. So if they're wearing their brace, compliantly and for the amount of time they're supposed to be, and you're going on a family trip for five days, then that's where we make some of those concessions where we'll say, "okay your average wear time is really good during these periods of time, and so over this trip we'll have you wear it at night and for as much of the day as possible, outside of doing your, you know, family activities, whatever that might be on their trip."

And they're able to do that because they're being really compliant on the front side and the backside of those types of events.

So there's ways to work around family activities, sports, recreational activities, you just really have to be intentional because time really does slip away, and especially when school is in session. If you're in school and your child's supposed to be wearing a brace, but they take it off for gym and then they have lunch, so they just decide not to put it on for lunch.

And then they have band, and then they decide not to put it on for the last hour of the day, but then they have track, and then they get home and they shower, and they don't get it back on until nine, 10 o'clock at night. You've now missed an entire portion of that day without even realizing it. So those times in between the activities are really crucial if you're in a brace to make sure that you're getting your wear time.

So that might look like you take the brace off for gym, you put it right back on, wear it through lunch. Maybe you then take it off for band or orchestra if you have to, and it goes right back on for the next hour and a half to two hours, and then it comes off for track practice and then goes straight back on.

So that intentionality is really key so that we don't miss out on the easier opportunities to get your brace wear in. And that's where I see a lot of struggle with the activities. It's not so much that they can't complete their activities, it's that trying to get those timeframes in, in between those activities, can be difficult.

Mostly because they're at school, they're at activities, their parents aren't there, and time just kind of gets away from them. So that's one of the key things that we have to look at if your child is in a brace. Now, obviously if your child's not in a brace and they're doing rehab or they're doing other sorts of uh, care because they're not to that bracing point, then that doesn't apply, and typically they can continue to do all of the things that they would like to do.

And again, coming back to some of those pain and symptoms, things like that, there's lots of different options for that, and that's where we talk about some of our providers that we can bring in as part of the care team. So if you think about it as far as the structural piece, figuring out, you know, do we need a brace?

Do we not need a brace? Are we doing rehabilitation programs and things at home to be able to work with this? But then also, what do we bring in on this other side if we're having pain or if they're unable to do key movements to be able to participate in activities? And that's where things like, uh, physical therapists or chiropractors, body work professionals, whether it's massage therapy or acupuncture, dry needling, all of the different things that we can pull in to help from a, a symptomatic standpoint so that we have better movement, better function, reduced pain, those are all really important things that we can coordinate along with the care, because if someone's in pain we're trying to complete treatment on this side of it, they're not going to be able to be very compliant if they're hurting every day, all day.

So we want to get them into a really healthy place so that they can do all of the things that they want to do so it's not affecting their ability to hang out with friends, to um, be with their family and to be able to do the things that they love.

Because in reality, if we take away the things that are really important to patients, and this is whether you're a teenager or a young child or an adult, it's for any of us. If we can't do the things that we love to do, then all of the work that we're putting in on that front end isn't going to be as beneficial as it could be just from an emotional standpoint.

And so we wanna look at the entire part of the patient, not just what's on the x-ray. So there's more to that conversation and that's really the things that we wanna talk about and to, to bring up and to bring awareness to, because the emotional part of this type of work is really important because we want people to be able to enjoy their families, their friends, their lives day to day, and also be able to do the best things that they can for their health.

So these are just some tips and some, uh, some things that I've seen throughout our patient care, that hopefully are really helpful for you. So if you've just have a new diagnosis, whether it's for yourself or for your child, you can kind of read through this and know that just because you have a diagnosis doesn't mean that everything in your life has to change.

We just have to find a new normal and a new balance. And having the right team to be able to do that is really important. That way we do the right things at the right time and we get the right care for you when you need it. So if you have questions or if you have a diagnosis and you're not sure where to go from there, feel free to click on the links below our podcast, uh, you can get information about our clinic. We can do discovery calls. So if you have an x-ray, what that looks like is just a 10 or 15 minute call where we chat a little bit. You can ask some questions, we give some, general information to you specifically, and then see if we can help you find the next step in your journey.

So feel free to reach out to us. We're happy to help. We'll be on next week as well, and we're gonna be talking about options for patients after scoliosis surgery. So we can't wait to share some of those, um, tips as well. And we hope you have a great week.

Thanks for spending time with me today. If you could leave a review before you go, that would help us reach more people that need this message. To learn more about the services and resources that we have available, visit us at behindthebrace.com. This show is produced by RAYMA Team Media. To learn more about how they can help you with your podcast, visit raymateam.com.